Psychology or Psychiatry?..Please help...

[Marnico]

So I am feeling very overwhelmed right now in terms of which career path to take. Currently I am a freshman in a public state university, majoring in Psychology. Originally, I had wanted to become a clinical psychologist. Now, I am not so sure. Although it does interest me, I feel extremely discouraged by everyone because they tell me that even with a Ph.D, I would not be making nearly enough to live a comfortable life when I could choose psychiatry for just as long of an education and make so much more doing a very similar thing. The possibility of becoming unemployed or even having a low salary frightens me so much because my family has always been struggling to make ends meet, and a big reason why I chose clinical psych is because I thought it would be a great balance for me: something I enjoy, something that (I thought) pays well with a Ph.D, and does not require many science or math classes. The reason why I am very hesitant towards pre-med requirements is because all of them include physics, calculus, statistics, bio, chem, etc. Biology doesn't scare me too much, but everything else certainly does. I am absolutely horrible at math, and fear classes like chemistry, physics, and calculus will only hurt my GPA and make it so that I can't even go to graduate school let alone medical school. Should I try anyway? Admittedly I am not the smartest person in the world, especially when it comes to math, but I am very hardworking and always try my best. Truly, my main goal is to support my family, it's the most important thing in the world to me. I don't want to ruin everything by taking the risk from psychology to psychiatry, but I also don't want to regret not trying knowing I could be giving them a better life. Also, if there are any medical schools at all that don't require calculus, or some other subjects I mentioned, please let me know. I would be very grateful for some advice, I feel very depressed and stuck right now and have no idea what to do.

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[Saifa]

Shadow a psychiatrist and psychologist and then decide. You'll probably have way more money and way more opportunities as a psychiatrist but you've gotta become a physician first.

 

[Stagg737]

Psychiatrist here. Both fields will give you an opportunity to make a comfortable living. So if finances are you major concern both paths are fine unless you rack up $100k+ in UG debt, then psychology may be rough.

Psychiatry is a longer educational path as it's 4+4+4 + 1 or two if you do a fellowship. Whereas pschology is a little shorter being 4+4 to7 years. So 12-14 years for psychiatry compared to 8-11 for psychology.

The real question is do you want to just focus on psychology or do you want to go to med school? If it's the former then be a psychologist, as you have to complete years of hard science courses in UG and med school to be a psychiatrist.

 

[allantois]

Psychology is not worth - long schooling with much smaller income.
I’d look into social work if you don’t like hard sciences.

 

[Marnico]

Psychology is not worth - long schooling with much smaller income.
I’d look into social work if you don’t like hard sciences.

But why social work? I read that that is literally the worst option and one of the lowest paying careers you can get from psychology.

 

[curbsideconsult]

But why social work? I read that that is literally the worst option and one of the lowest paying careers you can get from psychology.

Where are you getting this information? There are plenty of mental health jobs for MSWs (or just jobs in general for MSWs). All you have to do is go to any job site and type in "MSW" in the search field and you can see for yourself. You'd be in school for a shorter period of time and have many opportunities. Not very many people want to go into the mental health field, that's why programs like NHSC throw money at folks who are committed to going into a mental health field.

Another good option if you want to go into mental health is to get your BSN then work on a psych floor or in a psych hospital or a treatment facility, etc. etc. If you decide you don't like the mental health field after that, you still have your nursing degree and you can go pretty much anywhere.

 

[allantois]

But why social work? I read that that is literally the worst option and one of the lowest paying careers you can get from psychology.

Well, you have multiple options if you want to do psychotherapy: PhD/PsD in Psychology, MS in Counseling , MS in Marriage therapy and MSW. MSW is probably the next best thing after clinical psychology because they are one of the first mental health professions, widely recognized and reimbursed by insurance companies. There is a mental health subforum on SDN that you may want to read through.
Also, echo nursing - nurse practitioners with a psych specialization are in very high demand due to shortage of psychiatrists. Nursing is also not a chem/physics/math heavy major.

 

[Cheenghee Koh]

A social worker here. Yes, social worker is the largest provider group in mental health field. It usually takes 2 years after you graduate from college. However, if you want to provide psychotherapy and get reimbursed from insurance company, you have to have your clinical social work license (LCSW or similar titles in different states). To sit in the exam, you have to have post-MSW 3000 (or two years) supervised working hours (this depends on the state's regulations), which makes it a 2 + 2 = 4 years before you can independently provide mental health services. Also, yes, usually social worker's salary is among the lower side across the mental health professions, in particular if you work in the community organizations (without license, it would be around 36,000-40,000). But if you work in the hospitals, after you get your license, you can still make decent money. A friend of mine who is a licensed social worker was offered $80,000 in Seattle. It was her 2nd year after she got her license. If you want additional training, we also have PhD or DSW programs. But note, PhD is for research and education careers. Finally, there are some slight differences across mental health professions regarding their approaches in psychotherapy. Social workers tend to pay more attention to how the social environments influence individuals' well-beings, and how the individuals can be empowered to take a lead to change their environments. I don't mean that other mental health professions don't do this. It is just a spectrum of emphasis.

 

[PsychScience]

Although it does interest me, I feel extremely discouraged by everyone because they tell me that even with a Ph.D, I would not be making nearly enough to live a comfortable life when I could choose psychiatry for just as long of an education and make so much more doing a very similar thing.

Psychiatry is a longer educational path as it's 4+4+4 + 1 or two if you do a fellowship. Whereas pschology is a little shorter being 4+4 to7 years. So 12-14 years for psychiatry compared to 8-11 for psychology.

Clinical Psychologist here. Although psychiatry is indeed a longer path than a PhD in clinical Psychology, the difference is only a few years. Most PhD programs will take 6 years (5 in school and a full year internship at the end) not 4 , which in most states is then followed by a 1-2 year postdoctoral fellowship. The need for a postdoc varies by states, some states require postdoc hours while others don't. The general recommendation, consequently, is to complete a fellowship so that you are license eligible in whatever state you move to. And so, the training is actually closer to 4+5+1+1. Making the length closer to 11-12 years**. Many PsyD programs will allow you to be done in 4 years instead of 5 (and then the full year internship), but the tradeoff is that these programs also often come with massive amounts of debt, whereas many of the PhD's are funded programs. Consequently, I left graduate school without having to takeout a single loan (undergrad is another story).
**This timeline is assuming you come in without a Masters degree. If you have a masters it may be a little shorter.

If you are in a funded program, and don't have to take on a high debt load, I think that you can make a very comfortable living as a clinical psychologist. If you are in an unfunded program, it is not worth it. In my opinion, the income of a clinical psychologist simply does not justify taking on almost $200K in debt.

Psychology is not worth - long schooling with much smaller income.
I’d look into social work if you don’t like hard sciences.

Think about what it is that you want to do, and make a decision from there. It sounds like you are uninterested in the sciences, and so I think Psychiatry would be a more challenging path. If what interests you is the therapeutic elements of both fields, social work is a great suggestion. You should look into the path to becoming a clinical social worker. Clinical social workers absolutely work in the context of a therapist. You will find clinical social workers working in very similar environments and capacities as psychologists. The biggest difference is that clinical social workers are often not trained or qualified to complete psychoeducational or neuropsychological assessments. It's true they make a little less than a clinical psychologist, but it's usually not that much less. And they don't have to go through as long of as a educational path. So, they may come out ahead in the long run (but I haven't done the actual calculations). So, if therapy is your thing, and you don't care about doing assessments, clinical social work is a great suggestion. There are other master-level clinician type jobs to consider as well, including Martial and Family Therapy, counseling, and school psychology (if you do end up interested in the assessment side). All of which to say, is that clinical psychology versus psychiatry are not the only options. You will want to do some research.

Also, if there are any medical schools at all that don't require calculus, or some other subjects I mentioned, please let me know. I would be very grateful for some advice, I feel very depressed and stuck right now and have no idea what to do.

Many med school don't require calculus, but they will still require statistics. However, you should know, that clinical psychology programs typically will also require statistics.Not just at the undergrad, but later at the graduate level. In fact at the graduate level, competency in basic statistics probably gets greater emphasis in clinical psych than the med school path (in my grad program we had to take 3 semesters of stats classes for the degree).

If I had to do it over again, I would probably go the med school route, but that is largely because I wish that I had greater training and understanding of human anatomy and physiology and I wish my practice scope was different. Clinical psych is not a bad path, but you will be much more limited in what you can offer patients than a psychiatrist.

 

[Stagg737]

Also, echo nursing - nurse practitioners with a psych specialization are in very high demand due to shortage of psychiatrists. Nursing is also not a chem/physics/math heavy major.

Given the poor quality of education NPs receive and the treatment plans most NPs I've seen come up with, I cannot ethically recommend that someone pursue a career as a psych NP. Literally half of my program's outpt clinic is fixing the terrible medication plans that non-psychiatrists (largely NPs in my geo area) have their patients on. I'd much rather a person just go from BSN -> LCSW (know a few who did) and stick to therapy rather than go for the NP, shadow for a few months, and think they have the knowledge to write prescriptions.

 

[PsychScience]

Given the poor quality of education NPs receive and the treatment plans most NPs I've seen come up with, I cannot ethically recommend that someone pursue a career as a psych NP. Literally half of my program's outpt clinic is fixing the terrible medication plans that non-psychiatrists (largely NPs in my geo area) have their patients on. I'd much rather a person just go from BSN -> LCSW (know a few who did) and stick to therapy rather than go for the NP, shadow for a few months, and think they have the knowledge to write prescriptions.

I agree with this. It's the same reason that I am also adamantly against clinical psychologists receiving prescriptive authority. If you want to prescribe like a medical doctor, you should have to be TRAINED as a medical doctor.

 

[allantois]

Given the poor quality of education NPs receive and the treatment plans most NPs I've seen come up with, I cannot ethically recommend that someone pursue a career as a psych NP. Literally half of my program's outpt clinic is fixing the terrible medication plans that non-psychiatrists (largely NPs in my geo area) have their patients on. I'd much rather a person just go from BSN -> LCSW (know a few who did) and stick to therapy rather than go for the NP, shadow for a few months, and think they have the knowledge to write prescriptions.

Hey somebody has to do it and they aren't going anywhere

 

[Stagg737]

Hey somebody has to do it and they aren't going anywhere

Not really. Many of those patients are better off without meds than getting the wrong meds. I can't tell you how many people I've seen with major depression come in with SI who were being prescribed benzos BID/TID. Or individuals with history of mania on stimulants. These people need the proper treatment, not "whatever they can get".

 

[allantois]

Not really. Many of those patients are better off without meds than getting the wrong meds. I can't tell you how many people I've seen with major depression come in with SI who were being prescribed benzos BID/TID. Or individuals with history of mania on stimulants. These people need the proper treatment, not "whatever they can get".

There are plenty of physicians who put patients on ridiculous drug regiments as well (basically everyone on opioids in my state was put on it by a physician as NPs/PAs can't prescribe Schedule II). It is up to the individual provider to be a competent and responsible prescriber. Credentials alone are no guarantee of receiving good, evidenced-based care.

 

[Stagg737]

There are plenty of physicians who put patients on ridiculous drug regiments as well. It is up to the individual provider to be competent and responsible prescriber.

True, but the number of physicians doing this compared to NPs is not even remotely comparable. Plus physician's educations which consist of medical school lectures and clinical rotations in psych as well as training in residency are FAR more extensive than NPs. Do you really believe that someone who basically did 2-3 months worth of shadowing with no formal education in pscyhopharm should be prescribing meds to patients? Because that's the extent of most new psych NP's education. If you think that's okay, I highly question your ethics in terms of standards of care.

 

[PsychScience]

Hey somebody has to do it and they aren't going anywhere

I don't know. Anecdotally, and in my albeit limited capacity as a clinical psychologist, the wrong medications can actively cause more problems than they solve. Symptom exacerbation is a very real and scary thing. So, I'm not sure I agree with the sentiment that somebody has to do it. It's not just that somebody has to do it, it's that the right person with the training and qualifications should do it.

 

[NeuroPsychosis]

I see a lot of inexperienced posts coming from folks putting down Psychology. Here are the particulars:

If you are into prescribing/medication management and interested in human medicine as a whole, then medical school is the route.
If interested in clinical work only (Screening, diagnosis, therapy, etc..) then PsyD is a good option.
If however, interested in clinical work from a scientist perspective (Research, teaching, and practice), then PhD all the way.

Now, that doesn't mean you cannot intersect them all in any of the field, foe example you can still be a PsyD practitioner and teach or have your mini research projects here and there. Same goes to PhD, you can be a clinical scientist by training and choose practice only. However, medical school is not the best option for psychotherapy purposes. It's more of a memorize--pass a test--Practice road where psychiatrists are best trained at medication management and administration.

In regards to salary, the degree itself is not what brings you the bucks, its where and how you use it. My lab Pi is a PhD clinical Psychologist, who does part time practice/research and also teaches behavioral medicine at the school of medicine with $200k+ salary. Also top sub-specialties like Neuropsychology, I/O psychology are one of the top paid $90k+ salaries (CA speaking) and those are usually PsyD/PhD holders.

Now coming to you science/math skills, this needs work on regardless of which of the 3 programs you enter. Courses such as neuroanatomy, neuropsychology, Psychopharmacology, biological psychology, and methods are essential foundations in the first years of the coursework portion (according to most schools). Therefore, you cannot really escape math and hard sciences in an allied health field like clinical psychology.

Best,

 

[raiderette]

I was a psych major, and love everything related to the mind. I even loved neuroanatomy in med school (few do). I am not going into psych or neurology. Many of my friends intended to be psychiatrists, but are headed to neurology, pediatrics and even surgery. Explore what it is to be a physician. You may find you have a passion for something off your radar right now.

 

[pillowfighty]

Money is a great factor when it comes to choosing a career, but it shouldn't be your only factor in whether you want to be a doctor of medicine or not. A psychiatrist goes through medical school (as you know) and is heavily involved in biology obviously, and you don't see the psychology aspect much until you can pick a residency. If you don't have a desire to help patients with physical ailments in any capacity, I can see how it would be very difficult for you to make it through med school and take Step 1 with a good enough score to get a match in psychiatry.

And psychologists can make good money if you pick the right field within it. You can do clinical practice or work for corporations, or work for universities doing research. Both are fulfilling options and you will be able to handle life at this. Some people make 20-40k a year and live happy lives. Some people make 80k a year and are miserable. It really depends on how you save and spend, and where you live. Choose what you think works best for you, not what makes the most money.

 

[NickNaylor]

I strongly advice against going to medical school just for the purposes of being a psychiatrist (I'm a psychiatry resident by the way). You must want to be a physician first and foremost if you're thinking about going to medical school, even if you think you're going to go into psychiatry at day 1. Medical school involves very little psychiatric training, and you will spend the overwhelming majority of your time studying things that aren't directly relevant to your future work as a psychiatrist. You have to find medicine and the human body intrinsically interesting in order to justify the time and cost required to complete the training - not to mention being able to make it through without becoming completely burned out.

Further, there is quite a bit of difference between the day-to-day practice of psychologists and psychiatrists. Of course they're related, but the approaches are often very different and the skills emphasized are very different. The both deal with pathology of the mind, but the way that pathology is conceptualized and treated varies quite a bit among the two fields. Further, psychiatrists can generally do everything a psychologist can with additional training. The reverse is not particularly true except for states in which psychologist prescribing is allowed (which, by the way, the training is woefully inadequate for).

 

[958587]

I was in the same boat as you. Interested in mental health and how to treat it. I'm just relaying advice that was given to me multiple times: don't be a doctor until you know that you are at least somewhat interested in the human body. Psychiatric training is a small bit in the 4 years of medical school.

Do you want to do therapy? Look at Masters in Social Work or Masters in Counseling. Ph.Ds, depending on the program will have a focus on research moreso than therapy/clinical training. Again this depends on the program. Regardless, a major research project is in your future should you go the Ph.D route. Make sure you can at least tolerate research

Something else to consider is that internship (between your doctoral program and practice) spots have not kept pace with how many Ph.Ds and PsyDs are being produced. Insurance reimbursement is not remotely where it ought to be for psychotherapy, thus those who provide it are not paid what their work is worth, imho.

Take some time to sit down and truly imagine where you would want to see yourself in 5 and 10 years from now. Imagine every aspect of your life: family, living situation/location, work location, work hours, what type of work. That may help clear up the path that you want to follow. Good luck!

 

[shaosoldier]

Psychiatry resident here. In my opinion, the difference between psychiatry and psychology is larger than most would think. I can't speak too much on psychology but for psychiatry we are heavy on the sciences just like all other medical specialties (Internal Medicine, Gen Surgery, etc). That is literally 95% of medical school curriculum. Our main job is to manage medications either to bring a patient back into reality or keep them from exiting reality. In doing so we have to manage the side effects as well and their interactions with other medications -- psychiatric and non-psychiatric. Because of this, psychiatrist have an intimate relationship with psychotropics and psychopathology. We also augment our medial treatment with psychotherapy but obviously, at least for the majority of us, the psychologist will be better at it than we are kinda like how a pure boxer will be better at boxing than a mixed martial arts fighter. Hence is why Pre-med students usually take more than the required science courses in order to compete with each other. It's a proving grounds in the sense that you have to show that you can handle medical school which is exponentially more difficult than undergrad, I would even be tempted to say its more difficult than most graduate programs as you're grinding hard competing with other former top undergraduate students.

In conclusion, give it a shot! Take a few required courses whether it be Gen Chm and maybe a Gen Biology (make sure it's gen and not intro) and at a university program as you'll get first hand what the pre-med culture is like. If you like it and do well (absolute minimum is a B+) I would say go down the psychiatry route. I love it. Keep in mind that it keeps getting harder and harder though (higher level of sciences each year for the next decade essentially), so have a back up plan.

PS: Just in case no one mentioned it above, medical path takes about 11-12 years (4 years undergrad + 4 years medical school + 3-4 year residency). You get paid in residency but only around 50k, this is where you become a specialist in any medical field, its very rare to find a physician without a residency these days.

 

[shaosoldier]

I strongly advice against going to medical school just for the purposes of being a psychiatrist (I'm a psychiatry resident by the way). You must want to be a physician first and foremost if you're thinking about going to medical school, even if you think you're going to go into psychiatry at day 1. Medical school involves very little psychiatric training, and you will spend the overwhelming majority of your time studying things that aren't directly relevant to your future work as a psychiatrist. You have to find medicine and the human body intrinsically interesting in order to justify the time and cost required to complete the training - not to mention being able to make it through without becoming completely burned out.

Further, there is quite a bit of difference between the day-to-day practice of psychologists and psychiatrists. Of course they're related, but the approaches are often very different and the skills emphasized are very different. The both deal with pathology of the mind, but the way that pathology is conceptualized and treated varies quite a bit among the two fields. Further, psychiatrists can generally do everything a psychologist can with additional training. The reverse is not particularly true except for states in which psychologist prescribing is allowed (which, by the way, the training is woefully inadequate for).

Spot on man

 

[shaosoldier]

I don't know. Anecdotally, and in my albeit limited capacity as a clinical psychologist, the wrong medications can actively cause more problems than they solve. Symptom exacerbation is a very real and scary thing. So, I'm not sure I agree with the sentiment that somebody has to do it. It's not just that somebody has to do it, it's that the right person with the training and qualifications should do it.

Absolutely correct, just like any disease process the wrong medication will just exacerbate the issue. Haloperidol in a Parkinson's patient is just like giving cigarettes to a COPD patient.

 

[shaosoldier]

There are plenty of physicians who put patients on ridiculous drug regiments as well (basically everyone on opioids in my state was put on it by a physician as NPs/PAs can't prescribe Schedule II). It is up to the individual provider to be a competent and responsible prescriber. Credentials alone are no guarantee of receiving good, evidenced-based care.

There are good providers and bad providers, but majority of physicians have extensive training and practice good medicine. Kinda like how there are terrible black belts and monster black belts out there. Another caveat to consider is that sometimes the physician may be doing something off the charts in terms of manipulating the medications in accordance to the patient's symptoms or perhaps even manipulating medication interactions between each other. Sometimes this can result in phenomenal effect and other times not so much.

 

[shaosoldier]

Shadow a psychiatrist and psychologist and then decide. You'll probably have way more money and way more opportunities as a psychiatrist but you've gotta become a physician first.

Agree, shadow both. I would say shadow inpatient and outpatient psychiatry as well as it differs drastically. As a psychiatrist you'll have to be comfortable doing both but down the line post-training you can focus on one or the other.

Psychiatrist you'll have to worry about other disease process aside from psych issues too. Never forget as a psychiatrist you're a physician who specializes in mental health.

 

[Mad Jack]

Very different fields. If you want to be an expert in therapy, the psychology route is the way to go. If you want to be a doctor that masters psychiatric medication and is serviceable but no expert in therapy, go psychiatry. Psychologists also know a lot about psychometric testing and such, which we don't really do as psychiatrists.