Psychology vs medicine (help)

[MustIReallyThough]

Hello all! I'm a junior psych major who really has no idea which path would be best for me after my degree. The other threads on this have been immensely helpful (thanks everyone for that) but I'm still very undecided. I wanted to post my particular thoughts and desires and see if I can get particular feedback.

I've always felt my calling would be working with SMI. I'm not very interested in any research or study that does not pertain to patients and their well-being. I believe this would include physical health as well. As far as treatment goes, I see medication and psychotherapy as equally valuable and am interested in both. As it stands, it seems that medical school would provide the most flexibility and clinical experience (though I do understand there are balanced PhD programs out there in psych) and overall make the most sense. I fear that much involved with a research degree would not be directly relevant to my goals. I also understand that psychiatrists can pursue training in psychotherapy outside of their official schooling and I would be very interested in doing that. Another selling point is that I would love to have life long relationships with patients and that seems much easier with psychiatry.

The flip side is that, while I'm confident I can get into medical school with much effort, I'm less confident I can do well enough to match into what I understand is an increasingly competitive residency. I've often heard you guys say that you need to think you'll be happy in >1 area of medicine before you make the plunge. I'm not sure this is the case with me. I don't think I'll rest until I'm working in a psychology related field in some capacity. This is my main concern at the moment or I'd be full steam ahead.

Any thoughts or advice? Anything at all would be immensely helpful. My current plan is to work as an EMT for awhile, volunteer in research labs, and interview professionals in both fields. I also think I need to take chemistry at my local CC and see if its palatable. I did quite enjoy biology. Any other steps/classes I should take to help decide if I should go ahead and do a post-bacc for medical school prerequisites?

When it's all said and done I just want to be the best clinician possible with the freedom to practice in the best interests of my patients.

Thanks for reading all that!

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[Bartelby]

If by SMI you mean schizophrenia, bipolar disorder, MDD with psychosis, etc. then medical school will equip you better for that because you can prescribe and you will know much more about the interface between their mental health concerns and their multiple medical comorbidities. I don't foresee psychiatry becoming anything like the most competitive specialties, and I suspect if you can get into medical school and you apply yourself that a match would still be realistic in the foreseeable future.

You are correct, though, that becoming a psychiatrist means becoming a physician first. A lot of what you study will not have direct relevance to mental health, so if you want to take a more direct route to working in mental health the psychology route is a very fulfilling option. Psychologists can also spend more time with patients in many setting, often have a greater emphasis on learning good psychotherapy skills during training, and have much greater comfort/familiarity with psychological testing and research statistical methods than would most MDs. While it is a tough choice, if both sound appealing I think you can also consider it one of these situations where you really can't go wrong either way.

 

[MustIReallyThough]

If by SMI you mean schizophrenia, bipolar disorder, MDD with psychosis, etc. then medical school will equip you better for that because you can prescribe and you will know much more about the interface between their mental health concerns and their multiple medical comorbidities. I don't foresee psychiatry becoming anything like the most competitive specialties, and I suspect if you can get into medical school and you apply yourself that a match would still be realistic in the foreseeable future.

You are correct, though, that becoming a psychiatrist means becoming a physician first. A lot of what you study will not have direct relevance to mental health, so if you want to take a more direct route to working in mental health the psychology route is a very fulfilling option. Psychologists can also spend more time with patients in many setting, often have a greater emphasis on learning good psychotherapy skills during training, and have much greater comfort/familiarity with psychological testing and research statistical methods than would most MDs. While it is a tough choice, if both sound appealing I think you can also consider it one of these situations where you really can't go wrong either way.

Yes that's mainly what I had envisioned! It does seem like the best path for me. I think I'm definitely more interested in physical health, even without any direct relevance, than statistics or testing. Also, please correct me if I'm wrong, but as I understand it psychologists are often focusing more on specialized areas now (addictions, nuero) that don't really excite me. I believe I'd rather have an understanding of the body as a whole more than specialized knowledge. The straight path is tempting though.

You're right though, I'd probably be happy either way honestly. This makes me lean medical for the job market. What you said about residency is really encouraging as well. I shall hang around the forums and try to get a feel for the trend going forward. Thanks a lot for your reply!

 

[AcronymAllergy]

There are psychologists who specialize in/focus on SMI, and there are various psychotherapies that can be very effective in that population. Still, just like psychiatrists are physicians first, specialty-trained psychologists (e.g., neuropsychologists) are still psychologists first. There are of course also numerous psychologists/psychology labs conducting research in this area.

But medical school is going to give you more flexibility overall RE: SMI, particularly with treatments as they currently stand. You're also likely to get paid more (e.g., see recent Medicare cuts that will likely impact psychologists much more than physicians). But it could be helpful to shadow folks in SMI settings to get more of a feel for what each provider does, if possible.

 

[MustIReallyThough]

There are psychologists who specialize in/focus on SMI, and there are various psychotherapies that can be very effective in that population. Still, just like psychiatrists are physicians first, specialty-trained psychologists (e.g., neuropsychologists) are still psychologists first. There are of course also numerous psychologists/psychology labs conducting research in this area.

But medical school is going to give you more flexibility overall RE: SMI, particularly with treatments as they currently stand. You're also likely to get paid more (e.g., see recent Medicare cuts that will likely impact psychologists much more than physicians). But it could be helpful to shadow folks in SMI settings to get more of a feel for what each provider does, if possible.

Ah ok, so I could still branch out and do others things if I specialized. I've read that working with SMI is high stress and low pay for psychologists. So perhaps the medicare cuts would make that even worse? It seems rather daunting. I can't get a clear picture on salary at all. Some say its great (relatively), others that its no where near worth it, and online estimates are all over the place.

The flexibility is really what I'm after though. I'd care less about salary if I felt I was in the place I'd have the most impact. I'll definitely look into shadowing so I can further compare therapy vs medication. Thank you, great to hear from another psychologist!

 

[FiveTwoFifty]

I'm nearing the end of psychiatry residency and was in a very similar place to you back several (many?) years ago. I ended up getting a master's degree in counseling and having some experience in psychotherapy. What tipped it over for me was missing out on the biological treatments and having an understanding of medical comorbidities and complexities that can affect mental health. In addition, the work of psychotherapy (to me) is very exhausting and can feel somewhat nebulous and slow at times. So I started to poke around in the medical world while doing my counseling training... and it was like a lightbulb went off. The medically trained are much more "my peeps" in terms of their way of approaching things, the day to day, etc. etc. - and the pace felt much more my style.

I knew medical school would involve experiencing multiple specialties - and that was exciting! I kept an open mind but once I rotated on psychiatry, it was clear that it was the one for me. It remains, despite growing more competitive, a relatively uncompetitive field to pursue with an overall high match rate. I did consider other specialties and if I *HAD* to not do psychiatry, I would find other parts of medicine in which to be happy. But boy am I glad I in this particular specialty.

In terms of SMI and working with that population, I have found the psychopharmacology aspect to be very, very satisfying. People with SMI often have many other comorbidities and having the knowledge to help guide treatment in that realm as well (in terms of getting folks connected with PCPs, etc.) can be very rewarding. The psychopharm aspect can be sort of investigative, trial/error, and can produce observable results (especially if you're doing inpatient work and tracking peoples' progress). Psychotherapy is a minimal part of my end career and I believe it is that way for most psychiatrists. It's cheaper to reimburse MFT or psychologist level folks to do therapy and leave the med management to prescribers. Does that mean you can't do psychotherapy? Not necessarily. They say "each interaction you have with a patient can be therapeutic" and to me that is satisfactory. I actually don't want to be doing hour-long CBT sessions with a patient, because I find my personality and interaction style with patients more effective in a supportive way... and we can get a lot done there.

For recommendations, I'd try to get into a hospital (perhaps a larger one) to see what it's really all about, including non-psychiatric specialties. For me, it was the energy that was attractive -- and then fitting a specialty into that realm is what made sense. For example, I really loved EM and the pace. There are county hospitals with freestanding psych ERs that are wonderfully fast paced and exciting - and could be an area of focus if you gravitate towards that later on. Similarly, you could have a private practice where you have a patient panel you see and perhaps even do therapy with some folks depending on reimbursement/insurance status.

I think you'll need to try and pursue those "lightbulb" moments if you can. I had one when setting foot into an emergency room, but you might have it by shadowing a psychiatrist or psychologist doing outpatient work. It's a long road to go through medical school and residency. But after having gone through it, I really couldn't imagine doing anything else. It'll come together! I wouldn't worry about the future steps, especially residency matching. I actually think that's the least worrisome part at this point. The bigger one would be determining whether or not you want to commit a decade of your life to this path.

 

[samac]

I do just want to note going to medical school is pretty challenging. If you go in set on psychiatry you’re going to spend most of your time doing unrelated things. Pre clinical was 1 month of psychiatry and clinical was the same. All other aspects of medicine take up the rest of the time and they can be pretty draining.

 

[Stagg737]

Something mentioned above that I would STRONGLY recommend to all pre-med hopefuls is to do a solid amount of shadowing in different fields and settings if possible. It can be surprising how different the reality of a field is compared to our perceptions, and even with significant shadowing as a pre-med (over 100 hours) my perceptions about some fields completely changed during clinical years, including psychiatry.

I'd also note that there are ways to become involved in biological/clinical aspects of psychiatry through PhD programs, though it will involve research. There's plenty of areas that could be explored including GI flora/relations to MH disorders, endocrine, exercise science and impacts on MH, etc. I've met a couple people who have done some pretty cool research on physical/medical disorders and their impact on MH. Though that route would certainly limit flexibility and be much more focused than becoming a psychiatrist, which sounds like something that wouldn't jive with OP's goals/desires as well.

 

[Merovinge]

If you can stomach medical school and are on board with what it means to be a doctor (including the debt, learning about the whole body and not just the brain, professional ethos, etc), I think MD is much better suited to SMI than PhD. There are key/essential people with PhDs who help in the SMI space but it's a tiny portion of the field and they are an ancillary part of the treatment, whereas every psychiatrist will get robust SMI exposure/training and you will be the front line of this very vulnerable population. You can lead an ACT team or work on a psychosis specialty clinic or inpatient unit with ease following a general psych residency.

Also, kudos to you for the SMI interest. It's actually the area I miss most doing CAP work, I can't tell you how excited I get to see teenagers with real mania and schizophrenia.

 

[NickNaylor]

I always say the same thing to people asking this question: you need to figure out for yourself if you are interested in being a physician. Even if you "know" that you're interested in becoming a psychiatrist, the reality is that you will spend a significant amount of time doing things that have variable degrees of relevance to you as a psychiatrist. To minimize the risk of becoming completely demoralized during medical training, I think it's important that you have some interest in learning about the human body, learning about disease, and being someone to address those issues first and foremost, even if you plan to go into the red-headed step-child that is psychiatry. If you don't know the answer to that question, then do some shadowing - including in areas other than psychiatry.

At both my medical school and current institution, the reality is that education related to psychiatry is paltry, and you are going to spend the bulk of your medical school experience doing non-psychiatry. Even half of your intern year is going to be spent on clinical services that aren't psychiatry. You must accept the fact that you're going to spend a lot of time, experience a lot of stress, and expend a lot of energy on things that are not at all directly related to what you ultimately want to do. IMO, the only way to make that bearable is if you have some intrinsic interest in medicine and being a physician generally.

 

[Ole_Toe]

I'm a current med student who was once in a similar position to you. It's a very, very long road, and you have to first and foremost want to become a physician. As others have said, if you can stomach it all, then you should absolutely pursue medicine! In my opinion you'll have way more flexibility, job security, compensation, and knowledge at the end of your training.

 

[heartsink]

I'll pile on and say I was in your shoes about 6 years ago - no pre-med classes to my name. Can't recommend enough: get shadowing, see what being a physician is really like, and really do your homework on what med school entails. There is a long road ahead of you before you touch anything psychiatry related.

 

[MustIReallyThough]

I'm nearing the end of psychiatry residency and was in a very similar place to you back several (many?) years ago. I ended up getting a master's degree in counseling and having some experience in psychotherapy. What tipped it over for me was missing out on the biological treatments and having an understanding of medical comorbidities and complexities that can affect mental health. In addition, the work of psychotherapy (to me) is very exhausting and can feel somewhat nebulous and slow at times. So I started to poke around in the medical world while doing my counseling training... and it was like a lightbulb went off. The medically trained are much more "my peeps" in terms of their way of approaching things, the day to day, etc. etc. - and the pace felt much more my style.

I knew medical school would involve experiencing multiple specialties - and that was exciting! I kept an open mind but once I rotated on psychiatry, it was clear that it was the one for me. It remains, despite growing more competitive, a relatively uncompetitive field to pursue with an overall high match rate. I did consider other specialties and if I *HAD* to not do psychiatry, I would find other parts of medicine in which to be happy. But boy am I glad I in this particular specialty.

In terms of SMI and working with that population, I have found the psychopharmacology aspect to be very, very satisfying. People with SMI often have many other comorbidities and having the knowledge to help guide treatment in that realm as well (in terms of getting folks connected with PCPs, etc.) can be very rewarding. The psychopharm aspect can be sort of investigative, trial/error, and can produce observable results (especially if you're doing inpatient work and tracking peoples' progress). Psychotherapy is a minimal part of my end career and I believe it is that way for most psychiatrists. It's cheaper to reimburse MFT or psychologist level folks to do therapy and leave the med management to prescribers. Does that mean you can't do psychotherapy? Not necessarily. They say "each interaction you have with a patient can be therapeutic" and to me that is satisfactory. I actually don't want to be doing hour-long CBT sessions with a patient, because I find my personality and interaction style with patients more effective in a supportive way... and we can get a lot done there.

For recommendations, I'd try to get into a hospital (perhaps a larger one) to see what it's really all about, including non-psychiatric specialties. For me, it was the energy that was attractive -- and then fitting a specialty into that realm is what made sense. For example, I really loved EM and the pace. There are county hospitals with freestanding psych ERs that are wonderfully fast paced and exciting - and could be an area of focus if you gravitate towards that later on. Similarly, you could have a private practice where you have a patient panel you see and perhaps even do therapy with some folks depending on reimbursement/insurance status.

I think you'll need to try and pursue those "lightbulb" moments if you can. I had one when setting foot into an emergency room, but you might have it by shadowing a psychiatrist or psychologist doing outpatient work. It's a long road to go through medical school and residency. But after having gone through it, I really couldn't imagine doing anything else. It'll come together! I wouldn't worry about the future steps, especially residency matching. I actually think that's the least worrisome part at this point. The bigger one would be determining whether or not you want to commit a decade of your life to this path.

Wow, I can't tell you how helpful it is to hear both perspectives like that! Its something I've read before that therapy is very draining. One of my biggest concerns with therapy is that I won't like it as much as I think I would. I'd be sort of screwed then, as the other paths in psychology don't seem as appealing in terms of direct patient care. Do you think your experience with therapy has anything to do with introversion? I'm wondering if introverted people would be better suited as doctors. Or what specifically about your personality or interaction style lends itself to medicine.

Also, thanks for clarifying the role of therapy in medicine. I see exactly what you mean now. I think I would be ok with supportive therapy! Its also reassuring to think that if I really, really liked therapy that I could carve some out for myself with much work. But as it stands, I believe I'd follow your own path sooner or later. The thought of pscyh ERs and rotations are pretty exciting for me as well (for now)!

A very reassuring point about residency as well. I do believe I'm ready to commit. Its truly the only thing I ever envisioned for myself and it would be a dream come true honestly. I'm beginning to better understand what a huge commitment it is though. So I'll temper my optimism with that going forward ^^

Again though, thank you very much for that. It's extremely helpful and I'll reread that more than a few times. I'll definitely set my sights now on as much shadowing as possible.

 

[MustIReallyThough]

I do just want to note going to medical school is pretty challenging. If you go in set on psychiatry you’re going to spend most of your time doing unrelated things. Pre clinical was 1 month of psychiatry and clinical was the same. All other aspects of medicine take up the rest of the time and they can be pretty draining.

I'll definitely keep that in mind! I think if I truly hate my pre-med classes I'll have to change course. Perhaps I can be completely honest with myself in that event.

 

[MustIReallyThough]

Something mentioned above that I would STRONGLY recommend to all pre-med hopefuls is to do a solid amount of shadowing in different fields and settings if possible. It can be surprising how different the reality of a field is compared to our perceptions, and even with significant shadowing as a pre-med (over 100 hours) my perceptions about some fields completely changed during clinical years, including psychiatry.

I'd also note that there are ways to become involved in biological/clinical aspects of psychiatry through PhD programs, though it will involve research. There's plenty of areas that could be explored including GI flora/relations to MH disorders, endocrine, exercise science and impacts on MH, etc. I've met a couple people who have done some pretty cool research on physical/medical disorders and their impact on MH. Though that route would certainly limit flexibility and be much more focused than becoming a psychiatrist, which sounds like something that wouldn't jive with OP's goals/desires as well.

Will do! Is there something you would have done differently specifically? Like more in a certain area or just more time spent overall?

 

[Stagg737]

Will do! Is there something you would have done differently specifically? Like more in a certain area or just more time spent overall?

I would have tried to get more inpatient shadowing for non-surgical fields, though this is likely the most difficult shadowing to find. I did a lot of outpatient (FM, IM, ortho, and EM) and spent some time in the OR. Never knew what the floors were really like until med school though. Would have been nice to know earlier, but nbd in the end for me.

 

[MustIReallyThough]

If you can stomach medical school and are on board with what it means to be a doctor (including the debt, learning about the whole body and not just the brain, professional ethos, etc), I think MD is much better suited to SMI than PhD. There are key/essential people with PhDs who help in the SMI space but it's a tiny portion of the field and they are an ancillary part of the treatment, whereas every psychiatrist will get robust SMI exposure/training and you will be the front line of this very vulnerable population. You can lead an ACT team or work on a psychosis specialty clinic or inpatient unit with ease following a general psych residency.

Also, kudos to you for the SMI interest. It's actually the area I miss most doing CAP work, I can't tell you how excited I get to see teenagers with real mania and schizophrenia.

This is exactly what I was thinking! I do find the body quite fascinating. I'm not sure it would be a slog per say to learn this stuff, even without direct relevance. But perhaps I'm not truly understanding how in-depth medical school is. Still, anything at all related to overall health would be worth my time.

Also, did you specialize in child and adolescent? I'm really interested in this population as well! Maybe not kids as much, but who knows.

 

[MustIReallyThough]

I always say the same thing to people asking this question: you need to figure out for yourself if you are interested in being a physician. Even if you "know" that you're interested in becoming a psychiatrist, the reality is that you will spend a significant amount of time doing things that have variable degrees of relevance to you as a psychiatrist. To minimize the risk of becoming completely demoralized during medical training, I think it's important that you have some interest in learning about the human body, learning about disease, and being someone to address those issues first and foremost, even if you plan to go into the red-headed step-child that is psychiatry. If you don't know the answer to that question, then do some shadowing - including in areas other than psychiatry.

At both my medical school and current institution, the reality is that education related to psychiatry is paltry, and you are going to spend the bulk of your medical school experience doing non-psychiatry. Even half of your intern year is going to be spent on clinical services that aren't psychiatry. You must accept the fact that you're going to spend a lot of time, experience a lot of stress, and expend a lot of energy on things that are not at all directly related to what you ultimately want to do. IMO, the only way to make that bearable is if you have some intrinsic interest in medicine and being a physician generally.

Will do! Shadowing seems like the only way. I guess the question is how much is "some interest in the body"? Its easy to say yeah sure but I doubt I'm comprehending what that means exactly. Someone mentioned once: "do you want to learn in-depth physiology of the lungs"? Which seems daunting, but not altogether trying. I'm rather curious. I can also see how it would be relevant in psych patients (if only a few times in a career).

 

[MustIReallyThough]

I'm a current med student who was once in a similar position to you. It's a very, very long road, and you have to first and foremost want to become a physician. As others have said, if you can stomach it all, then you should absolutely pursue medicine! In my opinion you'll have way more flexibility, job security, compensation, and knowledge at the end of your training.

Agreed! If you don't mind me asking, how are you feeling about your decision now that you're in? Also, are you worried about matching psych or have you changed course?

 

[MustIReallyThough]

I'll pile on and say I was in your shoes about 6 years ago - no pre-med classes to my name. Can't recommend enough: get shadowing, see what being a physician is really like, and really do your homework on what med school entails. There is a long road ahead of you before you touch anything psychiatry related.

Yeah I'm getting a more daunting picture as time goes on to say the least! I definitely want to be sure of what I'm getting into. If you don't mind, are you still in med school and how do you feel about it all?

 

[MustIReallyThough]

I would have tried to get more inpatient shadowing for non-surgical fields, though this is likely the most difficult shadowing to find. I did a lot of outpatient (FM, IM, ortho, and EM) and spent some time in the OR. Never knew what the floors were really like until med school though. Would have been nice to know earlier, but nbd in the end for me.

Gotcha! Yeah I don't have many contacts right now but might can swing something in the future. How were the floors though? I imagine its extremely trying for a new graduate.

 

[mdwpsyd]

In addition to all the superb advice you've received here, let me add that you don't have to—in fact you can't—give up on psychotherapy, broadly speaking, if you become a psychiatrist. Almost all the top-notch psychiatrists I've worked with over the years have excellent psychotherapeutic skills, and a couple even offer good 'ol fashioned 50-minute hour psychotherapy (on a limited basis).

Psychiatrists must possess solid interpersonal skills generally, and psychotherapeutic skills specifically, no matter what psychiatry subspecialty, e.g., working with SMI patients, they end up in.

I agonized over clinical psych vs. psychiatry for my first two years as an undergrad, mainly because so many people in my family have been or are physicians, but with lots of great feedback from friends, family, mentors, and professionals, I finally realized that my motivation for medicine, which was mainly to garner approval from my father, would never get me through the rigors of the discipline. And then there was all that blood! 😱

I matriculated in a PsyD program 34 years ago and I've been a happy camper ever since.

 

[Merovinge]

This is exactly what I was thinking! I do find the body quite fascinating. I'm not sure it would be a slog per say to learn this stuff, even without direct relevance. But perhaps I'm not truly understanding how in-depth medical school is. Still, anything at all related to overall health would be worth my time.

Also, did you specialize in child and adolescent? I'm really interested in this population as well! Maybe not kids as much, but who knows.

Yes, it's worth the extra one total year for anyone who plans to do the work (via fast-tracking). It is pretty at odds with SMI, although the CAP equivalent is severe ASD/ID which I do a lot of work in.

 

[MustIReallyThough]

In addition to all the superb advice you've received here, let me add that you don't have to—in fact you can't—give up on psychotherapy, broadly speaking, if you become a psychiatrist. Almost all the top-notch psychiatrists I've worked with over the years have excellent psychotherapeutic skills, and a couple even offer good 'ol fashioned 50-minute hour psychotherapy (on a limited basis).

Psychiatrists must possess solid interpersonal skills generally, and psychotherapeutic skills specifically, no matter what psychiatry subspecialty, e.g., working with SMI patients, they end up in.

I agonized over clinical psych vs. psychiatry for my first two years as an undergrad, mainly because so many people in my family have been or are physicians, but with lots of great feedback from friends, family, mentors, and professionals, I finally realized that my motivation for medicine, which was mainly to garner approval from my father, would never get me through the rigors of the discipline. And then there was all that blood! 😱

I matriculated in a PsyD program 34 years ago and I've been a happy camper ever since.

Thank you for another great psychologist perspective! This is very encouraging. It honestly sounds like best case scenario for me. Even if I didn't get to practice therapy very much at all I'd still like to be proficient in the end I think. Though, I will have to be very honest with myself about why I want to follow this rigorous path as you were. Perhaps an urge to understand both medicine and psychology will be enough. Also, I don't mind blood!

 

[MustIReallyThough]

Yes, it's worth the extra one total year for anyone who plans to do the work (via fast-tracking). It is pretty at odds with SMI, although the CAP equivalent is severe ASD/ID which I do a lot of work in.

Ah I missed the acronym my first go round. ^^ Ya learn things. So most SMI is focused in the adult population. Interesting, I'll see where I'm led. ASD/ID work would be quite fulfilling as well I think.

 

[MustIReallyThough]

Again, thank you all for every post and taking the time. Truly invaluable information that I'll reference many times going forward!!

 

[heartsink]

Yeah I'm getting a more daunting picture as time goes on to say the least! I definitely want to be sure of what I'm getting into. If you don't mind, are you still in med school and how do you feel about it all?

I'm barely half-way through first year and just now getting my feet on the ground after the initial overwhelming pace and volume of material. You'll hear the phrase "drinking from a fire hose" often, but it still won't prepare you for what its like once you're in it. Maybe its easier for others, but for me, every week i'm studying harder and longer than I ever did for any finals week during undergrad. As someone that also went in primarily interested in the specialty of psychiatry, I'm still interested enough in the material presented right now that its not a total slog. Learning about pharmacology, the immune response, physical exams and anatomy has been cool to understand since it all relates to health that is important to absolutely everyone.

 

[Ole_Toe]

Agreed! If you don't mind me asking, how are you feeling about your decision now that you're in? Also, are you worried about matching psych or have you changed course?

Medicine is awesome! It opens so many doors and new possibilities. Psychiatry still feels like my calling, but the cool thing about medical school is that if you want to put in the hours and the work, you can become anything from a family doc to a brain surgeon. There's nothing else like it. That being said, if you're not careful it will take over your life perhaps more than grad school in other fields. So really take the time to make sure it's what you want not just right now, but in 5 - 10 years when you will likely still be in training.

Oh and if you have the drive to get into medical school, then you shouldn't be worried about doing well in the psych match. It's more competitive than 5 years ago, but I don't think many people would be worried about not matching at all. You've probably read some of the horror stories on here of people not matching in psych or falling way down their rank list. People just have to be smarter with how they apply these days, but really don't let that factor into this at all for you.

Again, you have to want to be a physician first and foremost, but I will say that you can be involved in mental health related volunteering, advocacy, and research throughout your post-bac and med school years to give you what you're looking for. Medical school is long, but so is the PhD track for psychology - and just as competitive. Job security, flexibility, and potential compensation should be important factors to consider.

 

[MustIReallyThough]

I'm barely half-way through first year and just now getting my feet on the ground after the initial overwhelming pace and volume of material. You'll hear the phrase "drinking from a fire hose" often, but it still won't prepare you for what its like once you're in it. Maybe its easier for others, but for me, every week i'm studying harder and longer than I ever did for any finals week during undergrad. As someone that also went in primarily interested in the specialty of psychiatry, I'm still interested enough in the material presented right now that its not a total slog. Learning about pharmacology, the immune response, physical exams and anatomy has been cool to understand since it all relates to health that is important to absolutely everyone.

Ah man I hear ya! So you're in the throes. I'm sure I'll have a similar experience acclimating. Keep grinding fam, you got this! Shoot me a pm anytime if you just wanna vent.

I think it'd be pretty cool to learn all of that too, overall health and all. I'd probably be in the same boat, slogging but not totally! Quite encouraging, thanks for that.

 

[deleted1012620]

If you're academically inclined with a good work ethic, I'd wager you'll be happier in the end having done med school and psychiatry residency.

It's a tough road so go shadow some internal medicine doctors who work in clinics and also inpatient (hospitalists), as that's gonna be a large part of your training. I think the first two years of med school aren't too bad if you like premed courses in college, since it's just more of the same at a higher volume and pace.

 

[MustIReallyThough]

Medicine is awesome! It opens so many doors and new possibilities. Psychiatry still feels like my calling, but the cool thing about medical school is that if you want to put in the hours and the work, you can become anything from a family doc to a brain surgeon. There's nothing else like it. That being said, if you're not careful it will take over your life perhaps more than grad school in other fields. So really take the time to make sure it's what you want not just right now, but in 5 - 10 years when you will likely still be in training.

Oh and if you have the drive to get into medical school, then you shouldn't be worried about doing well in the psych match. It's more competitive than 5 years ago, but I don't think many people would be worried about not matching at all. You've probably read some of the horror stories on here of people not matching in psych or falling way down their rank list. People just have to be smarter with how they apply these days, but really don't let that factor into this at all for you.

Again, you have to want to be a physician first and foremost, but I will say that you can be involved in mental health related volunteering, advocacy, and research throughout your post-bac and med school years to give you what you're looking for. Medical school is long, but so is the PhD track for psychology - and just as competitive. Job security, flexibility, and potential compensation should be important factors to consider.

Excellent news! It seems you're quite content 😀 The flexibility you speak of would be great, outside school and in. Who knows, I may change course completely and wouldn't be able to do that in grad school. I'll definitely keep the time constraints in mind as well. I guess there's absolutely nothing else I'd rather do once I decide between the two options. So hopefully I'll be ok. I think if anything it'll be a relief to finally be involved in the field.

Hah, yeah I've seen a few of those horror stories! Very encouraging though, if all else fails I think I'd be content with a low ranked residency. I've read it doesn't really matter in terms of practicing.

 

[Mad Jack]

They used to try to talk schizophrenia away. It was... Not very successful. However, if you like improving the lives of more functional patients, psychology is a great way to go.

 

[MustIReallyThough]

They used to try to talk schizophrenia away. It was... Not very successful. However, if you like improving the lives of more functional patients, psychology is a great way to go.

Point taken! I assume we're talking moderate depression/anxiety, cyclothymia, some personality disorders etc.? I do believe this would be fulfilling, but I'm not sure if I'd be left wanting more. Or maybe that'd I just like to see the entire gamut if that makes sense. I'll definitely investigate further the role of psychologists in hospitals. Btw, are you seeing a trend of psychologists being replaced by master level clinicians or do they still primarily treat moderate/severe illness in hospitals? As I understand it they're trending towards administration.

 

[MustIReallyThough]

If you're academically inclined with a good work ethic, I'd wager you'll be happier in the end having done med school and psychiatry residency.

It's a tough road so go shadow some internal medicine doctors who work in clinics and also inpatient (hospitalists), as that's gonna be a large part of your training. I think the first two years of med school aren't too bad if you like premed courses in college, since it's just more of the same at a higher volume and pace.

I certainly seemed to enjoy studying and tests more than most. Its usually a rewarding challenge. Is that what you mean by academically inclined? As far as research goes, I can read it but have no interest in conducting it really.

Will do! Another poster mentioned floor experience so I'll definitely try to get in with some IM folks.

 

[Deleted member 1077394]

@MildlyMagicalMagi Just some unsolicited advice from another undergrad, but especially if you go to public school, it is usually cheaper to add on a fifth year (declare a second major if financial aid will give you trouble - you don't have to actually finish it and can drop it the semester you apply for graduation) than to do a post-bacc. Formal post-baccs are frequently at expensive private schools. Financial aid for DIY post-baccs can get really messy and I have seen that throw a wrench in people's plans. I can't speak to the finances of private school, but this is what I've learned about public university from my own experience.

Just a thought. 🙂 Best of luck to you. 🙂 Keep us posted on your decision as you wish.

 

[MustIReallyThough]

@MildlyMagicalMagi Just some unsolicited advice from another undergrad, but especially if you go to public school, it is usually cheaper to add on a fifth year (declare a second major if financial aid will give you trouble - you don't have to actually finish it and can drop it the semester you apply for graduation) than to do a post-bacc. Formal post-baccs are frequently at expensive private schools. Financial aid for DIY post-baccs can get really messy and I have seen that throw a wrench in people's plans. I can't speak to the finances of private school, but this is what I've learned about public university from my own experience.

Just a thought. 🙂 Best of luck to you. 🙂 Keep us posted on your decision as you wish.

Ah great point!! Please keep the advice coming haha I need as much as I can get. So delay graduation by declaring a second major? I'm running entirely on loans at this point, so hopefully I could do it here at my local university. That would actually work great as I've still got at least 2 more semesters anyways. So they're less willing to give loans for DIY post-baccs? I was leaning towards formal schooling since I don't have much pre med experience, but I suppose it doesn't matter much where you go.

 

[Mad Jack]

Point taken! I assume we're talking moderate depression/anxiety, cyclothymia, some personality disorders etc.? I do believe this would be fulfilling, but I'm not sure if I'd be left wanting more. Or maybe that'd I just like to see the entire gamut if that makes sense. I'll definitely investigate further the role of psychologists in hospitals. Btw, are you seeing a trend of psychologists being replaced by master level clinicians or do they still primarily treat moderate/severe illness in hospitals? As I understand it they're trending towards administration.

Our psychologists do a lot of therapy on the unit but over half their time is devoted to administration, they kind of are admits that are managers for the social workers. Every hospital is different though.

 

[FiveTwoFifty]

Wow, I can't tell you how helpful it is to hear both perspectives like that! Its something I've read before that therapy is very draining. One of my biggest concerns with therapy is that I won't like it as much as I think I would. I'd be sort of screwed then, as the other paths in psychology don't seem as appealing in terms of direct patient care. Do you think your experience with therapy has anything to do with introversion? I'm wondering if introverted people would be better suited as doctors. Or what specifically about your personality or interaction style lends itself to medicine.

Also, thanks for clarifying the role of therapy in medicine. I see exactly what you mean now. I think I would be ok with supportive therapy! Its also reassuring to think that if I really, really liked therapy that I could carve some out for myself with much work. But as it stands, I believe I'd follow your own path sooner or later. The thought of pscyh ERs and rotations are pretty exciting for me as well (for now)!

A very reassuring point about residency as well. I do believe I'm ready to commit. Its truly the only thing I ever envisioned for myself and it would be a dream come true honestly. I'm beginning to better understand what a huge commitment it is though. So I'll temper my optimism with that going forward ^^

Again though, thank you very much for that. It's extremely helpful and I'll reread that more than a few times. I'll definitely set my sights now on as much shadowing as possible.

Glad it was helpful! I hadn't considered the introversion piece - not sure that has a terrible big role to play. I wouldn't consider myself a raging extrovert, hah, but many of my classmates are. As with everything, there is a spectrum. I do find that I am much more drawn to objective data (when possible) but in terms of preferring various social situations or need for recharging due to exhaustion from socializing, it's a mixed bag.

Separate from this, I would advocate for some time in between undergraduate and medical school. I think that is becoming more the rule than the exception these days. I can absolutely tell a difference from my classmates who went straight through versus those who took time to work. Residency will be your first foray into a working environment if you chose the "straight through" option... and I think there are many skills in the working world that would be valuable to obtain before that. Additionally, it makes for interesting interview fodder and just gives you life experience so your decision is more informed.

 

[Matthew9Thirtyfive]

I’m only a med student interested in psychiatry, but I just finished preclinicals and will say that if you have an interest in medicine and the whole body, med school is great. Even though I am primarily interested in psych, I was able to find stuff in each systems block that related to psych in someway. And the stuff that didn’t seem to be related very much, some of it was interesting anyway and some of it I didn’t care too much about, but told myself I needed to learn it to get where I wanted to go.

 

[MustIReallyThough]

Our psychologists do a lot of therapy on the unit but over half their time is devoted to administration, they kind of are admits that are managers for the social workers. Every hospital is different though.

Ah man, that is definitely not what I'm looking for at the present. I wonder how hard it would be to find a position that was mainly clinical then. I assume it would be increasingly difficult as masters folks gain wider acceptance.

 

[Mad Jack]

Ah man, that is definitely not what I'm looking for at the present. I wonder how hard it would be to find a position that was mainly clinical then. I assume it would be increasingly difficult as masters folks gain wider acceptance.

The VA tends to have a lot of clinical jobs with challenging patients

 

[MustIReallyThough]

Glad it was helpful! I hadn't considered the introversion piece - not sure that has a terrible big role to play. I wouldn't consider myself a raging extrovert, hah, but many of my classmates are. As with everything, there is a spectrum. I do find that I am much more drawn to objective data (when possible) but in terms of preferring various social situations or need for recharging due to exhaustion from socializing, it's a mixed bag.

Separate from this, I would advocate for some time in between undergraduate and medical school. I think that is becoming more the rule than the exception these days. I can absolutely tell a difference from my classmates who went straight through versus those who took time to work. Residency will be your first foray into a working environment if you chose the "straight through" option... and I think there are many skills in the working world that would be valuable to obtain before that. Additionally, it makes for interesting interview fodder and just gives you life experience so your decision is more informed.

I see! I think I lean introverted but I don't mind speaking the words. Probably would have a similar experience.

This is really encouraging as well. I'm a non trad even before I do any form of post bacc. I definitely want to spend the 1-3 years post undergrad that I would have spent gaining RA experience for psych grad school working as an EMT and not rushing my decision. However...I'm not getting any younger hah. I'm 26 now so I'm looking at matriculating at 30ish. I suppose it doesn't make any real difference?

 

[MustIReallyThough]

I’m only a med student interested in psychiatry, but I just finished preclinicals and will say that if you have an interest in medicine and the whole body, med school is great. Even though I am primarily interested in psych, I was able to find stuff in each systems block that related to psych in someway. And the stuff that didn’t seem to be related very much, some of it was interesting anyway and some of it I didn’t care too much about, but told myself I needed to learn it to get where I wanted to go.

Anotha one! You guys are gonna put me deeply and snuggly in debt and absolve me of any personal responsibility. It seems if I have an interest in both the choice really is clear. How hard did you find med school and are you worried about matching? Though the latter really doesn't seem like a big concern at all. Thanks for chiming in!

 

[MustIReallyThough]

The VA tends to have a lot of clinical jobs with challenging patients

I've heard that, good pay and working conditions. I'll have to see if I can shadow some in that particular setting. Someone else mentioned that clinical jobs aren't always that competitive either.

 

[Matthew9Thirtyfive]

Anotha one! You guys are gonna put me deeply and snuggly in debt and absolve me of any personal responsibility. It seems if I have an interest in both the choice really is clear. How hard did you find med school and are you worried about matching? Though the latter really doesn't seem like a big concern at all. Thanks for chiming in!

I’m just starting rotations so I’m not worried about matching yet. But honestly if you can do well in undergrad, med school is not that hard. It’s just a lot of material in high volume that makes it difficult. But efficient studying and a routine make it manageable.

 

[Mad Jack]

Anotha one! You guys are gonna put me deeply and snuggly in debt and absolve me of any personal responsibility. It seems if I have an interest in both the choice really is clear. How hard did you find med school and are you worried about matching? Though the latter really doesn't seem like a big concern at all. Thanks for chiming in!

Med school is a lot of moderately difficult material. Imagine intro chem, now imagine taking that ten times per semester. Not super hard but there's a lot of it. Matching in paych is kind of hit or miss, honestly, but who knows whether it'll be more or less competitive in a few years

 

[mdwpsyd]

Our psychologists do a lot of therapy on the unit but over half their time is devoted to administration, they kind of are admits that are managers for the social workers. Every hospital is different though. … Ah man, that is definitely not what I'm looking for at the present. I wonder how hard it would be to find a position that was mainly clinical then. I assume it would be increasingly difficult as masters folks gain wider acceptance. … The VA tends to have a lot of clinical jobs with challenging patients.

Working for the Department of Veterans Affairs​

I've worked for VA during internship (1989–1990), and for six years in the 2010s. I really liked the patients (veterans), and I enjoyed working with almost all my coworkers. I also liked the fact that psychologists & psychiatrists work collaboratively and respect each other much more than in other settings, such as private (profit or nonprofit) hospital systems and community mental health.

For clinical & counseling psychologists, the current VA pay and benefits are better than any other salaried positions. If you do a VA internship, VA postdoc, and then two years (or less) working for VA under supervision (to qualify for independent licensure), you'll be earning about $95,000/year + better benefits than almost any job (for psychologists).* Psychiatrists earn at least twice that much (per GlassDoor.com, although I think it's more like 250% more, if you factor in all the benefits), and receive more leave time right away—39 leave days (312 hours), plus 10 federal holidays. (For psychologists its 26 leave days, which increases to 39 leave days after about 10 years.)

Primary advantages: M-F, 0800–1630 work day (still the norm, although more evening and Saturday hours would serve veterans better, so it might change); excellent health insurance; job stability; not too difficult to transfer to other duty stations (medical centers or outpatient clinics); and VA's mission (caring for the men and women who put their life on the line for the rest of us).

Main disadvantages: It's a huge bureaucracy (2nd largest Department, next to DoD); top-down management structure (authoritarian would be too strong a term in most instances, but not all).

If you have entrepreneurial drive, like to have a reasonable amount of control over your work life, chafe at bureaucratic b.s., and want to solve problems quickly and decisively, then working for VA is not for you. (At least not in the long term—most VA internships provide very good training).

Paths to Success in the Private Sector (for clinical psychologists)​

Higher-paying niche markets for clinical psychologists in the private sector include forensic psychology (which covers a lot—it's not just criminal evaluations), sports psychology, and consulting (many types), among others. And, an underappreciated factor, providing the highest quality services in your area will allow you to develop a self-pay, "managed-care free" psychotherapy or assessment practice.

Becoming the best in your area is an underappreciated factor. I've seen way too many psychologists obsess over getting on insurance panels, which pay 40% less for 40% more work (my estimate); invest in complicated, billing, EMR, and scheduling systems; throw gobs of cash at ineffective advertising & marketing, etc., and neglect investing time and money into becoming the best, e.g., paying for ongoing consultation with senior psychologists for many years after licensure.
---
* That's the salary for much of the U.S., from the "Rest of the United States" Locality Pay Table. Salaries increase where the cost of living is higher, although the increases do not keep pace with the cost of living in cities like New York or San Francisco.

~ Mark

Sources:
FederalJobs.net, Special Compensations Systems.

GlassDoor.com, US Department of Veterans Affairs Clinical Psychologist Salaries (19 Nov 2020).

GlassDoor.com, US Department of Veterans Affairs Psychiatrist Salaries (6 Dec 2020).

National Health Care Recruitment Service. Total Rewards of VA Employment: Physician Careers. New Orleans: Department of Veterans Affairs, 2020.

Office of Personnel Management (OPM), 2020 General Schedule (GS) Locality Pay Tables.

Office of Personnel Management (OPM), Rest of the United States (consisting of those portions of the United States and its territories and possessions as listed in 5 CFR 591.205 not located within another locality pay area), in 2020 General Schedule (GS) Locality Pay Tables.

Weeks, William B., and Alan N. West. “Veterans Health Administration Hospitals Outperform Non–Veterans Health Administration Hospitals in Most Health Care Markets.” Annals of Internal Medicine 170, no. 6 (December 11, 2018): 426–28. https://doi.org/10.7326/M18-1540

 

[ThatSerb]

If you can stomach medical school and are on board with what it means to be a doctor (including the debt, learning about the whole body and not just the brain, professional ethos, etc), I think MD is much better suited to SMI than PhD. There are key/essential people with PhDs who help in the SMI space but it's a tiny portion of the field and they are an ancillary part of the treatment, whereas every psychiatrist will get robust SMI exposure/training and you will be the front line of this very vulnerable population. You can lead an ACT team or work on a psychosis specialty clinic or inpatient unit with ease following a general psych residency.

Also, kudos to you for the SMI interest. It's actually the area I miss most doing CAP work, I can't tell you how excited I get to see teenagers with real mania and schizophrenia.

what excites you so much about it?

 

[MustIReallyThough]

I’m just starting rotations so I’m not worried about matching yet. But honestly if you can do well in undergrad, med school is not that hard. It’s just a lot of material in high volume that makes it difficult. But efficient studying and a routine make it manageable.

Very encouraging! Thanks man and good luck on your rotations.

 

[MustIReallyThough]

Working for the Department of Veterans Affairs​

I've worked for VA during internship (1989–1990), and for six years in the 2010s. I really liked the patients (veterans), and I enjoyed working with almost all my coworkers. I also liked the fact that psychologists & psychiatrists work collaboratively and respect each other much more than in other settings, such as private (profit or nonprofit) hospital systems and community mental health.

For clinical & counseling psychologists, the current VA pay and benefits are better than any other salaried positions. If you do a VA internship, VA postdoc, and then two years (or less) working for VA under supervision (to qualify for independent licensure), you'll be earning about $95,000/year + better benefits than almost any job (for psychologists).* Psychiatrists earn at least twice that much (per GlassDoor.com, although I think it's more like 250% more, if you factor in all the benefits), and receive more leave time right away—39 leave days (312 hours), plus 10 federal holidays. (For psychologists its 26 leave days, which increases to 39 leave days after about 10 years.)

Primary advantages: M-F, 0800–1630 work day (still the norm, although more evening and Saturday hours would serve veterans better, so it might change); excellent health insurance; job stability; not too difficult to transfer to other duty stations (medical centers or outpatient clinics); and VA's mission (caring for the men and women who put their life on the line for the rest of us).

Main disadvantages: It's a huge bureaucracy (2nd largest Department, next to DoD); top-down management structure (authoritarian would be too strong a term in most instances, but not all).

If you have entrepreneurial drive, like to have a reasonable amount of control over your work life, chafe at bureaucratic b.s., and want to solve problems quickly and decisively, then working for VA is not for you. (At least not in the long term—most VA internships provide very good training).

Paths to Success in the Private Sector (for clinical psychologists)​

Higher-paying niche markets for clinical psychologists in the private sector include forensic psychology (which covers a lot—it's not just criminal evaluations), sports psychology, and consulting (many types), among others. And, an underappreciated factor, providing the highest quality services in your area will allow you to develop a self-pay, "managed-care free" psychotherapy or assessment practice.

Becoming the best in your area is an underappreciated factor. I've seen way too many psychologists obsess over getting on insurance panels, which pay 40% less for 40% more work (my estimate); invest in complicated, billing, EMR, and scheduling systems; throw gobs of cash at ineffective advertising & marketing, etc., and neglect investing time and money into becoming the best, e.g., paying for ongoing consultation with senior psychologists for many years after licensure.
---
* That's the salary for much of the U.S., from the "Rest of the United States" Locality Pay Table. Salaries increase where the cost of living is higher, although the increases do not keep pace with the cost of living in cities like New York or San Francisco.

~ Mark

Sources:
FederalJobs.net, Special Compensations Systems.

GlassDoor.com, US Department of Veterans Affairs Clinical Psychologist Salaries (19 Nov 2020).

GlassDoor.com, US Department of Veterans Affairs Psychiatrist Salaries (6 Dec 2020).

National Health Care Recruitment Service. Total Rewards of VA Employment: Physician Careers. New Orleans: Department of Veterans Affairs, 2020.

Office of Personnel Management (OPM), 2020 General Schedule (GS) Locality Pay Tables.

Office of Personnel Management (OPM), Rest of the United States (consisting of those portions of the United States and its territories and possessions as listed in 5 CFR 591.205 not located within another locality pay area), in 2020 General Schedule (GS) Locality Pay Tables.

Weeks, William B., and Alan N. West. “Veterans Health Administration Hospitals Outperform Non–Veterans Health Administration Hospitals in Most Health Care Markets.” Annals of Internal Medicine 170, no. 6 (December 11, 2018): 426–28. https://doi.org/10.7326/M18-1540

Wonderfully detailed post, thanks for taking the time!! The VA does seem like an excellent avenue for clinical work. I definitely won't count out psych yet. Did you leave to pursue more entrepreneurial opportunity?

The private sector is perhaps less interesting to me, unless I could carve out a niche in psychotherapy. If I did invest into becoming the best, how hard do you think it would be to do that considering how many masters level folks there are now in PP? Of course, if I do go that route I'm sure I'd find other areas more interesting than I do now.