Psychology vs. Medicine? Seeking advice

[Haqiqa]

Hey All - I am trying to decide between pursuing medical school (I would opt towards becoming a DO) or becoming a clinical psychologist/ therapist. I am really split down the middle in terms of my interests - were I to become a doctor, I would absolutely seek additional training in therapy/ counseling. However what is holding me back from focusing on medical school right now is that I am afraid I'll realize it was a mistake, and that my mind is more psychology-oriented rather than oriented towards the physical sciences. But my interests are what they are, and I can't seem to let the medical school idea go. I find psychosomatic illness interesting, and I know there are many routes to approach this field.
Just to give you my background, I feel my interests and abilities are most strongly in the realm of clinical psychology, but I still have a persistant interest in health/ illness in the physical body. As an undergrad I majored in psychology and neuroscience, and took some chemistry and biology & did well, but would still have to return to post-bacc classes to fill premed requirements. I have research experience in psychology, so at this point I feel ready to apply to graduate school. I just want to make this decision already and focus on one path!
Could any of you tell me about your experiences, or offer any advice you can?

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[Dr Trek 1]

Hey,

I have a similar background. I have always been interested in psychology and have my BA in psychology and am currently doing a MS in counseling. I have always had an interest in psychotherapy and have been doing it for almost a year now as part of my training. I also worked in a psychiatry department and shadowed many psychiatrists. So, I think I have a good idea of the differences.

Psychiatrists do not simply do 15 minute med checks, contrary to popular belief. Many chose to only do those, however, because they can make more money that way. However, psychiatrists can still bill for 50 minute psychotherapy sessions, just as clinical psychologists can, if they chose to. Of course, there are politics about this with different insurance companies but all of the psychiatrists I know are able to do it. Also, many psychiatry residency programs DO provide excellent psychotherapy training. I worked at one that did. So psychiatrists indeed can be well-trained in psychotherapy.

What I think made me realize I do not want to be a PsyD/PhD in clinical psychology for a living is that the work is a bit too slow paced. Don't get me wrong, I love doing therapy, but it's not something that I think would keep me happy for the rest of my life if it was all that I did. I also have a strong interest in clinical medicine, especially primary care. I believe that my therapy skills, however, are invaluable in treating patients. In psychotherapy, a good client-therapist relationship is based upon the therapy relationship, and it's not much different in medicine. If you have an excellent relationship with your patient, things will go better for both of you. Also, I am glad that now I can do "mini therapy sessions" with patients to deal with their anxiety, etc. of certain diseases (of course I won't be paid for this but oh well, don't expect to be paid for anything once you become a doctor )

In conclusion, I think my therapy skills will be paramount to the quality of patient care I will provide. Therapy, in and of itself, would not satisfy me if that is all I did for a living. However, this is just me. It's important to have an honest conversation with yourself. If you are in question, there is no harm in doing a terminal masters program in couseling or clinical psychology just to check it out.

I like to think of osteopathic physicians as doctors that are also therapists (or therapists who are also doctors, whichever way you want to think of it). It is certainly a fantastic cobination for osteopathic medicine.

Hope this helps somewhat, PM me if I can be of any help.

 

[OSUdoc08]

Hey All - I am trying to decide between pursuing medical school (I would opt towards becoming a DO) or becoming a clinical psychologist/ therapist. I am really split down the middle in terms of my interests - were I to become a doctor, I would absolutely seek additional training in therapy/ counseling. However what is holding me back from focusing on medical school right now is that I am afraid I'll realize it was a mistake, and that my mind is more psychology-oriented rather than oriented towards the physical sciences. But my interests are what they are, and I can't seem to let the medical school idea go. I find psychosomatic illness interesting, and I know there are many routes to approach this field.
Just to give you my background, I feel my interests and abilities are most strongly in the realm of clinical psychology, but I still have a persistant interest in health/ illness in the physical body. As an undergrad I majored in psychology and neuroscience, and took some chemistry and biology & did well, but would still have to return to post-bacc classes to fill premed requirements. I have research experience in psychology, so at this point I feel ready to apply to graduate school. I just want to make this decision already and focus on one path!
Could any of you tell me about your experiences, or offer any advice you can?

Just go to medical school and do a residency in psychiatry. There is not much of a job market demand for non-physician psychologists.

 

[Haqiqa]

Just go to medical school and do a residency in psychiatry. There is not much of a job market demand for non-physician psychologists.

Really? What makes you say that? I don't get that sense from people I know who are psychologists. I work in a research setting right now as well, and there are tons of employed researchers/ clinicians all around me!

 

[Oculus Sinistra]

Hello!

I had the same dilemma three years ago. I realized how much I enjoyed talking to people, drawing out their hidden feelings, fears and thoughts, and working with them to create some sort of first step forward to improving themselves. I felt like it was very rewarding and I thought, "If I could do this for a living, I would be very happy."

I was dissuaded by multiple factors. I noticed, for instance, that people cannot change until they are ready -- but that doesn't stop them from dwelling on their misery. They complain and overanalyze for years and years and YEARS and I kept picturing myself talking to a wall, frustrated because different creative approaches at the same problem would still end up nowhere.

For instance, my mother has a big heart and she met a guy about a year ago that was really hung up on this girl that dumped him FOURTEEN times. My mom, who is not licensed in therapy, is currently trying to help him realize why he needs to get over this girl. He called her 17 times on Saturday. That's the average for a weekend. She answered about four of those. I've listened to her be blunt, use metaphors, read passages from self-help books, and even yell at him. Nothing works.

I thought about having patients like that. I decided not to do it. I know this doesn't represent the broad spectrum of counseling, mental illness, etc, but it was enough to kill off my professional interest in it.

I'm more interested in medicine anyway; I get absorbed in anatomy, physiology, and pathology. As interesting as mental illnesses are, I'm also fascinated by viral illnesses and traumatic injuries. Sure, not all patients will take their medication or follow doctor's orders, but I'm hoping to work in a specialty with a high level of compliance.

Anyway, best of luck to you making your decision.

 

[OSUdoc08]

Really? What makes you say that? I don't get that sense from people I know who are psychologists. I work in a research setting right now as well, and there are tons of employed researchers/ clinicians all around me!

Psychiatrists are more in demand. There are so many master's degree level counselors that can do the same job as a psychologists.

Noone can do the same job as a psychiatrist.

 

[Dr Trek 1]

A lot of topics have come up on this board. Fortunately, I feel like my input is somewhat accurate since I have experience in the counseling profession.

Yes, there are a plethora of master's level counselors, social workers, etc. Even PsyD/PhD level clinical psychologists are abundant. However, this is for good reason. There is an increased need for mental health in this country. In fact, New York state just approved licensure for mental health counselors, when they only licensed social workers in the past. However, this is not really a good paying profession anymore. Unelss, of course, you move into a higher-SES area and set up a private practice (which is much more difficult for master's level therapists to do but the main goal of many doctoral level therapists).

And, like medicine, managed care is changing the field of therapy. Therapists are now pressured to practice cognitive behavioral therapy (CBT) because it shows more "success" in the short-term. It is more difficult for therapists to practice good old fashioned Carl Rogers, person-centered therapy when they are collecting third party payments for their service. There are endless styles of therapy that therapists associate themselves with but HMOs and PPOs are pushing them to practice CBT.

I agree that psychiatry is an ideal field. You can do psychotherapy in addition to all the medical stuff. And if you simply want to practice psychotherapy and not take insurance, you can legitimately charge much more and people will pay it (since you are a psychiatrist and not a psychologist). Even though at many places psychiatrists only do 15 minute med checks, you can do much more, especially if you go into private practice.

As for the comments that have been made about clients in therapy not being able to "get it" and change their behavior- it's part of therapy. As was said, people cannot change unless they truly want to and unless they feel comfortable doing so. With lots of time in therapy, it may become possible if they chose to do it. This is just one more reason why therapy is a very time consuming, sometimes frustrating process. And it indeed does take a certain type of therapist to support the client unconditionally, and to have enough patience.

Carl Rogers, the founder of person-centered approach, acknowledged the self-healing properties of the human body and the human psyche. He postulated that as long as the therapist provides unconditional positive regard, genuineness, and empathy for a client, the client will benefit, in whatever way is important for them. It's not all that different from the osteopathic approach to medicine.

As I have said before, I personally find practicing medicine with the empathy, unconditional positive regard, and genuineness of a good therapist to be the optimal, most rewarding career I could possible imagine. That's why I personally would not want to be soley a therapist.

 

[billydoc]

Psychiatrists are more in demand. There are so many master's degree level counselors that can do the same job as a psychologists.

Noone can do the same job as a psychiatrist.

Actually Psych NPs do pretty much anything that their psychiatrists counterparts are doing, including psychopharm. Many have independent practicies where they combine meds and therapy. Some are even cash only. Having said that, I'm not suggesting that it's a good thing. But GP/FP know about FNPs, Anesthesiologists about CRNAs, OB/GYN about CNMs and FNPs. Same goes for psych docs and psych NPs

 

[OSUdoc08]

Actually Psych NPs do pretty much anything that their psychiatrists counterparts are doing, including psychopharm. Many have independent practicies where they combine meds and therapy. Some are even cash only. Having said that, I'm not suggesting that it's a good thing. But GP/FP know about FNPs, Anesthesiologists about CRNAs, OB/GYN about CNMs and FNPs. Same goes for psych docs and psych NPs

Psych NP's are mid-level providers, whom do not have all of the autonomy as physicians do.

Why would you do the same job for half the salary anyway? It's only 2 more years of school ! !

 

[docmd2010]

I most def. agree with osudoc, just go to med school and become a pyschiatrist (however the hell u spell it). read some current issues of the american journal of pyshciatry, it describes the urgent need for shrenks and exemplifies the significant shortage in america for shrenks. although non physician therapists can find jobs there aren't as high in demand as MD's/DO's.

good luck to u in ure future

 

[billydoc]

Docmd and OSUdoc,
I couldn't agree with you more guys,but....You will notbe doing yourself a favor by denying the fact that Advance Practice nursing scope is ever-expanding. I'm an RN myself, but in med school too. By saying NPs are just mid-levels we are in denial. As far as legal end of their practice is concerned, they are independent practitioners, and are not regulated by medicine. So there is no stoping this practice. Also on the issue of "all the work for a half-pay"? Who is to set those numbers? I know psych NPs, and CNMs in the private practices, or in partnership (sort of frenchise) with other docs and NPs.They do direct billing, or practice on the cash-only basis, and have lots and lots of clients. The general public does not care that much about medical hierarchy. Al they care is they get their pills Rx, and not at the corner, and the counseling/therapy. Do you think they really care if the provider has MD/DO after their names? Please....that's not a reality. Of course, you have to be a physician to be a medical director or something of that nature. But to deny the obvious is just not helpful when fasing the reality. Sad but true.

 

[Dr Trek 1]

I most def. agree with osudoc, just go to med school and become a pyschiatrist (however the hell u spell it). read some current issues of the american journal of pyshciatry, it describes the urgent need for shrenks and exemplifies the significant shortage in america for shrenks. although non physician therapists can find jobs there aren't as high in demand as MD's/DO's.

good luck to u in ure future

Just figured I'd throw into the discussion the fact that child psychiatrists are probably more in demand than any other field of therapy. Child psychiatry takes lots of time and patience for the already low psychiatrist salary. But this country is in grave need of psychiatrists who will specialize in children.

 

[Haqiqa]

Hey All - thanks so much for your advice. Does anybody know of psychiatry residencies in which there is an emphasis on training in psychotherapy as well rather than pure medication management? Excuse my ignorance, but I am not sure exactly when in the post-med school process a psychiatrist would receive this specialized training. Also, are psychiatrists typically trained in Psychodynamic theory or CBT?? For how many years do they receive this training, and is it comparable to the psychotherapy training that a psychologist receives?

 

[Dr Trek 1]

Hey All - thanks so much for your advice. Does anybody know of psychiatry residencies in which there is an emphasis on training in psychotherapy as well rather than pure medication management? Excuse my ignorance, but I am not sure exactly when in the post-med school process a psychiatrist would receive this specialized training. Also, are psychiatrists typically trained in Psychodynamic theory or CBT?? For how many years do they receive this training, and is it comparable to the psychotherapy training that a psychologist receives?

Good questions. They all depend on the training program. Since I worked in this program, I know that Upstate (www.upstate.edu) has an excellent psychiatry residency program where you become well versed in many types of psychotherapy. There are many more as well, you may want to check out APA's website for more info. on them (www.psych.org). For the record, it's an allopathic hospital that is very DO friendly. The psychiatry dept., for instance, only requires COMLEX scores for DOs and welcomes their applications and treats their applications the same as they treat US MD applications. I worked directly under the PD for the psych. program and he told me this personally- not to mention there are many DOs in the department already.

Most psych. residency programs are 4 years. I would say that the programs that do provide good psychotherapy training do just a good of a job as PhD/PsyD programs in clinical psychology.

 

[OSUdoc08]

Docmd and OSUdoc,
I couldn't agree with you more guys,but....You will notbe doing yourself a favor by denying the fact that Advance Practice nursing scope is ever-expanding. I'm an RN myself, but in med school too. By saying NPs are just mid-levels we are in denial. As far as legal end of their practice is concerned, they are independent practitioners, and are not regulated by medicine. So there is no stoping this practice. Also on the issue of "all the work for a half-pay"? Who is to set those numbers? I know psych NPs, and CNMs in the private practices, or in partnership (sort of frenchise) with other docs and NPs.They do direct billing, or practice on the cash-only basis, and have lots and lots of clients. The general public does not care that much about medical hierarchy. Al they care is they get their pills Rx, and not at the corner, and the counseling/therapy. Do you think they really care if the provider has MD/DO after their names? Please....that's not a reality. Of course, you have to be a physician to be a medical director or something of that nature. But to deny the obvious is just not helpful when fasing the reality. Sad but true.

You arguments seem to be very misdirected.

Mid-level practitioners, by definition are NP's and PA's. The scope of practice is really irrelevant here, since this is what they are defined as.

By saying an NP or a PA is not a mid-level practitioner would be like saying a DO or MD is not a physician.

The scope of practice is truly irrelevant here, as is the general public. NPs and PAs suffer from a diminished autonomy AND recieve just a fraction of the compensation as MDs/DOs do.

As long as you don't mind the lack of automony and compensation, while also realizing that it is only 2 more years of school (all clinicals, mind you), then go for it.

 

[sasevan]

Hey All - thanks so much for your advice. Does anybody know of psychiatry residencies in which there is an emphasis on training in psychotherapy as well rather than pure medication management? Excuse my ignorance, but I am not sure exactly when in the post-med school process a psychiatrist would receive this specialized training. Also, are psychiatrists typically trained in Psychodynamic theory or CBT?? For how many years do they receive this training, and is it comparable to the psychotherapy training that a psychologist receives?

Hi Haqiqa,
I'm a psychologist finishing up pre-med this semester and hopefully entering med school in the fall of '07; planning on becoming a psychiatrist.

IMO, psychiatrists are not psychologists who can prescribe meds. First of all, in some States psychologists already do that and more likely than not there will be an expansion of prescription privileges (RxP). Second, psychologist are not limited to providing therapeutic treatments; what really differentiates psych PhD/PsyD from other mental health practitioners such as psychiatrists, social workers, counselors, etc. is psychological assessments (including intellectual and personality functioning and neuropsychological and psychoeducational testing). If one is a psychologist primarily providing clinical services, then treatment (with or without RxP) has to be complimented with assessment. Of course, psychologists are also very involved in teaching, research, consulting, etc.
If someone wants to provide exclusively therapeutic services he/she does not need to pursue psychology or psychiatry. Though both disciplines provide training in this area neither is exclusively focused on psychotherapy.
BTW, in my experience (4 years at a med school/med center psychiatry dept working as a psychology resident side-by-side with psychiatry interns, residents, and fellows), the training in psychology in this area is far more comprehensive than in psychiatry. In a 7 year PhD/PsyD program one is exposed to all schools and modalities of therapy from the end of year 1; in an 8 year MD/DO program one is not exposed until year 5 (not counting the 6 week psych rotation in year 3) and, understandably, the exposure is generally limited to supportive therapy and to a relatively small number of patients. Of course, there are post-board fellowships in therapy and other avenues for a psych MD/DO who is really interested in psychotherapy to attain a more comprehensive or specialized training, e.g., becoming a psychoanalyst.
So, what is so special about being a psychiatrist? I think the mod of the psych forum said it best when he said:

Hi Sasevan.
This is basically what it boils down to. That's why I eventually gave up some years and chose to do the same. I didn't feel like being a revolutionary for the rest of my life begging and hoping for still lower-level privilages when there was already an established method with superior training to do this.

I told myself that I was determined to never play second fiddle again to a more respected, higher paid, and more comprehensive health care leader if I could help it. This way, I'm ensured that I can write for whatever I want, conduct TMS therapy (on the way soon...lot of cool new data), perform ECT without legal battles, never worry about inferior training lawsuit threats, receive substantially higher pay, be much more marketable, have full access to established physician-only continuing education programs, have equal and full respect amongst my physician colleagues, write for non-psychiatric drugs as I saw fit to further help my patients, not worry about insurance coverage providing payment to non-physicians, have a comprehensive medical background so that I am fully versed with my patients' many, varied and often complex medical questions, work in psych C/L settings if I so chose without impunity, have full access to drug company samples to help patients who cannot immediately pay or have access to medications, have the peace of mind knowing that I can relocate to anywhere in the country knowing that great jobs are available, teach psychiatry at a university at physician level pay if I so chose, have full gamut of psychiatry APA approved fellowships should I want to pursue them (I do), and simply know that I went through the most extensive training available to 'do what I do.'

How's that for a run-on sentence?

IMO, if the primary goal is to treat with psychosocial interventions and to assess with psychometric testing then psych PhD/PsyD but if the primary goal is to treat with biochemical interventions and to assess with medical tests (e.g., labs, neuroimaging-and genetic?) then psych MD/DO.

In any case, both are great disciplines and integral parts of the mental health field.

Good luck on your decision.