Psychology vs Psychiatry and my thoughts on it

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lol'd when I saw people comparing LCSW training to a PhD in clinical psych.

Clinical Psych is a broad field. Some do research only, some practice only, and most do both.

As for the pay, it really comes down to what you do. Want to get your PhD and then make as much as a social worker? Do psychotherapy only. Want to earn a decent living? Go into neuropsych and do assessment, and/or become a forensic psychologist (if you have the balls to be cross examined all the time). Or you can try your hand at tenure (good luck lol).

Fact is, clinical psychologists have a place in severe mental illness treatment, and so do psychiatrists. There needn't be any penis stroking here.

And as for prescribing, it's not like clinical psychologists who can prescribe (a limited number of states allow it, as well as the U.S. military) simply move to a certain state and apply for a DEA #. You need a postdoc masters degree in Psychopharmacology, pass a state board exam, and then work under licensed prescriber (psychiatrist generally) for at least a year. Now I don't really have an opinion on this either way. Just simply stating fact.

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I don't mean to generalize, but they tend to have a lot of psych problems.

You don't say? Haha, I think that's part of the problem, the taboo of mental illness. They're sick, just like any other patient.
 
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Amazing how things get turned around. I am NOT comparing LCSW's to Ph.D. or Psy.D. I am just saying, I have been out here doing this for 18 years. Most agencies do NOT want to pay a Psychiatrist to do psychotherapy. Most agencies do NOT want to pay a Psychologist to do Psychotherapy. Consequently, based on salary demand and reimbursure rates, the different credentials get channeled into certain roles. Social workers are used for psychotherapy as there is more "bang for the buck" salary wise ( they work for next to nothing). We are told to "refer out" to Clinical Psychologists for testing. Specialist referral and rate under most insurances. Every Psychiatrist I have worked with in an agency does between 15 minute and 1/2 hour sessions, evaluates, diagnoses, and prescribes. Agencies LOAD these clinicians, and bill, bill, bill at the psychiatry rate.

It is a whole other ball of wax when it comes to private practice....You can put the combination together any way you like. But in an agency, or even inpatient setting..that is pretty much how the work is broken down between credentials.

No intimation that one credential is greater or lesser, just that reimbursure rates and salary rates differ, and insurances call the shots.
 
Amazing how things get turned around. I am NOT comparing LCSW's to Ph.D. or Psy.D. I am just saying, I have been out here doing this for 18 years. Most agencies do NOT want to pay a Psychiatrist to do psychotherapy. Most agencies do NOT want to pay a Psychologist to do Psychotherapy. Consequently, based on salary demand and reimbursure rates, the different credentials get channeled into certain roles. Social workers are used for psychotherapy as there is more "bang for the buck" salary wise ( they work for next to nothing). We are told to "refer out" to Clinical Psychologists for testing. Specialist referral and rate under most insurances. Every Psychiatrist I have worked with in an agency does between 15 minute and 1/2 hour sessions, evaluates, diagnoses, and prescribes. Agencies LOAD these clinicians, and bill, bill, bill at the psychiatry rate.

It is a whole other ball of wax when it comes to private practice....You can put the combination together any way you like. But in an agency, or even inpatient setting..that is pretty much how the work is broken down between credentials.

No intimation that one credential is greater or lesser, just that reimbursure rates and salary rates differ, and insurances call the shots.

+1

After working in insurance I can attest that everything you have stated is true. From an insurance perspective, Psychiatrist are utilized mainly for medication management, psychologist for testing, LCSW for Psychotherapy (as you stated, more bang for your buck).
 
I personally believe that psych should should be adding in more physiology and neurophysiology into their basic curriculum. Psychology is strongly moving towards becoming more and more a biological and etiology based area of study.

But regarding prescription rights it is complicated. I think that if a person finishes a post-graduate masters in clinical pharm and understands the biology then they shouldn't have much problem prescribing basic ssris, xanax, and other drugs for non-serious depression and anxiety. But obviously they should and likely do stay far away from serious psychiatric illness and more severe forms of mental illness which can be drug resistant.

Regarding clinical psychologists focusing on the psychology aspect, what the hell does that even mean? They're there usually to train you to deal with mental issues, of course they will use psychology, but likewise most psychiatrists probably do the same, though paradigm wise psychiatrists are usually more psychodynamic as opposed to behaviorists like psychologists.

And I think we're all psychologists in our lives either way. So an internist has a good idea of what to expect or deal with in his life of working with his patients. However a psychologist is far likely more prepared to properly treat them if they have a significant problem than the internist who likely may be going off of gut feeling and not specific methodology.

Ya know, I was thinking the same thing and I'm glad you brought it up! If psychologists have additional training and are competent in psychopharmacology, but there is the issue of them not knowing enough about dangerous drug interactions, why not give them limited prescribing rights, where there they are limited to psychiatric drugs such as benzos and SSRIs which don't have a real dangerous profile as far as interacting with other meds.?
 
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Ya know, I was thinking the same thing and I'm glad you brought it up! If psychologists have additional training and are competent in psychopharmacology, but there is the issue of them not knowing enough about dangerous drug interactions, why not give them limited prescribing rights, where there they are limited to psychiatric drugs such as benzos and SSRIs which don't have a real dangerous drug profile as far as interacting with other meds.?

You bumped a post 2 and a half years old. Not sure how you found it.
 
I think you are missing my point. Clinical Psychologist focus way too much on simply the Psychological aspect, they have a limited understanding of Physiology and science (that varies). A Psychologist just doesn't take the whole person into account. No Psychologist should be prescribing medication, I stand firmly against it.

There are enough Physicians with class action lawsuits against them for simple mistakes and you want to give prescription privileges to someone that does not have a comprehensive understanding of Physiology, doesn't understand the differences of how drugs may affect children compared to adults. Physicians are often scared to death to prescribe Benzo's and you are going to hand this kind of power to a Psychologist? I think an experienced internist has a better understanding of behavior just through observation than many Psychologist.
This is a limited view of Psychologists. I'm a PsyD and 70% of my job involves medical/physiological evaluation. I'm a director of a psych dept at one of the largest hospitals in the US, trained in med psych, medical staff in dept of psychiatry. I teach courses in labs, physio, diagnostics, etc.

Yes many PhD Psychologists are limited to more research or even testing but that isn't all that one can do. Some Psychologists even have degrees in psychopharmacology and also prescribe.

I work with a lot of psychiatrists and often they call my dept to do testing to clarify diagnostics between axis 1 vs 2 or r/o malingering.

All of that said, psychiatry does offer more opportunities in certain medical areas but then psychology offers more in others, you don't see Psychiatry doing medical clearance testing or psychotherapy often, both of which have their own value. Each has their own strengths and weaknesses.

Personally, I wouldn't recommend either but that's my own opinion, as I like EM, oncology, and family practice better.


Just saw this was ancient... Nevermind

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This is a limited view of Psychologists. I'm a PsyD and 70% of my job involves medical/physiological evaluation. I'm a director of a psych dept at one of the largest hospitals in the US, trained in med psych, medical staff in dept of psychiatry. I teach courses in labs, physio, diagnostics, etc.

Yes many PhD Psychologists are limited to more research or even testing but that isn't all that one can do. Some Psychologists even have degrees in psychopharmacology and also prescribe.

I work with a lot of psychiatrists and often they call my dept to do testing to clarify diagnostics between axis 1 vs 2 or r/o malingering.

All of that said, psychiatry does offer more opportunities in certain medical areas but then psychology offers more in others, you don't see Psychiatry doing medical clearance testing or psychotherapy often, both of which have their own value. Each has their own strengths and weaknesses.

Personally, I wouldn't recommend either but that's my own opinion, as I like EM, oncology, and family practice better.


Just saw this was ancient... Nevermind

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Great perspective! So are you for or against prescribing rights for psychologists?
 
Great perspective! So are you for or against prescribing rights for psychologists?

I'm on the pro side, more specifically if the psychologist is a clinical neuropsychologist. They have an internship year plus 2 years of fellowship dealing with patients, so I feel they would have enough training under their belt to prescribe.
 
Great perspective! So are you for or against prescribing rights for psychologists?
I'm for it IF the Psychologist is a clinical psychologist with the additional 2 yrs of schooling (a lot of which is very similar to what a PA gets but more specialized in psych) and a yr of clinical practice under a physician. The states that allow prescription priv require such and for 20yrs there has been a complaint filed by a patient over such.

Right now the majority of psych meds are prescribed by NPs or primary care docs, who have much less training in psych. Many physicians i work with now ask my opinion on psych meds as depression and anxiety often overlap and some meds can exacerbate the other. If it's beyond my scope I'll call up a psychiatrist and consult them over.

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I'm on the pro side, more specifically if the psychologist is a clinical neuropsychologist. They have an internship year plus 2 years of fellowship dealing with patients, so I feel they would have enough training under their belt to prescribe.
Medical Psychologists have more knowledge than a neuropsychologists. Depending on the neuro person they may or may not have the real clinical training, as some are more rat runners.

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