Psychology Vs Psychiatry

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Haggler, Dec 11, 2007.

  1. Haggler

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    Hello Everyone,

    Breifly, I began college as a business major; however, I grew disillusioned with the fact it's mostly about money. Due to some personal experienes and classes I took, I began to drift towards the Psychology/Psychiatry fields. However, I have had a lot of difficulty trying to choose between the two. I seem to be right in the middle of both of them (as far as for what I am looking for in a career), so I am hoping the knowledgable people on this site can help me better determine my route.

    Here are my symptoms, what is your diagnosis? (Psych/:idea:/Psychi)
    • I can handle the sciences; however,I tend to slighly enjoy the "arts" side of things more. (Chemistry lab reports don't get me warm and fuzzy, but I could get through them.)
    • I would like to counsel patients and not just solely medicate them.
    • However, I feel the biological approach is also fundamental to recovery.
    • I don't like the idea of being a psychologist and sending my patients to get medicine from someone else (a MD). I want to treat the whole patient and the whole realm of thier problems. I would like to know that I have all the possible tools (couseling, Medication, etc.) to combat the mental ailment.
    • I feel that there are better opportunities as a psychiatrist. Namely, there seems to be more demand for them.
    • Additionaly, psychiatrists command a much better salary; however, this is only a consideration, not my primary goal. (However, if I tended to counsel more than medicate, I understand I would make less. However, does anyone know how much less? Is it significant?)
    • I like to take the road less traveled, and it seems like virtually everyone is going into psychology. This makes me lean towards psychiatry.
    • The idea of assisting in surgery, cutting up cadaviers, and spending many hours in other rotations doesn't make me excited about medical school. (In fact, everyone makes it sound pretty awful/ horrible.)However, psychiatry does excite me. Does that mean I should/ shoudn't pursue a the MD even though I would likely dislike much about the Med-School experience?
    I have read books, talked to people, and nothing has helped. I just get deeper entrenched in the middle. Above are the things I am looking for. Can anyone tell me which field would suit me best? I seem to be squarely in the middle.

    Thank You Very Much; Any Assistane Is Greatly Appreciated.



    (I hope no one minds I put this thread on the psychiatry section too. I just wanted to get a balanced opinion. Thanks!)
     
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  3. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Cross-posting isn't allowed at SDN, so I closed your thread over there, but I left a re-direct over here, so anyone who wants to provide you feedback can do so.

    I'll respond a bit later when I have more time.

    Welcome to SDN.

    -t
     
  4. JackD

    JackD -

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    You could get a degree in clinical psychology and then move to Arizona or Louisiana (i think those are the right states), which would give you prescribing power.

    Also, i am not sure but can't you prescribe psychoactive medication if you earn a degree in clinical and then get training in psychopharmacology?

    I think there are alternative routes to becoming a psychiatrist.
     
  5. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    After you become a licensed clinical psychologist you'd need to do a post-doc MS. in Clinical Psychopharmacology, and then a 1-2 year residency under an MD/DO.

    There are only a handful of place a clinical psychologist with the proper training can prescribe: New Mexico, Louisiana, Military bases/facilities, and Guam. A number of states have legislation in the works, but it will take awhile to see other states grant rights.

    There is a thread all about RxP for Clinical Psychologists. It is a touchy topic, so please keep all of that discussion in there. I'd be happy to address the topic in there if people have questions, etc.

    --

    As for becoming a psychiatrist....the only way to become a psychiatrist is to attend medical school, and then do your residency in psychiatry. The worlds of clinical psychology and psychiatry are much more different than the same, so you should probably poke around the forums to see the differences.

    If you do a search, there are probably a dozen threads that go through the differences. I am swamped at the moment, but maybe someone can post some of those links.

    -t
     
  6. psychanon

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    My understanding is that most psychiatrists end up mainly prescribing medication rather than doing therapy, even if they want to do therapy (for insurance reasons). But people with more direct knowledge of psychiatry would be a better source on that. I do think, and this may be a bias, that you get far better therapy/ assessment training in psychology, simply because it starts sooner and is a fundamental focus of training, although obviously you get more extensive training in other areas in psychiatry.

    Well, in general, you can't prescribe as a psychologist. Read the RxP thread for more info on this, but I would not go to graduate school for psychology with this as an expectation. Yes, you could become a PA or something like that and prescribe, but really the more direct route, if this is truly your goal, would be to become a psychiatrist. However, you should think about whether this is truly necessary to achieve what you want to achieve--you could certainly retain an appreciation for the biological approach, and work collaboratively with other disciplines.
    This is possibly true.
    This is definitely true. No, I don't know exact numbers, but yes, it is significant.
    Eh, I don't think this is a good reason one way or another. This is a major life decision you're making-- don't base it on trying to be different. Besides, I think you are misperceiving things-- I don't think too many people really go onto psychology, unless you're hanging out with psychology majors all the time (half of whom will give up on it before they apply, or they won't get in) or if you're on this forum a lot. Yes, the supply of applicants far outstrips the demand, but if you compare it to, say, law, or even medicine, it's tiny numbers.
    Only you can determine that. Just get as educated as you can on both disciplines, and I think the answer will become clear. They are, indeed, very different disciplines with very disparate approaches to training. Another question to ask yourself is whether or not you want to do research, as this is a fundamental component of psychology training, but not necessarily of psychiatry.
     
  7. davidperez1970

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    this is a dilemma that i am facing too... and so i just wanted to "write out loud"

    I am trying to figure this out myself, also. I believe that every statement that you have made seems to be an accurate description, as far as I can tell, also of me. Haggler, you speak my mind.

    I don't know if this is helpful, but here are some thoughts running through my mind.

    I work with a very well-respected clinical psychologist in Los Angeles. He is, by all measures of success in the field of clinical psychology, extremely successful. His client list includes some of the Hollywood elite. He also has M.D. envy. His hourly rate is approximately $250 per hour, and still he has told me that, all things else being equal, he wishes that he had the immediate status that the letters "M.D." (least in his imagination) give to people. According to him, also, medical doctors have very transferable credentials and -- you can go anywhere in the states and your degree is still recognized. (For some reason, he seemed to believe that a degree in clinical psychology was not as flexible.) His advice, to me, was this: if you can do the medical degree, then you should.

    He rattled off a list of influential people in the world of mental health. Most of these in his opinion were M.D.'s. R. D. Laing, Herbert Benson, Larry Dossey, Bernie Siegel, Dan Siegel, Fritz Perls, Robert Hall. (I'm not sure I completely agree with him, but these people have definitely used their status as M.D.'s to package themselves to the world.)

    I work with a lot of clinical psychologists as peers. By and large, the general sentiment on psychiatrists is that the majority of them do not have adequate interpersonal training or genuine psychotherapeutic skills. The majority simply do medication management. However, there are exceptions to this.

    There is a consensus agreement, also, however, and the statistics and job advertisements definitively bear this out, as well -- psychiatrists are paid, generally speaking, significantly more than psychologists, at least for staff positions, it seems. In some instances, psychiatrists are in fact paid double. I understand your motivation not being financial. My motivation is not financial either. However, there does seem to be a clear way in which power often follows money. Within the mental health field, it appears as if psychiatrists play "top dog", often to the great chagrin of other people in the mental health field -- some of whom might be more capable or qualified, even, than the psychiatrists.

    Personally, I think that there are a lot of bozos in psychiatry. May just be my bias. I have met fewer truly incompetent people in clinical psychology than in psychiatry. Psychiatrists, in my experience, tend to be more full of themselves, and usually for less good reason.

    Medical school sounds like a hazing ritual. The actual skill level and competence required to adequately perform psychiatry is not something that IMHO requires studying surgery rotations.

    The most gifted therapist that I have ever met has no degrees -- no Ph.D., no M.D., not even a bachelors degree.

    I do not have faith in my own abilities to walk into the world without the protection of prestige or the fallback safety of a degree.

    I agree that clinical psychology degrees appear to be fairly common. I forget the exact numbers, but I believe there are at least four times as many clinical psychologists as there are psychiatrists -- and possibly even the multiple may be higher. I know of clinical psychologists who have struggled to develop their own private practice. This might also be the case for psychiatrists -- although it would seem then psychiatrists would have medication management to fall back on.

    Personally, I do not know what I want to do. I believe that I would get a better training as a psychotherapist in a clinical psychology program. But I also believe that psychiatrists generally have more power within the field, and with that, also, more autonomy. I am not immune to desire for prestige or status or financial stability. It is a very strange and challenging decision.
     
  8. JockNerd

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    My vote is that if you want to practice, especially with meds, go the psychiatry route. Training is less focused on clinical interventions, but my impression is that it's far, far easier for a psychiatrist to move to more therapy, less meds than for a psychologist to move to more meds. Plenty of psychiatrists work as pill dispensers, but that's really more to make a ridiculous amount of money than anything else. The versatility the MD can give you in practice would serve you better, in my opinion.

    Just suck up the other rotations :p I don't think that's a good reason in itself not to go the MD route. Actually, from your post, that seems to be your only real hesitance to going to MD route.
     
  9. Therapist4Chnge

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    It really depends what you want to DO as a career. I was considering both, and chose clinical based on my career goals....though it is different for each person. On average, psychiatry makes far more money, though the gap can shrink significantly if you specialize and are not just another run of the mill clinical psychologist. Of course, the same can be said for psychiatry, where you can make $200-$300k+ in some specialties (forensics for instance).

    For me I took money out of the equation (I can make that in my previous career), and I looked at quality of life, what I wanted to accomplish in my career, and what would be a more enjoyable path for my interests. When I looked at psychiatry I really liked the strong basis in hard sciences (duh) and the brain (duh), but I was concerned with gaining in-depth (not just adequate) training in psychotherapy. I was also concerned with research training. I considered M.D. / Ph.D. programs, but I didn't think I had the energy to do both, nor did I want to be an academic doctor.....which is where many ended up.

    Clinical offered me the psychotherapy training, research training, teaching opportunities, and if I planned it right....a pretty strong basis in the hard sciences (though not at the same depth/breadth as I'd get in med school) with some additional schooling. I surprised myself with how much I enjoy research, and I love my specialty area, so I'm pretty happy overall.

    As for the whole prescribing rights issue....if you primarily want to do meds management, go into psychiatry. I think more states will add prescribing rights in the next 5-10 years, but I really think in the long-term it will be a niche thing for clinical psychology, like neuropsychology. I really hope it doesn't go mainstream, as I believe there are many areas that clinical psychology should focus on before that. Just my 2 cents.

    -t


    ps. For full disclosure, I support RxP with the right training, and I'm currently in training for it, though it isn't a main area of focus for me, as med management isn't what I want to do, though I wanted the knowledge to better inform my clinical work.
     
  10. Haggler

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    Thank You all for the time you took answering my question. You all gave me a lot to think about. It's reassuring to know others have battled over the same question.

    Thanks
     
  11. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    I hope you stick around, as we have a pretty active forum here, and a nice collection of diverse opinions.

    -t
     
  12. worriedwell

    worriedwell Senior Member

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    Psychiatrist response, point by point:

     
  13. Therapist4Chnge

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    I think this part is especially important.

    Great post.

    -t
     
  14. JackD

    JackD -

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    What would a psychiatrist know about psychology that a clinical psychologist with training in psychopharmacology wouldn't know? I have to imagine that would be the easier route than going through medical school, going through internship and residency, and then specializing in psychiatry.
     
  15. Therapist4Chnge

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    I don't think easier, I'd think different....since the career paths are also different. When we are learning all about stats and research, med students are learning the nitty-gritty about the body. They are physicians first, and clinical psychologists are scholars first.

    I think if the PRIMARY goal is to prescribe, then go to med school. If it is a secondary thing and/or there are other goals more suited for clinical work, become a clinical psychologist (and the pursue additional RxP training).

    The discussion of the psychopharmacology I'd like to keep up in the other thread (feel free to post up there, I'd just rather it not start down here, because it always seems to derail the thread....and I don't want that to happen)

    -t
     
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  17. solumanculver

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    Hey Jack, I'm pretty sure that psychiatrists know a lot less about psychology than psychologists, regardless of whether those psychologists have psychopharmacology training or not. Psychiatry takes from psychology whatever is helpful to them and leaves the rest...

    Well that much is obvious, there wouldn't be much of a point in becoming a psychologist if they didn't even know more about psychology than non-psychologists. The heart of psychiatry is neuroscience and pharmacology, not psychology.

    I, for one, am planning on becoming a psychiatrist and I hope that I never have to do any therapy after residency... that's what psychologists are for. That's what you guys got into psychology to do, isn't it? Well my interest is in the brain itself, how disease disrupts its functioning and how that function can be restored. To be frank, I kind of find it hard to believe that a person can be a real expert in two things as dissimilar as neuroscience and therapy... That's kind of why I see a natural division between psychology and psychiatry, though of course that division is a pretty blurry one at times... but then again, what do I know?
     
  18. zeldazelda

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    Wow! Amazing post -- thank you. That is the best piece I have read yet about how the two disciplines diverge and intersect.

    I give you a lot of credit -- medical school definitely sounds tough!
     
  19. Markp

    Markp Clinical Psychologist

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    Don't kid yourself about medical school being the harder road. Each road has it's challenges. I watch our med school compatriots and sometimes they have it easier than we do, other times we have it a little easier. Right now, I am doing more work than they are, or so it would seem in discussions with my friend who is in the med school. He has a social life and I don't.

    Then again, I will be done long before he is with residency, etc. They are different roads and I am sure that he will have some serious emotional and mental challenges. However defining either as the "easier" route, I don't think I would go that far. For those strong in chemistry and biosciences, but weak in statistics and research methodology, I think the med school route could be easier... just as the psychology route is easier for those of us who are Bioscience-challenged (like myself.)

    That said, if you have the option to pursue a degree in Psychiatry and have the patience to make it all the way through 4 years of med school before specializing in Psychiatric studies, you should seriously consider it. Psychiatrists usually make a good deal more money than Psychologists and don't have the additional hurdles to address when RxP comes into play. You have the proper training from the get go and you get the privledge to prescribe as a direct result.

    Mark
     
  20. Faebinder

    Faebinder Slow Wave Smurf

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    I don't know why, but I got drawn here to answer as well. My words are in red.

     
  21. Markp

    Markp Clinical Psychologist

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    "Salary in medicine blows when you consider the amount of time you paid from your better years of life + the debit of med school + the license and CME. A 250k debit becomes more like 500k after years of interest. You still wanna buy a house? You dont want that 1990 nissan? You are better off investing money into the housing market or stocks."

    I am sorry but I disagree with the above, while it is entirely possible to end up with a mountain of debt from med school, there are also ways to end up with 0 debt. While there is always a price to pay for that 0 debt, it's still 0 debt.

    HPSP Students, USUHS Students, Students (PHS Scholarships) who do residency/work in low income and rural areas all get breaks. Still if you go the traditional route, yes, you are gonna owe $100,000+ with ease.

    Knowing that you can get paid to go to medical school vs paying to go to medical school makes sense to some. To others the price is simply too high, and the risks/indentured servitude does not match the reward.


    Mark
     
  22. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Faebinder, I appreciate you taking the time and talking about some of the challenges that often get over-looked.

    I think in the end it is a personal decision, but it is really helpful to have the pro's and con's of each path, and insight from those who have gone through the process.

    -t
     
  23. Haggler

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    I understand the issues the previous post discussed. Medical students do have to bear the burden of heavy tuition debt, continuing education, licensing, and malpractice. However, don't many clinical psychologists face the exact same issues? I have heard that most PsyD grads have atleast $100,000 in debt, plus many states require continuing edu., they have malpractie insurance, and I am not sure but assume they also have to pay for licensing. Thus, psychologists have to bear similar burdens while at the same time making in most cases less than half the amount of a physician and most of the books I have read explain how pay for psycholgists (unlike their MD counterparts) has contniued to fall. (Granted, MD loans are higher, but thier pay is much higher. Thus, as a ratio, the loan burden seems similar in either path.) Additionally, most of the books I have read say that psychologists are and will continue to face increasing competition from Masters Degree level counselors beacause insurance companies prefer to cover them because of lower rates. In the end, I think you dig yourself into a huge hole no matter which path you pick.
     
  24. Ollie123

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    Our malpractice insurance is generally much much lower (though I have no idea what it would be like for prescribing psychologists).

    We do deal with the rest, but tuition debt is generally a choice for psychologists since most programs out there offer substantial, if not full, tuition waivers, so loans are only necessary if you want to supplement the stipend, whereas it is the rare med student who gets to go for free.
     
  25. Therapist4Chnge

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    Div 55 should have this answer. I know the APA offers malpractice insurance rates for members, they'd be the people to call.

    -t
     
  26. Anon15

    Anon15 Senior Member

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    Psychiatry (MD) is a professional degree
    Psychology (PhD) is an academic degree
     
  27. IWantToBeFreud

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    Well, I'll raise my hand and say that I too wrestled (and still am wrestling) with the whole psychology vs. psychiatry career choice.

    I, very similarly to the OP, enjoy the arts side WAY more (I'm also a Jazz Studies major); I'm way more interested in actual psychotherapy than medication; and I think I could make it through the hard sciences of med school, but I'd hate every minute of it. Taking all of that into consideration, I still wanted to be a psychiatrist. I wanted the prestige of the M.D., the increased money, the power to prescribe medication, and I wanted my parents to be able to say their son is a doctor.

    After contacting and shadowing a few local psychiatrists I decided that I just couldn't deal with doling out meds all day. Only 1 out of the 11 psychiatrists I shadowed performed ANY psychotherapy and that was on a very limited basis. Their days consisted of med checks and an occasional consult. I personally also had a terrible experience with a psychiatrist and anti-depressants that convinced me that psychotherapy and lifestyle changes are the only ways to properly deal with depression. Finally, I spoke with several psychologists in my area that were all wonderful people and the ones that had a full-time private practice made quite a lot of money (175K+).

    Another perk to pursuing psychology is that many Ph.D. programs are funded and will provide stipends for those qualified students that agree to teach some classes or assist in research. This is important to white male from a lower-middle-class family (me).

    Finally, it seems to me that it's only a matter of time until psychologists have limited prescription capabilities. This will eventually allow me to have a private practice that focuses on psychotherapy with the ability to occasionally prescribe medication in incidences where I feel it will help.

    So, long story short, what did I conclude?
    Psychiatrists: Give out meds with very limited psychotherapy (please
    note the sweeping generalization).
    Psychologists: Treat with psychotherapy, limited prescription rights
    (hopefully) coming soon.

    Looking at it that way, and knowing that I want to be a psychotherapist before a physician, how could I not pursue psychology?

    Good luck making these difficult decisions!
     
  28. Haggler

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    I have heard a few people talk about how psychology graduate degrees offer more chances for loan forgiveness, however, I assume this is only for people getting a PhD. Are these kinds of loan forgiveness and/or teaching postions offered to PsyD students?
     
  29. ekm0924

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    I myself struggled a bit with this decision. At first I thought about going to nursing school and then becoming a psych nurse practitioner, but I didn't like the idea that someone would always have to sign off on what I did. Then I really thought about medical school for psychiatry, but I sort of realized at one point, why go to school for so long, rack up so much debt, and not even be able to study what I want to study for a good 4-6 years? Not to mention the fact that I wasn't pre-med and I would have had to do some kind of post-bac program. And though I love reading about science, doing it in a classroom has never been my thing. So all this just for the prestige and the ability to prescribe drugs? I think I sort of came to my senses. I know there is a lot of attraction to the idea of having that MD after your name, but PhD is a prestigious degree as well, and you still get to be called doctor!

    I would also like to mention my thoughts on Psychiatrists and therapy. Some of them do practice therapy and do it really well. I had a psychiatrist that I saw for therapy and she really changed my life. But I had to stop seeing her -- I just couldn't afford it. $175 an hour! My insurance wouldn't pay for me to see her for more than a once-monthly 30 min. med management session. It really sucked because it can be hard to find someone that can really get you motivated to make changes in your life. But it was just too much. If you want to be a psychiatrist and practice therapy, be prepared to see only wealthy patients. Of course, even rich people have problems, so you'll still be doing some good, right?. You could perhaps donate time to a free clinic or something as well. I don't know how that works.

    I saw one psychiatrist who was a resident at Georgetown U (good school/hospital) and he had the thickest accent and I could barely understand him when he asked me if I was experiencing any side effects. He was also extremely self-conscious about it. This kind of says to me that the priority for psychiatry programs isn't necessarily the doctor's ability to speak (sometimes literally) to patients.

    I think you should make your decision by whittling down the things that are truly, truly important to you. Figure that either way you're going to lose out on something. That's life!
     
  30. terrybug

    terrybug happy

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    Psychiatry is part of the materialist attitude that runs so deeply in our culture. The emphasis is on reducing things down to the biological level and expecting to make money hand over fist. It's 2 sides of the same, physical-focused coin.

    Psychology can be just as materialistic for some practitioners and researchers, but it also has the potential to be a reflection of empowerment, wisdom, self-efficacy, etc. That's what inspired me to go into the field.

    When I read about psychologists pushing for prescription rights, I wonder why would anyone want to be a junior psychiatrist? I think people are afraid of HMOs and have a 'if you can't beat em, join em' attitude and they think prescription rights are the answer. I disagree.
     
  31. Ollie123

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    There's a few PsyD programs that offer tuition waivers - generally the "better" ones do, though there are certainly a fair number that don't...I've just never heard of a bad one that DOES. I know for a fact Baylor, Rutgers, and Virginia all offer this to PsyDs. I think there are others too, I just don't know what they are.

    Also note that we aren't talking about loan forgiveness. That implies you take out loans and then later apply and someone pays your loans back for you. Most of us don't pay at all, up front, thus no loans (or minimal loans anyways to pay for cost of living on top of what the schools pay us), and no risk of not getting loan forgiveness later on.

    If funding is a big concern, I'd look at clinically-oriented PhD programs as well. They tend to offer better funding. Unfortunately, many people automatically assume PhD = research degree, but there are plenty of PhD programs that either focus on training clinicians, or at least are set up so people can effectively pursue either route. My (biased) opinion is that these schools generally offer BETTER clinical training than a large portion of PsyD programs out there, so I'd encourage you to look into your options there.
     
  32. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Yes. Same licensure, same opportunity for loan forgiveness. You can still teach with a Psy.D., it is just less likely as academia is still strongly rooted in research and publishing, something many Psy.Ds don't want to do full-time.

    -t
     
  33. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    It isn't about being a 'junior' psychiatrist.

    (This is a discussion for the RxP thread)

    -t
     
  34. solumanculver

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    Terrybug, first of all I don't see what your point is about materialism and psychiatry... it seems like you're playing on an ambiguity of the word "materialism". Psychiatry doesn't generally believe in spirits, so that's materialistic. You're saying that because of that they want to make a lot of money... that's an unrelated use of the word "materialism".

    Also, are you a psychology student or an MD/PhD student? It says MD/PhD under your name, but you're saying that the wisdom of psychology inspired you to go into that field. Are you leaving your MD/PhD program to study psychology?
     
  35. Chimed

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    Those are good points, ekm. You are correct in observing that psychiatrists that do therapy often see wealthy patients. HOWEVER, it is not because they have to see those patients, it is because they have a standard amount of money they want to make and choose to charge more. Whether that is a good or bad thing is another topic :(. There are many reasons for this including the idea that they don't want to lose money for doing therapy when they can make more with medication checks. The idea that we have to charge an outragous fee is not true. If I want, I can go out and have a competitive fee with my collegues with a PhD or masters degree.
     
  36. Chimed

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    Wow-- It always amuses me when people speak of "psychiatry" as if it's this objective monster running rampant. Watch out! Psychiatry is coming to get us and is going to destroy our culture! :laugh: It's almost funny to read psychologists putting down psychiatrist given the fact that they themselves are unfortunately also looked down upon by many in the general population.

    Generally, people that go into psychiatry often put off prestige, the ability to make much more money, and face critism both from other MD's and psychologists, as many negative posts on this site demonstrate. We do this because we care about those with mental illness (as I know psychologists do) and want to help one of the most underserved populations in medicine. If I wanted to make money "hand over fist," I would not have racked up 6 figures in debt and gone into this field!

    PS. Maybe the face of psychiatry looks like the Heat Miser in my avatar? :laugh:!!!
     
  37. edieb

    edieb Senior Member

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    I chose a PhD in clinical psychology, but, in retrospect I kick myself for not choosing psychiatry/med school. Psychology, as a field, is imploding. Additionally, psychiatry is ascendant, and always will be, in the mental health field. First of all, all sorts of other professionals with lower-level degrees can do what a clinical psychologist can do (e.g., testing, therapy, diagnosis). Adding insult to injury, psychiatrists, who can also do therapy, get paid more than psychologists for adminstering it. So although we get more training in therapy, we get paid less. However, when you compare a psychologist's reimbursement for therapy compared to a social worker's reimbursement, it is almost equal. As a result, psychologist salaries, all ready low, are falling in regards to inflation. Next, in psychology you have to constantly battle uphill for very little monetary reward. For example, to secure an internship is very, very hard. Matter of fact, the # of people unmatched every year is growing exponentially. This year tons of people did not even get interviews. It is even harder to get an internship at an APA accredited site. I, myself, only got 10 interviews at APA accredited sites. On the other hand, there are not enough residents to fill up psychiatry residencies. As a result, you definitely match and move on with your career. Finally, when you're a 4th year resident (PGY-4), you're being bombarded with job offers. However, as a psychologist, you have to scramble to get a job. All-in-all, psychiatrists are more valued. If a hospital has funding cuts, it will cut the $18K internship or 25K psych post-doc way before it ever reduces a psychiatry resident's $50K salary... just some thoughts!:eek:
     
  38. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    They've found us....RUUUUUUUUUUUN!!!!

    :laugh:

    Good post.

    -t
     
  39. Ollie123

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    Not saying psych is right for everyone, and maybe I'm just being naive and idealistic, but this seems overly cynical to me.

    If I'm remember the numbers correctly, 75% of people who participate, match. Of the 25% who don't match, I believe 1/5 are Argosy grads. One of the major goals that APA has right now is fixing this problem, so I expect you'll see improvement in the near future. Given the match stats (# of clinical hours, # of pubs, etc.) the average stats of folks matching don't seem unreasonable at all. Heck, I should be over the average # of pubs by the end of my first year, and I'm still in the process of ramping up my research production! (Actually I guess I should say I'll have the manuscripts submitted anyways, we'll see how long reviews go). I'm going to be focusing more on pubs than on clinical hours given my career path, but even there I'm not expecting to have problems getting enough hours - they don't seem to fall into your lap, but if you're willing to seek them out they're almost always there.

    Admittedly I'm not there yet, but to me this doesn't sound "very, very hard". Everyone here seems to match without a problem, excepting a few who limited heavily based on geography, or had other outstanding issues.

    Again, this isn't to say psychology is or is not right for anyone, but the faculty here have made a big deal about calming people's nerves about internship, so I thought I would pass it on.
     
  40. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    I was talking to an administrator not too long ago about match %'s, and he said people 'can' get placements through the clearing house, but they turn it down because they are unwilling to re-locate, and that can lower program stats.

    -t
     
  41. JockNerd

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    I agree, Ollie. My program doesn't have a 100% match rate but it's up there, and the misses have been primarily due to geographical restriction (Florida is beautiful). I actually don't even see the weakening match as a problem. The people it's going to force out will primarily be weak students from weak schools who didn't make good plans (CERTAINLY not to say that qualified people always match and those who don't match are all weak, but it's obvious that this is how things work out for the most part).

    I also don't share the rest of edieb's cynicism about the field. I came in with a solid plan that my adviser and I are enacting at a rate faster than what I had expected. It's not a difficult field to excel in and make good money at if you make yourself rise to the top. To extend what Chimed said a little, I think it's pretty crazy to go into either psychiatry or psychology to make a ton of money--there are MUCH more effective alternatives for people interested in money and a nice lifestyle. I'd have been a damn good corporate lawyer if all I cared about was cash :D I'm also not in competition with psychiatrists for my future career, so maybe that's why I'm a little less cynical.
     
  42. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    That is what made me finally choose clinical. I'll use my non-clinical work to fund my clinical interests, and the rest if gravy.

    -t
     
  43. Ollie123

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    That's a good point too - its pretty unlikely mid-levels or MDs will be taking over my (our? Pretty sure you wanted to go into academia as well, but wasn't sure if you were talking about academia, or research interests...) area anytime in the near future. See it a tiny bit since adjuncts are more popular than before, but it seems like there's still plenty of people getting tenure track jobs.

    And yes, though I'm sure plenty of good students get caught up in the not-matching category due to just plain bad luck in terms of what sites they applied to, we need SOMETHING to weed people out when certain schools will let anyone, their brother, and their pet rock into the program. I'd rather it happen on the front end than the back end, but c'est la vie.
     
  44. Haggler

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    I read a book called The Psychology Major's Handbook by Tara L Kuther (she is a doctor and professor of psychology). In the book, she wrote an entire section titled: "Cautions for Clinicians: The Changing Roles of Psychologists." In this section of the book she discussed various problems that incoming doctors (PsyD/ PhD) will face. Most alarmingly, the author forewarns of a time in the not so distant future when most, if not all, psychptherapy will be done by professionals with a Masters degree. It goes on to say that private practice will continue to become more unfeasable as doctoral level psychologist are "underbid" by masters level social workers, counselors, and psychological assistants. Does anyone know how much truth is in this and does anyone know where I could find some reputable sources on this (Such as an APA document)??

    Thanks
     
  45. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    I think as long as your have a specialty area and are a competent and respected clinician, you will never hurt for work. The people on the fringe should be worried though.

    *edit*

    I also believe that there will be supervisory roles for doctoral level people, and less opportunity to work 'in the trenches' at general facilities because of insurance reimbursement. I think people who JUST want to do private practice will probably get a better value from an MS, though the training is different.

    -t
     
  46. edieb

    edieb Senior Member

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    With all respect, Therapist4Change's, I would take the opinion of a psychologist already out in the field rather than a graduate student...the author probably knows what she is talking about
     
  47. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Fair enough. I'm speaking from what I hear from colleagues out in the field. All of them have specialty areas (neuro, forensics, assessment, ED, substance abuse, etc) and do very well in their private practices, though only a couple do it full time, most do other things to balance their work. I never planned on doing therapy for more than 6-10 hours a week, so I'm not as concerned, but YMMV.

    -t
     
  48. Haggler

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    Out of simple curiosity T4C, what kinds of things are these other non-full time people doing with the rest of their time? What do you intend to do with the rest of your time if you only want to counsel for under 10 hours?
     
  49. JockNerd

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    This has been my experience talking to people in the field as well. Generalists in any field have a rough time and are much more disposable and easily replaced. So, it's not a good plan to get an PsyD or PhD (esp. unfunded) with the intention of being a MFT. But an I/O specialist, a neuro specialist, a specialist in one of many treatment areas (such as those T4C mentioned) will tend to do fine.
     
  50. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    People I know also: Teach, write/research, IQ assessments, support groups, consult (things like social and communication skills training, corporate mediation, etc).

    I previously had a business consulting career, so I'll be going back into that part-time, in addition to teaching a class while I build a small private practice. My consulting work (which pays much better) will allow me to eventually fund my clinical endeavors (research and fund an out-patient center). I don't want to have to see patients to pay the mortgage; I want to be able to do my work without economic influence. I am obviously in the vast minority in my goals, but I like to share so people see that there are other options out there instead of just teaching, researching, assessment, and private practice. It is up to each professional to carve out their own niche.

    -t
     
  51. Sanman

    Sanman O.G.

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    Frankly, I don't see things as all that bad either. Most of the psychologists I speak to are doing fairly well. Granted, my focus is on health psych and neuro. No, you probably shouldn't get a doctoral degree if all you want to do is therapy at a counseling center. Master's level individuals still do not have the power to assess/diagnose patients. In many facilities, the primary job for psychologists will be to assess and diagnose while doing some therapy as well. The problem with listening to others view is that it is not always accurate and is affected by the individual's expectation. For example, my supervisor always bellyaches about how insurance rejects assessment hrs (neuropsych) and how it is a hard way to make a living. Yet, he still makes a six-figure salary...not exactly working in the mines for a pittance.

    EdieB, you are complaining about having 10 interviews? The average applicant who matches only has six. How many programs did you apply to?

    In the end, you will have more than enough cash in either of these fields to live comfortably. If the difference between 100k and 200k is such a huge deal breaker, than go to MD school. As I alluded to earlier, the mistake that often happens with psychology is lump the entire field in together. The truth is the salary and need for a psycholgist is highly dependent on what they want to do. VA Medical Center jobs are increasing significantly due to the current conflict in Iraq, these are very high-paying jobs when compared to other institutions and are becoming much more available. Also, the issue of who 'rules' the field depends on the insititution and the hierarchy therein. Neither field is perfect and there are positive and negative forecasts for both (masters deg'd taking over therapy; psychologists taking over scripts.....and either lowering the going rate).

    A couple of notes, insurance will not generally cover a psychiatrist performing therapy and thus makes it difficult to see patients except on a cash only basis, even then the rate would have to be reduced to be competitive. Additionally, a psychiatrist doing anything but the bare minimum of therapy will take a significant pay cut. Thus, the financial 'advantage' goes away. I also have to say that in the current day and age, the 'do-it-all' provider is very rare and I am not so sure it is a feasible idea in any case. The better choice would likely be to pick something you enjoy go for that. If you want to do therapy, the question becomes which could you live with better; doling out meds only or only assessment/ testing services, report writing, and possibly research.
     
  52. Chimed

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    That is too bad you feel that way. I think that both psychiatry and psychology (PhD/PsyD) are excellent ways to make a positive change and help others that can be extremely rewarding. After all, shouldn't that be the point! The psychologists I know do very well if you take in the whole picture--career satisfication and lifestyle.

    In the end, to say that one path is better then the other will always be subjective and ultimately comes down to an individual choice. As long one has done some real soul searching on what path is better for that individual, I don't think one can go wrong.

    BTW, I think the post by Worriedwell above is an outstanding contrast between the fields. Anybody who is considering the two paths should read that post.
     

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