What is the big deal?

[pschmom1]

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Ok, I have read sooo much on SDN and have come to a slight conclusion that psychiatrists and psychologists have this forever burning need to one up the other or belittle the other, in a very nice way for the most part. I am majoring in psych, and then off to med school to specialize in psych! I guess I am confused what the big competitiion is? Are we not supporting the same party? I just don't understand what the big deal is and why everyone is always at each others throats. There is a specific "job" description (if you will) for each, so why is there so much confusion on what you should (and can) or should not do? I hope to work hand in hand with a psychologist one day, to provide adequate therapy to the patients that I can not. I would also like to work with social workers. Am I crazy for thinking this? I ask this b/c I trust the opinions from you on here and you seem very knowledgeable and professional. I guess I don't wan't to be niave, at the same time I have goals that I continue to work towards and I somehow see them working out in the future. There is no way to tell if I am thinking realistically than to call upon you all for your opinions. I just don't understand the discrepancy between the two. Maybe someone can enlighten me 😀 Thanks!

 

[Solideliquid]

The last thing we want in the psych forum is another iatry vs. ology thread.

Now I suppose the main problem that I have (speaking for myself) is that psychologists are demanding the right to prescribe medications. I for one do not think it is appropriate for psychologists or anyone else to prescribe psych medicines without a medical education and residency training.

And no, in case someone brings it up, I do not think the example of the optometrists prescribing eye drops can compare.

To all the psychologists out there reading this, please do not post counter arguments as I am not trying to start a debate, just answering the questions of our pre-med here. If you want to carry on a debate about this please lets have it at the psychology forum.

 

[pschmom1]

I agree with you Solid, but I'm not talking just the rx rights. I have seen this a lot and I've even had a taste of it in my ab psych class last year. We had a guest speaker that is a world reknowned (is that right?) forensic psychologist and there was a comment made like "psychiatrists study psychology for 4 yrs and psychologists study psychology for 10". I have no interest in the rx rights as of yet. On the other hand, I can see how this may turn into a SDN war and that's not what I want. I guess this is something that I will understand throughout the years maybe. Thanks for your reply 🙂

 

[PublicHealth]

We had a guest speaker that is a world reknowned (is that right?) forensic psychologist and there was a comment made like "psychiatrists study psychology for 4 yrs and psychologists study psychology for 10".

I don't think psychiatrists would have a problem with this statement.

 

[Doc Samson]

I don't think psychiatrists would have a problem with this statement.

I might change it to "psychiatrists study psychology for 4 years, basic science for 4 years, and medicine for 8 years; and psychologists study psychology for 10 years."

 

[nortomaso]

My take on the OP's initial question is that there are turf battles in every area of health care. The psychology/psychiatry mutual ribbing is like every other such quibble. Most of the arguments and denigrating comments on both sides are motivated by insecurity and greed. Just be happy that you have the opportunity to do something you (hopefully) love and let the rabble duke it out if it makes them feel better.

 

[PublicHealth]

I might change it to "psychiatrists study psychology for 4 years, basic science for 4 years, and medicine for 8 years; and psychologists study psychology for 10 years."

There is a lot of overlap in those years, both intra- and interprofessionally!

 

[ratched]

In my experience on the wards and in clinics, there's no (or minimal) conflict between MD's and PhD's/PsyD's. Disagreements certainly arise in particular cases, but I've not seen any breach of respect. At least in the academic setting, everyone realizes the rigorous training and years of experience each has undergone. Not all psychiatrists are pill-pushers and not all psychologists want to prescribe. While you may hear all sorts of opinions on these boards, you should know that most people play nice on the outside (and I'm sure the people that post here are no exception).

 

[50960]

So true, thanks for saying it.

 

[LM02]

Completely agreed.

I just spent a day in a translational research workshop - the psychiatrists and psychologists might as well have been holding hands and singing kumbaya toward the end. There is a lot of mutual respect and collaboration.

I know I have said it several times over here, but I've loved working side-by-side psychiatrists. It's definitely one of the best parts of my job.

 

[50960]

I agree LMO2, and this has been the same for me as well. I do psychopharm work daily, but I really look forward to my 1 hr/wk supervision with the psychiatrist so I can learn more.

 

[Poety]

Completely agreed.

I just spent a day in a translational research workshop - the psychiatrists and psychologists might as well have been holding hands and singing kumbaya toward the end. There is a lot of mutual respect and collaboration.

I know I have said it several times over here, but I've loved working side-by-side psychiatrists. It's definitely one of the best parts of my job.

This wasn't my experience at a research hospital - the psychologists bashed the MD's a lot and it annoyed me to no end - I left my research program short a paper partly because of this - the other part was because the psyD's seemed nutty themselves and I couldn't take it anymore 😛

Hi Psici! creeping around again I see 😉

 

[Solideliquid]

Originally Posted by Psyclops
I would predict that the advent of sidespread RxP for psychologist will be the death of psychiatry. I think that it will be more likely that psychiaty will fade away than integrate.

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This was posted on the psychology forum. I do not feel that the field of psychiatry is "threatened" by people like this. However, the fact that there are people out there who are practicing psychology and are of this mindset is disturbing.

I am more than happy to work with psychologists, as they are competent mental health professionals and may allow psychiatrists more time to treat the more complicated and Axis III involving cases. In other words they in theory would lighten the load for us.

As you can see the goal of working hand in hand with psychiatrists to help patients doesn't seem to be a primary goal for a few psychologists.

That's the big deal.

 

[Poety]

Originally Posted by Psyclops
I would predict that the advent of sidespread RxP for psychologist will be the death of psychiatry. I think that it will be more likely that psychiaty will fade away than integrate.

---

This was posted on the psychology forum. I do not feel that the field of psychiatry is "threatened" by people like this. However, the fact that there are people out there who are practicing psychology and are of this mindset is disturbing.

I am more than happy to work with psychologists, as they are competent mental health professionals and may allow psychiatrists more time to treat the more complicated and Axis III involving cases. In other words they in theory would lighten the load for us.

As you can see the goal of working hand in hand with psychiatrists to help patients doesn't seem to be a primary goal for a few psychologists.

That's the big deal.

psych isn't going anywhere, I agree with you solid. Also we're becoming so medically and biologically based, its going to evolve into just another specialty and I'd be more concerned that therapy is going to fall by the way side once they realize the biological base for many of the disorders. 😱

 

[Anasazi23]

You guys have to understand, that as a profession, psychology's prognosis is very poor. Prescription privilages, professional schools, etc. are somewhat desperate attempts to save a profession that has in essence eliminated itself from the competitive workforce. This is clearly evidenced in the proliferation of doctoral psychology degrees and now, competition with Master's level therapists, who will eventually win psychological testing rights and payment parity. Their professional organization has become rabidly obsessed with diversity issues and other politically correct measures at the expense of their field's future. It's actually quite sad, as the original roots of their profession at one time helped lead to great understanding of human behavior.

While these practice scope rights will be fought out for decades, stay focused on your psychiatry, and its advances, which will see great leaps in clinical imaging utility, genetic interventions, and the next generation of procedure-based treatment options.

Dont' overly concern yourself with these things. Your life is busy enough as a physician.

 

[Hurricane]

psych isn't going anywhere, I agree with you solid. Also we're becoming so medically and biologically based, its going to evolve into just another specialty and I'd be more concerned that therapy is going to fall by the way side once they realize the biological base for many of the disorders. 😱

I think there is room for both. Imaging studies show that the brain changes in response to some psychotherapies, suggesting there is a "biological basis" for therapy as well. IMO, the brain is so complex and plastic that it would be short-sighted to assume that all biological-based treatments will consist soley of squirting chemicals on receptors. Chemicals change the brain, but so does experience, so we should take advantage of both.

But what do I know - I'm just a lowly, naively optimistic 4th year... 🙂

 

[Poety]

I think there is room for both. Imaging studies show that the brain changes in response to some psychotherapies, suggesting there is a "biological basis" for therapy as well. IMO, the brain is so complex and plastic that it would be short-sighted to assume that all biological-based treatments will consist soley of squirting chemicals on receptors. Chemicals change the brain, but so does experience, so we should take advantage of both.

But what do I know - I'm just a lowly, naively optimistic 4th year... 🙂

This is true Hurricane, I think what I worry about is patients saying ahhh, just give me the drug to fix it - ya know? We all know what an instant type of society we live in - God forbid we put the work into fixing the problem when that little pink pill can take it all away 😳

 

[Hurricane]

God forbid we put the work into fixing the problem when that little pink pill can take it all away 😳

I thought it was the little blue pill that fixed all of life's problems. 😉

Oh wait, that's only for the guys...

 

[Poety]

I thought it was the little blue pill that fixed all of life's problems. 😉

Oh wait, that's only for the guys...

 

[docjohng]

I might change it to "psychiatrists study psychology for 4 years, basic science for 4 years, and medicine for 8 years; and psychologists study psychology for 10 years."

Can you break that out for me in terms of how that translates into your educational background? I know psychiatrists that are 26 or 27 years old. With 16 years, according to your view, that means they started this process back when they were 10? 🙂

John

 

[docjohng]

I think it comes from a number of things...

1. Psychology is arguably the younger of the two fields, and the one that didn't really gain as much respect and attention until WWII. As the younger field, people in it generally will always feel a little like the "underdog" or needing to prove something more to the other established fields. Psychology, to this day, has an inferiority complex because they are younger and they are not in the medical profession.

2. They work in the same field, treating the same disorders, with very, very different treatments that often come from very, very different ways of looking at people's behaviors and what's the issue for the person. Psychiatry, as a medical profession, generally looks for disease and categorizes things accordingly (by how "diseased" the person is). Then psychotherapeutic training is later graphed onto this model through residency. Psychology tries to look at human behavior from a different perspective, which may not be any better or worse. But it is different than the medical model.

3. Psychiatry is rooted in the medical model and medical training. Many medical training programs (still, although this is changing in some of them) reinforce doctors' egos and teach them that they are the experts in their field. Psychology is rooted in social sciences and research, which results in a different emphasis in their training, generally.

4. Psychologists' attempts to gain prescription privileges only drives this division further. Psychologists are not medical professionals, nor do the vast majority have any medical background or training. When a profession makes a move like this, it usually makes the relationship between the competing profession far worse. (See, for example, some psychologists' general disdain for any Master's level social-worker-based therapist.)

Just my two cents.....
John

 

[Anasazi23]

I think it comes from a number of things...

1. Psychology is arguably the younger of the two fields, and the one that didn't really gain as much respect and attention until WWII. As the younger field, people in it generally will always feel a little like the "underdog" or needing to prove something more to the other established fields. Psychology, to this day, has an inferiority complex because they are younger and they are not in the medical profession.

2. They work in the same field, treating the same disorders, with very, very different treatments that often come from very, very different ways of looking at people's behaviors and what's the issue for the person. Psychiatry, as a medical profession, generally looks for disease and categorizes things accordingly (by how "diseased" the person is). Then psychotherapeutic training is later graphed onto this model through residency. Psychology tries to look at human behavior from a different perspective, which may not be any better or worse. But it is different than the medical model.

3. Psychiatry is rooted in the medical model and medical training. Many medical training programs (still, although this is changing in some of them) reinforce doctors' egos and teach them that they are the experts in their field. Psychology is rooted in social sciences and research, which results in a different emphasis in their training, generally.

4. Psychologists' attempts to gain prescription privileges only drives this division further. Psychologists are not medical professionals, nor do the vast majority have any medical background or training. When a profession makes a move like this, it usually makes the relationship between the competing profession far worse. (See, for example, some psychologists' general disdain for any Master's level social-worker-based therapist.)

Just my two cents.....
John

Very good post...honest. I had the same feelings when I was involved with it.

 

[Psyclops]

Originally Posted by Psyclops
I would predict that the advent of sidespread RxP for psychologist will be the death of psychiatry. I think that it will be more likely that psychiaty will fade away than integrate.

---

This was posted on the psychology forum. I do not feel that the field of psychiatry is "threatened" by people like this. However, the fact that there are people out there who are practicing psychology and are of this mindset is disturbing.

I am more than happy to work with psychologists, as they are competent mental health professionals and may allow psychiatrists more time to treat the more complicated and Axis III involving cases. In other words they in theory would lighten the load for us.

As you can see the goal of working hand in hand with psychiatrists to help patients doesn't seem to be a primary goal for a few psychologists.

That's the big deal.

First I'd like to thank you for mischaracterizing my opinions, you neglected to report that I tend to argue against RxP for psychologists. I don't want 'em. You can keep them.

The fact that there are people out there practicing psychiatry that share your opinions is disturbing to me. You suggest that it takes a psychiatrist to treat the more complicated disorders. If by complicated you mean ones that need a diferential diagnosis of bi-polar or temporal lobe epilepsy sure I'd like to have an MD see the patient as well (although I think you should bring in a Neurologist). But if by complicated you mean Axis II, then you should probably leave it to the psychologists. No amount of valproic acid and olanzapine will succesfully treat a distressed client suffereing from a PD.

The reduction of everything to bio-genetic model is a mistake especially at this juncture. I don't see anxiety disorders as a problem with regulating gaba. And as I'm sure you know, there is more than one way to change the neurochemical environment, not to mention the wiring of the big gray sponge.

 

[Solideliquid]

First I'd like to thank you for mischaracterizing my opinions, you neglected to report that I tend to argue against RxP for psychologists. I don't want 'em. You can keep them.

The fact that there are people out there practicing psychiatry that share your opinions is disturbing to me. You suggest that it takes a psychiatrist to treat the more complicated disorders. If by complicated you mean ones that need a diferential diagnosis of bi-polar or temporal lobe epilepsy sure I'd like to have an MD see the patient as well (although I think you should bring in a Neurologist). But if by complicated you mean Axis II, then you should probably leave it to the psychologists. No amount of valproic acid and olanzapine will succesfully treat a distressed client suffereing from a PD.

The reduction of everything to bio-genetic model is a mistake especially at this juncture. I don't see anxiety disorders as a problem with regulating gaba. And as I'm sure you know, there is more than one way to change the neurochemical environment, not to mention the wiring of the big gray sponge.

I never referred to you, I was only using your post as an example. It had nothing to do with your opinion. By complicated I meant Axis III, which I clearly stated in my post, or so I thought. While we are on the matter, I do think psychiatrists are more capable of handling the more complicated Axis I AND II disorders. And I submit to you that the majority of psychologists probably feel the same, or at least would venture to bring in an iatrist to consult on said cases.

EDIT: The primary point of my post was to point out that there are psychologists out there who would see themselves replacing psychiatrists, not working with us. And another thing, not that I have any power over you but I would appreciate it if you would keep the psychology > iatry to your prospective forum. It only serves as a distraction to those of us wishing to discuss matters of our field.

 

[Poety]

I never referred to you, I was only using your post as an example. It had nothing to do with your opinion. By complicated I meant Axis III, which I clearly stated in my post, or so I thought. While we are on the matter, I do think psychiatrists are more capable of handling the more complicated Axis I AND II disorders. And I submit to you that the majority of psychologists probably feel the same, or at least would venture to bring in an iatrist to consult on said cases.

EDIT: The primary point of my post was to point out that there are psychologists out there who would see themselves replacing psychiatrists, not working with us. And another thing, not that I have any power over you but I would appreciate it if you would keep the psychology > iatry to your prospective forum. It only serves as a distraction to those of us wishing to discuss matters of our field.

ssshhhh solid, he WANTS the axis II, they can have those 😀

 

[Psyclops]

Happy to oblige. But in answer to the OP, I think it has been psychiatry's long standing disdain for psychology as an applied science. It started long ago with psychitrists not wanting to allow psychologists to be able learn psychoanalysis and therapeutic techniques. As I see it it continued from there...

 

[Solideliquid]

ssshhhh solid, he WANTS the axis II, they can have those 😀

Yeah sorry lol..

your baby, its....looking right at me.. 🙂

 

[Psyclops]

Sorry for taking it personally SL. I'm happy to bash psychiatry on the psychology forum, and you can bash psychology on the psychiatry forum. I'm only kidding of course.

In answer to the OP's question, I think it comes from psychiatry's longstanding disdain of psychology as an applied science. It began long ago with psychiatrists wanting to ban psychologists from being allowed to learn psychoanalysis and therapeutic interventions, and continues to this day. Take the tone of some of these posts as evidence. Clinical psychology and psychiatry have diverged over time in the way they approach the same problems. Furthermore, most people involved in these professions are high performers and have large egos, it is almost inconceivable to them that they are not looking at things the "right" way.

SORRY FOR THE DOUBLE POSTS DIDN"T THINK THE FIRST WENT THROUGH.

 

[Doc Samson]

Can you break that out for me in terms of how that translates into your educational background? I know psychiatrists that are 26 or 27 years old. With 16 years, according to your view, that means they started this process back when they were 10? 🙂

John

Starting at 18:

Basic science pre-med requirements in college = 4 years

Medical school = 4 years

Psychiatry residency = 4 years (I counted this as an additional 4 years of medicine, and 4 years of psychology, since we do both all the time)

 

[docjohng]

Cool, thanks.

 

[docjohng]

My sense of these divisions is that they're ultimately harmful to most (not all) people's care. When I worked on a true multidisciplinary team at the VA, it offered -- by far -- the best treatment regimen to patients. Everyone was represented, everyone was respected for their expertise, and the patient got the best care anywhere.

Then when you get out into the "real" world and see all of these small private practices where so many professionals end up, where referrals are done to other professionals, but there's no real teamwork going on. (This, of course, varies; larger practices that do have a representative sample of professionals working for them do this much better than the 1 or 2-person offices. CMHC can also do this well, if the philosophy is there.)

Psychologists make the argument that there's not enough psychiatrists to prescribe (especially in rural areas). That's fine to point out, but I don't think the solution logically (or even reasonably) follows that Profession Y therefore should be given prescription privileges. I would think a more reasonable solution is to offer greater incentives for professionals to enter psychiatry (or psychiatric PAs) in those underserved areas.

Just my random thoughts...

John

 

[50960]

😍 😍 😍 😍 PA's are better trained...come on??

 

[pschmom1]

WOW!!!! For one brief second, as I typed my question, I thought I would get to the point and not have any conflict. Obviously I was delusional 😉 I have been truly and obviously informed throughout the responses however. My passion lies with psychiatry and that's what I will be more than proud and honored to practice one day. I know that if I ever have any more questions reguarding this topic that I will pm a few consistant and professional sources here on this forum. I think, however, that I am clear and informed about my original question. It's almost like politics, Republicans vs. Democtrats Like anything else in life, what seems so simple and so obvious is obviously not that simple! World peace is a figment of a niave liberals imagination! Oh well, at least I tried 🙂 Sorry for stirring the pot, just a confused premed I guess. Maybe if it wasn't so hard to get into the PhD program, I would give up this premed crap and try for something better 🙄

 

[Anasazi23]

It's almost like politics, Republicans vs. Democtrats

If psychiatry and psychology are like republicans and democrats, I WANT TO BE MICHAEL SAVAGE....

YEAH !!!!

 

[50960]

Then I get to be Stephen Colbert (coal-bear)!!! 😉

 

[Poety]

😍 😍 😍 😍 PA's are better trained...come on??

Where we goin?