PublicHealth said:
If my posts suggests that I have come out against clinical psychology, it's likely due to my trying to justify my own decision to pursue medical training. I am still in favor of psychologists getting RxP given appropriate training, but I often wonder if the profession's seeking RxP speaks more to their lack of identity in the healthcare field than it does to their wanting to serve their patients better.
My decision was based on my need for a more biologically oriented approach to studying, diagnosing, and treating psychiatric disorders. I have limited interest in psychotherapy, so I did not want to train solely in these treatment modalities for 5+ years. Moreover, I noticed how disillusioned many of the psychologists and neuropsychologists with whom I have talked were with their careers. Pay is also decreasing for psychologists. Starting salaries in academic posts range from $40-60K. In psychiatry, they're $100-150K. More in private practice.
As a psychiatrist, I will be able to offer my patients comprehensive medical and psychiatric care. While clinical psychologists are an important component of the treatment process, they are increasingly being replaced by LCSWs and other mid-level practitioners. Medical doctors, on the other hand, tend to have more of a clearly defined position in behavioral healthcare.
I've also published a bit and plan to continue conducting research in whichever specialty I choose. At the moment I am leaning toward psychiatry with specialization in psychosomatic psychiatry. But that could change. I'm also interested in neurology, anesthesiology, and preventive medicine.
In sum, I want to understand the human condition from the inside out with an emphasis on biology. I also seek career stability and do not want to feel limited in terms of the services that I could provide my patients.
Hi PH, I wholeheartedly agree with this post.
Hi everyone, very interesting discussion here on psychology's identity.
As a recently licensed psychologist currently completing pre-med requisites in preparation for one day being a psychiatrist, I thought I would add some of my thoughts on this issue which I have struggled with for the last couple of years.
When I entered psych school I naively believed that psych PhD/PsyD were held in similar regard to psych MD/DO, i.e., similar professional status, pay, privileges and comparable scope of practice-both could do psychotherapy, PhD/PsyD could do testing and MD/DO could do medicating.
As I began to discover during my psych residency, there's no comparison between the two professions in either medical schools, medical centers, or in the managed healthcare system.
In my experience, PhD/PsyD are often seen by MD/DO as being helpful in one of two ways, as statisticians that can be of critical assistance to their research and as therapists that can be ordered to treat the patients that they are/aren't medicating-kind of like physical therapists are to physicians.
Additionally, psychiatrists make 2-3x more than psychologists-I was recently offered a job at 50k/40 hrs while I know just licensed psychiatrists who are making 100k/20 hrs-and while psychologists are facing a monumental struggle to obtain RxP, psychiatrists (and master level mental health providers) are increasingly asserting and exercising testing privileges.
In other words, psychology is caught between not being as high as psychiatry and being threatened with no longer being higher than social work, counseling, etc.
Why is this the case? In my IMHO, I believe it is because psychology still struggles between being a social science profession and a healthcare profession. That is why current PhD/PsyD curriculum is an amalgamation of statistics, research design, social psychology, psychopathology, physiological psychology, psychopharmacology, etc. This model often leaves the psych student uncertain as to the identity of his/her future profession: is the training for one to become a research scientist or to become a healthcare provider?
Supposedly, APA has been increasingly committed to cl psych being a healthcare profession thus the advocacy for RxP but in my opinion this commitment has not been strong enough. Current psych residencies put interns at a disadvantage from the beginning when they are in med ctrs, i.e., unlike med interns psych interns are not yet doctors. I believe it would be better for psych to have a two year (or more) post-doc residency but no pre-doc internship. I also believe that psychology needs to have RxP if it is going to be regarded in any way as comparable to psychiatry-control of a desired comodity provides authority and power. If only med has RxP than they will inevitably have the most authority/power. Furthermore, I believe that if cl psych is going to really be a healthcare profession than psychopharmacotherapy training needs to be part of the doctoral curriculum and not of a post-doc MS program in psychopharmacology-this is something tha APA has still not endorsed, preferring to see med psych as a sub-specialty of cl psych rather than RxP as a front-line tool of all cl psychs.
BTW, I'm personally very happy to have gone through psych school and to now be a psychologist but unfortunately, I'm very professionally dissapointed and would find it very difficult to encourage others to pursue psychology instead of psychiatry. Anyway, enough rambling. I will ultimately be a psychiatrist and I support psychologists having RxP but I just wanted to add my two cents in case there are some here in this forum that I may help to avoid this professional identity problem.
