Why be a psychologist rather than a Psychiatrist?

[Salsa45]

I'm debating what I want to do right now, and I'm leaning towards psychiatry. It seems they have a greater freedom in their ability to help the people they see. But I'm curious to what you guys think. What do you see as being the benefits of being a psychologist, rather than a psychiatrist, without factoring in length of education/cost of training.

I did a search, but I just found threads that were asking the difference between the two.

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[myelin]

or you could split the two and become a prescribing psychologist (RxP). I believe, currently, there are 2 states that allow the RxP (New Mexico and Louisiana). i have a strong feeling there will be more in the future with the need for psychological services with war veterens.

you'll likely get a biased opinion in favor of psychology on this board as this is a PhD forum, not MD. with that being said, i prefer psychology over psychiatry because i am not a fan of pharmacological interventions as a sole means of treatment. there is an over reliance on pharma in mental health (american healthcare in general) and not enough on the mind-body connection. i believe in behavioral and cognitive methods of treatment. e.g. i believe in stimulus desensitization and exposure therapy versus prescribing an anxiolytic and being done with it.

 

[erg923]

There was thread a while back title Differences between Psychology and Psychiatry, or something to that effect. Is should show up in a search. Although they both deal with mental illness, they are very different. They look at pathology from different perspectives, and the careers themselves are vastly different. It really a personal preference on what you want to do. You can't really point out pros and cons except from you own personal preferences.

 

[Salsa45]

Already did a search, the results were a bit informative but not that great. Some had become flame wars fairly quick, some were just generalities, I didn't really find what I wanted to see. If you have a link to the thread you have in mind that would be great.

Also, I want to see what you guys consider the pro's to the profession being. I know that what I will find a pro/con depends on my preference, but I can analyze what I would like and dislike from what I see that you guys like.

you'll likely get a biased opinion in favor of psychology on this board as this is a PhD forum, not MD. with that being said, i prefer psychology over psychiatry because i am not a fan of pharmacological interventions as a sole means of treatment. there is an over reliance on pharma in mental health (american healthcare in general) and not enough on the mind-body connection. i believe in behavioral and cognitive methods of treatment. e.g. i believe in stimulus desensitization and exposure therapy versus prescribing an anxiolytic and being done with it.

So you see psychiatry as being essentially just a med dispensing practice, whereas you wanted a more holistic approach? How crippled is a clinical psychologist in their ability to get a patient who needs them meds, are they forced to refer them to someone else?

I expected a biased opinion in favour of psychology, and that's actually what I kind of want. I posted a similar thread in the psychiatry forums asking roughly the same from their point of view, I think this one will show me the strengths of the psychology route a lot better than psychiatry will, and vice versa.

Along with a general overview, I'm also curious as to what the jobfield looks like for research in the field of psychology as a whole, not just in terms of the patient aspect. We've all read about the Milgram and Zimbardo experiments, but how typical is it really for psychologists to conduct experiments?

All input is appreciated.

 

[erg923]

This could be a very very long discussion. But, its not going to be cause im busy tonight. All areas of psychology can, and do conduct research. The people you mentioned (Milgram, Zimbardo) happened to be experimental psychologists, who only do research. With a degree in "clinical psychology" you can see patients, but are also competent to conduct research. Sounds like you want to see patients (correct?)........so you will need a degree in clinical psychology, not one of the experimental branches (i.e., cognitive, social, etc.). The Ph.D degree in clinical psych will prepare you better for a research orientated career than the the Psy.D. (please don't ask me to get into the Ph.D/Psy.d differences right now...lol). You can practice with both.

I chose clinical psychology, not because I'm biased against psychiatry at all, but rather, I just had no interest in medicine or pharmacology. Four years of med school to get to something I really liked would have been a waste for me. Second, I was more interested in psychology than psychiatry, meaning that i have significant research interests in normal behavior as well. Psychology is much more broad in that sense. Psychiatry really deals exclusively with mental illness. Third, I was also interested in psychometrics, psychological testing, and measurement issues. This is clinical psychology's area, psychiatry is not trained in this. Fourth, I have interest in psychotherapy, and no interest in psychopharm. Psychologist are not trained to prescribe medication unless you do a specialized post-doc in pychopharm. Even at that, its only legal for psychologists to prescribe in 2 states that I know of. So yes, if your patient needs meds, you do have to refer to psychiatry. Psychiatrists can still do therapy, although they don't really for various reasons (mostly financial, but also has to do with their training model and their more steadfast biologic view of mental illness). Regardless, psychologists get much, much more training in it. All of these things translated to psychiatry creating a very different, and more limiting career for me than one in clinical psychology.

 

[ny1020]

What do you want to do after graduate school? Once I figured out that I wanted to do research and practice part-time - the phd was the only option for me. Do you want to be an md? I contemplated psychiatry until I realized that I don't really care for medical school and am not the least bit interested in prescribing medication.

As far as beliefs go, I support using both therapy and meds to treat a variety of mental illnesses. And, as a clinician, I would be happy to refer clients to a psychiatrist that I trust. I wouldn't feel as though I was forced to do it. I would want to - because my specialization would be therapy, not knowing the ins and outs of meds and any contraindications. I would want my client to go to a specialist for that.

I don't know too many psychiatrists that do therapy. I'm not familiar with programs that could train an md as well in therapy as a clinical psych program would. I, personally, would prefer to have two different doctors, knowing that each one was very well trained in what they did.

But, I do know a psychiatrist who did a post-md psychoanalytic training for 4 years - now she's an md,lp.

 

[bigdodge53]

For me the biggest difference between psychology and psychiatry is the length of time one must complete in medical school to become a psychiatrist. Yes, you do the 4 year generalized medical school but you also have to do much more beyond that. My understanding is that you also have to include roughly 3-4 years of specialized training and about a 2 year residency. I am not an expert on this but this is what I have read online. Yes, getting a doctoral degree i clinical psychology can take 5-6 years and you don't have quite the immediate financial rewards afterwards that psychiatry promises; however, there is a very good reason that it is easier to find young psychologists than it is to find young psychiatrists. I don't mean to say I am all about the financial end of this process but I am just not too keen on having my career officially start in my late thirties or early forties.

 

[JockNerd]

Psychiatrists don't do the kind of research I do, and anyway tend not to work in treatment modalities I'd use if I were going clinical. Easy enough decision

If I were interested primarily in treatment, I'd probably have gone psychiatry. I'm definitely not interested being a med manager, but it seems like it would be easy enough to get some additional therapy training after med school and do private practice using therapy and drugs.

I know a lot of people on the board are all about prescribing psychologists, but really everything is too up in the air to enter psychology with the intention of taking on that career, IMHO.

 

[sunlioness]

It's an interesting question. I am a pscyhiatrist. I went to medical school because I thought I wanted to be a pediatrician and maybe an infectious disease specialist. I had taken electives in psychology as an undergrad and found them interesting, but never considered psychology or psychiatry as a career. I had picked up a bias from my family that while the mental health field may be intellectually interesting, they never actually helped anybody in any tangible way. So I went to medical school, decided I didn't like pediatrics at all, and ended up matching into internal medicine.

My intern year was miserable. I hated what I was doing, was not interested in it and also began to be really overwhelmed by anxiety. I had struggled with anxiety my entire life, but always managed it ok on my own. Intern year, it started to get away from me and I was actually refered to a psychiatrist who in turn referred me to a psychologist. It was through working with them that I completely reversed my bias against the field and realized how important and useful mental health treatment really is. So I switched into a psychiatry residency. At the time, I kind of bemoaned this. I personally felt that therapy was the #1 thing that was helping me personally and didn't like how biologically oriented psychiatry was. But I had already been to med school by that point, so there really was no point in going back and becoming a psychologist then. And now when I look at it, I think everything happens for a reason and I am glad to be an MD.

Because this is the deal, I feel like I have a lot more flexibility and options in what I want and am able to do. I can prescribe meds. I can also do psychotherapy and I can do both together with the same patient, which is a really cool thing to be able to do. A lot of psychiatrists don't want to do this, whether because they are more biologically-oriented, or don't like therapy, or realize that they make more money doing med checks, be that at it may. The fact is that it CAN be done. Psychologists training in psychotherapy is better and more extensive that you would get in a psychiatry residency. But that isn't insurmountable. You can always take extra trainings, get extra supervision, etc. The reverse isn't true. Except in certain states, psychologists can't prescribe meds. And I don't think that will change in the near future. Psychiatrists don't do neuropsych testing, so that would be a reason to choose psychology, but personally I don't have much interest in doing that myself. So it all worked out.

 

[sunlioness]

The lengths really aren't all that different.

Average PhD program completion is 5-7 years + postdoc.
A an appropriately trained neuropsychologist, for example, would be 7 years of training, mininum. Psychiatry salaries will be higher more quickly, as well.

Psychiatry is 4 years med school + 3 years residency. . . It's the same.

Psychiatry is a 4 year residency after 4 years med school. The difference though is that during residency you're already a doctor and making a salary. Not a great salary, but a livable one. For PhD, aside from intern year, all of that time is spent being an unpaid student. Though the flipside of that is that in grad school, you're not going to spend two months holding a retractor and getting "pimped" by a surgery attending.

 

[Psyched77]

I like your question, because I actually was on the fence for a bit some time ago.

Here's why I wanted to be a psychiatrist:
1. HUGE shortage of psychiatrists is creating great job stability (like the RN field)
2. phenomenal pay
3. would see clients
4. would have the ability to prescribe meds

Here's why I wanted to be a psychologist:
1. psychologists get to do more therapeutic work with clients (meet with them more frequently)
2. ability to research questions other than pharmacological ones
3. belief in CBT & multi-systemic approaches
4. desire to work on & look at childhood externalizing dysfunctions outside of the biological/pharmacological constraint

I've decided to go the psychology route, because research & ability to meet with clients more frequently were both high on my priority list. There are efforts occurring right now to change the laws such that psychologists can prescribe relevant meds. From what I've seen, psychiatrists & psychologists often work in collaboration. In other words, psychiatrist X refers clients (after prescribing meds) to psychologist Y. And psychologist Y refers clients who need meds to psychiatrist X. I haven't sensed contemporary resistance between the two fields. (Psychiatrists don't seem to feel threatened by psychologists, & psychologists don't seem to feel threatened by psychiatrists.) It is a personal choice/decision, as people above have mentioned. For the sake of info, here's my pro/con list:

Psychiatry pros:
1. somewhat easier to get into med school (11% vs. 2% in clinical PhD)
2. much easier to get into psychiatry programs, b/c of shortage
3. shortage creates job stability
4. higher pay
5. can do pharmacological research
6. have the power to prescribe
7. biologically based
8. less psychiatrists out there means a greater chance of the individual being recognized for doing something great (ie, Nobel Prize for some amazing discovery)

Psychiatry cons:1. often less funding for school/greater debt to complete
2. biologically based (yes, I intentionally put it on both lists...for looking at biology, but not being trained to consider a great deal else)
3. lesser relationships with clients
4. research orientation is on meds/biology
5. pharmacology industry is corrupt in many ways...can I rectify that within my conscience if Rx is a major component of my job?
6. some lingering negative public perception
7. time commitment

Psychology pros:
1. harder to get into a good program
2. lots of wanna be (including me! lol) & current psychologists can threaten to saturate the market & make employment harder to get or keep
3. good pay over the life of career
4. more of a multi-systemic approach (with some exceptions) to the context of the individual (social, relational, learning, cognitive, etc.)
5. free tuition & funding for many programs / potential for no debt out of school

Psychology cons:
1. harder to get into a good program
2. can have lame salary level in early career
3. do not have the power to prescribe
4. harder to get approval/support for biologically based research
5. some lingering negative public perception
6. time commitment
7. more competitive to get a good job

Those are in no particular order, but demonstrate my various considerations of each while I was trying to decide. Of course, I thought of things like my interest in biology but not in blood & guts (regarding what I would be taught in early, generalized med school LOL). All being said, I want to point out the irony of creating a pros/cons list, because in my psychology undergrad studies, I read a couple of research papers that found that pro/con lists don't actually help people make decisions. Often, they create more confusion & anxiety! (<-- That kind of stuff is part of what I find fascinating about psychology!)

Good luck!

 

[bigdodge53]

The lengths really aren't all that different.

Average PhD program completion is 5-7 years + postdoc.
An appropriately trained neuropsychologist, for example, would be 7 years of training, mininum. Psychiatry salaries will be higher more quickly, as well.

Psychiatry is 4 years med school + 3 years residency. . . It's the same.

I actually read online after my post that the stuff after that first 8 is if you want to specialize.

 

[Psyched77]

JS...I was talking about MY perspective. For example: "Here's why I wanted to be a..." I was answering the question from how I saw things & why. Plus, it seems that you missed my entire point about me having been on the fence, as well as the balanced positivity I gave to each field. I wasn't bashing either, so I'm not sure why you felt compelled to respond this way. Write your own posts & try to be a little less invasive of others'.

Here's why I wanted to be a psychiatrist:
2. phenomenal pay disagree
3. would see clients
4. would have the ability to prescribe meds

Here's why I wanted to be a psychologist:
1. psychologists get to do more therapeutic work with clients (meet with them more frequently) this is completely a choice in psychiatry
2. ability to research questions other than pharmacological ones also, not a limitation in psychiatry
3. belief in CBT & multi-systemic approaches also not a limitation in psychiatry
4. desire to work on & look at childhood externalizing dysfunctions outside of the biological/pharmacological constraint not a psychiatry limitation

Psychiatry pros:
1. somewhat easier to get into med school (11% vs. 2% in clinical PhD) debateable. . . very different applicant pool, psychology has lots of bottom feeders that would have no hope of getting into medical school, but can get into a professional school
2. much easier to get into psychiatry programs, b/c of shortage after they get into medical school? You mean, compared to other medical residencies?
4. higher pay depends
5. can do pharmacological research so can psychologists
6. have the power to prescribe
7. biologically based so should be psychology
8. less psychiatrists out there means a greater chance of the individual being recognized for doing something great (ie, Nobel Prize for some amazing discovery) I don't see that argument at all.

Psychiatry cons:1. often less funding for school/greater debt to complete

3. lesser relationships with clients choice and debateable
4. research orientation is on meds/biology choice
5. pharmacology industry is corrupt in many ways...can I rectify that within my conscience if Rx is a major component of my job? this is not really fair. the pharmacological industry does not necessarily taint psychiatry. psychiatrists make their own decisions with respect to prescription. it is their ethical responsibility to properly evaluate treatments.



Psychology cons:

4. harder to get approval/support for biologically based research Not true

 

[Psyched77]

Agreed. That is the info I found when considering the field.

I actually read online after my post that the stuff after that first 8 is if you want to specialize.

 

[myelin]

Already did a search, the results were a bit informative but not that great. Some had become flame wars fairly quick, some were just generalities, I didn't really find what I wanted to see. If you have a link to the thread you have in mind that would be great.

Also, I want to see what you guys consider the pro's to the profession being. I know that what I will find a pro/con depends on my preference, but I can analyze what I would like and dislike from what I see that you guys like. So you see psychiatry as being essentially just a med dispensing practice, whereas you wanted a more holistic approach? How crippled is a clinical psychologist in their ability to get a patient who needs them meds, are they forced to refer them to someone else?

I expected a biased opinion in favour of psychology, and that's actually what I kind of want. I posted a similar thread in the psychiatry forums asking roughly the same from their point of view, I think this one will show me the strengths of the psychology route a lot better than psychiatry will, and vice versa.

Along with a general overview, I'm also curious as to what the jobfield looks like for research in the field of psychology as a whole, not just in terms of the patient aspect. We've all read about the Milgram and Zimbardo experiments, but how typical is it really for psychologists to conduct experiments?

All input is appreciated.

yes, from my experience on an inpatient unit, the psychiatrists would come in, do rounds, flip through charts, change medications accordingly, and leave. both patients on the child/adolescent and adult units complained of the lack of empathy and caring nature of the psychiatrists. in their defense, the psychiatrists had 10+ patients to see in a short period of time and so the time spent they spent with patients was limited.

also what annoyed me was when i was working with a patient who was behaving in an inappropriate way on the unit, the psychiatrist would come in, see the behavior noted on the chart, and increase/change medication for that patient. after the med change, the patient would be very sedated (if they even got up out of bed the next day) rendering my work with the patient useless. it was frustrating to say the least. but meds work quick and people want the quick fix without all of the work. quicker treatments = less time spent in treatment = less money = happier managed care companies. it's a mess.

 

[sunlioness]

I was just commenting on the points you brought up, not intended in a hostile manner. I don't think they all truly differentiate psychiatry and psychology (fall within the common misconceptions realm). So, I thought it might be helpful to spur some discussion of those things.

I agree with you, Jon. If you hadn't posted those comments, I probably would have posted something similar. Because I AM a psychiatrist who will see some patients weekly for psychotherapy and I think CBT is great.

That is not the case. Residency is specialization. The length of residency varies per chosen specialty. Psychiatry's is four years, on average. Neurosurgery residencies, for example, can be 8 years post medical school. You can get optional fellowships after residency for additional training options (these tend to be at much more reasonable pay levels).

Yep. It's

4 years of undergrad (unless you do one of those whacky accelerated programs)

4 years of med school

4 years of psychiatry residency.

You can stop there and be a psychiatrist, or continue on and do a fellowship in such things as child/adolescent, forensic psychiatry, addiction, etc.

 

[sunlioness]

yes, from my experience on an inpatient unit, the psychiatrists would come in, do rounds, flip through charts, change medications accordingly, and leave. both patients on the child/adolescent and adult units complained of the lack of empathy and caring nature of the psychiatrists. in their defense, the psychiatrists had 10+ patients to see in a short period of time and so the time spent they spent with patients was limited.

also what annoyed me was when i was working with a patient who was behaving in an inappropriate way on the unit, the psychiatrist would come in, see the behavior noted on the chart, and increase/change medication for that patient. after the med change, the patient would be very sedated (if they even got up out of bed the next day) rendering my work with the patient useless. it was frustrating to say the least. but meds work quick and people want the quick fix without all of the work. quicker treatments = less time spent in treatment = less money = happier managed care companies. it's a mess.

That's inpatient for you. Inpatient is all about stabilizing the patient so they don't have to be in the hospital anymore. It didn't used to be that way from I understand and I personally don't plan to be an inpatient psychiatrist.

 

[deleted176373]

Psychiatry is a 4 year residency after 4 years med school. The difference though is that during residency you're already a doctor and making a salary. Not a great salary, but a livable one. For PhD, aside from intern year, all of that time is spent being an unpaid student. Though the flipside of that is that in grad school, you're not going to spend two months holding a retractor and getting "pimped" by a surgery attending.

Think again. I'm getting paid pretty well as a student. However after a few years, you'll be making a good deal more than I will.

Mark

 

[Ollie123]

I actually think its more typical for psychologists to do research than psychiatrists. Psychology degrees are MUCH more focused on research than medical degrees are (for the most part, though this obviously varies by school).

I looked at both and that was the deciding factor for me. I thought about MD/PhD too, but those tend to be more like a "Diet PhD" and if I was going to skimp on anything I'd want it to be the medical/clinical training, not the research aspect.

 

[Neuropsych2be]

I'm debating what I want to do right now, and I'm leaning towards psychiatry. It seems they have a greater freedom in their ability to help the people they see. But I'm curious to what you guys think. What do you see as being the benefits of being a psychologist, rather than a psychiatrist, without factoring in length of education/cost of training.

I did a search, but I just found threads that were asking the difference between the two.

For myself, my interest in psychology derives from interest in the human condition and behavior. Psychology is a sprawling field which is vastly broader field than psychiatry. Even though I am studying clinical psychology and have worked in the field of mental health at the master's level for about 15 years, my interests extend into areas beyond mental health treatment. I have interests in language development, memory, cognition, intelligence, social constructivism and evolutionary psychology. These are areas that generally lie outside the purvue of psychiatry. Originally I started out in my undergraduate education as an anthropology major and eventually switched to psychology because of its heavy use of experimental methodology.

 

[chiachia]

i wanted to comment and reitterate that there is a great amount of overlap between the two. i offer my thoughts and observations. first - i have applied to clinical psychology phd programs this year (been accepted!!! YAY for me!!!) and work in psychiatry right now as a research coordinator. i work with a neurologist, a few psychiatrists, and a resident. we do research on severe, treatment resistant depression, and i want to do research on depression. so keep all of that in mind as, although i will try to be un-biased, as humans we always are.

the resident i work with is being supervised by someone who specializes in CBT, and someone who is very psychodynamically focussed. both PhDs.

the work we do is way beyond simple med management. granted very biologically focused, but each time our patients come in (and... keep in mind it is me not the psychiatrist who does this) they get TONS of psychological measurements (hamilton depression scale, BDI, BAI, dysfunctional attitudes scale, temperament scale....ETC) that will be looked at and written about. some by the people i work with - MDs. but, this will probably be in relation to more biological factors (fMRI, PET, genetics, endocrine...).

one of the psychiatrists that works with us is also one of two main inpatient MDs. he does that, our study, and another study looking at first onset depression (mostly med management stuff with that last study).

we talk a lot about personality and interpersonal factors with our patients. why people arent getting better.

we talk a lot about more biological factors - sleep patters, blood levels, neuroanatomy related stuff.

not only do the psychiatrists do all of the above, they also actively participate in neurosurgery (not placement of hardware but....)

they mostly read article about meds, brain pathways, again the biological things, not more.

i, with all that being said, do feel a bit stuck. even though we touch upon all aspects of topics, it always tends to go back to something biological. i want to be able to look at the more thinking-cognitive not pathway-cognitive, interpersonal, behavioral, even some psychodynamically related things. those are the things that get thrown to the side and never discussed.

you only have so many hours in the day and sometimes you just cant do everything.

bottom line - you can pretty much do it how you want. you can also be a psychologist and work in psychiatry, participating in research that spans all. even psychiatry does CBT research and... believe it or not (but its true)... even psychiatry does psychoanalysis research. mostly in the northeast but theres some of that happening in medical settings.

and, i think that in asking for thoughts here and on a psychiatry forum you are doing yourself well. you might also want to find some people who do both for a living and try to talk to them. you'd be surprised how many would probably talk to you for a little bit. people love to talk about how great what they do is!!! my boss, pretty famous research neurologist, has even been open to randomly talking to some undergrads.

feel free to PM me - even though i didnt consider medical school as an option, i definitely have been exposed to the different aspects of psychiatry, as well as have taken it upon myself to get to know a lot of psychologists.

 

[cara susanna]

Can clinical psychologists work inpatient? I've always wondered.

 

[Therapist4Chnge]

Can clinical psychologists work inpatient? I've always wondered.

Yes.

 

[cara susanna]

Ah, okay. Thanks. I thought so, but whenever you look at hospital staff you always see the MDs in behavioral health inpatient.

 

[biogirl215]

I shadowed in an inpatient neuropsychiatry pharmacy last year, and there were multiple clinical psychologists on staff.

 

[erg923]

just curious to what a inpatient neuropsychiatry pharmacy is?

 

[biogirl215]

I was shadowing at the in-house pharmacy at the hospital-affilated neuropsychiatric center, where they do a lot of in-patient detox, child in-patient treatment, major depression treatment, etc. Is that clearer?

 

[myelin]

Ah, okay. Thanks. I thought so, but whenever you look at hospital staff you always see the MDs in behavioral health inpatient.

that is an interesting observation that i made as well while working at an inpatient behavioral health facility. it isn't uncommon for a psyc inpatient unit to have MA level therapists (LPCs) and psychiatrists, but no psychologists. that's because they can pay the LPCs less than the psychologists with PhDs.