Psychologist vs Psychiatrist

[Guest toroHaro]

I have recently graduated with a double major in human biology and psychology. Medicine has always been on my mind throughout my undergraduate career, but now that I really need to pick a training program, I am questioning whether the choice is the right one.

 

Two things seem to be conflicting here: interest and ability. My courses initially were all medical science courses and I did really well in them without pouring in the greatest number of hours. Then I took psychology in 2nd year and was hooked to it, and switched from a life science specialist to a double major to accommodate my new found passion. Unfortunately, despite my interest and hard work, my psy courses have lower marks (well, not too low...like A-'s)

 

I know I should not choose a career based on marks alone, since different subjects have different marking criteria (like objectivity of the MC vs subjectivity of the Essays....). But the grade disparity does lead me to question my aptitude. In addition, practically, psychology graduate committee may also see those differences as a potential indication that I may fare better elsewhere.

 

I am very drawn to the mental health and counseling field. Naturally, clinical psychology and psychiatry are two of my options. Personally, I believe that medication should be used only as the last resort to heal mental illness because of their side effects and less well known long-term effects. And I believe in healing the whole person, understanding their life histories and circumstances that may have contributed to their current mental states.

 

From this point of view, clinical psychology seems to be a better fit. However, psychiatrists have greater flexibility in their practice because of prescription privileges. They can choose not to give medication, but clinical psychologists CANNOT give meds. Psychiatrists also have greater power in committing patients to hospitals, higher job security and earning potential. And I don't think I have problems doing med courses, even though a huge part of them may be irrelevant later should I focus on psychotherapy.

 

What are your views?

[Guest moo]

They really are two different fields. I worked in a psych hospital for three years before med school, and I just came off my psychiatry rotation, so I have seen both psychiatrists and psychologists in action.

 

Psychiatry is vastly different from psychology, IMHO. While there is significant overlap, psychiatrists don't do much counseling. However, with that said, among the medical specialties, psychiatrists "do the most talking." You can, as a psychiatrist, undertake training in CBT or individual psychotherapies but this is by and large pretty rare.

 

As you said psychiatrists can prescribe medications. While medications do have their side effects, I believe the benefits far outweigh the risks. I have had personal experience with this, having been diagnosed with bipolar and now being on lamotrigine. This medication has changed my life, and I would take a pill over counseling any day. But also remember that there is also a difference in the types of patients you see. Psychiatrists will deal more with the patients more amenable to treatment with drugs, like depression, schizophrenia, bipolar, substance abuse, etc. Psychologists may deal more with patients who cannot be treated with drugs, like marriage counseling, sex therapy, people with phobias or OCD, patients with personality disorders, etc. There is overlap; for example, there's nothing to say that a depressed patient can't see a psychologist but the firstline treatment for depression is medication and not counseling. You'll always prescribe an SSRI before sending a patient to a therapist, unless the patient insists on seeing a therapist and is refusing medications.

 

There is also talk down here in the US that some psychologists in some states are pushing for prescription rights. So in the future psychologists may be able to prescribe a limited set of medications. I doubt this will ever fly in Canada though, and I personally do not agree with psychologists having prescription rights.

 

Med school courses are also highly relevant to psychiatry. For example, in patients with conversion disorder (where a stressor is "converted" into a neurological symptom), it is imperative that one be able to perform a full neurological exam and understand diseases of the nervous system. In patients who have hypochondriasis, one needs to be able to understand the work-ups previous physicians have done. Many drugs have rare side effects that is important to recognize: anti-convulsants used as mood stabilizers can cause a rash that could be deadly; olanzapine, an anti-psychotic, can cause diabetes mellitus (in fact I had a patient come in with DKA, and had to be admitted to the MICU); the old tricyclic anti-depressants, when taken in large doses (as in an overdose) can cause prolongation of the QT interval and heart conduction abnormalities. I can go on and on but you see my point. You need a thorough understanding of medicine before you can become a psychiatrist.

 

Personally, I'd go with whatever floats your boat. Becoming a psychiatrist is a long road. So is psychology, but you already have an undergraduate degree in that, so if you go to a PhD program you only have another 4-5 years to go, whereas you're looking at easily another 8-9 years to become a psychiatrist.

 

Psychiatrists and psychologists work hand in hand. One is not the boss of the other. Sounds to me like you are more interested in the behavioral/counseling side of psych. In that case, I'd become a psychologist.

[Guest toroHaro]

Moo, what did you work as in the psych hospital? I am hoping to do exactly that before going back to school. I am currently working as an RA in the psychiatry dept. in a general hospital, but the position ends in mid-July.

 

You are right to say that I am inclined to the behavioral aspects of mental health. And my main motivation to be a psychiatrist would be to help re-emphasize the importance of psychotherapy on top of medication. Perhaps I am being overly ambitious here, but it hurts me to see patients not getting enough psychotherapy from psychiatrists, and many of them cannot afford it from psychologists (whose services are not covered by the Ontario govt.). Does reality allow psychiatrists to practise more CBT/IPT?

 

I am actually fascinated by the complexity of a psychiatrist's work you described here. Integrative physiology really appeals to me because there are so many things to consider and cracking a case can be so satisfying (like organic chem synthesis). But that also translates to much greater responsibility than a psychologist's work, which doesn't involve medication. Time wise, I think it is similar because you would start earning money by the time you start residency. The training will only get more exciting as you see real cases and more focused on mental health.

[Guest moo]

I was a psych nurse's aide. It was a good job, fascinating and I saw way more there than I did on my psych rotation. I don't mean to sound vain, but I think I knew more about psych than my psych intern as a third year. In fact, I thought about being a psychiatrist for a long time. Then I thought I wanted to be a radiation oncologist (did physics/math honours at UBC and did my thesis in biomedical physics) so I went to a hard-core research oriented US school. Then I thought I wanted to do Internal Medicine and then GI after. Now, I'm interested in anesthesiology or FP/EM. Funny how things change huh?

 

Anyway, I still had psychiatry in the back of my mind when I went into my rotation, but there's no way I will do psych after actually experiencing psychiatry from the point of view of a physician. While interesting, the patients I found were too often untrustworthy. So many times when I was on call did I go see a patient in the ER who came in claiming they were suicidal only to demand food. When food was not given they recanted their story and wanted to leave. It's hard to take a history from a patient when you constantly question what they say. That's where collateral information comes in handy. While it's true that most of what you do as a psychiatrist is on an outpatient basis and you can always choose to do child and adolescent psych or deal mostly with depression, for example, I just don't want to be so specialized. Anyway, to make a long story short, I don't think I could survive a psych residency (would make ME go crazy) and am quite content in my decision not to do psych.

 

If you're interested in psychotherapy, I suggest doing a PhD. I suppose you could do an MD/PhD but I've never seen a psychiatrist with a dual degree. But you have to realize that with an MD, you will have much more options in the future. I thought I wanted to do psychiatry... Turns out I didn't. The point of my story above is that people's career aspirations change. Your view of medicine changes as you rotate through the specialties. Four years ago, I had no idea what an anesthesiologists did... I thought, like everyone else, that all they did was put people to sleep. Was I ever wrong!

[Guest toroHaro]

Moo, that was a really good reminder. I switched programs a few times during undergrad, and I agree that interests and aspirations do change with time and experience. I am always envious of people who seem to know right from the start what they want to do in life (my friend decided that she wants to be a vet at 10, and is finishing vet sch).......but

I guess everyone has a different career path, or life journey for that matter. Shall share some of my life stories on more relevant threads this summer. Thanks again.

 

Any other opinions?