Should I go for Psychologist or Psychiatrist?

Pre-Med & Medical School Careers in Medicine
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Okay, so I’m headed off to Boston University this fall and am trying to decide what to focus on. My whole life I’ve been fascinated with Psychology, and have studied it independently since elementary school. Back then I was so set on being either a psychologist or psychiatrist, but I lost a lot of confidence in my early years of high school and then decided that obtaining the degrees necessary for those careers wouldn’t be feasible for me. However, Jr. and Sr. year I’ve gained a lot of confidence, obtaining an SAT score in 99th percentile and rising to the top Top 10 students (out of 300) in my class. I was going through a substantial personal struggle freshman and sophomore year and I feel that i’m now back on track.

My major next year is Behavior and Health, which is a program similar to pre-med but for Occupational Therapy graduate school rather than med school. I decided to be an OT a couple years ago because it seemed mildly interesting and obtainable. But I’ve decided that I should at least try to pursue my dream. I’m going to keep my major, but I have the option of taking pre-med electives or psychology electives to also prepare me for graduate programs in those areas.

I’m no scientific genius, but I managed A-s and As in chem and bio (AP) in high school. However, i’m nonetheless terrified of huge pre-med chem classes and I wonder if i’ll survive. Is med school reserved for true scientific geniuses that can survive those classes? Should I try to obtain a doctorate in psych to avoid crazy science classes? The man reason I want to be a psychiatrist is I don’t want to only be able to treat patients with therapy, I’d love to be able to prescribe medicine as well. I’m more attuned to the humanities (psych, history, english) than I am the sciences, but i’m also an extremely hard worker.

Should I take the plunge and sign up for pre-med classes? Advice please!!

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Med school is not the domain of scientific geniuses. While med school does require an definite aptitude for science and mathematics, a strong work ethic, persistence and a willingness to go above an beyond the minimum is equally necessary.

(As the mother of both a medical resident and a MS2, I can assure you while my daughters are both very bright, with strong science aptitudes, neither is a “genius”–although I love to think they are!)

Lower level science classes (thru Ochem at least and perhaps biochem) at BU will be “weeders”–that is their purpose is to weed out/flunk out/discourage those who lack either the work ethic/persistence/effort or necessary scientific skills. This is true at [almost] all colleges and not just BU. It’s essential that you do well in these courses since your sGPA (bio, chem, phys and math) is a critical factor in gaining an admission to med school.

RE: psychiatry—it’s way, way, way too early to be considering a possible medical specialty. Research shows that the average med student changes his/her mind about their specialty at least 3 times during med school. (The one exception seems to be orthopedists–who are remarkably single-minded about their choice.)

RE: Psychiatrist vs. psychologist – In 12 states clinical psychologists have limited prescribing rights. (That is, licensed clinical psychologists (PsyD or PhD) can prescribe psychoactive medications.) This trend [toward granting prescription rights] is accelerating since there is a national shortage of mental health treatment professionals.

You should also be aware that clinical psychologists and psychiatrists have very different treatment modes, models and approaches. This is something that you need to research and evaluate for yourself before making any final decisions about your career path.

Psychiatry requires a minimum of 12-14 years of post high school training (4 year undergrad, 4 years med school, 4 years residency, plus 1-2 years fellowship)

http://residency.wustl.edu/Choosing/SpecDesc/Pages/Psychiatry.aspx

Clinical psychology requires 7-9 years of post high school training (4 years undergrad, 3-5 years graduate)


I looked at BU's curriculum for your proposed major. **The biology classes required for your major do not fulfill pre-med requirements.** Med school admission requires that all science classes be the ones required for science majors. BI 105 is **not** what bio majors take. You'd need to take BI 107.

If you have any thoughts about pursuing med school, you'll need to change your course selections.
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@wayoutwestmom First off, thank you for your extremely informative and helpful answer! And my guidance counselour is going to help me to take the necessary science classes I need when I meet with her at orientation. Also, another factor that I have considered is the pay. Clinical psychologists have to go to more school than OT’s but make around the same salary. Psychiatrists of course have to go to more school, but there is a huge leap in pay. So are you saying that Clinical Psychologists can prescribe medicine?

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In some states yes, clinical psychologists can prescribe psychoactive medications if they meet state requirements to do so. And my mistake–it’s currently 3: New Mexico, Louisiana, Illinois. It’s under legislative consideration in New Jersey, Hawaii, Montana, Oregon and Tennessee.

On the national average, psychiatrists make approx 2x what a PsyD or a OT, earns but individual income for each profession varies tremendously depending location, practice type and hours worked. Over 20% of psychiatrists earned less $100K/year in 2013. (Latest year data is available.)

Consider also that loan repayment for psychiatry will be higher. Average med student indebtedness is between $180K-$230K at graduation. (And you will be earning less than your high school teachers do during during residency and fellowship so repaying your loans during those years is difficult.)

The current medical reimbursement environment makes it much easier for both OTs and PsyD to have a stand-alone practice, whilst the trend in medicine is towards salary-based large group practice. IOW, as an OT or PsyD you can have your own business and work as little or as much as you prefer, while for physicians (of any type) that is getting increasingly difficult to do. So factor that into your consideration also. If you’re planning on having a family and working less than full-time, that’s much more difficult to do as physician.

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I definitely want to have a family, that’s why being an OT is slightly more attractive to me. I originally wanted to have kids in my late twenties but that doesn’t seem feasible if I go the psychiatrist route. I love children and I want to be a great mom for my kids, and I do worry that being a physician would sacrifice that. I just don’t like the idea of getting a doctorate in psychology in order to be a clinical psychologist, and then making as much as I would have with a masters in OT.

However, I come from a large Jewish family that’s lacking any doctors and lawyers, and I know my grandfather sees me as the one with a chance to successfully take the plunge. I also feel like when your parents are doctors, you feel more confident that you’ll be able to become on as well. My brother made a comment the other day that there has to be that one person who sacrifices in order to make things better for future generations, and it really stuck with me.

I also have a genuine interest in psychology and mental health that I’ve pursued my whole life. I know that OT’s study psychology and need to have knowledge of it, but I don’t want to end up feeling unfulfilled. But maybe the better family life would compensate for that…

Sorry, tons of thoughts running through my head right now! Thanks for all your advice, any more comments?
@WayOutWestMom

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No doctors (or lawyer or other professional school grads) in our family either so 2 out of 2 becoming doctors was a huge surprise.

A word of advice–family pressure/hopes/expectations are a terrible reason to pursue medicine as a career. It will likely leave you bitter, angry and unfulfilled. Become a physician only if you cannot see yourself doing anything else with your life. Medicine is calling as much as the call to become a rabbi/priest/minister is.

Medicine require tremendous personal sacrifices. Physicians have much higher than average rates of divorce and suicide. Female physicians are more likely to remain unmarried or to be divorced than even their male colleagues.

If you are interested in working with those with mental health issues, there are other careers you should consider: nurse practitioner and physician assistant. NPs and PAs can specialize in a variety of fields, including psychiatry/mental health. NPs and PAs can write prescriptions–and not just for psychoactive medications. NPs can even have (in many states) an independent medical practice and work without physician oversight. Also clinical psychiatric social worker (requires a MSW)–there’s huge critical shortage of these!

I would strongly recommend that you do some job shadowing–OTs, physicians, PAs, NPs, clinical psych & clinical social work to see what a day-in-the-life is like for each of these careers. Ask those whom you’re shadowing questions about job satisfaction and work/life balance. You might also ask about income, but tread lightly–it can be a touchy subject.

You’re still young and don’t need to make critical career choices just yet. Even if you take the “wrong” bio or chem class next year at BU, it’s not an irrecoverable issue. (A bad GPA isn’t either, but will take longer to fix.)

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bump

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@wayoutwestmom As far as family pressure, trust me I don’t have a lot. No one in my family has even suggested that I become a doctor, the only person that ever has pushed it on me is the boss of this fishing company I work at part-time, lol. It’s really a personal thing because I’ve begun to realize that all the books I love to read about psychological topics are written by M.D’s, my favorite author being Aaron Beck. So clearly, the people that know the topic most in-depth are M.D’s. I feel like I really could contribute a lot to the field of psychology and don’t want to be regretful of not even trying.I think shadowing is a really good idea and I’ll definitely try to set that up. I appreciate the careers you listed but my primary interest isn’t working with the mentally ill, it’s helping them to recover and trying to understand what went wrong. I don’t think i’d be satisfied with a career as a nurse.

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I want to correct a few of your misconceptions:

Helping an individual recover is working with the mentally ill.

Trying to understand what went wrong is primary the purview of academic research and not within the day-to-day practice of most psychiatrists.

Nurse practitioner (DNP) ≠ nurse.

A NP can diagnose and can treat low acuity and non-emergent medical issues independently and without being under the supervision of physician.

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Maybe I’m mistaken but clinical psych and psychiatry are much closer to each other than OT is to either. I was under the impression that OT is largely about getting people to be self sufficient with ADLS and IADLS. While you may work with people with psych disorders, ultimately you’re just trying to get them functioning, not really treating the psych disorder in essentially any capacity. A psychologist or a psychiatrist will be the ones actually diagnosing and working to treat the underlying disorder. It would be like the difference between a physical therapist and physiatrist/rheumatologist/orthopedist.

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“RE: Psychiatrist vs. psychologist – In 12 states clinical psychologists have limited prescribing rights. (That is, licensed clinical psychologists (PsyD or PhD) can prescribe psychoactive medications.) This trend [toward granting prescription rights] is accelerating since there is a national shortage of mental health treatment professionals.”

I agree that it is way too early to be picking a specialty, although I think I knew in eighth grade. It is also true that there are a growing number of non psychiatrists and non MD’s with prescribing privileges. In fact in the US most prescribing, maybe even 75 percent of it is done by primary care doctors.

While some people focus on the prescribing vs not-prescribing privileges, that to me, is the most superficial aspect of what we do. It is also about the nature of the evaluation and formulation of the problem. I think preferring to focus on the “body” rather than “the mind” is what you will need to discover in college. Yes, they are connected, but the coursework often has a different path, and you might find yourself more drawn toward one.

Finally, in my neck of the woods, finding someone to prescribe is rarely an issue. Everyone thinks they can do it. I’ve had folk go tell their pcp that their neighbor said they should have so-and-so, and that was the end of the evaluation. But finding someone good at doing evidence based therapies, and understanding how to understand and question the research and the literature is what COULD set a psychologist apart. A very rare bird around here.

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Do you want to counsel or manage medical treatment. At many of the clinics with which I am familiar, patients receive counseling from psychologists or social workers, and see the psychiatrist if meds are indicated (and speak with the psychiatrist only about the meds and whether or not they are managing symptoms).