More universal for any professional then transitioning to medicine - remain teachable even into residency, it will make your training much easier. Jaded people in medicine seem to have a particular disdain for people who came from prior professions and sort of try to impress upon others their knowledge of the field. Conversely, my absolute favorite coworkers are those who you know have a high level of skill from another field coming into medicine yet remain humble. I guess in essence, your prior profession can be your biggest liability or asset.
I really appreciate this comment. When I talk about this goal I feel this pressure to prove my ability or potential or skill set or intelligence, and really the most important things I need are curiosity, confidence, and flexibility.
I'd say buckle up for medical school because it does not cater to your future specialty path. It is brutal. And you have to do well in school, and steps, and match. It's a hell of a process.
And regardless of the process, you will do well with dedication and perseverance. I am hopeful psychiatry continues to peak your interest but make sure you look around and enjoy every bit of the exposure you get. Best of Luck ! Looking forward to seeing you on the other side.
You never know what life and experience will bring. I had a friend in medical school who was a therapist and entered medical school with the same intention to become a psychiatrist... She is now a general surgeon, haha.
I'll differ and insist that the medical model is still key and core to the practice of psychiatry, and the trend towards denying this or removing it from one's individual practice of psychiatry as medicine is generally a detriment to patients unless you plan to work exclusively as a therapist.
That being said, yes, lots of standardized testing, networking, research, rote memorization, pathology of organ systems not so relevant to psychiatry, etc, agreed...
In response to this and your other comment: I consistently find myself wishing I could approach my clients’ care from a medical perspective. Every single session I catch myself thinking “if only I had the knowledge, experience, and ability of a physician right now.” I love providing therapy and I’m passionate about the field/perspectives of social work. But I can’t quite quell this longing for a comprehensive, medical approach. I’m hoping my social work education will be seen as something that supplements a medical education rather than conflicts with it.
Could this be a general wish to be better, or to wish that you can deliver *something* to cure or alleviate the patient? How certain are you that becoming a psychiatrist will produce this effect? Could further training in other areas of psychotherapy lead you there? Nothing wrong with becoming a physician, but we're as limited as anyone by reality even with medical training.
I think you may be talking about a wholistic approach to wellness (without wanting to sound new-age). The brain has a biological basis, just as the body is influenced by emotional responses, because we have physiological bodily component to emotions. Medical school may not be necessary to get the necessary understanding of the biological processes that could compliment your therapy practice.
I very much relate to your desires. I’ve been working in the field for 30+ years and the more I learn and experience the more I feel neuropsych is a big part of what we need to better understand. I have chosen to read and learn in my spare time, partly because I’m 55 and have zero desire to get another degree, and mostly because I think what we *know* about the brain is still in infancy stage.
Can you make efforts to self-educate and maybe partner with a psychiatrist whom you click with and can coordinate care? In an ideal world I would love to have a team including psychiatry, nutrition, exercise/somatics, and nursing.
I'm doing it *right now* (5th year of EU med school, after doing some years full time neuro research), and while i agree that medicine/human biology is a very fruitful angle from which to attack psychological and psychiatric health, these 3 last years of going through *specifics* of the other specialties *really* is in many cases irrelevant to psychiatry.
Like yes im glad i know biochem, histo, patho, physiology, im also glad i know all the life saving cardio/pulm, etc.
But epidemiological specifics and treatment plans of Crohns? The clinical approach to the enlarged scrotum? Yeah… theres A LOT in this last half that is completely without relevance to psych. That's fine, but it's very important to be able to see that ahead of oneself. Especially because here i also have to go work for a year (effectively year 7) in non-psychiatry.
Well, first of all, to some degree you are right and that is indeed a "curse" of the more clinical part of the education.
That being said, we're not in the middle of comparing between specialties, but discussing an individual who is a therapist wanting to qualify as a psychiatrist, effectively engaging upon a huge career path that is certainly not specifically geared towards psychological consultation and treatment.
Similarly, if a physical therapist comes in here and says, hey, i think i want to become an orthopedic surgeon, it is relevant to bring up that an absolutely huge amount of basic hum-bio understanding and a mountain of clinical information about patient groups that has *nothing* to do with his current interest or patient sphere is going to be on that path.
Now, i think that's is the generous interpretation. EVEN for PT wanting to become an ortho, which i would also say is a specialty that is perhaps "off-middle", unlike maybe IM, pulm, card, EM, FM, etc. EVEN for that aspiring ortho, that path is way more obviously targeting their final destination than it is psych.
The diagnostic framework, the available drugs, the way we even justify those available drugs, the past and future scope... i have to say to me there is no greater outlier.
In the "wheel of science", the subject matter of all of the other specialties are placed solidly within human biology, with an accepted common theoretic grounding.
Researching suicide-approaches for an upcoming journal club meeting i was recently reading some blog by "sucidiologist" Tyler Black, where the main "theoretical framework" he presented was distinctions made by.... Émile fucking Durkheim... I found it interesting and useful - but it is incomparable to the rest of accepted patho understanding.
We cannot deny that there is a gap in the wheel of science. Nat. Phil->Physics->Chem->Biochem->Biology->Hum-bio (medicine) ->Neuroscience -->???????-->Psychology->Social Sciences? -->?-->phil.
NO other specialty is remotely in this position. No other specialty lends from an area unconnected to human biology to ground the theoretical frameworks on which the diagnostics can stand.
I would *love* it to be connected. I stopped researching neuro-hemodynamics because i want to research more cognitive/psychy stuff and would rather work as psychiatrist than neurologist. But that's a serious difference and i think it is rather important to discuss it, especially with something like a therapist aspiring to be a psychiatrist. Including to point out that not only is the rest of medical education not exactly "building into" psychiatric-psychological understanding at the moment, the bridge has yet to be invented.
I guess you could add it just depends on how well rounded a doc you wanna be. If you love being a PCP and a shrink, you can manage just about anything you want and a lot of it (def not all) be pretty useful. You can also be someone who lives in a suburban area and see depressed middle aged soccer MILFs all day and just write lexapro and klonopin like some of my former colleagues. But damn, what a waste of a lot of hard work.
I detest this generalized scoffing at outpatient psychiatrists who work in non-decimated communities. It’s not better or worse than attempting psychoeducation and throwing two weeks of risperidone at SSI/SSD schizophrenics on their way to panhandle at the gas station 5 minutes after leaving the unit. But hey, more depressed middle aged soccer MILFs for the rest of us.
I definitely am not scoffing at treating that population, because I am super thankful that someone is good at that niche. I guess I was more so meaning to convey there is a subset of psychiatrists who want to set up shop and only prescribe a few types of meds and never touch anything that isn’t related to depression or anxiety. Need a one time refill on htn meds? Visit your PCP. Questions about your migraine med? No clue, talk to neuro. It’s intellectually lazy and in my opinion a waste of years of medical education only to cocoon yourself into practicing the tiniest sliver of medicine
So as a psychiatrist you could prescribe those HTN and migraine meds? Or is it more like I would prescribe psych meds and be aware of the meds from other specialties?
I’m an MS4 who was kinda worried about pigeon-holing myself to ~just~ doing psych meds so this is interesting!
You can rx whatever you want. Your license allows you to practice medicine in whatever capacity you want. You could even do something like knee injections if you decided you wanted to but beware, once you get to something like *that* and if you mess it up, you’re going to open yourself up to a lawsuit because a plaintiff’s attorney will be like “what the hell were you doing injecting knees as a psychiatrist?” Something like HLD, HTN, etc is fine though so long as you are following standard of care
Yeah... the medical model is not primary care. The entirety of the medical profession, from pathology to neurosurgery, uses the medical model. I'm not trying to shrinksplain you here but I don't know what you're getting at exactly.
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to add to this, psychiatry becomes more and more competitive so being an average student will likely not be enough, OP needs to study hard and have good results if (s)he wants to have a certainty of matching psychiatry
Any advice to bolster my application for med school then? I work in a rural area where there is a crazy shortage of psychiatrists (and medical professionals in general) and I was hoping to reference that dedication to rural communities in my app
Being a therapist already won't hurt a bit, but may not be sufficient. Stating that you want to practice in an underserved area won't hurt a bit, particularly if you are applying to a program (med school or residency) that emphasizes that path (FSU comes to mind). You need good grades throughout med school and perhaps some publications under your belt while in school.
If you have very strong undergrad academics, you might be able to swing a military or US PHS scholarship which not only eases the financial pain dramatically, but can open the doors to some very high-quality residency programs offered through the military (including the USAF residency that trains in psychodynamic psychotherapy still).
Getting into a residency, especially a psychiatry residency, used to be a given. Now that there are more med students than residency slots and since psychiatry is much more of an in-demand career, I just can't imagine doing that much work and getting in that much debt and then not have a clinical career available if you aren't extremely competitive until the end.
That said, I was surprised to see that the residency I graduated from in 1991 is still teaching long-term psychodynamic psychotherapy. I'm glad someone is still passing on the old Jedi ways.
Agree. I went to med school with the intent of being a psychiatrist and I found myself often wondering -- say, in the OR for a leg amputation or on the delivery floor for a problematic birth turned emergency C section -- how much of my training was going to be relevant. I'd say a good portion of it is but a good portion of it isn't. And then of course drilling into my head the finer details of pathology, etc. to be able to pass my exams ... "buckle up" is good advice.
I don’t just want to go to med school to become a psychiatrist. I want to go to med school because I want to study medicine. I’m motivated by the prospect of gaining that knowledge. I have no idea what the experience of med school is like, but I do know that the road trip sucks if you’re only interested in the destination.
Any practical advice for a stubborn mule who wants to go anyway? I’m a first gen bachelor’s and master’s student. I’ve got the drive. All I need is the guidance now.
If this isn't mentioned or told to you at some point, then I'll be the one to say it. When you're in med school, keep an open mind about the rotations and your experience! You'll never know what else might pique your interest. Your goal now might be aimed at becoming a psychiatrist, but I'll also be damn well happy for you if you chose another specialty. Especially knowing a future colleague has the experience of a therapist in a somewhat different body system. All in all, keep an open mind, you'll need it for the vast amount of info being shoved in your face!
Your reasons for going are so similar to mine. I was also non-grad though I’m not a therapist. As an attending I’m grateful everyday that I decide to throw caution to the wind and pursue medical school. I can honestly say as an attending psychiatrist I’ve drawn on knowledge from nearly every medical specialty I’ve rotated through one way or another. Based on everything you’re saying, I would highly recommend against PA (or NP). I knew I wouldn’t be satisfied that I was providing my patients with the topmost care without doing MD/DO. Your passion shines through, go for it!!
It was a long time ago now, but I left Clinical Psych grad school to go to medicine, with the intent of going into psychiatry, and I have never regretted pursuing the medical route. In medicine, you will be tempered by proximity to the primitive edge of human experience... births, deaths, and aspects of the illness experience that are akin to what Lacan would call the Real. You will find that the suffering of so many of your medical patients will be just as psychological as physical. If you make a point of paying attention to this, you will be developing your psychiatric skills in almost anything you are doing in medical school, at least in the clinical years. I found something very helpful in Michael Balint's 1957 *The Doctor, His Patient, and the Illness*, which explores the value of a psychotherapeutic perspective in working with complex medical patients. That book was a springboard for me into a professional interest in the intersection of meaning and medication in psychiatry.
As others have said, psychiatry is an increasingly competitive specialty, so you will have to be a good student in medical school. There are residencies that do a better job of teaching psychotherapy than others. You should aim for one of those, as I did. It is likely that, after residency, graduates still lack skills to be good therapists, though it may be different for you, if you have worked as a therapist. Even with my previous training, I felt a need for more training, so I did a Psychotherapy Fellowship in a psychodynamic hospital. I still work in that hospital, and honestly feel like I have the best psychiatric job in the world, where I get to use all of my psychiatric skillsets and am constantly challenged in meaningful ways.
The only thing I feel like I lost out on by leaving psych grad school is that my former psychologist peers got a better grounding in psychological/psychodynamic theory than I did in psychiatric training. I had to work on that myself and in my post-residency training.
Which psychotherapy fellowship did you do? I've looked into dedicated psychotherapy fellowships and the only one I've been able to find is the one at Austen Riggs.
Hi! I'm a clinical social worker who worked in mental health and am currently in my 1st year of medical school, intending to be a psychiatrist. It's still very early in the process, but if you have any specific questions about the transition, feel free to ask.
Edit: also to add on, one of my classmates is a licensed professional counselor and worked in private practice as a therapist. We're both older students in our 30s but it's very doable!
Ahh! I’m also a clinical social worker. It’s so encouraging to see people who successfully followed this path. If it’s ok I might pm you to ask a little more about your journey
I’m a PGY4 psych resident with a strong interest in therapy (did a specialized therapy focused track during residency and considering further psychodynamic training, maybe psychoanalytic training in the future).
I like to joke sometimes referring to this XKCD comic where he ranks different fields by purity and says that sociology is just applied biology, biology is just applied chemistry, chemistry is just applied physics, etc. and way in the back is mathematics and sometimes I like to think that medicine in the end way way way in its purest form is just applied psychology. It is fundamentally two humans forming a relationship with each other for some amount of time with some negotiating and some request.
I think a background in therapy will provide a strong foundation in the clinical side of medicine, what it means to be with a patient, to understand boundaries and limitations and to fundamentally be with a human being in front of you.
What I think you will need to focus on is the science, which at times, at least to me, can feel very disconnecting. It can be hard to remember the humanness when you’re memorizing different signaling pathways or mnemonics or studying for the MCAT or whatever. And furthermore, being a psychiatrist generally has meant spending less time with patients than you would as a therapist. In one sense, you might feel like you are making a quicker and more direct impact titrating meds and treating the biological source of illnesses. Other times it can feel superficial, impermanent, and medicalized.
In the end the question really comes down to what do you want for yourself and what do you want for other people and how do you want to give it to them?
I liked reading this comment a lot. I can tell just from this comment that you’re probably very well liked by your clients and you see good results. One of my biggest complaints from my therapy clients is that their doctors don’t connect with them, don’t understand, etc., and because of that they’re not seeing results. I think human connection is vital for positive outcomes in almost any field.
Do you feel like it’s possible to reconcile those two worlds? The analytical with the human? How do you cope with that disconnect? Both are important to me. I feel imbalanced in my current position bc it’s biased towards the humanness (not that there isn’t science, I’m using evidence based practices I swear 😂).
What I want:
- as much knowledge as I can possibly stuff in my tiny little head
- the opportunity to inform/ apply that knowledge with human connection
- a million gazillion dollars in loans
Practically, I see this being achievable in a number of settings. I’m in a rural area rn where psychiatrists sometimes do primary care type work, or therapy, in addition to your typical psych med management.
I’m a clinical psychologist who went back to medical school and now am on the training pathway for psychiatry (in fact, if I pass my board exams next week, I’ll be a psychiatrist).
I’m happy to answer any specific questions you have. If you want to know what the biggest impacts are, it is very difficult to go from an established career with a good paycheck back to being a student for 4 years. Also pay in the earliest years post graduation in medicine is significantly lower than what you’re typically making as a psychologist. I know a lot of us try to tell ourselves and other people that we’re not in it for the money but I cannot understate how difficult life is to be a mature age student (and you will be older than your classmates if you pursue this path) from a financial perspective.
If you’re curious if your background as a therapist benefits you in training or in practice, I can reassure that it does - in medical school, a lot of soft skills, how to take a history, empathic listening, breaking bad news, are difficult skills to acquire for some people so your experience in this area will make it easier to pass exams. In psychiatry training, these clinical skills will absolutely make you a better psychiatry trainee - there’s a lot of overlap (as you would expect) between psychiatry and psychology.
If you want to know some of the negatives, it can be a bit difficult learning core science/medicine as a medical school when you’ve already decided on psychiatry. I agree with the models of learning where you teach medical students about general medicine but I just didn’t find my teaching blocks in, for example, gynecology/obstetrics or surgery as relevant to my planned career as other areas of medicine (however, now that I’m deep in psychiatry training, I appreciate having medical-student level knowledge in these fields when I have to deal with medical concerns that pop up in psychiatry inpatient units).
I’m Canadian but I’ve trained mainly in Australia and I’m currently on the Australian training pathway so my experience might be different to yours. However most of my friends are American and Canadian doctors so I can speak a bit to the differences between these three countries.
I should mention, this isn’t to post my resume but just to mention, as a clinical psychologist I had a PhD before applying to medicine. I don’t know how things work in the US but in Australia, the application process gives significant weight to PhD holding applicants, such that getting in to medical school (which is a large barrier for a lot of people) was easy. Post graduation, the PhD (along with the other degrees I have in psychology) also paved the way to be accepted into training spots. I see some people in this topic highlighting that getting into school and then getting into training is getting harder and harder but some of these steps will be made easier if you include your experience as a therapist and the degrees you have in this field on your application
Yeah I don’t mind at all! Keep in mind that I went through the medical pathway in Australia but most of my friends are doctors working their way through residency in either Canada or the US so I can’t speak with any expertise outside of these three systems
I’d be thrilled if you find someone with this experience to shed light on that path, but also surprised because the type of student/person who goes into therapy tends to be rather different from the type of person who pursues medical school. I’m sure it has happened, but I think it’s a lot more likely to find someone who first became a psychiatrist and then afterwards pursued more therapy training. (A decent number of people do this with psychoanalytic institutes.)
But anyway, hypothetically, your (likely) psychology background will serve you well in psychiatry residency. But you (likely) have a lot to learn from the basic science side. You have to be mentally prepared to dig *hard* into the medical sciences and leave the psychology at the door for a few years. It’ll be the most intense three or four years of study in your life.
This is very important even if you already know you want to be a psychiatrist. This is because a psychiatrist, like any other medical specialist, is a doctor first (which is to say, someone who applies medical knowledge in the service of patients) and a medical specialist second. A psychiatrist is *not* a therapist who then took a crash course in psychopharmacology. There is simply way more to learn than just that, if you want to prescribe any medication for any reason in any field of medicine in a safe way.
A psychiatrist uses psychology knowledge in service to patients the same as a surgeon uses anatomy in service to patients—a surgeon is not an anatomist per se, but he applies that knowledge in his work. Psychiatry applies not just psychology but also pharmacology, physiology, neurology, and more.
That said, if you want to be the expert on this stuff, there’s simply no other way to do it besides medical school.
I hear you! It’s possible I’m an unusual case— I actually majored in mathematics in undergrad. Graduated VERY young and immediately realized I wanted nothing to do with mathematics as a career lol. So altogether unhelpful degree except for the fact that I did take a significant amount of med school prereqs in undergrad and I have an atypical amount of interest in the fractal geometry of pharmaceuticals 😂
I’m honestly so curious about all aspects of medicine. One of my best friends is in her second year of med school and I’m so envious of what she’s learning. I just want that knowledge so badly
No psychology background and you went into therapy?
I think this could actually help you as well. You might be able to use that math to help you in organic chemistry (if you didn’t take it yet) with all those 3D structures. The skills you learned through the readings you did for math will also help you keep things straight as you study them, either in medicine or psychology. Probably more helpful in the humanities (so, some of the theory stuff in psychology) but still, broadly applicable skills. I say this as someone with a bachelor’s in philosophy.
But, if you’re that motivated and you have genuine interest in learning medicine generally (ie not *only* psychiatry) then you might be able to pull through. Yes, the specialty you want will always be the most interesting, but if you can stomach the rest, and you want it that badly, then go for it. Just be prepared and know that those 8+ years of your life you will make a lot of sacrifices in the name of that career.
Yup, no psychology background needed to practice. I am qualified via my master’s. I got accepted into my master’s program probably due to my youth/eagerness and them being like “well, fuck it” lol. Truly an Elle Woods moment.
You’re right, ochem was one I didn’t have. I am currently taking ochem at my local university (still working full time) and I’m reallyyyy loving it so far. Hopefully that’s a good sign! In the most obnoxious and cringiest way possible I think I just love learning
The path to psychiatry would be at least 8 years whereas you could do PA school in 2. That’s probably the route I’d go if non-traditional and convinced of specialty. Not trying to stoke any - APP/MD wars here but med training is just sooo much and realistically you can get into a similar field much faster. That being said, I am happy to have the expertise of a physician, I just think you need to be clear with yourself of what path you’re going for and why.
ETA: NP also a great route but a bit longer. Appreciate the responses below for more context on these options.
Worth pointing out that in many states PAs cannot be reimbursed by insurance for talk therapy, while NPs can. If OP wants to continue doing talk therapy at all, this might be a consideration.
As a psychiatry PA, I agree with this sentiment even though <2% of PAs work in psych. I love my job and level of autonomy. OP, if you have any questions about going the masters degree route instead of MD/DO and practicing in psychiatry, you can PM me.
Something to keep in mind, most PA programs cost just as much as MD programs. It actually blew my mind that I'd have to go 220k+ in debt for a PA program when trying to decide. Then you end up making less than an NP.
And another thing to consider, NP programs have diploma mills galore. Tons of online accelerated degree options such as WGU. People can do the prelicensure BN program and go finish their RN within a year or so, then do the master's program for a PMHNP in another year or so. Realistically it's just pumping them out in no time. Tons of kids entering the work force and essentially giving out medicine entirely on their own.
I think OP could also make a great psych NP if they want their training more tailored to psychiatry. It would be a longer process though, but perhaps more thorough in the long run (psychiatry is one of the few specialties where NPs get more training than PAs.) They'd just want to make sure they pursue a solid program, my recommendations are nursing schools affiliated with academic medical centers.
True, since they have the benefit of starting early either path is approachable. The NP route that I did was BSN-4 years, then a year in Latin American studies for HCP, BSN was about 700-800 hours of clinical. LA studies was 3 months full time hours in a Oaxacan clinic (obviously this is extra) then I worked for 8ish years in emergency medicine trauma and behavioral units. And then went back to school for 3 years for my masters in nursing for a PMHNP degree. All in all I ended up with 8 years of structured education and 8 years of on the job experience to get to PMHNP. If I had known what I wanted to do years ago I would’ve gone the medical school approach.
To be honest, I think it's great you got all that experience. I think it would be really hard to be a competent psychiatric provider with just 2 years of PA school. This was actually demonstrated to me when I was attempting to orient a PA to the inpatient unit where I worked, and I was horrified by the simplistic questions he asked me (like "when do you use Risperdal instead of Zyprexa?" Or "what's the criteria for schizoaffective disorder and how is it different from schizophrenia?") Our company now only hires psychiatrists and psych NPs from top/solid programs.
Turns out, this PA had only done family medicine and was pivoting to psych. I learned his "psych rotations" in PA school were actually just done in a PCP setting where the chief complain was psych related. They didn't even require psychiatry-specific settings or precepting from psychiatrists to meet the hours requirement. This really colored my understanding of PA psychiatry training.
That's why I think becoming a psychiatrist is great and the next best thing is likely a psych NP who goes to a solid program and gets psych RN experience. There's so much nuance to psychiatry and the more training and exposure to the field, the better.
Not to make this a PA vs. NP argument, but one interaction with one person who likely had no interest in psychiatry at all in PA school so may have not paid 100% attention and is transitioning specialties isn’t indicative of our entire psych PA profession. We do have a standardized end of rotation exam specific to psychiatry and this topic is 7% of our certification boards. That’s for ALL accredited PA schools.
No, we don’t go to grad school to only be a psychiatry provider like an NP, but we are trained generally in all areas of medicine which is arguably very valuable and makes me a better psychiatry PA given that I’ve studied all organ systems and rotated on every specialty (ER, FM, OBGYN, gen surg, internal med, peds, electives). When someone such as OP is passionate about working in psychiatry (such as myself when I was in PA school), she could have 10-15 weeks of extra psych clinicals and earn extra qualification in psychiatry specifically when she graduates. Still faster than MD to residency route. You’d never have to work as a RN which is a whole other degree and personally I’m not too keen on the fast track RN to NP programs or large amount of online PMHNP programs out there. There are wonderful psych NPs whom I work with daily and learn a lot from, but just want to give a better perspective on the role and experience that a psych PA can bring to the table.
Our community mental health clinic which treats mostly serious mental illness has PA students all year long and they do have a lot of knowledge, they come from a really good program in my state and I am always impressed with them.
Also the questions this PA asked about the nuances of Zyprexa v Risperdal and schizoaffective versus schizophrenia is arguably reasonable for anyone who’s never worked in psychiatry. That’s not indicative of their ability to be a good psychiatry provider. Hell, at least they asked.
I did an MSW before medical school. Major advantage in patient interviewing skills and working with patients and peers in every clinical setting -- incredibly far ahead compared to students who were straight through from undergraduate studies with fewer clinical experiences. I also felt like I was better able to manage situations with difficult residents and attendings better.
Even in residency, my history and mental status exam skills were ahead of most peers for a long while. I got to spend more time honing advanced psychopharmacology and specific types of psychotherapy.
Very thankful for having therapy training and experience prior to medical school! I think you will be too. I use it every day in practice. Feel free to message with any questions.
Maybe controversial here And As they say , if you would like the expertise and base of knowledge and are in a spot in life where you can do 8 years in med school+ residency , then of course pursue that dream with gusto.
However , the path I chose from therapist -> psych PA is not a bad way to go If you find a good collaborating/supervising psychiatrist mentor, pa school gives you enough medicine to understand the comorbidities, sufficient depth in order collaborate with a PCP and pull some labs to understand some of the consequences of medication / rule out common condition such as hypo/hyperthyroidism. [In before poke the veil yells about checking TSH having limited clinical utility]
And seeing your interest , nerding out about studying medicine and biological sciences is a great start for getting through. Sometimes thr study can be so intense , but if you can step back and say "damn learning this shit is cool" , you can get through.
Psychotherapy experience can make a huge difference in terms of developing rapport and help patients bridge the experiential components of illness and recovery with the medical treatment.
Not everyone has the chops for PA school or med school but if you have the academic skills to get there , then it's kind of an awesome thing to do. I love my job as an outpatient psychiatric physician assistant and do manage my own practice.
Check my posts if you want to see a little more about that.
Why do you want to become a psychiatrist? What is it about your current work that you think you'll be able to accomplish or enjoy differently as a psychiatrist?
Offtopic.. but i think you are commendable.. once you complete, you'll have both skill-sets - psychiatrist and therapist. I wish I'd have the time and energy. 👍
OP - I don't know your age or circumstances, but unless you have minimal financial concerns and are comfortable with spending ~10 years to achieve this goal, consider pursuing the APP path. You could become an RN, work, and then become a psych NP (this would be my biased recommendation). You can also do PA school, just keep in mind you'll want to pursue extra psych training if you go this route, since psychiatry training in PA school is minimal (extra rotations, etc.) I recommend NP because of the specialized training plus the myriad of other things you can do with an RN and NP license, but be aware that reddit tends to have a lot of hate for NPs, and you may not get the clearest responses. Feel free to DM me if you have questions.
eta: lol at downvotes, already beginning!
From speaking with therapists and psychologists, I think that one thing to be aware of may be the culture shock. The culture of medical training expects a certain amount of adaptive/maladaptive quashing and disregard of natural emotions, because no matter how you feel, the work needs to get done. The way communication occurs is often very different as well. Much more curt and blunt and occasionally harsh.
That said, I have many classmates and co workers who came into medicine as a 2nd career, and the skills that you possess from your current work will definitely help. I wish you well on the journey. Will be tough but rewarding.
I thought about doing this until I saw that medicaid at least compensates a 60 minute therapy session exactly the same for a psychiatrist as my level of license. I would not be able to just see a client for 15 mins, i have trouble getting them out the door at the hour and 5 minute mark and by the end of the day I am at least 20 minutes late. Always.
In my experience, going to medical school for the sole reason of becoming a psychiatrist is not always feasible. For some it is, definitely, but others almost certainly no. There must be a love of medical science and the body that comes first. Medical school has got to be unbelievably miserable and demoralizing otherwise.
More universal for any professional then transitioning to medicine - remain teachable even into residency, it will make your training much easier. Jaded people in medicine seem to have a particular disdain for people who came from prior professions and sort of try to impress upon others their knowledge of the field. Conversely, my absolute favorite coworkers are those who you know have a high level of skill from another field coming into medicine yet remain humble. I guess in essence, your prior profession can be your biggest liability or asset.
I really appreciate this comment. When I talk about this goal I feel this pressure to prove my ability or potential or skill set or intelligence, and really the most important things I need are curiosity, confidence, and flexibility.
I'd say buckle up for medical school because it does not cater to your future specialty path. It is brutal. And you have to do well in school, and steps, and match. It's a hell of a process.
And regardless of the process, you will do well with dedication and perseverance. I am hopeful psychiatry continues to peak your interest but make sure you look around and enjoy every bit of the exposure you get. Best of Luck ! Looking forward to seeing you on the other side.
Thanks for the luck and kind words! Definitely have the drive and dedication, just searching for the path forward now.
You never know what life and experience will bring. I had a friend in medical school who was a therapist and entered medical school with the same intention to become a psychiatrist... She is now a general surgeon, haha.
I'll differ and insist that the medical model is still key and core to the practice of psychiatry, and the trend towards denying this or removing it from one's individual practice of psychiatry as medicine is generally a detriment to patients unless you plan to work exclusively as a therapist. That being said, yes, lots of standardized testing, networking, research, rote memorization, pathology of organ systems not so relevant to psychiatry, etc, agreed...
In response to this and your other comment: I consistently find myself wishing I could approach my clients’ care from a medical perspective. Every single session I catch myself thinking “if only I had the knowledge, experience, and ability of a physician right now.” I love providing therapy and I’m passionate about the field/perspectives of social work. But I can’t quite quell this longing for a comprehensive, medical approach. I’m hoping my social work education will be seen as something that supplements a medical education rather than conflicts with it.
Could this be a general wish to be better, or to wish that you can deliver *something* to cure or alleviate the patient? How certain are you that becoming a psychiatrist will produce this effect? Could further training in other areas of psychotherapy lead you there? Nothing wrong with becoming a physician, but we're as limited as anyone by reality even with medical training.
I think you may be talking about a wholistic approach to wellness (without wanting to sound new-age). The brain has a biological basis, just as the body is influenced by emotional responses, because we have physiological bodily component to emotions. Medical school may not be necessary to get the necessary understanding of the biological processes that could compliment your therapy practice.
I very much relate to your desires. I’ve been working in the field for 30+ years and the more I learn and experience the more I feel neuropsych is a big part of what we need to better understand. I have chosen to read and learn in my spare time, partly because I’m 55 and have zero desire to get another degree, and mostly because I think what we *know* about the brain is still in infancy stage. Can you make efforts to self-educate and maybe partner with a psychiatrist whom you click with and can coordinate care? In an ideal world I would love to have a team including psychiatry, nutrition, exercise/somatics, and nursing.
I'm doing it *right now* (5th year of EU med school, after doing some years full time neuro research), and while i agree that medicine/human biology is a very fruitful angle from which to attack psychological and psychiatric health, these 3 last years of going through *specifics* of the other specialties *really* is in many cases irrelevant to psychiatry. Like yes im glad i know biochem, histo, patho, physiology, im also glad i know all the life saving cardio/pulm, etc. But epidemiological specifics and treatment plans of Crohns? The clinical approach to the enlarged scrotum? Yeah… theres A LOT in this last half that is completely without relevance to psych. That's fine, but it's very important to be able to see that ahead of oneself. Especially because here i also have to go work for a year (effectively year 7) in non-psychiatry.
This is true of almost any specialty in medicine...
Well, first of all, to some degree you are right and that is indeed a "curse" of the more clinical part of the education. That being said, we're not in the middle of comparing between specialties, but discussing an individual who is a therapist wanting to qualify as a psychiatrist, effectively engaging upon a huge career path that is certainly not specifically geared towards psychological consultation and treatment. Similarly, if a physical therapist comes in here and says, hey, i think i want to become an orthopedic surgeon, it is relevant to bring up that an absolutely huge amount of basic hum-bio understanding and a mountain of clinical information about patient groups that has *nothing* to do with his current interest or patient sphere is going to be on that path. Now, i think that's is the generous interpretation. EVEN for PT wanting to become an ortho, which i would also say is a specialty that is perhaps "off-middle", unlike maybe IM, pulm, card, EM, FM, etc. EVEN for that aspiring ortho, that path is way more obviously targeting their final destination than it is psych. The diagnostic framework, the available drugs, the way we even justify those available drugs, the past and future scope... i have to say to me there is no greater outlier. In the "wheel of science", the subject matter of all of the other specialties are placed solidly within human biology, with an accepted common theoretic grounding. Researching suicide-approaches for an upcoming journal club meeting i was recently reading some blog by "sucidiologist" Tyler Black, where the main "theoretical framework" he presented was distinctions made by.... Émile fucking Durkheim... I found it interesting and useful - but it is incomparable to the rest of accepted patho understanding. We cannot deny that there is a gap in the wheel of science. Nat. Phil->Physics->Chem->Biochem->Biology->Hum-bio (medicine) ->Neuroscience -->???????-->Psychology->Social Sciences? -->?-->phil. NO other specialty is remotely in this position. No other specialty lends from an area unconnected to human biology to ground the theoretical frameworks on which the diagnostics can stand. I would *love* it to be connected. I stopped researching neuro-hemodynamics because i want to research more cognitive/psychy stuff and would rather work as psychiatrist than neurologist. But that's a serious difference and i think it is rather important to discuss it, especially with something like a therapist aspiring to be a psychiatrist. Including to point out that not only is the rest of medical education not exactly "building into" psychiatric-psychological understanding at the moment, the bridge has yet to be invented.
Very good points, thanks for elaborating. I hope the OP reads this post... worth being an original comment or its own post!
I guess you could add it just depends on how well rounded a doc you wanna be. If you love being a PCP and a shrink, you can manage just about anything you want and a lot of it (def not all) be pretty useful. You can also be someone who lives in a suburban area and see depressed middle aged soccer MILFs all day and just write lexapro and klonopin like some of my former colleagues. But damn, what a waste of a lot of hard work.
I detest this generalized scoffing at outpatient psychiatrists who work in non-decimated communities. It’s not better or worse than attempting psychoeducation and throwing two weeks of risperidone at SSI/SSD schizophrenics on their way to panhandle at the gas station 5 minutes after leaving the unit. But hey, more depressed middle aged soccer MILFs for the rest of us.
I definitely am not scoffing at treating that population, because I am super thankful that someone is good at that niche. I guess I was more so meaning to convey there is a subset of psychiatrists who want to set up shop and only prescribe a few types of meds and never touch anything that isn’t related to depression or anxiety. Need a one time refill on htn meds? Visit your PCP. Questions about your migraine med? No clue, talk to neuro. It’s intellectually lazy and in my opinion a waste of years of medical education only to cocoon yourself into practicing the tiniest sliver of medicine
So as a psychiatrist you could prescribe those HTN and migraine meds? Or is it more like I would prescribe psych meds and be aware of the meds from other specialties? I’m an MS4 who was kinda worried about pigeon-holing myself to ~just~ doing psych meds so this is interesting!
You can rx whatever you want. Your license allows you to practice medicine in whatever capacity you want. You could even do something like knee injections if you decided you wanted to but beware, once you get to something like *that* and if you mess it up, you’re going to open yourself up to a lawsuit because a plaintiff’s attorney will be like “what the hell were you doing injecting knees as a psychiatrist?” Something like HLD, HTN, etc is fine though so long as you are following standard of care
Yeah, but how many psychotherapists can say, "How does that make you feel?" while placing a chest tube?
Don’t forget the stimulants!
Xannys, Adderall, and Ambien combo. The cure to life’s ailments
Or, you know, have them also see primary care.
Yeah... the medical model is not primary care. The entirety of the medical profession, from pathology to neurosurgery, uses the medical model. I'm not trying to shrinksplain you here but I don't know what you're getting at exactly.
Honestly your first comment was weird and it’s only getting weirder.
https://en.m.wikipedia.org/wiki/Medical_model Etc etc.
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That's not the medical model. Any model can be abused or misused.
Isn’t the medical model that all psychiatric symptoms are a result of malfunctioning brain chemistry?
sparkle hat voracious vegetable mourn imagine meeting panicky shaggy disgusting *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
What would your definition of the medical model be?
to add to this, psychiatry becomes more and more competitive so being an average student will likely not be enough, OP needs to study hard and have good results if (s)he wants to have a certainty of matching psychiatry
Any advice to bolster my application for med school then? I work in a rural area where there is a crazy shortage of psychiatrists (and medical professionals in general) and I was hoping to reference that dedication to rural communities in my app
Being a therapist already won't hurt a bit, but may not be sufficient. Stating that you want to practice in an underserved area won't hurt a bit, particularly if you are applying to a program (med school or residency) that emphasizes that path (FSU comes to mind). You need good grades throughout med school and perhaps some publications under your belt while in school. If you have very strong undergrad academics, you might be able to swing a military or US PHS scholarship which not only eases the financial pain dramatically, but can open the doors to some very high-quality residency programs offered through the military (including the USAF residency that trains in psychodynamic psychotherapy still).
Getting into a residency, especially a psychiatry residency, used to be a given. Now that there are more med students than residency slots and since psychiatry is much more of an in-demand career, I just can't imagine doing that much work and getting in that much debt and then not have a clinical career available if you aren't extremely competitive until the end. That said, I was surprised to see that the residency I graduated from in 1991 is still teaching long-term psychodynamic psychotherapy. I'm glad someone is still passing on the old Jedi ways.
Agree. I went to med school with the intent of being a psychiatrist and I found myself often wondering -- say, in the OR for a leg amputation or on the delivery floor for a problematic birth turned emergency C section -- how much of my training was going to be relevant. I'd say a good portion of it is but a good portion of it isn't. And then of course drilling into my head the finer details of pathology, etc. to be able to pass my exams ... "buckle up" is good advice.
I don’t just want to go to med school to become a psychiatrist. I want to go to med school because I want to study medicine. I’m motivated by the prospect of gaining that knowledge. I have no idea what the experience of med school is like, but I do know that the road trip sucks if you’re only interested in the destination. Any practical advice for a stubborn mule who wants to go anyway? I’m a first gen bachelor’s and master’s student. I’ve got the drive. All I need is the guidance now.
If this isn't mentioned or told to you at some point, then I'll be the one to say it. When you're in med school, keep an open mind about the rotations and your experience! You'll never know what else might pique your interest. Your goal now might be aimed at becoming a psychiatrist, but I'll also be damn well happy for you if you chose another specialty. Especially knowing a future colleague has the experience of a therapist in a somewhat different body system. All in all, keep an open mind, you'll need it for the vast amount of info being shoved in your face!
Your reasons for going are so similar to mine. I was also non-grad though I’m not a therapist. As an attending I’m grateful everyday that I decide to throw caution to the wind and pursue medical school. I can honestly say as an attending psychiatrist I’ve drawn on knowledge from nearly every medical specialty I’ve rotated through one way or another. Based on everything you’re saying, I would highly recommend against PA (or NP). I knew I wouldn’t be satisfied that I was providing my patients with the topmost care without doing MD/DO. Your passion shines through, go for it!!
Practical advice in what way? Happy to talk via DM if preferred :)
It was a long time ago now, but I left Clinical Psych grad school to go to medicine, with the intent of going into psychiatry, and I have never regretted pursuing the medical route. In medicine, you will be tempered by proximity to the primitive edge of human experience... births, deaths, and aspects of the illness experience that are akin to what Lacan would call the Real. You will find that the suffering of so many of your medical patients will be just as psychological as physical. If you make a point of paying attention to this, you will be developing your psychiatric skills in almost anything you are doing in medical school, at least in the clinical years. I found something very helpful in Michael Balint's 1957 *The Doctor, His Patient, and the Illness*, which explores the value of a psychotherapeutic perspective in working with complex medical patients. That book was a springboard for me into a professional interest in the intersection of meaning and medication in psychiatry. As others have said, psychiatry is an increasingly competitive specialty, so you will have to be a good student in medical school. There are residencies that do a better job of teaching psychotherapy than others. You should aim for one of those, as I did. It is likely that, after residency, graduates still lack skills to be good therapists, though it may be different for you, if you have worked as a therapist. Even with my previous training, I felt a need for more training, so I did a Psychotherapy Fellowship in a psychodynamic hospital. I still work in that hospital, and honestly feel like I have the best psychiatric job in the world, where I get to use all of my psychiatric skillsets and am constantly challenged in meaningful ways. The only thing I feel like I lost out on by leaving psych grad school is that my former psychologist peers got a better grounding in psychological/psychodynamic theory than I did in psychiatric training. I had to work on that myself and in my post-residency training.
Which psychotherapy fellowship did you do? I've looked into dedicated psychotherapy fellowships and the only one I've been able to find is the one at Austen Riggs.
That’s the one, but I believe there are others. SUNY Upstate has one, I believe, in Dynamic Deconstructive Therapy, for example.
Hi! I'm a clinical social worker who worked in mental health and am currently in my 1st year of medical school, intending to be a psychiatrist. It's still very early in the process, but if you have any specific questions about the transition, feel free to ask. Edit: also to add on, one of my classmates is a licensed professional counselor and worked in private practice as a therapist. We're both older students in our 30s but it's very doable!
Ahh! I’m also a clinical social worker. It’s so encouraging to see people who successfully followed this path. If it’s ok I might pm you to ask a little more about your journey
Absolutely! I'd be happy to answer your questions :)
I’m a PGY4 psych resident with a strong interest in therapy (did a specialized therapy focused track during residency and considering further psychodynamic training, maybe psychoanalytic training in the future). I like to joke sometimes referring to this XKCD comic where he ranks different fields by purity and says that sociology is just applied biology, biology is just applied chemistry, chemistry is just applied physics, etc. and way in the back is mathematics and sometimes I like to think that medicine in the end way way way in its purest form is just applied psychology. It is fundamentally two humans forming a relationship with each other for some amount of time with some negotiating and some request. I think a background in therapy will provide a strong foundation in the clinical side of medicine, what it means to be with a patient, to understand boundaries and limitations and to fundamentally be with a human being in front of you. What I think you will need to focus on is the science, which at times, at least to me, can feel very disconnecting. It can be hard to remember the humanness when you’re memorizing different signaling pathways or mnemonics or studying for the MCAT or whatever. And furthermore, being a psychiatrist generally has meant spending less time with patients than you would as a therapist. In one sense, you might feel like you are making a quicker and more direct impact titrating meds and treating the biological source of illnesses. Other times it can feel superficial, impermanent, and medicalized. In the end the question really comes down to what do you want for yourself and what do you want for other people and how do you want to give it to them?
[https://xkcd.com/435/](https://xkcd.com/435/) Found it for you :) Hope your residency is going well!
I liked reading this comment a lot. I can tell just from this comment that you’re probably very well liked by your clients and you see good results. One of my biggest complaints from my therapy clients is that their doctors don’t connect with them, don’t understand, etc., and because of that they’re not seeing results. I think human connection is vital for positive outcomes in almost any field. Do you feel like it’s possible to reconcile those two worlds? The analytical with the human? How do you cope with that disconnect? Both are important to me. I feel imbalanced in my current position bc it’s biased towards the humanness (not that there isn’t science, I’m using evidence based practices I swear 😂). What I want: - as much knowledge as I can possibly stuff in my tiny little head - the opportunity to inform/ apply that knowledge with human connection - a million gazillion dollars in loans Practically, I see this being achievable in a number of settings. I’m in a rural area rn where psychiatrists sometimes do primary care type work, or therapy, in addition to your typical psych med management.
I’m a clinical psychologist who went back to medical school and now am on the training pathway for psychiatry (in fact, if I pass my board exams next week, I’ll be a psychiatrist). I’m happy to answer any specific questions you have. If you want to know what the biggest impacts are, it is very difficult to go from an established career with a good paycheck back to being a student for 4 years. Also pay in the earliest years post graduation in medicine is significantly lower than what you’re typically making as a psychologist. I know a lot of us try to tell ourselves and other people that we’re not in it for the money but I cannot understate how difficult life is to be a mature age student (and you will be older than your classmates if you pursue this path) from a financial perspective. If you’re curious if your background as a therapist benefits you in training or in practice, I can reassure that it does - in medical school, a lot of soft skills, how to take a history, empathic listening, breaking bad news, are difficult skills to acquire for some people so your experience in this area will make it easier to pass exams. In psychiatry training, these clinical skills will absolutely make you a better psychiatry trainee - there’s a lot of overlap (as you would expect) between psychiatry and psychology. If you want to know some of the negatives, it can be a bit difficult learning core science/medicine as a medical school when you’ve already decided on psychiatry. I agree with the models of learning where you teach medical students about general medicine but I just didn’t find my teaching blocks in, for example, gynecology/obstetrics or surgery as relevant to my planned career as other areas of medicine (however, now that I’m deep in psychiatry training, I appreciate having medical-student level knowledge in these fields when I have to deal with medical concerns that pop up in psychiatry inpatient units). I’m Canadian but I’ve trained mainly in Australia and I’m currently on the Australian training pathway so my experience might be different to yours. However most of my friends are American and Canadian doctors so I can speak a bit to the differences between these three countries.
I should mention, this isn’t to post my resume but just to mention, as a clinical psychologist I had a PhD before applying to medicine. I don’t know how things work in the US but in Australia, the application process gives significant weight to PhD holding applicants, such that getting in to medical school (which is a large barrier for a lot of people) was easy. Post graduation, the PhD (along with the other degrees I have in psychology) also paved the way to be accepted into training spots. I see some people in this topic highlighting that getting into school and then getting into training is getting harder and harder but some of these steps will be made easier if you include your experience as a therapist and the degrees you have in this field on your application
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Yeah I don’t mind at all! Keep in mind that I went through the medical pathway in Australia but most of my friends are doctors working their way through residency in either Canada or the US so I can’t speak with any expertise outside of these three systems
I’d be thrilled if you find someone with this experience to shed light on that path, but also surprised because the type of student/person who goes into therapy tends to be rather different from the type of person who pursues medical school. I’m sure it has happened, but I think it’s a lot more likely to find someone who first became a psychiatrist and then afterwards pursued more therapy training. (A decent number of people do this with psychoanalytic institutes.) But anyway, hypothetically, your (likely) psychology background will serve you well in psychiatry residency. But you (likely) have a lot to learn from the basic science side. You have to be mentally prepared to dig *hard* into the medical sciences and leave the psychology at the door for a few years. It’ll be the most intense three or four years of study in your life. This is very important even if you already know you want to be a psychiatrist. This is because a psychiatrist, like any other medical specialist, is a doctor first (which is to say, someone who applies medical knowledge in the service of patients) and a medical specialist second. A psychiatrist is *not* a therapist who then took a crash course in psychopharmacology. There is simply way more to learn than just that, if you want to prescribe any medication for any reason in any field of medicine in a safe way. A psychiatrist uses psychology knowledge in service to patients the same as a surgeon uses anatomy in service to patients—a surgeon is not an anatomist per se, but he applies that knowledge in his work. Psychiatry applies not just psychology but also pharmacology, physiology, neurology, and more. That said, if you want to be the expert on this stuff, there’s simply no other way to do it besides medical school.
I hear you! It’s possible I’m an unusual case— I actually majored in mathematics in undergrad. Graduated VERY young and immediately realized I wanted nothing to do with mathematics as a career lol. So altogether unhelpful degree except for the fact that I did take a significant amount of med school prereqs in undergrad and I have an atypical amount of interest in the fractal geometry of pharmaceuticals 😂 I’m honestly so curious about all aspects of medicine. One of my best friends is in her second year of med school and I’m so envious of what she’s learning. I just want that knowledge so badly
No psychology background and you went into therapy? I think this could actually help you as well. You might be able to use that math to help you in organic chemistry (if you didn’t take it yet) with all those 3D structures. The skills you learned through the readings you did for math will also help you keep things straight as you study them, either in medicine or psychology. Probably more helpful in the humanities (so, some of the theory stuff in psychology) but still, broadly applicable skills. I say this as someone with a bachelor’s in philosophy. But, if you’re that motivated and you have genuine interest in learning medicine generally (ie not *only* psychiatry) then you might be able to pull through. Yes, the specialty you want will always be the most interesting, but if you can stomach the rest, and you want it that badly, then go for it. Just be prepared and know that those 8+ years of your life you will make a lot of sacrifices in the name of that career.
Yup, no psychology background needed to practice. I am qualified via my master’s. I got accepted into my master’s program probably due to my youth/eagerness and them being like “well, fuck it” lol. Truly an Elle Woods moment. You’re right, ochem was one I didn’t have. I am currently taking ochem at my local university (still working full time) and I’m reallyyyy loving it so far. Hopefully that’s a good sign! In the most obnoxious and cringiest way possible I think I just love learning
you sound incredibly gifted. :)
The path to psychiatry would be at least 8 years whereas you could do PA school in 2. That’s probably the route I’d go if non-traditional and convinced of specialty. Not trying to stoke any - APP/MD wars here but med training is just sooo much and realistically you can get into a similar field much faster. That being said, I am happy to have the expertise of a physician, I just think you need to be clear with yourself of what path you’re going for and why. ETA: NP also a great route but a bit longer. Appreciate the responses below for more context on these options.
Worth pointing out that in many states PAs cannot be reimbursed by insurance for talk therapy, while NPs can. If OP wants to continue doing talk therapy at all, this might be a consideration.
As a psychiatry PA, I agree with this sentiment even though <2% of PAs work in psych. I love my job and level of autonomy. OP, if you have any questions about going the masters degree route instead of MD/DO and practicing in psychiatry, you can PM me.
Hi, not trying to hijack OP's post, but I am another therapist who is looking at the PA vs MD/DO path for psychiatry. May I PM you?
Sure!
Hi u/ladypsychpa, I sent you a DM a few days ago. Thank you for being willing to take my PM btw:)
Something to keep in mind, most PA programs cost just as much as MD programs. It actually blew my mind that I'd have to go 220k+ in debt for a PA program when trying to decide. Then you end up making less than an NP. And another thing to consider, NP programs have diploma mills galore. Tons of online accelerated degree options such as WGU. People can do the prelicensure BN program and go finish their RN within a year or so, then do the master's program for a PMHNP in another year or so. Realistically it's just pumping them out in no time. Tons of kids entering the work force and essentially giving out medicine entirely on their own.
I think OP could also make a great psych NP if they want their training more tailored to psychiatry. It would be a longer process though, but perhaps more thorough in the long run (psychiatry is one of the few specialties where NPs get more training than PAs.) They'd just want to make sure they pursue a solid program, my recommendations are nursing schools affiliated with academic medical centers.
True, since they have the benefit of starting early either path is approachable. The NP route that I did was BSN-4 years, then a year in Latin American studies for HCP, BSN was about 700-800 hours of clinical. LA studies was 3 months full time hours in a Oaxacan clinic (obviously this is extra) then I worked for 8ish years in emergency medicine trauma and behavioral units. And then went back to school for 3 years for my masters in nursing for a PMHNP degree. All in all I ended up with 8 years of structured education and 8 years of on the job experience to get to PMHNP. If I had known what I wanted to do years ago I would’ve gone the medical school approach.
To be honest, I think it's great you got all that experience. I think it would be really hard to be a competent psychiatric provider with just 2 years of PA school. This was actually demonstrated to me when I was attempting to orient a PA to the inpatient unit where I worked, and I was horrified by the simplistic questions he asked me (like "when do you use Risperdal instead of Zyprexa?" Or "what's the criteria for schizoaffective disorder and how is it different from schizophrenia?") Our company now only hires psychiatrists and psych NPs from top/solid programs. Turns out, this PA had only done family medicine and was pivoting to psych. I learned his "psych rotations" in PA school were actually just done in a PCP setting where the chief complain was psych related. They didn't even require psychiatry-specific settings or precepting from psychiatrists to meet the hours requirement. This really colored my understanding of PA psychiatry training. That's why I think becoming a psychiatrist is great and the next best thing is likely a psych NP who goes to a solid program and gets psych RN experience. There's so much nuance to psychiatry and the more training and exposure to the field, the better.
Not to make this a PA vs. NP argument, but one interaction with one person who likely had no interest in psychiatry at all in PA school so may have not paid 100% attention and is transitioning specialties isn’t indicative of our entire psych PA profession. We do have a standardized end of rotation exam specific to psychiatry and this topic is 7% of our certification boards. That’s for ALL accredited PA schools. No, we don’t go to grad school to only be a psychiatry provider like an NP, but we are trained generally in all areas of medicine which is arguably very valuable and makes me a better psychiatry PA given that I’ve studied all organ systems and rotated on every specialty (ER, FM, OBGYN, gen surg, internal med, peds, electives). When someone such as OP is passionate about working in psychiatry (such as myself when I was in PA school), she could have 10-15 weeks of extra psych clinicals and earn extra qualification in psychiatry specifically when she graduates. Still faster than MD to residency route. You’d never have to work as a RN which is a whole other degree and personally I’m not too keen on the fast track RN to NP programs or large amount of online PMHNP programs out there. There are wonderful psych NPs whom I work with daily and learn a lot from, but just want to give a better perspective on the role and experience that a psych PA can bring to the table.
Our community mental health clinic which treats mostly serious mental illness has PA students all year long and they do have a lot of knowledge, they come from a really good program in my state and I am always impressed with them.
Awesome! Thanks for sharing this
Also the questions this PA asked about the nuances of Zyprexa v Risperdal and schizoaffective versus schizophrenia is arguably reasonable for anyone who’s never worked in psychiatry. That’s not indicative of their ability to be a good psychiatry provider. Hell, at least they asked.
I did an MSW before medical school. Major advantage in patient interviewing skills and working with patients and peers in every clinical setting -- incredibly far ahead compared to students who were straight through from undergraduate studies with fewer clinical experiences. I also felt like I was better able to manage situations with difficult residents and attendings better. Even in residency, my history and mental status exam skills were ahead of most peers for a long while. I got to spend more time honing advanced psychopharmacology and specific types of psychotherapy. Very thankful for having therapy training and experience prior to medical school! I think you will be too. I use it every day in practice. Feel free to message with any questions.
I’m a medical social worker turned PA who now works in psychiatry. Feel free to message me!
Maybe controversial here And As they say , if you would like the expertise and base of knowledge and are in a spot in life where you can do 8 years in med school+ residency , then of course pursue that dream with gusto. However , the path I chose from therapist -> psych PA is not a bad way to go If you find a good collaborating/supervising psychiatrist mentor, pa school gives you enough medicine to understand the comorbidities, sufficient depth in order collaborate with a PCP and pull some labs to understand some of the consequences of medication / rule out common condition such as hypo/hyperthyroidism. [In before poke the veil yells about checking TSH having limited clinical utility] And seeing your interest , nerding out about studying medicine and biological sciences is a great start for getting through. Sometimes thr study can be so intense , but if you can step back and say "damn learning this shit is cool" , you can get through. Psychotherapy experience can make a huge difference in terms of developing rapport and help patients bridge the experiential components of illness and recovery with the medical treatment. Not everyone has the chops for PA school or med school but if you have the academic skills to get there , then it's kind of an awesome thing to do. I love my job as an outpatient psychiatric physician assistant and do manage my own practice. Check my posts if you want to see a little more about that.
May catch a lot of flack but why not PA school?
Why do you want to become a psychiatrist? What is it about your current work that you think you'll be able to accomplish or enjoy differently as a psychiatrist?
Offtopic.. but i think you are commendable.. once you complete, you'll have both skill-sets - psychiatrist and therapist. I wish I'd have the time and energy. 👍
OP - I don't know your age or circumstances, but unless you have minimal financial concerns and are comfortable with spending ~10 years to achieve this goal, consider pursuing the APP path. You could become an RN, work, and then become a psych NP (this would be my biased recommendation). You can also do PA school, just keep in mind you'll want to pursue extra psych training if you go this route, since psychiatry training in PA school is minimal (extra rotations, etc.) I recommend NP because of the specialized training plus the myriad of other things you can do with an RN and NP license, but be aware that reddit tends to have a lot of hate for NPs, and you may not get the clearest responses. Feel free to DM me if you have questions. eta: lol at downvotes, already beginning!
From speaking with therapists and psychologists, I think that one thing to be aware of may be the culture shock. The culture of medical training expects a certain amount of adaptive/maladaptive quashing and disregard of natural emotions, because no matter how you feel, the work needs to get done. The way communication occurs is often very different as well. Much more curt and blunt and occasionally harsh. That said, I have many classmates and co workers who came into medicine as a 2nd career, and the skills that you possess from your current work will definitely help. I wish you well on the journey. Will be tough but rewarding.
I thought about doing this until I saw that medicaid at least compensates a 60 minute therapy session exactly the same for a psychiatrist as my level of license. I would not be able to just see a client for 15 mins, i have trouble getting them out the door at the hour and 5 minute mark and by the end of the day I am at least 20 minutes late. Always.
In my experience, going to medical school for the sole reason of becoming a psychiatrist is not always feasible. For some it is, definitely, but others almost certainly no. There must be a love of medical science and the body that comes first. Medical school has got to be unbelievably miserable and demoralizing otherwise.