Quite realistic, I believe, especially as a psychiatrist in private practice. I've posted on my practice as a psychiatrist, in which therapy or therapy plus medication is 70% of my work. The key is to figure out how you will respond to the insurance issues in which you will find incentives as a psychiatrist to see patients for a minimal time period and for medication only. You need not let those pressures dictate how you practice, yet these are powerful forces that you will need to address.

did you for the most part learn about all of this insurance spiel during your residency? I really want to incorporate therapeutic methods into my work. I don't know if I can just manage medicine and do nothing else to help patients.

additionally, I was wondering where you got your training in pyschotheraply, psycho analysis, etc. as I've heard most of that stuff is not covered under a normal pyschiatry residency. My undergrad major will most likely be pyschology with a minor in biology. Hopefully this will fullfill my requirements to get into med school, and the pyschology that I previously took will help me when it comes down to the pyschotherapy, analyssis, etc.

Undergrad studies may give you something of a theoretical underpinning to psychotherapy and psychology, but to learn to do psychotherapy involves further learning. The bases of this are reading, one's own clinical work, and direct clinical supervision. Some would also add one's own experience in psychotherapy. Be aware that it takes many years to become a capable psychotherapist. It takes patience and commitment, among other things.

It is not as easy as it once was to get good psychotherapy training in residency. I am not up on what are currently the best places to go for psychotherapy training. My residency (which I completed in 1990) had excellent psychotherapy teaching and supervision. I feel fortunate to have had that.

It is possible to supplement one's psychotherapy training in residency by pursuing psychoanalytic training, or a shorter less ambitious program of psychotherapy training at a psychoanalytic or psychotherapy institute.

I agree that doing psychotherapy in addition to using other therapeutic modalities makes the work much more interesting and alive for me. It makes me feel that I am able to provide the means necessary to meet the therapeutic needs of most patients who come into my office.

Figuring out the "Insurance Spiel" was not something I was taught in residency. I had to learn it on my own from my experiences in my first years in practice.

I'm somewhat doubting my choice to go premed at this point because of what I've heard about pyschiatrists and how they mostly manage medicine. However, your story does give me hope. I guess I'm just really confused and lost righ tnow...

If you check out my description of my practice and how I arrived at it, perhaps that will be one example to you of how one psychiatrist has built the kind of practice you seem to seek:

www.med-psych.net/modules/newbb/viewtopic.php?topic_id=46&forum=2

If you can't find it, it's in the forum Psychology vs psychiatry, more toward the bottom. I'm logged in there as a visitor.

[ Edited by Polymath on 2004/11/3 15:37 ]

[ Edited by Admin on 2004/11/3 19:50 ]

polymath what state are you located in?

New York

I too am in NY and hope to attend med school and practice in NY also. I'm hoping that I can find a good residency with decent psychoanalytical training

In response to your initial question... psychiatry is the ONLY field to go into if you want to provide psychotherapy AND meds. Psychologists can't (and what's more, oughtn't).

We had a psychiatrist guest lecturer recently, and he was asked about the potential (albeit unlikely) possibility of psychologists being licensed to prescribe medications. His answer was awesome...

"I'm all for it... with one stipulation."

(Long pause, as if that answered the question.)

"What stipulation?" three people asked at once.

"That they graduate from medical school."

🙂

If that is, indeed, what you want to do, medicine is the path to take to get there. Good luck to you!

i fully agree that pyschologists shoudln't be able to prescribe medicine, but the same can be said about psychiatrists and pyschotherapy. this is a strange and confusing world.

I disagree. There is a huge difference between a psychiatrist practicing psychotherapy, and a psychologist wanting to write scripts.

If a psychiatrist completes the training for psychotherapy during residency (or thereafter), WHO BETTER to practice it than someone who also understands the organic component of mental illness?

On the other hand, a psychologist can't just complete the medical training without going all the way through med school... that's a bit much to ask!

That being said, I know some really crappy psychiatrists, and some outstanding counselors who are MSWs and PhDs. Counseling and psychotherapy have less to do with the degree, and more to do with the practitioner, in my opinion.

First of all, legislation has already passed to allow psychologists to prescribe medications in at least two states that I'm aware of: New Mexico and Louisiana. There may be others. I don't know that any psychologists have actually started prescribing meds, though, as there are certain training and supervision requirements before they can do so.

My own opinion is that it is a very bad idea to allow psychologists to prescribe medicines. However, the rationale in New Mexcio was that there are rural areas where people have no access to psychiatrists - the choice for those people would either be to do without any medications, or have a psychologist prescribe the meds for them. Or at least that is my recollection for part of the New Mexico law. Actually I had posted a news blurb about it on this site back in March 2002 - so the law in New Mexico has actually been around a while.

As for psychiatrists vs. psychologists at providing psychotherapy - all psychiatrists have psychotherapy training as part of their residency. However, I agree that there are many excellent (as well as bad) therapists from both backgrounds.

so pyschotherapy in essecne is covered in every psychiatry residency?

yes, as Dr. Admin stated...

wrote:
all psychiatrists have psychotherapy training as part of their residency

Psychotherapy is part of the training in all psychiatry residencies, but programs will vary considerably in how much time and energy is put into that training, the breadth and variety of modalities covered, the range of faculty skilled and available to teach and supervise cases, the exposure to patients across a range of diagnoses and therapeutic needs, etc.

If you want to do therapy as a psychiatrist, the opportunity is there. The training is provided at least at minimum baseline level. To me the questions, if therapy is something you want to do, are whether you need or desire more advanced or specialized training beyond what is provided in residency, and how are you going to set up your professional life to enable you to do it. For instance, will you take a job in which you do little therapy, but have a part-time private practice in which you do therapy? Full-time private practice? A job in which you balance a variety of roles and tasks including some therapy? ETC.

from what I understand a pyschiatrist has a lot of control over his or her hours.

Control of one's time as a psychiatrist has a lot to do with the setting in which one practices. The psychiatrist in private practice has freedom to choose his own hours, although he has to make it work around the available hours of his patients too. In a job, the psychiatrist may be expected to be available to address problems between specific hours, eg. 8:30 AM to 5 PM, or overnight as the case may be. Some postions may involve night call, others not. If maximal control over one's time is the objective, I think psychiatry is a very viable option.