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Hi Guys, 

 

I am going to keep this as short as possible. I am currently an undergraduate approaching my junior year. I have only a couple of pre-PA courses left and will be finished with my clinical hours by the end of this year. I am a psychology major with a minor in neuroscience. I would have a major in neuroscience or behavioral science if only my University offered it. However, I have adjusted accordingly by integrating many biological components within my academic resume. 

 

 

Background explanation completed. Long story short: I want to be a Clinical Psychologist (obviously this entails a Doctoral degree in psychology) and a licensed PA. My goal is to integrate the two if at all possible. I used to want to be a Psychiatrist (MD) until I saw the lack of patient-to-doctor time which doesn't allow for adequate analysis of psychiatric conditions, IMO. 

 

Having the depth of understanding of a Clinical Psychologist along with the ability to prescribe medications as a PA looks to be an ideal solution. But here come the questions: Is this realistic and feasible? I wouldn't want to be utilizing one without the other. Would there be hiring opportunities for what I am describing? Can you really integrate the two simultaneously? If so, how much freedom and solidarity would I have to practice? 

 

I don't mind long or straightforward answers. And I am willing to communicate any additional questions anyone may have. I appreciate you taking the time to read this. 

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Patient to doctor time for a Psychiatrist can vary from Psychiatrist to Psychiatrist, it can be as long or short as you want it to be. Remember, as a physician you make your hours and distribute your time as you see fit.

 

A degree in clinical psychology I think would be helpful in the mental health arena, but not sure about doing both the clinical psychology and PA. The two worlds are completely different with diffent priorities to the patient being the main one in my opinion. The PA profession is a great one and has a place in mental health that I think most over look.

 

I would suggest you shadow a few PA's in the mental health field and in general along with a few Psychiatrists to get a real look into the practices. Not every Psychiatrist practices the same, just like not every PA practices the same.

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You'd end up a limited-duty psychiatrist and most likely need to be supervised by one.  PsyD+PA school is a lot of work and cash outlay... Dunno whether that would fit better for you than MD+Psych residency or not.

 

 

rev ronin, you have made an excellent point. Your last sentence sums up the entire dilemma. A way to compare it (if you are able to be interactive and bear with me here), is the years of schooling, total cost, and other expenditures that tally along the way. 

 

In a hypothetical scenario, if I were to choose the PA+PsyD route, I would most likely enter PA school firstly. MD Psychiatry years of schooling would be around 7-10 with residency, correct? Not sure the accuracy on that. PA school 2-3 years + 5-7 for PsyD depending on the institution / program. Based on those figures, we are looking at around the same time. We know that the debts incurred through loans in PA school is usually significantly less than that of medical school... Is there a such thing as a feasible part-time PA position? If I could accumulate capital through working as a PA part time while attending graduate school for psych, the payment may be doable. If this could work, the debt would be significantly less than that of medical school. Though, the salary as an MD is also something to consider. 

 

If we look at the education, I much prefer the PsyD when compared with a Psychiatry MD - based on what I have seen. I have observed a MD and a PA in these fields, as well as listened to live seminars, guest speakers in the neurology department. Also, I have tracked a friend who is now completing her residency for Pedes and Psychiatry and we had this same discussion about the education a PsyD / PhD in clinical psych provides over Psychiatry education. 

 

Still naive and still looking for input on this though. I hope I provided more useful information.

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I thought about this over 30 years ago and I am very glad I didn't do it.  Pay and reimbursement for PAs is well above that for the average clinical psych PhD and they are really struggling with what they should be doing......watch the prescribing battles, etc.  They used to specialize in psychological testing but that is now pretty much outmoded, and the "mid level" social workers and masters level therapists are doing all of the therapy.  There are only a few niches where they are really used, prisons, military, VA, and disability evals being three of them, not requiring insurance reimbursement.   Sort of a dinosaur field.  A friend of mine who is a clinical psychologist says she would never ever recommend the field in this day and age.  

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That is kinda what I was thinking.  I read on the forum that the VA rewards multiple degrees and doctorates with higher pay, but that isn't to say one would ever even make a dent in the cost of acquiring the PsyD.  If it is relegated to a tack-on for NPs & PAs, it needs to be online, part-time, and cost effective.

 

A PsyD might open a lot of doors for teaching?  Both PA and NP?  That might be interesting.

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I have read all of the replies and I appreciate the input. At the end of the day, I conceptually know what I want to be a part of. It is fulfillment from both practicing and researching medicine with my specific area of interest being psychological components of disease and treatment. 

 

I suppose the second sentence above without my additional fluff may provide easier navigation for what a good ending option would be. 

 

 

I thought about this over 30 years ago and I am very glad I didn't do it.  Pay and reimbursement for PAs is well above that for the average clinical psych PhD and they are really struggling with what they should be doing......watch the prescribing battles, etc.  They used to specialize in psychological testing but that is now pretty much outmoded, and the "mid level" social workers and masters level therapists are doing all of the therapy.  There are only a few niches where they are really used, prisons, military, VA, and disability evals being three of them, not requiring insurance reimbursement.   Sort of a dinosaur field.  A friend of mine who is a clinical psychologist says she would never ever recommend the field in this day and age.  

 

I am more looking to integrate the two if at all possible. As opposed to being a stand-alone psychologist. I have heard similar to what you are referencing. Prescribing medication and taking a physiological treatment approach outside of any form of cognitive/behavioral therapy is crucial in a multitude of conditions. E.g. PTSD, fibromyalgia, chronic fatigue, schizophrenia, etc. But commonly, several autoimmune, neurological, and even psychological issues are treated one way as opposed to integrative. is there a way to be a one-stop-shop? 

 

 

Why even bother going PA?  As a psychologist you can just write your recommendations down and have the patient's PCP write the scripts.

 

I would honestly rather be the prescriber for assurance and certainty purposes. 

 

He is likely considering the advantages of being a PsyD who can write scripts and address a patient's medical needs.  Having that ability sounds like a huge advantage to me.  What is less clear (to me) is what the advantage of the PsyD is...

 

 

 I always thought a PsyD was more particular to practicing as opposed to teaching. Teaching is never a bad option though. 

 

 

I hate to say it but have you considered psych np?

 

That sounds like a good suggestion. A RN or NP (albeit though vastly different) are both positions based on my little experience, I would like to avoid if at all possible. 

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psych np in many states are independent providers and can rx psych meds. if you didn't like the quality of the initial program there are several 1 yr pa/np psych residencies out there which are equivalent to the first yr of a psych md residency.

psych is tough to do as a pa. folks do it, but the competition and requirements for working with a doc add a layer of complexity the nps and PsyDs don't have to deal with.

a PA/PsyD would still need to work with an MD/DO despite having their own doctorate.

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psych np in many states are independent providers and can rx psych meds. if you didn't like the quality of the initial program there are several 1 yr pa/np psych residencies out there which are equivalent to the first yr of a psych md residency.

psych is tough to do as a pa. folks do it, but the competition and requirements for working with a doc add a layer of complexity the nps and PsyDs don't have to deal with.

a PA/PsyD would still need to work with an MD/DO despite having their own doctorate.

 

 

Hm, so would you say that having the PA in addition to the PsyD is useless for what I am trying to do? 

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I agree with emedpa, becoming a psych NP (instead of PA) would be the more linear path (this is based off the fact that NPs dominate psych compared to PAs, psych NP school is far more psych intensive than PA school, NPs have more opportunities for autonomy, etc). Don't assume you will have more time with patients than a psychiatrist, though. Anyone who has an rx pad (MD, PA, NP, whoever) will face pressure to churn through patients.

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I agree with emedpa, becoming a psych NP (instead of PA) would be the more linear path (this is based off the fact that NPs dominate psych compared to PAs, psych NP school is far more psych intensive than PA school, NPs have more opportunities for autonomy, etc). Don't assume you will have more time with patients than a psychiatrist, though. Anyone who has an rx pad (MD, PA, NP, whoever) will face pressure to churn through patients.

 

That would work great under the assumption I would like to become a NP. Unfortunately, this isn't the case. Maybe Psychiatry MD is the best option all things considered. I would have thought that the PA + PsyD / PhD combination would be more plausible. If I weren't to consider job market, is it still an impossible feat? 

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Hm, so would you say that having the PA in addition to the PsyD is useless for what I am trying to do? 

in a state in which a PsyD can prescribe independently, yes.

you would have more knowledge of general medicine, which could be helpful, but to practice under your PA license you need to have a physician supervisor/collaborator.

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That would work great under the assumption I would like to become a NP. Unfortunately, this isn't the case. Maybe Psychiatry MD is the best option all things considered. I would have thought that the PA + PsyD / PhD combination would be more plausible. If I weren't to consider job market, is it still an impossible feat? 

 

Haha, the reason why people keep bringing up NP is because in many settings NPs and PAs are interchangeable, but in some settings one is typically preferred over the other. In psych, NPs dominate (as already stated). You are apparently dead set against considering the NP route, for whatever reason. Unless you can get into one of the few fully funded programs, PsyDs are a pretty bad investment due to the extremely high cost and the fact that psychologist pay is relatively poor. Then you'd have debt from PA school to add onto that. in your case I'd recommend going to medical school. Why spend 5-6 years on a psychology doctorate + ~2 years on PA school when you can just become a physician and make more money and have fewer headaches? You can do pretty average on the MCAT and get into DO school. Psychiatry is not a competitive medical specialty at all so you won't even have pressure to do well on your boards - you just need to merely pass.

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Haha, the reason why people keep bringing up NP is because in many settings NPs and PAs are interchangeable, but in some settings one is typically preferred over the other. In psych, NPs dominate (as already stated). You are apparently dead set against considering the NP route, for whatever reason. Unless you can get into one of the few fully funded programs, PsyDs are a pretty bad investment due to the extremely high cost and the fact that psychologist pay is relatively poor. Then you'd have debt from PA school to add onto that. in your case I'd recommend going to medical school. Why spend 5-6 years on a psychology doctorate + ~2 years on PA school when you can just become a physician and make more money and have fewer headaches? You can do pretty average on the MCAT and get into DO school. Psychiatry is not a competitive medical specialty at all so you won't even have pressure to do well on your boards - you just need to merely pass.

 

 

Well jeez, I would hope that I could at least perform in the realm of decent on the MCAT. Really, my blunder with pre-reqs for the MCAT is having to take Physics and Organic Chemistry II. Dreadfully fear Physics... I will still have to research PA outlooks in neuropsychology and behavioral health as a stand alone without the additional Psych degree. Interesting to know the realities of NP preference in Psychiatry though. 
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PA+ PA psych residency is an option as well. most of those folks become psych pcps at the VA.

 

 

That may work, I will look further into that. Since we have established that having two certifications that allow clinical practice in Psychiatry is more of an unnecessary double-up, do you know of any option that allows for a PA to stay involved in academia? For physicians, they have MD/PhD programs, research Physicians and so forth. I would like to stay involved in academia without committing an overabundant amount of time in school. 

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Well jeez, I would hope that I could at least perform in the realm of decent on the MCAT. Really, my blunder with pre-reqs for the MCAT is having to take Physics and Organic Chemistry II. Dreadfully fear Physics... I will still have to research PA outlooks in neuropsychology and behavioral health as a stand alone without the additional Psych degree. Interesting to know the realities of NP preference in Psychiatry though. 

 

physics is fun and easy, don't fear it.

 

That may work, I will look further into that. Since we have established that having two certifications that allow clinical practice in Psychiatry is more of an unnecessary double-up, do you know of any option that allows for a PA to stay involved in academia? For physicians, they have MD/PhD programs, research Physicians and so forth. I would like to stay involved in academia without committing an overabundant amount of time in school. 

pa/mph, pa/dhsc, pa/phd

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physics is fun and easy, don't fear it.

 

pa/mph, pa/dhsc, pa/phd

 

 

How do you like the dhsc process you're doing, thus far? Out of the three you mentioned, I would be trying to earn the most applicable degree. I am in an area of research now that is really neat and I am cure to delve into some others... just don't ever want a degree I don't utilize. 

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That may work, I will look further into that. Since we have established that having two certifications that allow clinical practice in Psychiatry is more of an unnecessary double-up, do you know of any option that allows for a PA to stay involved in academia? For physicians, they have MD/PhD programs, research Physicians and so forth. I would like to stay involved in academia without committing an overabundant amount of time in school. 

 

The only issue is that as a PA you will not be able to practice/bill for psychotherapy. There is no training in psychotherapy in PA school and in the psych PA fellowships I have looked at (I have looked at both NP and PA post-grad fellowships for psychiatry) they are pretty much focused on psych assessment and med management. NPs and psychiatrists get structured psychotherapy training. Some say that as long as the SP does psychotherapy, the PA can as well, but I have heard from several psych PAs that insurance companies have refused to reimburse for PAs who code for psychotherapy, since they aren't trained in it. Plus, obviously, psychotherapy skills aren't something you can just learn on the job and require structured training and supervision... it really is too bad that PA psych residencies don't seem to include this content in their training. If you're not interested in doing therapy, then going the PA route is fine, but if you want to do it at all you should look at becoming a psychiatrist or psych NP. I guess you could also become a duel psychologist/MFT/LCSW+PA to ensure you have psychotherapy training, but why get two degrees when one degree would suffice?

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