Medical School vs LCSW (or other career in psychology)

[gb_19]

*posting in both threads in the hopes of getting a good variety of readers

Hi all,
I was hoping to get some input from this community surrounding a big decision I have to make. I have dreamt of becoming a physician since I was a child, and over the course of a few years as I’ve been applying to medical school I have also fallen in love with the mental health field. I work alongside psychiatrists, clinical psychology PhDs, LCSWs, and LMFTs every day and I am so inspired by all of their work. I was recently lucky enough to be accepted into an osteopathic medical school, however it is on the other side of the country from my family. I am still on the waitlist for a school closer to home but there are no guarantees.

I am torn between the choice of becoming a physician (I imagine I would end up becoming a psychiatrist) or becoming a licensed therapist. There are many pros and cons to both sides. I have younger siblings with very serious, progressive health conditions and just overall place a high value on time spent with loved ones and maintaining personal wellness. I worry that I would lose those things if I chose medicine.

I really want to study intensely to the highest level of education I can obtain, to be a leader within a team and make clinical decisions and diagnosis, to have the science component, and to partner alongside patients through their highs and lows. I want to be surrounded by people who are smarter than me and inspire me. There are obviously enormous salary differences between the two options, and that does factor in when I think about being able to take care of my family comfortably and have a family of my own some day.

I think clinical psychology is off the table for me because there are a lot of requirements I don’t have (I did cancer biology research not psychology research, I’m missing psychology coursework) and the sheer competitiveness of vying for a limited number of spots. PsyD I just simply can’t afford. I have also considered the NP/PA route but I just can’t get behind the short training time, I know I don’t want to work as a nurse, and those programs have requirements I don’t have as well.

I could see myself becoming a really great LCSW, I’m passionate about social justice work, and I know I would still be helping people. There is much less toxicity in the field and they definitely share some of my values of family time and wellness.

When I look back on my life, I doubt I will say I wish I had spent less time with my loved ones, traveling, and enjoying free time. However, I also worry I would look back and feel regret that I didn’t take the leap of faith in medicine and reach my full potential.

Lots of rambling I know, thanks for sticking with me. I’m wondering if anyone has any immediate thoughts or reactions? Do you wish you had taken your education further or done less? Thank you in advance for your help!

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[summerbabe]

just overall place a high value on time spent with loved ones and maintaining personal wellness

The next ~8 years of your life (a bit less so if you can match to a residency near home) will be pretty low on both if you go the DO/MD path.

I really want to study intensely to the highest level of education I can obtain, to be a leader within a team and make clinical decisions and diagnosis, to have the science component, and to partner alongside patients through their highs and lows. I want to be surrounded by people who are smarter than me and inspire me. There are obviously enormous salary differences between the two options, and that does factor in when I think about being able to take care of my family comfortably and have a family of my own some day.

There are definitely ways to reach this goal as a social worker. However, working on interdisciplinary teams in hospital settings may impact your pay compared to private practice therapy where your earning ceiling is likely higher.

On some interdisciplinary teams, social workers may exclusively perform non-clinical tasks while that same agency may employ other LCSWs to exclusively do intakes and provide therapy. However, those roles may or may not provide much time/room for interactions with colleagues (e.g., 26 booked apts a week doesn't leave a whole lot of time for actively working with teammates).

While it sounds like you know what you'd do as a DO/MD, do you know what type of social work you'd like to do? Do you need to gather more info on common/possible career paths?

 

[PsyDr]

1) social workers have 1-2 years of education in mental health… total.

2) What do you want to do, in your day to day? Do you want shorter appointments? Longer discussions? The ability to help? The ability to tell people it’s hopeless? On call? Free after 5pm? That all matters.

3) How do you picture your financial status? $300k, with linger work hours but the ability to pay for your kids Harvard tuition ok the fly? $100k with the ability to buy a house and worrying about your kids tuition? $80k and being unable to do those things? There is no “right” answer. Only trade offs.

 

[gb_19]

The next ~8 years of your life (a bit less so if you can match to a residency near home) will be pretty low on both if you go the DO/MD path.

There are definitely ways to reach this goal as a social worker. However, working on interdisciplinary teams in hospital settings may impact your pay compared to private practice therapy where your earning ceiling is likely higher.

On some interdisciplinary teams, social workers may exclusively perform non-clinical tasks while that same agency may employ other LCSWs to exclusively do intakes and provide therapy. However, those roles may or may not provide much time/room for interactions with colleagues (e.g., 26 booked apts a week doesn't leave a whole lot of time for actively working with teammates).

While it sounds like you know what you'd do as a DO/MD, do you know what type of social work you'd like to do? Do you need to gather more info on common/possible career paths?

Thank you for your reply! I don’t think I know enough about the types of social work beyond knowing I’d want to do clinical therapy work. I know I’m interested in the SMI population and modalities like DBT and EMDR, but I do think I should gather some more information on possible paths!

 

[gb_19]

1) social workers have 1-2 years of education in mental health… total.

2) What do you want to do, in your day to day? Do you want shorter appointments? Longer discussions? The ability to help? The ability to tell people it’s hopeless? On call? Free after 5pm? That all matters.

3) How do you picture your financial status? $300k, with linger work hours but the ability to pay for your kids Harvard tuition ok the fly? $100k with the ability to buy a house and worrying about your kids tuition? $80k and being unable to do those things? There is no “right” answer. Only trade offs.

1) would be tough for me to swallow. I think I would have to be scrappy and seek out further educational opportunities on my own.

2) longer discussions, longitudinal relationships. I want to help people live their fullest life. If that means I can really help or fix a problem, fantastic. If that means I help them figure out how to live a meaningful life within the context of hard, unfixable things, I would like that too.

I’m sure call would not be fun and of course leaving at a reasonable hour would be ideal. I’ve heard that psychiatry is better for that relative to other fields but I know it would be rough.

3) I think anything around the 150k mark would give me the stability and comfort I’m striving for. Social work makes less and psychiatry is more so no perfect answer!

Thanks for your reply, lots of good things to think about.

 

[summerbabe]

I know I’m interested in the SMI population

Individuals with SMI generally have lower SES and some don't do a great job of managing their health so you're most likely to work with these populations on acute inpatient units, state hospitals or community mental health. VAs have outpatient (PRRCs) and community based (ICMHR) options for SMI and some hospitals have first episode psychosis treatment.

longer discussions, longitudinal relationships

The trend in managed care settings for therapy is time limited episodes of care (e.g., 8-12 sessions of an evidence based practice and then discharge) but you can pack a lot into each hour session if you're a good therapist.

If you're providing more case management and stick around in your organization for a while, you can definitely build some long-term relationships but there may not be as much depth to these interactions n

Private practice can hit both of these targets but you'll lose the ability to work collaboratively on a team. State hospitals where residents may stay until death would meet the latter but you'll have to determine if the former would be fulfilling in this setting.

I think anything around the 150k mark would give me the stability and comfort I’m striving for.

Depending on your area, a salaried LCSW job is much more likely to be less than half that figure and sometimes significantly less in community mental health given the median LCSW salary is just above $50k according to BLS data.

If you want to make more than 6 figures with a social work degree, you'll almost certainly need to build a successful private practice that has at least some (if not a lot of) cash pay clients who likely would not fall under the SMI umbrella. But you would have a lot of options for what type of therapy you want to specialize in and receive additional training in beyond grad school.

Another route could be administration within a hospital/agency setting but pay would likely be capped by the LCSW degree (versus MD or PhD) and exchanging clinical work for admin duties might not be a good fit.

 

[R. Matey]

Agree with above--you probably would have to do private practice or some level of administration (hospital systems like SWs anyways) in order to reach your salary requirements. The psychiatrists on the board can probably speak better to it than I can, but I know it's not uncommon for a psychiatrist to do 1-2 days in a CMHC and then the rest in PP, all for a cozy salary. Best of both worlds if you're willing to front end some misery to get there.

 

[Sanman]

As @PsyDr mentioned, there are no wrong answers only trade-offs. I once had a professor talk to us in a lab meeting about careers as a professor and he said you can be well-known/famous or you can have your weekends to yourself, it is your choice. That is what I will reiterate here. The truth is that if you want to make money or be well known, you will work more hours and the degree will not matter much. The head of social work/psychology/psychiatry at my hospital does not work only 40 hours. Managers/leaders that do are often held in poor regard because they are blowing off some of their duties in one way or another. Based on your lifestyle and income requirements, becoming a PA/NP will provide you with most of the things you say you want. However, you shot that down in your original post. Psychologist, LCSW, or Physician could do so as well. It is your choice which of your requirements you want to flex on.

 

[VirginiaIsForLovers]

Kudos to you for really doing your research! End of the day it is really going to just depend on your interest, time commitment, and what you value (e.g. type of work, money, etc.).

I've worked with really skilled and great SW's. Although obtaining 2 years of education, in a lot of places in order to become an LCSW and to practice independently, SW's are getting 2-3+ years of supervision and training. Many also seek out extra trainings to specialize. Also, many BH departments and psych hospital departments are run by SW if you're interested in the admin side. I imagine it will take longer to make 150K unless you're in PP or admin.

DO/MD - I know a few DO's that are psychiatrists now and from what I can tell it is an easier residency to match in. For the most part most of the psychiatrist I work with do 15-30 min. med management meetings. I also know a few that will have a few long-term therapy cases. After residency you'll make 150K easily working in most settings. Although I live in a large city with a saturation of therapist and psychiatrist, everyone whether it is private practice or CMH, have long waitlist, so having patient's is not going to be an issue. Our department is run by psychiatrists, so there opportunities for admin work too.