Enlightened Practice Podcast
In this new episode of the Enlightened Practice Podcast, Dr. Ken Braslow and Dr. Kari Kagan provide some clarity on the various training paths most psychologists and psychiatrists follow. They discuss master’s degrees, pre-doctoral internships, doctoral degrees, and answer a very common question: what is the difference between a PsyD and a PhD. Enjoy!
Transcript of the podcast
Ken: Hi Kari. Welcome back.
Kari: Hi Ken. Thanks for having me.
Ken: Today, we’re going to talk about training pathways and one of the questions that I think a lot of psychiatrists might have is understanding the pathways that psychologists go down. It’s always been a little confusing to me when somebody talks about being in a post-doc program, or they’re doing an internship in psychology because on the medical side we have our own version of internships and post-docs, a little confusing for us. So, I wanted to use this opportunity for us to pick your brain and understand the pathway that most psychologists go down, and then I figure I can speak to psychiatry training and what that pathway looks like so that therapists can understand what we go through.
Kari: Yeah, I’m going to try to provide some clarity.
Ken: Great. Okay. So, the first question that comes to my mind is what is the difference between a PsyD program and a PhD program?
Kari: Yeah. It’s a great question and I’ll try to sum it up in really simple terms. A PsyD program tends to be more focused on the clinical side of psychology and a PhD program tends to be more focused on the research side of psychology. So, usually people who choose to go on the side of PsyD programs are really interested in the clinical work so, working with clients, working with mental illness, in the here and now, helping someone work through depression or anxiety for example. Usually, people who go into PhD programs are interested in studying a number of different things. And one of which could be studying the clinical side of things. In psychology understanding which treatments work the best for example, or receptors for depression and stuff like that. So, that’s the main difference between a PsyD and a PhD.
Ken: Okay. And if I were in college thinking about PsyD versus PhD, would I also be thinking about a master’s program or can I go right into one of those from getting a BA?
Kari: You can go right into either one of those and along the way you will get your masters. Another path forward is, if you’re not sure if you want to commit to the full length of a PsyD or PhD program because they are quite lengthy, you can start with a master’s program and then that can potentially transition into a PhD or a PsyD program or then you could reapply for a PsyD or PhD after that.
Ken: Would you get credit for the hours and time you put into a master’s program as part of your PsyD or PhD, or you have to start fresh?
Kari: It’s a really good question. And I want to say that I actually think that you have to start fresh. If you do get your master’s first in like a separate program and you want to acquire a PhD program, you can’t like scoot ahead a couple of years, you actually have to start fresh. So, to some people that might be worth it if you’re really not sure. And for other people like the path I chose myself. I just went right in, got my master’s, left a year or two, or three I want to say, and then PsyD.
Ken: Okay. Tell me a little bit more about some of the differences in general between PhD and PsyD programs, like how big they tend to be, and how long they are, and is it easier or harder to do one or the other pathway?
Kari: Yeah. Actually, there’s a lot of overlap so both of them are five years to get the doctorate and then an extra year of clinical work needed to become licensed. By the way, I should mention, when I’m thinking of PhD, I’m thinking of a PhD in clinical psychology and not being the closest thing to a PsyD which is a focus in clinical psychology. There could be other kinds of PhDs in psychology of course as well. But they’re very similar in that they’re five years to get the doctorate and then an additional year to get more hours that you will need to eventually get licensed. So, about six years in total, it could be longer for a PhD, also I guess for a PsyD but often times more so for a PhD depending on your research and how that’s going. Actually they’re similar, again especially a PhD in clinical psychology in that you have to get the same number of hours, face-to-face clinical hours. So, PhD are getting that exposure as well as PsyDs but the emphasis is more on their research and again, people who are getting PhDs are often more interested in the research. They’re doing the hours because that’s part of the program but they’re actually more interested in the research part of it, and I would say vice versa for PsyDs they’re doing their research because that’s part of the course but they’re more interested in the clinical side of things. But, both are 5–6 years, possibly 7. I would say in terms of availability PhD programs tend to be smaller so there are fewer spots for people. Sometimes it’s 3 or 4 in class compared to a Psyd program which tends to be pretty significantly bigger than that, like 20 -30, sometimes even 40 in a class.
Ken: Oh, wow.
Kari: And then cost is a huge factor to consider. If you get a PhD from an academic institution for example, the University of California, Berkley, you get paid to go to school. That being said, there are PhD programs that you have to pay for, that might be from a professional program as opposed to a university based program. So, it’s a program not just specific for example clinical psychology PhD. PsyDs you always have to pay for, so there’s no program I think in the country that pays you to get your PsyD. So, no doubt a PhD is cheaper in general, so that’s a huge difference.
Ken: Okay. And in terms of a dissertation or thesis in a PsyD program, how much of a commitment is that or how much of the program does that take up?
Kari: They are the same actually. So, for both of them you have to defend a dissertation. In the PysD world it could be as much or as little as you want it to be. So, if you’re really not interested in research, you’re really just doing what you need to, to get it done, in defend a dissertation. As opposed to a PhD, their dissertation could go on to be the book they write, it could go on to be the class they teach after their program. So, it could be much more important just to their career.
Ken: Oh, okay.
Ken: That makes sense. Okay, so, in what point in either program do you actually start seeing clients?
Kari: Year one. The summer after year one is probably more accurate. So, pretty early on in both programs you start to do the clinical work and do that for however long it takes to get the hours that you need in order to make you eligible to apply for internship. So, that usually looks like about three years of clinical work part-time because of course you’re part-time in school. And then you would have enough hours to be eligible to apply for internship.
Ken: I see. So, are you describing the practicum?
Kari: Yeah. So those are the practicum.
Ken: Okay. So, then when are you applying for internship?
Kari: So, internship you are applying for usually around year four to be in your internship for year five. So, year five of grad school is the internship year so you’re not in school at all. I believe you have to have proposed your dissertation in order to be eligible to apply for internship and have a certain number of hours. And that is the pre-doctoral internship, meaning you need to complete that internship in order to be eligible to graduate as well as have defended your dissertation not just proposed it.
Ken: Okay. So, you get your degree once you’ve completed the internship, yes?
Kari: Yes and the dissertation.
Ken: And the dissertation. And when do you get licensed?
Kari: So, then you can get licensed after you complete your proposed doctoral hours, which I believe might vary state by state. In California I think it’s somewhere between 1500 and 2000 hours post-doc. And after you complete those hours then you have to take a couple of exams in order to get licensed in your state.
Ken: Okay. So, would a PhD usually do a post-doc?
Kari: A PhD would do a post-doc. They don’t have to get licensed if they’re not wanting to practice.
Kari: Most do a post-doc as a way of continuing their learning. For example, they might do a post-doc in a research clinic or at an academic institution and they would still accumulate hours but they could choose to not take the exams to get licensed. And I know people who have done that when they’re really certain they don’t want to do the clinical work.
Ken: So, you get your degree after internship and then you get licensed after post-doc?
Kari: Yeah, that’s right.
Ken: Okay. Tell me about being a psych assistant and what that looks like.
Kari: A psych assistant is a type of post-doc. So, you can do your post-doc for example at a hospital. Like in California we have a hospital system called Kaiser. And that’s an example of a place that one can do a post-doc, or you can do it as a psych assistant and that is more in like the private sector. So for example, you have to get it approved through the board to work in someone’s private practice essentially and that is what a psych assistant is. And the board accrues the hours.
Ken: Okay. And how long does the assistantship last?
Kari: That is completely up to the person. So, at least a year usually because it takes that long to work the hours that you need, and it could be up to five years if you’re seeing only three clients a week or something like that. Some people do take their time if they have to for some reason. So it’s up to the person.
Ken: Okay. And then once you’re done with your post-doc, you’re licensed and off to go into independent practice.
Kari: Yes, after you pass exams.
Ken: Okay. Well, no wonder I was confused. Now that was very, very helpful to understand. Did we leave anything out or is that it?
Kari: No. I was just wondering if that’s similar to the psychiatrist path or not?
Ken: Um, no. so, you can major in college in pretty much anything you want to as long as you’ve taken pre-med requirements. Then you go to med school. Med school is typically four years and during the first couple of years it’s usually classroom-based and you get classes on psychiatry just like you get classes on everything else. And usually, in third year, maybe fourth year at med school you’ll do a clerkship, which is depending on the school, six weeks or a couple of months in all the various specialties. So, I remember doing cardiothoracic surgery, right before I did six weeks of psychiatry. You get a full sampler of all the different fields in medicine. And as you are approaching the end of your third year of medical school, you’re thinking really about where you want to go for residency. So that in your fourth year of medical school you’re applying to residency programs and on match day which is in March, every med student in the country at the exact same second finds out where they’re going for residency. I would say 95 percent and then for 5 percent who for whatever reason don’t match it’s called a scramble, I think they find out a couple of days before so hopefully, everybody is matched into the field at least that they want to go into if not the specific program.
Ken: So, after graduation from med school, you have your degree but you can’t do anything. And then you go into residency and your first year of residency is called internship. It’s also called your PGY one-year post-graduate, year one. And after your first year of post-graduate work, or internship, or residency, then you’re eligible in most states, certainly California, to apply for your license. So, that’s also in conjunction with passing some national exams that you take while you’re in med school and then at the end of internships. So, you pass your exams, you have your degree, you finish your first year of training, and now you are a licensed physician who still can’t do anything. That’s not totally true. You can moonlight at that point. But you still have a few years of residency training and nobody is going to hire you without you having completed residency.
Ken: So, psychiatry residency is four years and that includes that first year of internship. After four years if you’re just going to do general psychiatry, adult psychiatry, you graduate from your psychiatry residency and you have your degree, your license, and now you can go out on your own.
Ken: But, most places will still want you to become board certified by the American Board of Psychiatry and Neurology. So typically, toward the very end of your training or at the very beginning after training, you’re studying for boards yet again. Back in the day, there used to be an oral exam and I remember having three senior psychiatrists stare at me while I interviewed a patient at some hospital, in some neutral city that I had flown into. So, once you’re board certified, now, finally you’re worthy of being hired. Some places will hire you without being board certified but typically they want to know that you’re working towards getting your boards.
Ken: I like to joke that I was finally ready to work after I had finished 25th grade. And that’s also because I did a fellowship in child psychiatry. That’s an extra two years with the caveat that because there are so few of us they actually allow you to end your adult training in your third year as if your entire fourth year of adult was just going to be in child.
Ken: But you end in your third and you go two years of child psychiatry. And the first year of child psychiatry training, I felt like it was the first year of medical school all over again. I realized that I didn’t know anything about working with kids and families. So, that was a steep learning curve.
Ken: So, then I passed my adult boards while I was doing my child fellowship and after my child fellowship, I had to go take my child boards and have three senior child psychiatrists stare at me while I interviewed a 15-year-old. So that was the past.
Kari: I can officially never complain about six years.
Ken: Now we can commiserate. And now, every ten years you have to get recertified by the ABPN, including doing continuing medical education, and performance in practice, and other standards that they hold you to. So, it never ends essentially.
Ken: That’s the deal. But I would encourage anyone who is interested to do it, it just takes a while that’s all.
Kari: Yeah. We can all appreciate it like patients, right. You would want your provider to be really educated, experienced, and well trained, and all that kind of stuff. But of course it’s a lot to go through and maybe they do that on purpose to really make sure that, not only to help you be prepared but to really make sure that you’re up for the work.
Ken: It’s really true. And after all of that, I cannot remember once a patient asking me, so where did you go to school or anything like that. They don’t care. They just want to get going and feeling better.
Ken: All right. Well, thanks Kari. I learned a lot here. My head is spinning a little bit from all that. But I appreciate you educating me and I’m looking forward to chatting soon.
Kari: Yeah, same. Thanks.
Ken: Talk to you then. Take care. Bye.
Kari: Talk to you soon. Bye.