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In a nutshell, Psychiatrists are physicians - we write prescriptions and are more focused on medical issues. Psychiatrists are on the lower end of the physician pay scale, but it's still in the pay scale range of what physicians make. This is why the pay scale is generally higher for Psychiatrists than Psychologists. The Psychologist I work with thought about medical school in college, but decided she wasn't a hard science person. I didn't ask the details, but I would guess she took some of the basic sciences and ran screaming in horror. She ended up studying Art History, did very well in that, and then went for her graduate degree in Psychology after that. In our program, she is much better at understanding the aesthetics of the reports and procedures we set up so that administrators can understand us, and patients like the program. I am better at understanding the technology underlying it, and figuring out the best way to set up the video monitors to communicate well with the computers, and how to get needed information quickly from one room to another room a hundred miles away.
To apply to medical school, you'd need to have completed the basic sciences in college: one year of physics, one year of biology, one year of general chemistry, one year organic chemistry, usually but not always, one year of calculus. For graduate school (Psychology doctorate) you'd take the GRE's as the entrance exam, for med school you'd take the MCAT's.
It was very selective to get into medical school when I entered in 1987, these days it's pretty insanely difficult. You can't really 'just decide' to go to medical school, unfortunately. There is an alternate path called Osteopathic School, which results in a D.O. degree. This is legally equivalent to an MD, and you can do anything an MD does. It's a bit easier to get into, and it focuses more on spine/muscle/whole patient (so they say). But if you're hoping to do research or get into the more selective residencies, the MDs have a leg up on the DO's. Some folks go to Medical Schools in other countries, where it is easier to get into. But coming back can be difficult, as once again, the American MD grads have a leg up on you.
If you get in, the first two years are generally basic science: biochemistry, anatomy, pharmacology etc ... you can look it up. Then it's 2 years of clinical rotations. The first year of clinical rotations (3rd year of med school) includes internal medicine, surgery, OB/Gyne, pediatrics, and psychiatry. This is the year you see in the TV shows/movies when the students run around the hospital getting trashed, feeling really stupid, and staying overnight wondering what the hell you got yourself into. The second year of clinicals (4th year of med school) is much kinder and gentler. Usually it's electives and catching up on things you may have missed in the first 3 years, plus allowing time off to interview for residency.
After finishing medical school you are officially an MD, but can't really do much of anything. You have to go to a residency in the specialty of your choice. This is when you choose to specialize in Surgery, Internal Medicine, Psychiatry, Pediatrics, Family Practice etc... Each residency has a different number of years, generally from 3 years to 5 years. Psychiatry is 4 years. Residency is what you see in the TV shows and movies when they show doctors in training getting trashed, staying up all night and really learning to become a physician. 'Scrubs' was about residents in training - I believe JD was an Internal Medicine resident and Turk was a surgical resident.
Comparing what I do as medical director of my program versus what my psychologist partner does as program manager: she tallies much more of the data - how many patients did we get referred to us? What diagnoses were they? How many clerical errors occurred and how can we minimize them? Are they satisfied with their care? Did they get better from our care? She writes reports on this and reports this at meetings. She attends meetings at the hospital and regional groups to obtain new information about programs that may affect ours and report our data. I make more decisions on the clinical flow of and medical issues related to the program. Is it reasonable that this degree of severity be seen in our program versus another? Is it medically appropriate to see a patient in this or that manner, or should they be referred to a different program? This type of treatment requires blood testing, so maybe they should do it this way, not that way. Because of my technical background, I do more of the figuring out what is possible or not, with the technology that we have.
Comparing what I do clinically as a Psychiatrist versus what my Psychologist partner does, I see a much greater volume of patients in shorter visits, focusing on their medications and guiding the overall plan. She sees the fewer patients for longer visits and much more frequently. If a patient gets a new prescription from her surgeon, she might call me to ask if it's ok to take it with the medicines I prescribe. If he gets anxious after being diagnosed with hyperthyroidism and noticing his heart is racing, he'd call me. If he gets anxious after seeing a car wreck that reminds him of being blown up by an IED while in the military, he'd call her (though he still might call me, as well). These are all generalizations, but it gives you an idea of the general differences.
Almost forgot to ask: Does the VA welcome people who would like to volunteer their time in some capacity? Seattle has a large VA presence and I would like to do more to help.