30 is looming closer and closer: How should I move forward with my career?

birthday cake large

The work I’ve done on this blog and the positive responses I’ve received (thank you all so much!) have opened up new ideas for me.  In the month and a half since I started working on this blog, I already feel as though I’ve been able to make somewhat of a difference in others’ lives.  I know I don’t have a ton of readers (yet), but it seems as though people who’ve faced similar issues to me have really appreciated the information I’ve collected here.  I’m incredibly gratified, and inspired to do more.  But how?

I’m definitely going to keep working on this blog, and possibly purchase my own domain name and create my own website on pain science in the future.  Right now that actually seems like the best way to get information out to people.

But as age thirty looms closer and closer, it would be nice to advance along my career path as well.  I would like to make a career out of helping people who have faced similar issues to mine, but I’m not sure of the best way to go about it.

I have a Bachelor’s degree, and for years and years I’ve been considering different options for graduate school.  I’ve been holding off because I can’t quite figure out what would be the best use of my time and money.  Here are the possible career roles I have considered going back to school for:

Social Work & Psychology

Throughout most of the time I was in college, I wanted to be a social worker/mental health counselor.  But as I got more experience with the field, I realized it wasn’t the career path for me.

I have always found psychology fascinating, and have the utmost respect for the vast majority of psychologists.  But in my opinion, the field of psychology is moving in the wrong direction on the subject of pain.

Though most psychologists and social workers today would be pretty quick to dismiss the ideas of Sigmund Freud as wacky and outdated, the one area of mental health where he still seems to hold an influence is in the treatment of pain.  It was Freud who first came up with the diagnosis of conversion disorder (where a patient’s “unconscious psychological conflicts” manifested themselves as unexplained pain or numbness in the body).  If you read this article by Toni Bernhard, you’ll see that as we enter 2013, today’s psychologists haven’t strayed very far from these ideas.

Diagnoses such as “somatoform disorder” and “psychogenic pain” imply that the patient is in pain because something is wrong with his or her mind.  Not only is this mindset disempowering, but it doesn’t take into account any of the things that neuroscientists have learned about pain in the past two decades.

freud
Freud. Image provided courtesy of http://www.all-about-psychology.com/

In my opinion, there’s no good excuse for this, really.  It seems like people who are already established in the fields of psychology and social work haven’t done a great job of opening themselves up to research in fields other than their own.  Critiquing work done by someone trained in another field just seems to be something that “isn’t done.”  Graduate students in these fields learn about the discoveries of the psychologists and social workers who came before them; and, for the sake of their own career success, learn to follow the rules and blend in.  Future therapists must protect themselves from liability by knowing here their limits are, and they are definitely not trained to dispense medical advice.  So it appears that these inaccurate, harmful conceptions of pain and illness are passed from one generation of mental health counselors to another.

Becoming a doctor

Having ruled out a career in mental health, I sometimes think about becoming a doctor.  I have met some pain specialists and physiatrists who I believe are really brilliant, intelligent people.  But with that being said, it seems their primary role is to order tests, rule out more serious conditions, and then refer the patient elsewhere for treatment.  Whether that’s physical therapy, occupational therapy, or mental health counseling, it’s always go see someone else, and I am interested in being the person who works one on one with the patient and helps him or her over time.

Additionally, the majority of the doctors I’ve seen over the years have all seemed to be short on time.  Rush, rush, rush: the next patient is always waiting.  Many times during my appointments, I haven’t had the chance to ask any of the questions I came there with until the doctor is halfway towards the door telling me it was nice to meet me.

I have heard of doctors setting up private practices.  That seems like a way to have control over the number of patients one sees.  However, I believe that is mostly something that primary care physicians do… I’m not sure how often doctors in physical medicine and rehabilitation or pain management do the same.

Nursing

nursing
Thank you to timefornurses on Flickr for the use of this photo.

Nursing is something that seems to hold a little bit more promise.  I once had a conversation with a fascinating doctor of nursing (yes, as much of an oxymoron as that sounds, you can actually earn a Ph.D. in nursing).  We had a great conversation about everything I’m interested in regarding pain and the nervous system.  She told me that once you get to the master’s and doctorate level of nursing, much of what you do is research.  She also told me about translational medicine, which is literally a branch of medicine/nursing that attempts to bridge the gap between what researchers are discovering, and the treatments actually given to patients.  This sounds absolutely fascinating to me, and I must know more.

That being said, I believe that the majority of nurses, including nurse practitioners (those with a master’s degree) spend most of their time doing what doctors do: running tests, ruling out serious conditions, and referring the patient elsewhere for physical therapy, etc.  I’ve never heard of a nurse that meets with patients regularly just to talk; at least not about the issues that I’m concerned with. Even at the Ph.D. level, I know there is often a huge divide in the academic world between those who research and those who treat; I’m not sure how much time a translational medicine researcher would be able to spend treating patients.

Physical therapy

pt with little kid

This is the career path I am probably focused on the most.  I have met some truly amazing physical therapists over the years, and in many cases they have helped me more than the doctors that sent me to them.  I would leave their offices basically wanting to be them, because I was so blown away by their knowledge and ability to understand both the body and my fears as a patient.

Good physical therapists are able to add a bit of counseling into the mix rather than just instruct you in exercises.  In general, I feel that when a physical therapist doesn’t appear to take the time to really try to relate to a patient, it is a reflection on his or her general inability to empathize rather than the field of physical therapy in general.

Much of the research I discuss on this blog was done by physiotherapists in Canada, the UK, and Australia (this is the equivalent of a physical therapist in the US where I live).  This bodes well for me: physical therapists have provided the most answers for me personally as well as academically.

The only limitation of a career in physical therapy would be that I wouldn’t have the ability to order any diagnostic tests such as x-rays or MRIs, to order blood-work to check for inflammatory conditions or Lyme disease, or to prescribe medication.  These are all things that must be done before any kind of diagnosis can be made, and before you can make any kind of pronouncement about a patient’s degree of central sensitization.   Since the field of medicine in general really has yet to catch up on issues of pain, I am afraid I would become frustrated as a physical therapist trying to treat patients who came in having been brushed aside by their doctors.  I am a very take-charge person, and I’m afraid I would regret going down a career path where I couldn’t just order tests and prescribe medication myself.

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So there you have it.  These are pretty much the major options I am considering returning to school for, and I am very interested in any input my blogging friends can give.

Have you ever been in a similar situation?  What did you end up deciding to do, and how did you make your decision?


20 thoughts on “30 is looming closer and closer: How should I move forward with my career?

  1. Yes, I agree with seekthesacred – don’t worry about having to settle on certain goals by certain ages!
    I’m sure you’d make a great physio (as we call ’em, in the UK).
    Everything I read about the American health care system freaks me out – I would hate to cope with it, as staff or patient. But all I can really comment on is the UK system. My husband is a GP (primary medicine/family doctor) and he said a while back he thought I’d have made a good doctor (I disagree – certain things I just couldn’t cope with, I reckon) and also suggested I re-train as a physio. For various reasons, some practical, I didn’t want to – but I think my main one was that I would find it frustrating. Here, NHS physios, like doctors and nurses, have all the ‘rush rush rush’ pressures of having too large a burden of work. But also – I have had two physio referrals in the past, and I noticed how the therapists *loved* me because I actually systematically did exactly the exercises they’d asked me to do at home, for the whole time they asked me to do it. With great results. I got a strong impression that many of their patients just don’t do what’s recommended. My dad said ‘well, that’s fine, that’s not the physio’s responsibility – you could be satisfied knowing that you’d given good advice and done everything you could’ – but I know that I’d be frustrated. Maybe I’d turn up on people’s doorsteps all wild-eyed and crazy, going ‘have you done your exercises tonight? Well, have you? I’m not going till you have’ ;-) The other thing about physios in the UK is they’re not very well paid – they earn an awful lot less than doctors. I’ve seen the responsibility and workload our local hospital physio copes with and that seems unfair to me. But – I guess all those things might be different in private practice in the States.
    Good luck with your decision! I’m sure you don’t need me to tell you that once you’ve done all your research, go with your gut/heart instincts. :-)

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