Applying to neurology and psychiatry?

[Gabby]

I love both and can't decide so I decided to apply to both and see what happens. I'm thinking of doing a fellowship in neuropsych after residency. My question is, would I be shooting myself in the foot by applying to both specialties at the same hospital?

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[michaelrack]

. My question is, would I be shooting myself in the foot by applying to both specialties at the same hospital?

yes.

Besides what you are doing, your other options if you are unsure are (in order of flexibility):

1. Apply to neuro/psych combined programs
2. Apply to neuro progragms
3. Apply to psych

You can always transfer from neuro to psych. The reverse is more difficult.

 

[bustbones26]

yes.

Besides what you are doing, your other options if you are unsure are (in order of flexibility):

1. Apply to neuro/psych combined programs
2. Apply to neuro progragms
3. Apply to psych

You can always transfer from neuro to psych. The reverse is more difficult.

I agree!! Those programs will know that you applied to both neuro and psych. That means that institutions that are reviewing your application will NOT rank you high unless you are comitted.

Either program will make you eligible for a neuropsych fellowship, so go with what makes you the most happy. In neuro, you see a lot of patients with comorbid psych issues and we see organic psychiatric disturbances from neuro diseases (Alzheimers, PD, etc). But we do not get into that who "axis whatever" system nor do we get into the whole biosocial factors as much as psychiatrists do.

Myself, I hated psych as a medical student. My preceptor was just a mean guy that passive aggressively punished inpatient ward patients and acted like a dictator. I had to do a month during my neuro residency and suddenly realized that I was somewhat good at psych, so I briefly thought about changing residencies.

I know it might be hard to decide, but ask yourself, do you enjoy sitting with patients, their families, and airing out their issues, or are you more focused on the physical exam side of the house?

 

[daptomycin]

Psych and neuro are similar only insofar as that they both deal with the the nervous system. There is obviously areas of neurology that more heavily overlap with psychiatry such as behavioral neurology, neuropsychiatry, movement disorders,etc. However, I would say that neurology has much more in common with internal medicine, and really ought to be thought of as an internal medicine subspecialty conceptually speaking, than it does with psychiatry. Psych is really its own beast that no other field approximates.

 

[Gabby]

Thanks for the responses! One other question. There are some programs that offer a combined neuro/psych residency (not fellowship, actual residency that's 6 years long). Would it be okay to apply to combined neuro/psych, apply to neuro, and apply to psych at that same hospital? I figure since they have a combined residency, they would understand someone who loves both. But maybe I'm wrong and I'd be shooting myself in the foot there too if I apply to anything other than the combined residency. Any thoughts?

As for the similarities between neuro and psych versus neuro and IM, I was exposed to a lot of overlap between the two, primarily with the psychiatric complications caused by traumatic brain injuries, strokes, and dementia. That's more neuro and psych, not IM. At least in my experience.

 

[typhoonegator]

Thanks for the responses! One other question. There are some programs that offer a combined neuro/psych residency (not fellowship, actual residency that's 6 years long). Would it be okay to apply to combined neuro/psych, apply to neuro, and apply to psych at that same hospital? I figure since they have a combined residency, they would understand someone who loves both. But maybe I'm wrong and I'd be shooting myself in the foot there too if I apply to anything other than the combined residency. Any thoughts?

As for the similarities between neuro and psych versus neuro and IM, I was exposed to a lot of overlap between the two, primarily with the psychiatric complications caused by traumatic brain injuries, strokes, and dementia. That's more neuro and psych, not IM. At least in my experience.

I don't think psych would mind if you applied to psych and neuro-psych at the same hospital, but I think some neuro people would. No one wants to get the impression that they are some sort of backup plan or sloppy-seconds.

Psychiatric complications of acquired structural brain disease often falls under the purview of neurology and PM&R, not that psychiatrists couldn't have a good impact on these patients as well. There is an enormous amount of neurology that has very little to do with psychiatry, and much more to do with cardiology, medicine, oncology, ID, and other medical specialties.

With all due respect, you might need broaden your exposure to neurology before you decide whether neuro is right for you. You seem to be very focused on the overlapping areas of neuro and psych, and these honestly don't make up the majority of clinical exposure for most neurologists, especially during training. Admitting acute strokes, AIDP, and brain tumors every call night for the next 3 years might not give you what you're looking for.

 

[darksideone]

I'm not the original poster and I'm just a third year, but I'm curious about something. If the above is true, then what do neuropsychiatrists do and why are there fellowships and residencies in it? I'm honestly asking since I really don't know.

http://en.m.wikipedia.org/wiki/Neuropsychiatry

 

[darksideone]

Thanks, but that still contradicts what the other poster said, which is why I was asking.

Nothing he said was incorrect.

"You seem to be very focused on the overlapping areas of neuro and psych, and these honestly don't make up the majority of clinical exposure for most neurologists, especially during training."

 

[typhoonegator]

True, but even if they don't make up the majority of clinical exposure for most neurologists, there still must be a market for neuropsychiatrists if there are residencies and fellowships in it. I took the poster's post to imply that wasn't the case, but I guess I misunderstood.

Most of the people I know who did dual training did it purely for research purposes (i.e. they spend their time on genetics or MRI volumetrics or tractography).

There is a market for these people, but typically they tend to segregate into one field or the other for their clinical careers due to their interests and research. There certainly are exceptions, as is the case for every rule, but there just aren't that many people who train in dual neuro/psych residencies, and from what I understand they aren't all making $500K a year filling some untapped need. You're looking at a very small subset of individuals -- the "market" for them is not really the point. These training programs suit the interests of a small group of people every year.

 

[unsung]

Nothing he said was incorrect.

"You seem to be very focused on the overlapping areas of neuro and psych, and these honestly don't make up the majority of clinical exposure for most neurologists, especially during training."

This is like saying, don't do IM residency if you are only interested in a subspecialty and dislike general IM issues. The only difference is, the way the system is set up, 3 yrs of IM is required. For whatever reason, neurologists don't have to do this. (I am NOT complaining.) Actually, if you think about it, a 6 yr combined program is the same length as an IM subspecialty. Only psychiatry is much more relevant to daily neurology (and vice versa) than general IM issues to most IM subspecialties like allergy, or something. I definitely saw a ton of psych issues on my neuro rotation.

I think it's fine to be focused on the intersection of neuro and psych... maybe it's because that is also my main interest. lol.

Admittedly, one of my concerns is that during training I'll be surrounded by a lot of folks who don't share my focused interest. It always surprises me when I meet neurologists uninterested in the "mind"- e.g. issues of consciousness, cognition, behavior. Most are interested, but some aren't. Obviously, those folks will be going into movement disorders or stroke fellowships or what not. Fine with me. They're probably baffled how I can be uninterested in neuromuscular problems. Don't get me wrong, I'd still much rather read an EEG than listen to heart sounds or deliver a baby, any day. There's room for diversity of interests in neurology, isn't there?

 

[typhoonegator]

This is like saying, don't do IM residency if you are only interested in a subspecialty and dislike general IM issues. The only difference is, the way the system is set up, 3 yrs of IM is required. For whatever reason, neurologists don't have to do this. (I am NOT complaining.) Actually, if you think about it, a 6 yr combined program is the same length as an IM subspecialty. Only psychiatry is much more relevant to daily neurology (and vice versa) than general IM issues to most IM subspecialties like allergy, or something. I definitely saw a ton of psych issues on my neuro rotation.

I entirely disagree. IM is central to the vast majority of IM subspecialties (your choice of allergy as an example is a strange one as it is a small subspecialty compared with many others, but it still holds true). And IM is more relevant to neurologists on a daily basis than psychiatry as well. Unless you want to be so broad as to consider "dealing with people and being a decent and insightful clinician" as psychiatry, knowing about IM will take you much further than psych. There are many psychiatric complications of structural brain disease, but we as neurologists are trained and capable of managing them -- sometimes in concert with a psychiatrist, but many times not.

Once again, if you're the kind of person who wants to deal with the overlap between psych and neuro, that's great. But being well-trained in psychiatry rather than IM won't make you a better neurologist.

 

[darksideone]

Question you have to ask yourself on your way to neuropsych/behavioral neurology is whether you want to do with psych stuff (bipolar, schizophrenia, suicide attempts, depression...etc.) or if you want to deal with neuro stuff (strokes, seizures, headaches, MS, PD....etc.). The answer lies right there once you can decide that.

 

[Gabby]

Not to dwell on this, but I'm confused. I'm applying to the neuropsych combined residency at this hospital (that part's already done). I'm also considering applying to psych and to neuro (I haven't yet). If my goal is to do a fellowship in neuropsychiatry (which I've addressed in my personal statement) should I not get the combined residency, then why would programs be offended that I'm applying to both neuro and psych? I'd be just as happy in a neurology residency as I would in a psychiatry one because both would get me to my end goal. I can see programs being turned off if I'm applying to neuro and derm or neuro and anesthesia, but if my goal is the fellowship that combines the two specialties, why would anyone think they're a back up?

 

[bustbones26]

Not to dwell on this, but I'm confused. I'm applying to the neuropsych combined residency at this hospital (that part's already done). I'm also considering applying to psych and to neuro (I haven't yet). If my goal is to do a fellowship in neuropsychiatry (which I've addressed in my personal statement) should I not get the combined residency, then why would programs be offended that I'm applying to both neuro and psych? I'd be just as happy in a neurology residency as I would in a psychiatry one because both would get me to my end goal. I can see programs being turned off if I'm applying to neuro and derm or neuro and anesthesia, but if my goal is the fellowship that combines the two specialties, why would anyone think they're a back up?

Let us assume that you are super medical student, excellent grades, letters, USMLE scores, etc. Then most programs would want you and rank you high, of course.

Now if I am the PD of a neurology program, let's face it, I can immediately read between the lines and detected that you are somewhat indecisive. I will probably be concerned that you might bolt on my program after a couple of years, leaving a gap. The only reason why I would consider ranking you high is due to your academic excellence, but I would not put you first on the list.

Now, if you are an average student, and I detect any indecisiveness, you are going to earn a spot anywhere from middle to bottom of the list. In fact, I might even consider a weaker student that yourself if I saw them on an audition rotation, really liked them, and felt that I could work with them, if they demonstrated committment to being a future resident at my program.

Reputable programs want committment!! Every program would love to have academically superior residents, of course, but they also want residents that are in it for the long haul.

A great example I can offer. My former program once had a medical student what was waffling between peds and neuro. She was not a bad student but did fail one set of boards. Everybody loved here whenever she rotated, both the peds and neuro programs!! They loved her so much that they were willing to overlook a board failure on her record. She admitted during interviewing that she was waffling between peds and neuro but justified this to our PD by saying that she would probably end up a child neurologist. Sounds legitimate, right?

Well, next thing you know she is at our institution as a PGY-1 transitional intern pre-selected for the public health program? She near immediately petitioned to change over the the internal medicine program, which they had gaps in their program so they were more than welcoming. By the end of her IM internship year, she was back down to neuro wondering if she could come aboard as a PGY-2? They weren't interested anymore!!

We also had a person quit in their PGY-3 year because he wanted to switch to Pysch. He left the program and did a couple years as a general medical officer (this was military setting), then in his first year of psych, called up neuro wondering if he could come back. They weren't interested anymore!!

These are the cases that programs try to avoid. Nobody likes to have any holes or gaps in their programs, hence why weak residents are often given 2nd, 3rd, 4th---nth chances before being fired from a program.

 

[typhoonegator]

I can see programs being turned off if I'm applying to neuro and derm or neuro and anesthesia, but if my goal is the fellowship that combines the two specialties, why would anyone think they're a back up?

Because you are not selecting a career that balances the two 50/50, nor are you selecting a career that is dependent on completing neurology residency. There is an enormous amount of neurology that as a neuropsychiatrist you will never deal with again after residency, and there are ways that you could reach your goal without completing neurology residency. I would wonder if you would burn out after your third q4 month on the stroke service and leave for some cushier psych program. This is different from someone coming into neurology residency with a total focus on movement disorders, because even though they won't be treating strokes or neurocysticercosis after residency, the program knows they're going to be all-in because there is no other way for them to get to do what they want to do, other than completing their residency commitment.

You don't seem to have been swayed by any of the arguments on this thread. You should do what you feel is most appropriate. But fair or not, people here are speaking from a position of some experience. Just because it makes sense to you doesn't mean it will play out well in the real world.

 

[HeartNeuro]

Because you are not selecting a career that balances the two 50/50, nor are you selecting a career that is dependent on completing neurology residency. There is an enormous amount of neurology that as a neuropsychiatrist you will never deal with again after residency, and there are ways that you could reach your goal without completing neurology residency. I would wonder if you would burn out after your third q4 month on the stroke service and leave for some cushier psych program. This is different from someone coming into neurology residency with a total focus on movement disorders, because even though they won't be treating strokes or neurocysticercosis after residency, the program knows they're going to be all-in because there is no other way for them to get to do what they want to do, other than completing their residency commitment.

You don't seem to have been swayed by any of the arguments on this thread. You should do what you feel is most appropriate. But fair or not, people here are speaking from a position of some experience. Just because it makes sense to you doesn't mean it will play out well in the real world.

sure you make a good point...if someone has an interest in both or the interface of both, then stroke and neuro icu might not be very motivating during residency to get to your endpoint...although, people on this board seem to imply that "stroke's not that hard."

 

[bustbones26]

sure you make a good point...if someone has an interest in both or the interface of both, then stroke and neuro icu might not be very motivating during residency to get to your endpoint...although, people on this board seem to imply that "stroke's not that hard."

Well, stroke is a bread and butter consult of neurology. In my residency days, if there was no suspicion of stroke/TIA in the ER, then we probably rarely would have been called.

I once asked a resident at a sister institution, "Hey, if neuro teams are admitting all of the strokes/hemorrhages, then what in the hell is the stroke fellow doing?". Their answer, "taking a break and actually focusing on learning".

Actually at that particular institution, they sneaked in an MPH degree on their stroke fellowship and published lots of epidemiological stroke data. The scutwork indeed was left to the residents.

Other stroke programs get into the critical care aspects of stroke management, albeit not purely a NC program.

At the end of the day, they all make you eligible for the ABPN vascular neurology examination.

The overall point that TN is trying to make is that if there are aspect of neurology that you dislike, well tough, you have to put up with it during residency until you can focus on your subspecialty later.

 

[unsung]

Because you are not selecting a career that balances the two 50/50, nor are you selecting a career that is dependent on completing neurology residency. There is an enormous amount of neurology that as a neuropsychiatrist you will never deal with again after residency, and there are ways that you could reach your goal without completing neurology residency. I would wonder if you would burn out after your third q4 month on the stroke service and leave for some cushier psych program. This is different from someone coming into neurology residency with a total focus on movement disorders, because even though they won't be treating strokes or neurocysticercosis after residency, the program knows they're going to be all-in because there is no other way for them to get to do what they want to do, other than completing their residency commitment.

You don't seem to have been swayed by any of the arguments on this thread. You should do what you feel is most appropriate. But fair or not, people here are speaking from a position of some experience. Just because it makes sense to you doesn't mean it will play out well in the real world.

I've heard people make this argument time & again. But the purpose of a combined residency program is that it DOES allow for a practice that balances 50% psych patients and 50% neuro patients. That is the whole point.

People say "oh but you'll just focus on one or the other after residency". Maybe. Maybe not. I think a majority of people probably do favor one or the other by quite a bit. It's the rare individual that truly likes both... since they are such different beasts, in terms of daily practice.

But I think for those few individuals who seek it out, it's possible to have a career that balances both. I don't think the dedication of these individuals toward neurology (or toward psychiatry) should be questioned. There is no other way to get to the end-point of treating both types of patients, other than through a combined program. I agree a combined program isn't good for the vacillating individual who can't choose... but it's the logical choice for the individual who truly desires to do both.

 

[typhoonegator]

You cannot be great at both. There is a reason they are separate specialties. I don't even feel comfortable with neurology outside vascular neurology and neurocritical care -- how is it that you think you are going to be comfortable as both a fully-fledged neurologist and psychiatrist?

I'm not trying to be argumentative. But please have enough respect for these two fields to recognize that anyone who tries to "have it all" could never be anything other than a dilettante.

 

[bustbones26]

I've heard people make this argument time & again. But the purpose of a combined residency program is that it DOES allow for a practice that balances 50% psych patients and 50% neuro patients. That is the whole point.

People say "oh but you'll just focus on one or the other after residency". Maybe. Maybe not. I think a majority of people probably do favor one or the other by quite a bit. It's the rare individual that truly likes both... since they are such different beasts, in terms of daily practice.

But I think for those few individuals who seek it out, it's possible to have a career that balances both. I don't think the dedication of these individuals toward neurology (or toward psychiatry) should be questioned. There is no other way to get to the end-point of treating both types of patients, other than through a combined program. I agree a combined program isn't good for the vacillating individual who can't choose... but it's the logical choice for the individual who truly desires to do both.

There is absolutely nothing wrong with a person who enjoys the overlapping areas of between psychiatry and neurology. There is also nothing wrong with a person that wants to be an expert in the "overlap".

I suppose my overall point would be, if you want both, then pursue a program that offers a dual program. If you must apply to a single program, there is nothing wrong with presenting your love the the "overlap" in your personal statement, but do not show any signs that you are indecisive or may be waffling between the specialties. That will hurt your chances of a good program taking you.

 

[Yoyomama88]

if applicants dual apply to psych and neuro, is it actually common that programs become aware that the applicant has applied to the other department?

I understand the possibility of bumping into familiar faces on different interview days for each specialty, but would it hurt to just apply and see what interviews you actually receive and then avoid interviewing for both specialties at the same place?

 

[pre med 2014]

Neuropsychiatry has nothing to do with neurology. They simply treat mental disorder which happens to be caused by neurological disease. Like anxiety related to loss of neurological function for example.

 

[TUGM]

I agree with above statements saying that neurology and psychiatry are really two very different fields. Neurology is much closer to the practice of IM than is psychiatry - and psychiatry is really incomparable to any other specialty.

You also need to make a distinction whether your end goal is that of neuropsychiatrist or behavioral neurologist. While related, these two fields are also fairly different. Neuropsychiatry deals w/ psychiatric issues secondary to neurological disease. It is still, however, still the sit-down-and-talk-to-patients-about-their-feelings-IF-they-can-communicate-them-despite-their-underlying-neurologic-disease kind of specialty. Behavioral neurology deals w/ diseases such as dementia, autism, ADHD but also explores the organic neurological causes behind agnosia, agraphesthesia, alexia, amnesia, a-etc.

The breadth of each specialty is so vast that it would be EXTREMELY difficult to get a masterful understanding of both (nothing is impossible). I mean just look at neurology and its rapidly growing list of subspecialties - Stroke, MS, NeuroID, Neuro-optho, Sleep, Critical Care, Movement Disorders, Neuro-oncology, Electrophysiology, Epilepsy, and so on. Each of these fields deals with different subgroups of patients.

Synaptic pruning bud... it's a b1$h, ain't it? BUT, if this is a path you can commit to, and it makes sense to you, then by all means, choose it. Just know it's the path less traveled and you'll most likely have to forge some of the way yourself.

 

[as90]

Hey,
I've got a question, I'm equally interested in both and I was wondering if I do an audition in both, is there any chance that the each program would know that I did an audition for Psych when I'm also applying Neuro? I would be happy matching either as I can see my life in either fields and am happy.

 

[typhoonegator]

Sure, it's possible, particularly if the institution isn't large. You could try to play it off as saying you just wanted to get more experience and have some fun with the other specialty if you get caught. This may shock you, but most of us have too much going on to care if that student down the hall may have done an away rotation with us a month ago.

 

[AlbinoHawk DO]

Neuropsychiatry has nothing to do with neurology. They simply treat mental disorder which happens to be caused by neurological disease. Like anxiety related to loss of neurological function for example.

So that's why the behavioral neurology fellowship is the same as the neuropsychiatry one?

 

[michaelrack]

So that's why the behavioral neurology fellowship is the same as the neuropsychiatry one?

2 totally separate fields. behavioral neurology is a neuro fellowship, neuropsychiatry is a psychiatric fellowship.

 

[AlbinoHawk DO]

2 totally separate fields. behavioral neurology is a neuro fellowship, neuropsychiatry is a psychiatric fellowship.

You do realize that the fellows in both of them are 100% shared, right? It's the exact same program. There's not 2 separate programs. Just 2 separate names.

 

[michaelrack]

You do realize that the fellows in both of them are 100% shared, right? It's the exact same program. There's not 2 separate programs. Just 2 separate names.

a quick web search reveals that you are right.. in certain locations/programs (not all- but you are right about Massachusetts General Hospital). Things have changed since I was a resident. I guess since these are non-ACGME/ABMS programs, the fellowship programs can choose their own definitions, standards, and training protocols for the fields.

 

[microshar88]

Lets say if one does an Psych audition at Kaiser for instance and applies to a Neurology and Psychiatry program at 2 different kaiser locales, is there any way for them to find out? Obviously my chances are higher at the place I did the audition, but if I'm ok with psych or neuro, and just want to increase my chances, should I take a chance and apply to both? To clarify, these residencies are at 2 different locations but within the Kaiser system.