Are there any neurology fellowships a psychiatry resident can do?

[MissAmanda]

Are there any neurology fellowships a psychiatry resident is eligible to do after finishing the psych residency?

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[bluntdissector]

Are there any neurology fellowships a psychiatry resident is eligible to do after finishing the psych residency?

I know what you mean, but it's a little confusing, since these fellowships are then by definition not 'neurology' fellowships but interdisciplinary. For example, sleep can be approached from neuro, psych, as well as other specialties.

There's an interesting article in the latest Neurology looking at the accredited fellowships and the pass rates of neurology, psychiatry and double-boarded residents.

http://www.neurology.org/cgi/content/abstract/75/12/1110

 

[bustbones26]

Are there any neurology fellowships a psychiatry resident is eligible to do after finishing the psych residency?

Neuropsychiatry/Behavioral Neurology
Sleep
Headache Medicine
Palliative Medicine

Possibly pain?? I imagine that would be tough to get into from psychiatry but maybe??

 

[indya]

Neuropsychiatry/Behavioral Neurology
Sleep
Headache Medicine
Palliative Medicine

Possibly pain?? I imagine that would be tough to get into from psychiatry but maybe??

pain: yes.

http://forums.studentdoctor.net/showthread.php?t=203581

 

[bluntdissector]

Neuropsychiatry/Behavioral Neurology
Sleep
Headache Medicine
Palliative Medicine

Possibly pain?? I imagine that would be tough to get into from psychiatry but maybe??

Some are not ACGMe certified, some not ABPN...

See this link: http://www.abpn.com/spec_subspec_description.htm#pain

Pain isn't a 'neurological' subspecialty, but a psych, neuro and peds neuro one. Only those kinds of 'neuro' fellowships are open to psych.

Vascular, movement, etc isn't, and for good reasons.

 

[MissAmanda]

Neuropsychiatry/Behavioral Neurology
Sleep
Headache Medicine
Palliative Medicine

Possibly pain?? I imagine that would be tough to get into from psychiatry but maybe??

Thanks for the info. I imagine these fellowships are open to psychiatrists for some programs and not for others. Is there any one site of list I can view to see which of these fellowships at which teaching institution is open to psychiatrists and which are not.

I know I can look at each program's website in the country, but that seems inefficient.

Also, why would some be ACGME accredited and some not?

 

[Fencer]

Clinical Neurophysiology is also allowed for Psychiatrists, but it is difficult to get in because it is the most popular fellowship for Neurologists.

To assess what can you do within the ACGME accredited fellowships, examine the program requirements: http://acgme.org/acWebsite/RRC_180/180_prIndex.asp

In I.B.1 of the Clinical Neurophysiology program requirements, the document states:

"Training in neurophysiology shall encompass a total of one year which must be preceded by the completion of a residency program in neurology, child neurology, or general psychiatry accredited in the United States or Canada." [bold added for emphasis]​

 

[bluntdissector]

From the article I mention above, the pass rates for neurophysiology for 1992-2008 were as follows:


Neurologists (N)
Examinees: 2,345
Pass : 1,790 (76%)

Double-boarded in N and P
Examinees: 29
Pass: 14 (48%)

Psychiatrists (P)
Examinees: 20
Pass: 8 (40%)

Of course not everyone will choose to be certified in the subspecialty, and they might practice with their certification in psychiatry. Still interesting statistics though, especially the double boards...

 

[MissAmanda]

What is the point, significance, or benefit of having psychiatrists and neurologists boarded by one organization - is it just because there is some overlap in education, or is it because after boarding they are eligible for some of the same fellowships?

 

[MissAmanda]

Clinical Neurophysiology is also allowed for Psychiatrists, but it is difficult to get in because it is the most popular fellowship for Neurologists.

To assess what can you do within the ACGME accredited fellowships, examine the program requirements: http://acgme.org/acWebsite/RRC_180/180_prIndex.asp

In I.B.1 of the Clinical Neurophysiology program requirements, the document states:

"Training in neurophysiology shall encompass a total of one year which must be preceded by the completion of a residency program in neurology, child neurology, or general psychiatry accredited in the United States or Canada." [bold added for emphasis]​

Thank you, this is a great link. So for MOST sleep and pain medicine fellowship programs, a psychiatrist is eligible? As far as I saw, that link gave eligibility criteria for physicians and programs - but where can I find out which fellowship programs a psychiatrist is eligible to apply to? Would I have to just look into each program's website across the country to find the eligibility criteria for each program?

 

[bustbones26]

Thanks for the info. I imagine these fellowships are open to psychiatrists for some programs and not for others. Is there any one site of list I can view to see which of these fellowships at which teaching institution is open to psychiatrists and which are not.

I know I can look at each program's website in the country, but that seems inefficient.

Also, why would some be ACGME accredited and some not?

Try www.ucns.org

That site will at least tell you which neurobehavioral/neuropsych programs and headache programs exist, institutions, potential applicants, etc.

No, not all programs are ACGME, and most of the specialties I mentioned of course are not restricted to pscyh, neuro, etc but are programs often sought by neurologists.

Why not ACGME? As I have been told, there needs to be at least 25 academic programs in existance before a particular specialty can petition to be an ABM accredited specialty??

Anyways, have fun in your searches.

 

[bluntdissector]

Try www.ucns.org

That site will at least tell you which neurobehavioral/neuropsych programs and headache programs exist, institutions, potential applicants, etc.

No, not all programs are ACGME, and most of the specialties I mentioned of course are not restricted to pscyh, neuro, etc but are programs often sought by neurologists.

Why not ACGME? As I have been told, there needs to be at least 25 academic programs in existance before a particular specialty can petition to be an ABM accredited specialty??

Anyways, have fun in your searches.

Feels like I'm spamming. But the article I mention above explains the tedious process a subspecialty undergoes before it is certified.

 

[michaelrack]

What is the point, significance, or benefit of having psychiatrists and neurologists boarded by one organization - is it just because there is some overlap in education, or is it because after boarding they are eligible for some of the same fellowships?

The significance is that neurology/psychiatry were initially one field.

 

[MissAmanda]

The significance is that neurology/psychiatry were initially one field.

how log ago was that? Is it now that it is too much work to separate out the head organization due to bureaucratic reasons?

 

[liquidshadow22]

i wonder if a psychiatrist completed this fellowship, would they actually be able to read and bill EEGs at a hospital?

 

[kchan99]

i wonder if a psychiatrist completed this fellowship, would they actually be able to read and bill EEGs at a hospital?

I suppose this would depend on whether a psychiatrist could obtain such privileges. I don't know if a psychiatry department would be able to ask a neurology department to offer limited privileges for EEG. There are plenty of neurologists reading EEGs.

 

[Thama]

Some behavioral neurology and movement fellowships accept psych residents. I wouldn't expect most other fellowships to be an option.

 

[liquidshadow22]

dont necessarily see why a psych couldnt read EEGs, it's not like the physical exam really matters in outpatient epilepsy either.

anyone know if neurologists that help with DBS placement in the OR get paid well or does all the $$ go the neurosurgeon?

 

[Thama]

dont necessarily see why a psych couldnt read EEGs, it's not like the physical exam really matters in outpatient epilepsy either.

anyone know if neurologists that help with DBS placement in the OR get paid well or does all the $$ go the neurosurgeon?

There isn't really any psychiatry crossover in epilepsy like there is in dementia and movement, which is why I've never seen a psych fellow there. The idea that a good neurologic exam isn't necessary in epilepsy is utterly foolish, it is necessary in all neurology subspecialties including the ones accepting psychiatrists and is something the psychiatrists would need to do some major catchup with. In epilepsy for example, if you find progressive aphasia, apraxia, hemianopsia, etc in the context of a focal epilepsy, are you going to know what to do next? Are you even going to be able to pick up on these signs before they become severe and so obvious your secretary would notice?

 

[liquidshadow22]

There isn't really any psychiatry crossover in epilepsy like there is in dementia and movement, which is why I've never seen a psych fellow there. The idea that a good neurologic exam isn't necessary in epilepsy is utterly foolish, it is necessary in all neurology subspecialties including the ones accepting psychiatrists and is something the psychiatrists would need to do some major catchup with. In epilepsy for example, if you find progressive aphasia, apraxia, hemianopsia, etc in the context of a focal epilepsy, are you going to know what to do next? Are you even going to be able to pick up on these signs before they become severe and so obvious your secretary would notice?

You might be right that the average psychiatrist will be behind on neuro exam skills, but how often does that really happen? And if those are acute neuro findings, you send them to an ER. If they have a brain tumor/aneurysm, you send them to their neuro-onc or re-image. I don't think it's that complicated. Outpt epilepsy pts rarely ever come in with acute issues. Usually they come in for followup after having had inc frequency of seizures, breakthrough seizures in setting of noncompliance etc...I think referring refractory cases for advanced therapies would be complicated, but that's what you do the fellowship for.

 

[Thama]

You might be right that the average psychiatrist will be behind on neuro exam skills, but how often does that really happen? And if those are acute neuro findings, you send them to an ER. If they have a brain tumor/aneurysm, you send them to their neuro-onc or re-image. I don't think it's that complicated. Outpt epilepsy pts rarely ever come in with acute issues. Usually they come in for followup after having had inc frequency of seizures, breakthrough seizures in setting of noncompliance etc...I think referring refractory cases for advanced therapies would be complicated, but that's what you do the fellowship for.

If you are practicing a neurology specialty, you will be expected to manage neurologic disease, not punt to an ER. The situation I described is not emergent.

 

[liquidshadow22]

What exactly is the situation you described...I assume it's aneurysm, AVM, or tumor related.

 

[Thama]

What exactly is the situation you described...I assume it's aneurysm, AVM, or tumor related.

It's a pretty classical description of Rasmussen's, though tumor would certainly be on the differential as would certain autoimmune encephalidities, indolent infections, etc. Epileptologists are neurologists and a wide spectrum of neurologic disease can manifest as epilepsy. The point I wanted to make is that the idea that you don't need the tools you learn in an entire neurology residency to practice competently in one of its core subspecialties is laughable. Planning to do a different and vastly easier residency and then thinking that a 1 year fellowship will catch you up to all the neurology you need is a bit like majoring in sociology and then taking a semester of 400 level engineering courses thinking it will qualify you to work for NASA.

 

[liquidshadow22]

Rasmussen's is a pediatric neurology issue. It's probably so rare, no one sees it during a adult neurology residency.

With regards to autoimmune encephalitis, or infection, these patients would likely present acutely to an ER or inpatient neurology unit... I highly doubt this is a frequent sighting for an outpatient epileptologist. For many neurology programs, your education is primarily in inpatient neurology, I don't see how it's that relevant to having to read EEGs and adjust people's AEDs.

I'm not denying knowledge of the neurological exam is an important skill which you don't learn in psychiatry, but I just disagree that it becomes relevant that often in outpatient epilepsy. Many epilepsy attendings will staff cases with residents without ever having laid eyes on the patient. A majority of the time the patient's neuro exams are completely normal or unchanged.

 

[Thama]

Rasmussen's is a pediatric neurology issue. It's probably so rare, no one sees it during a adult neurology residency.

With regards to autoimmune encephalitis, or infection, these patients would likely present acutely to an ER or inpatient neurology unit... I highly doubt this is a frequent sighting for an outpatient epileptologist. For many neurology programs, your education is primarily in inpatient neurology, I don't see how it's that relevant to having to read EEGs and adjust people's AEDs.

I'm not denying knowledge of the neurological exam is an important skill which you don't learn in psychiatry, but I just disagree that it becomes relevant that often in outpatient epilepsy. Many epilepsy attendings will staff cases with residents without ever having laid eyes on the patient. A majority of the time the patient's neuro exams are completely normal or unchanged.

Besides the part where adult neurologists regularly manage pediatric patients who have "graduated", I personally have seen it in a young adult. Frankly if your epileptologists practice without seeing patients themselves then I would question both the quality and integrity of the institution where you are drawing this clinical experience from. Regardless, as a subspecialist you have to be equipped to recognize and treat even rare things in your field. There's nobody to punt to, you are the one generalists and general neurologists go to for help in difficult cases and your better pay etc is justified by you knowing what to do with them.

 

[splik]

There isn't really any psychiatry crossover in epilepsy like there is in dementia and movement, which is why I've never seen a psych fellow there.

Two issues: firstly epilepsy just like movement disorders and dementia is a disorder at the neurology-psychiatry interface, and in face in most developing countries epilepsy is treated by psychiatrists and the world health organization recognizes epilepsy as one of the top 10 neuropsychiatric disorders. Given that so many patients seen in epilepsy clinics and telemetry units have PNES, that psychiatrists are probably the most comfortable rxing anticonvulsants after neurologists, and neuropsychiatric symptoms and disorders are highly comorbid with epilepsy, psychiatrists are in a great position to contribute to the care of these patients. I feel quite comfortable doing basic management of AEDs in epilepsy in my psychiatric patients.

However, I do agree that psychiatrists doing an EEG fellowship does not an epileptologist make. There are psychiatrists who do/have done clinical neurophysiology in the past, but none of them that I know work in epilepsy. These are academic psychiatrists who wanted to get training in EEGs and use EEG and qEEG to research psychiatric disorders and/or sleep disorders etc. It's less common for people to do EEG research in psychiatry these days (as it has mostly been supplanted by various functional neuroimaging techniques) which is probably part of the reason it's much less common for psychiatrists to do such training. At any rate, I cannot imagine a neurology dept hiring a psychiatrist to do epileptology or read EEGs.