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I am a combined neuro-psych PGY1. There seems to be paucity of good info and a bit of misinformation going on about combined neurology-psychiatry programs. The combined program is 6 years in length. The best place to find information is both the particular program's website (most can be found with a simple Google search) as well as the American Neuropsychiatric Associations website.
There is a certain degree of increased competition due to the number of applicants and the few spots available. There are currently combined neuro-psych programs at NYU, Brown, MUSC, and UMass. These are the programs which had open slots and I believe that only 4 applicants were accepted; MUSC offered and filled two combined neuro-psych slots (future match data will clarify some of this). The programs are picky about which applicants they take and there are varied reasons for that. One is that a good number of combined applicants apply to combined programs because they are indecisive about which one they like better. Another is that this is a 6 year program; that is a long time to be in residency and some people just get burned out. Some programs organize the schedule of training so that you do 3 years of neurology then 3 years of psychiatry. This will often tempt combined residents into changing to just neurology, completing the 4th year and being finished with residency rather than finish the prior commitment to the combined program.
Most of the aforementioned programs offer their curriculum for combined training on their website. Here is an example of one program's curriculum:
-PGY 1 is a prelim year in medicine (the same as if you were to apply to most neurology programs) with 8 months medicine, 2 months psych and 2 months neuro.
-PGY 2 neurology year
-PGY 3 psychiatry year (which for categorical psych residents would be their PGY 2 year of psychiatry)
-PGY 4 neurology year
-PGY 5 outpatient psychiatry year
-PGY 6 is an integrated year where you do half and half, most of these months are electives and you can work with faculty to design unique and specialized electives based on your interests
There are reasons to pursue this course of training versus doing one or the other then a Neuropsychiatry/Behavioral Neurology fellowship. Combined training broadens both your possible scope of practice and options after training. A fellowship usually narrows focus rather than expanding it. During interviews I met several combined trained physicians. They often held positions with both departments at their institutions as well as conducting large amounts of research. Some examples: director of neurology at a state psychiatric hospital, attending position with both departments (rounded both on the neurology inpatient service as well as a locked psych unit); director of functional neuroimaging and director of ECT/TMS/other brain stimulation modalities; one was mostly research based and only conducted clinic in the population he was studying.
Before undergoing combined training most people like one specialty more than the other; often during training the opinion reverses itself. Financially speaking there is likely no salary advantage to combined training; I would argue however that more faculty and group positions are available to you. You could imagine that psychiatrists and neurologists are often referring patients to one another. The sequelae and comorbity involved with CNS pathologies of whatever cause is often substantial. A comprehensive treatment approach is optimal for a significant number of patients. The number of overlapping conditions is vast; major ones include the dementias, Huntingtons, Epilepsy (especially of the temporal lobe), multiple sclerosis, and Parkinson Disease.
There is an obvious bias toward research in this field. Lots of new drugs, imaging modalities, and advances in brain stimulation methods are being developed and applied clinically in both fields. Essentially, when sufficient advances are made in psychiatry to elucidate pathophysiology, the disease then becomes a neurologic condition. Psychiatry and neurology used to be the same field during the asylum days - every psychiatrist was trained in neurology. A widely cited quote by neurologist Joseph B. Martin, former Dean of Harvard Medical School sheds some light on the topic: "...the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway."
I know this was a long post, but I was hoping to answer a lot of questions I have read in multiple threads. If anyone has other questions feel free to ask and I will try to answer them.
There is a certain degree of increased competition due to the number of applicants and the few spots available. There are currently combined neuro-psych programs at NYU, Brown, MUSC, and UMass. These are the programs which had open slots and I believe that only 4 applicants were accepted; MUSC offered and filled two combined neuro-psych slots (future match data will clarify some of this). The programs are picky about which applicants they take and there are varied reasons for that. One is that a good number of combined applicants apply to combined programs because they are indecisive about which one they like better. Another is that this is a 6 year program; that is a long time to be in residency and some people just get burned out. Some programs organize the schedule of training so that you do 3 years of neurology then 3 years of psychiatry. This will often tempt combined residents into changing to just neurology, completing the 4th year and being finished with residency rather than finish the prior commitment to the combined program.
Most of the aforementioned programs offer their curriculum for combined training on their website. Here is an example of one program's curriculum:
-PGY 1 is a prelim year in medicine (the same as if you were to apply to most neurology programs) with 8 months medicine, 2 months psych and 2 months neuro.
-PGY 2 neurology year
-PGY 3 psychiatry year (which for categorical psych residents would be their PGY 2 year of psychiatry)
-PGY 4 neurology year
-PGY 5 outpatient psychiatry year
-PGY 6 is an integrated year where you do half and half, most of these months are electives and you can work with faculty to design unique and specialized electives based on your interests
There are reasons to pursue this course of training versus doing one or the other then a Neuropsychiatry/Behavioral Neurology fellowship. Combined training broadens both your possible scope of practice and options after training. A fellowship usually narrows focus rather than expanding it. During interviews I met several combined trained physicians. They often held positions with both departments at their institutions as well as conducting large amounts of research. Some examples: director of neurology at a state psychiatric hospital, attending position with both departments (rounded both on the neurology inpatient service as well as a locked psych unit); director of functional neuroimaging and director of ECT/TMS/other brain stimulation modalities; one was mostly research based and only conducted clinic in the population he was studying.
Before undergoing combined training most people like one specialty more than the other; often during training the opinion reverses itself. Financially speaking there is likely no salary advantage to combined training; I would argue however that more faculty and group positions are available to you. You could imagine that psychiatrists and neurologists are often referring patients to one another. The sequelae and comorbity involved with CNS pathologies of whatever cause is often substantial. A comprehensive treatment approach is optimal for a significant number of patients. The number of overlapping conditions is vast; major ones include the dementias, Huntingtons, Epilepsy (especially of the temporal lobe), multiple sclerosis, and Parkinson Disease.
There is an obvious bias toward research in this field. Lots of new drugs, imaging modalities, and advances in brain stimulation methods are being developed and applied clinically in both fields. Essentially, when sufficient advances are made in psychiatry to elucidate pathophysiology, the disease then becomes a neurologic condition. Psychiatry and neurology used to be the same field during the asylum days - every psychiatrist was trained in neurology. A widely cited quote by neurologist Joseph B. Martin, former Dean of Harvard Medical School sheds some light on the topic: "...the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway."
I know this was a long post, but I was hoping to answer a lot of questions I have read in multiple threads. If anyone has other questions feel free to ask and I will try to answer them.
