Recently I have heard of this new sub-specialty through a couple of residents I spoke to, which focuses on the use of things like ECT and TMS, among others. Some google and SDN searches have not revealed much information, at least recent thoughts. It seems intriguing.
It is intriguing. Interventional psychiatry is basically divided into three domains:
- Things psychiatrists can already do that work (think ECT)
- Things psychiatrists can already do that might work (think TMS, ketamine infusions)
- Things psychiatrists can't do, but can participate in (think VNS, DBS)
The first bullet is fairly bread and butter and at many programs you can get sufficient exposure to get "certified" to practice the modality independently at the hospital you trained at. When you look for a new job after graduation, whether they give you privileges outright or have you do some cases with senior faculty is dependent on where you're applying. A fellowship won't change that. There is no license or permit as such.
The second bullet is more experimental and dependent on where you train. Some places have their own TMS set-ups or relationships with them (often at a research-focused VA). Few programs have this kind of experience as a core training product, because the use of TMS and Ketamine is not standard practice and is still being researched. But if you're interested, if programs have the TMS, you should be able to set these up as fourth year experiences.
The third bullet is stuff that is really cool, but psychiatrists are not driving. At the end of the day, the truly interventional stuff where you are implanting devices, it is a surgical process and you are monitoring and adjusting treatment on the patient after the fact. Most places let you scrub in if you're interested, but you're an observer in the OR.
I think if you are interested in this stuff, the key is to find a residency that has the opportunities you are interested in so that you can get involved during residency. This way you can find how much of it you really want to make a practice out of and if it is justified by a one year fellowship. For 90% of what you would do clinically, a fellowship will be of limited utility (e.g.: if you go to a likeminded residency program, you can get the foundation you need in TMS and ECT during residency itself with the right electives). If you are interested in academics and research (which is where things like DBS and VNS mostly live) it might be helpful.
You will find few-to-no jobs in which you are doing interventional psychiatry full-time. Even for folks dedicated to the most employable interventions (like ECT), it is typically no more than 25% or so of their practice. If you were at an academic center in which its a leader, you might bump that up a little, but you'll still have other duties. Frankly, if you're interested in interventional, your best asset will be a skilled clinician working with treatment-refractory patients, so you'd likely be working with Mood Disorder clinics and inpatient units and the like.
So as you're looking at programs, I'd ask them this about their residency programs:
- Is their program a true tertiary care center where patients are referred after failing treatment in the community and potentially smaller academic centers?
- When is exposure to ECT? When do residents start managing ECT cases? How are fourth year electives and are they sufficient that I can get privileges by graduating residency?
- Do you have TMS? Is this part of training? If not, is it available as an elective and when? How many cases could I expect to work on?
- Do you do VNS/DBS? How many cases per year? Would I be able to be involved as a resident and in what capacity?
- What is your program's take on interventional psychiatry and opportunities for residents?
