QoL Neurology vs. Psychiatry

[k_med_]

Hello,

II wanted to ask about people who have had experience in Neuro vs. Psych particularly about the quality of life aspect as a resident and future attending. I like both specialties and find both of them interesting. But I also like things better when I have enough sleep and can see my friends/family.

How do these specialties compare with say, IM? I don't want to become bitter and demoralized (although that may happen regardless). But I am trying to weight the pros and cons of two specialties I thoroughly enjoy in aspects beyond the actual pathologies and subject matter.

Thanks for any tips!!!

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[Sushirolls]

Neurology
Psychiatry
IM

If they open their own outpatient private practices all equally have the ability to have quality of life. But the nuances of what that private practice is, how to grow it, and how to shape it are unique to each field.

1) get into medical school first.
2) don't drink all the kumbaya koolaid of the Social Justice Warriors
3) Pick the specialty you want - assuming your competiveness is on par
4) Then figure out the nuances of opening your own private practice

 

[Psychresy]

FWIW at my hospital the neuro residents have one of the worst call schedules and psych...well it's no comparison.

 

[comp1]

Psych on average is happier and has a better work life balance as an attending. Resident quality of life in psychiatry is orders of magnitude better than neuro.

 

[deleted456421]

Neurology residents have it rough. Those at my home institution essentially did two intern years: a year of medicine then a year of neurology with the latter possibly being worse than the former. Neurology residents took tons of stroke call on top of managing their designated units.

Even worse, few of my attendings seemed happy, other than a neurocritical care attending who really loved his life (I suspect it's because he could afford a chef and housekeeper). Even the private practice people seemed kind of miserable. This might be entirely location/institution dependent, however, and you'll get a better feel during medical school rotations.

The real problem I had with neurology was how many patients presented with functional deficits but adamantly refused to consider the psychological origins of their distress. The neurologist would get frustrated, refer to psychiatry, then the patient simply wouldn't show or perseverate on their perceived neurological deficits. I much preferred working working with this group from the psychiatry side of things.

As much as I enjoyed neuroscience and the pathophysiology of neurology, becoming a neurologist sounds like hell.

 

[deleted1100659]

neurology is one of the fields with the highest rates of burn out,

psychiatry generally has the best lifestyle of the three, in most but not all cases

 

[painfuldoc]

At my institution, difficulty/stress level IM >>>>> neurology >> psych.
Neurology is rough and at some places comparable to IM. If you want a good QOL, do psych and don’t look back.

 

[Celexa]

At my institution the neuro residency schedule is absolutely brutal. Probably worse than medicine due to the volume of stroke call but I don't know enough details to say for sure. And of course neuro is a year longer.

Attending life... Easy to find happy psych attendings. A lot of the adult neurologists seem pretty happy working outpatient at least.

I would never counsel someone to go into psych JUST for the lifestyle but generally speaking if you do like it there's no better specialty for work life balance.

 

[liquidshadow22]

One thing to consider is that NPs can easily eat your lunch in psych, less likely in a subspecialty in neurology. But yes neuro lifestyle in inpt is far worse than any psych.

Outpt neuro you can carve out a good lifestyle

 

[nowaysanjose]

One thing to consider is that NPs can easily eat your lunch in psych, less likely in a subspecialty in neurology. But yes neuro lifestyle in inpt is far worse than any psych.

Outpt neuro you can carve out a good lifestyle

At least where I’m at, lots of midlevels in neuro, ordering MRIs and EEGs for every little thing. I’m sure the hospital is giddy

 

[liquidshadow22]

At least where I’m at, lots of midlevels in neuro, ordering MRIs and EEGs for every little thing. I’m sure the hospital is giddy

MRI doesn't make money for neuro. For eeg, I don't think they will be able to bill for the eeg read. Too difficult for an NP to do.

Epilepsy can be a money maker in neuro cause of the continuous Eeg monitoring especially in ICU. You need a 2 yr fellowship at most places

 

[mistafab]

In terms of difficulty in residency I would say Neuro >IM >>>>> psych. Neuro programs usually just arent that big, so their call rotation for stroke can be really rough. Our program has q3 stroke call, and its like 30 straight hours. Maybe other programs arent as rough but they cant be that much better.

My psych program is on the high end of the spectrum in terms of work compared to other programs. Despite this, we had on average 55-60 hours per week averaged across intern year, and 50-55 for 2nd year. It's a joke compared to IM or Neuro. Our roughest hours were just our normal IM rotations lol.

I cant speak about lifestyle for attendings.

 

[Monocles]

We had a 2 month neuro requirement intern year. We had weekly EEG reading afternoons and on the first day I wanted to scoop my eyeballs out with a spoon and knew that I wanted nothing to do with neuro for the rest of my life. Hours and hours wasted staring at squiggly lines while all the neurologists held their chins going "hmmm" collectively.

The squigglies haunt me in my dreams.

 

[toros102]

Neurology definitely has it tougher hours-wise but most people I know who went into neurology don’t like psychiatric patients and would likely burn out pretty quickly if they switched over.

 

[90sportsfan]

neurology is one of the fields with the highest rates of burn out,

psychiatry generally has the best lifestyle of the three, in most but not all cases

As a future Neurologists who has looked into the field closely, I think this needs to be taken with a grain of salt. Neurology has one of the most vast number of practice options than any field I can think of. With general neurology, there are tons of consults and Stroke can be rapid and stressful, which can lead to burnout, but there are also tons of subspecialties. Neuromuscular Medicine, Movement Disorders, Headache, Sleep, Aging, tons of primarily research Clinician-Scientists, etc.

It's hard to put Neurology in a box. I think the variety of options, many of which are great lifestyle/low stress/low burnout is what is attractive to many.

 

[Merovinge]

As a future Neurologists who has looked into the field closely, I think this needs to be taken with a grain of salt. Neurology has one of the most vast number of practice options than any field I can think of. With general neurology, there are tons of consults and Stroke can be rapid and stressful, which can lead to burnout, but there are also tons of subspecialties. Neuromuscular Medicine, Movement Disorders, Headache, Sleep, Aging, tons of primarily research Clinician-Scientists, etc.

It's hard to put Neurology in a box. I think the variety of options, many of which are great lifestyle/low stress/low burnout is what is attractive to many.

This is definitely true and there are clearly areas of less stress in neuro. It is also true they are referencing medscape (and maybe other data) to show that neurology as a field does have a very high rate of burnout. You'all deal with super heavy diagnosis including brain death, brain cancer, dementia, ALS, etc etc.

I have a huge amount of respect for neurologists and loved all the time I spent with adult and peds neuro in training, and dated a neurologist for a year, but I think its pretty clear the field on the average is more intense for the average person and certainly residency is more intense than psychiatry.

 

[MacDonaldTriad]

I know this has selection bias because I work in psychiatry, but every double boarded Neuro/Psych person I have met are practicing psychiatry.

 

[tr]

If you like them both equally and lifestyle is your deciding factor, it's psych hands down.

One of my siblings is a neurologist (movement disorders) and I would never have wanted to go through that residency. Mine was super cush.
We are both attendings now, both in clinical academics, and psych still beats neuro for lifestyle. My sibling can't stand psych patients though so it's not like they would want to trade with me.

 

[sloop]

As a future Neurologists who has looked into the field closely, I think this needs to be taken with a grain of salt. Neurology has one of the most vast number of practice options than any field I can think of. With general neurology, there are tons of consults and Stroke can be rapid and stressful, which can lead to burnout, but there are also tons of subspecialties. Neuromuscular Medicine, Movement Disorders, Headache, Sleep, Aging, tons of primarily research Clinician-Scientists, etc.

It's hard to put Neurology in a box. I think the variety of options, many of which are great lifestyle/low stress/low burnout is what is attractive to many.

There are definitely ways to practice neurology that are lower stress/lower intensity. That being said, the residency is rough and, by comparison, you almost have to go out of your way to find a highly stressful psychiatry job.

I trained at a place that is considered pretty intense. Even so, neurology had it awful by comparison. Their call was atrocious. Absolutely terrible. Bread and butter neurology can also be pretty depressing. There is just no comparison in terms of quality of life between psych and neuro.

As has been mentioned, the key is really that you have to like working with psych patients. A lot of neurologists really dislike this, so obviously psych isn't a great option. If you do like working with psych patients, though, there are simply more options for low-stress practice in a wider variety of locations.

 

[FlowRate]

My sibling can't stand psych patients though so it's not like they would want to trade with me.

That's rough given how many movement disorder patients (and most outpatient neuro in general) are functional.

The neuro faculty where I did a lot of my med school and residency stuff were amazing, inspiring people who seemed genuinely happy and loved neuro. And thanks to top-down institutional priorities were also a very psych-friendly/collaborative neuro department. But those residents worked HARD. A lot of the attendings I worked with had reasonable outpatient schedules but a lot also did a ton of research as well.

 

[OldPsychDoc]

Neuro is 90% plumbing and packaging.
Psychiatry is the real frontier of brain science.

 

[TexasPhysician]

I think I’d start by continuing to better examine these specialties. While the same organ may be involved, we are talking completely different approaches with mostly different treatments/plans.

While psych has a better lifestyle in my opinion, the average neurologist would not be happy in psychiatry.

 

[nexus73]

I just looked at the salary data in the recent Modern healthcare. Psych was around 270-280K. Neuro was around 330K. But I assume the neurologists are busier.

 

[TexasPhysician]

Same question, but how about child psychiatry vs child neurology?

At my past academic institution, anyone boarded in peds has to hake peds inpatient call including weekends. The child Neuro faculty would wait and purposefully let their child boards lapse to not take call. They were very excited to reach this milestone. Child psych at the same place take child consult call which averages 1 call/week managed during normal hours.

 

[Sushirolls]

At my past academic institution, anyone boarded in peds has to hake peds inpatient call including weekends. The child Neuro faculty would wait and purposefully let their child boards lapse to not take call. They were very excited to reach this milestone. Child psych at the same place take child consult call which averages 1 call/week managed during normal hours.

Wow.
I hope they also made the cardiology, GI, Rheum, ID, Endo also do hospitalist medicine for a few weeks per year.
Or made all the sleep medicine practice their base specialty, or have the REI do general OB, too.
Just wow.

 

[TexasPhysician]

Wow.
I hope they also made the cardiology, GI, Rheum, ID, Endo also do hospitalist medicine for a few weeks per year.
Or made all the sleep medicine practice their base specialty, or have the REI do general OB, too.
Just wow.

Nope. Peds chair rule.

 

[calvnandhobbs68]

MRI doesn't make money for neuro. For eeg, I don't think they will be able to bill for the eeg read. Too difficult for an NP to do.

Epilepsy can be a money maker in neuro cause of the continuous Eeg monitoring especially in ICU. You need a 2 yr fellowship at most places

It's a money maker for the hospital though.

Yeah spend a weekend on stroke call with the neuro residents and you'll feel bad for them how bad they have it. At my med school they got run ragged cause "stroke" for neuro is kind of like "SI" for psych...you get called every freaking time someone even mentions or thinks about it. But the sheer volume of stroke calls ends up being just out of control. Neuro vs psych call is definitely not even comparable.

Attending lifestyle you can probably make however you want as neuro, there are definitely outpatient private practice neurologists but I think those are starting to become more rare.

 

[k_med_]

I wanted to thank everyone for the wonderful responses. I really appreciate it and it has helped me further. I am very grateful for this community.

 

[Postictal Raiden]

Is this even a real question?

Psych wins big time

Like mentioned above, our (neuro) residency call is very tough. The only residents who work harder and longer hours than us are surgical residents.

However, depending on what neuro subspecialty you go into, life can eventually get much much better. The lifestyle of certain outpatient neurosubspecialists (MS, movement, sleep) can be very comparable to that of psych. 4 days a week, no nights or weekends, etc

 

[MacDonaldTriad]

This is not a question. The world is round, the sky is blue, vaccines work, and psych rules. Please feel free to disagree with any of these, they are equally defensible in any debate.

 

[Candidate2017]

Neurology residents have it rough. Those at my home institution essentially did two intern years: a year of medicine then a year of neurology with the latter possibly being worse than the former. Neurology residents took tons of stroke call on top of managing their designated units.

The real problem I had with neurology was how many patients presented with functional deficits but adamantly refused to consider the psychological origins of their distress. The neurologist would get frustrated, refer to psychiatry, then the patient simply wouldn't show or perseverate on their perceived neurological deficits.

100%. I spent a lot of time on stroke call and stroke service in intern year. It sucked a lot. In terms of residency hours, neuro beats IM, and handily beats psychiatry. Our neuro residents would consider their psychiatry rotation to be a vacation. Neuro also has a fair amount of patients in deep denial of psychiatric issues and who do not want to seek psychiatric help. Neurologists can get exasperated by those patients.

But OP, as pointed out by others, neurologists absolutely love neurology and absolutely hate psychiatry. And usually vice-versa for psychiatrists. So you'll figure out your path quickly.