Hi, I'm a PGY-1 psych resident, and a MSTP graduate.
As for how I got to psychiatry... I had an interest in neuroscience ever since I took a neurophysiology course in college. I ended up doing some electrophysiology research, and after I decided to do the MD/PhD, I ended up in a lab doing more of the same. Clinically, I figured I was going to do something neuro: neurology, neuropath, neurorads, maybe psych but I didn't know which exactly. All I knew was that I liked brains.
However, after almost a year, a whole lot of things started to change at once. The project was going nowhere, I was bored looking at oscilloscopes all day, I started taking the required behavioral neuro class, and a new faculty member moved in next door who was doing all of this cool behavioral and functional neuroanatomy work. I realized my interests had changed, that behavior was the aspect of neuroscience that got me excited. Turned out that the new faculty member was interested in stuff my advisor was doing and vice versa, so I started a new project with the both of them as co-advisors, and things worked out beautifully. My new project involved sexual behavior and reward circuitry in rats. Besides being something I was intellectually passionate about, it was perfect from a practical standpoint, because I used so many varied techniques - behavior, immunohistochemistry, tract tracing, genomics, etc.
So this would be my advice for picking a project: 1) the obvious, pick a mentor you can learn something from. 2) pick a project that lets you use a wide range of techniques, not because it's terribly important to know the specific techniques, but because it's important to learn different ways to approach a specific problem, esp in an inherently multidisciplinary field such as neuroscience. 3) don't be afraid to switch labs, better to lose a year than stay on the wrong path.
Anyway, when I entered my clerkships, I was hoping I would like psych because on an intellectual level it seemed like such a perfect fit with my interests in behavioral neuroscience. And I did - first and foremost, I loved the patients. Most people have a binary reaction to psych - they either love or hate it, and I think it boils down to whether you like the patients. Also, I liked the fact that the field is in a state of growth and evolution, and that at this point what we don't know far outweighs what we do know. As a scientist, I find that exciting. And I like that in addition to the science, pysch is also intimately concerend with things outside of medicine like social issues, psychology, philosophy, politics. The lifestyle is nice too - amenable to both research and an outside life.
When I did my neuro rotation, I kept an open mind. But I really did not enjoy the day-to-day practice of neurology. Like someone said above, it's like IM for the brain. In some ways, it's kind of the opposite of psych in that they can diagnose and explain the mechanism for a lot of pathology, but they can't do a heckuva lot about it. Whereas with psych, we have some meds that can really impact people's symptoms and improve their quality of life, but we're still pretty sketchy on how they work. The latter makes for a more exciting future IMO. As for the combined residency option, I thought about it very briefly. I think many people who go into psych have a moment of pause where they consider the possibility that they won't be a "real doctor." But my interests are how the brain controls behavior. Although some neurologists are interested in this, the bulk of neurology is concerned with how the brain controls motor/sensory function and peripheral nerves and whatnot, and I didn't want to spend even more years in training studying stuff I'm not interested in.
As far as residency goes, the basic structure of a psychiatry residency is already set up to make a research track very feasable. Most are front-loaded so that you do your hospital rotations and call in the first 2 years. The third year is outpatient, and there is some time for research. And the 4th year at most programs is usually 80-90% elective, which of course can be set aside for research. Some (like mine) have a formal research track with extra didactics and protected time, but it's not usually a separate application process like the IM fasttrack programs. Also, the field is hungry for people with basic science research experience and interests. I was told by some of my faculty mentors that as an MD/PhD, I would pretty much have my pick of where to do residency. I didn't believe it until I started interviewing, but it's true. I have good stats but not stellar derm applicant stats, and was pleasantly surprised to find that I was so "desirable." Didn't stop me from stressing out about the match though
Anyway, hope this was helpful. Please excuse the typos, damn finger bandaids, damn cat.
