child neurology vs child psychiatry

[student08643]

what's the main difference and pros/cons between the two? I'm debating which one to apply to for residency and am torn.

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[Postictal Raiden]

Child neuro: diagnose and treat NEUROLOGICAL disorders (seizures, cerebral palsy, etc...). You do 2 years of general peds followed by 1 year of adult neuro and 2 years of child neuro.

Child psych: diagnose and treat PSYCHIATRICAL/BEHAVIORAL disorders (autism, adhd, anxiety, etc...). You do 4 years of psychiatry residency then 1 year of child psychiatry.

Both field are in great demand. Both have good lifestyle.

I feel that both field are very different. You need to rotate in both before deciding.

 

[liquidshadow22]

Do you want to be a pediatrician or a social worker?

Peds Neuro= lots of sick kids, reading EEGs, looking at brain scans, treating epilepsy. Probably moderate to hard residency depending on where you train.

Child psychiatry is closer to being a social worker: basically talking to parents and teachers , gathering collateral, looking at IQ testing, neuropsych testing etc. No brain scans. Limited medical skills necessary. Giving out a ton of adderall scripts. Easy residency.

Also consider a neurodevelopmental disorders residency too.

 

[babybrains]

Echoing that both are very different fields.

As was said before, you should definitely be planning on doing a rotation/sub-I with at least one of them prior to applications, as that will be expected; if you're this unsure and torn, it'd be recommended to rotate with both to understand what the differences are and what they are both like in practice. Otherwise, it'd be premature to apply into either.

Of note, I disagree with the poster above me, as psych disorders (in adults or children) can be quite challenging. It's not the field for me, but I have a lot of respect for their work and they do a lot of good.

 

[liquidshadow22]

I'm not saying the diagnosis isn't challenging in child psych. It's just that often times it's too hard to actually figure out realistically, so you just end.up throwing meds at kids to see what sticks. 75% time the actual pathology is with the parents.

I think for someone who really wants to really understand in depth learning disorders, developmental issues, autism etc. You will get.bored in child Psych and are better off doing a ndd or. Child. Neuro

 

[babybrains]

I think for someone who really wants to really understand in depth learning disorders, developmental issues, autism etc. You will get.bored in child Psych and are better off doing a ndd or. Child. Neuro

I don't think autism/developmental delays are generally considered in the child neurology realm, excepting for NDD and those kids where it's secondary to a neurological disorder (ex. Lennox-Gastaut). At least at my school, child psych is the primary provider for those patients. So I'm not sure how much exposure one would really get to those cases in a child neuro residency, if that happens to be the OP's interest.

 

[liquidshadow22]

Psychiatrists in general get very poor training in dealing with patients with organic brain problems. Youre correct that autism is often seen by child psych but definitely also seen by child neuro as well.

Social work is really a big part of child psych, so if you don't want to do all that nonclinical work, I would avoid child psych like the plague

 

[hamstergang]

basically talking to parents and teachers , gathering collateral, looking at IQ testing, neuropsych testing etc. No brain scans. Limited medical skills necessary. Giving out a ton of adderall scripts.

Child psychiatry, peds neuro, and neurodevelopmental peds overlap in the areas of Autism, ADHD, and learning disabilities, which are the issues in which most of the quoted happens. Such patients typically only come to psychiatry when there are additional behavioral or emotional concenrs.

As a child psychiatrist, I can tell you that my work does not resemble that of a social worker. My diagnoses aren't made based on labs or imaging, but my work is still very much medical. When I get medically complex kids, I have to understand what's going on with them as it relates to their psychiatric presentation and my medications. Monitoring medication side effects involves lab work and general medical knowledge (patients will complain of something and I have to determine if the cause is my med or something else). I must also consider medication interactions.

The mental status exam is part of the physical exam. Just because it doesn't involve touching doesn't mean it's not medical. And my MSEs are much more thorough than any social workers' that I've seen.

Finally, the work that we do in psychiatry takes place in the human body. Without medical knowledge, how could I understand the mechanisms and uses for new medications? How could I understand research into etiologies? How could I explain whether a patient should take l-methylfolate if they have an MTHFR mutation (I get asked this a lot)? Being a psychiatrist certainly uses a different skill set than other fields of medicine, but it's certainly practiced like a medical field.

All that said, I was torn between child psych and peds neuro as a med student. What pushed me one way was spending an afternoon in a seizure clinic. So many stable patients just getting refills was boring. I'm not sure how typical such a set up is, but at the time I didn't know any better.

 

[Naruhodo]

Psychiatrists in general get very poor training in dealing with patients with organic brain problems. Youre correct that autism is often seen by child psych but definitely also seen by child neuro as well.

Social work is really a big part of child psych, so if you don't want to do all that nonclinical work, I would avoid child psych like the plague

As the above, very informed, poster mentioned this assessment really doesn't really give psychiatry its fair due. Some of the most brilliant MD/PhDs I know chose to become psychiatrists because there is so much interesting research work to be done on understanding the brain. I personally like neurology but I could see one complaining that all neurologists do is look at imaging and they generally don't have disease mechanism-based therapies to offer *either*. Perhaps we can agree that as the line between the mind and the brain becomes increasingly blurred the purview of psychiatry and neurology is likely to continue to have significant overlap.

 

[Thama]

As the above, very informed, poster mentioned this assessment really doesn't really give psychiatry its fair due. Some of the most brilliant MD/PhDs I know chose to become psychiatrists because there is so much interesting research work to be done on understanding the brain.

Research into understanding the brain can be done from either specialty (or others, such as radiology). Indeed, some of the best MD and MD/PhD neuroscientists are psychiatry trained, though I can't help but think that the vastly lesser clinical requirements placed on psychiatrists in terms of training rigor, real inpatient call (the kind where people can and do die in front of you on a fairly regular basis), and spectrum of knowledge needed to achieve a basic level of clinical competency offers something of a fast track for researchers that want to dispense with their white coat ASAP.

I personally like neurology but I could see one complaining that all neurologists do is look at imaging and they generally don't have disease mechanism-based therapies to offer *either*.

Now this is just wildly inaccurate . We have thrombolysis and thrombectomy in stroke, ASO based gene therapies in SMA (soon to be in HD), a dozen points of immunomodulation in MS, thymectomies and immunomodulation in MG, rational channel-based pharmacotherapy for various epilepsy types (as well as potentially curative topectomy with our neurosurgery colleagues), placement of neuromodulatory probes based on listening to the affected brain regions in DBS... just a few off the top of my head. The only big, common disease in neurology that has been an abject failure in developing disease-mechanism based treatment is AD.

Meanwhile, we do have imaging for a lot of things. We also don't have imaging for a lot more. And, at least where I trained, imaging overuse is considered the sign of a badly trained neurologist (as a resident we would be ashamed to get an MRI on a stroke patient and have it come back with an obvious location we should have been able to discern with exam alone). Diagnostic electrophysiology is almost as important as being able to read neuroimaging for most general neurologists.

Perhaps we can agree that as the line between the mind and the brain becomes increasingly blurred the purview of psychiatry and neurology is likely to continue to have significant overlap.

Possibly, although history would suggest that what has happened in the past will continue to happen: as psychiatric diseases become better understood at a mechanistic level, their purview is shifted to neurology. This happened to Alzheimer's, it happened to dystonia (people used to think this was a somatoform disorder!), it recently happened to NMDA-encephalitis and quickly the rest of the limbic encephalidities, and I see it currently happening to tic disorders. OCD is probably next on the block as it's probably mostly a basal ganglia disorder that is quite amenable to DBS.

 

[hamstergang]

It's probably also worth pointing out that it's easy to practice psychiatry poorly and not so much like a medical field and yet keep your job. So you will see this out there, but you don't have to be like that.

 

[Staphylococcus Aureus]

Isn’t child psych salary far higher as well

 

[Postictal Raiden]

It's probably also worth pointing out that it's easy to practice psychiatry poorly and not so much like a medical field and yet keep your job. So you will see this out there, but you don't have to be like that.

From what I have seen, this can be said about neurology too (specially adult neurology).

 

[Naruhodo]

Sorry I didn't mean to offend - Neuro clearly has a number of therapies (so does psych for that matter), but there are still many, many things they they do not yet have effective therapies for. You mention AD, I'd add ALS, and almost all of the childhood neuro conditions like Leigh syndrome, pontocerebellar hypoplasia, adrenoleukodystrophy, Aicardi syndrome, holoprosencephaly, lissencephaly, Angelman syndrome, brain iron accumulation disorders, Freidrich's ataxia, and on and on and on. They may be individually rare, but collectively still contribute a considerable amount to morbidity and mortality. I'm as excited for ASOs as the next person, but I still think it's up for debate whether nusinersin just converted a lot of folks with SMA type 1 into more of an SMA type 2 or 3 picture...and only time and longitudinal studies will tell us that. I still think that at least child neuro folks should be prepared for a career in which a lot of what they see are things that they can't necessarily cure.

I agree with your point about clinical time and getting back to the lab, but to be fair I've also me folks like this in neuro and onc. Probably even more so than either of those specialties, path attracts some doctors who really just want to get back to research.

 

[pineapples15]

what's the main difference and pros/cons between the two? I'm debating which one to apply to for residency and am torn.

I am a new MS4 also torn between these two fields. Have you made your decision and if so what was your reasoning?