Considering Psychiatry ? Fielding Your Questions.....(I almost applied IM too)

Monkey House

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Considering applying for a psychiatry residency position but unsure? Know you want to do psychiatry but not sure about which programs are right for you?

Senior psychiatry resident at Harvard Longwood here to field your questions!

Nope, I don't know what your chances of getting into program X are...sorry
 

weasel23

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What made you choose it over IM?

What do you plan on doing when you finish residency (inpatient/outpatient, employed/starting a PP/some of both, fellowship, etc) and what made you choose this direction?
 
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system1c

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What if any fellowships are you interested in? Have you moonlighted at your program?
 
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Considering applying for a psychiatry residency position but unsure? Know you want to do psychiatry but not sure about which programs are right for you?

Senior psychiatry resident at Harvard Longwood here to field your questions!

Nope, I don't know what your chances of getting into program X are...sorry
I'm interested in university programs in decent areas that consider DOs with chill/laid back supportive people, 60 hr work week or less, great research opportunities and lots of teaching from the attendings. What programs would those be?
 
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bonedrone14

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I'm interested in university programs in decent areas that consider DOs with chill/laid back supportive people, 60 hr work week or less, great research opportunities and lots of teaching from the attendings. What programs would those be?
On the flip side of this...I'm interested in laid back programs where teaching is a focus +/- research but instead of the usual cities I'm looking for more rural places. Any word on good places to check out?

Thanks for doing this by the way
 

Shikima

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I'm interested in university programs in decent areas that consider DOs with chill/laid back supportive people, 60 hr work week or less, great research opportunities and lots of teaching from the attendings. What programs would those be?
My understanding and experience is that fellowship is a harder time for work compared to residency.
 

shan564

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I'm interested in university programs in decent areas that consider DOs with chill/laid back supportive people, 60 hr work week or less, great research opportunities and lots of teaching from the attendings. What programs would those be?
My program (WashU) fits all of those criteria.
 
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Achillees

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I was between Neuro and Psych for the longest time. What was your deciding factor to going into Psych?
 
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MacDonaldTriad

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Every dually boarded neurologist/psychiatrist I know is practicing psychiatry. Now this could be a selection bias as I practice psychiatry, but I cannot name a single dually boarded person that is doing neurology.
 

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Every dually boarded neurologist/psychiatrist I know is practicing psychiatry. Now this could be a selection bias as I practice psychiatry, but I cannot name a single dually boarded person that is doing neurology.
its selection bias and possibly geographic, i know of several
 

Blitz2006

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Very interesting. I wonder why.

Do psychiatrists earn more than neurologists?

I don't know anything about neurology salaries...


Every dually boarded neurologist/psychiatrist I know is practicing psychiatry. Now this could be a selection bias as I practice psychiatry, but I cannot name a single dually boarded person that is doing neurology.
 
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Monkey House

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Psychiatry residency opens up many more career options that most realize. Let's look at fellowships: Neuropsychiatry is newer fellowship but allows you to really get great neurology training and see patients that fall between the gaps of neurology and psychiatry. Sleep Medicine is another area I have seen residents successfully apply into for fellowships. Pain medicine is yet another pathway few think about. Then of course there is fellowship training in consult liaison psychiatry - where you are often working with inpatient medical patients and teams all day. You have to know your internal medicine to do that job. Geriatric psychiatry has some similar features too. Of course you can still see patients in your office for therapy or medication management - and there are plenty of those positions to go around!

So with psychiatry, you are keeping many great options open and even though you are 'committing' to one field - you have superb opportunities to partner with other areas of medicine and work in some of the most exciting corners of healthcare. Thus you really want a residency that offers your broad training so that you can keep all your options open and perhaps even stumble across what you really love....there is so much more to psychiatry than you really get to see as a medical student!
 

MacDonaldTriad

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There isn’t a huge difference in pay. The psychiatrists I know who are boarded in neurology say they got tired of headaches and strokes. They find psychiatry much more varied. Again, selection biased, but to state it most correctly: Of the dually boarded doctors I happen to know that practice psychiatry, they find psychiatry more interesting.
 

Dharma

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I was between Neuro and Psych for the longest time. What was your deciding factor to going into Psych?
I went through the same thing myself. I'm only an MS4 but in the end I found the bread and butter of psych way more interesting than that of neuro. This only came after multiple rotations in each field though.
 
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Shikima

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If you're interested in both, I'd say go for it but with the caveat that you'll want to tailor your practice for geriatrics and movement disorders and/or TBIs while working with one foot in an academic environment.
 

Blitz2006

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Yeah I have a strong interest in both.

But I love psychopharmacology, hence me swinging into psych. Plus I just feel psych is on the upswing in the next decade

But I plan on doing a 1 year neuropsychiatry fellowship, so win-win.

Splik i believe mentioned that places like Mt. Sinai has neuropsychiatry consult service. That sounds like my dream job.
 
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Monkey House

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If anyone is thinking about neuropsychaitry, also look at Longwood (BWH + BIDMC + Mass. Mental). Because both BWH and BIDMC have neuropsych fellowships and strong neuropsych departments - as a resident you can get a lot of experience as a resident and set yourself up for a good shot at a great fellowship!
 

Dharma

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If anyone is thinking about neuropsychaitry, also look at Longwood (BWH + BIDMC + Mass. Mental). Because both BWH and BIDMC have neuropsych fellowships and strong neuropsych departments - as a resident you can get a lot of experience as a resident and set yourself up for a good shot at a great fellowship!
Any other programs known this? Even those without fellowships?
 
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Monkey House

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What if any fellowships are you interested in? Have you moonlighted at your program?
From a Harvard Longwood (BWH + BIDMC + Mass. Mental) perspective there are a ton of great fellowship folks apply and match into. Given my interests, geriatrics, CL and neuropscyhiatry are my favorites - but child and forensics are also very popular too. Several residents have pursued further psychotherapy training as well. I am looking at some research type fellowships as well - which this residency has prepared me well for.

Residents can moonlight from our program and many do. Even in a 'big city' like Boston there are more moonlights spots than their are residents so it is easy to find a position if you want.
 
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Monkey House

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What made you choose it over IM?

What do you plan on doing when you finish residency (inpatient/outpatient, employed/starting a PP/some of both, fellowship, etc) and what made you choose this direction?

At this risk of drawing the ire of SDN, IM felt a bit like being an air traffic controller. Psychiatry to me feels more dynamic and the patients are more interesting to work with. You can get psychiatry patients much better, often rather quickly, and seeing that change is always rewarding. Add in that psychiatry has so much still unknown - so much more opportunity for helping to make a positive impact in the field - be in research, clinical work, policy etc. The fact that most psychiatrists are generally easy going and fun people helps too. Finally, thinking about all the fellowships you can do after psychiatry residency - including the the more uncommon ones like sleep medicine or pain - there are many ways to be working with IM if so desired. (of course CL goes without saying)

All that said, I wanted a residency program that still respected and would keep me well connected to IM with strong medicine department as well as CL and neuropsychiatry service. Thus when looking where to apply - I looked for places that would give me great psychiatry training and not limit my interests in therapy etc by being overly dogmatic - but also value medical psychiatry as well. I like to think I found a great program to do that at - but know there are also other programs as well that can offer this balance. As an applicant - it may take some scoping out but they do exist!
 
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Shikima

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At this risk of drawing the ire of SDN, IM felt a bit like being an air traffic controller. Psychiatry to me feels more dynamic and the patients are more interesting to work with. You can get psychiatry patients much better, often rather quickly, and seeing that change is always rewarding. Add in that psychiatry has so much still unknown - so much more opportunity for helping to make a positive impact in the field - be in research, clinical work, policy etc. The fact that most psychiatrists are generally easy going and fun people helps too. Finally, thinking about all the fellowships you can do after psychiatry residency - including the the more uncommon ones like sleep medicine or pain - there are many ways to be working with IM if so desired. (of course CL goes without saying)

All that said, I wanted a residency program that still respected and would keep me well connected to IM with strong medicine department as well as CL and neuropsychiatry service. Thus when looking where to apply - I looked for places that would give me great psychiatry training and not limit my interests in therapy etc by being overly dogmatic - but also value medical psychiatry as well. I like to think I found a great program to do that at - but know there are also other programs as well that can offer this balance. As an applicant - it may take some scoping out but they do exist!
For context, I do a lot of "air traffic control" type work in my practice as issues pop-up in terms of medical health which was non-nonchalantly overlooked both by the Pt and PCP.
 
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For context, I do a lot of "air traffic control" type work in my practice as issues pop-up in terms of medical health which was non-nonchalantly overlooked both by the Pt and PCP.
Frequent Flyer 8921 now circling ED Crisis Department requesting clearance to land on Inpatient Runway 29L...
 
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Did you ever consider combined programs given your interest in IM? (IM-Psych programs)? If so, what made you choose otherwise? Who should more seriously look into combined IM-psych?
 
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Did you ever consider combined programs given your interest in IM? (IM-Psych programs)? If so, what made you choose otherwise? Who should more seriously look into combined IM-psych?
Good question. Yes I did look at combined programs but ultimately decided against them. I talked to many folks much more senior that me - and it seems few actually end up using the joint training and most who do it end up being more on the psychiatry side of the fence. Second - there are not many IM-Psych programs and not many spots either. You really do limit yourself in terms of training sites/programs with dual programs. Third - if you consider a CL or neuropsych or geriatric fellowship you can get to the same place you would with the dual training programs - but with expert training. Fourth - the funding and political situation of combined programs is always in flux. I looked at the UC Davis one - but then it disappeared for a year! - although now seems to be back. Fifth - in addition to great clinical training you also want some time for research and with a packed dual program that is going to be harder. Sixth - there are many residencies that give your a solid medicine experience (in part why I picked where I am now). But mostly importantly - looking back I am happy I picked the psychiatry path and think the dual training was alluring but would not have been a great career move (then again not like it would have been a bad move either). Psychiatry is still wide open enough that you can define you role and future how you want it - use that to your advantage!
 
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shan564

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At this risk of drawing the ire of SDN, IM felt a bit like being an air traffic controller. Psychiatry to me feels more dynamic and the patients are more interesting to work with. You can get psychiatry patients much better, often rather quickly, and seeing that change is always rewarding. Add in that psychiatry has so much still unknown - so much more opportunity for helping to make a positive impact in the field - be in research, clinical work, policy etc. The fact that most psychiatrists are generally easy going and fun people helps too. Finally, thinking about all the fellowships you can do after psychiatry residency - including the the more uncommon ones like sleep medicine or pain - there are many ways to be working with IM if so desired. (of course CL goes without saying)

All that said, I wanted a residency program that still respected and would keep me well connected to IM with strong medicine department as well as CL and neuropsychiatry service. Thus when looking where to apply - I looked for places that would give me great psychiatry training and not limit my interests in therapy etc by being overly dogmatic - but also value medical psychiatry as well. I like to think I found a great program to do that at - but know there are also other programs as well that can offer this balance. As an applicant - it may take some scoping out but they do exist!
Good question. Yes I did look at combined programs but ultimately decided against them. I talked to many folks much more senior that me - and it seems few actually end up using the joint training and most who do it end up being more on the psychiatry side of the fence. Second - there are not many IM-Psych programs and not many spots either. You really do limit yourself in terms of training sites/programs with dual programs. Third - if you consider a CL or neuropsych or geriatric fellowship you can get to the same place you would with the dual training programs - but with expert training. Fourth - the funding and political situation of combined programs is always in flux. I looked at the UC Davis one - but then it disappeared for a year! - although now seems to be back. Fifth - in addition to great clinical training you also want some time for research and with a packed dual program that is going to be harder. Sixth - there are many residencies that give your a solid medicine experience (in part why I picked where I am now). But mostly importantly - looking back I am happy I picked the psychiatry path and think the dual training was alluring but would not have been a great career move (then again not like it would have been a bad move either). Psychiatry is still wide open enough that you can define you role and future how you want it - use that to your advantage!
Wow, those two posts were spot on - I could have written them myself verbatim. Next time a med student asks me why I chose psychiatry and why I decided against IM/psych combined programs at the last minute (despite interviewing at three of them), I may as well refer them back to these posts and say that I might as well have written them.
 
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Thanks for doing this, the answers are much appreciated.

Question about neuropsych - to what degree does the fellowship expand your scope of practice towards neurology? For example would you co-manage most patients with a neurologist or would you be the primary doc following them? Would you be reading your own EEGs? Any new interventions? From the curriculum I see what they manage but I guess I'm interested in how that plays out.

Thank you!
 
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How does an MS1 go about looking for opportunities to shadow different types of psych practices?
 
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Amygdarya

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How does an MS1 go about looking for opportunities to shadow different types of psych practices?
1) See if your school has some sort of a psychiatry interest group. Its member may know of shadowing opportunities in psychiatry at your school - in fact, some schools have lists of physicians open to shadowing.
2) Contact your school's psychiatry clerkship director or someone like that (director of behavioral science course or whatever your school calls it etc.). They're usually very enthusiastic about helping students interested in their specialty. Make sure not to sound like you're trying to suck up to them, but otherwise I see absolutely nothing wrong about contacting people who regularly work with students and are aware of resources available to them.
3) You can contact some psychiatrists directly. As a medical student, you have a bit of legitimacy in the clinical world (as opposed to pre-med where you have none) which makes physicians more open to having you shadow them. For psychiatry, try hospital-based services: emergency, consult-liaison, inpatient. Some child psychiatrists are open to shadowing. But, of course, you can forget about outpatient private practice and individual therapy.
4) Most medical schools now have some sort of free clinics; some of them have psychiatry clinics. Volunteering for a free psych clinic was the best outpatient psych experience I've got so far (and I just started my 2nd year!)
5) If all of the above fails, try catching some psych cases by shadowing regular ER. Again, as a medical student, you have more legitimacy in the ER, so that docs will be more willing to teach you or even let you do something (this is very site-dependent and also depends on your relationship with ER docs/residents, but I got to do some very minor procedures like stapling a wound even as a first year student). And even if you don't see all that many psych cases at your ER, I still recommend shadowing ER *as a medical student* because I personally learned a ton of medicine this way.
 
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But, of course, you can forget about outpatient private practice and individual therapy.
I would strongly recommend getting to try to see outpatient and individual therapy, as it has been one of the things that really got me interested in psychiatry, and allowed me to see the field was much more than meds-meds-meds in the outpatient setting. This should be possible at just about any school, especially if you're only M1 and have plenty of time to ask around. Most schools are also getting better about including a little bit of outpatient and therapy in clerkships, but have a long way to go.

Outpatient psych is where more than half of psychiatrists practice so you wouldn't want to "forget about it" I don't think! Otherwise great advice above!
 
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Monkey House

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Certainly agree with the above re shadowing -but just meeting with and talking to senior residents and attending may give you nearly the same information much easier. Not always - but perhaps the best place to start? (and if you want to and can shadow - then superb!)
 

Amygdarya

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I would strongly recommend getting to try to see outpatient and individual therapy, as it has been one of the things that really got me interested in psychiatry, and allowed me to see the field was much more than meds-meds-meds in the outpatient setting. This should be possible at just about any school, especially if you're only M1 and have plenty of time to ask around. Most schools are also getting better about including a little bit of outpatient and therapy in clerkships, but have a long way to go.

Outpatient psych is where more than half of psychiatrists practice so you wouldn't want to "forget about it" I don't think! Otherwise great advice above!
I agree that outpatient setting is important because that's where most of psychiatry is practiced. However, there are obvious barriers to shadowing outpatient psychiatry and individual therapy in particular. I really don't see how this can be possible "at just about any school", and physicians at my school are surprisingly open to shadowing in general - but patient interests, including privacy, should come first. If you've had outpatient and therapy shadowing experience, that must be a pretty unusual setup.
As I mentioned above, I've had outpatient psychiatry experience at a free clinic (consultations/med management), and, while I greatly appreciate the experience and try to get involved with the clinic as much as I can, I can also see how this setup of having two or more people with a patient in the exam room is far from ideal for patients. In fact, there've been many instances where I could tell (and attendings confirmed my thinking) that a patient could really benefit from discussing their problems right there and then, but wouldn't be willing to do it in the presence of more than one person. In fact, sometimes an attending would take a few minutes one on one with a patient, and I'm not upset about being left out because it's better for patients.

You can observe elements of therapy even in hospital settings. Eg., I've seen C/L psychiatrists doing bits of therapy (supportive and CBT) with their patients. Although, of course, it's very different from outpatient therapy sessions.

To learn more about therapy, one can undergo therapy oneself. You don't have to have a serious mental disorder to get therapy. Unfortunately, not everyone can afford to have therapy for a whole lot of reasons regardless of their psychopathology or lack thereof, but I highly recommend it if you can. I've been very lucky to have access to infrequent but very high quality and affordable psychodynamic psychotherapy sessions, and not only are they helping me figure some of my **** out, but I've also gained an appreciation of therapy (psychodynamic therapy in particular, even though I used to be quite sceptical of it), and it has deepened my interest in psychiatry.

-------------------

I also agree with Monkey House that residents are a great source of information and creating a relationship with them is a good way of "plugging into" a specialty for medical students. Unfortunately, preclinical students are rarely exposed to residents, so, unless there's some preexisting arrangement to put preclinical students in touch with residents (like residents participating in student psychiatry interest group etc.), it's simply easier to first identify faculty members to contact (and they may actually put you in contact with some residents).
 
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system1c

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Every dually boarded neurologist/psychiatrist I know is practicing psychiatry. Now this could be a selection bias as I practice psychiatry, but I cannot name a single dually boarded person that is doing neurology.
Now I wonder, does this mean that getting a fellowship in neuropsychiatry is just as a waste of time or more beneficial than that of a dual residency? I thought it would the dual residency would be great in terms of CTE and PCS...a lot old retired atheletes have reported periods of rage and aggression...wouldn't this fall in a dual boarded person, or neuropsychiatry? I don't want to spend an extra two years if I don't need it.
 
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I thought it would the dual residency would be great in terms of CTE and PCS...a lot old retired atheletes have reported periods of rage and aggression...wouldn't this fall in a dual boarded person, or neuropsychiatry? I don't want to spend an extra two years if I don't need it.
I know of a singly boarded psychiatrist with no fellowship training that has built his practice catering to athletes and head injuries (he gave us a talk on PCS).
 

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Neuropsychiatry fellowships have a lot that are neurobehavioral heavy. These may be enough unless you are fond of headaches and strokes. Oh, and localization and very long rounds. Neurologists love to talk. Like I have said before, neurologists don't treat illnesses, the admire them.
 
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Dharma

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Neuropsychiatry fellowships have a lot that are neurobehavioral heavy. These may be enough unless you are fond of headaches and strokes. Oh, and localization and very long rounds. Neurologists love to talk. Like I have said before, neurologists don't treat illnesses, the admire them.
Just sharing my thoughts as a future psychiatrist (hopefully) with an interest in neurology:

Sounds like a field for the research oriented types. For those looking to go straight-up clinical, appears more like a year making less money and maybe even one developing less practical skill. How much of a niche really exists that this field would call for a plethora of sub specialists? (I don't ask that rhetorically either). It sounds alluring for those interested in both fields but I question the practicality of it all beyond research and academic interests. For the vast majority, at the end of the day, an individual has to ask whether he wants to be a neurologist or a psychiatrist. Very few will walk in that very interesting yet thin grey zone of overlap and still flip the bills. Guess we could still bust out the hammer and tuning fork every now and then when instinct calls for it.

My thoughts are that we will see more detailed explanations/propositions of the neuropathological mechanisms underlying psychiatric conditions across the board, and this will work its way into the collective understanding and mainstream practice. However this won't entail some neurology take-over of psychiatry or even a merging of the fields (or significant creation of a new one). Psych is most definitely becoming more interesting on its own, and for most of us with an interest in neurophysiology, this won't entail an extra year of servitude. If anything it means extra inquiry and effort on one's own part to continue studying, questioning, observing, reading, and practicing... To keep digging on. Idealistic? Yes. But exciting too!

That's my lunch break ramble. Peace.
 
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Monkey House

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at the end of the day, an individual has to ask whether he wants to be a neurologist or a psychiatrist.
It is not so difficult to practice at the confluence of neurology and psychiatry. And if you look where the National Institute of Mental Health (NIHM) wants to take the field - it is even closer towards the neurosciences. Granted the NIMH is only one player in a complex arena - but there are numerous opportunities for psychiatrists to work in the "grey zone" referred to above and it mostly certainly will "flip the bills."
 

Dharma

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It is not so difficult to practice at the confluence of neurology and psychiatry. And if you look where the National Institute of Mental Health (NIHM) wants to take the field - it is even closer towards the neurosciences. Granted the NIMH is only one player in a complex arena - but there are numerous opportunities for psychiatrists to work in the "grey zone" referred to above and it mostly certainly will "flip the bills."
I'm just curious as to how much this is possible outside of the realm of academic medicine. In the hospitals I have rotated at for inpatient/C&L psychiatry and neurology (busy units and services), I can only think of 1 or 2 cases that would call for such expertise. Granted, my experience is limited but it seems like a nice niche for a select few in a given region, depending on population size. Psychiatry as a whole will be more influenced by neuroanatomical understanding in coming years regardlessly.
 

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NIMH's research agenda is highly relevant for intramural researchers at NIMH, less so for what clinical practice in the majority of places is going to look like.
 

system1c

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I'm just curious as to how much this is possible outside of the realm of academic medicine..
I think that’s what I'd be most curious about, and I'm not talking about working for academic hospitals, but working for one's own or partner practice could you not apply for grants for your own studies and contribute to the wide open field? Maybe it’s a pipe dream, but I wouldn't mind conducting my own research parallel to a regular practice as far as functional MRIs or PET scans go if I could get grants for it. Psychopharmacology and PET scans?
 
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clausewitz2

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If you are not at an academic institution, whose MRI are you going to use to run functional studies? Who is going to draw up your radioactive tracers for PET? "Independent investigators" do not get R01s.