Duke Psychiatry vs Neurology

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lego1234

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Rank list deadline is nearly and I am still very confused between Psycbiatry and Neurology. I equally like both specialties but am unsure of career prospects in each (high salary, job satisfaction)

Please advise me if I should rank a high end Psychiatry program (Duke, Baylor) vs Neurology programs on top??

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Pretend I've got a gun to your head and telling you to certify the damn list.

Outside of that, there's not much in this post that we've got to work with.
 
Pretend I've got a gun to your head and telling you to certify the damn list.

Outside of that, there's not much in this post that we've got to work with.


Hahaha! That's exactly what my family tells me. Can't do anything after a week.


Plz et me know Duke Psyc or Neuro???
(CNt change anything after 25th)
 
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Hahaha! That's exactly what my family tells me. Can't do anything after a week.


Plz et me know Duke Psyc or Neuro???
(CNt change anything after 25th)

I presume you believe I'm more qualified to make life decisions for you?
 
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Plz et me know Duke Psyc or Neuro???
(CNt change anything after 25th)
How are we supposed to decide for you? Help us understand what draws you and scares you away from each if you want a helpful answer.
 
miss_cleo.jpg
 
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Neuro:
- Pros: prestigious, more competitive, avg salary higher, more fellowship options
- Cons: busier, lower job satisfaction

Psyc:
-Pros: better lifestyle, becoming competitive than before, interesting cases
- Cons: less prestigious, lower avg salary, some stigma.

Having said this Duke Psychiatry has one of the best psychiatry programs, and will prepare me very well in psychotherapy. Am interested in research and it's a leading institute for research. N I think training here than some lower end programs will open broader doors for jobs and likely better pay and demand with "Duke" training
 
Rank list deadline is nearly and I am still very confused between Psychiatry and Neurology. I equally like both specialties but am unsure of career prospects in each (high salary, job satisfaction)
Please advise me if I should rank a high end Psychiatry program (Duke, Baylor) vs Neurology programs on top??

toss-a-coin1.jpg
 
Seated before you are two patients. One, an elderly man with acute loss of function of the left arm and face, the other a former attorney who is talking to imaginary elves in the room and interestingly shut down her practice 2 months ago.

Which kind of workup would you enjoy doing more? Trust your gut.
 
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Seated before you are two patients. One, an elderly man with acute loss of function of the left arm and face, the other a former attorney who is talking to imaginary elves in the room and interestingly shut down her practice 2 months ago.

Which kind of workup would you enjoy doing more? Trust your gut.
the latter patient would see a neurologist
 
Lilliputian hallucinations. I couldn't resist. Let's agree the second patient would see both, a neurologist and psychiatrist just to be complete.
 
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Seated before you are two patients. One, an elderly man with acute loss of function of the left arm and face, the other a former attorney who is talking to imaginary elves in the room and interestingly shut down her practice 2 months ago.

Which kind of workup would you enjoy doing more? Trust your gut.

In this case the attorney talking to imaginary elves. Though I also imagine myself seeing stroke n Neuro-Oncology
 
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so youre choice is between some fairly decent psychiatry programs and some bottom of the barrel neurology residency programs?! I find it hard to believe you are asking this. also since you aren't asking this in the neurology forum it is clear to me you do have a preference for psychiatry. It is pretty unusual for someone to like both neurology and psychiatry as they are very different fields. Often people debate between psych vs IM/EM/Peds/FM/Surgery but it is not common for people to like both unless they are mostly interested in the neuro-psych interface (dementia, TBI, epilepsy, movement disorders). It is common for people to have reservations about lack of respectability of the field, lack of prestige, lack of procedures, or giving up being a "real doctor" (whatever that means). These are very common feelings that applicants may have. I don't know if this is the case for you but I don't believe the I'd be happy with both thing.

actually the toss up is between headaches/epilepsy vs depression/schizophrenia - which would you rather do all day? The other thing to consider is would you feel sad not to do procedures - there aren't any procedures in psychiatry, and even if there do become some available (which I doubt) psychiatrists will not being doing the technical bits. So if you realy want to do procedures psychiatry is not for you.

A good neurologist would actually be comfortable treating psychosis in parkinson's disease, depression, behavioral symptoms of depression, impulse control disorders pharmacologically but wouldn't have any psychotherapeutic skills. That said it is questionable the kind of training you would get at the neurology programs at your disposal. In contrast most psychiatrists don't treat any neurological conditions.

It is also possible to cultivate an interest in neuropsychiatry which is an academic but very fascinating subspecialty. I routinely do neurological examinations including cognitive assessments on patients, as well as ordering MRIs, PETs, SPECTs, EEGs and work closely with neurologists. I see very fascinating cases at the interface of neurology/psychiatry including Huntington's, FTD, early onset dementia, neurosarcoid, conversion disorder, TBI, poststroke behavioral problems etc.
 
This situation is slightly hard to understand because the day to day practice of neuro and psych are completely different.

But if your truly undecided, let the neuro ICU decide. If working with critically ill patients is exhilarating to you do neuro, if your going to dread those ICU months do psych.
 
Neuro:
- Pros: prestigious, more competitive, avg salary higher, more fellowship options
- Cons: busier, lower job satisfaction

Psyc:
-Pros: better lifestyle, becoming competitive than before, interesting cases
- Cons: less prestigious, lower avg salary, some stigma.

Having said this Duke Psychiatry has one of the best psychiatry programs, and will prepare me very well in psychotherapy. Am interested in research and it's a leading institute for research. N I think training here than some lower end programs will open broader doors for jobs and likely better pay and demand with "Duke" training

So to sum up, you're mainly considering neurology over psychiatry because the average salary is higher and because other people might think better of you for being a neurologist rather than a psychiatrist. You believe that you'll have a better lifestyle and more job satisfaction doing psychiatry.

It looks like you need to decide if you like psychiatry enough to do it even if some people will look down on you for being a psychiatrist.
 
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Neuro:
- Pros: prestigious, more competitive, avg salary higher, more fellowship options
- Cons: busier, lower job satisfaction

Psyc:
-Pros: better lifestyle, becoming competitive than before, interesting cases
- Cons: less prestigious, lower avg salary, some stigma.

Having said this Duke Psychiatry has one of the best psychiatry programs, and will prepare me very well in psychotherapy. Am interested in research and it's a leading institute for research. N I think training here than some lower end programs will open broader doors for jobs and likely better pay and demand with "Duke" training
If psychotherapy training is important to you, then you don't want to be a neurologist.
 
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So to sum up, you're mainly considering neurology over psychiatry because the average salary is higher and because other people might think better of you for being a neurologist rather than a psychiatrist. You believe that you'll have a better lifestyle and more job satisfaction doing psychiatry.

It looks like you need to decide if you like psychiatry enough to do it even if some people will look down on you for being a psychiatrist.

I have done 4 MS4 rotations in psychiatry and loved it. I also did 2 Neuro electives and love it (my research publications are in vascular!). I qually like both. But I think Neuro seems more prestigious and salary is much higher with fellowship (stroke, EEG, neuro-onc), you make $300K easily??
 
If psychotherapy training is important to you, then you don't want to be a neurologist.

personally I want to receive great training but I am more towards inpatient/academics/research rather than OP psychotherapy
 
so youre choice is between some fairly decent psychiatry programs and some bottom of the barrel neurology residency programs?! I find it hard to believe you are asking this. also since you aren't asking this in the neurology forum it is clear to me you do have a preference for psychiatry. It is pretty unusual for someone to like both neurology and psychiatry as they are very different fields. Often people debate between psych vs IM/EM/Peds/FM/Surgery but it is not common for people to like both unless they are mostly interested in the neuro-psych interface (dementia, TBI, epilepsy, movement disorders). It is common for people to have reservations about lack of respectability of the field, lack of prestige, lack of procedures, or giving up being a "real doctor" (whatever that means). These are very common feelings that applicants may have. I don't know if this is the case for you but I don't believe the I'd be happy with both thing.

actually the toss up is between headaches/epilepsy vs depression/schizophrenia - which would you rather do all day? The other thing to consider is would you feel sad not to do procedures - there aren't any procedures in psychiatry, and even if there do become some available (which I doubt) psychiatrists will not being doing the technical bits. So if you realy want to do procedures psychiatry is not for you.

A good neurologist would actually be comfortable treating psychosis in parkinson's disease, depression, behavioral symptoms of depression, impulse control disorders pharmacologically but wouldn't have any psychotherapeutic skills. That said it is questionable the kind of training you would get at the neurology programs at your disposal. In contrast most psychiatrists don't treat any neurological conditions.

It is also possible to cultivate an interest in neuropsychiatry which is an academic but very fascinating subspecialty. I routinely do neurological examinations including cognitive assessments on patients, as well as ordering MRIs, PETs, SPECTs, EEGs and work closely with neurologists. I see very fascinating cases at the interface of neurology/psychiatry including Huntington's, FTD, early onset dementia, neurosarcoid, conversion disorder, TBI, poststroke behavioral problems etc.

Thanks! I did comment in neurology forum as well. The neuro programs I am interested in are very good and not at barrel of list (Loyola, LSU, Tulane, Kentucky). Yes one of my reservations is lack of respectability/prestige (though training at top program will overcome), lack of procedures, lower income, and less options i future. Neurologists have many more fellowship options and a very high salary vs psychiatrists.

Having said this most of my MS4 electives were in psyc though my research is in neuro and I did 2 neuro electives. I am interested in academics/teaching/research rather than outpatient setting. I believe neurology has an edge when it comes to academia and inpatient setting. Psychiatrists do fairly well as OP.

I am okay with/without procedures. Although doing a few here and there will be great. In terms of clinical cases and pathology neurology is interesting but gets boring after doing same thing (stroke), psychiatry is more interesting and there is always some action. However, neuro requires broader expertise and knowledge and you tend to treat various psychiatric conditions as a neurologist (demention, confusion, ie).
 
So it sounds like you're not giving very good reasons for neuro. You've got salary, which if it were me I'd entertain some kind of correction factor with lifestyle, then you've got prestige. If it were me, I think I'd have a pretty clear answer.
 
One thing worth noting is that there is less descepancy in salaries between specialties in academia than there are between the same specialists in private practice.

Also for my own curiosity, are you worried so much about salary because you have a ton of debt or because of cultural/prestige reasons?
 
One thing worth noting is that there is less descepancy in salaries between specialties in academia than there are between the same specialists in private practice.

Also for my own curiosity, are you worried so much about salary because you have a ton of debt or because of cultural/prestige reasons?

hey...sorry am making a fuss here...but after 25th I cannot change my rank list! debt...yes! but also cultural aspect as there is a notion and stigma against psychiatrist...though I interviewed at top notch programs that avg applicants dont get invite at.
 
hey...sorry am making a fuss here...but after 25th I cannot change my rank list! debt...yes! but also cultural aspect as there is a notion and stigma against psychiatrist...though I interviewed at top notch programs that avg applicants dont get invite at.

Do neurology, unless you have a dramatic shift in your value system your not going to get the prestige you want in psych

Personally I think its stupid to worry about prestige, but its clearly important to you so unless you see your views changing then it's extremely important to consider
 
To me it sounds like you'd prefer to go into psychiatry, but have pressure from family and/or friends to choose neurology instead. I'm kind of repeating myself, but you have to decide whether you're willing to put up with negative comments from them to do what you really want to do.
 
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To the original poster: I torn between psychiatry and neurology as well, especially because one of my mentors from medical school (with whom I did research) is one of the world's most highly regarded behavioral neurologists and really shaped the way I think about brain disease. The finesse with which experience neurologists examine patients, localize, and generate differentials is one of the most difficult yet amazing skills in all of medicine. And I hate that in psychiatry we are forced to use a horribly bastardized incarnation (DSM5) of a once good idea (DSM3) because we simply don't know enough about the brain to be more sophisticated in our diagnostic methods. And moreover, it seems that anyone who knows how to read and and has had exposure to a mental health setting (nurses, SWs, techs, PATIENTS) self qualifies himself or herself as a diagnostician. Yes, this happens in all of medicine, but I think that it is most pronounced in psychiatry. I picked psychiatry, however, because the pathologies are without question the most interesting and most controversial in medicine, and the hope is that in my lifetime we will be able to make diagnoses based on pathophysiology and abnormal brain function. And at Duke, Dr. Lisanby is a champion of biological psychiatry.

Furthermore, you do 2 months of neurology as a resident (maybe you can do more if your program allows it), and if you are at an elite program, you get the best of both worlds. I am currently on one of my neuro months (my institution likewise has one of the top neuro departments) and absolutely love it! There are times when I want to switch, but I remind myself that my true passion is psychiatry. Good luck!
 
So it sounds like you're not giving very good reasons for neuro. You've got salary, which if it were me I'd entertain some kind of correction factor with lifestyle, then you've got prestige. If it were me, I think I'd have a pretty clear answer.

i equally love both speciaties...psyc can be fun dealing with interesting patients. neuro has many more options and subspecialty rotations. lifestyle is true to some extend but I can also make my own schedule to lighten workload...n yes salary discrepency is huge
 
Do neurology, unless you have a dramatic shift in your value system your not going to get the prestige you want in psych

Personally I think its stupid to worry about prestige, but its clearly important to you so unless you see your views changing then it's extremely important to consider

prestige is external factor....unfortunately some people aren't educated enough to realize that...personally institutions like Duke, Tulane, Baylor are very hard to get into for psychiatry and are prestigious...issue is down the road after residency...some people neglect psyc...internally i know I will be among the brightest
 
To me it sounds like you'd prefer to go into psychiatry, but have pressure from family and/or friends to choose neurology instead. I'm kind of repeating myself, but you have to decide whether you're willing to put up with negative comments from them to do what you really want to do.

again...internally for me psychiatry = neurology...i respect and love both specialties..wish could have applied to few combined neuropsyc programs out there...and there is some family/friend pressure...for me salary does matter as i will be working hard no matter what i do...and i think neuro pays alot higher than psyc (not sure of exact difference?)
 
Honestly neurology isn't that prestigious... obviously psych really isn't either.

IMO, outside of the medical community, prestige goes something like:

Neurosurgeon ("brain surgeon!!!")
Cardiologist ("heart doc")
Oncologist ("cancer doc")
General surgeon ("surgeon")

...and then everything else.

Average Joe citizen likely has no idea what a neurologist does. Or an otorhinolaryngologist. Or a rheumatologist.

Many do think they know what psychiatrists do...but unfortunately it is a bit off.
 
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To the original poster: I torn between psychiatry and neurology as well, especially because one of my mentors from medical school (with whom I did research) is one of the world's most highly regarded behavioral neurologists and really shaped the way I think about brain disease. The finesse with which experience neurologists examine patients, localize, and generate differentials is one of the most difficult yet amazing skills in all of medicine. And I hate that in psychiatry we are forced to use a horribly bastardized incarnation (DSM5) of a once good idea (DSM3) because we simply don't know enough about the brain to be more sophisticated in our diagnostic methods. And moreover, it seems that anyone who knows how to read and and has had exposure to a mental health setting (nurses, SWs, techs, PATIENTS) self qualifies himself or herself as a diagnostician. Yes, this happens in all of medicine, but I think that it is most pronounced in psychiatry. I picked psychiatry, however, because the pathologies are without question the most interesting and most controversial in medicine, and the hope is that in my lifetime we will be able to make diagnoses based on pathophysiology and abnormal brain function. And at Duke, Dr. Lisanby is a champion of biological psychiatry.

Furthermore, you do 2 months of neurology as a resident (maybe you can do more if your program allows it), and if you are at an elite program, you get the best of both worlds. I am currently on one of my neuro months (my institution likewise has one of the top neuro departments) and absolutely love it! There are times when I want to switch, but I remind myself that my true passion is psychiatry. Good luck!

thanks I appreciated such a good message...it seems like I am in a mirror image situation of what you were in...my neuro attending is one of the biggest neuromuscular attendings in the country and my research mentor is well known for his vascular studies around the world. i never thought of neuro until my rotation..that's where I got to see some amazing cases and learned so much about localization and pathophysc.

I was a psychology minor in undergrad and always wanted neurosciences (psyc or neuro), did addendum electives in each specialty and enjoyed both...psyc was slightly more entertaining with lots of action.

there are some neuropsyc combined programs and if I am still confused down the road I can hope to switch to one of those.

I agree Dr. Lisanby is one of the leading pioneers in psychiatry anad well known for brain stimulation therapies...Duke has the best psychotherapy program though I am more towards academics/research and acute inpatient setting.
 
Honestly neurology isn't that prestigious... obviously psych really isn't either.

IMO, outside of the medical community, prestige goes something like:

Neurosurgeon ("brain surgeon!!!")
Cardiologist ("heart doc")
Oncologist ("cancer doc")
General surgeon ("surgeon")

...and then everything else.

Average Joe citizen likely has no idea what a neurologist does. Or an otorhinolaryngologist. Or a rheumatologist.

however in medical community it is more prestigious than psyc and most of IM subspecialties (minus GI, cardio, Onc)
 
however in medical community it is more prestigious than psyc and most of IM subspecialties (minus GI, cardio, Onc)

It is one thing to aim for something prestigious to impress general schmoes at cocktail parties or women at the bar...

But trying to impress those in the medical community is even more fruitless, imo. No specialty as a whole respects any other specialty as an equal. Everyone's specialty is better than the other guy's because X, Y, Z.

As one of the attendings said in another forum, paraphrasing, "Medicine is the land of strong opinions and fragile egos."

Just my .02
 
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I understand that you say there's a big cultural emphasis on prestige and perhaps I'm a little culturally insensitive when I'd suggest it's a little silly that you weigh that cultural perception so highly when it appears you really favor psych. Favoring neuro on your list because it's "more competitive" shouldn't even be on your radar. Even within traditional American culture there's a lack of prestige, but C'est la vie. If you're looking for competitive, I'd imagine jumping into the sack with Michael Moore would also be a rather competitive opportunity in some regard. Doesn't really change the nature of the experience, though.
 
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Case in point at the bottom. Here is a great example (albeit somewhat on the extreme end) of how physicians sometimes act towards other specialties:

Give me a minute to explain. I am surgical subspecialist, and actually deal with the ED "physicians" a lot. To be clear, I do not consider themphysicians, nor do I value any of their clinical judgement, or hold in any esteem any skill sets they claim to have. Lets just start by defining what a physician is. They are an individual that is involved in the diagnosis, prevention, and management of systemic manifestation of pathology.

Lets just take the first part in diagnosis: They do not really diagnose anything. They may be equipped to recognize certain diseases and manifestations of thosediseases, but they are rarely involved at a point in patient care in which they are the diagnosing physician. Theymay have clinical suspicion of an underlying disorder based on a finite, limited differential diagnosis- however, they quite often enlist consultants in the final diagnoses andmanagement of patients that present. The second part-prevention. I think we cansafely say that these individuals do not play a role in anydisease prevention. Finally, management- they are not involved in the continuous care of any patients. They may find a lump, mass, etc- but ultimately the care of the patient is relinquished to a real physician.

People go into ED medicine because they think their lives will be like that 90s TV show ER- a glorified depiction of physicians doing chestcompression, aortic cut downs, and chest tubes. Anyone who has worked in a hospital, will tell you, that traumas are handled by in house trauma surgeons. Walk into any ED in the country, your ED doctorwill be sitting at a desk, typing a note, with a phone in their hand calling a consult. Most of the time, their physical exams are lacking (if they do it at all).

This is all coming fromsomeone who has worked in the ED as part of my training. I can confidently say that was the worse time of my life. Icould not take pride in any of the work that I did. It was adark time, and I had zero job satisfaction. I felt like I took no responsibility or ownership of any patients. I was simply atriage system designed to babysit patients until the real doctors showed up. Do notthink the field is anything more than it is.

Also- there is something that should be said when most of the people that have posted in defense of ED physicians site "Good Money, with Good work hours". Id like to tell you this- ED physicians consistently rank lowest in terms of job satisfaction of all physicians, and have the highest burn out rate. So there is some truth to the fact that they really don't do much, and after a while I think they realize it.

A final thought, if a job can bedone by an NP out in the middle of nowhere or an EDcan hire on an internist, general surgeon, urologist to moonlight in their department- that probably means that the "speciality" is a sham. Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docswould have to agree, unless theirs a phone that they can use to place a consult)

Nobody respects ED docs, most of all, other physicians.
 
It is one thing to aim for something prestigious to impress general schmoes at cocktail parties or women at the bar...

But trying to impress those in the medical community is even more fruitless, imo. No specialty as a whole respects any other specialty as an equal. Everyone's specialty is better than the other guy's because X, Y, Z.

As one of the attendings said in another forum, paraphrasing, "Medicine is the land of strong opinions and fragile egos."

Just my .02

100% true, and it's dangerous. Doctors need to band together because we are fighting a tough battle against our real enemies: lawyers, hospital administrators, a for-profit insurance industry, and midlevel (specifically NP) encroachment. And the interests of those groups prevent us from delivering the best patient care that we can.
 
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Case in point at the bottom. Here is a great example (albeit somewhat on the extreme end) of how physicians sometimes act towards other specialties:

haha this is so interesting...it is true we have have misconceptions for other subspecialties...aka neurologists think of internists in similar manner you described etc.
 
100% true, and it's dangerous. Doctors need to band together because we are fighting a tough battle against our real enemies: lawyers, hospital administrators, a for-profit insurance industry, and midlevel (specifically NP) encroachment. And the interests of those groups prevent us from delivering the best patient care that we can.

totally agree! there is a huge conspiracy against doctors...unfortunately we keep fighting among ourselves as lawyers and hospital administration is taking full advantage...and i agree NPs and PA are both enroaching into our health care system...am seeing many NPs and PA doing work what a neurologist/psychiatrist is liscensed to do...n they get paid fairly well from their degree perspective
 
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