future MD/PhDs in psychiatry?

[PsychoCat]

There are more than a few MD/PhDs on psych-related articles. Are there any MD/PhD students out there thinking about going into psychiatry? I know it's a non-traditional specialty for MD/PhDs, but with the increasing role of neuroscience in psychiatric practice and research, there must be someone else out there! So far I've met only one person (online).

It would be kind of encouraging to hear from other psych-bound MD/PhDs and find out what they're doing. (And how people react when you say you want to go into psych.) 😀

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[URHere]

Right now I'm thinking about going into psych (although I'm a first year, so saying that I want to go into psych at this point is like crawling out of the womb and proclaiming that I want to be a lawyer...).

But anyway, I am interested in one very specific branch of psychiatry: addiction psychiatry. I have always been fascinated by pharmaceuticals (and no less by illicit drugs) and the effects they have on the brain. When I rotate next summer, I will be working in one lab that focuses on methamphetamine abuse treatment and another that studies alcohol abuse / FAS...hopefully I'll still like addiction medicine/research after that. Either way, don't worry, you aren't the only psychiatry-lover out there! And you definitely aren't the only one who has friends stare at you in shock when you mention psychiatry and ask: "but why would you want to listen to people whine at you all day!?".

Sigh.

 

[magwi11]

I'm another 1st year MD/PhD who is planning on psych. I spent some time at NIMH before starting med school, and one of the PIs for my summer rotations is an MD/PhD psychiatrist. Both experiences showed me that there's a lot of room for productivity and discovery in research psychiatry, so trust me, you are not alone.

I'm interested mostly in pediatric psychopathology and mood disorders, and I've done a bunch of imaging work and some with animals, I haven't figured out what labs I'll be rotating in next summer, but I am as set on psych as it is possible to be in the first year... I guess we'll see how it turns out.

 

[QofQuimica]

Considering it; I'm interested in addiction research. We'll see how I feel after I finish my psych rotation. 😉

 

[RxnMan]

Considering it; I'm interested in addiction research. We'll see how I feel after I finish my psych rotation. 😉

You should come to the 2008 APSA meeting in NYC. We're going to try to get Stanley Glick to speak and I can introduce you.

 

[ClarinetGeek]

I'm am still considering it. Although after my inpatient internal med rotation, I am leaning more towards medicine or neuro. We'll see how my psych rotation goes...in about 4-5 years.

 

[Neuronix]

I was interested in Psychiatry and Neurology and chose Neuroradiology. Part of that was I noticed a lot of the professors in both Psych and Neuro did research using MRI or nuclear medicine. Our 3T setup for fMRI is pretty much completely run by the Neurology department and there are several well funded professors in Neurology and Psychiatry who study all kinds of illnesses wholly or in part by imaging. The problem for me was that outside of the physicists, the investigators didn't really understand the technology they were using at all. I wanted to really understand what was going on under the hood, and I feel that many of the advances with imaging research have come about because of the application of new techniques to established diseases.

Radiologic techniques also give you a definite physical basis behind the thing you're studying, as opposed to survey approaches and such. For me I wanted to be very strong in Radiologic techniques, but want to apply them to studying the brain and disease.

Anyhow, that's just my pitch for Neurorads and how my thinking went.

 

[QofQuimica]

You should come to the 2008 APSA meeting in NYC. We're going to try to get Stanley Glick to speak and I can introduce you.

How far is Albany from NYC? Are you also offering to put me up? 😀

When is this meeting? While I'd love to see you and go on a boondoggle up to NYC, realistically I probably can't give the powers that be a very good reason to let me skip out on one of my clerkships for it. 😳

 

[RxnMan]

How far is Albany from NYC? Are you also offering to put me up? 😀

When is this meeting? While I'd love to see you and go on a boondoggle up to NYC, realistically I probably can't give the powers that be a very good reason to let me skip out on one of my clerkships for it. 😳

It'll be sometime in Nov (if I remember correctly). It's about 2.5 hrs from ALB -> NYC by train, and the meeting's only one day. It'll be a good time, but it won't be worth driving 8-10hrs from Cleveland -> NYC.

We're trying to host next year's meeting - closer for the folks in Rochester, Syracuse, and Buffalo, and the hotel rates are better.

 

[strangeglove]

I'm an MD-PhD who is now a resident in psychiatry in a research-focused program in the Northeast. I did my PhD in the area of cognitive neuroscience, which is the study of things like language, memory and emotion using techniques such as functional brain imaging, the lesion method and experimental psychology.

I'm not sure why you would say that psychiatry is a non-traditional MD-PhD field. Certainly, many more MD-PhD's go into internal medicine, but psychiatry is right up there. There is so much to learn in psychiatry about the basic mechanisms of normal and pathological brain function that this is a real growth field. In fact, of you look at the NIMH research budget (that's the National Institute of MENTAL Health), which is the largest single funder of neuroscience research, most of it is relevant to psychiatry.

Also, the culture of psychiatry is very conducive to research. You will find that psychiatrists in general (the good ones, at least) tend to be pretty intellectual and curious about how the mind works. Also, psychiatry is one of the few fields where you can actually find time to work in the lab and have a clinical practice.

I could go on, and there are threads in this forum that have addressed the issue of psychiatry and research careers: http://forums.studentdoctor.net/showthread.php?t=334567&highlight=strangeglove

The point is that you are not alone in you interest in psychiatry as an MD-PhD. Also, there are many top residency programs that are very much interested in MD-PhDs, unlike fields such as Radiology.

 

[Neuronix]

Also, there are many top residency programs that are very much interested in MD-PhDs, unlike fields such as Radiology.

Ok, now that that's out of my system... Sorry, it's kind of a sore spot with me to imply that somehow Radiology residencies don't want to produce academic research. There's a few people that keep implying to me that by doing Radiology I'm somehow selling out, which contributes to this sore spot.

There are many top programs in Radiology that have the goal of producing researchers. The program here tells those who interview not to come here if they don't plan on staying in academics and persuing research. It's a waste of our resources. Similar things can be heard and research tracks are provided or can be negotiated at a multitude of Radiology residencies including but not limited to MGH, BID, Hopkins, Penn, WashU, UCSF, Stanford, UCLA, UCSD, UWash, etc etc and the list goes on...

I can pull you numerous articles from the journal Academic Radiology about how to get residents more interested in or perform better in Radiology research. This is of course why doing some sort of research is pretty much required for these top programs, though it is unfortunate that many medical students do research and lie about their desire to do academics to get into the top programs for the specific purpose of getting into the top programs and have no desire to continue in academics. This isn't the programs faults' and... I'm gonna hit a sore spot here...

I'm sorry if Psychiatry/Neurology/IM/Peds applicants don't feel the need to pretend to be academically-oriented to get into these less competitive residency programs.

My point is that it doesn't mean that the Radiology programs don't want MD/PhDs, it just means they stand out less against your run of the mill Radiology program's other published, 240+ Step I, AOA applicants. Still, if you look at the match lists (of which there are more Radiology MD/PhDs than Psychiatry MD/PhDs) you'll see the MD/PhDs are still at top, research-oriented programs.

COME TO THE DARK SIDE LUKE. Really, we have the death star and we're pointing it at academic medicine, or something.

 

[strangeglove]

Ok, now that that's out of my system... Sorry, it's kind of a sore spot with me to imply that somehow Radiology residencies don't want to produce academic research. There's a few people that keep implying to me that by doing Radiology I'm somehow selling out, which contributes to this sore spot.

There are many top programs in Radiology that have the goal of producing researchers. The program here tells those who interview not to come here if they don't plan on staying in academics and persuing research. It's a waste of our resources. Similar things can be heard and research tracks are provided or can be negotiated at a multitude of Radiology residencies including but not limited to MGH, BID, Hopkins, Penn, WashU, UCSF, Stanford, UCLA, UCSD, UWash, etc etc and the list goes on...

I can pull you numerous articles from the journal Academic Radiology about how to get residents more interested in or perform better in Radiology research. This is of course why doing some sort of research is pretty much required for these top programs, though it is unfortunate that many medical students do research and lie about their desire to do academics to get into the top programs for the specific purpose of getting into the top programs and have no desire to continue in academics. This isn't the programs faults' and... I'm gonna hit a sore spot here...

I'm sorry if Psychiatry/Neurology/IM/Peds applicants don't feel the need to pretend to be academically-oriented to get into these less competitive residency programs.

My point is that it doesn't mean that the Radiology programs don't want MD/PhDs, it just means they stand out less against your run of the mill Radiology program's other published, 240+ Step I, AOA applicants. Still, if you look at the match lists (of which there are more Radiology MD/PhDs than Psychiatry MD/PhDs) you'll see the MD/PhDs are still at top, research-oriented programs.

COME TO THE DARK SIDE LUKE. Really, we have the death star and we're pointing it at academic medicine, or something.

Right. Sorry to touch a nerve. However, at the risk of touching more nerves, I will add that you can go into psychiatry with a PhD in imaging physics, if you like. You will likely be more of a hot commodity here, it seems from what you are saying, than in a radiology program, where most applicants with an MD-PhD - and even many with just a straight MD - would seem to have this background. And you can continue to work with people who are pretty sophisticated about brain imaging, even though they may not be physicists. They tend to know a lot about the aspects of functional brain imaging that involve experimental design and interpretation of data - an aspect that goes beyond physics and involves some level of insight into the human mind/brain. These are the folks who are getting published in Science and Nature these days, not the medical physicists.

Take a look here for an example of where psychiatry research is headed: http://www.sciencemag.org/cgi/content/abstract/321/5890/806.

 

[Neuronix]

Right. Sorry to touch a nerve.

No problem. I went for a run in the park and got chased after and yelled at for two blocks by a crazy guy and then had some dinner so I'm back to normal.

However, at the risk of touching more nerves, I will add that you can go into psychiatry with a PhD in imaging physics, if you like. You will likely be more of a hot commodity here, it seems from what you are saying, than in a radiology program, where most applicants with an MD-PhD - and even many with just a straight MD - would seem to have this background.

Actually it's far fewer than you might think. The number of MD/PhDs going into Radiology with a background in hardcore Imaging Science is pretty small. The vast majority of MD applicants did clinical research in Radiology or case review. The vast majority of MD/PhD applicants did some kind of cell & molecular biology. This is because 95% of research in medical schools is cell & molecular based, even when it's research in atypical departments like Bioengineering. They then of course try to spin their experience as preparation for "molecular imaging". Most students get interested in imaging towards the end of medical school, not the beginning, as they get little experience with Radiology and its research early in medical school. You then further hear most program administrators say "you shouldn't worry about residency you want to do someday", and many students buy into that, thinking they should just get any PhD and worry about residency later. It's not a bad thing mind you, but this all contibutes to a relative lack of imaging physics people in residency programs. It's only after seeing how it is a huge influence on all their third year clerkships and get experience in the basics of films that students often decide on Radiology. Instead, the pre-meds all hear about how Radiology is for sell-outs who like to live like hermits in basements without people around. This kind of bias typically exists through the PhD, unless the student did imaging research before starting medical school or has family members in Radiology has been my experience.

And you can continue to work with people who are pretty sophisticated about brain imaging, even though they may not be physicists. They tend to know a lot about the aspects of functional brain imaging that involve experimental design and interpretation of data - an aspect that goes beyond physics and involves some level of insight into the human mind/brain.

Hold on a sec, I'm loading SPM5...

...

Ok Matlab 2007b is really slow...

...

Ok, ready to learn about Neuroimaging.

(Sorry, can't help but be a brat, but this really is much of Neuroimaging research and it would drive me crazy)

These are the folks who are getting published in Science and Nature these days, not the medical physicists.

You sure?
http://www.nature.com/nature/journal/v453/n7197/full/nature07017.html
http://www.sciencemag.org/cgi/content/full/sci;318/5852/980

Look, I don't want this to turn into a Psychiatry/Radiology pissing match. They're both good specialties. How can I have something against Psychiatry when my own mom is a schizophrenic. I think you should really choose based on your own interests. I just wanted to point out there are neato things going on in Radiology, but maybe in retrospect it was misplaced.

 

[Neuronix]

I know it's a non-traditional specialty for MD/PhDs

Oh btw, I would hardly call it non-traditional. IMO, hold your head high!

http://www.dpo.uab.edu/~paik/match.html -- Data over the past 5 years. So what is traditional anyways? My MD/PhD program director recently gave a presentation where he said the "traditional" MD/PhD specialties were IM, Peds, Path, and Neuro. Yet over the past 5 years more students have gone into Rad Onc, Psychiatry, and Derm than Neurology. I'm not even sure what this "non-traditional" thing means anymore, and I'm beginning to think it's a term being used to subtly steer MD/PhDs into certain specialties perceived to be research friendly.

If we look at historical data:

http://www.aamc.org/research/dbr/mdphd/bsullivan_residencychoices.pdf

It appears Surgery was the #4 most popular specialty for 4 out of 6 of those cohorts for MSTPs (and frequently #3 for non-MSTPs!). Does this mean surgery is a traditional MD/PhD specialty? Or are we only talking about the narrow definition of medicine, path, and peds? Will Rads one of these days overtake Path (it seems likely!)? Does this mean Rads will someday be the "traditional" MD/PhD specialty and Path will be the "ancient" one?

I propose we get rid of the traditional/non-traditional notation. It's just confusing everyone.

 

[dl2dp2]

There are more than a few MD/PhDs on psych-related articles. Are there any MD/PhD students out there thinking about going into psychiatry? I know it's a non-traditional specialty for MD/PhDs, but with the increasing role of neuroscience in psychiatric practice and research, there must be someone else out there! So far I've met only one person (online).

It would be kind of encouraging to hear from other psych-bound MD/PhDs and find out what they're doing. (And how people react when you say you want to go into psych.) 😀

Psych is not a "non-traditional" specialty for MD/PhDs, due to generally light clinical schedule and a historically highly productive set of psychiatrist scientists. Older examples include Eric Kandel and more recent examples include Karl Deisseroth. Clinical neuroscience in psychiatry is well-established as a pathway toward a career in academic research.

There is a yearly recruiting meeting at the NIH if you are more interested in meeting people in this field. Tom Insel is a great guy.
Here is the link for the meeting, and hopefully you'll find some interesting material there.
http://intramural.nimh.nih.gov/MSRP/event/home.jsp;jsessionid=52EDBA7BD86F96334DDFE228E81FC63A

Not to jump too deep into this other thread of this post, radiology is currently one of the most powerful fields in medicine. Generally radiology departments bring in both the most revenue and most staff, equipment and grants. NIH director is a radiologist. The entire medical enterprise is moving towards interventional/endoscopic/imaging guided procedures.

That said, while research is radiology is quite extensive, generally they tend to focus less on the questions in cognitive neuroscience and more on imaging modalities, techniques. In fact, most of the basic questions in cognitive neuroscience aren't really addressed by clinicians, but by academics in psychology and basic neuroscience. If you are a clinician scientist, you should have some level of commitment to some disease entity. Secondly, while imaging science is considered an emerging and extremely important discipline (NIBIB), historically what is considered "neuroscience" (everything written in textbook by Kandel et al.) is not done by radiologists. I cannot come up with a single name of a famous "neuroscientist" who is trained as a radiologist. Now whether this is a cause or effect or both is up to debate.

Other important facts:
(1) Psychiatry is a bit misunderstood/stereotyped by the general public.
(2) Psychiatry has an excellent work worked/pay.
(3) Psychiatry, overall, has the lowest salary in medicine. That said, psychiatrists generally still have a higher salary than pure basic researchers.
(4) Psychiatry is one of the few areas where living in a large city tends to give you more opportunities for higher salaries in boutique, cash only practices, even if your primary job is research @ an academic center.

Radiology:
(1) Radiology generally has an excellent work/pay ratio.
(2) Radiologists can have unreal salaries (> 1 mil). These people do work very hard and have very good business acumen, but the ceiling in this field is very high. Ceiling in psychiatry, even in private practice, is generally ~200k. In general, salary is about twice to three times as much as psych, both in academia and private practice. You can think about if your aspiration of cognitive neuroscience is worth all the opportunity cost.
(3) Radiologists work with non-brain body parts for 4 yrs at least during residency, and are likely to require supplementary for non-brain work after, even if you are a neuro-rads specialist.

 

[Hurricane]

I'm an MD/PhD, and currently a third year resident in psychiatry. My residency has a research track that gives us a day a week in the third year, and virtually all of the fourth year for research. (Psych residencies in general are conducive to research, because the 4th year is usually comprised of electives anyway, so relatively little restructuring is required.)

My PhD was in Neuroscience, and I studied reward systems and sexual behavior in rodents. Currently my interests are in cognitive remediation in schizophrenia. Initially I planned to continue basic research, but after two years in the clinics, I found my interests had shifted to more translational research. My current project allows me to still pursue my interests in neuroanatomy (via imaging) as well as community psychiatry (via the patient population).

As far as psych being nontraditional, that may be true but it didn't affect my choice one way or the other. And the PhD really was a huge advantage during the residency application process. I had heard that before, but figured people were exaggerating - not so.

I think there are some other md/phds on the psychiatry forum. Might want to ask around there too...

 

[parapraxish]

sorry to revive an old thread, but i was wondering whether going into psychiatry but pursuing an unrelated research field (such as cancer) has been done before or is even possible? are there any established researchers who have done this? or is this idea completely pointless?

 

[helloxkittyador]

bump to comment by @parapraxish md/phd in cancer biology here w/ background in computational drug discovery and interest in systems medicine/genomics with potential leading to "personalized psychiatry" if such a future can be attained. Also possible to move this to the psych forums for greater visibility?

 

[strangeglove]

There are a number of MD-PhDs who have a change of heart after doing their psych rotations following PhDs in fields like immunology and microbiology and do quite well in psychiatry. Pretty much everyone interested in research does a fellowship after residency anyway, even with a neuroscience PhD, so you can use that to make the shift in your research area. You'll still be way ahead of the non-PhD physician-scientists in terms of understanding the general processes of research.