Interested in psych but questioning the neurology …

[jmariengd]

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Just finished my psych clerkship and loved the nature of psychiatry. Loved how much time you get talking to the patients, loved the nature of the interviews, thought everything I saw was very interesting, and I think it fits my personality well.

BUT I'm not too interested in neurology and I know these two can have quite an overlap. Is it possible to be happy as a psychiatrist without having a genuine interest in neurology as well? I tried searching the forums for students with similar conflicts but it seems most students going into psych also have a profound interest in neurology.

 

[Doctor Bagel]

Just finished my psych clerkship and loved the nature of psychiatry. Loved how much time you get talking to the patients, loved the nature of the interviews, thought everything I saw was very interesting, and I think it fits my personality well.

BUT I'm not too interested in neurology and I know these two can have quite an overlap. Is it possible to be happy as a psychiatrist without having a genuine interest in neurology as well? I tried searching the forums for students with similar conflicts but it seems most students going into psych also have a profound interest in neurology.

I'll confess that I'm not super fascinated by neurology either. I found it somewhat interesting in medical school, and my interest has decreased over time. I'm in a neurobiology heavy field of psychiatry right now and feel a little distant from that. However, I suspect my interest level is pretty normal for psychiatry as a whole. I think there's a perception that we should all be really interested in neurology, so everyone says they are -- that's my cynical take.

 

[lego1234]

I am in exact same undecisive state. I equally like Psyc and Neuro and interviewed at both programs. Am seeing which ones to rank higher. Honestly am happy either way.

In general Neuro is more competitive than IM or Psyc. And it is more prestigious and has more fellowship options. You can make more money easily.

Cons: Neuro has terrible lifestyle, less job satisfaction than Psyc and you work way more hours in general as mostly it is hospital base field.

> Did see the trend psyc is becoming more competitive and psychiatrists are starting to making alot of money, and it is expected to go up.

 

[jmariengd]

I am in exact same undecisive state. I equally like Psyc and Neuro and interviewed at both programs. Am seeing which ones to rank higher. Honestly am happy either way.

In general Neuro is more competitive than IM or Psyc. And it is more prestigious and has more fellowship options. You can make more money easily.

Cons: Neuro has terrible lifestyle, less job satisfaction than Psyc and you work way more hours in general as mostly it is hospital base field.

> Did see the trend psyc is becoming more competitive and psychiatrists are starting to making alot of money, and it is expected to go up.

I think you misread my post, I'm actually in the opposite boat 😵 I wish I liked neuro so my decision could be easier but the fact is I think I'm going to struggle with that aspect of psych….

Thanks Doctor Bagel for your insight! That helps. Any other residents out there feel the same way?
On a similar note, I'm not planning to openly admit this on a psych interview but if someone asks my thoughts on the neuro aspects and I say I'm not too fond of it will I somehow get docked? Just not sure how valuable an interest in neurology is to psychiatrists!

and just FYI I haven't actually done my neurology rotation but the little exposure I've had of it so far (joint conferences in psych) I don't think I would be very interested. The whole where's the lesion thing just doesn't get me excited and thinking about the memorization of all the pathways and brain functions just makes me feel .

 

[liquidshadow22]

neuro is very divorced from psych. i dont think your distaste for neuro matters much really .

 

[JTJ]

I love psychiatry and have very little interest in neurology. One of the nice things about having two specialties responsible for the same organ is that you don't have to take care of every patient with a brain-based disorder. You do need a reasonable baseline knowledge of neurology, but it's honestly pretty shallow compared to neurology. And in my opinion, that's great!

 

[Cinclus]

I am interested in psychiatry. I have completed rotations in both psych and neuro, and I found the neuro rotation to be mind-numbingly boring, for the most part. Neurology was probably my favorite course back in the preclinical days, but in practice...man, oh, man. Stroke, stroke, stroke. Round, round, round. CT, MRI, CT, MRI, CT, MRI. (Very few of the imaging studies ever result in a difference in management.) "Order PT and OT for this patient, that patient, this patient's mom, and that patient's dog. Consult PM&R. Why isn't medicine handling this patient's problems? WHY WERE WE CONSULTED FOR THIS?! "I felt like we weren't actually doing anything for most of the patients.

 

[clausewitz2]

I am interested in psychiatry. I have completed rotations in both psych and neuro, and I found the neuro rotation to be mind-numbingly boring, for the most part. Neurology was probably my favorite course back in the preclinical days, but in practice...man, oh, man. Stroke, stroke, stroke. Round, round, round. CT, MRI, CT, MRI, CT, MRI. (Very few of the imaging studies ever result in a difference in management.) "Order PT and OT for this patient, that patient, this patient's mom, and that patient's dog. Consult PM&R. Why isn't medicine handling this patient's problems? WHY WERE WE CONSULTED FOR THIS?! "I felt like we weren't actually doing anything for most of the patients.

I was also interested in stroke until I actually spent two weeks on the stroke service and learned that the reality was that, as one of my attendings put it, "we play around figuring out where the lesion probably is, then we look through the magic lantern and it tells us the real answer and we're done." Some of the rarer problems on our general neurology service were much more interesting but treatment was so limited. I kept being drawn to the patients that neuro decided were "functional" and being really disappointed when this meant the service washed their hands of them.

 

[whopper]

Few but some departments have a combined neurology and psychiatry department that interact more hand-in-hand. You could also choose to follow a more specific biological route in your training.

 

[birchswing]

Few but some departments have a combined neurology and psychiatry department that interact more hand-in-hand. You could also choose to follow a more specific biological route in your training.

I think she/he wants the opposite of that.

 

[slappy]

Everyone having such a dislike for neuro work should try outpatient neurology (not dementia/headaches) at least once in their lifetime. I've never been in a more fascinating clinic.

 

[slappy]

Few but some departments have a combined neurology and psychiatry department that interact more hand-in-hand.

Are there any in the country except SLU?

 

[liquidshadow22]

outpatient neuro for me was basically all headaches, followup for epilepsy, dizziness, back pain, peripheral neuropathy... How is that more exciting than psychiatry?

 

[liquidshadow22]

I think if you were seeing only cool cases: movement disorders, brain tumors, neuropsych issues, brain trauma, acute strokes, acute seizures, then that would be more exciting/interesting. But, every specialty has bread and butter cases that can be pretty boring.

I think psychosis is very fascinating and you probably see this more often in psychiatry than neuro does the zebra/interesting cases...what do others think?

 

[Cinclus]

I think that psych has the most interesting bread and butter stuff. I prefer mood and anxiety disorders to headache, stroke, and "dizziness," fo sho. And I love me some psychosis, which I saw multiple times each shift on my emergency psych month. Oh, and the mania. Such stories.

 

[notdeadyet]

I think that it's easy to love neurology, it's hard to love being a Neurologist. I have a hunch many psychiatrists probably feel this way.

OP- you will have required neurology rotations not to make you a neurologist but to improve your knowledge of neurology, which is important to the field. I think being able to say that you find the subject of neurology interesting but not the clinical practice as a career path is a safe answer and likely an honest one.

 

[shan564]

Just finished my psych clerkship and loved the nature of psychiatry. Loved how much time you get talking to the patients, loved the nature of the interviews, thought everything I saw was very interesting, and I think it fits my personality well.

BUT I'm not too interested in neurology and I know these two can have quite an overlap. Is it possible to be happy as a psychiatrist without having a genuine interest in neurology as well? I tried searching the forums for students with similar conflicts but it seems most students going into psych also have a profound interest in neurology.

Yeah, you have to have some understanding of neuroscience to be a 21st century psychiatrist, but you don't use that on a regular basis. You can spend your entire career as a psychiatrist without ever doing a neuro exam or looking at a brain MRI or localizing a stroke or reading an EEG report... not that I think you should, but many people do.

By the way, is there a particular reason why you don't like neurology aside from the stuff you mentioned earlier? One thing to beware of is to rely too much on your 2nd-yr med student-level knowledge of something. I didn't like neurology when I was at your stage either for the same reasons, but I grew to like it a lot more when considering neurological stuff as it relates to psychiatry (dementias, neurological syndromes causing behavioral symptoms, movement disorders, etc). And when I was at your stage, pathology was my favorite subject and I had no real interest in psychiatry.
Point is - every specialty is VERY different in the real world from how it sounds in a classroom, so you shouldn't be bothered by a distaste for it at this stage.

 

[heyjack70]

Neuro is basically pseudoscience. Just kidding. Inpatient wasn't that great, but outpatient Parkinson's disease/movement disorders, and neuromuscular disease (nerve conduction and electromyograms) was pretty interesting.

 

[whopper]

Are there any in the country except SLU?

There are but off-hand I don't know which ones are. Most people here know I'm at SLU.
I know there's a few others cause the department head here, Henry Nasrallah occasionally mentions in lectures "there's only X departments in the country with a combined neuro and psych department" and the number is greater than one.

Some departments might not be combined but are heavily biologically based such as Washington U.

 

[shan564]

Some departments might not be combined but are heavily biologically based such as Washington U.

Yeah, we like to think of the neurologists as our academic brethren. Although come to think of it, I can think of more research collaborations between our department and radiology, anesthesiology, psychology (obviously), etc than neurology.

 

[jmariengd]

Wow! I'm so excited by all the responses and encouragement… I spent the day studying for my psych shelf and my breaks were spent reading blogs etc. about why psychiatry is a good specialty to go into and the kinds of traits as a person you need to be successful in it: Being genuine, empathetic, nonjudgmental were only some of the characteristics but seems like you guys are exemplifying all these things with my simple post (I really was only expecting 2 or 3 replies). So awesome! Definitely have a good impression 😉

To answer your question shan no I don't have really many reasons to not like neuro other than those joint psych/neuro conferences I saw and the fact that I feel after first and second year there are just too many pathways, structures, and interactions in the brain that I just don't care too much for right now… I think I would be able to handle the basics though to understand reasonable differentials and psychopharm!

 

[shan564]

To answer your question shan no I don't have really many reasons to not like neuro other than those joint psych/neuro conferences I saw and the fact that I feel after first and second year there are just too many pathways, structures, and interactions in the brain that I just don't care too much for right now… I think I would be able to handle the basics though to understand reasonable differentials and psychopharm!

Despite being at arguably the most neuroscience-oriented psych program in the universe, I can say with fair certainty that I know a grand total of 1 psychiatrist who could localize a stroke, and 1 (a different one) who could read a real EEG. The pathways/structures/interactions are inundating in your 1st/2nd year of med school, but they're much more pleasant when you're looking at them from a patient care perspective. And despite being more interested in structural/functional neuroanatomy than 95% of psych residents, I can't remember a LOT of basic Step 1-level neuroanatomy (i.e. the different regions of the thalamus, the cranial nerve pathways, distributions of any artery aside from ACA/MCA/PCA, etc.). I'd say that I probably know less structural neuroanatomy now than I did when I took Step 1, although I know a lot more about functional neuroanatomy as it applies to psychiatry... which, in my opinion, is much more interesting and easy to remember, sinc eyou don't have to point out a weird Latin name on a brain slice, but rather are just thinking about stimulation of the reward pathway as it applies to addictions.

 

[Mass Effect]

neuro is very divorced from psych

Uh, not really. There is a lot of overlap, especially nowadays. You don't have to like neuro to be a psychiatrist and after residency, you can certainly choose to ignore all neuro and focus just on psych, but like it or not, if you're training at an academic center, you'll find a lot of overlap between the two fields, which is why neuropsychiatry is a growing field.

 

[shan564]

Uh, not really. There is a lot of overlap, especially nowadays. You don't have to like neuro to be a psychiatrist and after residency, you can certainly choose to ignore all neuro and focus just on psych, but like it or not, if you're training at an academic center, you'll find a lot of overlap between the two fields, which is why neuropsychiatry is a growing field.

Unless you're an analyst...

 

[Jorje286]

When I was in my neuro rotation, I had some amazing and very rare cases. Mercury poisoning, neurobrucellosis manifesting as psychosis concomitant with ascending numbness (!), autoimmune autonomic gangliopathy that started with erection problems..etc. I also wouldn't say that dizziness and headache are boring. The diff. diagnosis is so wide, that you really need to be careful with the hx and PE and creative with your suggestions. Having said that the day to day practice wasn't nearly as dynamic as psychiatry, and that was the deciding part for me. It's "dead", was the closest description I could think of, despite the fact that the clerkship was very intellectually stimulating. Neuroanatomy was probably my favorite subject in the preclinical years. I also worked with psychiatrists in behavioral neurology/behavioral medicine, and the interplay between the two disciplines can be really fascinating. Some countries like Germany have an entirely different specialty called psychosomatic medicine, which I don't think has an equivalent in the states. All in all, you wouldn't be in bad company if you hate neurology. Most psychiatrists do hate neurology, because the patient approach is almost diametrically opposed and the skills you need to master have little to do with each other.

 

[slappy]

Unless you're an analyst...

There's also neuropsychoanalysis. It's one of my main fields of interest, and I believe, one with a lot of promise. When prominent neurologists like Eric Kandel and Oliver Sacks turn to it for answers, you know there's something to it.

 

[Mass Effect]

When I was in my neuro rotation, I had some amazing and very rare cases. Mercury poisoning, neurobrucellosis manifesting as psychosis concomitant with ascending numbness (!), autoimmune autonomic gangliopathy that started with erection problems..etc. I also wouldn't say that dizziness and headache are boring. The diff. diagnosis is so wide, that you really need to be careful with the hx and PE and creative with your suggestions. Having said that the day to day practice wasn't nearly as dynamic as psychiatry, and that was the deciding part for me. It's "dead", was the closest description I could think of, despite the fact that the clerkship was very intellectually stimulating. Neuroanatomy was probably my favorite subject in the preclinical years. I also worked with psychiatrists in behavioral neurology/behavioral medicine, and the interplay between the two disciplines can be really fascinating. Some countries like Germany have an entirely different specialty called psychosomatic medicine, which I don't think has an equivalent in the states. All in all, you wouldn't be in bad company if you hate neurology. Most psychiatrists do hate neurology, because the patient approach is almost diametrically opposed and the skills you need to master have little to do with each other.

What is psychosomatic medicine there? We have psychosomatic medicine here. It's consult psych. Also, in my experience, most psychiatrists don't hate neurology (at least not all of neurology). Maybe it's just where you train and who you train with.

 

[clausewitz2]

I can't remember a LOT of basic Step 1-level neuroanatomy (i.e. the different regions of the thalamus, the cranial nerve pathways, distributions of any artery aside from ACA/MCA/PCA, etc.). .

I will never forget a different neuro attending (who is a big deal dementia researcher primarily) telling me that "some people insist on getting more specific with the artery involved in a stroke than ACA/MCA/PCA, but that's just them being dinguses."

 

[Leo Aquarius]

I actually really enjoy neurology and will pick up a neuro textbook on occasion in our library to brush up on it. In fact, last week I brought home a book on epilepsy.

You can be a psychiatry resident who really loves neuro, which comes in handy on services like CL.

 

[vistaril]

Just finished my psych clerkship and loved the nature of psychiatry. Loved how much time you get talking to the patients, loved the nature of the interviews

I'd definitely keep in mind that this is one of those things that is very different as a med student, resident, or even(in some cases) an attending in an academic program where you are salaried. vs the real world in an insurance based(or medicare/aid) inpatient and/or outpt practice. Yes, I suppose I could spend gobs of time talking to my inpatients about wheat their favorite Italian dish is or why wallpaper went out of style, but if I did that I would never make it to clinic to see my patients(meaning they would be upset and I would be upset too because I wouldn't get paid....lose-lose)

A lot of the things you see med students, residents, and even some attendings do in academia just doesn't exist in the real world. That could be a good or bad thing depending on what your interests are.

 

[Armadillos]

I'd definitely keep in mind that this is one of those things that is very different as a med student, resident, or even(in some cases) an attending in an academic program where you are salaried. vs the real world in an insurance based(or medicare/aid) inpatient and/or outpt practice. Yes, I suppose I could spend gobs of time talking to my inpatients about wheat their favorite Italian dish is or why wallpaper went out of style, but if I did that I would never make it to clinic to see my patients(meaning they would be upset and I would be upset too because I wouldn't get paid....lose-lose)

A lot of the things you see med students, residents, and even some attendings do in academia just doesn't exist in the real world. That could be a good or bad thing depending on what your interests are.

To add some grains of salt, OP remember that the essence of vistaril's post is true for all fields. As a medstudent you see the radiology attending discussing some interesting case with residents and the surgeon who is about to operate on the patient in question, but you dont see the private practice radiologist reading 40 chest x rays an hour or whatever.

 

[pisekar]

I really liked neurology too and just finished my rotation. But psychiatry and neurology are very different specialities in terms of patient care. My opinion, neurology is more close to the internal medicine.

 

[clausewitz2]

I actually love the pathophysiology of most neurological disorders -it is elegant, subtle, and very satisfying to walk through intellectually. I would be very pleased to pick up on signs of something neurological in a future patient that had previously been missed and it seems like a distinctly plausible scenario, so i will try my best to keep up with it. It is the doing neurology and nothing else part that seems less than ideal.

 

[Armadillos]

My absolute dream in medicine is being Oliver sacks, I can't imagine a more fascinating or exciting job. But that's kind of like deciding to go to law school planning to be on the SCOTUS. So the day to day practice of psychiatry is a much better fit for me, but if you can't look at aspects of neurology with some interest as a psychiatrist then part of me thinks you may have been better served by social work school.

 

[clausewitz2]

My absolute dream in medicine is being Oliver sacks,

I could skip his prosopagnosia, by this basically is exactly how I feel about the matter.