Neuro vs Psychiatry - help required

[Jorje286]

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Yes, I know, this is another really lame "can't make a decision between Neuro and Psych" but I need your help, cause time is ticking out and I need to make the decision.

It's a little heart-wrenching for me, cause I really like both and I can't seem to commit to one and forget about the other. I posted a similar post in one of the neurology thread, apologies for that, but I also need the perspective of psych people.

I love neuroanatomy. I love the intellectual aspects about neurology. Given that I'm also interested in research, neurology is slightly closer to my research interests because I'm really into decoding information coding/transfer and that is more doable with neurologic disease (epilepsy, motor..etc).

OTOH, nothing comes close to the physician-patient relationship in psychiatry. I love going over psychodynamics involved, and the reasoning in psychiatry is different than any other medical specialty. Clinically you can also do more for your patient than neurology. Lifestyle is better (and that's a huge thing for me). Matching for IMGs is a little easier, and I've managed to build research connections in psychiatry with a prominent psych researcher.

I'm also a bit scared how much bad mouthing Neuro is getting lately. From alarming statements on the AAN website to surveys that are constantly showing neurologists in the bottom half of the happiness scale (in contrast to psych).

If anyone has any input on this dilemma, I would greatly appreciate it.

 

[digitlnoize]

Yes, I know, this is another really lame "can't make a decision between Neuro and Psych" but I need your help, cause time is ticking out and I need to make the decision.

It's a little heart-wrenching for me, cause I really like both and I can't seem to commit to one and forget about the other. I posted a similar post in one of the neurology thread, apologies for that, but I also need the perspective of psych people.

I love neuroanatomy. I love the intellectual aspects about neurology. Given that I'm also interested in research, neurology is slightly closer to my research interests because I'm really into decoding information coding/transfer and that is more doable with neurologic disease (epilepsy, motor..etc).

OTOH, nothing comes close to the physician-patient relationship in psychiatry. I love going over psychodynamics involved, and the reasoning in psychiatry is different than any other medical specialty. Clinically you can also do more for your patient than neurology. Lifestyle is better (and that's a huge thing for me). Matching for IMGs is a little easier, and I've managed to build research connections in psychiatry with a prominent psych researcher.

I'm also a bit scared how much bad mouthing Neuro is getting lately. From alarming statements on the AAN website to surveys that are constantly showing neurologists in the bottom half of the happiness scale (in contrast to psych).

If anyone has any input on this dilemma, I would greatly appreciate it.

I'm not sure if this will matter or not, but I would BEG you to go into this type of psych research. There is plenty of psych research funding out there, and much more to come, if the new brain mapping project is any indication.

We desperately need more researchers, especially along lines such as this. Most people who go into psych don't go into it for research, so it's very difficult to find people who want to do this type of research, which is desperately needed to help better delineate some of our pathology.

My point is that going into neuro-psych research will make a MUCH bigger difference/impact in the world than another epilepsy researcher.

I will also say that you'd be hard pressed to find a better work-life balance than psych. At my residency, we consider our neuro months our worst months, lol. Not that I don't find it interesting a bit, but the workload is TOTALLY different.

 

[OldPsychDoc]

Bottom line--what patients do you want to be seeing 5 years from now?
Epilepsy, headaches, and Parkinson's, or depression, anxiety, and psychosis?

 

[dl2dp2]

Without knowing more precisely the type of research project you are pitching it's difficult to make an assessment of what would be a clinical angle that would match that interest. Rest assured, it's very difficult to get significant time during residency in neurology to do research, 6 months at most and oftentimes requiring a R23. Whereas with psych most of the programs have a fourth year free, and can get more time out third year.

This also depends on your eventual goal and your CV. Do you want to do significant bench research? As it turns out I think it's now becoming easier to do this in psych than in neuro, though there's still room for the latter. Epidemiology and clinical research is equally doable in both. Are you interested in ICU/interventional/procedures?

Keep in mind that once you go into neurology you'll be either doing a lot of general neurology, which consists of peripheral nervous system, headaches, nonspecific "numbness", psych complaints etc., or very specialized in a niche academic practice. The training cycle for academic neurology is much longer than for academic psychiatry, with a necessary fellowship, which is often 2-3 years of mostly clinical work of often frequent calls, whereas in psych it's either a pure research fellowship or a mix of research/clinical, with very rare calls. With psych, it's always CNS, but there's more social work type stuff. Private practice flexibility is VASTLY better in psych, but the salary ceiling is higher in neuro. Per hour pay I'd imagine is actually better in psych.

I had a similar decision to make. For me it boiled down to: I can't deal with seeing Medicaid carpal tunnel and checking sphincter tone during residency. Neuro exam, while fun in theory, feels like scut in practice. ICU. The hours. Stroke patients that are fun to talk about but nothing to do for. Psych: I need to deal with more SW, and there's a stigma, and there's not as much necessary factoids to memorize and be seen as smart, but once you get over that everything else is basically pleasant, and people do get better. And if you like epilepsy I would say a modern psychopharm practice is very similar to a modern epilepsy practice, especially if you are TMS certified, except for the reading EEG bit, which (i.e. useful biomarkers in pharmacotherapy of depression/anxiety, and the consequent interpretation work), who knows, may also happen in the next n decades. The other thing I didn't really appreciate until much after med school is in psych,with the stigma, you also interface with the rest of society a LOT more, which makes your job much more interesting at a cocktail conversation level, and it's really nice to have a snazzy cool job. You might feel smart as a neurologist from a med student perspective, it's kind of awkward to not have anybody care about your factoids once you actually grow up.

 

[Residentcool]

Yes, I know, this is another really lame "can't make a decision between Neuro and Psych" but I need your help, cause time is ticking out and I need to make the decision.

It's a little heart-wrenching for me, cause I really like both and I can't seem to commit to one and forget about the other. I posted a similar post in one of the neurology thread, apologies for that, but I also need the perspective of psych people.

I love neuroanatomy. I love the intellectual aspects about neurology. Given that I'm also interested in research, neurology is slightly closer to my research interests because I'm really into decoding information coding/transfer and that is more doable with neurologic disease (epilepsy, motor..etc).

OTOH, nothing comes close to the physician-patient relationship in psychiatry. I love going over psychodynamics involved, and the reasoning in psychiatry is different than any other medical specialty. Clinically you can also do more for your patient than neurology. Lifestyle is better (and that's a huge thing for me). Matching for IMGs is a little easier, and I've managed to build research connections in psychiatry with a prominent psych researcher.

I'm also a bit scared how much bad mouthing Neuro is getting lately. From alarming statements on the AAN website to surveys that are constantly showing neurologists in the bottom half of the happiness scale (in contrast to psych).

If anyone has any input on this dilemma, I would greatly appreciate it.

This may be a lame suggestion, but why not do neuro-psychiatry? You can do psych as residency + neuropsych fellowship and treat patients who have psychiatric problems secondary to neurological problems.

 

[Jorje286]

Thank you all for the replies.

Without knowing more precisely the type of research project you are pitching it's difficult to make an assessment of what would be a clinical angle that would match that interest.

Currently I'm doing fMRI/SPECT/EEG stuff related to depression. Now that's already a very neuro approach to psychiatry. My dream is to do something a lot more computational (as I love math and I have a year experience in computational neuroscience) and a lot more action potential related - (basically involving cell neurophysiology and recordings). This line of research is much more in line with neurology, I think, than psychiatry - because we're not anywhere close to have a sound theoretical framework that starts from the cell basis of much simpler brain mechanisms, nevermind psychosis or feeling depressed. Having said that, there ARE computational psychiatrists, so I'm not sure how "real" this factor is.

As you aptly pointed out, however, psychiatry is much more open for research nowadays than neurology. There are more research-track residencies, there's more time during residency, and it also seems there's more money for psych research than neuro. My connections are also better in the psych world.

If I want to sum it all up, my heart is slightly tilted for neurology and my brain is slightly tilted for psych. And both are important. Currently, I'm going with my brain.

This may be a lame suggestion, but why not do neuro-psychiatry? You can do psych as residency + neuropsych fellowship and treat patients who have psychiatric problems secondary to neurological problems

I have thought about double programs, but there are too few at the moment to make them a goal in themselves. I would still need to chose between psych/neuro. Psych followed by neuropsych fellowship actually seems a good idea (but the priority also needs to be taken). TBH, I think it's about time the two specialties get closer together and get merged at some point. I can't see how you can be an excellent brain clinician without being good in both behavior and neuroanatomy/physiology.

 

[psychked]

I think it's about time the two specialties get closer together and get merged at some point. I can't see how you can be an excellent brain clinician without being good in both behavior and neuroanatomy/physiology.

Agreed. Also I think that you can have much more of an impact In Psychiatry.

 

[vistaril]

Yes, I know, this is another really lame "can't make a decision between Neuro and Psych" but I need your help, cause time is ticking out and I need to make the decision.

It's a little heart-wrenching for me, cause I really like both and I can't seem to commit to one and forget about the other. I posted a similar post in one of the neurology thread, apologies for that, but I also need the perspective of psych people.

I love neuroanatomy. I love the intellectual aspects about neurology. Given that I'm also interested in research, neurology is slightly closer to my research interests because I'm really into decoding information coding/transfer and that is more doable with neurologic disease (epilepsy, motor..etc).

OTOH, nothing comes close to the physician-patient relationship in psychiatry. I love going over psychodynamics involved, and the reasoning in psychiatry is different than any other medical specialty. Clinically you can also do more for your patient than neurology. Lifestyle is better (and that's a huge thing for me). Matching for IMGs is a little easier, and I've managed to build research connections in psychiatry with a prominent psych researcher.

I'm also a bit scared how much bad mouthing Neuro is getting lately. From alarming statements on the AAN website to surveys that are constantly showing neurologists in the bottom half of the happiness scale (in contrast to psych).

If anyone has any input on this dilemma, I would greatly appreciate it.

how much do you like(or can tolerate) medically ill patients, icu settings, lines, procedures, etc? Thats a big thing.....if you don't want to do those things, psych is more your fit because you won't do any. If you do want to do those things, then neuro is more you thing.

A few other factors to consider is that with neuro you have the potential to do neurointerventional down the road.....which has the possibility to send you into a whole differerent income level. You also have a realistic chance to get a pain fellowship from neuro if your interested.

How much is the stigma(inside and outside medicine) of being a psychiatrist going to bother you? If the answer is none at all, that's a bonus for psych.

Another thing to consider is that neuro has to do a real intern year....so if that's going to be a problem, thats a plus for psych. Schedule for pgy-2s in neuro is also much worse than that of most all psych programs during any year.

One bonus for neuro is that neuro is going to be under *MUCH* less midlevel pressure than psych in the future.

 

[dl2dp2]

Currently I'm doing fMRI/SPECT/EEG stuff related to depression. Now that's already a very neuro approach to psychiatry. My dream is to do something a lot more computational (as I love math and I have a year experience in computational neuroscience) and a lot more action potential related - (basically involving cell neurophysiology and recordings). This line of research is much more in line with neurology, I think, than psychiatry

I'm not sure where you get this idea. I would say exactly the opposite. If you want to be a practicing MD and do neurophysiology and computational neuroscience, it's VASTLY better to be in psych than neuro. What kind of computational neuroscience do you want to do in neurology? The two big time neurology trained neurophysiologists I can think of (Michael Shadlen and Michael Goldberg) don't really do any clinical work that's remotely related to their research. There are numerous GENERATIONS of neurophysiologists born and raised in psychiatry, all the way from Eric Kandel to Karl Deisseroth who are doing physiology in psychiatric illnesses. The scientific basis at the neuronal level for a lot of psychiatric illnesses is actually a lot richer than in neurological illnesses. Neurology is going in a totally different direction. I would almost say that there's no neuroscience in neurology. "Neuroscience" in neurology is mostly at the molecular level: what molecules are involved in cell death, cell repair, neuron-glia interaction, infections, etc. Not at the circuit level. You could do movement disorders, but again nobody cares about the circuit that affects Parkinsons--as long as you make sure the cells don't die, you cured it.

The only direction that might be advantageous for a neurologist is possible greater accessibility for research in epilepsy surgery. But I'm not sure if you want to do animal models or human research.

 

[SuperSoccer19]

Bottom line--what patients do you want to be seeing 5 years from now?
Epilepsy, headaches, and Parkinson's, or depression, anxiety, and psychosis?

I second this.

Also liked that patients in psych tended to get better while in neurology I was often diagnosing terminal, debilitating disease that I could only slow the progression...and there was a lot of psych in neuro, but for some reason this somatiform disorders tended to not peak my interest at all. At the same time, some days I wish I did something more hands on or was closer to general medicine.

I've looked into the neuro-psych fellowship and I don't think its accredited so much and I couldn't find a whole heck of a lot to support a significant difference in job description.

 

[PETRAN]

I'm a trainee clinical neuropsychology who also does cognitive neuropsychology and cog. neuroscience research and have worked on both neurology and psychiatry departments so i'll just offer my 2 cents from the overall experience and vibe i got by working in the two departments.


I think it would be better if you go into psychiatry, simply because its much more "chill" and you can dedicate a lot of time studying this exciting field. In neurology you have to be in constant standby mode for strokes and epilepsies, and i don't think that you gonna gain much-computational neuroscience-wise- by interpreting the EEG (i mean, how can epileptiform activity inform you about possible algorithms that single neurons use in "solving" visual perception, motor patterns or attention? Although im no expert in EEG, i don't think that it will be much valuable). The neuro examination is nice with the lesion-focused approach, but it kinda gets boring and stereotyped after a while (although if you add some imaging and EEG interpretation can get more interesting). Unless you go into behavioral neurology in which you can do interesting research in relation to cognition and brain-behavior relationships but i think you can also do this from psych (or do a C/L fellowship if you like body-mind relations in general).

A very important thing is what kind of patients you like more (as others have posted previously). Work in both departments and see what you like and leave research on the side. If you strictly want to do research in relation to your clinical field, cognitive/computational neurosciences have a lot to offer on basic cognitive and emotional processes which can relate to psychiatry IMO(E.G. the hypermnestic activity of PTSD in relation to emotional associations in the amygdala, or problems in "attentional-filtering" in psychosis, or cognitive rigidity of fronto-striatal circuits in OCD, just to name a few examples. And you can always do dementias from psychiatry anyway).

 

[michaelrack]

What you are advising sounds reasonable, except for the part about the C/L fellowship

I'm a trainee clinical neuropsychology who also does cognitive neuropsychology and cog. neuroscience research and have worked on both neurology and psychiatry departments so i'll just offer my 2 cents from the overall experience and vibe i got by working in the two departments.


I think it would be better if you go into psychiatry, simply because its much more "chill" and you can dedicate a lot of time studying this exciting field. In neurology you have to be in constant standby mode for strokes and epilepsies, and i don't think that you gonna gain much-computational neuroscience-wise- by interpreting the EEG (i mean, how can epileptiform activity inform you about possible algorithms that single neurons use in "solving" visual perception, motor patterns or attention? Although im no expert in EEG, i don't think that it will be much valuable). The neuro examination is nice with the lesion-focused approach, but it kinda gets boring and stereotyped after a while (although if you add some imaging and EEG interpretation can get more interesting). Unless you go into behavioral neurology in which you can do interesting research in relation to cognition and brain-behavior relationships but i think you can also do this from psych (or do a C/L fellowship if you like body-mind relations in general).

A very important thing is what kind of patients you like more (as others have posted previously). Work in both departments and see what you like and leave research on the side. If you strictly want to do research in relation to your clinical field, cognitive/computational neurosciences have a lot to offer on basic cognitive and emotional processes which can relate to psychiatry IMO(E.G. the hypermnestic activity of PTSD in relation to emotional associations in the amygdala, or problems in "attentional-filtering" in psychosis, or cognitive rigidity of fronto-striatal circuits in OCD, just to name a few examples. And you can always do dementias from psychiatry anyway).

 

[Jorje286]

Thank you all for your input.

After much thought and a discussion with my mentor, psychiatry it will be. Feels very exciting to have made the decision.

 

[OldPsychDoc]

Thank you all for your input.

After much thought and a discussion with my mentor, psychiatry it will be. Feels very exciting to have made the decision.

Welcome to the Dark Side....

 

[digitlnoize]

Thank you all for your input.

After much thought and a discussion with my mentor, psychiatry it will be. Feels very exciting to have made the decision.

You have chosen...wisely.

 

[Leo Aquarius]

Congratulations, that's fantastic. I remember the day I made the decision. All I have to do is look at other residents and instantly realize how good I have it, and I'm at a program that works us.

A friend of mine is a neurologist and she complains about the long hours for whatever that's worth.

 

[clement]

"One bonus for neuro is that neuro is going to be under *MUCH* less midlevel pressure than psych in the future. "

Ok but what about Medicare cuts? There's some
verry unhappy neurologists out there already.
And it's not just the EMG folk- it's everyone who
relies on that revenue. If anything, midlevels
can help out one's practice? Ie anesthesiologists
who supervise crnas.