PhD in neuropsychology vs. MD cognitive neurology/neuropsychiatry specialty

[NoPatients]

Hello, I have posted recently over in the nontraditional forum about my thoughts of going to medical school. But, I am also now considering a PhD in neuropsychology or health psychology since I have a BA in psychology. I want to make sure I have fully considered all of the options before I commit myself and my family to either time-consuming program.

If I go to medical school, my goal is to go into the subspecialty of behavioral neurology and neuropsychiatry. In my decision, I am trying to ignore the salary differential between the MD and the PhD in order to decide based on interest and career satisfaction. I'm not at all interested in writing prescriptions all day while ignoring the cause of psycho/neuro pathology though.

One thing that disturbs me, and makes me inclined to choose to pursue the MD, is that it seems that clinical neuropsychology is a field which is being threatened with extinction by medical subspecialties. The following is from the Behavioral Neurology & Neuropsychiatry Core Curriculum (http://www.ucns.org/certification/pdfs/core_curr_beha.pdf):

II. Neuropsychiatric Assessment
The Fellow in Behavioral Neurology & Neuropsychiatry will be provided with education and experience in the areas of clinical assessment listed below. Note that area C is an exception to this and is most appropriately regarded as area in which acquisition of advanced knowledge, and not necessarily performance skills, is an appropriate goal of fellowship training. [emphasis added by me]
....

C. Neuropsychological Assessment
1. The content, sensitivity, and specificity of neuropsychological testing, including:
a. Fixed assessment batteries.
b. Flexible batteries.
c. Projective testing.
d. Personality assessment tools.

2. The influence of age, education, cultural background, fatigue, drugs, sensory impairment, and primary psychiatric illnesses on test performance.
3. The role of and indications for neuropsychological testing in the evaluation and treatment planning related to neurobehavioral and neuropsychiatric disorders.
4. The relationship between neuropsychological test results and bedside or office-based screening mental status examinations.
5. The anatomic and disease correlates of neuropsychological test abnormalities.

I think all this means is that the MD in this subspecialty is expected to be thoroughly familiar with neuropsychological assessment, rather than a qualified expert in assessment administration and interpretation, right? But apparently MDs have their own neuropsychological assessments they can use, such as the MMSE, CCSE, SPMSQ. (http://www.anpaonline.org/documents/research/ANPA_RC_Malloy1997.pdf)

On the other hand, the narrow focus of the PhD in neuropsychology would allow me to avoid the overwhelming and all-encompassing medical knowledge I would have to obtain with an MD. Honestly, I think I just might prefer to stay in my own little super-specialized world. Or, maybe I'll just go the "no patients" route and do basic nonclinical research in cognitive psychology.

Is clinical neuropsychology moving towards something done by MD subspecialties rather than PhDs in psychology?

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[psy86]

Is clinical neuropsychology moving towards something done by MD subspecialties rather than PhDs in psychology?

I have not gotten this impression. Maybe others will disagree, but my sense is that the time demands imposed on MD's due to managed care etc. would make it essentially impossible for them to perform the functions of a neuropsychologist.

For what it's worth (and not that you asked), many people in the field feel that it is preferable for neuropsychologists to obtain a Ph.D. in clinical psychology and then later specialize and do a post-doc, etc., as opposed to getting a Ph.D. in neuropsychology off the bat. Obtaining a strong foundation in basic clinical skills is seen as desirable.

 

[PublicHealth]

I have not gotten this impression. Maybe others will disagree, but my sense is that the time demands imposed on MD's due to managed care etc. would make it essentially impossible for them to perform the functions of a neuropsychologist.

For what it's worth (and not that you asked), many people in the field feel that it is preferable for neuropsychologists to obtain a Ph.D. in clinical psychology and then later specialize and do a post-doc, etc., as opposed to getting a Ph.D. in neuropsychology off the bat. Obtaining a strong foundation in basic clinical skills is seen as desirable.

This is what I have heard (and encountered) as well. Clinical neuropsychologists typically have a PhD/PsyD, 1-year internship in clinical neuropsychology or clinical psychology with a major rotation in neuropsychology, and a 2-year postdoc in clinical neuropsychology.

On average, in 2004, neuropsychologists made $110K/year. http://www.ncbi.nlm.nih.gov/entrez/..._uids=16895852&query_hl=8&itool=pubmed_docsum

This is likely to go up, as the CPT codes for neuropsychologist services increased from $75/hour to $120/hour in 2006.

I am not entirely sure what neuropsychiatrists make, but I would imagine it's somewhere in the $100-200K/year range, depending on if they're in academic or private practice.

My advice would be to shadow some neuropsychiatrists and neuropsychologists. You will notice that neuropsychologists tend to spend MUCH more time with patients and that they administer long batteries of tests. The neuropsychologists I shadowed a number of years ago spent anywhere from 4 to 8 hours per patient. Neuropsychiatrists, in contrast, spend anywhere from 20-45 minutes per patient. The scope of medical knowledge differs vastly between these two groups of professionals, with neuropsychiatrists having a much broader comprehension of medical/neurologic factors underlying cognitive function and dysfunction. Neuropsychologists tend to be better trained in psychologic/functional and statistical aspects of cognitive function and dysfunction. Neuropsychologists also tend to function primarily as assessors, not treaters, with the exception of some neuropsychologists who do psychotherapy and/or cognitive rehabilitation. Neuropsychiatrists may also treat pharmacologically, whereas neuropsychologists generally do not (exceptions are those neuropsychologists who completed psychopharmacology training in New Mexico and Louisiana).

Clinical psychology PhD programs are fully funded with stipends. Medical schools, unfortunately, are not. Depending on what you ultimately want to do (academic vs. private practice), this is an important consideration, especially if you go to a private medical school. Time to train is also different, with 4-5 years PhD + 2 years post-doc for neuropsychology; or 4 years MD/DO + 4 years residency + 1 year behavioral neurology fellowship.

More reading:

http://www.ncbi.nlm.nih.gov/entrez/...uids=16787885&query_hl=10&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/...uids=12153815&query_hl=10&itool=pubmed_DocSum

 

[NoPatients]

Thank you psy86 and PublicHealth for your very helpful responses.

 

[PublicHealth]

Thank you psy86 and PublicHealth for your very helpful responses.

So what have you decided?

 

[NoPatients]

I am going to meet with a few neuropsychologists and hopefully shadow them some. If I'm still not sure after that, I'm going to try to find an MD with a neuropsychiatric-oriented practice to shadow. Nonclinical research is still an option too. The shadowing will really help me decide.

 

[PublicHealth]

I am going to meet with a few neuropsychologists and hopefully shadow them some. If I'm still not sure after that, I'm going to try to find an MD with a neuropsychiatric-oriented practice to shadow. Nonclinical research is still an option too. The shadowing will really help me decide.

You mention in your profile that you're from the midwest. Close to Chicago? If so, try to shadow Jerry Sweet, PhD. He's a very well regarded clinical and forensic neuropsychologist: http://www.enh.org/healthandwellness/clinicalservices/mentalhealth/academics/default.aspx?id=2072

Bob Heilbronner, PhD is good, too: http://www.chicagoneuropsychology.com/

May be tough to shadow them, as they conduct many forensic exams, which adhere to standard administration (two people in room). Good to talk to, at the very least.

Tons of others...it depends on where you are!

 

[Neurobound]

No Patients,

You asked the exact question that was on my mind. From what I have heard, neuropsychologists spend time getting to know the patient much more so than a M.D. does (though I have only heard this about neurologists, not neuropsychiatrists). If fact, I heard that the neuropsycologists are usually the only ones that actually talk to the patients and often times are the ones explaining the procedures taking place in the hospital. This is only wht I have heard from neuropsychologists. Like you I haven't shadowed any M.D.'s or Ph.D.'s yet. I am anxious to see what the difference is between a neuropsychiatist and a neuropsychologist. From what I have read, it seems that the former is more involved with psychological disorders such as depression that occur with a neurological problem and a neuropsychologist is more involved with the cognitive functioning of the neurological patient.


By the way, does anyone know of any good neuropsychologists and neuropsychiatrists that one could shadow in the L.A. area preferably close to Ventura county?

 

[PublicHealth]

No Patients,

You asked the exact question that was on my mind. From what I have heard, neuropsychologists spend time getting to know the patient much more so than a M.D. does (though I have only heard this about neurologists, not neuropsychiatrists). If fact, I heard that the neuropsycologists are usually the only ones that actually talk to the patients and often times are the ones explaining the procedures taking place in the hospital. This is only wht I have heard from neuropsychologists. Like you I haven't shadowed any M.D.'s or Ph.D.'s yet. I am anxious to see what the difference is between a neuropsychiatist and a neuropsychologist. From what I have read, it seems that the former is more involved with psychological disorders such as depression that occur with a neurological problem and a neuropsychologist is more involved with the cognitive functioning of the neurological patient.


By the way, does anyone know of any good neuropsychologists and neuropsychiatrists that one could shadow in the L.A. area preferably close to Ventura county?

Not the best, but a start:

http://en.wikipedia.org/wiki/Clinical_neuropsychology

http://en.wikipedia.org/wiki/Neuropsychiatrist

http://www.alaska.net/~drussell/ars/ma2_5.html

 

[NoPatients]

PublicHealth, thanks, I currently work at an academic hospital, so I had no trouble locating a few neuropsychologists here in Columbus, Ohio. My interviews were very informative, but they also reinforced my fears that I might not be as happy with a clinical position. I've got more thinking to do about this.

I am anxious to see what the difference is between a neuropsychiatist and a neuropsychologist. From what I have read, it seems that the former is more involved with psychological disorders such as depression that occur with a neurological problem and a neuropsychologist is more involved with the cognitive functioning of the neurological patient.

Neurobound, my impression from reading and interviewing is that neuropsychologists focus on assessment. Much of this is standardized psychometrics, but some is just talking and getting to know the patient. Also, they do some general clinical psychology with neurological patients, such as helping a patient with epilepsy overcome depression. The big question of course is whether the source of the depression is the brain/epileptic activity, or the mind (negative thought patterns) like someone without epilepsy would have.

Neuropsychiatrists use assessment as one of their tools to diagnose and treat the patient. They do a much broader range of things, and they are more focused on the practical application of science and assessment data. They do some limited assessment/testing, but the more lengthy and detailed testing is done by the neuropsychologist. Neuropsychiatrists practice the art of medicine (based on many sciences), neuropsychologists apply the science of psychology and assessment to the patient's cognitive functioning.

http://www.anpaonline.org/about/subspecialty/
On June 30, 2004 Behavioral Neurology/Neuropsychiatry was approved as a single subspecialty.

Here are some patient-focused links which give some detailed and straightforward descriptions:

http://www.epilepsy.com/epilepsy/specialists_behavioralneuro.html
http://www.epilepsy.com/epilepsy/specialists_neuropsychologists.html

 

[Lilysann]

Hi, I found this thread to be very useful and was hoping to see another posting on the decision NoPatients made. I'm headed for a Masters in Psychology with the intention of pursuing Neuropyschology. I am not interest in becoming an MD. I hope that in 2010, this field is still a great choice for those hoping to pursue a PhD in Psych.

 

[emerl98]

Hi guys, sorry to revive an old thread but I thought it would be better than making a new one. What are the distinct differences between Behavioural Neurology and Neuropsychology? I'm looking for a speciality that combines both aspects of psychology and neurology, but probably more focused on a psychological approach.