psych?... neuro?... neuroscience?... behavior fellowship?... HELP!

[MDgonnabe]

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someone, please give me ideas on what i should do with myself (aside from take a valium 😉 ):

i 😍 psych, but i have a very hard time dealing with patients with substance abuse issues. i'd rather deal with more "purely" depressed patients or patients with comorbid medical conditions. the patients i tended to gravitate towards during third year were the very sick, depressed patients, so i was thinking c-l psych for the longest time. i adore consultation work. so many cases each day, so many challenges. no mundane disposition red tape b.s. to deal with. just interview, examination, a/p. i also very much doubt i'll be happy doing any psychotherapy (i vaguely need instant gratification, or as close to it that i can get in these fields! 🙂 ). recently, i started my fourth year neurology rotation and am 😍ing it too. but the more i talk with the neurologists the more i feel this huge rift between psych and neuro that is unsettling to me. i really wish the two fields could be so much more integrated. now it seems that neurologists need a full year of im, and i kinda like that. the medical stuff is what separates psychiatrists from psychologists. i also like the thought of localizing behaviors in the brain. so one of the neurologists at my institution recommended i do neuro and follow up with a behavioral fellowship. but what about the neuroscience fellowship i've vaguely heard about? what're the differences between these fields? what type of patients do they see? i like neuro, but i'd also go crazy working up strokes all day long... i'm so freakin' 😕 and the neuro application process is well underway! any thoughts/advice would be greatly appreciated. thanks in advance!

(i'll cross-post this to the neuro forum to get their feedback as well.)

 

[OldPsychDoc]

someone, please give me ideas on what i should do with myself (aside from take a valium 😉 ):

i 😍 psych, but i have a very hard time dealing with patients with substance abuse issues. i'd rather deal with more "purely" depressed patients or patients with comorbid medical conditions. the patients i tended to gravitate towards during third year were the very sick, depressed patients, so i was thinking c-l psych for the longest time. i adore consultation work. so many cases each day, so many challenges. no mundane disposition red tape b.s. to deal with. just interview, examination, a/p. i also very much doubt i'll be happy doing any psychotherapy (i vaguely need instant gratification, or as close to it that i can get in these fields! 🙂 ). recently, i started my fourth year neurology rotation and am 😍ing it too. but the more i talk with the neurologists the more i feel this huge rift between psych and neuro that is unsettling to me. i really wish the two fields could be so much more integrated. now it seems that neurologists need a full year of im, and i kinda like that. the medical stuff is what separates psychiatrists from psychologists. i also like the thought of localizing behaviors in the brain. so one of the neurologists at my institution recommended i do neuro and follow up with a behavioral fellowship. but what about the neuroscience fellowship i've vaguely heard about? what're the differences between these fields? what type of patients do they see? i like neuro, but i'd also go crazy working up strokes all day long... i'm so freakin' 😕 and the neuro application process is well underway! any thoughts/advice would be greatly appreciated. thanks in advance!

(i'll cross-post this to the neuro forum to get their feedback as well.)

Psych--with psychosomatic (C/L) fellowship.

 

[Anasazi23]

Agree with above.

Psych c/l or private practice with emphasis on medical psychiatry. This seems to be becoming more popular anecdotally to me, and is the way things should have been to begin with, if it wasn't already. You don't have to treat drug addicts if you don't want to. I see quite a few psychiatrists with 'boutique' practices, hand picking patients that they want to work with, pay well, conduct therapy, and don't have these sorts of problems.

I was in a similar position when I was at that step, and I ultimately went with my original like/love - psychiatry.

The four months is significant. Remember, a full year of med internship often has a few months of electives and often some repeats, like ER....which you may not benefit from all that much in the long run.

Remember, you're technically boarded in both psych and neuro...a significant portion of your psych board exams will be clinical neurology and neuroscience. Just don't grossly overstep your bounds. Neurologists often treat simple psych disorders.

 

[MDgonnabe]

feedback much appreciated!

which schools are well known for their c-l departments? also, does where i do residency impact my fellowship placement? my med school c-l department is insanely busy and seems to give great clinical experience. however, it's not a brand name school and i wonder if getting into fellowship might be a challenge.

 

[OldPsychDoc]

feedback much appreciated!

which schools are well known for their c-l departments? also, does where i do residency impact my fellowship placement? my med school c-l department is insanely busy and seems to give great clinical experience. however, it's not a brand name school and i wonder if getting into fellowship might be a challenge.

I think you should aim at a residency at a place which has or will have the fellowship, as you'll have an inside track that way. Aim at programs which have large academic teaching hospitals--the Pittsburghs, Michigans, Emorys, etc.

 

[Anasazi23]

That's true...try to apply to a place that has the fellowship you want.

Also, try to apply to area-specific fellowship cities or regions that have lots of fellowship spots (ie. NYC, Boston, Cali, etc.) That way, you can sometimes do outside electives, and have the added bonus of being a "local" with minimal moving stress and readjustment, and know the local resources. They take these things into consideration.

 

[MDgonnabe]

again, advice much appreciated, gentlemen!

quite frankly, i'm not so sure what my chances are at the brand name academic institutions. i failed step 1 on my 1st attempt (179). retook it and ended up with a 197. i know that'll be the topic du jour for my interviews wherever i go. the reason for my failure still remains ambiguous to me. part of it i think was a mid-med school crisis (i wasn't liking my core rotations 3rd year until i did the neuroscience-y stuff). another part of it was also that i learn so much better by doing than just by reading. i think that's probably why my score improved on the second shot. either way, i failed it, and the academic programs won't like that. my background is ok. i majored in psych as an undergrad and earned honors by doing a thesis. worked in a neuropsych lab for some odd number of years. nothing mind-blowing beyond that. in med school, i honored my behavioral sciences course 1st year, high passed a couple others, and high passed family med, psych, and ob/gyn core rotations (at a non-name brand school). i was never a grade grubber nor anal about grades. i just know what i like, and i try hard when i like what i'm doing. my letters of rec i think show my genuine 😍 of the field. 🙂 so yeah, i doubt the name brand places will take me based on all this. i'll give it a shot, but for now i'm thinking i'll probably end up at my own school and do an away elective at the institution i'll consider for fellowship. doesn't seem like c-l is an insanely difficult fellowship to get into at the moment-- though who knows how things will change in the future?

also, if anyone is curious, i have gotten 3 interviews thus far with even my crappy numbers (uva, umdnj camden, and jhu).

 

[OldPsychDoc]

again, advice much appreciated, gentlemen!

quite frankly, i'm not so sure what my chances are at the brand name academic institutions. i failed step 1 on my 1st attempt (179). retook it and ended up with a 197. i know that'll be the topic du jour for my interviews wherever i go. the reason for my failure still remains ambiguous to me. part of it i think was a mid-med school crisis (i wasn't liking my core rotations 3rd year until i did the neuroscience-y stuff). another part of it was also that i learn so much better by doing than just by reading. i think that's probably why my score improved on the second shot. either way, i failed it, and the academic programs won't like that. my background is ok. i majored in psych as an undergrad and earned honors by doing a thesis. worked in a neuropsych lab for some odd number of years. nothing mind-blowing beyond that. in med school, i honored my behavioral sciences course 1st year, high passed a couple others, and high passed family med, psych, and ob/gyn core rotations (at a non-name brand school). i was never a grade grubber nor anal about grades. i just know what i like, and i try hard when i like what i'm doing. my letters of rec i think show my genuine 😍 of the field. 🙂 so yeah, i doubt the name brand places will take me based on all this. i'll give it a shot, but for now i'm thinking i'll probably end up at my own school and do an away elective at the institution i'll consider for fellowship. doesn't seem like c-l is an insanely difficult fellowship to get into at the moment-- though who knows how things will change in the future?

also, if anyone is curious, i have gotten 3 interviews thus far with even my crappy numbers (uva, umdnj camden, and jhu).

You're gonna do fine....

 

[atsai3]

feedback much appreciated!

which schools are well known for their c-l departments? also, does where i do residency impact my fellowship placement? my med school c-l department is insanely busy and seems to give great clinical experience. however, it's not a brand name school and i wonder if getting into fellowship might be a challenge.

Also consider applying to programs with high-volume medicine and surgery services. Lots of C-L fodder.

If you're interested in integration, why not apply to a combined neuro/psych program? Dunno how many are out there -- I think NYU has one...

-AT.

 

[MDgonnabe]

Also consider applying to programs with high-volume medicine and surgery services. Lots of C-L fodder.

how would one attain volume stats for various services?

If you're interested in integration, why not apply to a combined neuro/psych program? Dunno how many are out there -- I think NYU has one...

-AT.

from what i've gathered, such programs don't really integrate so much as divide your training between psych and neuro. i've also considered psych-im and psych-fp. but again, it seems like you basically become an outcast from both fields, kinda in limbo between specialties and departments. i guess the people in each field question your dedication to their specialty when you divide your time thusly. who knows? another, more obvious downside is the time commitment. i can't say for sure whether or not i'd like to stick to this for 6 full years, living away from my family like that. i come from an imigrant family and they live in the philly area. i have no friends/family anywhere else in the country. seems like social support would be a very good thing during residency (let alone a 6-year one), no? and the final downside is the practicality. seems like you end up practicing one or the other mostly. again, poor integration. 🙄 thanks.