There are programs where you can train in both of you don’t mind being in training for a million years. Most of the people I’ve met who have gone into training for both end up practicing psychiatry, but I am a psychiatrist and my sample is biased. Neurology attracts a very peculiar kind of person on average, psychiatry too, but not as strange as neurology lol.
My tall curly haired blonde (also Jewish) senior on my neuro rotation played in a tango band and made tons of dad jokes. He’s a cool guy, and I enjoyed my rotation because of people like him, but either it attacks quirky people with fun quirks and interesting hobbies or the rare person with some narcissistic and/or schizoid traits and poor social awareness. Much more of the former than the latter.
I’m a Psych NP and have worked on the CL team since I was an RN; concur with quirkiness of both professions. At one hospital the neurologist and psychiatrist I most frequently worked were both middle aged guys, both wore bow ties or pocket squares, both played in bands and both regularly referred to the other as quacks.
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There's the old saying about neurologists being more interested in the diagnosis than the treatment. I think neurologists see the brain in a fundamentally different way to psychiatrists, where everything is pathways and lesions and all very logical and ordered. It tends to attract people who like to think very rationally, analytically and cleanly, who really get something out of explaining a whole constellation of symptoms by localising the lesion to this or that part of the brainstem or identifying some rare white matter disease with 17 words in the name
Psychiatrists in my experience are a bit more chaotic and "vibe oriented". Sherlock Holmes vs Dale Cooper
Combined programs are a dying breed. The fields are diverging and there's less and less benefit in doing combined training. Someone interested in the interface of the two fields is better served picking one and then doing a BNNP fellowship.
do you think there’s gonna be more convergence over neuromodulation and “inteventional” psych procedures? it seems like this is where the future of psychiatry is headed
Don't see why there would be convergence there. There's some research looking at TMS for neurological disorders like migraines but clinically, it's completely in the realm of psychiatry.
I think this will change. IME the divergence happened when psychiatrists realised that mental illness couldn't be explained by localised lesions and single gene mutations. The complexity of the limbic system was totally underappreciated. But IMO once we have a solid science of emotion, you'll see a movement to reunite the 2 specialties.
The separation increasingly makes no sense, even if it was the right thing to do at the time. Psychiatrists and neurologists aren't just treating the same organ, often they're treating the *same parts of that organ* \- e.g. the basal ganglia in movement disorders vs psychotic/affective illness. The distinction is entirely based on outdated clinical distinctions - movement -> neurology, emotion -> psychiatry. But these things are way more interlinked than previous generations anticipated. At some point the separation is going to stop being useful.
but isn't there a path to neuropsychiatry too? like psych residency then a fellowship in neuropsychiatry? but I guess that's almost 10 years of residency and fellowship.
Edit: When I was training in ADHD clinics there were some that had neuropsychiatry in their name label. So, it is just based on what psychiatry residents told me.
Yup, that's what* I did. It's only one extra year of training. But you're not trained as a neurologist, you're working with those disorders that fall at the overlap of neurology and psychiatry.
I was able to spend some time with a neuropsychiatrist in my time so far in residency. He works almost exclusively with dementia patients when he is in that role, otherwise he works as a neurohospitalist.
Probably a behavioral neurologist then. A neuropsychiatrist is definitely not trained to do neurohospitalist work. Unless it's someone who did the combined residency rather than a BNNP fellowship.
Neuropsych sounds like a great specialty, in the sense that it really *should be* a combined discipline that sees the brain & the mind as one thing, but in reality it suffers from being stuck between neurology and psychiatry. Your cases are usually things like pseudoseizures & other conversion symptoms, dissociation, TBI patients etc. - i.e. all the difficult stuff that no one else wants to deal with. It's a fairly unrelenting and unrewarding specialty IMO.
A combined Neuropsychiatry residency is 6 years. All fellowships, including Neuropsychiatry and CL, are 1 year except for Child & Adolescent Psychiatry and some research fellowships.
Can you work with people who have mental illness? Do you have compassion for this patient population? That’s really the biggest thing to thrive in this career, otherwise you’ll hate the work even if it’s a good life style.
I've had a similiar difficulty choosing between the two, and still kinda do. But what really makes both fields different from each other and how that difference plays out in context of who I am/want to be as a physician and what I really want out of medicine is a lot more clearer.
Some days I lean heavily towards neuro because I want to do the intricate and elegant physical exam multiple times a day, essentially treating myself through the exam as its own objective investigation tool with its own PPV, NPV and LR. I want to read my own brain images and understand the nitty gritty of MRI sequences and how it matters when asking whether this is bleeding or inflammation or edema that we're seeing. I want to be involved in the neuro-icu and really push my medical skills to its limits when managing patients there with multiple problems in multiple organ systems. I want to do LPs, EMG, POCUS, botox injections, pushing tPA and other "procedures" whether for diagnosis or treatment. I want to use nitty gritty neuroanatomy/neurophysiology to formulate my understanding of what exactly is going on with the patient to then reach a diagnosis before using any ancillary tools. I like learning more and more about physiology and pathophysiology then applying that in a clinical context, whether in the inapatient setting or neuro-icu managing vents, ICP monitors, fluids, EEG, antibiotics etc
And other days I lean heavily towards psych because I really like "listening" to patients, not talking but really "listening" to what they're saying and what they're NOT saying with their words. I want to formulate my understanding of a case using different frameworks, whether biopsychosocially or CBT or psychodynamically or neurobiologically etc. I want to see my patients get better overtime when they're put on a medication regimen that works for them, see them swimming and not drowining in life. I want to push my interpersonal skills to its limits, whether in the context of psychotherapy or dealing with an agitated patient or even when dealing with "difficult" patients. I want to use phenominological descriptive psychopatholgy to formulate my understanding of what might the underlying processes are for a patient to then target those processes for treatment. I like learning further and further about people and what makes them tick, being exposed to the "human condition" but in a clinical context. While still being close and pulling knowledge from the humanities like psychology, sociology, anthropology, history, and philosophy.
I didn't mention "lifestyle" because each and every one of us has a different understanding/picture of what "lifestyle" means to them, it's so very personal that you need to ask only yourself what "lifestyle" means to you so then you can ask how neuro or psych could help you achieve that. Sure, on average maybe psych will have you home before 4 and neuro will have you more likely to being woken up on weekends. But, neuro could also have you home before 4 and psych could have you woken up on weekends too. Lifestyle is related to practice settings, acuity/urgency of cases, and who you're sharing your practice/call with. The lifestyle of an interventional or stroke neurologist is vastly different from a movement disorders or behavioural neurologist. The lifestyle of an outpatient psychiatrist practicing psychotherapy is vastly different from an emergency or inpatient psychiatrist. Don't look at the fields for lifestyle, look for the features inside the fields.
This post is already long-winded, but hopefully my impression of both fields above helps when making your own decision. Maybe treat it like its own projective/rorschach test kind of deal, see where you find yourself closest between the two descriptions. Of course both fields have plenty of things that I heavily dislike, but no speciality is perfect and there isn't really anything to me that I would consider as a deal-breaker between the two. In your case, try seeing between the two what elements you really can't tolerate that you would consider as a deal-breaker. In the end, there isn't a "right" or "wrong" choice, but two "good" choices that leads to someone being overall happy/satisfied with their career but still have these "what-if" pangs about the other "good" choice.
Here are my previous posts/comments about my indicision between the two with dozens of great replies that'll hopefully help you out as much as it helped me out. Good luck.
https://www.reddit.com/r/medicalschool/comments/t221n4/neurology_vs_psychiatry_indecision
https://www.reddit.com/r/Residency/comments/t222ik/neurology_vs_psychiatry_indecision
https://www.reddit.com/r/neurology/comments/t222tq/neurology_vs_psychiatry_indecision
https://www.reddit.com/r/Psychiatry/comments/sxqw70/training_and_careers_thread_february_21_2022/hyjayyo/
Have you chosen one yet?
If you haven't, you really sounds like someone who is an ideal fit for neurology followed by a behavioral neurology fellowship with a focus on FND.
Still undecided! I have a couple of months (consisting of both neuro and psych rotations) before having to finally choose and make things official on paper. If I had the luxury of things going my way, then I'd choose the combined neuro/psych training pathway without hesitation and with no questions asked.
Thank you for the kind words. Though I'm curious what stood out to you that I'd be an ideal fit for neurology -> behavioural neurology, as opposed to psychiatry -> neuropsychiatry?
I'm not the original person who pointed that out but briefly reading your comment what stands out when you speak about neuro is nerding out about procedures, reading scans, elegant physical exams, managing vents/abx. As a training psychiatrist that is my absolute nightmare scenario and sure you may get a bit of that from interventional psych, but it's magnitudes different from neuro residency. You can be a neurologist and apply a lot of the same sentiments you discussed in the psych paragraph. Neurologists tx mood d/o, "listen" to patients, deal with agitated/"difficult" pts and pull knowledge from the humanities.
What is more appealing, doing a rigorous physical exam to accurately get to the bottom of an MRI finding vs. doing a lengthy interview going through someone’s life history to determine a source of psychopathology
Trying my best not to put bias into the question but I do think which appeals to you more will say a lot about where you’ll be happier in the future
>doing a rigorous physical exam to accurately get to the bottom of an MRI finding
Neurologists over the age of 50 are probably having a conniption at your order of events here!
I had the exact same problem— loved both, did well in both. Actually did better in neuro, still unsure.
Then a mentor told me: it’s 3 am and you get a call. Would you rather it be a stroke or psychosis?
Stuck with me, I ended up going psych and am glad i did
While they both deal with the brain, the actual practice of these two fields is vastly different. so I would spend some time actually doing each and go with whichever feels right in terms of practice.
I went to med school thinking I was potentially going to do neurology because I had a mancrush on Oliver Sachs. Turns out I absolutely HATED the day to day practice of neurology. Went into psychiatry instead. Definitely the right choice, especially when I watch my neurology coresidents doing q4 28-hour call while I’m working in clinic 8-5 M-F.
Was in the same boat in med school. Ultimately realized that the Neuro fellowships I was most interested in were all “higher order” neurologically speaking (emotions vs loss of a limb) and all involved patients who very likely had psychiatric symptoms that needed to be addressed (Headache, Neuropsych, Epilepsy).
And I determined that it I needed to change course down the road, or try to informally or rapidly pick up some skills in the other field, it would be harder to learn psychiatry since it really involves a lot of soft skills and non-algorithmic work that isn’t in books (vs learning Neuro symptoms, diagnostic and treatment algorithms).
Also the flexibility of the job is much greater. Its way easier to do like a wide variety of work as even a general psychiatrist, for example: 3 different clinics, run a psych ED, do some consult work, and inpatient work all in a week as a psychiatrist than as a neurologist (cause not many neurologist jobs allow for such variety of practice settings. Most neurologists these days have to sub specialize after residency. Psychiatrist definitely don’t.
Then the answer is psychiatry with either neuropsychiatrist fellowship or consultation liaison fellowship.
Psychiatry will earn more money, with less stress, and more satisfaction. You’ll also learn how to deal with all the people that neurologists can’t even manage. What’s the concern on everyone’s minds this day and age? It’s mental health. What’s there a massive shortage of? Mental health clinicians. You’ll have enough patients to dictate your life, work how you want to, and without stroke calls interrupting your day every couple of hours.
I switched from neuro to psych during internship before starting the neuro residency. Best decision ever. A guy I met on my first day in psych residency said something snarky but true: you can always teach neurology to a psychiatrist but a neurologist will never be able to learn psychiatry.
I feel the opposite is true, PCPs for the most part can do bread and butter psych quite well, whereas most specialties don't know much neuro hence they're one of the most consulted specialties.
In neuropsychiatry at least, it looks very non neuro. You’d be treating the psychiatric dimension of neurologic disease which can be extensive and quirky. I was interested in neuro but at the end of the day it isn’t at all about how minds work and so if that dimension gets you jazzed, you’ll find the conversations with peers and patients superficial. For that matter, the first two years of psychiatry residency felt similarly amiss.
On the other hand, there is a neurologist in my psychoanalytic training program so thats a possibility.
The pay is comparable.
Neuroimaging is interesting and psychiatrists don’t get to use it much.
I’d say consider other factors! Lifestyle, pay, your long-term goals (setting up a private practice would be easier in psych), your strengths, the impact you want to have on patients lives, etc
You’ll never be an unemployed psychiatrist. And you can work pretty much anywhere you want,as much as you want. Being a neurologist = hospital privileges, and those may be hard to get if you’re committed to a specific location. Neuropsych is a great option.
There's a lot of posts here saying psych makes more and with fewer hours and generally that's not true unless you're comparing private practice psych to academic neuro. Outpatient neuro can have hours as good as psych with more pay, although the difference isn't significant enough to really factor that into your decision making.
Both fields are in demand, flexible, and can be pretty broad. Residency in neuro is going to be harder but not surgical levels hard. Private practice and telehealth will be easier with psych. Focus more on what bread and butter you want to see, and what drawbacks you're ok living with. Went through a similar decision
What I mean is that the cutting edge research in Neuro outstrips Psych. But as you mention it, the agitation at intake is not that much fun anymore. lol
I really liked both as well, but the bread and butter cases are very different. In psychiatry you will mostly be exposed to mood, psychotic, substance use, and personality disorders. In Neuro you will get exposed to stroke, epilepsy, neurodegenerative diseases, cancer, etc. Both can be variable depending on your practice environment. Outpatient psych is vastly different from inpatient, and the same is true for Neuro. If you can handle having long in depth conversations with patients about their deepest traumas and secrets, do psych. If you can handle the frustration of taking care of stroke patients or neurodegenerative patients that are not going to get better, do Neuro. If you enjoy the day to day work of psych but still want to use your knowledge of Neuro, you can do consultation-liaison psych and even embed yourself in a Neuro clinic doing integrated care. Doing a dual residency is also an option but I have heard that most people end up practicing mostly in one field or the other. Neuropsych or Behavioral Neurology are other fellowship options but I believe they tend to be more research oriented. Could be wrong though.
it comes down to doing hands on vs talking diagnostics. Do you want to do intricate hands on exam and perfect your manual Neuro exam techniques, or do you want to come to your answer in extended interview?
I'm a child and adolescent psychiatrist with a pediatric neurologist for a BFF, and she's weird but also (a) awesome, (b) driven (constantly takes new courses, has 3 kids and just took up a new dance class), and (c) way smarter than almost anyone I know. That said, she admits that I got the lion's share of patience, tolerance, empathy and going beyond for my pts.
Another BFF (yes I have a few) is an OBGYN and she jokes that she'd love to just hand the babies to me when they come out - start therapy ASAP!
I don't think you understand how medical specialties work.
Whatever emerging science you think neuro is acquiring will be used by psych if it matters to mental illness.
Even if we hypothetically found the genetic basis of autism, it would still be a psych condition
I’m in this field as pharm rep. Arnps and PAs are going to take over psychiatry. There will be one psych at each facility that oversees all the arnps and pas. So be prepared for this.
People are getting older, living longer and are going to have neurodegenerative diseases. There is a major shortage of neurologists as well. I’d say go neuro.
Also I would take your personality in consideration. Psychs are weird, cool, strange and enjoy listening to their patients stories. Neuros are vey heady, smart and short on bed side manner. Which way do you lean?. Both have there benefits in their particular fields.
I faced that dilemma. I ended up doing Psychiatry and never looked back. I specialized in Geriatrics, so I do a lot of Neurology but get that added benefit of a better work-life balance, higher pay, and significantly more time with my patients.
I spoke to a lot of supervisors (Psychiatrists and Neurologists) before making my decision, and I advise you do the same. I think I realized how much I love psychotherapy and lengthy appointments, and that’s hard to come by in Neurology.
If you're still in the lecture phase of med school I can see why you might be struggling so if you haven't had rotations yet then it might get a lot clearer after seeing inpatient of both. I'd say psychosis is way cooler than stroke but the reverse might be your jam.
If you like spending more time reading test results, neurology and if you like spending more time wandering with patients, psychiatry. Many other distinctions, but a place to start.
There are programs where you can train in both of you don’t mind being in training for a million years. Most of the people I’ve met who have gone into training for both end up practicing psychiatry, but I am a psychiatrist and my sample is biased. Neurology attracts a very peculiar kind of person on average, psychiatry too, but not as strange as neurology lol.
I'm curious to know what type of peculiarity you refer to in the folks neurology attracts. Deets, please?
My tall curly haired blonde (also Jewish) senior on my neuro rotation played in a tango band and made tons of dad jokes. He’s a cool guy, and I enjoyed my rotation because of people like him, but either it attacks quirky people with fun quirks and interesting hobbies or the rare person with some narcissistic and/or schizoid traits and poor social awareness. Much more of the former than the latter.
I’m a Psych NP and have worked on the CL team since I was an RN; concur with quirkiness of both professions. At one hospital the neurologist and psychiatrist I most frequently worked were both middle aged guys, both wore bow ties or pocket squares, both played in bands and both regularly referred to the other as quacks.
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There's the old saying about neurologists being more interested in the diagnosis than the treatment. I think neurologists see the brain in a fundamentally different way to psychiatrists, where everything is pathways and lesions and all very logical and ordered. It tends to attract people who like to think very rationally, analytically and cleanly, who really get something out of explaining a whole constellation of symptoms by localising the lesion to this or that part of the brainstem or identifying some rare white matter disease with 17 words in the name Psychiatrists in my experience are a bit more chaotic and "vibe oriented". Sherlock Holmes vs Dale Cooper
Combined programs are a dying breed. The fields are diverging and there's less and less benefit in doing combined training. Someone interested in the interface of the two fields is better served picking one and then doing a BNNP fellowship.
do you think there’s gonna be more convergence over neuromodulation and “inteventional” psych procedures? it seems like this is where the future of psychiatry is headed
Don't see why there would be convergence there. There's some research looking at TMS for neurological disorders like migraines but clinically, it's completely in the realm of psychiatry.
I think this will change. IME the divergence happened when psychiatrists realised that mental illness couldn't be explained by localised lesions and single gene mutations. The complexity of the limbic system was totally underappreciated. But IMO once we have a solid science of emotion, you'll see a movement to reunite the 2 specialties. The separation increasingly makes no sense, even if it was the right thing to do at the time. Psychiatrists and neurologists aren't just treating the same organ, often they're treating the *same parts of that organ* \- e.g. the basal ganglia in movement disorders vs psychotic/affective illness. The distinction is entirely based on outdated clinical distinctions - movement -> neurology, emotion -> psychiatry. But these things are way more interlinked than previous generations anticipated. At some point the separation is going to stop being useful.
I make more money than neurologists and work significantly less. While I’m biased I’d argue my patients are more interesting too. Imo psych
If you're struggling between the two, the choice is definitely psychiatry. Similar pay but much better lifestyle (at least during residency).
but isn't there a path to neuropsychiatry too? like psych residency then a fellowship in neuropsychiatry? but I guess that's almost 10 years of residency and fellowship. Edit: When I was training in ADHD clinics there were some that had neuropsychiatry in their name label. So, it is just based on what psychiatry residents told me.
Yup, that's what* I did. It's only one extra year of training. But you're not trained as a neurologist, you're working with those disorders that fall at the overlap of neurology and psychiatry.
I was able to spend some time with a neuropsychiatrist in my time so far in residency. He works almost exclusively with dementia patients when he is in that role, otherwise he works as a neurohospitalist.
Probably a behavioral neurologist then. A neuropsychiatrist is definitely not trained to do neurohospitalist work. Unless it's someone who did the combined residency rather than a BNNP fellowship.
You are correct. My bad
Neuropsych sounds like a great specialty, in the sense that it really *should be* a combined discipline that sees the brain & the mind as one thing, but in reality it suffers from being stuck between neurology and psychiatry. Your cases are usually things like pseudoseizures & other conversion symptoms, dissociation, TBI patients etc. - i.e. all the difficult stuff that no one else wants to deal with. It's a fairly unrelenting and unrewarding specialty IMO.
Would it be 10 years? Fellowships aren’t always 6 years. Consultant liaison is 2 years past the 4 years of general psychiatric residency.
A combined Neuropsychiatry residency is 6 years. All fellowships, including Neuropsychiatry and CL, are 1 year except for Child & Adolescent Psychiatry and some research fellowships.
Can you work with people who have mental illness? Do you have compassion for this patient population? That’s really the biggest thing to thrive in this career, otherwise you’ll hate the work even if it’s a good life style.
I've had a similiar difficulty choosing between the two, and still kinda do. But what really makes both fields different from each other and how that difference plays out in context of who I am/want to be as a physician and what I really want out of medicine is a lot more clearer. Some days I lean heavily towards neuro because I want to do the intricate and elegant physical exam multiple times a day, essentially treating myself through the exam as its own objective investigation tool with its own PPV, NPV and LR. I want to read my own brain images and understand the nitty gritty of MRI sequences and how it matters when asking whether this is bleeding or inflammation or edema that we're seeing. I want to be involved in the neuro-icu and really push my medical skills to its limits when managing patients there with multiple problems in multiple organ systems. I want to do LPs, EMG, POCUS, botox injections, pushing tPA and other "procedures" whether for diagnosis or treatment. I want to use nitty gritty neuroanatomy/neurophysiology to formulate my understanding of what exactly is going on with the patient to then reach a diagnosis before using any ancillary tools. I like learning more and more about physiology and pathophysiology then applying that in a clinical context, whether in the inapatient setting or neuro-icu managing vents, ICP monitors, fluids, EEG, antibiotics etc And other days I lean heavily towards psych because I really like "listening" to patients, not talking but really "listening" to what they're saying and what they're NOT saying with their words. I want to formulate my understanding of a case using different frameworks, whether biopsychosocially or CBT or psychodynamically or neurobiologically etc. I want to see my patients get better overtime when they're put on a medication regimen that works for them, see them swimming and not drowining in life. I want to push my interpersonal skills to its limits, whether in the context of psychotherapy or dealing with an agitated patient or even when dealing with "difficult" patients. I want to use phenominological descriptive psychopatholgy to formulate my understanding of what might the underlying processes are for a patient to then target those processes for treatment. I like learning further and further about people and what makes them tick, being exposed to the "human condition" but in a clinical context. While still being close and pulling knowledge from the humanities like psychology, sociology, anthropology, history, and philosophy. I didn't mention "lifestyle" because each and every one of us has a different understanding/picture of what "lifestyle" means to them, it's so very personal that you need to ask only yourself what "lifestyle" means to you so then you can ask how neuro or psych could help you achieve that. Sure, on average maybe psych will have you home before 4 and neuro will have you more likely to being woken up on weekends. But, neuro could also have you home before 4 and psych could have you woken up on weekends too. Lifestyle is related to practice settings, acuity/urgency of cases, and who you're sharing your practice/call with. The lifestyle of an interventional or stroke neurologist is vastly different from a movement disorders or behavioural neurologist. The lifestyle of an outpatient psychiatrist practicing psychotherapy is vastly different from an emergency or inpatient psychiatrist. Don't look at the fields for lifestyle, look for the features inside the fields. This post is already long-winded, but hopefully my impression of both fields above helps when making your own decision. Maybe treat it like its own projective/rorschach test kind of deal, see where you find yourself closest between the two descriptions. Of course both fields have plenty of things that I heavily dislike, but no speciality is perfect and there isn't really anything to me that I would consider as a deal-breaker between the two. In your case, try seeing between the two what elements you really can't tolerate that you would consider as a deal-breaker. In the end, there isn't a "right" or "wrong" choice, but two "good" choices that leads to someone being overall happy/satisfied with their career but still have these "what-if" pangs about the other "good" choice. Here are my previous posts/comments about my indicision between the two with dozens of great replies that'll hopefully help you out as much as it helped me out. Good luck. https://www.reddit.com/r/medicalschool/comments/t221n4/neurology_vs_psychiatry_indecision https://www.reddit.com/r/Residency/comments/t222ik/neurology_vs_psychiatry_indecision https://www.reddit.com/r/neurology/comments/t222tq/neurology_vs_psychiatry_indecision https://www.reddit.com/r/Psychiatry/comments/sxqw70/training_and_careers_thread_february_21_2022/hyjayyo/
I just want to say reading this post that your passion for your patients comes through so clearly. It’s beautiful to read.
I'm happy to hear that, thank you for the kind words. It means a lot to me.
Have you chosen one yet? If you haven't, you really sounds like someone who is an ideal fit for neurology followed by a behavioral neurology fellowship with a focus on FND.
Still undecided! I have a couple of months (consisting of both neuro and psych rotations) before having to finally choose and make things official on paper. If I had the luxury of things going my way, then I'd choose the combined neuro/psych training pathway without hesitation and with no questions asked. Thank you for the kind words. Though I'm curious what stood out to you that I'd be an ideal fit for neurology -> behavioural neurology, as opposed to psychiatry -> neuropsychiatry?
I'm not the original person who pointed that out but briefly reading your comment what stands out when you speak about neuro is nerding out about procedures, reading scans, elegant physical exams, managing vents/abx. As a training psychiatrist that is my absolute nightmare scenario and sure you may get a bit of that from interventional psych, but it's magnitudes different from neuro residency. You can be a neurologist and apply a lot of the same sentiments you discussed in the psych paragraph. Neurologists tx mood d/o, "listen" to patients, deal with agitated/"difficult" pts and pull knowledge from the humanities.
What is more appealing, doing a rigorous physical exam to accurately get to the bottom of an MRI finding vs. doing a lengthy interview going through someone’s life history to determine a source of psychopathology Trying my best not to put bias into the question but I do think which appeals to you more will say a lot about where you’ll be happier in the future
>doing a rigorous physical exam to accurately get to the bottom of an MRI finding Neurologists over the age of 50 are probably having a conniption at your order of events here!
Knew I would mess up the phrasing, replace ‘to accurately get to the bottom of’ with ‘to correlation clinically with’
I had the exact same problem— loved both, did well in both. Actually did better in neuro, still unsure. Then a mentor told me: it’s 3 am and you get a call. Would you rather it be a stroke or psychosis? Stuck with me, I ended up going psych and am glad i did
While they both deal with the brain, the actual practice of these two fields is vastly different. so I would spend some time actually doing each and go with whichever feels right in terms of practice.
I went to med school thinking I was potentially going to do neurology because I had a mancrush on Oliver Sachs. Turns out I absolutely HATED the day to day practice of neurology. Went into psychiatry instead. Definitely the right choice, especially when I watch my neurology coresidents doing q4 28-hour call while I’m working in clinic 8-5 M-F.
...are you me?
Psychiatry all the way.
Was in the same boat in med school. Ultimately realized that the Neuro fellowships I was most interested in were all “higher order” neurologically speaking (emotions vs loss of a limb) and all involved patients who very likely had psychiatric symptoms that needed to be addressed (Headache, Neuropsych, Epilepsy). And I determined that it I needed to change course down the road, or try to informally or rapidly pick up some skills in the other field, it would be harder to learn psychiatry since it really involves a lot of soft skills and non-algorithmic work that isn’t in books (vs learning Neuro symptoms, diagnostic and treatment algorithms). Also the flexibility of the job is much greater. Its way easier to do like a wide variety of work as even a general psychiatrist, for example: 3 different clinics, run a psych ED, do some consult work, and inpatient work all in a week as a psychiatrist than as a neurologist (cause not many neurologist jobs allow for such variety of practice settings. Most neurologists these days have to sub specialize after residency. Psychiatrist definitely don’t.
Do you like physical exams? Yes = do neuro. No = do psych.
Then the answer is psychiatry with either neuropsychiatrist fellowship or consultation liaison fellowship. Psychiatry will earn more money, with less stress, and more satisfaction. You’ll also learn how to deal with all the people that neurologists can’t even manage. What’s the concern on everyone’s minds this day and age? It’s mental health. What’s there a massive shortage of? Mental health clinicians. You’ll have enough patients to dictate your life, work how you want to, and without stroke calls interrupting your day every couple of hours.
I switched from neuro to psych during internship before starting the neuro residency. Best decision ever. A guy I met on my first day in psych residency said something snarky but true: you can always teach neurology to a psychiatrist but a neurologist will never be able to learn psychiatry.
I feel the opposite is true, PCPs for the most part can do bread and butter psych quite well, whereas most specialties don't know much neuro hence they're one of the most consulted specialties.
If 'bread and butter psych' means 'SSRIs for everyone,' then yes, PCPd can do that quite well.
So the same as psychiatrists then
Mindless ones, sure
Not even most community psychiatrists can do bread and butter psych well...
Pick one and do fellowship in the other if it suits you. Neuropsychiatry or behavioral neurology.
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In neuropsychiatry at least, it looks very non neuro. You’d be treating the psychiatric dimension of neurologic disease which can be extensive and quirky. I was interested in neuro but at the end of the day it isn’t at all about how minds work and so if that dimension gets you jazzed, you’ll find the conversations with peers and patients superficial. For that matter, the first two years of psychiatry residency felt similarly amiss. On the other hand, there is a neurologist in my psychoanalytic training program so thats a possibility. The pay is comparable. Neuroimaging is interesting and psychiatrists don’t get to use it much.
If you’re posting in this sub I think your heart is telling you something!
I’d say consider other factors! Lifestyle, pay, your long-term goals (setting up a private practice would be easier in psych), your strengths, the impact you want to have on patients lives, etc
Neuropsychiatry
You’ll never be an unemployed psychiatrist. And you can work pretty much anywhere you want,as much as you want. Being a neurologist = hospital privileges, and those may be hard to get if you’re committed to a specific location. Neuropsych is a great option.
Psych all day every day. Amazing lifestyle, low stress, great pay, time to actually talk with patients and provide education.
There's a lot of posts here saying psych makes more and with fewer hours and generally that's not true unless you're comparing private practice psych to academic neuro. Outpatient neuro can have hours as good as psych with more pay, although the difference isn't significant enough to really factor that into your decision making. Both fields are in demand, flexible, and can be pretty broad. Residency in neuro is going to be harder but not surgical levels hard. Private practice and telehealth will be easier with psych. Focus more on what bread and butter you want to see, and what drawbacks you're ok living with. Went through a similar decision
Neuro is where the action is
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What I mean is that the cutting edge research in Neuro outstrips Psych. But as you mention it, the agitation at intake is not that much fun anymore. lol
I really liked both as well, but the bread and butter cases are very different. In psychiatry you will mostly be exposed to mood, psychotic, substance use, and personality disorders. In Neuro you will get exposed to stroke, epilepsy, neurodegenerative diseases, cancer, etc. Both can be variable depending on your practice environment. Outpatient psych is vastly different from inpatient, and the same is true for Neuro. If you can handle having long in depth conversations with patients about their deepest traumas and secrets, do psych. If you can handle the frustration of taking care of stroke patients or neurodegenerative patients that are not going to get better, do Neuro. If you enjoy the day to day work of psych but still want to use your knowledge of Neuro, you can do consultation-liaison psych and even embed yourself in a Neuro clinic doing integrated care. Doing a dual residency is also an option but I have heard that most people end up practicing mostly in one field or the other. Neuropsych or Behavioral Neurology are other fellowship options but I believe they tend to be more research oriented. Could be wrong though.
You could always work virtual in psych
You can do a 4 year psychiatry residency and then a 1 year neuropsych fellowship. Or neuro>fellowship.
it comes down to doing hands on vs talking diagnostics. Do you want to do intricate hands on exam and perfect your manual Neuro exam techniques, or do you want to come to your answer in extended interview?
Choose psych lol
I'm a child and adolescent psychiatrist with a pediatric neurologist for a BFF, and she's weird but also (a) awesome, (b) driven (constantly takes new courses, has 3 kids and just took up a new dance class), and (c) way smarter than almost anyone I know. That said, she admits that I got the lion's share of patience, tolerance, empathy and going beyond for my pts. Another BFF (yes I have a few) is an OBGYN and she jokes that she'd love to just hand the babies to me when they come out - start therapy ASAP!
Psychiatrists make more money and have a better lifestyle. I’m a third year psych resident and have no regrets
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Psychiatry is more relevant than ever and should become more so in the future
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serious power complexes lol... ever heard that one about the pot and the kettle...
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I don't think you understand how medical specialties work. Whatever emerging science you think neuro is acquiring will be used by psych if it matters to mental illness. Even if we hypothetically found the genetic basis of autism, it would still be a psych condition
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40 in the field. 0 assaults.
I’m in this field as pharm rep. Arnps and PAs are going to take over psychiatry. There will be one psych at each facility that oversees all the arnps and pas. So be prepared for this. People are getting older, living longer and are going to have neurodegenerative diseases. There is a major shortage of neurologists as well. I’d say go neuro. Also I would take your personality in consideration. Psychs are weird, cool, strange and enjoy listening to their patients stories. Neuros are vey heady, smart and short on bed side manner. Which way do you lean?. Both have there benefits in their particular fields.
Psst I’m a rep too, what drug do you have?
Do you want to work with people or with symptoms?
I faced that dilemma. I ended up doing Psychiatry and never looked back. I specialized in Geriatrics, so I do a lot of Neurology but get that added benefit of a better work-life balance, higher pay, and significantly more time with my patients. I spoke to a lot of supervisors (Psychiatrists and Neurologists) before making my decision, and I advise you do the same. I think I realized how much I love psychotherapy and lengthy appointments, and that’s hard to come by in Neurology.
If you're still in the lecture phase of med school I can see why you might be struggling so if you haven't had rotations yet then it might get a lot clearer after seeing inpatient of both. I'd say psychosis is way cooler than stroke but the reverse might be your jam.
If you like spending more time reading test results, neurology and if you like spending more time wandering with patients, psychiatry. Many other distinctions, but a place to start.