Would Appreciate Insight

[NataliaGB]

I've applied to both psych and neuro...I cannot for the life of me decide.

This is taking its toll on me as far as my peace-of-mind and arranging my ROL...I don't think I will rank contiguously. Did anyone else go through this same debate? I found an old thread, but in light of more recent legislative changes impacting either field or lifestyle or opportunity changes, any new input? Anyone else go through this?

As a residency, psych programs appear less intense overall, but I don't want that to tempt me when I should be thinking long-term. I don't plan on doing a fellowship in either field. In psych, I'm not a huge fan of psychotherapy and social work. In neuro, I'm not a huge fan of stroke/ICU/hospitalist work/greater liability. In either, I would be a general clinician.

Overall, I find neuro slightly more satisfying, but my psych programs are in more desirable locations for long-term settling down and closer to family.

Climate and family are what would make me happy as a resident. I'm lost.

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[snowkhat]

I had the same issue, albeit earlier on in the process. I seriously considered neurology as I have a passion for neuroscience (two degrees in Neuroscience and Cognition). My decision to pursue psychiatry came from my third year experience and enjoying my psychiatry rotation. I did a neurology rotation at Children's hospital and found that certain aspects really didn't appeal to me. I don't like NICU, pronouncing brain death (we had 5 in one day), EEGs, and movement disorders. I also spent time on an adult dementia unit which was also too heartwrenching. I went on one neurology interview at an excellent program and it scared the crap out of me. It was incredibly busy
and the PD basically said "don't plan on any life events over the next four years" (i.e. having children, if you are female). I was obviously put off and cancelled all my other neurology interviews. On the bright side, I was thrilled to find that my flavor of neuroscience was actually being done at several psychiatry programs. My experience reassured me that there are plenty of psychiatrists that are just as interested in the brain as any neurologist.

Best of luck making a tough decision.

I've applied to both psych and neuro...I cannot for the life of me decide.

This is taking its toll on me as far as my peace-of-mind and arranging my ROL...I don't think I will rank contiguously. Did anyone else go through this same debate? I found an old thread, but in light of more recent legislative changes impacting either field or lifestyle or opportunity changes, any new input? Anyone else go through this?

As a residency, psych programs appear less intense overall, but I don't want that to tempt me when I should be thinking long-term. I don't plan on doing a fellowship in either field. In psych, I'm not a huge fan of psychotherapy and social work. In neuro, I'm not a huge fan of stroke/ICU/hospitalist work/greater liability. In either, I would be a general clinician.

Overall, I find neuro slightly more satisfying, but my psych programs are in more desirable locations for long-term settling down and closer to family.

Climate and family are what would make me happy as a resident. I'm lost.

 

[Fermata]

Residency in neurology is more difficult than psychiatry at most institutions. However, the lifestyle afterward can be comparable.

Which do you most prefer: the psych interview or the neuro exam?

MDD/GAD/bipolar vs. stroke/HA/TBI/?

 

[Cinnameg]

I've applied to both psych and neuro...I cannot for the life of me decide.

This is taking its toll on me as far as my peace-of-mind and arranging my ROL...I don't think I will rank contiguously. Did anyone else go through this same debate? I found an old thread, but in light of more recent legislative changes impacting either field or lifestyle or opportunity changes, any new input? Anyone else go through this?

As a residency, psych programs appear less intense overall, but I don't want that to tempt me when I should be thinking long-term. I don't plan on doing a fellowship in either field. In psych, I'm not a huge fan of psychotherapy and social work. In neuro, I'm not a huge fan of stroke/ICU/hospitalist work/greater liability. In either, I would be a general clinician.

Overall, I find neuro slightly more satisfying, but my psych programs are in more desirable locations for long-term settling down and closer to family.

Climate and family are what would make me happy as a resident. I'm lost.

Oooh, I totally connect with this. I was considering psych vs. neuro for my entire medical education and only decided a few months ago to apply in psychiatry. I even went to the AAN conference this past year, and my research projects in med school have been in the neurology department. Because of my research and the LOR I got from a neurologist, who was not entirely happy I chose psych, I've had to answer the question of "why psych and not neuro?" a lot this interview season. What I've answered was the following: for the most part, the diseases in psychiatry and neurology are equally interesting to me. I really like the brain, and both treat brain disorders. However, I found I had less interest in spinal problems and peripheral nerve problem than brain problems. I also found that, within neurology, I was most drawn to the psychiatric (mood, cognition) manifestations of neurological disorders, and less interested in the physical effects like weakness. I also have been a counselor of one kind or another for years, since high school. I would have been a great therapist, and it was something I considered doing instead of medical school. Being a psychiatrist would let me be a medical doctor dealing with the issues I've been most drawn to, and do therapy.

Was this the right decision? Who knows. I still debate it. As a neurologist, I wouldn't have to deal with the "you're not going to be a real doctor" crap that psychiatrists put up with, nor would I be giving up the opportunity to do the neuro exam (which I love) regularly and do some physical interventions. Neurology doesn't have an entire religion (Scientology, fyi) calling their field evil and trying to take them down, nor are there many people who hate the field of neurology in the way some people have passionate negative feelings about psychiatrists and psychiatry. There is a LOT of stigma around psychiatric illness, both for those who suffer from it and those who treat it. Neurologists also get paid more.

What it comes down to is, I'll love psychiatry and I'll be good at it. I probably would have also loved neurology and been good at that too, but I think I would have had more regrets and "what if's" on my mind had I gone into neurology and missed doing therapy and advocacy for sufferers of mental illness than I will have going into psychiatry and missing doing lumbar punctures, DBS adjustment, or botox injections.

Ah, one other thing: When I was at the AAN conference in Toronto this past April, I talked to a LOT of neurologists about their career choice, and how they picked neurology over psychiatry if they considered both. The reasons they had for picking neurology often did not apply to me, and that was telling. Some said they didn't like the uncertainty in psychiatry, which excites me more than bothers me. Others said they didn't like talking to patients for long periods of time or dealing with emotional baggage, which didn't apply to me. Still others said they wanted to do procedures, towards which I have no particular attraction. In the end, it seemed that most reasons people had for not going into psychiatry were reasons that didn't apply to me . . . and so I ultimately chose psychiatry.

Good luck with your decision. I hope you are happy with whichever field you end up pursuing.

 

[peppy]

I have always found neuro interesting as well. However, most of the neurology attendings I worked with had worse lifestyles than the psychiatrists I've worked with have so that was one reason I steered away from it.

Even though you don't find the fellowship idea appealing, the best compromise might be to think about either psychosomatic medicine or Neuropsychiatry/Behavioral Neurology.

A lot of places like to use residents as cut rate social workers. That was actually one of the things I looked at in a residency: how good is the support staff? If you're at a place that actually has a good social work team, the social work issues aren't really all that bad. I'd say that social work is a large part of inpatient neuro too though, considering that there are many neuro conditions that require rehab or home health care, etc. (such as TBI/stroke/Parkinson).

Neuro, as you probably realize, has a stereotype of "Finding the diagnosis but not being able to do anything about it". I know that's no longer as true as it used to be, thankfully, but I did see one of the neurologists I worked with have to have the conversation that was basically "Yes there is something going on but sorry but there isn't much we can do about it" with a few clinic patients.
At least one nice thing about psychiatry is that, while there is still a lot that is unknown about mental illness, we do have treatments to offer that in some cases do make a big difference for people.

 

[whopper]

This is a highly individualized question and requires a highly individualized answer. I can't answer it for you but I will offer you this advice.

Perceptions of how both fields are, especially in medical school, and how the field truly is day-to-day are different.

In my opinion, people need to base their career choices on a more practical level than what I usually see from medical students. (This of course is a generality, not specific to you). E.g. one guy might pick a career only because it's the most competitive or at least make it a large factor in his choice. The competition and prestige thing tends to weigh heavily on a person, especially in medical school.

But the reality is, unless one goes into an academic/research field, such things are usually of less importance if any importance at all. E.g. if you are an attending at a hospital, do good work, things like what school you went to, or residency aren't of much if any concern whatsoever. Yes a good residency will tend to produce a better attending but a lot of it is up to the individual.

This may not apply to your Neuro vs. psych question other than that how the field actually is by the time you've arrived to it (e.g. later residency years and attending) need to mesh well with your personality and what you want out of life. I do not see enough people factoring this in to their decision-making process.

Do you feel you know enough of both fields? Have you thought of how each field fits with your personality?

Just to give an example, I love psychiatry. Many of my friends in medical school didn't know what field was right for them, and picked one because of the notion of competition or it's more prestigious among doctors.

So it's a year later, and I talk to some of them, and I'm telling them how I love residency, love what I'm doing, and the call schedule wasn't too bad. They're telling me how they are working over 80 hrs a week in violation of ACGME but they are too scared to report anything because of fear of being kicked out, dying from the stress, and don't even like what they're doing. They found several of their attendings to be overly controlling and full of a desire to haze. All of a sudden it appeared that the "prestige" thing didn't matter. Some of them even started to resent me because my call schedule in comparison with theirs was a cakewalk. (1/3 of my calls, I only got beeped 1-2 times a night and I was able to go home after 10pm).

The point is not that you need to go into the easier field, but that if you like what you're doing, things will seem a lot easier because the inspiration is there and the frustration is not. Yeah my calls were easier but that's not a major point.

Bear in mind that some programs emphasize the neurology aspects much more than others. Just as mentioned above, I have seen some programs literally make the residents cheap labor to replace social workers. Others truly give a very good biological psychiatric approach. If you choose psychiatry, you might want to shoot for that type of program. Yes, all areas, psychotherapy, psychosocial, etc, are important but so too is exploiting and fulfilling your curiosity to get the most you can out of a residency.

 

[NataliaGB]

Many thanks to all of your for your generous insight. You've been extremely helpful too me. The conclusion that I've drawn for myself is that a big part of my perception of either field and happiness will be where I am and who I'm working with, even moreso than WHAT I'm doing. Ultimately I could love neuro 20% more than I love psych, but if I'm at a god-awful malignant place for four years, uninspired and unhappy, I won't pursue my work with enthusiasm and the result will make me hate what I thought I liked.

 

[Cinnameg]

Many thanks to all of your for your generous insight. You've been extremely helpful too me. The conclusion that I've drawn for myself is that a big part of my perception of either field and happiness will be where I am and who I'm working with, even moreso than WHAT I'm doing. Ultimately I could love neuro 20% more than I love psych, but if I'm at a god-awful malignant place for four years, uninspired and unhappy, I won't pursue my work with enthusiasm and the result will make me hate what I thought I liked.

I'm really curious what you decided. I think your screenname is safely anonymous, would you be willing to share what you did with your ROL?

 

[whopper]

Ultimately I could love neuro 20% more than I love psych, but if I'm at a god-awful malignant place for four years, uninspired and unhappy, I won't pursue my work with enthusiasm and the result will make me hate what I thought I liked.

I came to the same conclusion when picking a fellowship. I got into some programs with a rep for being some of the best but the fellowships also had a rep for being uneccesarily difficult on the fellows. (e.g. the PD had a rep for being narcissistic, and during the interview, he matched the rep.) I already encountered a particular attending in residency where I loved the field, but because of the attending's strange personality characteristics I couldn't stand the rotation. I chose a fellowship where I believed I would get a good education, but the program would also keep me inspired to enjoy what I was doing.

 

[NataliaGB]

I'm really curious what you decided. I think your screenname is safely anonymous, would you be willing to share what you did with your ROL?

My ROL ended up with smatterings of both...I listed a few neuro programs on top (both with very few positions) followed by a very biologically focused psych program, followed by a "more balanced" psych program...The middle was psych and neuro intermittent and the lower third was all neuro...Yeah, I really like to surprise myself. I kind of regret doing that, but some of the neuro programs were in much less desirable locations and overall the caliber/location of psych programs I got was better. I could see myself doing a psychosomatic fellowship, but doesn't seem like they're that plentiful. Overall the truth is my application was a lot more geared toward psych and it is what I'm naturally skilled at (I'm told), but became intrigued by neuro later in the game. Demographically I find the psych community friendlier and more receptive, neuro tends to be more cut and dry culturally, but I also enjoy the ease of things black and white.