In Practice: Becoming a Doctor, One Conversation at a Time
Welcome to In Practice, where we explore the choices, challenges, and changes that shape a doctor’s path: from applying to med school all the way through choosing a specialty and practicing medicine!
In Practice: Becoming a Doctor, One Conversation at a Time
Dr. Christina Kay: Neuropsychologist
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Join me and Dr. Kay in a unique episode of In Practice, since Dr. Kay is actually a PhD, not an MD! Dr. Kay sees patients in a clinical setting as a neuropsychologist, interviewing and assessing adults to help diagnose and tailor treatment for a variety of neurological and psychological conditions. We discuss her path towards her present career and how it compares to the work and journey of a medical doctor. This is a great episode for those unsure of non-medical school pathways into clinical, patient-facing work!
Okay, welcome back to another episode of In Practice. We have actually a very special episode today because I have someone who is not technically an MD, so is not a medical doctor, but we've talked a little bit about how this wonderful human is a clinical doctor. So, Christina, if you want to introduce yourself and sort of talk about why I'm saying you're a clinical doctor.
SPEAKER_00Sure. Um, I'm Christina Kay. I am a neuropsychologist at Mass General Hospital. Um, and neuropsychologists are um technically clinical doctors. We um we all have PhDs or PsyDs. Um, and we're psychologists who who really specialize in understanding how the brain and behavior are connected and see patients clinically.
SPEAKER_01That's awesome. Um and why don't you talk a little bit about so I have actually shadowed um Dr. Kay before, so I know what her daily life is like, but why don't you talk a little bit about it? Because it's super interesting.
SPEAKER_00Yeah, so um neuropsychologists can see patients across the lifespan at any age. I specialize in seeing adults and older adults. Um, so you know, they're my typical day if I'm seeing a patient is I will have, I will evaluate a patient, they'll come in for a comprehensive assessment with us. Um, I'll interview the patient after I've looked through their records. And then we we launch into a couple hours of cognitive assessment where we're evaluating thinking skills such as memory, attention, language, problem solving. Um, because we're psychologists, we also fold into that an assessment of their mental health and emotional functioning to really help diagnose and treat conditions that affect the brain, but also may have overlap with psychiatry. Um, so these evaluations, as you saw when you came in, are, you know, usually several hours long. Um, many of us will employ the help of psychometrists or neuropsychology technicians, and they will do some of the testing for us. But that's really just the face-to-face portion. Um, you know, after the patient leaves, we then score all of those tests and really integrate that into a comprehensive assessment with our clinical impressions of, you know, the patient's performance and how that fits into any underlying conditions.
SPEAKER_01What are some of the most common conditions you feel like you would see or diagnose or treat? I guess you're not technically diagnosing, but um sort of assess.
SPEAKER_00Yeah, well, we do diagnose conditions. Okay. Um the common conditions that we're really well equipped to diagnose are primarily in the psychiatric spectrum because we are psychologists. Yeah. However, um, we do diagnose cognitive disorders, learning disorders, you know, attentional and behavioral disorders, dementias, um, because these things are, you know, um conditions that we can formally make decisions about and help patients understand that they meet diagnostic criteria just based on our exam. Uh, sometimes the underlying etiology or cause of those things warrants further workup. So, for example, you know, I might see a patient who meets criteria for dementia. Dementia is a broad term, and I might not be able to say this is Alzheimer's disease or frontotemporal dementia or vascular dementia without further neurological workup. Um, but our exam is one piece of that workup that helps the neurologist really determine that underlying cause. Um, so some I guess, you know, for me seeing older adults, I do see a lot of patients with mild cognitive impairment or dementia. Um I specialize in autoimmune and infectious disease. So I see a lot of patients coming in who have, you know, MS or lupus or they've had an encephalitis process, and we're trying to determine what their cognitive functioning is, you know, after those insults or in the context of those illnesses. But broadly speaking, our clinic will um see patients who have had stroke, um, epilepsy, um, ADHD, brain tumor, um, a whole you know, gamut of um, you know, neuropsychiatric conditions.
SPEAKER_01Yeah, wow, that's super cool. How did you decide that this was something you wanted to do? How did you decide? Maybe I guess maybe I don't know if you were ever considering medical school, if you decided against medical school and for a PhD, sort of how your path kind of formed itself.
SPEAKER_00Yeah, um, I had sort of an interesting path. I I did um pursue an undergraduate degree in psychology, but also while I was still in college, realized there were some limitations to what you can do with a bachelor's in psychology. And knowing that graduate school was definitely in my future, um, I had taken an intro to forensics class and thought that was really interesting. So I pursued a master's degree in forensic psychology first, and then worked in the prison system for a while. Um, there I was really introduced to assessment and I was doing a lot of intellectual assessments really to determine if inmates were capable of participating in their care and their case. Yeah. Um, and that's really when I discovered assessment and really enjoyed that, you know, taking all these pieces of a puzzle, so to speak, and putting them together into a clinical formulation was just really interesting to me. Um, and then, you know, so I and then I actually worked in clinical research for a while on uh some of those trials were for Alzheimer's, and then became more interested in neuropsychology. At that point, went back to school to pursue my PhD for that. So certainly a lot of people go straight on from undergraduate to their PhDs, but I I uh pursued a master's first and then worked for a few years.
SPEAKER_01That's super cool though. You can see how it sort of all starts to come together in in all the things that you did. Did you ever consider um did you ever consider medical school and like psychiatry as a specialty or neurology, or was that not really something that initially interested you?
SPEAKER_00I did. Um, I went to Tufts undergraduate and they have a really excellent and rigorous pre-med, you know, kind of program and and the coursework. Um, I I found it, I found it a lot more challenging than I thought in terms of the hard sciences, and then really started to fall in love with some of the psychology coursework I was taking. Um, so kind of, you know, quickly decided that I was gonna pursue that. Tufts actually has a really nice uh you can major in clinical psychology, uh, not just psychology. And the difference being that in your senior year, you actually do a clinical placement, um, which is kind of like a practicum experience that you would have um in graduate school. So you get a real taste of, you know, what is it like to work with patients or, you know, individuals in a mental health setting? That's super cool.
SPEAKER_01Do you ever find it difficult to be doing sort of these long like interview processes with people that sometimes are having a really hard time?
SPEAKER_00Mm-hmm. Yeah, interviews are a craft that I think we're I'm still mastering because you you never really know how it's gonna go. Um, I think you know, we all know the information we need to get, but you patients respond in a variety of different ways. Sometimes they have little to no insight into their condition. Sometimes they become quite tearful, and you know, talking about their histories conjures up a lot of things. Sometimes they become um upset and angry. You know, why am I here? My son told me I have to do this, but I don't want to be here. Um, so there's really a whole host of things that could arise. And, you know, some of it is actually that's where you put your psychology hat on and try to manage some of those, you know, behaviors and emotions and really help the patient understand why we're doing this and that it's for their benefit. Makes sense.
SPEAKER_01Did you ever think about working with kids or did you always know that you wanted to work with adults?
SPEAKER_00Yeah, I always knew I wanted to work with adults. Um, I think, you know, I went to graduate school a little bit later. I think I entered my PhD program when I was 30. So I was sort of the dinosaur of the program. Um, and before I even earned my PhD, I had my first son and realized, at least for me, that um I think working with children all day and then coming home to my own children would be really challenging. Um, I also just really enjoyed my work um with uh the Alzheimer's Association and Alzheimer's uh clinical trials, that I just knew I had a little special place in my heart for older adults. Um, you know, so it's it's a good question though, because a lot of people, I think, you know, if you when you're kicking off into a PhD or a CID program, I don't think you necessarily have to know if you want to work with adults or kids. Um, but that's something that you will learn and sort of shape as you go through the doctoral process because there really are different training paths for pediatric neuropsychology versus adults. And then, you know, a select few go-getters are are lifespan neuropsychologists who really um, you know, get full training in both. That's pretty cool.
SPEAKER_01Is it um did you have to do anything after your PhD to to sort of specialize with with neuropsychology work that you do now, or is that only if you wanted to do something pediatric?
SPEAKER_00Um, you mean for oh it are you saying are the training paths for them different for physical? Right.
SPEAKER_01So like I'm sort of thinking of it in the medical context, right? Like if you I just actually spoke with a pediatric neurologist, right? So she does a different sort of residency path than someone who just wants to be like an adult neurologist. So I'm sort of thinking in that way, is it different if you're becoming like an adult neuropsychologist as opposed to a pediatric one?
SPEAKER_00Yes, that's a great question and a good point. So maybe I can talk about this a little bit in the context of the training like path and try to make some analogies to medical school. So um, you know, PhD and CID programs are very lengthy. Um, usually there's at least, you know, five years. Some people take up to seven, and that'll include, you know, heavy coursework, research, um usually some therapy training, even if you're going to be a neuropsychologist, you do some kind of basic psychology training and practicum placements, and then heavy neuropsychassessment experience. So that's sort of the course, and then of course there's a dissertation. Um the after, you know, in the in the final year of your your doctoral program, there is a one-year clinical internship. And that is can that's akin to like a residency in medical school. Um, this is a full clinical year where there's a match process, you're placed at a placement. And that's the point where you know trainees should really have an understanding of if they want to work with PEDs or adult or both, because there are specialized internships for pediatric neuropsychology or you know, general.
SPEAKER_01Yeah.
SPEAKER_00Um, after that, you pursue a two-year postdoctoral fellowship specializing in neuropsychology. Again, that would be um more geared toward the population that uh, you know, of interest, yeah. Um, and or the setting of interest, you know, there I did a lot of my training at academic medical center settings, but there are rehab hospitals, there are VAs, there are private practices, you know, there's a whole there's community health hospitals. So there's, you know, a whole bunch of different settings that people can do this training in. Um, but that path and that sort of two-year postdoctoral fellowship, I guess, is akin to a you know, a medical fellowship. Um after that, you know, um, people are eligible for board certification. Um, licensure actually usually happens during the fellowship time. So you don't have to have completed two years of fellowship to be licensed. You just have to complete one year. But all neuropsychologists who want to seek board certification do two years. So the the typical path is after the first year of fellowship, you seek licensure and then you continue the second year, and then you're eligible for boards. Nice. Very interesting.
SPEAKER_01Um, I I don't know if this is a silly question. Are there acute settings for neuropsychologists or is it only clinic-based?
SPEAKER_00No, that's a great question. And there are um, you know, a lot of rehab hospitals or um, you know, some larger hospitals have inpatient service where they will employ neuropsychologists for more of these, you know, sort of quicker assessments of a patient's neurocognition and and emotional functioning after acute illness or injury. You know, these are usually less um laborious and and I don't want to say less comprehensive because they are for that um, you know, for for that um condition.
SPEAKER_01But they're shorter in length, though, I assume.
SPEAKER_00Yeah, shorter in length. I mean, if a patient has had a stroke, you know, and they're that occurred very recently, it may be really valuable to get a baseline assessment of what they're capable of cognitively in the days or weeks after. However, that exam is going to be much more limited than something you would do with that same patient a year later to assess their progress and recovery. Um, and we we've had a couple of trainees through the MGH program go on to placements um just like that. Yeah, just like rehab hospitals and recovery centers.
SPEAKER_01Um, and then I meant to ask this what's the difference between PhD and Psy D, and why did you decide PhD and not Psy D?
SPEAKER_00Mm-hmm. So a PhD is um, you know, doctorate of philosophy in whatever profession it, you know, would be in uh clinical psychology for a lot of these programs. Um a psy D is a um doctorate of psychology, also usually in clinical psychology. Um I, you know, I I think one big difference is, you know, a lot of PhD programs have a much more kind of rigorous training process. There is usually uh dissertation that's focused on original research and data collection. Um a lot of the advisors in PhD programs are well connected in terms of things like you know already having established labs, grant funding. So I I think, and I think there's a lot more opportunities in terms of the breadth of you know professional things you can do with a PhD. Um, certainly if if someone was to pursue academic, you know, teaching, mentorship, or having a lab, that would probably be the path I would advise. A Psy D was um, you know, is a relatively kind of newer degree over the last several decades. And I think the premise was, you know, there's a lot of people who know they just want to do clinical work and um, you know, don't necessarily want to have kind of the research pedigree to, you know, to pursue that. So that you know, that's certainly an option. Um, I, you know, I think I think candidly, you know, a lot of the PhD candidates that we have coming through that apply for our internship, for example, have a much more competitive um application.
SPEAKER_01Yeah, just be it sounds like there's just more that you do or can do in a PhD program.
SPEAKER_00Yeah, I mean, right, particularly with regard to research and teaching. Um, however, that's not to say that I mean, there are some excellent Psy D neuropsychologists out there. So um, you know, I think that is certainly worthy of looking into. Um you know, also sort of logistically, there's typically less funding available in Ph uh, it's sorry, in CID programs. So, you know, the student loan issue and debt is likely to be higher with a Psy D, whereas a PhD, there's a lot of grant funding, and you can have like tuition remission and you know do some teaching. And that's that's really, really helpful, particularly in today's economy. So very much so, yeah.
SPEAKER_01Um you did some research before PhD. Do you still do any research? Do you have interest in doing research at all?
SPEAKER_00I do. I just wish I had, you know, 36 hours in the day. Um yeah, I've I've done, you know, I've done a I did a bunch in my PhD program, focusing mostly on predictors of Alzheimer's disease. That was really a big focus of my lab. Um, and then also did um research as part of my fellowship program. Um, that's when I really shifted more into um interests in the autoimmune and infectious disease. And I did some research on encephalitis. I've written a few papers on that, on long COVID, um, book chapter on autoimmune and infectious disease. Though for me, this is really about carving out time for those things because I don't have any formal research time right now. Um, I'm full-time clinical, and that's by choice. Um, but I do enjoy research. It's just hard to find the time. I would say, though, a lot of um PhD neuropsychologists that work at academic medical centers may have dedicated research time that this is just not what I have. You know, some people are like, you know, 60, 40 or something like that. So, you know, they have a a couple days a week where they're they're dedicated to research and they have funding for that. I just I'm not set up for that right now.
SPEAKER_01Yeah, that makes sense. I mean, a lot of MDs are also like that, like medical doctors, they'll have some of them are just full-time in clinic all the time, and then some of them do like a couple days a week, and then they also have a lab or research that they're they're working on. So it sounds pretty similar in that regard.
SPEAKER_00Yeah, exactly. I do like the flexibility though, because you know, at an academic medical center, you sort of can choose, you know, if I if I wanted to do more research, I could seek out that funding and then reduce my clinical time accordingly.
SPEAKER_01So well, this is super cool to learn about. Um tell me to finish off, what's the favorite, what's your favorite part of what you do if you had to answer that question.
SPEAKER_00Yeah, I I think a hundred percent working with the patients and their families. Um it's it's just really rewarding work. And even with, you know, really challenging cases, there's always some reward in knowing that you've helped the f the patient and their family better understand what's happening with their brain. And, you know, one thing I didn't really get to circle back to after I talked about the evaluation process is the value of providing feedback to the patient and their families about how they did. You know, after that long testing day, then my separate scoring and writing, we then meet the patient again. And that's really the most rewarding piece is to communicate those results in a meaningful way and you know, talk to them about really thoughtful and tailored recommendations for what's next, because that's what they. Really want to know. Yeah.
SPEAKER_01Absolutely. That's awesome. Right. Well, thank you so much, Christina. It was great to talk to you and great to hear about sort of, I think, a very not well known career. I mean, I certainly didn't know about it before I met you. So it's super cool. Super great work that you do.
SPEAKER_00Great. Well, thanks for having me today. This was awesome. Yeah.