How does the role of a palliative care psychiatrist differ from a palliative care physician who did a fellowship from a IM or FM residency? Could a psychiatrist manage things like pain meds/dyspnea/nausea/etc in addition to the mental health side of things? What is the job market like compared to something like general adult psych? Besides working in a hospital with inpatients what are the other main job settings? Thanks so much!
Palliative care psychiatry
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You can apply to many palliative care fellowships as a psychiatrist. Without doing that, you wouldn't have a role managing physical palliation meds. Your average internist will have much better ability to do so and people this sick should have access.
Psychiatrists generally don't manage these types of meds for the well. They certainly wouldn't do so for the very ill.
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Psychiatrists generally don't manage these types of meds for the well. They certainly wouldn't do so for the very ill.
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I thought about it. Then I realized that I'd do a year of fellowship training to take a pay cut and decided against it.
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Hi notdeadyet! Sorry, to clarify I meant practicing with the addition of the fellowship of course. So with a palliative care fellowship would one be able to do the same medical management as physician in a non-psych specialty who did a palliative fellowship? I would be concerned that I'd forget a lot of medicine during my psych residency years, but hopefully that would come back in fellowship.
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I think the medicine would come back fast.
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I know of several psychiatrists working on palliative medicine services who are not fellowship trained. you probably can't get away with this nowadays but in the past it was possible. TBH it is not terribly difficult to learn how to manage
btw there is a difference between a palliative care psychiatrist and a palliative medicine physician who has their basic training in psychiatry. Palliative care psychiatrists are essentially C/L psychiatrists, often with an interest in psycho-oncology and end-of-life issues. someone like susan block or scott irwin would be an archetypal example of a palliative care psychiatrist. essentially providing psychiatric consultation to patients with cancer or at the end-of-life or with other terminal diagnoses. common consultations would be demoralization, existential anxiety, refusal of treatment, capacity assessment, delirium, agitation. on the other hand a palliative medicine physician who happens to be trained in psychiatry would be working on a palliative medicine service in the same way as another physician from another background (and it's not just IM or FM, though those are most common). Consultations include referrals for hospice care, management of pain, nausea and vomiting, anxiety, agitation, constipation, diarrhea, confusion, breathlessness, providing psychosocial support, dealing with complex family systems issues. So yes a palliative medicine physician who happened to be a psychiatrist would have to manage the whole gamut of problems on a palliative care service that someone with another background would.
I think psychiatry provides a great background for palliative medicine since both specialties focus on symptom control and privilege psychosocial aspects of care, and the importance of multidisciplinary working, and there is an overlap with some of the consultations though the approaches differ and palliative medicine has a more more collaborative approach that psychiatry typical does.
I really loved palliative care but decided there was no way I could do it in this country where you are working against a system that will not accept death.
btw there is a difference between a palliative care psychiatrist and a palliative medicine physician who has their basic training in psychiatry. Palliative care psychiatrists are essentially C/L psychiatrists, often with an interest in psycho-oncology and end-of-life issues. someone like susan block or scott irwin would be an archetypal example of a palliative care psychiatrist. essentially providing psychiatric consultation to patients with cancer or at the end-of-life or with other terminal diagnoses. common consultations would be demoralization, existential anxiety, refusal of treatment, capacity assessment, delirium, agitation. on the other hand a palliative medicine physician who happens to be trained in psychiatry would be working on a palliative medicine service in the same way as another physician from another background (and it's not just IM or FM, though those are most common). Consultations include referrals for hospice care, management of pain, nausea and vomiting, anxiety, agitation, constipation, diarrhea, confusion, breathlessness, providing psychosocial support, dealing with complex family systems issues. So yes a palliative medicine physician who happened to be a psychiatrist would have to manage the whole gamut of problems on a palliative care service that someone with another background would.
I think psychiatry provides a great background for palliative medicine since both specialties focus on symptom control and privilege psychosocial aspects of care, and the importance of multidisciplinary working, and there is an overlap with some of the consultations though the approaches differ and palliative medicine has a more more collaborative approach that psychiatry typical does.
I really loved palliative care but decided there was no way I could do it in this country where you are working against a system that will not accept death.
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Yeah. I had a consult once while covering CL. An argument had brewed between the palliative service and the critical care service about whether a patient really understood his decision to go comfort measures only and transfer to hospice. I had to sort it out. The patient was pissed. He understood perfectly well what he was deciding and it was hard enough without the critical care folks fighting him on it. I got it sorted. But poor guy.
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The C part is easy, it is that darn L part that takes more skill.
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I'm a psych resident who will be applying for palliative medicine fellowship next year. I don't think it will be too big of a change, we manage lots of sick patients on psychiatry and difficult medications that other physicians won't touch....so will just take some learning. Thinking of brushing up on my medicine next year and using some elective time to do a month of wards and MICU.
Overall I think many psychiatrists would make great palliative medicine doctors. It could segway nicely into psychoncology, treating those difficult pain patients who are also misusing medications, and while folks are hospitalized really helping the families understand the health system. Plus many palliative teams work with a psychologist and a care manager, so we are already used to working in teams.
Think it would also make you a better overall psychiatrist, staying on top of your basic medicine.
Overall I think many psychiatrists would make great palliative medicine doctors. It could segway nicely into psychoncology, treating those difficult pain patients who are also misusing medications, and while folks are hospitalized really helping the families understand the health system. Plus many palliative teams work with a psychologist and a care manager, so we are already used to working in teams.
Think it would also make you a better overall psychiatrist, staying on top of your basic medicine.
