going into psych as PGY2

Sorry to hear about your situation. It's really too bad that med school is set up in such a way that by the time you know for sure what you want to do it may be too late. Yes, you can switch into Psych from IM as a PGY-2 without losing any ground. Some programs seem to make a point of looking for PGY-2 switchers. Several that I've heard about that seem to be like that are Johns Hopkins, University of Maryland, and Medical College of Wisconsin (just so you know that it is not just a Maryland thing ) .
I personally think that a strong foundation in IM will make you a better psychiatrist, especially if you have any interest in C-L psych or geriatric psychiatry.

Yale as well.

Lots of programs have them, they just may not be the programs you necessarily want to go to geographically. I think doing a year of medicine would make you a competitive PGY2 applicant if you do well and the rest of your record is strong. Others that take PGY2s routinely are USC, U. New Mexico, Stanford, University of Washington. San Diego frequently takes PGY2s as well, but has not formal track for them. I think that UTSW also has spots each year.

Shrink Wrap said:

Thanks for the encouragement. I'm starting to feel much better about everything.

I think the reason that I had such a hard time deciding is because I'm very attracted to areas that interface between medicine and psychiatry -

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break it down to it's core with a question: It's 7pm on a "short call" and the phone rings with an admit from the ED. Would you prefer it to be:

1) a multiple admit with end stage liver disease who still drinks a ton and will need tapped just before you leave for the night and just after you admit him
2) a multiple admit with borderline who is having issues with her mom again and took 10 klonopin and will probably require(or get is a better word) admission after you go down and see her

Which one of those everyday cases would you be more interested in picking up the phone for? For me it's #2.....if it's not for you, do medicine instead.

psychotrope, I think that's a great way of looking at it! [I would also choose #2 any day of the week.]

Shrink Wrap said:

So I think I really screwed up this whole matching thing. I spent so much time agonizing over medicine vs. psychiatry that I put in my ERAS applications late and didn't get interviewed at some programs because there were no spots left! The sad part is that I wasted time trying to make a decision, and then I ended up interviewing at psych, combined, and medicine programs anyways.

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Well aside from the fact you really need to think about what you *want* to do(because they are SO different); if you decide in the next few weeks you want to do psych for sure, consider not ranking your medicine programs and going for a ty instead of a medicine prelim year....

I say that because those 2 neuro months you can do(as an elective for example) in your ty make a BIG difference in terms of your ability to segway in as a pgy-2 vs interviewing as a pgy-1........

a ty who has done 2 months of neuro(if they were planning it that way) is 2 months ahead of a medicine prelim who wasnt able to do the 2 months of neuro....

and being 6 months "behind" in psych is much more advantageous to being 8 months "behind" in psych. Someone who did a prelim and not a ty(if the ty contained 2 months of neuro) *might* be able to qualify in terms of finishing the program if the 4th year was almost excluslvelt electives as many are, but he wouldn't actually get to do any of those electives. The ty would have time to do some electives(at least 2 more months worth) his 4th year......

If I knew I didn't want medicine and wanted my best route into psych as a pgy-2(and again you still may want to apply through the match as a pgy-1...I met several good candidates this year on the trail who were interns), I'd do a transitional over a medicine prelim....

psychotrope said:

break it down to it's core with a question: It's 7pm on a "short call" and the phone rings with an admit from the ED. Would you prefer it to be:

1) a multiple admit with end stage liver disease who still drinks a ton and will need tapped just before you leave for the night and just after you admit him
2) a multiple admit with borderline who is having issues with her mom again and took 10 klonopin and will probably require(or get is a better word) admission after you go down and see her

Which one of those everyday cases would you be more interested in picking up the phone for? For me it's #2.....if it's not for you, do medicine instead.

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What's behind Door #3?

OldPsychDoc said:

What's behind Door #3?

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An obvious surgery patient/consult?

I didn't mean to be overly simplistic about it....was just emphasizing that doing psych is *VERY* different than doing fm/im etc.......everything is different. and people who say it isn't(from med students to residents to fellows to atendings) aren't being realistic....

Door #3 http://www.youtube.com/watch?v=36WEn-9zs1U

Pick door #2

From a biased psych resident: match into psych!

Sure, there are programs that will have open PGY-2 spots. But your options will be much more limited going after one or two spots in the handful of programs that lost an intern the previous year. So in addition to extending your residency by half a year, you're enduring an extra 6 months of IM (oh, the humanity), and you risk not finding a spot or finding a spot at a less desirable program than ones you've already interviewed at.

Of course, if you're leaning more towards IM, or you absolutely wouldn't want to go to any of the psych progs you interviewed at, then it makes sense to match into IM.

Sneezing said:

Door #3 http://www.youtube.com/watch?v=36WEn-9zs1U

Pick door #2

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"He chose... Poorly."

God I love that line!

I scoured the ends of the internet to find the scene when Indy has "chosen wisely" to link to door #2 but it isn't on the internet!

psychotrope said:

break it down to it's core with a question: It's 7pm on a "short call" and the phone rings with an admit from the ED. Would you prefer it to be:

1) a multiple admit with end stage liver disease who still drinks a ton and will need tapped just before you leave for the night and just after you admit him
2) a multiple admit with borderline who is having issues with her mom again and took 10 klonopin and will probably require(or get is a better word) admission after you go down and see her

Which one of those everyday cases would you be more interested in picking up the phone for? For me it's #2.....if it's not for you, do medicine instead.

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You sure #1 can't wait until the morning? heh....
... Besides, #2 is the bread and butter of our profession. Next to the sampsonite sign.

Actually he would still graduate from residency in the same amount of time. A transitional year, medicine prelim year, or categorical IM PGY-1 can all count for a pgy-1 in psych in the ABPN's view with no need to make up any rotations.

I think being comfortable with general medicine is important in psych. There are many situations where psych patients don't see any other docs other than psychiatrists.

peppy said:

Actually he would still graduate from residency in the same amount of time. A transitional year, medicine prelim year, or categorical IM PGY-1 can all count for a pgy-1 in psych in the ABPN's view with no need to make up any rotations.

I think being comfortable with general medicine is important in psych. There are many situations where psych patients don't see any other docs other than psychiatrists.

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this is true, but you're fourth year(and parts of your second as well) would be a much different schedule.....if you did a strict prelim medicine year with no neuro, thats 8 months of electives your fourth year you wouldn't get to do, which is about the number of electives most programs have total that year.

Also the option of going into child after pgy3 wouldn't be there.

I think aside from those two things though, the biggest drawback would be the limited number of programs one can apply to(it all depends on the openings). My program had a resident do a year of medicine(or a ty..forget), then match as a pgy-1....it sucked because he lost the year, *but* he was already done with every non-psych rotation(and the program gave him credit for these), so even though he was technically a pgy-1 he got to do some electives his first year rather than medicine, neuro, etc and then psych. He'll still have to be in the program all of his pgy-4 year, but it will be pretty sweet I would think.....but of course some programs might still make you repeat the off service months...I dunno.

Shrink Wrap said:

I think I am fairly comfortable with the idea of doing a year in medicine. I think it would be good for me actually. My understanding is that many programs have several PGY2 spots every year, so that I could then transfer in if that's what I still want.
Has anyone out there done this or considered this? I would be grateful for any advice.

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Plenty of people do this. As people have mentioned, you should be able to finish 'on time' (i.e., after 4 years of training / no lost time). During your PGY2 psych year you will probably be completing PGY1 inpatient psych rotations, and during your PGY3 psych year you may still have to finish up a few PGY2 rotations, but by the middle of your PGY3 year you should be caught up.

Your application timeline will be something like this (depending on institution and program):

• July: start medicine intern year
• Jul-Sept: identify psych programs with PGY2 openings.
• Sept: notify your program director of your intentions to transfer into psychiatry. There is no way around this. You may need a letter of recommendation from your program director to accompany your application. At a minimum, you will need a letter of good standing (which basically says "Shrink Wrap is a resident in our program and is currently in good standing. Please do not hesitate to contact me if you wish to verify her academic record", or something like that). Either way, you will need to tell your program director. And, even if you didn't have to tell your program director, you should tell her because it is the nice thing to do. When you transfer, your program director will have to scramble to find a new PGY2 medicine resident to replace you, and the more lead time she has, the easier it is for her to find a replacement.
• Sept-Oct: apply to psych programs. Many programs require at least one letter from a psychiatry attending. If you are at a medicine program, then you may have difficulty coming up with a psych letter. This means you will probably need to contact one of your old psych attendings from medical school. (Psych programs expect this of transfer applicants.)
• Nov-Jan: interview at psych programs. Even though transfer positions are filled outside the Match, most places will interview you at the same time as new PGY1 applicants.
• Jan-Mar: find out where you are going. Some programs will notify you on a rolling basis. Other programs will notify you around Match Day.

Congratulations on your decision to switch to psych.

-AT.

.....