Question posted anonymously:
is there a chance that it might hurt my med/psych applications if I also apply for psych at the same program?
With the exception of Duke there really aren't any good med/psych programs. Many of them are v. uncompetitive, have trouble filling and you are bound to get one, but the quality of the psychiatry training would be highly questionable, you would probably be in the middle of nowhere, there is no time for research, no time to learn psychotherapy, no provision for electives in psychiatry, and unless you are interested in primary care (which you're not otherwise you would be applying to IM/FM and med/psych not psych + med/psych) there is no good reason to do a med/psych residency, and lots of reasons not to.
I can tell you that you have next to no chance of getting into the med/psych residency at Duke the residents are stellar (compared with their psych residents who are mostly mediocre). They have a strong medicine program and if you dont have a chance of getting into the IM residency you don't have much chance of the med/psych (though of course it is less competitive).
I suspect you want to do med/psych under the misapprehension you will be a 'proper doctor'. It is completely understandable that you would be reluctant to turn your back on your medical training to be a psychiatrist. But if that is what you want to do, you will need to make your peace with it. The concern is that many people think that those who do med/psych have a negative perception of psychiatry or are scared of not being a 'real doctor'.
Well you know even in psychiatry we do the odd bit of 'real doctoring' - I draw labs, start IVs, to ABGs, physical exams, order investigations. This past week I have requested an MRI, EEG, CBC, Chem-10, HIV, syphilis, ANA, ANCA, ENA, antineuronal antibodies, skin punch biopsy, and genetic testing for a patient I don't know what's wrong with her (diff dx psychotic depression, CADASIL, metachromatic leukodystrophy, Wegener's granulomatosis, neurobehcet's, paraneoplastic limbic encephalitis, progressive multifocal leukoencephalopathy etc..)
Psychiatry is psychiatry because much of the time neurobiology doesn't help us understand what is wrong with our patients, because the act of listening intently is the examination, because the experience of being listened to is the therapy, because of the level of explanation we use to formulate the case may not be a biomedical one but psychodynamic, cognitive, behavioral, systemic, sociocultural, or social constructivist and having a pluralistic approach frees us from the dogmatism that may prevent us from understanding the patient in front of us, who hasn't read the DSM and doesn't know she's supposed to present in this way or that way..
The challenge and fun of medicine is the diagnosis; the challenge and fun of psychiatry is the formulation. How do we make sense of the patient in front of us, her symptoms, her problems, her presentation, and how do we use that understanding to help her? Learning this well is why psychiatry residency is 4 years.. you can learn the DSM and psychopharmacology in 2.5 years doing med/psych. You cannot learn psychotherapy and case formulation well in such a short time, and you and you patients will be all the poorer for it.
I would strongly discourage you from applying to med/psych, but if you are going to I would apply to psych programs at those institutions as well anyway as although it may disadvantage you in getting into the psychiatry program, it will not disadvantage you getting into med/psych as at the competitive places you are unlikely to get an interview, and at the non-competitive (i.e. most) places they are so desperate that it wont make a difference.
N.B. Duke for a decent IMG would not be a reach for categorical psychiatry, it would be for med/psych.