Anybody go on to a second residency after completing one?

[Attending1985]

Finishing up my psych residency in June. Have been contemplating going on to do a second residency in IM as I don't hate psych but miss general medicine. Talked to the IM PD at my institution about my situation and he offered me a spot. I told him that having a toddler made me hesitant to undertake another residency due to time demands. He said he understood and he would be willing to create a 50% position for me where I would be part time. Possibly one month on/one month off but flexible. This is really appealing but two huge negatives are obvious. Making basically no money and being a resident for 6 more years?! These two things suck but my husband makes around 75K so we wouldn't be starving and residents at my institution are treated pretty well. My question is has anyone completed a second residency and are you glad you did it?

---

Members don't see this ad.

 

[NotAProgDirector]

I have had residents who complete IM go on to complete another residency. So it can be done.

If you do a residency at 50% for 6 years, you might be able to "moonlight" in psych in the intervening months to help boost your income -- although your program might prevent that.

 

[J ROD]

I have known a few that have gone on to do a second residency and they did not get the deal you were offered.

 

[akwho]

We have a legend at our institution who completed a 6-year surgical subspecialty residency, and is now an R7 neurosurgery resident about to go onto 1-2 more years of fellowship. You magnificent bastard. They will make you leave training some day, but TODAY IS NOT THAT DAY.

 

[Doctor4Life1769]

Finishing up my psych residency in June. Have been contemplating going on to do a second residency in IM as I don't hate psych but miss general medicine. Talked to the IM PD at my institution about my situation and he offered me a spot. I told him that having a toddler made me hesitant to undertake another residency due to time demands. He said he understood and he would be willing to create a 50% position for me where I would be part time. Possibly one month on/one month off but flexible. This is really appealing but two huge negatives are obvious. Making basically no money and being a resident for 6 more years?! These two things suck but my husband makes around 75K so we wouldn't be starving and residents at my institution are treated pretty well. My question is has anyone completed a second residency and are you glad you did it?

To be honest, you should have considered the issues you are considering now PRIOR to seeing the IM PD. It sounds like a fair deal to be a part time resident and spent more time in residency. See if you can do the moonlighting, although it might make the IM PD wonder why you would like to be a part time IM res if you were going to moonlight as opposed to spending time with your child/fam

 

[j4pac]

I imagine moonlighting in Psych would be difficult. If you want to do general medicine, why don't you get a moonlighting urgent care job with your unrestricted license. It saves you the time and substantial loss in income.

There is no way that I would do a second residency unless I was absolutely miserable in the first and was contemplating quiting. The financial tool is insane.

 

[wholeheartedly]

what about some middle ground with something like psychosomatic medicine fellowship? a couple people I know wanted to hang on to the "medicine" side, went that route, and seem pretty happy with that decision. not bad for a one year fellowship.

 

[netminder]

We have a legend at our institution who completed a 6-year surgical subspecialty residency, and is now an R7 neurosurgery resident about to go onto 1-2 more years of fellowship. You magnificent bastard. They will make you leave training some day, but TODAY IS NOT THAT DAY.

I love this.

 

[TexasPhysician]

what about some middle ground with something like psychosomatic medicine fellowship? a couple people I know wanted to hang on to the "medicine" side, went that route, and seem pretty happy with that decision. not bad for a one year fellowship.

This is a good idea, and there are also psych positions where you can flex your medicine knowledge. Some inpatient psych facilities have medicine staff only available as consults 24+ hours out. You treat everything, await a consult, or ship out. Some addiction jobs will allow you to treat most medical issues as well.

Unless you hate psych and want a pay cut for years, there is little reason to do another residency.

 

[fantasty]

For your original question: It's quite common for preventive medicine and occupational medicine to do 2 residencies. Both require at least one year of another residency prior to applying (and many complete their first and go on to become dual boarded).

My understanding is that there can be funding issues if you change (or do two sequential residencies) in most other clinical disciplines. This coming from the fact that most residency spots are CMS funded, so there's something about you "exhausting" your allotment. Someone has posted a linked to a GME bulletin that describes this in more detail, but some of the regulars may be able to better explain this off the top of their head (in fact, I'm thinking aPD might have been someone who mentioned that before). But, I've been told that if the (second) program wants you, the funding issue is usually not a problem (as they'll find the funds to support the trainee through other means).

For your specific situation, though - I agree that psychosomatic medicine (or other fellowship) might be a good option to get more "medicine" (how about addiction medicine? I was just talking to a friend about the need in that field as well). But, also, I came from an environment with a strong Med-Psych residency. And, I know that they had accepted "advanced" residents in the past (I believe one did most or all of FP before transferring). Even though it's normally 5 years, you might be able to go in with credit for what you've done so far and be able to streamline your way toward becoming dual-boarded. [Just a thought...]

 

[fantasty]

For fun, found the AAMC document I was thinking of:

Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know
January 2013

https://members.aamc.org/eweb/upload/Medicare Payments for Graduate Medical Education 2013.pdf

 

[Attending1985]

The PD said he was confident he could get my position funded and wasn't worried about it. I haven't pulled the trigger yet but I'm seriously thinking about it. Financially it's a real drag but I don't see any other huge drawbacks for myself.

 

[phoenx]

Any ideas of ways to get your position funded during a second residency?

 

[Crayola227]

lol

 

[northernpsy]

We have a legend at our institution who completed a 6-year surgical subspecialty residency, and is now an R7 neurosurgery resident about to go onto 1-2 more years of fellowship. You magnificent bastard. They will make you leave training some day, but TODAY IS NOT THAT DAY.

Since this was posted a year ago, I kind of wonder what's going on with the never-ending trainee now. Did they finally force him into attending-hood, or is he lining up another fellowship to do once this one's over?

 

[michaelrack]

I imagine moonlighting in Psych would be difficult.

If the OP does one month on and one month off, it shouldn't be that hard to find some short term locums assignments or weekend coverage (of inpt psych wards) on her month off

 

[Raryn]

I imagine moonlighting in Psych would be difficult.

It depends on how much time off they get from their program, but 3rd year IM residents (for example) frequently do get time/permission to moonlight. And moonlighting within psychiatry is super easy, there's tons and tons of opportunities for tele-psychiatry, picking up weekends on inpatient psych wards, etc. etc. I know psych residents who moonlight in their off time and easily double or triple their residency salaries as 4th years.

 

[bannie22]

We have a legend at our institution who completed a 6-year surgical subspecialty residency, and is now an R7 neurosurgery resident about to go onto 1-2 more years of fellowship. You magnificent bastard. They will make you leave training some day, but TODAY IS NOT THAT DAY.

lols

 

[Psai]

We have a legend at our institution who completed a 6-year surgical subspecialty residency, and is now an R7 neurosurgery resident about to go onto 1-2 more years of fellowship. You magnificent bastard. They will make you leave training some day, but TODAY IS NOT THAT DAY.

He was the best intern ever

 

[gutonc]

Since this was posted a year ago, I kind of wonder what's going on with the never-ending trainee now. Did they finally force him into attending-hood, or is he lining up another fellowship to do once this one's over?

There was a surgical fellow at my hospital who was freaking epic. She did 2 years of research during residency, then did a CT fellowship, followed by a Peds Surg fellowship, before finally switching institutions to do a peds CT fellowship.

I wonder if they even had a PGY13 pay scale in place.

 

[Psai]

There was a surgical fellow at my hospital who was freaking epic. She did 2 years of research during residency, then did a CT fellowship, followed by a Peds Surg fellowship, before finally switching institutions to do a peds CT fellowship.

I wonder if they even had a PGY13 pay scale in place.

Should have been getting attending level pay like 7 years ago

 

[Gastrapathy]

OP, why not ask the IM PD to defer for a year. See if you like psych attendinghood and make some money for a year.

 

[Raryn]

Or do a psychosomatic fellowship.

 

[DrSnips]

Or do a psychosomatic fellowship.

Before you can do the psychosomatic fellowship you have to do 4 pain fellowships, 2 GI fellowships, a reproductive fellowship and a pseudoneurology fellowship.

 

[Raryn]

Before you can do the psychosomatic fellowship you have to do 4 pain fellowships, 2 GI fellowships, a reproductive fellowship and a pseudoneurology fellowship.

That's actually just the one word name for fellowships in Consultation/Liaison Psychiatry. Psychiatrists who are experts in evaluation of patients who also have acute medical issues, more or less.

 

[fantasty]

That's actually just the one word name for fellowships in Consultation/Liaison Psychiatry. Psychiatrists who are experts in evaluation of patients who also have acute medical issues, more or less.

And, the advantage of that over med-psych?

 

[northernpsy]

And, the advantage of that over med-psych?

Psychosomatic Medicine is more about the interface between medicine and psychiatry : depression in a cancer patient, adjusting psych meds for dialysis in an ESRD patient, managing psychosis in a pregnant lady, delirium of all types...that kinda stuff.

If anyone is interested in learning more about this branch of psych, the APM conference every November is always a good time:
Academy of Psychosomatic Medicine -- Home Page

 

[fantasty]

Psychosomatic Medicine is more about the interface between medicine and psychiatry : depression in a cancer patient, adjusting psych meds for dialysis in an ESRD patient, managing psychosis in a pregnant lady, delirium of all types...that kinda stuff.

If anyone is interested in learning more about this branch of psych, the APM conference every November is always a good time:
Academy of Psychosomatic Medicine -- Home Page

Thanks for clarifying, and I realize that there are practical issues as well, so my question may have come off unintentionally snarky. We had a med-psych program where I trained, and I liked working with the residents. (And overall, I think they've been pretty happy with their decision once they are out in the real world). We rotated on the med-psych inpatient unit, which I always kind of enjoyed. And, my continuity clinic for 1 year was semi-loaded with med-psych type patients because my attending was one of those faculty.

 

[michaelrack]

And, the advantage of that over med-psych?

Doing psychiatry residency followed by a C/L fellowship is a lot easier then doing med-psych, which trains you to be a full psychiatrist and a full internist.

 

[MediCane2006]

There was a surgical fellow at my hospital who was freaking epic. She did 2 years of research during residency, then did a CT fellowship, followed by a Peds Surg fellowship, before finally switching institutions to do a peds CT fellowship.

I wonder if they even had a PGY13 pay scale in place.

Most places top out at PGY-7 on the pay scale

(source: PGY-10)

 

[fantasty]

Doing psychiatry residency followed by a C/L fellowship is a lot easier then doing med-psych, which trains you to be a full psychiatrist and a full internist.

Well, just playing devil's advocate. Isn't Med-Psych 5 years? How long is Psych + fellowship? Sure, there's the joy (and cost) of being dual-boarded and MOC and whatever. But, would someone who wants to work in psychosomatic medicine (with the types of patients mentioned above) be a more qualified applicant (if both people were applying for the same position)?

 

[michaelrack]

Psych + fellowship is typically also 5 years. I did a med-psych 5 year residency followed by a 1 year sleep fellowship (and am certified in sleep through the ABIM), and also was able to take and pass the psychosomatic boards without doing a fellowship. Although I agree that someone who did a med-psych residency would have a better knowledge-base to work in psychosomatic medicine, most psychosomatic medicine positions are academic, and those that involve teaching in a psychosomatic fellowship program typically require psychosomatic certification. In addition, IM is much more difficult than psych, and doing psych + fellowship is much easier (as far as hours worked, knowledge required) than doing a combined residency. Also IM certification/knowledge base is overkill for any type of psych job. Knowing which abx to use for nosocomial pneumonia won't help a doc perform in a psychosomatic job

 

[BeddingfieldMD]

Finishing up my psych residency in June. Have been contemplating going on to do a second residency in IM as I don't hate psych but miss general medicine. ... My question is has anyone completed a second residency and are you glad you did it?

I understand that you "miss general medicine," but do you have a specific plan of what you're planning on doing with this extra residency?

You seem somewhat aware of the financial ramifications, but be aware that you will essentially be paying at minimum $500k for this residency in opportunity cost, unless you can arrange some part-time faculty position to go along with your residency--or a moonlighting position as someone else recommended.

Is it really worth the time, stress, and half a million bucks?


Sent from my iPhone using SDN mobile

 

[RadOncDoc21]

I understand that you "miss general medicine," but do you have a specific plan of what you're planning on doing with this extra residency?

You seem somewhat aware of the financial ramifications, but be aware that you will essentially be paying at minimum $500k for this residency in opportunity cost, unless you can arrange some part-time faculty position to go along with your residency--or a moonlighting position as someone else recommended.

Is it really worth the time, stress, and half a million bucks?


Sent from my iPhone using SDN mobile

I can answer that question for the OP... hellz no!

 

[northernpsy]

I do agree it probably isn't worth doing a second residency in most cases...but if you really hate your original specialty and feel very confident that you'll like the new one a lot more, I think it could be worth it.
In the big picture, is that extra $500k going to make such a difference to your life that it's worth spending 30 years in a job you hate? Maybe if you're in a specialty you like, you'll work a few years more instead of getting fed up and retiring early

 

[michaelrack]

Women in Italy may soon get paid premenstrual leave

 

[BeddingfieldMD]

I do agree it probably isn't worth doing a second residency in most cases...but if you really hate your original specialty and feel very confident that you'll like the new one a lot more, I think it could be worth it.
In the big picture, is that extra $500k going to make such a difference to your life that it's worth spending 30 years in a job you hate? Maybe if you're in a specialty you like, you'll work a few years more instead of getting fed up and retiring early

That's kind of what I was getting at. Is this an early career change or just being a perpetual student? What's the ultimate goal. In general, an IM residency is going to be more time-consuming than psychiatry. There is also the opportunity cost that the OP will miss much of her kid's early years. I'm just saying there are a lot of potential downsides to this decision. the OP should make sure she has a definitive plan before proceeding.

 

[rokshana]

but is this much different than doing a residency and then doing fellowship in the number of years spent in training? Being Psych/IM could make you more competitive in the workforce.

 

[DrSnips]

I'm not really sure I understand the job opportunities for these joint training programs. EM/IM, med-peds, med-psych, etc. What percent of these people end up in a job where they can employ both parts of their training on a regular basis? It seems like if you just end up practicing one of the two fields, then the extra time spent training was wasted.

 

[fantasty]

I'm not really sure I understand the job opportunities for these joint training programs. EM/IM, med-peds, med-psych, etc. What percent of these people end up in a job where they can employ both parts of their training on a regular basis? It seems like if you just end up practicing one of the two fields, then the extra time spent training was wasted.

That's a good question. I guess maybe I assumed that being dual-boarded wasn't uncommon, but I "grew up" in an academic environment where being trained in that manner helped people create a certain niche. Like, med-peds folks wanting to be a specialist that made sense being both (or focusing on adolescents or whatever). I don't know many folks that did med-peds with the idea that they would be like uber-FM minus OB, but I guess that would be the goal if you wanted to be a community doc doing both. And, similarly, the [med/FP]-psych folks I knew found jobs doing inpatient med-psych or ambulatory care for complex patients. Peds-psych probably is a different beast due to child psych being a bit of it's own world anyhow.

(I'm sorry - I haven't had enough caffeine yet so I'm not sure why I decided to comment - I should let people who actually know why they've made these choices post...)

 

[fantasty]

Slightly more coffee...

I guess I should also just add that most of the dual-boarded folks I know started out with that intention - in a combined program. And, my exposure was mostly to the people working in IM, so they probably skew differently. Some of the people who were med/peds had pretty much committed to being internists and were mostly practicing peds on the side (like urgent care or picking up the occasional shift).

Tying it back to the OP, I know relatively few people who did two different specialties sequentially, and in many cases that was following the situations where people truly wanted to change career goals.

That being said, I have to mention again that many occ-med and preventive medicine folks are dual-boarded, because we're almost always doing sequential residencies. And, I think some people think about their second residency as if it were a fellowship leading to their second certification (third, whatever).

 

[michaelrack]

but is this much different than doing a residency and then doing fellowship in the number of years spent in training? Being Psych/IM could make you more competitive in the workforce.

It does help some, but it's not a dramatic effect. It can help you advance in a job/position more so than in getting an initial job. As a Psych/IM who primarily practices psych (as most of us do), the combined certification has helped me advance at my main psychiatry position (inpatient psych ward) by allowing me to supervise the nurse practitioners ( 1 combined family practice/psych and 1 family practice). Previously the hospitalists at our medical hospital supervised the NP's with one of our psychiatrists providing the psychiatic supervision. (the medical and psych parts of the hospital are about 1/2 mile apart).

If a medical situation arises that I can't handle, then the NP will just call the hospitalist; but it is a big convenience for the hospital for me to do all of the NP collaboration paperwork.

From a financial perspective, it's probably best just to do a straight psych residency- 1 less year of training, and it costs a lot to maintain certification in 2 specialities

 

[AdmiralChz]

I'm shocked this thread is still going, but it's largely going in circles with Psych/IM. Some arguments for it, most against.

Anesthesiology gets its fair share of people who complete full residencies in pediatrics and IM.

Also wanted to remind people the thread itself is over a year old and the OP hasn't been on SDN for almost 2 months. Doubtful they will come back to check but I've been wrong before.

 

[byaaaaaaah23]

No, I don't think anyone has ever done that.

 

[fantasty]

...
Also wanted to remind people the thread itself is over a year old and the OP hasn't been on SDN for almost 2 months. Doubtful they will come back to check but I've been wrong before.

I'm only happy when old threads are necrobumped or completely off topic by the end of page 1. I understand that's not necessarily the viewpoint of the folks that prefer "Question" --> "Answer" --> "Thread close"

 

[Winged Scapula]

Most places top out at PGY-7 on the pay scale

(source: PGY-10)

Yep...I made the same as a PGY-8 fellow as the PGY7s ( as a matter of fact when they first sent me the contract they sent it for a PGY six salary and I sent it back saying that was wrong… Actually got it changed! )

 

[NotAProgDirector]

Yep...I made the same as a PGY-8 fellow as the PGY7s ( as a matter of fact when they first sent me the contract they sent it for a PGY six salary and I sent it back saying that was wrong… Actually got it changed! )

That's because no one in their right mind would do a PGY-8. Amirite?

 

[Winged Scapula]

That's because no one in their right mind would do a PGY-8. Amirite?

I never claimed to be in my right mind!

 

[Psai]

Yep...I made the same as a PGY-8 fellow as the PGY7s ( as a matter of fact when they first sent me the contract they sent it for a PGY six salary and I sent it back saying that was wrong… Actually got it changed! )

dat extra 2k a year was worth it?

 

[Winged Scapula]

dat extra 2k a year was worth it?

Absolutely...you gotta fight for your right to be slightly less underpaid!