Best place to volunteer to apply for second residency?

[futuredo32]

Briefly, I'm a psychiatrist wanting to do a second residency in FP or IM. I know it's not likely but I still want to try. I volunteered at a free primary care clinic in the past when I sat out a year after graduating med school. I was really open with them about wanting to volunteer as a PCP with supervision (I did a TRI prior to residency) after graduating from my psych residency and said that I specifically wanted to do primary care and they said welcome back but quickly said that they needed a psychiatrist not a primary care doctor so I left because the clinic director was a different one than the prior one and he wasn't open to negotiation..
2 Saturdays a month would be ideal. Would it be better to do it at a free clinic (there were SO many volunteers at the previous clinic that I didn't get to know one doctor well enough to ask for a LOR despite volunteering for 10 months) or to ask to shadow at a PCP's office who has Sat hours? The purpose of doing so would be 1.To get at least one up to date LOR and 2. To brush off the dust and relearn. I should have started this earlier, but life happened so...……. I am guessing with paperwork etc I could start in May, I do plan to stay beyond application season. Thanks for any suggestions. I'm in SE Mich.

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[chocomorsel]

I have to be nosy and ask why. Seems crazy to me to leave a high need higher paying field to go back and do primary care.
Have you thought of maybe looking to partner up with a PCP and share maybe some office space where patients can get one stop shopping for physical and mental health? Your overhead will be much higher though.

Listen, if you did a strong intern year, no one is stopping you from incorporating some primary care into your practice. I bet some psychiatrists do this. Simple things like B/P, cholesterol, diabetes, health and wellness management can be managed by any doctor who wanted or put some effort into it. You can pick up a book/journals and learn lots of stuff as well. I have a friend who did not finish a surgical residency and opened up a PCP practice. Now of course, you gotta know your limits and keep things simple. You got any PCP friends you can bounce this idea off?

I am on the other side and chose anesthesia over psych and sometimes regret it often enough. But I am back doing a fellowship and trying to make the best of the situation because there is no way I would go back for another three years. Even two. Thankfully this year for me has been nonmalignant and quite interesting.

I guess what I am trying to say is, if you aren't completely miserable, make some lemonade. Change things around where you are now and make the best of it. There is a huge need for psychiatrists everywhere and you can write your ticket anywhere. But good luck in your decision.

 

[AD04]

I have a friend who did not finish a surgical residency and opened up a PCP practice.

I will graduate from residency. But can you tell me how he's doing financially? Was he able to get credentialed with the insurance companies? How did he start the practice when I'm sure he has medical school loans?

 

[chocomorsel]

I will graduate from residency. But can you tell me how he's doing financially? Was he able to get credentialed with the insurance companies? How did he start the practice when I'm sure he has medical school loans?

It's a she. And she had medical student loans. I don't know the specifics of her finances but she's not struggling. She's making at least six figures. She has been able to get credentialed with insurance companies. But she thinks she would get better contracts if she had finished residency and was board eligible/certified.
It has not been an easy road, but she's making it work. She talks of going back to residency but so far hasn't in the past six years. Just busy with her practice.

 

[AD04]

It's a she. And she had medical student loans. I don't know the specifics of her finances but she's not struggling. She's making at least six figures. She has been able to get credentialed with insurance companies. But she thinks she would get better contracts if she had finished residency and was board eligible/certified.
It has not been an easy road, but she's making it work. She talks of going back to residency but so far hasn't in the past six years. Just busy with her practice.

Good for her. I hope she makes more than NP / PA on per hour basis.

It gets tougher and tougher to go into residency as the years go by. First, she is used to calling the shots. Second, programs prefer people that recently graduated (although that may not apply to her as she kept up with her clinical skills).

 

[Keona]

Can you work in an immediate care center? We had retired ents and various other specialties that were there. A lot of primary care is immediate care type work. It’s focused though and you don’t have to deal with every single medical condition that the patient has which would be a good way to ease your way in. With psych you have to do a significant amount of IM usually so I’m not sure you’d necessarily need a new residency to practice. (I’m family Med and do a lot of psych as well just because of the patients). I feel like the fields overlap more than if you were trying to switch from surgery to a pcp field.

 

[IMreshopeful]

Can you work in an immediate care center? We had retired ents and various other specialties that were there. A lot of primary care is immediate care type work. It’s focused though and you don’t have to deal with every single medical condition that the patient has which would be a good way to ease your way in. With psych you have to do a significant amount of IM usually so I’m not sure you’d necessarily need a new residency to practice. (I’m family Med and do a lot of psych as well just because of the patients). I feel like the fields overlap more than if you were trying to switch from surgery to a pcp field.

I do not believe if you want comprehensive medicine training that most psych residencies offer enough IM education. Sorry. The psych residents at my hospital (good residency) were atrocious at medically managing stuff short of restarting home meds. Perhaps there are programs which are better at teaching it, but it’s simply not the same IMHO as a full medical residency. They didn’t even do a full IM intern year, and their medicine rotations were at a less acute hospital site. Similarly as an FM provider I truly doubt you have the comprehensive education that a psych residency gives. I can also start antidepressants and can treat acute psychosis but beyond that I do not feel comfortable managing stuff on my own.

 

[Keona]

I do not believe if you want comprehensive medicine training that most psych residencies offer enough IM education. Sorry. The psych residents at my hospital (good residency) were atrocious at medically managing stuff short of restarting home meds. Perhaps there are programs which are better at teaching it, but it’s simply not the same IMHO as a full medical residency. They didn’t even do a full IM intern year, and their medicine rotations were at a less acute hospital site. Similarly as an FM provider I truly doubt you have the comprehensive education that a psych residency gives. I can also start antidepressants and can treat acute psychosis but beyond that I do not feel comfortable managing stuff on my own.

The psych patients rotated with the IM program at my program in a tertiary hospital with very high acuity of patients but I only ever rotated with them as a student. (Family med had our own service at same hospitals) It’d depend on how this persons IM rotations were. I definitely don’t manage complex psych either.

 

[mvenus929]

I do not believe if you want comprehensive medicine training that most psych residencies offer enough IM education. Sorry. The psych residents at my hospital (good residency) were atrocious at medically managing stuff short of restarting home meds. Perhaps there are programs which are better at teaching it, but it’s simply not the same IMHO as a full medical residency. They didn’t even do a full IM intern year, and their medicine rotations were at a less acute hospital site. Similarly as an FM provider I truly doubt you have the comprehensive education that a psych residency gives. I can also start antidepressants and can treat acute psychosis but beyond that I do not feel comfortable managing stuff on my own.

I was in Peds residency at the only stand alone children’s hospital in the state (and the only “children’s hospital” in the region), which meant that the ED and FM residents from our affiliated programs rotated with us. It drove me absolutely crazy when we babied them (pun intended). I don’t expect a FM resident in April to be on par with a Peds resident in April in taking care of Peds patients, but I expect them to function at the level of, say, a August Peds resident. Intentionally giving them the easier kids just because they aren’t going to manage the more difficult kids in their careers does a disservice to their education.

Not directed at you, just a general complaint I have.

 

[Keona]

I was in Peds residency at the only stand alone children’s hospital in the state (and the only “children’s hospital” in the region), which meant that the ED and FM residents from our affiliated programs rotated with us. It drove me absolutely crazy when we babied them (pun intended). I don’t expect a FM resident in April to be on par with a Peds resident in April in taking care of Peds patients, but I expect them to function at the level of, say, a August Peds resident. Intentionally giving them the easier kids just because they aren’t going to manage the more difficult kids in their careers does a disservice to their education.

Not directed at you, just a general complaint I have.

I wasn’t babied when we rotated in peds and I appreciated it. I work in a rural environment and while I’m not handling super complex babies I am dealing with them as adults and have a much stronger knowledge base compared to some because of my peds rotations.

 

[moto_za]

I have to be nosy and ask why. Seems crazy to me to leave a high need higher paying field to go back and do primary care.
Have you thought of maybe looking to partner up with a PCP and share maybe some office space where patients can get one stop shopping for physical and mental health? Your overhead will be much higher though.

Listen, if you did a strong intern year, no one is stopping you from incorporating some primary care into your practice. I bet some psychiatrists do this. Simple things like B/P, cholesterol, diabetes, health and wellness management can be managed by any doctor who wanted or put some effort into it. You can pick up a book/journals and learn lots of stuff as well. I have a friend who did not finish a surgical residency and opened up a PCP practice. Now of course, you gotta know your limits and keep things simple. You got any PCP friends you can bounce this idea off?

I am on the other side and chose anesthesia over psych and sometimes regret it often enough. But I am back doing a fellowship and trying to make the best of the situation because there is no way I would go back for another three years. Even two. Thankfully this year for me has been nonmalignant and quite interesting.

I guess what I am trying to say is, if you aren't completely miserable, make some lemonade. Change things around where you are now and make the best of it. There is a huge need for psychiatrists everywhere and you can write your ticket anywhere. But good luck in your decision.

May I ask why you regret it often for not choosing psych?

 

[Piebaldi]

Briefly, I'm a psychiatrist wanting to do a second residency in FP or IM. I know it's not likely but I still want to try. I volunteered at a free primary care clinic in the past when I sat out a year after graduating med school. I was really open with them about wanting to volunteer as a PCP with supervision (I did a TRI prior to residency) after graduating from my psych residency and said that I specifically wanted to do primary care and they said welcome back but quickly said that they needed a psychiatrist not a primary care doctor so I left because the clinic director was a different one than the prior one and he wasn't open to negotiation..
2 Saturdays a month would be ideal. Would it be better to do it at a free clinic (there were SO many volunteers at the previous clinic that I didn't get to know one doctor well enough to ask for a LOR despite volunteering for 10 months) or to ask to shadow at a PCP's office who has Sat hours? The purpose of doing so would be 1.To get at least one up to date LOR and 2. To brush off the dust and relearn. I should have started this earlier, but life happened so...……. I am guessing with paperwork etc I could start in May, I do plan to stay beyond application season. Thanks for any suggestions. I'm in SE Mich.

I know this is not the question at hand, but why would you go back into primary care, which is saturated by midlevels, from a more in demand field like psych at this time?

 

[chocomorsel]

May I ask why you regret it often for not choosing psych?

In psych I would have the ability to be my own boss. The ability to make my own hours. The flexibility of not having to work nights and weekends. Not having to deal with egotistical surgeons. I had this idea of having my own cash only practice as well as complementing it with doing C and L inpatient work.

 

[moto_za]

In psych I would have the ability to be my own boss. The ability to make my own hours. The flexibility of not having to work nights and weekends. Not having to deal with egotistical surgeons. I had this idea of having my own cash only practice as well as complementing it with doing C and L inpatient work.

Thanks for the response. Isn't all of this possible with a pain fellowship? (Something I have thought of doing from psych in the future)

 

[chocomorsel]

Thanks for the response. Isn't all of this possible with a pain fellowship? (Something I have thought of doing from psych in the future)

I absolutely have no desire to deal with that patient population.
Drug seekers/addicts are some of the most manipulative patients out there. And they can get real evil. That’s a chunk of your patients in pain.
No Thanks.

 

[LookForZebras]

I agree that changing fields requires brushing up and relearning. BUT you're already a board-certified, licensed physician. You probably don't need to volunteer your time. You could probably find a setting like urgent care or correctional medicine that would pay you to practice while simultaneously allowing you to brush up on internal medicine skills. If you really want to volunteer, of course there's nothing wrong with that and it's selfless and everything.. just don't feel like that's the only route to transition to another specialty.

 

[IMreshopeful]

I was in Peds residency at the only stand alone children’s hospital in the state (and the only “children’s hospital” in the region), which meant that the ED and FM residents from our affiliated programs rotated with us. It drove me absolutely crazy when we babied them (pun intended). I don’t expect a FM resident in April to be on par with a Peds resident in April in taking care of Peds patients, but I expect them to function at the level of, say, a August Peds resident. Intentionally giving them the easier kids just because they aren’t going to manage the more difficult kids in their careers does a disservice to their education.

Not directed at you, just a general complaint I have.

I generally agree, and some psych residencies do have their residents rotate at the same sites as their IM colleagues. However I still don’t think it’s enough. Until I was near the end of my second year I don’t think I had truly developed enough of a comfort level with managing complex IM patients on my own. Arguably, I find clinic and outpatient even harder. Being a cardiologist is much easier in some ways since you’re siloed into your own niche.