Combined IM/Psy v. Psychosomatic Fellowship

Discussion in 'Psychiatry' started by J DUB, 09.27.14.

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  1. J ROD

    J ROD Watch my TAN walk!! Lifetime Donor 10+ Year Member

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    I am just into my 3rd year but I am interested in Emergency Psy and C/L Psy. Some of my professors have mentioned to me that I should do a combined IM/Psy. I was thinking about the Psychosomatic fellowship if I definitely wanted to do C/L.

    Both are 5 yrs. Would doing more IM make me a better C/L or the fellowship? I am thinking the fellowship.

    I am not seeing how the IM part would help me consult on Psy better. And I do not see how I can really work in both fields. Only in academia. Seems like wasted time and effort for no compensation for your extra training.

    I am more leaning not to do academia due to the BS. I like to teach but hate the BS.

    Any thoughts from those with experience of what would be best? Is there additional training for emergency?

    Just trying to get some more input..........thanks
     
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  3. jjmack

    jjmack Senior Member 10+ Year Member

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    I don't see many benefits of doing IM/psych especially with your interests. I can see it being beneficial if you want to run a detox center or be a medical director of a psych hospital, but overall it's a lot of training.
     
  4. Nasrudin

    Nasrudin Apropos of Nothing 10+ Year Member

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    You don't do an entire residency, especially not something as splendidly sh!tty as IM, for whimsical reasons. Or for any sane reason at all really. There are people who recommend these sorts of things. But these are not the sort of people who I would ask the time of day. Choose the base specialty you would be most happy with.

    If psych...you may decide completely against C&L in the years ahead. These things are impossible to know until felt. Carrying the consult pager, working closely with an attending. Would you want to do this sort of work? What are the opportunity costs of training as a fellow for a year and for what benefit?
     
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  5. J ROD

    J ROD Watch my TAN walk!! Lifetime Donor 10+ Year Member

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    Thanks. I have an elective next month where I will spend a week on C/L Psy. So, hopefully, that will give me more insight on that. But, I agree. I do not see the need for IM. Unless I want to do IM. I want to do Psy and maybe pursue several different avenues within Psy. I have done ER Psy and I loved that. But, I am not sure how easily one can find a job just doing that. From what I understand, most places have folks that cover the floor and ER. I guess bigger places do. But, I am not a big city person.

    I just have been told I am too competitive to just do Psy and I should do something more. I say how about if I like it and it is what I want to do. I can not help it is not competitive. Everyone wants to be the best, etc. All about Steps and GPAs and LORs, etc. I just want to pick the career in medicine I want to do for 30+ years and be happy in. I thought that was the point of med school. To learn how to become the physician you want to be and be competent and more.
     
  6. Nasrudin

    Nasrudin Apropos of Nothing 10+ Year Member

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    I had some nascent and naive thoughts about the co-mongling of EM and psych being interesting based on a mixture of academic interests and separately enjoyable experiences. But EM pscyh is usually a side gig or a first job for people growing their private practice or something along these lines. C & L might more closely resemble your current notions about operating at the intersection of medical and psychiatric complaints.

    I mean I'm just an intern. So don't put too much stock in what I'm saying. Except that it's important to grow your notions quickly as possible into something more closely resembling what the work is really like lest you might choose based on something not realistic.

    For me psych was a good match in general so my inaccurate notions of the specifics were less important.

    As far as being highly competitive, consider, you will be highly courted applicant in psych, able to choose exactly where you want to go. So it's never a bad thing to be in any field.
     
  7. Armadillos

    Armadillos 2+ Year Member

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    Also keep in mind whoever is saying "your too competitive to do psych" may additionally have other motivations in mind other than just your happiness, they may feel it looks good for them or their medschool to have more students doing x specialty instead of psych
     
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  8. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    Putting in extra time in a field you don't want to practice in because someone insists you're "too competitive" for "just" psychiatry is ridiculous. It's like if someone said, "well, with your scores, you should be doing derm or ortho surg even though you hate them because you've got the stats." The whole point of being a competitive applicant is being able to choose the program you want. You're incredibly fortunate that you like a specialty where you will have your pick of programs.

    And who knows what the future holds. Maybe with government changes in reimbursement and the loss of private practice in other fields, psychiatry will become more competitive in the future as people realize the value of being able to own their own practice with low overhead while also maintaining a high quality of life. It's entirely possible that high stat people like yourself could turn psychiatry into the new derm, which was considered in the 1980s to be "the least among equals" in medicine due to the lack of prestige and respect physicians in dermatology were afforded. Not that prestige is really important anyway, but it's a very mercurial thing in the world of medicine. Specialties rise and fall on the whims of bureaucrats and reimbursement changes, so what is "in" today could very well be considered a nightmare tomorrow. Look no further than the rapid decline of anesthesia and radiology for proof of that.
     
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  9. J ROD

    J ROD Watch my TAN walk!! Lifetime Donor 10+ Year Member

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    I am not a high stat guy. Just average. I think they were meaning with all my pharm and such why just do Psy. I felt like I was being recruited for IM and FM. I have not interest in the more competitive fields except EM and I do not want that schedule and hell after thinking about it more. I am definitely applying to Psy. I do not think I will have my pick per se but I will at least get to pick a certain area. I was just trying to see if that combined deal was worth anything more than sounding cool. I am double boarded in IM and Psy. I am more about making cents......$
     
  10. splik

    splik 5+ Year Member

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    speaking as someone who likes IM and has more IM training that most psych residents, I thought about doing combined training but it is pretty worthless. You can learn enough medicine in that time, but you cannot learn enough psychiatry and you will have little/no psychotherapy training which is very important to psychiatry training even if like me you have no intention of ever practicing psychotherapy. Especially in C/L being able to understand the psychodynamics of consultation, providing motivational interviewing, use cognitive and behavioral techniques, provide support to the demoralized patient, work with families, and use hypnosis are valuable skills to use in brief encounters. you won't be able to get these skills with combined training. also the only decent combined IM/psych program is Duke. there are only a few programs, they are (Except Duke) fairly uncompetitive, and haven't got the balance right.

    In terms of psychosomatics fellowships, currently it isn't necessary to do this even in most academic centers to work in C/L but this may change as the APM has been pushing for this. If you go to a very C/L heavy program you probably don't need to do psychosomatic fellowship. Interestingly most of the C/L faculty at my program are geriatrics trained. Also by the time you get there, there is a good chance you will be able to fast-track into fellowship so doing residency + fellowship would be 4 rather than 5 years.

    Inpatient C/L is a fairly academic specialty however, so if you are not interested in working in academics I'm not sure why or even how you would do C/L. Most community hospitals don't have a C/L service. Most psychiatrists (even in academic centers) don't do C/L full time. It is actually pretty hard to find a full-time inpatient C/L gig. It is much easier to find an ER psych gig but full time this would almost certainly been in an academic hospital or at least affiliated county hospital as most hospitals don't have psych ERs. C/L is hard to bill for so hospitals end up eating the cost. They exist because other docs don't want to deal with mental illness and if you can show that you save the hospital money by identifying delirium, depression etc that lead to increased length of stay, readmissions, increased healthcare utilization etc. I would also imagine that C/L would be a lot more boring at some community hospital than say a level-1 trauma center, or a hospital where they do lots of transplants, oncology and see weird and wonderful stuff.

    If you want to do outpatient C/L which is becoming more common, especially primary care psychiatry given the move towards collaborative care, there will be more and more outpatient jobs. However you don't necessarily have to do psychosomatics fellowship to do these, and in fact most psychosomatic fellowships don't give you enough outpatient experience for this.
     
  11. michaelrack

    michaelrack All In at the wrong time SDN Advisor 7+ Year Member

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    While some IM training can be helpful in doing addictions, it isn't necessary and won't actually help you get the job or higher pay. IM training wouldn't help you at all for being a medical director of a psych hospital; I think jjmack may be confusing the job duties of medical director and a medical consultant.
     
  12. IN321

    IN321 2+ Year Member

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    I remember interviewing at some IM/Psych programs, and in the end I realized that I would likely end up doing psych, so I decided that putting in an extra year, PLUS doing ALMOST ALL of your elective time in IM was not worth it for me. IM/Psych would be someone that likes end of life care, and even then, you can go into a palliative fellowship with psych. Regardless, the money will be the same. Also, you know, as a medical student, there is plenty of conversation about competitiveness of residency types; once your in residency, that goes away, and once you graduate, one one cares. So don't fall into the hype and go into what you like. If psych is for you, don't attach IM to it for competitiveness, as you will be miserable if you don't like IM, and you will miss out on really fun elective time.
     

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