Combined residency

[Jollygooddoc]

Hello, all - thank you for your helpful replies to my previous posts. Sorry to be such a pain in the neck, but I have another question that I have not been able to find an answer to in the previous posts. What is the standing of so-called combined residency programmes? Are the graduates of these programmes treated the same way as the graduates of one-specialty categorical programmes? For example, if I went into a combined FP/Psych, or Psych/Neurology, would I be as attractive (as a Psychiatrist, of course) to the future employer as if I did my residency in Psych only? The thing is I love Psych, and see my relocation to the US as a perfect opportunity to have proper Psych training. On the other hand, it would be a shame to waste all my years of GP training and practice. Or, would Psychosomatic Medicine Fellowship be the answer? Any ideas would be most gratefully received.

Best wishes,
L.

 

[BrianUM]

Hey OP

I am only going to be an M-1 this fall so take my words with a grain of salt

If you are interested in a more medically integrated approach to psychiatry, then psychosomatic medicine may be a possibility

However, check out Neuropsychiatry fellowships accredited by the UCNS. It sounds great and you can enter it after completing a psychiatry or neurology residency: http://www.ucns.org/accreditation/application/BN_NP_Core_Curriculum_8-2-04.pdf

Also keep in mind that rumors have been circulating that Neuropsychiatry was actually approved as A COMPLETELY NEW RESIDENCY, separate from psychiatry and neurology and that it will soon be available across the country. Don't ask me for sources as this is simply what someone told me who has spoken with a Neurologist/Neuropsychiatrist in the know. Supposedly all UCNS Neuropsychiatry and Behavioral Neurology fellowships will be turned into formal residencies.

 

[Doc Samson]

Hey OP

I am only going to be an M-1 this fall so take my words with a grain of salt

If you are interested in a more medically integrated approach to psychiatry, then psychosomatic medicine may be a possibility

However, check out Neuropsychiatry fellowships accredited by the UCNS. It sounds great and you can enter it after completing a psychiatry or neurology residency: http://www.ucns.org/accreditation/application/BN_NP_Core_Curriculum_8-2-04.pdf

Also keep in mind that rumors have been circulating that Neuropsychiatry was actually approved as A COMPLETELY NEW RESIDENCY, separate from psychiatry and neurology and that it will soon be available across the country. Don't ask me for sources as this is simply what someone told me who has spoken with a Neurologist/Neuropsychiatrist in the know. Supposedly all UCNS Neuropsychiatry and Behavioral Neurology fellowships will be turned into formal residencies.

This isn't happening anytime soon. The time scale for the approval of a new residency field is quite extensive, and as far as I know the ABPN (who'd have to approve it) haven't been approached.

 

[BrianUM]

This isn't happening anytime soon. The time scale for the approval of a new residency field is quite extensive, and as far as I know the ABPN (who'd have to approve it) haven't been approached.

Yeah I was wondering how it would get approved so quickly. The person who told me this said that the residency was just approved this past year and that programs such as UCSF are in the process of converting the fellowship into a residency. Again, I have no way of knowing if this is accurate or not; im just passing along what I heard.

 

[Chewbacca Jung]

Hello, all - thank you for your helpful replies to my previous posts. Sorry to be such a pain in the neck, but I have another question that I have not been able to find an answer to in the previous posts. What is the standing of so-called combined residency programmes? Are the graduates of these programmes treated the same way as the graduates of one-specialty categorical programmes? For example, if I went into a combined FP/Psych, or Psych/Neurology, would I be as attractive (as a Psychiatrist, of course) to the future employer as if I did my residency in Psych only? The thing is I love Psych, and see my relocation to the US as a perfect opportunity to have proper Psych training. On the other hand, it would be a shame to waste all my years of GP training and practice. Or, would Psychosomatic Medicine Fellowship be the answer? Any ideas would be most gratefully received.

Best wishes,
L.

Just make sure that when you are doing a combined residency that you are planning to fulfill a niche that is not met by either residency alone. One of my preceptors (med/psych) was doing both psychiatry inpatient and medicine for another job. On the psych inpt unit, he kept getting bombarded with other attendings trying to dump medically complicated psych patients on his floor, which would equate to more work and the same amount of pay. Now he is switching over to a new med/psych floor where he will treat medically complicated psych patients, but will be reimbursed for his work. So if you have a dual boarding you really have to advocate for your self and draw some serious lines, because you can become enmeshed in both fields' problem patients.

 

[solumanculver]

There's a rumor about a neuropsychiatry residency? What would be the purpose of said residency? It seems like there's barely a purpose to neuropsychiatry fellowships... dementia...? Does anybody have a link to the source of this rumor?

 

[jjmack]

There's a rumor about a neuropsychiatry residency? What would be the purpose of said residency? It seems like there's barely a purpose to neuropsychiatry fellowships... dementia...? Does anybody have a link to the source of this rumor?

I am confused about the utility too.

 

[sga430]

i feel one residency is enuff for a lifetime. i recommend looking into consultant liasion or psychosomatic psychiatry. u do 4 years plus 1 year fellowship. actually a fellowship is not a requirement. maybe important in academic settings.

c/l psychiatrists work in hospitals and deal with interdisciplinary problems. (eg. someone with kidney failure needs to adjust his psych meds, those with steriod rx with psych probs, etc.) ur background would serve u well.

also combined programs r more competetive. as an img u need to apply to plain psych. i recommend going with one residency. if u want to learn more do fellowships. (check the forum on info on this.)

also i doubt a combined residency would equal more pay. psych pays more than fp and u will be doing psych most likely. doing a fellowship may increase ur salary.

there r other medical oriented fellowships as well like neuropsych, psychopharm, pain psychiatry, etc.

 

[HCE]

If you get the urge to combine psych and neurology, or psych and medicine, just do the psych residency and use your elective time to explore the other field. This seems to make more sense then doing another or a combined residency, as you can focus your elective time on those aspects of the secondary field that actually interest you....in my humble opinion..

 

[lloyd braun]

If you get the urge to combine psych and neurology, or psych and medicine, just do the psych residency and use your elective time to explore the other field. This seems to make more sense then doing another or a combined residency, as you can focus your elective time on those aspects of the secondary field that actually interest you....in my humble opinion..

I will be starting a combined residency soon, and I thought about doing what is posted above. However, if you truly want to get a solid knowledge base in medicine, you can't satisfy this by merely doing electives. It would also be near impossible to have continuity clinics in medicine, which was very important for me.

I strongly encourage anyone who is seriously interested in doing a combined residency to check it out. There are advantages and disadvantages of course, but I think it is worth it. Feel free to PM me if you have more questions.

 

[sasevan]

I will be starting a combined residency soon, and I thought about doing what is posted above. However, if you truly want to get a solid knowledge base in medicine, you can't satisfy this by merely doing electives. It would also be near impossible to have continuity clinics in medicine, which was very important for me.

I strongly encourage anyone who is seriously interested in doing a combined residency to check it out. There are advantages and disadvantages of course, but I think it is worth it. Feel free to PM me if you have more questions.

hi,
what do you see as the benefit of doing a combined residency in psych/med, as opposed to doing a fellowship in psychosomatic med? will one limit your future professional development?

 

[sga430]

hi,
what do you see as the benefit of doing a combined residency in psych/med, as opposed to doing a fellowship in psychosomatic med? will one limit your future professional development?

of course a c/l psychiatrist is no substitute for an IM doc and vice versa probably.

 

[Anasazi23]

I thought I could chime in with a couple comments.

First off, there is a neuropsychiatry dual residency possibility in which one becomes boarded in both psychiatry and neurology. We've had semi-extensive threads on this in the past, but I can sum it up by saying that this is a very interesting and lucrative field. Theoretically, a neuropsychiatrist specializes in conditions and syndromes that are likely neurological in nature, and have psychiatric sequelae. Not to create a mind-body dualism, I'll provide an example:

Post-TBI patient who develops personality change, seizures, and is suffering functional loss.

The neuropsychiatrist would be able to treat this person comprehensively (i.e. the seizures, brain recovery, and psychiatric symptoms).

In practice, neuropsychiatrists treat seizure disorders, may conduct EEGs or EMGs, see and manage Parkinson's, Huntington's, and all sorts of Parkinson'g Plus syndromes, and lots of other stuff.

When it comes to psych-med vs. psychosomatic, one must realize that simply completing a psychosomatic medicine fellowship will not really put you on track to practice internal medicine. To borrow from the American Academy of Psychosomatic Medicine, a definition of a psychosomatic medicine specialist could be: clinicians dedicated to the scientific understanding of the interaction of mind, brain, body and social context in promoting health and contributing to the pathogenesis, course and treatment of disease.

One could see how this is different from psych/IM residency, which will basically allow one to be boarded in either, and in most cases, have you practicing psychiatry (likely in a hospital setting), and manage medical problems concomitantly. There are also Med-Psych units which employ these types of physicians. These units are basically for medically sick psychiatric patients, and often incorporate end stage dementias and the like.

Hope this helps.

 

[BrianUM]

I thought I could chime in with a couple comments.

First off, there is a neuropsychiatry dual residency possibility in which one becomes boarded in both psychiatry and neurology. We've had semi-extensive threads on this in the past, but I can sum it up by saying that this is a very interesting and lucrative field. Theoretically, a neuropsychiatrist specializes in conditions and syndromes that are likely neurological in nature, and have psychiatric sequelae. Not to create a mind-body dualism, I'll provide an example:

Post-TBI patient who develops personality change, seizures, and is suffering functional loss.

The neuropsychiatrist would be able to treat this person comprehensively (i.e. the seizures, brain recovery, and psychiatric symptoms).

In practice, neuropsychiatrists treat seizure disorders, may conduct EEGs or EMGs, see and manage Parkinson's, Huntington's, and all sorts of Parkinson'g Plus syndromes, and lots of other stuff.

When it comes to psych-med vs. psychosomatic, one must realize that simply completing a psychosomatic medicine fellowship will not really put you on track to practice internal medicine. To borrow from the American Academy of Psychosomatic Medicine, a definition of a psychosomatic medicine specialist could be: clinicians dedicated to the scientific understanding of the interaction of mind, brain, body and social context in promoting health and contributing to the pathogenesis, course and treatment of disease.

One could see how this is different from psych/IM residency, which will basically allow one to be boarded in either, and in most cases, have you practicing psychiatry (likely in a hospital setting), and manage medical problems concomitantly. There are also Med-Psych units which employ these types of physicians. These units are basically for medically sick psychiatric patients, and often incorporate end stage dementias and the like.

Hope this helps.

Hey Anasazi,

As far as you are aware can a Neurologist or Psychiatrist who is fellowship trainined in Neuropsychiatrist run the same practice as a double boarded Psychiatrist and Neurologist? I was under the impression that combined psych and neuro programs were fading away in the face of Neuropsychiatry fellowships. Also when you say that the field is lucrative, can you give me an estimate as to how much such physicians make?

Thanks!

 

[Anasazi23]

Hey Anasazi,

As far as you are aware can a Neurologist or Psychiatrist who is fellowship trainined in Neuropsychiatrist run the same practice as a double boarded Psychiatrist and Neurologist? I was under the impression that combined psych and neuro programs were fading away in the face of Neuropsychiatry fellowships. Also when you say that the field is lucrative, can you give me an estimate as to how much such physicians make?

Thanks!

The truth is that neuropsychiatry fellowships are in their infancy. It will be years before neuropsychiatry fellowship docs replace combined residency docs in numbers, I would think.

I would also think that there wouldn't be a tremendous difference between the two aforementioned fields, though there may be some differences. My thought would be that a neuropsychiatry fellowship trained 'psychiatrist' woud probably not act as a full fledged attending on a neurology floor part time or more, which I believe occurs a significant amount of time now, if my experience is any indication. The practice of a fellowship trained neuropsychiatrist would likely remain more outpatient, specialized practice like I described earlier, with more emphasis on psych cases and neuropsychiatry cases than pure neurology cases per se.

Neurologists generate money through imaging, and can charge for procedures such as EMG, EEG reading, botox and more. We already know that psychiatry can be lucrative. Combined trained physicians are often eligible for higher level positions in hospitals, as department heads, medical directors, etc. These also produce large salaries...especially combined with faculty practice or separate private practice. Further, forensic testimony from these docs are highly sought-after. So yes, it can be very lucrative. The ones with which I worked are pulling in around 400 to 500k.

 

[BrianUM]

The truth is that neuropsychiatry fellowships are in their infancy. It will be years before neuropsychiatry fellowship docs replace combined residency docs in numbers, I would think.

I would also think that there wouldn't be a tremendous difference between the two aforementioned fields, though there may be some differences. My thought would be that a neuropsychiatry fellowship trained 'psychiatrist' woud probably not act as a full fledged attending on a neurology floor part time or more, which I believe occurs a significant amount of time now, if my experience is any indication. The practice of a fellowship trained neuropsychiatrist would likely remain more outpatient, specialized practice like I described earlier, with more emphasis on psych cases and neuropsychiatry cases than pure neurology cases per se.

Neurologists generate money through imaging, and can charge for procedures such as EMG, EEG reading, botox and more. We already know that psychiatry can be lucrative. Combined trained physicians are often eligible for higher level positions in hospitals, as department heads, medical directors, etc. These also produce large salaries...especially combined with faculty practice or separate private practice. Further, forensic testimony from these docs are highly sought-after. So yes, it can be very lucrative. The ones with which I worked are pulling in around 400 to 500k.

Thanks so much for your input! As always you are very informative!

I am only going to start medical school this year so my main interests are likely to change but I am certainly intrigued by both psychiatry and neurology. I am going to go to UMiami for med school and I know they have a combined psych/neuro program. Perhaps by the time I graduate med school, I will have a better idea of which path I should take if I remain interested in psych and neuro: neuropsych fellowship, combined residency or even staight neuropsych residency if they exist by then in 2011 😱

Once again, thanks a lot!

 

[lloyd braun]

hi,
what do you see as the benefit of doing a combined residency in psych/med, as opposed to doing a fellowship in psychosomatic med? will one limit your future professional development?

Those who do med/psych residencies go on to do many things, and are certainly not limited to practicing psychosomatic medicine. I am not very interested in practicing psychosomatic medicine, so doing a fellowship would not be the best use of my time. I am, however, interested in primary care and general psychiatry issues as they relate to public health. I don't think doing a fellowship or a combined residency will ever limit your professional development. On the contrary, I think it leaves a lot of doors open--some of which will likely have to be closed later. Nevertheless, at this time, I don't want to limit my future career options...make sense?

 

[BrianUM]

Hey All,

I was wondering if its possible to train in Neurology followed by a Neuropsych residency and see pts. with primary psychiatric disorders. According to mhtml:http://www.uchsc.edu/psychiatry/res...Intro_and_Historical_Overview_files/frame.htm , there is no fine line b/w psychiatric and neurological illness and both are interpreted as "brain disorders." Even psychological factors are interpreted as affecting the brain. Thus, would it then be possible for a Neurologist trained in this fellowship to not only manage complicated Neurological and Psychiatric comorbities but also primary psychiatric cases? In such a scenario, the physician could open a practice and see cases ranging from MS and epilepsy w/ psych comorbitites (if any) to primary psychiatric disorders. Kind of like being double boarded in psych and neuro except only trained in Neuro and this fellowship.

Thanks

 

[nala56]

I thought I could chime in with a couple comments.

First off, there is a neuropsychiatry dual residency possibility in which one becomes boarded in both psychiatry and neurology. We've had semi-extensive threads on this in the past, but I can sum it up by saying that this is a very interesting and lucrative field. Theoretically, a neuropsychiatrist specializes in conditions and syndromes that are likely neurological in nature, and have psychiatric sequelae. Not to create a mind-body dualism, I'll provide an example:

Post-TBI patient who develops personality change, seizures, and is suffering functional loss.

The neuropsychiatrist would be able to treat this person comprehensively (i.e. the seizures, brain recovery, and psychiatric symptoms).

In practice, neuropsychiatrists treat seizure disorders, may conduct EEGs or EMGs, see and manage Parkinson's, Huntington's, and all sorts of Parkinson'g Plus syndromes, and lots of other stuff.

When it comes to psych-med vs. psychosomatic, one must realize that simply completing a psychosomatic medicine fellowship will not really put you on track to practice internal medicine. To borrow from the American Academy of Psychosomatic Medicine, a definition of a psychosomatic medicine specialist could be: clinicians dedicated to the scientific understanding of the interaction of mind, brain, body and social context in promoting health and contributing to the pathogenesis, course and treatment of disease.

One could see how this is different from psych/IM residency, which will basically allow one to be boarded in either, and in most cases, have you practicing psychiatry (likely in a hospital setting), and manage medical problems concomitantly. There are also Med-Psych units which employ these types of physicians. These units are basically for medically sick psychiatric patients, and often incorporate end stage dementias and the like.

Hope this helps.

Are neuropsychiatrists in the United States as rare as neurosurgeons in the United States (there are only 2500 neurosurgeons in the U.S.A.)?🙁