Dangerous idea?

[Drrrrrr. Celty]

I've always been very interested in psychiatry and it's my first choice. But subsequently I've as time has gone by become interested in internal medicine as a specialty. I would like to apply to both specialties and see if I can through such improve my chances of being able to practice locally to where I am from and where I would like to eventually live.

Is it dangerous considering that many programs are run under the same university? Should I limit my applications to universities and programs that don't have both programs? What about applying to both programs in both specialties and then only attending one if given both or just the one that I receive the interview?

I think I could be a lot more happy doing psych in the long run, but I think that being able to settle down with an IM program locally and do a fellowship probably would equal out in terms of happiness down the road. Obviously local + psych probably would be undoubtedly the greatest outcome.

I'd also like to really limit myself from ending up in the soap or scramble and ending up across the country honestly as well.

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[BorntobeDO?]

My general thought is that you do one or another at any institutions you apply for. I have heard that if you are up front about it you can interview at both at the same institution. I have had some similar thoughts myself (tho not psych and IM specifically).

Location is a big deal but so is your specialty. I am inclined to think that if you apply to two different specialty at one hospital you decrease your chances of matching either one. But I think a summons is in order. What do you think @aProgDirector ?

 

[MiaMia14]

On SDN it is taboo to apply to two separate specialties at the same hospital, but just from experience I would say my program director likely has no idea who applied to the other programs at my hospital...they are too busy to talk about every applicant with every specialties program director. We are swamped with our own applicants, the program director has her own practice, and is also running the program. It would likely be fine.

 

[DocWinter]

An app is only an app. Throw them both at the programs and see if you get one (or both). From my experience interviewing and matching, I would be very suprised if PDs and PCs cared to sit down and interdepartmentally vett the list . Also, it only brings up the obvious interview question "why", and you have a good answer for that

 

[NotAProgDirector]

Although I don't routinely check to see if someone is applying to more than one program, I might reach out if your application looks like you might be dual applying -- for example if there's both a psych and IM SubI, or lots of psych research, or interest groups, etc. Also, if you interview with both programs you might cross paths with someone from your 1st interview day on your 2nd. I don't want to be someone's second choice specialty.

 

[Chibucks15]

Although I don't routinely check to see if someone is applying to more than one program, I might reach out if your application looks like you might be dual applying -- for example if there's both a psych and IM SubI, or lots of psych research, or interest groups, etc. Also, if you interview with both programs you might cross paths with someone from your 1st interview day on your 2nd. I don't want to be someone's second choice specialty.

Is it at all realistic to truly be interested in both specialties? Say like neuro/IM? Or is it just not worth the risk unless you write up two different applications to avoid the situation you described.

 

[Drrrrrr. Celty]

Although I don't routinely check to see if someone is applying to more than one program, I might reach out if your application looks like you might be dual applying -- for example if there's both a psych and IM SubI, or lots of psych research, or interest groups, etc. Also, if you interview with both programs you might cross paths with someone from your 1st interview day on your 2nd. I don't want to be someone's second choice specialty.

well if I cant even get an interview in psych at your program then you're totally as an IM program near home a more high choice than other things is my mindset.

but I see.

Sent from my SM-G950U using SDN mobile

 

[QueenJames]

You are way too smart for psych dude.

I can see you being a subspecialist no doubt.

Do what makes you happy though!

 

[ankiii]

You are way too smart for psych dude.

I can see you being a subspecialist no doubt.

Do what makes you happy though!

This is incredibly insulting.

 

[Chibucks15]

This is incredibly insulting.

He obviously didn't mean it derogatory towards psych or anything cmon now...

 

[QueenJames]

This is incredibly insulting.

Oh come on dude!

Give me a damn break.

I've seen celty on here for a while. His/her interests lie in more cerebral specialties.

Jesus.

Are you a millennial? Stop getting all butthurt.

 

[Peach Newport]

Oh come on dude!

Give me a damn break.

I've seen celty on here for a while. His/her interests lie in more cerebral specialties.

Jesus.

Are you a millennial? Stop getting all butthurt.

Being a good psychiatrist, especially one who does research, is as cerebral and challenging as it gets. Psych does use a slightly different skillset.

 

[QueenJames]

Being a good psychiatrist, especially one who does research, is as cerebral and challenging as it gets. Psych does use a slightly different skillset.

Which I absolutely agree with.

IMO Psych is a pure art form.

However, some of the shadiest things I have seen in clinic and psych and the DSM and constant medication and pill-pushing just doesn't do it for me or for the psychiatrists I have talked to.

I have huge amount of respect for those docs who still do talk therapy... THAT is a gift.

Any monkey can switch meds if one doesn't work.

But relating to a patient and helping them redirect their mental thought...?

That requires patience, empathy, and pure tenacity that I just don't have because I'd have to restrain myself from telling the depressed 15 year old to "Get the eff over it and move on. It could always be worse. There are kids out there who have way less than you that are making things work and your life is not as hard as you would like to believe."

I'm not trying to piss anybody off but these days...?

I really just dgaf.

More spoiled brats and millennials entering medicine and being crybabies about words.

Jesus.

 

[Peach Newport]

Which I absolutely agree with.

IMO Psych is a pure art form.

However, some of the shadiest things I have seen in clinic and psych and the DSM and constant medication and pill-pushing just doesn't do it for me or for the psychiatrists I have talked to.

I have huge amount of respect for those docs who still do talk therapy... THAT is a gift.

Any monkey can switch meds if one doesn't work.

But relating to a patient and helping them redirect their mental thought...?

That requires patience, empathy, and pure tenacity that I just don't have because I'd have to restrain myself from telling the depressed 15 year old to "Get the eff over it and move on. It could always be worse. There are kids out there who have way less than you that are making things work and your life is not as hard as you would like to believe."

I'm not trying to piss anybody off but these days...?

I really just dgaf.

More spoiled brats and millennials entering medicine and being crybabies about words.

Jesus.

The challenge, IMO, is listening to a patient’s words and thought processes, cross-referencing that with their history, and putting together a reasonable profile of their neurochemistry. Thinking about how to tweak that profile with drugs and therapy.

Don’t forget that psychiatry is a medical specialty. You’re identifying neural pathology and altering neural and somatic physiology with drugs. The problem is that, in other specialties, your parameters and results are often clean, easy to read numbers. In psych, your data points require training, critical thinking, and empathy to properly interpret.

 

[Drrrrrr. Celty]

Oh come on dude!

Give me a damn break.

I've seen celty on here for a while. His/her interests lie in more cerebral specialties.

Jesus.

Are you a millennial? Stop getting all butthurt.

I'm not sure Psych isn't a cerebral specialty lol. Probably more so than a lot of other fields from my perspective.

 

[QueenJames]

The challenge, IMO, is listening to a patient’s words and thought processes, cross-referencing that with their history, and putting together a reasonable profile of their neurochemistry. Thinking about how to tweak that profile with drugs and therapy.

Don’t forget that psychiatry is a medical specialty. You’re identifying neural pathology and altering neural and somatic physiology with drugs. The problem is that, in other specialties, your parameters and results are often clean, easy to read numbers. In psych, your data points require training, critical thinking, and empathy to properly interpret.

Correction.

A GOOD psychiatrist will do these things.

A MAJORITY of them (atleast the ones that have turned me off to mental health) are the ones who strictly rely on the DSM for EVERYTHING and go through medication after medication after medication or diagnose everything as "mdd".

Psychiatry is one of the hardest fields to do WELL at in my opinion. It's just that the fascination with mental health is now so new that we have a bunch of people (not EVERYBODY for you Bozos that don't know how to read) in the field that do the bare minimum and become pull pushers and that's all.

 

[Drrrrrr. Celty]

Which I absolutely agree with.

IMO Psych is a pure art form.

However, some of the shadiest things I have seen in clinic and psych and the DSM and constant medication and pill-pushing just doesn't do it for me or for the psychiatrists I have talked to.

I have huge amount of respect for those docs who still do talk therapy... THAT is a gift.

Any monkey can switch meds if one doesn't work.

But relating to a patient and helping them redirect their mental thought...?

That requires patience, empathy, and pure tenacity that I just don't have because I'd have to restrain myself from telling the depressed 15 year old to "Get the eff over it and move on. It could always be worse. There are kids out there who have way less than you that are making things work and your life is not as hard as you would like to believe."

I'm not trying to piss anybody off but these days...?

I really just dgaf.

More spoiled brats and millennials entering medicine and being crybabies about words.

Jesus.

Overall plenty of doctors practice some shady or crappy medicine. I've seen more random non-psychiatrists prescribing benzos like candy.

I think all medicine is an art form. I think IM at least for me is probably a bit too conformist and far too industrial. I would probably be an unhappy camper in the long run managing 25 beds + admits a day in patient for sure. Because for what it's worth I really wouldn't be able to do what I find most interesting in medicine, actually have legitimate interactions with patients.

I think most medicine is pretty much give med and watch effect, play around with it.

 

[Drrrrrr. Celty]

An app is only an app. Throw them both at the programs and see if you get one (or both). From my experience interviewing and matching, I would be very suprised if PDs and PCs cared to sit down and interdepartmentally vett the list . Also, it only brings up the obvious interview question "why", and you have a good answer for that

So you think it's fine and it won't hurt me?

 

[hallowmann]

So you think it's fine and it won't hurt me?

I don't think applying to both will hurt you. You should make both separate apps pretty unique to each specialty. Make sure your letters are unique to one or the other or at least don't have them specify a specialty. I don't know what your school's transcript looks like, but most SubI's and aways/auditions are in 4th year, and my transcript barely had any 4th year rotations on it.

When it comes to actually interviewing, I would not interview at both programs in the same institution. Having been through the selection process and ranking process for my program this year, there definitely were people that were seen at other interviews, and that was an instant reason to rank them lower or not at all (depending on other factors).

As for combined, IM/Psych is certainly an option, but there are only like 12 of those programs and they take 2-3 residents a year. If the region you want to end up in has one (or more) of those and its something you actually want, then it might be worth it. I wouldn't apply to all 3 programs though at those sites (IM, Psych, and IM/Psych), I'd limit it to two.

Now I will say that IM and Psych have very different lifestyles, residencies, and even practice styles. If you're going to apply to both, make sure you do plenty of rotations in both, and really pay attention to how you feel attending each interview. You should be able to tell if you "fit" somewhere.

I'm not sure what your reasons are for wanting to be in a very specific region, but make sure you rank places based on what you want to do for the rest of your life. If by the end of interview season they really are truly equal in your mind, then by all means base it solely on location.

 

[Drrrrrr. Celty]

I don't think applying to both will hurt you. You should make both separate apps pretty unique to each specialty. Make sure your letters are unique to one or the other or at least don't have them specify a specialty. I don't know what your school's transcript looks like, but most SubI's and aways/auditions are in 4th year, and my transcript barely had any 4th year rotations on it.

When it comes to actually interviewing, I would not interview at both programs in the same institution. Having been through the selection process and ranking process for my program this year, there definitely were people that were seen at other interviews, and that was an instant reason to rank them lower or not at all (depending on other factors).

As for combined, IM/Psych is certainly an option, but there are only like 12 of those programs and they take 2-3 residents a year. If the region you want to end up in has one (or more) of those and its something you actually want, then it might be worth it. I wouldn't apply to all 3 programs though at those sites (IM, Psych, and IM/Psych), I'd limit it to two.

Now I will say that IM and Psych have very different lifestyles, residencies, and even practice styles. If you're going to apply to both, make sure you do plenty of rotations in both, and really pay attention to how you feel attending each interview. You should be able to tell if you "fit" somewhere.

I'm not sure what your reasons are for wanting to be in a very specific region, but make sure you rank places based on what you want to do for the rest of your life. If by the end of interview season they really are truly equal in your mind, then by all means base it solely on location.

I think I'm just not sure what I should do about the potential that I go unmatched tbh. Like I'd rather not scramble into a Tri in a place that I wouldn't be happy. Hence why I was considering IM as a back up.

But I think I've resolved my worries more or less.

 

[hallowmann]

I think I'm just not sure what I should do about the potential that I go unmatched tbh. Like I'd rather not scramble into a Tri in a place that I wouldn't be happy. Hence why I was considering IM as a back up.

But I think I've resolved my worries more or less.

As a backup, its fine, apply IM as a backup. But to be honest, if you apply broadly for Psych and don't limit yourself to university-only and specific region only, you should be fine.

 

[Drrrrrr. Celty]

As a backup, its fine, apply IM as a backup. But to be honest, if you apply broadly for Psych and don't limit yourself to university-only and specific region only, you should be fine.

I think as long as I'm on the East Coast between NC and New York I'll be content.

 

[ortnakas]

I think as long as I'm on the East Coast between NC and New York I'll be content.

That’s a wide enough net I think you should be okay. The people that run into trouble that I know of are the ones who restrict themselves to one city they absolutely have to be in, especially when it’s a city that’s popular to start with.

You only have one ERAS, so just make sure you have distinct letters for IM and psych, and distinct personal statements as well. You can upload as many of you want— just make sure your letter writers know what they are recommending you for, and that all files labeled correctly so you assign them to the right programs.

 

[Candidate2017]

I've always been very interested in psychiatry and it's my first choice. But subsequently I've as time has gone by become interested in internal medicine as a specialty. I would like to apply to both specialties and see if I can through such improve my chances of being able to practice locally to where I am from and where I would like to eventually live.

Is it dangerous considering that many programs are run under the same university? Should I limit my applications to universities and programs that don't have both programs? What about applying to both programs in both specialties and then only attending one if given both or just the one that I receive the interview?

I think I could be a lot more happy doing psych in the long run, but I think that being able to settle down with an IM program locally and do a fellowship probably would equal out in terms of happiness down the road. Obviously local + psych probably would be undoubtedly the greatest outcome.

I'd also like to really limit myself from ending up in the soap or scramble and ending up across the country honestly as well.

Apply psych in your geographical preference. Scramble IM if you don't match. Tons of IM spots will be unfilled and you will likely waltz into your geographical choice. The average IM residency is interchangeable with any IM residency, they all suck.

 

[Candidate2017]

Because for what it's worth I really wouldn't be able to do what I find most interesting in medicine, actually have legitimate interactions with patients.

"Legitimate" interactions with patients also include things like patients screaming at you for not giving them pain meds, death threats, overly involved family members demanding daily meetings and rectals.

 

[hallowmann]

"Legitimate" interactions with patients also include things like patients screaming at you for not giving them pain meds, death threats, overly involved family members demanding daily meetings and rectals.

Yeah, but in psych, they explain that the reason they're screaming at you is because you're part of a conspiracy orchestrated by engineered cyborgs created by the illuminati to control the world (especially their mind and make them do things). And then you try to convince them to take their antipsychotics. Then you commit them, so that you can make them take the antipsychotics. Then they get better and complain about hospital food. Its a great field.

 

[Candidate2017]

Yeah, but in psych, they explain that the reason they're screaming at you is because you're part of a conspiracy orchestrated by engineered cyborgs created by the illuminati to control the world (especially their mind and make them do things). And then you try to convince them to take their antipsychotics. Then you commit them, so that you can make them take the antipsychotics. Then they get better and complain about hospital food. Its a great field.

The science behind schizophrenia and related disorders is very cool, as well as the improvements we can make with meds. In practice on the inpatient units I find it to be mundane. Schizophrenic goes off meds, blubbers about illuminati/government conspiracy/devil/electronic surveillance/brain implant, refuses to take meds, get court order, transition to long acting injectable or clozaril or ECT, manage and watch for side effects, wait 2 weeks, get placement, repeat the cycle within 6 months. Its the psychiatric equivalent of noncompliant diabetic or HF bounce backs on IM. It's more algorithmic and predictable, making it closer to IM than the rest of psych because the medications are so effective ironically. More science than art. To each their own. The anorexics, paraphillics, personality disordered I find more interesting (but not always) because there is no magic pill, more art than science.

 

[hallowmann]

The science behind schizophrenia and related disorders is very cool, as well as the improvements we can make with meds. In practice on the inpatient units I find it to be mundane. Schizophrenic goes off meds, blubbers about illuminati/government conspiracy/devil/electronic surveillance/brain implant, refuses to take meds, get court order, transition to long acting injectable or clozaril or ECT, manage and watch for side effects, wait 2 weeks, get placement, repeat the cycle within 6 months. Its the psychiatric equivalent of noncompliant diabetic or HF bounce backs on IM. It's more algorithmic and predictable, making it closer to IM than the rest of psych because the medications are so effective ironically. More science than art. To each their own. The anorexics, paraphillics, personality disordered I find more interesting (but not always) because there is no magic pill, more art than science.

Personally I find the manic patients and schizophrenics way more interesting than another borderline patient threatening to kill themselves, getting "better" in days, and then coming back next month with exactly the same story, but 100 reasons why they can't do DBT. To each their own I guess. I've seen more recidivism in the personality disorder patients than I have in the ones with psychosis, but maybe I've just been lucky.