Family Med fellow in mental health vs. Psychiatry?

[Pharmohaulic]

So I keep seeing many Family Medicine fellowships in mental health/ behavioral medicine to help fill meet the needs for all the mental health patients out there who don't have a psychiatrist and rely on their primary care doctor.

As I was looking through the fellowships, many said the provide and intense 1 year ddactic training in psychiatry where they learn the diagnosis and med management of psychiatric diagnosis and how to do some psychotherapy.

In this case, what then becomes the difference between a FM physician with this training and a psychiatrist?

---

Members don't see this ad.

 

[MrChance2]

2.5 years of psychiatric training it would seem.

 

[MrChance2]

.oops said it twice.

 

[Pharmohaulic]

2.5 years of psychiatric training it would seem.

Well yes, but I mean in terms of what they can do?

 

[MrChance2]

Well yes, but I mean in terms of what they can do?

Sorry, not the best response. The answer is whatever they are comfortable with and what kind of patients they can get.

I would think a family med who does a fellowship in psych would see more psych patients but would still primarily function as a PCP. I don't think they would get psych referrals ever.

Psychologists who are board certified spend 8 years or so learning therapy. Learning it in one year is impossible. But I think it would help you be supportive and teach some tricks to help with compliance. I think Doing actual billable therapy would borderline unethical and insurance companies wouldn't pay for it.

I think some psychiatrists would appreciate this around as they could do some med checks and some of the maitnence stuff on less complex patients. Some docs consult psych VERY light.

I'm a 4th year med student going into psych so possibly some more experienced people can comment.

 

[Pharmohaulic]

Sorry, not the best response. The answer is whatever they are comfortable with and what kind of patients they can get.

I would think a family med who does a fellowship in psych would see more psych patients but would still primarily function as a PCP. I don't think they would get psych referrals ever.

Psychologists who are board certified spend 8 years or so learning therapy. Learning it in one year is impossible. But I think it would help you be supportive and teach some tricks to help with compliance. I think Doing actual billable therapy would borderline unethical and insurance companies wouldn't pay for it.

I think some psychiatrists would appreciate this around as they could do some med checks and some of the maitnence stuff on less complex patients. Some docs consult psych VERY light.

I'm a 4th year med student going into psych so possibly some more experienced people can comment.

Yes but I was comparing them to psychiatrist's and not psychologists because psychologists don't have medical training... unless they are in a state where they can get additional training to rx psychotropics

 

[MrChance2]

Yes but I was comparing them to psychiatrist's and not psychologists because psychologists don't have medical training... unless they are in a state where they can get additional training to rx psychotropics

Truth. To connect the dots. They have less therapy training than psychiatrists who often get not enough to really use it in my opinion.

 

[FrustratedFamDoc]

In my area to be a good family doc, you have to be comfortable at managing psych patents because resources are pretty slim. I do a lot of Bipolar, anx, dep, ADD and some schizophrenia. I only have a few schizophrenic patients, fortunately. My residency was very psych heavy with our clinic patients so I had to get comfortable with it or be pretty miserable. I think a psych fellowship would help a fam doc who didn't have much psych exposure that wants to practice in an area where psychiatrists are in short supply.

Edit: In no way would you come out being equivalent to a psychiatrist after such training.

 

[SansaStarkMD]

Psychiatry gets tricky. For every side effect, you need a drug that combats that side effect, which in turn has side effects. The game stops when there are no other psych medications and the patient is too numb to complain.

 

[FrustratedFamDoc]

Psychiatry gets tricky. For every side effect, you need a drug that combats that side effect, which in turn has side effects. The game stops when there are no other psych medications and the patient is too numb to complain.

All medications have the potential for adverse effects and psychiatric meds are no different. Some are dirtier than others and any good practitioner knows what they are and uses them as a last resort. The majority of my patients are quite happy on their particular regimen. I don't do zombies and tell my patients this right off the bat. I certainly don't have a single patient on a medication to counteract the effects of another medication. That's pretty dumb and irresponsible polypharmacy at it's finest.

There's a lot to psychiatry that med school don't teach.

 

[michaelrack]

I don't think they would get psych referrals ever.
.

In most parts of the country, they could get plenty of psych referrals.
The big issues are credentialing/insurance reimbursement/cross-coverage.

 

[Pharmohaulic]

All medications have the potential for adverse effects and psychiatric meds are no different. Some are dirtier than others and any good practitioner knows what they are and uses them as a last resort. The majority of my patients are quite happy on their particular regimen. I don't do zombies and tell my patients this right off the bat. I certainly don't have a single patient on a medication to counteract the effects of another medication. That's pretty dumb and irresponsible polypharmacy at it's finest.

There's a lot to psychiatry that med school don't teach.

How do you and other internal med physicians feels about the move in some states where some appropriately trained psychologists with an additional 2.5 years of medical training in a post PhD masters, being allowed to collaboratively prescribe with primary care docs to ease the burden?

 

[FrustratedFamDoc]

How do you and other internal med physicians feels about the move in some states where some appropriately trained psychologists with an additional 2.5 years of medical training in a post PhD masters, being allowed to collaboratively prescribe with primary care docs to ease the burden?

Collaboration is a terrible idea. If you want to write something just write something. Psychologists try to suggest medicines to me all the time and I pay it little attention. At the end of the day, it's my license on the line.

 

[Pharmohaulic]

Collaboration is a terrible idea. If you want to write something just write something. Psychologists try to suggest medicines to me all the time and I pay it little attention. At the end of the day, it's my license on the line.

So are you accepting of them prescribing with the appropriate training on their own?

 

[TableMD]

Sounds like a terrible idea.

To keep things simple, if I need help with a diagnosis, I refer to a psychologist, with a note of my concerns/hx/screening scales

If I think someone may need treatment with a medication(s) that I am uncomfortable prescribing, then I refer to a psychiatrist, and hope that

1.) they go
2.) their insurance covers the visit/psychiatrist accepts them
3,) it isnt a 7 month wait

Im not sure where a psychologist-prescriber fits into all of this. Sounds like they want to be a psychiatrist without med school and residency.

 

[JustPlainBill]

Didn't we see this thread a few days/weeks ago?

 

[FrustratedFamDoc]

this is the thread that started all this. when he further questioned me, I didn't take the bait knowing that this would just cause my brain to hurt. After I didn't reply, I believe he made the thread that everyone else chimed in on.

 

[TableMD]

Gotcha. We'll have to ride this out until he moves on to the psych forum


Sent from my iPhone using SDN mobile