Fm/Psych-how competative

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medhead1990

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Hey question or two for sdn world...

1. How competitive is Fm/Psych programs? Regarding is there special letters of rec I should consider, should I spend more EC time doing psych or fm during med school, whats the average step score of one of these programs (I keep reading that's its a little more competitive than either FM or Psych alone but both are rather low step1 scores and as such what ends up being a little bit more)?

2. I am still in the early stages of figuring out what I would want to specialize in as a physician and am apt to change my mind 20 times during med school, however at this point my goal is to go into addiction medicine and open up my own rehabs. I am interested in being able to address both the psych side of addiction as ell as being able to help early recovery type problems such as infections. Is it worth going through the time just to be able to treat both or is it possible to do both from both sides of the fence individually?


thanks in advance!!

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I am also applying for Psych/FM. I have no clue how competitive it is but I was told by a psych/fm doc to attend the Med Psych conference to make connections. It's in Chicago on Oct 10-11.
 
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Applied to 4 of the programs here as well. Also not really sure the op would need the fp portion for what they are describing
 
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Applied to 4 of the programs here as well. Also not really sure the op would need the fp portion for what they are describing

thank you good to know... Also from a Step score standpoint what would you say a good target step 1 would be for med psych?
 
Has anyone heard good news yet? Hoping to meet people on the interview trail!
 
Has anyone heard good news yet? Hoping to meet people on the interview trail!
I've heard nothing yet. 2/4 I applied to are in cali, and being a DO without strong connections to cali I'm not surprised by this
 
I've heard nothing yet. 2/4 I applied to are in cali, and being a DO without strong connections to cali I'm not surprised by this

Beyond being originally from there, what constitutes strong connections? I'm thinking about heading out there for residency, because my wife is originally from there and all her family is out there. Would that be a "strong connection"? Or should I try to become a state resident out there? (I don't know if I actually want to do that right now).
 
hey so you guys who are in the cycle right now what were your USMLE-1 scores? Just so i know what ballpark I should be shooting for...
 
Most docs I know who did any sort of combined program ended up just practicing in just one of the fields- all say they wished they'd focused only on one area.
 
Edit: Didn't realize this was an old thread.

Anyway, for people applying now, here's some info: I applied to the 3 non-Cali ones. I got an interview from Iowa and haven't heard from Pitt or Cincy yet.
 
Most docs I know who did any sort of combined program ended up just practicing in just one of the fields- all say they wished they'd focused only on one area.

The exception being Med/Peds
 
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what's the difference between med/peds and family medicine then?
Think about the difference between IM and FM. Then the differences between peds and FM. Now combine those differences. Congratulations, you have now discovered the differences between FM and IM/Peds.

Basically you're much more qualified to specialize and take care of far sicker patients, but not as capable of dealing with Ob/Gyn.
 
what's the difference between med/peds and family medicine then?

NMPRA does a great job explaining this on their website, but I can give you a few differences.


FM: 3 years of training, 4 (?) months of peds, greater emphasis on outpatient, residents rotate through OB and surgery

Med/Peds: 4 years of training, 24 months of peds, greater emphasis on inpatient and ICU, residents do not rotate through OB or surgery, tons of fellowship options
 
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I am also applying for Psych/FM. I have no clue how competitive it is but I was told by a psych/fm doc to attend the Med Psych conference to make connections. It's in Chicago on Oct 10-11.

Wow. Two years later and this thread has 4600 views with only 16 posts-lots of lurkers. =) With only 10 total spots in the country 4100 is a surprisingly huge number looking at a post about fm/psych.

For anyone who is interested (namely the lurkers) I recently took the advice from Lizjhu and was at the most recent med-psych conference in chicago just this last weekend. It was an excellent experience and I plan on moving forward in a combo residency, that being said it was surprisingly competitive, and i felt quite intimidated. Relative to the demand there is a miniscule amount of residency spots available for the number of applicants who apply. I believe the numbers are 150 applicants to FM-Psych 50/50 split of UMG and IMG for 10 spots, and a similar breakdown for IM-psych with 250 (ish) applicants for 22 spots. https://www.aamc.org/services/eras/stats/.

I will say in the application process is it seems like they definitely try to screen out those who want to do a combined residency because of ambivalence in deciding one specialty or the other. Naturally the better you can do on the boards the better your chances, however that being said I feel the most salient selling point for getting into a combined program is two part 1. Are you a good fit with our program specifically? 2. Are you a good fit for our tight knit weird combo community? Because you really do have to be a certain kind of weird to want to this type of program.

There are some very specific things that combined training are good for and if you are interested in those than it is the perfect place for you. I personally am interested in pain/addiction/correctional medicine as well as integrative primary care delivery. If you are interested in the field because you want to be a psychiatrist but "don't want to hang up the stethoscope" (as has been said in other sdn posts)- or on the other hand want to do FM/IM but still really enjoyed your psych rotations and don't want to let that go, combo training is probably not the place for you. You can still apply but that underlying mind set will probably be picked up along the way in your application process (remember they are psychiatrists). One of the biggest tragedies with so few spots in the country is for a program to take someone on and then come year 3 or 4 they drop out. PD's are very intent on making sure that does not happen. To put it plain they don't want people who have interests in both fields, they are interested in people who want to practice combined medicine.

Disclaimer this is my take on it, I could be totally off base here but this was the vibes I got.

Hope this helps! =)
 
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Wow. Two years later and this thread has 4600 views with only 16 posts-lots of lurkers. =) With only 10 total spots in the country 4100 is a surprisingly huge number looking at a post about fm/psych.

For anyone who is interested (namely the lurkers) I recently took the advice from Lizjhu and was at the most recent med-psych conference in chicago just this last weekend. It was an excellent experience and I plan on moving forward in a combo residency, that being said it was surprisingly competitive, and i felt quite intimidated. Relative to the demand there is a miniscule amount of residency spots available for the number of applicants who apply. I believe the numbers are 150 applicants to FM-Psych 50/50 split of UMG and IMG for 10 spots, and a similar breakdown for IM-psych with 250 (ish) applicants for 22 spots. https://www.aamc.org/services/eras/stats/.

I will say in the application process is it seems like they definitely try to screen out those who want to do a combined residency because of ambivalence in deciding one specialty or the other. Naturally the better you can do on the boards the better your chances, however that being said I feel the most salient selling point for getting into a combined program is two part 1. Are you a good fit with our program specifically? 2. Are you a good fit for our tight knit weird combo community? Because you really do have to be a certain kind of weird to want to this type of program.

There are some very specific things that combined training are good for and if you are interested in those than it is the perfect place for you. I personally am interested in pain/addiction/correctional medicine as well as integrative primary care delivery. If you are interested in the field because you want to be a psychiatrist but "don't want to hang up the stethoscope" (as has been said in other sdn posts)- or on the other hand want to do FM/IM but still really enjoyed your psych rotations and don't want to let that go, combo training is probably not the place for you. You can still apply but that underlying mind set will probably be picked up along the way in your application process (remember they are psychiatrists). One of the biggest tragedies with so few spots in the country is for a program to take someone on and then come year 3 or 4 they drop out. PD's are very intent on making sure that does not happen. To put it plain they don't want people who have interests in both fields, they are interested in people who want to practice combined medicine.

Disclaimer this is my take on it, I could be totally off base here but this was the vibes I got.

Hope this helps! =)

When applying FM-Psych, do most people apply for categorical psych as a backup, or categorical IM as a backup? Do programs care?
 
When applying FM-Psych, do most people apply for categorical psych as a backup, or categorical IM as a backup? Do programs care?
yes you can /no they dont care. This was asked both at the conference back in November and the other week during a conference call put on by the AMP student outreach committee. Yes most people apply to categorical programs as well. All the PD's understand the situation your in when there is only 10 spots total in the country for fm-psych. Its even acceptable to apply to the categorical programs at the same program as well. However you have to be very straightforward in your interview that this is the case.
 
Yeah, while everyone seems to think that you're only practicing one field with combined training, the truth is that in most cases that's too simplistic. I would also argue that FM-psych is a combination that inherently goes together, because psych is such a huge part of primary care.

Even the docs that only work in one type of setting are utilizing their training and it changes how they practice with a clear emphasis on both fields. Many combined docs have explicitly said that they don't wear two hats that they switch between, they wear one that just happens to combine both fields.

In any case, I thought I'd refresh this thread. In terms of numbers, you should at least be competitive for FM and psych respectively. The biggest thing that gets you invites though is networking, meeting people, and having a very targeted application. You need to go to AMP. You need to have a PS that explicitly describes why you want combined training and how you'll use it in the future. You need LORs from each field (i.e. at least one from FM and one from Psych, plus others), and at least some of those LORs should mention combined training. You need to network and stay in contact with combined residents, because its a small community, and you'll be seeing them for years to come.

There's only five programs, and each one is a bit unique:

UCD - Strong and established PD in AMP community, agricultural community with a lot of migrant workers, unique combination of city and nearby agriculture, requires 4 LORs and a supplemental application that's on their website

UCSD - Large university, incredible continuity clinic at St. Vincent de Paul, where you are caring for the homeless population, lots of traveling and issues with parking according to residents, but also lots of opportunities to do a lot of different things in the city

Iowa - Strong emphasis on primary care, PD and some other faculty made up of combined trained docs from the program or the IM-Psych program, IMP program in-house, heavy VA psych curriculum, psmaller University town with a very family friendly atmosphere

Cincy - Very detailed FM curriculum with modules and regular "quizzes", strong emphasis on global health, FM at community hospital, PD is well known in the AMP community and is a psych trained doc

UPMC - Large university system, newest program, huge and incredible Psych hospital (WPIC), PD is a foreign (UK) trained psychiatrist that also worked as a GP, global health emphasis, features two settings for FM training, an unopposed inpatient heavy program in a middle-upper class community (StM) and a hospital with an in-house IM residency in a severely economical depressed/underserved area (McK)

Obviously you can get more from the individual websites and talking to residents. One thing repeatedly said by the residents from all programs is that all the remaining programs are the strongest and all will provide excellent training. It's more a matter of finding where you fit best.

When applying FM-Psych, do most people apply for categorical psych as a backup, or categorical IM as a backup? Do programs care?

You have to apply to a backup. Everyone does. There's only 5 FMP and 11 IMP programs. Some people do FM/IM, some do psych, and some do both. Each year is different, but this year seemed like more people were applying to psych to me. The programs know and understand this.
 
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Yeah, while everyone seems to think that you're only practicing one field with combined training, the truth is that in most cases that's too simplistic. I would also argue that FM-psych is a combination that inherently goes together, because psych is such a huge part of primary care.

Even the docs that only work in one type of setting are utilizing their training and it changes how they practice with a clear emphasis on both fields. Many combined docs have explicitly said that they don't wear two hats that they switch between, they wear one that just happens to combine both fields.

In any case, I thought I'd refresh this thread. In terms of numbers, you should at least be competitive for FM and psych respectively. The biggest thing that gets you invites though is networking, meeting people, and having a very targeted application. You need to go to AMP. You need to have a PS that explicitly describes why you want combined training and how you'll use it in the future. You need LORs from each field (i.e. at least one from FM and one from Psych, plus others), and at least some of those LORs should mention combined training. You need to network and stay in contact with combined residents, because its a small community, and you'll be seeing them for years to come.

There's only five programs, and each one is a bit unique:

UCD - Strong and established PD in AMP community, agricultural community with a lot of migrant workers, unique combination of city and nearby agriculture, requires 4 LORs and a supplemental application that's on their website

UCSD - Large university, incredible continuity clinic at St. Vincent de Paul, where you are caring for the homeless population, lots of traveling and issues with parking according to residents, but also lots of opportunities to do a lot of different things in the city

Iowa - Strong emphasis on primary care, PD and some other faculty made up of combined trained docs from the program or the IM-Psych program, IMP program in-house, heavy VA psych curriculum, psmaller University town with a very family friendly atmosphere

Cincy - Very detailed FM curriculum with modules and regular "quizzes", strong emphasis on global health, FM at community hospital, PD is well known in the AMP community and is a psych trained doc

UPMC - Large university system, newest program, huge and incredible Psych hospital (WPIC), PD is a foreign (UK) trained psychiatrist that also worked as a GP, global health emphasis, features two settings for FM training, an unopposed inpatient heavy program in a middle-upper class community (StM) and a hospital with an in-house IM residency in a severely economical depressed/underserved area (McK)

Obviously you can get more from the individual websites and talking to residents. One thing repeatedly said by the residents from all programs is that all the remaining programs are the strongest and all will provide excellent training. It's more a matter of finding where you fit best.



You have to apply to a backup. Everyone does. There's only 5 FMP and 11 IMP programs. Some people do FM/IM, some do psych, and some do both. Each year is different, but this year seemed like more people were applying to psych to me. The programs know and understand this.

Awesome post thank you! I really don't want to be either categorical counterpart but rather the "one hat" blend as you put it, which is a hard concept to explain to others outside of the combo community.

I think what you said near the end is probably the most important part of it all. If you are going to be going somewhere for 5 years you should really make sure it has the right feel for your personality. If you don't get invited somewhere a good way to look at it is, that the program didn't think you were a right fit for them, so it would be safe to say in turn that they probably won't be the right fit for you.

One of the positive points to applying to the combined programs is that in order to have a combo program in the first place you have to have strong categorical programs to support it. I've decided that I will be getting great training no matter where I go, the trick is now to find where myself and my family will be most happy.

Application season is coming up i'm curious to see how many SDN'er are thinking about putting their hat in the combo cycle (both FM and Im psych)? If your reading this put up a quick post. =)
 
Anyone else planning on going to the conference?
 
Interviews for combined are basically over for this cycle. What were people's thoughts? It would be nice for interviewees to post a review of their experiences for future applicants.
 
Longtime lurker, planning to apply to combined training and interested in integrative primary care. Did anyone march IM/Psych or FM/Psych this cycle? Any impressions on the interview trail?
 
Longtime lurker, planning to apply to combined training and interested in integrative primary care. Did anyone march IM/Psych or FM/Psych this cycle? Any impressions on the interview trail?

I mean 23 people match IMP and 12 FMP every year, so I think the likelihood of one or more of them being on SDN every year is pretty low. Consider reaching out to AMP for mentorship.
 
Hello, intentional necrobump.

I'm still far, far out but like to dream about the future. This combination has popped up in my head a lot, but I have no real world idea of what it would be like.

In my head the fantasy is being some small town / rural doc, you know, where everybody knows everybody. And I am the person people come to for all of their problems, be it the flu, a broken finger, ADHD, or maybe they need to talk about some things in their life that are really bothering them. And I can hopefully be highly-competent and trusted and use all of those close relationships to have a huge impact in the community and do a lot of good work.

Is this just a fantasy? Would a combined program let me do something like this?

I presently live in a semi-rural area and it seems like telehealth options may be the best option for dedicated therapy / psych vs going to see their local doc. But I have no idea, I'm trying to learn more now about the field.
 
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Hello, intentional necrobump.

I'm still far, far out but like to dream about the future. This combination has popped up in my head a lot, but I have no real world idea of what it would be like.

In my head the fantasy is being some small town / rural doc, you know, where everybody knows everybody. And I am the person people come to for all of their problems, be it the flu, a broken finger, ADHD, or maybe they need to talk about some things in their life that are really bothering them. And I can hopefully be highly-competent and trusted and use all of those close relationships to have a huge impact in the community and do a lot of good work.

Is this just a fantasy? Would a combined program let me do something like this?

I presently live in a semi-rural area and it seems like telehealth options may be the best option for dedicated therapy / psych vs going to see their local doc. But I have no idea, I'm trying to learn more now about the field.
Some people do this. I know a few FM/Psych docs that do purely rural primary care and psych.

It's typically difficult to combine psychotherapy, and often it's made unnecessarily logistically difficult by CMS and insurance companies from a billing standpoint. In other words the dream of walking from one room to the next treating colds, doing therapy, and then treating schizophrenia is often not how it works out. What ends up happening is you become a chameleon that shifts either day to day or half-day to half-day, sometimes in different clinics or settings, where each is dedicated to a specific area. For example, today is primary care day, and sure you might do some psych med management on primary care day, but it's mostly primary care. Tomorrow is psychotherapy/psych day. The next day is TMS, etc.

Plenty of combined trained docs go into specific fields or settings like CCBHCs or FQHCs where they will practice in multiple roles within those settings, but because of the demand and dynamic differences, psych is generally favored (its harder to recruit psychiatrists to these settings than it is primary care).
 
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Some people do this. I know a few FM/Psych docs that do purely rural primary care and psych.

It's typically difficult to combine psychotherapy, and often it's made unnecessarily logistically difficult by CMS and insurance companies from a billing standpoint. In other words the dream of walking from one room to the next treating colds, doing therapy, and then treating schizophrenia is often not how it works out. What ends up happening is you become a chameleon that shifts either day to day or half-day to half-day, sometimes in different clinics or settings, where each is dedicated to a specific area. For example, today is primary care day, and sure you might do some psych med management on primary care day, but it's mostly primary care. Tomorrow is psychotherapy/psych day. The next day is TMS, etc.

Plenty of combined trained docs go into specific fields or settings like CCBHCs or FQHCs where they will practice in multiple roles within those settings, but because of the demand and dynamic differences, psych is generally favored (its harder to recruit psychiatrists to these settings than it is primary care).
thank you for this reply And all that still sounds amazing.

my thought or concern just or just me randomly thinking is what about Telehealth I mean I want to be able to provide really good care But if I can just set up a computer in my office somewhere and a closed room and they have access to a 100% psychiatrist wouldn't that be the better for the patient?

Obviously I can see ways that wouldn't be great but my concern would first and foremost be the person getting the best health care possible with utilities that we have
 
thank you for this reply And all that still sounds amazing.

my thought or concern just or just me randomly thinking is what about Telehealth I mean I want to be able to provide really good care But if I can just set up a computer in my office somewhere and a closed room and they have access to a 100% psychiatrist wouldn't that be the better for the patient?

Obviously I can see ways that wouldn't be great but my concern would first and foremost be the person getting the best health care possible with utilities that we have
I think there is a bit of a disconnect here.

I would venture to say that since the pandemic, the majority of psychiatric outpatient care that is not otherwise employed in a very specific setting is in fact already being delivered via telehealth in some way. Most outpatient docs aren't going back, despite this there still are areas with very little options. Also, there are many cases (in fact likely the most in need) where telehealth is not what is best for the patient nor what is best for public health in general, and its why ACT teams that physically go to SMI patients where they are is crucial. There are also a lot of things that are very difficult to do via telehealth, specifically a physical exam that could very quickly lead you to a specific diagnosis.

Both family medicine and psychiatry is very much in demand, and there are large parts of the country where access to either is not being met even with telehealth. The idea that you could easily recruit both a psychiatrist and a family physician to serve these areas is great in theory and certainly has been made easier by the pandemic/telehealth, but is still very difficult.

Then there's the large segments of the country that in fact don't have access to high speed internet (including cell phone service) that would support reliable videoconferencing.

I will also say that the thing that kills patients with psychiatric conditions most consistently at higher rates than the general population is actually the poor preventative health that they receive, and the poor management of chronic conditions like DM2, HTN, and CAD. As someone that has treated patients with very limited primary care options in rural areas, I can assure you that its basically impossible to overcome the negative outcomes of poor preventative care no matter how good your psychiatric care is.

If you want to be a psychiatrist, by all means, be a psychiatrist. If you want to do combined training for a specific purpose (e.g. to serve communities that have neither competent primary care nor psychiatry), do combined training. Regardless of which direction you go, it'll be much more valuable for you to not be burnt and remain in the career as long as possible. Your training should be in what you enjoy and what you want. No one is going to pat you on the back for taking more call or the extra sleepless nights involved with combined training, so do it for yourself first and foremost.
 
@hallowmann

Thank you so much for taking the time to respond. I am still trying to find my way on this path. I started in 2012 with the passion for mental health and pursued psychiatry. I have been on this road for a long time, and have since come to love (almost) every specialty in medicine. I feel pulled in separate directions, with one half of me being devoted to mental health, and the other half being, well, to just about everything else.

I'm still in UG so I know it's nothing pressing yet, despite my still trying to figure out if I'm going to finally graduate as Psychology, Biology, or a meet in the middle as Neuro :D

Trying to look ahead helps keep me grounded and give me the inspiration to not give up, since it's already been a decade. Thank you for shedding some light on the field and it will help me continue to look forward to my career.
 
@Fluidity of Movement thanks for this necro-bump.

I'm an MS-0 (starting med school this summer) with a very deep interest in FM/Psych. I'm a non-trad, career-changer in my early 30s without any family in medicine, so I'm trying to figure out how to show interest in such a competitive combined field.

For those who have been successful, would you say going to that conference starting in my first year would be advisable? What else can I do from day one to show interest? Thanks!
 
With only 150 applicants for something like this it seems as if there should have more spots. This is the type of care that we need more providers of rather than interventional rocket surgery with laser robots. It seems like the program is more interested in finding people who are the right match rather than a dickwave of stats and publications. I know that technically can be true for ALL programs, but the post further up really was trying to hammer the point of actually doing both, rather than having an interest in them separately.

It would be interesting to hear about what consists of their shortlist, and then how heavily they care about MD / steps / pubs.

Also, what are the options for people who don't match? Are there fellowships for traditional programs that could maybe bridge the gap without necessarily having two certifications?
 
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@Fluidity of Movement thanks for this necro-bump.

I'm an MS-0 (starting med school this summer) with a very deep interest in FM/Psych. I'm a non-trad, career-changer in my early 30s without any family in medicine, so I'm trying to figure out how to show interest in such a competitive combined field.

For those who have been successful, would you say going to that conference starting in my first year would be advisable? What else can I do from day one to show interest? Thanks!
I honestly don't think you need to think about this in first year. Maybe join the mentoring program via AMP in 2nd or 3rd year, and if ambitious attend conference in 3rd and 4th year. Focus on doing well in med school and passing boards in the beginning.

Also, what are the options for people who don't match? Are there fellowships for traditional programs that could maybe bridge the gap without necessarily having two certifications?
There are fellowship programs for behavioral health after primary care training. There aren't a ton of programs, but it can be one path. There are also specific programs that will have some overlap, but not necessarily be similar to have both types of training, specifically things like addiction fellowship or palliative/hospice fellowship.

If you want certification in both, but don't match combined, you can also do residency sequentially, but that is easier said than done.
 
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