MD Help -- Dual Applying Psych & Pediatrics vs FM?

[discerningdantrolene]

My main question / TLDR: Since Psych is not a guarantee bc of my grades, do I dual apply to Peds or to FM as my "backup"??? or BOTH??? Is triple applying even possible, or more like very ill-advised?

Hi everyone, you probably need a lot of context with this. I'm a US MD MS3 female. I always thought I would do peds, but fell in LOVE with psych during rotations. I love the flexibility, lifestyle, and median compensation of the field, the patient interactions, the patient population, pathologies, the treatment options & solutions, the team-based approaches of inpatient care, the outpatient hours, the possibilities for research, and so on. I LOVE Psych.

The problem is, I don't think I'm the most competitive applicant for Psych, especially in light of the recent uptick in Psych's popularity after the pandemic. I failed my first block exam in med school, successfully remediated it over the summer, but then failed another exam in MS2. I failed to remediate this one, so was forced to repeat M2 year (despite passing other M2 exams). Thankfully, I passed everything 2nd time around and passed Step 1. For clinical rotations, I've been getting HP across the board (due to low shelf scores with strong evaluations), except in Psychiatry and FM where I got Honors. My unofficial transcript says my current GPA is 2.04. I still have 2 more rotations - neurology and surgery, and have yet to take Step 2, so there's a chance I could do well in all of those, but I clearly haven't been a strong test-taker. I'm also pursuing a dual degree where we had to take MPH classes over the summer (GPA 3.78), and which likely contributed to my lack of focus with my M2 classes the first time around.

Since I have some red flags, I've been advised to strongly consider dual applying. Since I've always considered pediatrics and DID find I enjoyed pediatrics and working with kids, it seemed like a great match as backup. Plus, I am considering Child Adolescent Psych down the line and if I match Peds instead of Psych, there's still an avenue for applying into a CAP fellowship. If I go into Peds, I would strongly desire to fellowship / subspecialize since I found regular outpatient to be frankly kinda boring.

However, I've recently been turned onto thinking about FM as a viable "backup" -- better compensation after 3 years doing outpatient than peds (would likely have to specialize), avenues for procedures and increased compensation (I did enjoy OB and some surgery), alternative payment structures, and I don't mind being a "jack of all trades, master of none." There's a part of me that might miss having more physical medical knowledge... The majority of my family and friends outside of my immediate med school friends are nowhere near the healthcare sector, and it's been fun sharing small bits of medical advice/knowledge or connecting their diseases / illness to medical knowledge I've learned. I enjoyed my FM rotation, but the doctor I worked with complained a lot about annoying patients and the business side of running her own practice. She said she wasn't making much of a profit, but she wouldn't trade it for the world because it gave her the freedom to practice when and however she wanted, and her patients loved her.

Let me reiterate & add: I'm an MS3 female approaching 30, would like to have kids in the next 5 years (during residency). I highly value flexibility during and after training, fair /decent compensation after residency (ideally 200-300k, I'm paying for med school and rent entirely through student loans), good work-life balance, and good job prospects in the NY/NJ/PA area. I currently live in the city for school. Ideally would stay in the city or suburbs during residency. Fiancé and I will probably prefer suburban life after residency.

My main question / TLDR: Since Psych is not a guarantee bc of my grades, do I dual apply to Peds or to FM as my "backup"??? or BOTH??? Is triple applying even possible, or more like very ill-advised?

I can see myself doing well in both Peds & FM. I love working with kids & would likely pursue CAP or Peds Cardio/NICU if I matched Peds. I don't love adults medicine enough to do IM, but I like knowing general adult medical needs, and being able to relate to adults. I like procedures, but I don't mind doing without it either in return for a better lifestyle / compensation / work-life balance. And I'm probably not competitive enough for MedPeds. This kinda comes down to a peds vs FM question, but with a twist that I have an eye on Psych... I can likely pursue CAP after Peds, but I don't think there's an avenue like that with FM -- HELP!

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[eyeeye_captain]

I will preface this with a few things. I am not in any of the fields you’ve mentioned. I do not know how competitive they are, or how much the red flags hurt you. You do not have a Step 2 score as of yet. I want you to succeed.

In light of this:

I think some of what you’re looking for is a little unrealistic. Our psychiatry colleagues would have a better idea of what Step score might make you competitive with your prior stumbles, but you’ve already said you’re not a strong test taker, so no guarantees there. They would also be able to tell you if a CAP fellowship is competitive.

I hadn’t heard about the Peds to CAP pathway so I looked it up. There are 5 total programs in the country, so extremely limited. The only one in the region you mentioned is at CHOP, so I would suspect it would be hard to get in.

Outside of FM, all of your paths are 6 years assuming CAP fellowship or NICU/Cards. You’re going to school for 5 years (maybe 6 with the MPH?) with your entire cost of attendance on student loans in a high cost of living area. You may have undergrad loans. The median MGMA data on those 6 year programs isn’t much above $300k (if at all in saturated areas), and you want to continue in a HCOL area, plus kids. Unless your fiancé is crushing it at work, that interest is compounding and paying off a likely massive number won’t be remotely easy unless you can find a way to get loan repayment, which potentially limits your job market and flexibility, two things you want.

My suggestion would be to go FM so it’s only 3 years. Use your elective time for psych rotations. Join or start a practice that will allow you to focus somewhat on lower complexity psych cases as there’s a decent amount of mental health in primary care. Money will be close to a wash.

Again, I wish you the best. Keep talking with your school’s advisors.

 

[FlowRate]

Psych here, second eyecap. FM lifestyle is certainly more rough on average than psych but there's a broad range if you have some flexibility. You will have the opportunity to do lots of psych-lite in FM, especially if you focus on learning as much about it as you can and getting comfortable with first and second line treatments for common presentations.

 

[mrbreakfast]

Few thoughts:
1) Agree that you should still apply psych but have a back-up plan. If psych is your #1 choice, your next year should be dedicated 100% to strengthening your application (and studying for step 2)

2) If I personally wanted to be a psychiatrist but couldn't, I'd just do FM and try to treat every psych complaint myself. You'd quickly build a patient/referral base.

3) You mention compensation a number of times in your post. If this is a big consideration for you, I would recommend you research it and talk to (private practice) pediatricians in your area, if possible. I know a number of pediatricians and while many love their jobs, none are happy with their salaries.

 

[mistafab]

Psych here.

An MPH does not help you become a resident, so if it is still taking focus away from classes just drop it.

You need to decide if you like mental health more or working with kids more. If its working with kids, then just do peds. CAP is not a realistic option for someone after peds - you have to understand that these are fully trained psychiatrists who go on to CAP fellowships you are competing with.

If it is mental health, FM may give you more options after residency to engage in mental health care. FM docs do not do inpatient psychiatry. You'd essentially go the addiction route or the outpatient holistic/mental health route in an FM style practice. I also doubt an FM doc would be allowed to work at a mental health urgent care - so you are limited mostly to outpatient practice, which is fine if that's what you like anyway.

I'd say though that if you are gungho about psych, do everything in your power to improve your app until you apply. Do as much networking as possible in your region and definitely buddy-buddy with everyone in your home program and regional programs. Nail step 2 to show that it was a fluke that you messed up initially.

Good luck.

 

[DO2015CA]

So I actually looked into the PPPP (post-pediatric portal program) as a resident. They are very limited but also are virtually invisible to applicants. They don’t participate in the match. I went to a zoom info session and reached out to one of the 5 programs. They actually reached back out to me about applying once the application was open. I politely responded about deciding to do something else. They said they got less than 5 applicants for their 1 spot. So I would say if you could show interest early ish (2 or early 3rd year of residency) then you would have a fighting chance.

 

[mvenus929]

I'm a peds specialist, but not in psych. Here's my $0.02.

If you enjoy working with kids but aren't dedicated to it, do FM. You can build a niche specialty where you handle simple psychiatric complaints in kids, adolescents, and adults - trust me, people will come to you. It also gives you more variety in what you would otherwise see in outpatient care, which is a plus if you found outpatient peds boring. You *can* get some training in mental health things as a general peds resident, and some do make it their focus to handle basic things (like simple ADHD, depression, anxiety), but you would be limited to kids and are unlikely to make the kind of money you're looking for, at least starting out.

 

[discerningdantrolene]

Thank you everyone for your advice and thoughts! You guys brought up a lot of points I didn't really consider. Sounds like the consensus is FM > Peds for the flexibility, shorter training, and compensation, but there's still a hope for combining & pursuing my interests if it's the other way around. Definitely gonna reach out to more advisors and contacts about this. Thanks!

 

[discerningdantrolene]

So I actually looked into the PPPP (post-pediatric portal program) as a resident. They are very limited but also are virtually invisible to applicants. They don’t participate in the match. I went to a zoom info session and reached out to one of the 5 programs. They actually reached back out to me about applying once the application was open. I politely responded about deciding to do something else. They said they got less than 5 applicants for their 1 spot. So I would say if you could show interest early ish (2 or early 3rd year of residency) then you would have a fighting chance.

VERY interesting and helpful to know. Can I ask roughly what year was this when you reached out? Maybe the numbers & popularity have changed a lot by now?

What did you decide on doing instead, or what are you doing now?

 

[discerningdantrolene]

I'm a peds specialist, but not in psych. Here's my $0.02.

If you enjoy working with kids but aren't dedicated to it, do FM. You can build a niche specialty where you handle simple psychiatric complaints in kids, adolescents, and adults - trust me, people will come to you. It also gives you more variety in what you would otherwise see in outpatient care, which is a plus if you found outpatient peds boring. You *can* get some training in mental health things as a general peds resident, and some do make it their focus to handle basic things (like simple ADHD, depression, anxiety), but you would be limited to kids and are unlikely to make the kind of money you're looking for, at least starting out.

Thanks, this is encouraging that I don't necessarily have to have a CAP fellowship if I still want to do some combo of Peds -> Psych. I figured it just wouldn't be viable. Maybe not at first, but further down the line.

Also curious which peds specialty you went into and why?

I enjoyed my peds rotation, but it was really busy, and we spent a lot more time with the residents than with attendings. We didn't get much attending face-time or attention and it was hard to ask them anything personal.

 

[mvenus929]

Thanks, this is encouraging that I don't necessarily have to have a CAP fellowship if I still want to do some combo of Peds -> Psych. I figured it just wouldn't be viable. Maybe not at first, but further down the line.

Also curious which peds specialty you went into and why?

I enjoyed my peds rotation, but it was really busy, and we spent a lot more time with the residents than with attendings. We didn't get much attending face-time or attention and it was hard to ask them anything personal.

When I was in residency, the psychiatrist (the single one) for the hospital actually sponsored a 'mental health for peds' program where at the end, the goal was to have primary care peds prescribe some basic mental health meds - think SSRIs, bupropion, etc, and assess for when these kids *really* needed to go to psych. They weren't doing psychotherapy (that is largely psychologists or LCSWs), but were doing follow-up of basic things. My friend in adolescent medicine also does a lot of mental health stuff. ADHD management (the basics anyway) should be a part of every pediatric resident training, and a lot of kids come in with various behavioral issues that you can help parents with as well.

I'm endocrinology. I like physiology, so was drawn to PICU and endo initially, and decided I didn't like the stress of working in the PICU (this is actually not an uncommon thing to hear--we had a prospective fellow a few years ago who did his PICU rotation and then switched to PICU, and I've met several endos who have said similar to things to me). I considered gen peds as well, but wanted more pathology. Now, I consider my job basically gen peds on steroids - I deal with growth and puberty as the bulk of my (endocrine) practice, with the addition of some 'simple' pathology like thyroid disease--and a handful of really weird and fascinating disease processes. And some diabetes--while most residents seem to think this is the bulk of endocrinology because that's what they're seeing on their inpatient rotations, I actually only see about 5 patients with diabetes per week (though there are some who make this a much larger part of their practice).

 

[DO2015CA]

VERY interesting and helpful to know. Can I ask roughly what year was this when you reached out? Maybe the numbers & popularity have changed a lot by now?

What did you decide on doing instead, or what are you doing now?

2020/21. I went into another peds pulmonary