HELP. I Can't decide- FM or Psych

[Panama Red]

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I loved both rotations and I am currently stumped on which to choose. I liked both because of the patient variety, women's health, mental health care, and work schedule. It is also interesting because I have observed that a lot of patients use their FM doc for their mental health managment eventhough I do not believe FM's receive adequate training in psychopharm. On the flip side, I feel that Psych is not as clinically concrete as FM and I am not keen on working with severe psychopathology. Has anyone run into this same dilemma as far as choosing between Psych and FM. What were the determining factors. Help please.

 

[iatrosB]

You've made some excellent points. They are somewhat similar, and you're right, primary care deals with A LOT of psych. The difference is, FPs will deal with bread and butter psych problems, mostly stuff that wouldn't excite the psychs (no schizo, mania, anything requiring hospital medicine...). So if you like hard core, significant pathology psych, go psych. FP's are more than capable of pharmacotherapy with minor depression, anxiety, panic attacks, somatoform disorders and such. Also remember, you can carve your own niche out in FM, spend some more time learning the pharmacotherapy.

You should really determine whether you want to do only psych, all the time, or only ~15-20% of the time. FM can be anything you want it to be, you can tailor it as you see fit. Only you can answer these questions for yourself, and remember people often try to decide between FM and lots of other fields because of the breadth involved, so don't feel like your alone in your struggle. Good luck.

 

[Frijolero]

You've made some excellent points. They are somewhat similar, and you're right, primary care deals with A LOT of psych. The difference is, FPs will deal with bread and butter psych problems, mostly stuff that wouldn't excite the psychs (no schizo, mania, anything requiring hospital medicine...). So if you like hard core, significant pathology psych, go psych. FP's are more than capable of pharmacotherapy with minor depression, anxiety, panic attacks, somatoform disorders and such. Also remember, you can carve your own niche out in FM, spend some more time learning the pharmacotherapy.

You should really determine whether you want to do only psych, all the time, or only ~15-20% of the time. FM can be anything you want it to be, you can tailor it as you see fit. Only you can answer these questions for yourself, and remember people often try to decide between FM and lots of other fields because of the breadth involved, so don't feel like your alone in your struggle. Good luck.

If you really can't decide, choose both: http://www.ama-assn.org/vapp/freida/srch/

There are a handful of combined programs out there. For me the deciding factor was wanting the majority of the psych issues I treat be ones that get significantly better.

 

[Panama Red]

I also feel the same way. I am not interested in combined programs because I know I will ultimately choose one or the other. I want my speciality of choice to deal with clinical medicine as well as "treatable psych" cases. I am a bit turned off by severe psychopathology, as well as the lack of diagnostic concreteness in psychiatry, namely the DSM-IV. So, I guess I should choose family. Now comes the issue of matching. I have only interviewed for psych programs, and one combined program at UPitt. Any advice on what I should do?

 

[deleted77919]

I can't say I really recommend it, but you could not rank any psych programs then scramble into an FM spot. Perhaps others will have better suggestions.

 

[Frijolero]

I also feel the same way. I am not interested in combined programs because I know I will ultimately choose one or the other. I want my speciality of choice to deal with clinical medicine as well as "treatable psych" cases. I am a bit turned off by severe psychopathology, as well as the lack of diagnostic concreteness in psychiatry, namely the DSM-IV. So, I guess I should choose family. Now comes the issue of matching. I have only interviewed for psych programs, and one combined program at UPitt. Any advice on what I should do?

Fine time you picked to figure that out! I guess it depends on how picky you are. You're likely to be able to scramble into family, but if I were in your situation I would take a year off, do some international work/research for a year, and reapply. I think that route would be far easier than completing a year of psych and then attempting to switch. Why not rank the combined program number 1 and take a year off and reapply to FM next year if you don't get it. You'd only have an extra year in it and you'd be far better trained to handle bread and butter psych issues than most FM guys. You'd also have more marketable skills. Good luck...

 

[marie337]

I'm trying to make a similar decision, although I'm a third year. I haven't rotated through psych yet, but I'm very interested in psych and enjoy the psych patients the most in family medicine. On the other hand, it's nice to have a variety of patients to help break up the day. I think it's going to be a very tough choice. I just wish that family medicine didn't require so many OB cases. I'm never going to practice OB as a family physician!

 

[FPLover]

I would suggest doing both if you feel that passionately about it. And the good thing is if you do a Family medicine residency first, many Psych programs will shave a year off of the Psych residency. You could do one of the combined programs, but it seems like you get less training in both fields (5 year program instead of 6 if you do them separately)