MD & DO Help with Med-Psych and alternatives!

[girlunobserved]

I'm looking into Med-Psych programs, but I know I need to be practical about a backup option because of my scores. I'm also not 100% sure what is "competitive" for these programs because while I know I messed up my Step 1 score, my 3rd year has been going a lot better than last year, and I've been trying to amp up my application with research and community service work.

So something I was thinking about was to do an IM residency and a Ph.D. in clinical psychology, so I could be trained in psychotherapy (because from what I understand, psychiatry residency has limited psychotherapy training). I was also looking at the PsyD, but then I realized that's expensive, and I don't want to go into more debt, and I'd instead do a Ph.D. which is stipended.

Another thing I was looking at was completing an IM residency first and then a research psychiatry residency (or a regular psychiatry residency, I'm more inclined towards research as it is and would want to do a research-focused residency if an option).

Would talking to current residents help? I live close to one program and my hometown is close to another, so I debated emailing someone there.
But honestly, I don't even know what to say or ask.

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[NotAProgDirector]

I hate to tell you this, and I mean this in the best way possible, but these are all terrible and impractical ideas.

A Med/Psych residency is the best of the bunch, yet remains a tough road. We have had a few residents over the years do a combined program, and I ended it some years ago. The problem is that graduates have great difficulty finding a job that taps into both skills. You might think that you could take care of psych patients with concomitant medical problems -- but you'll discover that those in both IM and Pysch will have no interest in cross covering your panel. Most people in my experience (which is a small number) end up deciding on one of the two fields, usually in their PGY-3, and then it's too late to change -- they slog through the remaining 2 years and then practice in only one field. You also have the problem that medical and psych issues are often covered by different insurance programs, so it's hard to practice both and bill correctly.

If you do an IM residency, you should not at all consider a psych PhD. This would be a research position and is not going to train you to do therapy. And, if you graduate from an IM residency and then do no clinical IM work for several years, no one is going to consider you for a position.

Completing IM followed by psych is possible, but horribly long. And, after 3-4 years of psych and no IM experience, again you'll find that no one in IM will hire you due to the gap and the issues in my first para. And if you do only research for a number of years, same outcome.

So, pick whether you want a clinical career or research. Pick IM or Psych. Once you know that, proceed. The good news is you still have lots of time to get experience in both fields and figure out which you think will make you happier.

 

[djiboutiman]

Psychiatry residency with a Consultation-Liaison fellowship can give you that overlap between IM and Psych. IM with a Hospice/Palliative Care fellowship has some of those psychosocial aspects to it as well. Plenty of residency programs have a research track, if you want to be more a researcher than a clinician.

I’m not quite sure what you want in a career. You say you want to do psychotherapy, but then also say you want to do research? But also want to do IM? I guess I can see your reasoning behind IM + PhD. That just sounds like way more trouble than it’s worth. Although, I did know a radiologist who also graduated from pharmacy and dental school. I guess you could look into Licensed Professional Counselor or Licensed Family and Marriage Therapist programs and do that kind of therapy work as a side hustle.