IM or Psych

[Perrotfish]

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I still have a lot of rotations to go, but I'm pretty sure that I'm ultimately going to want to do Med/Psych or FM/Psych. However I'm aware that the Navy does not do combined residencies except for very rare deferments. So my question is: given the choice do you guys think it's a better choice to do Navy Psych followed by Civilian IM/FM, or Navy IM/FM followed by Civilian Psych? What path maximizes my chances of having a good experience in the Navy, straight through training (I know, it's unlikely), high quality training, etc?

 

[IgD]

I still have a lot of rotations to go, but I'm pretty sure that I'm ultimately going to want to do Med/Psych or FM/Psych. However I'm aware that the Navy does not do combined residencies except for very rare deferments. So my question is: given the choice do you guys think it's a better choice to do Navy Psych followed by Civilian IM/FM, or Navy IM/FM followed by Civilian Psych? What path maximizes my chances of having a good experience in the Navy, straight through training (I know, it's unlikely), high quality training, etc?

You've got to pick one or the other. Do you want to manage blood pressure, diabetes, thyroid levels, do a medicine subspecialty or talk to patients and manage their moods, anxiety or psychotic symptoms. The two can't co-exist IMHO.

 

[notdeadyet]

I still have a lot of rotations to go, but I'm pretty sure that I'm ultimately going to want to do Med/Psych or FM/Psych.

You might find that fade. 90% of folks originally interested in Med/Psych or FP/Psych in 3rd year eventually come to terms with the fact that they are just having trouble with the concept of hanging up the stethoscope and end up doing Psych.

I was very interested in the combined residency, but opted not out of fear for being moderately trained in two specialties rather than well trained in one. And aside from that, keeping sharp skills and a good knowledge-base in as wide an area as Psych and Family Practice just doesn't strike me as realistic. There's a reason why in spite of the fact that a combined program is only one year longer than a Psych program, there are so few slots out there.

So my question is: given the choice do you guys think it's a better choice to do Navy Psych followed by Civilian IM/FM, or Navy IM/FM followed by Civilian Psych?

You might want to contact some combined programs that you're interested in and ask if they'd let you apply as a PGY-2 into their program. Most of the programs are small and tightly structured to churn out double boarded folks in 5 years. Finding one that will take in someone PGY-2 might be a challenge. I'd make some calls.

 

[Perrotfish]

You've got to pick one or the other. Do you want to manage blood pressure, diabetes, thyroid levels, do a medicine subspecialty or talk to patients and manage their moods, anxiety or psychotic symptoms. The two can't co-exist IMHO.

I don't know, when I did inpatient psych it seemed like the majority of the psychiatrists there were also doing a significant amount of medical management. Almost all the patients had other medical conditions, and the only primary care provided by the inpatient psych facility was a very overworked NP with weekly supervision from an FM.

I felt like I saw significantly better outcomes with the patients managed by Med/Psych doctors than those managed by dedicated psychiatrists. Just my opinion, though.

You might find that fade. 90% of folks originally interested in Med/Psych or FP/Psych in 3rd year eventually come to terms with the fact that they are just having trouble with the concept of hanging up the stethoscope and end up doing Psych.

To be honest there's this too. I feel like I might get bored with either profession, but probably not with both. I like the idea that I could still add some urgent care/ER moonlighting to my Psych work.

 

[notdeadyet]

To be honest there's this too. I feel like I might get bored with either profession, but probably not with both. I like the idea that I could still add some urgent care/ER moonlighting to my Psych work.

Yeah, I felt the same way. I talked to the PD of one of the better combined residency programs and asked him what he looked for in applicants, and he said to picture yourself in five, ten, twenty and thirty years. If you see yourself doing one job and dabbling in the other, a combined program is not the way to go. A combined program's main sell is for folks who want to work on a combined service in academic medicine or for folks who want to go way rural and invest enough time and money to run a dual practice. Jobs in the former are apparently not all that easy to come by and folks in the latter tend to end up doing all psych due to need and reimbursement.

That (and a lot of navel gazing) did it for me. I wanted to primarily do psych but not lose some of the other skills I'd acquired. That's not enough reason to really do a combined residency. There are far easier ways...

Good luck with your decision. Do a few Sub-I's in medicine and psych and see which you would truly be passionate doing for the rest of your life. If you truly love both equally, you're probably a rare one.

 

[Gastrapathy]

Med-Psych = extra-long psych residency.

Pick a specialty.

 

[AF M4]

Solution to dilemma is simple.

Find nearest wall. Bash head against it. Hard.

When dizziness wears off, what is first question that comes to mind?

If question is, "What did I just do to myself?", then you are IM or FP.

If question is, "What the hell is the matter with me?", then pick Psych.

Self-knowledge is key to practicing good medicine.

 

[Slevin]

Solution to dilemma is simple.

Find nearest wall. Bash head against it. Hard.

When dizziness wears off, what is first question that comes to mind?

If question is, "What did I just do to myself?", then you are IM or FP.

If question is, "What the hell is the matter with me?", then pick Psych.

Self-knowledge is key to practicing good medicine.

👍

 

[Perrotfish]

solution to dilemma is simple.

Find nearest wall. Bash head against it. Hard.

When dizziness wears off, what is first question that comes to mind?

If question is, "what did i just do to myself?", then you are im or fp.

If question is, "what the hell is the matter with me?", then pick psych.

Self-knowledge is key to practicing good medicine.

rofl.