It seems like the IM/Psych combined residency is designed to produce physicians who either work in these specialized Med/Psych units or who provide primary care in underserved populations. What do you guys think about these career tracks? Are they feasible, first of all, and do they have a different income profile from ordinary single-boarded psychiatrists/IM docs?
The dual career tracks are feasible but they are difficult. This issue has been discussed in several previous threads; if you do a search, you'll probably find most of the threads.
Some of the feedback that others have provided:
1) Most dually trained folks do not practice in both specialties. They choose one or the other. At Duke, for example, many of the double board grads stayed on at Duke to be teaching faculty and to be attendings on the med-psych service, which is basically an amped up medicine ward.
2) It can be extremely difficult to stay current on the literature in both fields, which is an additional reason for #1.
3) Unless your institution has a specialized med-psych service as in #1, your life as an attending can be difficult. If you are a medicine attending, your colleagues will try to give you all the borderlines. If you are a psychiatry attending, your colleagues will try to give you all the medically ill patients. This can make for a rich practice setting, but you don't get paid for the extra time you spend with the more complicated patients. So unless you are hypervigilant, your service will become a dumping ground. (At Duke, the medicine services try really hard to dump "awaiting dispo" patients on the med-psych service, but the med-psych service has complete control over who they do and do not accept. If they feel they're getting too busy, they can just say "we have too many patients" or "she's not appropriate for our service" and the matter is settled.)
4) You have to choose to bill as a psychiatrist OR as an internist for your office visits; you cannot double-bill.
5) Being double boarded can be a significant advantage if you are bent on an academic research career. Some prominent double boarded physicians come to mind, Greg Simon (UW/Puget Sound Group Health) and Benjamin Druss (Emory), for example. They have had extremely successful research careers, and my guess is that the double board helps them get grants whenever the research addresses any issues at the interface of mental health and chronic illness.
6) You have to be extremely circumspect when picking a med/psych program. In order for your training experience to be a good one and so that you don't just get lost in the cracks when you are 'off-service', you need the following: a strong medicine program director; a strong psychiatry program director; a strong medicine program director who supports the concept of med/psych training and who will advocate for your education; a strong psychiatry program director who supports the concept of med/psych and who will advocate for your education; and a strong med/psych program director who can manage the med PD and the psych PD. Same goes if you are interviewing for family med/psych. If your program doesn't have all of these elements, your training will suffer. (I interviewed for psych and med/psych -- and ultimately chose to go psych-only -- but for what it's worth, the only program that I felt met #6 was Duke.)
Hope this helps
-AT.
