Internal Medicine to Psychiatry

[St347]

Hello,

I am currently an OMS-IV slated to start an IM residency in June. However, after some soul-searching and research, I realized that Psychiatry was the right path for me. I already signed the contract and am basically stuck for intern year. I was wondering what options I have for how to go about doing this transfer or if I should just go through the Match again. I scrambled into this residency most likely due to having to take the PE twice and having my passing score arrive in early March. However, I definitely don't want to have to go through the SOAP again if I don't have to.

I was also wondering when I should let my program know and some tips on how to make myself more competitive for programs during this process.

Thank you!

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[Bartelby]

I believe a good number of programs accept PGY-2s. You will need your current program director's support, so you have to let them know in time to write you a letter. I would do the intern year and then apply for one of those PGY-2 spots

 

[SourceOfDenial]

I wish psychiatry still did a medicine intern year. You’ll do fine.

 

[moto_za]

I wish psychiatry still did a medicine intern year. You’ll do fine.

Thank God we don't!

 

[MacDonaldTriad]

So we got rid of the TY year and oral boards, but now we have MOC and shelf tests with clinical skills exams. Things don't seem to change that much.

 

[DreamofClinical]

So it's not quite as easy as people say- Hopkins is the main program that offers PGY2 spots, many others that did don't. You should tell your program director as soon as you start, and plan to apply by September of your intern year if you want to start the following year. You will need a letter of good standing from your intern program.

 

[Merely]

I wish psychiatry still did a medicine intern year. You’ll do fine.

Wtf no

 

[EarlyCareerAcademicPsych]

From the perspective of an associate training director involved in residency recruitment x 6 years:
with this situation, we are trying to figure out whether you are primarily moving AWAY from internal medicine or you are primarily moving TOWARD psychiatry. If it is the former, then please go do something else other than psychiatry (which takes real commitment and passion to practice well). If it is the latter, then read on for more advice!

I am a strong believer in reflection, but it will help your cause if you have something more substantive than soul searching to demonstrate the wisdom of your decision-making.

By this, I mean
-- Did you complete a medical school rotation in psychiatry AFTER you decided to pursue internal medicine?
-- Did you do a psychiatry sub-internship in medical school?

If the answer to these questions are no, then I recommend that you ask your medicine internship director for some rotations in psychiatry. Of course, this may not be possible.

It is much more compelling to hear that you like the work - because you have actually done the work - than to hear that you like the work because you think you like the work.

Hope this makes sense. Good luck to you!

 

[Merely]

From the perspective of an associate training director involved in residency recruitment x 6 years:
with this situation, we are trying to figure out whether you are primarily moving AWAY from internal medicine or you are primarily moving TOWARD psychiatry. If it is the former, then please go do something else other than psychiatry (which takes real commitment and passion to practice well). If it is the latter, then read on for more advice!

I am a strong believer in reflection, but it will help your cause if you have something more substantive than soul searching to demonstrate the wisdom of your decision-making.

By this, I mean
-- Did you complete a medical school rotation in psychiatry AFTER you decided to pursue internal medicine?
-- Did you do a psychiatry sub-internship in medical school?

If the answer to these questions are no, then I recommend that you ask your medicine internship director for some rotations in psychiatry. Of course, this may not be possible.

It is much more compelling to hear that you like the work - because you have actually done the work - than to hear that you like the work because you think you like the work.

Hope this makes sense. Good luck to you!

I mean it’s important to note that psych is probably the easiest specialty to practice at standard of care, practicing well is difficult in any field but in terms of reaching standard of care the bar is lowest in psych compared to any field of medicine imo

 

[Orgone]

Somebody entered the class above me doing what OP is trying to do, he was able to graduate on time as well via some scheduling antics. He switched from a different hospital but same system so I don't think he had to go through the match. Networking in your area with PD's might be a good idea.

I mean it’s important to note that psych is probably the easiest specialty to practice at standard of care, practicing well is difficult in any field but in terms of reaching standard of care the bar is lowest in psych compared to any field of medicine imo

Generally agree with this sentiment but the flip side is that I still see plenty of sub-standard psychiatrists causing absolute havoc on people's lives. Sometimes irreparably.

 

[Sushirolls]

Somebody entered the class above me doing what OP is trying to do, he was able to graduate on time as well via some scheduling antics. He switched from a different hospital but same system so I don't think he had to go through the match. Networking in your area with PD's might be a good idea.



Generally agree with this sentiment but the flip side is that I still see plenty of sub-standard psychiatrists causing absolute havoc on people's lives. Sometimes irreparably.

For every 1 psychiatrist there are probably 3-5 ARNP

 

[Sushirolls]

OP, stick with IM, do outpatient primary care and open up a Direct Primary Care practice. Still get plenty of basic psych, but don't have to get entrenched in the Axis II.

 

[nexus73]

Do IM and become a cardiologist. Buy a lake house and retire at 55 years old. Or become a psychiatrist and call me, we need to hire you.

 

[Shufflin]

Cards is an awesome field, but extremely intense and tiring. Not life-style friendly. Considered doing it. Very rewarding if you love it.

 

[EarlyCareerAcademicPsych]

I mean it’s important to note that psych is probably the easiest specialty to practice at standard of care, practicing well is difficult in any field but in terms of reaching standard of care the bar is lowest in psych compared to any field of medicine imo

I’d love to better understand how you came to this opinion.

 

[Merely]

I’d love to better understand how you came to this opinion.

Do you disagree? The amount of knowledge needed to practice psychiatry reasonably is way lower than say IM, surg or most other fields. Perhaps there are a few other fields with less knowledge required like PM&R but overall psych is probably the most basic. Again not to say it doesn’t require a lot of effort to practice well but to just practice reasonably I’d say my statement is true.

 

[michaelrack]

The amount of knowledge to pass a recertification exam is definitely higher for primary care specialties than for psychiatry

 

[EarlyCareerAcademicPsych]

Do you disagree? The amount of knowledge needed to practice psychiatry reasonably is way lower than say IM, surg or most other fields. Perhaps there are a few other fields with less knowledge required like PM&R but overall psych is probably the most basic. Again not to say it doesn’t require a lot of effort to practice well but to just practice reasonably I’d say my statement is true.

I think that I could best communicate my opinion if I knew whether you had ever practiced psychiatry before or not.
But I'll give it a shot without that information.

I agree that the amount of established knowledge necessary to master is larger in other fields. I agree with Michael Rack that it is especially high in primary care. IMO, a good primary care physician is gold.

However, practicing psychiatry effectively requires many skills which are not regularly needed by other physicians. These skills are challenging. These skills include some which are qualitatively different and they are not easily described (though I would try to do so, if you are really interested, LMK).

From college, I already knew how to read books and I knew how to study. In medical school, I learned how to carefully assess history, conduct an exam, consider a differential diagnosis, order labs & studies, develop a treatment plan - the basic tasks involved with working as a physician. However, it was my psychiatry residency (and some other post-graduate work) which helped me learn how to work as a psychiatrist.

This is why I would like to know if you have every practiced psychiatry before or not.

 

[Merely]

I think that I could best communicate my opinion if I knew whether you had ever practiced psychiatry before or not.
But I'll give it a shot without that information.

I agree that the amount of established knowledge necessary to master is larger in other fields. I agree with Michael Rack that it is especially high in primary care. IMO, a good primary care physician is gold.

However, practicing psychiatry effectively requires many skills which are not regularly needed by other physicians. These skills are challenging. These skills include some which are qualitatively different and they are not easily described (though I would try to do so, if you are really interested, LMK).

From college, I already knew how to read books and I knew how to study. In medical school, I learned how to carefully assess history, conduct an exam, consider a differential diagnosis, order labs & studies, develop a treatment plan - the basic tasks involved with working as a physician. However, it was my psychiatry residency (and some other post-graduate work) which helped me learn how to work as a psychiatrist.

This is why I would like to know if you have every practiced psychiatry before or not.

I’m a psychiatry resident so I have a little experience

 

[TexasPhysician]

The amount of knowledge to pass a recertification exam is definitely higher for primary care specialties than for psychiatry

That’s true for primary care compared to any specialty.

 

[Doctorows]

I’m a psychiatry resident so I have a little experience

No offence, but you've been a psychiatry resident for two weeks.
This is the time interns figure out how the EMR works and where the bathroom is, not come to a generalized conclusion (that holds any merit anyway) for what it truly takes to practice psychiatry.

 

[Merely]

No offence, but you've been a psychiatry resident for two weeks.
This is the time interns figure out how the EMR works and where the bathroom is, not come to a generalized conclusion (that holds any merit anyway) for what it truly takes to practice psychiatry.

I agree

 

[hamstergang]

I mean it’s important to note that psych is probably the easiest specialty to practice at standard of care, practicing well is difficult in any field but in terms of reaching standard of care the bar is lowest in psych compared to any field of medicine imo

Why do you think this is an important consideration for a psych residency program when reviewing an applicant already in IM? Are you suggesting the program should lower its standards since it's easier for that applicant to ultimately practice at the minimum standard of care in Psychiatry than in IM?

For every 1 psychiatrist there are probably 3-5 ARNP

Why is this relevant? I see people all the time say something similar, and I just don't get it -- is the implication that we should lower our standards to that of the least rigorous APN program? Otherwise, we maintain our standards of care/training as psychiatrists regardless of what other professions are doing.

 

[Sushirolls]

It is a reminder for people who wish to disparage the quality of a Psychiatrist. It is context that the level of psychiatric providers is quite varied, and psychiatrists still represent the Gold Standard.

In an ideal world I advocate the continued maintenance of quality for the profession to weather the next Flexner Report type of house cleaning. However, what I have lived and seen of the current bureaucratic mess of the health care system and its intersection of politics, I anticipate physicians will eventually drift away to obscurity as 'cheap' and 'access' is valued over all other metrics. I see little momentum for another Flexner. Our clinging to standards may be our undoing similar to Beta Tapes, and the proverbial "better mouse trap." Society, health systems, our very out academic centers, and also medical societies all believe in the expansion and use of Mid levels in the name of access. Rather than advocating for less paper work to increase our ability to undertake more volume, we are where we are.

It raises the question, perhaps we need to loosen the standards in medicine. Ditch step 3 for state licensures. MD/DO grads are now independent. IMGs now only need 1 year of internship to get independent license. De-link board cert from hospital privileges and even insurance privileges.

 

[EarlyCareerAcademicPsych]

It is a reminder for people who wish to disparage the quality of a Psychiatrist. It is context that the level of psychiatric providers is quite varied, and psychiatrists still represent the Gold Standard.

In an ideal world I advocate the continued maintenance of quality for the profession to weather the next Flexner Report type of house cleaning. However, what I have lived and seen of the current bureaucratic mess of the health care system and its intersection of politics, I anticipate physicians will eventually drift away to obscurity as 'cheap' and 'access' is valued over all other metrics. I see little momentum for another Flexner. Our clinging to standards may be our undoing similar to Beta Tapes, and the proverbial "better mouse trap." Society, health systems, our very out academic centers, and also medical societies all believe in the expansion and use of Mid levels in the name of access. Rather than advocating for less paper work to increase our ability to undertake more volume, we are where we are.

It raises the question, perhaps we need to loosen the standards in medicine. Ditch step 3 for state licensures. MD/DO grads are now independent. IMGs now only need 1 year of internship to get independent license. De-link board cert from hospital privileges and even insurance privileges.

Just let go and watch it all happen ... is that it?

 

[EarlyCareerAcademicPsych]

I’m a psychiatry resident so I have a little experience

I really wish you the best with all of it! Try to have fun along with the work, if you can

 

[Sushirolls]

Just let go and watch it all happen ... is that it?

That is what we are all doing now. Look around.

 

[EarlyCareerAcademicPsych]

That is what we are all doing now. Look around.

Some are trying to do more. I speak from personal experience about my own efforts and the efforts of some close colleagues.