Med/Psych Programs

[bth7]

Hi folks,

I'm a 3rd year DO med student seriously thinking about med/psych. Some questions?

How competitive are these programs?

Most of the seem to be at university affiliated hospitals, this would seem a major plus in terms of the overall atmosphere, quality of the program. Is this true? I'm really hoping to avoid facilities with poor patient care values and a malignant educational environment.

Some people tell me there absolutely no point in doing med/psych. That anyone is "just going to wind up doing one or the other so why don't you just pick one." Thoughts on this analysis?

Any general comments about your experience, if you are glad you chose med/psych, or why you are considering it. Thanks!

bth

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[nevercold]

Hi,

I never felt comfortable enough with psych to want to do it, but I am doing Med/Peds. I get the same sort of "why don't you just pick one or the other?" questions. At my medical school, our medicine clerkship director is Med/Psych and she is extremely smart and attends in both Medicine and Psychiatry (she happened to be my attending on my Psych rotation). You don't have to ultimately choose one or the other and there's nothing wrong with wanting one or the other to enhance your training in a way you think would influence your practice positively if you did decide to ultimately focus on just one of the two.

Usually the people that tell you to pick one or the other have an agenda: either they specifically disliked Medicine or Psychiatry, or else they see "5 years" in the requirements and think "woah, that's too long for *anything*."

I don't know much about the residency programs themselves, but in general the combined specialties tend to be at academic centers, so you'd probably have plenty of great places to apply to!

 

[diosa428]

We have a med/psych program here (Duke) and there is a gen med team that is strictly med/psych - that is, other med teams call them when they have a medicine patient who also has a serious psychiatric co-morbidity. That team can pick and choose which of these pts they would like to take on their service, and there they treat both the psychiatric and medical issues. The medicine clerkship director here is actually med/psych and she works as a psych attending sometimes, as a medicine attending sometimes, and sometimes she's the attending for the med/psych team. We have another med/psych person here who's really interested in HIV pts and their psychiatric co-morbidities. I'm not really sure how prevalent situations like this are (they probably aren't really that common yet, but I feel like they may become more prevalent in the future) but there are opportunities out there to use both.

 

[DD214_DOC]

I am looking at either med/psych or fm/psych myself. I do get the, "you're an idiot" statements occasionally.

My reasoning was mainly personal, I have a great interest in psych. In my experience, I think FM docs and peds inadequately treat and manage the psych conditions they're presented with as well. I plan to practice in a largely rural area, and with the nearest psychiatrist an area away I wanted to be able to split my hours between the two to provide this service to the community. This could be reasonably done without sacrificing revenue if you're business savvy.

Also, I'm pretty interested in a C-L fellowship and I think the combined programs match up quite nicely.

 

[bth7]

I am looking at either med/psych or fm/psych myself. I do get the, "you're an idiot" statements occasionally.

My reasoning was mainly personal, I have a great interest in psych. In my experience, I think FM docs and peds inadequately treat and manage the psych conditions they're presented with as well. I plan to practice in a largely rural area, and with the nearest psychiatrist an area away I wanted to be able to split my hours between the two to provide this service to the community. This could be reasonably done without sacrificing revenue if you're business savvy.

Also, I'm pretty interested in a C-L fellowship and I think the combined programs match up quite nicely.

Great idea there on the C-L connection.

So what are you thoughts on competitiveness of these programs? Strategies for getting accepted to ones preferred choices?

bth

 

[Jack Daniel]

Pardon me,
C-L? I don't follow.

 

[bth7]

Pardon me,
C-L? I don't follow.

Consultation-Liason

 

[nitemagi]

Great idea there on the C-L connection.

So what are you thoughts on competitiveness of these programs? Strategies for getting accepted to ones preferred choices?

bth

My impression when interviewing was that it's generally less competitive than either individual specialty. I would likely not have gotten an interview at Duke for medicine alone (though my CV was heavily psych weighted), but did for the combined program. Also many grads of these programs often come from less "name" med schools. Not that that has any relation to their ability as physicians because these programs have some really outstanding training.

As for the C/L issue, that's an interesting one which I explored when researching the Med-Psych concept. So overall there's a shortage of C/L people and so anyone with psych credentials can do it. Perhaps one day it will be limited to those who have done fellowships, but that time is nowhere in the immediate future. Now I further believe that both combined med-psych and c/l fellowship will give independent unique trainings, but they're by no means equivalent. But I'm sure double boarding would help a bit, as well as many training programs using c/l as a big component of their training. Finally, right now you can be grandfathered into c/l board certification, but after 2009 the only way to get board certified will be to have done a fellowship.

Ignore those people who tell you there's no point in double boarding. Now while I'm not doing it myself, I did talk with a dozen different attendings as well some residents in such programs, and it's far from useless. But it's also a helluva lotta work that primarily s useful for one of two purposes: having absolute career flexibility (see my earlier post about duke graduates getting positions "created" for them anywhere they want to go), or for very well defined niche practices for which you would be specifically qualified but should probably have really planned out before choosing that type of residency.

Oh and the head of the UC Davis med-psych program is a DO. And a fantastic teacher, or so I'm told from my colleagues.

 

[bth7]

What are your thoughts on doing "audition rotations" at these places? Is it necessary or advantageous? Is it better to do the with the IM service or the psych service?

bth

 

[nitemagi]

What are your thoughts on doing "audition rotations" at these places? Is it necessary or advantageous? Is it better to do the with the IM service or the psych service?

bth

Some programs have externships on their med-psych service (a combined inpatient unit, or with their specific C/L team). I don't think (not that you were asking me )it's necessary unless you don't think you're competitive enough to match on your creds, just like most externships. I think it's probably more useful to see whether you like the program or not. As you'll find on interviews is that everyone puts on their best face, as you'd expect, but being there for 3-4 weeks give you a real sense of things.

 

[michaelrack]

I finished med/psych at West Virg- Morgantown 2002 and finished my sleep fellowship at the U of MS 2003. Currently boarded in Internal Medicine and Psychiatry, as well as the old sleep boards (still waiting to hear back from the new ABMS November sleep examination), taking the psychosomatic boards in April 2008. Currently in private practice- mainly sleep, a little psychiatry.

Reasons for doing med/psych:

1. planning an academic career. It is possible to practice both specialties in academia; I did this for a few years at U of MS (1/2 day supervising resident medicine clinic, the rest of the time psychiatry or sleep).
2. want to do mainly medicine with a little psychiatry. If you are part of an internal medicine practice, it is possible to do some psychiatry on the side- either within the practice or moonlighting at a mental health clinic 1/2 day a week, etc.

Reasons not to do Med/psych

1. Want to do mainly psychiatry with a little medicine, or an equal mixture of the two. This is very difficult to do outside of academia. It is hard to do part-time internal medicine due to the necessity of providing coverage of the practice for patient emergencies.

 

[solumanculver]

I finished med/psych at West Virg- Morgantown 2002 and finished my sleep fellowship at the U of MS 2003. Currently boarded in Internal Medicine and Psychiatry, as well as the old sleep boards (still waiting to hear back from the new ABMS November sleep examination), taking the psychosomatic boards in April 2008. Currently in private practice- mainly sleep, a little psychiatry.

Reasons for doing med/psych:

1. planning an academic career. It is possible to practice both specialties in academia; I did this for a few years at U of MS (1/2 day supervising resident medicine clinic, the rest of the time psychiatry or sleep).
2. want to do mainly medicine with a little psychiatry. If you are part of an internal medicine practice, it is possible to do some psychiatry on the side- either within the practice or moonlighting at a mental health clinic 1/2 day a week, etc.

Reasons not to do Med/psych

1. Want to do mainly psychiatry with a little medicine, or an equal mixture of the two. This is very difficult to do outside of academia. It is hard to do part-time internal medicine due to the necessity of providing coverage of the practice for patient emergencies.

Hey,
Psychiatry and medicine have an obvious overlap in sleep disorders, what about psychoneuroendocrinology/immunology? Is there a useful niche to be a psychiatrist/endocrinologist in academia?

 

[michaelrack]

Hey,
Is there a useful niche to be a psychiatrist/endocrinologist in academia?

Psychiatry/endocrinolgy would be a useful niche in academia. On the research side, metabolism/glucose regulation in bipolar disorder/schizophrenia and the metabolic effects of psychiatric drugs are hot areas of research. Clinically, the combination would be useful for evaluating and managing the endocrinological effects of psychiatric drugs (for example, hyperprolactinemia).

 

[solumanculver]

Psychiatry/endocrinolgy would be a useful niche in academia. On the research side, metabolism/glucose regulation in bipolar disorder/schizophrenia and the metabolic effects of psychiatric drugs are hot areas of research. Clinically, the combination would be useful for evaluating and managing the endocrinological effects of psychiatric drugs (for example, hyperprolactinemia).

Oh, thanks a lot, that's exactly what I had in mind. Do you see endocrinology playing a bigger role in the training of psychiatrists in the future?

 

[michaelrack]

Do you see endocrinology playing a bigger role in the training of psychiatrists in the future?

Not really. I think most psychiatrists will continue to do the recommended testing for monitoring psychotropics (testing TSH for lithium, monitoring glucose, lipids and weight on those taking antipsychotics) without doing too much treatment of the abnormal labs. Psychiatrists will continue to rely on pcps/medicine specialists for the evaluation of abnormal lab results. There are a lot of psychiatrists out there uncomfortable prescribing synthroid for an elevated TSH.

 

[jettavr6]

Resident in Psychiatry here... I wish I'd have done a dual residency program... I highly recommend doing a combined residency program to anyone who is thinking about psychiatry. The bottom line is that Internal Medicine knowledge is becoming increasingly important in psychiatry.

 

[bth7]

Resident in Psychiatry here... I wish I'd have done a dual residency program... I highly recommend doing a combined residency program to anyone who is thinking about psychiatry. The bottom line is that Internal Medicine knowledge is becoming increasingly important in psychiatry.

Could u say anything more about why you wish you'd made a difference choice and at what point in your training you figured that out? As someone who really on the fence between straight psych and med/psych, I'd really appreciate hearing your thoughts.

Also, is there a way now for you to get more med training? Would you ever consider going on a medicine program after psych?


bth

 

[nitemagi]

I want to chime in that the level of IM training learned in IM is really beyond the level you should be expected to know as a psychiatrist. I certainly do not want to learn to manage ICU patients, or those with advanced osteomyelitis. Do I need 3 years of medicine to feel comfortable doing psychiatry? I don't think so, as long as I make small efforts to stay up to date on the medicine I do know. Lifelong learning, y'know? Like today in medicine clinic I had a patient with conjunctivitis that could be keratoconjunctivitis. Being on a medicine rotation (outpatient), does that mean that I should really be doing an ophtho rotation on top of medicine? No, because what's key for me is learning when to refer, and how to communicate adequately between providers of different specialties. I honestly think that it's more like IM folk should do a psych rotation than we should do more medicine. I constantly get questions from my IM colleagues about antipsychotic use and antidepressant use that I feel they should be taught, but aren't.

 

[EricS]

nitemagi: what do you know about the combined fm/psy program at UCSD (since you're in SD)? I'm applying this year and thinking about the sub-I.. I know they only take 2 per year. Any thoughts?

 

[nitemagi]

nitemagi: what do you know about the combined fm/psy program at UCSD (since you're in SD)? I'm applying this year and thinking about the sub-I.. I know they only take 2 per year. Any thoughts?

I think it's fantastic, and the residents I know in it are fantastic. I also think it's a lot of work, as are most combined programs. From what I've heard it's also fairly competitive to get into, including compared to other FP/Psych programs. Sub-I would likely help, unless you're an extraordinarily strong applicant. I'd be happy to put you in touch with any residents from the program, if you'd like.

 

[BobA]

I'm thinking of doing Med/Psych to have greater career flexibility - including going into academics (as a psych attending), or a sleep fellowship.

Since I'm planning on applying to psych anyway, med/psych is only one extra year, and to me that might be worth it to have greater flexibility when I'm done training.

I also have to admit to having a small bit of fear about being locked into a career "for the rest of my life" and always like options. (For example, I'm jealous of my PA friends who jump from ED to Heme/Onc just for the variety).

What do folks think of these intentions?