Practicing psychiatry and critical care

[Pershing]

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I'm a longtime lurker here in the Psych forums. I'm thinking about doing a combined Internal Medicine-Psychiatry residency with the eventual goal of practicing both critical care (after a 2-year fellowship) and psychiatry (maybe even a C-L fellowship, or maybe not). I know this sounds insane, but if you could suspend your disbelief for just a moment, is this possible to do? Obviously, there aren't jobs out there set up for this, but can one work part-time in the ICU and part-time psychiatry whether that be clinic, inpatient, or C-L?

Perhaps Michael Rack could shed some light on this.

 

[whopper]

You could do this, but you could also spend a lot more years of residency indentured servitude too.

If you're young, bold and can graduate from the combined program & the additional CL & ICU fellowships without much regrets--(e.g. being a 40 year old resident, your personal life may suffer a bit & still in a heap of debt) then go for it.

If I could live & have the body & mind of someone in their 20s for 30 years, I would've done more with my education, maybe gotten a JD, a Ph.D. in Psychology, have done more fellowships, become a chef, but there comes a time in one's life where you need to just start making the money if you actually want to have kids & a wife (or husband) that is not going to leave you because their own lives are in limbo due to your education.

Its very possible, and some people have the talent, intelligence, drive & youth to do this. Factor in all these, and decide.

A colleague of mine has a Family Practice, Psychiatry residency under his belt, a forensic fellowship, a JD, and a graduate engineering degree. Well he's working as a psychiatrist. I'm sure at some times his over the norm training does come in & assists him to be a better psychiatrist, but was it worth extra how many years? I guess that's only a question he can answer.

 

[GATORANALYST]

I'm sure you can do it but, if you don't mind my asking, what is it about both fields that interests you?😕

 

[Pershing]

You could do this, but you could also spend a lot more years of residency indentured servitude too.

I will be finishing medical school next year without debt, but will be a long-term indentured servant to old Uncle Sam (read: military). Because of my extended obligation, I will likely stay in for 20 years for retirement benefits. The military will limit my flexibility significantly (location, hours, structure of practice, deployments, etc.), but one benefit is that I will get attending pay during fellowship training.

My fantasy of practicing both critical care and psychiatry is likely a transient one. However, I'd imagine the most feasible way to do this in the military is to practice 1-2 years of mostly general psychiatry since combined residency graduates are required to do this and then go back to do a critical care fellowship, after which I'd mainly work in the ICU with some psych clinic (C-L seems more and more implausible as I think about it). I will be doing away rotations at military sites later this year, so I'll be asking a lot of questions to see if this is even feasible. My main question to this forum, however, is about practicing both once I'm out in the civilian world. Anecdotal stories about physicians practicing both medicine and psychiatry would be great. I know that there are plenty that end up practicing only one.

I'm sure you can do it but, if you don't mind my asking, what is it about both fields that interests you?😕

I like taking care of sick patients in the ICU, and I enjoy psychiatry because of the patients' stories and the therapeutic relationship between patient-psychiatrist. Both are intense as well as cerebral, though in different ways, and doing both would be a happy balance for me. I'm still figuring things out though, so who knows.

 

[peppy]

I have to admit I have no firsthand knowledge of this issue, but I think the biggest challenge you'd face in this sort of setup would be keeping up on the literature in two separate fields after graduation (that was one of the things that made me decide against doing a combined residency). After all, your education doesn't end with residency if you want to be the best doctor for your patients, but being well-versed in the current research in one field can be time-consuming enough.
My advice is that you may want to think about if your desire to combine psychiatry with ill patients could be served by a more conventional psych sub-specialization like palliative care, neuropsychiatry, or geriatric psychiatry (since many geriatric psych patients also have other illnesses). If the acute aspect of the ICU appeals to you, maybe working in a psychiatry ER would be interesting for you. Those are just some ideas to consider...if you find this is the best path for you, good luck!