Psych/Family Med Combined program reputations?

[hippiedoc13]

I'm considering applying to combined Psych/Family Med programs for 2008-09. I want to get solid training in both disciplines so I'm trying to find out which institutions have individual programs with the best reputations.

What can anyone tell me about the Psych departments at the following institutions:
UC Davis
UC San Diego
University of Iowa
University of Cincinnati
Case Western Reserve University
University of Oklahoma - Tulsa
University of Pittsburgh
West Virginia University

Also, if anyone is in one of these combined programs (or is in a categorical psych program at one of these institutions and has contact with the residents in the combined program), I would love to hear from you.
Many thanks for your help!

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[maranatha]

The only thing I know is that Pitt just started their combined program this year. So it is brand spanking new and ripe for guinea pigs!

 

[Neurotica]

One of my interviewers at Case was part of the combined program, and said that the program had been recently discontinued.

 

[Hurricane]

I went to Cincinnati for med school. They have a strong psych program, with a dedicated psych ER, access to a psychoanalytic institute, a top children's hospital, a VA. I met a few of the family/psych residents, and they seemed happy.

 

[hippiedoc13]

Thanks for the info guys, please keep it coming! I'd really like to hear about the California programs...

 

[sunlioness]

The only thing I know is that Pitt just started their combined program this year. So it is brand spanking new and ripe for guinea pigs!

I was going to say that I didn't even know Pitt had one! Is the family med piece through St Margaret's?

What do people do with combined programs when they're done? I know one of our attendings is double boarded in psych and medicine and when I asked him about it, he said he doesn't use the internal medicine very much. I mean knowledge is never a waste and always helpful, but it just seems like such a long road when in the end you really are going to be doing pretty much one or the other.

 

[hippiedoc13]

What do people do with combined programs when they're done? I know one of our attendings is double boarded in psych and medicine and when I asked him about it, he said he doesn't use the internal medicine very much. I mean knowledge is never a waste and always helpful, but it just seems like such a long road when in the end you really are going to be doing pretty much one or the other.

Thanks sunlioness, I think that is a great question and a great point.

I want to do it because I want to do integrated primary & psychiatric care for patients with chronic mental illness. My interest is underserved populations, esp homeless & immigrants. I have found that the seriously mentally ill (schizophrenic, true bipolar, etc) are an underserved population of their own. These patients have at least as many co-morbid medical conditions as non-psych patients, if not more, and they have major access issues, as well as often a negative experience with the medical establishment (esp non-psychiatrists who don't like psych pts, we all know those docs are out there). So my vision is to have a practice that integrates psych and primary care for these patients. Make it one-stop shopping for them, so it's easier for them to have continuity of care and someone they trust. Of course I figure that I will also have some patients who are just primary care and a few who are just psych.

I know that quite a few physicians who do double-board programs say that they end up doing one or the other in the end. I have also heard of several people who have found novel ways to combine their two fields into an integrated practice. I think it's exciting to see that it's possible to shape your career according to your own vision for it, and create new models of patient care. I think it's also important to realize that doing combined training is not about being half-psychiatrist, half-family doc, and it's not the same as doing 2 separate residencies. It is its own territory, with its own philosophy and possibilities.

 

[Hurricane]

That sounds cool hippiedoc.

I have heard, but I have no idea if it's actually true, that the reason more people who are double-boarded in FM/psych don't practice both is because of billing obstacles. Something about not being able to bill as both a PCP and a specialist.

 

[sunlioness]

That IS cool. Good luck with it!

 

[chocomorsel]

That sounds really cool OP. I've thought about something similar, except dividing up days as such MWF see psych patients, and T,TH see family patients. Never really thought about the actual psych patients having other comorbidities though, yeah I know dumb. But that's a great idea. What about the billing thing though, I wonder if that's actually a problem that can become an obstacle. Anyway, keep us posted. And you are soo right about the severely mentally ill usually being underserved. I've thought about just taking cash only once I open practice but that would mean people who really suffer the most would be neglected, so I can't do that. But my cousin did give me an idea of opening up two offices (if financially able), one in the poor area and one in the more middle class area in order to attract both types of clientele and not have them feel like they are out of their element. You know, rich not wanting to mingle with the poor and vice versa in the waiting room. Anyways good luck, I will just stick with psych, as fammed didn't pique my interest as much.

 

[hippiedoc13]

Thanks for the positive feedback, all. That's an interesting point about the possible difficulty with billing. Unfortunately I really have no idea about billing issues...I know, that is a bad thing, as I must become cognizant of $$$ issues when in practice. Heh, I will end up being that doc who pulls in $35,000 a year...

 

[sunbeams end]

based on the reputations of the psych and family med programs individually, I would guess that UCSD would probably be the best of the programs you listed.

this does sound very cool. some thoughts:

- you could consider broadening your search to include psych/internal med residency programs as well.
- how would you handle kids in your combined primary care/psychiatry practice? presumably, as someone trained in family medicine, you would want to be able to provide care for entire families. but i think it would be pretty difficult to really provide the best quality of treatment for kids with psych problems if you haven't done a child-adolescent psych fellowship. if you do the fellowship, that would be 7 years of training all together.
- keep in mind that to provide great, integrated psychiatric and primary care to your patients, you don't necessarily have to be all things to all people on your own. you could consider joining with some like-minded folks to form a practice consisting of both primary care docs and psychiatrists, all sharing the same patients, all sharing institutional knowledge. patients could schedule their primary care and psych appointments back-to-back. for those patients with active psych problems but stable medical problems, they could primarily see the psychiatrist, but still have their meds, lipids, Hgba1c, etc monitored during their visits. and vice versa. if you run into a medical or psych problem with a patient that exceeds your knowledge, you can easily consult a colleague, maybe even refer your patient to be seen the same day.
- i would imagine that it would take a lot of work to maintain your board certification in both psychiatry and family med, and stay up to date with latest developments in both fields. completing the combined residency is only the first step . . .

anyway, just some thoughts. i like your ideas!

 

[Hurricane]

- keep in mind that to provide great, integrated psychiatric and primary care to your patients, you don't necessarily have to be all things to all people on your own. you could consider joining with some like-minded folks to form a practice consisting of both primary care docs and psychiatrists, all sharing the same patients, all sharing institutional knowledge. patients could schedule their primary care and psych appointments back-to-back. for those patients with active psych problems but stable medical problems, they could primarily see the psychiatrist, but still have their meds, lipids, Hgba1c, etc monitored during their visits. and vice versa. if you run into a medical or psych problem with a patient that exceeds your knowledge, you can easily consult a colleague, maybe even refer your patient to be seen the same day.

That's an excellent point. I've actually seen this done on several occasions, and it seems to work well. For example, at our county hospital's HIV clinic they have psychiatrists on staff for exactly the kind of "one-stop shopping" the OP was referring to. Also at the hospice clinic. And when I was a med student, I rotated with a child psychiatrist who had a joint clinic with a neurologist to help manage the behavioral problems of kids with tuberous sclerosis.