Psych / FM

[commonwealth ki]

I know that training programs exist but what do you think the feasibility of doing both in a private practice setting is?

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[Faebinder]

WAY TOO MANY PATIENTS!

Do you need THAT huge of a scope. The best setting for you is a med/psych unit not private practice.

 

[nancysinatra]

This is kind of a mind boggling combination. Family medicine is geared for outpatient treatment of adults/kids/OB. If you want to work on a med/psych unit--then I'd think you'd be better off with an IM/psych program. If you do family medicine/psych, well maybe you could work in a clinic and address the psych issues that PCPs see daily (depression, anxiety, some stuff beyond that). But that would waste most of the actual psych training and sounds boring.

I don't really know what people do with this combo, unless they live in rural areas and provide the absolute full range of care to everyone. For that, it seems ideal. Partly because without the psych residency part, you'd have no psych training at all, and you might be the only person for miles around. The family part covers almost all the rest of medicine! About all you couldn't do yourself would be surgery, anesthesia, rads, path, etc. But you would be spread very thin.

 

[Chrismander]

I know that training programs exist but what do you think the feasibility of doing both in a private practice setting is?

My understanding is that the major limiting factor for private practice in FP-psych (or IM-psych or peds-psych) is the billing. You can't bill for both FP and Psych services delivered on the same day. So you'd be doing twice as much work (addressing both medical and psych issues) per visit (and taking twice as long) but getting the same reimbursement. Or you'd be doing a crappy job in both areas trying to cram the full gamut of medical and psychiatric services into one regular-sized appointment. My program used to have a FP/psych sister program that's now defunct, because as previous posters have mentioned, almost all people choose one over the other (usually psych). Med/psych units in academic settings are a possibility with this training, and possibly certain academic outpatient practices where billing wouldn't be as important--maybe as faculty in a med/psych teaching clinic, or some homeless clinic that has funding from an outside source? Maybe someone on this board has experience or knowledge of such a clinic. One possibility might be to contact one of the remaining dual programs and ask what practice settings their graduates go into that use both of their specialties. Hopefully the answer will be something other than "they stay here to train the next generation of FP-psych faculty, who will stay here to train..." and so on. Our medicare dollars at work.

All in all, it's pretty impractical. No point in suffering those additional years unless you already have a clear career plan that requires both trainings. This isn't college anymore, no extra glory in double majoring.

 

[TexasPhysician]

I very briefly considered FM/Psych. I talked to a FM/Psych graduate, and he advised me against it. He said the programs were well suited for people wanting a VERY rural job or something more in public health. He said that most FM/Psych graduates ended up only practicing psych because it was more lucrative.

Not for me.

 

[hippiedoc13]

Check out the websites of a couple of the combined FM/Psych programs, they have alumni profiles with descriptions of what they are doing:

http://www.ucdmc.ucdavis.edu/psychiatry/residency/combfam/residents.html (UC Davis)

http://www.combinedresidency.org (UCSD)

 

[Doc Samson]

As others here have predicted, the majority of these graduates are practicing psych only or are working in very rural settings.

 

[DD214_DOC]

An attending once told me that the FM/Psych programs are for people who wanted to do psych but were afraid to tell their parents.

 

[billypilgrim37]

I know about 8 FM/Psych people at 4 different programs (Davis, Iowa, Cincy, Pitt). Most of them have pretty interesting ideas about what they want to do with the training, some more fiscally possible than others. One is interested in very comprehensive addictions work, another wants to be an "ACT or CTT or whatever your local team is that follows the mentally ill folks around under bridges" doc, etc. I think the training makes the most sense for people who are planning on being family docs, but think "two more years of training isn't much to be much more comfortable with psychiatry." I mean, people do an extra year or so to do sports medicine after family. Why not do something useful and learn how to be a psychiatrist instead? It is much harder to be a "psychiatrist who knows how to do primary care correctly" for the reasons described in other posts.

The training makes the most sense for specialized university clinics that can afford to eat some of your salary (like a prenatal OB clinic for the severely mental ill) or for county funded positions (like the assertive community teams).

Given how few slots there really are for this training, it's amazing how much we talk about it.

 

[igottaquestion]

An attending once told me that the FM/Psych programs are for people who wanted to do psych but were afraid to tell their parents.