Psych +/- medicine

[watermanMD]

MS-3.75 here—I'm having some trouble deciding what I want to be when I grow up.

I like a lot of things. I loved Ophtho and ENT but really don’t want to be a surgeon. I hate it in there. So I don’t think the OR lyfe is for me. FM was good, but so too was everything else. Unexpectedly, I loved psych. The pathology-psychosis, depression, etc.-was fascinating to me. I love listening. I enjoy digging deep in the history of a patient to uncover things. I enjoy the deeper connection. Not to mention, the more time I spend with patients, the more I realize how underrecognized and prevalent psychiatric undertones are in all fields of medicine. So, I was originally thinking IM/Psych. However, as I finish my peds rotation, I'm realizing how much I love the kiddos. I love the person I get to be around them, their innocence, and even the less-glamorized parts like battling anti-vaxxer parents. I like the opportunities for advocacy in the field. When I sit down and contemplate it, I don't think I could live without seeing another kid in practice. I could probably go without seeing another adult patient.

So lately, I've been looking into the triple board programs, imagining it will be a great marriage between my interests. What do you all think?

I wanted to gather some more general info about the training. There seems to be some negative views of condensed training on the interwebs. But I've had a couple attendings advise “for” and a couple “against” TB, saying maintaining 3 boards is too much. I think they're just lazy though. I love school. I love studying. I love learning. BRING IT ON, I say.

Options (all semi-impractical):
-Psych + CAP fellowship + fellowship in wilderness medicine on the side for hobby and international use (lose a good bit of medicine)
-TB (lesser training in all 3)
-IM/Psych + CAP fellowship (longer, but I love skool)
-Med/Peds (and just spend a long time talking to patients)

---

Members don't see this ad.

 

[michaelrack]

But I've had a couple attendings advise “for” and a couple “against” TB, saying maintaining 3 boards is too much.

3 boards is nothing. I maintain 4 boards- Psych/consult psych/IM/sleep, and am thinking about adding addiction medicine (ABPM)

 

[Evidence Based]

However, as I finish my peds rotation, I'm realizing how much I love the kiddos. I love the person I get to be around them, their innocence, and even the less-glamorized parts like battling anti-vaxxer parents. I like the opportunities for advocacy in the field. When I sit down and contemplate it, I don't think I could live without seeing another kid in practice. I could probably go without seeing another adult patient.

So lately, I've been looking into the triple board programs, imagining it will be a great marriage between my interests. What do you all think?

Curious as to what the "value add" of the triple board is here vs. psych + CAP fellowship. All the things you like about working with kids seem like the psychosocial parts of peds, do you have specific interests in the medical care of kids? I never really considered triple board programs so I can't say I'm an expert, but cramming that amount of training into 5 years is grueling.

I also don't think people advising against the triple board are "lazy." Most people who get dual boarded in say IM/psych or FM/psych or something like that end up only practicing one specialty due to A) job availability and B) it being really hard to keep current in multiple (very different) fields. There are definitely exceptions (like michaelrack), but most people aren't them.

And while you may be super stoked to train forever now, I'd be cautious in thinking that attitude won't be different in a couple of years when you're on the other end of residency.

 

[watermanMD]

How do you "love" ophtho and ENT if you don't like the operating room? This makes no sense, they are surgical specialties. You are just trying to make yourself seem smart/interesting, perhaps just drop that line when you're trying to sell yourself.

People are not "lazy" for discouraging triple boarding. They are prudent. Don't be an ass.

What in particular do you want to accomplish with your professional life? Do you have a spouse and children? Do you plan on having a spouse and children? Do you feel that they have a significant claim to your time, or have you adopted the erroneous modernist "work trumps all" moral arguments? Good advice can only be given if you address these sorts of details.

My school isn't affiliated with an academic center so I rotated through community practices. My Optho and ENT attendings spent one half-morning a week in the OR. I loved both clinics. Both attendings said they didn't love the OR.
I have no skin in the game here, why would I need to make myself feel smart/interesting. Thanks for that advice though.
Perhaps they're being prudent. Perhaps they don't like studying and taking tests.

 

[908377]

Sounds like you like everything you've done except operating. I say go FM

 

[raisinbrain]

I agree it would be a good time and opportunity to reflect more on what you want to be doing on a daily basis. I gather you don't want to give up working with kids. Why then med/peds as opposed to peds?

But as stated about - it really does sound like family med may be a good fit for you. Depending on the institution, you may have less flexibility in appointment lengths, but so do many outpatient psychiatrists. Family med should give you plenty of time (years, decades with the same patients and families) to develop strong relationships with your patients. You would still have plenty of psychiatric concerns to address. Still battling the anti-vaxers.

I don't think the arguments for or against combined training should really be based on length of training time, since the value of that really depends on the person. And don't just do combined training because you can withstand the longer training, but rather that the specifics of that condensed training fits your specific career goals.

May be good to clarify what it is you're looking for beyond child psych.

 

[Bad Moose]

A surgeon who doesn't like the OR is like a psychiatrist who doesn’t like talking to patients.

 

[SourceOfDenial]

3 boards is nothing. I maintain 4 boards- Psych/consult psych/IM/sleep, and am thinking about adding addiction medicine (ABPM)

Yet you still put your pants on like everyone else, one leg at a time.

 

[TexasPhysician]

I generally advise against doing boards in completely separate fields because the vast majority of those people will stop using the lower paying field. Jobs that utilize both are rare and generally pay less trying to accommodate the mix.

Peds pays significantly less than child psych while requiring higher volume. It makes sense to get more advanced training in psych/child psych over triple board.

Our current system rewards specialization. If you just enjoy training, consider 1-2 fellowships after 1 residency. It’ll open up many more doors vs psych/peds.

Similarly in peds, peds subspecialties are in higher demand.