Psych programs-Non-trad student & 2nd residency?

[provocatrice]

Mid-career board certified pediatrician looking to pivot to psychiatry, with hope to have own holistic practice. Aiming to train in a program with kind, smart people, which trains one well but doesn't work one to the bone, based in nature filled location with not insane cost of living, ideally which incorporates some education on psychedelics as well. What programs might fit this wish list?

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[Celexa]

Are you aware of the peds portal programs? They'll let you train in three years instead of four (at the cost of most elective time) and there aren't many of them. Would render some other preferences moot though given the limited selection.

 

[provocatrice]

Are you aware of the peds portal programs? They'll let you train in three years instead of four (at the cost of most elective time) and there aren't many of them. Would render some other preferences moot though given the limited selection.

Yes I am aware of those. None in places I truly want to live. Also, I've been told it's program dependent whether I do 3 or 4 years in psych residency. So may not matter. That said, because at the end of those, one could be board eligible in either adult or child/ adolescent psych, there is an appeal. Need to reach out to a program director to see what percentage of grads sit for both and what grads do. Thanks!

 

[phonyreal98]

Yes I am aware of those. None in places I truly want to live. Also, I've been told it's program dependent whether I do 3 or 4 years in psych residency. So may not matter. That said, because at the end of those, one could be board eligible in either adult or child/ adolescent psych, there is an appeal. Need to reach out to a program director to see what percentage of grads sit for both and what grads do. Thanks!

You'd be eligible for both adult and child/adolescent psych. Unless I am mistaken, you have to be eligible in adult psych in order to be eligible in child/adolescent psych.

 

[Celexa]

Yes I am aware of those. None in places I truly want to live. Also, I've been told it's program dependent whether I do 3 or 4 years in psych residency. So may not matter. That said, because at the end of those, one could be board eligible in either adult or child/ adolescent psych, there is an appeal. Need to reach out to a program director to see what percentage of grads sit for both and what grads do. Thanks!

Not sure where you're getting your info but the way you're talking about this implies you aren't yet clear on the basics of psychiatry residency and fellowship training and possibly getting bad information.

Psychiatry is a four year categorical residency. Someone entering traditionally and not doing a fellowship will complete the program in four years. This includes six months of off service (two months of neurology and four months of some combination of medicine or EM, with peds being an acceptable option).

Child and adolescent fellowship is two years, but there is an option to 'fast track' in after year 3 and complete adult + child in 5 years. All other psych fellowships are one year, and none offer fast tracking, so someone in a typical path for psych who is fellowship trained did five years of training. There is NO way to be board certified in child and adolescent without also being board certified in adult psychiatry.

If you come to psych having done another residency first, you often can get credit for your off service months. And, sometimes you can sacrifice elective time. The details of any arrangement like this have to be worked out directly with your program. It could be feasible to finish in under four years and/or to start off cycle. Possibly you could get it all into three years. However, it would be unlikely to be able to fast track into child and adolescent doing this. So however much time you could shave off, if you wanted to do child, you would most likely still need to do the full two year fellowship.

The peds portal programs are custom built by the institutions to accelerate you through all the requirements for both general adult and child and adolescent in three years. So if you want to be a child psychiatrist, they are by far the most efficient way to do that. The cost of moving that quickly through all the requirements is the lack of flexibility.

 

[provocatrice]

Forgive me for not being clear. I was not implying that doing child/ adolescent psych would be three years. Only that doing a psych residency might be three years for someone like me. That is based on having asked the board of psychiatry and neurology how one's previous residency is counted as well as input from one psychiatry program. I am very much in exploration mode, hence my original post and some of what I've shared in subsequent post. Appreciate your input!

 

[FlowRate]

Aiming to train in a program with kind, smart people,

Aside from identifying any possibly malignant programs through word of mouth, this is something that's really hard to gauge or guarantee.

which trains one well but doesn't work one to the bone,

Do you have a bar for being worked to the bone? Most psych residencies are relatively chill compared to other specialties.

based in nature filled location with not insane cost of living,

What's your definition of "nature filled?" Or, rather, what counts as not being "nature filled?"

ideally which incorporates some education on psychedelics as well.

I'm curious if there are any programs which do more than touch on this a little in didactics.

hope to have own holistic practice

What do you mean by "holistic?" Most of the time I associate that word with practices that offer add-on snake-oil services.

 

[comp1]

Did anyone else just feel a visceral "no" response pop into their head reading the OP's post? I don't know anything about a peds portal, but if that sort of thing exists for the OP, they should grab the heck onto it because outside of some purpose built program, I just don't see this happening. Doing a second residency is hard and rare. The funding for the program is very complicated in second residency situations. Of course some people do actually complete a secondary, but they don't generally get to dictate any of the specifics for the program (eg location) like they might get to in picking a first residency because of how rare such opportunities are. And...ugh...psychedelics. They are unlikely to be anything more than passively mentioned in any residency program, even high powered research programs. Even esketamine is too new for much of a focus in residency. Other stuff isn't even approved, so it'll be years and years before they show up in any sort of curriculum (beyond the risks of use like persistent psychotic disorders). I also strongly associate the word "holistic" with snake oil.

 

[Merovinge]

There are certainly places that you could already get into psychodelics research during residency (e.g. Wash U) and I expect many places will at least have a few didactics on this over the coming years. I agree that there is always a trendy thing in mental health that is far beyond what the science shows and almost always disappoints, and that thing right now is psychodelics, but I would also be surprised if nothing use came from it.

On a related note, other than "best practice", is there a phrase for psychiatric care that does actually discuss all the relevant features of mental illness and treatment of it that is evidenced based. I hate the word holistic as well but feel like there is still a really positive association with it with the lay public somehow. Like a practice that discusses sleep, exercise, diet, checks levels of things that can matter but is not a random micronutrient or gut flora array, social connectedness/helping others/prosocial behaviors, matching appropriate psychotherapy to the problem(s) at hand (and obviously meds). I do long for a good word to explain this.

 

[comp1]

If you need a word other than holistic (and you might since that one is pretty bad), you could consider comprehensive, but...you really should not need these adjectives. General psychiatry should address sleep, exercise and diet. Anything else is just bad psychiatry. It's not just some more focused form of psychiatry that needs an additional perspective. This whole line of thought is why I will never do anything resembling private practice. The marketing aspect is just icky.

 

[calvnandhobbs68]

OP, I suspect you need to narrow expectations to what programs would actually accept you in the first place if you don't do a peds portal program, which are specifically designed for this type of situation including from a funding aspect.

You can get the technical information from ABPN or whatever about technical program requirements but I'm not sure you're gonna find any categorical residency programs who are falling all over themselves to match a mid-career physician to an essentially unfunded categorical slot (you already used your funding when you did your categorical peds residency).

I know you don't see it this way but you come with possible problems and questions vs a 4th year med student...are you gonna decide psychiatry isn't for you and bail out halfway through residency back into pediatrics, forcing the program to scramble to figure out call/rotation coverage and match a PGY-2/3? Are you going to be able to work with interns and take orders from senior residents who are 10+ years younger than you? Psychiatry has no problem matching people at this point (99.5% fill rate in 2024) if you look at recent match data, so there are lots of other viable candidates for categorical programs, especially if you're only looking at a few select locations.

You also sound quite non-committed if your response to the peds portal idea is "ew I don't want to live in those places for 3 years" when we're talking about a whole career change. It's interesting that you'd be willing to do basically at least 2 more years of residency/fellowship if you can do a 3+2 psychiatry residency+ child fellowship (so 5 years total) vs the 3 year peds portal program. Yes, you have to pass adult psychiatry boards to be eligible to take child psychiatry boards.

Unless you're saying you ONLY want do do adult psychiatry, in which case this would raise even more questions for a categorical program.

 

[Stagg737]

Good info so far, but some clarifications on things:

Mid-career board certified pediatrician looking to pivot to psychiatry, with hope to have own holistic practice. Aiming to train in a program with kind, smart people, which trains one well but doesn't work one to the bone, based in nature filled location with not insane cost of living, ideally which incorporates some education on psychedelics as well. What programs might fit this wish list?

This is going to vary based on the opinions of the people you talk to. I feel like the bolded fit where I did residency, but I know some of my colleagues probably wouldn't have agreed. A lot of what you're asking here is going to be subective with opinions regarding what "nature filled" means or working one hard. Most psych programs in general should be fairly laid back. Idk anywhere that will have psychedelics involved in core curriculum beyond didactics, but some places have electives in it (where I went our TRD clinic involved Spravato for many patients).

Only that doing a psych residency might be three years for someone like me. That is based on having asked the board of psychiatry and neurology how one's previous residency is counted as well as input from one psychiatry program.

This is a huge maybe and unless you can match directly into a PGY-2 position I would assume that you will be doing a 4 year program if you enter psych. I know several people who switched to psych (mostly those who were physicians in other countries before coming to US, though a couple who switched in the US), and all of those had to do 4 years. Only people I know that matched as PGY-2s were residents switching into psychiatry.

Psychiatry is more competitive now. I'm at a mid-tier academic program and am surprised by the (high) quality of some of the incoming class who matched here (did auditions at places like Columbia and Stanford). As others have mentioned, you've also already used funding on completing another residency, meaning you'd likely have to be working with a PD willing to find a way to get outside funds to cover this or do residency at a privately funded program which will likely be lower quality education (ie, residents are bodies to increase profits). I could see a place like that being interested, especially knowing you're already fully licensed, but sounds like that is the type of program you're looking to avoid.

 

[calvinhobbes]

Check out the post pediatric portal program, there are 4 solid good programs in 4 great locations that fully train you in gen psych and child psych (you’re a resident and fellow concurrently in both programs) and you become board eligible in both. its three years , not four, because you don’t have to do all that IM stuff in the first year that gen psych does (since you already did peds). They also give you credit for peds neuro if you did that in peds residency. Hope that helps. This is your only real path to become a psychiatrist, and plenty of folks who do it practice gen (adult) psych only afterwards.

Also, psychiatry is not “holistic” — it’s an evidence-based medical specialty. Sounds like you’re looking for a homeopathic naturopathic program, which you can do by enrolling into a new program called ND (naturopathic) or you can become a chiropractor, if that’s what you’re looking for. Tons of them prescribe supplements and “holistic” crap in California and the west coast (usually to the patient’s detriment, however).

 

[TexasPhysician]

Mid-career board certified pediatrician looking to pivot to psychiatry, with hope to have own holistic practice. Aiming to train in a program with kind, smart people, which trains one well but doesn't work one to the bone, based in nature filled location with not insane cost of living, ideally which incorporates some education on psychedelics as well. What programs might fit this wish list?

“Holistic” has a negative association in psychiatry, so I wonder what experience you have that draws you to psychiatry? I wouldn’t recommend using that word on the interview trail.

The rest of your requests are subjective which I can’t help with.

A BIG problem that you’ll have is reduced funding. Some programs won’t consider this an issue, but others will automatically exclude you. Multiple institutions in Texas used to accept such residents, but last I checked, their new policies exclude you.

You will likely need to apply very broadly and be willing to accept whatever programs bite.

 

[ObsequiousAplomb]

if you're looking to have a holistic practice with a bunch of other aspects that really aren't part of current psychiatric practice, I'm just gonna ask - why bother with the psych residency and fellowships? As a pediatrician, you're probably already prescribing all the medications a psychiatrist prescribes. You definitely are more comfortable managing the medical complications of psychotropics than psychiatrists, since we don't generally treat the metabolic syndrome. If I were in your shoes and seemingly just wanted to branch out, I'd just go for therapy training or psychedelic training. A second residency just seems like extra steps to "legitimize" a pedigree that isn't really related to what you're saying you want to do.

 

[provocatrice]

Thank you to the many posters here. I really appreciate what people have shared and it has prompted me to dig deeper on various aspects of my endeavor.

As for the PPPP, they are not accredited and only 3 of the 5 are currently enrolling, it's off cycle and they accept 2 people per year. Not exactly the sure fire way to transition to psychiatry. One of the things that I've wondered is whether I could train in adult psych, and simply fill in gaps to treat children in a way that complements previous pediatric training. I am reaching out to various connections to understand this more.

I do appreciate how competitive psych training has come. There are other elements to my background which change my candidacy beyond what I've shared here, and which may allow me to get a position funded. It's a complicated route that I am not going to get into but which may bypass the complications of funding for 2nd residency.

As for holistic, definitely appreciate that the word has a certain connotation, which I had not previously been aware. So thank you all for that. My desire would be to learn pharmacology but have other tools in the tool box--hypnosis, intensive short-term dynamic psychotherapy, DBT, for example. Multiple people have advised me to choose a program which teaches good therapy but I've yet to hear of a program which does this. If folks here have suggestions, I'm all ears.

And yes, I recognize that as an older applicant going for 2nd residency, this is all a risk but it is what it is.

 

[calvnandhobbs68]

As for the PPPP, they are not accredited and only 3 of the 5 are currently enrolling, it's off cycle and they accept 2 people per year. Not exactly the sure fire way to transition to psychiatry. One of the things that I've wondered is whether I could train in adult psych, and simply fill in gaps to treat children in a way that complements previous pediatric training. I am reaching out to various connections to understand this more.

This comes off as "I've pretended to think about what you're saying but not really".

I have no idea what you mean by the programs being "not accredited" and this is really bad information for other people who may be looking at this. They are 100% accredited by the ABPN and are just as much a combined pathway as any of the other pathways.

Combined Training Programs - ABPN

Learn about combined training programs offered through The American Board of Psychiatry and Neurology.

abpn.org

https://www.abpn.com/wp-content/uploads/2022/01/PPPP-guidelines.pdf

They aren't "off cycle", they are outside of the match. So there is no matching system for these program. I also don't know what you mean by "not exactly the sure fire way to transition". It's actually 100% a sure fire way to transition if you were accepted to a program. I just think you don't want to apply.

 

[Celexa]

This comes off as "I've pretended to think about what you're saying but not really".

I have no idea what you mean by the programs being "not accredited" and this is really bad information for other people who may be looking at this. They are 100% accredited by the ABPN and are just as much a combined pathway as any of the other pathways.

Combined Training Programs - ABPN

Learn about combined training programs offered through The American Board of Psychiatry and Neurology.

abpn.org

https://www.abpn.com/wp-content/uploads/2022/01/PPPP-guidelines.pdf

They aren't "off cycle", they are outside of the match. So there is no matching system for these program. I also don't know what you mean by "not exactly the sure fire way to transition". It's actually 100% a sure fire way to transition if you were accepted to a program. I just think you don't want to apply.

Agree. OP is coming off as someone who thinks they can half-ass psychiatry training because they are an attending in a completely different field. Not a great look.

Although in that sense the peds portal programs could indeed not be a guaranteed path....in that if the OP were to come off in interviews the way they are coming off here, they'd have little chance of acceptance.

 

[mistafab]

I know one person personally who 2nd careered into a psychiatry residency program - dropped out after 6 months.

It is tough to pick up your life again and put control back into a program's hands. It is a tough pill to swallow that you will have to take what you can get, and can't necessarily "choose" where you want to train. It is tough to take call, do nights, etc. etc. etc... All those "chill" programs are going to have fresh grads applying for spots that you are competing with a spot for. Not impossible, but definitely an uphill battle for you.

I recommend you dig deep and ask yourself if you HAVE TO complete a psychiatry residency to do the things you want to do. It would be much easier, take away less control, and continue your salary if you paid out of pocket for psychotherapy training and classes. The pharmacology can be learned by reading/studying a good pharm book. You already have a license to practice medicine so you can just tailor your practice.

You need to understand that psychiatry residency teaches you bread and butter psychiatry. That is a huge chunk of time devoted to schizophrenia, bipolar disorder, delirium, agitation, addiction, major depression, anxiety, and treatment resistant cases. It focuses a big chunk of time on inpatient psychiatry, emergency psychiatry, as well as some outpatient and interventional. Holistic practices may need almost none of that knowledge - and your understanding of risperidone vs olanzapine in a low functioning person is not going to help you in a PP holistic setting.

So I would ask yourself - where do I want to be in 5 years and what does that look like? Once you get a clear picture, ask yourself - what are the rate limiting steps to get there? Is it knowledge? Is it a certificate (i.e. board certification)? Is it practice? Only one of those 3 requires a residency.

Best of luck.

 

[nexus73]

I've met a handful of people completing psych as a second residency, or after completing an intern year elsewhere, and all starting as PGY2's. One guy finished family med and immediately went into psych. Also know younger people have transferred after 1 year of surgery, IM, rads, recognizing psych was what they really wanted. Older folks I've seen from anesthesiology, family med, and ophthalmology, combination of interest in the specialty plus other pragmatic issues (aging ophthalmologist with mild tremor affecting surgery, anesthesiologist with history of substance use in remission making primary specialty a bit risky with access to controlled meds). I know a small number of residencies seem to specifically hold a spot to recruit a PGY2 transfer as a way to diversify the resident mix and have found good benefit for the group dynamics bringing in people with different backgrounds. I'm not privy to the details of how prior training was credited, but it seemed like they all started as PGY2s and on track to complete general psych residency in 3 years. I'm unsure how this would work if you wanted to fast track into child, if that's even possible.

 

[provocatrice]

I've met a handful of people completing psych as a second residency, or after completing an intern year elsewhere, and all starting as PGY2's. One guy finished family med and immediately went into psych. Also know younger people have transferred after 1 year of surgery, IM, rads, recognizing psych was what they really wanted. Older folks I've seen from anesthesiology, family med, and ophthalmology, combination of interest in the specialty plus other pragmatic issues (aging ophthalmologist with mild tremor affecting surgery, anesthesiologist with history of substance use in remission making primary specialty a bit risky with access to controlled meds). I know a small number of residencies seem to specifically hold a spot to recruit a PGY2 transfer as a way to diversify the resident mix and have found good benefit for the group dynamics bringing in people with different backgrounds. I'm not privy to the details of how prior training was credited, but it seemed like they all started as PGY2s and on track to complete general psych residency in 3 years. I'm unsure how this would work if you wanted to fast track into child, if that's even possible.

Thank you for this. I've met a number of people in going down this path that came into the field late in life, including from other specialties, for a variety of reasons. Could you share which specific programs you know of which are warmer to nontraditional applicants?