Psych to PCP practice

[rosings]

So I am hoping if the moonlighters around can tell me how this works. I am applying for primary care jobs working with recruiters, and trying to explain how 2 years of psych is enough to have a license and apply fro primary care jobs. Obviously my situation is a little unusual as I don't have a diploma or anything, although I have patient reviews and kept a case log with signatures. I heard there is another type of boards that I could try or take the addiction boards exam????

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[tr]

Are you saying you want to practice primary care solo, without supervision, with no FM or IM residency???

 

[WisNeuro]

Are you saying you want to practice primary care solo, without supervision, with no FM or IM residency???

"I mean, listen, we're talking about practice, not a game.."

 

[littlefred]

Are you saying you want to practice primary care solo, without supervision, with no FM or IM residency???

General practitioners are not uncommon. Most of the ones I've seen have medicare/medicaid caseloads or do aesthetic medicine (laser hair removal and dermatological procedures, hair implants etc.)

The requirement to be a general practitioner is 1 year of internship or residency (most medical boards would accept it) but paneling with insurances and hospitals might prove a little more difficult.

Also, posting a rhetorical question would you prefer to be seen by the original poster or a NP/PA for your medical needs?

 

[TexasPhysician]

Very difficult hurdle as nobody with 2 years of psych is out there applying for PCP jobs, except maybe you.

You are a much better candidate for psych moonlighting positions or working in a psych private practice.

 

[shoomer]

To be brutally honest, I don't see how any recruiter would take you on for primary care with no experience in that field.

For psychiatry positions, it's possible if you have the licensure. Although I imagine everyone will ask why there's only 2 years of training on your CV.

 

[Sushirolls]

1) get your independet license first
2) line up an insurance that will say yes to coverage as GP, put on hold until you line up a job
3) if jobs don't materialize, make your own. Start your own private practice. Anticipate cash only

Good Luck

 

[calvnandhobbs68]

General practitioners are not uncommon. Most of the ones I've seen have medicare/medicaid caseloads or do aesthetic medicine (laser hair removal and dermatological procedures, hair implants etc.)

The requirement to be a general practitioner is 1 year of internship or residency (most medical boards would accept it) but paneling with insurances and hospitals might prove a little more difficult.

Also, posting a rhetorical question would you prefer to be seen by the original poster or a NP/PA for your medical needs?

Sure but they've also generally done a medicine prelim year or a year of FM/IM/Peds or something actually relevant to primary care. OP literally has 0 experience with outpatient primary care....

yeah I mean you might get like a preventative medicine or indian health service or corrections gig or something but not regular outpatient jobs.

You're also impossible to get paneled with private insurance without being at least board eligible for some speciality, so yes it'd either be government jobs or cash only or some "consulting" stuff or something.

 

[Sushirolls]

Or be the ARNP/PA "doc of record" for hire in some states.

 

[Merovinge]

OP I wish you the best of luck, your situation sounds a little unwieldly as it appears you just stopped in the middle of training without lining up an alternative. You don't seem very aware of what practice looks like having not completed training which makes me think something might have happened to you. Please make sure you are taking care of yourself during this time, I had a close colleague in residency who developed schizophrenia during training and she actually responded very well when she took medication but this came too late and ended up being too inconsistent for her to move forward as a doctor.

 

[littlefred]

OP I wish you the best of luck, your situation sounds a little unwieldly as it appears you just stopped in the middle of training without lining up an alternative. You don't seem very aware of what practice looks like having not completed training which makes me think something might have happened to you. Please make sure you are taking care of yourself during this time, I had a close colleague in residency who developed schizophrenia during training and she actually responded very well when she took medication but this came too late and ended up being too inconsistent for her to move forward as a doctor.

From prior posts it looks like OP got fired from their residency program or maybe they are not allowing them to continue as a PGY-3. Rough set of circumstances but it's interesting that OP was doing PCP things whilst doing specialty psychiatric care.

I am guilty of sometimes refilling a blood pressure med or giving an RX for minor medical conditions outside of my scope, but obviously try to keep in my lane and do it for emergent reasons. I think OP would've been better doing a FM residency or a combined med/psych program.

Feel bad for OP as they have put in so much time and effort to become a doctor and now their wings have been clipped. At any rate, god luck OP.

 

[tr]

Also, posting a rhetorical question would you prefer to be seen by the original poster or a NP/PA for your medical needs?

I think that would depend on the amount of clinical experience in primary care that the NP/PA had, and also on the type of medical need. It's not at all an obvious choice in this situation.

 

[tr]

Very difficult hurdle as nobody with 2 years of psych is out there applying for PCP jobs, except maybe you.

You are a much better candidate for psych moonlighting positions or working in a psych private practice.

Someone in our residency program got kicked out after PGY-2. I believe they went and opened up some kind of holistic boutique nutraceutical private practice. Financially it seemed like it went well.

 

[TexasPhysician]

Can a psych residency drop-out who completed step 3 and received their license actually get these moonlighting jobs though? I've only seen psychiatry residents who are STILL in residency doing them...

I’m sure it’s easier in a residency program, but I’d consider hiring someone to utilize like a mid level assuming the reason for not continuing wasn’t inappropriate.

 

[nexus73]

Definitely an uphill battle at best to get hired somewhere. Especially with psych background. I've gotten into arguments with rads that an inpatient psychiatrist probably does more general medical management than they ever do. Psych are not real doctors in the eyes of others...not even the doctors who look at pictures all day, never order labs, and never order prescriptions.

 

[slowthai]

Definitely an uphill battle at best to get hired somewhere. Especially with psych background. I've gotten into arguments with rads that an inpatient psychiatrist probably does more general medical management than they ever do. Psych are not real doctors in the eyes of others...not even the doctors who look at pictures all day, never order labs, and never order prescriptions.

This is too interesting. What was the substance of their arguments?

 

[Merovinge]

This is too interesting. What was the substance of their arguments?

Something something we have higher step one scores, something something would be my guess

 

[Candidate2017]

Someone in our residency program got kicked out after PGY-2. I believe they went and opened up some kind of holistic boutique nutraceutical private practice. Financially it seemed like it went well.

In psychiatry, and many specialties, income is inversely related to medical knowledge.

 

[comp1]

Please don't do this.

 

[futureapppsy2]

OP I wish you the best of luck, your situation sounds a little unwieldly as it appears you just stopped in the middle of training without lining up an alternative. You don't seem very aware of what practice looks like having not completed training which makes me think something might have happened to you. Please make sure you are taking care of yourself during this time, I had a close colleague in residency who developed schizophrenia during training and she actually responded very well when she took medication but this came too late and ended up being too inconsistent for her to move forward as a doctor.

Do you know what your colleague ended up doing, out of curiosity?

 

[nexus73]

This is too interesting. What was the substance of their arguments?

Main thing was they saw so much pathology and were often giving recs for next steps in treatment or workup. Not sure how true that is, or if it matters if you aren't the doc actually ordering the next treatment or workup.

 

[TexasPhysician]

This is too interesting. What was the substance of their arguments?

To give them credit, most do a full transitional year that involves 12 months in other fields. That has the potential for a lot more outpatient PCP care than us right?

 

[michaelrack]

To give them credit, most do a full transitional year that involves 12 months in other fields. That has the potential for a lot more outpatient PCP care than us right?

They can also do a preliminary internal medicine year, or a prelim surgery year.

 

[Merovinge]

Do you know what your colleague ended up doing, out of curiosity?

I believe she dropped out during her PGY 4 year and has since been varying degrees of psychotic. She was quite catatonic at one point. Her family is fairly affluent and as far as I know cover her living expenses. I have seen her on a few occasions and it's about what you expect for someone with mid to late twenties onset and high pre-morbid functioning. She had a very positive response to Abilify but did not stay on it for an extended period of time. Insight has varied but is typically very low despite nearly completing a psychiatry residency, such is the horror of schizophrenia.

 

[mistafab]

I'll just point out that we can't say the poster is "psych" given that psych training was not completed. General internship was completed, and a full license would make them a general practitioner in a state they practice.

Though I wouldn't want to do this, I think they are probably against a wall looking for jobs.

You can enter a preventative med residency if you were so inclined OP, which may help you get training and appear more like a "primary care doctor." But technically, you can just go out and practice medicine if you wanted to. You can just tell the recruiters you are not a psychiatrist, you are a GP with a license.

 

[Splenda88]

I'll just point out that we can't say the poster is "psych" given that psych training was not completed. General internship was completed, and a full license would make them a general practitioner in a state they practice.

Though I wouldn't want to do this, I think they are probably against a wall looking for jobs.

You can enter a preventative med residency if you were so inclined OP, which may help you get training and appear more like a "primary care doctor." But technically, you can just go out and practice medicine if you wanted to. You can just tell the recruiters you are not a psychiatrist, you are a GP with a license.

Yes they are... But it is not extremely difficult as some people might think.

OP should be open to work for health departments, prisons, Indian Health Service (IHS).

A GP good friend of mine is working for IHS making a little over 200k with 20k or 25k/yr student loan repayment seeing < 10 patients/day.

 

[futureapppsy2]

I believe she dropped out during her PGY 4 year and has since been varying degrees of psychotic. She was quite catatonic at one point. Her family is fairly affluent and as far as I know cover her living expenses. I have seen her on a few occasions and it's about what you expect for someone with mid to late twenties onset and high pre-morbid functioning. She had a very positive response to Abilify but did not stay on it for an extended period of time. Insight has varied but is typically very low despite nearly completing a psychiatry residency, such is the horror of schizophrenia.

It is indeed cruel. A friend's son developed schizoaffective disorder (much, much more on the "schizo" side of the disorder) at 19 and went from being an incredibly high-achieving college student and D1 athlete to being unable to do really anything productive, not even productive leisure activities, let alone any type of work or school. Last I heard (~10 years post-onset), he's been hospitalized for over 6 months straight with active psychosis (is being treated--under guardianship--but apparently has stopped responding to meds).

 

[calvnandhobbs68]

I believe she dropped out during her PGY 4 year and has since been varying degrees of psychotic. She was quite catatonic at one point. Her family is fairly affluent and as far as I know cover her living expenses. I have seen her on a few occasions and it's about what you expect for someone with mid to late twenties onset and high pre-morbid functioning. She had a very positive response to Abilify but did not stay on it for an extended period of time. Insight has varied but is typically very low despite nearly completing a psychiatry residency, such is the horror of schizophrenia.

Yeah one of the patients I'll never forget was from the inpatient psych unit in med school, a guy who was a practicing surgeon in Canada before he developed psychosis (don't remember how old he was when he had his first break, we were seeing him pretty far down the line). Wasn't doing too well, pretty delusional even when he discharged eventually. Really made me make sure to get disability insurance...

 

[mistafab]

Oh yeah, forgot to mention that both preventative med and occupational med are options for OP, given they completed a PGY1 year. I think they are outside the match.

Both could line you up to do PCP type work, and give you a "specialty" outside of just being a GP. Nothing wrong with just doing GP work if you have your license though.

 

[G Sheb]

Someone in our residency program got kicked out after PGY-2. I believe they went and opened up some kind of holistic boutique nutraceutical private practice. Financially it seemed like it went well.

"Funny" thing is that many of those PP "alternative medicine" "nutraceutical" shops have been opened by graduates of top 5 residency programs.
Seems like an "elite" education makes no difference in psychiatry.

 

[ObsequiousAplomb]

Yes they are... But it is not extremely difficult as some people might think.

OP should be open to work for health departments, prisons, Indian Health Service (IHS).

A GP good friend of mine is working for IHS making a little over 200k with 20k or 25k/yr student loan repayment seeing < 10 patients/day.

Well, I hope they can get those jobs. Most prison systems I'm aware of require board eligibility at the least.

 

[deleted456421]

You've been inundated with unhelpful responses. However, similar questions have been answered numerous times on this forum. As long as you have a license, you might be eligible to practice in federal and Native American settings (IHS). If you're intrepid, you might also be able to acquire state licenses and practice independently since you've completed more than the minimal requirements for most states (2 years of post-graduate training should be enough).

There are people with far inferior training providing independent care in most states at this point.

 

[deleted456421]

Are you saying you want to practice primary care solo, without supervision, with no FM or IM residency???

I think that would depend on the amount of clinical experience in primary care that the NP/PA had, and also on the type of medical need. It's not at all an obvious choice in this situation.

Gasp! A doctor with four years of medical school + three months of internal medicine as an intern + at least two months of neurology as an intern + seven months of psychiatry as an intern + another 12 months of psychiatry wants to treat patients! How dare they! Should probably go back and train as an NP or PA for a few months!

They should then hope to gain enough experience over 20 years of practice without any true supervision to be equal to this hypothetical MD.

I know the MD passed Step 1, Step 2, and Step 3, but darn it, it's just not the same as decades of using principles learned from a few hours of shadowing and "practicing" without any meaningful feedback. But burn the actual MD for asking to provide medical care!

Fools abound on this forum.

 

[calvnandhobbs68]

You've been inundated with unhelpful responses. However, similar questions have been answered numerous times on this forum. As long as you have a license, you might be eligible to practice in federal and Native American settings (IHS). If you're intrepid, you might also be able to acquire state licenses and practice independently since you've completed more than the minimal requirements for most states (2 years of post-graduate training should be enough).

There are people with far inferior training providing independent care in most states at this point.

Yeah people (including myself) already said this. You aren't adding anything new here.

Gasp! A doctor with four years of medical school + three months of internal medicine as an intern + at least two months of neurology as an intern + seven months of psychiatry as an intern + another 12 months of psychiatry wants to treat patients! How dare they! Should probably go back and train as an NP or PA for a few months!

They should then hope to gain enough experience over 20 years of practice without any true supervision to be equal to this hypothetical MD.

I know the MD passed Step 1, Step 2, and Step 3, but darn it, it's just not the same as decades of using principles learned from a few hours of shadowing and "practicing" without any meaningful feedback. But burn the actual MD for asking to provide medical care!

Fools abound on this forum.

Dramatic and a false dichotomy. I don't think most NPs should be doing primary care independently FOR THE SAME REASON that I don't think someone who's done half a residency in a different specialty should be doing primary care independently. They're both inadequately trained. Is the half trained psychiatry resident better trained than the direct entry NP? Sure. Would I want to see such a person for my own primary care? Nope.

 

[Splenda88]

Yeah people (including myself) already said this. You aren't adding anything new here.



Dramatic and a false dichotomy. I don't think most NPs should be doing primary care independently FOR THE SAME REASON that I don't think someone who's done half a residency in a different specialty should be doing primary care independently. They're both inadequately trained. Is the half trained psychiatry resident better trained than the direct entry NP? Sure. Would I want to see such a person for my own primary care? Nope.

In an ideal world (or ideal United States) most people would agree with you. But it's not what we have in front of us.

I don't think we should tell other physicians who are eligible for licensure that they should not try to make a living.

True story. I know one NP who did not do the minimum 500 hrs require to become an NP. He had people signing the clinical papers for him saying he completed the hours. The only things that worked in his favor is that he was an IMG (GP) in another country.

This individual probably passed step1 in 4 attempts and step2 CK in 3 attempts and was never able to pass step2 CS.

Now has he his own VERY successful private practice in a desirable location seeing psych patients w/o supervision.

 

[finalpsychyear]

In an ideal world (or ideal United States) most people would agree with you. But it's not what we have in front of us.

I don't think we should tell other physicians who are eligible for licensure that they should not try to make a living.

True story. I know one NP who did not do the minimum 500 hrs require to become an NP. He had people signing the clinical papers for him saying he completed the hours. The only things that worked in his favor is that he was an IMG (GP) in another country.

This individual probably passed step1 in 4 attempts and step2 CK in 3 attempts and was never able to pass step2 CS.

Now has he his own VERY successful private practice in a desirable location seeing psych patients w/o supervision.

Medicine in the states is a flawed system. You cannot combine capitalism with the premise of medicine " doing the best for the patient" and say it even remotely makes sense. Insurance companies, pharmaceuticals, admin, Private equity, device companies all have inserted themselves between you and the patient and gobble up most of the $ with little or no risk then call you in for a meeting when your "productivity" dips even in the slightest.

I'll also add while we can have the best medical care possible with most of the cutting edge there is no personal responsibility to be "healthy" Aren't we one of the unhealthiest nations in the developed world while we supposedly have the best medical care? What does this tell you... until people actually get held up to some standards of maintaining a certain bmi, bp, sugar, chol/ldl and literally are fined or taxed more the system is doomed to fail. Of course instead of holding the individual accountable they tied payments to PCPs for patients improving a1c, lipids, bp numbers how irrational is that like you can control what joe smoe decides to do once he leaves your office. Complete insanity.

 

[shoomer]

Gasp! A doctor with four years of medical school + three months of internal medicine as an intern + at least two months of neurology as an intern + seven months of psychiatry as an intern + another 12 months of psychiatry wants to treat patients! How dare they! Should probably go back and train as an NP or PA for a few months!

They should then hope to gain enough experience over 20 years of practice without any true supervision to be equal to this hypothetical MD.

I know the MD passed Step 1, Step 2, and Step 3, but darn it, it's just not the same as decades of using principles learned from a few hours of shadowing and "practicing" without any meaningful feedback. But burn the actual MD for asking to provide medical care!

Fools abound on this forum.

Midlevels are trained inadequately for independent practice. Someone with an incomplete residency is also trained inadequately for independent practice. These are not mutually exclusive and the existence of one should not beget the other.

 

[Splenda88]

Midlevels are trained inadequately for independent practice. Someone with an incomplete residency is also trained inadequately for independent practice. These are not mutually exclusive and the existence of one should not beget the other.

I am an internist. I don't know about other specialties, but I believe most IM residents are safe to practice independently after PGY2.

In my low tier academic program, attending would call the PGY3 (or even residents that are close to completing PGY2) to ask them if they even need to come to the hospital to see your patients.

I was admitting 8-12 patients at the beginning of PGY2 from 7pm to 7am by myself at the VA. There was no supervising attending.

I wonder if most psych residents would not be safe to practice independently after the completion PGY3.

I find it hard to believe that someone in primary care specialties or psych would not realize when they are in over their head and ask for suggestions after completing 7000+ hrs (clerkship + 2-3 years residency) of training.

Even as attending, we sometimes ask our colleagues what they think about cases.

 

[splik]

You aren't qualified for PCP jobs. You would need 2 yrs of doing IM or FM. I'm not sure why you don't just do psych. You could have your own practice. You can bill medicare (which pays relatively well), tricare, medicaid and some of the crappier insurances (e.g. blue shield of california allows GPs to be credentialed). You could do disability evals for social security or C&P evals for the VA (I knew someone who did this with 2 yrs of psych residency).

 

[Candidate2017]

So do you think that the worst psychiatrists make the most money and vice versa?

Not always. But there are only so many ways you can exceed the average income of a psychiatrist through the actual practice of psychiatry, other than being a nationally known psychiatrist who can command very high fees. Labor intensive work is rate limiting. You will have to veer into being a businessperson rather than a physician.

Consider several students who apply to FM:

Student 1's goal is to become a renowned FM affiliated with the world's best med school.
Student 2's goal is to make a difference by reducing obesity, smoking, cannabis, HTN and DM, increase childhood vax rates.
Student 3's goal is to get a decent paying job.
Student 4's goal was to gun for plastics, but failed a couple classes, and now their goal is to sell nutraceuticals and spa services to affluent housewives, as well as employ midlevels to increase access to ADHD and anxiety treatment.

Who will make more? Who will likely reach their goal? Who will have better Yelp reviews?

 

[B52slinger]

You aren't qualified for PCP jobs. You would need 2 yrs of doing IM or FM. I'm not sure why you don't just do psych. You could have your own practice. You can bill medicare (which pays relatively well), tricare, medicaid and some of the crappier insurances (e.g. blue shield of california allows GPs to be credentialed). You could do disability evals for social security or C&P evals for the VA (I knew someone who did this with 2 yrs of psych residency).

Is this true for every state? So a PGY-4 can get paneled by medicare and medicaid if they were to start their own private practice? Thanks