Psychiatry as a Second Residency

[confusedapplicant]

Hello,

I'm a MS4 interested in med-psych. I was only impressed with 2 or 3 of the med-psych programs unfortunately. The others seemed to have weak psychiatry or internal medicine, and I don't see the point of being dually certified if I don't have strong training in both. I fortunately last minute decided to apply to categorical internal medicine and categorical psychiatry. I've been exploring the idea of doing all of an internal medicine residency and then doing a second psychiatry residency or vice versa.

I know it's a bit harder because of lack of CMC funding, but does anyone know how feasible this would be? I'd prefer to not have to repeat an intern year, but will reluctantly do it if it is hard to get a good PGY2 spot. Would it be more feasible to do IM and then psych or psych then IM?

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[TexasPhysician]

If you want to do med/psych, strongly consider applying to all of those programs.

Medicare reimbursements for residents has been dropping. Residents doing a separate 2nd residency don’t have full funding. Most programs can’t afford anyone without full funding anymore. My training institution recently banned all of their residencies from taking any resident without full funding. I was in the meeting, and all PD’s have filtered out all such applicants. Put simply, an IMG with 2 fails on every step would be more competitive. Sad but true.

 

[raisinbrain]

I personally don't know much about the CMC funding aspect, but I do know there are people out there who have done sequential training (IM then psych or psych then IM). I'll cross my fingers for you that the 2-3 combined programs you liked work out (I was similarly not as impressed with several programs as I had hoped, and I switched over to peds/psych programs and feel much happier with the training options). If you decide to try for sequential, I have heard that IM before psych is a much better (or at least possibly faster) way to go, since IM with neuro requirements often fulfill many of the psych intern year requirements. If you want more input, there is a current resident doing sequential training who is affiliated with the AMP, Association for Medicine and Psychiatry, who put together a little handout about sequential training options and who would probably be happy to talk more about that. PM me and I can try to find that info (not sure where it is, but 70% chance it's in my desk or email somewhere).


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[MacDonaldTriad]

If you do psych first, you will probably stop there. Almost all with dual or triple boarded people are practicing psychiatry. This may be observer bias, but it seems very true.

 

[J ROD]

I agree. If any part of you sees yourself doing psych then that will be your full time job. Some do some internal. Maybe a week on. But then it is hard to just step away from your primary psych job for a week. In the end just pick one.

 

[Monocles]

Residency is awful. Don't do 2 of them.

 

[michaelrack]

If you want to do med/psych, do a combined residency. IF for someone reason you decide to do so sequential training do IM first

 

[jkc17]

Hello,

I'm a MS4 interested in med-psych. I was only impressed with 2 or 3 of the med-psych programs unfortunately. The others seemed to have weak psychiatry or internal medicine, and I don't see the point of being dually certified if I don't have strong training in both. I fortunately last minute decided to apply to categorical internal medicine and categorical psychiatry. I've been exploring the idea of doing all of an internal medicine residency and then doing a second psychiatry residency or vice versa.

I know it's a bit harder because of lack of CMC funding, but does anyone know how feasible this would be? I'd prefer to not have to repeat an intern year, but will reluctantly do it if it is hard to get a good PGY2 spot. Would it be more feasible to do IM and then psych or psych then IM?

I wanted to do a combined program. Unfortunately I didn’t match into a combined program and matched Medicine with the thought of doing Psychiatry after. Half way through intern year I really miss Psych. Try for the combined programs. I’m currently keeping my eyes pealed for any PGY-2 Med/Psych openings but I doubt I’ll find any.

 

[neoexile]

I wanted to do a combined program. Unfortunately I didn’t match into a combined program and matched Medicine with the thought of doing Psychiatry after. Half way through intern year I really miss Psych. Try for the combined programs. I’m currently keeping my eyes pealed for any PGY-2 Med/Psych openings but I doubt I’ll find any.

Question about changing residencies. I'm not a resident yet, but it sounds like a Program Director would not be supportive of someone leaving the residency. How would you go about changing residencies if you don't have the support of the Program Director? It feels like a path to unemployment.

Can someone clarify this?

 

[jkc17]

Question about changing residencies. I'm not a resident yet, but it sounds like a Program Director would not be supportive of someone leaving the residency. How would you go about changing residencies if you don't have the support of the Program Director? It feels like a path to unemployment.

Can someone clarify this?

You should be honest and open. You’ll need a letter of recommendation to even apply for a position...

 

[neoexile]

You should be honest and open. You’ll need a letter of recommendation to even apply for a position...

Won't the Program Director get angry though?

 

[luckrules]

I interviewed at one Med/Psych program where, when telling their story of how they began, stated it all kind of started when a resident (can’t remember if they were Psych or Med) wanted to create the dual training option. How feasible would this be? Like if you approached your Psych PD in PGYII and said “hey I really want dual training, can we talk to the internal medicine people (or maybe family medicine or Peds, depending on your interests) about “creating” a dual training spot for me?” Maybe not in 5 years, but less than sequential training? Assuming the resident had good experiences, reputation, scores, etc? How would this be received?

 

[hamstergang]

Won't the Program Director get angry though?

Some are actually good people who want you to be happy and successful.

Plus, they'd rather try to get someone who wants to be there -- managing an unhappy resident can be a pain.

 

[splik]

Won't the Program Director get angry though?

we had several residents leave (either switch to a different psych program or different specialty) and they never convinced anyone to stay because the residents were easily replaceable. we all had multiple residents come in from different psych residencies or different specialties. most program directors actually care about their residents and want to support them even if that means losing them. some are of course vindictive, but they are in the minority, especially in psych. in my experience, there are usually signs it is not working out, or a specific incident that happens that propels the switch, or the person was not suited to that specialty so the PDs are usually understanding and aren't surprised much of the time. if it is a program that will struggle to replace the leaving resident that may cause more tension and of course you may be dead to your co-residents in your remaining months in that program but such as it is.

 

[futuredo32]

I wanted to do a combined program. Unfortunately I didn’t match into a combined program and matched Medicine with the thought of doing Psychiatry after. Half way through intern year I really miss Psych. Try for the combined programs. I’m currently keeping my eyes pealed for any PGY-2 Med/Psych openings but I doubt I’ll find any.

You may luck out if you are willing to do a second residency. I switched from a residency program that was brand new and good not a fancy name but good,therapy focused (which was what I wanted) major bad changes happened and our PD quit. The program tanked, we were the first year the ACGME came out with the rule that PGY1s couldn't work without attendings or a PGY2 or above so we did outpatient first. The inpatient was AWFUL and it took forever to find a new PD. I worked max 120 hours in a week no kidding and got in 2 car accidents and got a ticket in that period from being too tired to drive. There was talk of the program closing. I went to what I thought was a better program where I had interviewed and had a good rapport with the PD. PGY2 spots do open up in psych because residents leave to do child psych. I actually got my PGY 3 spot because one of their residents didn't pass step three of the USMLE. They didn't tell me this and to make it "fair " (to who I have no idea) I was doing a PGY2 call schedule in PGY3 and a PGY3 call schedule in my PGY4 year. Maybe a psych program would give you six months if you end up finishing your IM program if you are willing and wanting to do a second residency. I am the exact opposite of you. I wish I had done FP. I miss all the rest of medicine so so much and I am pretty miserable in psych.

 

[jkc17]

I’m sorry you had that experience! I can’t imagine working that many hours. I’m hoping you’re doing better now

You may luck out if you are willing to do a second residency. I switched from a residency program that was brand new and good not a fancy name but good,therapy focused (which was what I wanted) major bad changes happened and our PD quit. The program tanked, we were the first year the ACGME came out with the rule that PGY1s couldn't work without attendings or a PGY2 or above so we did outpatient first. The inpatient was AWFUL and it took forever to find a new PD. I worked max 120 hours in a week no kidding and got in 2 car accidents and got a ticket in that period from being too tired to drive. There was talk of the program closing. I went to what I thought was a better program where I had interviewed and had a good rapport with the PD. PGY2 spots do open up in psych because residents leave to do child psych. I actually got my PGY 3 spot because one of their residents didn't pass step three of the USMLE. They didn't tell me this and to make it "fair " (to who I have no idea) I was doing a PGY2 call schedule in PGY3 and a PGY3 call schedule in my PGY4 year. Maybe a psych program would give you six months if you end up finishing your IM program if you are willing and wanting to do a second residency. I am the exact opposite of you. I wish I had done FP. I miss all the rest of medicine so so much and I am pretty miserable in psych.

 

[futuredo32]

I’m sorry you had that experience! I can’t imagine working that many hours. I’m hoping you’re doing better now

Thanks, sorry I got carried away with my own personal drama. I just should have said psych residencies may take you due to one or more residents leaving to do a child psych residency, if you have done a prior residency because I have seen it done and it kinda makes sense for a large program which may have three residents leave to take someone who can at least use 6 months from their prior residency towards psych instead of losing all the money they lost from the residents who left to do child psych. Again sorry for the personal drama I included, it wasn't necessary or relevant.