Psychiatry Transfer from PGY-1 FM

[deleted1078679]

Hello all! I am currently a PGY-1 in Family Medicine.
I am an IMG, old grad YOG: 2016, have ALL Step scores, including Step 3 and prior work experience in psychiatry in my home country (not residency) and psych rotations here in USA.

I want to transfer to Psychiatry as that is the speciality I enjoy the most and I am the most passionate about and see myself being happiest long term in. I am currently in my psychiatric rotation inpatient at CSU And also outpatient and I TRULY love it- I look forward it. Overall, I know I want to work outpatient.
Can anyone please advise me how I can go about transferring to psychiatry? Esp dealing with having to get a LOR from my Program Director. I want to go about this best way possible. If anyone has done this before, would be truly appreciate. Thank you!

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[smq123]

Would you be ok with just doing an addiction medicine fellowship? Or do you really just want to do only psych?

 

[Drrrrrr. Celty]

Unless you have a spot that is borderline already yours as a wink wink nudge nudge type of deal it's time to consider psych 3 year residency that will be a fellowship after your residency in FM is over.
Risking not matching, losing your spot, etc is not worth it for you.

 

[gutonc]

As an "old" IMG, your safest bet, assuming you intend to stay in the US and practice medicine, is to finish FM and apply for psych at the end of your current residency.

If you don't care if you practice medicine at all if you can't practice psychiatry, then sure, go all in on reapplying, recognizing that it's a longshot and you might wind up without a psych spot OR your current spot.

It's also a bit late to get started on this year's application process unless you've already got everything loaded in ERAS and you're just waiting for Wednesday for it all to go live. If you can't catch this cycle, you're looking at completing 2 years of FM before potentially matching, at which point you might as well just finish it up and push for psych as a 2nd residency if that's still your dream.

 

[deleted1078679]

As an "old" IMG, your safest bet, assuming you intend to stay in the US and practice medicine, is to finish FM and apply for psych at the end of your current residency.

If you don't care if you practice medicine at all if you can't practice psychiatry, then sure, go all in on reapplying, recognizing that it's a longshot and you might wind up without a psych spot OR your current spot.

It's also a bit late to get started on this year's application process unless you've already got everything loaded in ERAS and you're just waiting for Wednesday for it all to go live. If you can't catch this cycle, you're looking at completing 2 years of FM before potentially matching, at which point you might as well just finish it up and push for psych as a 2nd residency if that's still your dream.

1. I applied to psychiatry and family medicine last year and matched into FM, the psych interviews told me they would not rank me without my step 3 which I did not have at that time. I do now.
2. I did not know I could apply to another residency specialist while currently being employed in one
3. I will not do two residencies. I don’t mind fellowship . Just looking for options . I was told I could do CAP fellowship, after my FM intern year, and then do 3 years of psych residency. Any knowledge on that?

 

[deleted1078679]

Unless you have a spot that is borderline already yours as a wink wink nudge nudge type of deal it's time to consider psych 3 year residency that will be a fellowship after your residency in FM is over.
Risking not matching, losing your spot, etc is not worth it for you.

1. I don’t. I need that secure spot lol. Does that even exist for IMGs?

2. What is psych 3 year residency that will be a fellowship after my 3 year Fm residency ? I don’t understand.

 

[deleted1078679]

Would you be ok with just doing an addiction medicine fellowship? Or do you really just want to do only psych?

1. I really just want to do only psych.

2. I saw addiction medicine fellowship and behavioral health fellowship under FM. I’m not sure how that works in USA, since in the end I’d still be a PCP and not a psychiatrist even after the fellowship correct?


3. I want to do outpatient long term. Addiction medicine is outpatient or inpatient?

 

[rokshana]

1. I applied to psychiatry and family medicine last year and matched into FM, the psych interviews told me they would not rank me without my step 3 which I did not have at that time. I do now.
2. I did not know I could apply to another residency specialist while currently being employed in one
3. I will not do two residencies. I don’t mind fellowship . Just looking for options . I was told I could do CAP fellowship, after my FM intern year, and then do 3 years of psych residency. Any knowledge on that?

as for number 2, really you can't...you can let go of your current residency and reapply for psych, but of course there is no guarantee you will match in psych the second go around.

not sure why you object to doing a second residency, but willing to do a fellowship...they generally are the same length...not sure if you can do CAP from FM...
if you really really want to do psych, then you will need to dodo a psych residency...whether you decide to leave the FM residence to pursue that or do a psych residency after completing your FM one is up to you.

 

[Drrrrrr. Celty]

1. I don’t. I need that secure spot lol. Does that even exist for IMGs?

2. What is psych 3 year residency that will be a fellowship after my 3 year Fm residency ? I don’t understand.

Psych will accept your residency as a first year of theirs. Hence you'll only need to do 3 years of Psych residency.

 

[alina_s]

3. I will not do two residencies. I don’t mind fellowship . Just looking for options . I was told I could do CAP fellowship, after my FM intern year, and then do 3 years of psych residency. Any knowledge on that?

Sorry, you heard wrong advice. You definitely need general psychiatry before child. The fastest you could go would be to enter a psychiatry program as a PGY-2, apply for early entry to child fellowship at the beginning of PGY-3, and have PGY-4 count as both your elective year of general psychiatry and first year of child fellowship. You’d still need to complete PGY-5 in child to be board-eligible.

 

[cj_cregg]

1. I really just want to do only psych.

2. I saw addiction medicine fellowship and behavioral health fellowship under FM. I’m not sure how that works in USA, since in the end I’d still be a PCP and not a psychiatrist even after the fellowship correct?


3. I want to do outpatient long term. Addiction medicine is outpatient or inpatient?

If you do a behavioral health or primary care psych fellowship after FM, you would still be a PCP, but be capable of managing more complicated psych patients in the outpatient setting (e.g. whereas many family docs are most comfortable managing depression, anxiety, and ADHD, one with a fellowship may also be able to manage psychotic disorders, bipolar, etc.).

Addiction medicine as I have seen FM docs do it is outpatient only. I've seen a handful who have outpatient practices, but offer inpatient consults at local hospitals for admitted patients who are on suboxone and need pain management or who want to initiate suboxone while inpatient for medical reasons (e.g. a patient with endocarditis who is going to need admitted for weeks to months for treatment, but is withdrawing from heroin in the meantime). Depends on your practice environment, but some do almost exclusively addiction medicine and some have large addiction treatment panels within a traditional family practice. We're talking prescribing things like suboxone, methadone, etc., and obviously those patient populations come with a large amount of psychiatric comorbidity as well that you would be managing. Some addiction docs in communities I've been basically see these patients as a consultant only for addiction/psych stuff and then the patient has a regular PCP who takes care of everything else, others manage primary care + addiction for their patient panel, some have a mix of both.

 

[Koukette]

Sorry, you heard wrong advice. You definitely need general psychiatry before child. The fastest you could go would be to enter a psychiatry program as a PGY-2, apply for early entry to child fellowship at the beginning of PGY-3, and have PGY-4 count as both your elective year of general psychiatry and first year of child fellowship. You’d still need to complete PGY-5 in child to be board-eligible.

Yup. That is the path my husband HAD to take. 3 year psych, apply for child fellowship, complete 2 years of child.
First year psych residency he did 3 months of internal medicine followed by neurology then psych.

 

[deleted1078679]

as for number 2, really you can't...you can let go of your current residency and reapply for psych, but of course there is no guarantee you will match in psych the second go around.

not sure why you object to doing a second residency, but willing to do a fellowship...they generally are the same length...not sure if you can do CAP from FM...
if you really really want to do psych, then you will need to dodo a psych residency...whether you decide to leave the FM residence to pursue that or do a psych residency after completing your FM one is up to you.

thanks for the input! The fellowships I see on FM were 1 year and CAP is one year also. So that is whY i object to doing 7 years, of additional training vs 4 years. I have finished medical school from 2016. Just answering the questions since you asked , and I do appreciate the clarity.

 

[deleted1078679]

Psych will accept your residency as a first year of theirs. Hence you'll only need to do 3 years of Psych residency.

Understood. Thanks for your help & response to the post.
1.i will try to get a spot or apply for vacancies via PGY-2 or transfer and make a post asking about behavioral health or psych PCP fellowship, post FM residency.
2. There is a psych program at the FM residency I am at. However I was advised by resident there NOT to even try transfer WITHIN small community hospital, as it is frowned upon and our fm old FM PD now DIO already said DO NOT TRY TO switch to psych.
3. I will do my best and leave the rest to above.

 

[deleted1078679]

If you do a behavioral health or primary care psych fellowship after FM, you would still be a PCP, but be capable of managing more complicated psych patients in the outpatient setting (e.g. whereas many family docs are most comfortable managing depression, anxiety, and ADHD, one with a fellowship may also be able to manage psychotic disorders, bipolar, etc.).

Addiction medicine as I have seen FM docs do it is outpatient only. I've seen a handful who have outpatient practices, but offer inpatient consults at local hospitals for admitted patients who are on suboxone and need pain management or who want to initiate suboxone while inpatient for medical reasons (e.g. a patient with endocarditis who is going to need admitted for weeks to months for treatment, but is withdrawing from heroin in the meantime). Depends on your practice environment, but some do almost exclusively addiction medicine and some have large addiction treatment panels within a traditional family practice. We're talking prescribing things like suboxone, methadone, etc., and obviously those patient populations come with a large amount of psychiatric comorbidity as well that you would be managing. Some addiction docs in communities I've been basically see these patients as a consultant only for addiction/psych stuff and then the patient has a regular PCP who takes care of everything else, others manage primary care + addiction for their patient panel, some have a mix of both.

This is very informative, well explained and helpful. At this point of my career as an intern here starting over in USA, I've graduated since 2016 & worked at Bellevue Psych hospital as MD in my home country , in Child Psych at a Children's hospital (not residency) & Primary care-- I still find myself more passionate about Psychiatry. So at least I have the option of Addiction Medicine or Behavioal Health/ PCP Psych fellowship. Just sucks to have to go through ALL of FM training( OB, newborn/peds, adult medicine) to end up doing Psych only. This system! & they say psychiatrists are needed! I really appreciate this!

 

[deleted1078679]

Yup. That is the path my husband HAD to take. 3 year psych, apply for child fellowship, complete 2 years of child.
First year psych residency he did 3 months of internal medicine followed by neurology then psych.

Yes that's how psychiatry residency works and if you want to do CAP- so 5 years. Glad I got the clarification on that misinformation of an "alternative" route. Thank you all!

 

[residency-unpacked]

Hello all! I am currently a PGY-1 in Family Medicine.
I am an IMG, old grad YOG: 2016, have ALL Step scores, including Step 3 and prior work experience in psychiatry in my home country (not residency) and psych rotations here in USA.

I want to transfer to Psychiatry as that is the speciality I enjoy the most and I am the most passionate about and see myself being happiest long term in. I am currently in my psychiatric rotation inpatient at CSU And also outpatient and I TRULY love it- I look forward it. Overall, I know I want to work outpatient.
Can anyone please advise me how I can go about transferring to psychiatry? Esp dealing with having to get a LOR from my Program Director. I want to go about this best way possible. If anyone has done this before, would be truly appreciate. Thank you!

As a former program director, I had the exact scenario presented to me by one of our residents. I appreciated the honesty (letting me know that her true passion was in psychiatry) and I was willing to give her a LOR because I also knew that there are plenty of applicants that would come in as a PGY2 (we in the program would always keep files of good candidates that could come in should a resident leave). Hope that helps!

 

[deleted1078679]

As a former program director, I had the exact scenario presented to me by one of our residents. I appreciated the honesty (letting me know that her true passion was in psychiatry) and I was willing to give her a LOR because I also knew that there are plenty of applicants that would come in as a PGY2 (we in the program would always keep files of good candidates that could come in should a resident leave). Hope that helps!

Thank you! When do you think is the best time to let my PD know this? I really don’t understand the process of transferring here in USA. Can I direct message you please ?