Discussion in 'Hospice and Palliative Medicine' started by AnnTaylor, Jun 13, 2012.

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  1. AnnTaylor

    AnnTaylor 2+ Year Member

    Jan 23, 2011
    Which palliative care programs have fellows from psychiatry or are receptive to non trad fields applying (i.e. not limited to IM and FM etc)?
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  3. brimcmike

    brimcmike brimcmike 7+ Year Member

    Jul 20, 2008
    Ohio Valley
    I think, as a rule, most programs are open to applicants from all of the co-sponsoring specialties.

    I am PM&R and/but spent 2 years in EM before switching (both a strength in terms of experience, but also a weakness in terms of being a quitter/damaged goods, if you will).

    I know MGH is picky, I got a phone interview, and it was clear that it was doubted that was "mediciney" enough; upon request I sent a list of all my rotations, including my 2 years of EM with multiple ICU rotations. I was not invited to an in-person interview. I know that they took someone from Rad Onc. Dartmouth's one slot was filled very early in my cycle. Everywhere else I applied I got an interview, including University of Minnesota where it explicitly said on their website that they took only IM/FM, but I checked directly with the PD, who said I'd be fine and got an interview offer. I also even got an interview offer from the Cleveland Clinic, where I even got a fellowship offer, but which I ultimately turned down (probably the hardest educational/career decision :boom: I've ever had to make) in favor of the strong clinical and :prof: academic program with an MS in Med Ed option, where I start in 9 days :soexcited:

    I think that if you come from a good medical school, do well in your core clerkships, have strong USMLE scores, take a strong medical internship (and perform like a physician there and not like some psychiatrist just trying to get by (sorry, I've seen this more than once and it is never appreciated or respected), and especially if you can get a letter from a supervising internist/intensivist/FM-type that you "get it") then you should not have a problem.

    I would just say, be a physician first, and a specialist second, and it should all take care of itself.

    Good Luck
    kingofmedicine likes this.
  4. AnnTaylor

    AnnTaylor 2+ Year Member

    Jan 23, 2011
    I am reaching the final years of my training and still very interested in hospice and palliative medicine...Officially, the ABHPM website says that each fellowship program can determine which specialties it will consider candidates from. Most websites do list off that they consider candidates from all the sponsoring specialties (including the American Board of Psychiatry and Neurology) but I'm not sure if that means they'd really consider everyone equally.

    Some program websites do seem to say they are geared toward internists and family practitioners, while still others say they might make exceptions on a "case-by-case" basis and require that some individuals rotate through more months of medicine before starting the fellowship. To complicate this more, there are some palliative fellowships (perhaps "unofficial") that are geared specifically for psychiatry graduates. There are some anecdotal stories out there from psychiatry residents that palliative medicine fellowships may not consider all candidates equally... I suppose I could definitely see some internists imagining that a psychiatry graduate has no clue how to manage "medical issues" (though we do manage our own medical issues all the time on inpatient psychiatry and rotate through medicine wards as interns). Personally, I had 7 months combined of medicine, emergency medicine, and neurology in my intern year.

    The irony is that when I read through the curriculum of many palliative fellowships, they mention training fellows in much of what psychiatrists already become really good at as residents, the least of which is taking a palliative approach to geriatric psychiatry/dementia, capacity consults, proxy + ethics issues, family meetings, work-up and relief from delirium, anxiety, insomnia, depression, and so on. I know "hardcore" pain management would be a bit more challenging not coming from a "mediciney" residency perhaps (though even pain fellowships widely accept psychiatrists as we both often treat the "toughest" opiate dependent patients, beyond the reach of Neurontin + TCA's+Cymbalta). Some may argue that much of the chronicity and debilitation treated by psychiatry makes it a "palliative field" at its core.

    All of that said, which accredited palliative fellowships are open to psychiatrists in NYC and is the job market for HPM just as saturated as it might be for general adult psychiatry on the isle of Manhattan?
    Last edited: Feb 22, 2014
  5. Otto of the Silver-Hand

    Otto of the Silver-Hand Account on Hold Account on Hold

    Mar 8, 2014
    Sorry if this is a little late... but try Mt Sinai
  6. primadonna22274

    primadonna22274 Senior Member 10+ Year Member

    Yes, I know an MUSC Med-Psych grad who is starting there this summer for a 2-yr combined Geri/HPM fellowship.
    Wow. I like the notion of all that training, but 7 yr of postgrad training that is fairly redundant didn't seem the best use of my 40s.
  7. qnht

    qnht User

    Sep 22, 2012
  8. AnnTaylor

    AnnTaylor 2+ Year Member

    Jan 23, 2011
    Update: I matched at a well-established program as the first graduate of a psychiatry program. We are still deeply under-represented in the field as a powerful force in end-of-life care, not only in the management of physical pain (which we are very comfortable with since tons of psych patients have chronic pain or addiction co-moribidities), but the emotional/psychological and communication aspects of care which are "our bread and butter." Psychiatrists are not only well-versed in pharmacology, but I came to the conclusion that we also underestimate (and others underestimate) our abilities to reach into the "general medicine hat," especially right out of residency. I really encourage more people from all ten sponsoring specialties to apply.
    northernpsy and primadonna22274 like this.
  9. mycathatesyou

    mycathatesyou New Member 10+ Year Member

    Apr 5, 2006
    Congrats on matching and good luck in July!!! I absolutely agree that psychiatry has much to offer in the field.

    Maybe we will cross paths in Philly for aahpm meeting in 2015!

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