Switching from FM to psych

[scharnhorst]

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I'm an FM physician, out of residency and in practice for 5 yrs

I was wondering if it would be still possible to get into a Psych residency program ? I did a fair amount of outpt psych for 3 yrs being an FP in a small town

Has anyone done that ? please share your experience
How long do I need to train ?
Is it even possible considering I have completed one residency

Thanks

 

[MacDonaldTriad]

This is possible, It will take 3 years, and the hardest part will be living on a resident's pay.

 

[scharnhorst]

This is possible, It will take 3 years, and the hardest part will be living on a resident's pay.

I live pretty frugally so that is not an issue
I guess I will have to work with a psychiatrist before the application process starts.I'm thinking of shadowing a psychiatrist or 2 for a month , do you think that would help ?
Will a psychiatrist allow me as another physician to shadow them ?

 

[Shikima]

You can do it, if you want. Just will be a hard 3 years. But you can moonlight doing ERs and UC with your time off.

 

[MacDonaldTriad]

Shadowing may help, but probably isn't critical. It depends on how geographically mobile you are. If you need to get into one of two or three places, this could be hard. If almost anywhere will do, you will be fine. At my Hospital, you have to be a student or in training to see patients. A lot of places allow shadowing. In fact I'm sure most psychiatrists would love to have some family medicine input while managing their cases.

 

[smalltownpsych]

Just out of curiosity, why are you thinking of switching? I, for one, think it is a great idea for many reasons. Foremost of which is the need for more good psychiatrists. Secondly, the solid experience of being a family doc will definitely give you a different perspective. My own experience has been that collaborating with family docs has often been more fruitful than collaborating with psychiatrists, mainly because psychologists and psychiatrists are often too closely aligned in our perspectives. It also could provide a more balanced or integrative view of the subtle or oftentimes glaringly obvious intersection between the psychological and the physical.

 

[Gavanshir]

Why do you want to switch?

Although not psychiatry, have you considered doing an addictions fellowship? I'm currently working with a FM doc who switched careers and is doing an addictions fellowship.

 

[W19]

I worked with a DO doc in south FL that did a FM residency, but treat only psych patients in nursing homes and assisted living...

 

[scharnhorst]

Why do you want to switch?

Although not psychiatry, have you considered doing an addictions fellowship? I'm currently working with a FM doc who switched careers and is doing an addictions fellowship.

Thanks I will look into that !
I was always more interested in Psych patients since my 2nd yr residency, and enjoyed treating them in my previous practice.But I feel like I need the training of a residency to handle the more challenging bipolars and schizophrenics

 

[scharnhorst]

One more issue, I have ADHD ( I know a lot of you out there don't believe it exists) and so far I have not needed meds as I keep my workload light but I have used them ( legally ofcourse) in the past when workload was high or during exams. I do intend to take them before residency starts is it something that will cause problems ?

 

[scharnhorst]

Just out of curiosity, why are you thinking of switching? I, for one, think it is a great idea for many reasons. Foremost of which is the need for more good psychiatrists. Secondly, the solid experience of being a family doc will definitely give you a different perspective. My own experience has been that collaborating with family docs has often been more fruitful than collaborating with psychiatrists, mainly because psychologists and psychiatrists are often too closely aligned in our perspectives. It also could provide a more balanced or integrative view of the subtle or oftentimes glaringly obvious intersection between the psychological and the physical.

Thanks I still love FM don't get me wrong but I feel like too much is demanded of FM docs these days ! I will still try to work at my FM job one day a week to keep up my skills

 

[scharnhorst]

You can do it, if you want. Just will be a hard 3 years. But you can moonlight doing ERs and UC with your time off.

Yes ! That's the plan
However any tips on how to improve my application ( apart from shadowing a Psych) ? I have no research experience in PSych
I had decent score 90 and 89 ( this was back in 2005) and step3 pass second attempt got 85
I had no gaps in training and no other issues since graduation , board certified

 

[clausewitz2]

Not in residency yet, but I can tell you the two digit percentile scores are no longer used for steps 1 and 2 in any serious way. What was the three digit?

 

[hamstergang]

ADHD ( I know a lot of you out there don't believe it exists)

You believe that a group of psychiatrists won't believe that ADHD exists? That seems so strange.

 

[heyjack70]

Becoming a psychiatrist is an awesome idea. You could probably moonlight in urgent cares on the weekends.

 

[Doctor Bagel]

You believe that a group of psychiatrists won't believe that ADHD exists? That seems so strange.

Maybe over (or at least sloppily) diagnosed, but yes, I think most psychiatrists think it exists. If you have a diagnosis and a legitimate prescription, I don't think a stimulant prescription would be a problem. No one needs to know.

 

[shan564]

Your experience will make you a much stronger applicant than the average 4th-year medical student. I don't think you need to shadow a psychiatrist.

 

[MacDonaldTriad]

You believe that a group of psychiatrists won't believe that ADHD exists? That seems so strange.

“Not believing in ADHD” is a little like saying you don’t believe in UFOs. It is all semantics. Everyone has to believe that there are unidentified flying objects, but not everyone believes they are piloted by little green guys from another planet. (This analogy is working out better than I thought).


I do believe that not all ADHD children, “grow out of it”, and there can be some residual impairments that go on into adulthood and these may even benefit from stimulants. What I don’t believe is that there can be so many people who have adult ADHD that wasn’t diagnosed as children, and who cannot produce any parents or school records to support ADHD. I once attended a grand rounds by a well-known psychiatrist, and he was asked about the adult ADHD controversy and he said that all adults deserve a stimulant trial and if they do better, they should be continued on it. Ya right, that would be about everyone I think.
🙄

 

[clausewitz2]

“Not believing in ADHD” is a little like saying you don’t believe in UFOs. It is all semantics. Everyone has to believe that there are unidentified flying objects, but not everyone believes they are piloted by little green guys from another planet. (This analogy is working out better than I thought).


I do believe that not all ADHD children, “grow out of it”, and there can be some residual impairments that go on into adulthood and these may even benefit from stimulants. What I don’t believe is that there can be so many people who have adult ADHD that wasn’t diagnosed as children, and who cannot produce any parents or school records to support ADHD. I once attended a grand rounds by a well-known psychiatrist, and he was asked about the adult ADHD controversy and he said that all adults deserve a stimulant trial and if they do better, they should be continued on it. Ya right, that would be about everyone I think.
🙄

I am guessing a thread arguing for transhumanist-style cognitive enhancement would be even less productive than the presidential debate thread.

 

[milesed]

It's easily doable. I trained under 2 psychiatrists who were previously in other fields- Anesthesia and Neurosurgery. I don't know details of how they switched.

I don't recommend this, but a local pediatrician bills himself as an ADHD/Bipolar expert for all ages and has a booming practice. Of course, every patient who walks into his office is dx adhd and/or bipolar and takes the same 3-4 meds no matter what. He says he has attended various trainings to justify his claim to fame. I'm waiting for him to get sued or lose his license. Point is you can practice psyc w/o residency.

 

[MacDonaldTriad]

Point is you can practice psyc w/o residency.

And you can practice psyc poorly even with a residency.

 

[smalltownpsych]

It's easily doable. I trained under 2 psychiatrists who were previously in other fields- Anesthesia and Neurosurgery. I don't know details of how they switched.

I don't recommend this, but a local pediatrician bills himself as an ADHD/Bipolar expert for all ages and has a booming practice. Of course, every patient who walks into his office is dx adhd and/or bipolar and takes the same 3-4 meds no matter what. He says he has attended various trainings to justify his claim to fame. I'm waiting for him to get sued or lose his license. Point is you can practice psyc w/o residency.

Most family medicine docs practice psychiatry to an extent, it's inevitable. Don't they prescribe the bulk of psychotropics? Of course, most are doing a better job than that quack and seek to refer when they feel it is beyond their scope, but I am thinking that the OP wants to learn how to do it better or he would be satisfied in the field of family medicine.

 

[scharnhorst]

And you can practice psyc poorly even with a residency.

I see what you guys are saying but I think with proper training I can make a real difference , right now we hardly get any psych patients we have a big psych clinic next door at my new job

Also I would like to train with more experienced psych docs so I figure out the art part of this field , the science is there but is not implemented right, in our EHR we have to do PHQ-9 and Bipolar screening now and if a patient waits 1 hr to see me then EVERY patient has a positive screen and the therapist then is on my a$$ for prescribing them meds !!!

 

[scharnhorst]

Your experience will make you a much stronger applicant than the average 4th-year medical student. I don't think you need to shadow a psychiatrist.

I hope so, the LOR will all be from FM or IM docs then that's the problem

Guess my question was if you are a Psych doc and hiring a new resident for a psych traning program
what will you look for from a candidate like me to show interest in psych ?
obviously if someone is willing to give up 3 yrs of their life as an attending to go back as a resident that should be a sufficient show of interest ? But that's just my biased view


thanks for the encouragement though

 

[scharnhorst]

Maybe over (or at least sloppily) diagnosed, but yes, I think most psychiatrists think it exists. If you have a diagnosis and a legitimate prescription, I don't think a stimulant prescription would be a problem. No one needs to know.

That's what Im hoping and do I need to report this if I file for a new state license or renew my present one ?

 

[scharnhorst]

You believe that a group of psychiatrists won't believe that ADHD exists? That seems so strange.

Im sorry Im still thinking that my audience is docs in general !
But I try not to use my ADHD as a crutch

 

[Doctor Bagel]

That's what Im hoping and do I need to report this if I file for a new state license or renew my present one ?

My state asks something like has your ability to practice ever been affected by an illness, including mental illness. As far as I know, you're not expected to report well-controlled MH conditions like ADHD if you're stable on medications. It likely depends on your state. However, tons and tons of physicians are on stimulants for ADHD -- I doubt it's a big issue.

 

[shan564]

I hope so, the LOR will all be from FM or IM docs then that's the problem

Guess my question was if you are a Psych doc and hiring a new resident for a psych traning program
what will you look for from a candidate like me to show interest in psych ?
obviously if someone is willing to give up 3 yrs of their life as an attending to go back as a resident that should be a sufficient show of interest ? But that's just my biased view


thanks for the encouragement though

I think your biased view is correct from my less-biased perspective. But my perspective is also not the most experienced in the world, since I'm just a PGY3.

 

[milesed]

My state asks about impairment from psyc issues, not just a dx.

 

[scharnhorst]

SO should I go ahead and apply right away with ERAS for Psych as soon as it opens or wait until Nov or so when I have done a observership with a Psychiatrist and have an LOR from them ?

Since I'm already in practice its very hard to follow a psychiatrist unless it is inpatient after hours, but without it I have no LOR from Psych

ANy suggestions ?

 

[sunlioness]

More power to you. Seriously. I admire that. I couldn't be a resident again. I just couldn't.


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[shan564]

SO should I go ahead and apply right away with ERAS for Psych as soon as it opens or wait until Nov or so when I have done a observership with a Psychiatrist and have an LOR from them ?

Since I'm already in practice its very hard to follow a psychiatrist unless it is inpatient after hours, but without it I have no LOR from Psych

ANy suggestions ?

Apply now and then add the LOR later if you have it. If a program screened you out due to the lack of that LOR, you can contact them and ask them to fix that.

 

[scharnhorst]

^ Thanks guys for the advice

 

[scharnhorst]

More power to you. Seriously. I admire that. I couldn't be a resident again. I just couldn't.


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Thanks I know its not going to be easy but I want to be happy too !