Thinking about just completing intern year

[zoner]

Hello everyone

So I scrambled into family. But i really wanted to go into psych. I LOVE therapy and want to be able to combine it with being able to prescribe

I am currently going over some options.

1. Finish the intern year, move back to Cali (my home) then do two years of marriage counseling therapy education.

Any suggestion or recommendation would be highly appreciated.

I still have not given up on mental health

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[smq123]

Hello everyone

So I scrambled into family. But i really wanted to go into psych. I LOVE therapy and want to be able to combine it with being able to prescribe

I am currently going over some options.

1. Finish the intern year, move back to Cali (my home) then do two years of marriage counseling therapy education.

Any suggestion or recommendation would be highly appreciated.

I still have not given up on mental health

You can always reapply for psych as a PGY-1 OR a PGY-2. Some psych programs have more PGY-2 slots than they do PGY-1.

Much of the PGY-1 year in psych is general medicine, which you will have already done.

I know someone who completed a family med residency, and then turned around and entered a psych program as a PGY-2. You wouldn't be the first.

 

[Bacchus]

And the above is what you should do. Listen to SMQ.

 

[smq123]

And the above is what you should do. Listen to SMQ.

Thank you for the unsolicited endorsement.

(Psst, your check is in the mail.)

 

[deleted87716]

[blunt] SRSLY. GTFO of FM it's it's not your bag, but if you bail on a med school education for some lame-ass therapy degree, you're the one who needs therapy. [/blunt]

 

[hallowmann]

You can always reapply for psych as a PGY-1 OR a PGY-2. Some psych programs have more PGY-2 slots than they do PGY-1.

Much of the PGY-1 year in psych is general medicine, which you will have already done.

I know someone who completed a family med residency, and then turned around and entered a psych program as a PGY-2. You wouldn't be the first.

OP, I'd stay in it, maybe apply out, but if you can manage to hang on to the FM training, that would be in your best interest. Worst case scenario, you're talking about 2 yrs of extra residency to be better trained to do psychiatry.

There are actually many people who have done/are doing sequential FM/IM-Psych training. Managing to do sequential and getting a year of credit means you get through training in 6 yrs, only 2 yrs longer than Psych and only 1 yr longer than FM-Psych. It also means you'll be better trained in managing and recognizing the major comorbidities that your psych patients will have. Also, a Psych program may actually see it as a benefit to have someone trained in FM as a resident.

Now obviously a residency in a field you don't like is not ideal, but if FM is something you could be motivated by and excel in, then I would stay the course. If you can't stand it, then yeah, I would apply elsewhere and plan to leave after 1 yr.

 

[Mad Jack]

Hello everyone

So I scrambled into family. But i really wanted to go into psych. I LOVE therapy and want to be able to combine it with being able to prescribe

I am currently going over some options.

1. Finish the intern year, move back to Cali (my home) then do two years of marriage counseling therapy education.

Any suggestion or recommendation would be highly appreciated.

I still have not given up on mental health

Why not do family then a primary care psych fellowship? You'll make literally five times more as a FM doc doing primarily psych than as a counselor

 

[psych md jd]

Transfer into one of these combined FP/Psych programs as a PGY-2?

Education | Combined Family Medicine/Psychiatry Residency Training Program

Program Overview - UC San Diego Combined Family Medicine & Psychiatry Residency Program

 

[TableMD]

There is so much psych in family med. Do a good job and do a 2nd residency in psych OR kick but intern year and transfer. You can carve out a deep niche in an area of interest in family med, or do the additional training and make it official. Put your time witg our specialty to good use and make some moves that will set you up long term. Dont become a counselor....

 

[hallowmann]

Transfer into one of these combined FP/Psych programs as a PGY-2?

Education | Combined Family Medicine/Psychiatry Residency Training Program

Program Overview - UC San Diego Combined Family Medicine & Psychiatry Residency Program

There are a total of 6 FM-Psych programs (as of this year):

Boston University (just started its first class now)
University of Cincinnati
University of California - Davis
University of California - San Diego
University of Iowa
University of Pittsburgh

And 13 IM-Psych programs:

University of California - Davis
Emory University
Southern Illinois University
University of Iowa
University of Kansas
Tulane University
East Carolina University
Duke University
Medical University of South Carolina
Texas Tech - El Paso
University of Texas Southwestern
WVU Charleston

Walter Reed - military

To learn more about combined training, look into the Association of Medicine and Psychiatry. Also, consider attending the AMP Annual Conference in Chicago in Oct.

 

[Sardonix]

There are a total of 6 FM-Psych programs (as of this year):

Boston University (just started its first class now)
University of Cincinnati
University of California - Davis
University of California - San Diego
University of Iowa
University of Pittsburgh


To learn more about combined training, look into the Association of Medicine and Psychiatry. Also, consider attending the AMP Annual Conference in Chicago in Oct.

Thank you so much for this.

 

[zoner]

Why not do family then a primary care psych fellowship? You'll make literally five times more as a FM doc doing primarily psych than as a counselor

Thanks for all your advice.

Btw, There are primary care psych fellowships?

Now what do I do if my current program doesnt support my change

 

[twospadz]

I am a resident that did pgy-1 neurology year and switched into a pgy 2 psych position. It is possible for you to also do this. Look on the APA website for openings. Also you can apply on ERAS for programs that traditionally offer pgy-2 positions within the match. The only big difficulty I see is family medicine gets 3 years of funding. So you will be without 1 year of funding if you transfer to psych pg-2 year. Most programs would see that as a negative.

 

[W19]

Is OP rely serious about leaving his FM program for a marriage counseling program (whatever that is)? You cannot be serious!

 

[hallowmann]

Thanks for all your advice.

Btw, There are primary care psych fellowships?

Now what do I do if my current program doesnt support my change

There are a number of primary care psych fellowships (also called behavioral health fellowships). None are technically "ACGME accredited," but in the fellowship world many are not to begin with unless you are truly seeking subspecialty certification. When people do those fellowships, more than anything they are seeking training as opposed to the certification.

Now normally, I would go to AMP again for this, but the truth is the links are almost all outdated/broken. For reference, here is the page with fellowship info: The Association of Medicine and Psychiatry » Fellowships.

Here's what I could find with searching, most are 1-2 years:
University of California - Irvine - Primary Care Psychiatry Fellowship
University of California - Davis - Train New Trainers Primary Care Psychiatry - Application
Columbia University Psychiatry - Family Medicine Fellowship
University of Alabama - Behavioral Health Fellowship

I'm pretty sure there are more, but its tough to know exactly how many there are. I don't know how competitive these are, but it might be valuable going to the AMP, APA, or AAFP and asking around if its really something you're interested in.

As far as your program is concerned, that's a tough one. If you try to apply to new programs, they need to know, because you'll need a LOR from your PD to apply to another program. That also means having the option to stay and finish is kind of over. I think you need to make the decision to either plan to finish out the 3 yrs in FM, then apply Psych or for a fellowship OR to call this an intern year and expect that you'll be at risk of not being in a residency program after 1 year of training, because that's what you'll have to tell your program.

I'd give it a couple months to think about, but don't take too long, because you'll have to have that convo with your PD sooner rather than later. If we are talking about the most economically sound and safe decision, its better to finish the 3 yrs and then move on, but that's a tough pill to swallow if you have FM and general medicine.

Is OP rely serious about leaving his FM program for a marriage counseling program (whatever that is)? You cannot be serious!

Counseling & Psychotherapy and the day-to-day of a FM doc are very different. I know a lot of people that can't handle/hate the day to day of even outpatient FM. There's no point staying in a medical field that you're miserable in even if you are paid better. Its a disservice to you and your patients, who will be invariably affected by your misery, to do so.

 

[zoner]

There are a number of primary care psych fellowships (also called behavioral health fellowships). None are technically "ACGME accredited," but in the fellowship world many are not to begin with unless you are truly seeking subspecialty certification. When people do those fellowships, more than anything they are seeking training as opposed to the certification.

Now normally, I would go to AMP again for this, but the truth is the links are almost all outdated/broken. For reference, here is the page with fellowship info: The Association of Medicine and Psychiatry » Fellowships.

Here's what I could find with searching, most are 1-2 years:
University of California - Irvine - Primary Care Psychiatry Fellowship
University of California - Davis - Train New Trainers Primary Care Psychiatry - Application
Columbia University Psychiatry - Family Medicine Fellowship
University of Alabama - Behavioral Health Fellowship

I'm pretty sure there are more, but its tough to know exactly how many there are. I don't know how competitive these are, but it might be valuable going to the AMP, APA, or AAFP and asking around if its really something you're interested in.

As far as your program is concerned, that's a tough one. If you try to apply to new programs, they need to know, because you'll need a LOR from your PD to apply to another program. That also means having the option to stay and finish is kind of over. I think you need to make the decision to either plan to finish out the 3 yrs in FM, then apply Psych or for a fellowship OR to call this an intern year and expect that you'll be at risk of not being in a residency program after 1 year of training, because that's what you'll have to tell your program.

I'd give it a couple months to think about, but don't take too long, because you'll have to have that convo with your PD sooner rather than later. If we are talking about the most economically sound and safe decision, its better to finish the 3 yrs and then move on, but that's a tough pill to swallow if you have FM and general medicine.



Counseling & Psychotherapy and the day-to-day of a FM doc are very different. I know a lot of people that can't handle/hate the day to day of even outpatient FM. There's no point staying in a medical field that you're miserable in even if you are paid better. Its a disservice to you and your patients, who will be invariably affected by your misery, to do so.

Thx for your astute insight and advise. It's not that I hate primary care/ family. It's much much better than most jobs I have held in the past and there are parts of it that I actually like a lot such as conversing with patients and getting to know them. Just that medicine bores me to tears and I find psychiatry and psychiatry related medicine fascinating and exciting. I really don't know what to do. Primary is just not where my passion is

 

[smq123]

Thx for your astute insight and advise. It's not that I hate primary care/ family. It's much much better than most jobs I have held in the past and there are parts of it that I actually like a lot such as conversing with patients and getting to know them. Just that medicine bores me to tears and I find psychiatry and psychiatry related medicine fascinating and exciting. I really don't know what to do. Primary is just not where my passion is

You need to stop thinking that this decision is final. You'll spend a year in family medicine, maybe less. You can easily transfer into a psych program, or re-apply and enter as a PGY-1. You won't be the first person to do so, and you certainly won't be the last. But deciding to quit medicine entirely and become a therapist is ludicrous. The door to psychiatry is not shut to you, but your fatalistic thinking is not doing you any favors.

 

[Ironspy]

You need to stop thinking that this decision is final. You'll spend a year in family medicine, maybe less. You can easily transfer into a psych program, or re-apply and enter as a PGY-1. You won't be the first person to do so, and you certainly won't be the last. But deciding to quit medicine entirely and become a therapist is ludicrous. The door to psychiatry is not shut to you, but your fatalistic thinking is not doing you any favors.

Transferring into psych is very common and many programs would let you start as a pgy2 with the expectation that you'd lose some pgy4 elective time to complete requirements. A lot of psych programs reserve pgy2 spots for transfers. I've seen transfers from IM, ob/gyn, neurosurgery, peds. Having a therapy + meds private practice is pretty common in psych and a more reasonable path imo than quitting to do family therapy.

 

[zoner]

Transferring into psych is very common and many programs would let you start as a pgy2 with the expectation that you'd lose some pgy4 elective time to complete requirements. A lot of psych programs reserve pgy2 spots for transfers. I've seen transfers from IM, ob/gyn, neurosurgery, peds. Having a therapy + meds private practice is pretty common in psych and a more reasonable path imo than quitting to do family therapy.

The thing is my program isn't supportive of us leaving the residency and states that they are going to make it very difficult - whatever that means.

Also regarding sticking out with family, my heart just isn't in it. I mean I can do the work but I m just not into it. Medicine bores me to tears. I mean it's better than a lot of other things just that I don't have the passion

 

[smq123]

The thing is my program isn't supportive of us leaving the residency and states that they are going to make it very difficult - whatever that means.

Also regarding sticking out with family, my heart just isn't in it. I mean I can do the work but I m just not into it. Medicine bores me to tears. I mean it's better than a lot of other things just that I don't have the passion

Understood - not everyone is cut out for family medicine. And that's fine.

But don't quit to become a therapist. I don't think that you understand the salary discrepancy, and how long it will take you to pay off your loans by making the average therapist's salary.

No, not everything should come down to money, but debt traps you, it really does. It keeps people in bad jobs because they don't have the freedom to just get up and walk away.

I'm sorry that your program won't be supportive, but that just means you'll have to try harder to find a way to transfer residencies. Again, you won't be the first to leave an unsupportive program, and you won't be the last.

 

[zoner]

Understood - not everyone is cut out for family medicine. And that's fine.

But don't quit to become a therapist. I don't think that you understand the salary discrepancy, and how long it will take you to pay off your loans by making the average therapist's salary.

No, not everything should come down to money, but debt traps you, it really does. It keeps people in bad jobs because they don't have the freedom to just get up and walk away.

I'm sorry that your program won't be supportive, but that just means you'll have to try harder to find a way to transfer residencies. Again, you won't be the first to leave an unsupportive program, and you won't be the last.

So that means they won't let me off for interviews and no LOR

 

[smq123]

So that means they won't let me off for interviews and no LOR

So you may have to use vacation time for interviews, or ask the psych program directors if they can do things by Skype/phone/on weekends.

Your program director can't prohibit you from switching. It's not slavery, although you might not feel that way now. But if you want to leave, then they have to let you leave, at least at the end of your contract.

I get it, it looks bleak. But the door to psych isn't closed. It may be difficult - no one is disputing that. But what we ARE saying is that just quitting now and giving up any dream of being a psychiatrist is a) excessively negative and b) financial suicide.

 

[W19]

Counseling & Psychotherapy and the day-to-day of a FM doc are very different. I know a lot of people that can't handle/hate the day to day of even outpatient FM. There's no point staying in a medical field that you're miserable in even if you are paid better. Its a disservice to you and your patients, who will be invariably affected by your misery, to do so.

If OP has no loan, I guess he/she can do whatever he wants, but he/she does have student loan like most of us (300k), he/she will be committing financial suicide. Not sure how happy someone can be when they can't pay their bills.

Let's be real here, many (or even most) physicians are not enamored with their jobs. Almost all physicians would tell you the day to day life of resident vs. an attending is different. Telling OP to leave when he has invested 9+ years in a career and is 2 years away from finishing is just plain wrong.

Save me that BS about disservice to patients... Geez!

FM docs treat a lot of psych patients anyway... OP can tailor his/her practice to treat psych patients. I knew one retired FM doc who exclusively treated psych patients.

 

[zoner]

If OP has no loan, I guess he/she can do whatever he wants, but he/she does have student loan like most of us (300k), he/she will be committing financial suicide. Not sure how happy someone can be when they can't pay their bills.

Let's be real here, many (or even most) physicians are not enamored with their jobs. Almost all physicians would tell you the day to day life of resident vs. an attending is different. Telling OP to leave when he has invested 9+ years in a career and is 2 years away from finishing is just plain wrong.

Save me that BS about disservice to patients... Geez!

FM docs treat a lot of psych patients anyway... OP can tailor his/her practice to treat psych patients. I knew one retired FM doc who exclusively treated psych patients.

Thx for that. I have just been really enamored with psychiatry and it's amazing power after reading Mindsight. And ever since I really wanted to contribute to the field of psychiatry from a humanistic view using a lot of therapy. I might be very naive and obviously I don't really know the day to day life of a psychiatrist. It might be just another job no different than being a fm or a surgeon. I guess I am stuck on very romantic and idealistic view of psychiatry even though some of my psych rotations weren't exactly that.

I m just afraid that my becoming a fm doc and focusing on psych by taking some workshop here and there, I won't be as in depth and knowledgeable as someone who went into psychiatry residency.

 

[hallowmann]

If OP has no loan, I guess he/she can do whatever he wants, but he/she does have student loan like most of us (300k), he/she will be committing financial suicide. Not sure how happy someone can be when they can't pay their bills.

Let's be real here, many (or even most) physicians are not enamored with their jobs. Almost all physicians would tell you the day to day life of resident vs. an attending is different. Telling OP to leave when he has invested 9+ years in a career and is 2 years away from finishing is just plain wrong.

Save me that BS about disservice to patients... Geez!

FM docs treat a lot of psych patients anyway... OP can tailor his/her practice to treat psych patients. I knew one retired FM doc who exclusively treated psych patients.

I think we're talking past each other. I was talking about situations in which the individuals hate their field. OP has said that is not the case for them, and in that scenario, as I said above, the safest option is to finish the FM program and then go from there.

The idea that someone should necessarily go through two more years of the hell that is residency for something they hate, is ridiculous. If you don't think mental state affects how that person would treat their patients or how well they would do in caring for their patients, then you need to interact with more docs that hate their jobs.

Also, with a license, which OP can get in >30 states with 1 GME year, they could work on the side and have real options to pay back loans. It may not be as lucrative as being BE/BC, but lets not act like I'm even remotely suggesting they leave medicine altogether to pursue minimum wage. I know multiple GPs that get by just fine, even with large loans. They just have to seek out more jobs and be more flexible in their location.

The work in psych that you do as a FM doc is not the same as you do as a psychiatrist. Could you learn counseling and self-study/complete workshops as a supplement, sure, but it will be very difficult to have even close to the level of comfort as a psychiatrist managing most psych conditions. Maybe with certain meds or certain unipolar mood disorders, but even though a huge chunk of FM is psych (more out of necessity than anything else), without some dedicated training most FM docs still don't feel comfortable prescribing most psychotropics.

 

[W19]

I think we're talking past each other. I was talking about situations in which the individuals hate their field. OP has said that is not the case for them, and in that scenario, as I said above, the safest option is to finish the FM program and then go from there.

The idea that someone should necessarily go through two more years of the hell that is residency for something they hate, is ridiculous. If you don't think mental state affects how that person would treat their patients or how well they would do in caring for their patients, then you need to interact with more docs that hate their jobs.

Also, with a license, which OP can get in >30 states with 1 GME year, they could work on the side and have real options to pay back loans. It may not be as lucrative as being BE/BC, but lets not act like I'm even remotely suggesting they leave medicine altogether to pursue minimum wage. I know multiple GPs that get by just fine, even with large loans. They just have to seek out more jobs and be more flexible in their location.

The work in psych that you do as a FM doc is not the same as you do as a psychiatrist. Could you learn counseling and self-study/complete workshops as a supplement, sure, but it will be very difficult to have even close to the level of comfort as a psychiatrist managing most psych conditions. Maybe with certain meds or certain unipolar mood disorders, but even though a huge chunk of FM is psych (more out of necessity than anything else), without some dedicated training most FM docs still don't feel comfortable prescribing most psychotropics.

Everyone knows that a FM doc will not magically be as good as someone with 4 year of psych training, but OP can use his electives in PGY2/PGY3 to learn more about psych... I am not sure why even go there. Not being enamored with what you do won't make you necessarily miserable...

FM doc can work 30 hrs/wk and still make ~150k/yr. So you are telling me working 30hrs/wk in something you don't love will make someone hate his/her life... Are native Americans really that fragile?

Not going to argue back and forth here anymore since I don't want to derail the thread...

 

[hallowmann]

Everyone knows that a FM doc will not magically be as good as someone with 4 year of psych training, but OP can use his electives in PGY2/PGY3 to learn more about psych... I am not sure why even go there. Not being enamored with what you do won't make you necessarily miserable...

FM doc can work 30 hrs/wk and still make ~150k/yr. So you are telling me working 30hrs/wk in something you don't love will make someone hate his/her life... Are native Americans really that fragile?

Not going to argue back and forth here anymore since I don't want to derail the thread...

Again talking past each other. "Something you don't love" and "not being enamored with what you do" is not what I was talking about. That implies tolerability. I was talking about individuals who hate what they do, but I agree, no point with further back and forth.

 

[TableMD]

Medicine, as you will learn, requires resiliency and will push and test you. You have work to do. Figure out what was missing that lead you to not matching in psych and get help from your institution's psych program to figure that out in an honest and blunt fashion. Your FM PD's function is to sign off on you satisfactorily completing your intern year. That person "not supporting you" by making your life easy with interview time etc will not prevent that from happening, they have to verify that you practiced medicine safely and consistently during your time there. The recommendation LORs can come from psych and FM attendings that you impress, which is on you to make happen. We had someone transfer into our program from a surgery program, that was not supportive, and they made the time to come in, so it can be done.

You need to understand that as a psychiatrist you are going to be counseling people through traumatic experiences and helping them make long term, life changes in the setting of all manner of personal hardships. You will ask your patient's to do this, so you ought to demonstrate that personal capacity to make change and evolve past this set back. Not knowing the "day to day life" of a psychiatrist is gap you need to fill.

 

[smq123]

Medicine, as you will learn, requires resiliency and will push and test you. You have work to do. Figure out what was missing that lead you to not matching in psych and get help from your institution's psych program to figure that out in an honest and blunt fashion. Your FM PD's function is to sign off on you satisfactorily completing your intern year. That person "not supporting you" by making your life easy with interview time etc will not prevent that from happening, they have to verify that you practiced medicine safely and consistently during your time there. The recommendation LORs can come from psych and FM attendings that you impress, which is on you to make happen. We had someone transfer into our program from a surgery program, that was not supportive, and they made the time to come in, so it can be done.

You need to understand that as a psychiatrist you are going to be counseling people through traumatic experiences and helping them make long term, life changes in the setting of all manner of personal hardships. You will ask your patient's to do this, so you ought to demonstrate that personal capacity to make change and evolve past this set back. Not knowing the "day to day life" of a psychiatrist is gap you need to fill.

Beautifully said.