This is the story ...

[leaves of grass]

I'm a first year FM resident and I've been offered the opportunity to join an FM/Psych residency as a second year. Now I'm wondering if I shouldn't just look for a PGY2 position in Psych. The problem is that I can't make up my mind. I like LEARNING medicine (and Psych). I prefer DOING Psych. How available are PGY2 positions in psych? Is the combined program helpful in being a better psychiatrist or is it a waste of time and energy?

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[Analyzethis]

A complete waste of time-even IM and psych or neuro and psych-but especially FP and psych-It would theoretically be great to have the psych knowledge of a residency and then go practice FP if you wanted but then you would be getting paid like s#it-basically getiting paid no more than a normal FP -although you would be good and your patients would benefit-you would make no more. Or you could just go practice psych-make twice or three times as much and that would be nice-but then there is absolutely no need for your FP skills if you just do psych-so there is really absoultely no benefit other than wasting an extra year of your life and another year of crappy salary-I would just do Psych IMO

 

[Mr. McDuck]

...all about how my life got flipped, turned upside down.

 

[Anasazi23]

I'm a first year FM resident and I've been offered the opportunity to join an FM/Psych residency as a second year. Now I'm wondering if I shouldn't just look for a PGY2 position in Psych. The problem is that I can't make up my mind. I like LEARNING medicine (and Psych). I prefer DOING Psych. How available are PGY2 positions in psych? Is the combined program helpful in being a better psychiatrist or is it a waste of time and energy?

I think there are some combined residencies, particulary in FM/Psych, that will not allow you to be board eligible for psychiatry when you're done. This can either be fine, or not fine.

If it's the former, you'll have to feel comfortable having a responsibly limited formulary and limit your psychiatric patient base. If it's the latter, and you'd like more practical knowledge on treating supposed easy-to-call psychiatric diagnoses in the context of family medicine, that's ok.

I would find out if the program will allow you to be board eligible in psychiatry.

 

[leaves of grass]

the program i'm interested in does allow you to practice psychiatry or FM. I'm having a hard time giving up medicine, even though it sounds like some of you are quite good at medicine too. And, by the way, FP's don't make 2- 3 x less than psychiatrists. In some parts of the country the income is comparable. I would practice psychiatry anyway.

 

[Analyzethis]

Well the average salary sites are pretty inaccurate-there are just so many FPs and so many rural FPs and city ones-their average is almost the same everywhere-there is NO room to make much more than the average even if you own your own clinic etc.

However psychiatry-sure lots of people make the average and have a fixed type income who work in academics or work for someone-but every pyschiatrist I have worked with outside of school set up a cash only pay business in the city-seeing upper end patients and making 300k plus-I think there is no other field like psychiatry where you can really treat it as a business and make your own niche and get paid well. You have a lot of flexibliity in psych to set up a practice in so many ways and potentially make much much more than the average.

WHere as FP-you can rarely make more than the average-there are no ways to set up a FP cash only pay(well there are a few boutique practices) but then you have the downsides of boutique medicine-but other than that you are relatively fixed. If you are business savvy and fine with workin gprivate practice-you can pull 300k easily in psych these days. FP is closer to 100k so yes I would say 3 times more is accurate. But good luck

 

[Anasazi23]

the program i'm interested in does allow you to practice psychiatry or FM. I'm having a hard time giving up medicine, even though it sounds like some of you are quite good at medicine too. And, by the way, FP's don't make 2- 3 x less than psychiatrists. In some parts of the country the income is comparable. I would practice psychiatry anyway.

Being "allowed to practice psychiatry" is a sticky statement. At what level?
If you could post the curriculum for the combined residency, we might be able to have a more informed opinion.

i.e. How much inpatient psych will there be? etc.

Requirements for board eligibility in psychiatry is pretty specific.

 

[leaves of grass]

The web site says the following,"The five-year program is approved by both the American Board of Family Medicine and the American board of Psychiatry and Neurology and leads to board eligibility in both specialties."

FM and Psych rotations are evenly divided at 30 months each.

I still don't know what to do. If I choose to go straight Psych I'm tempted to bail in January from my FM program. It feels silly to do OB, Surgery etc. Would leaving mid-PGY1 year be morally reprehensible? I feel very guilty even leaving next July but at least I didn't sign a contract to stay later than that.

What the hell do I do?

 

[Mr. McDuck]

Don't you have to do an intern year for psych? Just finish your FM year if they'll use that as your intern year, and switch in July. Then, you can sleep at night.

 

[atsai3]

I'm a first year FM resident and I've been offered the opportunity to join an FM/Psych residency as a second year. Now I'm wondering if I shouldn't just look for a PGY2 position in Psych. The problem is that I can't make up my mind. I like LEARNING medicine (and Psych). I prefer DOING Psych. How available are PGY2 positions in psych? Is the combined program helpful in being a better psychiatrist or is it a waste of time and energy?

I seriously considered IM/Pysch but have not met a single physician who maintains a dual practice. Most of the dually trained physicians I have met tend to fit one of the following profiles: 1) academic researcher who does work on persons with chronic illnesses, eg depression + diabetes, CHF + depression, etc, and if she has any clinical practice at all it is probably a general medicine outpatient clinic a few afternoons a week; 2) hospitalist internist who is very comfortable with managing delirious and agitated patients; 3) consult psychiatrist who is very comfortable providing advice on how to take care of delirious patients who are very sick; or 4) outpatient family physician who is a little more comfortable prescribing psych meds than the average family doc. Given that that it's very difficult to stay current with the literature in two specialties, I guess it's not surprising that there are very few true dual practice physicians out there.

With that in mind, is it worth the additional 2 years of training? And it's not even just that there's 2 years of training -- it's 2 years of training <U>as a resident</U>. If you wanted to become Profile #3, it wouldn't be hard to imagine doing a psych residency and picking up a few extra inpatient medicine months. Or if you wanted to become Profile #4, you might be able to do a family medicine residency and then cobble together a fellowship year in which you learn some psychopharm (depends on how flexible your institution). But those additional years of training would be as a fellow, not as a resident.

If you decide that it's worth the additional 2 years of training, then you have to pick a program. There are a lot of dual programs out there, but few of them are any good. The problem is that you have to have a strong medicine (or FP) program, a strong psychiatry program, and a IM/psych program director who is strong enough to give you good support when your IM PD doesn't care about your psych training and your psych PD doesn't care about your IM training. It takes a really strong program director to hold it all together. The only dual program I saw that really fit this description was at Duke.

-AT.

 

[Anasazi23]

I still don't know what to do. If I choose to go straight Psych I'm tempted to bail in January from my FM program. It feels silly to do OB, Surgery etc. Would leaving mid-PGY1 year be morally reprehensible? I feel very guilty even leaving next July but at least I didn't sign a contract to stay later than that.

What the hell do I do?

You can bail in January and start a straight psych residency the following month? Or you'd take off till July and start as a PGY-1 again?

See if you can complete the FP year and start straight psych as a PGY-II. I'm not sure if a FP intern year will count for you, however. Check the APA website or call them up.

I tend to agree with Atsai. Few combined programs produce physicians that truly practice both aspects of the field. But, the easier road at this point (In October) might be to start the five year program next year, but get at least some credit for your medicine months. Frankly, I would refuse to re-do the medicine months again. Medicine as an intern is bad enough...let alone having to do it twice. That way, you can either graduate early, or stay on as chief for a 1/2 year, and moonlight, or some other scenario.

We have a guy in our program, now a PGY-II, that did this. He completed an internship in IM, then bailed at the end of the year for straight psych. He got credit for his medicine months, and will have to stay only a little while longer to get in all his neurology and some inpatient. He'll either stay on as a chief and moonlight, or graduate early. Not a bad deal considering.

 

[jeff2005]

I've decided to switch to straight psych. Thanks for all the advice!

jeff2005
(AKA leaves of grass)

 

[Poety]

You can bail in January and start a straight psych residency the following month? Or you'd take off till July and start as a PGY-1 again?

See if you can complete the FP year and start straight psych as a PGY-II. I'm not sure if a FP intern year will count for you, however. Check the APA website or call them up.

I tend to agree with Atsai. Few combined programs produce physicians that truly practice both aspects of the field. But, the easier road at this point (In October) might be to start the five year program next year, but get at least some credit for your medicine months. Frankly, I would refuse to re-do the medicine months again. Medicine as an intern is bad enough...let alone having to do it twice. That way, you can either graduate early, or stay on as chief for a 1/2 year, and moonlight, or some other scenario.

We have a guy in our program, now a PGY-II, that did this. He completed an internship in IM, then bailed at the end of the year for straight psych. He got credit for his medicine months, and will have to stay only a little while longer to get in all his neurology and some inpatient. He'll either stay on as a chief and moonlight, or graduate early. Not a bad deal considering.

Well Im over my whole I wanna do med thing- I find psych 200x more difficult than the cookbook medicine that i was so familiar with. However, going into forensics, Im thinking along the lines of doing lots of electives in medicine/addictions and then doing a forensic fellowship - I tned to love reading charts and fingout out the whole story of pt.s ya know? Im WORDY if you know what i mean, oh well ofcourese you do.

Anywya, ineed help with my sleep atter. I'v been waking up everyday at liek 1p and 5p and not being able to go back to sleep, I have to gt up at 7. I took an extra lunesta itsnot working, with 150 traz, she wanted to try me on sonatoa but said that only works fo 4 hours too - HWAT DRUG WILL KEEP ME DOWN FOR THE NIGHT, I HAVE PRITE AND BOARDS CMING UP IN THE NEXT COUPLE OF WEEKS - im me if you have it;