Triple Board Residency- Would anyone be able to tell me of their experience?

[futureherooftime622]

Hi there,

Is there anyone who has completed/is currently in a triple board program (peds/adult psych/child psych)? If so, where? How did you go about deciding on triple board? What do most triple boarders end up doing career wise? This is actually my dream residency program. I really interested in both child psychiatry as well as paediatrics. What are some things I should keep in mind for applying? What is the cut off score for STEP?

I am currently a final year medical student. My plan is to graduate in June and then take time to do both my STEP 1 and 2.

Hopefully I'll hear back from someone soon!

Sincerely,

A hopeful triple boarder 🙂

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[Monkey House]

When I pondered this as a medical student, everyone told me not to do it. They were right. Pick one and go full force at it. That will lead to a more productive career where you can later bridge to other specialties.

 

[TexasPhysician]

Total triple boarders with peds is quite low, so I’m not sure any post here.

I’ve met a few and all practice exclusively psych, with a mostly child lean. Any work that includes peds will reduce pay, and child psych is higher demand with employers.

Some academic centers require all peds boarded faculty to take call in peds. I’ve seen “triple boarders” refuse to take the peds boards to avoid taking peds call.

 

[Fabio001]

Forgive the unsolicited opinion:

I'm at a program with a large triple-board program, but am myself a C&A resident. All the triple boarders at our program are amazing folks who began residency feeling passionate about pediatrics. However, the reality is that on the back end of the 5-years of training, it's hard to dabble in general pediatrics when the pay and work is so much better practicing psychiatry. Thusly, most of them end up practicing child psychiatry with less training in the field (condensing 9 years of training into 5 does have a cost, stop kidding yourself.)

Another interesting tid-bit is that jobs where you do a mix of child psych and adult psych are super common, and I know a hand-full of triple boarders who have wound up in those types of jobs. The kicker is that the amount of adult training the triple-boarders get is very low. Something else to keep in mind is that the 5 years of training is not enough to meet acgme requirements for peds, c&a psych, and adult psych, and still get any sort of handle on psychotherapy. In a psychiatry practice, (which is what the vast majority of these residents are graduating in to) a more robust background in psychotherapy will 9 times out of 10 be much more useful and practical than having a bunch of knowledge and experience in general pediatrics.

There are a handful of jobs where I think the triple board will come in handy, and my thought is that anyone considering triple board better be able to articulate that they want this type of job, and describe why barely being a pediatrician, barely being an adult psychiatrist, and barely being a C&A psychiatrist sets them up to perform that job better than someone who committed. More often, I think the decision hinges on the applicants indecisiveness. My recommendation is to have a very sincere hour of reflections, and if there is any part of your decision that is fueled by indecisiveness, invest a thousand bucks in some therapy for yourself and figure it out. You'll save yourself a very difficult residency.

 

[MacDonaldTriad]

Hi there,

I am currently a final year medical student. My plan is to graduate in June and then take time to do both my STEP 1 and 2.

Hopefully I'll hear back from someone soon!

Sincerely,

A hopeful triple boarder 🙂

? What kind of school are you in that doesn't require both step I and II to graduate?

 

[whopper]

I haven't done the triple-boarding training but I've noticed this among those who have.

They aren't exceptional in any of the 3 areas. It's like they're becoming more of a generalist among the 3. E.g. I've noticed several psychiatrists doing inpatient psychiatry for years get way good at prescribing antipsychotics and have better knowledge of them, but when triple-boarders were asked about things like CATIE they didn't have this knowledge on the tips of their fingers.

There are cases where having all 3 really helps but this is not often and not IMHO worth sacrificing years of training when you just could've partnered up with someone in the other field. You could for example run a peds and child-psych practice but the money is far better just doing child-psych.

It's not like there's a huge market for triple-boarders either where specifically triple-boarders are needed. I likened it before to a combined gas-station/dry-cleaner/ movie theater. Would it be cool to drop off your car, see a movie, get your suit cleaned, and then you get to pick up your car with a full tank and your suit with a nice fresh smell? Yeah but it's not like anyone really needs one to the point where anyone's going to make one.

 

[Mad Jack]

Only utility I can see is eating disorder treatment, as you'll be more medically competent with younger patients. Other than that it seems pretty useless

 

[NickNaylor]

I've worked with a faculty member who was triple-boarded, and the reality is that she is primarily a psychiatrist and does only psychiatric work. I suppose you could make the argument that she brings a bit more knowledge to the table with her pediatrics training - particularly given that she works on a psychiatric consult service - but it's not as if she's going to work on a wards team a few weeks each year. She is, effectively, only a child psychiatrist.

Most people that I spoke to in medical school recommended against any sort of multiple boards programs, the one exception being IM/pediatrics. The knowledge might be helpful and may very well make you a better physician, but the bottom line is that you're not going to utilize all of your certifications to their full potential.

 

[671002]

Most people that I spoke to in medical school recommended against any sort of multiple boards programs, the one exception being IM/pediatrics. The knowledge might be helpful and may very well make you a better physician, but the bottom line is that you're not going to utilize all of your certifications to their full potential.

A little off topic but could the same be said for family medicine/psych? Especially considering the amount of psych seen in a primary care setting?

 

[TexasPhysician]

A little off topic but could the same be said for family medicine/psych? Especially considering the amount of psych seen in a primary care setting?

Fam/psych is designed for someone that wants to practice in the middle of nowhere.

 

[NickNaylor]

A little off topic but could the same be said for family medicine/psych? Especially considering the amount of psych seen in a primary care setting?

Yes, but like Texas said people that do that training are probably going to go out in the middle of nowhere and “be the town doc.” I would imagine that for FM/psych, you would primarily be a PCP with the ability to also manage psychiatric conditions in an area where there may be very few or no dedicated psychiatrists nearby.

In areas where the closest hospital is 100 miles away and the closest psychiatrist is a several hour drive away, then that training makes sense. I’m not sure it makes sense if you’re planning on living in a large metro area.

 

[Fabio001]

Even if someone is planning to practice in a more rural community, I imagine a psychiatrist will still be able to fill up a practice, with rare exception. Needing to have a general family practice gig to stay busy when all the psych patients dry up seems like shaky justification for so much additional training, not to mention watering down your basic psychiatry training.

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[calvnandhobbs68]

Somewhat relevant to this topic, it looks like the AACAP is trying to move child psych into a residency program of its own that ideally would only be 4 years total. The idea that there would be more pediatrics exposure (rather than adult medicine exposure and shaving off some of the tons of adult inpatient time) since child psychiatry has a lot more in common with pediatrics than medicine or even adult psychiatry. So yeah, you may end up mostly practicing psychiatry at the end of a triple board or post pediatric portal program but there's already some thought on an organizational level that the pediatrics background is actually a bit more valuable than the adult background for this specialty. Of course, a more specialized pediatric rotation exposure focusing more on general pediatrics/development/adolescents/child neurology and less PICU/NICU/pediatric subspecialty is going to be more helpful overall for this field.
(Need a subscription to JAACAP to access)
https://www.jaacap.org/article/S0890-8567(18)31222-X/fulltext

 

[Silverhand]

Only a resident, so take with a grain of salt, but I feel there are some niche interests that having that extra pediatric training may be helpful, even if you only practice child psych. Having developmental training really helps if you want to focus on children with intellectual delays, autism, cerebal palsy and so forth. According to this 2013 study, CAP fellows don't get very much experience with those children with medical comorbidities/delays. As with anything pediatric-related, the pay difference, opportunity cost of doing combined training, and issues with insurance will make it much more difficult than if you decided to focus on just one.

Consult liaison, eating disorders, med-psych units, rural areas, LGBTQ+ hormone/psych, developmental pediatrics/psych -- none of these REQUIRE multiple boards, but I'd argue that it gives a different lens that pure psych training (esp if you did minimal general pediatric training) is able to give.

 

[raisinbrain]

It's really all about what you want to do with your life, your career. I like Silverhand's list of places where triple board training can be particularly helpful or at least relevant. But indeed, no matter if you support combined training residency programs or are skeptical, pretty much everyone will agree that you have to have a good rationale and be able to articulate why you view the training may be helpful to you. Thus far everyone who has commented had decided that combined training did not suit their career interests/goals/view of the fields, and that is totally acceptable, but it does not discredit the possible value in combined training (this option, or others).

I also disagree with the idea of triple board training being three completely irrelevant things scooped into one (i.e. the analogy of gas station, dry cleaners and movie theater). First of all, recall that you can't currently do child psych without adult psych, and no, I don't know anyone who independently practices adult psychiatry, child psychiatry, and stand-alone pediatrics. But I know personally, and know of/briefly met several other TB-trained folks who do some combination of child psychiatry and a pediatrics practice (e.g. a reason to stay peds board-certified). That could be in clinic for gen peds patients, for developmental peds patients, eating disorder patients, etc.

And as for keeping up with the field after residency, that's going to be completely related to whatever your scope of practice is. If you see medically-complex OCD tweens, or adolescent eating disorder patients, sure, you may have less knowledge of lipid-related side effects of first versus second gen antipsychotics in adults. But you keep up with what is relevant to your patient population, and that's what matters.

 

[TexasPhysician]

Consult liaison, eating disorders, med-psych units, rural areas, LGBTQ+ hormone/psych, developmental pediatrics/psych -- none of these REQUIRE multiple boards, but I'd argue that it gives a different lens that pure psych training (esp if you did minimal general pediatric training) is able to give.

I’m not in disagreement that triple-boards gives a different perspective, but often that perspective is not the best fit.

If I’m hiring someone for consults, I’d rather have someone that completed a fellowship in CL. A CL psych that communicates well is of high value here.

Eating disorder units are rare in academia as is. You would be better off finding a training center where you can actually spend quality time on the unit in a psych residency.

Hormone psych also very rare. You should ideally find training where they have a dedicated clinic. General peds is not handling this often at all.

Dev peds and psych training are vastly different in most areas. Dev peds is in bigger need than CAP in many areas. They may do 1 eval/day with no follow-ups. It’s a waste of CAP in my opinion. The dev peds I know detest gen peds.

Combined units in rural areas are the ideal positions. Combined units in urban areas would do better in my opinion to have 2 fully trained docs working together.

The triple board programs are training people to be adequate in the 3 general fields. They are not training folks well in the niche overlaps which would be more useful in my opinion. If this has changed recently then I apologize for outdated data.

 

[michaelrack]

I also disagree with the idea of triple board training being three completely irrelevant things scooped into one (i.e. the analogy of gas station, dry cleaners and movie theater). First of all, recall that you can't currently do child psych without adult psych, and no, I don't know anyone who independently practices adult psychiatry, child psychiatry, and stand-alone pediatrics. .

Not exactly the same situation, but I did a combined IM/psych (adult) residency and I practice adult psychiatry, child psychiatry (inpatient only), and internal medicine (The IM is primarily through supervision of NP's, but I also have a sleep medicine clinic- I am boarded in sleep medicine through the American Board of Internal Medicine).

 

[Silverhand]

The triple board programs are training people to be adequate in the 3 general fields. They are not training folks well in the niche overlaps which would be more useful in my opinion. If this has changed recently then I apologize for outdated data.

Great points that location and institutional resources to support your interests matter a ton, probably more than the "combined" portion of training. Not doing a combined residency, but several of the Triple Board programs I interviewed at in medical school recognized the need to cover training in the "overlap" by including residents in the child med/psych unit/clinic or in the transgender/GNC youth clinic, etc -- there is definitely variation in the training opportunities and structure, so YMMV.

Just quickly regarding the developmental psych piece, should have clarified I meant treating psychiatric conditions (vs doing the full DB evals) in those children with significant delays/ASD and so forth, especially in the 3-6 year old population. Not sure if this is worth anything, but anecdotally, rotating as a resident at a large institution with ~10 DBP faculty presence, the consensus seems to be that it's difficult to find child psychiatrists outside of academia wholly comfortable taking on these cases.