what are the hours like for a FM/Psych combined residency program?

[Deepa100]

I am a third yr trying to decide what to do in the future. I know some universities offer FM+Psych 5 yr programs. Does anyone know what kind of hours these residents work? I am hoping somewhere in between FM and Psych hours

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[Doctor Bagel]

So not an fm/psych resident, but like all psych residencies, I bet it varies. The one program I was familiar with (at my med school) had residents alternate between family medicine and psychiatry rotations, so they worked as hard as FM people on FM rotations and psych people on psych rotations. You'd probably do 80 hour weeks on ob/gyn and maybe inpatient medicine, 40 hour weeks on outpt psych and outpt fm months and 40 to 70 hour weeks (depending on the program) on inpatient psych/cl months.

I've got to admit I never quite understood pursuing this residency path, but I know it works for some people.

 

[TexasPhysician]

Agree with Dr. Bagel.

The usefulness for the dual program is pretty tiny. Any particular reason you are thinking about it?

 

[billypilgrim37]

The usefulness of the programs are much more if your identity is that of a family practice physician who has psychiatry expertise rather than as a psychiatrist who can also do primary care. In private practice, it's a wash, as you're going to be a psychiatrist unless you just like making less money and giving people metformin all day, as there are plenty of family docs compared to the number of psychiatrists out there. But in academics or in larger behavioral health organizations, there is a growing niche for primary care for folks with severe mental illness in medical home models. It still doesn't make the combined program necessary, but it does make it more valuable, and that is a niche that will probably grow.

I know lots of folks in triple board and fm/psych programs, and most of them are pretty miserable compared to their categorical colleagues. Some of that has to do with the sorts of personalities that pick combined programs.

 

[Deepa100]

Hi,
I am just investigating what options I have. I know I will go into FM/IM/Psych. Just trying make the final decision. I am reluctant to do pure psych because I like the procedural part of medicine and the analytical aspect of IM.

 

[splik]

I like the diagnostic aspect of IM and the zebra hunting but psychiatry practiced well is very analytical in terms of trying to come up with a decent case formulation and there are enough exciting cases to make you think - is this patient delirious or is it non-convulsive status epilepticus? is this catanonia due to depressive stupor or paraneoplastic limbic encephalitis from an ovarian teratoma? Is this early onset dementia or subacute sclerosing panencephalitis? (okay that one is just ridiculous)... Consultation-liaison psychiatry is where it's at for that sorta thing.

You could do pain medicine if you were interested in procedures through psychiatry.

Otherwise maybe you would be better off doing FM or IM. Remember FM is the defacto mental health system in the US they provide most of the psychiatric care, it is becoming more popular these days, and they pay will almost certainly become more favorable as we realize how important primary care is.

 

[notdeadyet]

Remember FM is the defacto mental health system in the US they provide most of the psychiatric care, it is becoming more popular these days, and they pay will almost certainly become more favorable as we realize how important primary care is.

In fairness, we've been hearing this for more than 10 years.

Primary care is the next hot thing... and always will be...

 

[F0nzie]

With all the combined 5 year residencies one can do in Psychiatry ie. Psych/FM, Psych/IM, Psych/Peds/Child Psych, Psych/Child Psych, Psych/Neuro, why not just make Adult Psychiatry a 3 year program. FP, IM, Peds seem to do fine with just 3 years. I suppose I'll be starting 4th year in several months and finding out why it's such a "critical" year.

 

[billypilgrim37]

With all the combined 5 year residencies one can do in Psychiatry ie. Psych/FM, Psych/IM, Psych/Peds/Child Psych, Psych/Child Psych, Psych/Neuro, why not just make Adult Psychiatry a 3 year program. FP, IM, Peds seem to do fine with just 3 years. I suppose I'll be starting 4th year in several months and finding out why it's such a "critical" year.

The main problem is that shortening makes longitudinal experience harder to accomplish. It's not an insurmountable problem, but a 5 year fm/psych resident can still follow therapy patients for 2-3 years and have multiple year long experiences which build upon one another. That would get lost in a shorter residency.

FP/IM/Peds work about as many hours in 3 years as we do in 4. Jamming those extra hours in to the 3 years probably wouldn't be very beneficial for education.

It will probably still happen someday, but there are some compelling reasons not to.

 

[rmj254]

Agree with Dr. Bagel.

The usefulness for the dual program is pretty tiny. Any particular reason you are thinking about it?

Would there be a use for a dual residency in FP or IM and Psychiatry if one wanted to practice in rural areas? Could one realistically practice both in that setting?

 

[TexasPhysician]

Would there be a use for a dual residency in FP or IM and Psychiatry if one wanted to practice in rural areas? Could one realistically practice both in that setting?

How rural are you talking?

The problem is that psych has higher demand and higher pay. Even dual boarded people rarely practice IM or FM because you take a pay cut to do so.

If you want to live in a place so rural that there are not enough psych patients within hundreds of miles, maybe being dual boarded would be beneficial to make a living. I have a hard time brainstorming where this may be. Eliminate all of TX and OK - places I am more familiar with.

 

[vistaril]

How rural are you talking?

The problem is that psych has higher demand and higher pay. Even dual boarded people rarely practice IM or FM because you take a pay cut to do so.
.

internists make as much or more than psychiatrists....outpt family medicine(depending on practice set up) makes a little less....

 

[rmj254]

How rural are you talking?

The problem is that psych has higher demand and higher pay. Even dual boarded people rarely practice IM or FM because you take a pay cut to do so.

If you want to live in a place so rural that there are not enough psych patients within hundreds of miles, maybe being dual boarded would be beneficial to make a living. I have a hard time brainstorming where this may be. Eliminate all of TX and OK - places I am more familiar with.

I'd be in the rural Southeast (think MS, AL, or LA). Places with around a thousand residents per town.

 

[Illinoisgrad]

internists make as much or more than psychiatrists....outpt family medicine(depending on practice set up) makes a little less....

Really? I thought most of the salary comparisons showed that psychiatrists make more, unless you're lumping in specialists. I would also imagine that even if they both make the same salary, that internists have to work longer hours to make that amount, so maybe that's why some may consider psychiatrists as the ones that make more money

 

[TexasPhysician]

internists make as much or more than psychiatrists....outpt family medicine(depending on practice set up) makes a little less....

Per hour, psych trumps general IM.

 

[vistaril]

Really? I thought most of the salary comparisons showed that psychiatrists make more, unless you're lumping in specialists. I would also imagine that even if they both make the same salary, that internists have to work longer hours to make that amount, so maybe that's why some may consider psychiatrists as the ones that make more money

average hospitalist makes about 225-240k and does 7 on/7off......thats generally a little better than psych.

there are also more ways to make extra cash in inpatient medicine(moonlighting where you just carry a pager for example) than psychiatry.

 

[vistaril]

Per hour, psych trumps general IM.

not really, although it would really just depend on inpt vs outpt, practice setups, etc.....most IM hospitalists make close 230-250ish...the similar positions in psych pay just short of 200 on average.

 

[Leo Aquarius]

I trust TexasPhysician far more than vistaril on this one.

If I'm not mistaken, IM doctors don't have a ready and willing market of private patients paying $250 to $300 cash per hour, psychiatrists do.

 

[TexasPhysician]

average hospitalist makes about 225-240k and does 7 on/7off......thats generally a little better than psych.

there are also more ways to make extra cash in inpatient medicine(moonlighting where you just carry a pager for example) than psychiatry.

Average hospitalist near me starts closer to 170k. 230k is possible, but 7 on/7 off is horribly brutal in my opinion. You can easily work your tail off and rarely sleep when on. Quite a beatdown. Non hospitalist gen IM make much less with clinic hours.

If you are doing night calls in psych, you are usually given a big bump in pay and/or rarely get called. There are gigs with almost no call 8-5 starting at 230k + benefits with no takers down here.

There are also many moonlighting jobs in psych. I currently moonlight at 2 places. One pays a minimum of $150/hour to residents for relatively basic work. I know of 4 others places in the area that need moonlighters. A 5th is starting up, and I've been working with them on compensation.

 

[BS81]

Average hospitalist near me starts closer to 170k. 230k is possible, but 7 on/7 off is horribly brutal in my opinion. You can easily work your tail off and rarely sleep when on. Quite a beatdown. Non hospitalist gen IM make much less with clinic hours.

If you are doing night calls in psych, you are usually given a big bump in pay and/or rarely get called. There are gigs with almost no call 8-5 starting at 230k + benefits with no takers down here.

There are also many moonlighting jobs in psych. I currently moonlight at 2 places. One pays a minimum of $150/hour to residents for relatively basic work. I know of 4 others places in the area that need moonlighters. A 5th is starting up, and I've been working with them on compensation.

Talking to some relatives who are in these two fields this seems to be the case around my parts, too. Although hospitalists usually have an added RVU bonus payment structure built in to their contracts and could theoretically get 50-100k more per year if they work their tail off. Even this very quickly stops being an incentive you work towards because a lot of internists consider hospitalist work to be absolutely miserable and leads to quick burnout.

 

[Igor4sugry]

Most FM/Psych residents I've met wished they just did one or the other. The program is busy because they cram everything into 5yrs. I don't think any combined programs are worth it these days. It won't affect your salary much and you will be forced with paying for both board exams and keeping up for both specialties for re-boarding.

 

[vistaril]

Average hospitalist near me starts closer to 170k. 230k is possible, but 7 on/7 off is horribly brutal in my opinion. You can easily work your tail off and rarely sleep when on. Quite a beatdown. Non hospitalist gen IM make much less with clinic hours.

If you are doing night calls in psych, you are usually given a big bump in pay and/or rarely get called. There are gigs with almost no call 8-5 starting at 230k + benefits with no takers down here.

There are also many moonlighting jobs in psych. I currently moonlight at 2 places. One pays a minimum of $150/hour to residents for relatively basic work. I know of 4 others places in the area that need moonlighters. A 5th is starting up, and I've been working with them on compensation.

of course such gigs exist....but Im guessing that gig that starts at 230k isn't taken for a reason....similarly unattractive jobs exist in hospitalist IM work for even more.

a lot of inpatient psychs who work for the state are making 150-175k....there isnt a single non-academic hospitalist alive who will work for that....

 

[vistaril]

I trust TexasPhysician far more than vistaril on this one.

If I'm not mistaken, IM doctors don't have a ready and willing market of private patients paying $250 to $300 cash per hour, psychiatrists do.

lmfao....good luck finding that ready and willing market at 300 dollars per hour out of residency. If you'll notice on this board, almost nobody here is seeing 300 dollar an hour cash pay patients regularly. And certainly not a whole practice full.

 

[diagonal]

of course such gigs exist....but Im guessing that gig that starts at 230k isn't taken for a reason....similarly unattractive jobs exist in hospitalist IM work for even more.

a lot of inpatient psychs who work for the state are making 150-175k....there isnt a single non-academic hospitalist alive who will work for that....

I would rather get diagnosed with lung cancer tomorrow than be a hospitalist. I imagine many on this forum would agree. So who gives a damn who makes more, most of those two cohorts despise the other field.

But to play along, the work per unit time as a hospitalist is far more exhausting and mentally annoying than the time spent as a psychiatrist. For a job that guarantees >150k/wk, good hours, impeccable job stability, prestige, generally interesting work, and relative to near-complete autonomy, there's not a better gig in America. Of course you gotta have a certain personality for it. I just feel blessed that I like it. The fact that it's such a sweet gig is the icing.

 

[digitlnoize]

of course such gigs exist....but Im guessing that gig that starts at 230k isn't taken for a reason....similarly unattractive jobs exist in hospitalist IM work for even more.

a lot of inpatient psychs who work for the state are making 150-175k....there isnt a single non-academic hospitalist alive who will work for that....

According to the Medscape 2012 Salary Survey:

IM: http://www.medscape.com/features/slideshow/compensation/2012/internal-medicine
Psych: http://www.medscape.com/features/slideshow/compensation/2012/psychiatry

Average Salary
Psych avg salary = 170k
IM avg salary = 165k

Consider themselves Rich:
IM: 8%
Psych: 9%
(interestingly, Plastic Surgery = 6%)

Huh. In Texas:
- Psych average salary: 163k
- IM average: 189k

Psych wins the Great Lakes (182k vs 158k) and Midwest by a wider margin. Other areas are closer...

Salary difference by setting
Average IM salary in a private hospital setting: 163k
Average Psych salary in a private practice setting:
Solo: 165k
Group: 197k

Academic IM: a horrible 128k. Ugh.
Academic Psych: 154k FTW.

% who feel fairly compensated:
Psych: 59%
IM: 45%

This is hard to describe, so we're going to pictures.

Hours worked:

IM:

Psych:

% < 40h/wk
IM: 45%
Psych: 73%

% > 60h/wk
IM: 14%
Psych: 2%

Time spent with each patient
Psych: 49% > 25 min each.
IM: 17% > 25 min each.

Would you choose the same specialty again
IM: 25%
Psych: 50%

Cash Only
IM: 2%
Psych: 11%

Grand Champion: Psychiatry

Surprise.

In most regions, the difference in yearly salary isn't THAT huge to be arguing over. However, the HOURLY salary is WAAAAAY different. We win. Hard.

 

[TexasPhysician]

I would try to convince you further, but I'm busy working on solo 401k stuff to hide my moonlighting loot from taxation.

 

[vistaril]

I would try to convince you further, but I'm busy working on solo 401k stuff to hide my moonlighting loot from taxation.

there are a better variety of moonlighting opportunities in internal medicine.....

 

[vistaril]

I would rather get diagnosed with lung cancer tomorrow than be a hospitalist. I imagine many on this forum would agree. So who gives a damn who makes more, most of those two cohorts despise the other field.

But to play along, the work per unit time as a hospitalist is far more exhausting and mentally annoying than the time spent as a psychiatrist. For a job that guarantees >150k/wk, good hours, impeccable job stability, prestige, generally interesting work, and relative to near-complete autonomy, there's not a better gig in America. Of course you gotta have a certain personality for it. I just feel blessed that I like it. The fact that it's such a sweet gig is the icing.

I think you drastically overrate the prestige with which most people(including other professionals) view psychiatry. IM has much more prestige, in and out of medicine.

 

[vistaril]

According to the Medscape 2012 Salary Survey:


In most regions, the difference in yearly salary isn't THAT huge to be arguing over. However, the HOURLY salary is WAAAAAY different. We win. Hard.

Im not seeing it...even your chart says 86% of internists still work less than 60 hrs a week. if you totaled all those bar graphs up and averaged it out you'd get.,.what....3-4 hr on average difference?

Both psych and IM are two of the lowest average paying fields....I'd rather do psych(obviously that's why I do), but IM has more prestige. Also, to actually make 3 and 4 times(or more) what a psychiatrist does by doing one of the higher IM specialties, you need to...umm...do IM first.

 

[surftheiop]

.

 

[surftheiop]

Im not seeing it...even your chart says 86% of internists still work less than 60 hrs a week. if you totaled all those bar graphs up and averaged it out you'd get.,.what....3-4 hr on average difference?

Both psych and IM are two of the lowest average paying fields....I'd rather do psych(obviously that's why I do), but IM has more prestige. Also, to actually make 3 and 4 times(or more) what a psychiatrist does by doing one of the higher IM specialties, you need to...umm...do IM first.

it says time "seeing patients", I assume they also have to do other paperwork/etc that would add atleast 5-10 hours to that right?

(Obviously psych has time tacked on also, but I imagine the "marginal pain" of extra works hours is higher the more your working)

 

[digitlnoize]

Im not seeing it...even your chart says 86% of internists still work less than 60 hrs a week. if you totaled all those bar graphs up and averaged it out you'd get.,.what....3-4 hr on average difference?

Both psych and IM are two of the lowest average paying fields....I'd rather do psych(obviously that's why I do), but IM has more prestige. Also, to actually make 3 and 4 times(or more) what a psychiatrist does by doing one of the higher IM specialties, you need to...umm...do IM first.

It's pretty simple. The salaries are higher, both objectively (in most places) and subjectively, as shown by the "are you rich" and "are you satisfied" questions. We would choose psychiatry again. 3/4 IM docs would not.

 

[surftheiop]

This is from 2005 from Archives of Internal Medicine

Hourly Salaries (I assume these are median?)

Psychiatry $72.24
Internal medicine $58.18


http://www.physiciansmoneydigest.com/personal-finance/Study-Finds-Huge-Gap-in-Physician-Hourly-Pay

 

[BS81]

Im not seeing it...even your chart says 86% of internists still work less than 60 hrs a week. if you totaled all those bar graphs up and averaged it out you'd get.,.what....3-4 hr on average difference?

Both psych and IM are two of the lowest average paying fields....I'd rather do psych(obviously that's why I do), but IM has more prestige. Also, to actually make 3 and 4 times(or more) what a psychiatrist does by doing one of the higher IM specialties, you need to...umm...do IM first.

Now you're comparing worst case scenarios vs best case scenarios. Medscape median for GI is about 280k. Sure about 13% make 500k plus, but they own/are partners in their practice. This is getting phased out, too, since most private practice groups are finding it harder and harder to function due to various medicare regulations and are selling out to hospitals and being employed.

Flip side, those internal medicine numbers include primary care outpatient docs. Hospitalists work a lot more and hence make quite a bit more than IM primary care. They have a lot more opportunity to grind out hours and further boost income.

Psych is a good gig that pays quite well per hour, somewhere in the middle of all specialties. Can you ever point out the positives in psych? This glass half empty stuff ALL THE TIME is really annoying

 

[TexasPhysician]

there are a better variety of moonlighting opportunities in internal medicine.....

Based on....

The IM residents here moonlight at $60/hour. They work too hard to put in more than a couple shifts each month. I moonlight at $150/hour, and I literally turn down opportunities weekly.

When you are living in a large metropolitan area and there are gigs where residents earn $150/hour going unfilled, are you really that shocked that BC docs aren't jumping at 230k/year starting in one of the less popular suburbs?