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[DrHouse-of--cards]

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The programs that do not require INPATIENT medicine (IM/FM/Peds) during the intern year are Palmetto, UTMB, and Iowa (technically Med-Psych instead of psych). If I recall there were a few more, but I can't remember anymore.

 

[Bartelby]

As painful as inpatient medicine can be I don't recommend avoiding it. I think even the brief exposure you typically get (3-4 months of inpatient) is valuable.

 

[Mad Jack]

The programs that do not require INPATIENT medicine (IM/FM/Peds) during the intern year are Palmetto, UTMB, and Iowa (technically Med-Psych instead of psych). If I recall there were a few more, but I can't remember anymore.

Inpatient medicine isn't that bad omg lol, it's only a couple of months and these kids need to chill

 

[Merely]

Lol IM is not that bad at all..bro there are people doing this **** for an actual living..

 

[tellme_areyoufree]

Some programs also fight for your IM hours and experience to be reasonable. My inpt IM is 8:30-4:30, M-F. My outpatient IM is harder than inpt (lol) by actually being 8-5.
My program prioritized our learning rather than extracting labor from us, and I am so so thankful.

 

[DrHouse-of--cards]

Some programs also fight for your IM hours and experience to be reasonable. My inpt IM is 8:30-4:30, M-F. My outpatient IM is harder than inpt (lol) by actually being 8-5.
My program prioritized our learning rather than extracting labor from us, and I am so so thankful.

The kids nowadays are more lifestyle focused (and maybe that's a good thing), and what tellme_areyoufree said above really seems to resonate with them. Lots of students now don't drink the Koolaid that I myself drank -- I was all onboard with thinking all of it was for experience and to make me a better doctor. And then as I got older I realized it is (mostly) all about extracting labor. I didn't really need to herd cattle at the VA from 6am to 6pm six days a week for 4 months to become a better psychiatrist.

tellme_areyoufree would you mind PM'ing me the programs you know that are trying to make it better and prioritize the learning.

 

[hallowmann]

The programs that do not require INPATIENT medicine (IM/FM/Peds) during the intern year are Palmetto, UTMB, and Iowa (technically Med-Psych instead of psych). If I recall there were a few more, but I can't remember anymore.

I'm not sure that Med-Psych actually counts as "not inpatient medicine." Every Med/Psych inpatient rotation I've been on in med school and residency is just as, if not more intense than a general medicine inpatient rotation.

 

[ridethecliche]

Apparently the folks that treat kids aren't real physicians...

 

[Sushirolls]

When I was a resident, my resident class year was vocal about the poor training, ridiculous intensity for the IM inpatient month. Some residents had a neutral experience contingent on their IM senior. Most had horrible experiences. Positively the psych PD listened and changed the rotation to a different site.

Inpatient can be good learning experience. What matters most is vetting he experience of the residents ahead of you to know. Odds are outpatient will be better, but you can only really know by talking with the senior residents. There is so much variability to blanket say no inpatient as a preference.

 

[MacDonaldTriad]

I think there is a thread about how psychiatrists aren't real physicians, so child psychiatrists must really not be physicians.

 

[Monocles]

Some residents had a neutral experience contingent on their IM senior.

So much this. As much as I hated medicine, out of the two seniors I had, one was decent and the other was phenomenal and I really liked them both as human beings. Made the experience infinitely less terrible than it could have been.

 

[DisorderedDoc417]

We had OP medicine months. On lots of occasions I learned to deal with mental health crisis (in addition to everything else) in a primary care setting. I felt this was very useful and applicable. No regrets having done that.

 

[tellmemore2020]

I am typically in the camp of "let me just do psychiatry" but knowing the standard work up for common physical symptoms and first line drugs for benign symptoms has come in handy on the inpatient floor.

 

[DisorderedDoc417]

I am typically in the camp of "let me just do psychiatry" but knowing the standard work up for common physical symptoms and first line drugs for benign symptoms has come in handy on the inpatient floor.

Agreed. Things typically complained about in the PCP's office vs. complained about while in the ICU with necrotizing pancreatitis.

 

[UTsksk]

My IM and FM inpatient months weren’t bad at all. Psych ER and inpatient psych have been way more stressful and busier. My PD loves using that line that we’re doctors first, but ALWAYS forces us to consult medicine for any little thing instead of letting us take care of it.

 

[pure skill]

Palmetto (Prisma) requires 2 months of IM inpatient. You are spreading misinformation.

 

[NickNaylor]

In Boston the Harvard/VA joint program recently got rid of their inpt medicine rotation at Metrowest/Framingham Union Hospital. The prior site was so terrible (HUGE patient safety issues, resident hazing, psych interns starting 1st day without any medicine seniors on weekends, etc) that both Beth-Israel and HSS pulled out in the same year.

I have endless schadenfreude for that terrible site for losing TWO harvard psych residency contracts in the same year.

An another note, I am perhaps one of the most vocal opponents of adult medicine rotations as I have found them to be extraordinarily useless. As someone who was dead set on child fellowship since DAY ONE of intern year (I came into psych wanting to be a child psychiatrist), the months I spent treating ERSD, COPD, CHF etc were completely and utterly useless misery and unnecessary torture. I wish I had the opportunity to do pediatric alternatives to learn about diseases that would have been actually relevant! But my PD refused, giving no other good reason aside from tradition of "we are physicians first and foremost".

*end rant*

Sounds more like an issue with your program director/program. At my program, we allow and encourage those with an interest in CAP to do 1 block of inpatient pediatrics and 1 block of inpatient child neurology. I'm not sure what treating kids has to do with being a physician "first and foremost."

 

[whopper]

As painful as inpatient medicine can be I don't recommend avoiding it. I think even the brief exposure you typically get (3-4 months of inpatient) is valuable.

Completely agree.

Psychiatrists that don't know basic IM are an embarrassment to the field and only further perpetuate the sometimes times true stereotype that we're wimps. While I did psych residency one of the attendings would request an IM consult for ridiculous things like a BP of 145/95, with only 1 reading. I'd even try to talk him out of it and when the IM consultant came in he'd be all ticked off and I'd tell the guy I tried to have it cancelled.

In ER and inpatient psych you need good IM skills. Heck you need it in all fields of psychiatry but in those 2 fields you will often times get patients who aren't medically stable and you need to rely on your IM skills to detect it and then get the guy off the floor. If you know your IM, your colleagues in the other fields will respect you and listen to you when they know you're decent in these areas. IM is absolutely vital in geri-psych and for obvious reasons. A 90 year old depressed patient with a long list if medical problems and being on 7 non-psych meds, geez you don't think IM is going to matter?

Also agree with the above statements that if someone has a major complaint about IM rotations, aside that they are usually tough, is the complaint about the specific program perhaps having a poor IM residency program? Hey when I did IM man it was tough, but the PD was fair. I did have major complaints with the nurses who were trying to exploit residents, but that also happened in psych. E.g. they weren't supposed to call residents on non-teaching patients (patients whose attendings weren't teaching faculty, the rotation was in a private hospital) but they did so anyways and would openly lie about it if asked if the patient was teaching or non-teaching. Residents would catch them in a lie but there were no consequences on the nurses. It even ticked off the PD when this happened and he did care this was happening.

As tough as IM was, I recall several times getting into arguments with ER and IM doctors about patients being medically stable or not and being able to stand toe-to-toe with them, and having a rep of being a psych doctor who knew medicine well. It was worth the pain.

 

[DrHouse-of--cards]

Palmetto (Prisma) requires 2 months of IM inpatient. You are spreading misinformation.

Thanks for the info, I am not purposefully spreading misinformation about Palmetto. For many years, it seemed that Palmetto & UTMB were pretty well-known for having very little call as well as not having IM inpatient months. And as far as I knew, that was still the case. But good to know it's changed.

 

[Taddy Mason]

Thanks for the info, I am not purposefully spreading misinformation about Palmetto. For many years, it seemed that Palmetto & UTMB were pretty well-known for having very little call as well as not having IM inpatient months. And as far as I knew, that was still the case. But good to know it's changed.

Also, Iowa requires true inpatient IM and the pts on the IM/psych unit have IM pathology that you’re expected to manage that you would encounter on pretty any general IM ward (e.g., NSTEMI, AKI, CKD, COPD, etc).

 

[Stagg737]

My IM and FM inpatient months weren’t bad at all. Psych ER and inpatient psych have been way more stressful and busier. My PD loves using that line that we’re doctors first, but ALWAYS forces us to consult medicine for any little thing instead of letting us take care of it.

My program is actually the opposite. One of my early inpt psych rotations the nurses told me a patient had a BP of ~165/100 which wasn't all that high for him when I checked. I was going to manage it myself (having just come off 2 months of IM) but they insisted I consult the IM team to get him moved off the unit since systolics>160 aren't supposed to stay on the unit. Asked my attending if he wanted me to place an IM consult and he looked at me and said, "Why? You're a doctor, aren't you?" Have seen this quite a few times on that rotation as we commonly manage BP, DM, and plenty of other non-psych meds for the inpatients. We typically only consult IM if we need a stat consult and most of our residents seem pretty comfortable managing the minor med stuff along with psych, which I appreciate a lot (and so do our other services).

 

[whopper]

A lot of this is going to depend on the individual psych doctor. I have noticed that in general, poor medical knowledge does translate to poor psych knowledge as well. I've also noticed the psychiatrists that didn't know their medicine well, there was also a higher correlation with the type of idiot psychiatrists that prescribed on a whim. E.g. "I prescribed Seroquel cause I can tell the patient's blue and Seroquel's pink." Yes I actually did hear that out of a colleague's mouth, and yes I did ask her what did she mean by that, to which she responded, "psychiatry isn't a science, it's an art." (She also said the patient was "blue" because "I can just sense these things" and no she didn't mean depression. The patient wasn't depressed).

Yes I've seen good psychiatrists use that "psychiatrist is an art" line but because of the above, I cringe when I hear that line even from a good psychiatrist.

It goes to a bottom line. Does the physician actually believe in evidenced-based medicine? Cause heck if you do, you're not going to likely separate good evidenced based IM vs good evidenced based psych especially when we see so much IM in our faces so often.