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Hello, I am currently wrapping up my M1 year so this may be a bit early to question, but I would like to know what I'm getting into and make clear goals for myself to stick to.
I have an interest in being certified in both IM and psych. Although it's way early to really think of a specialty that may be suitable before I have even begun rotations, this interest was the result of my love for psychology/psychiatry and my deep interest in being the first contact for patients and foster a strong bond with my patients. Questioning which approach I would want to practice in (essentially, psychiatry vs some type of IM or FM), I was eventually introduced to the idea of combined residency programs. The idea of being double certified in IM-psych is appealing to me. I just don't want to be blinded by naivety and make sure this is a practical route to pursue as medicine continues to change in the future.
Before I begin listing reasons as to why I begin discussing my findings from some articles I found to help formulate my opinion, I want to say that I would appreciate any posts in this thread if you have any personal experience or you are close to a friend that has gone through this process and could tell me what you/your friend think of this route.
I have some questions, but the following write up is just some findings and my interpretations of what I found to give some background on what I am questioning. Feel free to skip below to after the quote to just address the questions if you are well-versed with this topic.
Questions I have
1. Does it really seem practical to pursue a med-psych training if the majority of respondents to surveys indicate that they do not practice in both specialties they are trained in?
2. Is getting this training too niche for a job market that does not necessarily value these skills in combination?
3. With 14 programs for med-psych, are these programs at all competitive simply due to the limited spots available? Would having to build a competitive application be worth going through a residency that takes longer to complete than either residency separately if these physicians typically practice in only one field?
4. Do you have any suggestions of how I should proceed in either learning about these combined residencies or making the most of my (in-progress) medical education to be able to figure out if I truly wish to pursue a combined training route when the time to apply comes?
5. Is the stress/workload of essentially two programs worth the double certification?
Thank you so much for reading and thank you in advance for your responses.
I have an interest in being certified in both IM and psych. Although it's way early to really think of a specialty that may be suitable before I have even begun rotations, this interest was the result of my love for psychology/psychiatry and my deep interest in being the first contact for patients and foster a strong bond with my patients. Questioning which approach I would want to practice in (essentially, psychiatry vs some type of IM or FM), I was eventually introduced to the idea of combined residency programs. The idea of being double certified in IM-psych is appealing to me. I just don't want to be blinded by naivety and make sure this is a practical route to pursue as medicine continues to change in the future.
Before I begin listing reasons as to why I begin discussing my findings from some articles I found to help formulate my opinion, I want to say that I would appreciate any posts in this thread if you have any personal experience or you are close to a friend that has gone through this process and could tell me what you/your friend think of this route.
I have some questions, but the following write up is just some findings and my interpretations of what I found to give some background on what I am questioning. Feel free to skip below to after the quote to just address the questions if you are well-versed with this topic.
I found this SDN article discussing med-psych written by Guera in 2018. It had a lot of good information that served as a good introduction and overview to med-psych. Very quick recap of that article: currently there are 14 med-psych programs int he US, med-psych is a 5-year training program, most med-psych graduates take on an academic role, and psychiatry (alone) had an increase in applicants in 2016.
According to a 2001 article by Stiebel and Schwartz, a survey with responses of n = 122 showed that 70% of respondents were involved only in the practice of psychiatry and 15% of respondents practiced in some type of combined med-psych setting. To me, this seems like pursuing med-psych would be a complete waste if the majority of certified physicians end up practicing solely psychiatry. However, I question the applicability of this finding because (1) it is an older article and (2) 83% of respondents had done training in separate residencies (93% of 83% initially completed IM training, and then on average 7 yrs later begun their second residency - indicating some type of dissatisfaction in their field perhaps... but the article mentions 2/3 of the 93% subgroup took a second residency out of interest in both fields), which may skew these results and findings to my needs. as that is a different route than what I am planning.
According to a 2011 article by Summergrad, Silberman, and Price, it seems like double certified psychiatrists are more likely to work in consultation or inpatient psych as opposed to outpatient. This is not inherently a problem, but this plays into possible loss of autonomy as a physician as medicine moves more towards business and administrative functioning. Further, concerning the evolution of medicine, a 2019 article by Smith and Jung shows that <40% of dual-boarded physicians practice in both trained specialties and employers/organizations are not necessarily recruiting physicians that acquired niche dual-certification training.
Contrasting from these questions of practice, it seems like the first article linked earlier by Guera and some threads on SDN that I have searched for before have described that some distress or negativity towards the prolonged training time, especially when peers (which will most likely end up practicing almost exactly the same way as the double-certified physicians as evidenced by previously linked articles) complete their training earlier and move on to be able to begin practicing, and also some negativity towards the increased stress and workload that comes with juggling two programs.
Questions I have
1. Does it really seem practical to pursue a med-psych training if the majority of respondents to surveys indicate that they do not practice in both specialties they are trained in?
2. Is getting this training too niche for a job market that does not necessarily value these skills in combination?
3. With 14 programs for med-psych, are these programs at all competitive simply due to the limited spots available? Would having to build a competitive application be worth going through a residency that takes longer to complete than either residency separately if these physicians typically practice in only one field?
4. Do you have any suggestions of how I should proceed in either learning about these combined residencies or making the most of my (in-progress) medical education to be able to figure out if I truly wish to pursue a combined training route when the time to apply comes?
5. Is the stress/workload of essentially two programs worth the double certification?
Thank you so much for reading and thank you in advance for your responses.