Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Should medical students consider a combined psychiatry residency?

Julia Frank, MD
Education
June 19, 2012
226 Shares
Share
Tweet
Share

“What about combined psychiatry-family medicine-neurology-internal medicine programs?  Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”

Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For example, major depression has steadily advanced up the ladder of the World Health Organization’s ranking of conditions accounting for years lost to disability (YLD) and disability adjusted life years—to the point that major depressive disorder now accounts for the highest number of YLDs and is fourth leading contributor to DALYs worldwide.  Together, alcohol, illicit drug and tobacco use are responsible for 9.1% of the total burden of disease around the globe. These numbers translate into millions of years of productive life loss, and billions of dollars of money inefficiently spent on medical consequences of preventable diseases. Don’t get me started on obesity.

While stress related illnesses, changing habits or adapting to chronic illness aren’t solely psychiatric concerns , within medicine , psychiatrists are uniquely qualified to address them with patients, and to enhancing the capacity of generalists and members of the allied health professions to diagnose and, sometimes, treat psychiatric, psychosocial, and behavioral problems.

Nevertheless, until now I have discouraged students from signing up for combined training programs. Even doctors who are eager and well prepared to deal with complex medical/psychiatric/behavioral problems cannot overcome the barriers of mental health “carve outs” and discriminatory reimbursement.  Those who want to integrate psychiatry with another specialty may find themselves unable to bill for psychiatric services. If someone wants to integrate another specialty with psychiatry, problems of building and supporting the necessary teams are as daunting as problems of reimbursement and access. Graduates of combined programs struggle to find positions that allow them to practice both specialties once they leave training.  Many default to practicing only one or the other, wasting precious skills acquired at considerable cost.

My advice is changing. Certain organized systems of care, in particular the Veteran’s Administration, have pioneered programs that make optimal use of psychiatric expertise at the interface of psychiatry and medicine/pediatrics/neurology. Provision 2704 of the Affordable Care Act has done much to encourage the creation of medical homes and accountable care organizations, places where the cost savings and increased professional satisfaction of providing integrated care quickly become apparent. At a recent meeting of the American Psychiatric Association, multiple presentations on integrated care attracted standing room only crowds. Many demonstration projects are sustained by grants; despite their obvious benefits, exciting new models for integrated care will not survive unless the system of payment for services evolves to make them viable.

Like my students, psychiatrists of every level of experience don’t want to give up being physicians in order to practice our unique specialty. We are eager to use our basic medical training throughout our professional lives, and to offer the fruits of what we have learned as specialists to our students and colleagues. For the first time in decades, I can now tell students this dream is becoming reality.

Come next spring, when a student sidles into my office and says, with some embarrassment, “Dr. Frank, I think I want to be a psychiatrist … um … er … what do you think about a combined program?” my answer is going to be “Go for it, kid!”

Julia Frank is a psychiatrist who blogs at Progress Notes.

Prev

Most medical students don't have what it takes for primary care

June 19, 2012 Kevin 16
…
Next

Why doctors should attend residency graduations

June 19, 2012 Kevin 0
…

Tagged as: Medical school, Primary Care, Psychiatry, Residency

Post navigation

< Previous Post
Most medical students don't have what it takes for primary care
Next Post >
Why doctors should attend residency graduations

More by Julia Frank, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Unregulated gun access and its drain on medical resources

    Julia Frank, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The stigma experienced by patients with psychiatric disorders

    Julia Frank, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why clinical decision making in psychiatry is difficult

    Julia Frank, MD

More in Education

  • The pros and cons of taking a gap year during medical school

    Med School Insiders
  • Breaking the silence: the truth about mental health challenges among medical students and why medical schools must take action

    Erin Waldrop
  • Breaking the stigma: Encouraging mental health help-seeking in medical trainees

    Anonymous
  • I’m not so different from Lionel Messi – and neither are you

    Lauren Tien
  • 6 ways ChatGPT can help you succeed in medical school

    Drew Bergman
  • Is it time to say goodbye to medical school rankings?

    James Goldchild
  • Most Popular

  • Past Week

    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Healing trauma and reconnecting: Unmasking the impact of dissociation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • A pediatrician’s journey into integrative medicine [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Could Semaglutide Help Curb Addictive Behaviors?
  • 'If the Narcan Isn't Working, Give More' and Other Myths About Naloxone Use
  • CDC: Children's Brain Infections Rose Last Winter, But Remained Rare
  • Inside the Fight Against Burnout Amid the Chaos of War in Ukraine
  • Cardiovascular Risk Models Still Fall Short for Arthritis Patients

Meeting Coverage

  • Cardiovascular Risk Models Still Fall Short for Arthritis Patients
  • De-Escalated Surgery Suffices for Low-Risk Cervical Cancer
  • More Evidence Backs Gout Benefit for Gliflozin Agents
  • Reaction to FDA's Approval of Upadacitinib for Crohn's Disease
  • CDK4/6 Extends Reach Into Early-Stage Breast Cancer
  • Most Popular

  • Past Week

    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Healing trauma and reconnecting: Unmasking the impact of dissociation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • A pediatrician’s journey into integrative medicine [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...