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Career Development - Med/Psych

What Does Training Look Like?

A combined Internal Medicine/Psychiatry program is a five year program that focuses on training physicians to competently care for both medical and psychiatric illnesses. Nearly 70% of patients with psychiatric issues have ongoing medical issues, and nearly 30% of patients with medical issues have psychiatric comorbidities. Med/Psych training prepares the physician to treat the entire patient holistically. Half of the five-year program is spent in psychiatry rotations and half in internal medicine rotations. At the end of five years of training, the resident is eligible for board certification in both internal medicine and psychiatry. After completing the residency program, residents are eligible to apply for any fellowships through internal medicine (for example, cardiology, pulmonology, infectious disease, palliative care, etc.). Residents are also eligible to apply for any fellowships available to psychiatry graduates (for example, forensics, addiction, pain, geriatrics, etc.).

 
Subspecialties

After completing the residency program, residents are eligible to apply for any fellowships through internal medicine (for example, cardiology, pulmonology, infectious disease, palliative care, etc.). Residents are also eligible to apply for any fellowships available to psychiatry graduates (for example, forensics, addiction, pain, geriatrics, etc.). There are also numerous non-ACGME accredited fellowships including, but not limited to, eating disorders, electroconvulsive therapy, perinatal psychiatry, and community psychiatry.

 
What Does a Typical Workday Look Like?

Practicing both internal medicine and psychiatry allows for a wide range of practice opportunities and thus leads to a varied workday. There is no typical workday as a result. Combined physicians practice in a variety of settings, both inpatient and outpatient. Some physicians will do a combination of inpatient and outpatient, and others will practice solely in an inpatient or outpatient location.

 
Important Qualities and Traits

Qualities recognized as important to medicine/psychiatry include:

 

  • Desire to treat patient’s medical and psychiatric illnesses simultaneously.
  • An appreciation for the overlap between medical and psychiatric conditions (including, but not limited to the fact that medical illnesses affect one’s psychological well-being, medical illnesses can present as psychiatric symptoms and vice versa, psychiatric medications can adversely affect medical comorbidities and vice versa, etc.).
  • An ability to master multiple topics simultaneously.
  • A desire to advocate for the integrated care of patients.
 
Shadowing Opportunities

For shadowing opportunities, please contact Dr. Ashley Ellison , or Dr. Brad McConville.
 
Research Opportunities

Students can engage in research in either the Department of Internal Medicine or the Department of Psychiatry. Students can inquire about projects through the Department of Medicine during the monthly research conference. This is held the 3rd Monday of the month at noon in the 7th floor library (room 7001) of the School of Medicine building. The Department of Psychiatry research webpage has some information about projects in the department. Med/Psych faculty at Tulane are also always open to assisting students who desire to create his or her own research project specific to combined med/psych care; students can contact Dr. Ashley Ellison , or Dr. Brad McConville to discuss research projects.

Additionally, students may want to pursue research opportunities through the DeBakey Scholars Program. This program offers medical students the opportunity to pursue and complete a longitudinal, structured, closely supervised research experience culminating in a capstone presentation prior to graduation. For more information, contact Dr. Kenneth Mitchell.

 
Specialty Interest Group

Currently, there is not a student specialty interest group for combined med/psych. However, if you are interested in starting a group, feel free to contact Dr. Ashley Ellison for assistance.

 
Who are the Specialty Academic/Career Advisors for this Specialty?

Dr. Ashley Ellison is the specialty advisor. Dr. Ellison is happy to meet with students who would like to learn more about combined programs, discuss the pros and cons of combined training and care, and discuss tips for applying to combined programs.

 
Recommended T3 & T4 Coursework

During the T3 year, students should complete their core internal medicine and psychiatry clerkships. As a T4 interested in applying to a combined program, it is helpful to have some psychiatry and medicine rotations on one’s schedule to demonstrate an interest in both fields.

Students applying for med/psych residencies often apply also to categorical psychiatry or categorical medicine programs. If one is applying to combined med/psych and categorical psychiatry programs, it is recommended to complete a sub-internship in psychiatry, and if time and scheduling permits, a sub-internship in medicine can be helpful, but is not 100% necessary. Likewise, if a student is applying for combined med/psych and also categorical medicine programs, a sub-internship in medicine should be completed, and if time and scheduling permits, a sub-internship in psychiatry can be helpful, but not 100% necessary.

Tulane offers a med/psych elective for students interested in combined training. This can be helpful, but is not mandatory to do if applying for combined training. Several med/psych programs across the country offer visiting student med/psych rotations via VSAS/VSLO. These can be helpful to elucidate one’s interests in combined care and training.

 

Specialty Statistics

Number of Applicants & Positions (from "Results and Data 2018 Main Residency Match")

 
Special Considerations When Applying for Residency

There are no special considerations when applying for residency.

 
Important Advice

Away rotations are not necessary in this field, however if a student wants to experience a specific combined residency program or wants clarity in how combined training and combined care function, away rotations can be helpful.

Students should look for programs they feel are a good fit in terms of size, program strengths coinciding with student interests, and “personality” of the program as a whole.

The most important elements to highlight in one’s application are the reasons for pursuing combined training and a demonstrated interest (via volunteer activities, leadership, research, etc.) in both medicine and psychiatry. Residency programs are seeking to ensure that students understand what combined care entails and that students have a rationale, be it philosophical or a specific career trajectory, for which he or she is pursuing combined training.

Students should have at least one letter of recommendation from internal medicine and at least one letter of recommendation from psychiatry.

 
How Many Programs Should I Apply To?

As of 2018, there are 12 combined medicine/psychiatry programs, each with two intern spots per year. It is recommended to apply to all or most of the combined programs. Given the small number of combined med/psych programs, it is not uncommon for students to also apply to categorical medicine or categorical psychiatry programs. The total number of programs an applicant should apply to depends on an applicant’s board scores, academic performance in medical school, extracurricular activities, etc.
 
Other Resources

AAMC Careers in Medicine

NRMP's Charting Outcomes in the Match 2018

NRMP's Program Director Survey 2018

Association of Medicine and Psychiatry is a national organization that focuses on combined training and care. It is an excellent resource for medical students. If one is a member of the organization, he or she can request a combined resident mentor. AMP also offers opportunities to be involved in committees that promote combined care. AMP also has an annual conference with a residency fair and numerous student-specific talks and activities. The conference is an excellent place to network and learn more about combined care and training.

Tulane’s Department of Psychiatry

Tulane’s Department of Medicine

Dr. Katrina D’Aquin can put you in touch with potential mentors.