Med-Psych Network Home Page : Frequently
Asked Questions
- What is a combined residency program?
- In what fields can one do a combined residency?
- What do people do with two specialties?
- What are the pros and cons of doing a combined residency?
- How long are the combined programs, and how much
time is spent in each specialty?
- Are combined residency programs competitive?
- What is the best program for combined residency
training?
- What should I look for in a combined residency
program?
- Where can I get more information about combined
residency programs?
What is a combined residency
program?
A combined residency program refers to a special program where the resident
completes training in two or more specialties simultaneously. For
example, rather than doing an internal medicine residency and then doing
a psychiatry residency, someone can do a combined program where they alternate
fields throughout their training and complete both, usually in less time
than if they were done sequentially.
In what fields can one do a combined residency?
The current combined residencies listed in the graduate medical handbook
(so called "green book") in order of the number of open first
year positions each year:
Internal Medicine and Pediatrics
Internal Medicine and Psychiatry
Family Practice and Pscyhiatry
Pediatrics, Psychiatry, and Child Psychiatry (Triple Board)
Internal Medicine and Neurology
Psychiatry and Neurology
Others could probably be done and customized, but the above programs are
recognized by the respective boards.
At this time, it is still relatively unclear what graduates of combined
programs will be doing. Ideally, graduates would practice both
areas of their specialty. It appears that most med-psych graduates
are primarily practicing psychiatry (about 95% by one survey). Interestingly,
half of the dual boarded FP-psych graduates are practicing both. Some
of the areas that have been well suited to dual training are: chronic
pain management, substance abuse, geriatrics, consultation psychiatry,
palliative care, and medical treatment of the chronically mentally ill. There
are also several med-psych units throughout the country that are ideally
staffed by a dual trained physician. These units are meant
to be for patients who need to be in the hospital for both their medical
and psychiatric problems, and thus are not well suited to either a general
medicine or psychiatry unit.
What are the pros and cons of a combined residency?
The major advantage of doing a combined program is at least one year is
usually cut off of training by combining residencies. Theoretically,
you will obtain more "integrated" training because the program
should have dedicated curriculum towards topics where the fields interface. Also,
you are more likely to work with others who are in dual training or have
completed dual training. These people with similar interests
function as mentors and supports that otherwise are not likely to be present.
The major disadvantages are that most programs are not well balanced nor
integrated between two departments. While many US graduates would
be able to match at a top caliber psychiatry residency, they may have to
compromise the quality of their psychiatry training some by going into a
combined program. Additionally, if there is poor communication
between the two departments, the residents may get stuck in between without
any good advocates. In theory, a resident may get better quality
training by selecting two different residencies and doing them sequentially.
Some of the other drawbacks of combined training are:
1. You proceed through residency at a different rate from the
majority of your collegues. The initial interns you start with
will move on while you will still have 1-2 years of residency remaining. Relationships
with collegues becomes more difficult because of this.
2. Additionally, relationships with collegues may be more difficult
to form, because you spend only part of your time in each department.
3. There may be some level of "jealousy" or other animosity
towards combined residents because they are "different".
4. You lose out on some elective time.
How long are the combined programs, and how much
time is spent in each specialty?
Internal Medicine and Psychiatry -
5 Years
30 months medicine, 30 months psychiatry
Family Practice and Psychiatry -
5 years
30 months family practice, 30 months psychiatry
Peds, Psych, Child Psych -
24 months peds, 18 months adult psych, 18 months child psych
I'm not familiar with med/neuro or neuro/psych.
Within every field, there is quite a bit of variability from specific program
to specific program. Overall though, everything is relative.
Everything is competitive if you are a foreign medical graduate. As
a US graduate, psychiatry is one of the least competitve fields. I
base this statement on the fact that the match fill rate is fairly low. This
means there are many open spots throughout the country. Of course,
there are several competitive psychiatry residency programs throughout the
country.
Internal medicine programs are moderately competitive. Decent
programs can be difficult to match in, and the top programs are very competitive. Internal
medicine is not as competitive as surgery, however.
My understanding is that during the past year's match (March 2000), family
medicine was not as competitive as it had been. With managed
care there had been a trend towards more people going into primary care. This
trend may be leveling off or even reversing. Time will tell. I
do not know much about family practice residencies, but my impression is
that in any given part of the country (except maybe California) family practice
will be less competitive than internal medicine and more competitive than
psychiatry.
Pediatrics programs in general are about as competitive as internal medicine
programs.
I would say that the combined programs and any particular institution is
going to be slightly more competitive than the more competitive of the departments. For
example, at Program A, they have a great medicine program and an average
psychiatry program. The combined med-psych program will probably
be slightly more difficult to get into than the medicine program. I
base this estimate on the fact that if you don't meet the requirements to
get into either department, they won't bother ranking you, and there less
spots in the combined programs than there are in the categorical programs.
Also, I think there is some variability between the different types of combined
programs. When I was looking at residency programs in 1996, all
of the combined peds/psych/child psych programs filled every year. Usually,
between half and 3/4 of the med-psych spots fill each year. I'm
not sure off hand what the data has been on the combined FP-psych programs.
Where ever you will be happiest.
I have my own opinions that I have based on meeting residents from various
programs as well as reputations I know about the specific departments. Additionally,
part of my bias probably relates to how long a program has been in existence
and word of mouth reputation of various programs.
When I looked at programs, I looked at a few things to determine how strong
I thought the program was. First, I looked at each department
separately. I wanted to make sure I would get at least adequate
training in each department. I would judge department strength
on reputation, match fill rates, and number of foreign medical graduates. I
don't by any means want to imply that foreign medical graduates are inferior
residents, because if anything, I think the opposite is true. However,
my experience has been that residency programs will choose a less excellent
US graduate over a better qualified foreign medical graduate. I
think a big part of this occurs because it is very difficult to assess the
strength of foreign medical graduates because the medical education systems
are so different throughout the world. Regardless of the reasons,
programs that have higher numbers of foreign medical graduates are generally
considered less desirable. Similarly, you can get a sense of
the strength of a program based on where in the US the residents came from.
I think it is also important to look at the number of residents who have
completed a program, as well as the current number and quality of those
residents. Additionally, I look at how many dual trained faculty
are present at a given program. The more, the merrier. I
have learned, however, that you should not count on any one or even two
staff members to guide you through training, because people do change where
they work, and it may happen during your residency. Additionally
perks at some programs are combined med-psych units and combined med-psych
outpatient clinics. These facilities can be a huge advantage
to learning how to integrate combined training in the real world.
To summarize, rather than name the names of programs here, I'll say that
you can judge the programs yourselves looking at a few things, and in order,
I would say they are:
1. Reputation of combined program and individual departments
2. Length of time the program has been around and had a good
reputation
3. Number of residents who have graduated a program compared
to the number whom have dropped out
4. Fill rates of combined program and individual departments,
as well as quality of those residents who did match
5. Number and quality of dual trained staff
6. Presence of a combined unit and/or clinic
See above question.
You can check out the information at the Association
of Medicine and Psychiatry web site. Next, I would definitely
look at the FREIDA
information on any program you are looking at. Of course,
you should request the actual residency application materials from any
program you are considering, as that information is likely to be the most
current. If there are other questions, or resources that I have not mentioned
here, please contact me directly and feel free to share your questions
or additional information. My e-mail is: malis@med-psych.net
Last updated 9/13/2002
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