Four years ago at this same time of year, I was visiting all the FMP programs around the eastern US and trying to explain why I wanted to be a combined trained doc. After four years of residency I have learned more about how to practice not as a family doc nor as a psychiatrist but rather as a physician with very clinically useful and marketable perspective on how to best help patients.
I could talk forever about how I feel like this training is helpful to patients, but I think that it is very intuitive to patients as well as many medical students. What I didn't think about back when I was going through the recruitment season as a medical student and as a resident in earlier years was how interested potential recruiters are in having dually trained physicians. The etiology of this interest is involved and includes a trend towards integration of care, anticipated changes in health insurance, and the high demand of both specialties.
All of that is pretty esoteric. When I was interviewing for combined residencies, I wanted to know what people where doing with their combined training. It's early on in my search but so far every small town clinic and hospital that I have contacted have been very interested. One place has already started to integrate care and wants to move further on this pathway. Another place is so desperate for psychiatrists that they are using telepsychiatry to staff their inpatient unit and the family docs have no one to consult. Another place is working to combine my skills with a community mental health center and a family medicine residency.
Just like applying to residencies, this is a mind spinning process. Luckily I have been able to ask other graduates of the program about places they applied, who they had write letters, and how they negotiated. It's great to have former residents who have learned to combine their skills in a clinical setting and are willing to share their experience with me.
Tuesday, December 27, 2011
Thursday, September 22, 2011
Fp-psych(ese)! My favorite new word (aka neologism!)
Time flies by quickly- I am now a third year resident: I am almost half way done with my training! I remember the beginning of my first year of residency: orientation during July, a month of inpatient psychiatry and inpatient family medicine in September. And, then, all of us (or almost all of us, fp-psych residents) left together to attend the Medicine- Psychiatry conference in Chicago (www.assocmedpsych.org). This year, the med-psych conference is 9/30-10/1, in Chicago, and almost (all) of us are going to it, except Matt.
I remember it took me a few months during my first year to "switch", so to speak, between being on a family medicine rotation to a psychiatry rotation and vica versa. I, first and foremost (like any intern quickly learns their first few months) had to learn a new hospital system (putting orders, who to consult etc), and then also two systems in two different departments. For example, when a patient is transferred out of inpatient psychiatry, a discharge summary is needed. When a patient is transferred from inpatient family medicine to another service, there is no need for a discharge summary. Imagine how confused I was, when I switched from inpatient psychiatry my first year, to inpatient family medicine, writing unnecessary discharge summaries! It sounds funny to remember this now, but at the time, it was NOT funny to me after wasting time writing discharge summaries! I learned to check with other fellow residents about "technical" details (thats what I like to call them!).
During second year, I learned to feel comfortable with belonging to two worlds, two groups of people, two departments. It also meant having more friends, more people to hang out with and more social events! I also learned how to be on my own track of self-study, compared to peers in categorical training (family medicine and psychiatry), who felt to me were 6 months ahead of me (which they were, but I was also ahead of my peers in other spheres of knowledge, whether it be family medicine or psychiatry). Starting second year, I also started to see patients at the Counseling and Health Promotion clinic (CHPS), where I began learn to do psychiatric evaluation/diagnostics and medications checks, a year ahead of my psychiatry categorical peers. And in CHPS, I also am able to ask about medical issues that may complicate my patient's mental health. This gives me another dimension into understanding the patient's world and integrating family medicine and psychiatry after finishing my intern year.
By now, being a third year resident, I feel more comfortable in my skin. The best way I can explain it- it is like being bilingual, and I like speaking fp/pscyh(ese). This is what I call it! For example, when being on inpatient family medicine service, it becomes second nature to me to pick out some psychiatric details/medicines that may not have been noticed or asked. It also becomes second nature that when rounding on inpatient family medicine, that I can answer psychiatry questions that may come up. On the flip side, when I am on psychiatry consults/calls/inpatient psychiatry, it is also second nature for me to assess the medical needs for my psychiatric patients and bring to attention medical issues that may have been missed before.
Check out the upcoming medpsych conference and medpsych association: http://www.assocmedpsych.org/.
More to come soon!
--Nesrin
I remember it took me a few months during my first year to "switch", so to speak, between being on a family medicine rotation to a psychiatry rotation and vica versa. I, first and foremost (like any intern quickly learns their first few months) had to learn a new hospital system (putting orders, who to consult etc), and then also two systems in two different departments. For example, when a patient is transferred out of inpatient psychiatry, a discharge summary is needed. When a patient is transferred from inpatient family medicine to another service, there is no need for a discharge summary. Imagine how confused I was, when I switched from inpatient psychiatry my first year, to inpatient family medicine, writing unnecessary discharge summaries! It sounds funny to remember this now, but at the time, it was NOT funny to me after wasting time writing discharge summaries! I learned to check with other fellow residents about "technical" details (thats what I like to call them!).
During second year, I learned to feel comfortable with belonging to two worlds, two groups of people, two departments. It also meant having more friends, more people to hang out with and more social events! I also learned how to be on my own track of self-study, compared to peers in categorical training (family medicine and psychiatry), who felt to me were 6 months ahead of me (which they were, but I was also ahead of my peers in other spheres of knowledge, whether it be family medicine or psychiatry). Starting second year, I also started to see patients at the Counseling and Health Promotion clinic (CHPS), where I began learn to do psychiatric evaluation/diagnostics and medications checks, a year ahead of my psychiatry categorical peers. And in CHPS, I also am able to ask about medical issues that may complicate my patient's mental health. This gives me another dimension into understanding the patient's world and integrating family medicine and psychiatry after finishing my intern year.
By now, being a third year resident, I feel more comfortable in my skin. The best way I can explain it- it is like being bilingual, and I like speaking fp/pscyh(ese). This is what I call it! For example, when being on inpatient family medicine service, it becomes second nature to me to pick out some psychiatric details/medicines that may not have been noticed or asked. It also becomes second nature that when rounding on inpatient family medicine, that I can answer psychiatry questions that may come up. On the flip side, when I am on psychiatry consults/calls/inpatient psychiatry, it is also second nature for me to assess the medical needs for my psychiatric patients and bring to attention medical issues that may have been missed before.
Check out the upcoming medpsych conference and medpsych association: http://www.assocmedpsych.org/.
More to come soon!
--Nesrin
Wednesday, September 21, 2011
Ah Sweet! You mean this is the first post to our new blog?!!!
Don't mind if I do!
Welcome to the blog of the Family-Medicine Psychiatry Combined Program at UIHC (University of Iowa). Nesrin's brainchild, I'm totally tagging along for the fun. I want to write about my day briefly in family medicine clinic.
7 AM: Give presentation on ADHD in sports medicine/athletes as part of sports medicine rotation
8 AM: See first patient, discuss depression/anxiety, how they impact adherence to his diabetes and specifically insulin
8:20 AM: See second patient, discuss refill of depression meds
8:40: See third patient, discuss sleep and fatigue issues
9 AM: Insta-curbside in the clinic, advice regarding anxiety management with an SSRI, recommended psychotherapy to FP staff!
9:30 AM: Well-child check #2 - mom with PPD and drug use, concerned about effects on child
10:30 AM: f/u continuity visit for nausea/vomiting with client on ACT team, weight loss, ???? somatic delusions vs. pancreatitis?
11 AM: f/u gastritis, stricture and bipolar co-managed with community psychiatrist
Tally for morning:
4 total curbside consults offhand in FP clinic re: psych-related issues
>50% patients with co-morbid psychiatric diagnoses
1 cup coffee
8 influenza shots
3 TDAPs
One really cute well-child check
One 14 year old with allergic rhinitis totally better, talked about spanish classes and used Acceptance and Commitment Therapy tenets to improve motivation to study, not procrastinate
3 substance use disorders
I don't think this is typical for any family medicine clinic in the US. I use my psych training day-in and day-out, and it makes me a better family physician.
As combined-trained clinicians, we have a unique hybrid skill set to offer, and are representatives of the field of psychiatry to patients unfamiliar with the system of mental health, and to providers unfamiliar with managing complex mental health. Today I was 1/2 family physician, and 100% psych C&L.
I'm ready for next week!
-- Erik
Welcome to the blog of the Family-Medicine Psychiatry Combined Program at UIHC (University of Iowa). Nesrin's brainchild, I'm totally tagging along for the fun. I want to write about my day briefly in family medicine clinic.
7 AM: Give presentation on ADHD in sports medicine/athletes as part of sports medicine rotation
8 AM: See first patient, discuss depression/anxiety, how they impact adherence to his diabetes and specifically insulin
8:20 AM: See second patient, discuss refill of depression meds
8:40: See third patient, discuss sleep and fatigue issues
9 AM: Insta-curbside in the clinic, advice regarding anxiety management with an SSRI, recommended psychotherapy to FP staff!
9:30 AM: Well-child check #2 - mom with PPD and drug use, concerned about effects on child
10:30 AM: f/u continuity visit for nausea/vomiting with client on ACT team, weight loss, ???? somatic delusions vs. pancreatitis?
11 AM: f/u gastritis, stricture and bipolar co-managed with community psychiatrist
Tally for morning:
4 total curbside consults offhand in FP clinic re: psych-related issues
>50% patients with co-morbid psychiatric diagnoses
1 cup coffee
8 influenza shots
3 TDAPs
One really cute well-child check
One 14 year old with allergic rhinitis totally better, talked about spanish classes and used Acceptance and Commitment Therapy tenets to improve motivation to study, not procrastinate
3 substance use disorders
I don't think this is typical for any family medicine clinic in the US. I use my psych training day-in and day-out, and it makes me a better family physician.
As combined-trained clinicians, we have a unique hybrid skill set to offer, and are representatives of the field of psychiatry to patients unfamiliar with the system of mental health, and to providers unfamiliar with managing complex mental health. Today I was 1/2 family physician, and 100% psych C&L.
I'm ready for next week!
-- Erik
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