Tuesday, March 22, 2005

Medicine/Psychiatry Combined Residencies

Looking over the match results from the last several years, it appears that the combined 5-year Internal Medicine/Psychiatry combined residency is slowly dying off (with a brief rebound in 2003):

////// Positions offered////// #filled US grads ///// #filled total

2001 /////41 ///////////////////////// 19 ////////////////// 23
2002 /////32 ////////////////////////// 14 /////////////////// 22
2003 /////31 ////////////////////////// 19 ///////////////////// 24
2004 /////26 ////////////////////////// 14 /////////////////////// 18
2005///// 23 ////////////////////////// 12 ////////////////////////// 17

This 5-year program combines the training of the 3-year internal medicine residency and the 4-year psychiatry residency. I think that the main reason that this residency program is shrinking is that the extra 1-2 years of training do not increase a doctor's income. It is hard to keep up in both specialities; most graduates end up practicing only one of the specialities. Previously many Med/Psych doctors did inpatient consultation psychiatry, but with the new Psychiatric subspeciality of Psychosomatic medicine, completing a med/psych residency no longer offers much of an advantage in this field.


james gaulte said...

The combined residency seems like a bad idea for several practical reasons.1.General internists cannot possibly keep up, having to also keep up with psy.makes it worse than impossible.2.My psy. friends tell me that with managed care all they get to do is to write rxs and the psychologists get to interact with patients and watch progress etc.3.I cannot think of a five year training program that would make less money for the doc that this one.

Michael Rack, MD said...

Thank you for your comments, James Gaulte. Regarding #1, it's difficult but not impossible to keep up in both specialties. Regarding #3, I totally agree. Regarding #2, Many psychiatrists see a wide variety of patients in various settings (group homes, inpatient, outpatient clinics, nursing homes, etc.) Although a psychiatrist usually can't make money if he does a lot of psychotherapy, many do see see several (1-3) patients a week for formal psychotherapy, as well as doing the informal psychotherapy that goes along with med checks.

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