Originally Posted: 2001-10-28 15:25
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People do a large variety of things after a combined residency. In private practice, you almost have to do one or the other because of the way insurance companies work. Most choose to do psychiatry, probably because of the lifestyle, but if you practice internal medicine, you are still doing a lot of basic psychiatric care (but you really aren't getting reimbursed for it as well as if you were a psychiatrist). Most people who go into academics do some of both, but usually are based more in one department. I'll have to pull up my data, but I did have a list of the graduates and what they are currently doing. At that time, about 40% were doing both in academic settings, but I would guess it may be even higher than that now. I know many of the recent graduates from various programs and most are doing both in some form. If you plan on doing one field or the other, I strongly advise against a combined program, because you are not just prolonging agony, but actually making it worse.

How many jobs are out there which actually allow double-boarded physicians to practice BOTH medicine (IM or FM) and psychiatry? I don't exactly see a lot of these types of gigs listed in the back pages of JAMA...

Is this a feasible career goal? I would love to hear specifics about/from anyone who is working in this type of a dual-practice environment.

[ Edited by Corpsman-Up on 2004/10/7 22:34 ]

There are jobs out there, but very (very) few that are advertised where you can practice both medicine and psychiatry. The majority of people I know who do both are in academic settings - it is easier as far as dealing with re-imbursement issues and malpractice coverage issues.

In the private sector, I'm guessing the people who practice both do primarily one field, but deal with people in the other. For example, a dual boarded doc might function doing geriatric psychiatry where the patients are typically also medical ill. In the private sector, though, it would be tough for one doctor to get re-imbursed for providing both medical and psychiatric services - they would probably only be able to bill for one service. Insurance companies are most likely not up to speed with the advantages of paying one doctor to do both services as opposed to having two doctors.

A place where jobs are posted can be found at: Combined Medicine - Psychiatry Job Postings

For those that are interested, I'd highly recommend joining The Association of Medicine and Psychiatry as almost the entire organization is made up of dual trained docs. I am currently managing their web site and also moderate the e-mail list. Membership is free for residents and students - and that'll get you access to the email discussion list.