Med-psych residencies are not as competitive as it would seem based on the few slots available. I don't know, yet, what the match results were for med-psych programs this year. I know in general they fill about 60% of the slots nationwide. Specific programs, however, may be fairly competitive, but overall, if you want to do a combined program, and you are an average US grad, you can probably get a spot somewhere.

The easiest way to gauge how competitve a specific med-psych program is would be to look at its medicine residency - the med-psych program will probably be slightly more competitive than the medicine residency at that specific place. Essentially, any combined applicant needs to meet the minimum standards for each program, and the medicine programs usually have slightly higher standards.

So, if you think you would be fairly competitve at a specific programs medicine residency, then you probably would also be pretty competitive in that places med-psych program.

Last, about 4th year electives - I'd recommend first do your sub-I in whatever field you plan on doing (or a standard rotation in that field) where you can get a good letter of recommendation for residency apps. Then, you should select interesting electives that are not in your main field of study. 4th year med school may be your last chance to do pediatrics, ob/gyn, or surgery - while you may not want to do them for a career, you may still have fun doing it as a student. You may also want to work with a specific person at your med school, as you may be doing residency somewhere else.

Let me know if you have more questions.

Rick

I am wondering what's the better Out of City rotation when trying to be competitve for Med/Psych: Medicine Sub-I or Psychiatry. I am limited on the amount of Out of City clerkships I can do, so I have to be careful how I use them.

I would do the sub-I in whichever department is most competitive - at most places that would be their medicine department. Some programs may have a med-psych clinic or med-psych unit where you could do your rotation, thus exposing you to both departments.

Remember, it isn't just an opportunity for you to impress them, but a chance for you to see if their program is up to your expectations for a training program. You may want to consider contacting their program director for their med-psych program and ask them which sub-I you should do - it'll also give you an idea of how responsive the program director is. The residency training director is a very important person - although I also wouldn't completely write-off a program if you don't get much help from a program director as there can be turn-over in program directors at some places.

Good luck!