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(@Anonymous)
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I am finishing my 3rd year of medical school, and was sure I wanted to do med-psych. I came to this conclusion because I like both fields and just can't choose between the two, so I thought the idea of training in both was great. However, when I talk to faculty members, they all ask me which I want to place emphasis on when I finish residency. They act as though at one point, I will have to choose between one or the other, and then I will have wasted a great deal of time and effort. The truth is I have no answer yet. I thought I had made a good decision, but now I worry that I simply decided to be indecisive (if that makes sense). Anyway, just feeling a little frustrated and wondered if you had any words of wisdom.


   
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(@drdave)
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I think your feelings are similar to many people who choose to look at (and often participate in) a med-psych residency program. Upon completing a combined residency, there are some, but not many, job opportunities where you can truly practice both fields. These are typically academic positions, state jobs, or VA positions as malpractice insurance is often a big barrier to being able to practice both fields. You really can't effectively bill for both services on the same patient (as far as I know, but I've never had to personally deal with billing issues) and so you really don't get reimbursed for the extra work you do to manage both issues in the same patient. It really takes a system (like a hospital) to realize that cost-savings you are able to provide by doing both services yourself, and typically those docs are salaried as opposed to a more typical private practice, fee for service set-up.

Having said that, most docs who complete a combined residency wind up choosing one field to practice in primarily - however, the knowledge base that one gets from a combined residency can be extremely valuable even in every day practice of one of the fields.

My own sense is that if you know that you want to practice one field primarily from the start, don't do a combined residency program - you are going to put in more time and energy than doing a tradional single residency. If however, you like both fields and are not sure which one you'd rather practice (if you can't practice both), I think doing a combined program is a reasonable option.


   
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