Why Do Combined Training?2010 Survey of Combined-Trained Physicians

Jane P. Gagliardi MD

Rationale for This Survey

• Medical students need honest information about combined training!

Rationale for This Survey

• Students in institutions without combined-trained physicians hear the following:– Billing is too complex; better to do one

specialty rather than two (or more)– Most people end up doing one or the other

specialty in their post-training lives– Condensed education would lead to deficient

training in both fields

Participants

• Past and current members of the Association of Medicine and Psychiatry

• Solicited anonymously through email

• Email sent 7/6/2010

• As of 7/16/2010: N=33 respondents

Results

27/33 (84.4%) Internal Medicine/Psychiatry5/33 (15.6%) Family Practice/Psychiatry

Board Certification

• ABIM• Internal Medicine, Psychiatry,

Psychosomatic Medicine• Internal Medicine• IM and Psych• med and psych• ABIM & ABPN• Family medicine, psychiatry, hospice and

palliative medicine• IM & Psych• Internal Medicine and Psychiatry• Internal Medicine, General Psychiatry,

Psychosomatic Psychiatry• Int Med, General Psych, Psychosomatic

Med, Geriatric Psych• ABIM, ABPN• medicine and psychiatry• ABPN, psychosomatic medicine• ABFM, ABPN • ABIM and ABPN• Family Medicine, Psychiatry,

Psychosomatic Medicine

• Internal Medicine and Psychiatry and Endocrinology and Metabolism

• Internal Medicine and Psychiatry• IM, Adult psych, Psychosomatic Medicine,

Geriatric Psychiatry• Medicine, Psychiatry, Psychosomatic

Medicine• Psychiatry & Neurology• IM and Psychiatry• IM and psych• Internal Medicine and Psychiatry• Psychiatry, Psychosomatic medicine,

emergency medicine (never took IM boards)• Family Medicine and Psychiatry• internal medicine, psychiatry in process

(part II pending)• ABPN ABFM• ABPN• Internal Medicine, Psychiatry, Geriatric

Medicine, Geriatric Psychiatry

100% of Respondents are Board-Certified:

9/33 (27.3%) Yes24/33 (72.7%) No

Fellowships (n=9 of 33; 27.3%)

• Consultation-Liaison Psychiatry (Psychosomatic Medicine) (3)

• Endocrinology and Metabolism (2)• Academic Fellowship in Primary Care

Research• Internal Medicine• Clinical Research Training Fellowship

(NIMH)• Geriatric Medicine

Work Settings• Academic inpatient psychiatry unit

Academic combined medical-psychiatric inpatient unitAcademic general medicine service Academic C/L

• Academic medical or primary care clinicAcademic Psychiatric Consultation ClinicMedical school

• Federal Public Health agencyPreviously worked as private practice medicine-psychiatry hospitalist (medicine service)

• Private practice psychiatric clinicAcademic medical or primary care clinicAcademic inpatient psychiatry consults

• Private practice combined clinic• Academic medical or primary care clinic

Academic psychiatric clinic• Academic medical or primary care clinic

Academic psychiatric clinicHospice medical director

• Private practice psychiatric clinicPrivate hospital inpatient psychiatry unitPrivate substance abuse inpatient unitConsult-liason psychiatry

• Academic combined clinic• Academic medical or primary care clinic

Private hospital consult• Academic medical or primary care clinic

Academic psychiatric clinic• Academic hospitalist in medicine

Inpatient Psychiatry Consults• Academic inpatient psychiatry unit• Academic medical or primary care clinic

Academic combined clinicAcademic inpatient psychiatry unitAcademic combined medical-psychiatric inpatient unitSkilled Nursing Facility

• Academic medical or primary care clinicAcademic hospitalist in medicine

• Private practice med or primary care clinicPrivate practice specialty medical clinicPrivate practice psychiatric clinicPrivate practice inpatient medical specialtyConsultation-Liaison

• Private practice psychiatric clinicAcademic medical or primary care clinicAcademic psychiatric clinicAcademic hospitalist in medicine

Work Settings• Service Chief at an Academic VA Hospital• Academic specialty medical clinic

Academic substance abuse clinicAcademic combined clinicAcademic inpatient psychiatry unitAcademic combined medical-psychiatric inpatient unit

• Private practice psychiatric clinicPrivate hospital inpatient psychiatry unitGeriatric Psychiatry Unit

• Academic combined medical-psychiatric inpatient unit

• Medical management consultingCover for consult psychiatrists at county hospital occasionally

• Private practice combined clinic• Private practice psychiatric clinic

Academic combined clinicAcademic inpatient psychiatry unit

• Psychiatry Research• Academic medical or primary care clinic

Academic specialty medical clinicAcademic psychiatric clinicAcademic combined clinic

• Private practice psychiatric clinicAcademic medical or primary care clinicAcademic inpatient psychiatry unit

• Private practice psychiatric clinicPrivate practice combined clinicAcademic medical or primary care clinicAcademic combined clinicAcademic inpatient psychiatry unitAcademic combined medical-psychiatric inpatient unit

• Academic inpatient psychiatry unitAcademic hospitalist in medicineAcademic combined medical-psychiatric inpatient unitPsych CLI consider myself a MedPsych hospitalist :-)

• Academic medical or primary care clinicAcademic psychiatric clinic

• Academic psychiatric clinic• Academic medical or primary care clinic

Academic combined clinicAcademic inpatient psychiatry unitAcademic hospitalist in medicine

• Academic consultation-liaison

N=33 respondents as of 7/16/2010

NHP = nursing home psychiatry

Periop = perioperative medicine

25

of

33

(7

5.8

%)

re

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ork

in t

he

last

12

mo

nth

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28

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4.8

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Table: Clinical Activities over the Last 12 Months

30/33 (90.9%) Yes3/33 (9.1%) No

Administrative Roles• Associate Dean • Assoc Dean of Hospital Affairs • Director of Medical Education • Director of Undergraduate Medical Education – medicine• Medical director of consult service, residency training program • Med-Psych Program Director • FMP training director • Program director

Program Director • Residency Director • Residency Director • Residency Director• Residency program director• Fellowship Director• IM Program Director • IM Program Director • Associate Program Director of psychiatry residency programs • Associate Program Director for residency in medicine/psychiatry• Medicine subinternship director• Medicine clerkship director• Course Director for second year medical student class

• President of national consulting company • President of national organizations • Member national specialty committees• Chairman local, regional, national committees • Board member and officer of state medical and psychiatric

organizations

• Service Chief at VA Hospital• Chair Care of Pts with Life Threatening illness • VP of Medical Affairs • Chief Psychiatry • Vice chair • Assistant Chair• Director of Department of Psychiatry• Department Director• Vice Chair of Clinical Operations in a Department of Psychiatry • Clinical Program Director• Medical Director• Medical Director for inpatient psychiatry services at the local

hospital • Medical Director med/psych combined service• Director of Medicine/Psychiatric Combined Inpatient Service,

Private Hospital • Medical Director C/L service• Medical Director for IM training clinic • Medical Director of clinic • Hospice medical director • Assistant Medical Director inpatient psychiatry unit • Assistant Medical Director med/psych combined service• Assistant Medical Director C/L service

Educational Departmental / Clinical

Responses include multiple administrative roles (past and current) listed by 28 of 33 respondents

Organizational

20/33 (60.6%) Yes13/33 (39.4%) No

Types of Research (specified by 19 of 33 respondents; some common research interests)

• Clinical research • Delirium • Medical education • Epidemiology of sexually transmitted diseases• Metabolic syndrome and antipsychotics• Depression and heart disease• CL topics• Panic disorder • Delay in Acutely Ill Patients • Health services research on the interaction of medical and mental

health conditions (formerly psychoneuroendocrinology) • psychopharmacology, brain imaging

30/33 (93.8%) Yes2/33 (6.3%) No1/33 No response

N=32

N=32

N=31

N=32

N=31

N=32

N=32

N=32

N=33