When I started medical school, I was strongly oriented toward family practice. It never occurred to me that I might be interested in psychiatry. I had this image of psychiatrists as bearded doctors in wood-panelled offices with leather couches who kept basically healthy folks in analysis for years and years with minimal results. That all changed during my third year of medical school, where I discovered that (1) a surprising number of folks visiting their primary care physicians have psychiatric issues affecting their health and (2) psychiatry has moved far beyond the model of endless analysis, and has a number of pharmacological and psychtherapeutic interventions that are at least as effective as the interventions for "physical" disease used by primary care physicians.
During inpatient and outpatient psychiatry rotations, I discovered that practicing psychiatry was something that really satisfied the need for patient interaction that was one of the forces which directed me toward medicine in the first place. I decided to specialize in psychiatry, though I was reluctant to give up the opportunity to practice clinical medicine.
One day I discovered that there was an organization called The Association of Medicine and Psychiatry which encouraged the development of joint internal medicine and psychiatry residency training programs. I was excited by the prospect of such a residency, but not completely satisfied.
In October 1995, just as I was preparing residency applications, I took a rural medicine clerkship in Chinle, Arizona at an Indian Health Service hospital. As I worked with the family medicine doctors there, I realized that family medicine training was much more appropriate for the kind of practice I wanted to have. I knew that UCSD was planning such a program, but it seemed unlikely that it would be available for the 1996 Residency Match. In speaking with the faculty doing the planning, however, I discovered that UC Davis already had such a program, with the Department of Family and Community Medicine and the Department of Psychiatry. It is a five-year program, and graduates are board elegible in both disciplines.
People always ask me what I'm planning to do after residency. Honestly, I haven't looked that far ahead, but the more I work in health care, the more convinced I become that there is a real need for practitioners trained in primary care and psychiatry.
Interested in combined training? You can join an email discussion list on all things psych/FP! It's free and open to everyone. You can subscribe by sending email to fpPsychListfirstname.lastname@example.org or by filling out the online subscription form.
The latest Family Medicine/Psychiatry FAQ is now online!
From the 1999 edition of FREIDA, here are some of the current combined FP/Psychiatry programs (reported in FREIDA order; honest):