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 sent 7/6/2010 As of 7/16/2010: N=33 respondents

Results

27/33 (84.4%) Internal Medicine/Psychiatry 5/33 (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%) Yes 24/33 (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 unit Academic general medicine service Academic C/L Academic medical or primary care clinic Academic Psychiatric Consultation Clinic Medical school Federal Public Health agency Previously worked as private practice medicine-psychiatry hospitalist (medicine service) Private practice psychiatric clinic Academic medical or primary care clinic Academic inpatient psychiatry consults Private practice combined clinic Academic medical or primary care clinic Academic psychiatric clinic Academic medical or primary care clinic Academic psychiatric clinic Hospice medical director Private practice psychiatric clinic Private hospital inpatient psychiatry unit Private substance abuse inpatient unit Consult-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 clinic Academic inpatient psychiatry unit Academic combined medical-psychiatric inpatient unit Skilled Nursing Facility Academic medical or primary care clinic Academic hospitalist in medicine Private practice med or primary care clinic Private practice specialty medical clinic Private practice psychiatric clinic Private practice inpatient medical specialty Consultation-Liaison Private practice psychiatric clinic Academic medical or primary care clinic Academic psychiatric clinic Academic hospitalist in medicine

Work Settings Service Chief at an Academic VA Hospital Academic specialty medical clinic Academic substance abuse clinic Academic combined clinic Academic inpatient psychiatry unit Academic combined medical-psychiatric inpatient unit Private practice psychiatric clinic Private hospital inpatient psychiatry unit Geriatric Psychiatry Unit Academic combined medical-psychiatric inpatient unit Medical management consulting Cover for consult psychiatrists at county hospital occasionally Private practice combined clinic Private practice psychiatric clinic Academic combined clinic Academic inpatient psychiatry unit Psychiatry Research Academic medical or primary care clinic Academic specialty medical clinic Academic psychiatric clinic Academic combined clinic Private practice psychiatric clinic Academic medical or primary care clinic Academic inpatient psychiatry unit Private practice psychiatric clinic Private practice combined clinic Academic medical or primary care clinic Academic combined clinic Academic inpatient psychiatry unit Academic combined medical-psychiatric inpatient unit Academic inpatient psychiatry unit Academic hospitalist in medicine Academic combined medical-psychiatric inpatient unit Psych CL I consider myself a MedPsych hospitalist :- ) Academic medical or primary care clinic Academic psychiatric clinic Academic psychiatric clinic Academic medical or primary care clinic Academic combined clinic Academic inpatient psychiatry unit Academic hospitalist in medicine Academic consultation-liaison

N=33 respondents as of 7/16/2010 NHP = nursing home psychiatry Periop = perioperative medicine 25 of 33 (75.8%) respondents report outpatient work in the last 12 months28 of 33 (84.8%) respondents report inpatient work in the last 12 months Table: Clinical Activities over the Last 12 Months

30/33 (90.9%) Yes 3/33 (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 program director Fellowship 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 EducationalDepartmental / Clinical Responses include multiple administrative roles (past and current) listed by 28 of 33 respondents Organizational

20/33 (60.6%) Yes 13/33 (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%) Yes 2/33 (6.3%) No 1/33 No response

N=32

N=31

N=32

N=31

N=32

N=33