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

1. Why Do Combined Training?2010 Survey of Combined-Trained Physicians Jane P. Gagliardi MD

2. Rationale for This Survey • Medical students need honest information about combined training!

3. 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

4. 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

5. Results

7. 27/33 (84.4%) Internal Medicine/Psychiatry 5/33 (15.6%) Family Practice/Psychiatry

8. 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 Board Certification 100% of Respondents are Board-Certified:

9. 9/33 (27.3%) Yes 24/33 (72.7%) No

10. 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

12. Academic inpatient psychiatry unitAcademic 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 clinicAcademic psychiatric clinic Academic medical or primary care clinicAcademic 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 clinicPrivate hospital consult Academic medical or primary care clinicAcademic psychiatric clinic Academic hospitalist in medicineInpatient Psychiatry Consults Academic inpatient psychiatry unit Academic medical or primary care clinicAcademic 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

13. Service Chief at an Academic VA Hospital Academic specialty medical clinicAcademic 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 clinicAcademic combined clinicAcademic inpatient psychiatry unit Psychiatry Research Academic medical or primary care clinicAcademic 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 clinicAcademic combined clinicAcademic inpatient psychiatry unitAcademic hospitalist in medicine Academic consultation-liaison Work Settings

15. Table: Clinical Activities over the Last 12 Months 25 of 33 (75.8%) respondents report outpatient work in the last 12 months 28 of 33 (84.8%) respondents report inpatient work in the last 12 months NHP = nursing home psychiatryPeriop = perioperative medicine N=33 respondents as of 7/16/2010

16. 30/33 (90.9%) Yes 3/33 (9.1%) No

17. 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 Administrative Roles Educational Departmental / Clinical Organizational Responses include multiple administrative roles (past and current) listed by 28 of 33 respondents

18. 20/33 (60.6%) Yes 13/33 (39.4%) No

19. 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

20. 30/33 (93.8%) Yes 2/33 (6.3%) No 1/33 No response

21. N=32

22. N=32

23. N=31

24. N=32

25. N=31

26. N=32

27. N=32

28. N=32

29. N=33