Non-psychiatrists practicing psychiatry

[clozareal]

It seems like out of all the specialties, psychiatry has the most non-psychiatry trained physicians practicing psychiatry and psychotherapy. I've seen emergency medicine physicians, family medicine physicians, ob/gyns, pediatricians, and even anesthesiologists who have mental health outpatient clinics and claim to do psychotherapy. This is especially common in ketamine-assisted psychotherapy. Do other specialties also have this same thing happening where physicians who not board eligible/certified are practicing solely in their specialties?

I'm not talking about the pediatrician who sometimes prescribes ADHD medications or the ob/gyn who always postpartum depression treatment themselves, but rather non-psychiatric physicians who are marketing themselves as providing solely psychiatric care. I was wondering what this group thinks of this practice.

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[tr]

I have never seen this. My impression is that most other physicians don't want to touch psychiatric patients with a ten foot pole.

 

[Old&InTheWay]

I've definitely witnessed this sort of scope creep during residency. I've seen at least a half dozen physicians in other specialties actively listening to their patients and validating their concerns.

 

[SeniorWrangler]

The ketamine guys are the same guys who were running Low-T clinics ten years ago and ten years from now are going to be running some other fringe medicine business to make a bunch of money before the FDA shuts them down.

 

[ProReduction]

On the flip side, there are Neurologists whose practice is 90% Psych despite us trying to avoid managing anything Psych at all.

 

[allantois]

They do shrooms/ketamine/ayahuasca/coke and think they discovered a cure for all snake oil none of which is spring chicken. If only those darn psychiatrists stopped pushing SSRIs on everyone..

 

[allantois]

I've definitely witnessed this sort of scope creep during residency. I've seen at least a half dozen physicians in other specialties actively listening to their patients and validating their concerns.

Half a dozen sounds disappointing

 

[splik]

I know several neurologists who do CBT, one who does hypnosis, one who is psychodynamically trained. There are several IM docs who "specialize" in ADHD. Lots of anesthesiologists doing ketamine (which is of course much more in their scope of practice than it is for psychiatrists), some FM, IM and EM docs. know of some people who didn't complete residency in different fields now with their own psych practices.

When I was in academics I saw that non-psychiatrists were cherry picking certain aspects at my institution. The IM docs were the ones doing suboxone (psychiatry did not), palliative care was doing ketamine (though we eventually caught up offering Spravato, IM and troches, but not IV) and OB was doing brexanolone, and neurosurgery and neurology doing neuromodulation with psych added as an after thought.

Treating basic mental health problems is definitely within the scope of practice of primary care specialties (e.g. IM, FM, peds, OB) and psych emergencies within scope of EM. A lot of physicians who become burnt out do seek greener pastures in focusing on mental health, addictions, or wellness/lifestyle medicine. There are also a lot of physicians doing "coaching" now as well. Additionally, some physicians have found they can make the same or more doing this kind of work than their own specialty. Finally, some people will not see psychiatrists but are fine seeing non-psychiatric physicians for their psychic woes.

Fact is demand for mental health services outstrips supply. That is why these physicians can do this. I'm fine with it except those people doing functional medicine and other quackery.

 

[PikminOC]

I know several neurologists who do CBT, one who does hypnosis, one who is psychodynamically trained. There are several IM docs who "specialize" in ADHD. Lots of anesthesiologists doing ketamine (which is of course much more in their scope of practice than it is for psychiatrists), some FM, IM and EM docs. know of some people who didn't complete residency in different fields now with their own psych practices.

When I was in academics I saw that non-psychiatrists were cherry picking certain aspects at my institution. The IM docs were the ones doing suboxone (psychiatry did not), palliative care was doing ketamine (though we eventually caught up offering Spravato, IM and troches, but not IV) and OB was doing brexanolone, and neurosurgery and neurology doing neuromodulation with psych added as an after thought.

Treating basic mental health problems is definitely within the scope of practice of primary care specialties (e.g. IM, FM, peds, OB) and psych emergencies within scope of EM. A lot of physicians who become burnt out do seek greener pastures in focusing on mental health, addictions, or wellness/lifestyle medicine. There are also a lot of physicians doing "coaching" now as well. Additionally, some physicians have found they can make the same or more doing this kind of work than their own specialty. Finally, some people will not see psychiatrists but are fine seeing non-psychiatric physicians for their psychic woes.

Fact is demand for mental health services outstrips supply. That is why these physicians can do this. I'm fine with it except those people doing functional medicine and other quackery.

Lots of other medical speciality services outstrip supply. Doesn't mean you see other physicians practicing those specialties.

 

[TexasPhysician]

I’ve seen anesthesia get into ketamine/TMS, but I haven’t seen any specialties claiming to do gen psych.

The most popular thing I’ve seen is PCP trained docs claim to be Derm. They focus on acne, aesthetics, and then biopsy what they don’t know. Quite lucrative.

 

[Liquid8]

Had one neurologist diagnosing everyone with ADHD and doing insane things with stimulants which led to him getting struck off, but for the most part there’s more of an aversion to seeing psych patients.

Here one can train in Addiction Medicine under either College of Psychiatrists or Physicians, so there is sometimes a bit of overlap in that area there. It’s not really threat or encroachment risk so to speak, as often the primary substance disorder patients will be the ones causing the most trouble in the inpatient setting and have some comorbid personality disorder.

More commonly it’s the pain specialist who are first to trial more novel treatments (eg. Ketamine), and I’m sure there are plenty of patients with treatment resistant depression but seeing them under the guise of chronic pain management.

We’ve had a lot of GP run startups that have taken over the medicinal cannabis prescribing space, which I’m frankly fine with. My gut feeling is that the “addictive personality” patient tends to gravitate more towards those areas, leaving the more cautious/anxious types where there is less chance of abusing medications.

Psilocybin and MDMA therapy have recently been approved but so far it is for psychiatrists only. Most of us are fairly cautious and skeptical on this matter, so it will be interesting to see if there are moves by some non-psychiatrists or underground “therapists” to lead this charge.

What is probably more common is the “Cosmetic surgeon” which isn’t a protected title, so there are all sorts getting into that kind of aesthetic work, including general practitioners and those who dropped out or could never get onto the surgery training programmes.

 

[MedMan80]

There is a behav pediatrician in my neck of the woods that does alot of psych. For some of these specialists they realize that it is a high demand and low over-head gig and so they keep doing it.

 

[PsyDr]

The worst I've ever seen: An RN (not NP) who exclusively practiced psychotherapy in a psychiatrist's office. I have no idea how they billed for that. It was outrageously bad.

I've seen the following specialties exclusively practice psychiatry: FM, Peds, neurology, two people who did not finish residency, and an ENT.
I know several anesthesiologists who own ketamine clinics.
I know of a few old physicians with other specialties, that were grandfathered for ER board certification, who cover freestanding ERs in order to keep an active license.

 

[ProReduction]

Had one neurologist diagnosing everyone with ADHD and doing insane things with stimulants which led to him getting struck off, but for the most part there’s more of an aversion to seeing psych patients.

Here one can train in Addiction Medicine under either College of Psychiatrists or Physicians, so there is sometimes a bit of overlap in that area there. It’s not really threat or encroachment risk so to speak, as often the primary substance disorder patients will be the ones causing the most trouble in the inpatient setting and have some comorbid personality disorder.

More commonly it’s the pain specialist who are first to trial more novel treatments (eg. Ketamine), and I’m sure there are plenty of patients with treatment resistant depression but seeing them under the guise of chronic pain management.

We’ve had a lot of GP run startups that have taken over the medicinal cannabis prescribing space, which I’m frankly fine with. My gut feeling is that the “addictive personality” patient tends to gravitate more towards those areas, leaving the more cautious/anxious types where there is less chance of abusing medications.

Psilocybin and MDMA therapy have recently been approved but so far it is for psychiatrists only. Most of us are fairly cautious and skeptical on this matter, so it will be interesting to see if there are moves by some non-psychiatrists or underground “therapists” to lead this charge.

What is probably more common is the “Cosmetic surgeon” which isn’t a protected title, so there are all sorts getting into that kind of aesthetic work, including general practitioners and those who dropped out or could never get onto the surgery training programmes.

As Neurologists we know just enough to be somewhat dangerous when being the primary provider for psych issues. Yes, we get way more formal training in psych than any other specialty, but if you are not formally dual boarded in Neuro Psych as a Neurologist you really have no business running point on the care. So many people need mental health care right now. It is pushing patients to the fringes where non-Psychiatrist providers provide suboptimal care.

 

[Merovinge]

I know several neurologists who do CBT, one who does hypnosis, one who is psychodynamically trained. There are several IM docs who "specialize" in ADHD. Lots of anesthesiologists doing ketamine (which is of course much more in their scope of practice than it is for psychiatrists), some FM, IM and EM docs. know of some people who didn't complete residency in different fields now with their own psych practices.

When I was in academics I saw that non-psychiatrists were cherry picking certain aspects at my institution. The IM docs were the ones doing suboxone (psychiatry did not), palliative care was doing ketamine (though we eventually caught up offering Spravato, IM and troches, but not IV) and OB was doing brexanolone, and neurosurgery and neurology doing neuromodulation with psych added as an after thought.

Treating basic mental health problems is definitely within the scope of practice of primary care specialties (e.g. IM, FM, peds, OB) and psych emergencies within scope of EM. A lot of physicians who become burnt out do seek greener pastures in focusing on mental health, addictions, or wellness/lifestyle medicine. There are also a lot of physicians doing "coaching" now as well. Additionally, some physicians have found they can make the same or more doing this kind of work than their own specialty. Finally, some people will not see psychiatrists but are fine seeing non-psychiatric physicians for their psychic woes.

Fact is demand for mental health services outstrips supply. That is why these physicians can do this. I'm fine with it except those people doing functional medicine and other quackery.

Just to clarify, do you support gas doing ketamine based on their assessments, without in house mental health, and determining treatment course of ketamine? There was a setup like this in the last city I lived and it seemed off to say the best. I don't doubt this person's technical ability to place an IV and manage acute problems from ketamine but my friends who practice gas have approximately zero minutes of training in the diagnosis or treatment of depression.

 

[splik]

Just to clarify, do you support gas doing ketamine based on their assessments, without in house mental health, and determining treatment course of ketamine? There was a setup like this in the last city I lived and it seemed off to say the best. I don't doubt this person's technical ability to place an IV and manage acute problems from ketamine but my friends who practice gas have approximately zero minutes of training in the diagnosis or treatment of depression.

No I don't. Especially as I know of some sketchy anesthesiologists who set up ketamine depression clinics after being fired etc. However, I would much rather refer to an anesthesiologist for IV ketamine than a psychiatrist. But I don't agree with anesthesiologists offering ketamine to all and sundry without referral and monitoring by psychiatry for psych issues. These are supposed to be patients with severe or refractory depression. While I do believe ketamine has a use in psychiatry, it is also clear that it is a fad as well. I've see a high proportion of borderline patients getting ketamine now too.

On a separate note, anyone see the coverage about some EM doc who is treating most of the ketamine patients online now with little monitoring? There were article in the WA post and NYT. his patients told the reporter they were addicted and abusing it and the doc had no clue. There are people needing cystectomies from ketamine addiction now.

ETA: here is the NYT article: A Fraught New Frontier in Telehealth: Ketamine

 

[Merovinge]

No I don't. Especially as I know of some sketchy anesthesiologists who set up ketamine depression clinics after being fired etc. However, I would much rather refer to an anesthesiologist for IV ketamine than a psychiatrist. But I don't agree with anesthesiologists offering ketamine to all and sundry without referral and monitoring by psychiatry for psych issues. These are supposed to be patients with severe or refractory depression. While I do believe ketamine has a use in psychiatry, it is also clear that it is a fad as well. I've see a high proportion of borderline patients getting ketamine now too.

On a separate note, anyone see the coverage about some EM doc who is treating most of the ketamine patients online now with little monitoring? There were article in the WA post and NYT. his patients told the reporter they were addicted and abusing it and the doc had no clue. There are people needing cystectomies from ketamine addiction now.

ETA: here is the NYT article: A Fraught New Frontier in Telehealth: Ketamine

Great link, my organization just discussed that as we as specialize in SUD but also treat refractory depression with Esketamine (and TMS).

This guy was exactly that, part time clinic offered to anyone for any reason, maybe with the guise of having you feel out some PHQ9.

 

[comp1]

I wish more specialists were comfortable with psych. I have definitely never seen anything like what the OP described. Quite the opposite. As soon as tears come out, every other specialty runs away.

 

[Sushirolls]

I wish more specialists were comfortable with psych. I have definitely never seen anything like what the OP described. Quite the opposite. As soon as tears come out, every other specialty runs away.

IM and FM should have a minimum of 4 months psych in their residency. This is one of my oldest rant / soap boxes. 2months OP, 1 month IP, 1 month psych ED.

 

[allantois]

IM and FM should have a minimum of 4 months psych in their residency. This is one of my oldest rant / soap boxes. 2months OP, 1 month IP, 1 month psych ED.

Especially given that 50% of their young patients present with mental health complaints

 

[VA Hopeful Dr]

IM and FM should have a minimum of 4 months psych in their residency. This is one of my oldest rant / soap boxes. 2months OP, 1 month IP, 1 month psych ED.

Nah.

Very very few of us are doing inpatient psych outside of doing the medical end while psychiatrists do the mental health end (seen that a few times). We have a decent amount of EM time which includes the psych part generally speaking.

You also have to remember that a big part of our time in residency is spent in FM clinic with on average 30% of visits being for psychiatric issues. I generally see about 25% of my patients for psychiatric problems.

And honestly I'd love to do even less but there's not enough psychiatry here to even begin to start lowering that number.

 

[clozareal]

Especially given that 50% of their young patients present with mental health complaints

The new ACGME requirements for pediatrics residency may improve this. The only specifically-required faculty now are in mental health (just "faculty with expertise," not child psychiatrists). They got rid of the specialty faculty requirements for everything else (PICU, NICU, EM, etc.) as well as much of the procedural requirements.

 

[Sushirolls]

Nah.

Very very few of us are doing inpatient psych outside of doing the medical end while psychiatrists do the mental health end (seen that a few times). We have a decent amount of EM time which includes the psych part generally speaking.

You also have to remember that a big part of our time in residency is spent in FM clinic with on average 30% of visits being for psychiatric issues. I generally see about 25% of my patients for psychiatric problems.

And honestly I'd love to do even less but there's not enough psychiatry here to even begin to start lowering that number.

It's not meant to make IM/FM be psychiatrists or Inpatient psychiatrists.
General ED is not the same as a Psych ED rotation.
The point is to give a more concentrated psych specific focus/exposure management, with Psychiatrists to optimize learning.

Saying that FM/IM exposure to psych in the general OP clinics and taught by IM/FM is akin to the blind leading the blind. Even the clinics that are purporting "psych services" by embedding an MSW or Psychologist just isn't the same. Imagine using this argument to say, 60% of my patients have diabetes, there aren't enough endocrinologists to go around, so we just manage the DM anyways, we don't need an endo rotation... I'm betting 95% of FM/IM rotations have 1, or even 2 rotations with Endocrinology - as they should.

That right there, your recognition that 30% of the visits are Psych, should dictate that 30% or near that are Psych rotations for the residents.

 

[VA Hopeful Dr]

It's not meant to make IM/FM be psychiatrists or Inpatient psychiatrists.
General ED is not the same as a Psych ED rotation.
The point is to give a more concentrated psych specific focus/exposure management, with Psychiatrists to optimize learning.

Saying that FM/IM exposure to psych in the general OP clinics and taught by IM/FM is akin to the blind leading the blind. Even the clinics that are purporting "psych services" by embedding an MSW or Psychologist just isn't the same. Imagine using this argument to say, 60% of my patients have diabetes, there aren't enough endocrinologists to go around, so we just manage the DM anyways, we don't need an endo rotation... I'm betting 95% of FM/IM rotations have 1, or even 2 rotations with Endocrinology - as they should.

That right there, your recognition that 30% of the visits are Psych, should dictate that 30% or near that are Psych rotations for the residents.

FM doesn't always rotate through endocrine, I never did. My internist wife didn't either.

I can't speak to everywhere, but one of the main attendings in my program who precepted us in clinic was FM/psych double boarded so I suspect my experience was just fine for dealing with the majority of psychiatric patients I will see in clinic with enough knowledge to say "this is way beyond me, you need a psychiatrist". That would be why I don't manage anything that requires beyond basic anxiety/depression medications.

I also find it fairly insulting that you think anyone teaching a specialty other than the specialist is "the blind leading the blind". That is utterly stupid. That would mean I can't learn ortho from anyone except an orthopedic surgeon, cardiology except from a cardiologist, hypertension except from a nephrologist, and so on.

And if you search, I've absolutely said before on SDN that if there's no/not enough primary care y'all definitely can manage diabetes or the other metabolic issues that your patients deal with.

 

[tr]

And if you search, I've absolutely said before on SDN that if there's no/not enough primary care y'all definitely can manage diabetes or the other metabolic issues that your patients deal with.

We do manage those issues. We learned how on our IM/FM rotations. Definitely not incidentally during our psych rotations. There's a big difference between being able to do something at an acceptable level of competence and being able to teach it to someone else.

I don't see why it's insulting to point out that it's best to learn a given topic from a specialist in the field. That seems pretty self-evident to me.

 

[annoyedpsychiatrist]

my prior job at a community health setting the medical director was an OB/GYN who did psychiatry. She was also 87 years old. But she was really nice, lol. She did not prescribe any controlled medications though, which actually made sense in that setting. They could not keep staff there, and had >60% staff turnover each year, they would have massive hiring events. In community health settings of undesireable regions i would guess it happens more

 

[VA Hopeful Dr]

We do manage those issues. We learned how on our IM/FM rotations. Definitely not incidentally during our psych rotations. There's a big difference between being able to do something at an acceptable level of competence and being able to teach it to someone else.

I don't see why it's insulting to point out that it's best to learn a given topic from a specialist in the field. That seems pretty self-evident to me.

Except:

1. That's not what was said in the post I was responding to. I tend to agree with you on this score mostly, but that's not the point I'm arguing against:

It's not meant to make IM/FM be psychiatrists or Inpatient psychiatrists.
General ED is not the same as a Psych ED rotation.
The point is to give a more concentrated psych specific focus/exposure management, with Psychiatrists to optimize learning.

Saying that FM/IM exposure to psych in the general OP clinics and taught by IM/FM is akin to the blind leading the blind. Even the clinics that are purporting "psych services" by embedding an MSW or Psychologist just isn't the same. Imagine using this argument to say, 60% of my patients have diabetes, there aren't enough endocrinologists to go around, so we just manage the DM anyways, we don't need an endo rotation... I'm betting 95% of FM/IM rotations have 1, or even 2 rotations with Endocrinology - as they should.

That right there, your recognition that 30% of the visits are Psych, should dictate that 30% or near that are Psych rotations for the residents.

2. Based on the previous post FM/IM isn't the expert in those issues so you're not getting good training learning it from us anyway.

 

[Sushirolls]

@VA Hopeful Dr
We've knocked posts against each other on this topic before in various threads over the years. I hear you. You hear me. We disagree. Nothing will change in residency training towards my proposed changes (sadly). So by default, through status quo, 'you win' Cheers goes to the home team. [applause for you]

 

[FlowRate]

I had a patient when I was a med student whose analyst was a cardiologist. But slightly different than the egregious situations in this thread, the cardiologist had retired from cardiology and done full analytic training.

 

[Candidate2017]

It seems like out of all the specialties, psychiatry has the most non-psychiatry trained physicians practicing psychiatry and psychotherapy. I've seen emergency medicine physicians, family medicine physicians, ob/gyns, pediatricians, and even anesthesiologists who have mental health outpatient clinics and claim to do psychotherapy. This is especially common in ketamine-assisted psychotherapy. Do other specialties also have this same thing happening where physicians who not board eligible/certified are practicing solely in their specialties?

We don't have a claim on psychotherapy. Psychiatry started as an asylum-only specialty. Upon urging of their wives and kids who did not want to live at the asylum, psychiatrists scope-crept into psychotherapy in order to escape into the outpatient world. The downside is outpatient psychiatrists can't go by the old school term of "alienist". I digress.

But yes, it is annoying that patients, and everyone and their mom believes they know how to do psychiatry, let alone therapy and "mental health". No patient/family ever tells a surgeon what sutures or knots work best for them.

I have never seen this. My impression is that most other physicians don't want to touch psychiatric patients with a ten foot pole.

But lots of EM and gas doctors will touch them with a ten foot ketamine IV, in exchange for cash.

 

[HemeOncHopeful19]

IM and FM should have a minimum of 4 months psych in their residency. This is one of my oldest rant / soap boxes. 2months OP, 1 month IP, 1 month psych ED.

I’m pretty sure IM only requires 1 month of general ED… no way should we do an entire month of whatever Psych ED is.

I could see a month or two of OP Psych being useful though, I doubt IP would be very helpful either. I also suspect that Psych interns aren’t getting a whole lot from doing a month of general medicine wards either but I guess I’d defer to you guys on that.

 

[Sushirolls]

General IM as OP and IP is something that wasn't pleasant, but necessary. It puts conditions into perspective. What is done. What is referred. What is discharged, when, etic. It also wraps around the total context of the How things flow, and able to understand what took place when patients say "I had experience XYZ" you can better grasp what took place. Or why the Hospitalist notes look the way they do. The Discharge summary or instructions look the way they do etc. These were valuable rotations for different reasons. Even though I'm not doing ECT or C/L or ED type work anymore but simply drifted into general OP psych. Conversely, it also helps me know and understand when I need to be very proactive to get ROIs and start faxing off every one of my follow up notes with the PCP to ensure wrap around care, compared to business as usual "silos" of care.

These are the additional nuances that would be gained with IM/FM doing some psych rotations compared to nothing now. A psych ED rotation would consolidate the ED presentations of psychiatry and be high yield. This is the range of SI. This is the range of acute intoxication. This is HI. Without worrying about the STEMI in bed 4 or the GI bleed in bed 6 while managing the "it hurts when I pee" in bed 9 or "my back hurts can I have a sandwich in bed 43, oh and I have CP now too!" But mostly, having these rotations would improve the management, the confidence, and overall experience/skills of the very people who proportionally are doing more psych than we are...

A large chunk of my job is undoing the mess from PCPs or the different types of messes from psych ARNPs. Can't impact anything ARNPs are doing but the residency training of IM/FM pcps, that possibly could be changed in time. But as evidenced here, learning psych from your IM attending is all you need...

I'm doing what I can in my small middle of nowhere ville and slowly my cell number is circulating to the PCPs. They call, and while I'm cooking dinner or loading the dishwasher I provide a curbside consult and help them out. Not even the same group or business or anything. But it's something to improve the management. Whether they want to continue long haul, short term or just realize they should refer - I'll try offer up what I can to help them in the context of what a verbal curbside can yield.

 

[VA Hopeful Dr]

General IM as OP and IP is something that wasn't pleasant, but necessary. It puts conditions into perspective. What is done. What is referred. What is discharged, when, etic. It also wraps around the total context of the How things flow, and able to understand what took place when patients say "I had experience XYZ" you can better grasp what took place. Or why the Hospitalist notes look the way they do. The Discharge summary or instructions look the way they do etc. These were valuable rotations for different reasons. Even though I'm not doing ECT or C/L or ED type work anymore but simply drifted into general OP psych. Conversely, it also helps me know and understand when I need to be very proactive to get ROIs and start faxing off every one of my follow up notes with the PCP to ensure wrap around care, compared to business as usual "silos" of care.

These are the additional nuances that would be gained with IM/FM doing some psych rotations compared to nothing now. A psych ED rotation would consolidate the ED presentations of psychiatry and be high yield. This is the range of SI. This is the range of acute intoxication. This is HI. Without worrying about the STEMI in bed 4 or the GI bleed in bed 6 while managing the "it hurts when I pee" in bed 9 or "my back hurts can I have a sandwich in bed 43, oh and I have CP now too!" But mostly, having these rotations would improve the management, the confidence, and overall experience/skills of the very people who proportionally are doing more psych than we are...

A large chunk of my job is undoing the mess from PCPs or the different types of messes from psych ARNPs. Can't impact anything ARNPs are doing but the residency training of IM/FM pcps, that possibly could be changed in time. But as evidenced here, learning psych from your IM attending is all you need...

I'm doing what I can in my small middle of nowhere ville and slowly my cell number is circulating to the PCPs. They call, and while I'm cooking dinner or loading the dishwasher I provide a curbside consult and help them out. Not even the same group or business or anything. But it's something to improve the management. Whether they want to continue long haul, short term or just realize they should refer - I'll try offer up what I can to help them in the context of what a verbal curbside can yield.

We have a minimum of 1 month psych required as part of residency already.

 

[Doctorows]

2. Based on the previous post FM/IM isn't the expert in those issues so you're not getting good training learning it from us anyway.

To be fair, you're equating a comparison of a specialty vs its subspecialty with that of two completely different specialties that require a distinct skillset and expertise.
IM/FM physicians are much better equipped to treat (and teach) endo or nephro than say surgery. Or psychiatry.

 

[Sushirolls]

We have a minimum of 1 month psych required as part of residency already.

I just reviewed a random sample on a program for IM, University of Alabama, and no where on their categorical nor the Primary Care track was Psychiatry even mentioned in core rotations nor elective options.

The 2022 ACGME requirements for FM, reflect on page 32 of the PDF the following: [no reference to required rotations, but merely business as usual with saying psych was covered in routine OP clinic days]
IV.C.17. The curriculum must be structured so behavioral health is integrated into the residents’ total educational experience, to include the physical aspects of patient care. (Detail) IV.C.18. There must be a structured curriculum in which residents are educated in the diagnosis and management of common mental illnesses. (Detail) IV.C.19. There must be a structured curriculum in which residents address population health, including the evaluation of health problems of the community. (Detail)

A random sample for FM at University of Missouri I had my hopes up with showing a 6 week Behavioral Health/Community Health rotation. But when you click on the rotation description, disappointment ensue seeing that it really is a public health rotation and not psychiatry:
Residents have an opportunity to work with numerous Family Medicine faculty who specialize in mental health and behavioral modifications. This rotation provides a unique perspective to health care needs in Columbia and resources available to those in our community. This includes understanding principles of public health and clinical epidemiology and working with medical and administrative staff members at the City Health Department.

You got my hopes up for nothing. I'm not seeing Psychiatry as required 1 month rotation. Even that at minimum that would be an amazing start.

 

[VA Hopeful Dr]

I just reviewed a random sample on a program for IM, University of Alabama, and no where on their categorical nor the Primary Care track was Psychiatry even mentioned in core rotations nor elective options.

The 2022 ACGME requirements for FM, reflect on page 32 of the PDF the following: [no reference to required rotations, but merely business as usual with saying psych was covered in routine OP clinic days]
IV.C.17. The curriculum must be structured so behavioral health is integrated into the residents’ total educational experience, to include the physical aspects of patient care. (Detail) IV.C.18. There must be a structured curriculum in which residents are educated in the diagnosis and management of common mental illnesses. (Detail) IV.C.19. There must be a structured curriculum in which residents address population health, including the evaluation of health problems of the community. (Detail)

A random sample for FM at University of Missouri I had my hopes up with showing a 6 week Behavioral Health/Community Health rotation. But when you click on the rotation description, disappointment ensue seeing that it really is a public health rotation and not psychiatry:
Residents have an opportunity to work with numerous Family Medicine faculty who specialize in mental health and behavioral modifications. This rotation provides a unique perspective to health care needs in Columbia and resources available to those in our community. This includes understanding principles of public health and clinical epidemiology and working with medical and administrative staff members at the City Health Department.

You got my hopes up for nothing. I'm not seeing Psychiatry as required 1 month rotation. Even that at minimum that would be an amazing start.

Admittedly I'm not familiar with the 2022 ACGME requirements. But everywhere I interviewed in 2009 had 1 month of "mental health" with the worst (ie. least psychiatric) being a month with the clinic psychologist.

In my residency we did a week with the geriatric psychiatrist on his inpatient floor, a week with our in-house residency psychiatrist, a week at the local state psychiatric hospital, and a week with the social workers that did assessments on ED psych patients. FWIW my old program still says its a week of psychiatry, though I've been gone for 10 years so I don't know the exact structure anymore.

 

[Sushirolls]

Your program is/was cream of the crop then with having even that much.