apache Posted February 17, 2011 Report Share Posted February 17, 2011 how could incorporate psych with routine medical practice, i quite enjoy psych, but i also don't want to just do psych if you know what i mean, if i do a fm residency, do i get like a year credit towards a psych residency... or would it be be better to do fm and get an ma in counseling (my undergrad is in psych and i have lots of relevant experience), any tips would be sweet, i ask a lot of shrinks this and they say they incorporate bread and butter medicine into their practice but honestly i don't really see it except for maybe in consult-liaison and even in the mental hospital there's a "consultant" fdoc. would it just be best to practice each separately, could i get an ma in counseling and prescribe with a fm residency, or is this some sort of conflict of interest? thanks guys Link to comment Share on other sites More sharing options...
moo Posted February 17, 2011 Report Share Posted February 17, 2011 how could incorporate psych with routine medical practice, i quite enjoy psych, but i also don't want to just do psych if you know what i mean, if i do a fm residency, do i get like a year credit towards a psych residency... or would it be be better to do fm and get an ma in counseling (my undergrad is in psych and i have lots of relevant experience), any tips would be sweet, i ask a lot of shrinks this and they say they incorporate bread and butter medicine into their practice but honestly i don't really see it except for maybe in consult-liaison and even in the mental hospital there's a "consultant" fdoc. would it just be best to practice each separately, could i get an ma in counseling and prescribe with a fm residency, or is this some sort of conflict of interest? thanks guys Doesn't happen often. I suppose it could be done, but the billing structure in most provinces makes this not very lucrative. For instance, there is a counseling fee in BC for family docs but you must spend at least 20 minutes with the patient and in the end you only get paid around 51 dollars (and you really don't need an MA to do this). Plus, the government audits you if you bill too many of these and you can only bill 4 of these per patient per year. I knew a family doc who booked in 20 minute increments and all she did was bill this fee... got audited but thankfully passed the audit as she had good documentation. For me personally, I will bill this fee on occasion. Usually it's for those patients for whom I spend more than 20 minutes listening to their life problems and giving the same advice your mother would give you. I have no counseling background whatsoever. As for psychiatrists doing gen med, most shrinks won't refill any meds unless they are psych meds. Link to comment Share on other sites More sharing options...
Ollie Posted February 18, 2011 Report Share Posted February 18, 2011 In Ontario, I came across some family docs who did "GP psychotherapy". Here is the website for their association http://www.gppaonline.ca/ There is extra training available but it's nowhere near what you would do in a psych residency or counselling psych MA. I assume they must have some way to bill that makes it a sustainable thing to do. Link to comment Share on other sites More sharing options...
apache Posted February 18, 2011 Author Report Share Posted February 18, 2011 thanks guys! Link to comment Share on other sites More sharing options...
Steve-0 Posted February 19, 2011 Report Share Posted February 19, 2011 You probably don't want to tell psychiatrists that you are interested in psych but also want to practice "real medicine". I think they may take some offense to that Link to comment Share on other sites More sharing options...
Steve-0 Posted February 19, 2011 Report Share Posted February 19, 2011 You probably don't want to tell psychiatrists that you are interested in psych but also want to practice "real medicine". I think they may take some offense to that Link to comment Share on other sites More sharing options...
Steve-0 Posted February 19, 2011 Report Share Posted February 19, 2011 You probably don't want to tell psychiatrists that you are interested in psych but also want to practice "real medicine". I think they may take some offense to that Link to comment Share on other sites More sharing options...
Steve-0 Posted February 19, 2011 Report Share Posted February 19, 2011 You probably don't want to tell psychiatrists that you are interested in psych but also want to practice "real medicine". I think they may take some offense to that Link to comment Share on other sites More sharing options...
apache Posted February 21, 2011 Author Report Share Posted February 21, 2011 i'm just joking around (if you know me i mean it in a bit of complimentive fashion, but it's definately a bit idiosyncratic, lol), but i know what you mean, i'm not going to say that to any psychs since a lot have a chip on their shoulder since they try and fit exclusively into the western model. i don't believe in purist biological psychiatry so i use "real medicine" interchangeably with traditional western medicine (with a focus on biological intervention). in fact i respect "good" psychiatrists enormously since they have to be more than just doctors, but be knowledgeable in numerous adjunctive fields (cbt, nlp, ipt, mindfulness training, social cognition and its' cultural variations, developmental psych, social determinants of mental health, the role of society/media in self-perception, religion etc.) but that's a totally different conversation cheers! You probably don't want to tell psychiatrists that you are interested in psych but also want to practice "real medicine". I think they may take some offense to that Link to comment Share on other sites More sharing options...
peachy Posted February 25, 2011 Report Share Posted February 25, 2011 how could incorporate psych with routine medical practice, i quite enjoy psych, but i also don't want to just do psych if you know what i mean, if i do a fm residency, do i get like a year credit towards a psych residency... or would it be be better to do fm and get an ma in counseling (my undergrad is in psych and i have lots of relevant experience), any tips would be sweet, i ask a lot of shrinks this and they say they incorporate bread and butter medicine into their practice but honestly i don't really see it except for maybe in consult-liaison and even in the mental hospital there's a "consultant" fdoc. would it just be best to practice each separately, could i get an ma in counseling and prescribe with a fm residency, or is this some sort of conflict of interest? There are many, many opportunities to incorporate psychiatry in a family medicine practice, depending on where your interests lie. To start with, there are a number of PGY3 training opportunities in psychiatry, largely in psychotherapy, but also in addictions, etc. The U of T list was easy to find, but I'm sure other schools offer them too: http://www.dfcm.utoronto.ca/prospectivelearners/prosres/pgy3.htm If psychotherapy is your main interest, you can do full-time psychotherapy as in the GP psychotherapy clinic someone else described. There is also lots of continuing medical education to learn about brief psychotherapeutic interventions you can incorporate into a full family medicine practice. Another option is to be a primary care provider specializing in patients with mental illness. In a climate where it is hard to find a family doctor for anybody, individuals with severe, chronic mental illness find it even harder. A good family doc can make a huge difference in anybody's life, but even more so for individuals with mental illness who have high health care needs and often have difficulty advocating for themselves. No matter what you do in family medicine, you will do LOTS of front-line psychiatry. You can really do as much as you feel comfortable with, and there is lots of training available to expand your scope. The vast majority of individuals with mood and anxiety disorders are managed by family doctors. Even individuals with stable psychotic illnesses are often managed by family doctors. Populations such as the homeless and adolescents often have substantial psychiatric needs that are managed by family medicine. In terms of the other direction, incorporating physical medicine into psychiatry, you rarely see psychiatrists (in Canada) playing a primary care medicine role. There is certainly a lot of "regular medicine" in psychiatry, in terms of psychiatric effects of physical illnesses, side effects of medications, etc, etc. But you're not going to be managing someone's non-psychiatric medications: that's not the psychiatrists role. On the other hand, there are lots of opportunities in psychiatry for working with medically ill patients. That includes C-L, like you mentioned. It also includes outpatient work with medically ill patients. That might be a palliative setting, dealing with end-of-life issues. It might be helping children with chronic medical illness to cope with their illness and ensuring that it doesn't interfere with their development. There's also a strong need for working with individuals who have difficulty managing chronic medical illness. E.g. Type 1 diabetics who have poor glycemic control secondary to psychiatric issues. Hope that helps. You have lots of opportunities, depending on what you are interested in. Link to comment Share on other sites More sharing options...
NLengr Posted February 25, 2011 Report Share Posted February 25, 2011 I know a family doc who used to book hour long counseling sessions as the last afternoon appointment. I guess it was economically sustainable if he was doing it. Link to comment Share on other sites More sharing options...
apache Posted February 28, 2011 Author Report Share Posted February 28, 2011 Thanks Peachy and Nlengr, really good advice, the fellowship in psychotherapy option sounds really appealing, I guess I'll just try to aim to get the most exposure to both and choose when the time comes, though the opportunities to incorporate psych into family look pretty promising and might be a good and flexible option! Link to comment Share on other sites More sharing options...
lloyder34 Posted March 28, 2013 Report Share Posted March 28, 2013 Hi all, I was just hoping to revive this thread as I was interested in incorporating psychotherapy into a GP-type setting. A preceptor at my school says she runs psych clinics a couple of half days each week and works as a GP the rest of the time. She has a separate roster for each. She is older, so she said that no additional training was required when she began, but has taken a handful of CME courses at reputable schools in the states in things such as CBT. Talking to a family resident today she seemed to think that there were fellowships you could do as a PGY3 after family med to be trained in such modalities. I was just wondering if anyone knew people who have done this and if there was a list of fellowship programs offered in Canada and any other general comments on this, thanks Link to comment Share on other sites More sharing options...
futureGP Posted March 30, 2013 Report Share Posted March 30, 2013 Hi all, I was just hoping to revive this thread as I was interested in incorporating psychotherapy into a GP-type setting. A preceptor at my school says she runs psych clinics a couple of half days each week and works as a GP the rest of the time. She has a separate roster for each. She is older, so she said that no additional training was required when she began, but has taken a handful of CME courses at reputable schools in the states in things such as CBT. Talking to a family resident today she seemed to think that there were fellowships you could do as a PGY3 after family med to be trained in such modalities. I was just wondering if anyone knew people who have done this and if there was a list of fellowship programs offered in Canada and any other general comments on this, thanks i also know of one FM who also has an extra interest in psychotherapy and does it as a part of his practice. i don't think he went through a formal training but rather took initiative and did a self-organized training. it seems to have worked out well for them. a quick search on google http://www.mountsinai.on.ca/care/psych/staff-education-programs/mspi/gp-psychotherapy-fellowship can't seem to find anywhere else Link to comment Share on other sites More sharing options...
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