There are often many similar questions amongst medical students interested in combined or sequential training. AMP has compiled here some of the most common FAQs from students in hopes that this improves your knowledge of combined training and careers. If you have further questions, please request an AMP mentor and come to our annual conference! We’d love to talk with you more about combined training and careers!
What is combined training?
On this site, when we discuss combined training, we are referring to medical residencies that combine a psychiatry residency with another residency program. There are types of non-psychiatry combined residencies such as medicine/pediatrics, but, for the purposes of our site here, when we mention combined residencies, we are referring to those that specifically involve psychiatry. The four types of combined psychiatry residencies are the following: Internal Medicine/Psychiatry, Family Medicine/Psychiatry, Pediatrics/Psychiatry/Child & Adolescent Psychiatry (also known as Triple Board), and Neurology/Psychiatry.
What is sequential training?
Sequential training is a form of medical residency training in which a resident completes one residency program in full and then sequentially completes another medical residency program in full. It is a pathway, other than combined residencies, to become a physician boarded in multiple specialties.
Why do combined training?
Individuals who pursue combined training often feel that it is of utmost importance for patients to be treated simultaneously for their medical and psychiatric problems. They also often are intrigued by the interplay of medicine and psychiatry. Many physicians have individual reasons for pursuing combined training and careers but most hold the notion of integrated care as a high priority for patients.
What are some of the benefits of combined training and careers?
Residents who complete combined training are eligible to sit for board exams in both specialties and thus can become dual-boarded. Having knowledge in multiple specialties makes an individual very attractive in the job market. Additionally, understanding both medicine and psychiatry specialties allows one to manage patients in a very complete manner. Combined physicians are able to single-handedly manage the metabolic complications of psychiatric medications and can utilize motivational interviewing to encourage insulin compliance in a poorly-controlled diabetic. Because of their knowledge in both specialties, combined physicians are often able to diagnose medical conditions in a psychiatric patient that may have been otherwise overlooked, or vice versa. They are often keenly aware also of psychiatric presentations of medical issues and vice versa. Many combined physicians feel that their dual knowledge enables them to be better physicians and identify and treat conditions that may have been missed without knowledge of both medicine and psychiatry.
What do combined-trained doctors end up doing?
Combined physicians occupy a wide variety of positions. As a dually-trained physician, you are very attractive in the job market and can market yourself in several ways. Some of the common positions taken are the following:
- Outpatient setting serving as patients' PCP and psychiatrist simultaneously
- Outpatient setting serving as a consultant psychiatrist within a primary care office
- Outpatient setting providing primary care for patients with severe mental illness
- Healthcare administration and academics
- Inpatient setting serving as psychiatrist and internist on a med/psych unit (also known as complexity intervention unit)
- Inpatient setting as medicine hospitalist
- Inpatient setting as a psychiatric hospitalist
- Inpatient or outpatient setting working with geriatric patients
- Inpatient consult/liaison psychiatry service (act as a consultant to medical teams who need assistance with patients who are admitted with active medical issues and also have active psychiatric issues)
- Emergency room psychiatry (requires strong medical knowledge base)
- More specialized training (some combined physicians pursue fellowships post-combined training)
- ID fellowship (focusing on medical and psychiatric care for HIV patients)
- GI fellowship (focusing on functional bowel disorders)
- Hem/onc fellowship (emphasizing psychological aspects of hem/onc)
- Pain fellowship
- Eating disorders fellowship
- Forensic fellowship (knowledge of medical comorbidities is helpful when testifying in court)
- Visit the AMP jobs board to get an idea of positions that are actively seeking combined physicians.
I have heard that combined doctors end up practicing one field or the other but not both. Is that true?
While it certainly can be true that combined physicians eventually lateralize to one field or the other, it is less likely to occur in physicians with combined training in psychiatry. In fact, a survey done of combined grads showed that >75% practice both specialties. See the results of this survey under “A Day in the Life: Profiles of Combined Physicians”. The vast majority of patients encountered have comorbid medical and psychiatric illnesses; 70% of all psychiatric patients also have a medical diagnosis and 30% of all medical patients have a psychiatric diagnosis. Thus, regardless of the job position you hold (be it more on the medical side or more psychiatric side), your knowledge in the other field will be utilized given that there are so many patients with comorbid illnesses.
What are some of the difficulties of combined training?
There are some difficulties that are unique to combined training. First, while in residency, there is often an adjustment period when switching between your medicine/pediatric/neurology rotations and psychiatric rotations. The mindsets and patient approaches of medicine and psychiatry are different, and it can take a few weeks to get back into the "medicine" approach to patients compared to that of psychiatry and vice versa. However, as your years of training progress, you will likely blend your medical and psychiatric approach to patients to a more holistic mind and body approach to use on both services.
One other difficulty lies in the fact that, because you are trying to master two different fields at once, you may feel behind in your knowledge base compared to your peers. However, you will catch up! Given that your residency training is longer than that of your non-combined peers, you will have time to catch up and feel competent in your knowledge base at the end of residency.
What do combined training programs look for when looking for applicants?
Each program will have different qualities that they search for based on the nature of their program. Overall, though, most programs ascribe to the belief that patients require care of both their body and mind and that one cannot treat a patients’ medical concerns without addressing psychiatric concerns and vice versa. Most programs seek applicants that are committed to these beliefs and model of care.
What electives should I do in medical school to be a good residency applicant?
Outside of the typical required electives, it is helpful to have acting internships/sub-internships in either psychiatry and medicine (or pediatrics if considering triple board, neurology if considering psych/neuro, etc). If you are able to do internships in both psychiatry and the medicine field, that is helpful but not necessary. Overall, your application should demonstrate an interest in the medicine/pediatrics/neurology specialty in addition to psychiatry. Some combined residency programs offer combined electives; these can help solidify your interest in combined training if you are unsure and give you experience into what life is like in a combined program. These combined electives are not necessary however to be considered for a combined residency program. For more information on the combined electives, please visit
How do I choose the right program for me?
Selecting a residency is a difficult task. While it often may feel like you are trying to sell yourself to the residency program, you need to make sure that the residency program is also a good fit for you also. On your interviews, you should be also interviewing the residency program to see if they align with your goals and needs. Consider the patient population you want to serve, the colleagues you would work with (do you get along with the residents?), your main goals of residency (do you want a strong base in psychotherapy? more hands-on procedures? more clinic time than inpatient? strong research facilities?), the location (community hospital, rural, urban? close to your family? a new location away from family? climate?), the activities outside of work, and your lifestyle. Giving weights to these different factors can help you rank what programs best align with your goals.
How many combined programs exist?
As of early 2019, there are 14 Internal Medicine/Psychiatry, 6 Family Medicine/Psychiatry, 9 Pediatrics/Psychiatry/Child and Adolescent Psychiatry (aka “triple board”), and 4 Neurology Psychiatry programs. Visit our residency programs page for detailed information on the programs.
Given the small number of programs, do most residents apply to the individual specialties in addition to the combined programs?
Given the limited number of residency programs and spots, most applicants do apply to some categorical programs in addition to the combined programs. It is not a requirement to apply to both categorical and combined programs, but some applicants feel more comfortable with their ranking chances if they do so.
If I don’t match into a combined program, can I still do combined training?
There certainly are pathways to become dually-trained if you do not match into a combined program. Sequential training (see FAQ above) is an option for individuals who desire to be dually-boarded and trained but who do not match into a combined program.
What is the extent of exposure to psychotherapy in combined training?
Given that combined residents must satisfy the certification requirements of both medicine (or pediatrics or neurology) and psychiatry boards, each combined resident is required to have a minimum of 12 consecutive months of supervised outpatient psychotherapy. Categorical psychiatry residents typically perform this outpatient psychotherapy during both their 3rd and 4th years of residencies. Each individual combined program has a different schedule, but most combined residents undergo their 12 consecutive therapy months at some point during their 3rd, 4th, or 5th years. The exact makeup of those months varies among programs, but typically involves exposure to several therapy modalities.
Are combined programs open to having DO residents?
DO residents offer a perspective and knowledge base that is consistent with the mission of combined training and thus they are certainly welcome and appreciated in combined programs.
Are the combined internal medicine/psychiatry, family medicine/psychiatry, pediatrics/psychiatry/child & adolescent psychiatry, and neurology/psychiatry programs ACGME accredited?
Combined programs on their own are not ACGME accredited but the individual programs (for example internal medicine on its own and psychiatry on its own) are ACGME accredited unless otherwise stated by an individual program. Combined trainees are board eligible upon completion of residency to sit for board exams in the individual specialties.
Are combined residents allowed to do fellowships?
Yes! Combined residents are certainly allowed to complete fellowships post-residency. They are eligible for the same fellowships available to graduates of their individual program components. For example, graduates of a combined internal medicine/psychiatry program are eligible for fellowships available to internal medicine residency graduates and that of psychiatry residency graduates.
Do many combined residents do fellowships?
Some combined residents do complete fellowship training post-residency. Some of the most common fellowships undertaken by combined residents are gastroenterology, hematology-oncology, infectious disease, pain, and forensics.
I still have some questions about combined training. What should I do?
We’d love to answer any other questions you have through our mentorship program! If you are a medical student member of AMP, you are able to request a mentor. You will be paired 1-1 with a combined or sequential resident with whom you can chat about combined training and careers. Visit the mentorship page for more information. Another great location to discuss combined training and careers is our annual conference. We hold a dynamic annual conference each fall that includes several events specific for medical students, including a residency fair. We’d love for you to attend our conference!
How do I get more involved?
We strongly encourage and would enjoy you becoming more involved in AMP! As the national organization for combined trainees and physicians, AMP is a great location for networking, advocacy, and mentorship. Our annual conference is a great time to get plugged into AMP. Additionally, if you are a member of AMP, you can become a member of our medical student committee. There are also many other committees such as outreach/advocacy, membership, research amongst others that are seeking enthusiastic members. Our different committees are listed on our AMP officers page. Feel free to contact us here to request involvement in a particular committee.