Combined Internal Medicine/Psychiatry (IMP) and Family Medicine/Psychiatry (FMP) residency programs are specific to the United States, and have existed for almost 20 years (1, 2). They produce physicians who are well prepared to provide optimal, integrated care (1, 2). Although some physicians become dually trained via sequential programs, IMP and FMP training programs are relatively uncommon, and few medical students elect to pursue combined training (1, 3, 4). Currently, an estimated 92 and 55 residents are pursuing IMP and FMP, respectively (4). One possible explanation for the low numbers is lack of awareness regarding what dually-trained physicians do. Surveys assessing IMP and FMP physicians are limited, and most are dated (1, 2, 5). Previous respondents were satisfied with training but reported practicing mostly psychiatry and underutilizing their integrative skills (1, 2, 5). In this pilot survey, we bring attention to the diverse roles and responsibilities that dually-trained physicians might undertake, with the goal of stimulating interest in combined training.

A survey was distributed at the 2010 Annual Association of Medicine & Psychiatry Conference in Chicago, to all dually-trained physicians who have completed training in IMP or FMP (sequentially or combined). The project was approved by the Springfield Committee for Research Involving Human Subjects (Institutional Review Board; Springfield, IL). PASW-18 was utilized for analysis (SPSS, Inc.; Chicago, IL).

Of 34 dually-trained physician-attendees, 28 (82.4%) returned surveys. The average age was 38 years (range: 28–56), and the majority were women (53.6%; N=15) and U.S. citizens who attended a U.S. medical school (67.9%; N=19). Most (92.9%; N=26) completed combined (rather than sequential) training, and most (78.6%; N=22) completed IMP training. Respondents completed training between 1984 and 2010 (median: 2005). Most (78.6%; N=22) report board certification in both specialties. Twelve respondents report fellowship training in Psychosomatic Medicine, Hospice and Palliative Medicine, Sleep Medicine, Geriatric Psychiatry, Addiction Medicine, and Endocrinology.

Most respondents (75%; N=21) work in a primarily academic setting, with a diverse array of work responsibilities, including education (N=22), clinic-based (N=18), hospital-based (N=17), consultative (N=17), administrative (N=17) and research (N=11). Only three respondents practice in only one specialty (two in Psychiatry, one in Primary Care). The majority (67.9%; N=19) report providing integrated patient care.

In addition to the survey results shown in Table 1, respondents reported satisfaction with their ability to keep current with new knowledge in Psychiatry (4.07; SD: 0.81; range: 2–5; mode: 4) and Primary Care (3.75; SD: 0.97; range: 2–5; mode: 4). Only 28.6% (N=8) report better compensation than colleagues in Psychiatry, whereas 42.9% (12) report better compensation than Primary-Care colleagues. Respondents feel strongly that they contribute positively to various aspects of patient care, such as handling complex patients and improving outcomes. However, respondents are not confident that the U.S. healthcare system encourages the practice of integrated medicine (2.61; SD=1.17; range: 1–4; mode: 2). Finally, most respondents report that, if they had to choose again, they would still choose a combined training program (92.9%; N=26).

This survey is the first in over a decade to assess attitudes of dually-trained physicians in IMP and FMP. Overall, most report satisfaction with their career choice, their training, their current work, and their field (Table 1).

Dually-trained physicians fill many roles. As compared with previous surveys (1, 2, 5), we found a higher proportion of physicians working in both Psychiatry and Primary Care and providing inpatient care. This trend is encouraging for combined training program directors and important to highlight for medical students who are interested in combined training and academic careers but who are concerned that their practice may be limited to one discipline. Furthermore, program directors have noted that single-category residents may benefit academically and clinically from the presence of combined residents (6). Finally, respondents' comments indicated that dual training provided a broad set of knowledge, greater opportunities to teach nonpsychiatric residents, an ability to see patients from both psychiatric and medical viewpoints, and a unique professional identity.

Although patient care and job satisfaction appear to be enhanced by dual training, financial compensation may not be. With mounting evidence that integrated care may improve patient outcomes and decrease costs, policymakers should consider alternative payment methodologies to boost integrated care of patients in the same visit by dually-trained physicians (1, 5, 7).

A majority of our respondents report academic, teaching, and administrative responsibilities. This finding has not been previously reported and may have important implications for academia. Combined training may play a unique role in shaping education and patient care, and may provide faculty well-suited to teach double-board as well as categorical internal medicine, family medicine, and psychiatry trainees.

Our study population is small and was drawn from conference attendees. We cannot draw conclusions about differences between IMP and FMP physicians, nor can we assess differences by training pattern (sequential versus combined). In May 2011, the American Board of Medical Specialties reported 419 dual-boarded IMP and 241 FMP physicians. We plan to survey these individuals to obtain nationally representative data that better characterize the range of opportunities available to dually-trained physicians and provide insight into possible areas for improved integration in combined training programs.

In the face of ongoing healthcare reform, the important roles of integrated care and combined training programs should be evident, yet the number of combined training programs has declined over the last decade (3, 4, 7). Creating more opportunities for combined training can be seen as an important priority for patient-centered, comprehensive-care models and should be encouraged. Our findings indicate that combined training can lead to a fulfilling and worthwhile career.

We thank the Association for Medicine & Psychiatry, Robert McCarron, D.O., and Charles Schwartz, M.D. Portions of this article were presented at the Annual Association of Directors of Medical Student Education in Psychiatry meeting, Savannah, GA, June 16–18, 2011, and the Association for Medicine & Psychiatry Annual Meeting, Chicago, IL, Sept. 30–Oct. 1, 2011. Paul Summergrad, M.D., is a consultant for MC Communications, Inc., and a speaker for CME Outfitters, Inc. (not a speakers' bureau). The other authors have no financial relationships to disclose. No financial support was provided for this study.