In 1995, the American Board of Family Practice and the American Board of Psychiatry and Neurology issued guidelines for the approval of combined family medicine and psychiatry training programs (1). These guidelines described the outlines of a 5-year program leading to dual board certification in psychiatry and family medicine. The curriculum of the combined programs had to meet the Residency Review Committee (RRC) special requirements for both disciplines.

In the 5 years since the issuing of these guidelines, 12 combined programs had been approved by both boards as of the summer of 1998. Three of the approved programs are military. The emergence of these dual board programs echoes the emergence in the early 1980s of the internal medicine—psychiatry programs and the "triple board" programs (pediatrics, adult psychiatry, and child psychiatry). The recent interest in combining family medicine and psychiatry reflects in part the recent shift in medical training from inpatient sites to outpatient sites.

Family medicine—psychiatry programs aim to train a small number of physicians (2—3 per program each year) to practice, teach, and do research in the areas of medicine that represent the overlap of the two disciplines. The objectives of the combined programs, as stated in the guidelines (1), are

The first graduates of the combined family medicine—psychiatry programs will graduate in 2000. In 1997, McCahill and Palinkas (2) published a survey of clinicians who were sequentially board-certified in family medicine and psychiatry, all of whom trained before the development of combined family medicine programs. Sixty percent of respondents reported that they continue to practice both family medicine and psychiatry, one-fifth in rural settings. Chapman and Nuovo (3) have described the launching of several combined programs at the University of California, Davis, including their family medicine—psychiatry program. However, there are no reports of the family medicine—psychiatry programs as a group. Because new family medicine—psychiatry programs have emerged rapidly, and the rates of growth have varied widely across programs, we conducted a descriptive, cross-sectional survey in the summer of 1998 to assess the current status of this educational experiment.

In July 1998, we faxed to training directors and coordinators of the 12 existing family medicine—psychiatry programs a one-page questionnaire (Appendix 1). In August and September 1998, we conducted brief phone interviews with at least one training director or coordinator from each program and a sample of current residents.

Enrollment for 1998 in the 12 approved programs is listed in t1.

Forty-one residents were enrolled in 11 programs. The number of first-year positions available ranged from 1 to 3 in each program, for a total of 22. Twelve first-year positions were filled through the 1998 National Resident Matching Program (NRMP), out of 32 applicants ranked in the match. Four first-year positions were filled through military match, and one position was filled outside the match. With 17 of 22 positions filling in 1998, the family medicine—psychiatry programs recorded a 77% fill rate. Seventy-seven applications led to completed interviews during the 1998 recruitment to both civilian and military programs.

Most training directors felt that the combined programs attracted high-quality residents who might not otherwise apply to their programs. No program engaged in substantial recruitment efforts for the combined program beyond those already established for the individual programs. The most common obstacle to recruitment cited by training directors was the lack of awareness in medical students of the combined family medicine—psychiatry option.

Two approved programs have suspended recruitment, each for complex reasons, including inadequate funding for the combined program at one site (Michigan) and probationary status of the general psychiatry program at another (Eisenhower). Six residents have dropped out of four programs over the past 4 years. Five of them changed to a general psychiatry program and one to family practice.

Among expected career paths identified by the training directors and residents for graduates of family medicine—psychiatry programs, group practice, rural primary care practice, and academics were commonly cited.

Among the problems noted, anecdotal reports from residents and training directors cited scheduling mechanics as a common source of frustration. The task of meeting requirements for both specialties leaves little room for electives or research; and residents and training directors noted that combined residents face a more complex process than the traditional resident of fitting into several resident groups in the first few years.

The experiment in family medicine—psychiatry combined training programs is young. The first graduates completed the 5-year program in June 2000. Two programs have suspended recruitment; several have only partially filled; and one new program was recently approved for the 1999 match (Case Western Reserve University).

How does the family medicine—psychiatry experiment compare with other combined programs? Yates (4) recently reported that there are currently 27 internal medicine—psychiatry programs, with 47 first-year positions offered, compared with 12 family medicine programs, with 22 positions. The first internal medicine—psychiatry programs began in the early 1980s. Eleven pediatrics—psychiatry ("triple board") programs offer 21 first-year positions; five of these programs have been in operation since the mid-1980s. The 1998 match rate of the family medicine—psychiatry programs (73%) compares favorably with the 1998 match rate for internal medicine—psychiatry (65%) and straight internal medicine (62%).

Many training directors noted that few medical students are aware of the family medicine—psychiatry option, and even fewer are well enough informed about the option to consider applying. A few training directors noted that most educators in psychiatry departments and family medicine departments remain unaware of this new option, so they are not in a position to guide students in this direction. The number of applicants to family medicine—psychiatry programs has risen sharply over the past 3 years, but it is not yet clear what the demand for family medicine—psychiatry training will be, either among medical students or in the job market.

Training directors uniformly felt that the combined programs improved relationships between the two departments through shared teaching responsibilities, coordination of resident schedules, and sharing of resources. None of the responders thought that the development of their combined programs had strained or worsened relationships between departments. However, it is too soon to know what role these programs and their graduates will play in the two disciplines of family medicine and psychiatry.

This work was presented at The Association for Medicine and Psychiatry Annual Meeting, Orlando, Florida, on November 18, 1998.