Training - Primary Care Psychiatrists

The UT Southwestern Psychiatry program was fortunate to be selected to be one of the few pilot sites for special training for psychiatrists to function in a primary care role for many of their patients.

There has been debate in recent years about whether psychiatrists should be considered primary care physicians. For many of our patients we are the only physician they see, and, when we do refer them, they often don't follow through, get inferior care, and unfortunately many of our colleagues in other specialties are uncomfortable with them and just as happy not to spend time with them. What has evolved is the concept of Primary Care Psychiatry.  Psychiatrists provide the principal care that many if not most psychiatric patients receive.

In considering preparing future psychiatrists for this role, some programs have developed combination med/psych or family practice/psych programs. We gave careful consideration to this possibility but concluded that it is not realistic to expect someone to become a fully competent psychiatrist and a fully competent internist or family practitioner and to maintain this throughout a career. Follow-up data on combination programs tends to confirm this position.  Recently, however, funding became available to train Primary Care Psychiatrists. We jumped at the chance and received special funding for this model program.

Those who opt for the additional training (towards the end of the PGY 2) will begin seeing patients in a specially designated ½ day clinic in the PGY-3.  They will be supervised on every patient by both an internist and a psychiatrist.  In addition, they participate in a special monthly case conference that focuses on the comprehensive care of patients from this clinic.  In the PGY 4, residents who have selected this track undertake a special focus.  Residents have undertaken research projects on the recognition and treatment offered psychiatric patients with Hepatitis B, or ambulatory C/L experiences in HIV, Sleep Medicine, Gastroenterology or other medical subspecialties.

We are very excited about this program, which graduated its first group of residents in June, 2002. We are currently conducting research to determine how effectively this pilot project is working. To us, this is the best answer to the dilemma that all psychiatrists have struggled with in recent years, and which we hear so much about from our applicants.