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Why Consider Fellowship Training in Psychosomatic Medicine?

Psychosomatic Medicine (PM) is that branch of psychiatry that deals with the understanding and advancement of medical science, education, and healthcare for persons with comorbid psychiatric and general medical conditions and is also referred to as Consultation-Liaison (C-L) Psychiatry or Hospital Psychiatry.  Whatever its name, it is an exciting and gratifying psychiatry subspecialty that, given the direction medicine and medical care is heading in the U.S., will be an important way new psychiatrists will be able to play an active role in the comprehensive medical care of a large portion of the population.

Training in PM currently follows completion of a General Psychiatry residency training program; PM fellows typically spend one additional year in training, although some training programs include an optional additional year.  There are now more than 50 ACGME-accredited PM Fellowship training programs, with numbers steadily increasing. Satisfactory completion of a PM fellowship qualifies each graduate to sit for the subspecialty board examination in PM administered by the American Board of Psychiatry and Neurology.

There are many ways a specialist in PM may be helpful to an in- or outpatient and to those caring for someone with comorbid psychiatric and medical or surgical conditions.  Some examples include: treatment of delirium tremens in an elderly woman with unsuspected alcohol dependence who just received coronary artery bypass surgery (CABG), consultation to an outpatient HIV/AIDS Clinic to help manage psychotropic medications for a patient about to begin a new antiretroviral regimen, co-treatment with the Maternal and Fetal Medicine Service of a young woman with Bipolar Disorder who is taking lithium for mania prophylaxis and who wishes to become pregnant, and inpatient consultation to the Oncology Service for a depressed middle-aged man with newly diagnosed, widespread pancreatic cancer.  In addition, PM physicians often work in primary care and outpatient specialty clinics (such as Diabetes and Women's Health clinics) and have key roles in developing population-based collaborative care models for patients with depression and anxiety and other mental health conditions.

Psychosomatic Medicine gives one the opportunity to "hold on to" a great deal of his or her medical and surgical training and to use it effectively and in addition, the chance to work more closely with medical and surgical colleagues than is typically the case for most psychiatrists.  It's a great way to make a big difference in the lives of those with complicated medical or surgical conditions who are suffering emotionally, those in hospital whose behaviors place them or others at risk, and for those who care for them.

Terry Rabinowitz, MD, DDS, FAPM
Chair, Academy of Psychosomatic Medicine Fellowship Education Subcommittee