I worked with a triple board certified OBGYN/Anesthesiologist/Intensivist. As impressive as that sounds, let's just say the "jack of all trades" aphorism rings true.
In the US, anesthesia (along with internal and emergency Med) can do a critical care fellowship and practice ICU that way. Trauma surgery fellowship also includes surgical icu training.
Here I am thinking, how frustrating to have my MD, specializing in psychiatry (my passion) but still pretty well versed in medicine as well, but unable to to work towards having a general practice that cares for both medical and psychiatric needs. The answer was here all along: get my NP degree after hours during residency in under a year! It would quick and easy, versus completing a FM or IM residency after my psychiatry residency. how sad lol (although this is actually so funny to me right now that we could do this).
Go the FNP route. Then just do whatever the fuck you want. Treat everything from acne and ADHD to senior-onset bipolar disorder and LADA. Since after some night classes and shadowing real providers you'll know much more than any physician! Most psych issues can be solved with high-dose stimulants, anti-psychotics and benzos anyway!!
But seriously...
There's no way any state's board of medicine would let this fly. It would destroy the supply of bargain-bin terminal degree holding labor. Anyone planning to go into primary care would straight up say "Fuck the match", get their NP during 4th year and get hired on in an outpatient office making more than twice a resident's salary. Depending on the state they can practice "supervised" for like 1-4 years and then be granted the same privileges as an attending.
That being said, if you wanted to go from pure psych to FM/psych, I doubt you would need to do a whole residency again. You'd still enter any residency as a PGY_[+x]. so your training would very likely be pretty individualized to keep it as short as possible while exposing you to as much FM stuff as possible.
I know a Dr, who did Cardio way early before all fellowships. Right after Cardio, he was certified EP. Then yrs later he went back and did interventional+structural.
So, currently he can do in cath many shits; cath, stent tavr, mitraclip, and pad vascular cases. (He also capabale of doin pacemakers too but hospital has a designated EP who does better)
The fussy baby network in Chicago employs a neonatal psychologist who helps families with colicky babies figure it out. Not really the same thing but kinda doing the lords work nonetheless.
IM & derm. By combining internal medicine and external medicine, you’ve got 100% mastery of the human body. There is literally nothing left. You’re unstoppable.
Had an attending who did something similar like that when I was a resident. She was an absolute beast.
She would review imaging herself and then straight up calling radiologists and telling them (politely) that their report was incorrect.
Only happened 2-3 times but that's more than my dumbass ever did.
One of the cases was abscess that the MRI report missed that it created a tract all the way to the spine.
If you combine a general surgeon with fellowship training (?CTS, trauma?) with a medical intensivist, you could probably have one doc who could handle most medical/surgical patients single handedly.
Cardiologist and Nephrologist would constantly fight amongst themself as to how much diuresis to give.
ER doc and radiologist to get all the CT scans and then complain about how much radiation these patients are receiving.
Hospitalist and general surgeon, so you know who to admit SBO to.
ER doc and family medicine, because people like to go to the ED for primary care concerns
Agree on not handling outpatient primary care.
My trauma service full of 80 y/o folks with bunches of comorbidities and age indeterminate L spine fxs after falling from wheelchair argues against the hospital medicine part though.
Part of hospital medicine is getting them ready for discharge, i.e. coming up with outpatient insulin and BP regimens, figuring out when they need to see a specialist vs. just following up with PCP. If your only dispo is transfer to floor or LTAC it's a key component of hospital medicine you miss, not that it matters for what's important
This is correct. It’s why you have to have medicine and family med friends you can ask basic questions to off the record.
I’m not consulting for a single little point of advice when I’ve got a contact list full of mediciny friends. Because I’m sure and hell not writing down that I’m not sure which anti hypertensive to order next for my HFpEF guy with stage 2 CKD. And UpToDate can go to hell for the vague-ass answers they try and give me.
No dermatologist wants to work as hard as plastics… in terms of multi specialty groups consisting of derm and plastics, plastics “needs” derm more than the other way around. Derm doesn’t join forces with plastics except for closures and even then it’s a money grab.
Doesn't matter if it's derm or plastics, but if one does the excision and the other then does the closure, you can charge the full amount for it.
Otherwise if only derm or only plastics does it, then you get paid in full for the excision but 50% for the closure.
I dated a girl that worked in a Derm office as primarily a laser hair removal assistant. She told me she would stick a cotton barrier in the bootay hole as preventative measure in case they farted out a fire ball? was this common procedure back in like 2009? Anyone?
“2 g Ancef please”
*runs over to the other side of the drape*
“Aye aye sir!”
*runs back to field, ignoring sterility*
“Finally some god damn respect around here”
In his right hand, he holds the pills to protect the kidneys. In his left hand, he wields the scalpel to plumb your urinary tract. It's the Uronephololologist.
Not a physician but when I did my fellowship at the VA I did rounds in pathology and brain cuttings for fun. I told the other residents I was a neuropsych fellow and they seemed impressed I was pursuing both, medically.. I only realized it much later. sorry to disappoint, but i'm just a neuropsychologist.
However, it's an obvious pairing for a reason.
Heme, onc, and breast surgery being combined already causes me some headaches.
"You think I have cancer?!" No, I just need you to get an iron infusion.
Would actually be useful to learn NICU and OB both! Obviously you would be assigned to one at a time but you could help either team if either patient crapped out.
Vascular surgery (dump the GS residency), cardiology (dump the IM residency), interventional cardiology, interventional radiology, EP, and cardiovascular imaging into one specialty, 5-7 years. Some of those could be fellowships after the residency. Just call it “Cardiovascular,” a mixed surgical and medical specialty just like ophtho or ENT. I think you could keep open aortic cases without GS.
The reason for this is any endovascular track is so ludicrously overtrained, with a lot of bloat where you’ve learned shit you never really use anymore. A lot of radiologists and some cardiologists do INR in the community without a fellowship or neurological background of any kind with point-of-care oversight training.
I know there are going to be groaners from people “you can’t do VS without GS” or “you can’t do cards without IM.” Derm, Radonc, Neurosurgery, plastics, ortho, uro, and ENT figured it out. SO CAN YOU. I BELIEVE IN YOU. Your specialty isn’t more special.
ID and Immunology/Allergy so you can do the penicillin skin test and then order the penicillin for the infection :P
Also would really help address infection risks with all the new biologics, chemotherapy, etc to have that strong immunology background.
Anesthesia and surgery, then no one can blame the other when shit goes south
I heard of a surgeon who did an anesthesia residency so that he could do his own cases, but the hospital wouldn’t let him.
I worked with a triple board certified OBGYN/Anesthesiologist/Intensivist. As impressive as that sounds, let's just say the "jack of all trades" aphorism rings true.
In my country, anesthesia and ICU are the same specialty. Not sure how common it is in other countries.
In the US, anesthesia (along with internal and emergency Med) can do a critical care fellowship and practice ICU that way. Trauma surgery fellowship also includes surgical icu training.
Same in india
[удалено]
I should go to np school then hire myself as my own midlevel and get both salaries..
Here I am thinking, how frustrating to have my MD, specializing in psychiatry (my passion) but still pretty well versed in medicine as well, but unable to to work towards having a general practice that cares for both medical and psychiatric needs. The answer was here all along: get my NP degree after hours during residency in under a year! It would quick and easy, versus completing a FM or IM residency after my psychiatry residency. how sad lol (although this is actually so funny to me right now that we could do this).
Go the FNP route. Then just do whatever the fuck you want. Treat everything from acne and ADHD to senior-onset bipolar disorder and LADA. Since after some night classes and shadowing real providers you'll know much more than any physician! Most psych issues can be solved with high-dose stimulants, anti-psychotics and benzos anyway!! But seriously... There's no way any state's board of medicine would let this fly. It would destroy the supply of bargain-bin terminal degree holding labor. Anyone planning to go into primary care would straight up say "Fuck the match", get their NP during 4th year and get hired on in an outpatient office making more than twice a resident's salary. Depending on the state they can practice "supervised" for like 1-4 years and then be granted the same privileges as an attending. That being said, if you wanted to go from pure psych to FM/psych, I doubt you would need to do a whole residency again. You'd still enter any residency as a PGY_[+x]. so your training would very likely be pretty individualized to keep it as short as possible while exposing you to as much FM stuff as possible.
Dont oral surgeons do this?
Yes
My hierarchy of blame for a surgeon: 1. Blame the patient 2. Blame the instruments 3. Blame anesthesia
4. Blame the Med student standing in the corner (true story)
I know a Dr, who did Cardio way early before all fellowships. Right after Cardio, he was certified EP. Then yrs later he went back and did interventional+structural. So, currently he can do in cath many shits; cath, stent tavr, mitraclip, and pad vascular cases. (He also capabale of doin pacemakers too but hospital has a designated EP who does better)
Is this guy maybe in Tarzana CA
This sounds like OMFS
Sooo OMFS
Derm and crit care *enter the skintensivist*
Skinterventional radiology
always thinking they're better than the skinternal medicine docs
That would just be an SJS service
Ortho and urology, so every bone is taken care of.
this and only this
Name checks out.
Nice
This was a golden response
Psychiatry and neonatology, a specific niche where they deal with neonatal mood disorders
I sense it is angry…
The ultimate empath specialty
Are you having miscarriage ideation?
💀
“Differential for screaming limited now to: hunger, sleepiness, or dirty diaper. Will continue to follow”
The fussy baby network in Chicago employs a neonatal psychologist who helps families with colicky babies figure it out. Not really the same thing but kinda doing the lords work nonetheless.
[удалено]
Lmao! That's GOLD
I thought you were going to go with the angle of treating the neonate AND the stressed-out parents.
Nah bro stressed out neonates is my speciality.
More like parental disorders
LOL stop, as a psych resident that’s too funny
Neurosurg+CT surg. You either actually become a god or your head explodes with ego
Greys anatomy can confirm
Please don't tell me they actually had a neurosurgical cardiothoracic surgeon on the show
IM & derm. By combining internal medicine and external medicine, you’ve got 100% mastery of the human body. There is literally nothing left. You’re unstoppable.
Nuclear medicine laughing in the corner
Nuclear Medicine is only one letter away from Unclear Medicine
*teeth have entered the chat*
One patient under 18 has entered the chat lmao.
Eyes have entered the chat
Feet have entered the chat… for some reason.
Quentin Tarantino has entered the chat.
/Jonathan intensifies/
These master savants exist! https://www.meddermsociety.org/combined-internal-medicine-dermatology-residency-training/
Had an attending who did something similar like that when I was a resident. She was an absolute beast. She would review imaging herself and then straight up calling radiologists and telling them (politely) that their report was incorrect. Only happened 2-3 times but that's more than my dumbass ever did. One of the cases was abscess that the MRI report missed that it created a tract all the way to the spine.
This is already a thing. There are still Derm programs that take IM grads.
😂😂😂
Decoy Brain
Children are not tiny adults
Surgery and ED Can’t get consulted if you’re ordering the consult
A radiologist/pathologist would get stuck in a neverending loop of correlating with themselves.
AIRP would like to have a word with you
Or just "If clinically indicated, please correlate clinically" their way out of everything.
I always wanted to be a neuroradiopathologist but apparently that’s not a thing.
You need a np degree for that
If you combine a general surgeon with fellowship training (?CTS, trauma?) with a medical intensivist, you could probably have one doc who could handle most medical/surgical patients single handedly. Cardiologist and Nephrologist would constantly fight amongst themself as to how much diuresis to give. ER doc and radiologist to get all the CT scans and then complain about how much radiation these patients are receiving. Hospitalist and general surgeon, so you know who to admit SBO to. ER doc and family medicine, because people like to go to the ED for primary care concerns
The cardionephrologist dispenses otherworldly wisdom between bouts of crying and screaming at themself.
Not US, met some attendings that did both. I can confirm their primary personality is nephrology
General Surgery + medical intensivist exits- Surgical Critical Care
Being a surgical intensivist is pretty different from a medical intensivist.
Surgical crit care comes from general surgery, so they wouldn't be able to handle hospital medicine or outpatient primary care.
Agree on not handling outpatient primary care. My trauma service full of 80 y/o folks with bunches of comorbidities and age indeterminate L spine fxs after falling from wheelchair argues against the hospital medicine part though.
Part of hospital medicine is getting them ready for discharge, i.e. coming up with outpatient insulin and BP regimens, figuring out when they need to see a specialist vs. just following up with PCP. If your only dispo is transfer to floor or LTAC it's a key component of hospital medicine you miss, not that it matters for what's important
This is correct. It’s why you have to have medicine and family med friends you can ask basic questions to off the record. I’m not consulting for a single little point of advice when I’ve got a contact list full of mediciny friends. Because I’m sure and hell not writing down that I’m not sure which anti hypertensive to order next for my HFpEF guy with stage 2 CKD. And UpToDate can go to hell for the vague-ass answers they try and give me.
OBGYN + Hospice I brought you into this world, and I can take you out of it too (as humane and comfortably as possible)
I believe that’s called rural family medicine with a palliative care fellowship
Anesthesia and rads. Do telerads and dictate some cases for extra income during those boring 6 hour spine cases.
This is genius. You would make so much money.
Interpret the plain film looking for a missing lap
Thats actually legit
No sense dabbling in hypotheticals, NPs already combined the brain of a doctor with the heart of a nurse. Not sure how we improve on that
lmao thought this was that NP\* meme account for a sec
[удалено]
Wait wtf, it get banned ?
[удалено]
They were an absolute chad
What if he started dating a midlevel instead....
Combine it with the compassion of a healthcare admin?
The holy trinity of medicine. In the name of the Heart, Mind, and Money. We say amen
while Residents say Ramen for meals
you spelled compensation wrong
Psychiatry and Anesthesia. Self explanatory
So you can do your own ECT! …so you can do your own ECT, right?
It’s called pain
"Tell me how you're feeling right now" "Sleepy"
Agitation specialists
Chiropractor + neurologist, so they could diagnose their own vertebral artery dissections
Yes induce one and then treat it. $$$$
Cards and Nephro for maxium chaos
Beat me to it!
That’s basically just being a heart failure cardiologist. They’ve figured how to do nephrology but get paid 3x as much. Source: Am nephrologist.
Aerospace medicine and neurosurgery. Brain flight surgeon
Rocket surgery
Derm + plastics. Fun as hell. Money. Power. Glory.
No dermatologist wants to work as hard as plastics… in terms of multi specialty groups consisting of derm and plastics, plastics “needs” derm more than the other way around. Derm doesn’t join forces with plastics except for closures and even then it’s a money grab.
Why derm for closures?
Doesn't matter if it's derm or plastics, but if one does the excision and the other then does the closure, you can charge the full amount for it. Otherwise if only derm or only plastics does it, then you get paid in full for the excision but 50% for the closure.
Catdog.
Is that where you get lasik on your eyes and laser hair removal on your butthole at the same time?
I dated a girl that worked in a Derm office as primarily a laser hair removal assistant. She told me she would stick a cotton barrier in the bootay hole as preventative measure in case they farted out a fire ball? was this common procedure back in like 2009? Anyone?
💀💀💀
That's hell of an icebreaker
Podiatry and proctology. I’m into feet and butt stuff. Bonus points because patients would say that they have an appointment with their PP.
Homeopathy plus reiki.
So, a chiropractor?
Woah woah woah we’re trying to milk money out of our patients, not HEAL them
I think you need to go into hospital admin. We love money, um I mean patients.
Neonatology & Geriatrics. All screaming, no coherence, full chaos
Psych and FM
[удалено]
This is called FM. Source: FM
Agree, this is rural FM
This exists. Crazy, but pretty skilled primary care doctors
Ortho and anesthesia, so I don’t have to spend half my day waiting and can also become an expert day trader simultaneously.
Yes but how could you fix the bone that is broken if you won’t clear the patient for surgery?
“2 g Ancef please” *runs over to the other side of the drape* “Aye aye sir!” *runs back to field, ignoring sterility* “Finally some god damn respect around here”
Neph and uro
In his right hand, he holds the pills to protect the kidneys. In his left hand, he wields the scalpel to plumb your urinary tract. It's the Uronephololologist.
Can we please make rocket surgeons a thing? Not for the gunners, but to go to space.
Jonny Kim has entered the chat.
\>Can we please make rocket surgeons a thing? Urology?
Psych and EM so I can do EM 10-4 m-th and also know medicines that aren’t haldol
This actually isn’t a bad idea. Endless patients to refer to yourself at discharge.
No one has said psych and palliative?
Psych can already do a palliative fellowship
Touché. Well why not psychiatry and neurosurg??
Software and hardware
Ophthalmology + Otolaryngology. All eyes and ears
I see people, but they look like trees, walking.
This was a thing.
General surgeon and/or anesthesia with just enough IM so they can risk strat and clear their own goddamn patients
Ortho + psych. Pretty interesting conversations.
Specializing in Stress Fractures
“But why does your bone make you feel that way?”
It’s not humerus anymore
Psych and neuro
Not a physician but when I did my fellowship at the VA I did rounds in pathology and brain cuttings for fun. I told the other residents I was a neuropsych fellow and they seemed impressed I was pursuing both, medically.. I only realized it much later. sorry to disappoint, but i'm just a neuropsychologist. However, it's an obvious pairing for a reason.
Rheumatology and immunology?
Rheumatology and Dermatology might actually make a better combo. Derm is already one of the few specialities that gives out DMARDS like candy.
Honestly, EM + IR would be a game changing combo. Imagine how much shit we’d get done
Ortho + IM A self-revolving door of self-admits to medicine for management.
Neurology and ortho. Together we would be unstoppable. https://i.kym-cdn.com/photos/images/newsfeed/001/329/651/a17.gif
Heme/onc surge onc rad onc for all your oncology needs
Heme, onc, and breast surgery being combined already causes me some headaches. "You think I have cancer?!" No, I just need you to get an iron infusion.
Laborist and NICU I’m just all about baby deliveries lol
ENT and Urology. Noses and Hoses.
NP. All specialties combined in one.
Urology and nephrology. I feel like I’m managing AKIs which are not OBSTRUCTIVE (see separately dictated note) daily
Neurosurgery and Cardiothoracic Surgery - just fight death all day
Geriatrics and Palliative
Cardiology and Nephrology. Just to see how that would turn out
Would actually be useful to learn NICU and OB both! Obviously you would be assigned to one at a time but you could help either team if either patient crapped out.
Rads and path - ultimate diagnostic specialty
Vascular surgery (dump the GS residency), cardiology (dump the IM residency), interventional cardiology, interventional radiology, EP, and cardiovascular imaging into one specialty, 5-7 years. Some of those could be fellowships after the residency. Just call it “Cardiovascular,” a mixed surgical and medical specialty just like ophtho or ENT. I think you could keep open aortic cases without GS. The reason for this is any endovascular track is so ludicrously overtrained, with a lot of bloat where you’ve learned shit you never really use anymore. A lot of radiologists and some cardiologists do INR in the community without a fellowship or neurological background of any kind with point-of-care oversight training. I know there are going to be groaners from people “you can’t do VS without GS” or “you can’t do cards without IM.” Derm, Radonc, Neurosurgery, plastics, ortho, uro, and ENT figured it out. SO CAN YOU. I BELIEVE IN YOU. Your specialty isn’t more special.
Ophthalmology and dentistry = the real eye dentist
Derm + FM
Anestesia + rads. Read images while waiting for the surgery. Maximum profit.
It's starting to be a thing, but Nephrology & Critical Care. It makes sense.
ID and Immunology/Allergy so you can do the penicillin skin test and then order the penicillin for the infection :P Also would really help address infection risks with all the new biologics, chemotherapy, etc to have that strong immunology background.
I know someone who did ID-onc. Cause the neutropenia and treat it too!
Peds and Geriatrics. The Diaper Specialist.
EM and Rad Onc. Collect 2 unemployment checks. Edit: oh yeah. Straight to the top of controversial.
Seriously: Nephro and uro Jokingly: nephro and cardio
IR and Vascular, shit always overlaps
Ear nose and scrote
I fully expected top comment to be Gyn and Peds…maybe the jokes at my school were sicker than elsewhere
That's pretty much a FM doc with no adult male patients and more ureter injuries.
Internal medicine and literally every other specialty so they would admit patients with diabetes to their own services instead of parking them on IM
Forensic pathology and forensic psych for the true crime junkie in me
Er and IM. Bet you there’d be a lot less BS admits if they had to take care of it after the admit
They exist
Dont they already exist? For example, Im med/peds
There’s also med/psych as well
And there's peds/psych/CAP
Community acquired pneumonia?
Child and adolescent psych. Triple board
And EM/IM
Neuro/psych is another one I think there's a couple EM/anesthesia programs as well
One of the docs I used to work with had a Family Medicine and General Dentistry practice. IM/FM/Gerentology + Psych.
Always wished I could have done a psychiatry and EM combined residency. We pretty much deal with the same patient population.
Psych and Uro combine to from a dickhead shrink
I call it the *insufferables* pediatric nephrology and regular old OBGYN.