UC Davis: Summary of the first week

My first week on medicine/psychiatry was a good one.

I am spending most of my time at the Sacramento County Primary Care Center (PCC), which mostly caters to an indigent patient population. There is a separate Integrated Behavioral Health clinic with a set of three dually trained physicians who supervise me and another fourth year student. She attends UC Davis and is applying for internal medicine residency. I am also spending a few mornings per week at a pain clinic staffed by the Medicine/Psychiatry program director.

Everyone with whom I have interacted is very nice and welcoming... and just as important, they all seem happy.

But so far, I haven't met any Medicine/Psychiatry residents. The one resident at PCC is a psychiatry intern and so is not a good person to talk with about dual training. The Medicine/Psychiatry chief resident, though, has been in close contact with me to make sure that I am having a good experience. I am looking forward to interacting more with the Medicine/Psychiatry residents. Beyond just asking them questions, I want to get a better feel for how happy they are in the program, with their training experience.


Regarding what I have discovered about the actual practice of combined medicine and psychiatry, I was surprised that the vast majority of patients who I saw at PCC were there only for management of chronic psychiatric conditions without addressing any of their medical problems. My attending says that this is mostly due to insurance reasons, because neither Medi-Cal nor Medicaid reimburse fully for office visits that address both psychiatric and medical problems. That is concerning to me but not altogether unexpected given some of the criticisms I have heard from various people about combined training programs.

I have been exposed to a lot more of mixed medicine and psychiatry in the pain clinic, where patients' chronic pain issues often stem from both physical and mental causes.

There is still so much to experience during this externship. Next week I will also see patients on the psychosomatic medicine inpatient unit.