Psychosomatic Medicine Fellowship
Director: Mark Bradley, MD
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ABOUT THE PROGRAM
The NYU Fellowship in Psychosomatic Medicine provides its graduates with the clinical experience, skill and confidence to function as leaders of psychiatric services for medically complex patients. The one-year program is fully accredited by the ACGME and offers three positions. With completion of the program, graduates are eligible to sit for subspecialty boards in Psychosomatic Medicine.
The fellowship has been in existence since 1993, where it began at Bellevue Hospital prior to receiving accreditation by the ACGME. In 2008, the Consultation and Liaison Psychiatry services at NYU-Langone, the New York VA and Bellevue Medical Centers collaborated with Bellevue Hospital to develop a unique, multi-site training program. Bellevue is New York City’s largest public hospital, NYU-Langone is a private, non-profit university hospital, and the Manhattan VA is part of the national healthcare program for active duty and former military personnel.
Fellows spend four months as part of the inpatient CL team at each facility, providing psychiatric care which is integrated within internal medicine, surgery and their subspecialties, ob-gyn, neurology, rehabilitative medicine, HIV and TB units, and intensive care settings. Additionally, fellows spend two half-days each week while at each site in ambulatory-care settings, which include Infectious Disease/HIV, Primary Care, Survivors of Torture or Women’s Health, Behavioral Neurology, and Oncology. Throughout the training program, fellows receive supervision from more than fifteen core teaching faculty. Our graduating fellows consistently report that the diversity of clinical exposure and teaching faculty is a particular strength of the program.
SITE: BELLEVUE HOSPITAL (Four Months)
- Andrea Kondracke, MD (Director of Service)
- Victor Rodack, MD
- Joseph Lux, MD
- Asher Aladjem, MD
- Matthew Rottnek, MD
- Gabriel Katz, MD
Founded 250 years ago, Bellevue Hospital Center is the oldest public hospital the United States and the largest hospital in the New York City public system. Bellevue has a culturally rich and highly diverse patient population representing nationalities and ethnic groups from around the world. It houses a vast array of clinical services and is staffed with a large and well-trained faculty with a diversity of interests.
Inpatient Rotation: Consultation-Liaison (C-L) Service
Clinical Supervisor: Andrea Kondracke, MD
The division of C-L psychiatry at Bellevue consists of two full time psychiatrists, 2 part-time psychiatrists, a half-time nurse-practitioner, a full-time social worker, and the Director. PGY 4 and PGY 2 general psychiatry residents also rotate on the service. Fellows conduct consultations in the general hospital including: Internal Medicine, Surgery, Surgical Subspecialties, OB-GYN, Neurology, Rehabilitation Medicine, HIV and TB Units, Trauma service, Toxicology, and the Traumatic Brain Injury Unit. Fellows also participate in all clinical and educational activities including supervision of residents and medical students, walk rounds, grand rounds, and case conferences. Each fellow presents a case to the Bellevue Department of Psychiatry. C-L fellows spend four months on the consultation-liaison inpatient service at Bellevue Hospital.
Outpatient Rotation: Virology Clinic
Clinical Supervisor: Joseph Lux, MD
The challenging and often complex psychiatric care of HIV patients is a model of integrated care. While on this rotation, the C-L fellow functions as a member of the Bellevue Hospital Virology treatment team, and provides expertise on the diagnosis and management of mood, anxiety, cognitive, psychotic and personality disorders, antiretroviral treatment adherence, HIV-related stigma, assessment of capacity, palliative care, and neuropsychiatric side effects of antiretrovirals and antibiotics.
Nearly half the patients receiving HIV care at this clinic have a psychiatric disorder. The Bellevue Virology Clinic’s target population is heterogeneous, with diverse cultural norms and values. Patients often speak of the ‘double stigma’ of HIV and psychiatric illness as a barrier to care. Furthermore, despite decreases in HIV-related dementia resulting from highly active antiretroviral therapy, the prevalence of memory and cognitive symptoms remains significant. Bellevue’s HIV-positive patients also have a high co-morbidity of the hepatitis C virus that may contribute to depression, including interferon treatment-emergent depression.
C-L fellows spend a half-day weekly for four months in the Bellevue Virology Clinic, with close supervision by Dr. Joseph Lux. There is also an opportunity to participate in ongoing HIV psychiatry academic initiatives.
Outpatient Rotation: Survivors of Torture Program
Clinical Supervisor: Asher Aladjem, MD
The Program for Survivors of Torture elective provides fellows with an in-depth exposure to an interdisciplinary model of refugee health. Fellows participate in the initial intake process, provide psychopharmacologic evaluations and treatment, and provide ongoing group or individual therapy with cross-cultural and trauma themes. All activities are accompanied by supervision and guidance. Fellows interested in forensics may also participate in the creation of affidavits and serve as expert testimony during the political asylum process.
The four-month elective is three hours/week. This may involve psychopharmacologic management and/or individual or group therapy as appropriate. The resident may also design a 4 month research project/literature review using the program’s database and patient records, pending prior approval.
Outpatient Rotation: Reproductive Psychiatry/Women’s Health Center
Psychosomatic Medicine fellows have the opportunity to spend one-half day per week over four months in the Women’s Health Center under the supervision of Dr. Judy Greene, the Director of Women’s Mental Health at Bellevue Hospital Center. Fellows are also welcome to attend a weekly interdisciplinary Reproductive psychiatry journal club. The Women’s Health Center at Bellevue Hospital Center provides prenatal care for approximately 120 new women per month. Patients are referred for mental health treatment by their OB/GYN provider, on site in the Women’s Health Center. The aim of this rotation is to train Psychosomatic Medicine fellows in the assessment and treatment of psychiatric symptoms that occur during the perinatal period, particularly among underserved, minority and lower income women. The fellow will acquire expertise in assessment and treatment of psychiatric disorders associated with the menstrual cycle, pregnancy, and the postpartum period.
SITE: VA NEW YORK HARBOR MEDICAL CENTER (Four Months)
The New York VA is a completely integrated system of healthcare for former and active duty military personnel, and its patients receive the full continuity of inpatient and outpatient primary and specialty care. The VA patient population suffers from a high prevalence of post-traumatic stress disorder, frequently coexisting with complex medical and surgical problems. Addictive disorders are especially common in this group. The VA also has an aging population, largely consisting of veterans from the Vietnam War, Korean War and World War II, resulting in a high prevalence of dementia, mild cognitive impairment, delirium, and other issues specific to older persons. The New York VA has strong divisions of neuropsychology, neurology, and neuroradiology, with which the fellows interface closely, enhancing their skills in the diagnoses and treatment of neuropsychiatric disorders in medically complex patients. At the VA, fellows also use one of the most advanced electronic medical record systems in the world.
Inpatient Rotation: Consultation-Liaison Service
The VA C-L service includes fellows in Psychosomatic Medicine, residents in Psychiatry, residents in Neurology, and fellows in Pain Management. Under close faculty supervision and support, the fellow functions as the team leader, triaging new cases, and providing case assignments and supervision. In this process, fellows develop progressive confidence in leading a C-L psychiatry service. In addition to daily teaching rounds with the Fellowship Director, weekly didactics at the VA with additional faculty include a Tuesday behavioral neurology conference, a Wednesday clinical case conference, and Friday clinical neuropsychology & brain imaging teaching rounds. Fellows rotate on this service for four months.
Outpatient Rotation: Primary Care-Mental Health Integration (PC-MHI)
Clinical Supervisor: Mark Bradley, MD
The PC-MHI program provides screening, detection, and early intervention for common mental health disorders in primary care. In the model of “immediate, co-located and collaborative care,” primary care providers and nurses screen for common mental health conditions, and a multidisciplinary mental health team on-site provides mental health assessment on the same day of referral, timely comprehensive evaluation, brief individual and group treatments, and supportive outside referral as indicated. The approach emphasizes accessibility and reduction of stigma to receive mental health attention.
Target disorders for the program include depression and anxiety, post-traumatic stress and alcohol use disorders. Additional areas of focus include traumatic brain injury, smoking cessation, cognitive disorders, and adjustment disorders or treatment adherence problems related to chronic diseases such as diabetes and congestive heart failure.
The population served is highly varied, and includes women veterans and younger veterans returning from active military duty in Iraq and Afghanistan. While the majority of referrals come from primary care, a substantial number also come from medical specialty areas such as HIV, transplant, neurology and pain management. The fellow in primary care conducts new evaluations and short term follow-up, focusing on patients with psychiatric symptoms co-morbid with chronic medical diseases. This rotation occurs for one half-day weekly, for four months.
Outpatient Rotation: Behavioral Neurology Clinic
Clinical Supervisor: Laura Boylan, MD
The Behavioral Neurology Clinic at the VA provides consultative evaluation and short term management of patients with known or suspected brain injury or disease, and problems with memory, mood, language, or thinking. Common neurologic conditions associated with behavioral problems include traumatic brain injury, epilepsy, Parkinson's disease, dementia, and stroke. Common referrals include patients with: overt neurological brain diseases; focal neurological symptoms or signs; late onset psychosis, cognitive impairment; transient "spells" possibly caused by seizures; movement disorders not typical for medication exposure; and/or a history of head trauma, abnormal brain imaging, or EEG.
Fellows in Psychosomatic Medicine rotating in this clinic enhance their skills evaluating and treating these neuropsychiatric symptoms. They have the opportunity to further develop their skills in conducting a focused neurological exam, and in the use and interpretation of neuropsychological assessment as well as CNS imaging. The clinic occurs Monday afternoons, preceded by an academic conference. At the conference, trainees present live patients to a multidisciplinary group of faculty and trainees (from neurology, neuropsychology and psychiatry) for discussion with reference to systems based practices.
SITE: NYU LANGONE MEDICAL CENTER (Four Months)
Inpatient Rotation: Consultation-Liaison Service, Tisch Hospital
Tisch Hospital, with 705-beds, is NYU Langone Medical Center’s flagship hospital, drawing patients from the community and around the world. Fellows work closely with attendings offering psychiatric consultations across all inpatient medical/surgical units and the emergency room. Fellows benefit from the experience of training in a private, not for profit university hospital, with a unique patient population and state of the art medical services.
Outpatient Rotation: Clinical Cancer Center
Clinical Supervisor: James Fraiman, MD
The NYU Cancer Center Institute, a part of the NYU Medical Center, is a “matrix cancer center,” meaning that it is a center without walls operating within the larger medical institution. Patients receive the care they need in one convenient location located a few blocks from the main campus of NYU Hospital.
The NYU Clinical Cancer Center’s Supportive Services Program provides emotional and practical support services to enhance the quality of life for patients living with cancer, their family members, loved ones and caregivers. The Psycho-Oncology Program provides psychiatric evaluations and referrals, crisis intervention, psychopharmacological assessment and treatment, counseling, clinical staff training, patient seminars and workshops, pain management, palliative care, physician and clinical staff consultation, and inpatient services coordination.
Fellows spend one-half day per week for four months, on site in the NYU Clinical Cancer Center’s Psycho-Oncology Program. They have the opportunity to evaluate and treat oncologic outpatients with psychiatric needs, under the supervision of Dr. Fraiman, the NYU Clinical Cancer Director of Psychiatry.
The formal curriculum provides fellows with a theoretical body of knowledge relevant to psychiatric services in medically and surgically complex patients. Teaching faculty come from multiple psychiatric, medical and surgical specialty areas from all three hospitals, such as from Palliative Care, Pain Medicine, Internal Medicine, Bariatric Surgery, Neurology, Neuropsychology, Health Psychology and Addiction Medicine, among others. Weekly seminars taught by the faculty alternate with clinical case conferences and literature reviews presented by the fellows. Additionally, each of the three CL teaching services incorporates its own unique set of weekly academic conferences and teaching rounds. Fellows also attend weekly Psychiatry Grand Rounds at NYU, followed by a bi-monthly Psychosomatic Medicine Fellows Process Group.
We look for mature, motivated applicants who must have satisfactorily completed an ACGME-accredited general psychiatry residency prior to entering the program. We consider such factors as one’s preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation, integrity and even temperament. We strive for a well-rounded, diverse class of three fellows with individual strengths in different areas. NYU does not discriminate with regard to sex, race, age, religion, color, national origin, disability, or any other applicable legally protected status.
The Academy of Psychosomatic Medicine, the organizational sponsor for the ABPN-accredited subspecialty of Psychosomatic Medicine (PM) has recently announced its participation in the NRMP Specialties Match Program. General Psychiatry fourth-year residents will now be able to apply for fellowships in Psychosomatic Medicine through the NRMP Specialties Match Program, for fellowship training starting July 2014. ERAS applications will not be used; applications should be sent directly to the program coordinator (address below).
Please submit the following materials:
- A completed application form* (Download PDF) (Download DOC)
- Your Curriculum Vitae/Resume
- A personal statement about why you wish to train in this Fellowship (one to two pages)
- A letter from your Medical School Dean
- Letters of reference **
*We also accept the APM Common Fellowship Application, which can be found at:
http://www.apm.org/career/common-app-pm-fellowship.shtml. Kindly note that we will still ask you to supplement the Common Application with Page 2 of the NYU Application Form.
**Please arrange for a minimum of two (but not more than three) letters of reference from persons who are familiar with the nature and quality of your work; one of those persons must be the Director of your General Psychiatry Residency Program. Letters of reference should be submitted directly by their authors.
International applicants must also submit the following documentation:
- Valid ECFMG certificate
- Proof of Visa status or US citizenship
ELECTRONIC SUBMISSION (Preferred)
NYU School of Medicine
Department of Psychiatry
1 Park Avenue, New York, NY 10016
The program begins reviewing applications in May and interviews are usually scheduled to take place in late summer/early fall. Interviews will not be able to take place after December 1st in order to make the rank order list deadline. No application is considered until all required materials have been received, including the training or clinical Director’s letter of recommendation. Applications are reviewed by a screening committee which identifies a list of short listed candidates who will be invited to interview. Interviews generally take a full day and include meetings with faculty representatives of several different rotations as well as a chance to meet current Fellows.
An offer of employment is not final until the fellow has been successfully credentialed by the NYU office of Graduate Medical Education. Terms of employment, including current year salary levels, benefits, duty hours, moonlighting policy, etc., may be found at http://gme.med.nyu.edu/about-gme/gme-policies-and-forms/graduate-medical-education-policies-and-procedures.
Mark Bradley, MD
Director, Psychosomatic Medicine Fellowship
(212) 686-7500, ext. 7180