When to Start Your Job Search: A Guide for Med-Psych Residents

Understanding the Medicine-Psychiatry Career Landscape

Medicine-Psychiatry combined training opens doors to a uniquely flexible career. You can work as a hospitalist, outpatient internist, consultation-liaison psychiatrist, inpatient psychiatrist, integrated care leader, addiction physician, or any combination of these roles. That flexibility is a huge asset—but it also makes timing your job search more complex than in a single-specialty residency.

For med psych residency graduates, the attending job search is not one-size-fits-all. Your ideal timing depends on:

• What balance of medicine vs psychiatry you want
• Whether you want academic vs community practice
• Whether you’re targeting hospital employment, group practice, or hybrid/portfolio work
• Your geographic constraints (family, partner’s job, visa needs)
• Whether you’re adding a fellowship (e.g., C-L, addiction, geri, HPM)

This guide focuses on job search timing: when to start, how to pace milestones, and how to avoid common timing pitfalls in the physician job market—specifically for medicine-psychiatry combined graduates.

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Big-Picture Timeline: From Residency to First Attending Job

Most med psych residents underestimate how early they should think about timing. Because the physician job market in psychiatry is generally strong, there’s a temptation to assume “I can find something anytime.” While partly true, poorly planned timing can still cost you:

• Ideal locations
• Positions with true combined practice
• Negotiation leverage
• A smooth transition between graduation and your first paycheck

Below is a general timeline for a 5-year med psych residency finishing in June PGY-5 and going straight into practice (no fellowship). You can adjust the months proportional to your situation.

18–24 Months Before Graduation (Early PGY-4)

• Clarify your broad career direction:
  • Approximate split: 100% psychiatry? 50/50 medicine psychiatry combined? 70% psych with some medicine coverage?
  • Preference: Academic vs community vs hybrid
  • Setting: Inpatient, outpatient, consult, ED psych, integrated primary care, correctional, VA, etc.
• Explore models of combined practice:
  • Talk to med-psych faculty and graduates about their jobs
  • Identify institutions that actually use your dual skillset (e.g., C-L psych with hospitalist cross-coverage, integrated clinics, medical-psychiatry units)
• Start geographic thinking:
  • Regions or cities you can/cannot consider
  • Partner/family constraints
  • Visa implications if applicable (H-1B/J-1)

At this stage, you are not actively applying, but you are mapping your options so you can pivot quickly when it’s time.

12–18 Months Before Graduation (Late PGY-4 / Early PGY-5)

• Decide: Fellowship vs job market now
  • If considering C-L, addiction, geri, or other fellowships, you are already deep into those application timelines.
  • If you’re skipping fellowship, this is when to begin light, strategic exploration of the physician job market.
• Start informal networking:
  • Let mentors and program leadership know your interests: “I’m looking for a combined medicine psychiatry residency–friendly job with X/Y balance.”
  • Attend relevant sessions at national meetings (APA, ACP, AAPL, Academy of Psychosomatic Medicine/ACLP) and introduce yourself.
• Update your CV and create a job-search email template.
• Start a “target list” of:
  • 10–20 institutions or health systems where a med psych residency background is valued
  • 3–5 regions you’d accept, plus 1–2 “daydream locations” just to keep options open

This is prep time. The real applied attending job search will likely ramp up 9–12 months prior to graduation.

9–12 Months Before Graduation (Mid PGY-5)

This is the sweet spot for most med psych residents going directly into practice.

• Begin actively searching and inquiring:
  • Search major job boards and specialty-specific resources:
    • APA job board
    • ACP career resources (if you’re open to hospitalist or outpatient medicine roles)
    • Academic institution listings
    • Physician job market platforms (like Doximity, PracticeLink, NEJM CareerCenter)
  • Reach out directly to department chairs, division chiefs, and medical directors.
• Send targeted, personalized emails:
  • Highlight your combined training: “I’m completing a 5-year Medicine-Psychiatry combined residency, board-eligible in both IM and Psychiatry in June [Year]. I’m interested in opportunities that allow X/Y balance…”
• Schedule initial conversations and interviews:
  • Many academic centers and large systems plan hiring 9–12 months out, especially if they want to build a medicine psychiatry combined service line or integrated clinic.

For graduates seeking true combined practice (not just “you’ll cover psych and some medical issues informally”), 9–12 months is the critical window. Institutions may need time to design or reconfigure a role that uses your skillset.

6–9 Months Before Graduation (Late PGY-5)

• Aim to have several serious leads or formal offers emerging.
• On-site or virtual site visits usually take place now.
• Negotiate contract details:
  • FTE split between medicine and psychiatry
  • Inpatient vs outpatient balance
  • Call responsibilities (on both sides)
  • Protected time for teaching, research, or program development
  • Compensation structure and benefits
• Confirm logistics:
  • State licensure timing (start early)
  • Credentialing and privileging timelines
  • Board exam dates and prep plans

By 6 months out, the goal is to have at least one viable offer you would be comfortable accepting—even if you’re still exploring. This gives you leverage and peace of mind.

3–6 Months Before Graduation

• Finalize your choice and sign a contract if you haven’t already.
• Complete licensing and credentialing requirements:
  • State medical license(s)
  • DEA registration
  • Hospital privileges
  • Insurance enrollment (Medicare/Medicaid, major payers)
• Plan your transition and moving logistics.
• Clarify specifics of your combined role:
  • First-year expectations
  • Performance metrics (RVUs, quality targets, teaching)
  • How your dual training will actually be utilized day-to-day

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When to Start the Job Search: Key Scenarios for Med-Psych

The question “when to start job search?” has different answers depending on your path. Below are the most common Medicine-Psychiatry trajectories and how timing typically works.

Scenario 1: Going Straight into Practice (No Fellowship)

Best window to start active search:
9–12 months before graduation

Why:

• Academic centers and large systems generally hire 6–12 months ahead.
• Combined roles may need role design time (e.g., building a med-psych clinic, med-psych inpatient unit, or integrated C-L/hospitalist hybrid).
• You want cushion for contract negotiation and licensing delays.

Too early?

• More than 18 months out can be premature except for very specific institutions or leadership-track roles.
• Hospitals may not be able to commit budget that far ahead.

Too late?

• Starting only 3–4 months before graduation can:
  • Limit geographic options
  • Force you into “generic psychiatry” roles that waste your internal medicine training
  • Leave gap months with no income if credentialing drags

Scenario 2: Planning a Fellowship after Med-Psych (e.g., C-L, Addiction)

Here, you actually have two job searches:

1. Fellowship search (during mid-PGY-3 to PGY-4 depending on specialty)
2. Post-fellowship attending job search

For the post-fellowship job:

• Start exploring about 12–18 months before you finish fellowship.
  • That often means: halfway through fellowship year.
• Actively search 9–12 months before fellowship completion.

Many combined-trained physicians worry: “Will I lose my internal medicine edge during psych-heavy fellowship?” You can mitigate that by:

• Seeking roles post-fellowship that explicitly value your med-psych background:
  • C-L with real medical decision-making authority
  • Med-psych units
  • Integrated medical-behavioral health clinics
• Maintaining some medicine exposure (e.g., moonlighting in medicine during fellowship, where allowed and realistic).

Scenario 3: Visa-Dependent Residents (J-1 or H-1B)

If you’re on a visa, when to start job search becomes more urgent.

• Start actively searching 12–18 months before graduation.
• Target employers with prior experience in:
  • J-1 waiver positions (often in underserved or rural areas)
  • H-1B sponsorship (large systems, VAs, academic centers)
• Clarify with employers early:
  • Their comfort with dual boards (IM + Psych)
  • Whether the position is framed as psychiatry, internal medicine, or hybrid for waiver purposes

Visa constraints can narrow your geographic range, but they can also be an opportunity:

• Many underserved areas actively seek psychiatrists.
• Combined-trained physicians may be especially valued where both medical and psychiatric needs are high but local workforce is thin.

Scenario 4: “Still Figuring It Out” in Late Residency

Some med psych residents legitimately don’t know what they want until late PGY-5. If you’re in this camp:

• Start low-pressure exploration by early PGY-5:
  • Talk to alumni in different roles (100% psych, 100% medicine, and combined positions).
  • Moonlight on both sides if allowed—hospitalist shifts, psych call, C-L coverage.
• If you only begin serious searching 4–6 months before graduation:
  • Focus broadly on the psychiatry side first; psychiatry jobs are more abundant and flexible.
  • Negotiate for the possibility of evolving the role into something more combined after year one (for example, adding integrated clinics or liaison responsibilities).

In this scenario, your first job may be more of a launching platform than a perfect final destination.

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Strategically Using Your Combined Training in the Job Market

Knowing when to search is only half of the strategy. For medicine psychiatry combined graduates, it’s equally important to define how you want to use your dual skillset—and align timing with that plan.

Choosing Your Clinical Identity

Before you dive into the physician job market, ask yourself:

• Do I want the world to see me primarily as:
  • A psychiatrist who can handle complex medical patients?
  • An internist/hospitalist with advanced behavioral health skills?
  • A true hybrid who splits time roughly evenly between IM and psych?

Your answer affects:

• Which departments you contact first (Medicine vs Psychiatry vs both).
• How far in advance you need to negotiate a combined job. Building a hybrid role often takes more lead time than filling a standard psychiatry vacancy.

Models of Combined Practice and How They Impact Timing

Common ways med psych residency graduates practice include:

1. Consultation-Liaison Psychiatry with Explicit Medical Role

   • Timing: Often academic centers; start 9–12 months out.
   • You may negotiate:
     • C-L plus occasional internal medicine consults
     • Coverage of psych needs on medicine floors, and medical input on psych units

2. Integrated Primary Care / Collaborative Care

   • Timing: Often health systems and large clinics; 6–12 months out is typical.
   • Roles where you:
     • Serve as psychiatric consultant to PCPs
     • Help design integrated clinics specifically for high-utilizer, medically complex patients

3. Med-Psych Inpatient Units or “Complex Care” Services

   • Timing: Plan early; these are niche but powerful roles.
   • If a system is building or expanding a med-psych service, they might:
     • Start recruitment more than a year in advance
     • Be highly interested in your input on program design

4. Standard Psychiatry with “Extra Skills”

   • Timing: The most flexible. Many systems will hire up to 3–6 months before start.
   • Your medication choices, risk assessments, and ability to handle medically complex patients stand out, even if your FTE is labeled “ Psychiatry.”

5. Hospitalist or Outpatient IM Roles with Behavioral Expertise

   • Timing: Hospitalist positions often recruit 6–9 months out; outpatient IM can be similar.
   • Emphasize:
     • Skills with patients who have SUD, psych comorbidity, functional symptoms, or high ED utilization
     • Comfort with de-escalation and behavioral plans

Each model has different timeline pressure. The more customized and innovative the role, the earlier you need to get on their radar.

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Practical Steps and Milestones in the Med-Psych Job Search

1. Build a Med-Psych-Specific CV and Professional Narrative

Your CV and elevator pitch should make your combined identity clear:

• Education: Highlight dual residency and expected board eligibility in both IM and Psychiatry.
• Key rotations or electives:
  • Med-psych units
  • Integrated care clinics
  • C-L electives with strong medical complexity
• Scholarly work:
  • Quality-improvement projects bridging medicine and psychiatry
  • Research or teaching on integrated care, SUD, functional disorders, etc.

Timing tip: Update your CV at least 12 months before graduation so you can respond quickly when roles appear.

2. Network Intentionally (Not Randomly)

The med psych world is small. Use that to your advantage:

• Ask your program leadership: “Which alumni are in jobs I might like?”
• Attend niche conferences or sessions:
  • Academy of Consultation-Liaison Psychiatry (ACLP)
  • APA special interest groups for med-psych and integrated care
  • ACP sessions on behavioral health integration
• Request brief informational interviews:
  • “Can we talk for 20 minutes about your job and how you got there?”
  • Ask specifically about when they started their search and what they’d change in hindsight.

Timing tip: Begin these conversations 12–18 months before graduation. They’ll often lead organically to “Let me connect you with X who is hiring.”

3. Approach Departments Proactively

Do not rely solely on posted jobs. For med psych residency grads, some of the best roles are never formally listed.

• Email department chairs or clinical chiefs (both Medicine and Psychiatry) around 9–12 months before graduation with:
  • Short introduction (training, interests, timing)
  • A 1–2 sentence description of your ideal combined role
  • Attached CV
• Ask whether:
  • They have existing roles that might fit
  • They’d be interested in creating or reshaping a position

Timing tip: This proactive step is most effective 9–12 months out; earlier than 18 months, they may not have clarity on staffing needs.

4. Understand Credentialing, Licensing, and Start-Date Lag

Even if the physician job market is friendly, bureaucracy is slow:

• State licensure can take 3–6 months (or more).
• Hospital credentialing can take 2–4+ months.
• Insurance paneling may add more delays in outpatient settings.

Work backward:

• Desired start date: July 1
• Aim to sign contract: December–February
• Start license application: as soon as you’re reasonably sure of the state (often 6–9 months before start)

Planning these steps early prevents avoidable “gap months.”

5. Negotiate Timing Flexibility and Role Evolution

Because med psych is relatively niche, you often have room to negotiate evolution over time:

• Ask for:
  • A clear starting role (e.g., 0.7 FTE psych inpatient, 0.3 FTE med-psych consults).
  • A 1–2 year review to adjust your balance of medicine vs psych based on departmental needs and your preferences.
• Clarify:
  • How quickly you must be fully onboarded (e.g., board certification deadlines, credentialing steps)
  • Whether they can delay your start date slightly if you have personal commitments or board exam timing concerns.

Align this with your job search timing: the earlier you start conversations, the more you can shape the role rather than just filling it.

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Common Mistakes in Job Search Timing for Med-Psych and How to Avoid Them

Mistake 1: Waiting Too Long Because “Psychiatry Is in Demand”

While psychiatry demand is high, good combined roles are limited. If you delay:

• You may end up in a 100% general psychiatric role with no structured medical component.
• You lose the chance to help design a med-psych or integrated program that fits your strengths.

Avoid it by:
Starting active search 9–12 months out, especially if you want a true medicine psychiatry combined job.

Mistake 2: Only Talking to Psychiatry Departments

Many med psych residency graduates forget half their training when job searching.

• Internal medicine departments may:
  • Be excited about your ability to manage complex patients with psychiatric comorbidities.
  • Be open to co-developing roles that bridge medicine and psychiatry.
• Hospital leadership (CMO, service line leaders) may:
  • Be looking for someone exactly like you to lead integrated initiatives.

Avoid it by:
Reaching out to both Medicine and Psychiatry leadership in your target institutions and keeping your options broad in the early phases.

Mistake 3: Underestimating Licensing/Board Exam Timing

If you time your job search too late:

• You might sign a contract very close to graduation.
• Then discover licensure and credentialing will delay your start date by several months.
• Financial stress and CV gaps can follow.

Avoid it by:
Aligning your attending job search with your licensing and exam schedule; aim to finalize a contract at least 4–6 months before your intended start date.

Mistake 4: Not Clarifying How “Combined” the Role Really Is

Titles can be deceptive. A position might be labeled “med-psych” but functionally be:

• A general psychiatry inpatient role with occasional simple medical consults
• A hospitalist job that occasionally fields a call about agitation

Avoid it by:

• Asking very specific questions during interviews:
  • “How much of my FTE is in Psychiatry vs Internal Medicine?”
  • “What are the typical diagnoses and consult types I’ll see?”
  • “How many other med-psych trained physicians are here?”
  • “What would a typical weekly schedule look like?”

The earlier you ask, the sooner you can filter roles and avoid misalignment.

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FAQs: Job Search Timing in Medicine-Psychiatry

1. When should I start my job search if I’m in a Medicine-Psychiatry combined residency and not doing a fellowship?

For most med psych residency graduates, begin active searching 9–12 months before graduation. Start light exploration and networking 12–18 months out, but focus concrete applications and interviews in that 9–12-month window, especially if you want a role that truly integrates internal medicine and psychiatry.

2. Is it harder to find a medicine psychiatry combined position than a psychiatry-only job?

Yes. While the overall physician job market for psychiatry is strong, truly integrated med-psych roles are fewer and often concentrated in academic or large health systems. This is why starting earlier matters—you may need time for an institution to shape a position around your combined skillset. That said, many standard psychiatry positions will value your internal medicine background even if your FTE is labeled “Psychiatry.”

3. What if I’m not sure how much medicine vs psychiatry I want in my first job?

If you’re unsure, treat your first job as a launching pad rather than a final destination. Start with roles that:

• Give you broad exposure (e.g., C-L services, units with high medical comorbidity)
• Are in systems open to role evolution (e.g., building integrated clinics or med-psych tracks over time)

Begin serious job exploration by early PGY-5, and prioritize employers who are explicit about their willingness to adjust your mix of medicine and psychiatry after the first year or two.

4. How does a fellowship (like C-L or addiction) change my job search timing?

Fellowship adds an extra layer. You’ll apply to fellowship earlier (often in PGY-3/4), then do an additional year before entering the attending market. For the attending job search, you still generally begin 9–12 months before completing fellowship. Because you’ll be even more specialized, it’s particularly helpful to reach out to departments 12–18 months out for networking and exploration, then formalize applications in the typical 9–12-month window.

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By thinking deliberately about when to start job search, aligning that timing with your preferred balance of medicine and psychiatry, and engaging both Medicine and Psychiatry departments early, you position yourself to step into a role that truly leverages your med psych residency training. The physician job market needs clinicians who are comfortable at the interface of body and mind; careful timing ensures that need translates into a career that fits your skills and goals.