Advice: Leaving Child Fellowship after Just One Year

[RyanS32122]

Hello:
I think I already know the answer to this but I would like to get input from others. I fast-tracked into a child psychiatry fellowship program, and am now in my first of two years (PGY-4).

An academic job opportunity has opened up that I am very interested in for 7/1/14. It's the sort of job that is pretty much ideal for me and I can see myself in this role and such. It is not the sort of opportunity that comes along very often and I feel quite compelled to snag it while I can.

If I was to take it, I would finish my PGY-4 year, and NOT do my PGY-5 year. Thus, I would be Boarded in General Psychiatry, and not Child Psychiatry, which is NOT a problem for me at all.

So, I guess I don't have a "question," just looking for thoughts I guess. Is this sort of thing done - ie., leaving a child program 1/2 way through? How frowned upon is this? Any thoughts would be appreciated.

Thanks all!

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[twright]

Hello:
I think I already know the answer to this but I would like to get input from others. I fast-tracked into a child psychiatry fellowship program, and am now in my first of two years (PGY-4).

An academic job opportunity has opened up that I am very interested in for 7/1/14. It's the sort of job that is pretty much ideal for me and I can see myself in this role and such. It is not the sort of opportunity that comes along very often and I feel quite compelled to snag it while I can.

If I was to take it, I would finish my PGY-4 year, and NOT do my PGY-5 year. Thus, I would be Boarded in General Psychiatry, and not Child Psychiatry, which is NOT a problem for me at all.

So, I guess I don't have a "question," just looking for thoughts I guess. Is this sort of thing done - ie., leaving a child program 1/2 way through? How frowned upon is this? Any thoughts would be appreciated.

Thanks all!

It's not typical. Medicine obviously selects for people who are good doobies. That said, if this job thing is a great opportunity that you don't want to pass up then you should do what you think it's best for yourself...

 

[psychattending]

Hello:
I think I already know the answer to this but I would like to get input from others. I fast-tracked into a child psychiatry fellowship program, and am now in my first of two years (PGY-4).

An academic job opportunity has opened up that I am very interested in for 7/1/14. It's the sort of job that is pretty much ideal for me and I can see myself in this role and such. It is not the sort of opportunity that comes along very often and I feel quite compelled to snag it while I can.

If I was to take it, I would finish my PGY-4 year, and NOT do my PGY-5 year. Thus, I would be Boarded in General Psychiatry, and not Child Psychiatry, which is NOT a problem for me at all.

So, I guess I don't have a "question," just looking for thoughts I guess. Is this sort of thing done - ie., leaving a child program 1/2 way through? How frowned upon is this? Any thoughts would be appreciated.

Thanks all!

It is rarely done and would be viewed negatively in the academic world especially if your PD was not in favor of it.

 

[honsano]

If the job is pretty rare would you assume there is going to be competition for this job? If so it would kind of suck to not get it, be out of fellowship and have to find another job. In general a fellowship makes you more attractive in the job market so that is also something to consider.

 

[whopper]

It is rarely done and would be viewed negatively in the academic world especially if your PD was not in favor of it.

I saw the title not expecting the actual content to match what I thought it was going to say.

Three people I know did child fellowship and voluntarily got out of it after one year. Each of them couldn't deal with medicating children and believed the infrastructure of treatment was highly pushed to do that when in fact the children had problems medications wouldn't improve. They were fed up with it and decided to leave.

I can't really comment without more specifics. I get job offers all the time. Residents and new attendings tend to think some job opportunities will never happen again when in fact they are actually quite frequent especially if you've kept your options open, have good networking, and people in the area know who you are and respect your clinical skills.

Another aspect is several people get sick of a job they thought they'd love. Yeah well when one does the same thing over and over for years, you get sick of it. Medschool and residency doesn't prepare us for this because up until then it was a dump of data on the brain of inhuman proportions.

What I'd factor my decision on is whether or not you like child psychiatry. If so, that's a factor to stay through with the fellowship vs what the proposed job will provide you.

 

[psychattending]

I saw the title not expecting the actual content to match what I thought it was going to say.

Three people I know did child fellowship and voluntarily got out of it after one year. Each of them couldn't deal with medicating children and believed the infrastructure of treatment was highly pushed to do that when in fact the children had problems medications wouldn't improve. They were fed up with it and decided to leave.

I can't really comment without more specifics. I get job offers all the time. Residents and new attendings tend to think some job opportunities will never happen again when in fact they are actually quite frequent especially if you've kept your options open, have good networking, and people in the area know who you are and respect your clinical skills.

Another aspect is several people get sick of a job they thought they'd love. Yeah well when one does the same thing over and over for years, you get sick of it. Medschool and residency doesn't prepare us for this because up until then it was a dump of data on the brain of inhuman proportions.

What I'd factor my decision on is whether or not you like child psychiatry. If so, that's a factor to stay through with the fellowship vs what the proposed job will provide you.

Leaving a training program because one has figured out it is not the area for him/her is a fine reason. In such situations, the trainee should be talking with his/her director about the issues and the director will agree with the conclusion the person has drawn. The director will be able to write a good letter in such situations and there will be no serious repercussions. In my 20 odd years, I know of only one person who left a child program after a year and is was for a reason similar to ones you gave.

 

[whopper]

Leaving a training program because one has figured out it is not the area for him/her is a fine reason. In such situations, the trainee should be talking with his/her director about the issues and the director will agree with the conclusion the person has drawn. The director will be able to write a good letter in such situations and there will be no serious repercussions. In my 20 odd years, I know of only one person who left a child program after a year and is was for a reason similar to ones you gave.

I'm digressing somewhat from the original author's question...

But the thought crossed my mind, how many fellows leave child psychiatry? Cause even as a resident I thought the market and clinical forces pushed to medicate kids inappropriately. When I knew of three that left and found out about them within two years, it made me wonder.

I think the market forces even push for adults to be inappropriately medicated. Who here hasn't seen a borderline PD patient with no Axis I put on lithium and misdiagnosed as bipolar disorder even with the prescriber, when asked, saying they don't have bipolar disorder. Thing with adults is at least they can put their foot down and say no.

 

[psychattending]

I'm digressing somewhat from the original author's question...

But the thought crossed my mind, how many fellows leave child psychiatry? Cause even as a resident I thought the market and clinical forces pushed to medicate kids inappropriately. When I knew of three that left and found out about them within two years, it made me wonder.

I think the market forces even push for adults to be inappropriately medicated. Who here hasn't seen a borderline PD patient with no Axis I put on lithium and misdiagnosed as bipolar disorder even with the prescriber, when asked, saying they don't have bipolar disorder. Thing with adults is at least they can put their foot down and say no.

Agree with your market forces statement. In addition I think that some people use drugs in a false sense that it will help because they have to do something. I continually remind my residents that medications can sometimes cause more harm than good and that it is the job of a good clinician to make the correct Dx and not use medications when it is not appropriate. I also remind them that there are more things we can do than just medications (e.g. psychotherapy).

 

[notdeadyet]

Job offers come and go. Leaving a fellowship program early has the potential to follow you around. If your reasons for wanting to leave are simply because of a good job offer, I would stick it out.

Seeing a bunch of applications come through, if one has someone who dropped out of fellowship halfway through, this would be a flag. Maybe an explainable one, but a flag. And since you seem to be interested in a competitive area like academics, I would lean towards avoiding creating flags on my resume.

 

[lupinibeanie]

Hi Ryan, and all

I can't believe I came across this thread! So when I began my CAP1 year (PGY4, I too fast tracked), I had significant difficulties with the transition. I moved to a new program, and obviously began a new field of psychiatry altogether. I began to question for the first time ever if what I always thought I wanted to do (child psych) was in fact what I wanted to do, and what I could see myself doing in my career. It was a very difficult time of transitions. With time, I have stuck it out through my first 4 months, and also attended the AACAP conference for the first time. Now I know that I do in fact want to work with children (what a relief to finally feel the click!) and that the field of child psych is right for me.

What I'm realizing, however, is my current program and I just do not fit together well (for multiple reasons), and from what I have heard and seen about the CAP2 year, things will be getting worse. I have been trying to find out -1. If there are any potential CAP2 positions available for next year (if people like you are out there and are NOT wanting to continue with child) and 2.how I can make the transition to a new program to complete my 2nd year

Any advice from anyone would be much appreciated

many thanks,
L.B.

 

[RyanS32122]

While I do enjoy child psychiatry, it is not as exciting to me as I thought (...and hoped) it would be. I'm surrounded by a bunch of great fellows who LOVE this area, and I am sort of so-so about it. However, you get me teaching, or developing curricula, or other elements within the realm of medical education such as this, and I buzz with the same enthusiasm as the others I work with do about child. When teaching, I go to work excited and leave even more excited. I am not getting that with child. Granted, there are elements of it I like, but much more so with teaching and administration. These elements, coupled with a great academic job offer, simply got me thinking of my options. And by academic, I do not mean Johns Hopkins, I mean a small medical school faculty position (with some clinical opportunities in college student mental healthcare).

 

[OldPsychDoc]

While I do enjoy child psychiatry, it is not as exciting to me as I thought (...and hoped) it would be. I'm surrounded by a bunch of great fellows who LOVE this area, and I am sort of so-so about it. However, you get me teaching, or developing curricula, or other elements within the realm of medical education such as this, and I buzz with the same enthusiasm as the others I work with do about child. When teaching, I go to work excited and leave even more excited. I am not getting that with child. Granted, there are elements of it I like, but much more so with teaching and administration. These elements, coupled with a great academic job offer, simply got me thinking of my options. And by academic, I do not mean Johns Hopkins, I mean a small medical school faculty position (with some clinical opportunities in college student mental healthcare).

I think those opportunities will be there, and more, if you have completed your fellowship.
Just my opinion.

BTW, if they REALLY want you, the may be willing to wait, especially if you will then be bringing additional credentials to the table.
And unless your fellowship is structured differently than most I've seen, you should have even more opportunities in the PGY5 year to further develop in those teaching, curricular, and administrative elements that you enjoy.

 

[DebDynamite]

I only did one year of child as a pgy4. I just could not stand the thought of six years of training and I was really wanting to do forensics. So, I left child after one year and graduated and went straight into forensics. It did not hurt me one bit. Granted, it ticked off my (Child) PD and he never really liked me after that. However, I simply did not use him as a reference. Because I had: #1, my forensic PD as my most recent PD for a reference, and #2, technically my child PD was not the PD who graduated me from general training, so I was not compelled to ever list him as my most recent PD ( because when you leave Child as a pgy4 you technically graduate from a general program, not Child). The only people I have ever encountered who have made comments about it "hurting" my reputation were pretty OCPD academic types. Most people I know have either said " I would leave Child too!" or, something along the lines of how it's too bad I didn't finish bc I would be great w/kids etc etc.

So, don't let the naysayers get you down. I have not one regret over the year of child I experienced, nor do I regret leaving it early. I developed the opinion that most generally trained psychiatrists miss out by not getting a longer exposure to child. I think it helped me tremendously with autism spectrum disorders and I can clearly see how many of my (very smart and well trained ) general colleagues miss ASD when child training could have prevented that. It also helped with my forensic training because I was exposed to reactive attachment (inhibited type) which does not equate to antisocial PD as an adult, but admittedly I may have thought so had I not done the year of child. I guess what I am saying is that I think the year I did made me a much better clinician. The second year seemed to be a long year of scutwork and I realized I had no desire to treat young children, so I left. Four years of psychiatry training, enough is enough!

I will add though, that if I wanted to really stay immersed in the world of Child, or treat young children, I would have gladly finished the last year. And OPD has a good point in that Academia favors more credentialing, not less. I would just consider what you want to do in the future. I was sure I didn't want to treat young kids with drugs and you can't adopt and re-parent them all.


Good luck in your decision.

 

[RyanS32122]

I am really enjoying hearing the varied responses, above. It helps me to know that I am not the only person that has been in this boat before. If I as head-over-heals about child, I probably would not even be asking this question. It's interesting, but so-so for me. I think that is one part of why I am bringing this up. I'm also a NHSC Scholar and that plays into my decision for this position with the current HPSA score designations.

In response to an earlier poster, absolutely, I am not going to leave the fellowship unless that job is "in the bag." If I do get it, I have the option of leaving the program or not. If I do not get it, I will stay for PGY5. It's not that I hate child and am dying to leave. I could do a PGY5 no problem if I had to.

What are people's thoughts on involving the PD at this early stage? No job in the bag yet. Should I wait to discuss this w her or do it now? I ask because if I end up not getting the job, it's a moot point. (It's a position I was chosen for, it's not advertised, so I think it's in the bag, but I don't want to be overzealous).

Thanks to you all for all this advise!

 

[DebDynamite]

You are going to receive a wide variety of speculative responses here about when/how to tell your current PD. It just depends on the developmental level of your PD as to how they will respond. In a perfect world they would have your best interest at heart and weighs the pros and cons with you and support your decision either way. Who knows how they will actually respond? I knew how my PD would respond because I had spent enough time around him/her to assess and I was correct. Could have been better, could have been worse.

If you can get into the NHSC program in a position you know you can stay in you will be making a very smart financial move.

 

[billypilgrim37]

In general, child people will find you bailing to be terrible, and adult people will cheer you on for your infinite wisdom of avoiding child psychiatry. Since you no longer want to be a child psychiatrist, it probably doesn't matter what the child people think of you. Just never imply that you're a CAP based on the half training, lest you seek the wrath of CAPs and lawyers alike.

 

[whopper]

If you truly have an interest in CAP, I'd say finish the fellowship unless the job offer is a once-in-a-lifetime opportunity. Don't jump the gun and think the job offer is. Fellows, residents, and new attendings IMHO tend to think any job offer is fabulous because our last real reference of job offers was getting into residency or fellowship, a situation where you're one of several applicants. Getting an attending job is the other way around. More like for every 10 jobs available, there's one psychiatrist around.

I just wanted to clarify, I do think there is an incredible need for child psychiatrists, good ones that is, not the ones that medicate anything. Same goes for general psychiatrists as well.

 

[touchpause13]

Random question. If you do a fellowship like this can you mainly focus on adolescents or are you pushed on mostly younger kids?

 

[daru1]

Same situation here, this is something happens from time to time. Having been in practice before doing fellowship, I was specifically told by my old boss, in a very objective, non-judgmental way, that if I wanted to return or in fact find a new job, that they would still write excellent reference letters. Talking to colleagues "in the field," I'm under the impression that if not going into academics, leaving after 1 year is not a problem.

 

[VMSmith]

I assume the job is okay with you leaving fellowship after one year?

I think I'd have to agree with what most people are posting - rather than base your decision on whether or not you get this job, base it on whether or not you want to be a C&A psychiatrist. To me, it sounds like you are not that interested in doing C&A psychiatry, but don't want to leave your fellowship unless you have a job lined up afterward. If that's the case, I think it's perfectly reasonable to speak with your PD about the fact that you've realized you want to do adult psychiatry and want to leave early; while they won't be happy about it it's better than telling them in April.

My impression is that in general there are more opportunities in academics in the C&A world just due to demand, so if you finish your fellowship I imagine you'll have a lot of offers. If the idea of getting a C&A academic job is not that appealing to you, then I think you need to just make a decision about whether you actually would want to do C&A psychiatry period. If not, then it becomes a much easier decision.

 

[Psychobabbling]

I think the market forces even push for adults to be inappropriately medicated. Who here hasn't seen a borderline PD patient with no Axis I put on lithium and misdiagnosed as bipolar disorder even with the prescriber, when asked, saying they don't have bipolar disorder. Thing with adults is at least they can put their foot down and say no.

I agree with this. Usually the reasons I've been given are the hopes that (a) Lithium would decrease suicidality (b) possibility BPD is within the Bipolar Spectrum (whatever, BPD used to be in the Schizophrenia spectrum...)

 

[Shikima]

The market does force/push for incorrect diagnosis, leading to inappropriate medication use - all for the sake of a billable code.
I am a sad panda because of this.

 

[OldPsychDoc]

The market does force/push for incorrect diagnosis, leading to inappropriate medication use - all for the sake of a billable code.
I am a sad panda because of this.

What makes you think that Borderline PD is an unbillable code?

 

[Shikima]

What makes you think that Borderline PD is an unbillable code?

Well, unfortunately you've got me with my learned dogma pants down. The truism I based this on was that you can only bill for Axis I disorders. Looking forward in being corrected --- but the caveat to all of this is, how does DSM-V alter this belief pattern?

 

[lupinibeanie]

Hi Ryan

just checking in to see if you've made any progress on your decision, as I'm trying to scope out the possibilities for available 2nd year fellow positions come next summer... still trying to find a switch!

thanks! hope you're decision making process is getting easier
please PM me if you're open to discussing

-L.B.

 

[whopper]

I agree with this. Usually the reasons I've been given are the hopes that (a) Lithium would decrease suicidality (b) possibility BPD is within the Bipolar Spectrum (whatever, BPD used to be in the Schizophrenia spectrum...)

As I've mentioned, it can get difficult to differentiate someone with a weaker bipolar disorder (e.g. Bipolar II Disorder or Cyclothymia) and a personality disorder, or having both. In which case I can understand if someone medicates the patient, though only after doing the best the provider can in trying to figure it out based on interview, signs and symptoms.

But after the person's been medicated, after an adequate trial, for Heaven's sake, stop that medication if it didn't do anything beneficial. I sometimes think those doctors out there putting their borderlines (no Axis I, just borderline PD) on medication-gumbo for years are causing the person more damage than someone criminally assaulting them, and for these people to never even put the math together that 1+0 doesn't equal 2 lies somewhere between idiocy and lack of human decency. (Meds usually don't do much if anything for borderline PD, they are expensive, cause side effects, and for a doc to keep someone on a med that doesn't work, for no good reason other than to "treat the symptoms" when in fact the meds aren't even doing that....)

I can't see how one can use the argument of medicating a personality disorder as "treating the symptoms" when it is not treating the symptoms. If the patient got better, then the term "treating the symptoms" fits.

 

[remeron]

I am in the same boat, pls feel free to PM to discuss

 

[smalley]

I am in some sort of a similar spot.. I am not fitting into my program and want to move. Currently a pgy4 /Child fellow year 1 . any open pgy5/child psych year 2 spots available ?

 

[lupinibeanie]

I feel the same as smalley.
I'm still looking for either a first year or second year child fellow position
I'm willing to repeat the first year if it means I can find a program that fits me better.

Smalley, Remeron, Feel free to PM me please
thank you

 

[swifteagle43]

As someone who left child fellowship after one year, it is one of the BEST decision I ever made.

You have 5 years to go back according to ACGME and complete the fellowship for the PGY-5 year.

 

[PistolPete]

As someone who left child fellowship after one year, it is one of the BEST decision I ever made.

You have 5 years to go back according to ACGME and complete the fellowship for the PGY-5 year.

Can you expound on this? Why was it the best decision ever?

 

[vistaril]

Hello:
I think I already know the answer to this but I would like to get input from others. I fast-tracked into a child psychiatry fellowship program, and am now in my first of two years (PGY-4).

An academic job opportunity has opened up that I am very interested in for 7/1/14. It's the sort of job that is pretty much ideal for me and I can see myself in this role and such. It is not the sort of opportunity that comes along very often and I feel quite compelled to snag it while I can.

If I was to take it, I would finish my PGY-4 year, and NOT do my PGY-5 year. Thus, I would be Boarded in General Psychiatry, and not Child Psychiatry, which is NOT a problem for me at all.

So, I guess I don't have a "question," just looking for thoughts I guess. Is this sort of thing done - ie., leaving a child program 1/2 way through? How frowned upon is this? Any thoughts would be appreciated.

Thanks all!

if you don't want to mostly see kids, LEAVE NOW. Nobody gives a **** whether you spent your pgy4 year on what is essentially a bunch of child rotations or a bunch of adult electives. You will be fine.....just exit out and do mostly adult psychiatry and that will be cool.

 

[lemonlove]

if you don't want to mostly see kids, LEAVE NOW. Nobody gives a **** whether you spent your pgy4 year on what is essentially a bunch of child rotations or a bunch of adult electives. You will be fine.....just exit out and do mostly adult psychiatry and that will be cool.

One of my friends ended up matching into C&A Psychiatry, it is in our current program and she is having some cold feet about starting due to regrets over losing another year of income. I told her to give it a shot for a year and if she doesn't like it after a year, she can leave and just finish as an adult at the end of her PGY 4 year.