Child Psychiatry, some general questions

[Madden007]

Hey all,
I am a PGY-1 Psych resident. Words cant describe how useful this forum/community has been to me. I have a few general questions that I would like to read some thoughts on:

Do more "competitive" C&A programs give the leg up to applicants who completed an entire 4 year general psychiatry program versus those who want to apply to start after 3rd year?

How do programs select applicants to interview, given all the applicants have done basically the same things?

Is there a SDN thread for interview or program reviews of C&A programs, preferably from fellows?

Lastly, if there is a specific program that I am interested in fast tracking in, how do I begin to shows interest?

Thank you all for your time.

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[OldPsychDoc]

You're worrying too much.
I don't know much about the selection process by CAP fellowships, but they are looking primarily for strong letters from attendings in your program who can attest to your clinical abilities and aptitude for Child. You should be getting these in your 2nd and early 3rd year as you do CAP rotations. Get to know these folks. Make sure your PD knows that you're really interested in CAP, and work with your program to plan your schedule accordingly.
As far as specific programs--if you feel strongly, then by all means try to go to some national meetings and network, try to get your own attendings to introduce/go to bat for you--what ever natural connections you can latch on to.
I don't think there is any particular advantage to not fast-tracking. In fact, they might be inclined to wonder why a resident didn't do so if they were eligible to.

 

[MacDonaldTriad]

It would be interesting to try and characterize the real reasons people go into fellowships. Actual interest in the field is probably the most ideal. Being a year ahead of a spouse and hanging out an extra year before relocating is honorable. Having watched about 100 residents make this decision, I have to say many have some ambivalence about leaving training. “Look for an actual job! I know an easy way to put that off for 12 months.”

As far as fast tracking, often the PGY-III applicants don’t share the ambivalence much and perhaps a greater portion are truly interested in the field, but they have a greater portion of residents trying to get away from their adult program for whatever reason. Residence can become disenchanted with a program for lots of reasons; failed relationship, rubbed other residents wrong, rubbed some faculty wrong, got called out for something mildly nefarious and now embarrassed. Most PGY-IV years are fairly cushy and C&A is miserable if you don’t like the work so if you are running, be honest about your reasons.

 

[DD214_DOC]

I can only attest to my experience in one program, but C/A fellowship is not cushy. Workload wise, it's somewhere between PGY1 and PGY2. There is also a large amount of, "non-clinical" stuff you are expected to do. I was genuinely interested in learning more about the, "grey area" of psychiatry so that adults made more sense. I like working with adolescents and pre-adolescents, but the younger patient population is not that interesting to me. Would I do it again? I'm honestly not sure. Many times, it seems the, "system" you work with does nothing more than shift responsibility around until it ultimately comes to you, and parents/schools expect you to somehow magically, "fix" the child but are not willing to actually participate in anything.

Every parent seems to think their child will graduate with a 4.0 from Princeton. Aligning expectations with reality gets you nothing more than an angry parent who complains, and letting it go leaves you with an unhappy kid who acts out because of unrealistic expectations, which gets you an angry parent who complains.

 

[MacDonaldTriad]

God bless child and adolescent psychiatrists because in my view they have already been condemned to the worst jobs I can imagine. To each his own, just not my cup of tea.

 

[alina_s]

I strongly agree with HooahDOc. The not-cushy part was absolutely true, and for some technical reason that I never understood, we weren't even called fellows. Maybe to emphasize the "PGY-1 take-2" aspect??

"Competitive" is a very relative term here. The general residency at my school is competitive. In screening applications for the fellowship, though, we didn't invite some people who looked obviously underqualified but there wasn't any selectivity about scores, schools, adjective choice in LOR's...we wanted to fill the program.

 

[DD214_DOC]

C/A fellowship doesn't really add that much to revenue or income. In fact, I bet it probably decreases it because of the extra work involved to practice c/a psych, "correctly". I also feel much less like a physician in that role, and more like some kind of weird half-assed psychologist social-worker person.

I think to be really effective in eliciting change requires a person who is not afraid to start collecting patient complaints. Challenging the status quo within a family dynamic is where it's at most of the time. Unfortunately the system most of us work in does not care why complaints are filed, just that they are. So instead of taking the risk of pissing off a bunch of parents when challenging maladaptive patterns within a family dynamic, we just pill up the kids so they become compliant little zombies, something I continue to refuse to do despite any parental backlash.

I guess I'm just venting. /rant

 

[SmallBird]

C/A fellowship doesn't really add that much to revenue or income. In fact, I bet it probably decreases it because of the extra work involved to practice c/a psych, "correctly". I also feel much less like a physician in that role, and more like some kind of weird half-assed psychologist social-worker person.

I think to be really effective in eliciting change requires a person who is not afraid to start collecting patient complaints. Challenging the status quo within a family dynamic is where it's at most of the time. Unfortunately the system most of us work in does not care why complaints are filed, just that they are. So instead of taking the risk of pissing off a bunch of parents when challenging maladaptive patterns within a family dynamic, we just pill up the kids so they become compliant little zombies, something I continue to refuse to do despite any parental backlash.

I guess I'm just venting. /rant

This is the system in which we find ourselves; to navigate these relationships = psychiatry.

 

[digitlnoize]

This is the system in which we find ourselves; to navigate these relationships = psychiatry.

You guys are making me feel great about starting fellowship in July

Our fellowship isn't too rough from what I hear. Essentially just clinic from 8-5. A few days here and there where you run out and do a state hospital for a half day and neuro for a half day, or something like that. We do some telemed at our clinic inside the 8-5 hours too. From stalking their schedule the past few months, it seems there are a few days where they see 10 patients a day, but far more where they see 5 or 6, which seems reasonable and better than my adult schedule now, even with the extra paperwork.

Call is home pager call, q week, divided by however many residents there are, which for me is 7. So q7 week home pager call just covering ED consults for kids under 13. The adult resident sees all kids 13+ in the ED. I've heard it's hit or miss, but 1 or 2 calls per week is about average. Sometimes less, sometimes more.

I'm 1000% sure the parents will be difficult though.

 

[jlubin]

C/A fellowship doesn't really add that much to revenue or income. In fact, I bet it probably decreases it because of the extra work involved to practice c/a psych, "correctly". I also feel much less like a physician in that role, and more like some kind of weird half-assed psychologist social-worker person.

I think to be really effective in eliciting change requires a person who is not afraid to start collecting patient complaints. Challenging the status quo within a family dynamic is where it's at most of the time. Unfortunately the system most of us work in does not care why complaints are filed, just that they are. So instead of taking the risk of pissing off a bunch of parents when challenging maladaptive patterns within a family dynamic, we just pill up the kids so they become compliant little zombies, something I continue to refuse to do despite any parental backlash.

I guess I'm just venting. /rant

I was under the impression that due to c/a shortages and private outpatient clinic fees, child psychiatrists have significantly more earning potential than adult psychiatrists, especially in the Midwest. Plz correct me if I'm mistaken.

 

[digitlnoize]

I was under the impression that due to c/a shortages and private outpatient clinic fees, child psychiatrists have significantly more earning potential than adult psychiatrists, especially in the Midwest. Plz correct me if I'm mistaken.

If you own your own practice, yes. Salaries for employed child psychiatrists aren't that much higher than their adult counterparts. Maybe a 10k pay bump?

The difference is that most places that would hire a child psychiatrist take insurance. Insurance doesn't care how old you are, and a 99213 pays the same regardless of age. So, there's no pay bump really.

If you have your own cash practice in an area with a shortage (mostly everywhere) and enough $$$ (not everywhere but many places) to pay your rates, then yes, child is more lucrative. But you have all the headaches of running your own office which most people aren't really interested in.

 

[hamstergang]

If you own your own practice, yes. Salaries for employed child psychiatrists aren't that much higher than their adult counterparts. Maybe a 10k pay bump?

At the hospital where I'm doing most of my rotations, I do believe C/A is a $10k increase.

As for parents, they can be difficult but are also useful at times. They can help convince patients of treatment options at times and also assist in providing an eye on the patients at home. Also, some cases become much clearer after interacting with the parents, something you rarely get with adults.

 

[F0nzie]

I'm 1000% sure the parents will be difficult though.

The apple doesn't fall far from the tree.

 

[Leo Aquarius]

At the hospital where I'm doing most of my rotations, I do believe C/A is a $10k increase...

And with that small incremental salary increase, it will take someone about 14 years to break even with the salary lost by delaying your physician salary a year.

 

[Merovinge]

I was under the impression that due to c/a shortages and private outpatient clinic fees, child psychiatrists have significantly more earning potential than adult psychiatrists, especially in the Midwest. Plz correct me if I'm mistaken.

With the lower supply there are more options for increasing your revenue should you choose to persue it. For example, doing inpatient, partial, and outpatient with fairly high volume. Places in the midwest will definitely buffer your salary to some degree when the need is severe, I know this because my home town is trying to do this very thing right now (got an email from them yesterday, 0% chance I'd go back). However, I would generally view child as allowing you to work pretty much anywhere you want rather than some significantly higher income potential. Plus kids are fantastic and the future of the world, so there's that.

 

[MacDonaldTriad]

Plus kids are fantastic and the future of the world, so there's that.

Frightening thought. I admire your optimism, but I still take comfort in the fact that I will be dead before millennials completely take over. Whenever I want to avoid the company of youth, I just go hang out at the library.

 

[OldPsychDoc]

Frightening thought. I admire your optimism, but I still take comfort in the fact that I will be dead before millennials completely take over. Whenever I want to avoid the company of youth, I just go hang out at the library.

I usually just reply, "I get to deal with enough Child Psychiatry at home."