Fellowship Importance and Purpose

[FranzLO]

Out of curiosity, besides a genuine interest, what types of things are considered when looking at the different fellowships? I have heard that the salary increases do to specializing but I also have seen arguments on here that say that, for example, the difference between a C&A psychiatrist and a general one may not be enough to warrant the two extra years of training. Trust me, I know enough that money isn't everything so I don't need that lecture haha, but maybe I end up falling in love with a topic that also financially makes sense in the long run. I personally would prefer to be a general psychiatrist. Just curious about how all the different specialties stack up and if there are differences, and if so, how much.

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[Bartelby]

First, think about what setting you would like to work in. Many academic programs give a pay bump for doing a fellowship, for the ones I am familiar with I believe it is approximately $10,000 per year. If you know that is your career path adding $10k to your salary for the next 35 years is pretty well worth spending an additional year as a trainee.

Also if you are in the private sector think about what you actually want to do day to day. For instance, you want to be a general psychiatrist but may find five straight days of full outpatient schedules draining. You could consider varying that up by doing 1-2 days of work in another setting. You can accomplish that by fellowship training, or other means depending on your interests.

As for whether any particular fellowship tends to be most lucrative I will let someone else chime in for that because I don't really know. What I can say, though, is that if you make earning a high salary a personal goal there are a lot of ways to bring in more cash within every subspecialty of psychiatry (higher volume, longer hours, moonlighting, run a practice with NPs/therapists, find consulting work, etc).

 

[notdeadyet]

Out of curiosity, besides a genuine interest, what types of things are considered when looking at the different fellowships?

Genuine interest would be about the only one. The salary differences between someone fellowship trained and not fellowship trained are not nearly as substantial as in most other fields in medicine (the difference between a cardiologist and internist, for example).

I'd personally do a fellowship if you're passionate about the subject and want an added qualification or focused experience. This may or may not be accompanied by a salary bump that may or may not offset the opportunity cost.

 

[Armadillos]

I've beard academics in general tends to favor fellowship trained people when it comes to promotion/etc.

Was curious how this plays out in psych, for example if you just a general adult inpatient attending w/ no fellowship, are they going to be less likely to be able to climb the academic ladder compared to a child inpatient attending or a geri inpatient attending who did their respective fellowships?

 

[wolfvgang22]

Ha. I actually took a significant pay cut while doing fellowship, as I moved from a higher paying adult psychiatry program in one state to do a fellowship in Texas that paid less, at a University that provided far fewer perks I had before (free parking, free food, generous CME and book stipend, lucrative moonlighting, etc.) Overall, doing fellowship in child psych was a financial loser for me, when I include the fact that I missed out on the opportunity cost of making attending level income during fellowship.

Child psych typically doesn't pay more than maybe $10k more per year on average as an employed physician. You can do better in private practice, but that is more work also, of course.
My supervising attendings warned me about these things while I was a resident. I am genuinely am interested in child psychiatry (yes, even after fellowship), and I knew I'd never go back and do a fellowship once I graduated residency. I did learn a huge amount in fellowship. So as a professional it was worth it, as I'm a better psychiatrist to all my patients. Fellowship was a winner in that regard.

So, I would recommend very strongly: Don't do child and adolescent unless you really do like working with children and their parents. Don't do it for ego reasons, either. Keep in mind that there is often a genetic component to a child's mental illness, so you really don't have just one patient in child psychiatry a lot of the time.

As an aside, I find it sort of interesting that professions that care for children get paid less overall. Such as pediatricians (generally the lowest paid medical specialty). We don't pay K-12 school teachers much in this country, either. I suspect that might have something to do with the fact that women historically work in these fields more frequently.

 

[Indodo]

General interest...but we aren't counting this one.
1) You can tell the borderlines you are better than their last psychiatrist.
2) Easy fellowships are a good time for moonlighting.
3) Something to market on online rating sites.
4) Go where there is only 1 fellow and you can say you were chief.
5) Extra diploma really completes the wall.
6) Nurses dig it.
7) You get to introduce yourself as "double boarded."

 

[FranzLO]

Very cool responses and I appreciate it a lot. It seemed to me that there is quite a big pay bump or lifestyle change when a fellowship is completed in other specialties but this is definitely really good to know about psych.

 

[digitlnoize]

First, think about what setting you would like to work in. Many academic programs give a pay bump for doing a fellowship, for the ones I am familiar with I believe it is approximately $10,000 per year. If you know that is your career path adding $10k to your salary for the next 35 years is pretty well worth spending an additional year as a trainee.

Not so much. I mean, that's 7k after taxes if you're lucky. Per year x 35 years is: 245,000. That's essentially 1.5 year's salary. If you had invested that 1 year salary you'd have far more in 35 years than the 7k per year bonus. Opportunity cost.

 

[Bartelby]

Not so much. I mean, that's 7k after taxes if you're lucky. Per year x 35 years is: 245,000. That's essentially 1.5 year's salary. If you had invested that 1 year salary you'd have far more in 35 years than the 7k per year bonus. Opportunity cost.

Very true, as long as you don't just scale up your lifestyle for the first year as an attending. If you live like a fellow your first year out and invest it all that head start would go a long way.

Overall as many are pointing out money is typically not a good reason to pursue fellowship. There needs to be the interest and drive. In some cases, though, fellowship is needed. To practice child psych it is essential to do a fellowship, to practice forensics (since you can't grandfather yourself in) it is quite helpful, and to get hired by a major academic C-L dept many will expect the fellowship. I personally would feel more comfortable taking large nursing home contracts if I had geri-psych training as well. And to start and run an addiction treatment center (which could be quite lucrative) having completed an addiction fellowship would probably be quite worthwhile. Still, outside of a few niches fellowship is not really needed, and will often be a money loser. I think that is why fellowship competitiveness typically drops off v residency competitiveness.

 

[TexasPhysician]

Fellowships really help in landing academic jobs. C&A and geriatric fellowships would currently make you a little more in demand, but there is a shortage of psychiatrists as is.

Most fellowships will allow moonlighting as hours are reasonable. I made as much moonlighting as my gen psych friend made his first year as an academic faculty. I only worked marginally harder.

 

[MLT2MT2DO]

Very cool responses and I appreciate it a lot. It seemed to me that there is quite a big pay bump or lifestyle change when a fellowship is completed in other specialties but this is definitely really good to know about psych.

Outside of internal medicine I think this is more of the exception than the rule.