How lucrative is BC in Forensic and C/A?

[HouseDO]

I have been MIA for quite some time. As I am about to formally complete my residency and enter the second year of C/A training, I am considering what to do with my post-military life. I recently participated in a military sanity board related to a criminal case and really enjoyed the forensic aspect of things. The forensic psychiatrist and I chatted for awhile afterwards and he revealed that he had considered doing a C/A fellowship because of the post-military earning potential of having both.

I'm curious, any thoughts or experience related to this niche area?

---

Members don't see this ad.

 

[nitemagi]

Child forensics (if that's what you mean) is a very specific niche that's grossly underserved in the civil arena (or so I've been told) and potentially very lucrative (in the range of you can charge what you want). Serving as an expert in arenas like custody battles, for example.

I have heard (again, anecdotally), that it's also the most dangerous. Ppl don't take it nicely when you get between them and their children.

 

[heyjack70]

I've heard the same thing about child custody evaluations from several people I've talked to about it. Whopper has also posted several times that it is a higher risk line of work. Having the C/A would give you an edge as an expert evaluating for psychological damages in a civil case.

 

[whopper]

Forensics could make tons of money but the sad reality is several psychiatrists that do fellowship don't ever get to utilize it in that manner.

Such a fellowship is beneficial even if you're just doing clinical work, so I still recommend anyone do it if you're interested, just don't expect to make lots of money.

The problem with the money is this. The money is usually to be made if you do private and high-profile cases. Getting that type of work can be difficult because you have need to be linked to lawyers who know they can hire you.

Being a forensic psychiatrist to these lawyers is like being an actor for a casting director. After awhile, the casting director starts using the same people over and over because that person knows the actor and the actor is now a known quantity and not a loose unpredictable canon, but breaking in to the cigar-smoke filled room is difficult.

Hey, ever wonder why there is an over-supply of lawyers and some can still charge up the wazzoo? It's all connections. Several law firms can charge hundreds of dollars an hour when there's dozens of lawyers out of work for every person they got with their firm. Several docs won't know how to form the connections. Several fellowships might not include their graduates into them unless they are highly trusted.

If you become a child-forensic evaluator, and you're in the right place, you could be the only one in several counties, possibly even the only person in your state that could do these that has the training to do so. Several docs may try their hand in this not really knowing what they are doing.

Getting back to private cases, they can be very stressful because each case is going to be unexplored intellectual territory for years. Several things in medicine become automatic such as dealing with your first violent patient, first suicide, etc. Those first times you sweat, you feel bad, maybe even freak-out, but you eventually figure it out and it becomes normal.

By the time you finish forensic fellowship, you're still very very green on a lot of things. Your first several private cases will be very very stressful and each one will bring in situations you've never seen before. Best analogy I can give is each case will be like taking a course with an exam in the end, where as regular psychiatric practice is often much less stressful and based more on intuition/experience vs having to anticipate a guy on the other side trying to ream you on the witness stand.

Point is it can make a lot of money but it's hard money, while doing something else such as a Suboxone practice could make about the same per hour but you're doing automatic stuff. E.g.vital signs, COWS scale, urine drug screen, interview, prescription....NEXT! Compare that to a work-capacity evaluation where you now got to research the job responsibilities for a specific profession before you can write a thorough report on whether or not the guy you're evaluating with a mental illness can do his job. Next time you do another work eval you then got to read up on all the job stuff for that new guy's profession.

This is a reason why I wanted to work in University of Cincinnati because their forensic clinical director is one of the top guys in the country and he was breaking me in so to speak, giving me cases at a steady amount that I could handle while he mentored me. Despite that I'm board-certified in forensic psychiatry, without him, I'd still be doing things almost blind. He pointed the way for me. (Heck I'm going to miss him when I leave UC).

Another problem with private cases is when you do them, they will intrude upon your regular job. Cases come and go. You could have a dryspell for weeks to months with no new cases or get deluged with several all at once or one mega-sized one that could keep you busy for years. My mentor had a case he completed a few months ago that had him working on it for about 10 years. When you have to testify, you can't just leave work at a moment's notice. If you're doing inpatient, this will make it very difficult for you to keep your schedule. Your boss will have to be open to you having to not show up now and then. For that reason some forensic psychiatrists that do private work only do private outpatient practice outside of the expert witness stuff.

 

[Nasrudin]

Forensics could make tons of money but the sad reality is several psychiatrists that do fellowship don't ever get to utilize it in that manner.

Such a fellowship is beneficial even if you're just doing clinical work, so I still recommend anyone do it if you're interested, just don't expect to make lots of money.

The problem with the money is this. The money is usually to be made if you do private and high-profile cases. Getting that type of work can be difficult because you have need to be linked to lawyers who know they can hire you.

Being a forensic psychiatrist to these lawyers is like being an actor for a casting director. After awhile, the casting director starts using the same people over and over because that person knows the actor and the actor is now a known quantity and not a loose unpredictable canon, but breaking in to the cigar-smoke filled room is difficult.

Hey, ever wonder why there is an over-supply of lawyers and some can still charge up the wazzoo? It's all connections. Several law firms can charge hundreds of dollars an hour when there's dozens of lawyers out of work for every person they got with their firm. Several docs won't know how to form the connections. Several fellowships might not include their graduates into them unless they are highly trusted.

If you become a child-forensic evaluator, and you're in the right place, you could be the only one in several counties, possibly even the only person in your state that could do these that has the training to do so. Several docs may try their hand in this not really knowing what they are doing.

Getting back to private cases, they can be very stressful because each case is going to be unexplored intellectual territory for years. Several things in medicine become automatic such as dealing with your first violent patient, first suicide, etc. Those first times you sweat, you feel bad, maybe even freak-out, but you eventually figure it out and it becomes normal.

By the time you finish forensic fellowship, you're still very very green on a lot of things. Your first several private cases will be very very stressful and each one will bring in situations you've never seen before. Best analogy I can give is each case will be like taking a course with an exam in the end, where as regular psychiatric practice is often much less stressful and based more on intuition/experience vs having to anticipate a guy on the other side trying to ream you on the witness stand.

Point is it can make a lot of money but it's hard money, while doing something else such as a Suboxone practice could make about the same per hour but you're doing automatic stuff. E.g.vital signs, COWS scale, urine drug screen, interview, prescription....NEXT! Compare that to a work-capacity evaluation where you now got to research the job responsibilities for a specific profession before you can write a thorough report on whether or not the guy you're evaluating with a mental illness can do his job. Next time you do another work eval you then got to read up on all the job stuff for that new guy's profession.

This is a reason why I wanted to work in University of Cincinnati because their forensic clinical director is one of the top guys in the country and he was breaking me in so to speak, giving me cases at a steady amount that I could handle while he mentored me. Despite that I'm board-certified in forensic psychiatry, without him, I'd still be doing things almost blind. He pointed the way for me. (Heck I'm going to miss him when I leave UC).

Another problem with private cases is when you do them, they will intrude upon your regular job. Cases come and go. You could have a dryspell for weeks to months with no new cases or get deluged with several all at once or one mega-sized one that could keep you busy for years. My mentor had a case he completed a few months ago that had him working on it for about 10 years. When you have to testify, you can't just leave work at a moment's notice. If you're doing inpatient, this will make it very difficult for you to keep your schedule. Your boss will have to be open to you having to not show up now and then. For that reason some forensic psychiatrists that do private work only do private outpatient practice outside of the expert witness stuff.

Very enlightening. Thanks.

 

[Chimed]

I completed a C/A fellowship and I'm 4 weeks away from finishing a forensic fellowship. I have a lot of mixed feelings about doing child forensic cases. There are a lot of areas you can focus on, but the constant work is typically in either doing juvenile delinquent work or parental rights/custody cases. Personally, custody cases are not my cup of tea. They can be very contentious and nasty. However, because there are such few child psychiatrist/forensic trained psychiatrists, you can make a lot of money once you developed professional connections, as whooper said. Personally, I don't think it's worth the money and, at this point, I do not plan on picking up that kind of work.

One thing to keep in mind is that doing a forensic fellowship does not mean you're going to step out of the fellowship and just be a forensic psychiatrist, unless you're doing treatment. Also, keep in mind that when you're being asked to do an evaluation or a forensic case, the main skills and expertise you're bringing is as a clinical psychiatrist. The forensic training helps you know how to ask the right questions, the legal issues involved in the case, and, probably by far the most important reason, is how to write a good report. I know people who have done child fellowships with no forensic background and pick up forensic cases because the attorneys just need someone with the degree and child background. Reading their reports makes me cringe. They also tend to get involved in stuff that they're really not prepared for because they don't have the background to know how to narrow the evaluation/report to specific questions that are useful for the court. The representing attorney doesn't mind, because often they're fishing for anything to help their case and the more expansive you are in your report, the more they can try to pull stuff out that may or may not be what you wanted to convey to the court. It can get tricky and if you get on the stand, the cross exam can get nasty.

 

[Nasrudin]

I completed a C/A fellowship and I'm 4 weeks away from finishing a forensic fellowship. I have a lot of mixed feelings about doing child forensic cases. There are a lot of areas you can focus on, but the constant work is typically in either doing juvenile delinquent work or parental rights/custody cases. Personally, custody cases are not my cup of tea. They can be very contentious and nasty. However, because there are such few child psychiatrist/forensic trained psychiatrists, you can make a lot of money once you developed professional connections, as whooper said. Personally, I don't think it's worth the money and, at this point, I do not plan on picking up that kind of work.

One thing to keep in mind is that doing a forensic fellowship does not mean you're going to step out of the fellowship and just be a forensic psychiatrist, unless you're doing treatment. Also, keep in mind that when you're being asked to do an evaluation or a forensic case, the main skills and expertise you're bringing is as a clinical psychiatrist. The forensic training helps you know how to ask the right questions, the legal issues involved in the case, and, probably by far the most important reason, is how to write a good report. I know people who have done child fellowships with no forensic background and pick up forensic cases because the attorneys just need someone with the degree and child background. Reading their reports makes me cringe. They also tend to get involved in stuff that they're really not prepared for because they don't have the background to know how to narrow the evaluation/report to specific questions that are useful for the court. The representing attorney doesn't mind, because often they're fishing for anything to help their case and the more expansive you are in your report, the more they can try to pull stuff out that may or may not be what you wanted to convey to the court. It can get tricky and if you get on the stand, the cross exam can get nasty.

Wow that's fantastic! Congrats. I'm glad we have a poster with your expertise on the forum.

Thanks to both of you. I just went and re-read all of whopper's and even anastazi's posts of forensics and it was daunting and yet very educational about whether forensics fellowship is something I should be looking to network into. I know I won't have time to think about it too much in the coming year or two, and I appreciate you contextualizing the need to learn great general psychiatry skills as a resident first, but I like having working what if's. I think helps in terms of keeping my peripheral vision sharp for opportunities to explore it further. Whether by learning how to arrange the best electives or going to appropriate conferences or whathaveyou.

I'm definitely still interested after contemplating the appropriate expectations, networking requirements, and job flexibility requirements.

 

[TexasPhysician]

I know a few C&A folks with forensic training. None do more than a rare forensic case. They report having a really hard time finding work.

 

[whopper]

The forensic training helps you know how to ask the right questions, the legal issues involved in the case, and, probably by far the most important reason, is how to write a good report.

Written like it's someone who knows what he's talking about. Forensic psychiatry is about knowing the mental health laws, court decorum, how to write (or more broadly, how to present your data to laymen in a manner they can understand. That means writing but also Power-Points, speaking succinctly), and being able to mentally spar with the guy who's going to cross-examine you.

When I worked for the state, they were very flexible in allowing me to take time off for private work because if you work on a forensic unit, your patients usually stay on the unit for months, possibly even years after you've stabilized them. I'd only get a new patient every several days, sometimes every few weeks.

If you do private practice you can always rearrange your schedule to allow yourself to testify.

If you, however, work on an inpatient unit that's not a long-term unit, it's going to be tough to just simply take off time whenever the court needs you to testify. Where I'm currently at, the department leadership understands this happens in forensic psychiatry but other smaller departments might not get it. I've already been in the position of telling a boss that I got expertise they don't and them not following my recommendation is really screwing me (or them) over and they don't get it.

A mark of a good department head is they have enough knowledge of the other fields to allow them to practice the way they should be practiced. For example, I worked at a place where they would not give me, a Suboxone provider, someone to do my prior authorizations and for Suboxone providers you have to do them on about 50-100% of your patients (and often!) where as other psych patients usually only about 5% need them. The leadership didn't get that because the guy in charge isn't a Suboxone provider.

Point is if you expect to work in the field, you have to make arrangements for you to be able to do your forensic work.

 

[DD214_DOC]

Interesting discussion. It seems the forensic stuff may not be what I was thinking it actually is. I recently participated in a forensic eval on an adult. The interview was fun. The write-up, not so much. It really tested the limits of my ADHD.

I'm trying to figure out what I can do in the event I ever get tired of doing clinical work. I want options for the future. I have considered the MBA/MHA route to have the option of transitioning to admin if I ever decide to. Although I enjoy the knowledge obtained during the C/A fellowship, I'm not super thrilled about seeing patients younger than 12 and I'm not certain, exactly, what other things I can do with it.

 

[whopper]

There's generally two types of forensic reports in terms of difficulty.

The type of report you can do rather quickly. It's not a big or complicated case. The write up could be something on the order of 1/2 an hour of work.

The other? A major case, it's complicated, and you have to write something on the order of dozens of pages. I'm not a great writer. I write in a "stream of thoughts" pattern like I do in my posts. I don't hold back, I just write what I think. Such may be more effective in a laid back type of atmosphere, but in court, it can bite you back in the butt. One simple grammatical error and the lawyer on the other side will spend possibly an hour just going over how you can't write better than a fifth grader and will try to destroy your credibility.

A buddy of mine that is also a forensic psychiatrist had the benefit of having a wife that was an English major and she proof-read his work. I wish I had someone like that.

I need a few days just to mentally distance myself from my report because I often-times can't see mistakes I made unless I've not read it for a few days.