Child Psychiatry is Miserable

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Anasazi23

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[rant]

Ok, I'm being provocative....but I'm also serious.

I'm working (including call) 70-80 hours/week on the inpatient unit, and I'm feeling like this will never end. Granted, I didn't really have an interest in child psych prior to this rotation, but now I must say that if there was one iota of interest left in me from a profession-choosing standpoint....it's been thoroughly squashed.

You can't scratch your butt without getting consent from a parent who hasn't had contact with their kid for 5 years, since you never have a court paper stating that their parental rights were terminated. As a result of this, kids go 4-5 days without medication change due to the social work and legal snags.

The kids are in school all day, and the teachers get pissed if you take them out. When I get there at 8, they're in class, if you get there before 8, you can't bother them because they're in "transition," or they're sleeping. Every admission requires a family meeting, and every discharge requires another...usually with 3-10 people present, including the parent (if they are allowed to have contact with the kid), the social worker, their social worker at the foster agency, the school principal, the teacher, the ACS worker, the foster agency representative, possibly a grandmother, and sometimes more.

The kids themselves are fine. Too bad I barely get to see them.

Another thing I hate is spending all day on the phone....in child psych, you better learn to love it, because you'll be making dozens of phone calls a day to get endless collateral on every admission...sometimes being required to call the same outside source multiple times to get medication histories, etc.

Add to this required case presentations, consents for everything you can imagine, unending seclusion paperwork, and evaluations for "tummyaches and headaches," and you want to just get up and walk out.

On top of all this, nobody is ever quite sure what the diagnosis is (bipolar vs. ADHD, anyone?) (Does childhood Bipolar even exist?), and use almost prozac and risperdal exclusively, thanks to legal-induced defensive medicine.

The interesting part of the work is that you can see these patients and know how your current adult patients 'got the way they are now.'

I acutally look forward to call nowadays, so that I can enjoy the post-call day mostly off. I've considered volunteering for more call for this purpose. That should tell you something.

I feel like anyone who voluntarily wants to do this on an inpatient basis is insane.

[/rant]

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...and now you know why there's a shortage of child psychiatrists.

I did a child elective as an MS4 and learned 2 things:
1) I never wanted to do child again; and
2) I wasn't as bad a parent as I feared.

God bless you all if you choose this route--because you are sorely needed.
 
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Somebody needs to help them although it can be quite frustrating and sometimes futile.
 
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[rant]
The kids are in school all day, and the teachers get pissed if you take them out. When I get there at 8, they're in class, if you get there before 8, you can't bother them because they're in "transition," or they're sleeping. Every admission requires a family meeting, and every discharge requires another...usually with 3-10 people present, including the parent (if they are allowed to have contact with the kid), the social worker, their social worker at the foster agency, the school principal, the teacher, the ACS worker, the foster agency representative, possibly a grandmother, and sometimes more.

[/rant]

It sounds like this might be a function of the unit you're woking on and the people you're working with. At my med. school, the teachers were always willing to let the kids out of school. We also have a set period of time after the kids get up and before school starts where attendings and residents/fellows have time to see about two kids before the day starts. Actually, there are only three times the kids can not be taken--during meals and one 30 minute group session.

We also have social workers and a charge nurse that do a lot of the leg work as far as calling about past Hx and stuff like that. But, yes, the fellows/residents/med students do spend a lot of time on the phone, but it doesn't sound nearly as much as what you're implying.
 
[rant]

On top of all this, nobody is ever quite sure what the diagnosis is (bipolar vs. ADHD, anyone?) (Does childhood Bipolar even exist?), and use almost prozac and risperdal exclusively, thanks to legal-induced defensive medicine.

[/rant]

What you describe is one of the reasons I think Child Psych is so cool. It is an area that is wide open for research and exploration. I also love trying to figure out if little Johny is showing early Sx's of psychosis or has a great imagination.

Yes, I might totally change my mind in residency, but right now I think the pediatric population is the funniest and most rewarding population. Plus, adding in autism and developmental disorders is very cool..

I don't have the stat right now, but the job satisfaction of child psychiatrists is higher then for adult psychiatrists....:D
 
I agree, you will not have to put up with all that collatoral BS outside of residency; they got you where they want you now.
 
...and now you know why there's a shortage of child psychiatrists.

I have a feeling that this shortage will be fleeting.

I'd guess that the majority of IMGs that I have met on the interview trail this year expressed an interest in child psych.

It seems as though the market is beginning to respond to this shortage.
 
I'm with you on this one Anasazi.

THough my own child rotation is far easier.

I see kids once a week for 3 hrs a day. Half the time they don't show up to the outpatient office so I'm just twiddling my thumbs, studying or trading stocks online.

But even with that limited exposure I got the same idea.

I have a feeling that this shortage will be fleeting.

I don't know. The shortage from what the child attendings tell me existed for years. The belief was that increased pay would end that shortage. However the same attendings told me the institutions that treat child psychiatric cases couldn't keep the inflated salaries, and now child psychiatrist salaries, though higher than regular attending salaries are not significantly higher--about an extra 20-30,000 per year.

Add to that the litigation problems in the field are higher because several psychotropic meds are not approved in children.

Note: the above is purely anecdotal data. If you find a better and more correct source, by all means correct me.
 
I have a feeling that this shortage will be fleeting.

I'd guess that the majority of IMGs that I have met on the interview trail this year expressed an interest in child psych.

It seems as though the market is beginning to respond to this shortage.

It's not just IMG's...it felt like pretty much every interview I went on, I was like the only person out of the candidates NOT going into child. One of the residents interviewing me even said it was refreshing to finally interview a candidate who wasn't looking at child.
 
One of the residents interviewing me even said it was refreshing to finally interview a candidate who wasn't looking at child.

At my last interview, there was 5 of us and NO ONE wanted to go into C + A. It really was refreshing actually. All of my other interviews at least half thought they'd be going into child, although faculty often pointed out that far fewer than that would actually end up doing so.
 
I forget where I read it...maybe on here even, but there was a quote from some place that said: "80% of entering psychiatry residents claim an interest in child psychiatry fellowships. 20% of residents actually go into child fellowships."

No idea if it's true or not.
I know in my program, about 3-4/5 per class are into child.
 
I hate saying it but I think any potential candidate during an interview is going to say they're interested in everything, instead of giving the truly honest answer.

Just like how about 90% of people who go into medschool do it for the money or because their parents made them do it, but they wrote down that the believe in truly healing people.
 
It's not just IMG's...it felt like pretty much every interview I went on, I was like the only person out of the candidates NOT going into child. One of the residents interviewing me even said it was refreshing to finally interview a candidate who wasn't looking at child.

I had much the same experience.
 
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I hate saying it but I think any potential candidate during an interview is going to say they're interested in everything, instead of giving the truly honest answer.

Well, I guess that set me apart. When asked about my interests in psychiatry, I was pretty straightforward about my career goals. We'll see if that comes back to bite me. (It did make for an awkward interview with at least one child psych attending.)

OTOH, if you haven't done a child psych rotation and you claim that it is your primary interest, then this may be a very high risk gambit.
 
I hate saying it but I think any potential candidate during an interview is going to say they're interested in everything, instead of giving the truly honest answer.

Given that soooooo many applicants claim an interest in Child Pysch, I actually felt like a putts for saying that was my interest--I wanted to sound original and NOT say I was interested in child psych, but I truly am.....I also did research as well as my SubI in child psych, so it was hard to avoid.
 
Well, I guess that set me apart. When asked about my interests in psychiatry, I was pretty straightforward about my career goals. We'll see if that comes back to bite me. (It did make for an awkward interview with at least one child psych attending.)

Unless you claimed to have an interest in something like the psychiatry of basket weaving or that you plan on working with the pet population, there is no way that being honest and upfront about your career goals is going to hurt you.
 
I have a feeling that this shortage will be fleeting.

I'd guess that the majority of IMGs that I have met on the interview trail this year expressed an interest in child psych.

It seems as though the market is beginning to respond to this shortage.
I don't think the shortage will end anytime soon. As others have pointed out, many more people express an interest in child psych while interviewing (or at the beginning of residency) than actually go into the field. This is for several reasons (people don't like child, decide they don't feel like doing extra fellowship time, etc.), but I think is a relatively long-standing phenomenon.

Also, even if there were increased interest, the shortage is so severe that it will not be readily corrected. I have heard that there are not enough child fellowship spots available to correct the shortage, even if all the spots filled, which they currently do not. In addition, there is supposed to be a large number of retirements in the near future, which will only worsen the shortage.
 
Well, I guess that set me apart. When asked about my interests in psychiatry, I was pretty straightforward about my career goals. We'll see if that comes back to bite me. (It did make for an awkward interview with at least one child psych attending.)

Well I should say the majority don't give the honest answer.

10% give the honest answer for real. They really do want to go into psychiatry for the real right reasons.

50% want to go into it because its an easier field with an easier residency. They couldn't bear the idea of being a med or surg resident doing 100 hrs a week of work.

30% tried to go into something else, but couldn't get in.

10% didn't know what to do and just ended up doing psyche.

Of course this is just my own anecdotal observation and its not like I did research on the numbers. Me? I'm in the honest 10%. I wanted to be a psychiatrist even before medschool. I only went to medschool to become one, but trust me, the fact that psyche residencies are easier is certainly good incing on the cake.
 
I'm with you on this one Anasazi.

THough my own child rotation is far easier.

I see kids once a week for 3 hrs a day. Half the time they don't show up to the outpatient office so I'm just twiddling my thumbs, studying or trading stocks online.

But even with that limited exposure I got the same idea.



I don't know. The shortage from what the child attendings tell me existed for years. The belief was that increased pay would end that shortage. However the same attendings told me the institutions that treat child psychiatric cases couldn't keep the inflated salaries, and now child psychiatrist salaries, though higher than regular attending salaries are not significantly higher--about an extra 20-30,000 per year.

Add to that the litigation problems in the field are higher because several psychotropic meds are not approved in children.

Note: the above is purely anecdotal data. If you find a better and more correct source, by all means correct me.

20-30,000 sounds like a lot to me..but maybe becaus that is because I am making NO money at all right now. :laugh:

The thing that bugs me about child psych right now is that it does seem liited as far as what meds can be prescribed- tools really seem limited, ya know?
 
Agree with you.

Another problem I have is sometimes parents or school staff want you to medicate the child to fix a problem that you may feel is not justified. Add to the confusion the med may improve the sx and you may still feel its not justified.

I had a patient yesterday, 9 yo boy who was given risperdal due to angry outbursts.

Does risperdal decrease these outbursts? Yes. Does it have FDA approval? no. Is having an angry outburst a psychiatric illness? IMHO no, especially if you're a little kid.

Geez, I was on the fence. The school, the parents wanted the kid medicated. Was it because it just makes it easier for them? The attending agreed to go with it. Fine.--I didn't have to make a decsion on that one but there's a lot of cases like this in Child Psyche.

The money thing: (again my data is anectdotal) IMHO 20-30,000 ain't much. Remember Child psyche is an extra 2 years of training (1 if you manage to do it and leave your program in the 3rd year which not everyone does). If you did 2 extra years of training at a pay of about $50,000 which is slightly more than what a PGY IV & V make, than comparing that to a salary of $150,000 as an attending, that's a loss of $200,000.

If you're paid $20,000 extra as a child psychiatrist, that's 10 years before you break even if you just became an attending without the fellowship. At $30K that's about 7 years, not to mention that's another 2 years while you live like a resident and not an attending. If you ask me it ain't worth it. If you were to put in about $50,000 in from your first year as an attending into a good mutual fund & avoid Child psyche, you'd actually end up making more money than the Child psychiatrist in the long run, and on top of that still be able to live like an attending on the $100,000.

An extra 20,000-30,000 IMHO is really just breaking even compared to regular attendings considering that you've lost $200,000 from your total work years you put in.
 
I'm writing a thesis on child psychiatry.
I hope you all don't mind if I include some of the material you've listed.
Let me know if you do.
 
Hey I got no problem.

And my opinion hasn't changed on this issue even though it's been some time since I posted in it.

Several times I see a patient under 18, they freeze up and are scared of me because I'm older and an authority figure, so I can't get a good clinical impression from them during the interview. So, becuase of that I don't really have much of anything to go on other than collateral information.

That collateral information is often times from people who IMHO have a conflict of interest in the situation. For example, I've seen teachers want kids medicated when the kid doesn't have a psychiatric disorder. The teacher either believes the child does based on counter-transference (yeah I know the teacher is not a doctor, but you get my point) or because the teacher wants the child zonked because it'll make life easier for that teacher. Same goes with parents.

So when I had the teacher fill out forms to see if the child has ADHD, the teacher is usually smart enough to figure out which parts of the forms to overemphasize to make me medicate the child. Same with the parent.

I sometimes wonder that perhaps the specific tests for ADHD such as the Connor scale should include a malingering-by-proxy section to weed out teachers and parents who exaggerate the symptoms to get the kid medicated.

This wasn't a child case, but it delivers the point, I onetime had a parent bring in their adult child because that adult was lazy. The adult had Addison's disease which if treated made him perfectly stable to work. What was going on was if the parents tried to make him do anything that required any work, as a form of protest he'd refuse to take his medications, and he was willing to push this to the point of having to go to the hospital and being required to go to the medical floor.

The person spent all his time playing video games, and the parent wanted me to give him a pill to make him want to go to college, get a job and get out of the parent's home. He didn't have a psychiatric disorder in the real sense. He had a form of malingering combined with a true medical disorder that allowed him to have a defacto gun to put to his head to demand anything from his parents.

Yes I did screen him for things such as depression, bipolar, etc. No he did not have any of those. The parent thought we psychiatrists could fix anything with our magic pills. It doesn't work that way.

I told the parents that in my opinion, the situation was that the person learned to be a manipulator. He had Addison's disease since he was a small child, and he learned to use that to manipulate the parents. Since he truly had a real serious disorder, it wasn't a situation where the parents could call his bluff because if he claimed to have symptoms, it could've been potentially fatal.

The parents got mad and told me they knew I had pills that would make their child want to go to college because their other doctor (the PCP) told them this was the case. I told them no, and those parents were very upset.

(While I was in child, the parent told us the teachers claimed we could do magic--this adult case was pretty much on the same order as a child case in several respects which is why I brought it up).

I truly sympathized with them, but I'm not going to medicate someone to create an effect that the medication is not supposed to do.

This type of problem is rare in adult psychiatry, but in child psychiatry, at least from my experience it was the majority of the cases.
 
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I'm a second year child fellow, and if I had to come up with a bumper sticker for child psychiatry, it would read:

****ing Collateral
+pity+

And I think the inpt environment is much easier to deal with than the outpt environment. Outpt is where the hell of collateral really bites you in the ass.:eek: The inpt unit we worked on in training sounds much easier to deal than the one you're working on, Sazi--we could pull kids out of pretty much anything, they know our time is limited. Is this part of your forensics training?

I find myself often missing the mano y mano of adult psychiatry. And frank psychosis. And good old ER ham sandwich malingering :laugh:. With child, you've got parents, stepparents, teachers, case managers all part of the system, transference flying at you from all corners, but only the kid is the IP.

Most PP child psychiatrists I know see about 1/3 child and 2/3 adults. I might be going into a group practice, doing more integrative family work, which I really love. I've had to seek out training in what I really love--infant-toddler mental health--b/c child psychiatry generally doesn't capture kids under 6.
 
So I might be the only C&A attending here? I do like it, but I'm mainly outpatient at this time, and only about 1/3rd of my patients are C&A.

But I did do 1.5 year IP/OP mix right after residency. Given, it was a private psych hospital, but it was harder to make things work well inpatient.

Outpatient is really enjoyable, though, and I'm glad that I am doing it. I love working with them and watch them get out of trouble and their grades go up. I would like to do more C&A and less adult/addiction, but since I'm it and with nobody else in the clinic, I take all that comes through the door.

Anybody want to come join me and take care of the grown-ups?
 
So I might be the only C&A attending here? I do like it, but I'm mainly outpatient at this time, and only about 1/3rd of my patients are C&A.

But I did do 1.5 year IP/OP mix right after residency. Given, it was a private psych hospital, but it was harder to make things work well inpatient.

Outpatient is really enjoyable, though, and I'm glad that I am doing it. I love working with them and watch them get out of trouble and their grades go up. I would like to do more C&A and less adult/addiction, but since I'm it and with nobody else in the clinic, I take all that comes through the door.

Anybody want to come join me and take care of the grown-ups?

Nice to know I'd have a fallback location if Mrs. PsychDoc ever shows me the door...;)
 
So I might be the only C&A attending here? I do like it, but I'm mainly outpatient at this time, and only about 1/3rd of my patients are C&A.

But I did do 1.5 year IP/OP mix right after residency. Given, it was a private psych hospital, but it was harder to make things work well inpatient.

Outpatient is really enjoyable, though, and I'm glad that I am doing it. I love working with them and watch them get out of trouble and their grades go up. I would like to do more C&A and less adult/addiction, but since I'm it and with nobody else in the clinic, I take all that comes through the door.

That's great to hear that you enjoy working with C/A's still. I'm hoping to match into a C/A fellowship and will know the results on Jan 6th. It very interesting to read some of my old posts on this thread from 2007! I was very interested in C/A then and am still very excited about starting up. I suppose it is just a field one either loves or hates?

BTW, how come you don't see more kids now?
 
What you describe is one of the reasons I think Child Psych is so cool. It is an area that is wide open for research and exploration. I also love trying to figure out if little Johny is showing early Sx's of psychosis or has a great imagination.

Yes, I might totally change my mind in residency, but right now I think the pediatric population is the funniest and most rewarding population. Plus, adding in autism and developmental disorders is very cool..

I don't have the stat right now, but the job satisfaction of child psychiatrists is higher then for adult psychiatrists....:D

Almost 3 years later after writing this as a med student and I still feel the same way!!!! :D
 
Different personalities see different things differently.

My wife loves treating borderline PD patients.

I find child psychiatry very frustrating, yet like forensic psychiatry.

Despite my whining, there will be several who love it for the same reasons I find it frustrating.
 
One of the reasons why I liked adult psychiatry better than child psychiatry is that when dealing with severe mental illness, reducing psychosis and keeping the adult patient from committing violence is considered acceptable results. With children, the system wants you to turn them into 'A' students bound for Harvard university.

Expectations are more realistic for adult psychiatrists.
 
I fell in love with psychiatry on the Adolescent unit. It was a combination of a great attending and feeling like I was making a real impact on the kids lives. (I am one of the legitimate 10% who went into psychiatry primarily because I loved it although I would argue that that number is actually higher, and yes, the nice lifestyle is some very nice icing on the cake.) I went into the application process for residency with the intention of eventually going into C&A and that was pasted all over my personal statement. I ran my statement past the attending I had for adolescent and she told me to be careful about pushing C&A so heavily because there are a lot of people that say they are going into C&A and then don't. Her recommending that kind of broke the spell and I realized that I really enjoyed seeing most psych patients so maybe I wouldn't be going into C&A after all. As I recall that's what I told people when I was interviewing, that I liked C&A, but also liked a lot of other stuff so I was taking it on a wait and see what happens in a few years. Well, in the meantime I learned that I have massive resistance to making phone calls. It's really weird. I don't get anxious over it, I just really really hate doing it. So as a resident I got the full gambit of the C&A experience, most of which is making phone calls and my interest dropped to almost non-existant. I still love working with adolescents directly, their issues are usually fairly straight forward and it is a matter of getting them to see that and teaching them to manage what is going on. But fellowship is a definite no go. It really makes it easier that on some level I really enjoy treating most populations.
 
One of the reasons why I liked adult psychiatry better than child psychiatry is that when dealing with severe mental illness, reducing psychosis and keeping the adult patient from committing violence is considered acceptable results. With children, the system wants you to turn them into 'A' students bound for Harvard university.

Expectations are more realistic for adult psychiatrists.
Not to many of the worried well around here. I'm happy when I get my D/F students up to B. And the autistic patients can stay in school and at home rather than the group home. And when the angry, impulsive kids get out of the legal system.
 
Agree with you.


The money thing: (again my data is anectdotal) IMHO 20-30,000 ain't much. Remember Child psyche is an extra 2 years of training (1 if you manage to do it and leave your program in the 3rd year which not everyone does). If you did 2 extra years of training at a pay of about $50,000 which is slightly more than what a PGY IV & V make, than comparing that to a salary of $150,000 as an attending, that's a loss of $200,000.

I don't have any real data either, but I've known a lot of people to go into a C and A fellowship, and all of them fast tracked. With not all the child programs even filling, unless you change your mind after residency, who wouldn't take the fast track option? Even at smaller programs that don't have a C and A fellowship(a minority), those programs usually let their people fast track at other programs. So calculating 1 extra year instead of 2 makes a difference.

And I think in many areas the pay difference(in private groups where most people work) is more than 20-30k. I guess it depends on where you want to live, but when I rotated through child the child fellows were telling me of their offers and how much more they were than general adult psych, and it was a lot more than a 20k difference. Of course they may be bias as well.
 
Child Psychiatrist

http://www.payscale.com/research/US/Job=Physician,_Child_Psychiatrist/Salary
25th%ile Median 75th%ile
$159,264 $182,666 $207,716

General Psychiatrist
http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_hc07000027.html
25th%ile Median 75th%ile
$157,294 $179,433 $201,245

this website is more optimistic, yet puts the average salary at about $175K
http://www.aacap.org/cs/root/developmentor/good_news_about_child_psychiatry_and_the_job_market

I have heard several believable stories of some child psychiatrists raking in a lot more. I think it'd depend on the area, and the business acumen of the child psychiatrist.
 
Child Psychiatrist

http://www.payscale.com/research/US/Job=Physician,_Child_Psychiatrist/Salary
25th%ile Median 75th%ile
$159,264 $182,666 $207,716

General Psychiatrist
http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_hc07000027.html
25th%ile Median 75th%ile
$157,294 $179,433 $201,245

this website is more optimistic, yet puts the average salary at about $175K
http://www.aacap.org/cs/root/developmentor/good_news_about_child_psychiatry_and_the_job_market

I have heard several believable stories of some child psychiatrists raking in a lot more. I think it'd depend on the area, and the business acumen of the child psychiatrist.

When I was an ms4, the child fellow(a pgy-5) stated that he had a private practice offer that he was taking(80/20 outpatient vs inpatient) for 325k. People who didn't do a child fellowship in that program and that area were getting 170k or so in private practice out of residency.

I think these salary surveys in some areas are really misleading because of the sample size. For example when I interviewed at UAB, the child psych person I interviewed with said that there were only 26 child psychiatrists in the whole state of alabama and that 13 of them were UAB faculty(and not adjunct type faculty who were more pp). She flat out told me if you wanted to practice child psych in alabama in mobile or montgomery or selma or outside auburn or wherever, 375k+ was pretty reasonable. Obviously if you wanted to be in an academic/university setting it's a different dynamic with resect to compensation.....

Unfortunately I don't like kids and am not interested in child psych though :(
 
Check this page out...

http://www.jobs-salary.com/child-psychiatrist-job-salaries.htm

It shows about 50 Child psychiatrist jobs--most earning about 150K/year.

I don't doubt there are several child psychiatrists out there earning much more than this, just that I also believe they are the exception, not the norm.

The other fellow in my program completed a child psychiatry fellowship and he will start out at 190K (having done 3 PGY programs--general psychiatry, child and forensic).

From my anectdotal experience, the very underserved areas tend to also be poorer areas. They may not be able to pay a child psychiatrist much more. I know one child psychiatrst attending where I did residency, and he worked full time on an adult unit. He barely did any child psychiatry. Why he chose to do that when it was apparent he did not like his job working on an adult unit, I do not know. He practiced in a southern state (forgot which one) where he was the only child psychiatrist in town. Despite this, he still left, and moved to NJ to work as an adult psychiatrist. (WHY?) I figured if anything, in an underserved area, he'd be making a lot of money if he worked at it.

I do think you can manage to make much more as a child psychiatrist, but I wouldn't expect it to happen. The individuals you mention that claim to start out at over 300K, I'd ask them specifics about it. 1) because they may be BS'ing you, and 2) if they are telling you the truth, you want to know as much as you can about it so you can exploit that opportunity for yourself.

The only guy I know who ended up making A LOT of money in child psychiatry opened up his own clinic, and he was good--darned good. I, however, think if he opened up an adult psychiatry outpatient office he'd be pretty much as successful.
 
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Agree. I can tell you, the sources I've checked out are not hearsay. For example, one of the sources I checked out were from the AACAP, and they mentioned the average salary being in tune with what I mentioned above----at just slightly above that of a general psychiatrist. If anything the AACAP would want to make their field look very good. The article I linked above if anything has a very positive tone.

So people claiming it makes over 300K as if that's normal are full of it. (Mind you the same goes for forensic psychiatry. You can earn a lot of money, but that's the exception, not the rule). I don't doubt people can do it, just that it's not the norm, and those people might've had to move to Alaska or work 80 hrs or something to that effect.

You also got to factor in that some people tend to inflate their salary because they want to brag about how much money they make.

If someone has some story of someone earning much more than the norm, get the specifics of how they were able to do that.
 
I'm confused. What is the truth here. If Child Psych only adds 20,000 more than the opportunity cost of 1 or 2 years of fellow pay is DEFINITELY not worth it.

Let's lay it out on the table. Based on personal or hearsay anecdotes, what are some of the opening salaries offered to child fellows?

C&A residents at my wife's program said they were being offered $180,000 in the midwest metro area where the program is located. They were being offered $200,000+ for positions further out from the metro. How's that for some anecdotal evidence!
 
C&A residents at my wife's program said they were being offered $180,000 in the midwest metro area where the program is located. They were being offered $200,000+ for positions further out from the metro. How's that for some anecdotal evidence!

And that really isn't different than general psychiatry. In several areas in the midwest, a general psychiatrist's pay can be on this order.
 
I'm confused. What is the truth here. If Child Psych only adds 20,000 more than the opportunity cost of 1 or 2 years of fellow pay is DEFINITELY not worth it.

Some people go into child because they like it, not because it pays more. If you're looking to make lots of $$$, I would think psych in general would not be the path to take, unless you're really good at business and are going to develop a lucrative private practice.
 
Shhhhhh! Don't tell them...
They might start thinking that the Coasts are not "all that"...

Don't worry they'll be sorry when the ice caps melt. Also, I'm sure you can build a pretty nice practice working with those who have to adjust from life on the coasts to the midwest (oh the humanity!). :D
 
Don't worry they'll be sorry when the ice caps melt. Also, I'm sure you can build a pretty nice practice working with those who have to adjust from life on the coasts to the midwest (oh the humanity!). :D


:rofl:
 
Are there any subspecialties within child psychiatry? What about child neuropsych? Who handles Tourettes or tic disorders, for example--child neuro or child psych? It's interesting because the DSM contains some things that I would think psych training alone would not make a person all that well prepared for--such as "motor skills disorders." Also what about rare pediatric dementing diseases--do they fall into child neuro, developmental peds, or child psych (or straight peds--as probably some are of infectious etiology)? And delirium in children? Or child psycho-oncology? Can someone specialize in these if they want--i.e. child c/l?

Mainly when "child psych" comes up the discussion seems to be more about autism, conduct d/o, adhd, etc so I wondered who handled these other things and if there were areas of subspecialization outside the mainstream. Obviously I realize there are no "accredited fellowships" but are there research or specialized training opportunities?

What about child psych for younger children and infants?

And can someone answer a burning question I've always had--what happens to autistic patients after they grow up? I never see them as adults! Granted I've only done a few months of inpatient, but where are they and what happens to them? We see MR as a comorbidity all the time.
 
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