A Question Re Fellowship

[penandpaper]

Since the entire 4th yr is an elective yr at a number of programs, can acgme psych fellowships ever take people in 4th yr (ie not just child fast tracking) that may not make you specialty board eligible but give you eligibility for gen adult??

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[VMSmith]

Some residencies that have mostly elective pgy4 years allow you to do certain fellowships during the year. Unless they advertise it though, you should probably assume that you'll have to set it up yourself and that there's a good chance that you'll run into conflicts between the requirements of your pgy4 year and the requirements of the fellowship.

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[peppy]

There has been some discussion among bigwigs in the field of allowing all fellowships to fast track like child does. I think eventually psych will transition to a 3 year program, personally. I doubt that it will happen in time to help the current crop of senior residents though, so I would say plan on doing your four years.

 

[whopper]

Several programs have a very easy 3rd and 4th year. My own PGY-IV year, if it weren't for me being a chief, would've had me working 20-30 hours a week. Of course as chief, I worked about 40-60, but even that had me thinking it was too easy.

I often thought what was the point of dragging it out 4 years if those last two were, IMHO, too easy? Not every program is like this. Some will work you very hard those years.

 

[jjmack]

From what I've heard there is talk of allowing other fellowships besides child after PGY3. Currently, some places allow PGY4s to basically do a "fellowship" during their elective 4th year; however, you're not board eligible for the fellowship since you can't do a fellowship until you finish your residency.

 

[penandpaper]

So say your PD says go for it (a non child fellowship) in pgy4. are you abpn-able for gen adult even if specialty board eligibility is out? Any anecdotal stories? I know of one person who did a non official fellowship where it basically didnt matter, but say a legit CL spot opens up and you dont care about being specialty qualified.

From what I've heard there is talk of allowing other fellowships besides child after PGY3. Currently, some places allow PGY4s to basically do a "fellowship" during their elective 4th year; however, you're not board eligible for the fellowship since you can't do a fellowship until you finish your residency.

 

[penandpaper]

Just wondering if anyone else can comment on this as I know not all psych fellowships fill, so do they sometimes take 4th years in these positions if the individual's gen adult pd supports the process?

 

[OldPsychDoc]

No. A fellowship is a set curriculum, requiring completion of a general residency. (Please don't blame me--this is the ACGME.)
I suppose that theoretically a PGY4 with 100% elective time could "do everything" as though they were filling an empty fellowship position, but as you said in your first post, it would still only count as elective credit toward the general residency, and would not count toward a subspecialty certification in the future.
There is some sentiment for allowing "fast tracking" into the 1 year fellowships (gero, addiction, PSM, forensic--especially gero and addiction), but it's still very much at the discussion stage, and I wouldn't count on it changing in the next 4 years.

 

[splik]

you could do a non-ACGME accredited fellowship such as public psychiatry/community psychiatry if you were interested in this. a number of these fellowships take 4th years residents if you have all elective time in your 4th year.

 

[shan564]

What about a research fellowship? Say you're interested in a 2-year research fellowship, and you spend 6-8 months doing the same research during your elective time in residency. Is there any reason why that couldn't shorten your fellowship?

 

[splik]

because you probably aren't going to do anything of consequence during those 6months. many people do 0.5FTE during their 3rd and 4th year just to be in a position to prepare themselves to do something meaningful during their research fellowship. in many cases the fellowship is in an unrelated or not directly related area. also if someone is getting you to do a 2-year post-doc (which is essentially what these research fellowships are) you can be sure as hell they are going to keep you for those 2 years. and many of these fellowships ask you finish residency (this is true of the MIRECC and T32 fellowships)

 

[MacDonaldTriad]

Here is my understanding,

ACGME approved fellowships are PGY-V years by definition. These include sleep, CL, forensic, geri, addiction… If your fellowship ends in an NBPN examination, as it currently stands, you must complete a PGY-IV year to be eligible for this training. You just cannot be a PGY-V after a PGY-III year.

If your fellowship isn’t accredited, there is not examination and they give you a nice piece of paper and you get to put it on your CV. Some of these are called Community fellowships, emergency psychiatry fellowships, mood disorder fellowships. I suppose this can be a PGY-IV year, but your new program would have to graduate you from general adult training and have a general adult program to do this. You would have to be under the training of the general adult PD, not the PD of the fellowship. Non-ACGME approved fellowships cannot give you ACGME training credit. This would be a transfer to a new adult program, or if the same program, it would be essentially hanging out with the fellows for your elective time. The issue at hand is if you truly completed a fellowship or not. This would be completely at the whim of the fellowship director. Unaccredited fellowships can hand out parchment to anyone as there are no real rules. There are a lot of rules about what would count for an ACGME PGY-IV year. Do these fellowships have 360 evaluations, do they monitor duty hours, and do they require participation in QA and QI activities?

I guess there might be some politics over who funds the PGY-IV (pseudo PGY-V) position as far as whose budget it comes from. At our institution, you cannot be paid as a PGY-V before you have completed a PGY-IV year.

Please be wary of the other ACGME rules like, 2 years must be in the same program, and there must be at least 12 continuous months outpatient. Too much moving around can make you not board eligible even after 4 years of training.

As others have pointed out, there is talk about changing this, but so far I believe this is the way it is.

This is my idiosyncratic interpretation of the question at hand. I could be wrong, but please be careful when playing around with training. The ACGME and the NBPN are not very flexible as it is their job to insure the quality of training.

 

[billypilgrim37]

What about a research fellowship? Say you're interested in a 2-year research fellowship, and you spend 6-8 months doing the same research during your elective time in residency. Is there any reason why that couldn't shorten your fellowship?

A research fellowship generally ends either when you get your K or they decide to stop funding you.

 

[SmallBird]

No. A fellowship is a set curriculum, requiring completion of a general residency. (Please don't blame me--this is the ACGME.)
I suppose that theoretically a PGY4 with 100% elective time could "do everything" as though they were filling an empty fellowship position, but as you said in your first post, it would still only count as elective credit toward the general residency, and would not count toward a subspecialty certification in the future.
There is some sentiment for allowing "fast tracking" into the 1 year fellowships (gero, addiction, PSM, forensic--especially gero and addiction), but it's still very much at the discussion stage, and I wouldn't count on it changing in the next 4 years.

I'd say its more than theoretical - our program is 100% elective in fourth year, and it is quite common for people to do the exact same year as the substance abuse or C-L fellows (which is really nice, because you can get jobs in these areas without fellowship accreditation in a lot of places).

 

[liquidshadow22]

Question about resident funding: If a resident fast tracks out of an adult residency into a child psych fellowship at another program. What happens to the funding for the program with the departing resident?