Addiction fellowship

[All Good]

Hi! I am considering an addiction fellowship starting in 2016 and have found little info on program websites. If anyone in this group has gone through the application process and would like to share some advice on how to go about the process (narrow down what schools to apply, how many programs apply ect).
I also have a family so if you know of family friedlly programs even better. Thank you in advance .

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[OldPsychDoc]

There's not a ton of competition for these--the most important qualification seems to be having a strong desire to do it!
I'd start with programs close to your present one, or if across country, perhaps where you'd like to end up. And as far as family-friendly...I've never heard of any that have bad hours or require weekends (at least not without weekday comp days.)

 

[HarryMTieboutMD]

One of my favorite attendings from medical school did his addiction fellowship at Yale (and actually just moved back to New Haven to accept a faculty there this past year) and absolutely loved it. Yale is historically one of the strongest centers for everything addiction related and the area/program are very family friendly. Some of the most important names in addiction medicine/addiction psychiatry have been at/are at Yale: Herb Kleber, Mark Gold, Eric Nestler, Marc Potenza, Patrick O'Connor...

 

[Ironspy]

One of my favorite attendings from medical school did his addiction fellowship at Yale (and actually just moved back to New Haven to accept a faculty there this past year) and absolutely loved it. Yale is historically one of the strongest centers for everything addiction related and the area/program are very family friendly. Some of the most important names in addiction medicine/addiction psychiatry have been at/are at Yale: Herb Kleber, Mark Gold, Eric Nestler, Marc Potenza, Patrick O'Connor...

Yale is excellent for addiction but Eric Nestler is at Mt. Sinai now.

 

[SmallBird]

One of my favorite attendings from medical school did his addiction fellowship at Yale (and actually just moved back to New Haven to accept a faculty there this past year) and absolutely loved it. Yale is historically one of the strongest centers for everything addiction related and the area/program are very family friendly. Some of the most important names in addiction medicine/addiction psychiatry have been at/are at Yale: Herb Kleber, Mark Gold, Eric Nestler, Marc Potenza, Patrick O'Connor...

For about a month I thought of doing the addictions fellowship at Yale - I had no prior interest in the area, and can't say I developed one, but the people are just so nice in that part of the department, and the fellowship seems to be insanely lifestyle friendly (9 - 3 most days??).

 

[Doctor Bagel]

I went to the addiction psychiatry conference this year, and Yale was hugely represented. It's also a big program, right? If you want a research/academic career, it's probably a great place to be. About the lifestyle friendly aspect, though -- it seems like all psych fellowships aside from child are lifestyle friendly with free weekends and evenings.

I'd vote for focusing on location because it's easier to stay where you are.

 

[All Good]

These are all very helpful comments. Thank you. I will look into the program.

 

[HarryMTieboutMD]

Yale is excellent for addiction but Eric Nestler is at Mt. Sinai now.

I wrote "have been at/are"... Yes, Dr. Nestler is at Sinai, Dr. Kleber is at Columbia, Dr. Gold was most recently Chair at Florida, etc etc etc. The point is those 3 names are some of the biggest in the field, and were all at Yale at one point. For example, Kleber and Gold were the first to investigate the use of clonidine in opiate withdrawal...

 

[strangeglove]

Consider whether you have an interest in research, since programs like Yale are known for this.

 

[All Good]

Yes strangelove, I am very interested in research. What other programs are strong for this?

 

[doubledeuce80]

Hi!
I did the Yale addiction psychiatry fellowship. It is the largest program in the country (7 fellows) and I believe NYU is next largest with 5. After that most programs have 1-3 fellows. The Yale fellowship has two tracks: a VA track which has a very very manageable workload and lots of research and medical education opportunities, but neither are mandatory. The other track is based at the Apt Foundation and has community psych focus with a heavier clinical workload and traditionally less research. The fellowship is very family friendly- manageable workload and no nights/weekends/call. One of my classmates w/ a family did the fellowship after working in private practice > 10 yrs and commuted ~1 hr each way without a problem. Overall, it was best educational thing I ever did (I love addiction, so might be biased) and would be happy to answer any questions people have?

I also interviewed at UCSF, UCLA, Columbia, MGH/McLean and know some of the fellows at each so could answer some general questions about those programs too.

 

[All Good]

Hi!
I did the Yale addiction psychiatry fellowship. It is the largest program in the country (7 fellows) and I believe NYU is next largest with 5. After that most programs have 1-3 fellows. The Yale fellowship has two tracks: a VA track which has a very very manageable workload and lots of research and medical education opportunities, but neither are mandatory. The other track is based at the Apt Foundation and has community psych focus with a heavier clinical workload and traditionally less research. The fellowship is very family friendly- manageable workload and no nights/weekends/call. One of my classmates w/ a family did the fellowship after working in private practice > 10 yrs and commuted ~1 hr each way without a problem. Overall, it was best educational thing I ever did (I love addiction, so might be biased) and would be happy to answer any questions people have?

I also interviewed at UCSF, UCLA, Columbia, MGH/McLean and know some of the fellows at each so could answer some general questions about those programs too.

Thank you for your reply. Congratulations on finishing your fellowship 🙂
It sounds like the VA track would be more compatible with my interest in research.
Some Q's:
How competitive is the program? What does the admission committee look at? I have a strong research background and excellent PRITE scores. Nevertheless my USMLE STEP 1 was awful. This is Yale we are talking about! I'm not sure if they would consider a candidate with a low STEP 1 score. How can I make myself more attractive for their program?

 

[doubledeuce80]

Thank you for your reply. Congratulations on finishing your fellowship 🙂
It sounds like the VA track would be more compatible with my interest in research.
Some Q's:
How competitive is the program? What does the admission committee look at? I have a strong research background and excellent PRITE scores. Nevertheless my USMLE STEP 1 was awful. This is Yale we are talking about! I'm not sure if they would consider a candidate with a low STEP 1 score. How can I make myself more attractive for their program?

Hi All Good,
1. The program has gotten more competitive in recent years, but I would stay still selects a diverse group of applicants. For example, my class had 1 DO and 2 IMGs (i.e. individuals who may not be interviewed/considered/selected by some "competitive programs")
2. Disclaimer: I'm not on the selection committee, but my feeling is they highly value a documented history/interest in addiction, strong LORs, and a friendly/drama free/works well with others personality. The program director is also a researcher and loves to have applicants that are interested in getting involved in research at the CT VA.
3. USMLE and PRITE scores are not part of the application process, so I don't think they will ever know about your "awful" step I or "excellent" PRITE scores. Application is: CV, 3 LOR, and brief statement of interest
4. More competitive: assuming you are a PGY-III/PGY-IV at this point- elective rotations in addiction psychiatry with strong letters of recommendation from attendings who directly observed your work (bonus: if they are big names in field), start/join addiction psychiatry interest group, apply for american academy of addiction psychiatry travel awards/regional travel awards and attend conference (lots of Yale people there to network with, including PD), more publications in addiction psychiatry, apply early and interview in first half of interview season (they do rolling admissions and class can fill up early)

Let me know if you have any other questions!

 

[strangeglove]

Yes strangelove, I am very interested in research. What other programs are strong for this?

Then for sure consider Columbia. Especially if you are interested in either clinical pharmacology or human laboratory research on addiction.

 

[All Good]

Thank you all for the great advice! I am looking forward to this next chapter.

 

[doubledeuce80]

Thank you all for the great advice! I am looking forward to this next chapter.

MGH/McLean has option for 2 yr combined research and clinical addiction psychiatry fellowhip.

Columbia is two years as well FYI. Possibly longer if you end up pursuing a K award.

 

[OldPsychDoc]

Agree that the names being mentioned here are great choices for addiction fellowships. Also, it is fairly common to find 1 year clinical fellowships paired with 1 year research fellowships for a 2 year program as described above. That said, the 1 year clinical fellowships are often wide open at good programs for residents who have a real desire to work in this field.

 

[EctopicFetus]

Im new to interest in this. Wondering how the hours and income are. Someone mentioned this to me.

 

[Leo Aquarius]

Im new to interest in this. Wondering how the hours and income are. Someone mentioned this to me.

What did that someone tell you?

 

[EctopicFetus]

What did that someone tell you?

Good pay, normal hours.

 

[HarryMTieboutMD]

Good pay, normal hours.

Like with any other branch of medicine, it depends on your setup/patients/etc. If you are the medical director of Betty Ford/Talbott/Hazelden etc, then yes, you will get paid well, but you have to be established in Addiction Medicine/Addiction psychiatry to do that (or probably even work at a big name treatment center as a psychiatrist). You can start your own rehab but you have to have infrastructure, credibility with ASAM, credibility with the state medical boards for treating impaired physicians, etc. If you just want to add suboxone to your practice (which can be lucrative), you don't need an addiction fellowship (provided you use judgment when you prescribe it). You just have to take the 8 hr course. I do know that with the increasing power of ASAM and more and more addiction medicine MDs coming from non psychiatric backgrounds, treatment centers are begging for psychiatrists to manage co morbid psychopathology and practice sound psychopharmacology. However, I am not so sure that the salaries are any higher than those of other psychiatrists.

Bottom line- patients with addiction are among the toughest in medicine/psychiatry, and though we have effective pharmacologic and psychotherapeutic treatments, we are still in the dark ages (though this is changing). So, you should do addiction if you really love the patient population and coming to work gets you up in the morning, not for the money.

*Cue other people disagreeing, but I don't care*

 

[OldPsychDoc]

Like with any other branch of medicine, it depends on your setup/patients/etc. If you are the medical director of Betty Ford/Talbott/Hazelden etc, then yes, you will get paid well, but you have to be established in Addiction Medicine/Addiction psychiatry to do that (or probably even work at a big name treatment center as a psychiatrist). You can start your own rehab but you have to have infrastructure, credibility with ASAM, credibility with the state medical boards for treating impaired physicians, etc. If you just want to add suboxone to your practice (which can be lucrative), you don't need an addiction fellowship (provided you use judgment when you prescribe it). You just have to take the 8 hr course. I do know that with the increasing power of ASAM and more and more addiction medicine MDs coming from non psychiatric backgrounds, treatment centers are begging for psychiatrists to manage co morbid psychopathology and practice sound psychopharmacology. However, I am not so sure that the salaries are any higher than those of other psychiatrists.

They aren't.

Bottom line- patients with addiction are among the toughest in medicine/psychiatry, and though we have effective pharmacologic and psychotherapeutic treatments, we are still in the dark ages (though this is changing). So, you should do addiction if you really love the patient population and coming to work gets you up in the morning, not for the money.

*Cue other people disagreeing, but I don't care*

No disagreement here!

 

[Shikima]

 

[Leo Aquarius]

Good pay, normal hours.

Do you enjoy patients lying to you all day long? Only the toughest psychiatrists should go into Addiction.

 

[smalltownpsych]

Do you enjoy patients lying to you all day long? Only the toughest psychiatrists should go into Addiction.

Are you implying that it's not true that the only meds that really work are benzos and Adderall?
😱
Seriously though, I have issues with some of the ways that both psychiatry and psychology deal with addiction. Especially the resistance to abstinence as a goal, 12 step groups as being effective in maintenance of long-term abstinence, and conceptualizing addiction as self medication of an underlying condition. The addicts want us to believe these things and they can be quite convincing, especially the high functioning ones who are our colleagues, coworkers, employees, and administrators.

 

[Doctor Bagel]

Do you enjoy patients lying to you all day long? Only the toughest psychiatrists should go into Addiction.

And lie about everything. It's amazing. Not easy and not a gold mine, but it's great training for learning how to deal with difficult patients.

I had a friend who was interested in taking a job in a suboxone clinic that was sold to her as pretty easy with high hourly pay. The administrator told her the patients did pretty well and just needed monthly check-ins. Sounded simple.With addicted patients, the less attention you pay, the better (and easier) and more lucrative the work seems to be. The more attention you pay, the harder it is.