Addiction Medicine...a Family Medicine fellowship?

[Leukocyte]

So now there is a an American Board of Addiction Medicine, with 10 accredited Addiction Medicine fellowships open to Family Medicine graduates.

So what do Psychiatrists think about this? I always thought Addiction Medicine as a Psychiatry fellowship. Do you think that an Addiction Medicine fellowship trained Family Phusician will do just as a good job? Can he/she compete for addiction medicine jobs with fellowship trained psychiatrists?

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[F0nzie]

With the psychiatric comorbidity it's kinda like practicing cardiology without knowing anything about internal medicine. The reality is there aren't enough psychiatrists subspecializing in addiction to address the need. Heck opening up addiction medicine to all physicians does not address the need. NP's have been fighting to get the authority to prescribe suboxone by using the "underserved population" card. Just a matter of time...

 

[OldPsychDoc]

So now there is a an American Board of Addiction Medicine, with 10 accredited Addiction Medicine fellowships open to Family Medicine graduates.

So what do Psychiatrists think about this? I always thought Addiction Medicine as a Psychiatry fellowship. Do you think that an Addiction Medicine fellowship trained Family Phusician will do just as a good job? Can he/she compete for addiction medicine jobs with fellowship trained psychiatrists?

ABAM is a recent spin-off from ASAM (American Society of Addiction Medicine), which has labored for years to bring its certification exam to the status of full ACGME-recognized board certification. Addiction Medicine fellowships have been available for years (longer than Addiction Psychiatry has existed as a sub-specialty), and open to all specialties, but were never ACGME recognized until now.

Yes, an ASAM/ABAM-trained specialist can do just as well as an addiction specialist. They are better at some things--hepatitis & HIV management, to name one thing--though perhaps not as sophisticated with psychiatric issues in dual diagnosis patients. Face it, there are NOT that many people lining up to treat the chemically dependent, so issues of job competition are pretty ridiculous, IMHO.

 

[nancysinatra]

With the psychiatric comorbidity it's kinda like practicing cardiology without knowing anything about internal medicine.

See I don't think so, because addiction overlaps with medicine as much as it does with psychiatry. And there are substance abuse patients who frankly have no other psychiatric comorbidity. When I did my substance abuse rotation I found those patients to be the most challenging because you really have to drop the whole "I'm a Psychiatrist and You are a Psychiatric Patient" deal that is so common in our field, and for which we seem to get pretty little training (for dropping it, I mean), at least at my program...

 

[splik]

With the psychiatric comorbidity it's kinda like practicing cardiology without knowing anything about internal medicine.

which i think is how cardiologists these days like to practice...

 

[vistaril]

See I don't think so, because addiction overlaps with medicine as much as it does with psychiatry. And there are substance abuse patients who frankly have no other psychiatric comorbidity. When I did my substance abuse rotation I found those patients to be the most challenging because you really have to drop the whole "I'm a Psychiatrist and You are a Psychiatric Patient" deal that is so common in our field, and for which we seem to get pretty little training (for dropping it, I mean), at least at my program...

excellent post......

many addiction specialists have no training whatsoever in psychiatry, and do a great job.

I don't think of addiction as under the branch of psychiatry any more than it is under the branch of internal medicine or whatever.

The reality is that there are not a lot of 'medical' treatments for addiction. That is one reason it isn't very popular(amongst internists or family medicine physicians)

 

[imp3tigo]

I don't think of addiction as under the branch of psychiatry any more than it is under the branch of internal medicine or whatever.

The reality is that there are not a lot of 'medical' treatments for addiction. That is one reason it isn't very popular(amongst internists or family medicine physicians)

Like you mentioned, due to the lack of "medical" treatments for addiction the bulk of treatment is psychosocial as well as psychiatric, and so a person from IM or FM is not going to have the background in psychotherapy or psychiatry to be able to effectively treat them. Of course, most psychosocial treatment in addictions is carried out by psychologists, social workers, and addiction counselors.

The only benefit from addiction medicine, versus addiction psych, is that those docs will be more equiped to function as the only physician in an addiction treatment center, especially residential (e.g. Betty Ford), where they would be expected to do physical exams and assess/treat any medical issues for the patients there. However, those places would still need a psychiatrist, so it's really kind of a wash in terms of neither being fully qualified to do both (and be the only doc for the facility).

 

[imp3tigo]

So now there is a an American Board of Addiction Medicine, with 10 accredited Addiction Medicine fellowships open to Family Medicine graduates.

So what do Psychiatrists think about this? I always thought Addiction Medicine as a Psychiatry fellowship.

Like someone already mentioned, addiction medicine (ASAM) has been trying to get accredited by the ABMS for years now, and is making real progress towards that goal. They have not, yet, actually achieved that goal. So while there are fellowship programs (and some have addiction psych AND addiction medicine within the same department) for addiction medicine, they are NOT accredited by the ABMS (among other things, that means you cannot claim the 200 hours of category I CME after getting board certified).

ASAM is much larger, and has been around longer, than AAAP (addiction psych). A lot of them are various docs (peds, surgery, etc.) in recovery from addiction themselves, and their meetings are sometimes described as "a bunch of drunks getting together" whereas AAAP is a much smaller community and more research/academic focused. Due to the lack of addiction psychiatrists though, there is certainly room for both to co-exist, which is probably what will eventually happen. There are quite a few addiction jobs that specifically want addiction psychiatrists though, so they probably still have an advantage in getting addiction field jobs.