Addiction Psychiatrists?

[itsallgood123]

Rising MS-2 here interested in Addiction Psychiatry. Are there any board specialized or practicing addiction psychiatrists I can contact here on SDN? I have tried to shadow in my area but to no avail. Just have some questions on the career; any referrals at all would be greatly appreciated.

Thank you all for your time

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[TexasPhysician]

Betty Ford has a med student internship that lasts about 7 days. They even pay your way. I loved it. You should contact them.

 

[splik]

The APA also has an addiction psychiatry externship for students from minority backgrounds (Addiction Psychiatry)

 

[itsallgood123]

Oh man it seems like I missed out on those opportunities for this year (since I go back to school next week) but Im def gonna check them out for my upcoming years so I appreciate it!

Nevertheless, do you all know of anyone I can contact on sdn (hope that doesnt sound creepy)? If not I guess I can just post my questions here for all to see

 

[TexasPhysician]

I have worked at an addiction center enough to grandfather in to addiction medicine. No fellowship in addictions though

 

[itsallgood123]

can you not contact the psychiatry clerkship director and see if they can arrange for you to shadow or preceptor an addictions doc? The easiest way to do this will be through your school, otherwise there are a bunch of hoops you have to jump through.

I have tried through my school before but unfortunately they only know of general psychiatrists I can shadow. Which doesnt make much sense to me - I will make another attempt as I do agree it's the easiest way. It does raise the question that perhaps there are not many psychiatrists who practice solely addiction?

I have worked at an addiction center enough to grandfather in to addiction medicine. No fellowship in addictions though

Awesome to hear. In your experience do you believe it is feasible for an addiction psychiatrist to work only on addiction patients and do you believe the fellowship can help steer one in that direction? Addiction is an area of medicine where I myself have dealt with and been exposed to and feel like I can help patients the most in this realm.

 

[splik]

I have tried through my school before but unfortunately they only know of general psychiatrists I can shadow. Which doesnt make much sense to me - I will make another attempt as I do agree it's the easiest way. It does raise the question that perhaps there are not many psychiatrists who practice solely addiction?

no, it raises questions about what kind of sorry excuse of a school you attend. ask for your money back! most psychiatrists don't practice exclusively addictions, but in many settings, addictions are comorbid in >50% of patients we see, and many psychiatrists will spend some time working in addictions oriented practice (e.g. suboxone clinic etc). And yes there are some psychiatrists who focus solely or predominantly on addictions. There is no shortage of patients! Because of the current opiate epidemic, addictions is a hot area right now. Also many family physicians and internists practice addictions.

BTW, If you join the american academy of addiction psychiatry you can get assigned a mentor. They also have travel awards for med students to attend their annual meeting which is in december and always somewhere sunny.

 

[ANCAdoc]

My wife is an Addiction Psychiatrist. She recently completed an Addiction Psych Fellowship. Many docs can practice addiction medicine (sorely needed) but few are board eligible or certified. I think Addiction Psych is a cool field because you can specialize in dual diagnosis, treating both addiction and underlying mental illness, which many other practitioners (who are not psych) who practice addiction can have difficulty.

Her practice is entirely outpatient addiction psychiatry. Excellent pay (I had no idea, it did increase with her fellowship). Excellent outpatient work hours.

 

[HarryMTieboutMD]

I'd look for an external rotation your MS4 year at a place that has an addictions unit. I would be glad to have an extern/subI really just interested in the subject of addiction psychiatry itself and not attempting to put on some sycophantic show in an attempt to match at our program

 

[3lefts]

Betty Ford has a med student internship that lasts about 7 days. They even pay your way. I loved it. You should contact them.

I did this, it was a great experience.


Sent from my iPhone using SDN mobile

 

[TexasPhysician]

It does raise the question that perhaps there are not many psychiatrists who practice solely addiction?


Awesome to hear. In your experience do you believe it is feasible for an addiction psychiatrist to work only on addiction patients and do you believe the fellowship can help steer one in that direction? Addiction is an area of medicine where I myself have dealt with and been exposed to and feel like I can help patients the most in this realm.

I was 100% addictions when I worked that job. I had done some moonlighting there while doing a child fellowship. While debating my first real job, one of the addiction trained folks left abruptly. They offered me his job, and I figured why not. I passed that job off about 1-2 years later to a friend who is not addiction fellowship trained either.

There are addiction fellowships that go years without anyone applying. The addiction jobs currently can't wait for someone fellowship trained because they are so rare. I get offers for part-time addiction work all the time.

 

[itsallgood123]

no, it raises questions about what kind of sorry excuse of a school you attend. ask for your money back! most psychiatrists don't practice exclusively addictions, but in many settings, addictions are comorbid in >50% of patients we see, and many psychiatrists will spend some time working in addictions oriented practice (e.g. suboxone clinic etc). And yes there are some psychiatrists who focus solely or predominantly on addictions. There is no shortage of patients! Because of the current opiate epidemic, addictions is a hot area right now. Also many family physicians and internists practice addictions.

BTW, If you join the american academy of addiction psychiatry you can get assigned a mentor. They also have travel awards for med students to attend their annual meeting which is in december and always somewhere sunny.

Yeah lolll my school is lame sauce sometimes im hoping there was somehow miscommunication on their end. Wonderful advice though, thank you for your reply! Just bookmarked the AAAP.

My wife is an Addiction Psychiatrist. She recently completed an Addiction Psych Fellowship. Many docs can practice addiction medicine (sorely needed) but few are board eligible or certified. I think Addiction Psych is a cool field because you can specialize in dual diagnosis, treating both addiction and underlying mental illness, which many other practitioners (who are not psych) who practice addiction can have difficulty.

Her practice is entirely outpatient addiction psychiatry. Excellent pay (I had no idea, it did increase with her fellowship). Excellent outpatient work hours.

Nice!! Those patients surely need her help. It's a pleasant surprise her pay is excellent as well I'd imagine many on heroin and opioids would struggle to find or keep employment. Can anyone enlighten me on how that could be the case? Also, does she treat behavorial addictions too?

I'd look for an external rotation your MS4 year at a place that has an addictions unit. I would be glad to have an extern/subI really just interested in the subject of addiction psychiatry itself and not attempting to put on some sycophantic show in an attempt to match at our program

Something I'd def looking forward to my MS4 year are opportunities like these.

I was 100% addictions when I worked that job. I had done some moonlighting there while doing a child fellowship. While debating my first real job, one of the addiction trained folks left abruptly. They offered me his job, and I figured why not. I passed that job off about 1-2 years later to a friend who is not addiction fellowship trained either.

There are addiction fellowships that go years without anyone applying. The addiction jobs currently can't wait for someone fellowship trained because they are so rare. I get offers for part-time addiction work all the time.

Interesting. With how big the opioid epidemic has become this slightly surprises me. Why do you think physicians choose not to pursue a fellowship? Is it because there really is not a need to given how much more the demand is than the supply?

Also, if you don't mind could you describe what the patients were like? For ex how grateful some were, the lying if there was any, if you ever felt frightened for your safety working for this population, and most importantly if you truly felt like you were able to really change someone's life around?

 

[itsallgood123]

Again, thank you all for the replies I know it's a lot of questions. I've tried surfing the internet and doing my due diligence of work but I figured coming straight to the most reliable sources were my best bet (second to actual shadowing ofc). And I will find a way to shadow one soon I promise yall.

 

[TexasPhysician]

Interesting. With how big the opioid epidemic has become this slightly surprises me. Why do you think physicians choose not to pursue a fellowship? Is it because there really is not a need to given how much more the demand is than the supply?

Also, if you don't mind could you describe what the patients were like? For ex how grateful some were, the lying if there was any, if you ever felt frightened for your safety working for this population, and most importantly if you truly felt like you were able to really change someone's life around?

An addiction fellowship is unlikely to result in any increase in pay. I've brought up taking the addiction boards with admin and while all were encouraging, none were willing to pay for it or increase my rates.

Patients are generally pleasant, but some are master manipulators. A firm stance is often needed. Never felt frightened, but refusing extra benzos/Subutex has led to yelling. Some patients return to former glory, and others end up in the ICU from an overdose.

 

[OldPsychDoc]

Interesting. With how big the opioid epidemic has become this slightly surprises me. Why do you think physicians choose not to pursue a fellowship? Is it because there really is not a need to given how much more the demand is than the supply?

It's the stigma within the stigma within the stigma.

Also, if you don't mind could you describe what the patients were like? For ex how grateful some were, the lying if there was any, if you ever felt frightened for your safety working for this population, and most importantly if you truly felt like you were able to really change someone's life around?

I've never felt unsafe--but I've always worked in settings with other people around.

I've never changed anyone's life around. They do that. I've got some patients who have 10+ years of valued sobriety, some who are vulnerable to periodic relapses and work through them, some who have succumbed. Never a truer axiom than that the light bulb has to want to change. But sometimes they want to and they need a lot of help from us. Patience and the judicious application of non-controlled pharmacology can go a long way. Every patient is an individual--think about your Stages of Change...how they got where they are, how motivated (or not, and why) they are to change. Usually if they're in a treatment setting they have some motivation to make a change, and it's your job to help them find it and to strengthen it, fan that ember into flame, as it were. Sometimes that motivation is external--the wife's ultimatum or the P.O.'s watchful eye. You can still try to help them figure out how to succeed. By the time they're seeing a psychiatrist explicitly for addiction services, they're usually beyond lying, though it can be a habit that's hard to break. But lying to get opiates or benzos--not so much. That's for the ones who haven't got to us yet, and are still shopping the ERs and FP clinics.

 

[TexasPhysician]

But lying to get opiates or benzos--not so much. That's for the ones who haven't got to us yet, and are still shopping the ERs and FP clinics.

I'll strongly disagree here, especially with the 18-26 crowd. These young adults are usually on parental insurance plans. They often have unreasonable requests like tapering off heroin with subutex while inpatient over 50 days. Some like to argue that heroin was a problem, but they never abused the Xanax 2mg TID prescribed. Then they demand you prescribe the Xanax as they have documentation that describes the valid "need".

Some report abusing alcohol heavily to get benzos added to their opiate detox after initially denying alcohol use. Later family will agree that the patient hates alcohol.

All of this occurs weekly in insurance based addiction centers, or maybe just mine....?

 

[OldPsychDoc]

I'll strongly disagree here, especially with the 18-26 crowd. These young adults are usually on parental insurance plans. They often have unreasonable requests like tapering off heroin with subutex while inpatient over 50 days. Some like to argue that heroin was a problem, but they never abused the Xanax 2mg TID prescribed. Then they demand you prescribe the Xanax as they have documentation that describes the valid "need".

Some report abusing alcohol heavily to get benzos added to their opiate detox after initially denying alcohol use. Later family will agree that the patient hates alcohol.

All of this occurs weekly in insurance based addiction centers, or maybe just mine....?

Well, populations do vary regionally and from program to program a little--but it's sad that they've learned there are docs that will let them get away with that. It's always something...

 

[ANCAdoc]

An addiction fellowship is unlikely to result in any increase in pay. I've brought up taking the addiction boards with admin and while all were encouraging, none were willing to pay for it or increase my rates.

In general probably, but it's supply and demand right now and demand is like nothing I've seen. I think if someone completed a fellowship in the area they could easily integrate into an existing large practice and become medical director (looks good for the program). That's what my wife did straight out of fellowship, but she's a good negotiator too. I'm sure geography and politics plays a large role. I make good money but she's about 100k above me.

 

[TexasPhysician]

In general probably, but it's supply and demand right now and demand is like nothing I've seen. I think if someone completed a fellowship in the area they could easily integrate into an existing large practice and become medical director (looks good for the program). That's what my wife did straight out of fellowship, but she's a good negotiator too. I'm sure geography and politics plays a large role. I make good money but she's about 100k above me.

You are correct in that demand is very high.

No fellowship needed to be medical director of an addiction center though.

I've had 2 offers in the last 2 months alone. They are literally cold calling docs in the area.