Addiction Psychiatry fellowship worth it?

[TheLoneWolf]

Hello,

I have a 3rd year psychiatry resident in my immediate family. Never rotated on forensic or addictions psych, which is a bit of a surprise to me. I would have imagined those are ACGME mandated rotations. Wants to do a fellowship but has no direction based on lack of experience. His residency program only offers a child psychiatry fellowship. No graduate who went into addictions in the past couple of years that he can reach out to for info. Is absolutely 💯 convinced he will be doing a fellowship, just isnt sure which way to go.

Thought he wanted pain management then got assaulted by a pain patient and got tired of getting dumped on by other services a large number of conniving, manipulative types who just want to get back on their narcotic of choice, not interestedin any psych management.

Changed his mind to child psychiatry then got assaulted by a teen as he was walking out of a unit. Also frustrated that a lot of the kids have poor parenting leading to outbursts rather than true underlying pathology.

Talked to his PD and they recommended addictions management fellowship as it is a good fit for his personality. Says it's fairly nice as an outpatient practice, would become very busy rather quickly. My brother countered that several psychiatrists practice and market addictions management without the fellowship. I'm rather unconvinced that general exposure during a psychiatry keeps one on the same level as a fellowship trained psychiatrist. Particularly with difficult cases.

I did a rotation in inpatient addictions management in a nice suburb and thought it was great. Granted, the attending was a family med doc with a 1 year fellowship, so maybe slightly different day to day than outpatient psychiatrists.

I would appreciate if anyone who practices addictions management (with or without the fellowship) would mind chiming in. At this point, he is rather listless and I don't have anyone who can provide information on the day to day practice, expected salary, and lifestyle. Does it remain enjoyable or does it become a grind over a few years? (ie like pain management where endless meds, procedures, and surgeries don't budge the pain scores or return to work rates.)

Thank you in advance for any response.

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[Bartelby]

Why do any fellowship? If there isn't a passion for that particular fellowship you are more than fine to just finish psychiatry residency and start work.

Addiction psychiatry will also often deal with pain patients who desperately want controlled substances. More often you get to see those who are motivated enough to show up to an addiction clinic, though, so it can be less intense / on average patients will be more open to doing reasonable things like tapers. Getting assaulted is possible in any subspecialty, but I don't think of pain, addiction, or child as particularly high risk (more ER and inpatient).

 

[TexasPhysician]

I would not avoid pain or CAP based on perceived assault risk. While I feel like CAP fellowship was yesterday, I have somehow been in private practice 10 years. Trying not to jinx myself, the most significant assault since the beginning of residency has been an 8 year old kicking the chair I’m in. I’d argue that managing running hugs from my own children has been more painful than psychiatry. While some physicians in all fields will become statistics of assault, the general risk in psychiatry specialties is not high. The resident from my class assaulted the most is Geri focused - rare slapping.

Being addictions boarded as well, the credentials help in obtaining addictions positions. One addictions position that I have was obtained because the place was not happy with the performance of the general psych that held the position before me. While I negotiated a higher pay than he had, I believe it is due to the facility recognizing the problems and how I explained my solutions to the problems. On average, I wouldn’t anticipate making more money in addictions than general psych. In private practice, anyone can advertise addictions services, but most don’t as addictions isn’t something most enjoy.

I particularly enjoy addictions work. That is just me. The credentials have helped me obtain positions that I would describe as more enjoyable, but that is probably a personal opinion. If you don’t really enjoy the work, I wouldn’t recommend doing it. It won’t pay off financially for average jobs.

If your goal is to make more money, “average jobs” are not the path to take. High volume interventional pain private practice is the only psych related field that may be able to argue that they earn more than me on average with typical jobs. Their range is high, but I know interventional pain people in my area earning 7 figures from 1 job. Securing higher paying part-time positions with my multiple credentials adds up to earning more than other singular psych specialty jobs. I could do this without addictions credentials, but it would make my enjoyable positions (my opinion) more difficult to obtain.

 

[comp1]

The OP's post does not make a lot of logical sense. It's clear that emotions are very high. Pain and addiction patient populations will have an extreme overlap, particularly on the East Coast. I concur with the above poster that there is nothing stated here that justifies any fellowship at all. Outpatient child psychiatrists are not somehow at higher risk of assault than adult outpatient psychiatrists. But most importantly, why would someone be "100% committed" to do doing any random fellowship? It is so backwards that I am strongly concerned that the person referenced might instead be afraid of going out into the real world after all this trauma. It needs to be faced. The only advice should be no fellowship, not any further discussions about lifestyles and incomes.

 

[Merovinge]

The OP's post does not make a lot of logical sense. It's clear that emotions are very high. Pain and addiction patient populations will have an extreme overlap, particularly on the East Coast. I concur with the above poster that there is nothing stated here that justifies any fellowship at all. Outpatient child psychiatrists are not somehow at higher risk of assault than adult outpatient psychiatrists. But most importantly, why would someone be "100% committed" to do doing any random fellowship? It is so backwards that I am strongly concerned that the person referenced might instead be afraid of going out into the real world after all this trauma. It needs to be faced. The only advice should be no fellowship, not any further discussions about lifestyles and incomes.

I think that will depend on how you define assault. A lot of general practice OP CAP involves ID/DD/ASD patients who certainly carry a higher rate of laying hands on the doc than the average adult patient. I have been kicked and headbutted over the span of the 3 years I spent doing OP CAP with a medicaid accepting population. I saw both of these events coming and neither was more than a graze, but the later patient was actually trying to bite me (thankfully I was able to avoid this). Now neither of these events even interrupted my clinic pacing and weren't a big deal at all, but I think they would be counted in surveys as both kids did connect with my body.

 

[comp1]

Fair point. You probably are more likely to be physically contacted in a child practice and that does define assault in many jurisdictions. I guess I more meant something that "would interrupt clinic pacing." I've also been "assaulted" by a 16 year old girl on an inpatient unit, but continued work uninterrupted.