Addiction psychiatry fellowship

[NeuroKlitch]

Talking from a financial perspective only , how much will an addiction fellowship add to overall salary and lifestyle. Compared to not doing a fellowship at all . I know with private practice it's how buisness savy u are, but say an addiction trained psychiatrist vs non fellowship trained psychiatrist with equal buisness acumen and equal morals were to practice , would there be any difference in income or ease of life style .

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[dl2dp2]

Addiction IMO is overall worth it. My estimate is about a 10-20% pay bump and opens up more jobs. Top end PP can be quite lucrative in this field if that’s your thing. I also think lifestyle is generally an improvement: I would pick voluntary inpatient addiction jobs over a general locked inpatient psych job ANY day. That said, dual diagnosis units are a pain in the butt.

However not everyone likes the content of this filed. I personally actually prefer it over general psych. Most don’t.

 

[NeuroKlitch]

Thanks was hoping to get ur opinion on this . Is addiction board certification viewed as favorably as say child when it comes to the job market , or is it along the lines of geriatric where maybe they see it as a negative that I will bring in medicare/medicaid patients largely ( based off what I read online).

With everyone and their mother now going into psych , I'm hoping to keep some sort of competitve edge so that I can work mostly anywhere I want .

Also what exactly is a top end private practice ? Thanks

 

[Bartelby]

I doubt that any setting would view addiction fellowship training as a negative. Still, I think you can easily find a job anywhere in psychiatry with no fellowship. If you want to do addiction work as a major focus of your career it could be worth doing the fellowship. Being great at your job opens many doors.

 

[docksan]

Is fellowship available later? On a loan forgiveness program that doesn't allow for fellowship. How necessary is it for practice?

 

[TexasPhysician]

I haven’t found my addiction board increase 3rd party job hourly rates. It may bring in more private practice patients. It certainly has provided contracted jobs that in my opinion are easier than gen psych jobs.

 

[dl2dp2]

Thanks was hoping to get ur opinion on this . Is addiction board certification viewed as favorably as say child when it comes to the job market , or is it along the lines of geriatric where maybe they see it as a negative that I will bring in medicare/medicaid patients largely ( based off what I read online).

With everyone and their mother now going into psych , I'm hoping to keep some sort of competitve edge so that I can work mostly anywhere I want .

Also what exactly is a top end private practice ? Thanks

I think you are overthinking it and there are various caveats. At the moment anyone with general training can get a job anywhere. Even in the worst-case scenario as I said in the other thread, what might happen is if you graduated from a lower-tier program you'll have less geographical/practice environment flexibility. You should not need to do a fellowship just so that you can have an edge in that sense--a quality university residency training followed by high-quality jobs after should be more than sufficient. It's also unclear if any generic poorly rated addiction fellowship will be much value-add (vs. working directly at a community addiction clinic as a general resident grad).

Jobs that are 100% addiction-focused (i.e. inpatient rehab, outpatient dual/suboxone/methadone clinic, etc) generally prefer addiction fellowship-trained, and frankly, I think those jobs are quite different in day to day content vs. similar jobs for a general psychiatrist, so I'm not sure general psychiatrists would even apply to those had they been acceptable (i.e. have an X number, etc.). So I'm not sure if you'll like these jobs per se. At the moment they are quite plentiful and tend to prefer psych people, as this allows them to avoid the step of getting another "psych consult" for the comorbid suicidality, etc. However, do be mindful that overtraining over the addiction side can happen also! Witness all the troubled ER/anesthesia people doing addiction medicine fellowships==> this will affect those jobs. As I said, they tend to pay 10-20% above equivalent jobs for general psych, but still much much lower than equivalent facility-based ER/anesthesia jobs, so this is not a concern at the moment. NP penetrance for this is also somewhat lower, but is growing.

As far as PP--some small number of addiction attendings can command a very high income (500k+) due to various niche practices, but this is not a consideration for the average. I think you need to be in the top 10-20% and develop relevant relationships and be business savvy. There's also no clear recipe to end up there and the pathways are very diverse. A good place to learn is to meet people at AAAP. Average PP (~300k) is still a nice lifestyle. Is it easier to end up 500k+ in addiction vs. general? Hard to say. I think perhaps there's a small effect, but it's not consistent or obvious.

I do find that in general people who did addiction fellowships end up focusing heavily on addiction, whereas the same cannot be said for child. Not sure why this is. @TexasPhysician do you find it to be case as well?

The bottom line is you shouldn't do the fellowship unless you are interested in the actual content of the work.

 

[futuredo32]

Have you considered the practice pathway?

 

[Animal Mother]

Curious how places that prefer fellowship-trained addiction med drs will feel about practice pathway board certified addiction doctors.

 

[NewYorkChildPsych]

There's a HUGE market for addiction psychiatrists in all sorts of settings. The fellowship is fairly benign (i.e., no overnight/weekend call work) and you'll graduate with a solid knowledge base. Moreover, it's a great opportunity to network in a new region/institution if you're moving to another city or state.

You can easily supplement your income with moonlighting and private practice as well.

 

[NeuroKlitch]

Thanks , I'm so back and forth and honestly a little burnt out. Light program malignancy on top of never endings bills makes me want to get out early. But very drawn to the idea and or the long term potentials of a leadership role down the line when I'm burnt out (again) .

 

[What'sTheWifiPassword]

Does anyone have advice on the type of addiction fellowship? My home program has an established addiction medicine fellowship within the department of psychiatry. I'd prefer to stay on for a year rather than move to another state for an addiction psychiatry fellowship. I already have moonlighting established locally. Am I crazy for thinking so?

 

[psyguru]

If you get involved in expert witness work like addiction FFD IMEs, DUI cases, big tobacco litigation, DFSA cases, court-martials involving DFSA, rehab med mal, opioid addiction in PI cases, FAA exams, etc you could do very well financially. I am a forensic psychiatrist with some addiction experience and an MRO and suboxone certification and do get some addiction-related cases.

 

[Sushirolls]

It will make no difference in your career. It will not overtly add money to your career.

Most job postings for addiction specific are geared more toward community mental health agencies or are part of the large for-profit psych hospital systems and they don't necessarily care or differentiate compared to general psych with pay, or even hiring.

The higher end voluntary inpatient addiction hospitals will pay higher - but they will work you harder - with more patient volume and higher call frequency, and expect that you take those middle of the night admission phone calls. This is because a very tight competitive market for these types of addiction facilities and they don't want to miss the chance to get an admission. You will certainly work for those few extra dollars.

The really high end facilities taps into Sluox-esque descriptions of pedigree and knowing people and well, there are only a few of these doors open and only a few people get to walk thru them. This is also the same for general psych jobs, too.

Private practice, taking insurance, isn't worth it in my opinion. There is such an increase in people doing suboxone, ARNPs, PAs etc and large pseudo-national firms that are suboxone mills that the volume dropped off. I only have 5-10 people in my practice for suboxone. A major need in the community is for medicaid and that typically goes to community mental health agencies or these pseudo-national firms. Alcohol use disorder pops up more frequently for treatment in my office, but this population is notorious for relapse and dropping off the radar. I had toyed around with the notion before I opened up my practice of doing 100% addiction outpatient focus, and so glad I didn't. At times I almost think of not advertising my addiction status any more simply because of the turnover aspect of AUD patients, that time could have been spent focusing on depression/anxiety/OCD which have better follow up rates. If one wants to really make an outpatient addiction practice work, I think you almost have to have the connected IOP/PHP program to go with it, and really work to get the referrals from ED when they discharge folks - but if you aren't taking medicaid, good luck being THE referral for ED Social Workers, and now you are on the same competition level as all the large Big Box shop entities that also offer Residential with their IOP/PHP.

None of my contracts with insurance pay me more for my addiction boards, or any enhanced pay because of it. I get the same generic rates as all the other psych with my insurance contracts.

I was on the verge of applying to a few programs at the end of my residency but reviewing the curriculum and rotations couldn't justify it over simply doing the practice pathway for addiction medicine.

 

[NeuroKlitch]

It will make no difference in your career. It will not overtly add money to your career.

Most job postings for addiction specific are geared more toward community mental health agencies or are part of the large for-profit psych hospital systems and they don't necessarily care or differentiate compared to general psych with pay, or even hiring.

The higher end voluntary inpatient addiction hospitals will pay higher - but they will work you harder - with more patient volume and higher call frequency, and expect that you take those middle of the night admission phone calls. This is because a very tight competitive market for these types of addiction facilities and they don't want to miss the chance to get an admission. You will certainly work for those few extra dollars.

The really high end facilities taps into Sluox-esque descriptions of pedigree and knowing people and well, there are only a few of these doors open and only a few people get to walk thru them. This is also the same for general psych jobs, too.

Private practice, taking insurance, isn't worth it in my opinion. There is such an increase in people doing suboxone, ARNPs, PAs etc and large pseudo-national firms that are suboxone mills that the volume dropped off. I only have 5-10 people in my practice for suboxone. A major need in the community is for medicaid and that typically goes to community mental health agencies or these pseudo-national firms. Alcohol use disorder pops up more frequently for treatment in my office, but this population is notorious for relapse and dropping off the radar. I had toyed around with the notion before I opened up my practice of doing 100% addiction outpatient focus, and so glad I didn't. At times I almost think of not advertising my addiction status any more simply because of the turnover aspect of AUD patients, that time could have been spent focusing on depression/anxiety/OCD which have better follow up rates. If one wants to really make an outpatient addiction practice work, I think you almost have to have the connected IOP/PHP program to go with it, and really work to get the referrals from ED when they discharge folks - but if you aren't taking medicaid, good luck being THE referral for ED Social Workers, and now you are on the same competition level as all the large Big Box shop entities that also offer Residential with their IOP/PHP.

None of my contracts with insurance pay me more for my addiction boards, or any enhanced pay because of it. I get the same generic rates as all the other psych with my insurance contracts.

I was on the verge of applying to a few programs at the end of my residency but reviewing the curriculum and rotations couldn't justify it over simply doing the practice pathway for addiction medicine.

Child and Forensics the only fellowships I can see a sizable return on ?

 

[Sushirolls]

Unless you have a well thought out plan in advance and willing to work hard for it.

Could wander into IME work as others reference. But simply, blindly picking a fellowship to improve ROI would be child, and less so forensics.

If you do some chin stroking, and match up a dream, a vision and infusion a lot of time/effort and even money, there are niches that can be developed with most any other aspect of Psychiatry - but that is a reflection of you doing that work - not simply grinding away at the medical machine to pick up another credential.

 

[hallowmann]

There's a HUGE market for addiction psychiatrists in all sorts of settings. The fellowship is fairly benign (i.e., no overnight/weekend call work) and you'll graduate with a solid knowledge base. Moreover, it's a great opportunity to network in a new region/institution if you're moving to another city or state.

You can easily supplement your income with moonlighting and private practice as well.

How big of an impact is the bolded? This is legitimately one of the reasons I would consider doing a fellowship. I'm planning to relocate to a whole other region, and while we have a fellowship in-house, I'm debating the value in the setting of practice pathway extension for addiction medicine and plans to relocate to another region.

I'm also wondering if I need to restrict my search to equivalent or higher university programs in the region I'm planning to move to. Will it look bad if I go from a decent University residency in a different region to a less prestigious university or community addiction fellowship that is in the region I'm planning to move to?

I'm also feeling burnt out, so the idea of going straight into another year of training, even 5 days a week, seems sucky, but that might be the pandemic, residency, and a busy home life...

 

[NewYorkChildPsych]

How big of an impact is the bolded?

Depends on the market and long-term goals.

The speed with which you'll fill a private practice, for instance, often hinges on the strength of your referral network (i.e., therapists, colleagues, addiction/rehab centers) that you'll surely develop during a fellowship year.

For competitive academic job markets in metro centers like NYC and Boston, the best jobs are almost always filled internally without the need for recruiters and headhunters. In that case, you may "fall into" a more ideal job within the institution/city if you're on-the-ground already as a fellow.

In the New York region, moonlighting opportunities are plentiful and well-compensated @ $150-250/hour; I'm sure other cities have similar per diem positions. The addiction fellowship is a year of foregone income as an attending, sure, but it's easy to supplement income as a fellow.

 

[Subconcious]

If you get involved in expert witness work like addiction FFD IMEs, DUI cases, big tobacco litigation, DFSA cases, court-martials involving DFSA, rehab med mal, opioid addiction in PI cases, FAA exams, etc you could do very well financially. I am a forensic psychiatrist with some addiction experience and an MRO and suboxone certification and do get some addiction-related cases.

If you get involved in expert witness work like addiction FFD IMEs, DUI cases, big tobacco litigation, DFSA cases, court-martials involving DFSA, rehab med mal, opioid addiction in PI cases, FAA exams, etc you could do very well financially. I am a forensic psychiatrist with some addiction experience and an MRO and suboxone certification and do get some addiction-related cases.

Thanks for this reply as I'm considering addiction psych as well. However some of these acronyms are unheard of to me. Could you please define them and also clarify how one moves toward such a line of work.