Addiction psychiatry fellowship

[beca1092]

Hi! I am currently applying to addiction psychiatry and need help with the rank list. What are your thoughts about Emory vs Yale?

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[mistafab]

Emory is in Atlanta which is a cool city. Yale is in New Haven, which sucks.

 

[Sushirolls]

Make a spreadsheet.
Compare the rotations for all 12 months, head to head.
Choose the one that gives you better training.
If one is just 6 months at a VA, for instance, pass.

 

[clozareal]

Make a spreadsheet.
Compare the rotations for all 12 months, head to head.
Choose the one that gives you better training.
If one is just 6 months at a VA, for instance, pass.

How would you quantify better training?

For me, it would be if it has the following components:

1. Opioid use disorder treatment: using all the different types of buprenorphine, methadone, naltrexone, learning how to give Vivitrol injections. Managing (car)fentanyl use, ISO, etc. I do like programs/clinic who collaborate or are integrated with chronic pain services.
2. Alcohol use disorder treatment: learning how to use the FDA approved options and more, having a rotation in alcohol detox, learning how to use the various withdrawal agents not just Ativan but benzo-sparing protocols, managing alcoholic hallucinosis and delirium tremens, learning how to get the various blood tests outside of GGT such as PEth and how to interpret them. Are you even addiction trained if you don't have a breathalyzer in your office?
3. Nicotine use disorder: learning how to use the various FDA approved options, including medications, NRT, and TMS, obtaining serum cotinine levels and knowing how to interpret yet.
4. Sedative/hypnotic use disorder: benzo tapers. Doing many of them and managing all that comes up with this.
5. Cannabis use disorder, meth use disorder, seeing xylazine in practice, managing PCP use, ketamine use disorder, etc.
6. Therapy: learning good motivational interviewing, contingency management, brief interventions, family therapy including multidimensional and couples, relapse prevention, attending a few 12-steps to see what they are like.
7. Since I'm CAP, I would highly encourage you finding a program that has adolescent addiction training.
8. Settings: inpatient detox, VA, residential, IOP, PHP, community mental health, private groups, academic centers with clinical trials, behavioral health court programs,

Don't forget if there are addiction psychiatrists who are really enthusiastic about teaching involved in that training program and are willing to try out these different medications/therapy approaches. This makes a huge difference in the education.

 

[comp1]

Oh wow, yeah, if you find a program tightly integrated into pain medicine, go there! (or work there at least, cause that would be a dream)

 

[Sushirolls]

Better = diversity and depth.
If you are just on a routine detox unit attached to a VA or academic center, you should have already gotten enough exposure in residency.

Basically, years ago I was on verge of applying but when reviewing what the clinical rotations were for the programs - and looking at programs that didn't utilize a VA for a higher potential ranking - it was quite apparent none had depth or diversity beyond what my base Psychiatry training had.

I skipped, got the Addiction Medicine practice pathway.

 

[clozareal]

Better = diversity and depth.
If you are just on a routine detox unit attached to a VA or academic center, you should have already gotten enough exposure in residency.

Basically, years ago I was on verge of applying but when reviewing what the clinical rotations were for the programs - and looking at programs that didn't utilize a VA for a higher potential ranking - it was quite apparent none had depth or diversity beyond what my base Psychiatry training had.

I skipped, got the Addiction Medicine practice pathway.

I would disagree that you should avoid the VA. The VA has a ton of NIH and VA funding for substance use treatment programs and clinical research so I wouldn't write it off as they're doing some cutting edge stuff.

Besides, both the programs OP is considering are affiliated with the VA there. Emory for example has a 21 bed SUD residential program at their VA and an IOP so you'll get higher levels of severity. They have high volume from their veteran population so you'd likely get more exposure in treating this patient population.

I would more so gather what kind of patients you'll see, what treatment modalities including medications you'll be using, and the quality of didactics and attending supervision.

 

[comp1]

Aw, someone going to bat for the VA and it wasn't even me. The VA is going to be a core part of most programs. It is the biggest overall healthcare system in the world, to say nothing of how big a part substance abuse treatment is of that care. I can get being slightly concerned if a fellowship is 100% VA, but it seems perfectly acceptable for the majority of rotations to be different components of substance abuse treatment within the VA.

 

[Merovinge]

I would disagree that you should avoid the VA. The VA has a ton of NIH and VA funding for substance use treatment programs and clinical research so I wouldn't write it off as they're doing some cutting edge stuff.

Besides, both the programs OP is considering are affiliated with the VA there. Emory for example has a 21 bed SUD residential program at their VA and an IOP so you'll get higher levels of severity. They have high volume from their veteran population so you'd likely get more exposure in treating this patient population.

I would more so gather what kind of patients you'll see, what treatment modalities including medications you'll be using, and the quality of didactics and attending supervision.

Absolutely agree in the case of SUD treatment. UCSF's big time addictionologists are associated with the VA they work with as an example.