zihuatanejo

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It is well known that the main disadvantage of doing a fellowship is the opportunity cost of at least an extra year of essentially a resident's salary. It is unclear to me whether doing an addictions fellowship is really worth it. I have a sincere and deep interest in addictions that derives from the fact that there is a tremendous public health need for this field and the fact that this field lies at the interface of medicine and psychiatry and requires an integrated knowledge of psychotherapy, pharmacology, internal medicine, and public health. However, I am not convinced that doing a fellowship would impart greater knowledge than could be gained from doing addictions electives during the fourth year and actually working with patients with addictions after residency. My questions are: What benefits are derived from doing an addictions fellowship if any in terms of employment opportunities and income? Is an addictions fellowship a requirement or a near requirement for certain administrative, research, leadership, or even clinical positions that involve dealing with substance abuse? If so, what sort of positions require the completion of an addictions fellowship? Thanks in advance for all replies.
 

BobA

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Great post! I have similar questions and would really appreciate any responses.
 

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It is well known that the main disadvantage of doing a fellowship is the opportunity cost of at least an extra year of essentially a resident's salary. It is unclear to me whether doing an addictions fellowship is really worth it. I have a sincere and deep interest in addictions that derives from the fact that there is a tremendous public health need for this field and the fact that this field lies at the interface of medicine and psychiatry and requires an integrated knowledge of psychotherapy, pharmacology, internal medicine, and public health. However, I am not convinced that doing a fellowship would impart greater knowledge than could be gained from doing addictions electives during the fourth year and actually working with patients with addictions after residency. .
Basically, you cannot sit for the Addiction Psychiatry boards without the fellowship. The alternative pathway of an addiction medicine certification is probably closing as that becomes a ACGME certified specialty, as well. Beyond that, the advantage of doing the fellowship as opposed to your reasonable proposal is that it does really give you the opportunity to focus on, consolidate, and internalize those values you express, and to become identified as an "expert" in the area.

My questions are: What benefits are derived from doing an addictions fellowship if any in terms of employment opportunities and income? Is an addictions fellowship a requirement or a near requirement for certain administrative, research, leadership, or even clinical positions that involve dealing with substance abuse? If so, what sort of positions require the completion of an addictions fellowship? Thanks in advance for all replies.

I wouldn't expect it to add a huge amount to your income, unless you're planning to aggressively pursue a high-end cash pay practice, catering to the rich and addicted. It's not an absolute requirement for the positions you mention, but doing the fellowship does "certify" your interest in going after those roles. I think it's probably truer to say that those who enter those positions do so because they are intrinsically interested in substance dependence, and want to work in those areas--and so they've done the extra training to enhance their abilities in the field. Beyond that, it is probably an "absolute requirement" for someone interested in doing substantial academic research in the field.
 
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masterofmonkeys

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Just because it wouldn't hugely increase your income potential doesn't mean that it wouldn't pay off pretty quickly. You're looking at a 100k differential between a PGY-5 salary in addiction fellowship and starting salary as a general psychiatrist, could actually be significantly less than 100k depending on benefits and where you do your fellowship as well.

In return you WILL make more than a general psychiatrist, from 10-20k to significantly more. I'd expect ROI in 5-10 years if estimated relatively conservatively.

And then there are the intangibles. How likely are you to get a job at one of hte more respected addiction centers (like CeDAR in denver, etc)? How likely are you to become chief of addiction? etc etc etc?

Ultimately those are the things you have to look at.

I'm facing a similar dilemma. Training in 5 years to become a child psychiatrist. Or taking 6 years to do it (more research, more psychotherapy) plus the likely addition of a T32 2 year postdoc after that. Blech.

Ultimately the money factor is pretty meh. You're going to be comfortable either way, and if you really wanted to make somedough, you wouldn't have been going into psych in the first place.

At the end of the day you just have to ask yourself which areas of psych most interest you, how strong that interest is, and how best to fulfill that interest.
 
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kumar28

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wanted to bump this thread...im in a similar situation right now. I want to primarily practice addiction medicine however unsure if it is worth doing the fellowship. I would ideally like to work somowhere where I do about 80% addictions and also a place that is mainly an addiction facility. Any others have thoughts on the matter...have things changed in the past 3-4 years where it now makes more financial sense to do a fellowship in addictions. Application process is getting late and im still not sure what to do..help?
 

OldPsychDoc

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wanted to bump this thread...im in a similar situation right now. I want to primarily practice addiction medicine however unsure if it is worth doing the fellowship. I would ideally like to work somowhere where I do about 80% addictions and also a place that is mainly an addiction facility. Any others have thoughts on the matter...have things changed in the past 3-4 years where it now makes more financial sense to do a fellowship in addictions. Application process is getting late and im still not sure what to do..help?

If you're a psychiatrist with an interest in doing 80% (or even 50%!) addictions, then I would see becoming board certified in Addiction Psychiatry as essentially non-negotiable. And for that--the fellowship is mandatory.
 

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For psychiatry fellowships, the ease of getting into some of even the most competitive fellowships is far easier than other fields of medicine. I know some residents that were the worst I've ever seen get into namebrand places such as Columbia, Harvard, etc.

The point being is that if you choose to go into any psychiatry fellowship, your odds of getting some exposure to high quality research and practice is far more than many fields of medicine. Pursuit of further education shouldn't be solely based on money.

As I've said before, just because a place has a name doesn't mean it'll be a good fellowship, but there are many places where you can get taught by some of the best and if they are a good teacher (some are not) you'll get an incredible learning experience.
 

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wanted to bump this thread as well. Is there anything that you can do only with an addiction fellowship. Are you more likely to get approved for opening up an opiod treatment facility like a suboxone or methadone clinic with a fellowhsip background.
 

sluox

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wanted to bump this thread as well. Is there anything that you can do only with an addiction fellowship. Are you more likely to get approved for opening up an opiod treatment facility like a suboxone or methadone clinic with a fellowhsip background.

I thought so initially myself, but after talking to various people I realized that this is NOT the case. While a strong fellowship trains you for various detox and maintenance "procedures" and gives you a bit more credentialing, most of the fellowships are really more for launching academic careers. There's nothing specific that you are trained during an addictions fellowship that you aren't qualified to do as a general psychiatrist. And per above posters, the benefits are mostly intangible.
 

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I thought so initially myself, but after talking to various people I realized that this is NOT the case. While a strong fellowship trains you for various detox and maintenance "procedures" and gives you a bit more credentialing, most of the fellowships are really more for launching academic careers. There's nothing specific that you are trained during an addictions fellowship that you aren't qualified to do as a general psychiatrist. And per above posters, the benefits are mostly intangible.
With the rise of ASAM (American Society of Addiction Medicine), creation of ABAM (American Board of Addiction Medicine) by ASAM, and recent creation of Addiction Medicine fellowships for non-psychiatric physicians by ABAM, the field of Addictions is changing and will likely no longer be just a sub-specialty of psychiatry. ABAM's goal is to make their fellowship ACGME approved and a requirement to get Addiction Medicine certified.

If you are a psychiatrist who wants to practice Addictions it will become a necessity to be Addiction Psychiatry certified. As new treatments for Addictions arise in the future, I anticipate certification will be necessary to implement them (either Addiction Psychiatry or Addiction Medicine certification). And even now Addiction Psychiatry or Addiction Medicine certification is enough to prescribe buprenorphine without the training course.
 

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Really? What if you have no interest in academics and want to go to a non-urban town in the midwest? I like addiction psychiatry and have no interest in doing a fellowship-I want to move on with my life!
 

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As I mentioned in my earlier posting I would strongly recommend becoming Addiction Psychiatry certified if you want to be an addiction specialist. I don't think general psychiatry training is adequate by itself anymore without additional training and certification in Addictions.
 

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Really? What if you have no interest in academics and want to go to a non-urban town in the midwest? I like addiction psychiatry and have no interest in doing a fellowship-I want to move on with my life!
As I mentioned in my earlier posting I would strongly recommend becoming Addiction Psychiatry certified if you want to be an addiction specialist. I don't think general psychiatry training is adequate by itself anymore without additional training and certification in Addictions.
 
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Really? What if you have no interest in academics and want to go to a non-urban town in the midwest? I like addiction psychiatry and have no interest in doing a fellowship-I want to move on with my life!

I think that you can do adequate practice in addictions as a part of a general psych practice without doing the fellowship--especially if you choose to do a lot of CME in the field. You could certainly prescribe Suboxone (much needed in the non-urban midwest) and network with local addiction resources. What you would not be able to do is call yourself an Addiction Psychiatrist.
 

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No but you would still be referred to as an 'addictions specialist' or addictionologist. Esp if you are able to get boarded by the ASAM.
 

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No but you would still be referred to as an 'addictions specialist' or addictionologist. Esp if you are able to get boarded by the ASAM.

True now--but that door will be closing with Addiction Medicine becoming ACGME-official, and will likely require a fellowship of its own. Again, one *can* choose to be a "self-taught" addictionist, be a member of ASAM and/or AAAP, study nothing but addictions, and see nothing but addicted patients, etc--but at some point some credentialling agency is going to say "You're really not an addictionist--show me your board certification." And if you're really serious about working in the field, well why the heck not get the fellowship done, get the focused time in, get the credentials.
 

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True now--but that door will be closing with Addiction Medicine becoming ACGME-official, and will likely require a fellowship of its own. .

Presumably, for the next 5 years, any BC psychiatrist will be able to grandfather into the new addiction boards by passing the new test and signing some attestation about experience in the field.
 

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To OPD...when you're $200k in debt with interest accumulating...even though it would be ideal to do the fellowship.. just the extra interest accumulating would be a reason to try to do it without the fellowship
 

beezley

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In the non-urban midwest towns that I have been to, most of the 'addictionologists' are family physicians with an interest in addictions, or, more often, there is no one serving this huge need. I think a psychiatrist with an interest in addictions would have a lot to add, especially with the dual diagnosis population. There is a huge need for suboxone. I truly think that to have addictions be PART of a general psychiatry practice in a non-urban upper midwest town, non-academic setting, is feasible and the fellowship would be overkill IN THIS PARTICULAR CASE. That is not to say it isn't a great thing for many. I just don't think it is for me.

And to clarify, I can or cannot get grandfathered into ASAM? One of my attendings recently said I could not, but not sure he is informed correctly.
 

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In the non-urban midwest towns that I have been to, most of the 'addictionologists' are family physicians with an interest in addictions, or, more often, there is no one serving this huge need. I think a psychiatrist with an interest in addictions would have a lot to add, especially with the dual diagnosis population. There is a huge need for suboxone. I truly think that to have addictions be PART of a general psychiatry practice in a non-urban upper midwest town, non-academic setting, is feasible and the fellowship would be overkill IN THIS PARTICULAR CASE. That is not to say it isn't a great thing for many. I just don't think it is for me. .
I wouldn't discourage any psychiatrist, urban or not, from making addictions a major part of their practice, or from using Suboxone appropriately. You can indeed do that without the fellowship, and if the opportunity cost is too daunting, then so be it.

I'd like to hear more about your "Non urban upper midwest opportunities". Drop me a PM when you have time.

And to clarify, I can or cannot get grandfathered into ASAM? One of my attendings recently said I could not, but not sure he is informed correctly.

You can always join ASAM, and attend their meetings and whatnot, but according to their website: "In 2009, The American Society of Addiction Medicine (ASAM) transferred the certification examination to the American Board of Addiction Medicine (ABAM), and the next examination will be offered by ABAM on December 1, 2012 and in subsequent years. A physician certified by ABAM is board certified. For More information please visit the ABAM Web site at www.abam.net."

As I read these criteria, I think it will be difficult to meet ABAM's eligibility requirements via the "practice pathway", and that it will eventually close completely. .
 

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With the rise of ASAM (American Society of Addiction Medicine), creation of ABAM (American Board of Addiction Medicine) by ASAM, and recent creation of Addiction Medicine fellowships for non-psychiatric physicians by ABAM, the field of Addictions is changing and will likely no longer be just a sub-specialty of psychiatry. ABAM's goal is to make their fellowship ACGME approved .

that's a nice goal, but right now it's just a rogue board, not an ABMS board
 

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that's a nice goal, but right now it's just a rogue board, not an ABMS board

For some reason your use of "rogue board" there had me pretty much laughing out loud. So true. I don't know if there's any other field where there's a "real fellowship" and a "trying to be real fellowship" in the same field. Of course, there are good reasons why this is true, and the "trying to be real fellowship" is rightfully well-respected, it's still just kinda funny.

I don't really understand how a family medicine doc can do a one year fellowship and be a competent psychotherapist per se. MI isn't the hardest thing on earth to learn, but certainly a psychiatrist simply has a much better foundation to build on. But, given the need in the field, beggars can't be choosers I guess, and the perfect shouldn't be the enemy of the good. And whatever other cliche makes sense there.
 

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Presumably, for the next 5 years, any BC psychiatrist will be able to grandfather into the new addiction boards by passing the new test and signing some attestation about experience in the field.
I've tried to find information on how long this pathway 1 will remain open. Where did you come by this information? Will this pathway cease in 2017 or is this the last year as the website dates seem to reflect?
 

michaelrack

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I've tried to find information on how long this pathway 1 will remain open. Where did you come by this information? Will this pathway cease in 2017 or is this the last year as the website dates seem to reflect?

didn't find this anywhere. A 5 year grandfather period is just how it always seems to work- I was just extrapolating from my experiences with the sleep and psychosomatic boards
 

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The Addiction Medicine topic was thoroughly discussed at the AAAP this year.There was no consensus, some think it will never make it to ACGME accreditation,some believe it will. What everybody did agree on was that the"grandfathering" rule is going to last a few years even after accreditation,as was the case with all fellowships.

I am currently doing addiction psychiatry fellowship. While you do not learnentirely new concepts, you do get a better idea regarding different topicswhich were not necessarily very clear in residency. If one does decide to dothe fellowship, I absolutely recommend doing it in a different program thanresidency, preferably a well renowned one (not very hard to get in, aspreviously stated). Staying in the same program for fellowship and doing moreof the rotations you already did as a resident...not worth it.
 

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family medicine resident with plans to do addiction medicine fellowship!!...
just picked up principles of addiction medicine, cant wait to crack into it..
any others on the same path, toss me a pm so we can chat:thumbup:
 

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Staying in the same program for fellowship and doing moreof the rotations you already did as a resident...not worth it.
[/QUOTE]

Are the job prospects better if you do the addiction medicine fellowship?
 
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