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.