Advice about doing Addiction Psychiatry Fellowship

[neolandrover]

I was wondering if I could get the perspectives of some of the more seasoned psychiatrists out there. I am currently a third year resident and have been back and forth trying to decide if I want to do an addictions fellowship. Our current program actually prepares us fairly well in basic substance abuse treatment and detox. These are sort of the pros/cons based on my values.

Pros
-In depth understanding of substance abuse, which is in huge demand/need in this country
-Probably would be able to go to a top tier program in a new city
-Continue to hone general skills as a psychiatrist
-Networking
-Increased potential for job opportunities

Cons
-I don't like busy work or scutwork. As a resident I have done social work, picked up meds for patients, accompanied them to MRIs etc. I don't want to do this ever again. Granted, I expect this to be much less of an issue as a fellow.
-I don't like doing research and I have not done any as a resident
-The potential pay as an attending is very lucrative. I really don't want to moonlight as a fellow to supplement income.

Ultimately, I still want to practice general adult outpatient psychiatry, and do not see myself doing solely addictions work. Any thoughts?

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[OldPsychDoc]

Pretty good pro/con list, and the only deal-breaker in the cons is the opportunity cost of that year. Nevertheless, the workload for most fellowships generally leaves plenty of room to augment income fairly easily, and it's only one year. If you don't do it as PGY5, chances are you never will. Once you've done it it's "confirmed credentials" as someone who knows their stuff with addictions, and that can't be taken away from you. Lots of ways to make yourself useful to your colleagues with that.

 

[OldPsychDoc]

...
Pros
-In depth understanding of substance abuse, which is in huge demand/need in this country
-Probably would be able to go to a top tier program in a new city
-Continue to hone general skills as a psychiatrist
-Networking
-Increased potential for job opportunities
...
Ultimately, I still want to practice general adult outpatient psychiatry, and do not see myself doing solely addictions work. Any thoughts?

Wanted to comment a bit more on the pros--especially #3. I honestly did NOT feel ready as a PGY4 to leap into attendinghood. I just felt that I needed a little more seasoning of my clinical abilities. I was probably underestimating myself to some extent, but everyone is different, and I was glad I took the extra year.

Also, you'll hear some folks say that you have to do a CAP fellowship to be a truly "complete psychiatrist", whatever that is.
I like to say that Addiction Psychiatry is the Ultimate Biopsychosocial Specialty--you've got the neuroscience, the learned behaviors, the family dynamics, the societal influences, and the government policies all tugging at each individual patient all at once. Can be fun, if you're into such things. And you DO ABSOLUTELY change lives and save lives. So that's cool...

 

[Mad Jack]

Pretty good pro/con list, and the only deal-breaker in the cons is the opportunity cost of that year. Nevertheless, the workload for most fellowships generally leaves plenty of room to augment income fairly easily, and it's only one year. If you don't do it as PGY5, chances are you never will. Once you've done it it's "confirmed credentials" as someone who knows their stuff with addictions, and that can't be taken away from you. Lots of ways to make yourself useful to your colleagues with that.

Except child psych

Child psych works you to the bone

 

[Taddy Mason]

Except child psych

Child psych works you to the bone

It’s program dependent. The fellows where I am have a pretty good schedule and plenty of time for moonlighting, spending time with SOs, etc.

 

[TexasPhysician]

It’s program dependent. The fellows where I am have a pretty good schedule and plenty of time for moonlighting, spending time with SOs, etc.

Ditto

 

[MedMan80]

It’s program dependent. The fellows where I am have a pretty good schedule and plenty of time for moonlighting, spending time with SOs, etc.

My program as well, almost no weekends, lots of moonlighting opportunities..

 

[Mad Jack]

It’s program dependent. The fellows where I am have a pretty good schedule and plenty of time for moonlighting, spending time with SOs, etc.

Interesting. The program near my hometown has a reputation for being so soul-crushing that it's described as being like intern year all over again. Knew one fellow that quit after her first year and regretted ever starting.

Maybe I can find something more relaxed if I look farther from home, but I'm really not looking forward to being away from home for another year or two, depending on whether I 3+2 or 4+2. Anyway, sorry for the derailment, carry on.

 

[Stagg737]

Ultimately, I still want to practice general adult outpatient psychiatry, and do not see myself doing solely addictions work. Any thoughts?

IMO that says everything. You don't want to specialize in addiction medicine, so unless you're doing it for purely academic reasons in order to satisfy a personal need for stronger training in that area, then I wouldn't do it. There's a massive demand for addiction treatment and you don't need a fellowship to see patients with addictions in the general psych setting.

 

[Shufflin]

... Ultimately, I still want to practice general adult outpatient psychiatry, and do not see myself doing solely addictions work. Any thoughts?

Then find a job with a fair component of addictions and you'll be addictions trained in a year or two as an attending.

 

[Achillees]

I was wondering if I could get the perspectives of some of the more seasoned psychiatrists out there. I am currently a third year resident and have been back and forth trying to decide if I want to do an addictions fellowship. Our current program actually prepares us fairly well in basic substance abuse treatment and detox. These are sort of the pros/cons based on my values.

Pros
-In depth understanding of substance abuse, which is in huge demand/need in this country
-Probably would be able to go to a top tier program in a new city
-Continue to hone general skills as a psychiatrist
-Networking
-Increased potential for job opportunities

Cons
-I don't like busy work or scutwork. As a resident I have done social work, picked up meds for patients, accompanied them to MRIs etc. I don't want to do this ever again. Granted, I expect this to be much less of an issue as a fellow.
-I don't like doing research and I have not done any as a resident
-The potential pay as an attending is very lucrative. I really don't want to moonlight as a fellow to supplement income.

Ultimately, I still want to practice general adult outpatient psychiatry, and do not see myself doing solely addictions work. Any thoughts?

I could've easily written every single word of your post. Also a PGY-3 interested in addictions. I decided against pursuing fellowship. I debated for the first 2 years and ultimately the clincher was to ask myself whether I would apply for the fellowship if it were contractual - like it is for intern year. The answer was a resounding no.
Other considerations were - assuming a ~30K raise as an addictions psychiatrist...it'd take me more years than I cared to sacrifice to break even for losing that first year attending salary. And that's before mentioning the ever-growing student loans. Also, I'm tired of being a trainee. Other attendings told me - "it's just a year", but that's a justification I've used for so long.
As your last sentence says - I also didn't see myself working solely addictions. I think that's your answer there, honestly.
Hope that helps.

 

[Monocles]

Can't you still grandfather into it by taking that test without doing the fellowship? This is the last year right?

 

[TexasPhysician]

Can't you still grandfather into it by taking that test without doing the fellowship? This is the last year right?

I believe 3 more years for addiction medicine, but to qualify you essentially need to work 1 year at an addiction facility.

 

[Nasrudin]

S'up groot. Low five. Don't do it. Psych fellowship is for suckers and permanent adolescent types.

Pros
-In depth understanding of substance abuse, which is in huge demand/need in this country
Demand is irrespective of in depth understanding. In depth understanding is a personal, self-directed pursuit. Experts are just hanging around waiting for someone to ask them enthusiastic questions about their work. You don't need to be a prosthetic psychiatric dildo working at a fraction of your income potential to obtain that.
-Probably would be able to go to a top tier program in a new city
How about doing that. And making 3 times what you would as a fellow.
-Continue to hone general skills as a psychiatrist
How about doing that. And making 3 times what you would as a fellow.
-Networking
How about doing that. And making 3 times what you would as a fellow.
-Increased potential for job opportunities
How about taking a lucrative job opportunity which... also has the potential for more job opportunities.

Cons: You should really heed your own advice.

You're on the reservation. Asking reservation residents. About the benefits of staying on the reservation. Whereas I'm suggesting you go into the desert, drop pscylocibin, and ask yourself your own question again for the answer.