Bailing on child psychiatry

[NeuroKlitch]

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Soon to be pgy3, and child psych do it die decision rapidly approaching. I have declared it o my program but have been honest about my uncertainty about fulfillment in the field and feel like I won't know unless I have more experience. I have done a month on child inpatient and have seen more than enough children in the cpep. It has been rewarding but not necessarily life changing. Prospects of higher earnings is admittedly one of my incentives. As well as the idea that my program my not be wholly representative of what child psychiatry truly encompasses. My question is , if I match into a fast track fellowship in a city I want to live in, work my butt off but realize that child is not for me after the first year , will there be professional consequences such as being black listed in the area for deciding to not complete the second year and decide to be a generalist.

 

[TexasPhysician]

You will certainly burn a bridge at that program and with your fellows that will pick up the slack. Whether that effects the region will probably depend on the size of the region and how influential the program is. In smaller cities, there may not be many other employers. It may also effect your ability to get into other fellowships if interested.

I wouldn’t go into it thinking that I’ll bail after 1 year. If interested enough to sign up for a harder PGY4, I’d recommend completing the final year for educational and future financial reasons.

 

[rjs2131]

Soon to be pgy3, and child psych do it die decision rapidly approaching. I have declared it o my program but have been honest about my uncertainty about fulfillment in the field and feel like I won't know unless I have more experience. I have done a month on child inpatient and have seen more than enough children in the cpep. It has been rewarding but not necessarily life changing. Prospects of higher earnings is admittedly one of my incentives. As well as the idea that my program my not be wholly representative of what child psychiatry truly encompasses. My question is , if I match into a fast track fellowship in a city I want to live in, work my butt off but realize that child is not for me after the first year , will there be professional consequences such as being black listed in the area for deciding to not complete the second year and decide to be a generalist.

I think this will also depend on what program you go to - most programs are inpatient/CL heavy the first year, so if you decide child psych isn't for you after 1 year that decision is pretty skewed. My second year of child fellowship was much more rewarding and I ultimately realized I enjoyed outpatient child/adolescent work more than outpatient adult. I also think that child fellowship tends to make you a better psychiatrist overall with a better understanding of development and family systems.

All that said - I've known of a few people who started child fellowship and decided after a year that it wasn't for them. As long as you approach it gracefully and complete your requirements, I think it'll work out okay. I wouldn't jump into it with the intention of leaving halfway though...that won't be fun for anyone involved.

 

[clozareal]

Soon to be pgy3, and child psych do it die decision rapidly approaching. I have declared it o my program but have been honest about my uncertainty about fulfillment in the field and feel like I won't know unless I have more experience. I have done a month on child inpatient and have seen more than enough children in the cpep. It has been rewarding but not necessarily life changing. Prospects of higher earnings is admittedly one of my incentives. As well as the idea that my program my not be wholly representative of what child psychiatry truly encompasses. My question is , if I match into a fast track fellowship in a city I want to live in, work my butt off but realize that child is not for me after the first year , will there be professional consequences such as being black listed in the area for deciding to not complete the second year and decide to be a generalist.

I wouldn't necessarily use your experience in the CPEP as your gauge on your interest in child & adolescent psychiatry. It's your gauge on how much you like crisis/emergency care in kids. This is undoubtedly my least liked experience in my child psychiatry fellowship as many of the cases are difficult, the tools to treat them are limited (hospitalize or not, if the latter then who knows if they followed up with your referrals), and I strongly internalized the affect of both the children and parents in this setting which made me at higher risk of burnout. I found CPEP work to be minimally rewarding.

Much of child psychiatry is on the outpatient setting and can be extremely rewarding since the treatments generally have a higher response rate than in adults. The effect size for treatments of certain childhood disorders (e.g., stimulants for ADHD, SSRIs for certain anxiety disorders, CBIT for tic disorders) are higher than those for adult disorders.

I'm only saying this because on an outpatient setting, you can see the result of your work with the patient which is much more rewarding than feeling like a cog in the wheel of admitting an acutely suicidal kid to the inpatient psych unit from the CPEP and not knowing what happened to them. To me, that felt unsatisfactory as if I was leaving loose ends untied and the patient and their parents often don't want to be there and don't want to be admitted, so I felt antagonistic in a way despite knowing that this is what was best to keep their kid alive.

For your question, patients won't care if you decide to not complete a child psych fellowship and be a generalist. It might hurt your chances of being faculty at that program, but you'll still be able to work and make money as a generalist. There shouldn't be a non-compete in your GME fellowship contract and even if there was, depending on what state you're in it may be unenforceable. The demand for psychiatric services is high enough and most people won't look at your pedigree, but rather whether you'll take their insurance.

 

[Monocles]

OP I think you should go for it.

It sounds like you have more to gain than to lose by going to fellowship. At least I imagine you'll live in a city that you want to be at, and there's a good chance that you'll really enjoy the work. Who knows, you might even find a niche that you didn't even know existed prior to fellowship.

Worse case scenario you can always just bail after the 1st year. As posters above said, as long as you don't burn your bridges it should be fine for your long-term career. Although some other things to consider are - you could have a potentially super chill PGY4 year, and you would be losing on a full year's attending salary by doing fellowship (3+2 years vs 4).

 

[NeuroKlitch]

OP I think you should go for it.

It sounds like you have more to gain than to lose by going to fellowship. At least I imagine you'll live in a city that you want to be at, and there's a good chance that you'll really enjoy the work. Who knows, you might even find a niche that you didn't even know existed prior to fellowship.

Worse case scenario you can always just bail after the 1st year. As posters above said, as long as you don't burn your bridges it should be fine for your long-term career. Although some other things to consider are - you could have a potentially super chill PGY4 year, and you would be losing on a full year's attending salary by doing fellowship (3+2 years vs 4).

Ya the missing out on year of attending salary is a big thorn in my side. Lots of debt to tend to.

 

[calvnandhobbs68]

Soon to be pgy3, and child psych do it die decision rapidly approaching. I have declared it o my program but have been honest about my uncertainty about fulfillment in the field and feel like I won't know unless I have more experience. I have done a month on child inpatient and have seen more than enough children in the cpep. It has been rewarding but not necessarily life changing. Prospects of higher earnings is admittedly one of my incentives. As well as the idea that my program my not be wholly representative of what child psychiatry truly encompasses. My question is , if I match into a fast track fellowship in a city I want to live in, work my butt off but realize that child is not for me after the first year , will there be professional consequences such as being black listed in the area for deciding to not complete the second year and decide to be a generalist.

I really wouldn't put "prospects of higher earnings" as really one of the incentives or at least really emphasize the "prospects" part. As someone who has recently been in the child psych job field, there are tons of jobs out there but they don't necessarily pay that much more than the adult jobs (or any more in some instances). The adult residents I know graduating are looking at the same range in terms of earnings first year out. There is a bit less pressure in child to see patients in less time, so you're more likely to get 30min patient visits rather than 15-20min "med checks". I think this idea that child psych makes so much more than adult is a bit overblown. There's also the same pressure to put more psych NPs in hospitals/CMHCs on the child side as well...definitely not immune from that.

I certainly think the cash market in child is probably stronger but this would involve someone basically being committed to either trying to join a cash private group or starting their own practice right off the bat, so a lot of upfront risk the first year out.

 

[J ROD]

Do the fellowship if you want to see kids. If you worried about money, just finish residency.

 

[TexasPhysician]

Ya the missing out on year of attending salary is a big thorn in my side. Lots of debt to tend to.

Go to a program that is moonlighter friendly. I earned more than many of my child faculty PGY-5.

 

[swamzi]

I was in a similar boat, but spoke with my mentors who convinced me to stay.... I'm am a happy CAP attending. PM me for details/thoughts/advice.

 

[MacDonaldTriad]

Going into a child and adolescent fellowship because of the relative minor increase in earning potential is horribly misguided and will end in disaster. If you don't love dealing with children and parents, you will not make it. This path will crush your sole and make you miserable. In the spirit of full disclosure, I would rather put sharp pins in my eyes that deal with children and parents. You may feel differently but this is the question you need to ask yourself.