Can a neuropsychiatrist see children with neurodevelopmental disorders without CAP fellowship?

[Ludwig2000]

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Hi all,
I’m curious - if I were to do a fellowship in Neuropsychiatry, would this potentially allow me to treat some kids in addition to adults- specifically if the kids had say ASD or Tourette’s, without doing a Child and Adolescent Fellowship?

And I know in theory, you CAN treat anyone, but I mean practically, would it be an issue in terms of scope of my license.

Apologies if it’s been asked before, didn’t see anything with cursory search. Thanks

 

[Sushirolls]

A medical license (DO/MD) can permit you to do surgery, OB, radiology, Rad Onc, primary care, psychiatry, etc.

However, we've had enough training to know to stay in our specialty lane (I mean we're just doctors. We didn't go to nursing school, we don't have Advanced Practice abilities; "Damn it Scotty! I'm a Doctor not a Nurse Practitioner!").

There is such a deficiency of people treating this population - no fellowships are needed - in order to do so.

Liability insurance is more likely to be a limiting factor for the practice of medicine than a medical license.

This population is considered part of routine general psychiatry.

 

[deleted1100659]

it is quite common for general psychiatrists to see peds patients. it is exceedingly rare in the community psych setting that you have a boarded child psychiatrist seeing the peds patients. At my facility I collaborate with a midlevel and manage them and im a general psychiatrist.

I think it would be a hard argument to make that they would need to see a child psychiatrist, because if that was the case most wouldnt get treatment.

 

[comp1]

I feel like this is something you will best figure out DURING the fellowship unfortunately. It's not something you should base doing the fellowship on... It's even going to be heavily dependent on the specifics of the fellowship site.

 

[Merovinge]

None of the several neuropsychiatrists I know see any children. They would potentially see a 16 or 17 year old for ECT evaluation/procedure. Fellowship is very unlikely to train you to treat children. If you want to treat children you could certainly find a very specialized place to train in this but there is actually not much cross over in these fields. ASD and Tourettes are bread and butter CAP work, not handled by neuropsychiatrists.

 

[splik]

If you feel comfortable doing so, there is nothing stopping you from doing so. I am a neuropsychiatrist. I am not CAP trained. I do not see patients under the age of 18. I do see adult patients with neurodevelopmental disorders. In my area there are plenty of child psychiatrists capable of seeing patients with ASD and intellectual disability. There are very few psychiatrists willing to see adults with neurodevelopmental disorders and I do see them though not my main focus.

 

[Ludwig2000]

I think there’s a broader theoretical question here too, about what it means to specialize. It seems like specialization comes in two forms: population based and pathology based.
In psych, population based is CAP vs adult vs geri. Pathology based would be eg Addiction, Sleep, Neuropsych to some extent (though it also tends to overlap with the geri population more than other populations).
I wonder if population based specializing is better for seeing an undifferentiated patient and making the diagnosis, whereas pathology based specialization is better for being referred a patient with a severe/complicated/refractory form of X disease and taking over management.
In med school I knew of a couple docs getting double boarded in IM/Peds, doing Pulmonology, and ending up treating primarily Cystic Fibrosis across the lifespan. Because they wanted to hyper specialize in pathology but not population, I guess.
Anyways I like “neuropsych” type disorders (although theoretically all psych is neuropsych right, unless you’re a Cartesian dualist or maybe a Kantian idealist) including neurodevelopmental disorders, but I’m really not interested in seeing undifferentiated Peds patients. Just curious, appreciate the responses, and enjoy such discussions. Particularly when I’m on night float just awaiting admissions or floor calls.

 

[TexasPhysician]

I would look at it as neuro vs pedi-neuro. You don’t see many neuro electing to treat kids.

The same goes for most fields - IM subspecialty vs peds subspecialty.

Even my buddy that is a pedi hand surgeon only does peds.

 

[calvnandhobbs68]

I think there’s a broader theoretical question here too, about what it means to specialize. It seems like specialization comes in two forms: population based and pathology based.
In psych, population based is CAP vs adult vs geri. Pathology based would be eg Addiction, Sleep, Neuropsych to some extent (though it also tends to overlap with the geri population more than other populations).
I wonder if population based specializing is better for seeing an undifferentiated patient and making the diagnosis, whereas pathology based specialization is better for being referred a patient with a severe/complicated/refractory form of X disease and taking over management.
In med school I knew of a couple docs getting double boarded in IM/Peds, doing Pulmonology, and ending up treating primarily Cystic Fibrosis across the lifespan. Because they wanted to hyper specialize in pathology but not population, I guess.
Anyways I like “neuropsych” type disorders (although theoretically all psych is neuropsych right, unless you’re a Cartesian dualist or maybe a Kantian idealist) including neurodevelopmental disorders, but I’m really not interested in seeing undifferentiated Peds patients. Just curious, appreciate the responses, and enjoy such discussions. Particularly when I’m on night float just awaiting admissions or floor calls.

This has been brought up in another thread where we were talking about if a general psychiatrist could/would see kids, but there are a lot of systems based things in child psychiatry that honestly you have no exposure to or any idea about in adult residency/fellowships and would really have to go out of your way to learn about, especially if you were seeing kids with neurodevelopmental disabilities who likely engage with a lot of support services. For instance, things like learning the differences between an IEP and 504 plan, what services these entitle kids to, parent rights and how to get parents to advocate and request schools provide these services, options for behavioral/ID/ASD geared schools in the area if needed, anticipating problems with transitioning kids with ASD/DD/ID from high school to adulthood (for instance services start switching over from the school system to the county mental health/ID board for adults, if they aren't aware of the need to enroll with the board for services this can be a real mess and gap in services).

The "medicine" is often not really the difficult part in child psychiatry.

 

[clozareal]

Yes.

 

[Therapist4Chnge]

If that is an area of interest, it could be a nice opportunity to collaborate with a pediatric psychologist or preferably a peds neuropsychologist on some cases. FWIW... in your position I'd be very hesitant to take on neuro dev peds cases w/o a clear set of diagnoses and collaboration with other professionals because they can be pretty complex and you don't know what you don't know. Collaborating with a peds neuropsychologist could allow for complementary interventions like behavior modification and parental education about the applicable neuro dev diagnoses, which could help with prescribing considerations.

 

[PreHippocrates]

As a current CAP fellow with an interest in neuropsychiatry, I thought about questions like this before taking the jump into CAP. Ultimately I agree with you about the notion of specialization into a niche diagnosis vs age-population - and you should also think about working with families in CAP, which is less true in other areas of psychiatry (maybe with the exception of geri). If you don't like working with families, don't go into CAP. I'd also encourage you to think about what kind of practice you ultimately want to go into.

For me, I don't really want to stay at an academic hospital, so it would take a fair amount of front-end work to carve out a niche with, say, tic disorders, unless I'm working in a big city and really want to do the PR work in order to make that happen. I like the amount of developmental disabilities and neuropsychiatric cases I've seen in fellowship, and it's pretty typical to see these kinds of kids in general outpatient, or other inpatient settings too. The other contributors appropriately set out that you really wouldn't want to work with populations like this (unless maybe doing one-time consultations) if you do not have a network of people that you can work with (SLP, OT, SW, Case Management, Schools, etc., etc.).

I'd also encourage you to look into neuropsychiatry fellowships and see what they are actually doing (lots of TBI cases? Dementias? Intervetional psychiatry like TMS/ECT?) and see how well that aligns with the day-to-day work you want to do. There are also neurodevelopmental fellowships at some universities, but I'm not sure that there is board-certification yet, and so buyer-beware about doing an extra couple of years that doesn't translate into an enhanced job description. You should really enjoy (or at least tolerate?) doing the bread-and-butter work of the specialty you choose - because you'll be doing a lot of it.

Finally, you should check out the book Pediatric Neuropsychiary: A Case Based Approach (Hauptman, Salpekar 2018) to get a sense of what it would be like to specialize in this population, and what typical (complex) cases would be like. Note, too, that both editors are CAP trained, not neuropsychiatry trained.

I hope this helps.

 

[clozareal]

There are also neurodevelopmental fellowships at some universities, but I'm not sure that there is board-certification yet, and so buyer-beware about doing an extra couple of years that doesn't translate into an enhanced job description.

The board certification for neurodevelopmental disabilities is for child neurologists and pediatricians.