Career impact of child fellowship prestige and opportunities

[Transistor]

Hello everybody, I will be applying to child psychiatry fellowships next year. Does prestige matter in terms of salary or job opportunities, or does particular strengths in a program impact my preparedness for certain niches in psychiatry? I'm still undecided in terms of what environments I want to practice in, but I've currently been thinking PHP/IOP or maybe outpatient (possibly part cash-only as well). I also have clinical interests that I'd like to be strong on, such as developmental disorders, eating disorders, and interventional psych. My and my partner's family are all located in big cities as well. I'm thinking about also staying at my home program (we have an internal match) but its strengths don't necessarily line up with my clinical interests. Furthermore, I'm thinking about leaving my current area and have no intention of staying at my current location/state after training. To maintain anonymity, I won't share my reasons why I would consider staying here for fellowship though I will say that I think it is a very reasonable rationale. Any input would be appreciated!

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[clozareal]

I've had patient's tell me they chose me because of the prestige of the institution(s) I went to for training over other psychiatrists. It's very helpful for high paying clientele. That does come with higher expectations too though. Outside of that and academia, I doubt it matters since there's such a shortage of child psychiatrists.

Most psychiatrists (67%) stay where they trained so pick where you want to live. It's the highest among any medical specialty. The local name/institution matters way more than prestige and the network/connections you build with that faculty and the alumni network matter more if you want to stay than coming from a "prestigious" school.

 

[shoomer]

Most psychiatrists (67%) stay where they trained so pick where you want to live. It's the highest among any medical specialty.

That's interesting, why do you think that is?

 

[clozareal]

That's interesting, why do you think that is?

Because of the non-competitiveness when the data was gathered, I think that psychiatry residents matched where they geographically wanted to stay compared to other more competitive specialties.

Table C4. Physician Retention in State of Residency Training, by Last Completed GME Specialty

Physician Retention in State of Residency Training, by Last Completed GME Specialty

www.aamc.org

 

[Celexa]

Prestige matters mainly if aiming for a funded research career. Much more important is if a program prepares you well for the type of work you want to do, and if you have a niche clincial interest that may vary considerably from program to program. And, as others have mentioned, there's a strong geographic influence simply in the fact if you train somewhere you know the lay of the land and have networking advantages. So if you are currently in residency somewhere you don't plan to live long term, I would certainly look at programs where you want to end up. That being said the demand for child psychiatrists is high and unlikely to change so you will have lots of options regardless.

 

[comp1]

Definite second geography. It's by far the most important thing. I'm not sure name brand recognition even compares. People stay where they train last because of the relationships they build there of all kinds. Personal relationships, work relationships, financial relationships, etc. It's very hard to justify severing all of that and starting completely over, particularly because it all gets even more difficult as you get older. Training is just 2 years, focus on the rest of your life.

 

[Sushirolls]

1) Pursue training at the best place, to make you the best CAP can you can be - not name brand seeking.
2) Choose training that has the lowest call burden. Just not needed to make you better at CAP.
3) Choose training that offers moonlighting and doesn't turn their nose up at it. In similar money venue, avoid HCOL areas
4) The dearth of CAP is substantial enough, that prestige means nothing. A CAP with a pulse, and who does a high percentage of CAP will be busy.
5) The barrier of training at XYZ location and moving where ever you want, really isn't that big of a deal. If you can learn knew rotation in medical school and residency within 30 days, you can learn the involuntary laws of a new state quickly.

 

[comp1]

I totally agree the barrier of moving TO the location of your final training isn't that bad. The issue is the barrier of moving FROM the location of your final training. It isn't chosen/forced upon you by a match process after that. That's why the geography should be the primary consideration with your rank list, cause that's where you're living until the ground takes you (statistically).

 

[clozareal]

1) Pursue training at the best place, to make you the best CAP can you can be - not name brand seeking.
2) Choose training that has the lowest call burden. Just not needed to make you better at CAP.
3) Choose training that offers moonlighting and doesn't turn their nose up at it. In similar money venue, avoid HCOL areas
4) The dearth of CAP is substantial enough, that prestige means nothing. A CAP with a pulse, and who does a high percentage of CAP will be busy.
5) The barrier of training at XYZ location and moving where ever you want, really isn't that big of a deal. If you can learn knew rotation in medical school and residency within 30 days, you can learn the involuntary laws of a new state quickly.

I agree with most of these except for number 2, but I think I'm in the minority here with how I feel about call. I think higher patient volume is crucial in training when you are supervised as the more patients you see, the better you get at doing these evaluations, at working with different and often unusual clinical circumstances, and at developing many types of treatment plans. I've had CAP colleagues who have done very minimal emergency room consultations because they had no call and their C-L rotation didn't include it.

I know some colleagues who don't care about #1 though. Many of my CAP friends don't see young kids anymore, only teenagers and above. They don't care to see eating disorders, evaluating and treating for autism especially when it comes to aggressive behaviors, evaluating and treating childhood abuse and the possible PTSD coming from it, childhood onset schizophrenia, preschool-aged ADHD, etc. Part of it was that their fellowship didn't teach this or give enough volume to be comfortable with this.

 

[Merovinge]

Go to where you want to be after training, don't overthink it. If you are talking major metros, I don't think there are any that are void of CAP options.

 

[TexasPhysician]

Geography is the priority of most.

The average person doesn’t know much about prestige, especially the farther away it is. If you live in Texas, UT has a great name. The average patient in Texas couldn’t tell you where to find Columbia University or how good it is. There are maybe a few programs like Harvard, Yale, and Stanford that most know the quality. Beyond that, most people are not researching the top 25 training programs before choosing a psychiatrist.

 

[HaileyMed]

I'm a current child fellow. I chose a well-known prestigious program because I have a lot of entrepreneurial endeavors in addition to child psychiatry, so I reasoned the name recognition would be important to business pursuits *plus* the program has very approachable leaders in the field so you can get whatever experiences you want and tailor your education which has been pretty cool so far.

Another consideration is if you're URM, prestige name recognition has been shown to improve outcomes for undergrads. I don't know that there's a definitive answer for why, but my thought is it can help mitigate prejudice and also increase networking opportunities. I don't believe there are any studies for if/how it improves graduate student or resident outcomes, but I would assume it can (but anyone who says it doesn't I could not argue with due to lack of data both ways).

Region was not important to me at all and I always planned on going back home after I finish fellowship... however I've also started to love it here and have met a lot of cool people so I might be seduced into staying. We'll see what happens!

 

[tortuga87]

It didn’t matter for me, especially clinically. Any hospital will take you — including academic, if that is what you want. Hospitals struggle to fill their spots with any child and adolescent psychiatrist modulo personality quirks of hospital leadership. Most hires in academic medical centers are in fact recent grads in the professional rapprochement phase.

NIH also does not care where you trained. They only want you to justify that your attending environment is solid in grant applications. And you can basically go anywhere as an attending per above paragraph.

I have yet to encounter any practical benefit from prestige (eg money, promotion) besides occasional patients or strangers giving me a pat on the back. People care almost exclusively about your performance right now than even your performance 2-3 years ago

 

[ridethecliche]

1) Pursue training at the best place, to make you the best CAP can you can be - not name brand seeking.
2) Choose training that has the lowest call burden. Just not needed to make you better at CAP.
3) Choose training that offers moonlighting and doesn't turn their nose up at it. In similar money venue, avoid HCOL areas
4) The dearth of CAP is substantial enough, that prestige means nothing. A CAP with a pulse, and who does a high percentage of CAP will be busy.
5) The barrier of training at XYZ location and moving where ever you want, really isn't that big of a deal. If you can learn knew rotation in medical school and residency within 30 days, you can learn the involuntary laws of a new state quickly.

I did CAP fellowship in an east coast city with much more call than many of the other programs I interviewed at...but it was paid call and there were lots of moonlighting opportunities. I worked less than I did during residency and doubled what I made because of picked up shifts.

There are lots of benefits to being in a HCOL area if the opportunities are there.