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Child/Adolescent Psychiatrist

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Mom-of-4

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I'm interested in pursuing a career as a Child/Adolescent Psychiatrist. I was previously interested in Clinical Psychology but I'm beginning to lean more towards Child/Ado. Psych. I've heard that's it's an exceptionally difficult career. I was just curious as to how that may be? If anyone could give me some insight as to how the work is and/or what it's like as a Child Psychiatrist would be greatly apppreciated.
 

Shikima

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Become a doctor first, and then specialize, and then sub-specialize.
 
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digitlnoize

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I'm interested in pursuing a career as a Child/Adolescent Psychiatrist. I was previously interested in Clinical Psychology but I'm beginning to lean more towards Child/Ado. Psych. I've heard that's it's an exceptionally difficult career. I was just curious as to how that may be? If anyone could give me some insight as to how the work is and/or what it's like as a Child Psychiatrist would be greatly apppreciated.

I'm finishing my child fellowship now. I wouldn't say it's exceptionally difficult. The hardest part honestly is the whole med school/residency thing. Psychiatry itself, I don't find that hard. Child psych has an added dynamic of dealing with parents, but it's usually easier in terms of number of problems per patient and medical comorbidies and patient's non-psych meds. All this greatly simplifies many (not all) cases.

Most of my cases are just straightforward ADHD or anxiety, with maybe one or two co-morbid diagnoses. Most respond well to treatment. Most are healthy and don't have much else going on. I have a handful of more difficult cases including a bad case of Tourette's, a couple psychotic patients, a couple kids with Reactive Attachment Disorder, and some Autistic kids of varying function. But those are the exception, even in my training program.

Again, the hardest part is the getting into med school, studying like mad for 4 years, getting into residency, working like mad for 5 years, then done. It's really just the time commitment.
 
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Unico

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My impression from speaking to residents on the wards was that child psych can be more depressing than other sub-specialities (although I'd guess that forensic would be even worse). It's hard on the psyche, especially for inpatient. But take my words as a grain of salt as I'm not in residency yet, this is just the feedback I got from my psych rotation.

Again, the hardest part is the getting into med school, studying like mad for 4 years, getting into residency, working like mad for 5 years, then done. It's really just the time commitment.

Was the getting fellowship competitive? I have a few years to go, but would appreciate your insights.


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Merovinge

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Was the getting fellowship competitive? I have a few years to go, but would appreciate your insights.

To be parsimonious and 100% accurate... No!
 
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DD214_DOC

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I'm finishing my child fellowship now. I wouldn't say it's exceptionally difficult. The hardest part honestly is the whole med school/residency thing. Psychiatry itself, I don't find that hard. Child psych has an added dynamic of dealing with parents, but it's usually easier in terms of number of problems per patient and medical comorbidies and patient's non-psych meds. All this greatly simplifies many (not all) cases.

Most of my cases are just straightforward ADHD or anxiety, with maybe one or two co-morbid diagnoses. Most respond well to treatment. Most are healthy and don't have much else going on. I have a handful of more difficult cases including a bad case of Tourette's, a couple psychotic patients, a couple kids with Reactive Attachment Disorder, and some Autistic kids of varying function. But those are the exception, even in my training program.

Again, the hardest part is the getting into med school, studying like mad for 4 years, getting into residency, working like mad for 5 years, then done. It's really just the time commitment.

I think you might be doing it wrong....
 

digitlnoize

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I think you might be doing it wrong....

lol. Yeah, we're in a small town, so the pathology in our outpatient clinic isn't too bad really. I have some ODD cases with refractory bad parenting, but overall, my kids tend to get better. We see sicker patients in our inpatient experience, so I know what to compare them to, and it's mostly night and day. Don't get me wrong, I have refractory cases, but the majority have improved quite a bit over my time with them.
 

DD214_DOC

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lol. Yeah, we're in a small town, so the pathology in our outpatient clinic isn't too bad really. I have some ODD cases with refractory bad parenting, but overall, my kids tend to get better. We see sicker patients in our inpatient experience, so I know what to compare them to, and it's mostly night and day. Don't get me wrong, I have refractory cases, but the majority have improved quite a bit over my time with them.

Gotcha. My fellowship experiences was very similar, with autism and such thrown into the mix. The real day-to-day practice of child is vastly different, though, but as always depends entirely on the demographics of the area you practice. The things I deal with on a daily basis and have become routine is what I'm told, "bread and butter" child psych actually is. It's certainly something, I'll tell you that.
 

digitlnoize

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Gotcha. My fellowship experiences was very similar, with autism and such thrown into the mix. The real day-to-day practice of child is vastly different, though, but as always depends entirely on the demographics of the area you practice. The things I deal with on a daily basis and have become routine is what I'm told, "bread and butter" child psych actually is. It's certainly something, I'll tell you that.

Like what? What's different?

I'm planning on setting up my own outpatient practice in the areas I'm in, so I can't imagine it'd be much different given that we pull from the same population.


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DD214_DOC

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Like what? What's different?

I'm planning on setting up my own outpatient practice in the areas I'm in, so I can't imagine it'd be much different given that we pull from the same population.


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I ended up in an area with a demographic of significantly-lower SES and younger. Families tend to be lower functioning and the majority of cases are predominantly behavioral issues combined with poor parenting skills, and a good chunk with the added fun of untreated parental pathology. The majority are noncompliant with treatment recommendations, have little to no interest in being involved in the treatment process, adjust meds on their own based upon their education and training at Google Medical School, and on and on and on.

I have had a parent insist on changing a well-tolerated and extremely-effective medication because a relative told them the outer layer may not completely digest and be seen in their stool, which naturally cause, "their guts to get all knotted up and make hemmorrhoids". Another parent and adolescent looked right at me and insisted the teen takes the medication, "every day", and has been without any missed doses or interruption, even after I very clearly showed them in the EMR the last time it was filled was for a 30-day supply 6 months ago.

Stuff like that. Several times a day. Every day. I vent about this thing I call the, "merry go round" patients try to trap me in. Essentially, they show up and complain about X; I recommend treatment to address this concern whether it's meds, therapy, or a combination; they are blatantly noncompliant with these reccs in some way, reducing the possibility that things may actually improve to zero; alas, they follow-up and lament that nothing has changed, we discuss their noncompliance and why they can't expect anything to change, rreview the treatment reccs again, then schedule a f/u. Repeat over and over and over, with about every third appt they demand a change to meds, which they also won't follow. If relevant, any attempt to venture into the whole, "identified patient" concept just leads to more misery, and eventually gets sabotaged when the kid is unnecessarily admitted for less than a week and discharged with a bogus diagnosis made during a half-assed evaluation that gives the parent exactly what they need to continue distracting from the real problem.

It really is insanity.
 
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PistolPete

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I ended up in an area with a demographic of significantly-lower SES and younger. Families tend to be lower functioning and the majority of cases are predominantly behavioral issues combined with poor parenting skills, and a good chunk with the added fun of untreated parental pathology. The majority are noncompliant with treatment recommendations, have little to no interest in being involved in the treatment process, adjust meds on their own based upon their education and training at Google Medical School, and on and on and on.

I have had a parent insist on changing a well-tolerated and extremely-effective medication because a relative told them the outer layer may not completely digest and be seen in their stool, which naturally cause, "their guts to get all knotted up and make hemmorrhoids". Another parent and adolescent looked right at me and insisted the teen takes the medication, "every day", and has been without any missed doses or interruption, even after I very clearly showed them in the EMR the last time it was filled was for a 30-day supply 6 months ago.

Stuff like that. Several times a day. Every day. I vent about this thing I call the, "merry go round" patients try to trap me in. Essentially, they show up and complain about X; I recommend treatment to address this concern whether it's meds, therapy, or a combination; they are blatantly noncompliant with these reccs in some way, reducing the possibility that things may actually improve to zero; alas, they follow-up and lament that nothing has changed, we discuss their noncompliance and why they can't expect anything to change, rreview the treatment reccs again, then schedule a f/u. Repeat over and over and over, with about every third appt they demand a change to meds, which they also won't follow. If relevant, any attempt to venture into the whole, "identified patient" concept just leads to more misery, and eventually gets sabotaged when the kid is unnecessarily admitted for less than a week and discharged with a bogus diagnosis made during a half-assed evaluation that gives the parent exactly what they need to continue distracting from the real problem.

It really is insanity.

This sounds like the current population that I serve in fellowship. Incredibly frustrating and one that I don't want to treat in private practice, if I'm being completely honest. This is where you see the cluster fuk of polypharm from psychiatrists who do 10 min visits and try to fix bad parenting.

You can only do so much.
 
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