What types of jobs have fellows taken in recent years? Can you comment on salary expectations?
From what you have seen, what percentage of PP child and adolescent psychiatrists generally see children and adolescents, versus adults?
How do you deal with patients whose behavioral problems are largely due to environment, i.e. foster care, bad parenting, etc? I feel like no amount of anti-psychotics will fix this, and is a bit of a sticking point for me in this field of psychiatry.
Do you feel that C&A psych is more therapy than medication management?
I obviously have nothing to say about Florida, but I can say this about my program:
3 out of 4 fellows in my southwest fellowship who graduated last year are doing telepsychiatry due to the geographical flexibility it gave them for their own personal reasons. I think they are doing only child psychiatry. They aren't making any more than most adult psychiatrists or other child psychiatrists from what they told me. They are on call a lot. Fellows the year before that mostly went into private practice and are now working very hard, and are earning a bit more than the median adult psychiatry employed jobs, but not massively more. They are really busy so I haven't seen them around much anymore at the University.
You are right medications do not solve all behavioral problems. ADHD is the bread and butter of child psych, our "otitis media", and is often co-morbid with Oppositional Defiant Disorder. How do we treat ODD? First we treat the ADHD and aggression with medication, then work on the parenting and behavior in therapy. It is hard to parent, and even harder if you are an ill equipped or uneducated parent or a parent that has his/her own psychiatric illness.
Treatment for ODD is generally behavioral psychotherapy that includes the parent (Parent Child Interaction Therapy), Parent Management Training, family therapy, maybe some cognitive therapy.
We do PCIT, PMT, and other therapy in my program during training, but increasingly we seem to be doing less and less therapy and more medication management and referring patients for psychotherapy with a social worker or psychologist. The effectiveness of the social workers and psychologists we refer patients to is poor in comparison to the outcomes I've seen in our University fellow clinic. Outpatient psychiatrists in this area don't seem to do PCIT or PMT much. Psychotherapy with both parent and child is difficult work, and is not more lucrative than medication management. Many patients don't have the insurance coverage or cash available for therapy. Most often the single mother, low income parent that needs PCIT wants a pill that solves the problem immediately instead of doing therapy work.
In short, C&A is more medication management and less therapy these days, just like adult psychiatry.
I assume it is probably the same in Florida?
