Consult - Liaison Psychiatry Programs

Hatov

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Hello everyone. I am looking for your guidance regarding CL programs. This is a very interesting area for me intellectually and I am looking into applying for the fellowship when the time comes. If anyone has insight regarding strong programs would you please share your thoughts with me. This will help make a program list that I will apply to. Interested in knowing the strengths and weaknesses of each program if possible.
 
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vistaril

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Hello everyone. I am looking for your guidance regarding CL programs. This is a very interesting area for me intellectually and I am looking into applying for the fellowship when the time comes. If anyone has insight regarding strong programs would you please share your thoughts with me. This will help make a program list that I will apply to. Interested in knowing the strengths and weaknesses of each program if possible.

what are your career goals?

Unless it is specifically to transition from one of these silly 1 year 'fellowships' directly into a junior academic position presumably doing the same thing(and even then is it really needed?), it would be a completely wasted year to spend a year making 55k or whatever in a 'consult-liason' fellowship.

I'll try to be as polite here as possible: there is no such thing as 'consult-liason' psychiatry. I see plenty of consults per day. Probably more than average 'consult-liason' specialist. You want to know whether I did a 'consult-liason' fellowship? lmao......

Look, if we were looking to add another psychiatrist and we saw that it was an early career psychiatrist straight out of such a fellowship, we would be concerned that this person doesn't have a clue how the real world operates. Anyone that is so backwards such as to sign up for a year program which is completely useless and irrelevant to see just a few patients per day(and basically take a year sabbitcal just as their career is starting) probably doesn't have the same goals we do as a practice. And by 'we' I'm referring to people in the real world......

So thats why anyone considering such a year sabbatical needs to think hard about what their goals are. If it's to work as a psychiatrist in the real world, I would strongly recommend against it. That person would be much better off(from a career standpoint and for their own training/education) to actually start working as a psychiatrist int he real world(which will include consults.....maybe more than you will get in that silly program hehe).
 
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Mass Effect

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OP please ignore the post by Vistaril.

There's a sticky about CL programs. Two of my residency colleagues did the fellowship. I would recommend if you're going to spend a year doing it, go to a top academic institution and don't waste time on the lower tier places that are likely to mimic your residency training.
 
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vistaril

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OP please ignore the post by Vistaril.

LMAO....yes, good to ignore someone who has worked in pretty much every setting there is outside an academic position on matters like this. What do I know. The hospital administrators I deal with and talk to about these matters and who control the contracts don't know what they are talking about either.

Just last week one said to me- "you know what we are looking for? Not someone who has shown us they can deliver quality and efficient care in a variety of settings and do it with all the challenges facing providers today- billing, scheduling, covering multiple sites, flexibility, working with consultants and other services, working with the team on the unit. No, what we are looking for instead is someone who spent a year after residency and completed the elusive psychosomatic fellowship. Managing multiple units in the real world after residency doesn't show me anything; it's those grand rounds one attends during their psychomatic fellowship year that make me want to give them the contract"

I'm not saying nobody should do a fellowship in psychiatry. But.....pretty close to nobody should do a fellowship in psychiatry.
 
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vistaril

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I agree with vistaril... I grandfathered into c and l certification without a fellowship ( though I am med psych), the certification hasn't done me any good.

[email protected]!

I got called to see a consult today and then the person on the other end of the phone said- "wait, did you do a C-L fellowship? I need this patient seen by someone who did a C-L fellowship. I'm sorry". You win some and lose some.
 

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[email protected]!

I got called to see a consult today and then the person on the other end of the phone said- "wait, did you do a C-L fellowship? I need this patient seen by someone who did a C-L fellowship. I'm sorry". You win some and lose some.

I have, like, less than zero interest in ever doing C&L work in any capacity, so understand I have no investment whatsoever in the idea of the fellowship being valuable. But prior to your hiatus you were known for exaggerating/making up your qualifications and insisting on the most sure possible picture of the state of psychiatry based entirely on the peculiarities of the job market in your corner of Alabama.


Of course academic positions are the only ones who care about you having the fellowship in terms of hiring you or not for a job. But those are also usually the places where you are seeing most of the cases that might really need that kind of expertise in the first place. If you are super interested in that field that is where you want to be going.

The fact you have no experience in that setting tracks pretty well with your not recognizing it might have value.
 
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vistaril

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I have, like, less than zero interest in ever doing C&L work in any capacity, so understand I have no investment whatsoever in the idea of the fellowship being valuable. But prior to your hiatus you were known for exaggerating/making up your qualifications and insisting on the most sure possible picture of the state of psychiatry based entirely on the peculiarities of the job market in your corner of Alabama.


Of course academic positions are the only ones who care about you having the fellowship in terms of hiring you or not for a job. But those are also usually the places where you are seeing most of the cases that might really need that kind of expertise in the first place. If you are super interested in that field that is where you want to be going.

The fact you have no experience in that setting tracks pretty well with your not recognizing it might have value.

Over the last 6 years I have worked in 4 different states. I've worked in cities(Charlotte, atlanta). I've worked in small towns. Ive worked community mental health. I've worked inpatient. I've worked outpt. I've worked addiction. Ive worked geri. I've worked....pretty much everything. Private systems, public systems, different types of funding. Insurance based, not insurance based. Now before you say "well you've bounced around a lot...whats the problem", no...a lot of that was in the same job. That said, some of it was moving due to family considerations. So yeah, I will challenge people who are freaking residents and haven't ever had a real job yet and think they know a lot about the market. Or academic people who have never worked outside of there.

It's also telling that you say "I have zero interest in ever doing C and L work in any capacity"? What the hell does this even mean? There is no such thing as 'C and L' work......that's called psychiatry. You've just made up some artificial distinction. Am I doing 'C and L' work when I went to see 4 patients who were originally admitted to med-surg this afternoon? Of course not.....
 
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splik

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While it is true that one does not need a C-L fellowship to practice in C-L settings, I disagree that doing consults is just bread and butter psychiatry like seeing medicine or neurology consults. The reason C-L is its own subspecialty is because the work is in many cases quite different from what the average psychiatrist is doing. This contrasts with medicine consults or other specialty consults where the work is exactly the same as what they might be doing in other settings with some notable exceptions (e.g. medicine consults for perioperative management of patients). There is a whole body of knowledge and skill set that goes along with C-L psychiatry, especially in larger hospitals (where academic or non-academic) that most general psychiatrists do not get.

One of the skills in C-L that differs from consults in other specialties is a good C-L service is providing consultation related to teams, and takes into account systemic dynamics, systems based practice, medicolegal issues, and ethical issues. Also, a really good C-L service will integrate things like brief psychotherapy, behavioral interventions, hypnosis, mindfulness etc into care of patients.

For example being really confident with psychopharmacology in medically complex patients, management of delirium, somatoform disorders, factitious disorders, transplant patients, HIV psychiatry, psycho-oncology, reproductive psychiatry, mind-body medicine, neuropsychiatry, chronic pain, addiction in medically complex patients etc. These are things most general psychiatrists are not good at.

I did not do a C-L fellowship but I do general C-L and neuropsychiatry consults both outpatient and inpatient. You can learn stuff on the job (and for some people it will be much better to do this), but for some people doing the fellowship provides the structure, mentorship and experiences to get them where they want to be. No, it's probably not going to make you more money. It's probably not going to make you more employable or be necessary at a community hospital. However, working at specialty hospitals or academic settings, C-L psychiatry is its own subfield which requires a higher knowledge base and skillset to do well compared to other areas of psychiatry. Also for those interested in administative medicine, leadership positions and medical education, you will note that C-L psychiatrists are overrepresented in such positions.

I second the comment about going somewhere that has a really good fellowship program or else there's probably not much point. Programs that have historically been strong in this include MGH, Brigham and Women's, Columbia, MSKCC, Stanford, UW, Inova Fairfax

Also even in academic settings, C-L fellowship is not required. I know of no institutions that require one to have such a fellowship to work on the C-L service. However other fellowships are also desirable e.g. addictions, forensic, geriatrics, palliative medicine, even child psych. The best C-L divisions have people from different specialty areas.
 
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vistaril

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For example being really confident with psychopharmacology in medically complex patients, management of delirium, somatoform disorders, factitious disorders, transplant patients, HIV psychiatry, psycho-oncology, reproductive psychiatry, mind-body medicine, neuropsychiatry, chronic pain, addiction in medically complex patients etc. These are things most general psychiatrists are not good at.

they damn sure should be, or they aren't very competent psychiatrists. Outside of psychodynamic work, all those things with the possible exception of mind-body medicine is 'general psychiatry'. Hell I don't know what 'general psychiatry' even is.

The reality is that you can see really interesting cases anywhere in psychiatry. It's different than other fields in that respect. Some kid with a real rare autoimmune disorder is always going to get shipped off to the tertiary care academic hospital. But psych doesn't work that way- me and my colleagues in community hospitals have seen really cool/weird things before there is very little literature on. Nobody thought "hey let's ship them off to some big city with a famous hospital". Psych doesn't work that way relative to other fields. Now research? Sure, that's different.....Im not going to BS you and tell you you can do research at community hospitals in psych, but the patients themselves? Heck yeah....

But JFC.....you need a consult fellowship to learn how to do delirium well? LMAO.....

Also, every single thing(with the possible exception of transplant patients depending on where you work) you listed above you will see in large community hospitals.
 

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While it is true that one does not need a C-L fellowship to practice in C-L settings, I disagree that doing consults is just bread and butter psychiatry like seeing medicine or neurology consults. The reason C-L is its own subspecialty is because the work is in many cases quite different from what the average psychiatrist is doing. This contrasts with medicine consults or other specialty consults where the work is exactly the same as what they might be doing in other settings with some notable exceptions (e.g. medicine consults for perioperative management of patients). There is a whole body of knowledge and skill set that goes along with C-L psychiatry, especially in larger hospitals (where academic or non-academic) that most general psychiatrists do not get.

One of the skills in C-L that differs from consults in other specialties is a good C-L service is providing consultation related to teams, and takes into account systemic dynamics, systems based practice, medicolegal issues, and ethical issues. Also, a really good C-L service will integrate things like brief psychotherapy, behavioral interventions, hypnosis, mindfulness etc into care of patients.

For example being really confident with psychopharmacology in medically complex patients, management of delirium, somatoform disorders, factitious disorders, transplant patients, HIV psychiatry, psycho-oncology, reproductive psychiatry, mind-body medicine, neuropsychiatry, chronic pain, addiction in medically complex patients etc. These are things most general psychiatrists are not good at.

I did not do a C-L fellowship but I do general C-L and neuropsychiatry consults both outpatient and inpatient. You can learn stuff on the job (and for some people it will be much better to do this), but for some people doing the fellowship provides the structure, mentorship and experiences to get them where they want to be. No, it's probably not going to make you more money. It's probably not going to make you more employable or be necessary at a community hospital. However, working at specialty hospitals or academic settings, C-L psychiatry is its own subfield which requires a higher knowledge base and skillset to do well compared to other areas of psychiatry. Also for those interested in administative medicine, leadership positions and medical education, you will note that C-L psychiatrists are overrepresented in such positions.

I second the comment about going somewhere that has a really good fellowship program or else there's probably not much point. Programs that have historically been strong in this include MGH, Brigham and Women's, Columbia, MSKCC, Stanford, UW, Inova Fairfax

Also even in academic settings, C-L fellowship is not required. I know of no institutions that require one to have such a fellowship to work on the C-L service. However other fellowships are also desirable e.g. addictions, forensic, geriatrics, palliative medicine, even child psych. The best C-L divisions have people from different specialty areas.
Echoing JerryMouse, I would love to get more information on what CL psych fellowships are good and the pros and cons for them.
 
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The fellowships splik listed are top-notch based on what I've anecdotally heard from other people, except for Inova which I've not heard about. It's been difficult to figure out the quality of other fellowships not in the elite few. Based on what splik said, the fellowship should ideally be at a major academic hospital with transplant services, a major cancer center, and enough specialty clinics to get exposure to niche fields. The other stuff like the quality/reputation of attendings I'm less sure how to find out.
 
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clozareal

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OP isn't asking whether or not a C-L fellowship is worth it, but rather how to make a program list.

I've heard of residents picking C-L fellowships based on the strength or ranking of the main hospital they are working at. I've also heard picking based on the strength of the other departments (surgery, specialty hospital units) in that hospital setting. If that hospital is a magnet for certain conditions (transplant, cancer, burn center, etc.) then you'll get the most experience in that area if you are interested in a particular subset of illnesses.

I would imagine taking the top 10 ranked hospitals and researching whether those can fit on your program list wouldn't be an unreasonable first approach. You'll have to look at the programs associated with that list because not all those hospitals will have fellowship programs at that hospital, but rather a satellite one. This is particularly the case with hospitals associated with VAs because some VAs pay for the fellowship spots.

Fellowship programs can also give you a foot in the door at that institution in terms of access to networking that you might not have had before which can also factor into your list.

Other than splik's list, probably adding to the list: UPMC, VCU, UNC, Yale, NYU, UCLA, Vanderbilt, Mayo, and Cleveland Clinic.
 
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OP isn't asking whether or not a C-L fellowship is worth it, but rather how to make a program list.

I've heard of residents picking C-L fellowships based on the strength or ranking of the main hospital they are working at. I've also heard picking based on the strength of the other departments (surgery, specialty hospital units) in that hospital setting. If that hospital is a magnet for certain conditions (transplant, cancer, burn center, etc.) then you'll get the most experience in that area if you are interested in a particular subset of illnesses.

I would imagine taking the top 10 ranked hospitals and researching whether those can fit on your program list wouldn't be an unreasonable first approach. You'll have to look at the programs associated with that list because not all those hospitals will have fellowship programs at that hospital, but rather a satellite one. This is particularly the case with hospitals associated with VAs because some VAs pay for the fellowship spots.

Fellowship programs can also give you a foot in the door at that institution in terms of access to networking that you might not have had before which can also factor into your list.

Other than splik's list, probably adding to the list: UPMC, VCU, UNC, Yale, NYU, UCLA, Vanderbilt, Mayo, and Cleveland Clinic.

I have had...personality conflicts with the leadership of the UPMC C&L program and declined an offer of one of the fellowship slots for next year (they didn't fill and so asked around) but if I had any interest in fellowship I would not have hesitated to accept. For all I don't mesh well with the style of the folks in charge they know their stuff and the training is excellent, thoughtful, and thorough.
 
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clozareal

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I have had...personality conflicts with the leadership of the UPMC C&L program and declined an offer of one of the fellowship slots for next year (they didn't fill and so asked around) but if I had any interest in fellowship I would not have hesitated to accept. For all I don't mesh well with the style of the folks in charge they know their stuff and the training is excellent, thoughtful, and thorough.
This is the type of discussion that is helpful.
 
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JerryMouse

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From reading fellowship websites, I noticed a few other factors that can influence the fellowship experience
  • whether there is emergency department coverage
  • amount of time spent at a VA medical center, if there is one
  • whether there are psychologists to help with consults for capacity evals, transplant evals, and psychotherapy
  • amount outpatient clinic time, ranging from one half day a week to multiple half days a week
It is not uncommon to have to cover the ED or work at a VA during CL fellowship. I personally dislike ED and VA work, so I will try to avoid fellowships with those requirements. A psychology service in the hospital would be helpful, though I'm not sure how common that is.
 
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Just throwing out there that the BWH fellowship is a lot of work. That's a good thing if you want to do a ton of consults and presumably learn a lot (by doing a lot). It's not a good thing if you want to have a relatively relaxed fellowship year.
Can you share more about the BWH fellowship if you're familiar with it?
 
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Hatov

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Thank you guys for all the information! I am interested in academics and all the nuances of medically ill patients with psychiatric comorbidities/overtones. I completely understand the earlier posts regarding it not necessarily being a financial move to go for such a fellowship. I do believe a strong general psychiatrist can do most of the subspecialty work, but my interest in CL goes beyond the general training or financial incentives of going into private practice right out of residency. I am trying to gather data on various top programs to help make a decision for which will be the best fit.
 

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Over the last 6 years I have worked in 4 different states. I've worked in cities(Charlotte, atlanta). I've worked in small towns. Ive worked community mental health. I've worked inpatient. I've worked outpt. I've worked addiction. Ive worked geri. I've worked....pretty much everything. Private systems, public systems, different types of funding. Insurance based, not insurance based. Now before you say "well you've bounced around a lot...whats the problem", no...a lot of that was in the same job. That said, some of it was moving due to family considerations. So yeah, I will challenge people who are freaking residents and haven't ever had a real job yet and think they know a lot about the market. Or academic people who have never worked outside of there.

I feel like you're telling us some things about yourself with this post that you might not realize you're telling us.
 
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psyguru

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LMAO....yes, good to ignore someone who has worked in pretty much every setting there is outside an academic position on matters like this. What do I know. The hospital administrators I deal with and talk to about these matters and who control the contracts don't know what they are talking about either.

Just last week one said to me- "you know what we are looking for? Not someone who has shown us they can deliver quality and efficient care in a variety of settings and do it with all the challenges facing providers today- billing, scheduling, covering multiple sites, flexibility, working with consultants and other services, working with the team on the unit. No, what we are looking for instead is someone who spent a year after residency and completed the elusive psychosomatic fellowship. Managing multiple units in the real world after residency doesn't show me anything; it's those grand rounds one attends during their psychomatic fellowship year that make me want to give them the contract"

I'm not saying nobody should do a fellowship in psychiatry. But.....pretty close to nobody should do a fellowship in psychiatry.

I disagree. I can't speak regarding C/L fellowships. I did complete a fellowship in Forensics (and also obtained BIM board-certification via the practice pathway so I am not opposed to avoiding another fellowship...I plan to obtain addiction board certification via the practice pathway....one fellowship for 4 board-certifications is not a bad deal ). As there are only about a dozen forensic psychiatrists who are BIM certified, I am getting quite a few referrals for PI MVA cases along with the odd TBI capital case. It is possible I could have gotten a few of those MVA with the forensic fellowship. However, I doubt I would have gotten the Capital murder case without it. It is possible to have gotten some of the cases without the forensic fellowship but not certain cases like the capital murder case. Feel free to PM me and I can provide more details on how my year was not wasted drinking good beer and Pinot (may provide a clue to where I did my fellowship) and that it was an excellent financial move. It was also my most interesting year of training and I have absolutely no regrets. I plan on taking up an academic position in a fellowship program as well.
 

psyguru

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While it is true that one does not need a C-L fellowship to practice in C-L settings, I disagree that doing consults is just bread and butter psychiatry like seeing medicine or neurology consults. The reason C-L is its own subspecialty is because the work is in many cases quite different from what the average psychiatrist is doing. This contrasts with medicine consults or other specialty consults where the work is exactly the same as what they might be doing in other settings with some notable exceptions (e.g. medicine consults for perioperative management of patients). There is a whole body of knowledge and skill set that goes along with C-L psychiatry, especially in larger hospitals (where academic or non-academic) that most general psychiatrists do not get.

One of the skills in C-L that differs from consults in other specialties is a good C-L service is providing consultation related to teams, and takes into account systemic dynamics, systems based practice, medicolegal issues, and ethical issues. Also, a really good C-L service will integrate things like brief psychotherapy, behavioral interventions, hypnosis, mindfulness etc into care of patients.

For example being really confident with psychopharmacology in medically complex patients, management of delirium, somatoform disorders, factitious disorders, transplant patients, HIV psychiatry, psycho-oncology, reproductive psychiatry, mind-body medicine, neuropsychiatry, chronic pain, addiction in medically complex patients etc. These are things most general psychiatrists are not good at.

I did not do a C-L fellowship but I do general C-L and neuropsychiatry consults both outpatient and inpatient. You can learn stuff on the job (and for some people it will be much better to do this), but for some people doing the fellowship provides the structure, mentorship and experiences to get them where they want to be. No, it's probably not going to make you more money. It's probably not going to make you more employable or be necessary at a community hospital. However, working at specialty hospitals or academic settings, C-L psychiatry is its own subfield which requires a higher knowledge base and skillset to do well compared to other areas of psychiatry. Also for those interested in administative medicine, leadership positions and medical education, you will note that C-L psychiatrists are overrepresented in such positions.

I second the comment about going somewhere that has a really good fellowship program or else there's probably not much point. Programs that have historically been strong in this include MGH, Brigham and Women's, Columbia, MSKCC, Stanford, UW, Inova Fairfax

Also even in academic settings, C-L fellowship is not required. I know of no institutions that require one to have such a fellowship to work on the C-L service. However other fellowships are also desirable e.g. addictions, forensic, geriatrics, palliative medicine, even child psych. The best C-L divisions have people from different specialty areas.
I agree. The reverse is true of some c/l psychiatrist losing touch with the "bread and butter" psychiatry. I did a rotation as a PGY4 at a top cancer hospital. They offer an informal psycho-oncology fellowship (similar to a super-specialized c/l fellowship). The attending there has worked there decades and would defer to us when there was a case of garden variety schizophrenia. However, he is probably one of the psychiatrists most well-versed in psycho-oncology.
 

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Over the last 6+ years I have worked in 3 different states. I've worked in cities(Memphis). I've worked in small towns. . I've worked inpatient. I've worked outpt. I've worked addiction. I have worked sleep.. Ive worked geri. I've worked....pretty much everything. Private systems, non-profit systems, different types of funding. Insurance based, not insurance based. Now before you say "well you've bounced around a lot...whats the problem", no...a lot of that was in the same tri-state area (Arkansas/TN/MS). So yeah, I will challenge people who are freaking residents and haven't ever had a real job yet and think they know a lot about the market. Or academic people who have never worked outside of there :)
 
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psycho-oncology? So you have cancer and you get depressed- are there certain SSRIs that work better for depression in cancer? Sorry, just seems like a bogus field to me.

I agree, I don't get psycho-oncology. But most psych fellowships that are super specific as opposed to actual subspecialties (like women's mental health or transitional aged youth or OCD fellowship or ADHD fellowship or sports psychiatry or HIV psychiatry or transplant psychiatry) is all about the patient population you want to work with or subject matter you want to be an expert in. Even sleep to a certain extent. That's one of the things I like about psychiatry. There are hundreds of subfields within the subspecialties that you can specialize in and only treat that population.
 

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psycho-oncology? So you have cancer and you get depressed- are there certain SSRIs that work better for depression in cancer? Sorry, just seems like a bogus field to me.

The psycho-onc people I’ve talked to all love Mirtazapine. I feel like I’ve read articles or a meta-analysis recommending it as first line treatment in these patients but can’t recall off the top of my head. I’ll see if I can find anything and post back if I do.
 

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The psycho-onc people I’ve talked to all love Mirtazapine. I feel like I’ve read articles or a meta-analysis recommending it as first line treatment in these patients but can’t recall off the top of my head. I’ll see if I can find anything and post back if I do.

Dude they like it cause cancer pts get chemo, lose weight and stop eating. And everyone has trouble sleeping in the hospital. Don't need a psych onc fellowship to figure that one out
 
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MamaPhD

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Dude they like it cause cancer pts get chemo, lose weight and stop eating. And everyone has trouble sleeping in the hospital. Don't need a psych onc fellowship to figure that one out

So, out of curiosity, what would be your first-line intervention for concentration and attention problems in a young adult returning to work after a course of whole brain irradiation? Depression in a prostate cancer survivor maintained on androgen deprivation therapy? Intense fear of recurrence and intrusive thoughts in a BRCA mutation carrier with high grade serous ovarian cancer who has already lost her mother and sister to the same disease?

Not that you couldn't figure out something to do, but surely knowing the population in some depth would be helpful, no? Like knowing, for example, that in many oncology populations (eg, breast cancer) chemo is often associated with weight gain. That's all that psycho-oncology or any specialized training is - learning things that most in your field don't know to better equip you to work with a specific population.
 

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psycho-oncology? So you have cancer and you get depressed- are there certain SSRIs that work better for depression in cancer? Sorry, just seems like a bogus field to me.
This sounds like something an NP would say.

"Psycho-oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process."

Having a subspecialty in psycho-oncology does not mean that general psychiatrists can't competently treat patients with cancer but recognizes that some people have expertise in providing clinical care, conducting research, and leading services providing psychological and psychiatric care to patients with cancer. There are some relevant psychopharmacological considerations with this population but more important is diagnostic issues (for example being familiar with neuropsychiatric manifestations of brain tumors, paraneoplastic syndromes, effects of chemotherapy agents including CAR-T therapy etc) and psychological aspects of care (e.g. treatment of demoralization). There are several psychotherapies including dignity therapy and meaning-centered psychotherapy that have been developed for end of life cancer patients and yes psychiatrists are involved in developing and providing psychotherapy for cancer patients in some cancer centers. There is also overlap with palliative medicine. Psycho-oncology is a really active area now, albeit primarily academic, but in recent years there has been interest in use of psilocybin and ketamine in this population, development of specific psychotherapies, and it's hard to keep up with the advances in cancer treatment as relevant to psychiatry.

Even in private practice, some people find it help to carve out a niche for themselves. If your focus is in caring for a specific patient population, keeping abreast of the literature for that population, attending conferences for that population, teaching about caring for that population etc, chances are you are more experienced and have value to add. It doesn't mean you have to have a fellowship or board certification or whatever to treat patients with x, but it raises red flags about how people practice when they flaunt that they don't know what they don't know.
 
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Stagg737

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Dude they like it cause cancer pts get chemo, lose weight and stop eating. And everyone has trouble sleeping in the hospital. Don't need a psych onc fellowship to figure that one out

Ask stupid questions and you’ll get obvious/stupid answers. Anyway, I was referring to studies showing Mirtazapine to be more efficacious than SSRIs specifically for the mood component beyond the obvious points you stated.
 
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cleareyedguy

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If you want a job in C-L at an academic medical center, you'll almost definitely need a C-L fellowship. Exceptions: a program may be looking to fill a hole, perhaps in addiction. Or a department might be desperate.

The credentialing body for C-L fellowships checks to ensure that programs have an adequate number of C-L trained faculty, which does motivate hiring. More important, the fellowship does teach stuff, and doing C-L is difficult. A good general psychiatrist can learn C-L without a fellowship, but it'd require serious, ongoing study for at least a year, preferably under the guidance of experts (sounds like a fellowship).

A good general psychiatrist could probably walk into the hospital and do the occasional consult, as long as the consult resembled the problems they were seeing as outpatients, but (IMHO) they would simply not have the expertise to do a complicated consult.

Psycho-onc is clearly a thing, with a definite body of knowledge. Sure, any psychiatrist can provide mirtazapine, but there's a lot more than that...

Obviously, there's an overall shortage of psychiatrists, and if you want to practice at a hospital without a C-L fellowship, you can probably get a job--though, my understanding is that many of those "jobs" are free-lance opportunities to earn a living via direct billing. Direct billing of insurance is problematic and won't pay as much as a C-L salary (ie, most full-time C-L jobs are underwritten by hospitals: they recognize the importance of inpatient psych consults and begrudgingly recognize that if they don't sweeten the deal, they won't get psychiatrists who combvine availability and expertise).

To answer your question, there are a lot of good fellowships. Generally speaking, I'd choose the fellowship based on where I wanted to live for the next decade. Obviously, you can probably move to any other city with a good fellowship, but people tend to stay where they trained (and hospitals tend to hire people they know). Or, if you know you want to go into, say, psycho-oncology, I'd go to a place with lots of cancer patients and specialists (eg, MSKCC or Dana Farber) and also understand that I might not be able to immediately find a psycho-onc job outside of a large medical center (though if you initially don't get a fully psycho-onc job in a chosen city, a diligent and lucky clinician can often get one within a few years).
 
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thomasina

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Hello, I also have some questions about CL fellowships.
  • Does it make sense to do fellowship in a region where I do not plan to practice or settle down in in the longer-term? I was considering doing CL fellowship where I did my med school, which is a decent academic center, but also know 100% that I am not going to settle down there. I have heard that it can be really useful to do fellowship in a city you plan to settle down in because it's a year to establish networks and get the lay of the land.
  • If I'm at a "big name" for psychiatry residency, does it not make sense to go to a smaller name for CL fellowship or does it not matter? Would it somehow hurt me? I'm not gunning for a research career but might like the option of working in an academic setting (see last question).
  • What do I even need to apply to CL fellowship? In med school, while applying for psychiatry, I know it was helpful to have activities and sometimes research related to psychiatry, but in residency I have mostly just done the standard rotations and have not done any CL research projects (or any research, to be honest). I imagine my evaluations are solid and my PDs seem to like me, but it's hard to tell without any grades or anything. Would lack of research really hurt me?
  • How many fellowship programs should people apply to? Do people ever apply to a very small number and accept the possibility they might not match at all, and simultaneously look for jobs outside of fellowship, or is that a bad idea / not logistically possible?
  • Not exactly related, but: Can somebody tell me a little bit more about the difference between community/private practice vs academic setting psychiatry? I don't mind/think I would actually like teaching, but I don't think I'd like to do research long-term. The main thing I've heard is just that the salaries are lower. But... are the people in academia "better"? I care about doing a good job - I don't care about being the best, but I want to be surrounded by people who care about learning and improving their practices.
Thank you!
 

splik

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Hello, I also have some questions about CL fellowships.

Does it make sense to do fellowship in a region where I do not plan to practice or settle down in in the longer-term? I was considering doing CL fellowship where I did my med school, which is a decent academic center, but also know 100% that I am not going to settle down there. I have heard that it can be really useful to do fellowship in a city you plan to settle down in because it's a year to establish networks and get the lay of the land.

It would depend on the other facts you aren't revealing. But in general it doesn't make sense to do a fellowship somewhere you have no interest at all in even possibly setting down in, unless the program is especially strong. Yes, it is very useful to do fellowship where you plan to end up if possible for the reasons you mention.

If I'm at a "big name" for psychiatry residency, does it not make sense to go to a smaller name for CL fellowship or does it not matter? Would it somehow hurt me? I'm not gunning for a research career but might like the option of working in an academic setting (see last question).
In general, it makes sense to do C-L fellowship at a big academic institution as that is where you will find the complex cases and most robust consult services with people who have expertise in those areas (e.g. psycho-oncology, transplant psychiatry, HIV psychiatry, neuropsychiatry, reproductive psychiatry). There are some smaller programs that have well known C-L psychiatrists but it doesn't make sense to do a C-L Fellowship at a community hospital for the most part.

What do I even need to apply to CL fellowship? In med school, while applying for psychiatry, I know it was helpful to have activities and sometimes research related to psychiatry, but in residency I have mostly just done the standard rotations and have not done any CL research projects (or any research, to be honest). I imagine my evaluations are solid and my PDs seem to like me, but it's hard to tell without any grades or anything. Would lack of research really hurt me?
See the ACLP website
See my applying to fellowships guide
in general, C-L fellowships are not competitive (mostly filled by IMGs) though specific programs may be competitive in a given year (e.g. if they have their own internal applicants).
How many fellowship programs should people apply to? Do people ever apply to a very small number and accept the possibility they might not match at all, and simultaneously look for jobs outside of fellowship, or is that a bad idea / not logistically possible?
In general 3-6 is suffice. some people just apply to one or two. 10 is probably the maximum. It may depend on your goals, your competitiveness, whether you are applying to your home program. Yes, some people decide they will take a "real job" if they don't match. The match results come out in early January so it works out fine. Not a bad idea to look for jobs and also fellowships as you might find your dream job.

Not exactly related, but: Can somebody tell me a little bit more about the difference between community/private practice vs academic setting psychiatry? I don't mind/think I would actually like teaching, but I don't think I'd like to do research long-term. The main thing I've heard is just that the salaries are lower. But... are the people in academia "better"? I care about doing a good job - I don't care about being the best, but I want to be surrounded by people who care about learning and improving their practices.
Thank you!
You may want to start a separate thread about this. Academic settings can vary from official academic medical centers to affiliated institutions. There is a wide variety of different non-academic settings including solo practice, psychiatry group practice, multispecialty group practice, hospital affiliated IPGs, community mental health, NGOs, residential programs, private for-profit hospitals, corrections, state hospitals, federal agencies etc. Even within private practice there are different models (e.g. insurance based, commercial insurance only, cash only, concierge, membership based, employed PP models). There are also differences in different revenue structures (straight salary, indepedent contract hourly, eat what you kill, % of collections, RVU based, salary base + RVU incentives). Worthy of its own thread.
 
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