Consultation-liaison fellowships

[PsychMD]

Anyone interested in applying for a fellowship in C/L Psych? Anyone currently a fellow in C/L Psych?

I'm wondering, among other things, about whether most C/L fellows plan to subsequently work primarily in an academic setting?

Now that the ABPN has formally recognized "Psychosomatic Medicine" as a distinct subspecialty, with the possibility of certification (albeit for an inordinately high exam fee)...I'm also wondering whether anyone (outside of academia) is actually going to sit for this certification exam (one can sit for the exam without a fellowship for the next 5 years or so, if one has been involved in at least 25% C/L practice work consistently in the past, but after this grace period, one would have to complete the formal fellowship before being allowed to take the certif. exam).

I've always maintained a specific interest in attempting to have the opportunity to be involved in C/L Psych. in the "real" clinical world of practice...but, there are fewer and fewer practical oppts./demand for this nowadays, when so many med-surge community hospitals have actually closed their inpatient units and so many psychiatrists have stepped away from inpt. work/away from the hospital setting, in fact (especially talking about psychiatrists formerly affiliated with suburban smallish/medium med-surge community hospitals or non-profit hospitals).

I realize that most participants in this forum are just beginning their residency training and their post-residency "career" goals/plans may not still be very well defined (even re. whether one plans to stay within an academic setting or not)...but, I'm thinking, any thoughts/comments may be helpful for all of us, whether we are just starting out as PGY I's, or almost done with training, or even completely done, and currently in practice.

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[Anasazi23]

To be honest, I have major reservations and feel a dubiousness about this new fellowship. Psychiatrists are trained and routinely operate in the setting of hospitals and medical facilities to engage in this type of work. It is the job of clinical psychaitrists to distinguish between masquerading medical disease and psychiatric illness, they are expected to understand the complexities and interactions between medical/surgical diseases and processes and psychaitric care, to be experts in interactions between psychotropic medications and other non-psychiatric formulary medications, to create treatment plans and act as a liason between medical/surgical physicians and other ancillay staff in dealing with patients with comorbid medical/psychiatric disease.

To the best of my knowledge, residency programs require this experience, and it is, in large part, what psychiatry residency largely incorporates. Indeed, our comprehensive understanding of these issues as a profession is another unique aspect of what separates psychiatry from other professions such as psychology.

I have become more and more cynical about the educational system since graduate school, and see this as simply another way to not only keep residents as "residents" (there are essays outlining the conspiracy to develop more and more, longer and longer fellowship programs to even out the job markets for existing attendings), but as a revenue-generating tool for specialty boards.

Where does the fellowship train end? Would you scoff at the development of the following specialty board creatings?
1. Inpatient psychiatry fellowship
2. Outpatient psychiatry fellowship
3. Schizophrenia fellowship (I think this is already in existence, though non-accredited, is it not?)
4. Depression fellowship
5. Emergency psychiatry fellowship
6. Why not a therapy/medication specialization fellowship?

Psychiatry residency is already 4 years...one LONGER than internal medicine. It is possible that one can learn all they should know about medicine in 3 years, but require an additional year to learn psychiatry? Admittedly, I can support the additional year of training, given the complexities of psychiatry not inherent in internal medicine....but still.

In sum, I am disappointed at the development of this fellowship, as it is a complete redundance in what essential psychaitry residency training entails, and implies that psychiatrists who have NOT completed this fellowship are unqualified to practice in such a manner. This will only artificially deflate the job market for psychiatrists wishing to work in dual capacities (performing hospital consults at night), and create more and more demand for these "specialy-trained" psychiatrists, forcing residents to stay even longer in residency so that they feel they complete practice opportunities.

 

[PsychMD]

Dr. Anasazi, I tend to agree with you. When I saw the exam fee, especially, for the subspecialty certification in C/L psych (or "psychosomatic medicine", as it is formally called, another quite unfortunate choice of words, in my opinion)...I sort of felt like... I wanted to say a couple of "impolite words" out loud. (talking of semantics, one does also notice that the ABPN is one of the few specialty boards that has a "com" in its url, while most others are "org"!)

OTOH, although this is not really about C/L, I was also thinking that most psych. residencies outside of the US (Canada, Australia, several EU countries) tend to be 5 years in length, rather than 4, and do encompass, typically addtl. child psych. and geropsych. skills (or slightly longer requirements for these rotations)...hence the US docs tend to be seen as somewhat "undertrained" when it comes to "harmonizations" of "standards". Obviously, "child psych" is a completely different thing; actually, IMHO, child psych. is probably an almost completely different specialty than general adult psychiatry, almost just like pediatrics is different from internal medicine.

 

[Miklos]

OTOH, although this is not really about C/L, I was also thinking that most psych. residencies outside of the US (Canada, Australia, several EU countries) tend to be 5 years in length, rather than 4, and do encompass, typically addtl. child psych. and geropsych. skills (or slightly longer requirements for these rotations)...hence the US docs tend to be seen as somewhat "undertrained" when it comes to "harmonizations" of "standards". Obviously, "child psych" is a completely different thing; actually, IMHO, child psych. is probably an almost completely different specialty than general adult psychiatry, almost just like pediatrics is different from internal medicine.

I categorically disagree.

The reason that post-graduate training is longer outside the U.S. is primarily economic.

Single-payer (state monopoly sponsored) healthcare directly benefits by extending the post-graduate training period of physicians, by gaining additional years of "indentured servitude".

Of the above mentioned, it is true that in comparison to the U.S., Canada and many EU countries only extend the period of residency for one year.

However, by this metric Britain is the arguably the worst. Five years is often no where near enough to attain a psychiatry consultancy. Unlike the U.S., where once someone has achieved board-certification shortly after their residency, in the UK one must often literally wait for someone to die or retire in order to become a consultant.

With regard to the intensity of the training, I believe that the North American programs beat the European ones by a long shot. The Europeans do not nearly work as much as the North Americans. In addition, I believe that North American training is far more organized than European training.

Miklos

 

[PsychMD]

Wow, Miklos! I'm sort of honored you even noticed this post. Thanks for the clarification. You are probably right...I don't have a lot of direct knowledge about postgrad training outside of the US...

Talking of C/L...I was googling yesterday, out of curiosity, some European sites for C/L Psych. associations...really "puny" across the board, except maybe for Germany...but I don't know much German, so obviously, I can't authoritatively comment on the "state of European C/L Psych."! It may be just a skewed perception because of the Internet. There isn't always a clear cut relationship between the complexity/reputation of a program/endeavor and having a spiffy website (actually one could even argue there might be, in some cases, a directly inverse relationship, especially in Europe, maybe!)

Seriously speaking, Miklos, I truly appreciate your work to continue maintaining this site as a very reputable one regarding correct information dissemination about Medical Education systems in Europe vs. US.

 

[john182]

The reason that post-graduate training is longer outside the U.S. is primarily economic.
Single-payer (state monopoly sponsored) healthcare directly benefits by extending the post-graduate training period of physicians, by gaining additional years of "indentured servitude".

State healthcare has nothing whatsoever to do with post-graduate training. E.g., in UK and Ireland, the Royal Colleges determine length of basic and specialist training. For basic ROyal College of Psychiatrists membership is a minimum of 30 months to sit the Part 2 of the exams, i.e., 3 year program to be able to be a fully fledged member. At this stage you can work as a consultant or staff grade, probably not on permanent contract of course because 3 years is very short (as is 4, as is 5 or 6 as a matter of fact).

After that, specialist training is another 3 years. For example, in forensics, it is a 3 year specialist training, likewise in general adult, child, or liaison psychiatry . Indentured servitude is the US residency system, which pays very little with very little time off and only completes a basic training anyway.

As a basic training membership but with out the specialist training (called SpR here for Specialist Registrar) you can work as a consultant.

However, by this metric Britain is the arguably the worst. Five years is often no where near enough to attain a psychiatry consultancy. Unlike the U.S., where once someone has achieved board-certification shortly after their residency, in the UK one must often literally wait for someone to die or retire in order to become a consultant.

This is true for surgery and general medicine, but is not true for psychiatry. There is currently a vacancy rate of 10-15% is posts for consultant psychiatrists. I don't know where you are getting you information from but it seems largely to be confabulated judging by the above comment: you obviously have no idea of what you are talking about. The 10-15% is from a 2003 study on UK national consultant occupancy rates and is excluded from the extensive private system.

Seeing as the basic training is 3 years and specialist training a further 3 years it is common for people to have done the 6 years. Of course 5 years is not enough, much like 4 years in US residency and 1 specialist fellowship is 5 years but what do you expect, 5 years in US system and be appointed overseer almighty clinical director?

With regard to the intensity of the training, I believe that the North American programs beat the European ones by a long shot. The Europeans do not nearly work as much as the North Americans. In addition, I believe that North American training is far more organized than European training.

This is again true of the surgical and general medical services, but not in psychiatry. The Royal College of Psychiatry is very very organised re: training and maintaining good stanard. Psych trainees get a 1:1 hour supervision per week with the consultant, half-day every week for lectures, plus other set periods for tutorials. This is totally unlike most other training schemes in UK/Ireland.

There are several areas lacking in US psychiatry, and it is almost shocking at times to see how primitive the services are. For example, the delay in implementing liaison psychiatry training *is* purely and economic one from the hospitals perspective because it simply helps people as opposed to generating profit (aka, seeign new OPD referrals or bookings for MRIs and so on).

Have a look at the liaison training in the UK.

Also , the aspect of domicallary visits. This again is limited in the US purely on financial grounds as insurance companies balk at psych fees anyway and this is viewed as "unnecessary" by and large. These visits are *essential* to any psychogeriatrics service according to mountains of research.

Psychiatry by it's very nature must be part of a socialised healthcare service which has equal provision for everyone. Not doing a domiciallary visit on a late paraphrenic patient because insurance won't pay for the fuel bill isn't good enough. In UK/Ireland, the government pays.

Regarding Liaison Psychiatry:
http://www.rcpsych.ac.uk/college/faculty/liaison/about.asp
It has been a special interest group in the RCPsych since the late 70s and was a separate facuty since 1997.

If we look here:
http://www.psych.org/pnews/00-10-06/cl.html
we can see clearly that the issue in the US is money and whether insurers cover and will pay for liaison services. This is not an issue in a socialised/public health care system. As such, I can only disagree with your comments regarding it as the problems stem from a overly privatised health care system and indeed a liaison psych service is an integral part of general hospitals over this side of the Atlantic.

From the article: Lyketsos commented, "As a physician, I am obligated to see the patient right away and help my medical colleagues out. But I also know my consultation is not covered by the hospital or the patient’s carveout, and I will spend hours on the phone trying to get paid. I have swallowed my fees in the past, but I can’t continue to do this much longer.". And this was back in 2000.

 

[almost done]

If I'm not mistaken, the term "consultant" is used in Britain the way the term "attending" is used here. That might explain some of the discrepancies in what is necessary to attain psychiatry consultant status in each country.

Or, I could have just made that up

 

[ptolemy]

After that, specialist training is another 3 years. For example, in forensics, it is a 3 year specialist training, likewise in general adult, child, or liaison psychiatry . Indentured servitude is the US residency system, which pays very little with very little time off and only completes a basic training anyway.

Can I ask what you are trained to do in the first 3 years, if you still need to do 3 more years to do either child psych or gen adult psych?

 

[Miklos]

State healthcare has nothing whatsoever to do with post-graduate training. E.g., in UK and Ireland, the Royal Colleges determine length of basic and specialist training. For basic ROyal College of Psychiatrists membership is a minimum of 30 months to sit the Part 2 of the exams, i.e., 3 year program to be able to be a fully fledged member. At this stage you can work as a consultant or staff grade, probably not on permanent contract of course because 3 years is very short (as is 4, as is 5 or 6 as a matter of fact).

After that, specialist training is another 3 years. For example, in forensics, it is a 3 year specialist training, likewise in general adult, child, or liaison psychiatry . Indentured servitude is the US residency system, which pays very little with very little time off and only completes a basic training anyway.

As a basic training membership but with out the specialist training (called SpR here for Specialist Registrar) you can work as a consultant.

I can see that we'll simply have to agree to disagree with regard to socialized medicine. Whether the Royal College sets the requirements or not, after all, it is the NHS that provides psychiatrists-in-training with their pay packets, is it not?

This is true for surgery and general medicine, but is not true for psychiatry. There is currently a vacancy rate of 10-15% is posts for consultant psychiatrists. I don't know where you are getting you information from but it seems largely to be confabulated judging by the above comment: you obviously have no idea of what you are talking about. The 10-15% is from a 2003 study on UK national consultant occupancy rates and is excluded from the extensive private system.

You are correct. I have overstated my case. It is true, for instance that the NHS is actively recruiting US psychiatrists. Nevertheless, many of these posts are locum appointments.

Seeing as the basic training is 3 years and specialist training a further 3 years it is common for people to have done the 6 years. Of course 5 years is not enough, much like 4 years in US residency and 1 specialist fellowship is 5 years but what do you expect, 5 years in US system and be appointed overseer almighty clinical director?

Here is where we differ again. I do not equate an SpR with a board certified psychiatrist.

This is again true of the surgical and general medical services, but not in psychiatry. The Royal College of Psychiatry is very very organised re: training and maintaining good stanard. Psych trainees get a 1:1 hour supervision per week with the consultant, half-day every week for lectures, plus other set periods for tutorials. This is totally unlike most other training schemes in UK/Ireland.

There are several areas lacking in US psychiatry, and it is almost shocking at times to see how primitive the services are. For example, the delay in implementing liaison psychiatry training *is* purely and economic one from the hospitals perspective because it simply helps people as opposed to generating profit (aka, seeign new OPD referrals or bookings for MRIs and so on).

From what I saw during my visiting elective in the UK, I felt that US PGY1s (and some very motivated MS4s) could run rings around UK SHOs.

 

[PsychMD]

Oh, my...although this discussion is actually very interesting...it was not really my intent to start a "war" in here. I do say it is interesting because, from my point of view, I remain interested in pursuing as much educational and mentorship opportunities I may get my hands on (be it via self-directed learning, formal fellowship training here in the US or maybe even abroad!-this idea just occured to me now!-). It just struck me now, as I am writing, that MENTORSHIP opportunities indeed seem to me, at least from my own perspective, qualitatively fragmented/inefficient maybe, even in such a highly evolved/superspecialized med. ed. system available to us here in the US...I understand very well there are numerous conflictual forces straining any system of med. ed. (economical, historical, technological, some factors inherent to the profession itself, etc.), I also understand a bit (or trying at least to learn more about) how these conflicts impact upon training in the specialty of Psychiatry, and its evolving subspecialties. What I do not really have a clue about...is how to learn and proceed from this understanding re. brainstorming for possible avenues of improvement/development. I guess no one does. I wonder even if it's useful to ask the questions...beyond just a pure "academic"/"rhetorical" interest. I also wonder whether there are other people asking these questions, either for themselves, in isolation, or in a more "organized" fashion, via groups of interest. I have observed, as a surface observation, maybe, that the Internet overall seems pretty silent/outdated re. C/L Psych.(relative to other preoccupations/occupations). There are a couple of C/L academic mailing lists in the UK, there are some references to the Academy of Psychosomatic Medicine and their journals, there are a couple of "meta-review" articles, the ABPN did find it interesting/motivating, at least from their perspective, to create/approve the subspecialty certification exam. To what effect, I wonder? And is there a "critical mass" of people actually interested/motivated? And are there any real job/practice opportunities anywhere, directly as pertaining to C/L Psych., outside of the academic setting? Should there be? I have no clue...as you all can see...I have more questions than answers.

I do feel good, however, that people are interested in reading/answering/opining re. this topic. In spite of occasional "flame-wars" here and there, I remain convinced that SDN is a GREAT forum for discourse.

 

[john182]

Can I ask what you are trained to do in the first 3 years, if you still need to do 3 more years to do either child psych or gen adult psych?

What you are trained to do and the requirements are listed in a downloadable handbook from the rcpsych.ac.uk website, it's all very clear and way too lengthy to mention here.

Needless to mention, both US and UK are essentially 4 years, as PGY1 is Intern year in US residencies and to get on Basic Specialist Training you must complete an intern year in 6 months surgery and 6 months of medicine (this extends to 18 months in several EU countries but that's outside the scope of here).

Having reviewed a lot of the details of per year training, real "psych" years start after intern year - PGY2 and on. Also, this is after the UK intern year, so another 3 pass to complete basic training on both UK and US after intern year.

From then, a US specialist training post (fellowship) is 1 year say in forensic psych, and is 3 years in UK (during which time you are also in some areas *required* to pursue additional postgard degrees such as PhD or masters research and so on).

In summary, the US residency is 4 years (1 year of which is Intern) and the UK training scheme is 3 years (prior to which you complete your Intern year). So basically it's 4 years to get basically trained on either side.

From *my own opinion* from reading what is learned in basic US residency, it is not as comprehensively defined or as complete (e.g., psychotherapy requirements) as the Royal College requirments. Any comments on this (the complete training profile for basic training is available on the website in PDF form if you want to peruse it). ????

 

[john182]

Here is where we differ again. I do not equate an SpR with a board certified psychiatrist.

Yes I know that is apparent.

However, by although equivalency measurements are hard to get, and example is the Bermuda consultancy posts in psychiatry. Bermuda is a british colony but salaries and so on are in $, so it's a mix of US and UK influences. The requirements are either 1) MRCPsych and UK SpR trained or 2) US board certified + 3 years experience as an attending. The hospital is St. Brendan's Hospital.

So in the view of a somewhat more neutral party, they view the US board certification as too incomplete without further experience. Your thoughts?

(the advertisement can be seen on bmjcareers.com

 

[Miklos]

Needless to mention, both US and UK are essentially 4 years, as PGY1 is Intern year in US residencies and to get on Basic Specialist Training you must complete an intern year in 6 months surgery and 6 months of medicine (this extends to 18 months in several EU countries but that's outside the scope of here).

Having reviewed a lot of the details of per year training, real "psych" years start after intern year - PGY2 and on. Also, this is after the UK intern year, so another 3 pass to complete basic training on both UK and US after intern year.

From then, a US specialist training post (fellowship) is 1 year say in forensic psych, and is 3 years in UK (during which time you are also in some areas *required* to pursue additional postgard degrees such as PhD or masters research and so on).

In summary, the US residency is 4 years (1 year of which is Intern) and the UK training scheme is 3 years (prior to which you complete your Intern year). So basically it's 4 years to get basically trained on either side.

Just a quick comment for now.
(I will look at the College requirements once I get a chance.)

A PGY1 (aka "intern" year) in a US psychiatry program is not equivalent to a PRHO year in the British Isles, as the US "intern" does not spend the six months on surgery that their counterparts across the Atlantic do. Instead, they're doing 6 months of in-patient psychiatry.

Miklos

 

[Miklos]

Yes I know that is apparent.

However, by although equivalency measurements are hard to get, and example is the Bermuda consultancy posts in psychiatry. Bermuda is a british colony but salaries and so on are in $, so it's a mix of US and UK influences. The requirements are either 1) MRCPsych and UK SpR trained or 2) US board certified + 3 years experience as an attending. The hospital is St. Brendan's Hospital.

So in the view of a somewhat more neutral party, they view the US board certification as too incomplete without further experience. Your thoughts?

(the advertisement can be seen on bmjcareers.com

I've always thought of Bermuda as part of the British empire (apologies to Bermudans), so I'm inclined to discount the "neutrality".

How about Canada? Which is part of the Commonwealth even now. (Apologies to Canadians with republican sentiments.)

From the RCPSC; can't get the html because it is locked in a pop-up

The American Board of Psychiatry and Neurology (ABPN) and the Royal College of Physicians and Surgeons of Canada (RCPSC) have created a reciprocity agreement that accepts the credentials of applicants to each other's examinations. To be eligible to sit the RCPSC Psychiatry examination the applicant must:

Have attained certification by the ABPN in Psychiatry.

Possess an unrestricted license to practiSe medicine in one of the United States or a province of Canada.

If trained in the United States, the applicant must have completed four years in a Psychiatry program accredited by the Accreditation Council for Graduate Medical Education (ACGME) and one year of specialty experience.

Though they accept the Royal College of Psychiatrists post-graduate training, what precisely does this mean?

http://rcpsc.medical.org/residency/certification/img_e.php

International postgraduate medical education systems that meet RCPSC criteria and are ACCEPTABLE
The following jurisdictions have been assessed and deemed to fulfill the RCPSC criteria in some specialties. Please note that:

1.only training taken in these systems within the acceptable timeframe will be taken into consideration;
2.the acceptance of a specialty does not imply that an applicant's total training is acceptable;
3.the applicant's total training must fulfill the RCPSC training requirements as specified per specialty on the website; and
4.the periods of acceptability are based on the current information available to the RCPSC, and these dates may be reassessed in the future.

 

[john182]

I was offering rebuttal for the notion you supposed that US training is somehow superior for no particularly well-justifed reason.

I would doubt that a 4 year residency (of which 1 year is an intern year) equates with a 6 years summary training scheme (of which e.g., 3 years is in that chosen speciality like old-age) - I am basing this on the many websites documenting required experience and work during specialisation (like this one, thr rcpsych, scutwork.com and so on, just to get an opinion of what goes on).

Nothing's perfect but my own conclusion (in contrast to yours) is that the documented training requirements for psych in the US are less than comprehensive (for the reasons I mentioned above, like psychotherapy and liaison speciality posts and training, etc., ). It's going in circles now so I'll stop.

 

[Anasazi23]

Yes I know that is apparent.

However, by although equivalency measurements are hard to get, and example is the Bermuda consultancy posts in psychiatry. Bermuda is a british colony but salaries and so on are in $, so it's a mix of US and UK influences. The requirements are either 1) MRCPsych and UK SpR trained or 2) US board certified + 3 years experience as an attending. The hospital is St. Brendan's Hospital.

So in the view of a somewhat more neutral party, they view the US board certification as too incomplete without further experience. Your thoughts?

(the advertisement can be seen on bmjcareers.com

The easy answer is that it is equal pay for equal work. The MRCPsych and SpR training is about 6 years? US board certified and 3 years attending is about 7. I'm slightly confused about the British requirements...feel free to correct if need-be. You can argue over the additional year. It simply seems, that it is a British Isle, that the equivalent salary is commensurate with time in practice, including as a resident. Since it is again British, the edge would of course go to European trained.

For what it's worth, I've worked with a number of Royal College-completed psychiatrists, I've seen that the European psychiatrists tend to be better trained in classical theory and descriptive psychopathology, and significantly lacking in psychopharmacological finesse compared to their US counterparts. This is, of course, from my personal and small sample size experience.

 

[PsychMD]

...so should I draw by now the sad conclusion that C/L psych. (AKA "psychosomatic medicine") is basically NOT a "viable" or "true"/real subspecialty of Psychiatry...at the very least it would be quite "fuzzy" in the REAL WORLD of practice (i.e. there is no real demand for anyone that would have been theoretically fellowship trained in C/L psych.), and at best it would be an academic intedisciplinary field of study...mostly interesting in a theoretical narrow academic sense or just for certain research funding/granting benefits?

 

[john182]

...so should I draw by now the sad conclusion that C/L psych. (AKA "psychosomatic medicine") is basically NOT a "viable" or "true"/real subspecialty of Psychiatry...at the very least it would be quite "fuzzy" in the REAL WORLD of practice (i.e. there is no real demand for anyone that would have been theoretically fellowship trained in C/L psych.), and at best it would be an academic intedisciplinary field of study...mostly interesting in a theoretical narrow academic sense or just for certain research funding/granting benefits?

To answer your question:
1. In the US - no it isn't viable. The reason is insurance and economic constraints of the privatised hospital system - not enough money to be made by providing this service as it isn't as clean cut as say, someone gets a colonoscopy or gets a medication review.

2. In the UK/Ireland - yes it is very viable. The reason is public access to health care/NHS as it's probably cheaper to sort out the high proportion of general inpatients with a dedicated liaison service than have them wait 6 months for an OPD assessment (and thus delerium, dementia, goes unmanaged which in all cases worsens psychiatric prognosis).

At least that summarises it for now. The evidence base for the value of liaison is quite large hence it's introduction here.

 

[PsychMD]

...so do they have dedicated c/l fellowships in the UK, or would any psych. MD -at consultant "grade level"?-- anticipated to be a potentially competent c/l consultant? Does anyone just do c/l psych. for a living (outside of academia)...or do they have to combine it with everything else, like any "general psych. boarded MD here" ?

more and more

 

[PsychMD]

Sorry for bumping this up...I was hoping that John may still be reading this and might have an answer. I did try to read as carefully as I could through the links he provided, but, I couldn't really see a specific scheme for formal training in Consultation-liaison psychiatry (or psychosomatic medicine, however one might call it) as a distinct subspecialty within the other designated schemes of the RCP-uk (like Child or Gero or Forensics, for example). Yes there is a Faculty of C/L Psych, as a distinct organization, and their links are quite interesting. Right up the alley of some of my current professional interests in fact. I am happy to continue to educate myself as best as I can, albeit informally, re. the tradition and continuity of C/L Psych. in Europe.

What I was also curious, however, to find out, was whether there are any formally "accredited" post-grad programs in C/L Psych (at the post-residency level, equivalent to our fellowships here) in the UK.

If indeed the ground seems more fertile re. opportunities to actively function in C/L Psych. in Europe, and particularly in the UK, than they currently seem to be in the US...I'm thinking, even as a tentative project...what would be wrong in attempting to pursue such further additional postgrad training in an European country and even aspire to continue practicing there for a while, if indeed one has such personal aspirations, (although this may be taking it too far within the fantasy realm!)? Yet, I'm thinking..who knows, maybe some people may be interested...

Seriously though...how and where does one begin to look for potential post-residency post-grad training SPECIFICALLY for C/L Psych in the UK? Is it a matter of hunting down programs which might be affiliated with major universities, individually, one by one? And also, how do the UK docs themselves who are interested in C/L psych. get to practice C/L in the "real world"? Is ANY UK doc who is a Fellow of RCP in General Adult Psych. (after all the training and all the exams required) and is presumably ready for a consultant level post anywhere theoretically able to start looking for C/L type jobs? Does anyone work predominantly or even full time C/L or is it a function of how one structures their own interests, dividing time between private practice and C/L, or inpatient and C/L, etc.? I know that's a lot of questions...John, if you do see this and if you do have the time, can you offer any pointers? Thank you.

I'll do some more Googling on my part in the mean-time, lest you all think I'm too lazy! If anyone else out there is interested re. this topic here, give us a sign...if this turns out to be of any interest to other people besides myself, I'll be spurred to work harder on the Googling and post more updates re. what I find out!

 

[john182]

Sorry for bumping this up...I was hoping that John may still be reading this and might have an answer.

Sorry, totally forgot this thread.

Anyway, the way it works is that you would go for an SpR 3 year specialist scheme most likely in General Adult/Liaison. This is the common way; for example, you could also do an SpR in GA and Old Age concurrently. The exceptions are the more specialised ones, like child or forensics.

I haven't a notion where you would start to call. I know that the liaison psychiatrists here are in general hospitals and typically "separate" to the main psych unit unless they send someone from the wards over after a say surgical team are discharging someone who is psychotic.

The liaison teams are usually made up of a consultant, some registrars/residents, a liaison nurse, psychologists and social workers. They don't have any inpatient beds themselves and work directly as consult to the whold general hospital. Over 65s and the Old Age liaison team would see them. The Old Age one would ideally have inpatient beds as per RCPsych guidelines whereas the liaison team would refer to the local services (the psych unit team), which themselves would take over followup, etc., .

I'm not interested in the fields myself but it's certainly quite a "progressive" one to reduce the bunker mentality of general psychiatrists (e.g., reduces stigma and creates more contact with psych services with patients and the other specialities).

 

[PsychMD]

I appreciate the response. It is quite useful to get a sense of how things work in the "real world" in other systems of care.