Doing a fellowship after being out of residency for years

[BlackBantie]

Is that a potentially good or bad move?

I've been flirting with the idea about doing a forensics fellowship but the thing is that I've been out of residency for almost 3 years and by the time I would be able to do one it will be a total of 6 years out of residency.

Possible pros is that it might be more interesting than clinical psychiatry and open up more job opportunities and increased pay. But cons would be going to through the application process, doing training and having an extreme drop in pay during the year of fellowship.

I'm not sure what's driving my interest or if it's strong enough to outweigh the potential cons. The thing is I enjoy working in forensic settings and it seems like a lot of jails and prisons prefer someone who is forensics trained.

Does anyone have any thoughts or feedback?

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[OldPsychDoc]

Thinking "Would I encourage a former resident to do this?"
I think that Forensics is the one area where I would encourage it if the decision really is founded in a strong interest and desire to move ahead in that subspecialty. My sense (all secondhand) of forensic psych training is that it is something way above and beyond stringing on additional rotations in jails and prisons...

 

[splik]

It is not uncommon for people to return to forensics after several years in practice, and forensic fellowships prefer people who have years of experience post-residency under their belt. This is particularly true for people who have to do military service and don't get approved to do the fellowship while in the military. I am not sure jails and prisons prefer people with forensic training, most can't be that picky! I think if you are going to do a fellowship you should make sure you are willing to do a good one where you will learn how to do a broad range of evaluations, and get training in as much as possible. You cannot learn it all in fellowship either and there are many things I am learning (e.g. sex offender evaluation, insanity evaluations) that I did not do in fellowship that I'm getting training in now. I think forensics is very interesting and while one certainly make a lot doing expert witness work, most people who do expert witness work are not fellowship trained, and most fellowship trained people do little forensic work.

You can moonlight during fellowship but the better ones you will likely be working your weekends and evenings on report writing and doing forensics evaluations too. My fellowship did not allow us to have a private practice, but some fellowships do allow this.

 

[nexus73]

It depends on what you want to get out of it. My fellowship did a lot of of evals for competency to stand trial and several for NGRI. I didn't do any disability evaluations or evaluations for civil lawsuits. I think this is pretty typical, because a lawyer doesn't want to pay for an untested trainee to do an evaluation when suing and potentially tens to hundreds of thousands of dollars are on the line. Plus, there is essentially unlimited demand for competency to stand trial evaluations so it isn't difficult to get plenty of exposure to this in fellowship.

I also got good exposure to treating jail and prison patients, which really isn't something you need a fellowship for. If you want to work in this setting, just apply for the job and you will learn the required nuances as you go along.

I'd say if you want to start contracting with the local forensic evaluation unit at the state hospital for competency to stand trial or NGRI evaluations, most fellowships will prepare you adequately. If you want exposure to civil work, you will need to ask the fellowship how much of this you can do, if any. It might be something where you can only shadow an experience forensic psychiatrist, which is still valuable.

You will also get specific didactic lectures on relevant forensic issues, which is valuable, even if you are just doing general adult psychiatry.

As far as what a fellowship does for you financially...
You might get paid more at an employed position just from the standpoint of having an additional year of training, or subspecialty board certification. But insurance won't pay you any better than before so private practice income would be the same. You can start adding on disability evaluations and other legal work, which has the potential to significantly increase your income, especially if you're getting civil cases where you might be able to charge $300/hour or more for your time, including record review, evaluation, preparation of report, and time in depositions and testifying. The latter work is hard to break in to and lawyers usually have specific psychiatrists they use repeatedly, so you have to get into this network somehow. The ability to add on these types of evaluations at a minimum provides some variety, instead of do clinical evals/followups all day.

Fellowship will also open up job opportunites at forensic evaluation units, typically employed by the state and working out of a state psych hospital. Will also give you an edge over other applicants if applying for jail or prison work, especially if the jobs are highly sought after such as in a large metro area with a big supply of psychiatrists. But these jobs usually don't pay better (sometimes a lot worse, will be state dependent) than a private sector or private practice income, and you really don't need a fellowship to work in corrections.

 

[SeniorWrangler]

My rule of thumb is to not do a fellowship that doesn't open up new possibilities to you, unless you're really really interested in the subject or want to be in academics. The income differential is massive and it's also a drag becoming a student again after being an attending for a while.

 

[UpstateForensicPsychiatry]

If you have any interest in Forensic Psychiatry, I concur with the posts that noted that we tend to like those with more experience, and certainly are open to those who have been out of training for a few years. Regarding doing forensic work without training, I strongly recommend against that. I can't tell you the number of times I've encountered poor evaluations and testimony by those who don't know what they are doing.
On that note, our fellowship at Upstate Medical University/CNYPC in Syracuse, NY has openings for 2018 and we would consider a strong applicant who may need to start off cycle. Feel free to contact me with any questions or if you'd like to discuss.

 

[TexasPhysician]

I may be crazy, but I’ve thought about doing a fellowship in the NE just for fun after I’ve built up a few businesses. Hopefully being 10 years out or so won’t be a problem.