Fellowship thoughts

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bonedrone14

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I'm a PGY2 so there's still lots of time left ahead...but I've been doing some soul searching about what I'd like to do once I finish training. I've read most of the threads on here about pros and cons of doing a fellowship and which one to do, so this isn't really a question of: should I? The only fellowship I've got an interest in at this point is CL. And it's really out of intellectual curiosity and feeling that I'd like to be more well rounded than a feeling of need or a thought that it'll advance my career (not particularly gunning for an academic professor type job).

With that said, I've got (as always) a small caveat. As the sole provider for my family, we can't be going to NYC or somewhere else with an astronomical cost of living. From what I've read, most of the fellowships that offer training to make it worth it are in NYC. I've been looking to see if there are some outside of the real expensive areas...and have found a couple? I'm just curious if anyone has first hand knowledge of the training, environment, etc of these places and wouldn't mind commenting.

Mayo (rochester)
Inova Fairfax
UPMC
Vandy
UNC
Cleveland Clinic
LSU New Orleans

Random list? Probably. I'm mostly looking for the best possible training while avoiding a huge metro area (is that possible?)

Any others that would fit this? Thanks for your thoughts!

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Ask about the fellowship's moonlighting policy. As a PGY-V you are board eligible and should be able to supplement if you have time and if it is allowed.
 
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Back when I was interested in CL, I was considering VCU. Cost of living in Richmond is on par with the US average, and a unique selling point of the program is that the CL training director wrote the Textbook of Psychosomatic Medicine.
 
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From what I've read, most of the fellowships that offer training to make it worth it are in NYC. I've been looking to see if there are some outside of the real expensive areas...and have found a couple? I'm just curious if anyone has first hand knowledge of the training, environment, etc of these places and wouldn't mind commenting.

A couple of Boston programs are pretty good also. You can live in a suburb and commute.
 
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Mayo will be low COL and lots of zebras to hone your intellectual skills on.
You might also think about U of IA or U of WI for livability and decent academic environment, though I don't have a sense of how active their PSM fellowships are right now.
 
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I'm a PGY2 so there's still lots of time left ahead...but I've been doing some soul searching about what I'd like to do once I finish training. I've read most of the threads on here about pros and cons of doing a fellowship and which one to do, so this isn't really a question of: should I? The only fellowship I've got an interest in at this point is CL. And it's really out of intellectual curiosity and feeling that I'd like to be more well rounded than a feeling of need or a thought that it'll advance my career (not particularly gunning for an academic professor type job).

With that said, I've got (as always) a small caveat. As the sole provider for my family, we can't be going to NYC or somewhere else with an astronomical cost of living. From what I've read, most of the fellowships that offer training to make it worth it are in NYC. I've been looking to see if there are some outside of the real expensive areas...and have found a couple? I'm just curious if anyone has first hand knowledge of the training, environment, etc of these places and wouldn't mind commenting.

Mayo (rochester)
Inova Fairfax
UPMC
Vandy
UNC
Cleveland Clinic
LSU New Orleans

Random list? Probably. I'm mostly looking for the best possible training while avoiding a huge metro area (is that possible?)

Any others that would fit this? Thanks for your thoughts!

UPMC's CL service is very busy (3000 odd consults a year at the academic flagship hospital alone) and is expanding rapidly as we gobble up more and more hospitals. CL work is not my cup of tea but the people who do it here are incredibly dedicated, passionate, and very committed to evidence based teaching and training in addition to actual practice. A lot of telepsych CL opportunities as well since the service covers hospitals that are hours away. The rapid expansion means they are also frequently hiring CL people so you would have a good chance of not having to move after fellowship. Specialized inpatient palliative psych service, rolling out an addiction psychiatry consult service, a crapton of transplant evals (our center invented liver transplants in the US), rapidly expanding psycho-oncology, big HIV clinic, functional movement disorder outpatient stuff, a dedicated chronic/functional abdominal pain service...I know I am leaving stuff out. Department is also one of the 800 pound gorillas of the system so other teams tend to respect you more than I have observed at some places which is a nice perk.

Pittsburgh is very doable for a family.

Feel free to PM me if you want more specific details.
 
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I'd definitely vote for UPMC. Their department is everything listed above and probably more along with a very doable COL area. That said if you don't want an academic job and your family is counting in you to provide, I can't imagine a lot of people would recommend doing the fellowship at all. I'd love to have done a CL fellowship, but at some point you just need to start being an attending and just keep your commitment to learning and rounding yourself out, which you can do at a reasonable pace job.
 
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Ask about the fellowship's moonlighting policy. As a PGY-V you are board eligible and should be able to supplement if you have time and if it is allowed.

Definitely a good point. I've been looking forward to that here as a resident as well.

Back when I was interested in CL, I was considering VCU. Cost of living in Richmond is on par with the US average, and a unique selling point of the program is that the CL training director wrote the Textbook of Psychosomatic Medicine.

I had read about that guy on the VCU website as well-the thing I'm always unsure about is that most places look great on their website, so it's hard to get a real feel for what the place is actually like. I've got a couple buddies from med school that went to VCU for other specialties but have no idea what the place is like for psych. Thanks for the tip!

A couple of Boston programs are pretty good also. You can live in a suburb and commute.

Looking at MGH and BWH they (even though I just said you can't take much from websites...) look like great programs that would be pretty fitting for what I'm looking at. Commuting is something I don't enjoy, but if it would work, it would work. I'm definitely pretty interested in them...just wondering how tough it'd be to go from a no name state program to one of those.
 
Mayo will be low COL and lots of zebras to hone your intellectual skills on.
You might also think about U of IA or U of WI for livability and decent academic environment, though I don't have a sense of how active their PSM fellowships are right now.

Mayo might be my favorite right now for those reasons. I'll look up the other two as well. As with the Boston programs...I wonder how difficult it'd be to target such a highly reputable place. Maybe it's not so reputable for CL fellowship? Thanks for the input!

UPMC's CL service is very busy (3000 odd consults a year at the academic flagship hospital alone) and is expanding rapidly as we gobble up more and more hospitals. CL work is not my cup of tea but the people who do it here are incredibly dedicated, passionate, and very committed to evidence based teaching and training in addition to actual practice. A lot of telepsych CL opportunities as well since the service covers hospitals that are hours away. The rapid expansion means they are also frequently hiring CL people so you would have a good chance of not having to move after fellowship. Specialized inpatient palliative psych service, rolling out an addiction psychiatry consult service, a crapton of transplant evals (our center invented liver transplants in the US), rapidly expanding psycho-oncology, big HIV clinic, functional movement disorder outpatient stuff, a dedicated chronic/functional abdominal pain service...I know I am leaving stuff out. Department is also one of the 800 pound gorillas of the system so other teams tend to respect you more than I have observed at some places which is a nice perk.

Pittsburgh is very doable for a family.

Feel free to PM me if you want more specific details.

UPMC definitely sounds like a place I'd be interested in as well. I'll shoot you a message. Thanks!

I'd definitely vote for UPMC. Their department is everything listed above and probably more along with a very doable COL area. That said if you don't want an academic job and your family is counting in you to provide, I can't imagine a lot of people would recommend doing the fellowship at all. I'd love to have done a CL fellowship, but at some point you just need to start being an attending and just keep your commitment to learning and rounding yourself out, which you can do at a reasonable pace job.

Very salient points as well. At this point I'm not sure if I'll ultimately do the fellowship or not. Personally I know I learn best through seeing things so that's driving the desire to do it, but with a growing family learning on the job sounds very enticing as well lol.
 
Inova fairfax is one of the top CL fellowship programs in the country. You would infer mayo and Cleveland clinic might be good places to do CL but I have no idea about their training program. You could just apply for a CL job somewhere and get paid more reasonably. Ideally somewhere you would get good mentorship and on the job training. I am not CL fellowship trained but am probably better than most CL trained people (by virtue of the fact that most people doing CL fellowships are just not very good) and have learned a ton by being thrust into a junior faculty position and having to teach and supervise residents and students. I don't think I would have learned as much as a fellow.

MGH and BWH both have excellent C/L fellowships. but boston has a very high cost of living too so i would assume that might be out for you.
 
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You could just apply for a CL job somewhere and get paid more reasonably. Ideally somewhere you would get good mentorship and on the job training. I am not CL fellowship trained but am probably better than most CL trained people (by virtue of the fact that most people doing CL fellowships are just not very good) and have learned a ton by being thrust into a junior faculty position and having to teach and supervise residents and students. I don't think I would have learned as much as a fellow.

This is an interesting point. With good mentorship I guess it's almost like you're still training but not in a fellowship role. Outside of going to a strictly academic institution, I guess larger, tertiary type hospitals would fit this? Would the type of mentorship be something you would expect to glean from an interview?
 
remember as physicians we are supposed to be lifelong learners. fellowships are one (formalized) was of continuing that learning but it is by means not the only way. it is a shame that with increasing formalization of education and training, the flexibility that the apprenticeship model and "on the job" model offered has faded away. Once upon a time if you really wanted to master a particular subfield or skill you'd go and train with one of the greats. I would recommend that you attend the academy of C-L psychiatry meeting later this year and you will get a chance to see some of the top CL psychiatrists and figure out who you might want to train with. There are some travel awards to offset the cost, but nowadays in practice you would need to submit an abstract for a poster or something in order to get that (which btw you should submit a poster presentation of a case report or review, a good way to meet people too!) You can also join the special interest groups or get involved as a trainee member of the subcommittees of the organization. You may also wish to apply for one of the APA fellowships and get appointment to the council on psychosomatic medicine to further interface with the leaders in this field.

you might also consider whether you can do more CL elective time (including potentially away electives in CL) as a 4yr. compared to say forensics, its uncommon for people to do away electives in order to get a fellowship given how uncompetitive these fellowships are and the quite frankly dreadful caliber of the applicant pool. but this is another way to gain further experience. even if you are not interested in an "academic" career, at this stage in your training, if you are intellectually curious then you should be reading voraciously, identifying mentors (including outside your institution), attending professional meetings, submitting abstracts for conferences, and writing up papers or book chapters on topics of interest. you'll learn a ton this way. of course it can seem overwhelming to think about doing various other things beyond getting through the grind of residency but finding manageable projects to do will help you be more well rounded. and even if you end up going to private practice or something equally dreadful, you can market yourself as having published x, presented y, or been involved in such and such national guidelines/committees etc.

if the quality of your residency training isnt very good, then doing a CL fellowship with a really top clinician can certainly help compensate.
 
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It doesn't sound like C/L is what you love, just what seems most tolerable of the fellowships. That's probably reason enough not to do it if that's your feeling.

You could also look at additional psychotherapy training via an analytic/psychodynamic institute if that was appealing, nonacgme fellowships like emergency psych, or less beaten path psych fellowships like palliative medicine or Geri psych.


And while Inova may have a great c/l fellowship, nova is certainly not a low CoL area.
 
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remember as physicians we are supposed to be lifelong learners. fellowships are one (formalized) was of continuing that learning but it is by means not the only way. it is a shame that with increasing formalization of education and training, the flexibility that the apprenticeship model and "on the job" model offered has faded away. Once upon a time if you really wanted to master a particular subfield or skill you'd go and train with one of the greats. I would recommend that you attend the academy of C-L psychiatry meeting later this year and you will get a chance to see some of the top CL psychiatrists and figure out who you might want to train with. There are some travel awards to offset the cost, but nowadays in practice you would need to submit an abstract for a poster or something in order to get that (which btw you should submit a poster presentation of a case report or review, a good way to meet people too!) You can also join the special interest groups or get involved as a trainee member of the subcommittees of the organization. You may also wish to apply for one of the APA fellowships and get appointment to the council on psychosomatic medicine to further interface with the leaders in this field.

you might also consider whether you can do more CL elective time (including potentially away electives in CL) as a 4yr. compared to say forensics, its uncommon for people to do away electives in order to get a fellowship given how uncompetitive these fellowships are and the quite frankly dreadful caliber of the applicant pool. but this is another way to gain further experience. even if you are not interested in an "academic" career, at this stage in your training, if you are intellectually curious then you should be reading voraciously, identifying mentors (including outside your institution), attending professional meetings, submitting abstracts for conferences, and writing up papers or book chapters on topics of interest. you'll learn a ton this way. of course it can seem overwhelming to think about doing various other things beyond getting through the grind of residency but finding manageable projects to do will help you be more well rounded. and even if you end up going to private practice or something equally dreadful, you can market yourself as having published x, presented y, or been involved in such and such national guidelines/committees etc.

if the quality of your residency training isnt very good, then doing a CL fellowship with a really top clinician can certainly help compensate.

I agree about the death of apprenticeship....and I haven't been to any conferences during residency but maybe that's something I need to revisit. I've definitely been thinking either I'll try to chock my 4th year full of CL electives if not doing a fellowship, or use 4th year to shore up other weak points (child) if I end up doing fellowship. The CL service here is not well regarded in our hospital and while we're a large academic center, the flagship center for our state is in another city so we don't see transplants etc. Anyway, I've got time to think, and you've certainly given me food for thought. Thank you!

It doesn't sound like C/L is what you love, just what seems most tolerable of the fellowships. That's probably reason enough not to do it if that's your feeling.

You could also look at additional psychotherapy training via an analytic/psychodynamic institute if that was appealing, nonacgme fellowships like emergency psych, or less beaten path psych fellowships like palliative medicine or Geri psych.


And while Inova may have a great c/l fellowship, nova is certainly not a low CoL area.

It's definitely the most tolerable fellowship, and the only one that I'm entertaining doing at all. I loved CL during my intern year but had it so early that I really had no idea what was going on and I didn't really learn that much because I was just trying to learn how to be a resident. I've got a solid year to really decide which way I want to go, and I'll be back doing consults at some point in PGY3 which will hopefully solidify my decision to or not to.

Thanks for your advice!
 
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