FM Addiction Medicine Fellowship

[Sardonix]

There's very little on SDN about addiction medicine fellowships--let alone from the FM side of things. And most of the relevant threads are about those who were grandfathered in rather than doing the actual fellowship since it's such a young specialty.

Any idea what fellowships are looking for other than just high volumes of suboxone/substance use disorders patients? The faculty at my residency is uncertain as well what the expectations or goals should be for a resident interested in potentially applying in 1-2yrs. Ex: no idea how large of a role research plays or what consists of adequate experience.

I myself am not 100% certain I want to do it, but I am certain I want more info and would love to hear from any FM docs who are addiction BC'd or even did the fellowship if they're on here. Thanks!

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[hallowmann]

Its an FM fellowship, its relatively new, and there are tons of them opening up all over due to the closing of the practice pathway. You'll be OK with good fit, good LORs, and a broad app. Things that I've seen is clear goal for use, MAT waiver training, preferably having obtained the waiver already, and experience in substance use treatment.

You don't need to overthink it. What I would recommend is getting involved in national organizations if possible, obviously getting the waiver, and having an elective in a MAT focused rotation. Research is great, just like anything else, but there are tons of fellowships that don't need/require it.

 

[Sushirolls]

I have posted a variant of this before, thought it relevant:

Addiction Medicine is Psychiatry.
Very rarely did I run into a patient on inpatient detox units or in out patient that didn't have a comorbid depression/anxiety/bipolar/personality disorder. The private insurance higher paying addiction facilities want Psychiatrists (+/- Addiction Psychiatry or Addiction Medicine board certification). Inpatient units typically want Psychiatrists, in part, because of the comorbidity of psych that keeps popping up. It is so hard to separate the two.

Perhaps in a large hospital health system an EM/IM/FM --> addiction medicine can lock in a gig doing the IM floor consults for alcohol detox and all the Hep C antiviral managements in the IV heroin using population on outpatient.

Simply opening up an office to do broad spectrum addiction medicine will be tough, some regional variability. But you will notice a higher skewing in patient population towards the medicaid - which doesn't exactly pay the bills. Then the other issue, is the Alcohol UD folks are bad at follow up.

I advertise my practice as Psychiatry and Addiction, but I just don't get much addiction on the front end, usually comes up as secondary issues from patient perspective. Alcohol UD have horrible follow up rates. Suboxone for OUD do follow up, but now the market it saturated with "providers" and most of the population is medicaid.

Without having the complete clinic for addiction, the PHP, the IOP, the detox unit, (maybe even the residential?) it's truly hard to capture the population. I've found that many of the clinics that do get the patients entering at their Detox/residential/PHP level, step down to the other and then follow up with the same clinic for their outpatient care. And don't venture out into the community to find a simple Addictionology practice. So doing a fellowship to then open up a solo practice - will be a very tough road.

In summary, I anticipate the bulk of FM addiction to find openings with the corporate methadone clinics as the medical director, which are often part time gigs of 4-12 hours per week. Or with inner city hospitals that have a detox unit, like one in Cleveland, OH at St Vincent's. Or possibly for a few hours connected with Community mental health agencies to do their methadone/MAT clinics if their psych folks are disinterested.

 

[Sushirolls]

Something else to consider, there is a reason why 1/2 of the Addiction Psychiatry fellowships don't fill.

Think hard why you want to do fellowship and then what you plan to do with it after. Chances are you probably don't actually need, and probably don't need to subject yourself to the pain and financial loss of another year of training.

 

[hallowmann]

I have posted a variant of this before, thought it relevant:

Addiction Medicine is Psychiatry.
Very rarely did I run into a patient on inpatient detox units or in out patient that didn't have a comorbid depression/anxiety/bipolar/personality disorder. The private insurance higher paying addiction facilities want Psychiatrists (+/- Addiction Psychiatry or Addiction Medicine board certification). Inpatient units typically want Psychiatrists, in part, because of the comorbidity of psych that keeps popping up. It is so hard to separate the two.

Perhaps in a large hospital health system an EM/IM/FM --> addiction medicine can lock in a gig doing the IM floor consults for alcohol detox and all the Hep C antiviral managements in the IV heroin using population on outpatient.

Simply opening up an office to do broad spectrum addiction medicine will be tough, some regional variability. But you will notice a higher skewing in patient population towards the medicaid - which doesn't exactly pay the bills. Then the other issue, is the Alcohol UD folks are bad at follow up.

I advertise my practice as Psychiatry and Addiction, but I just don't get much addiction on the front end, usually comes up as secondary issues from patient perspective. Alcohol UD have horrible follow up rates. Suboxone for OUD do follow up, but now the market it saturated with "providers" and most of the population is medicaid.

Without having the complete clinic for addiction, the PHP, the IOP, the detox unit, (maybe even the residential?) it's truly hard to capture the population. I've found that many of the clinics that do get the patients entering at their Detox/residential/PHP level, step down to the other and then follow up with the same clinic for their outpatient care. And don't venture out into the community to find a simple Addictionology practice. So doing a fellowship to then open up a solo practice - will be a very tough road.

In summary, I anticipate the bulk of FM addiction to find openings with the corporate methadone clinics as the medical director, which are often part time gigs of 4-12 hours per week. Or with inner city hospitals that have a detox unit, like one in Cleveland, OH at St Vincent's. Or possibly for a few hours connected with Community mental health agencies to do their methadone/MAT clinics if their psych folks are disinterested.

I get what you're saying here, but the reality is that FM fellowships are rarely designed to transition to a separate field. They're rather designed to give a PCP more training in an area of interest, mainly to carve out their own niche in their primary care practice. Fellowships in addiction medicine, HIV medicine, Global health, even geriatrics, rarely result in graduates doing ONLY that type of practice, so the endpoint you are describing (opening up an addiction clinic) isn't really the goal for most.

Most FM trained addiction medicine docs I know incorporate it into their PCP practice and just happen to have a tool in their toolkit to treat and manage SUD more than their colleagues. They will often get referral from within and their panels will reflect a preponderance of SUD (and as you allude to, likely primary psychiatric conditions - save the psychotic disorders and true bipolar do).

As an aside, I personally know a fair amount of non-psychiatrists (mainly FM, EM, and OB) that have become Addiction medicine certified (mostly through the practice pathway). Most have found positions in hospital systems where their certifications have actually opened doors to practices that previously were simply not present at their institutions. But you're right, the idea of opening your own practice for addiction medicine or a true treatment program would be hard to do.

Now that all said, I do agree with the below. A PCP (and psychiatrist for that matter) could certainly learn what they need to to practice addiction medicine without a fellowship. The downside is with the closing of the practice pathway in 2021, the access to certification will be limited to only those with fellowship training. I do suspect that addiction programs will see higher demand with the closing of the practice pathway, but I also think there will still be plenty of spots left unfilled as well.

Something else to consider, there is a reason why 1/2 of the Addiction Psychiatry fellowships don't fill.

Think hard why you want to do fellowship and then what you plan to do with it after. Chances are you probably don't actually need, and probably don't need to subject yourself to the pain and financial loss of another year of training.

 

[galactus]

Agree with the above poster. FM docs who do fellowships use it to augment a skillset in primary care, not subspecialize. The FM/addiction faculty where I work at do both primary care and run a detox center.

Also starting 2022, you are required to do ACGME accredited addiction medicine fellowship in order to sit for the boards.

 

[dant71]

I get what you're saying here, but the reality is that FM fellowships are rarely designed to transition to a separate field. They're rather designed to give a PCP more training in an area of interest, mainly to carve out their own niche in their primary care practice. Fellowships in addiction medicine, HIV medicine, Global health, even geriatrics, rarely result in graduates doing ONLY that type of practice, so the endpoint you are describing (opening up an addiction clinic) isn't really the goal for most.

Most FM trained addiction medicine docs I know incorporate it into their PCP practice and just happen to have a tool in their toolkit to treat and manage SUD more than their colleagues. They will often get referral from within and their panels will reflect a preponderance of SUD (and as you allude to, likely primary psychiatric conditions - save the psychotic disorders and true bipolar do).

As an aside, I personally know a fair amount of non-psychiatrists (mainly FM, EM, and OB) that have become Addiction medicine certified (mostly through the practice pathway). Most have found positions in hospital systems where their certifications have actually opened doors to practices that previously were simply not present at their institutions. But you're right, the idea of opening your own practice for addiction medicine or a true treatment program would be hard to do.

Now that all said, I do agree with the below. A PCP (and psychiatrist for that matter) could certainly learn what they need to to practice addiction medicine without a fellowship. The downside is with the closing of the practice pathway in 2021, the access to certification will be limited to only those with fellowship training. I do suspect that addiction programs will see higher demand with the closing of the practice pathway, but I also think there will still be plenty of spots left unfilled as well.

Im FM but have an outpt addiction and pain mgmt practice. Can you email me/[email protected] any contacts that have used practice path? It is unclear what the new board considers ok experience for FMs because they limit 'general practice' hours. But what if 75% of gen practice is addiction? Id like to talk to some FMs cleared the hurdle, see they were really full time detox inpatient units or had a 'general practice' with lots of addiction/MAT/etc that the board accepted. Thank you

 

[dant71]

It is unclear what the new board considers countable experience for FM or others because they limit 'general practice' hours to 480. Do they mean 480 hours unrelated to addiction medicine is the max, or 480 hours of addiction medicine during and through a general practice? Big difference if they only count working in a detox clinic or psych ward for the bulk of the hours. BTW 'general med' is any practice like fm/er per their powerpoint.

But what if 75 or 90% of your 'gen practice' is addiction? I have MAT and non-gme pain fellowship after FM. Also how would I prove my solo practice numbers without hipaa violations?

Id like to talk to some FM or others who cleared the hurdle, see if they were really full time detox inpatient etc or had a 'general practice' with lots of addiction/MAT/etc that the board accepted. Thank you for discussing with me- [email protected]

 

[Sardonix]

I have posted a variant of this before, thought it relevant:

Addiction Medicine is Psychiatry.
Very rarely did I run into a patient on inpatient detox units or in out patient that didn't have a comorbid depression/anxiety/bipolar/personality disorder. The private insurance higher paying addiction facilities want Psychiatrists (+/- Addiction Psychiatry or Addiction Medicine board certification). Inpatient units typically want Psychiatrists, in part, because of the comorbidity of psych that keeps popping up. It is so hard to separate the two.

Perhaps in a large hospital health system an EM/IM/FM --> addiction medicine can lock in a gig doing the IM floor consults for alcohol detox and all the Hep C antiviral managements in the IV heroin using population on outpatient.

Simply opening up an office to do broad spectrum addiction medicine will be tough, some regional variability. But you will notice a higher skewing in patient population towards the medicaid - which doesn't exactly pay the bills. Then the other issue, is the Alcohol UD folks are bad at follow up.

I advertise my practice as Psychiatry and Addiction, but I just don't get much addiction on the front end, usually comes up as secondary issues from patient perspective. Alcohol UD have horrible follow up rates. Suboxone for OUD do follow up, but now the market it saturated with "providers" and most of the population is medicaid.

Without having the complete clinic for addiction, the PHP, the IOP, the detox unit, (maybe even the residential?) it's truly hard to capture the population. I've found that many of the clinics that do get the patients entering at their Detox/residential/PHP level, step down to the other and then follow up with the same clinic for their outpatient care. And don't venture out into the community to find a simple Addictionology practice. So doing a fellowship to then open up a solo practice - will be a very tough road.

In summary, I anticipate the bulk of FM addiction to find openings with the corporate methadone clinics as the medical director, which are often part time gigs of 4-12 hours per week. Or with inner city hospitals that have a detox unit, like one in Cleveland, OH at St Vincent's. Or possibly for a few hours connected with Community mental health agencies to do their methadone/MAT clinics if their psych folks are disinterested.

I appreciate the input, but I have no intention of opening up my own shop. The region where I'm doing residency has lots of IV drug use and alcoholism and not enough addiction specialists. My ideal set up would be as an FM doc who is really well versed in all things addiction but still maintains at least some of a normal primary care practice in addition to chemical treatment patients.

 

[Sardonix]

Something else to consider, there is a reason why 1/2 of the Addiction Psychiatry fellowships don't fill.

Think hard why you want to do fellowship and then what you plan to do with it after. Chances are you probably don't actually need, and probably don't need to subject yourself to the pain and financial loss of another year of training.

This is something I am indeed thinking hard about. Also I had no idea that half the addiction med fellowship slots don't fill.

 

[DO.ctor]

I went through this last year so I can speak a bit about the process. There are fellowships associated with IM, FM, and psych departments. If you're coming from FM, keep that in mind. You may not have exposure to certain sub-populations that are substance using (ie. adolescent and OB) if you are training in a psych or IM based fellowship. I am in an FM based fellowship and couldn't be happier.

Things I did to set myself up for this were:
- Addiction elective, waiver training, integrating SUD care into continuity clinic, QI work focused on MAT, and attended an ASAM conference

I agree with the above comment that research is not necessary. Demonstrated experience, commitment and, to a lesser extent, post-training goals matter.

 

[Sardonix]

I went through this last year so I can speak a bit about the process. There are fellowships associated with IM, FM, and psych departments. If you're coming from FM, keep that in mind. You may not have exposure to certain sub-populations that are substance using (ie. adolescent and OB) if you are training in a psych or IM based fellowship. I am in an FM based fellowship and couldn't be happier.

Things I did to set myself up for this were:
- Addiction elective, waiver training, integrating SUD care into continuity clinic, QI work focused on MAT, and attended an ASAM conference

I agree with the above comment that research is not necessary. Demonstrated experience, commitment and, to a lesser extent, post-training goals matter.

Thank you so much!

 

[simpler2]

I imagine you simply need to apply and show interest. It would be a good idea to understand a bit the culture and language of addiction medicine to avoid rubbing a program director the wrong way when interviewing (people have substance use disorder and are not "addicts", know names of limited available medication treatments, understand what patient centered care is and how to talk about it, etc.). Some of these things may seem obvious to some but responses are what I have used and seen used in weeding out bad applicants looking to work in substance use disorder treatment settings.

I'll echo other's sentiments that the field is young and not competitive. One of my colleagues is starting a fellowship at the local university and I can almost guarantee all she will be looking for is someone with basic knowledge of addiction medicine who seems passionate about going into the field.

 

[hallowmann]

There's very little on SDN about addiction medicine fellowships--let alone from the FM side of things. And most of the relevant threads are about those who were grandfathered in rather than doing the actual fellowship since it's such a young specialty.

Any idea what fellowships are looking for other than just high volumes of suboxone/substance use disorders patients? The faculty at my residency is uncertain as well what the expectations or goals should be for a resident interested in potentially applying in 1-2yrs. Ex: no idea how large of a role research plays or what consists of adequate experience.

I myself am not 100% certain I want to do it, but I am certain I want more info and would love to hear from any FM docs who are addiction BC'd or even did the fellowship if they're on here. Thanks!

Just heard some news: Practice Pathway has now been extended through 2025!!!

Addiction Medicine – American Board of Preventive Medicine

All credit goes to @Sushirolls for posting it on the Psych forum

 

[scharnhorst]

how much is the need for a fellowship trained addiction specialist ? vs those with practice pathway
as a BC FM doc does it really make you more competitive ? I feel like its more for those for a true passion /special interest in this field

 

[AlbinoHawk DO]

how much is the need for a fellowship trained addiction specialist ? vs those with practice pathway
as a BC FM doc does it really make you more competitive ? I feel like its more for those for a true passion /special interest in this field

Depends what you mean competitive. There are small cities desperate for addiction docs. In most medium or big cities, it's niche and will pay the same as regular FM

 

[Drellismd]

how much is the need for a fellowship trained addiction specialist ? vs those with practice pathway
as a BC FM doc does it really make you more competitive ? I feel like its more for those for a true passion /special interest in this field

As an IM who has worked in addiction medicine I found that only the BC in Addiction vs the fellowship seems to matter in non-academic centers. In academia or large hospitals they value the fellowship.

 

[Tadeys]

I graduated in 2019 from a non-psych Addiction Medicine Fellowship in one of the most prestigious Universities in the US. I love the field, but If I could go back in time I would not do it again: difficult to do full-time and for those interested, the pay is a bit less --to a lot less-- than regular FM pay (depending where you go).

 

[Sardonix]

I graduated in 2019 from a non-psych Addiction Medicine Fellowship in one of the most prestigious Universities in the US. I love the field, but If I could go back in time I would not do it again: difficult to do full-time and for those interested, the pay is a bit less --to a lot less-- than regular FM pay (depending where you go).

Please expand (message me if don't wanna say here)!