Forensic fellowship after being an attending?

[mytushp85]

Long time lurker, first time poster.

I am a board certified inpatient psychiatrist in the Midwest. Graduated from residency in June of 2018 and started a full time inpatient gig shortly after. Attending life is not exactly what I expected, which may be more of a reflection of the health system I work for than my own job satisfaction as I love being a psychiatrist.

I’ve always been interested in forensics. Recently a college of mine suggested I break my contract and do a forensic fellowship.

Does anyone have experience leaving the attending life and “regressing” to be a fellow? Was it worth it? I am single, no kids, from California but planning to move back there eventually.

Thank you SDN community for the valuable discussion and resources through my med school, residency and now attending life!

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[Sushirolls]

Are you doing it just because its interesting? If so, probably not the best use of your time. If you plan to use it for future practice, then go get it done. Have fun, good luck.

 

[splik]

It is not uncommon for people to return for forensic fellowships and fellowship programs usually strongly prefer applicants who have worked as attendings beforehand. For the more competitive programs, sometimes people have to spend a year as an attending in order to get in. You certainly don't need to do a forensic fellowship to do forensic work, but it is one avenue and the more straightforward pathway. you will get more out of the fellowship having practiced as you are already board certified and have some attending experience, which may allow you to have cases you could not otherwise do. There are still vacancies for July 2020, but the best programs you will need to apply in April or May for a July 2021 start.

 

[psyguru]

Long time lurker, first time poster.

I am a board certified inpatient psychiatrist in the Midwest. Graduated from residency in June of 2018 and started a full time inpatient gig shortly after. Attending life is not exactly what I expected, which may be more of a reflection of the health system I work for than my own job satisfaction as I love being a psychiatrist.

I’ve always been interested in forensics. Recently a college of mine suggested I break my contract and do a forensic fellowship.

Does anyone have experience leaving the attending life and “regressing” to be a fellow? Was it worth it? I am single, no kids, from California but planning to move back there eventually.

Thank you SDN community for the valuable discussion and resources through my med school, residency and now attending life!

I worked as an attending for 1 year before doing my forensic fellowship. I did not have any issues with regression. The clinical work that I did as a fellow required almost zero supervision, i was independent,and i was not treated as a trainee when doing clincal work. It was the forensic expert witness work that I recieved supervision in. It was my most interesting year of training.

50% of my work now is expert witness work. What i dont really understand is that many do the fellowship but then go on and hardly do any expert witness work. Some do correctional work but the fellowship is not really required for correctional work.

I think that my forensics board certification helps with marketing and is a requirement in my state to do certain kinds of criminal evaluations. Only 3% of the psychiatrists have it.

Also my BIM board certification helps grow a niche in the personal injury space and helpful considering that half of the incarcerated have a history of TBI. Only about 12 forensic psychiatrists are BIM boarded in the US last I counted.

My MRO is pending and I hope to help grow the DFSA/ DUI niche. I was toying with the idea if getting a CCHP to expand in the correctional med mal market but most attorneys probably never heard of it.

As much as i enjoyed the fellowship, i am avoiding any other fellowships. I got BIM board certified before the fellowship was required. I am hoping to get addiction board certified before the fellowship is required.

If you are not sure, get a job at a state hospital affiliated with a fellowship. There are some state hospitals that come to mind on the west coast. Feel free to PM me.

 

[romanticscience]

Maybe my perspective will help. Before graduating residency, I always "assumed" that I'd do a fellowship (It's just what you do, right?). I did all of the right things (create connections with forensic faculty), present on forensics (posters at AAPL), and do my SDN research (thanks guys!). However, nearing PGY-4, I found that I REALLY wanted to do private practice, first and foremost. It also bothered me to learn about the career trajectories of former fellows; most were working in some form of inpatient, CL, state hospital, or academia. I hated all of these practice settings.

I tried talking to my forensic faculty about a part-time private practice while in fellowship. They wouldn't allow it, and it was going to mess up insurance credentialing. So, instead, I didn't do the fellowship and went right into private practice 100% after residency. (By the way, my decision was also informed by this post.) What I did do was contract with a company that provided criminal forensic evaluations in the state. The pay wasn't fantastic, but I saw it as experience. I spoke with a senior forensic at AAPL about getting started in the field and he said it is common for young forensics to do criminal work first with public defenders. Later, when these attorneys go into private practice, they retain you civilly. During my first 1-2 years in private practice, I laid low, doing good clinical work, doing the evaluations, and getting experience.

Now and then, I think about going back for fellowship. I don't for a few reasons. When I look at the rotations and take out what I don't like, there is little left (no kids, no sexual offenders, no corrections, etc). Pretty much what was left was trial competency and insanity (what I was doing with some supervision, I arranged with a local forensic psychiatrist, attended related courses at AAPL w/ Resnick) and civil (mostly opinions related to general psychiatry).

Going forward, I'm trying to get good at my clinical work (combined med and therapy for emotional/trauma in young adults) and to create an expert niche somehow. The clinical work in my market pays at least or better than the going forensic rate. I've been considering doing the SEAK expert witness training. I have the books and wonder if there's more to the courses. Do any of you have experience with the program?

 

[whopper]

Some people can't re-adjust to following orders and no longer being the captain of their own ship. You will earn much less as a fellow. Also many who even become licensed forensic psychiatrists don't really work much in that area or work in forensic psychiatry but didn't need the fellowship to do their job nor earned more money as a result of the training.

E.g. many state hospitals have a forensic unit and if you work that unit you don't earn more money vs the other units.

If you, however, get into a good program it could be worth the learning experience.

 

[psyguru]

I have no regrets doing the fellowship. If you are interested in doing more forensic work and getting good cases (40 hr cases), it is worth it. 6 months of my fellowship was doing criminal evaluations. There were a few asylum evaluations. The correctional exposure was a total 24 full days at jail and 24 half days prison telepsych. There was no exposure to kids and no sex offender evaluations. (I can pm you this fellowship , they are laid back and flexible).

Now i do all types of cases from occupational IMEs (seen two conversion cases back to back) ,PTSD title 9, sexual assault, MVA personal injury, capital murder cases, pedophiles, TBI, DUI, wrongful death, correctional malpractice, criminal, military, immigration, etc. The clinical variety I see is much more varied and interesting than the case load during my one year in private practice. I also have more variety than the forensic expert witness cases I did as a fellow. I am not sure if I was able to grow my forensic and afford to be a part time clinician this early if I did not do the fellowship.

Some criminal cases by law require forensic board certification.

Without the board certification it maybe harder to get the higher profile cases unless you have some kind of niche.

Fyi many of the older forensic psychiatrists have private practices.

You could moonlight as a fellow and do forensic cases. Perhaps you could do a part time fellowship over two years. Perhaps there is a fellowship that will credential you with a private practice (you could see the pts via telepsychiatry).

If you intend on doing less than 10-20% forensic work it may not be worth doing the fellowship. Oddly, it seems you are doing more expert witness work than most of the docs I know that have done the fellowship.

 

[ArdorAyurveda]

Seems like there's some disagreement over whether one should do forensic work or not. I was under the impression, however, that if one does expert witness work without board certification in forensic psychiatry, this opens you up to questioning the validity of your expert opinion.

It does seem like to me the fellowship would be worth it for the education alone. I don't buy the argument that the loss of one year's worth of an attending's salary will prevent you from retiring comfortably. But that's just my opinion. You can always moonlight as a resident and during fellowship to get a head start on retirement savings. Or get a roommate, etc, there's always options.

Very helpful thread though. Thanks to everyone that has shared their opinions. I'm a medical student interested in forensic psychiatry so I always try to learn from these threads.

 

[splik]

Seems like there's some disagreement over whether one should do forensic work or not. I was under the impression, however, that if one does expert witness work without board certification in forensic psychiatry, this opens you up to questioning the validity of your expert opinion.

This is definitely not the case, particularly for civil matters (e.g. malpractice, personal injury, civil competencies, disability). Your expertise is as a clinical psychiatrist, not as a forensic psychiatrist. For most matters attorneys are looking for experts in clinical matters. Many attorneys don't even know what a forensic psychiatrist is and most don't know that there is board certification in forensics. Few (<10%) psychiatrists who do medicolegal work are forensically trained.

Now, for insanity cases, malingering, violence risk assessment, sex offender evaluations etc These are definitely more in the province of forensic psychiatry and a decent fellowship should prepare you for this. But it is also possible to do such work without fellowship training.

 

[whopper]

I was under the impression, however, that if one does expert witness work without board certification in forensic psychiatry, this opens you up to questioning the validity of your expert opinion.

It can but there's also a thousand other angles a cross-examining lawyer could use against the psychiatrist. There's plenty of psychiatrists without the forensic training that do the job, and unfortunately it can be because the judges and lawyers in the specific locality don't have the sophistication, expertise or availability of people trained in the field to better steer them out of the darkness, it could also be that the non (edit-fellowship) forensically trained psychiatrist is doing a very good job.

A non-(edit fellowship) forensically trained psychiatrist can do work on the par of someone who is trained, possibly even better, but if so it's because they kept up with the field on their own, and spent at least dozens if not hundreds of hours in experience, CMEs and or reading up on it. Getting the fellowship and the license offers officiation of the training, but also a structure next to impossible to attain if you didn't undergo the official training.

Kind of like an IM doctor doing a bunch of psych CMEs hoping to practice psychiatry. Can it be done? Yes but don't expect it do be done well.

 

[psyguru]

If you did the fellowship and it helped you get 20% more cases at a higher hourly rate in the first 10 years, it will more than pay for your lost year as an attending, provided you do enough forensic work.

I do realize that it is possible to do forensic work without the fellowship. However, many of the skills at evaluating and report writing for competency to stand trial translate to all cases. 6 months of having two reports a week redlined during supervision (from a graduate of Dr. Resnik's program) will be hard to replicate outside a fellowship, even during a 5 year period. The redlining prepared me well.

Many attorneys do not really know what a forensic psychiatrist is. After they contact me and review my website, they do know and I feel they are more likely to hire a forensic psychiatrist. I do see an uptick in TBI casss after my BIM certification so believe the same is true for thr forensic psychiatry certification if one attends to marketing and practice development.

I have also seen the difference between forensic and non-forensic psychiatrists, psychologists and neuropsychologists. Many times, I can tell the difference after reading the report. Of course there are outliers.

 

[whopper]

I have also seen the difference between forensic and non-forensic psychiatrists, psychologists and neuropsychologists. Many times, I can tell the difference after reading the report. Of course there are outliers.

Agree. One of the only outliers I saw that did a good job was back in the day before fellowships were a thing some of the very skilled first forensic psychiatrists took on psychiatrists as proteges. This, however, was extremely rare.

 

[whopper]

Just a little story, on a few occasions, lawyers not knowing how the eff the process worked referred a client to me for a forensic evaluation. So this person shows up to my office and signs up AS A PATIENT WITHOUTH THE LAWYER TELLING ME WHAT IS GOING ON. So I see them as a patient they often times have a mental issue, I treat them then it's like 3 months later and the lawyer calls me up telling me the patient was sent to me as a forensic evaluation.

I tell the lawyer that I can't now do a forensic evaluation because I now have a doctor-patient relationship and they don't know what I'm talking about which I find downright frustrating and then start thinking the lawyer is an idiot cause they're supposed to know how it works with expert witnesses.

My biggest frustrations in forensic psychiatry wasn't within it in and of itself but lawyers and judges who don't know how it's supposed to work but they're the people who really have the control over what's going on. You just do the evaluation. I've had times where judges asked me to do things that violated APA/AMA/AAPL guidelines, and when I told them this isn't supposed to be how it works they tell me how another psychologist or psychiatrist (that I know and that person is clueless) told them this is the way to do it and they just go with whatever is easier.

 

[psyguru]

I had a situation where I evaluated someone for competency to stand trial. Half way thru I realized I treated him for as an inpatient (3 day uneventful hospitalization) several years prior. I didnt remember him and he had several names he used in the records. I thought I would have to recuse myself but I was not conflicted as I did not remember him as a patient. Also there was no current doctor patient relationship. However I did nention this in my report (against the attorney's wish) and summarized my own note.

When i was working in a private clinic occasionally evaluees would show hoping to get a forensic evaluation paid by insurance within the 30-60 minute time slot.

Once an attorney asked me to write a letter regarding an ex patient psychiatric prognosis in relation to custody. I wrote a letter but made it clear i am doing it as a treater and not an expert. Also made it very clear i had no opinion on custody but said the patient was unstable in the past due to SSRI-induced mania s/p post partum mood instability but now stable. I also said i do not do custody evals.