For myself, the decision to want to go into forensic psychiatry were based on the following....
3rd party oversight. Psychiatry is more subjective than the other fields of medicine and has a broader range of choices in care. I've seen too many doctors psychiatrically use that to fudge & push treatment in a manner I don't agree with. E.g. someone's depressed--> given them Paxil--all of them, even though each antidepressant has its own characteristic pros & cons. E.g. someone comes in with a complaint--they automatically give them an antidepressant without doing a formal DSM diagnosis.
Forensic Psychiatry because it involves the legal system & is often times linked to the adversarial court process is reviewed by independent reviewers on a much more frequent basis--> forcing FPs to be more objective, be able to defend their choices & having to explain in detail the thought processes of their decisions.
Money-It supposedly pays the most, though I'm certainly not benefitting in that category. Actually the more I'm learning of the field, the more I would suggest to not go into this field for the money. A regular forensic psychiatrist working on a forensic unit from what I'm seeing in 2 states (NJ & Ohio) appear to have to work more for the same amount of money. The big money appears only to be in the expert witness stuff and that takes years of building relationships & forensic experience, and IMHO would also need such a FP to work on a forensic unit for some time.
Why work more for the same amount of money? A FP has to do all the clinical work a regular psychiatrist has to do-e.g, however FPs have to also write several court reports for their patients/clients & appear in court much more often than regular clinical psychiatrists. Those court reports can take several hours of work. There is no guideline I've seen that allows FPs working on a forensic unit to fudge on their clinical duties because they have to do more work on the forensic end. Add to that, pretty much all forensic units are state run--so you get the run of the mill state salary.
I've done about 15 forensic reviews using an HCR-20 (take about 1.5 hrs each), done about 4 competency reports (take about 5 hrs each), working on a sanity evalution right now (takes about 20 hrs), had to go to court in the city 5x regarding a specific legal issue that was not related to involuntary commitment (about 2 hrs each time I went). All of this is work the regular clinical doctors do not have to do, and I'm getting paid the exact same they are, but have the same patient load & clinical responsibilities.
Self Esteem: I didn't want to have the same level of training as several other psychiatrists I've seen who I thought were mediocre or worse. This aspect I guess is purely ego driven. I've noticed though that no matter how many degrees, training etc, you will still have good & bad in every field.
Justice: there's a cop side to me I guess. I got sick & tired of seeing patients come into the ER & fake symptoms to get disability, free food, a place to stay at a taxpayer expense of $1500/day. I felt the clinical psychiatrists where I did residency were too lax on the people they knew full well were malingering.
Forensic Psychiatry is the one area where you are trained to objectively diagnose someone, and have measures at your disposal to detect malingering. These techniques are often times not taught in a regular residency such as use of the MFAST, MMPI, SIRS.
Now that I've worked as a FP (without the fellowship training-that starts in July), there certainly are some things I miss about regular psychiatry. I've only had 1-2 Major Depressive Disorder cases (actually both IMHO don't have it, I think they were misdiagnosed) & no GAD in 6 months. I've only had one patient who I believe may have had OCD but is not giving me enough DSM criteria to diagnose it so I put him down as Anxiety DO NOS (mentioned in another thread that he had OCD). Over 95% of the patients I've treated are pretty much psychotic/bipolar/substance disorder patients, and the treatment guidelines are usually not within the typical patient doctor relationship. E.g. several patients, I'm supposed to get them improved simply so the court can find them competent. There's also a lot of manipulation from the forensic population-many malingerers, people intentionally trying to stay ill because they don't want to face the music in court, negative attitudes.
I'm really missing that therapeutic bond feeling you get with some patients when you get them better.
I however am quite content with my decision to go into forensic psychiatry. I can fulfill those things I feel that I'm missing by eventually doing some clinical work on the side which I will perhaps pursue after fellowship. In fact that actually is preferable for a FP because if you will need to keep your clinical skills honed when evaluating forensic patients/clients. That cop side of me will always be there, and I know full well had I simply just done clinical psychiatry, a part of me would always long to have been trained in forensics. By going the forensic route, I can do both.
