Forensic Psychiatry Fellowship vs. JD Degree + General Psychiatry

[drdanmeister]

Hi all.

I'm currently an MS-3 with a strong interest in psychiatry. I know it is early in my career to be considering fellowships, but I have been thinking a lot about forensic psychiatry after being exposed to several psycho-legal issues during my rotations which I found to be very fascinating. Prior to deciding on medicine, law school had always been a close second choice, and after discovering and learning more about forensic psych, I now feel as if I could have the best of both worlds.

An alternative route I realized I could also take was earning a JD after completing psychiatry residency.

Comparing both routes:

1. Psych residency + forensic psychiatry (6 years) = Board certified psychiatrist and Board certified forensic psychiatrist
2. Psych residency + law school (7 years) = Board certified psychiatrist with JD degree

I was wondering if anyone with knowledge of either / both of these routes could provide some insight as to:

• How does the resulting practice of each look like?
• What are the the pros / cons for each profession?
• What type of patient populations / clients would one be working with for each?

*For the purpose of this conversation, let's assume that money (i.e. paying for law school, 3 more years unemployed / fellowship salary) is not an issue.*

Thanks!

- D

*Edit 1: added thought*
*Edit 2: spelling*

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[Stagg737]

Assuming that the very big issue of money is not an issue the biggest thing I've gained from talking to forensic psychiatrists is that they actually know more about mental health law than the lawyers they work with. If you go to law school you're getting a general law degree, so you'd have a wider breadth of knowledge but not as great of depth in the psychiatric fields. If you become a forensic psychiatrist you're specifically learning the law within that field and would be the better route for knowledge specifically within the forensic psychiatry world, but would not be able to spread out from there or represent clients in court (if that's something you're interested in).

 

[NickNaylor]

A JD is not going to be an adequate substitute for forensics training. I suppose the background knowledge might be helpful, but being an attorney is not going to suddenly make you prepared to perform forensics evaluations.

When I was in medical school, I had a fleeting thought of going the MD/JD route and ultimately decided against it. I spoke with one of our faculty who received a JD/MD who felt that the JD really wasn't all that helpful for him, though his interest was primarily in healthcare policy rather than forensic psychiatry.

Whether you have a JD or not, you will still have the ability to do forensics work. For "high-stakes" cases in which forensics certification is necessary, waving a JD around is not going to abrogate that requirement.

If you're interested in forensics, save yourself the time and money and do the fellowship. I don't think the JD will be that helpful to you - especially given the time and money required.

 

[TexasPhysician]

A good expert witness should be heavily clinically involved, know the subject matter well, and communicate effectively. You want someone who sees these cases all of the time. The jury should be convinced that your word is accurate. A forensic fellowship isn’t even mandatory.

A JD would be clinically weak after 3-4 years off. If anything, it would be a negative for forensic psychiatry. JD focuses on general law, not mental health. Are you an attorney, a psychiatrist, or what in the eyes of the jury? It’s like asking Lebron James to retrain in baseball and ask him to teach it instead of basketball.

A MD/JD would have a leg up on malpractice, policy, and making large scale changes within the legal system.

 

[justfolks]

Just a patient, but also a lawyer. Law school will teach you absolutely nothing that is useful as a forensic psychiatrist. Law school barely teaches anything that is useful as a lawyer. There was an MD in my first year class who had a similar thought, he dropped out after the first year when he realized it was a waste of time and money. Do not go to law school unless you want to be a lawyer for some reason.

 

[EatSleepForensics]

My mentors and supervisors in forensics haven't ever suggested anything especially worthwhile about being an MD/JD. I would echo the aforementioned sentiment that most law schools offer rather limited curricula relevant to mental health issues, so I think going to law school envisioning a career as a forensic psychiatrist is likely a low-yield proposition. When you get into doing expert work, especially on cases that present more nuanced issues, good attorneys will work with you to sharpen how you address certain legal issues in your evaluation and opinion formulation, getting into nitty gritty on case law, etc. I've found that collaborative process to be one of the more enjoyable aspects of working on big cases, but I've never once thought to myself "Wish I'd gone to law school."

 

[Bartelby]

As others have mentioned law school would be a waste of time. Keep in mind that your job as a forensic psychiatrist is to perform a high-quality psychiatric evaluation, reach accurate opinions, and convey them effectively. You don't need a law degree for any of that, and the three years off from practice would seriously weaken your clinical skills.

Also residency + forensics is 5 years in the US, versus 7 for residency + JD.

 

[splik]

I know several MD/JD forensic psychiatrists and all of them are fellowship trained in forensics. A JD does not a forensic psychiatrist make and most law has absolutely nothing to do with psychiatry or medicine. For the most part, historically forensic psychiatrists are expert witnesses. A law degree does not make you an expert in psychiatry. A JD is especially not going to train you in assessment of malingering, violence risk, sexual violence recidivism, criminal competency, criminal responsibility, civil competencies, psychiatric disability, fitness for duty, psychic injury or the myriad of other psychological questions that are of relevance to the law. Attorneys are experts in the law and they are retaining you for expertise in psychiatry/psychology (they often don't know the difference) and are not interested in your knowledge of the law. In fact, sometimes this may be considered a liability. Furthermore, law school provides little to no training in practical skills related to trials and depositions.

In addition, most physicians are not of the caliber to be able to get into a top law school. A JD from a non top 10 institution will add little value to your career advancement in this day and age. If you are interested in learning for learning's sake that is a separate issue.

I do forensics and have often thought of doing a JD but only because I am interested in legal scholarship from an academic perspective. I decided against it because I do not think it would be sufficiently helpful for those purposes.

The only way that a JD could be helpful to a forensic psychiatrist is if it provides a professional network of attorneys (i.e. your colleagues) that might form a referral base.

if you are interested in forensic psychiatry, I would recommend you join AAPL (american academy of psychiatry and the law), which i believe is free for students. We have a mentorship program for students too. The Annual Meeting may also be of interest. That said, forensic psychiatrists are probably the least friendly of all psychiatrists, but don't let that stop you!

 

[phyonaphan]

I work in forensic psychiatry and know colleagues who trained in law prior to becoming doctors and forensic psychiatrists. They are helpful in training sessions; that is those who actually practised can help prepare people for cross-examination in court and sometimes in critiquing reports as to whether the legal tests have adequately been addressed , but their legal background does not add huge value in the role they currently occupy and it’s really a matter of choosing one path or the other. In my opinion, If you want to be a forensic psychiatrist choose the fellowship and maybe a masters degree in forensic psychiatry/medicine if you are motivated for more postgraduate training rather than a pure law degree.

 

[drdanmeister]

It appears there is a clear consensus among all responders that forensic psychiatry fellowship is the way to go if I want to pursue a psycho-legal career.

Thanks everyone!

 

[psyguru]

Hi all.

I'm currently an MS-3 with a strong interest in psychiatry. I know it is early in my career to be considering fellowships, but I have been thinking a lot about forensic psychiatry after being exposed to several psycho-legal issues during my rotations which I found to be very fascinating. Prior to deciding on medicine, law school had always been a close second choice, and after discovering and learning more about forensic psych, I now feel as if I could have the best of both worlds.

An alternative route I realized I could also take was earning a JD after completing psychiatry residency.

Comparing both routes:

1. Psych residency + forensic psychiatry (6 years) = Board certified psychiatrist and Board certified forensic psychiatrist
2. Psych residency + law school (7 years) = Board certified psychiatrist with JD degree

I was wondering if anyone with knowledge of either / both of these routes could provide some insight as to:

• How does the resulting practice of each look like?
• What are the the pros / cons for each profession?
• What type of patient populations / clients would one be working with for each?

*For the purpose of this conversation, let's assume that money (i.e. paying for law school, 3 more years unemployed / fellowship salary) is not an issue.*

Thanks!

- D

*Edit 1: added thought*
*Edit 2: spelling*

Psych residency plus forensics fellowship is 5 years. Fyi if you do md/jd you will never be a board certified forensic psychiatrist. Only 3% of psychiatrists are bc in forensics. Plus jd does not train you in forensic psychiatry. I have met some that have both...mostly forensic psychologists. I think it is only worth it if you want to practice law as well.

 

[psyguru]

I know several MD/JD forensic psychiatrists and all of them are fellowship trained in forensics. A JD does not a forensic psychiatrist make and most law has absolutely nothing to do with psychiatry or medicine. For the most part, historically forensic psychiatrists are expert witnesses. A law degree does not make you an expert in psychiatry. A JD is especially not going to train you in assessment of malingering, violence risk, sexual violence recidivism, criminal competency, criminal responsibility, civil competencies, psychiatric disability, fitness for duty, psychic injury or the myriad of other psychological questions that are of relevance to the law. Attorneys are experts in the law and they are retaining you for expertise in psychiatry/psychology (they often don't know the difference) and are not interested in your knowledge of the law. In fact, sometimes this may be considered a liability. Furthermore, law school provides little to no training in practical skills related to trials and depositions.

In addition, most physicians are not of the caliber to be able to get into a top law school. A JD from a non top 10 institution will add little value to your career advancement in this day and age. If you are interested in learning for learning's sake that is a separate issue.

I do forensics and have often thought of doing a JD but only because I am interested in legal scholarship from an academic perspective. I decided against it because I do not think it would be sufficiently helpful for those purposes.

The only way that a JD could be helpful to a forensic psychiatrist is if it provides a professional network of attorneys (i.e. your colleagues) that might form a referral base.

if you are interested in forensic psychiatry, I would recommend you join AAPL (american academy of psychiatry and the law), which i believe is free for students. We have a mentorship program for students too. The Annual Meeting may also be of interest. That said, forensic psychiatrists are probably the least friendly of all psychiatrists, but don't let that stop you!

A referral base is a plus point. However with a good marketing plan, it would not be necessary long term. Instead of doing JD, you would be better off developing a niche and getting a third board certification in child, addictions (MRO), neuropsychiatry or BIM.

 

[prominence]

What does BIM board certification stand for?

 

[psyguru]

What does BIM board certification stand for?

Brain injury medicine

 

[whopper]

the biggest thing I've gained from talking to forensic psychiatrists is that they actually know more about mental health law than the lawyers they work with. I

I liken a law degree to being the equivalent of an MD working in something where he/she doesn't have a specialization in it in regards to forensic psychiatry.

Most judges and lawyers I've seen don't know mental health law.

If you become a licensed forensic psychiatrist you'll have to memorize dozens of landmark cases. I've only known about 3 judges that knew these as well as I did, and maybe about 5 lawyers but these were ones that specialized in mental health law. I've even seen judges and lawyers do mental health law all the time and still not know even the most basic landmark psych cases on involuntary commitment, etc.

 

[downwithDTB]

To play devil's advocate and point out what may be obvious but hasn't been said... if money really is no object (i.e. you could easily pay off med & law school debt without taking a financial hit)... the advantage of getting a JD would be that you could actually practice law. If you want to be a judge, represent people with psychiatric illnesses or the public in mental hygiene court then you may want to go to law school (if you can get into a good one if the judge route is your goal). With only forensic psychiatry training you're pretty much limited to advising lawyers, being an expert witness and practicing medicine (although you could in theory be elected or appointed to a bench or even pass a bar in a state that doesn't require a law degree and practice law, good luck). Of course, you could have just gone to law school in the first place or go instead of residency... but maybe you really want to understand the mental illnesses of the people that you're working with in court and the workings of the systems that actually treat them! Perhaps if everyone who made mental illness-related laws completed a psychiatry residency, a forensic fellowship, went to law school and practiced in mental hygiene court for a few years we'd have better laws on the books.

Likely the reason that no one suggested these is that you'd almost certainly be taking a massive pay cut vs. practicing forensic psychiatry + tons of extra debt... no one here seems to know a board eligible/certified MD with a JD who mostly practices law so there has to be a compelling reason... but if your partner is pulling in a few million a year or your parents are billionaires... (or you want to join a medical class action firm and are willing to work hard enough to make partner and take that massive risk)... and you would rather practice law than medicine at the end of the day... go for it.

 

[psych md jd]

ipsa scientia potestas est

 

[MacDonaldTriad]

ipsa scientia potestas est

and A cerebrum est formidabilem,

"A Brain is a Terrible Thing"

 

[psyguru]

After completing a forensics fellowship you could do some kinda online jd program. During your forensics fellowship you will run into some lawyers and get a better idea about its advantages. Do you want to practice law too?

 

[whopper]

A thing I've picked up from working with several lawyers is it's a tough gig unless you're doing law that's very structured. E.g. working in a probate court where we did involuntary commitment hearings or guardianship hearings, I saw the same lawyers and judges most of the time. It was a usual job where they showed up to work the same hours of the day, and like any job lots of the same things happened, e.g. someone would bring in the doughnuts, pleasantries exchanged and it was work as usual.

In trials it was very different. There was more a competition going on, kind of like the stress of taking an exam. You also would see lawyers hire "hired-gun" expert witnesses willing to say anything. While you make more money in this type of thing it's much more stressful. Also during such hearings you'd have to work as if you're studying for an exam in medical school, sometimes burning the midnight oil getting a report out or preparing to give testimony.

If someone with an MD wants to practice law, more power to you but something's going to give. You're going to have to close your doors to medicine dramatically, or close your doors to law. The two worlds don't interface much and when they do it's not like you're going to do a lot of both worlds even in case that might need both. You won't be able to keep your medical skills sharp practicing law most of the time, or vice versa practicing medicine most of the time.

 

[psyguru]

I know of one forensic psychologist/ JD who does law for 4 times a week and will do a competency to stand trial evaluation once a week. I think he works as the lead attorney in as a public defendant for those in mental health court or something similar. For some reason I have seen more forensic psychology JDs than forensic psychiatry JDs. In any case, I don't think a forensic psychiatry fellowship or law school will necessarily substitute each other. I would recommend doing the fellowship first as it is one year and you get paid vs three years and incurring more debt. This give you the option of working as an expert witness during law school. To be an expert witness, I would at minimum, do 10-20 hours of clinical work ($2000-$4000) a month. Then 1-2 cases a month (it may take a while to get referrals...you will need to spend time and $ marketing your practice). which will net another $5k-$15k a month (average-sized cases/ IMEs).

I would also recommend doing the fellowship to see if you like medico-legal work and like learning about the law. 80-90% of the forensic psychiatrist I see spend 97-100% of the time doing clinical work (either general or forensic/correctional clinical) and 0-3% expert witness/ IME work (maybe 0-2 cases a year). Going into the fellowship, I was under the impression forensic psychiatrists would be more interested in doing expert witness work. I see forensic psychologists doing much more expert witness work (there is more of a market for them do salaried competency to stand trial or other evals at a lower salary). To me, it seems like doing a cardiology fellowship and then working as a hospitalist and doing little cardiology work.

 

[psyguru]

An alternative route I realized I could also take was earning a JD after completing psychiatry residency.

Comparing both routes:

1. Psych residency + forensic psychiatry (6 years) = Board certified psychiatrist and Board certified forensic psychiatrist
2. Psych residency + law school (7 years) = Board certified psychiatrist with JD degree

OP, you math is a little off. Psych residency is 4 years and the fellowship is 1 year. total 5 years. if you do child psychiatry, then the total is 6 years. I think the logical option is doing the fellowship unless you want to practice law.

If you had 7 years to do psychiatry and JD it would be better to do child psychiatry (5 years), forensic psychiatry (1 year) and then another fellowship (BIM, Addictions, Neuropsychiatry, etc -- 1 year) which would equal 7 years. Also, you could do a combined neurology and psychiatry residency and then do the forensic psychiatry fellowship. I think there are some neuro-imaging (maybe research-based) fellowships as well that maybe useful in litigation. The bottom line is if you have 7 years, there is much better use of your time to develop your expertise than doing JD.

 

[notdeadyet]

Doing a JD for the sake of being a forensic psychiatry would be madness. Half the time you see forensic psychiatrists getting killed on the stand is when they stray from providing medical opinions and start to sound like lawyers. A JD could make that much worse.

 

[psyguru]

Doing a JD for the sake of being a forensic psychiatry would be madness. Half the time you see forensic psychiatrists getting killed on the stand is when they stray from providing medical opinions and start to sound like lawyers. A JD could make that much worse.

I just read about this in Dr. Reid's book about setting up a forensic practice.

 

[notdeadyet]

I just read about this in Dr. Reid's book about setting up a forensic practice.

Never read it. Is he recommending this as an option?

The problem with the original post is that I’d argue that someone with a psych residency + good forensic fellowship (5yrs) would be MORE qualified in forensic psychiatry than someone with a psych residency + JD (7 years).

I’ve never been to law school but I would confidently wager than 97% of what you spend time learning is not applicable to doing a forensic psychiatry evaluation, report or testimony.