Forensic Psychiatry - Opportunity, Pay, and Choosing a Residency

[Psychapplicant133]

Hi Everyone,

I'm an MS4 who has a question about the forensic psychiatry fellowship. I plan to work in correctional psychiatry out of residency ~30-40 hours/week and ~5-10 hours working as an expert witness. I'd imagine this would be quite lucrative as correctional gigs are well-paid and expert witness gigs allow me to earn $400+/hour. My questions are these:

1. Would having a forensic fellowship make it more likely to secure a corrections psychiatry gig? I recognize you don't need a fellowship for this, but would the forensic fellowship allow me to negotiate a higher salary?

2. I understand it is hard to secure clients (i.e. lawyers) as a forensic psych expert witness. How challenging is this in reality? My worry is completing an entire year of forensics and then having just one client every six months or so.

3. My home institution does not have a forensic psychiatry fellowship. How important is it that the residency I go to have the fellowship I plan to complete? In other words, is it significantly more challenging to get a fellowship at a school one did not go to medical school or residency at? I'd imagine the answer is yes, but I'm not sure I'm willing to base my residency decision solely on the availability of a fellowship that I may/may not end up pursuing.

Thank you all for your responses!

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[splik]

Hi Everyone,

I'm an MS4 who has a question about the forensic psychiatry fellowship. I plan to work in correctional psychiatry out of residency ~30-40 hours/week and ~5-10 hours working as an expert witness. I'd imagine this would be quite lucrative as correctional gigs are well-paid and expert witness gigs allow me to earn $400+/hour. My questions are these:

1. Would having a forensic fellowship make it more likely to secure a corrections psychiatry gig? I recognize you don't need a fellowship for this, but would the forensic fellowship allow me to negotiate a higher salary?

2. I understand it is hard to secure clients (i.e. lawyers) as a forensic psych expert witness. How challenging is this in reality? My worry is completing an entire year of forensics and then having just one client every six months or so.

3. My home institution does not have a forensic psychiatry fellowship. How important is it that the residency I go to have the fellowship I plan to complete? In other words, is it significantly more challenging to get a fellowship at a school one did not go to medical school or residency at? I'd imagine the answer is yes, but I'm not sure I'm willing to base my residency decision solely on the availability of a fellowship that I may/may not end up pursuing.

Thank you all for your responses!

1. Forensic fellowship is not necessary for corrections but it would certainly be a positive. For locums positions, no it won't affect your pay. Otherwise salaries are fixed by the state or county, not really something you can negotiate. However, some places will give you a pay bump (about 5% for an additional board certification)
2. It can take a while to get started but if you do good work it is not challenging to get forensic work. It helps if you have attended prestigious medical schools or residency programs, have a faculty appointment, are active in teaching, have published papers, present at conferences, are an excellent clinician, are involved in professional societies, have leadership positions etc. None of the aforementioned is necessary, but helps in establishing your expertise early on. As you build your experience, things like how many IMEs you've done, number of depos and trial testified at can carry more weight. Having good attorney references and transcripts or videos of testimony can also be helpful.
3. My residency did not have a forensic fellowship. It is ideal if you go to a program that does have a fellowship but it certainly isn't a dealbreaker. However they should have some forensics faculty. Forensics is not a competitive fellowship overall but specific fellowship programs can be depending on the year and how many internal candidates they have.

I think starting off in corrections could be very good but most forensic psychiatrists with successful practices are not working on corrections. Getting that corrections experience would certainly help for correctional malpractice cases or being a special master to a correctional system to review compliance with court requirements.

Not all correctional jobs are well paid - really depends on where it is. Similarly expert witness work can vary in compensation. The lowest I've done this yr is $150/hr, and the highest is $1000/hr. Criminal cases tend to pay less. The lowest paid work I've done is for the medical board. But it's interesting work and valuable experience.

The general rule is you may end up making as much from forensic work as clinical. In some locales, clinical compensation can outstrip forensic pay significantly nowadays.

 

[Psychapplicant133]

1. Forensic fellowship is not necessary for corrections but it would certainly be a positive. For locums positions, no it won't affect your pay. Otherwise salaries are fixed by the state or county, not really something you can negotiate. However, some places will give you a pay bump (about 5% for an additional board certification)
2. It can take a while to get started but if you do good work it is not challenging to get forensic work. It helps if you have attended prestigious medical schools or residency programs, have a faculty appointment, are active in teaching, have published papers, present at conferences, are an excellent clinician, are involved in professional societies, have leadership positions etc. None of the aforementioned is necessary, but helps in establishing your expertise early on. As you build your experience, things like how many IMEs you've done, number of depos and trial testified at can carry more weight. Having good attorney references and transcripts or videos of testimony can also be helpful.
3. My residency did not have a forensic fellowship. It is ideal if you go to a program that does have a fellowship but it certainly isn't a dealbreaker. However they should have some forensics faculty. Forensics is not a competitive fellowship overall but specific fellowship programs can be depending on the year and how many internal candidates they have.

I think starting off in corrections could be very good but most forensic psychiatrists with successful practices are not working on corrections. Getting that corrections experience would certainly help for correctional malpractice cases or being a special master to a correctional system to review compliance with court requirements.

Not all correctional jobs are well paid - really depends on where it is. Similarly expert witness work can vary in compensation. The lowest I've done this yr is $150/hr, and the highest is $1000/hr. Criminal cases tend to pay less. The lowest paid work I've done is for the medical board. But it's interesting work and valuable experience.

The general rule is you may end up making as much from forensic work as clinical. In some locales, clinical compensation can outstrip forensic pay significantly nowadays.

Thank you very much for your detailed response! It was very helpful. My next question would be how is it that forensic could be the same as clinical? I agree as you mentioned that some corrections are equal to or lower than some salaries clinical positions. Most clinical positions in my area cap at around $375-400k, and those seem to be few and far between (most positions around $300-320k). With a low paying corrections gig at say $325,000, and a side gig of expert witnessing as much as $1000/hour as you say, how could it be that forensics is less than clinical? To me it seems quite lucrative, especially considering most corrections pay upwards of $400k starting.

 

[TexasPhysician]

Thank you very much for your detailed response! It was very helpful. My next question would be how is it that forensic could be the same as clinical? I agree as you mentioned that some corrections are equal to or lower than some salaries clinical positions. Most clinical positions in my area cap at around $375-400k, and those seem to be few and far between (most positions around $300-320k). With a low paying corrections gig at say $325,000, and a side gig of expert witnessing as much as $1000/hour as you say, how could it be that forensics is less than clinical? To me it seems quite lucrative, especially considering most corrections pay upwards of $400k starting.

You may be looking at isolated opportunities. Corrections work near me is not paid well and isn’t desirable.

Forensics takes a lot of work to break in. It can pay well, but you’ll need to network and market yourself. The majority of forensic trained psychs I know are not finding forensic work that pays better than general outpatient.

 

[magdellan]

Hi Everyone,

I'm an MS4 who has a question about the forensic psychiatry fellowship. I plan to work in correctional psychiatry out of residency ~30-40 hours/week and ~5-10 hours working as an expert witness. I'd imagine this would be quite lucrative as correctional gigs are well-paid and expert witness gigs allow me to earn $400+/hour. My questions are these:

1. Would having a forensic fellowship make it more likely to secure a corrections psychiatry gig? I recognize you don't need a fellowship for this, but would the forensic fellowship allow me to negotiate a higher salary?

2. I understand it is hard to secure clients (i.e. lawyers) as a forensic psych expert witness. How challenging is this in reality? My worry is completing an entire year of forensics and then having just one client every six months or so.

3. My home institution does not have a forensic psychiatry fellowship. How important is it that the residency I go to have the fellowship I plan to complete? In other words, is it significantly more challenging to get a fellowship at a school one did not go to medical school or residency at? I'd imagine the answer is yes, but I'm not sure I'm willing to base my residency decision solely on the availability of a fellowship that I may/may not end up pursuing.

Thank you all for your responses!

1. You don't need forensics fellowship to work in corrections. If you have forensics board certification it might bump your salary up by 10,000.
2. It's very challenging in reality. You will very likely be passed over for someone who's worked in the field for decades and has done lots of court testimonial work. Don't count on expert witness gigs as a source of steady income but more of a supplemental source. 5-10 hrs/week is def overshooting tbh, you might not have any gigs for months on end.
3. Not so important but it might help.

 

[magdellan]

Thank you very much for your detailed response! It was very helpful. My next question would be how is it that forensic could be the same as clinical? I agree as you mentioned that some corrections are equal to or lower than some salaries clinical positions. Most clinical positions in my area cap at around $375-400k, and those seem to be few and far between (most positions around $300-320k). With a low paying corrections gig at say $325,000, and a side gig of expert witnessing as much as $1000/hour as you say, how could it be that forensics is less than clinical? To me it seems quite lucrative, especially considering most corrections pay upwards of $400k starting.

Because expert witness gigs are not steady and reliable so you can't count on it to be a consistent stream of income.

 

[Psychapplicant133]

Thank you very much for your response! It sort of sounds like given the challenges of getting involved with becoming an expert witness, in combination of not needing forensic fellowship to get a corrections job, that a forensic fellowship is not financially worth it? I've seen from all the other posts on this forum that CAP and forensics are the only fellowships that financially make sense. How is forensic worth it financially if expert witnessing is not feasible since its so hard to get a gig? I guess its based on if you somehow do get an academic gig you'll be set as an expert witness?

 

[magdellan]

Thank you very much for your response! It sort of sounds like given the challenges of getting involved with becoming an expert witness, in combination of not needing forensic fellowship to get a corrections job, that a forensic fellowship is not financially worth it? I've seen from all the other posts on this forum that CAP and forensics are the only fellowships that financially make sense. How is forensic worth it financially if expert witnessing is not feasible since its so hard to get a gig? I guess its based on if you somehow do get an academic gig you'll be set as an expert witness?

Like any other field, it's worth it if you're in the top 1%. And to get into the top 1% that takes time and a lot of luck. I would recommend only doing forensics fellowship if you're passionate about the field. And again, you can still do expert witness work and corrections without a forensics fellowship.

 

[TexasPhysician]

Thank you very much for your response! It sort of sounds like given the challenges of getting involved with becoming an expert witness, in combination of not needing forensic fellowship to get a corrections job, that a forensic fellowship is not financially worth it? I've seen from all the other posts on this forum that CAP and forensics are the only fellowships that financially make sense. How is forensic worth it financially if expert witnessing is not feasible since its so hard to get a gig? I guess its based on if you somehow do get an academic gig you'll be set as an expert witness?

With forensics, you won’t find jobs that involve being an expert witness for $$ just sitting around. The majority find their fellowship to be a waste of $$. Some absolutely kill it financially.

Think of it like this: There are 2 private poker games in the city with high stakes and weak players. The good poker players want to be at those tables, but there are only so many seats. If you get a seat, you don’t want to give it up. You need to earn a seat. How do you do that? You may need to take weaker jobs for awhile. You’ll want to network by meeting with various attorneys and judges. Maybe attend functions and political type events. It’s a long-term project, not a get rich quick plan.

 

[splik]

Thank you very much for your detailed response! It was very helpful. My next question would be how is it that forensic could be the same as clinical? I agree as you mentioned that some corrections are equal to or lower than some salaries clinical positions. Most clinical positions in my area cap at around $375-400k, and those seem to be few and far between (most positions around $300-320k). With a low paying corrections gig at say $325,000, and a side gig of expert witnessing as much as $1000/hour as you say, how could it be that forensics is less than clinical? To me it seems quite lucrative, especially considering most corrections pay upwards of $400k starting.

$325k is not a low paying gig, it sounds about average to me. 250k is on the lower end for an employed corrections, whereas as a contractor one could make around 600k doing inpatient corrections in CA. The $1000/hr rate is for depositions, which is a very small fraction of forensic work. Some people do charge that or more for regular forensic work but don't count on it unless you're very experienced or a true expert in some niche. I've also been at this for a while now. When you start out, you charge much less in order to compete. All I can tell you is my former residents charge more coming out of the gate for clinical work than they would be able to get for forensic work. It's unlikely an attorney will pay a newly graduated resident highly when they could get someone much more impressive. Conversely, many senior clinicians seem to charge less than new grads for clinical private practice.

There is a wide range of forensic work. Some of it pays little to nothing (e.g. many people do immigration/asylum evals pro bono or low bono), some pays little (like court appointed competency evals, SSA evals, C&P evals), some pays somewhat similar or less than criminal (e.g. criminal cases through the DA/public defender's office, worker's compensation cases), and then there are cases that can be quite lucrative (e.g. full fee criminal cases, personal injury cases, undue influence/testamentary capacity cases). Working with attorneys can be challenging at times and most everyone has had at least one occasion where they weren't paid. There are ways to mitigate this, but it can still happen.

Overall my clinical work pays the same or more than my forensic work. There is a lot of hassle that comes with forensic work (tight deadlines, working with difficult lawyers, not getting paid or having to chase down money, aggrieved parties in litigation, moral distress, reading through tons of records, writing long reports, dealing with cross-examination -not for the faint-hearted, juggling testimony around patient care). The work may require late nights and weekends. I do it because I find the work really really interesting at times, intellectually stimulating, get to use my skills in a different context, diversify my income streams and work etc.

 

[comp1]

Concur that $325k is an average for clinical work in most of the country. $250k would be on the lower end, although certainly average for LCOL. Do forensics (or any fellowship) because you enjoy it, not because of money. Forensics might have a slightly better chance of increasing your salary than C&L or addictions, but certainly no guarantees.

 

[TexasPhysician]

I've seen from all the other posts on this forum that CAP and forensics are the only fellowships that financially make sense.

CAP and Forensics have fair possibilities of earning a good return on your investment after a couple decades of work. It isn’t immediate, and it isn’t guaranteed.

 

[Bartelby]

To chime in about a couple of relevant topics in this thread, because I think forensic fellowship makes a lot of sense for you:

1- You don't need an addiction psychiatry fellowship to work in an addiction center, or a geriatric fellowship to see elderly patients, or a C-L fellowship to take a consult psychiatry job, or a forensic fellowship to work in corrections. For most psychiatrists these don't make sense. If, though, you plan to build your career around one of these subspecialty niches I think the relevant fellowship makes a lot of sense! It will genuinely deepen your expertise and make you more effective in the role, which I think is very worth it long-term.

2- You can come out financially ahead with an expert witness practice plan like the one you outlined. I agree with others that you will not be booking 10 hours of work per week right out of fellowship. I think getting to that point would average around five years presuming that you are good and that you make at least basic efforts to get the work (networking, giving talks, taking most cases that come your way, etc.). Still, you are considering working 40 hours per week in corrections. As a junior attending you will need to consider how much time to dedicate to work v to your home life and family. Time demands can change a lot between MS4 and attendinghood.

If you do four 10s in corrections you could leave one day open every week for forensic work. Even if you only manage 10 hours per month averaged out in your first few years, that could yield an estimated 10 x $500 x 12 = $60k for work that is (I think) a lot more engaging and generally flexible than moonlighting. Adding that to a correctional salary likely puts you in the 400k's range starting your first year out, which isn't bad. As forensic work expands from there you can decide how you want to grow each area of your practice, for example whether you want to go part-time clinically and have more days dedicated to forensic work.

I agree with others that not every forensic psychiatrist does expert witness work. For many, once they are out and working a consistent 40-hour primary role it isn't worth continuing to take on the work. Expert witness work also is not an easy way to make money, but with the thought you are putting into this I suspect you are the type who can put in the effort and excel. If you are still interested in the plan you outlined above by midpoint in residency I think going for the fellowship makes sense.

 

[FatherPsychiatry]

Hi Everyone,

I'm an MS4 who has a question about the forensic psychiatry fellowship. I plan to work in correctional psychiatry out of residency ~30-40 hours/week and ~5-10 hours working as an expert witness. I'd imagine this would be quite lucrative as correctional gigs are well-paid and expert witness gigs allow me to earn $400+/hour. My questions are these:

1. Would having a forensic fellowship make it more likely to secure a corrections psychiatry gig? I recognize you don't need a fellowship for this, but would the forensic fellowship allow me to negotiate a higher salary?

2. I understand it is hard to secure clients (i.e. lawyers) as a forensic psych expert witness. How challenging is this in reality? My worry is completing an entire year of forensics and then having just one client every six months or so.

3. My home institution does not have a forensic psychiatry fellowship. How important is it that the residency I go to have the fellowship I plan to complete? In other words, is it significantly more challenging to get a fellowship at a school one did not go to medical school or residency at? I'd imagine the answer is yes, but I'm not sure I'm willing to base my residency decision solely on the availability of a fellowship that I may/may not end up pursuing.

Thank you all for your responses!

1. Not really. Many/Most corrections facilities are hurting for psychiatrists, so for the most part, if you have a pulse and no(t too many) disciplinary stuff on your medical license, you'll get in. In terms of negotiating a higher salary because of a forensic fellowship, doubtful. Some places have a bonus written into their contract/MOU, such as Los Angeles County Department of Health Services which gives a 2.5% bonus if you have a second board certification.

2. I agree with the above replies. A lot of it is region specific. Here in Los Angeles, if you get on the mental health court expert panel (not hard to do), you can get steady work. However, it doesn't pay that much although there are ways to negotiate that if you get some mentorship as to how.

3. Refer to Splik's reply above. My residency did not have a fellowship either, but we had faculty that did their fellowship at a nearby program, which led to me getting connected for an audition "forensic" rotation of sorts there during PGY4 year which I think helped me get in. My year was competitive, with many people both from my residency, as well as their own home program, applying, but subsequent years from what I understand that program had to reach pretty deep to fill. I personally would not choose a residency solely based on thinking about forensic fellowship as MS4.

Best of luck to you

 

[Psychapplicant133]

You all are awesome thank you very much for the information 🙂

 

[romanticscience]

Hi Everyone,

I'm an MS4 who has a question about the forensic psychiatry fellowship. I plan to work in correctional psychiatry out of residency ~30-40 hours/week and ~5-10 hours working as an expert witness. I'd imagine this would be quite lucrative as correctional gigs are well-paid and expert witness gigs allow me to earn $400+/hour. My questions are these:

1. Would having a forensic fellowship make it more likely to secure a corrections psychiatry gig? I recognize you don't need a fellowship for this, but would the forensic fellowship allow me to negotiate a higher salary?

2. I understand it is hard to secure clients (i.e. lawyers) as a forensic psych expert witness. How challenging is this in reality? My worry is completing an entire year of forensics and then having just one client every six months or so.

3. My home institution does not have a forensic psychiatry fellowship. How important is it that the residency I go to have the fellowship I plan to complete? In other words, is it significantly more challenging to get a fellowship at a school one did not go to medical school or residency at? I'd imagine the answer is yes, but I'm not sure I'm willing to base my residency decision solely on the availability of a fellowship that I may/may not end up pursuing.

Thank you all for your responses!

1. No. Psychiatry, in general, is in high demand. Like others mentioned, it's not a specialty where subspecialization is required. When I was in your shoes, this blog post helped guide me (see #2).

2. I didn't do a fellowship because the private practice of psychiatry was more important. Rather than defer this another year, I opened mine right after residency. It was discouraging to hear how many fellows either didn't do any expert witness work or worked in non-preferred (for me) positions (e.g., state hospitals or academics). I'll affirm others' responses that it takes time to get the work. I got my first experience doing low-level bread-and-butter stuff: Court-based trial competency evals, some low-level insanity cases, and disability IMEs. From there, I got a few personal injury cases, some from some sketchy lawyers. It is hard to balance "getting experience" and "getting good cases." At this point in the game, I realized without a general forensic reputation due to training and/or faculty position, it would be better to find a niche that is backed up by my clinical experience. This may be what interests you, what you have an odd case about, or related to other experiences (e.g., geriatric experience helping with undue influence/will stuff).

3. It would be very important for your home institution to have one if you don't pursue the fellowship. My residency had one, where I got involved with my first trial competency evaluation experience, among other training that I continued into my attending work. @splik gave me very good advice: At least be active in AAPL and do their board-review course. Don't base your residency choice wholly on this; some programs have better fellowships than general training. First, focus on the breadth and depth of training in general psychiatry; this will, if you don't do a fellowship, give you credibility that you've worked with some stuff. For example, I'm glad I did a specific rotation in adults with developmental disorders.

It's a long game, but it never hurts to prepare early. I'd read everything you can (Melton, Rosner, Guteil, Reid, Forensic Best Practice Series, etc.) and consider the SEAK offerings, which were helpful for me without an academic home base.