Forensics and Child Psych

[Chimed]

I'm wondering if there is anyone on this forum who is familiar with or doing child forensics psychiatry. I honestly have very little exposure to this area (haven't done my rotation yet). There are some openings in a forensic fellowship and a few folks are encouraging me to look into doing the fellowship. My understanding is that those trained in forensics don't like doing child cases, which I think I can understand. I would hate to do the fellowship and not utilize my child training if I went down that path.

Any general thoughts about the combo of child psych and forensics would be appreciated.

Thanks!

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[OldPsychDoc]

I'd ask around your program--I know there are a number of folks who like to do multiple fellowships around there...

OTOH--maybe what you really want is to get out and practice already?

 

[Chimed]

I'd ask around your program--I know there are a number of folks who like to do multiple fellowships around there...

OTOH--maybe what you really want is to get out and practice already?

Thanks. Oh yeah, I want to start working in a bad way. But I'm still trying to find something that can give me versatility so I can spend about 2 days per week seeing patients and do a more consult (not inpatient) type practice the rest of the time.

I'm getting in touch with some folks who have done both. I'm just checking with SDN because sometimes a more "uncensored" opinion is interesting to read. 😉

 

[dl2dp2]

Another option worth considering is some kind of academic research oriented work for a few years when you establish yourself in this niche, as the expert in "forensic issues in children and adolescents." And you can then build a resume pointing to the cases that you consulted on, likely initially with a more senior person. Then once you develop that network you can probably market yourself more efficiently. I would think outside of the box of necessarily doing a formal fellowship if you truly want to develop a niche practice like that, because you'll go into a fellowship then get months and months of rotations doing forensic reports for state forensic hospitals, which i'm pretty guessing isn't what you want to do.

I would discuss this with the forensic program director either at your institution or outside of your institution.

 

[whopper]

I've seen a few combined forensic and child psychiatrists. My fellowship PD was one. Just like in clinical psychiatry, treating a child without a child fellowship puts you at a disadvantage, same goes with child forensic cases.

There certainly is a need for a combined psychiatrist. E.g. child custody cases, child abuse, rape, etc. Custody cases from what I'm told are truly toxic, and I've mentioned this before on the forum. The few people I've seen who do them told me they record every single moment because the risk of being falsely accused of some type of bad conduct gets high. In cases like this, the parents are usually already in a very angry/malignant/toxic relationship. Most parents realize that fighting over a child for custody can damage the child and will try to compromise at least when it comes to the custody of the children though they may fight on other areas such as distribution of the bank account. When a forensic evaluation is pulled, wow, it's to the degree where it's severely bad, and parents may be willing to do anything to foul up the other including using the child as a emotional weapon.

there's a shortage of psychiatrists, an even bigger shortage of forensic and child psychiatrists but when you are both, you might be the only one in a few states, literally.

 

[diagonal]

Not to hijack, but along those same lines, what do you think of the marketability of Addiction + C&A?

 

[OldPsychDoc]

Not to hijack, but along those same lines, what do you think of the marketability of Addiction + C&A?

VERY high.

 

[diagonal]

VERY high.

What kind of setting would someone with that kind of training likely work in? Would you recommend going this route?

EDIT: Also, how many psychiatrists in the country would you guess are double-boarded in Addiction and C&A?

 

[whopper]

When you are one of the only docs in town with education on this level, you might have to not just set up shop but place yourself in a niche where people know to get you for your services. For addition and C&A, you could, for example, set yourself up at an addiction treatment center or make one yourself. But if you work in a hospital, they might just shove you in a psychiatric position any psychiatrist could've been in.

I don't know how many are double-boarded in C&A and child but I'd guestimate it's at the most a few hundred. I'd be willing to bet it's possible it's less than 100.

 

[diagonal]

When you are one of the only docs in town with education on this level, you might have to not just set up shop but place yourself in a niche where people know to get you for your services. For addition and C&A, you could, for example, set yourself up at an addiction treatment center or make one yourself. But if you work in a hospital, they might just shove you in a psychiatric position any psychiatrist could've been in.

I don't know how many are double-boarded in C&A and child but I'd guestimate it's at the most a few hundred. I'd be willing to bet it's possible it's less than 100.

Hmm. My dream would be a lucrative PP addiction center for kids on drugs. Kinda the epitome of medicine for me. So I guess this is how one goes about it.

Is this the sort of thing that with said training you can just basically walk into?

 

[whopper]

I'd say no. I'm going to compare this to forensic psychiatry. Several psychiatrists that graduated from a forensic fellowship never work in forensic psychiatry other than to do things all psychiatrists do such as file papers for involuntary commitment.

If you do C&A, there's enough open doors IMHO to get into a C&A job, but for addiction, it's like forensics in the sense that if you do it, you'd likely just stumble upon stuff they'd stick any doctor to do unless you start looking for the doors yourself to open.

If you really want to capitalize on a C&A and addiction training, IMHO, you need to seek out a position where you'll really shine. If you work in any old hospital system, I can see them shoving you in a place that any psychiatrist could've done it, or not pay you more if you did child and addiction. Work in a university system, you'll have more opportunities for research if that is what you want but many places don't pay much though I've seen some places that do. Where I'm at, it's a university and they do pay psychiatrists well.

Some suggestions: You could work at an addiction treatment center, make your own C&A practice with an emphasis and advertising that you also treat addiction, or work at a private facility that is recognized as one of the best in the country that hires specialized psychiatrists that have a rep for being top-notch. Such places are the Meninger Clinic (in TX) or the Lindner Center in the Cincinnati area (headed by Paul Keck), among a few others.

 

[splik]

Hmm. My dream would be a lucrative PP addiction center for kids on drugs. Kinda the epitome of medicine for me.

 

[diagonal]

I'd say no. I'm going to compare this to forensic psychiatry. Several psychiatrists that graduated from a forensic fellowship never work in forensic psychiatry other than to do things all psychiatrists do such as file papers for involuntary commitment.

If you do C&A, there's enough open doors IMHO to get into a C&A job, but for addiction, it's like forensics in the sense that if you do it, you'd likely just stumble upon stuff they'd stick any doctor to do.

If you really want to capitalize on a C&A and addiction training, IMHO, you need to seek out a position where you'll really shine. If you work in any old hospital system, I can see them shoving you in a place that any psychiatrist could've done it, or not pay you more if you did child and addiction.

Some suggestions: You could work at an addiction treatment center, make your own C&A practice with an emphasis and advertising that you also treat addiction, or work at a private facility that is recognized as one of the best in the country that hires specialized psychiatrists that have a rep for being top-notch. Such places are the Meninger Clinic (in TX) or the Lindner Center in the Cincinnati area (headed by Paul Keck).

Thanks for the response. I actually meant starting my own Meninger Clinic, so to speak. I guess that's another animal entirely. Some can pull it off, others can't.

 

[diagonal]

Did I just get barfed on by a socialist?

 

[splik]

> yes but don't worry it's not contagious

 

[diagonal]

> yes but don't worry it's not contagious

I know. I'm reading the headlines.

 

[whopper]

I'll never fault someone making money in the field so long as they're providing good ethical care.

I actually meant starting my own Meninger Clinic, so to speak. I guess that's another animal entirely. Some can pull it off, others can't.

You might then want to get a business degree or some business experience plus some very good experience before you start something like this, or enter one of those private places and work yourself up.

The first PD of my fellowship program had an MBA in addition to being a forensic psychiatrist. He was one of the doctors that was instrumental in founding the Lindner Center. He was the guy that got me convinced to go to Cincinnati for fellowship so I was bummed that he left the position right before I started fellowship, but his replacement is one of the top doctors in the field and considered even higher than that first PD so I couldn't complain. (I likened it to having Hercules being replaced by Zeus).

He later left his prestigious position at that institution to become a top medical officer in a very large hospital system.

Remember, higher rates demand higher quality. In private institutions, they often attract very rich patients, but they have much higher expectations of treatment. This can be difficult, especially when the family has unrealistic expectations and are used to their money getting anything they want. Several people on this forum mentioned they aspired to be in a lucrative private practice. I can tell you from experience that these patients and their families can be very difficult. I remember having a conversation with a patient's father (a corporate officer in a major corporation) who told me he insisted on having me do a treatment team meeting with the all the other doctor's who've treated this patient in the last few years-some of them in other parts of the country, and those doctors could not bill for showing up to the hospital....

And this patient was IMHO going to be a very high risk for suicide no matter how well a job I did. I could see this guy possibly doing something bad, and then the father getting a team of the world's best lawyers to sue me not knowing I was doing way over the standard of care for his son.

 

[whopper]

I'll never fault someone making money in the field so long as they're providing good ethical care.

I actually meant starting my own Meninger Clinic, so to speak. I guess that's another animal entirely. Some can pull it off, others can't.

You might then want to get a business degree or some business experience plus some very good experience before you start something like this, or enter one of those private places and work yourself up.

The first PD of my fellowship program had an MBA in addition to being a forensic psychiatrist. He was one of the doctors that was instrumental in founding the Lindner Center. He was the guy that got me convinced to go to Cincinnati for fellowship so I was bummed that he left the position right before I started fellowship, but his replacement is one of the top doctors in the field and considered even higher than that first PD so I couldn't complain. (I likened it to having Hercules being replaced by Zeus).

He later left his prestigious position at that institution to become a top medical officer in a very large hospital system.

Remember, higher rates demand higher quality. In private institutions, they often attract very rich patients, but they have much higher expectations of treatment. This can be difficult, especially when the family has unrealistic expectations and are used to their money getting anything they want. Several people on this forum mentioned they aspired to be in a lucrative private practice. I can tell you from experience that these patients and their families can be very difficult. I remember having a conversation with a patient's father (a corporate officer in a major corporation) who told me he insisted on having me do a treatment team meeting with the all the other doctor's who've treated this patient in the last few years-some of them in other parts of the country, and those doctors could not bill for showing up to the hospital....

And this patient was IMHO going to be a very high risk for suicide no matter how well a job I did. I could see this guy possibly doing something bad, and then the father getting a team of the world's best lawyers to sue me not knowing I was doing way over the standard of care for his son. I talked to his outpatient psychiatrist who also told me he sometimes had problems going to sleep at night because if his son ever did anything dangerous, he could see the family getting so upset they might set him in their legal cross-hairs, even though he too was doing a good job.

When it's your own business and you're not part of a huge institution, you sure as heck better worry about this. If I got sued in my current job, the university handles the malpractice. I don't have to worry about the legal fees no matter how bad they get. If I lose, the university pays for it. End of story, I can sleep at night. If it's my own private practice and someone wants to go against you in the legal battlefield you could end up losing the business, even your house if you're not savvy.

Another problem with wealthy patients and their families is they often have borderline traits, not because of abuse but because the families are dysfunctional and their money has a large part to do with it. Getting a wealthy patient can be something on the order of getting a problematic borderline patient who is intrusive, emotionally cumbersome, and their family thinks you can give them a pill to just shut them up.

I had one patient with an extremely wealthy husband (he paid over $300K for his wife's treatment over the past few years). The guy was litigious-happy. He sued almost every prior doctor she ever had. He also had some legal eagle ambulance-chaser lawyer who'd bully doctors with lawsuits all the time. She tried to pull that crap on met not knowing I was a forensic psychiatrist and at one point I told the lawyer to go ahead and sue me because we both knew the lawsuit wouldn't pass and then I'd counter-sue for the waste of time it would be on my practice and the likelihood of me winning would be pretty good. After trying to be friendly with this lawyer after being on the phone with her for 45 minutes and going through enough of her BS, I basically quickened the conversation to it's end point with the following statement to the effect of...

(Coldly): I'm a forensic psychiatrist. I've been in court hundreds of times on cases much more difficult than this. You don't scare me and I know the tricks here lady. Don't ever try this BS on me. Don't try it now, don't try it ever. You and I know how this works and just as much as you can make life difficult to me, I can do it to you worse.

The conversation ended within a few minutes.

I was able to do this because of my legal experience. That shut that a-hole lawyer up. I later terminated that patient but did it in a manner where I was rock-solid not going to get sued unless the patient's husband decided to do a frivolous lawsuit that we both know wouldn't work. Problem for you is I doubt you'll get that type of experience unless you become a forensic psychiatrist.

Point is don't gun for the money in this field just for the money. It's not worth it. Work hard, do good work, and keep your eyes open for better job opportunities and that'll be a much less stressful way to make the money.

 

[diagonal]

^It's difficult for sure, but that's on me. I just want to make sure I'm doing it right.

As far as the right intentions bit, I was a heroin addict that is now a 4th year med student. I think my motivations are solid.

 

[whopper]

If they are, if you do good work, if you are trying your best, all the best too you, and if you make good money while doing solid care, even better for you and your patients.