Forensics fellowship question

[sillypsych]

Hi all, I'm a PGY4 currently interviewing for forensics fellowship and I would appreciate some advice on the decision-making process. I have really liked several of the places I have interviewed and have had positive responses from them indicating that I may receive multiple offers, so I don't think this problem is going to be solved for me by only receiving one. One of my main questions is: how much does name recognition matter in terms of future opportunities? I am specifically looking to ultimately stay in an academic setting as a teaching attending, probably in a clinical role, supplemented by forensic work. I like the idea of having the option to just do forensic work at some point if I want to leave/reduce clinical practice for whatever reason, but definitely not in the immediate future.

I have a lot of family and friends, including in medicine, strongly recommending that I push to go somewhere with the best "name brand" or recognition, i.e. "think of all the extra credibility and job offers/improved salary negotiations you'll get if you have Harvard on your resume." (And I genuinely liked the feel I got for the Harvard/Brigham/MGH fellowship when I interviewed, or I wouldn't keep it on my list just for that - I understand that the MGH solo program was not necessarily highly recommended, but now that it's merged with Brigham I'm not sure if that has changed?) But I don't necessarily want to live in Boston/Massachusetts long-term. I am also looking at more internally-recognized programs, like UMass or Case Western or Denver, which I have also liked a great deal, as well as programs that are more appealing to me location-wise and have very good if not top reputations (OHSU). After my interviews I genuinely feel that the actual training I would get at any of these places would be good (with some variations on specifics - what I really liked about Harvard, for example, was the integration into the CL and other clinical work at Brigham, which seems unique, and other specifics that make each stand out in one way or another).

So my question is, essentially: does having the name brand matter? Will I receive more respect or better offers in my career by having a recognized name like Harvard or Yale or etc. or an internally top name like UMass or Case Western, compared to other solid but not necessarily "touted" programs? Or is this something I should strike from my consideration as much as possible because it's ultimately immaterial?

Thank you in advance for your advice! I see there was a forensics thread here from late July but I didn't want to derail that person's specific conversation.

PS: I am also asking forensic-boarded attendings at my program what they think, but they're quite far out from fellowship time-wise and I'm not sure how updated or relevant their information is to me, since they're established and I would just be starting out.

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[romanticscience]

Who's hiring you? What offers? Psychiatry is a buyer's market. The only forensic jobs that I know of are correctional and, like other psychiatry positions, are non-competitive.

The pedigree might matter in the cash private practice market, but then again, why would a patient pay a premium or even care where you were forensically trained?

The money in forensics is in private cases. Lawyers are your clients. They don't think like us, and some don't even know what a fellowship is (v. residency, v. medical school). They care more about your demonstrated efficacy (reports, testimony, personality) than your resume. Granted, if you stay in academia and have an appointment publishing a bunch of stuff, then maybe the name matters. However, this would be many years after your fellowship.

I'm biased because I entered private practice immediately out of residency. When you own the job, you see things differently. It goes from "how do I curate a pretty resume and get picked" to "how do I demonstrate value and get paid." It's a hard mindset to breakout of because it was the game we played to get here (i.e., high SAT --> USNW Top college --> pre-med As --> high MCAT --> Top Med School --> Top residency --> ).

 

[TexasPhysician]

If your goals are broad, it doesn’t help to narrow things down.

If academia is your goal, the academic world knows what programs are the best, regardless of public name recognition.

The Harvard name is cool for self-esteem, but outside of select markets, it doesn’t do much.

If you want to work in mostly forensics or a niche in forensics, I’d look into what programs fit your specific forensic interests.

 

[Bartelby]

It depends on what you want to do. Taking a job that has a significant forensic component (corrections, state hospital or similar) would not be very competitive. They would likely be thrilled to have anyone with forensic training and are unlikely to get caught up in the prestige of the fellowship you attend.

For IMEs / expert witness work, having a big name on the resume does help some. Attorneys know it will have some impact to say the expert is "Harvard trained" or whatever else. As you mentioned, some of the best programs (like UMass) are not going to have that "wow" factor for the average layperson, even though they will be well-respected within the forensic psychiatric community. What has a much bigger impact, though, is experience and personal connections. Attorneys want an expert who has proven herself by having completed similar IMEs, having testified, having written good and easy to follow reports, etc. Demonstrating that you are a solid expert who can present an opinion in a coherent and compelling way will matter much more than the names on your CV. In addition, working with a wide network of attorneys and other forensic people in your area makes you a known quantity. Attorneys will be much more comfortable retaining you if they have seen you in action or if an attorney they trust refers you / vouches for you.

In short, if you are (for instance) deciding between a solid program local to the place you want to end up or a more impressive-sounding program across the country I would tend to go for the local program. This, of course, assumes that you have done your homework and that the program will provide a solid fellowship experience. Prestige matters, but direct experience, local connections, and individual skill matter quite a bit more.

 

[sillypsych]

Thank you for your candid responses! Essentially it sounds like the brand name might buy you "wow points" but what matters functionally is the quality of training (which makes sense) and the appropriateness of the specific features of the program for your career goals, including networking in the area by training where you want to be. So I should put aside the name recognition concern more or less entirely.

 

[splik]

So my question is, essentially: does having the name brand matter? Will I receive more respect or better offers in my career by having a recognized name like Harvard or Yale or etc. or an internally top name like UMass or Case Western, compared to other solid but not necessarily "touted" programs? Or is this something I should strike from my consideration as much as possible because it's ultimately immaterial?

If you did your residency at Yale or a Harvard affiliated program vs a non top program, then yes I think it does make a difference in terms of career opportunities. However, this does not really extend to fellowship, especially forensic fellowships. The reason is a) they are not competitive (and it is the competitive factor that is part of what makes the difference) and b) this particular fellowship is not highly rated compared to many other forensic programs. you could advertise you were "harvard trained" but I would consider that stretching the truth a bit.

It is also interesting that you liked the "integration with C-L" which honestly I think is a red flag. While there is definitely a lot legal and ethical issues in C-L, I do not believe it is high yield for forensic fellows to be rotating on a C-L service (though it is not clear to me what the C-L component of this fellowship is).

My recommendation would be to go where you think you will get the best training, and bonus points if if is somewhere you think you will end up practicing.

 

[shoomer]

If you did your residency at Yale or a Harvard affiliated program vs a non top program, then yes I think it does make a difference in terms of career opportunities. However, this does not really extend to fellowship, especially forensic fellowships. The reason is a) they are not competitive (and it is the competitive factor that is part of what makes the difference)

Piggybacking off of this, how much does prestige matter for CAP fellowship?

 

[whopper]

At least last time I checked Harvard or Yale didn't have "top" programs. Just cause Harvard and Yale are name-brands doesn't make their program THE BEST program. Now that all said I did hear great things about those programs and the name, for better or worse, does have some swaying power for laymen.

The program with the best rep at least used to be Case Western cause it was headed by Phil Resnick. Resnick has retired although the person now in charge of it is still in the category of a most highest respected person in the field. So you want to be trained by one of the best people in the field with a rep for being one of the best teachers in the field or a place that has "namebrand" recognition that is not considered one of the best?

In short the programs that have the best people in the field that also teach are usually the programs for consideration. Such people include Alan Felthous, Debra Pinals, among others and notice they're not Ivy League locations?

One of the best forensic psychiatrists is Paul Applebaum who is currently (at least last time I checked) at Columbia (so yes here is a fellowship with top person that is Ivy League) although I've known several graduates from the NYC fellowships that said (and this was years ago so this is likely not relevant anymore) that among Columbia, NYU and Einstein fellows favored Einstein the most. The PD of Einsten at that time had the rep of being the best teacher although he was not the most published, and unfortunately that PD is no longer with that program. I've heard from several that while Applebaum certainly deserves his title as one of the top people in the field and is arguably unmatched in terms of publications he's not the most personable teacher.

 

[Auvelity]

At least last time I checked Harvard or Yale didn't have "top" programs. Just cause Harvard and Yale are name-brands doesn't make their program THE BEST program. Now that all said I did hear great things about those programs and the name, for better or worse, does have some swaying power for laymen.

The program with the best rep at least used to be Case Western cause it was headed by Phil Resnick. Resnick has retired although the person now in charge of it is still in the category of a most highest respected person in the field. So you want to be trained by one of the best people in the field with a rep for being one of the best teachers in the field or a place that has "namebrand" recognition that is not considered one of the best?

In short the programs that have the best people in the field that also teach are usually the programs for consideration. Such people include Alan Felthous, Debra Pinals, among others and notice they're not Ivy League locations?

One of the best forensic psychiatrists is Paul Applebaum who is currently (at least last time I checked) at Columbia (so yes here is a fellowship with top person that is Ivy League) although I've known several graduates from the NYC fellowships that said (and this was years ago so this is likely not relevant anymore) that among Columbia, NYU and Einstein fellows favored Einstein the most. The PD of Einsten at that time had the rep of being the best teacher although he was not the most published, and unfortunately that PD is no longer with that program. I've heard from several that while Applebaum certainly deserves his title as one of the top people in the field and is arguably unmatched in terms of publications he's not the most personable teacher.

I apologize for piggybacking off her thread. But If I want to move to Florida or SC (I can't deal with the weather), and forensic fellowship is just one year. Would it be better to get trained at let's say for example Case Western and then move to FL or SC and starting over down there? Or just to pick the local program and creating connections in the area?

 

[whopper]

Can't answer your question. There's too many life variables you're not mentioning. Kind of like someone asking, "should I marry this person or wait a year." Wait you didn't tell me anything else. I can't answer.

 

[Auvelity]

Can't answer your question. There's too many life variables you're not mentioning. Kind of like someone asking, "should I marry this person or wait a year." Wait you didn't tell me anything else. I can't answer.

Fair enough. My question would be are there any good programs in FL or SC to look at? Because if not I will try to get one of these best rep programs for the teaching and then move to wherever I see myself long term (FL or SC)
My focus in teaching is because my current program has non existent forensic rotations, doesn't have an in-house forensic fellowship, and we don't have any forensics attendings affiliated...

 

[whopper]

The advantage of going to fellowship where you will choose to live is much of forensic psychiatry is establishing relationships with the local courts and lawyers. When I graduated from U of Cincinnati I had a rep among many local judges and lawyers going farther than 100 miles away because I was regularly testifying in court. The fellowship gave me that introduction to this localized system.

When I moved to St. Louis no judge or lawyer knew me. It's like being an actor and director relationship. Scorsese used to use Deniro a lot because he knew Deniro. He knew what to expect. Same with lawyers. You do good work with them they'd rather stick with what they know. My forensic work went down in frequency after I moved but I'm not exactly complaining cause in your 30s when a dangerous person threatens you it's nowhere near as scary as when you're in your mid to late 40s and you have kids.

I still do forensic work but it's on the order of 1-2x a year vs what used to be 3-5x a week.

 

[nexus73]

Charles Scott at UC Davis is well regarded also. And while it's a UC, it's not like the brand name of Stanford, or other UC programs.

 

[psyguru]

The advantage of going to fellowship where you will choose to live is much of forensic psychiatry is establishing relationships with the local courts and lawyers. When I graduated from U of Cincinnati I had a rep among many local judges and lawyers going farther than 100 miles away because I was regularly testifying in court. The fellowship gave me that introduction to this localized system.

When I moved to St. Louis no judge or lawyer knew me. It's like being an actor and director relationship. Scorsese used to use Deniro a lot because he knew Deniro. He knew what to expect. Same with lawyers. You do good work with them they'd rather stick with what they know. My forensic work went down in frequency after I moved but I'm not exactly complaining cause in your 30s when a dangerous person threatens you it's nowhere near as scary as when you're in your mid to late 40s and you have kids.

I still do forensic work but it's on the order of 1-2x a year vs what used to be 3-5x a week.

I moved to another state after my fellowship and have been able to grow my forensic practice without any issues. It may take some time. I do several cases a month but most of my cases are larger cases (many are over 20 hours). Most are civil and I do get a variety from probate to PI to med mal. I tend to avoid those that are less than 10 hours (or they avoid me). Most of my referrals are not by word of mouth or from a judge but I have not really focused on word-of-mouth referrals. I plan on it and the word of mouth. My repeat referrals are growing with time. I get quite a few out-of-state referrals (and even one in Canada) as well but most are in-state. I would imagine it would take me 1-3 years to build it up to this level if I were to move to another state depending on the density of forensic psychiatrists.

 

[psyguru]

If you did your residency at Yale or a Harvard affiliated program vs a non top program, then yes I think it does make a difference in terms of career opportunities. However, this does not really extend to fellowship, especially forensic fellowships. The reason is a) they are not competitive (and it is the competitive factor that is part of what makes the difference) and b) this particular fellowship is not highly rated compared to many other forensic programs. you could advertise you were "harvard trained" but I would consider that stretching the truth a bit.

It is also interesting that you liked the "integration with C-L" which honestly I think is a red flag. While there is definitely a lot legal and ethical issues in C-L, I do not believe it is high yield for forensic fellows to be rotating on a C-L service (though it is not clear to me what the C-L component of this fellowship is).

My recommendation would be to go where you think you will get the best training, and bonus points if if is somewhere you think you will end up practicing.

I agree. I did not go to a top fellowship but did get good training and I don't think most attorneys care if I went to an Ivy League fellowship or not. Perhaps if it was a high-profile case. There are other factors (academic affiliation, additional board certifications, etc).

I think if you are looking at programs, find out how many cases you will be able to do and what the supervision is like. Also, find out if you will do real cases or shadow cases (where you observe an attending and then do a parallel report). Mine had real cases but I imagine it would be good to have both. I did over 40 cases in my fellowship and it prepared me well. You may want to find out how many times you will testify. If you get good didactics and good clinical supervision, it is a plus. Another plus is if you get exposure to a variety of cases in fellowship, especially civil (most fellowships will expose you to mainly criminal).

 

[psyguru]

Hi all, I'm a PGY4 currently interviewing for forensics fellowship and I would appreciate some advice on the decision-making process. I have really liked several of the places I have interviewed and have had positive responses from them indicating that I may receive multiple offers, so I don't think this problem is going to be solved for me by only receiving one. One of my main questions is: how much does name recognition matter in terms of future opportunities? I am specifically looking to ultimately stay in an academic setting as a teaching attending, probably in a clinical role, supplemented by forensic work. I like the idea of having the option to just do forensic work at some point if I want to leave/reduce clinical practice for whatever reason, but definitely not in the immediate future.

I have a lot of family and friends, including in medicine, strongly recommending that I push to go somewhere with the best "name brand" or recognition, i.e. "think of all the extra credibility and job offers/improved salary negotiations you'll get if you have Harvard on your resume." (And I genuinely liked the feel I got for the Harvard/Brigham/MGH fellowship when I interviewed, or I wouldn't keep it on my list just for that - I understand that the MGH solo program was not necessarily highly recommended, but now that it's merged with Brigham I'm not sure if that has changed?) But I don't necessarily want to live in Boston/Massachusetts long-term. I am also looking at more internally-recognized programs, like UMass or Case Western or Denver, which I have also liked a great deal, as well as programs that are more appealing to me location-wise and have very good if not top reputations (OHSU). After my interviews I genuinely feel that the actual training I would get at any of these places would be good (with some variations on specifics - what I really liked about Harvard, for example, was the integration into the CL and other clinical work at Brigham, which seems unique, and other specifics that make each stand out in one way or another).

So my question is, essentially: does having the name brand matter? Will I receive more respect or better offers in my career by having a recognized name like Harvard or Yale or etc. or an internally top name like UMass or Case Western, compared to other solid but not necessarily "touted" programs? Or is this something I should strike from my consideration as much as possible because it's ultimately immaterial?

Thank you in advance for your advice! I see there was a forensics thread here from late July but I didn't want to derail that person's specific conversation.

PS: I am also asking forensic-boarded attendings at my program what they think, but they're quite far out from fellowship time-wise and I'm not sure how updated or relevant their information is to me, since they're established and I would just be starting out.

I think you should go for a program you like. I do recommend OHSU. See my post above on what to look for in a fellowship. I think a name-brand fellowship is one factor in your CV (in terms of expert witness work). There are others (academic affiliation, publications. additional board certifications or experience if relevant to the niche, etc). For example, working as a medical director could lead to an inpatient med mal case.

For getting a clinical job in a forensic setting, any fellowship will help especially for admin chief gigs as many non-forensic psychiatrists will work in forensic settings. Unless you are intent on doing forensic clinical chief director jobs, a fellowship is not required to work in corrections or state hospitals. Only about 3% of psychiatrists are forensic psychiatrists.

In regards to income, a forensic fellowship would be worth it if you plan on invoicing at least about 10-15 hours a month in forensic work. Even if the fellowship did not pay off, I would have no regrets as my fellowship year was the most interesting year of training by far. Doing forensic work makes you a better clinical psychiatrist.