Forensics unfilled spots?

[jiggabot]

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How many forensics fellowship spots are available? Are there usually spots that go unfilled each year?

 

[nitemagi]

http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page

 

[whopper]

Forensics is not on the match. Although I have not officially studied this, from my understanding, programs here and there do not fill up. The problem is you're going to have to call them up one at a time to find out what is available. Another problem is many programs don't have program coordinators that are organized enough to call you back in a timely manner.

 

[jiggabot]

Forensics is not on the match. Although I have not officially studied this, from my understanding, programs here and there do not fill up. The problem is you're going to have to call them up one at a time to find out what is available. Another problem is many programs don't have program coordinators that are organized enough to call you back in a timely manner.

Is there any truth that forensics guys cannot be full-time forensics? As in, they have to spend at least half their time seeing patients or something? Also, how difficult is it for a non-fellowship trained psych to just start doing forensics on the side.

 

[whopper]

Is there any truth that forensics guys cannot be full-time forensics? As in, they have to spend at least half their time seeing patients or something?

Yes, in fact some people even encourage this. The problem with private cases is they are freelance. It's not like there's always cases around, and if you're doing one case you might not want to do another at the same time due to the level of commitment required.

Having another job will keep your clinical skills sharp, provide another source of income, and if you don't have benefits, it could do that.

It is possible to work as a forensic psychiatrist without the training but this entails several problems, the most obvious being that you will not know WTF you are doing. I've seen several people do this and make major rookie mistakes such as refer to the defendant as the patient. Great idiot, now you just declared, on legal record, that you have a doctor-patient relationship, and now you've given the court strong reason to believe that you are no longer an objective and neutral witness. Okay, want to take it back? Now you look like an idiot for making this mistake in front of the court.

Forensic psychiatry, for better or worse, is still in a phase where you could set up shop and be possibly one of only a few, if not the only one in the entire state. For this reason, while it does create a good demand for you, it also allows plenty of people with poor skills and knowledge able to take up this trade. If you suck, too bad, they still have to go to you.

Another problem is much of forensic psychiatry, and I completely believe that forensic psychology is ahead of us in this regard, is that several psychiatrists have poor understanding of statistics and psychological testing. It turns out in studies that clinical opinion in many cases has no merit above a layman's such as in malingering, being able to tell if the person is telling the truth, etc. In other cases such as predicting future violence, clinical opinion is better than a layman, but not by much, and actuarial data is more accurate than clinical.

But psychiatrists go on the stand with none of the above knowledge established in studies, give their opinion, and often times misleadingly so, try to make as if their opinion is somehow mystical because they are psychiatrists. This type of practice is IMHO unethical, and it has led to people going to execution. The APA has voiced against this type of practice in the case of James Griggson, who without any science to back his claims, told Texas juries that convicts eligible for the death penalty should be put to death.
http://www.time.com/time/magazine/article/0,9171,954817,00.html

Indeed, Grigson's predictions are what most trouble his critics. In the Ernest Smith case decided last week by the Supreme Court, the American Psychiatric Association filed a brief that questioned the use of testimony like Grigson's. Said the brief: "It gives the appearance of being based on expert medical judgment, when in fact no such expertise exists."

I'll also add that programs, even at name-brand institutions, have forensic psychiatrists running the program that know nothing of psychological testing that are considered basic to psychologists. E.g. a SIRS, Atypical Presentation Scale, TOMM, etc. This is pathetic when you consider that a significant number of forensic cases involve malingering and that has been confirmed in studies, and that a psychiatrist's ability to tell if someone is malingering simply on clinical opinion is insignificant.

IMHO, you should shoot for programs that have a psychologist on-board as faculty (very few have this, or have a psychiatrist whose knowledge of it is on par and I only know less than 6 programs that have that), will teach you about psychological testing, and the real science behind giving an accurate evaluation.

The following programs I know for a fact will give you a good background in psychological testing: U. Mass, Case Western, UC Davis, U. of Cincinnati.

(Notice none of them are in the Ivies or other programs that people readily identify as namebrand?)

Most programs offer little in this area.

I kid you not, and I've mentioned this before on the forum, I've seen a guy, now highly ranked at a name-brand place who told me he knew nothing of objective testing used for malingering, and told me his guy was going to win simply because "I got a better suit." Given that the case was about a man who raped a twelve year old girl and even plead guilty to it, and the doctor on the other side had objective testing that was extremely reliable and valid saying the guy was malingering, let's just say that I thought this forensic psychiatrist was less than honorable. What I found more reprehensible was that any person is in a position to make 6 figures being a general psychiatrist. Is is really worth it to allow a child-rapist go free so you could make more money? (Not that doing it is ever acceptable). He was using the unethical Griggson approach of presenting himself as an M.D. as if his comments were medical science when in fact they were not.

Lawyers can at least argue that they're part of a system where ethically, they must do everything they can, even zealously, within the bounds of the law to defend their client, even if they suspect their client is guilty. The legal system is built on a premise that is often true that adversarial debate often brings out the truth. Expert witnesses? No. They are supposed to tell the truth, the whole truth, and nothing but the truth, yet several are in reality hired guns willing to say anything for the right amount of money fancying themselves as lawyers as if they operate under lawyers' ethics.

 

[Ibid]

Lawyers can at least argue that they're part of a system where ethically, they must do everything they can, even zealously, within the bounds of the law to defend their client, even if they suspect their client is guilty. The legal system is built on a premise that is often true that adversarial debate often brings out the truth. Expert witnesses? No. They are supposed to tell the truth, the whole truth, and nothing but the truth, yet several are in reality hired guns willing to say anything for the right amount of money fancying themselves as lawyers as if they operate under lawyers' ethics.

There is a fly in the ointment though. The defendant is still entitled to have the scum bag point made by an expert witness though. If the expert witness, who does appear for one side or the other, does not make the scum bag point, then it just leaves the door open to appeal.

Ethics aside thats the practicality of an adverserial system, no? The scum bag point has to be made one way or another so it might as well be made straight away.

The only possible way of it would be to have an inquistorial system like the French do. I'm not sure that system is so great either.

 

[sonofthesouth]

How many forensics fellowship spots are available? Are there usually spots that go unfilled each year?

All of the information posted in here is VERY helpful. But then again, what else would we expect from whopper? Anyway, to answer your original question jiggabot, there are 40-41 (it changes annually) programs right now, with the "average" program having 2 positions. I estimate there are probably around 90 spots. Each year, 1 or 2 programs do not fill. This year, it was Maryland. So I assume it was just one position that didn't fill. In recent years, the following programs have not filled: UMass, Pitt, Georgia (?)... that's all I can remember. Not filling is not any indication of how good a program is, as it might be in the general match. Instead, it just means they didn't interview enough people. Most of these programs are interviewing 4-8 people for 2 spots. Hope that helps!

 

[whopper]

The defendant is still entitled to have the scum bag point made by an expert witness though. If the expert witness, who does appear for one side or the other, does not make the scum bag point, then it just leaves the door open to appeal.

This is an arguable point. I see some merit in it, but at the same time the expert witness is supposed to do what I mentioned--the whole truth and nothing but it. Not just the cherry-picked, out-of-context tidbits that are misleading, or flat out lying. They are not supposed to give data that does not meet a Frye or Daubert standard, meaning there has to be some scientific credibility to their statements.

The expert witness could make the scumbag point but it still has to follow the above rules. In the case of Griggson, his comments were certainly not scientific and he misleadingly presented himself as an expert. The argument you make certainly doesn't apply in his cases or several others.

Simply because the scumbag point is not made doesn't always make an argument for appeal. Further, scumbag points that need to be made for the sake of completeness still need to follow the rules of law and the ethics of the profession. Believe me, I actually want the scumbag points to be put out for completeness, but not points that are intentionally misleading to those that don't understand the field and rely on our expertise to guide them to the truth. Remember, this cuts both ways. Prosecutors could also use a misleading guy to get people unfairly put into prison.

There are ways to ethically provide some defense for those that are guilty. E.g. if the person truly is guilty of the crime, an expert witness psychiatrist could provide mitigating factors to reduce the sentence (e.g. the guy was abused, has poor education, etc.), or there's a realistic reason to believe that treatment could prevent the person from commiting a future illegal act.

 

[Manicsleep]

Objectivity usually is affected when opinion and money are linked.

 

[nitemagi]

Objectivity usually is affected when opinion and money are linked.

And I never underestimate our ability as physicians to rationalize whatever point we want to at the moment. Whether it's a "dissociative" episode leading to a killing spree, or why this pt. should be turfed to another service.

Talking with several Forensic PD's at AAPL last year, they said they were getting a lot more applicants than prior years.

 

[Manicsleep]

And I never underestimate our ability as physicians to rationalize whatever point we want to at the moment. Whether it's a "dissociative" episode leading to a killing spree, or why this pt. should be turfed to another service.

Talking with several Forensic PD's at AAPL last year, they said they were getting a lot more applicants than prior years.

Strange. Did they mention why or speculate?

 

[Ibid]

Simply because the scumbag point is not made doesn't always make an argument for appeal. Further, scumbag points that need to be made for the sake of completeness still need to follow the rules of law and the ethics of the profession. Believe me, I actually want the scumbag points to be put out for completeness, but not points that are intentionally misleading to those that don't understand the field and rely on our expertise to guide them to the truth. Remember, this cuts both ways. Prosecutors could also use a misleading guy to get people unfairly put into prison.

Yes, as you put it, it is probably more relevant when a solictor is testing an arguement to distruction by making scum bag points to a victim rather than picking apart an expert.

There are ways to ethically provide some defense for those that are guilty. E.g. if the person truly is guilty of the crime, an expert witness psychiatrist could provide mitigating factors to reduce the sentence (e.g. the guy was abused, has poor education, etc.), or there's a realistic reason to believe that treatment could prevent the person from commiting a future illegal act.

Interesting point. In the UK at least mitigating factors are not considered until after the verdict. And not to put to fine a point on it, its basically comedy hour in the court room because there is no standard for mitigating factors. Anything can be introduced, they saw their Grandmother get out of the shower naked once, they were not allowed a pet as a child, they lived in a house criss crossed with power cables. Anything. I think the brief makes the arguements rather than an "expert" (who could be a struck off african witch doctor, im not kidding here). Its all down to the judge what they want to take into account. Obv goes without saying a psychiatrists words would carry more weight.

 

[Ibid]

And I never underestimate our ability as physicians to rationalize whatever point we want to at the moment. .

Just think, that same brain that got you into and then through medical school is the same brain that will tell you it's a good idea to buy a two seater German sports car with the heavy engine placed sticking out, over and past the rear axle. And that very same brain will tell you that sleeping with your girlfriends sister is a good plan as well. Amazing really.

 

[nitemagi]

Strange. Did they mention why or speculate?

Nope, just that it seemed like the field was getting more competitive. At least at their programs.

 

[whopper]

Objectivity usually is affected when opinion and money are linked.

Of course, in fact in one Supreme Court case, Ake v. Oklahoma, one of the Justices disagreed with the majority ruling. In that case a guy (who turned out to be as guilty as sin), was offered a new trial because he was not given a doctor to examine if he met the not guilty by reason of insanity criteria. They ruled that anyone requesting such an evaluation should be given one by the state.

The disagreement (and I find strong merit in it), pulled by the Justice was that there's an inherent conflict of interest when the doctor is hired by the lawyer. Now the lawyer's the doctor's boss. While in theory they are supposed to be objective, it's obvious to many they are not when only one side is footing their bill and they worked in collaboration with that side. This Justice recommended that expert witnesses should be neutral, and thus not hired by one side but by the Court in general. Several problems we see now were cited by this Justice, such as each side bringing in experts to the point where two people with expertise are in complete disagreement that can only serve to cause confusion among jury members.

A problem here is that jury members are often not people who understand the science behind expert testimony, and as a result, can easily be misled. IMHO, had that psychiatrist mentioned above actually had another mental health professional in the jury, he would've been screwed because they would've known his comments were pretty much as valid as anyone else's who was paid big bucks by the lawyer.

And this Justice's disagreement was addressed by the Court. They retorted that people have the right to hire and get whoever they can to provide a defense. To deny this would be unconstituational (and I also agree with that as well).

In the UK at least mitigating factors are not considered until after the verdict.

Same in pretty much every area of the US as far as I can tell. It's also similar in what you mentioned...being something of a comedy, especially in desperate cases. "He should not spend life in prison! Yes he may have raped 12 children, but this is a man who wakes up and gives coffee to his wife every morning!" (Yes I made that up, but stuff like this actually does happen).

they said they were getting a lot more applicants than prior years.

I haven't seen hard numbers but I've heard the same as well. Programs are supposed to allow their fellows to go to AAPL. The numbers attending the review course have dramatically gone up from what I've heard.

 

[sonofthesouth]

Nope, just that it seemed like the field was getting more competitive. At least at their programs.

Experts have argued that the "CSI Effect" has led to an increased interest and prestige in all things forensic. Hence, the increased interest in forensic psychiatry. Personally, I think it's unfortunate because a lot of people have inflated, much more glamorous perspectives of what forensic psychiatry is. Read more about it here:

http://en.wikipedia.org/wiki/CSI_effect

 

[Ibid]

but this is a man who wakes up and gives coffee to his wife every morning!" .

However, frankly, that should be an offense on its own, he should get sent down for that all by itself. Maybe the odd birthday you could explain away with excentricity but everyday, somethings not right with the guy.....

 

[whopper]

Regarding the CSI effect, I was at the last Academy of Forensic Sciences convention and presented a luncheon lecture, and well there were tons of cute babes! (Yes I'm married, and yes occasionally my wife checks out these forums because too is a mental health professional--I'm saying it to make a point).

The CSI effect has gotten to the point where people outside of lab geeks want to go into forensics.

Only complaint I had about the lecture was they charged me a few hundred to attend the convention, they charged people (several dozen) I believe about $100 to attend my lunch lecture, and I didn't get any of it. I'm fine with not getting any of the money but couldn't they have given me a free ticket?

I think a lot of people are going to be disappointed if they attend a program where all it is about is seeing someone and writing an evaluation without actually teaching that fellow the real science (or lack thereof) behind several issues in forensic psychiatry.

An instructor of mine last year was hired to provide anything he could of a defense for a serial killer. The case gained some national coverage though most of it was local. The instructor, after reviewing all of the evidence told me that the bottom line was that he couldn't provide the guy with anything that would've gotten the guy off without violating ethics, and he refused to do that. He did tell me he could've attempted to get him off the death penalty but that was probably it.

As for providing a real defense, he was able to determine in one case that the defendant, an MR person with dependent features, was coerced into pleading guilty on a murder case. This prompted internal affairs to investigate the police officers that got the defendant arrested, and it turned out they planted evidence and later evidence popped up proving they harassed the defendant into pleading guilty. The investigation yielded further evidence that got the real killer.