Has anyone withdrawn from a Child & Adolescent Fellowship after 1 year...

[RGL01]

Will this impact my ability to sit for the Adult Board Certification Exam?

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[DD214_DOC]

I personally didn't do this, but I know a few who did. The answer is that it depends on if you are a 3+2 or 4+2. Since you're even asking this question, I assume you're a 4+2, in which case I cannot think of any reason why it would affect your ability to take the adult boards. You should already be BE based on completing the general residency.

If you are a 3+2, I believe as long as you have SUCCESSFULLY completed the first year of fellowship you should be BE for adult.

 

[heysexylady]

Will this impact my ability to sit for the Adult Board Certification Exam?

You have to do 4 years to be board eligible... So if you already finished 4 years of adult psychiatry, you could leave your program tmrw and set up shop. Now, if you fast tracked... You have to wait till June 30th to tell them that you want to leave. You will still be board eligible and can take your boards next September.

 

[thoffen]

Yes if you complete 4 years and meet all general psych residency requirements you can do this and be board eligible. Some people have been encouraged to do that at my program as a way out. I've not been happy to hear that, but it may be possible that the PD was transparent about that possibility prior to going to fellowship. Sometimes an unfilled spot is worse than a marginal fellow.

 

[RGL01]

So yes I am 3 + 2. I just finished my General Adult Residency one year early, and have my diploma sitting next to me. I was figuring what you guys are saying, namely that I need to finish this 1st year of Fellowship (PGY-4), and then I will be BE for September 2018. It's weird that the APA didn't give me an unequivocal answer, although it was essentially what is being said here, and the ABPN specifically would not answer my question, and directed me to my PD. Thanks so much for the replies. They are much appreciated and have reduced my anxiety in a big way. ;-)

 

[heysexylady]

So yes I am 3 + 2. I just finished my General Adult Residency one year early, and have my diploma sitting next to me. I was figuring what you guys are saying, namely that I need to finish this 1st year of Fellowship (PGY-4), and then I will be BE for September 2018. It's weird that the APA didn't give me an unequivocal answer, although it was essentially what is being said here, and the ABPN specifically would not answer my question, and directed me to my PD. Thanks so much for the replies. They are much appreciated and have reduced my anxiety in a big way. ;-)

Why do you want to leave your program... I'm inning asking because I'm a busybody.

 

[calvnandhobbs68]

Why do you want to leave your program... I'm inning asking because I'm a busybody.

I'd assume OP decided he/she would just rather do general psych than child specifically considering there's no talk of trying to switch to another program. Doubt it's the program itself but I could be wrong.

 

[DD214_DOC]

I'd assume OP decided he/she would just rather do general psych than child specifically considering there's no talk of trying to switch to another program. Doubt it's the program itself but I could be wrong.

It was pretty common for my program to lose about one fellow per year. Every couple of years they wouldn't. It had nothing to do with the program, and more likely the nature of child psych. I have absolutely nothing for comparison, but I would imagine it's similar for many other programs.

 

[inveggar]

I just matched Child Psychiatry at my home program. I would have been happy about it a month ago, but now I am having regrets as I am seeing how much I enjoy just general psychiatry and I how much I want to be able to practice to pay back my loans. I fast tracked so I am now ethically stuck for the first 45 days, however, I plan on trying to at least give it a shot for a year. Question is, can I leave after a year and still be board eligible? I will try to be professional about it, but I hope it will not leave a bitter taste in my program's mouth if I leave this way.

In truth, I realized Child Psychiatry was a lot more draining than I anticipated originally. I find working with Veterans at the VA outpatient clinic to be something that appeals to me more for what I want to do long term.

 

[OldPsychDoc]

Yes you can leave after PGY4 and be Board Eligible PROVIDED your program was set up such that you completed all adult requirements before fast-tracking.
Not leaving a bitter taste...can't guarantee anything there for ya. Depends on you and the program and how amicably you can "divorce".

 

[inveggar]

Since, I did match at my home program, do any of you suggest talking to them and letting them know I am having second thoughts. Perhaps going after a match waiver of something so I can do my 4th year as an adult resident?

 

[inveggar]

I'm starting to have increased regerets about my decision to go for the fellowship. If I wait 45 days and withdraw, I'm worried they won't find someone to replace me.

 

[splik]

I'm starting to have increased regrets about my decision to go for the fellowship. If I wait 45 days and withdraw, I'm worried they won't find someone to replace me.

they probably wont be able to find someone to replace you either way. more and more psychiatrists would not touch child psych with a bargepole. personally I would advise you to talk to your program director about your feelings and whether they are happy to have you stay. they may even have guidance or help broach the topic with the fellowship PD. If so, then tell the fellowship you won't be joining them. You dont need and wont be able to obtain a "match waiver". You will be blacklisted from participating in the NRMP but big deal (completely irrelevant for you) and potentially blacklisted from that child psychiatry dept (again who cares if you're not doing child psychiatry and if youre dept turns against you then you definitely don't want to work there anyway). It is unfortunate you are only realizing this now, but you owe this child fellowship nothing. Yes, you did participate in the match and made a "gentleman's agreement" to be bound by the match, but you have no ethical or legal obligation to do so. hopefully your program director will be supportive and allow you to stay on but you need to speak up NOW. there is a possibility your PD will tell you to suck it up cuz it does look bad on the program and since its the depts own fellowship it's kinda of awkward but hopefully they will be supportive.

 

[neoexile]

they probably wont be able to find someone to replace you either way. more and more psychiatrists would not touch child psych with a bargepole. personally I would advise you to talk to your program director about your feelings and whether they are happy to have you stay. they may even have guidance or help broach the topic with the fellowship PD. If so, then tell the fellowship you won't be joining them. You dont need and wont be able to obtain a "match waiver". You will be blacklisted from participating in the NRMP but big deal (completely irrelevant for you) and potentially blacklisted from that child psychiatry dept (again who cares if you're not doing child psychiatry and if youre dept turns against you then you definitely don't want to work there anyway). It is unfortunate you are only realizing this now, but you owe this child fellowship nothing. Yes, you did participate in the match and made a "gentleman's agreement" to be bound by the match, but you have no ethical or legal obligation to do so. hopefully your program director will be supportive and allow you to stay on but you need to speak up NOW. there is a possibility your PD will tell you to suck it up cuz it does look bad on the program and since its the depts own fellowship it's kinda of awkward but hopefully they will be supportive.

Why is child psych becoming less popular?

 

[MacDonaldTriad]

I have seen people who transfer after PGY-II to a new program and then fast track get stuck in the "12 continuous months of outpatient" requirement because this is viewed as dividing training across 3 programs. If you fast track into your home program, this may be OK or if you get 12 months of outpatient credit by the end of PGY-III you will be fine. The ABPN will not answer your question because it all depends upon what your PD is willing to put in writing, or now it is what we upload into the ABPN web site in terms of training credit. I assume you have 36 months of adult training, you need to find out what that 36 months is labeled as and what if any requirements are left.

 

[reca]

more and more psychiatrists would not touch child psych with a bargepole.

Why is that? I thought child psychiatry was the most popular fellowship?

 

[MacDonaldTriad]

There were only a handful of SOAP slots in the last general psychiatry match, and all fellowships only filled between 60 - 70% of their slots. Programs are building fellowships at a very high rate, but trainees have figured out that they can do a lot of things as a general psychiatrist. Child is about the only thing you need to have to practice in that specialty. Otherwise, you can do addictions, geri, C&L... who needs a PGY-V year? More and more, fellowships are for academics. Otherwise it just doubles your MOC problems.

 

[cutetendon]

There were only a handful of SOAP slots in the last general psychiatry match, and all fellowships only filled between 60 - 70% of their slots. Programs are building fellowships at a very high rate, but trainees have figured out that they can do a lot of things as a general psychiatrist. Child is about the only thing you need to have to practice in that specialty. Otherwise, you can do addictions, geri, C&L... who needs a PGY-V year? More and more, fellowships are for academics. Otherwise it just doubles your MOC problems.

Fellowships also increase your salary and/or desirability by a tiny percentage.

 

[nexus73]

From a standpoint of paying off loans, I'd imagine you can look around for smaller cities where hospitals or clinics are willing to pay significant amounts towards student loans for a child psychiatrist (adult psychiatrist too, but probably nowhere near as much). Just something to consider.

 

[deleted736562]

Why is that? I thought child psychiatry was the most popular fellowship?

One reason is that the administrative burden is immense and can lead to very quick burnout.

 

[MedMan80]

One reason is that the administrative burden is immense and can lead to very quick burnout.

This and dealing with patient's family's as well, but in all honesty I feel that I made the right decision 7 months in. My previous program was a POS and i feel the work-life balance in my current fellowship is excellent, I feel blessed not dealing with an indigent population.

 

[inveggar]

they probably wont be able to find someone to replace you either way. more and more psychiatrists would not touch child psych with a bargepole. personally I would advise you to talk to your program director about your feelings and whether they are happy to have you stay. they may even have guidance or help broach the topic with the fellowship PD. If so, then tell the fellowship you won't be joining them. You dont need and wont be able to obtain a "match waiver". You will be blacklisted from participating in the NRMP but big deal (completely irrelevant for you) and potentially blacklisted from that child psychiatry dept (again who cares if you're not doing child psychiatry and if youre dept turns against you then you definitely don't want to work there anyway). It is unfortunate you are only realizing this now, but you owe this child fellowship nothing. Yes, you did participate in the match and made a "gentleman's agreement" to be bound by the match, but you have no ethical or legal obligation to do so. hopefully your program director will be supportive and allow you to stay on but you need to speak up NOW. there is a possibility your PD will tell you to suck it up cuz it does look bad on the program and since its the depts own fellowship it's kinda of awkward but hopefully they will be supportive.

Will the fact that I withdrew from the fellowship be reportable to State Licensing Agencies?

 

[DD214_DOC]

One reason is that the administrative burden is immense and can lead to very quick burnout.

Spot on. As a CAPS in my third year of practicing as an attending, I am already looking forward to leaving. I won't necessarily walk away from CAPS completely, but I will certainly be selective in the particular demographic I provide care to.

To highlight the point mentioned in the quote, I spend just as much if not more time during my work day managing administrative things beyond just documentation, such as requests for information from therapists, school psychologists, or teachers, completing physician statements for schools to use during initial and update IEP meetings, requets for homebound instruction, applications for RTF admissions, and on and on and on. Bear in mind, 90% of these things are not brought during an appointment but randomly brought it by parents and left at the front desk for me to complete. A parent dropping off one thing needting attention results in notification from admin staff that it's here, review of whatever the thing is they're requesting, then either completing it if I'm able to do so or discussing with scheduling and the nurse to coordinate notifying the parent that an appt is necessary and get it scheduled. This can eat up 10-15 minutes of my time for ONE random thing. I get multiple things left almost every day, in addition to parents randomly showing up to clinic demanding to speak to me for who knows what, parents calling to leave messages for refills, medication-related concerns, behavior concerns, or telling the nurse they refuse to tell anyone other than me what the concern actually is. This is all on top of an almost-always full schedule of appointments.

Just a little insight into anyone considering CAPS.

 

[ara96]

Spot on. As a CAPS in my third year of practicing as an attending, I am already looking forward to leaving. I won't necessarily walk away from CAPS completely, but I will certainly be selective in the particular demographic I provide care to.

To highlight the point mentioned in the quote, I spend just as much if not more time during my work day managing administrative things beyond just documentation, such as requests for information from therapists, school psychologists, or teachers, completing physician statements for schools to use during initial and update IEP meetings, requets for homebound instruction, applications for RTF admissions, and on and on and on. Bear in mind, 90% of these things are not brought during an appointment but randomly brought it by parents and left at the front desk for me to complete. A parent dropping off one thing needting attention results in notification from admin staff that it's here, review of whatever the thing is they're requesting, then either completing it if I'm able to do so or discussing with scheduling and the nurse to coordinate notifying the parent that an appt is necessary and get it scheduled. This can eat up 10-15 minutes of my time for ONE random thing. I get multiple things left almost every day, in addition to parents randomly showing up to clinic demanding to speak to me for who knows what, parents calling to leave messages for refills, medication-related concerns, behavior concerns, or telling the nurse they refuse to tell anyone other than me what the concern actually is. This is all on top of an almost-always full schedule of appointments.

Just a little insight into anyone considering CAPS.

Are you being reimbursed for all this extra work? This is BS.

With that being said, I have seen a lot of C&A certified Psychiatrists just practice adult Psychiatry. Does the fellowship make you a more seasoned and better trained adult Psychiatrist?

Thanks

 

[inveggar]

A part of me just wants to suck it up and try it for a year, but lets say I leave after 1 year, whenever I fill out a form for state licensing or for hospital credentialing, will I have to indicate that I did not finish my training or I left a program without completing it? I'm just concerned about ramifications on my ability to get a job later on.

Thanks

 

[inveggar]

I just wish that we would be able to finish adult before going into child.

 

[inveggar]

I did not pick up the courage to tell them in February. However, I'm going to give the PGY4 year the best that I can.

 

[psyguru]

Maybe you could ask the program to switch you back to the general residency and offer to whatever rotations they offer...child or adult or a mix. Technically even if someone was doing general residency... nothing would bar him or her doing some extra child months as an elective.

Sent from my SM-G965U using Tapatalk

 

[shahseh22]

Has anyone who has done the fellowship regretted it? I'm a bit bummed about the loss of income and not seeing adults as much as I finish my third year. I really had a few patients in my continunity clinic that I really enjoyed seeing. I guess I could moonlight during fellowship but still...

 

[DD214_DOC]

Are you being reimbursed for all this extra work? This is BS.

With that being said, I have seen a lot of C&A certified Psychiatrists just practice adult Psychiatry. Does the fellowship make you a more seasoned and better trained adult Psychiatrist?

Thanks

Nope, I'm not. I'm also salaried and in the military, but even on the outside there isn't any extra reimbursement. I use the same E/M and CPT codes as the adult psychiatrists. Child psych has the potential to earn more than adult given the right business structure and economic area to setup a practice in, but otherwise it's just more work without more pay -- if you do it the, "right", way.

Most end up doing it the, "wrong", way, merely churning people through for med management and not really looking at the broader systems/family issues or obtaining proper collateral. Most child cases honestly don't really require medication of any type, but this isn't the world in which we live. Parents aren't usually receptive to any feedback regarding how they parent or their contribution to a child's presentation, and they usually just get pissed off and don't come back -- which is bad for business. This is why it's really common -- especially from therapists -- to never confront a parent on these issues (or because they're conflict avoidant to begin with) and so you just end up colluding with the parent's pathology and wasting your time and energy to not get anywhere with the patient. This is also why so many kids end up on medications they don't need to begin with for a presentation that is really the result of family and parent issues.

I think the additional training in C/A makes one a better psychiatrist in general, to include adult work, if your fellowship program is a good one. I wouldn't really do it for financial reasons.

 

[MedMan80]

Nope, I'm not. I'm also salaried and in the military, but even on the outside there isn't any extra reimbursement. I use the same E/M and CPT codes as the adult psychiatrists. Child psych has the potential to earn more than adult given the right business structure and economic area to setup a practice in, but otherwise it's just more work without more pay -- if you do it the, "right", way.

Most end up doing it the, "wrong", way, merely churning people through for med management and not really looking at the broader systems/family issues or obtaining proper collateral. Most child cases honestly don't really require medication of any type, but this isn't the world in which we live. Parents aren't usually receptive to any feedback regarding how they parent or their contribution to a child's presentation, and they usually just get pissed off and don't come back -- which is bad for business. This is why it's really common -- especially from therapists -- to never confront a parent on these issues (or because they're conflict avoidant to begin with) and so you just end up colluding with the parent's pathology and wasting your time and energy to not get anywhere with the patient. This is also why so many kids end up on medications they don't need to begin with for a presentation that is really the result of family and parent issues.

I think the additional training in C/A makes one a better psychiatrist in general, to include adult work, if your fellowship program is a good one. I wouldn't really do it for financial reasons.

Very well summed up, I would add also that in fellowship training we have patient contact quotas we have to meet, especially in second year. This means that we can't take an hour to see a patient for a 30 minute visit, which means corners have to be cut..and we end up gravitating towards the "wrong" way to do things.

I would say it did make me a better psychiatrist however, especially if I look back on my adult program (very weak didactics, almost nonexistent), however If I came from a very strong program with good didactics, I would have regretted my decision to come over to child.

 

[DD214_DOC]

Very well summed up, I would add also that in fellowship training we have patient contact quotas we have to meet, especially in second year. This means that we can't take an hour to see a patient for a 30 minute visit, which means corners have to be cut..and we end up gravitating towards the "wrong" way to do things.

I would say it did make me a better psychiatrist however, especially if I look back on my adult program (very weak didactics, almost nonexistent), however If I came from a very strong program with good didactics, I would have regretted my decision to come over to child.

Thanks. I think the C/A training opened my eyes up to the whole concept of a systems approach, and in retrospect I see how incredibly useful this would have been with adult work, since adults don't live in a vacuum, either.

Ultimately, unless you're in private practice, you become, "the pill guy". Even when a medication isn't indicated and unlikely to be beneficial. Therapists who can't get anywhere with a patient -- typically for the reasons in my above post -- use a medication referral as a way out, claiming, "Maybe meds will help", when the real problem is they may just suck as a therapist. Now you're stuck with a patient and parent with unrealistic expectations presenting for an issue for which treatment is NOT medication, which you don't actually have time allocated in your schedule to provide. Explaining this to the parent is almost always futile, and refusing to give them a medication will likely result in a complaint to the hospital or other system that employs you -- creating additional work you don't have time for. If by chance you somehow manage to get them to understand and not piss them off, they'll still not likely continue with therapy and continue to follow-up with you every other month to complain about the same issues already discussed and wonder why you're not giving a pill to fix it.

It's a special kind of hell, really. Sometimes it isn't like this and you really do good things to help a child and family.

 

[hamstergang]

Now you're stuck with a patient and parent with unrealistic expectations presenting for an issue for which treatment is NOT medication, which you don't actually have time allocated in your schedule to provide. Explaining this to the parent is almost always futile, and refusing to give them a medication will likely result in a complaint to the hospital or other system that employs you -- creating additional work you don't have time for. If by chance you somehow manage to get them to understand and not piss them off, they'll still not likely continue with therapy and continue to follow-up with you every other month to complain about the same issues already discussed and wonder why you're not giving a pill to fix it.

My experience has been nothing like this for the most part. When I have patients for whom I don't think meds (or diagnoses of ADHD or bipolar disorder) are indicated, I say so and don't see them again for several months if at all. No complaints about this have ever come to my attention.

 

[shahseh22]

Thanks. I think the C/A training opened my eyes up to the whole concept of a systems approach, and in retrospect I see how incredibly useful this would have been with adult work, since adults don't live in a vacuum, either.

Ultimately, unless you're in private practice, you become, "the pill guy". Even when a medication isn't indicated and unlikely to be beneficial. Therapists who can't get anywhere with a patient -- typically for the reasons in my above post -- use a medication referral as a way out, claiming, "Maybe meds will help", when the real problem is they may just suck as a therapist. Now you're stuck with a patient and parent with unrealistic expectations presenting for an issue for which treatment is NOT medication, which you don't actually have time allocated in your schedule to provide. Explaining this to the parent is almost always futile, and refusing to give them a medication will likely result in a complaint to the hospital or other system that employs you -- creating additional work you don't have time for. If by chance you somehow manage to get them to understand and not piss them off, they'll still not likely continue with therapy and continue to follow-up with you every other month to complain about the same issues already discussed and wonder why you're not giving a pill to fix it.

It's a special kind of hell, really. Sometimes it isn't like this and you really do good things to help a child and family.

Very well summed up!

 

[whopper]

I've seen this happen a few times and out of those times when I asked the person why drop, the answer was usually that they didn't know they'd be medicating kids so much and it was something they didn't like.

I'm not trying to make it out like C&A is all about this and that medicating kids is wrong. Some kids really do need the medication, I know plenty that are effectively treated and they are all the better for it, and some excellent C&A psychiatrists, but I think in these specific fellows, they either thought their program was pushing on the medication side too much or they just weren't cut out for it. E.g. a good friend told me of the classic bad parenting so the parents blame the kid saying he must have ADHD. Which is why great C&A psychiatrists are needed to do the hard work of being able to tell if and when a medication is needed and to fight the trend of over-medicating.

Agree with Shahseh22.

 

[DD214_DOC]

I've seen this happen a few times and out of those times when I asked the person why drop, the answer was usually that they didn't know they'd be medicating kids so much and it was something they didn't like.

I'm not trying to make it out like C&A is all about this and that medicating kids is wrong. Some kids really do need the medication, I know plenty that are effectively treated and they are all the better for it, and some excellent C&A psychiatrists, but I think in these specific fellows, they either thought their program was pushing on the medication side too much or they just weren't cut out for it. E.g. a good friend told me of the classic bad parenting so the parents blame the kid saying he must have ADHD. Which is why great C&A psychiatrists are needed to do the hard work of being able to tell if and when a medication is needed and to fight the trend of over-medicating.

Agree with Shahseh22.

Unfortunately, trying to do what’s right and fighting the trend of over-medicating ultimately just creates problems for yourself. In private practice you don’t have the administrative hammer brought down upon you, but you will lose patients and possibly affect referrals and volume. Providing the treatment that’s actually indicated may reduce your actual earning potential.

I’ve beeen practicing as the only CAPS in my system and surrounding area for over 3 years now, and that is 3 years out of fellowship. I am already burned out because of all the factors mentioned. I find that I sigh due to an internal sense of dread when I realize during an evaluation or follow-up that I, clinically, need to have the, “your child doesn’t need meds / doesn’t have X diagnosis you insist he or she has / what concerns you is totally normally”, conversation, because I know what else comes along with it. I also know that I will probably be having the exact conversation with the exact same parent 6 weeks from now when they come back to me instead of the therapist I referred them to having tried absolutely none of the behavioral interventions we discussed.

I used to welcome the challenge and opportunity. Every time that it happens now, I just sigh and pause, if only for a second, to ask myself if it’s really worth the hassle or should I just do whatever they want and use the extra spare time to get home a little earlier than usual to have more time with my own family.

No idea if I wil do CAPS when I leave here.

 

[shahseh22]

Unfortunately, trying to do what’s right and fighting the trend of over-medicating ultimately just creates problems for yourself. In private practice you don’t have the administrative hammer brought down upon you, but you will lose patients and possibly affect referrals and volume. Providing the treatment that’s actually indicated may reduce your actual earning potential.

I’ve beeen practicing as the only CAPS in my system and surrounding area for over 3 years now, and that is 3 years out of fellowship. I am already burned out because of all the factors mentioned. I find that I sigh due to an internal sense of dread when I realize during an evaluation or follow-up that I, clinically, need to have the, “your child doesn’t need meds / doesn’t have X diagnosis you insist he or she has / what concerns you is totally normally”, conversation, because I know what else comes along with it. I also know that I will probably be having the exact conversation with the exact same parent 6 weeks from now when they come back to me instead of the therapist I referred them to having tried absolutely none of the behavioral interventions we discussed.

I used to welcome the challenge and opportunity. Every time that it happens now, I just sigh and pause, if only for a second, to ask myself if it’s really worth the hassle or should I just do whatever they want and use the extra spare time to get home a little earlier than usual to have more time with my own family.

No idea if I wil do CAPS when I leave here.

I'm having the same struggles myself. I feel like a lot of the therapy is given to me as a responsibility as a fellow who is starting. I really think I've made a big mistake going into C&A. The hours of paperwork and talking to parents to fulfill their expectations is draining. I'm spending double the time I would be spending with adults. I really just want to quit because I'm in way over my head. I'm hoping it will get better after I do my inpatient months.

 

[DD214_DOC]

I'm having the same struggles myself. I feel like a lot of the therapy is given to me as a responsibility as a fellow who is starting. I really think I've made a big mistake going into C&A. The hours of paperwork and talking to parents to fulfill their expectations is draining. I'm spending double the time I would be spending with adults. I really just want to quit because I'm in way over my head. I'm hoping it will get better after I do my inpatient months.

I think the therapy being given to you will be useful, evne though you're not likely to really be providing, "therapy", per se as an attending. You can still try to provide some non-medication interventions in the time of your appointments, as long as your office staff is efficient and you get enough. The experience is more useful, I think, in being able to really understand what's going on in the relationship and family dynamics to recognize what actual treatment should occur. Since you'll rely on other clinicians to provide the therapy, having the experience and understanding from doing it yourself makes it easier to know when the therapist you're relying on is an incompetent *****. If you're in an interdisciplinary setting, you'll also become the go-to person when someone needs help with a case, as well as the de facto dumping ground for, "all the stuff that's hard". Many therapists use the, "maybe meds will help", way to dump patients they can't figure out, help, or know what to do with.

One piece of advice: it's not your job to fulfill parental expectations, although it certainly feels like it and is often tempting when you're just drained from CAPS. Our job is to manage their expectations, feedback to which they can either accept or not. If they don't like it, they're always free to go elsewhere for care.

Second piece of advice that makes CAPS work easier: become comfortable with pissing people off.

 

[shahseh22]

I think the therapy being given to you will be useful, evne though you're not likely to really be providing, "therapy", per se as an attending. You can still try to provide some non-medication interventions in the time of your appointments, as long as your office staff is efficient and you get enough. The experience is more useful, I think, in being able to really understand what's going on in the relationship and family dynamics to recognize what actual treatment should occur. Since you'll rely on other clinicians to provide the therapy, having the experience and understanding from doing it yourself makes it easier to know when the therapist you're relying on is an incompetent *****. If you're in an interdisciplinary setting, you'll also become the go-to person when someone needs help with a case, as well as the de facto dumping ground for, "all the stuff that's hard". Many therapists use the, "maybe meds will help", way to dump patients they can't figure out, help, or know what to do with.

One piece of advice: it's not your job to fulfill parental expectations, although it certainly feels like it and is often tempting when you're just drained from CAPS. Our job is to manage their expectations, feedback to which they can either accept or not. If they don't like it, they're always free to go elsewhere for care.

Second piece of advice that makes CAPS work easier: become comfortable with pissing people off.

I agree it's good to know how to do. I really struggle with this piece. I find therapy very draining and complex. my adult residency was largely med management based. We hardly had any supervision for therapy. To be honest, I was not interested in it either.

What's even shocking to me is how little I am relating to children and their families during family meetings. I feel like I have a hard time communicating with young kids and with teenage girls. I honestly think my personality is mostly fitted for adults doing med management appointments (more like the VA population). I feel like I really really suck at this. I'm kind of shocked it's taken me as long as my first year of fellowship to realize this. During our mainly outpatient child experience as third years, I was seeing primarily straightforward ADHD cases and Depression. Doing almost no therapy with good results with just meds.

 

[MedMan80]

I agree it's good to know how to do. I really struggle with this piece. I find therapy very draining and complex. my adult residency was largely med management based. We hardly had any supervision for therapy. To be honest, I was not interested in it either.

What's even shocking to me is how little I am relating to children and their families during family meetings. I feel like I have a hard time communicating with young kids and with teenage girls. I honestly think my personality is mostly fitted for adults doing med management appointments (more like the VA population). I feel like I really really suck at this. I'm kind of shocked it's taken me as long as my first year of fellowship to realize this. During our mainly outpatient child experience as third years, I was seeing primarily straightforward ADHD cases and Depression. Doing almost no therapy with good results with just meds.

You're not alone in feeling this way, therapy isn't easy; but it's best to get the experience while you're in training. I also find CAP pretty draining and managing parental expectations is different as we have expectations to see many patient's each month, even in fellowship. However it has improved my ability to be a psychiatrist overall I would say.

 

[shahseh22]

You're not alone in feeling this way, therapy isn't easy; but it's best to get the experience while you're in training. I also find CAP pretty draining and managing parental expectations is different as we have expectations to see many patient's each month, even in fellowship. However it has improved my ability to be a psychiatrist overall I would say.

In what ways do you think it has improved your ability to be a Psychiatrist overall? Thanks for the validation by the way. I felt like I was the only one struggling with being able to talk to kids. I think part of the reason I struggle so much is because I had a very atypical childhood (was the eldest sibling with a huge age difference, almost a third parent, financial struggles etc.) I have a hard time relating to children or even playing with them as I never had toys when I was younger.