Having trouble deciding whether do to a Child Fellowship?

[kitsens]

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PGY3 year is here and I cannot decide whether to do a Child Fellowship. There are definitely aspects of it I enjoy (the developmental aspects) and it is only one more year of training.

Not sure if I want to see children, but it sounds like some c/a psychiatrist mostly see adults.

Some camps say, "do the fellowship it ll open tremendous opportunities." other say, "whatever opportunities are there within five years of being an adult attending they won t be substantial."

additionally, fourth year has the potential to have it s own tremendous growth if i don t do a fellowship with the new found time I will have on my hands to consolidate many years of information. not to mention with that extra year i could always if i decide to do a forensics fellowship.

Not concerned about the extra year per se but wanted to hear from people in "real world" whether it makes substantial differences in money, opportunity, and other factors.

 

[Chimed]

PGY3 year is here and I cannot decide whether to do a Child Fellowship. There are definitely aspects of it I enjoy (the developmental aspects) and it is only one more year of training.

Not sure if I want to see children, but it sounds like some c/a psychiatrist mostly see adults.

Some camps say, "do the fellowship it ll open tremendous opportunities." other say, "whatever opportunities are there within five years of being an adult attending they won t be substantial."

additionally, fourth year has the potential to have it s own tremendous growth if i don t do a fellowship with the new found time I will have on my hands to consolidate many years of information. not to mention with that extra year i could always if i decide to do a forensics fellowship.

Not concerned about the extra year per se but wanted to hear from people in "real world" whether it makes substantial differences in money, opportunity, and other factors.

Questions about these kinds of decisions are always difficult to respond. My thought would be not to do a C/A fellowship because you're hoping it would make a difference in money or opportunity unless you really want to work with kids and parents. Historically C/A psychiatrists can demand a higher salary. And while this is still likely true, it seems like the adult and child salaries are becoming closer. You said that you're not really sure you want to work with kids. If you're not, perhaps you can get more experience working with that population to help you decide. One thing to remember is that you can do your 4th year in adult and still do the child fellowship if you decided that's what you really want to do.

I know it's difficult to choose a road sometimes. But just pick one path, commit to it, and remember you can always make changes. Best of luck.

 

[alina_s]

I don't think that the difference in money after child fellowship is substantial. There is sometimes a
small salary premium- from the ads, some agencies, especially government, will add 5% for additional board certification/eligibility- but it would take a very long time for that to make up for the extra year of resident salary. The difference in job options depends on what you decide you want to do- working exclusively with kids will narrow your options, most employers seem to prefer someone who is comfortable seeing adults and kids, whoever comes along. Having been on the interview trail recently, I've come across some employers who don't seem to understand/value specialization at all and are searching for a psychiatrist who can treat kindergarten to 80 year olds from adjustment disorder to combat-related PTSD, preferably authorized to prescribe suboxone. I guess some people must be comfortable with that range but I'm not. After fellowship, I feel more comfortable with adults than I did at the end of 3rd year, so some of the experience does translate, but I feel less comfortable with geropsych. I agree with Chimed, but in favor of doing the fellowship now 1) it cuts a year off the total training and 2) I would find it extremely hard to re-enter training after being out for a few years.

 

[billypilgrim37]

The best and really only reason to do a child fellowship is because you want to be a child and adolescent psychiatrist. It's approximately that simple. You can still see adults, but you will be seeing adults with the benefit of much more understanding of development. You will have a much better understanding of ADHD in particular than your adult colleagues. Your understanding of the effects of trauma will be much richer.

As a CAP fellow, my entirely biased and mildy irrational opinion is that being a CAP is simply being a complete psychiatrist. Don't do it for income. Don't do it for vague opportunities that may or may not exist in the future. Do it because that's what you want to be. That's the only reason to do any fellowship in psychiatry, because, besides forensics, none of them are a slam dunk to pay for themselves.

 

[whopper]

I've written this before.

Based on data on the avg salary of a C&A psychiatrist vs. a general psychiatrist, and factor in that you're losing 1-2 years of attending salary vs. fellow salary (and this difference could be over 100K), it's going to take something on the order of 10-15 years (I'm basing this on memory, I actually did the calculation on a prior thread) for it to be financially worth it all things being equal.

But things usually aren't equal. Your student debt is likely going to not get reduced much, it's another 1-2 years of you taking orders and being treaed as a modern day indentured servant, and if you got started earlier, if you put the money into wise investments you could be losing far more than the attending salary.

If you worked as hard as a typical fellow as an attending, I'd say you'd make far more than the typical psychiatrist. I'm arguing more than 200K, maybe even 250K if you're savvy and lucky given that most fellows do far more than 40 hours a week.

Only do it if you want to treat children and/or want to broaden your horizons in this field. If you're after the money, you'll do far better in actually reading up on some business books on the side and figuring out how to run a private practice.

I know of 2 attendings that went into child fellowship and hated it. They dropped out. Don't do it unless you have some interest in it.

 

[vistaril]

I've written this before.

Based on data on the avg salary of a C&A psychiatrist vs. a general psychiatrist, and factor in that you're losing 1-2 years of attending salary vs. fellow salary (and this difference could be over 100K), it's going to take something on the order of 10-15 years (I'm basing this on memory, I actually did the calculation on a prior thread) for it to be financially worth it all things being equal.
QUOTE]

child psych private practice though in the right area with the right need is one area where it is feasible to do both cash pay and fairly high volume(ie adhd med mgt) at the same time......not guaranteed, but possible. I've heard of some child people doing much better than their adult counterparts under this model....

in adult it is possible to do cash pay to some degree, but it's pretty damn hard to do cash pay and high volume cash pay....in child with the right pt population(middle class and upper middle class adhd kids) it is more possible and also not as location dependent as adult.

 

[Dapplegrey]

Don't do C&A psychiatry for any other reason than enjoying it, money is there either way. I hated my C&A rotations and love adult psychiatry...I'm definitely not hurting for cash. The C&A psychiatrists I graduated with originally took only "cash, check, or charge" but all have since joined insurance panels and are seeing mostly adult patients. Nowhere else in the medical field can doing a year of child count toward adult board eligibility. It's like getting credit for a 3rd year pediatrics residency satisfying an internal medicine residency. I'm much more competent to treat adults than my C&A counterparts.

 

[hamstergang]

I'm much more competent to treat adults than my C&A counterparts.

Do you feel that your 4th year in residency helped you that tremendously? I mean, I can see some confounding variables if your rating of competency is to be trusted (they spent the last 2 years of residency treating C&A, not adults, they enjoy working with the C&A population more than adults presumably), but I'm debating for myself still what the value of the 4th year is when considering when to start the C&A fellowship.

 

[billypilgrim37]

but I'm debating for myself still what the value of the 4th year is when considering when to start the C&A fellowship.

It would depend a whole lot on the particulars at your program. At my program, I'm pretty sure I lost absolutely nothing that I couldn't also pick up in the fellowship. Even as a child fellow, right now I'm working at a methadone clinic, moonlighting in the ER, working at the college counseling center, working at an LGBT specialty clinic*, and an early psychosis program that covers pretty much from 13 to 30 in addition to somethings that are only child. I'm not sure what I would get in an adult 4th year that doesn't overlap with what I'm doing now.

*Tonight I had to involuntarily commit a transgendered vampire (drinks a few vials of blood weekly from willing donors).