How do I know if pursuing a child fellowship is right for me?

[UnderGrad]

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I'm a PGY-2 in my general psych residency. I've been trying to think about my future career plans, and at this point (who knows when/if this will change), I am thinking about doing general private practice in a remote rural area. I feel very passionately about going back to my roots and providing a much-needed specialty for such an underserved population. The area where I'm considering has 1 psychiatrist in about a 60 mile radius. The closest child psychiatrist is a 3 hour trip away. Because of this, I would find myself treating people of all ages, including kids and geriatrics. I am not interested in only treating kids, but after talking to the general psychiatrist in this area, I feel like a general psychiatry residency won't prepare me adequately to take care of the patient population I'm dealing with. I feel like for me to take good care of kids (based on what this guy has told me -- who feels completely overwhelmed), that I will need a child fellowship.

My fear is that if I DO complete a child fellowship, I am going to be so drowned with child cases that it won't leave me time for anything else.

Does anyone have any input on this? Considering what I want to be doing, is a fellowship going to be "worth it" if I don't plan on specifically making child my main practice?

Thanks for the input.

 

[doctor4ever]

I’m a 1st year child psychiatry fellow (PGY-4). After starting child psych I realized how different it was from adult and geri. Children are much more difficult to diagnose and treat. I plan on treating adults, geri, and peds. It’s worth the extra year in training to be sure that you can treat kids. In fact, I think the extra training will make me a better adult psychiatrist.

 

[UnderGrad]

Thanks for the input. What do you think about me being "overrun" with kids' cases? Do you think that will happen?

 

[OldPsychDoc]

Thanks for the input. What do you think about me being "overrun" with kids' cases? Do you think that will happen?

It will depend very much on how much control you exercise over your own practice. If you are good at setting limits, have some control over your own schedule, and have good support staff you don't have to get overrun by anything. If you're salaried by someone else who tells you how many of what case you have to see, you may feel overrun.

 

[MBK2003]

I agree with OPD, there are ways to exert control over your practice where you can retain a spectrum of patient ages. This is where you should rely on a good mentor to help you ensure that the practice situation you are signing onto/into when you leave fellowship is exactly what you want and will give you that level of control/support.

Things to think about -
1) Will you only see kids during certain days of the week or certain time slots?
2) Can your support staff help you accumulate a list of good community therapists who deal with kids, kids & adults, kids & families, and adults, so that you can refer your psychopharm clients to someone for good therapy?
3) Do you feel comfortable offering outpatient consults to local PCPs, so that they can continue to manage the kids or adults, leaving your ongoing treatment slots for the more complex cases? And will your support staff make this an easy proposition (e.g. making sure all the info and records are obtained prior to the consult, sending your note to the PCP without you needing to spend extra time on correspondence, setting up the therapy referral if needed, etc).

It's totally doable, and I would also recommend the 2 years of child fellowship if you are going to be practicing in a location where there's limited access to other child psych. You'll feel much more comfortable and be able to utilize the developmental perspective in your adult patients as well.

Good luck!!

 

[sydney1]

I have a HUGE question about child psych. I would really appreciate any and all answers especially from people doing child/adolescent work..

My background: I am a community pediatrician who has always had a interest in psychosocial aspects of illness and child development. I am intrigued by the obesity epidemic, increase in diagnosed autism, varying parenting styles, epidemic of ADHD diagnosis etc. General pediatrics was too boring and fast paced (ie 30-35 patients a day 20 of which were viral uri's or gastoenteritis in the winter) with not as much continuity as I expected. Importantly, there wasn't adequate time to adress the children's REAL problems ie depression, obesity, learning disability, sleep issues etc. I know this sounds strange but I also enjoy complex medical problems, like seen in crital care/neonatology for instance. I have considered a career in neonatology but worry about the rigorous lifestyle (lots in house call etc.)

Interestingly, I have recently entertained the idea of child psych after hearing that pediatricians (via peds portal project) can train in 3 yrs to be child/adult psychiatrists. Where will those programs be?? I hear some may be eligible to start in July 2008. Does anyone know anything about these??

Also, What is being a child psychiatrist like in private practice. I get bored easily so is it stimulating enough??? or millions of ADHD medchecks?? Can you adress some of these pediatric issues ie obesity etc? Is being a psychiatrist mentally draining?? Would being a pediatrician and child psychiatrist help with employment opportunities? Can you do academics and NOT get paid miserbly and have half of your salary depend on next years NIH grant?? Is it easy to set up a private practice in child psych?? How is the billing?? In peds it is a nightmare if you do it yourself.

I know this is a lot of questions but thanks

 

[sydney1]

I have a HUGE question about child psych. I would really appreciate any and all answers especially from people doing child/adolescent work..

My background: I am a community pediatrician who has always had a interest in psychosocial aspects of illness and child development. I am intrigued by the obesity epidemic, increase in diagnosed autism, varying parenting styles, epidemic of ADHD diagnosis etc. General pediatrics was too boring and fast paced (ie 30-35 patients a day 20 of which were viral uri's or gastoenteritis in the winter) with not as much continuity as I expected. Importantly, there wasn't adequate time to adress the children's REAL problems ie depression, obesity, learning disability, sleep issues etc. I know this sounds strange but I also enjoy complex medical problems, like seen in crital care/neonatology for instance. I have considered a career in neonatology but worry about the rigorous lifestyle (lots in house call etc.)

Interestingly, I have recently entertained the idea of child psych after hearing that pediatricians (via peds portal project) can train in 3 yrs to be child/adult psychiatrists. Where will those programs be?? I hear some may be eligible to start in July 2008. Does anyone know anything about these??

Also, What is being a child psychiatrist like in private practice. I get bored easily so is it stimulating enough??? or millions of ADHD medchecks?? Can you adress some of these pediatric issues ie obesity etc? Is being a psychiatrist mentally draining?? Would being a pediatrician and child psychiatrist help with employment opportunities? Can you do academics and NOT get paid miserbly and have half of your salary depend on next years NIH grant?? Is it easy to set up a private practice in child psych?? How is the billing?? In peds it is a nightmare if you do it yourself.

I know this is a lot of questions but thanks

 

[MBK2003]

Interestingly, I have recently entertained the idea of child psych after hearing that pediatricians (via peds portal project) can train in 3 yrs to be child/adult psychiatrists. Where will those programs be?? I hear some may be eligible to start in July 2008. Does anyone know anything about these??

My fellowship program has applied to be a peds portal site and we currently have a pediatrician who's returning part-time for a psych/child psych residency (paid for by his home hospital). My sense is that these are potentially a great training opportunity for people who envision a career in child psychiatry or child behavioral health.

Also, What is being a child psychiatrist like in private practice. I get bored easily so is it stimulating enough??? or millions of ADHD medchecks??

It's as interesting as you structure it, if you just want to be the Adderall XR dispensing machine, you can do it 🙂eek🙂 but most of child psychiatry is not boring and private practice can remain exciting if you learn how to refer kids back to their PCP when the med regimen is stable and sxs are in remission.

Can you adress some of these pediatric issues ie obesity etc?

Absolutely, we have a C&A psychiatrist on staff whose expertise is obesity and C/L issues. She consults to a state-wide initative to lower childhood obesity rates and is the guru we turn to when kids get fat on their meds.

Is being a psychiatrist mentally draining??

Not for me, but others can weigh it. You learn your countertransferences and your limits. I definitely don't lay awake at night worrying about my patients, but I do have the new experience (now that I moved to a smaller locale) of occasionally going to the mall with my kids and running into my patients.

Would being a pediatrician and child psychiatrist help with employment opportunities?

Yup, although there will be more demand on you (depending on where you decide to live) to be a full-time child psychiatrist. My training director and another attending are triple-boarders. They have the peds expertise, but don't practice pediatrics, just child psych.

Can you do academics and NOT get paid miserbly and have half of your salary depend on next years NIH grant??

You can do clinical academic track and get paid miserably as a full-time position, but then (depending on the institution's policies about private practice) leverage the academic affiliation for a full-fee part-time private practice.

Is it easy to set up a private practice in child psych?? How is the billing?? In peds it is a nightmare if you do it yourself.

There are computer programs to bill insurance, although the time consuming thing is not the billing but rather the authorization for additional visits (the dreaded OTRs) that are specific to mental health managed care. I know very few private practice child psychiatrists who take insurance, most are full-fee or sliding scale cash.

Hope this helps!

 

[sydney1]

that was VERY helpful