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How does one make themselves most competitive for post-residency jobs outside of their residency's region?

Psychferlyfe3000

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Hello again SDNers,

I will be attending a Midwest residency program, but would like to end up in California in a "highly desirable" city such as San Francisco, Los Angeles or San Diego. My program is university and in the top 40% of programs, but is not a HUGE name-brand. Does anyone have any tips on how I can make myself most competitive for getting a job in these cities considering I cannot make local connections very easily from the other side of the country? I am just very desperate for more sunshine in my life! Thank you for any advice.
 
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CalmAndCollected

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Hello again SDNers,

I will be attending a Midwest residency program, but would like to end up in California in a "highly desirable" city such as San Francisco, Los Angeles or San Diego. My program is university and in the top 40% of programs, but is not a HUGE name-brand. Does anyone have any tips on how I can make myself most competitive for getting a job in these cities considering I cannot make local connections very easily from the other side of the country? I am just very desperate for more sunshine in my life! Thank you for any advice.
Not at that point yet myself, but I have met many recent residency grads (from different specialties) come from many different parts of the country to California after residency, both in academic and non-academic settings.

If you are really concerned about your chances of getting a job in California, you could always do a fellowship (particularly if you are interested in academic centers). Fellowships in psych aren’t anywhere near as competitive as residency, and you are very likely to land a good one.

I don’t predict you will have any issues either way.
 
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Psychferlyfe3000

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I always try to be personable in interviews (as well as outside of them). But, my best efforts at being personable didn't get me over there this time around. So, I'm hoping to try to complement those efforts next time with whatever I can!

Be personable when you interview. Be well rested when you interview.

Better yet, skip CA, and go to any of the other places that have sunshine.
 

Psychferlyfe3000

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I would love to end up at an academic center over there. That's the dream. I had assumed that fellowships over there would be more competitive than jobs, or is that a wrongheaded assumption?

Not at that point yet myself, but I have met many recent residency grads (from different specialties) come from many different parts of the country to California after residency, both in academic and non-academic settings.

If you are really concerned about your chances of getting a job in California, you could always do a fellowship (particularly if you are interested in academic centers). Fellowships in psych aren’t anywhere near as competitive as residency, and you are very likely to land a good one.

I don’t predict you will have any issues either way.
 

CalmAndCollected

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I would love to end up at an academic center over there. That's the dream. I had assumed that fellowships over there would be more competitive than jobs, or is that a wrongheaded assumption?
Outside of child, fellowships in psychiatry don’t generally make you more money the same way doing an IM fellowship would, for example. Most people pursue fellowships for high interest in those specific fields, because they want to work in a highly specialized area, or because they would like to enter academia in that specific subfield.

This means that your average psych fellowships is never that competitive, and you have a good chance to get into a top tier program even if you didn’t go to a top tier residency. If you don’t believe me, feel free to check out the background of those attending fellowships across California.
 
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Monocles

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If you're deadset on cali, other than fellowship which has been mentioned above, could always consider doing some sort of away rotation during pgy-4 year for a couple of months to

1) decide if you like living in cali
2) make some connections with attendings, friends, etc who would be able to write you recs or hook you up with jobs
 
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myPsychAlt

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Outside of child, fellowships in psychiatry don’t generally make you more money the same way doing an IM fellowship would, for example. Most people pursue fellowships for high interest in those specific fields, because they want to work in a highly specialized area, or because they would like to enter academia in that specific subfield.

This means that your average psych fellowships is never that competitive, and you have a good chance to get into a top tier program even if you didn’t go to a top tier residency. If you don’t believe me, feel free to check out the background of those attending fellowships across California.

Plus you've got the "living in the Bay Area/LA on a PG5 salary" that holds down the desirability of places like UCSF/UCLA/wherever.
 
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Orgone

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As others have said, this is a non issue. The jobs will be waiting for you. You're about to start intern year and should be worrying about that.

Actually you shouldn't do that either, just go do something fun for the next 5 weeks.
 
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Trismegistus4

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California is a big state.... you can get licensed and get a job in a less desirable area before you move to your dream city
Yeah, when I was doing locums, I took an assignment in an "undesirable" area of California, and then while I was there, the locums agency wanted to pitch me to a hospital in the Bay Area. So it doesn't seem too difficult to "pivot" like that.
 
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psyguru

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Outside of child, fellowships in psychiatry don’t generally make you more money the same way doing an IM fellowship would, for example. Most people pursue fellowships for high interest in those specific fields, because they want to work in a highly specialized area, or because they would like to enter academia in that specific subfield.

This means that your average psych fellowships is never that competitive, and you have a good chance to get into a top tier program even if you didn’t go to a top tier residency. If you don’t believe me, feel free to check out the background of those attending fellowships across California.
Forensics is another exception. I would argue you could make more with that then child...unless you do both child and forensics. It's not guaranteed and requires a well-marketed expert witness practice.
 
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CalmAndCollected

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Forensics is another exception. I would argue you could make more with that then child...unless you do both child and forensics. It's not guaranteed and requires a well-marketed expert witness practice.
Theoretically, any psychiatrist can build a practice that makes well over the average psychiatrist salary. Anecdotally, we all hear of the one forensic psychiatrist who makes over 500k a year doing nothing except being an expert witness, but my understanding is that, in practice, psychiatrists who did a forensic fellowship have the same average earnings as a psychiatrist without it.
 

psyguru

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Theoretically, any psychiatrist can build a practice that makes well over the average psychiatrist salary. Anecdotally, we all hear of the one forensic psychiatrist who makes over 500k a year doing nothing except being an expert witness, but my understanding is that, in practice, psychiatrists who did a forensic fellowship have the same average earnings as a psychiatrist without it.
It is not impossible to do without the forensic fellowship but it would be harder. For starters, some jurisdictions require forensic board-certification or CMEs to do criminal work. Other than IMEs with less challenging medico-legal questions (disability), there are other non-criminal evaluations that would require dedicated self-learning and possibly a mentor. So it would take some time to have a comfort level on taking a wide variety of cases. So if you have forensic board-certification in maybe possible to bill a higher hourly rate with the forensic background as well and to get a wider variety of cases.
 

CalmAndCollected

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It is not impossible to do without the forensic fellowship but it would be harder. For starters, some jurisdictions require forensic board-certification or CMEs to do criminal work. Other than IMEs with less challenging medico-legal questions (disability), there are other non-criminal evaluations that would require dedicated self-learning and possibly a mentor. So it would take some time to have a comfort level on taking a wide variety of cases. So if you have forensic board-certification in maybe possible to bill a higher hourly rate with the forensic background as well and to get a wider variety of cases.
I meant in general, not just through being an expert witness.
 

psyguru

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I meant in general, not just through being an expert witness.
Outside expert witness work, the fellowship is not crucial unless you want a fast track to leadership positions in prisons or state hospitals. Those roles may come with a 10% (and in rare cases 30%) pay raise. However, more than that could be made as an expert witness. Aside from pay, forensics is interesting.
 

romanticscience

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Theoretically, any psychiatrist can build a practice that makes well over the average psychiatrist salary. Anecdotally, we all hear of the one forensic psychiatrist who makes over 500k a year doing nothing except being an expert witness, but my understanding is that, in practice, psychiatrists who did a forensic fellowship have the same average earnings as a psychiatrist without it.

Something to consider regarding forensics is the market in which you work. Where I am, the going expert rate approximates the hourly clinical rate in private practice. It's a low COL city, not NYC/LA/Boston/Chicago.

When I was starting out, I assumed that you should charge more per hour for forensic work than you would for clinical consultation. So, I got my first call from an attorney and pitched him my fee (+133% clinical). He was shocked, said it was more than the best/senior expert in my city. Not sure if he was low balling me though. I've asked some forensic colleagues and this seems right. I was seriously undervaluing my private practice rate. N=1.

I'm doing some expert witnessing work without a forensic fellowship. PM for questions. @psyguru makes a valuable point; the fellowship is best for having a general/broad forensic practice.
 
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romanticscience

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How necessary is it to do forensics fellowship to become an expert witness?

Not necessary. "Expertness" is not bestowed by a fellowship but by a combination of credential and experience. I guess it would be ultimately determined by a judge through the process of voir dire.
 
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psyguru

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Something to consider regarding forensics is the market in which you work. Where I am, the going expert rate approximates the hourly clinical rate in private practice. It's a low COL city, not NYC/LA/Boston/Chicago.

When I was starting out, I assumed that you should charge more per hour for forensic work than you would for clinical consultation. So, I got my first call from an attorney and pitched him my fee (+133% clinical). He was shocked, said it was more than the best/senior expert in my city. Not sure if he was low balling me though. I've asked some forensic colleagues and this seems right. I was seriously undervaluing my private practice rate. N=1.

I'm doing some expert witnessing work without a forensic fellowship. PM for questions. @psyguru makes a valuable point; the fellowship is best for having a general/broad forensic practice.

Next time the attorney balks at 133% your clinical rate, remind him or her that neurosurgery experts charge up to 2k an hour to testify. 133% is low. It could be for misdemeanor cases or IMEs from those IME mills that generally may go to forensic psychologists. You won't see that issue in larger cases (civil cases or homicide). I have seen Psychologists, blood splatter experts, etc charge around $250/hr. In almost all fields, I believe you should be able to charge at least double your clinical locum rate. Also with experience the rate will go up and then may plateau out. Once an opposing psychologist who was a top PTSD researcher was charging $700/hr but she did little forensic work. When I get pushback about the rate, I will pushback and tell the attorney they may want to consider a psychologist or a newbie.
 

asdf123g

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Next time the attorney balks at 133% your clinical rate, remind him or her that neurosurgery experts charge up to 2k an hour to testify. 133% is low. It could be for misdemeanor cases or IMEs from those IME mills that generally may go to forensic psychologists. You won't see that issue in larger cases (civil cases or homicide). I have seen Psychologists, blood splatter experts, etc charge around $250/hr. In almost all fields, I believe you should be able to charge at least double your clinical locum rate. Also with experience the rate will go up and then may plateau out. Once an opposing psychologist who was a top PTSD researcher was charging $700/hr but she did little forensic work. When I get pushback about the rate, I will pushback and tell the attorney they may want to consider a psychologist or a newbie.
Any place to get experience other than fellowships and rotations? Are there training programs that you can pay for certification?
 
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