heysexylady

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Before anyone asks me to do a search... I did but found nothing substantial on this board.

I'm worried because I'm an IMG...in a low tier program on the east coast. I passed all boards the first time, granted my step 1 score wasn't the greatest. I've had nothing but good evaluations from all my attendings.

Right now, I'm thinking of applying to like 15 programs.

What do you guys think?
 

splik

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waaay too many programs no one cares about your board scores or that you are an IMG it's irrelevant for fellowship - they will mainly be interested in your clinical performance during residency. if you have strong letters speak English and otherwise come across well you should be able to get into a very good program
 
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masterofmonkeys

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10% spots went unfilled. There were fewer applicants than spots. 5-10.
 
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splik

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most of those people come in wanting to do it come to their senses and run screaming the other direction. probably most or all of the top programs have questionable people in their fellowships
 

Merovinge

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most of those people come in wanting to do it come to their senses and run screaming the other direction. probably most or all of the top programs have questionable people in their fellowships
That's so grossly untrue that I can only start to address this with a few points (and a prime example why CAP folks were asking for their own subforum).

  • Getting to take care of children is a privilege in our society (evidenced by the pay of pediatric specialties being far below most equivalent adult specialties and still filling) yet CAP folks get to do it with the same or more reimbursement as adult psychiatry. You are trusted with the only thing more important than a person's own thoughts/feelings, that of their child's.
  • There are absolutely competitive folks that go into CAP and the field has big names. Harvard is not filling with IMGs who failed STEP 1 twice.
  • The effect size of your work absolutely feels bigger, although I am sure it is difficult to accurately quantify. You get to intervene early in psychopathology and prevent or lessen problems before adulthood. Early intervention >> late interventions.
  • People always complain about the parents, and they absolutely can be ruinous both to your patients ability to get better and to the provider's sanity. That said, accomplishing family therapy changes feels amazing, reminiscent of success with personality disordered adults, and even 1 win fuels me through a dozen losses.
  • When parents tell you, and you see demonstrably, that they are keeping their child because of your intervention. Well, it does not get much better than that.
I've never understood how adult psychiatrists can look down so much upon CAP. We all play for the same team, with the same drugs, similar interventions, and of course we are all boarded in adult and many of us even see some adults.
 
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heysexylady

heysexylady

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anyone got an interview?

My PD forgot to upload my CAP Eligibility training verification along with my letter of recommendation and so half the programs won't look at my application without it. One program has offered me an interview not before they get that form from my PD.

I was talking to a child fellow and he told me that he applied to like 30 programs. Now, I'm like maybe I should apply to more.
 

Merovinge

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I was talking to a child fellow and he told me that he applied to like 30 programs. Now, I'm like maybe I should apply to more.
That's pretty unheard of. Sure some people applied to 50 for adult residency too, but really common is 3-10 for CAP.
 

slappy

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Apr 1, 2014
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I cannot think of a visa issue that would necessitate applying to more than 10 programs, let alone 50. unless of course the issue is not having/being able to obtain one in which case it wouldnt matter if they applied to 100 programs! For those on an H1b most institutions will consider sponsoring visas for those who already on one, even if they claim otherwise. Being on a J1 should similarly be a non-issue.
I don't know how true this is. I think most programs that don't sponsor H1-B visas say so on their website and stick to that because it's usually institutional policy. I'm fairly certain Cambridge and UCSF don't sponsor H1-Bs?
 

splik

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I don't know how true this is. I think most programs that don't sponsor H1-B visas say so on their website and stick to that because it's usually institutional policy. I'm fairly certain Cambridge and UCSF don't sponsor H1-Bs?
well both cambridge and ucsf said they would sponsor an H1b for me so yeah... institutional policy is BS especially when all large academic medical centers/medical schools have tons of post docs and other people on H1bs. also there is usually some exclusion (there is usually some mechanism for the department chair to petition for it if the applicant is exceptional or they can't find anyone good). I can tell you that UCLA, UCSF, UCSD, UC Davis, Hopkins, Case Western, and Stanford all have GME policies of not sponsoring visas for residents and they all have done so in the past few years. Cambridge may not I have no idea whether they actually would, but they definitely haven't sponsored one for a resident/fellow in the past 4 years. The only place I know that definitely does not is NYPH, though NYPSI has done so in the past few years (not quite sure how that works...) I am talking institution wide, individual departments can of course do what they like. It is harder to get on one (i.e. as a resident), but once you are on one (i.e. applying for fellowship or faculty position) hospitals tend to be happier doing transfers.
 
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slappy

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well both cambridge and ucsf said they would sponsor an H1b for me so yeah... institutional policy is BS especially when all large academic medical centers/medical schools have tons of post docs and other people on H1bs. also there is usually some exclusion (there is usually some mechanism for the department chair to petition for it if the applicant is exceptional or they can't find anyone good). I can tell you that UCLA, UCSF, UCSD, UC Davis, Hopkins, Case Western, and Stanford all have GME policies of not sponsoring visas for residents and they all have done so in the past few years. Cambridge may not I have no idea whether they actually would, but they definitely haven't sponsored one for a resident/fellow in the past 4 years. The only place I know that definitely does not is NYPH, though NYPSI has done so in the past few years (not quite sure how that works...) I am talking institution wide, individual departments can of course do what they like. It is harder to get on one (i.e. as a resident), but once you are on one (i.e. applying for fellowship or faculty position) hospitals tend to be happier doing transfers.
That's quite interesting!
 

HooahDOc

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That's so grossly untrue that I can only start to address this with a few points (and a prime example why CAP folks were asking for their own subforum).

  • Getting to take care of children is a privilege in our society (evidenced by the pay of pediatric specialties being far below most equivalent adult specialties and still filling) yet CAP folks get to do it with the same or more reimbursement as adult psychiatry. You are trusted with the only thing more important than a person's own thoughts/feelings, that of their child's.
  • There are absolutely competitive folks that go into CAP and the field has big names. Harvard is not filling with IMGs who failed STEP 1 twice.
  • The effect size of your work absolutely feels bigger, although I am sure it is difficult to accurately quantify. You get to intervene early in psychopathology and prevent or lessen problems before adulthood. Early intervention >> late interventions.
  • People always complain about the parents, and they absolutely can be ruinous both to your patients ability to get better and to the provider's sanity. That said, accomplishing family therapy changes feels amazing, reminiscent of success with personality disordered adults, and even 1 win fuels me through a dozen losses.
  • When parents tell you, and you see demonstrably, that they are keeping their child because of your intervention. Well, it does not get much better than that.
I've never understood how adult psychiatrists can look down so much upon CAP. We all play for the same team, with the same drugs, similar interventions, and of course we are all boarded in adult and many of us even see some adults.
I take it you're still a fellow?

The reimbursement isn't any different. I use the same e/m and cpt codes as the adult providers. CAPS, however, comes with a much larger burden of ancillary work that is NOT reimbursable, so you can actually lose money on a per hour basis if you do CAPS, "properly". You can find higher salaried positions or make more doing a cash-only setup if the market will tolerate it simply due to the enormous demand and severely-limited supply of CAPS. This limited supply is maintained by both a general aversion to CAPS and a very high burn-out rate.

Doing CAPS is probably similar to this scenario: imagine you are a mechanic trying to fix someone's car, and every weekend they go home and pour water into the gas tank. Then, on Monday, they bring the car back and tell you that nothing you did worked, you're not helping at all, and demand that you fix their car immediately. If you dare point out that, just maybe, they're not properly maintaining their car, they run screaming to your manager and file a complaint against your mechanic shop. Finally, imagine that you have about 2-3 customers like this every single week....
 

Merovinge

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I take it you're still a fellow?

The reimbursement isn't any different. I use the same e/m and cpt codes as the adult providers. CAPS, however, comes with a much larger burden of ancillary work that is NOT reimbursable, so you can actually lose money on a per hour basis if you do CAPS, "properly". You can find higher salaried positions or make more doing a cash-only setup if the market will tolerate it simply due to the enormous demand and severely-limited supply of CAPS. This limited supply is maintained by both a general aversion to CAPS and a very high burn-out rate.

Doing CAPS is probably similar to this scenario: imagine you are a mechanic trying to fix someone's car, and every weekend they go home and pour water into the gas tank. Then, on Monday, they bring the car back and tell you that nothing you did worked, you're not helping at all, and demand that you fix their car immediately. If you dare point out that, just maybe, they're not properly maintaining their car, they run screaming to your manager and file a complaint against your mechanic shop. Finally, imagine that you have about 2-3 customers like this every single week....
I absolutely agree that happens. It is also a primary reason why the field is not for everyone. However there are outrageously graceful/appreciative parents (the majority unless your practice is really messed up) and like everything in medicine and particularly psychiatry, one needs to fill up on the good and let go of the bad. Also there are many annoying things in adult psychiatry I rarely have to deal with now. I almost never have an overwhelming sense of hopelessness going into a CAP case, as opposed to that being a routine basis for inpatient adult psych.

As far as reimbursement, for cash pay, you will almost assuredly do better in CAP than in adult. Salaried positions are offering around 10% higher due to scarcity and the fact that every kid in America has insurance of some kind. Reimbursement for ancillary work is a pain, but much of it can be improved by completing it only with the patient in the office, although clearly this can't always be achieved for optimal care.

Folks are SO down on CAP on this board. I came into fellowship skeptical, and frankly miserable for the first month or two. Now, I can't imagine having not done it. The environment on the aggregate is so much more positive, as is the case for basically every peds field compared to its sister adult field.
 
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heysexylady

heysexylady

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Paranoid question but what are the odds of ranking six or 7 programs and not matching?
 

PistolPete

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well both cambridge and ucsf said they would sponsor an H1b for me so yeah... institutional policy is BS especially when all large academic medical centers/medical schools have tons of post docs and other people on H1bs. also there is usually some exclusion (there is usually some mechanism for the department chair to petition for it if the applicant is exceptional or they can't find anyone good). I can tell you that UCLA, UCSF, UCSD, UC Davis, Hopkins, Case Western, and Stanford all have GME policies of not sponsoring visas for residents and they all have done so in the past few years. Cambridge may not I have no idea whether they actually would, but they definitely haven't sponsored one for a resident/fellow in the past 4 years. The only place I know that definitely does not is NYPH, though NYPSI has done so in the past few years (not quite sure how that works...) I am talking institution wide, individual departments can of course do what they like. It is harder to get on one (i.e. as a resident), but once you are on one (i.e. applying for fellowship or faculty position) hospitals tend to be happier doing transfers.
I'm a US medical grad and I can tell you from personal experience that after I was granted interviews at UC Davis, USC, and UCSD, I had to withdraw my app because I made sure to specifically point out to the PD that I needed the fellowship to continue my H1b, and they wouldn't do it due to institutional policy, even though they wanted to. "We can only do J1." Very frustrating. Your miles may vary, and things can change quickly, so make sure to ask.
 

Wilf

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  • Getting to take care of children is a privilege in our society (evidenced by the pay of pediatric specialties being far below most equivalent adult specialties and still filling) yet CAP folks get to do it with the same or more reimbursement as adult psychiatry. You are trusted with the only thing more important than a person's own thoughts/feelings, that of their child's.
This would be a little more convincing if NPs and PAs weren't seeing children and adolescent psychiatry patients without physician oversight. I have been very surprised/angered about this since starting CAP fellowship.
 

HooahDOc

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This would be a little more convincing if NPs and PAs weren't seeing children and adolescent psychiatry patients without physician oversight. I have been very surprised/angered about this since starting CAP fellowship.
You don't NEED the CAPS fellowship to see that age group, as a general psychiatrist can also do it. The added benefit of the fellowship is all of the systems theory and family dynamic/parent-child type stuff, which unfortunately isn't valued after training since more than likely you will get pushed into the extremely-limited, "prescriber" role, which really doesn't require the fellowship.
 

Merovinge

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This would be a little more convincing if NPs and PAs weren't seeing children and adolescent psychiatry patients without physician oversight. I have been very surprised/angered about this since starting CAP fellowship.
We have minimum penetration of mid levels here for CAP services. They are significantly more common in adult care than CAP and the places that do use them in CAP are using them under physician oversight (not saying those setups are ideal). I think folks with means are much more likely to want their kids to have an MD/PhD vs a mid level as no one wants to sleep at night thinking they cut corners for their kid's care. I'm sure there is geographic variability but this is actually an argument I hear as to why one should consider CAP.
 

PistolPete

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We have minimum penetration of mid levels here for CAP services. They are significantly more common in adult care than CAP and the places that do use them in CAP are using them under physician oversight (not saying those setups are ideal). I think folks with means are much more likely to want their kids to have an MD/PhD vs a mid level as no one wants to sleep at night thinking they cut corners for their kid's care. I'm sure there is geographic variability but this is actually an argument I hear as to why one should consider CAP.
Agreed.