NeuroKlitch

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PGY2 here. Hope this isn't a stupid question , but it seems to me that forensic psychiatrists who don't choose to practice exclusively on inpatient forensics units seem to do Forensics work as part time . Is that correct? What does a "full schedule " look for a forensic psychiatrists in a private practice . Is it bread and butter normal outpatient work with the occasional forensics case or evaluation? How time consuming are those cases generally and how do you work around or with ur regular outpatient patients ? I've been posting alot more than recent trying to figure out if fellowship is for me or not. Are US imgs at a significant disadvantage in this career path (in terms of getting high paying cases as opposed to being accepted to fellowship). any insight would be appreciated .
 
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whopper

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There will even sometimes daily be incidents where your forensic training comes into play setting you apart and more trusted vs psychiatrists without the training.

But what I think you're referring towards is actually specific work that only forensic psychiatrists are expected to do such as expert witness testimony, depositions, forensic evaluations etc.?
This ranges from hardly ever to daily.

Even most of the top forensic psychiatrists did regular clinical psychiatry. It's not surprising why. You want to keep your clinical skills sharp. E.g. Doug Mossman, a Guttmacher award winner, and churning out publications with high volume, plus being a professor within U of Cincinnati's medical school but also law school, still saw outpatients several days a week.

IMGs earning less? I don't think there's enough of an infrastructure within forensic psychiatry to get a hold of people within the field and show this phenomenon is happening. I do think a court, and lawyers will be more impressed with what the doctor's done in the last 5-10 years instead of where they went to school.

How time consuming? Can be very very consuming. It's also at times hard to work around patients. You could get called in to do expert witness work and given a time and date to appear in court in a manner that just wrecks your schedule. I've had it happen. A colleague of mine in the same office is a forensic psychiatrist and we usually have morning coffee. A few times we've whined to each other that these court things are a pain in the butt. You get called in for court, for example, and you got to drive to court, takes about 30 minutes to just get in there cause all the security, then you wait a few hours, etc.

And yes you bill for the entire thing, but sometimes lawyers refuse to pay you despite that you already had an agreement and they themselves are billing for things like waiting in court, but oh you're a doctor so you don't get to do it but we do....!
 
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splik

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In general you’re expected to do at least 50% clinical to maintain your credibility as as a clinical psychiatrist (as forensic experts are clinical experts first and foremost) but it will depend on what kind of work you do. But it is rare for people starting out to do mostly expert witness work whereas people at the end of their careers may exclusively do that type of work. I spend 10-25% of the time on forensic work (usually closer to 20%). Often you can make the same or more doing clinical work as doing forensic work though you get paid for record review and report preparation etc which can be done from your own bed which is nice. You need to have an attention to detail be able to read thousands of pages worth of records and watch tedious videos or listen to hours of audio recordings end write often long reports (reports should be concise but detailed ones can be 30+ pages sometimes). Most cases do not go to trial or deposition but you must be prepared to testify.

Being an IMG does not impact how much you could charge though obvious pedigree does matter to attorneys but the most important thing is you do good work. That said, sometimes trainees have this idea that you can make bank doing forensics. Well, you can but it is not a given, can take years to establish yourself, and you can make even more just doing clinical work in certain markets. I would never be able to charge what I get for seeing patients for forensic work at this stage in my career. It is also much easier just to see pts. But I find the work very intellectually stimulating and it is nice to have variety. That said, I also find it dull to summarize hundreds of pages of records and my favorite cases are where I get paid to do nothing and/or don’t have to write a report.
 
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psyguru

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I see patients 3 days a week and do Forensics twice a week. So far all my clinical jobs are not too busy so conducive to a lot of forensic work.. I may go down to doing clinical work 2 days a week. I don't have a private clinical practice but my Forensics rate is about 2.5 my clinical hourly (about 3.3 x for testifying). My clinical rate is above average. My forensic income is about 50% my income. From my estimate, a psychoanalyst in LA would charge less than I would hourly (except maybe those rare Psychiatrists who serve the top 1% at $1000/hr). I have raised my rate due to the growing demand but that could be a function of geography and my robust marketing. Most forensic psychiatrists do not focus on optimizing rapid practice growth and patiently wait establishing themselves via word of mouth. Also it is conceptualized as a side-gig by many. I also mostly do civil cases and am able to turn down cases that try to offer me less or cap my hours due to the volume. Regarding geography, I do get out of state cases and may even get a Canadian case. You could gross over 200k and only testify or get deposed about 5 times a year. Attorneys do ask me about availability for testifying and usually honor my request for 6 weeks notice to change a clinic day. I don't think my situation is the usual. I do invest in practice development, both time and otherwise, and have a unique 3rd board certification. Fyi I am a US IMG. It is possible my geography, marketing, 3rd board certification and faculty appointment may neutralize the lack of a US med school and non-ivy pedigree. Practice development is not only for income. It is to obtain a variety of cases to gain experience and also I enjoy it. I don't think I could go back to FT clinical. I like the variety and to be my own boss.
 
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heartsink

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I recently heard from a mid-career forensic psychiatrist that practices in a large city on the west coat and they claimed they were "100%" forensics, with zero regular clinic patients. They were apparently busy enough with forensic work that they did not need to do clinic work and apparently had not yet run into an issue of their clinical skills atrophying. It sounds like this psychiatrist is an outlier, but is this considered risky with regard to lawyers attacking your credibility?
 

splik

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I recently heard from a mid-career forensic psychiatrist that practices in a large city on the west coat and they claimed they were "100%" forensics, with zero regular clinic patients. They were apparently busy enough with forensic work that they did not need to do clinic work and apparently had not yet run into an issue of their clinical skills atrophying. It sounds like this psychiatrist is an outlier, but is this considered risky with regard to lawyers attacking your credibility?
It depends on what kind of cases you are doing. If you are primarily doing criminal work (e.g. competency evals, criminal responsibility, mitigation, violence risk assessment, or sex offender risk assessments) then having a lot of experience doing these evaluations matters more and it doesn't really matter if you are doing any clinical work. For disability work it probably doesn't matter much either. If you are doing malpractice cases, then it matters alot. In some states, the law specifically requires an expert to do 50% or more of their work as clinical. However it is not uncommon for senior/retired psychiatrists to only do malpractice type cases and no clinical work. For civil cases, it might depend on the case but a good attorney will want someone who has a lot of clinical experience with whatever is at issue (e.g. TBI, PTSD, FND). There are some notable examples of forensic psychiatrists who don't do any clinical work (e.g. Park Dietz) but they are the exception that proves the rule. Also sometimes experts might be academics with more of a research background. There are obviously a number of ways to establish expertise and seeing lots of patients with x is one way. Having done a lot of medicolegal work with y is another. Having been on the DSM-5-TR committee for a diagnosis, teaching students/residents/physicians, written some guidelines, held leadership positions in professional organizations, written books, published papers etc are still others.

There will always be something lawyers will attack your credibility about. At my stage I get attacked for being "young and inexperienced" where as those who have done a lot of expert witness work will be impugned as "hired guns". You just have to be prepared for the critiques and inoculate against it before voir dire or cross-exam. Somethings will be a given. You will always be asked how much you charge and how much you've made off this case, so it is better for your retaining attorney to bring it up before opposing counsel does.
 
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psyguru

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It is possible to be 100% Forensics. I see it is more common amongst Forensic psychologists. I know of one west coast Forensic Psychiatrist who is close to 100% Forensic and does a few hours pro-bono nursing home care a month and gives the appearance he is clinically active. Attorneys usually will not ask specifics about patient volume. If you are a med director and purely admin work, Attorneys will assume you treat patients. Usually the ones who are 100% Forensics get so much business or they are close to retirement.
 
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