Is geriatric Psychiatry fellowship worth it?

[Nudexta]

I have been accepted to a great IV league fellowship program in geriatrics I always had a passion to work in memory care clinics and clinical trials. I am debating going to the fellowship vs starting an adult psychiatrist attending job. Most consensus mentions that the geriatric fellowship does not add any additional income.
One thing I do like about the fellowship is the name given that I went to a community program. Kinda lost between the name/prestige vs the job and $. Any help is appreciated.

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[Shufflin]

Went through a similar experience. Ultimately decided to get the fellowship and am sure glad I did. It gives you deeper knowledge in a focused area, which comes into play on a daily basis and you will be that much better at treating those cases. Any fellowship you do will spill over into some area of psychiatry. Employers will hang on to you a bit more because you have that special background. Your pay may not go up initially, but you may be offered a leadership position down the road in which case it may boost your earnings. Your options increase. In the community you're known as that gal or guy who is the geri expert. The community is small. It adds a trump card to your hand. I just remembered that Kaiser does, or did, give an income boost to fellowship trained psychiatrists. Maybe others may as well. This may be site specific, I don't know (be cautious about working for Kaiser).

 

[Nudexta]

Thanks that was helpful. My program did provide excellent training in geriatric and I was lucky to be trained under a big name. That’s what made me passionate about it.
Shuffling, if you don’t mind where did you complete ur fellowship?

 

[SourceOfDenial]

Depends on what you want to do. You say you want to do clinical trials--if by this you mean you want to design a trial, get grand funding, be a PI, etc you need some sort of research credentials or experience doing what you want to do. A geriatric fellowship could turn into a research fellowship to hone those skills, then a CDA or NIH path, etc. It's hard to envision completing a general residency, going and taking a job, and being a part of trials unless you take a clinical job at an institution running them and learn as you go. There are a lot of geriatric research funding opportunities out there once you start looking, especially within the VA. Also, I don't know what you mean by 'clinical trials'...you talking medications? Therapeutic interventions? Or some other form of research?

A one year geri fellowship will make you a better psychiatrist(hopefully), you'll see things from a different academic perspective, and you'll grow some. That's valuable, even if it's not financially valuable for that one year.

If you just want to see patients and you already feel comfortable seeing geriatrics now...then pass.

If you'll regret not doing it, go ahead and do it.

 

[Nudexta]

I mean pharmaceutical clinical trials. I don’t know if that needs a fellowship but I would guess adding another credential helps.

 

[Shufflin]

Thanks that was helpful. My program did provide excellent training in geriatric and I was lucky to be trained under a big name. That’s what made me passionate about it.
Shuffling, if you don’t mind where did you complete ur fellowship?

Without giving too much away, I went to a top program in my given fellowship field, probably in the top 3.

 

[psyguru]

I am glad I did a forensic fellowship. Fyi with a geriatric fellowship you could possibly do non criminal expert witness work like geriatric med mal or testementory capacity. In fact, the testamentary capacity lecture in my fellowship was given by a geriatric psychiatrist.

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[clausewitz2]

I am glad I did a forensic fellowship. Fyi with a geriatric fellowship you could possibly do non criminal expert witness work like geriatric med mal or testementory capacity. In fact, the testamentary capacity lecture in my fellowship was given by a geriatric psychiatrist.

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We have an attending in our department who did a geriatric fellowship and a forensic fellowship. He's the director of our psych ED now. So...hold your ultimate career plans lightly, I guess?

 

[whopper]

Fellowship will always be worth it if you want to expand yourself as a psychiatrist and you are in a great program.

But if you're not very into geriatric it might not be worth it. Financially it might not be (but that's up to you. You could profit off of it quite nicely if you play the game right).

 

[Nudexta]

I gathered some info about it and it seems that if one wants to be in an academic program like running the Geri unit at John Hopkins then it would make sense but in private practice it does not really carry much value. Things like clinical trials, geriatric consults ...etc can be still done with good pay if someone is comfortable in geriatrics during residency.

 

[SeniorWrangler]

One more factor nobody's mentioned is finances: if you're doing OK financially, there's no harm in it and it might open some doors for you.
On the other hand, don't expect people to pay you extra for a fellowship which isn't relevant to the job you're being hired for, and you're putting off earning attending-level salary for a year while your student loans keep growing.
On the third hand, if the fellowship is in a place where you'd like to practice, then it's a great way to make some connections and find out more about where you'd like to live in the area.

 

[Sushirolls]

Do it if:
1) You are just plain passionate about it.
2) Plan to open a private boutique clinic that is Medicare Non-Par (or completely opted out of medicare) and want the additional advertisement piece. As the baby boomers age, and eventually the millennials gray, there will be a large enough population base to seek out the high end services.
3) Plan to practice in academia.
4) Plan a private clinic that chases after every geriatric research study it can.

Otherwise it's just not worth the time expenditure. General psychiatry will allow you to practice how you wish. Name brand fellowships only go so far. If you step on the wrong person's toes, you'll be nudged out and fellowship training doesn't mean anything. If the administrator of organization you work for wants to save a few pennies, you'll be replaced by an ARNP or PA. Admins don't care about clinical quality or subtle nuances that physician level training commands. They care about meeting meaningful use requirements, press ganey scores, and capturing private insurance dollars (i.e. not the medicare heavy field of geriatrics). Outside of true independent private practice, big box shop health systems, or agencies, or corporations only want a warm body to produce the widgets. In summary, a geriatric fellowship won't make you a better widget maker.

 

[Dharma]

Just a bump to see if any one has anything else to add here regarding a geri fellowship. Most seem to say not worth it if having adequate exposure during training. My geri months were not truly such and I'm wondering if I have seen enough w the exception of the tons of delirium and dementia on C/L. Did not rotate on a geri inpatient nor do I have THAT many elderly folks outpatient. So I'm wondering if an extra year could help supplement. Thoughts?

 

[michaelrack]

Just a bump to see if any one has anything else to add here regarding a geri fellowship. Most seem to say not worth it if having adequate exposure during training. My geri months were not truly such and I'm wondering if I have seen enough w the exception of the tons of delirium and dementia on C/L. Did not rotate on a geri inpatient nor do I have THAT many elderly folks outpatient. So I'm wondering if an extra year could help supplement. Thoughts?

Probably not necessary.... what are your plans after you finish training?

 

[Dharma]

Probably not necessary.... what are your plans after you finish training?

In all honesty, not 100% sure yet.

I've enjoyed a lot of my rotations in different venues. Whether I end up outpatient, inpatient, or CL (or a mix of the above) will depend upon the job offer to be honest. I've about had enough of BIG university academia (prefer community hospitals tbh) but certainly would not mind position where I can still work with students and residents (although not necessary).

I'm pretty confident I would not want to work with any one patient population and prefer a variety of pathology. So, I doubt I would go all-out geri following a fellowship.

One potential upside of the geri fellowship I'm considering is the relocation factor. Planning to move back to the NYC area and that could help establish myself there (maybe?). If I wanted to stay closer to the city (likely outerboroughs since Manhattan is saturated) the program could help.

That said, I could probably land a job in the suburbs (where I'm from) without too much of a problem right out of residency. I've already spoken with one place that fits the type I alluded to above (potential mix of roles, students, residents, community-feel, mid-sized system with educational mindset however def not big house academia). No guarantee however they're growing and there will probably still be a lot of openings when it comes time to sign on (late this year?).

So, maybe location establishment and the opportunity for extra training with a growing population- one I'm not sure I've worked enough with in a training setting.

 

[michaelrack]

Dharma, you should NOT do a geri fellowship

 

[futuredo32]

My 2 cents and it's based largely on my residency training is if you are looking to be more marketable, Child psych. I see tons of geriatric patients and I didn't do a fellowship. I worked for a bit in nursing homes, they weren't looking for someone who had done a geri fellowship. But I am about to start some weekends in child and it is understood that when they find someone with a child fellowship I am out. I understand that. If I have a child, I would take my child to a pediatrician not a FP Dr and if my child had psych issues I would take my child to a child psychiatrist. People (in my experience) tend to be very choosy in who they will take their kids to. (NOT based on a study just my observations. )

 

[psyguru]

One way to make a lot or money on the side is to do expert witness work. You could do Testementory Capacity (competency to make a will), undue influence (related to wills) and geriatric psychiatric malpractice. When I was doing my forensic fellowship, the testemantory capacity lecture was given by geriatric psychiatrist. As far as I recall, she was not a forensic psychiatrist. PM if you would like more info.

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[Dharma]

Dharma, you should NOT do a geri fellowship

As I was responding to you, I was thinking the same! Thanks for the question. What in particular caught your eye?

 

[Dharma]

My 2 cents and it's based largely on my residency training is if you are looking to be more marketable, Child psych. I see tons of geriatric patients and I didn't do a fellowship. I worked for a bit in nursing homes, they weren't looking for someone who had done a geri fellowship. But I am about to start some weekends in child and it is understood that when they find someone with a child fellowship I am out. I understand that. If I have a child, I would take my child to a pediatrician not a FP Dr and if my child had psych issues I would take my child to a child psychiatrist. People (in my experience) tend to be very choosy in who they will take their kids to. (NOT based on a study just my observations. )

Thanks for the reply! I do not have it in me to work with parents on a regular basis. I can deal with one or two in a blue moon (which I already have in clinic when I see IDD folks) but I can reach my limit quite easily there. Maybe I have spent too much time working on CA cases in the ED and just burnt on parents.

 

[futuredo32]

Thanks for the reply! I do not have it in me to work with parents on a regular basis. I can deal with one or two in a blue moon (which I already have in clinic when I see IDD folks) but I can reach my limit quite easily there. Maybe I have spent too much time working on CA cases in the ED and just burnt on parents.

That was my take on child psych. In my experience it was dysfunctional parents who wanted their kids medicated far more often than not. Unless you are going for a position as a director of a nursing home or academics I fail to see the need to do a geri fellowship.

 

[hermoine2005]

I had completed a geriatric psychiatry fellowship and to tell the truth, it is not necessary to complete a fellowship to treat geri psych patients. Honestly, I did not learn anything more than what I learned in residency. If you are interested in research in geriatric psychiatry then it would be worth it to complete the fellowship.

In terms of programs, I recommend going to a top program such as Yale, Stanford, UCLA, UPenn, and UPMC. I would not recommend smaller programs including UCSD as they are struggling to maintain faculty as well as recruit fellows. Hope this helps.

 

[michaelrack]

As I was responding to you, I was thinking the same! Thanks for the question. What in particular caught your eye?

You don't seem to have a strong clinical or research interest in geriatric psychiatry, and the fellowship is useless from a non academic financial perspective