Is it more worth it to do a fellowship in Child Psych or Pain Management to make more money in NYC?

[experiment113]

Hi all, is it worth it to do a Child Psych fellowship or Pain management fellowship to make more money in NYC as a Psychiatrist? Thanks.

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[Sushirolls]

Do both. Then strive to open up a child and adolescent chronic pain rehab unit.

 

[rjs2131]

Hi all, is it worth it to do a Child Psych fellowship or Pain management fellowship to make more money in NYC as a Psychiatrist? Thanks.

These are such different types of practice...figure out what you actually enjoy doing, money won’t matter much if you’re unhappy and burnt out. You can make pretty solid money either way and if you want more money, just moonlight or see more patients.

 

[Psychresy]

My understanding was pain was quite difficult to get into from psych. It had crossed my mind but I somewhat wrote it off thinking it would be out of reach.

 

[SmallBird]

My understanding was pain was quite difficult to get into from psych. It had crossed my mind but I somewhat wrote it off thinking it would be out of reach.

there is interventional pain which is very difficult to get into from psych and there is non-interventional pain which is easier I believe.

 

[Merovinge]

Do both. Then strive to open up a child and adolescent chronic pain rehab unit.

Presuming all your patients are very high SES and have comorbid SA use issues (to make the money this OP seems to be after in medicine), you have perfectly described my personal hell job.

 

[Monocles]

I feel like having a child fellowship doesn't make you THAT much more money. Esp consider the amount of extra work getting info from parents and families, etc. Pain, however is $$$.

In fact, the amount of money you lose in opportunity cost from one year of attending salary is like... $200,000 minimum. Just for funsies, assuming you invest in sp500 with a conservative 7% gain each year, over the course of 40 years that could have compounded to close to $3 million...

But of course if you love working with kids/teens or hate adults then you should absolutely do a CAP fellowship! Otherwise there are easier ways to make money.

 

[experiment113]

there is interventional pain which is very difficult to get into from psych and there is non-interventional pain which is easier I believe.

Whats the difference? I thought there was just one general type of pain fellowship.

 

[experiment113]

I feel like having a child fellowship doesn't make you THAT much more money. Esp consider the amount of extra work getting info from parents and families, etc. Pain, however is $$$.

In fact, the amount of money you lose in opportunity cost from one year of attending salary is like... $200,000 minimum. Just for funsies, assuming you invest in sp500 with a conservative 7% gain each year, over the course of 40 years that could have compounded to close to $3 million...

But of course if you love working with kids/teens or hate adults then you should absolutely do a CAP fellowship! Otherwise there are easier ways to make money.

Do you mean interventional pain only?

 

[Sushirolls]

There is only one pain fellowship.
Only a tiny handful, 3 that I know of, that have a month rotation with their attached chronic pain rehab units.
"needle jockies" loathe that month. And very few if any people go into chronic pain rehab.
The country as a whole needs to flip this paradigm, and create more rehab units and less interventional pain doctors.

 

[dl2dp2]

Neither. You are not thinking about this in the right way. Making more money (especially in NYC) in psychiatry is not about doing fellowships (that you seem uninterested in content-wise).

 

[experiment113]

Neither. You are not thinking about this in the right way. Making more money (especially in NYC) in psychiatry is not about doing fellowships (that you seem uninterested in content-wise).

Then what is it about? How do you make more?

 

[dl2dp2]

Then what is it about? How do you make more?

You need more information to go on. The answer depends on the person asking this question. It would be useful if you post your [anonymized and summarized] CV.

 

[TexasPhysician]

Hi all, is it worth it to do a Child Psych fellowship or Pain management fellowship to make more money in NYC as a Psychiatrist? Thanks.

There are many factors here, so I would focus less on money and more about what you enjoy.

On average, an interventional pain specialist will earn more at an average employed position.

An active, hustling child psychiatrist could make more per hour by selecting the better gigs which may be just as demanding as pain.

A child psychiatrist trained at an elite, name brand institution has the possibility of charging the highest hourly rate, but this will entail risk and starting a solo practice.

An entrepreneurial pain specialist will more easily be able to expand and add other specialists that perform procedures which increases net revenue. While there are more moving parts, revenue could be higher than all above options.

So your answer is both could earn more than the other depending on what you include and what path you take.

 

[Monocles]

Do you mean interventional pain only?

I... I didn't know there was more than one type of pain.

 

[NeuroKlitch]

Neither. You are not thinking about this in the right way. Making more money (especially in NYC) in psychiatry is not about doing fellowships (that you seem uninterested in content-wise).

Would you recommend a fellowship at a place with high name recognition for a Resident training at Community hospital in a major city to become more competitive?

 

[SmallBird]

Whats the difference? I thought there was just one general type of pain fellowship.

Sorry you might be right, there might only be one fellowship type. But there are psychiatrist working in chronic pain that don't do procedures and don't really make extra money by doing this but have that interest.

 

[michaelrack]

I... I didn't know there was more than one type of pain.

There are more types of pain than u can imagine

 

[LimpSpatula]

Presuming all your patients are very high SES and have comorbid SA use issues (to make the money this OP seems to be after in medicine), you have perfectly described my personal hell job.

I would rather sell crack than do that job.

 

[NewYorkChildPsych]

I wouldn't pursue either Child/Adolescent Psychiatry or Pain Management if I didn't have an interest in the fields.

There's a reason for the ever-present shortage of C&A psychiatrists and why those that actually see kids/teens charge higher rates: the work is difficult, time-consuming, and extends well beyond the billable face-time with the patient/family.

 

[Frazier]

There indeed used to be some "noninterventional" pain medicine fellowships. I think maybe MD Anderson offered one long ago, maybe it was MSK... anyway...

They were just what it sounds like -- treating pain without the procedures.

I dont know if many (if any) still exist. That said, pursuing a noninterventional pain medicine fellowship in the aim of skyrocketing income... equates to high risk of practicing a "specific sort of way" that isnt likely to end well for the patients -- or the doc for that matter.

 

[NeuroKlitch]

Does the income potential of child psych outweigh the opportunity cost of that one extra year of fellowship ? How easy would it be to moonlight . 200k missed on this bull market rn seems like an ungodly amount. And how challenging would it be to start a cash only private practice without one as an IMG who trained at a community hospital in a major city. I love working the ED (we get 6+ months training in a very busy cpep ) and know I can make good hourly and would be fulfilled but don't see any longivity or lifestyle/family life potential in that line of work . Vs a cash practice with child .

 

[calvnandhobbs68]

Does the income potential of child psych outweigh the opportunity cost of that one extra year of fellowship ? How easy would it be to moonlight . 200k missed on this bull market rn seems like an ungodly amount. And how challenging would it be to start a cash only private practice without one as an IMG who trained at a community hospital in a major city. I love working the ED (we get 6+ months training in a very busy cpep ) and know I can make good hourly and would be fulfilled but don't see any longivity or lifestyle/family life potential in that line of work . Vs a cash practice with child .

Likely not from what I’ve seen so far. The child job offers are honestly not much more than the adult job offers based on the people I’ve talked to vs my own experience. Salary and production bonuses for many of these jobs are pretty similar. The main benefit may be that you can argue for more time spent with patients in child than the adult outpatient jobs where I hear jobs pressuring attendings to do 20min followups. But your patients are going to be at least 10min more complex so it basically cancels out. It’s not like insurance pays any more for seeing kids and the best you can add on in terms of insurance is interactive complexity codes which are like 15-20 bucks.

Now if you want to go start a cash private practice maybe but that comes with all the delayed income of starting a cash practice.

 

[Sushirolls]

There indeed used to be some "noninterventional" pain medicine fellowships. I think maybe MD Anderson offered one long ago, maybe it was MSK... anyway...

They were just what it sounds like -- treating pain without the procedures.

I dont know if many (if any) still exist. That said, pursuing a noninterventional pain medicine fellowship in the aim of skyrocketing income... equates to high risk of practicing a "specific sort of way" that isnt likely to end well for the patients -- or the doc for that matter.

The chronic pain rehab programs are multidiscipline and the patient who enter them do so because:
1) They've already had every procedure done and nothing left to do
2) They don't want more procedures and want to optimize their function
3) They get pushed into them by family who are tired of them

The demand is there, but they are resource heavy to start up and logistical billing nightmare to do for all the people involved. PT/OT/Psychiatry/PsyD, etc

 

[nexus73]

I wouldn't pursue either Child/Adolescent Psychiatry or Pain Management if I didn't have an interest in the fields.

There's a reason for the ever-present shortage of C&A psychiatrists and why those that actually see kids/teens charge higher rates: the work is difficult, time-consuming, and extends well beyond the billable face-time with the patient/family.

Agreed. I used to be a bit miffed that I, a general psychiatrist, seemingly didn't have the appropriate training to see child/adolescents despite a fair exposure in residency, but an ARNP (with no supervision in an independent practice state) with a fraction of the training does. In reality, it's much more that general psychiatrists just don't want to see kids because it's so much work and stress balancing all of the demands treating them.

 

[psyguru]

Consider doing child and Forensics. Another new one that may involve some pain would be a Brain Injury Medicine fellowship. Most will be PMR based and you can possibly learn some pain procedures. With the fellowship you can set up a personal injury clinic and do some med-legal work. You could get certified as a life care planner.