Job vs Fellowship

[bayviewdoc314]

Hello,

I am nearing the end of my PGY-III year and did interview with two jobs prior to everything getting shut down. While I have not received an official offer, both places informed me of intent to submit an offer letter to me if I were interested. Both places then requested that this continue once things have died down with the Covid-19 virus as I am still more than a year out of graduation. I have heard that some hospital systems and states hospitals are doing hiring freezes in my area, but it is unclear as to whether this is with psychiatrists or not.

Throughout residency, I have had an interest in applying for a forensic fellowship, but was leaning towards forgoing that to work right away due to my desire to pay off my student loans.

My question would be with everything going on, would it be better to consider doing the fellowship so that I can see how things play out? I know one of the jobs will likely still be hiring (constant hiring) but the other may not and I am ok with this.

---

Members don't see this ad.

 

[Sushirolls]

Be true to yourself. What do you want. What do you want to do? How do you want to practice? What do you value to feel more fulfilled in life?

 

[dl2dp2]

You are not thinking about this in the right way. There's no reason to do a fellowship because of logistics. Either way you'll have a job lined up. Fellowships are meant to fit into a specific KIND of job you might not get otherwise without one.

 

[Merovinge]

You are not thinking about this in the right way. There's no reason to do a fellowship because of logistics. Either way you'll have a job lined up. Fellowships are meant to fit into a specific KIND of job you might not get otherwise without one.

If OP was 50/50 and just going to flip a coin to determine if they should do a fellowship, I would say this could push one a little over the edge as the market will almost certainly be better a year out. Otherwise I completely agree that this is a small factor and the overwhelming factor is do you actually want to be a forensic psychiatrist and will the fellowship change your practice. If so, do it; if not, the small change in job market is not going to make up for the year's difference in salary.

 

[calvnandhobbs68]

If OP was 50/50 and just going to flip a coin to determine if they should do a fellowship, I would say this could push one a little over the edge as the market will almost certainly be better a year out. Otherwise I completely agree that this is a small factor and the overwhelming factor is do you actually want to be a forensic psychiatrist and will the fellowship change your practice. If so, do it; if not, the small change in job market is not going to make up for the year's difference in salary.

Agree, I think that should be a very small consideration if anything. OP if you really want to do forensics, then do the fellowship. Otherwise, you'll still make 3-4x as much as you would as a fellow even in a less stable job market for the next year and if you want to jump ship to somewhere else after a year for better pay, you can structure your first job so that isn't a problem (or just do telepsych/a few locums gigs for the first year and easily still make more than you would as a fellow). The economics shouldn't play too much into it as even the worst attending position far outearns a PGY-5.

 

[vistaril]

Unless one wants to see mostly kids/adolescants, a fellowship is stupid.

All these other fellowships- C/L, addiction, geriatrics,etc....bad ideas.

I see a ton of geri patients. I did no fellowship. Nobody cares.

you're going to learn far more about psychiatry by going out and getting a real job in the real world than anything else.....

Even in forensics, those contracts arent neccessarily going to go to people who have done a fellowship in forensics. A new fellowship trained forensics person is delusional and will be laughed at if he/she thinks they are going to pull forensics work from someone who has the contacts, experience, etc from actually doing it and having the contracts all these years.....not going to happen.

 

[J ROD]

I would say first you have to decide if you want and plan to do forensic work primarily or work towards that end. IF so, then you would benefit from the fellowship. If you just kinda want to do it because it sounds cool or whatever, then just get a job and make money.

 

[J ROD]

Unless one wants to see mostly kids/adolescants, a fellowship is stupid.

All these other fellowships- C/L, addiction, geriatrics,etc....bad ideas.

I see a ton of geri patients. I did no fellowship. Nobody cares.

you're going to learn far more about psychiatry by going out and getting a real job in the real world than anything else.....

Even in forensics, those contracts arent neccessarily going to go to people who have done a fellowship in forensics. A new fellowship trained forensics person is delusional and will be laughed at if he/she thinks they are going to pull forensics work from someone who has the contacts, experience, etc from actually doing it and having the contracts all these years.....not going to happen.

I agree. I have several folks in my class going into fellowship besides child and I just laugh. I rather have the kind of paper that spends at this point. Forget another piece of paper in a plaque.

 

[psyguru]

Unless one wants to see mostly kids/adolescants, a fellowship is stupid.

All these other fellowships- C/L, addiction, geriatrics,etc....bad ideas.

I see a ton of geri patients. I did no fellowship. Nobody cares.

you're going to learn far more about psychiatry by going out and getting a real job in the real world than anything else.....

Even in forensics, those contracts arent neccessarily going to go to people who have done a fellowship in forensics. A new fellowship trained forensics person is delusional and will be laughed at if he/she thinks they are going to pull forensics work from someone who has the contacts, experience, etc from actually doing it and having the contracts all these years.....not going to happen.

I completed a forensics fellowship about 6 years ago. In my case, it was very useful and only 3% of psychiatrists do this. Certain types of cases such as Criminal Responsibility require it in some jurisdictions. Currently, I work part-time clinical and part-time expert work. I am not sure what is meant by "contracts". Of couse I may have been able to get some work as an expert witness without the fellowship. However I believe I have an advantage with board-certification in Forensic Psychiatry and also Brain Injury Medicine and MRO. I plan on obtaining a CCHP and also Addiction Medicine board certification. The BIM/ Forensics combo is great as half those in corrections have a history of TBI and not to mention the PI MVA cases. Only about a dozen docs have this combo. My marketing strategy is national and ranges from criminal to TBI PI to DUI to Military to Occupational IME to DBA to correctional malpractice to testementory capacity. It would have been hard to expand my forensic practice as I have without the fellowship training. I think it is the best decision I made and I think it is up there with child psychiatry, provided you utilize it as I had done.

With the increasing level of forensic referals, even in the pandemic, I just gave myself a raise. I regularly have referrals from other states (and I turned down a case in Canada. I did some probono rebuttal for the Trinidad AG). One thing they may not teach you in fellowship is how to market a forensic experrt witness/ IME practice.

Of course there are some psychiatric expert witnesses out there who are non-forensic. However I dont see them with the same variety of cases. The two I know of that do as well or better than me (financially) I believe mostly do cases for big tobacco.

The forensics board certification helps get referrals for the larger/ interesting cases. Without the fellowship, it would have taken dedicated self education and time to get the confidence and know how on how to navigate a box full of records and provide an opinion in a challenging homicide case or complicated stress from pre-eminent death case.


I am not so sure it is laugh-worthy creating a private practice that does not depend on insurance reimbursement or competition from NPs. The work is very interesting. From my forensic work I see much greater variety than if I worked clinicaly at 5 different clinics (only 2 for me now). I enjoy clinical care as well, particularly since I do it 3 days a week (vs the 5 day week). I am my own boss at my IME practice. The variety is nice. Also the flexibility of working from home. If I want to go back to a salary just a little higher than my pre-fellowship non-forensic salary, I can drop the hours I work to 24 hours a week (1 day clinical and 2 days expert witness).

Hourly reimbursement is not too shabby, even in comparison to child. My goal is to add more experts to my practice. Instead of laughing at those who do a forensic fellowship, what I find much more amusing is sending clinical recruiters my forensic fee schedule to deter them. It actually worked well in terms of a negotiating gambit for my part time clinical job.

 

[psyguru]

I agree. I have several folks in my class going into fellowship besides child and I just laugh. I rather have the kind of paper that spends at this point. Forget another piece of paper in a plaque.

As a forensic psychiatric expert witness, I respectfully disagree. In the medicolegal industry, plaques/certicates converts well into the "paper that spends".

 

[psyguru]

Hello,

I am nearing the end of my PGY-III year and did interview with two jobs prior to everything getting shut down. While I have not received an official offer, both places informed me of intent to submit an offer letter to me if I were interested. Both places then requested that this continue once things have died down with the Covid-19 virus as I am still more than a year out of graduation. I have heard that some hospital systems and states hospitals are doing hiring freezes in my area, but it is unclear as to whether this is with psychiatrists or not.

Throughout residency, I have had an interest in applying for a forensic fellowship, but was leaning towards forgoing that to work right away due to my desire to pay off my student loans.

My question would be with everything going on, would it be better to consider doing the fellowship so that I can see how things play out? I know one of the jobs will likely still be hiring (constant hiring) but the other may not and I am ok with this.

If you are interested in forensics, you should go for it. Even if you invoice only 50 hours a year as an expert witness (1 large case with testimony days or about 4 regular IMEs or quarter of a capital mitigation case) you will make up the difference in 4 years. Aside from the supposed "financial folly" of doing a forensic fellowship, it was the most interesting year of training. Hands down, AAPL is my favorite conference. If you are interested in it, you will not regret it. Pm me for more.

 

[J ROD]

As a forensic psychiatric expert witness, I respectfully disagree. In the medicolegal industry, plaques/certicates converts well into the "paper that spends".

See above that thread where I talked about forensic work. That one and child are difference makers. The rest to me are not needed. I guess I did not spell that out clear enough. I always think of forensic kind of by itself since it is rather unique.

 

[TexasPhysician]

If you are interested in forensics, you should go for it. Even if you invoice only 50 hours a year as an expert witness (1 large case with testimony days or about 4 regular IMEs or quarter of a capital mitigation case) you will make up the difference in 4 years. Aside from the supposed "financial folly" of doing a forensic fellowship, it was the most interesting year of training. Hands down, AAPL is my favorite conference. If you are interested in it, you will not regret it. Pm me for more.

Maybe attending AAPL should be a requirement before forensics. haha. I thought I wanted to do forensics after my child fellowship. I attended AAPL and thought it was the worst conference ever.....still do. I decided against the fellowship that week.

 

[MacDonaldTriad]

The forensic application process is well underway, and admittedly ridiculously early. Very soon no decision will be a decision. Well at least for some places, I'm sure there are unfilled positions nationally.