LOR from now-fellow

[WhoisJohnGalt]

I'm trying to get my psych LOR's lined up, and I'm running into some issues, as my third-year psych attending who had the most glowing reviews of me is no longer on faculty. The next attending that I would ask (who was at the time a general psych attending) is now a fellow at my university. My inclination is that a fellow probably isn't a good choice even if they were an attending at the time I worked with them, but since I'm having a hard time with LOR's I thought I'd double check just in case. Any thoughts?

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[Doc Samson]

I'm trying to get my psych LOR's lined up, and I'm running into some issues, as my third-year psych attending who had the most glowing reviews of me is no longer on faculty. The next attending that I would ask (who was at the time a general psych attending) is now a fellow at my university. My inclination is that a fellow probably isn't a good choice even if they were an attending at the time I worked with them, but since I'm having a hard time with LOR's I thought I'd double check just in case. Any thoughts?

The letter would be printed on generic university/hospital letterhead and would somewhere state "...in my experience working with WIJG as his attedning during his psychiatry clerkship." You can hope (or gently request) that the writer doesn't add "fellow" to his signature line. With this format, the reader will never know that the writer is now a fellow (not that is should really matter).

 

[peppy]

Personally, I don't think it will hurt you even if the doc mentions that he is a fellow.
In theory, anyone who has completed a general psych residency should be equally able to spot the qualities that will make a student good in the field, so what's the harm if he has some extra training on top of that?
A fellow should be able to speak from a better position of authority than, say, I could at this point - when I'm a brand new intern bumbling around trying to figure out how to work the computer system and what the hospital's cafeteria hours are.

 

[Anasazi23]

I always found it funny - the fellow/attending dynamic. What is it about the 'academic' environment that knocks a fellow down on the totem pole so drastically when in truth, if that same human being was hired as an attending, at that same institution, they would be flowered with praise and respect.

I think this is institution-specific also, but I would go as far as to say that it's nearly universal that the fellow status is underappreciated. Luckily, my own fellowship program treated me well, but things are never the same when you're not an attending. Some may argue that it's the "training role" that causes this, or that taking orders and being submissive to a degree is a necessary component of being a trainee itself. This must be considered in theory, but when one considers the lack of competitive salary, lack of flexibility in schedule, and myriad 'dumped' responsibilities (often senior type call, etc) fellowship can quickly look less attractive.

In ending, I agree with Doc Samson. I would think that a fellow knows to whom this LOR is going, and that announcing the fellow status all over said letter would be more harmful, rightfully or wrongly, than simply not mentioning it or indeed, stating that they knew the MS as an attending.

Good luck to you.

 

[whopper]

. What is it about the 'academic' environment that knocks a fellow down on the totem pole so drastically when in truth, if that same human being was hired as an attending, at that same institution, they would be flowered with praise and respect.

I'm experiencing that now--having been an attending for 1 year, now I'm a fellow. Wierd, having been the top of the totem pole to the bottom. Yeah, well I'm still above the residents, but I'm since there's no residents working in fellowship--yep I'm at the bottom again.

I offered to write some LORs to some psychology students I worked with. If I wrote the letter a few months ago, those letters would be in higher standing from an attending than from a fellow, yet at this point in time, due to the fellowship, I actually know more, and have more experience & knowledge than when I was an attending.

 

[psychotrope]

This must be considered in theory, but when one considers the lack of competitive salary.

this is wrong wrt basic economic theory. If people doing 1 and 2 yr fellowships(in any field) continue to work for 55k instead of 190k, there are other reasons for that........you know the reasons obviously(enhanced career opportunities, potential increase in futute earnings, sheer enjoyment of additional training in a more focused area), but those *are* the reasons why the salary of 1/4 to 1/3 the alternative makes it competitive. If it wasn't a competitive salary, then child and forensics fellowships would be completely empty, and obviously they arent.

 

[billypilgrim37]

this is wrong wrt basic economic theory. If people doing 1 and 2 yr fellowships(in any field) continue to work for 55k instead of 190k, there are other reasons for that........you know the reasons obviously(enhanced career opportunities, potential increase in futute earnings, sheer enjoyment of additional training in a more focused area), but those *are* the reasons why the salary of 1/4 to 1/3 the alternative makes it competitive. If it wasn't a competitive salary, then child and forensics fellowships would be completely empty, and obviously they arent.

Two economists are walking down the street, discussing a new controversial paper in econometrics from George Mason.

One looks down at the ground, and says, "Hey, look, there's a 20 dollar bill?"

The second says, "That's impossible. If there were a 20 dollar bill lying on the ground, someone would have already picked it up!"


I've been in company where we laughed for a solid five minutes the first time we heard that joke. I think MoM might need to buy ME a round soon.

To address your argument however, as long as their are people more qualified than the current applicants who would otherwise pursue a fellowship *if not* for the salary, and the fields would benefit from their participation in the fellowships, then one can make a clear argument that the salaries are not competitive. If your criterion is simply *filling* the spots, your reasoning is correct. But by that same reason, we should open up med school admissions to anyone willing to pay tuition, or just let secondary providers perform brain surgery and rocket science, since obviously they're willing to do it on the cheap.

 

[psychotrope]

Two economists are walking down the street, discussing a new controversial paper in econometrics from George Mason.

One looks down at the ground, and says, "Hey, look, there's a 20 dollar bill?"

The second says, "That's impossible. If there were a 20 dollar bill lying on the ground, someone would have already picked it up!"


I've been in company where we laughed for a solid five minutes the first time we heard that joke. I think MoM might need to buy ME a round soon.

To address your argument however, as long as their are people more qualified than the current applicants who would otherwise pursue a fellowship *if not* for the salary, and the fields would benefit from their participation in the fellowships, then one can make a clear argument that the salaries are not competitive. If your criterion is simply *filling* the spots, your reasoning is correct. But by that same reason, we should open up med school admissions to anyone willing to pay tuition, or just let secondary providers perform brain surgery and rocket science, since obviously they're willing to do it on the cheap.

1) someone *will* pick up that 20 if 3 or 4 more people walk by......so that can be viewed as a transient inconsistency in economic theory. Last I checked, that can't be said for child and other fellowships.

2) the basis of your argument is completely unsound though. Of course there are more people who would do a fellowship if it paid more. Heck there are also people who would take a 2 year break and vacation in bermuda if it paid more as well. To understand the whole concept of "competitive" salary, you have to look at other factors as well. And some fellowhips(especially child) are still somewhat competitive so I don't even see that as an issue.

I know Im sort of ranting here, but if people dont want to accept 55k or whatever for a fellowship for a year or two....there is a solution to that. Don't do it.

 

[billypilgrim37]

2) the basis of your argument is completely unsound though. Of course there are more people who would do a fellowship if it paid more. Heck there are also people who would take a 2 year break and vacation in bermuda if it paid more as well. To understand the whole concept of "competitive" salary, you have to look at other factors as well. And some fellowhips(especially child) are still somewhat competitive so I don't even see that as an issue.

The simple fact that we disagree on what the ideal equilibria would be for applications to fellowships does not make my argument unsound. It just means you didn't take Econ 301! j/k. *weak snap*

I don't know by what parameters you would consider child fellowships competitive. They are typically less competitive than general psychiatry residencies, which by most standards we would not call relatively competitive.

 

[psychotrope]

The simple fact that we disagree on what the ideal equilibria would be for applications to fellowships does not make my argument unsound. It just means you didn't take Econ 301! j/k. *weak snap*
.

that sorta gets to my point. It's not for me or you to decide what the "ideal equilibria" is. It is what it is.

The same argument/principle can be seen in a young attending taking an academic position vs taking a position outside academia. The latter may pay 20%(or more) less, but that certainly doesnt mean the salary is "noncompetitive" because there are other non-monetary(at least not immediate monetary) advantages associated with it than in many cases overcome that.

 

[billypilgrim37]

It's not for me or you to decide what the "ideal equilibria" is. It is what it is.

Because there's no such thing as "policy?"

I'm not even arguing that I think fellowships necessarily should pay more or that child or forensic fellowships *need* to be more competitive. Geri fellowships need some serious incentives in place, and the same might be said for addictions, but salary is probably not an effective way to do that. Just plain better compensation, loan forgiveness programs, etc would be more stable.

I'm just in it for the economic nerd fight!

 

[psychotrope]

Because there's no such thing as "policy?"

I'm not even arguing that I think fellowships necessarily should pay more or that child or forensic fellowships *need* to be more competitive. Geri fellowships need some serious incentives in place, and the same might be said for addictions, but salary is probably not an effective way to do that. Just plain better compensation, loan forgiveness programs, etc would be more stable.

I'm just in it for the economic nerd fight!

if salary is not an effective way to do that, then that's a good indication that the salaries aren't noncompetive.

Also one point on non-child(ie geri, addictions) fellowships that hasn't been mentioned: you(meaning the system as a whole and programs to some extent) don't *need* to fill them all. Maybe that's a good thing if they don't all fill.

As for loan forgiveness, these are 1 and 2 year fellowships. And in some of them(especially something like addictions and forensics) you can do substantial outpatient work on your time off to make up for part of that lost income and substantially boost your salary.

 

[billypilgrim37]

If what you said was true, we would not face such a devastating shortage of geriatric psychiatrists.

 

[psychotrope]

If what you said was true, we would not face such a devastating shortage of geriatric psychiatrists.

many geriatric units(or facilities with high#'s of geri pts) don't require a fellowship trained geriatric psychiatrist. If these facilities and jobs that hire psychiatrists all the time who haven't done a geri fellowship would increase the pay differential more for those who have, then that problem would be solved......

 

[honsano]

Question (without making a new thread): Would a clinical Psychologist's letter be worthwhile? I mean I spend a lot of time with the guy, he knows me and I'm pretty sure he'd write an awesome letter but I'm scared there may be a stigma with a letter from an individual without an MD. Thoughts, comments, coffee, tea?

 

[WhoisJohnGalt]

Question (without making a new thread): Would a clinical Psychologist's letter be worthwhile? I mean I spend a lot of time with the guy, he knows me and I'm pretty sure he'd write an awesome letter but I'm scared there may be a stigma with a letter from an individual without an MD. Thoughts, comments, coffee, tea?

From what I've heard, you really want to stick with MD's unfortunately. I come from a pretty conservative area though so it's possible that other areas are more liberal about titles.

 

[Anasazi23]

So I'm in the process of being credentialed at a number of south florida hospitals. One has informed me that my training director and former program chair can not count toward my evaluations since "that was in training."

To make matters worse, the then forensic fellows that I had used as references are also ineligible since "they are in training." This made me laugh, whilst simultaneously infuriating me.

Aside from the fact that my forensic fellow colleagues and I have now completed our "training," I think it's high time that we stand up and inform the hospital credentialing and other interested masses that fellows are otherwise attendings, and that it's a ludicrous notion to assume that because someone has entered advanced training, that this somehow disqualifies their opinion of another doctor's credibility or practice ethic.

 

[whopper]

So I'm in the process of being credentialed at a number of south florida hospitals. One has informed me that my training director and former program chair can not count toward my evaluations since "that was in training."

That's crazy. You can't start to work unless you have references on your work experience, but you don't have that because you haven't worked as an attending yet.

Thankfully where I first worked did allow me to use instructors as references so I could get the ball rolling.

 

[Anasazi23]

Imagine how credentialing will be when Obamacare goes through.

It'll be like the DMV for doctors.

 

[OldPsychDoc]

Imagine how credentialing will be when Obamacare goes through.

It'll be like the DMV for doctors.

C'mon.

Credentialling is simple in a single-payer system.
It's when you have to get credentialled on multiple panels, with different forms, different standards of compliance...

OTOH--I work for a large organization that does it all for me and just sends me stacks of papers to sign every year or three....