Most "Worth It" Fellowship other than Child

[Psyxh1]

Hi everyone,

So perusing many of the threads on the forum it appears that the general consensus is that other than Child(and maybe Forensics), the other psychiatry fellowships are a waste of time unless you are interested in academics. I know that financially psychiatry fellowships other than the two mentioned are a net loss. However, in terms of education, gaining clinical acumen, and being better prepared and skilled at treating patients in the addictions/geri/C/L realms are the fellowships really so unnecessary/superfluous? Which of them would be the most useful?

Thanks!

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[OldPsychDoc]

The one you're actually interested in.

 

[PistolPete]

In my opinion, child and forensics are the only "required" fellowships. The rest you should have had plenty of exposure in residency, and they probably won't add much to your income and you should only do if you want to do academics or have a really strong interest in it/them.

 

[Shikima]

In my opinion, child and forensics are the only "required" fellowships. The rest you should have had plenty of exposure in residency, and they probably won't add much to your income and you should only do if you want to do academics or have a really strong interest in it/them.

Sleep too

 

[PistolPete]

Sleep too

Yes, agreed! Sleep too. My bad!

 

[MacDonaldTriad]

Generally being a fellow does make you more talented in areas as compared to your average general psychiatrist. I think the real question is who will you be working with during a fellowship and how much mentoring is there. It doesn't matter if they call you a fellow or not, surrounding yourself with excellent psychiatrists makes you grow.

 

[SeniorWrangler]

There's a 5 year practice pathway for addiction boards right now, so consider that before signing up for an addiction fellowship.
People rarely talk about pain fellowship, but that's an interesting option for the few psychiatrists who are suited for it.

 

[TexasPhysician]

In my opinion, child and forensics are the only "required" fellowships. The rest you should have had plenty of exposure in residency, and they probably won't add much to your income and you should only do if you want to do academics or have a really strong interest in it/them.

I haven't seen forensics be a requirement.

 

[michaelrack]

There's a 5 year practice pathway for addiction boards right now, so consider that before signing up for an addiction fellowship.
.

good point. Here is a link for the requirement for the Addiction medicine certification through the American Board of Preventitive Medicine: http://www.theabpm.org/images/docs/AddictionMedicine.pdf

1920 hours are required through the practice pathway. I think I am going to do this in 2018.

 

[Shikima]

I'm glad I did a fellowship, it did sharpen my skills significantly.

 

[masterofmonkeys]

Addictions, Forensics, and Sleep.

Pain, I guess, but there are some severe reductions in payments/procedures coming down the pipeline. Some has already started.

 

[SmallBird]

In my opinion, child and forensics are the only "required" fellowships. The rest you should have had plenty of exposure in residency, and they probably won't add much to your income and you should only do if you want to do academics or have a really strong interest in it/them.

I feel like I could be way better at addictions if I did an addictions fellowship. I'm sure the suboxone and methadone prescribing isn't difficult, but I think that a solid year of supervised clinical experience working with patients who have substance use disorders could really help in better understanding who is likely to benefit from these treatments, key psychosocial determinants that are important to look for and try and address, understanding the different systems of care that can be mobilized for these patients, and improving capacity for therapeutic communication. No doubt such experience is possible outside a fellowship too, but that could be said about many types of clinical skills, and a fellowship is probably quite an efficient way to accumulate these skills. I think folks who want to work in addictions long term should strongly consider the fellowship.

 

[splik]

I think it would depend on your interests of course. There are many reasons why one might do a fellowship in x or y and there are many reasons not to. Depends on what your career goals are, how much you like training, where you do the fellowship etc etc. See my fellowships thread, but my ranking would be something like this:

1. Pain Medicine
2. Child and Adolescent Psychiatry
3. Behavioral Neurology/Neuropsychiatry
4=. Addiction Psychiatry/Addiction Medicine
4=. Forensic Psychiatry
6. Occupational and Environmental Medicine
8. Clinical Informatics
9. Sleep Medicine
10. Neuromodulation/Interventional Psychiatry
11. Hospice and Palliative Medicine
12. Headache Medicine
13. Geriatric Psychiatry
14. Psychosomatic Medicine
15. Public Psychiatry

This is based on skills learned, $$$ potential, and demand.

You absolutely do not need do a psychosomatic fellowship except if you wish to work at certain academic centers in the NE or wish to be a psychosomatic fellowship director. Bizarrely I was offered the position of PSM fellowship director at two reasonably regarded institutions despite not actually being eligible lol (ACGME requires the fellowship director to be board certified in that specialty, which of course makes sense). I could see how doing a PSM fellowship at a major quaternery center where you see a ton of zebras and get exposure to neuropsych, transplant, psychonocology, HIV psychiatry, women's mental health/perinatal, cardiac patients etc and get mentorship from leaders in the field might be pretty neat, especially if you did not get such exposure in general residency, but your average fellowship probably doesn't have much to offer.

A good geriatrics fellowship will give you strong training in serving this population and dementia in general, but most general psychiatrists work with older adults and no one cares about them. Also its all medicare. I was told by one place "we don't want you doing geriatrics because we don't want to attract more medicare pts", another place incentivized privately insured patients, and my friend was told at one place "you're worth less because of your geriatric training."

Headache medicine has no money in it, except maybe for botox. which is why they are open to psychiatrists.

palliative medicine no money in it, likely to decrease your income vs. general psych.

neuromodulation/interventional psych - very few jobs for non-research people. You could of course set up your own clinic, but would need referrals or collaboration and invest in equipment (e.g TMS chairs). but much of this can be learned in residency or out in your own practice. can be potentially lucrative if you are in an area where you can corner the market and have the business savvy and start up costs to invest appropriately.

sleep medicine is in decline because of declining reimbursements over the past decade. though you would learn a ton. doing expert witness sleep medicine work potentially v lucrative. may have difficulty getting jobs as a psychiatrist if they are looking for a pulm person or a neurologist.

clinical informatics is for the more technologically inclined. the market is being cornered by quite a few people but you can potentially get work consulting with tech companies, EMR companies, creating your own innovations etc. not necessary to do the fellowship for any of this of course.

OEM is gonna be big for psychiatry in the future as psychological injury, and psychiatric related disability including somatoform disorder (electromagnetic sensitivity, multiple chemical sensitivity etc) are the major causes of workforce morbidity - its no longer lung or skin disease. occupational/organizational consulting, doing certain kinds of disability evals and fitness for duty evals can also be lucrative. you would get training in general occupational/environmental medicine issues too which is the crux of what is currently offered

A good forensics fellowship will give you exposure and training in a wide range of criminal and civil competencies/evaluations and improve your overall acumen as a clinical psychiatrist. However it is absolutely not necessary to have a forensic fellowship in order to be an expert witness and the overwhelming majority of civil expert witness work in psychiatry is done by non-forensic trained people (BTW forensic fellowships have been around since at least 1969). Now often these people do pretty awful work, and are plaintiff's ****** (defense experts often tend to be very senior psychiatrists, again mostly not forensics trained but more likely to be), but they exist anyway. It's not necessary of course to be forensics trained to work in state hospitals, corrections, or community forensics either.

Addiction Medicine and Psychiatry is a growth area, especially with our iatrogenic opioid epidemic and the 21st century CURES Act. I am seeing more and more non-academic jobs demanding or strongly preferring addictions boards. Given that most programs provide substandard training in addiction psychiatry, it can definitely be worth doing an addiction fellowship. Potential to do MRO work interpreting urine drug test results, and lots of consulting/expert witness work relates to substance use issues. You can always sell out and open a bougie addictions practice or residential treatment centers. Though high-end residential is a saturated market and these places are struggling to fill with cash-paying or private insurance paying pts.

Behavioral neurology/neuropsychiatry - you will learn a ton in a good fellowship. clinical work is not usually well paying but can be. typically more academically oriented. forensic work can be highly lucrative especially related to TBI.

child - worth bearing in mind that vast swathes of the country general psychiatrists provide treatment to children (not usually great care) such is the need. in some cases with consultation with a general psychiatrist. I was recently asked to provide coverage for adolescents in a saturated part of the country, and declined. most people do not receive adequate child psych training during general residency (canada, UK, australia, NZ, and Ireland all require 6 months of child psych training).

 

[michaelrack]

I would put sleep higher on the list due to a fellowship being pretty much required to read sleep studies....
I am currently doing a methadone clinic without addiction certification
Some doctors at community mental health centers see both adults and kids without child certification

 

[TexasPhysician]

I would put sleep higher on the list due to a fellowship being pretty much required to read sleep studies....
I am currently doing a methadone clinic without addiction certification
Some doctors at community mental health centers see both adults and kids without child certification

What is the difference in pay for a methadone clinic vs sleep hours?

 

[NickNaylor]

It also depends on what your goals are. For example, if you're interested in academics or administration but want to primarily do C/L work, at least at my institutions it is essentially required that you be fellowship-trained if you want to, for example, be the medical director of the consult service or be involved in any way in educational leadership. That being said, for those that don't have this interest a fellowship is not required to do the clinical work - most of the C/L faculty aren't fellowship trained. The same seems to largely be true in addiction medicine, i.e., even though you can do the clinical work without a fellowship, advancement in academia and administration seems to be limited without the additional training.

 

[splik]

I would put sleep higher on the list due to a fellowship being pretty much required to read sleep studies....
I am currently doing a methadone clinic without addiction certification
Some doctors at community mental health centers see both adults and kids without child certification

you obviously learn a lot more in sleep than in addictions. one thing I'm wondering though is what the job market is like for a sleep psychiatrist? You are med-psych and sleep trained and it seems outside of some academic depts a lot of places are not looking for a sleep psychiatrist but want someone with a different specialty background. what are your thoughts on prospects for newly minted psychiatrists getting sleep training.

 

[watto]

you obviously learn a lot more in sleep than in addictions. one thing I'm wondering though is what the job market is like for a sleep psychiatrist? You are med-psych and sleep trained and it seems outside of some academic depts a lot of places are not looking for a sleep psychiatrist but want someone with a different specialty background. what are your thoughts on prospects for newly minted psychiatrists getting sleep training.

Well I can only speak from my experience, but I think I am the only psychiatrist in my town who is almost exclusively doing sleep now - am in cash only private practice. I am part time by choice but could add more hours if I wanted to. I would say I have 10% general psychiatry patients (not taking any news and not replacing any that leave my practice), 60% insomnia (brief behavioral treatment, addressing meds if needed, structured plan for tapering off sedative-hypnotics as well, I will also mention that half of these end up being delayed circadian phase folks who need phase advancement to function in society), 10% hypersomnia (please everyone check ferritin levels, even PCPs miss this as an easy to correct cause of hypersomnia and RLS), 10% narcolepsy specifically, and 10% grab bag of remaining sleep disorders.

I have been doing this for a couple of years and really wish I had some competition, I feel a little overloaded sometimes by the referrals and try to see as many as I can. I have kept a pretty low for market rate fee, do not want to increase because what I charge seems fair and I like seeing sleep patients. It is a pretty specific niche that could use some more MDs with a psych background. Doing therapy plus being able to do meds is so useful in sleep.

 

[michaelrack]

There aren't that many pure sleep jobs out there anymore (and those that are there are primarily osa). I have "attached myself" to several sleep labs and bill for the patients I see; I bill for the interps for some of the sleep studies I read, the rest I am paid for on a contract basis. Once a psychiatrist is established in an area, it is pretty easy to become medical director of a small sleep lab (these become available all the time) or if a psychiatrist has his own office, it is pretty easy to add 2 sleep-testing beds.
I am getting back in the sleep lab ownership business and am building a 4 bed sleep lab with several former business partners.

 

[michaelrack]

What is the difference in pay for a methadone clinic vs sleep hours?

I got my methadone gig through my locums company. I am doing it 6 hours per week; plan to stop later this year to devote myself more to inpt psych and also sleep medicine

 

[TexasPhysician]

Once a psychiatrist is established in an area, it is pretty easy to become medical director of a small sleep lab (these become available all the time) or if a psychiatrist has his own office, it is pretty easy to add 2 sleep-testing beds.

Interesting. You convert an office to beds for pm hours? How did you gain the business education to put this together?

 

[michaelrack]

Interesting. You convert an office to beds for pm hours? How did you gain the business education to put this together?

I have never done this. I know 2 sleep psychiatrists (actually 1 is a neurologist/psychiatrist/sleep/ and multiple other specialties that he grandfathered into- he is 65) in Jackson MS who do this. At least 1 has dedicated rooms (doesn't use during day for other purposes). Doesn't require much business knowledge beyond running a physician practice, other than what is gained working in the sleep field.

 

[Blitz2006]

Addictions, Forensics, and Sleep.

Pain, I guess, but there are some severe reductions in payments/procedures coming down the pipeline. Some has already started.

Pain is still well reimbursed (Pain Docs in PP can average around 500-700k), although yes, not as well as it was 5 years ago.

For anyone interested in pain jobs, gaswork.com gives an idea.

 

[Blitz2006]

I think it would depend on your interests of course. There are many reasons why one might do a fellowship in x or y and there are many reasons not to. Depends on what your career goals are, how much you like training, where you do the fellowship etc etc. See my fellowships thread, but my ranking would be something like this:

1. Pain Medicine
2. Child and Adolescent Psychiatry
3. Behavioral Neurology/Neuropsychiatry
4=. Addiction Psychiatry/Addiction Medicine
4=. Forensic Psychiatry
6. Occupational and Environmental Medicine
8. Clinical Informatics
9. Sleep Medicine
10. Neuromodulation/Interventional Psychiatry
11. Hospice and Palliative Medicine
12. Headache Medicine
13. Geriatric Psychiatry
14. Psychosomatic Medicine
15. Public Psychiatry

This is based on skills learned, $$$ potential, and demand.

You absolutely do not need do a psychosomatic fellowship except if you wish to work at certain academic centers in the NE or wish to be a psychosomatic fellowship director. Bizarrely I was offered the position of PSM fellowship director at two reasonably regarded institutions despite not actually being eligible lol (ACGME requires the fellowship director to be board certified in that specialty, which of course makes sense). I could see how doing a PSM fellowship at a major quaternery center where you see a ton of zebras and get exposure to neuropsych, transplant, psychonocology, HIV psychiatry, women's mental health/perinatal, cardiac patients etc and get mentorship from leaders in the field might be pretty neat, especially if you did not get such exposure in general residency, but your average fellowship probably doesn't have much to offer.

A good geriatrics fellowship will give you strong training in serving this population and dementia in general, but most general psychiatrists work with older adults and no one cares about them. Also its all medicare. I was told by one place "we don't want you doing geriatrics because we don't want to attract more medicare pts", another place incentivized privately insured patients, and my friend was told at one place "you're worth less because of your geriatric training."

Headache medicine has no money in it, except maybe for botox. which is why they are open to psychiatrists.

palliative medicine no money in it, likely to decrease your income vs. general psych.

neuromodulation/interventional psych - very few jobs for non-research people. You could of course set up your own clinic, but would need referrals or collaboration and invest in equipment (e.g TMS chairs). but much of this can be learned in residency or out in your own practice. can be potentially lucrative if you are in an area where you can corner the market and have the business savvy and start up costs to invest appropriately.

sleep medicine is in decline because of declining reimbursements over the past decade. though you would learn a ton. doing expert witness sleep medicine work potentially v lucrative. may have difficulty getting jobs as a psychiatrist if they are looking for a pulm person or a neurologist.

clinical informatics is for the more technologically inclined. the market is being cornered by quite a few people but you can potentially get work consulting with tech companies, EMR companies, creating your own innovations etc. not necessary to do the fellowship for any of this of course.

OEM is gonna be big for psychiatry in the future as psychological injury, and psychiatric related disability including somatoform disorder (electromagnetic sensitivity, multiple chemical sensitivity etc) are the major causes of workforce morbidity - its no longer lung or skin disease. occupational/organizational consulting, doing certain kinds of disability evals and fitness for duty evals can also be lucrative. you would get training in general occupational/environmental medicine issues too which is the crux of what is currently offered

A good forensics fellowship will give you exposure and training in a wide range of criminal and civil competencies/evaluations and improve your overall acumen as a clinical psychiatrist. However it is absolutely not necessary to have a forensic fellowship in order to be an expert witness and the overwhelming majority of civil expert witness work in psychiatry is done by non-forensic trained people (BTW forensic fellowships have been around since at least 1969). Now often these people do pretty awful work, and are plaintiff's ****** (defense experts often tend to be very senior psychiatrists, again mostly not forensics trained but more likely to be), but they exist anyway. It's not necessary of course to be forensics trained to work in state hospitals, corrections, or community forensics either.

Addiction Medicine and Psychiatry is a growth area, especially with our iatrogenic opioid epidemic and the 21st century CURES Act. I am seeing more and more non-academic jobs demanding or strongly preferring addictions boards. Given that most programs provide substandard training in addiction psychiatry, it can definitely be worth doing an addiction fellowship. Potential to do MRO work interpreting urine drug test results, and lots of consulting/expert witness work relates to substance use issues. You can always sell out and open a bougie addictions practice or residential treatment centers. Though high-end residential is a saturated market and these places are struggling to fill with cash-paying or private insurance paying pts.

Behavioral neurology/neuropsychiatry - you will learn a ton in a good fellowship. clinical work is not usually well paying but can be. typically more academically oriented. forensic work can be highly lucrative especially related to TBI.

child - worth bearing in mind that vast swathes of the country general psychiatrists provide treatment to children (not usually great care) such is the need. in some cases with consultation with a general psychiatrist. I was recently asked to provide coverage for adolescents in a saturated part of the country, and declined. most people do not receive adequate child psych training during general residency (canada, UK, australia, NZ, and Ireland all require 6 months of child psych training).

I'm surprised Neuropsychiatry is so high up at #3, despite no need for it to get a job unless you want to work in an academic environment as a neuropsychiatrist in the Boston area, correct? Also, it doesn't really add $$ value?

Also I'm surprised with Forensic. Like pistolpete, I was under the impression it was "required". Guess I was wrong, as you ranked it along with addictions, a fellowship I thought was not 'required'....

 

[Bartelby]

I think a good way to this of it is "worth it" in terms of your own career and life, rather than in an abstract sense. Ask yourself: what can I do with this fellowship that I could not do (or would be limited in doing) without it?

Several situations stand out as good reasons to do the fellowship:

-You want to work at a major academic center, and the extra qualifications will help you establish yourself as an expert. This can help with securing jobs, advancement, posts such as fellowship director, etc.

-You want to do something full-time and you want to be maximally qualified for your niche. For instance, a geriatric psychiatrist who contracts with several nursing homes and then runs a full-time outpatient geri practice, or an addiction psychiatrist who wants to work full-time in addiction treatment programs. This can help you in hiring, promotions, and providing the best possible care.

-You want special expertise that opens up more part-time opportunities, to vary things up from your "day job." For instance, while you can do forensic work without the forensic qualification, you will be better prepared and more likely to build a meaningful part-time forensic practice if you have done the fellowship. This is especially true for those of us who don't have decades of relevant experience under our belts.

-You want the expertise and "branding" to create a subspecialty practice, such as a neuropsychiatrist who sees hospital-based neuropsych consults and then follows a large panel of subspecialty cases in a private clinic. Again, you can do this without a fellowship, but the fellowship helps (especially for those starting out).

It is also fine to the do a fellowship because you are personally curious, able to take the hit in income/lifestyle, and you feel like the extra training will help you provide better care.

In my mind, child and forensics are the most "worth it" in an abstract sense, but pretty much any fellowship can be either valuable or pretty useless depending on what you do with it. With that said, it's worth keeping in mind that the four-year residency should qualify you do do just about whatever work you want to do, and you can (and will) hone your expertise on the job as well.

 

[A Witty Fool]

Pain fellowship transforms you into a pain physician, period. We do surgeries. We inject anywhere and everywhere in the body including delicate regions like the cervical epidural space. We master neurology and the medical knowledge of pain. I learned psychiatry in residency, but I'm now a pain doctor, unlike the other fellowships mentioned on this board that add a special form of psychiatry to a psychiatrist. Nothing is like interventional pain medicine, and pain medicine is unlike anything else. So I agree it's the most worth it fellowship, but you become an entirely different kind of doctor and it's extremely challenging training. I don't recommend psychiatrists try it unless you are VERY hard-working and motivated. If instead of talking to patients all day you get really excited at treating any kind of pain with the latest and greatest injections, radiofrequency ablations, spinal cord stimulators, intrathecal pumps, and highly specialized medication regimens, then look into it. It's really for the psychiatry resident who almost went into surgery or anesthesia. Otherwise, just enjoy psychiatry! Yes, the pay bump is significant, we're talking I went from offers of around $200K out of residency to $400K out of fellowship, but you gotta love it! And I love treating both pain and psych issues now!

 

[NeuroKlitch]

Is there any money to be made in neuropsychiatry ? I know it's largely acedemic but can I practice outside that setting ? It's the most interesting subject matter in psych and Neuro in my opinion . But I got 300+++ in loans .


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[slappy]

Is there any money to be made in neuropsychiatry ? I know it's largely acedemic but can I practice outside that setting ? It's the most interesting subject matter in psych and Neuro in my opinion . But I got 300+++ in loans .


Sent from my iPhone using SDN mobile

Not any more than you can make being a psychiatrist or a neurologist.

 

[NeuroKlitch]

Not any more than you can make being a psychiatrist or a neurologist.

Good enough for me . Thanks


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[notdeadyet]

The utility of fellowships depend on what you personally want to DO. Once you have a full, unrestricted medical license, you can theoretically carve out whatever you want.

But in practice, fellowships will enable you to either do more or do more earlier than if you didn’t have them. How much a lack of fellowship will restrict your practice depends on the type of fellowship.

The biggies would be:

Pain Medicine- Without the fellowship, you will not be able to function as a Pain Medicine doc. Yes, you can do mindfulness and other therapy to help individuals with chronic pain, but the field of Pain Medicine also includes blocks, surgeries, etc. You will not be doing these as a psychiatrist without the fellowship.

Hospice and Palliative Medicine- Again, you can get a job at a hospice as a psychiatrist without fellowship, but the field of HPM is in large part responsible for doing consults on patients with refractory pain, nausea, vomiting, diarrhea, and other issues. You will not have this capability without fellowship.

Child and Adolescent- You can definitely see adolescents without the fellowship, and nothing is really stopping you from seeing children but caveat emptor.

To a slightly lesser degree:

Forensic Psychiatry- You do not need a fellowship for doing the $400 competency evaluations, particularly in remote areas. But for building an actual career forensic practice, it’s getting harder and harder to do. Reports and testimonies of many folks without formal training is often fairly weak, and their business is being encroached by those who do better work. If folks are considering this as a career, trying to do so without the fellowship would be bad strategy. The majority of folks with good forensic practices without fellowship fall into one of two camps: a) they’re old or b) they are limited to testifying in a very, very specific field where fund of knowledge is more important to report and testimony (which is fairly rare and hard to do more than a handful of cases per year). I consider Forensic Psychiatry akin to Emergency Medicine: you can go plenty of places in the country and get ER work with a Family Practice residency under your belt, but considering a career in it would be hard to recommend someone into an emergency medicine career without recommending the EM residency.

I’d put the rest of the major fellowships (psychosomatic, public, geri, addiction, etc.) into the category of fellowship being a career enhancer. Which I think is an important and deliberately chosen term. These fellowships will enhance your career. These fellowships will potentially mean that you will get selected over someone else for a particular job. These fellowships will open up opportunities for competitive teaching jobs at academic centers. And (far and away most importantly), these fellowships will give you a strong foundation after a year of focused practice and training in a very specialized subject that will influence the quality of the work you do (and the satisfaction you get from doing it) for many years to come.

Does that make the fellowship worth it? That’s a completely personal calculus based just on you. But I wouldn’t steer someone away from a fellowship based on opportunity cost without the applicant doing a lot of navel gazing.

 

[Salpingo]

Hi everyone,

So perusing many of the threads on the forum it appears that the general consensus is that other than Child(and maybe Forensics), the other psychiatry fellowships are a waste of time unless you are interested in academics. I know that financially psychiatry fellowships other than the two mentioned are a net loss. However, in terms of education, gaining clinical acumen, and being better prepared and skilled at treating patients in the addictions/geri/C/L realms are the fellowships really so unnecessary/superfluous? Which of them would be the most useful?

Thanks!

You have to factor in the individual program. For example, the pain fellowship people at my home institution were pretty interested in recruiting psychiatry residents into the program. But I can't imagine that was because they wanted to train another private practice pain doc performing procedures in their office. They were probably looking for someone to perform CBT or mindfulness for pain, manage the substance abuse and personality disorders.

Conversely,if you match into the top program of one of the "superfluous" fellowships, your career CAN be accelerated several years (although not necessarily income potential). Nothing will be handed to you, and you still have work hard (which some people resent), but doors open, and you'll be a significantly better clinician.

 

[SourceOfDenial]

For hospice and palliative medicine there are 7000 practiconers that are board certified in their speciality and HPM since 2008(when it became ACGME accredited fellowship). Of those only 110 are psychiatry and neurology board certified.

I think there is tremendous value in doing a palliative fellowship, as a psychiatrist. The value you bring in management of anxiety, depression, understanding the complex range of emotions at the end of life, being able to sit with and be present with suffering, and management of delirium. What can be learned is medical management of complex symptoms, gaining experience and knowledge working with families and groups and facilitating difficult conversations, and the last area of medicine that still heavily uses home visits.

As a resident during the hospice and palliative rotations I did every site was incredibly grateful to have a psychiatric perspective and wished more psychiatrists would enter the field. It was strange to be a rotator and to be thanked for being there.

The downside is that like other fellowships, it likely doesn't correlate with being paid more.

 

[clausewitz2]

For hospice and palliative medicine there are 7000 practiconers that are board certified in their speciality and HPM since 2008(when it became ACGME accredited fellowship). Of those only 110 are psychiatry and neurology board certified.

I think there is tremendous value in doing a palliative fellowship, as a psychiatrist. The value you bring in management of anxiety, depression, understanding the complex range of emotions at the end of life, being able to sit with and be present with suffering, and management of delirium. What can be learned is medical management of complex symptoms, gaining experience and knowledge working with families and groups and facilitating difficult conversations, and the last area of medicine that still heavily uses home visits.

As a resident during the hospice and palliative rotations I did every site was incredibly grateful to have a psychiatric perspective and wished more psychiatrists would enter the field. It was strange to be a rotator and to be thanked for being there.

The downside is that like other fellowships, it likely doesn't correlate with being paid more.

Hospice and palliative is generally a ticket to lower salaries regardless of specialty, as full time positions I have seen are frequently in the 120-140k range. It is a thing to do if you want to do it, not because you are trying to get them ducats.

 

[SourceOfDenial]

Hospice and palliative is generally a ticket to lower salaries regardless of specialty, as full time positions I have seen are frequently in the 120-140k range. It is a thing to do if you want to do it, not because you are trying to get them ducats.

If you went to med school for ducats, you're doing it wrong already. Your price ranges are off as well, typically 175k to 215k that's academic palliative/non profit hospice/VA jobs. I see 100k-120k for palliative or behavioral oncology NPs.

 

[SuperSoccer19]

Interesting threat with a lot of opinions...

I am in a geriatric fellowship after being an attending for 4+ years and, for me, it is totally worth it. I have a much better understanding of geriatric medicine and it also gave me some time to figure things out and allowed me to fill a few other goals. I think doing a fellowship is a personal decision and how worthwhile it is depends upon your personal objectives. Yes, you can do most things in psych without the fellowship, but if you have an area of interest and think you want to learn more or see different work areas or make connections, doing a fellowships in whatever area interests you might not be a bad idea.

Some of the advice above also might be very specific to your location. I actually have had two job offers in pain medicine with no fellowship at all. I had another one in sleep. Some of the ones high on the list above are not even accredited and most employers won't give a crap, but some might. I'd just encourage anyone considering a fellowship to do what you feel is right for you. If are willing to take a year or two pay cut to enhance your learning or figure you life out, it can be a good experience. If you're self motivated or are just doing this because, perhaps rethink this.

 

[michaelrack]

Interesting threat with a lot of opinions...


Some of the advice above also might be very specific to your location. I actually have had two job offers in pain medicine with no fellowship at all. I had another one in sleep. Some of the ones high on the list above are not even accredited and most employers won't give a crap, but some might. I'd just encourage anyone considering a fellowship to do what you feel is right for you. If are willing to take a year or two pay cut to enhance your learning or figure you life out, it can be a good experience. If you're self motivated or are just doing this because, perhaps rethink this.

They may call the job "pain" or "sleep", but you are not really doing pain medicine unless you are doing injections, and you aren't doing sleep medicine unless you are independently interpreting polysomnograms.

 

[SeniorWrangler]

You have to factor in the individual program. For example, the pain fellowship people at my home institution were pretty interested in recruiting psychiatry residents into the program. But I can't imagine that was because they wanted to train another private practice pain doc performing procedures in their office. They were probably looking for someone to perform CBT or mindfulness for pain, manage the substance abuse and personality disorders.

If it's an ACGME-accredited pain fellowship, then you have to get trained in all the injections and stuff. It is part of the requirements, just like every GI fellow in medicine is requirement to drive a certain number of scopes.

EDIT: Just to be clear, this is different than picking up a job as "psychiatrist in a pain clinic", which is also an interest opportunity but where you'll probably get more mileage out of things like training in CBT, ACT, MI and Suboxone prescribing.
To do a pain fellowship, you gotta step up and wear scrubs and fight for cases like a surgical resident.

 

[notdeadyet]

They may call the job "pain" or "sleep", but you are not really doing pain medicine unless you are doing injections, and you aren't doing sleep medicine unless you are independently interpreting polysomnograms.

^^^ Yes, this is what I was alluding to (though maybe not well). A psychiatrist practicing psychiatry in a pain clinic is not the same thing as a pain doc. Likewise, a psychiatrist practicing psychiatry for a hospice is not a palliative medicine doc.


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[psyguru]

The utility of fellowships depend on what you personally want to DO. Once you have a full, unrestricted medical license, you can theoretically carve out whatever you want.

But in practice, fellowships will enable you to either do more or do more earlier than if you didn’t have them. How much a lack of fellowship will restrict your practice depends on the type of fellowship.

The biggies would be:

Pain Medicine- Without the fellowship, you will not be able to function as a Pain Medicine doc. Yes, you can do mindfulness and other therapy to help individuals with chronic pain, but the field of Pain Medicine also includes blocks, surgeries, etc. You will not be doing these as a psychiatrist without the fellowship.

Hospice and Palliative Medicine- Again, you can get a job at a hospice as a psychiatrist without fellowship, but the field of HPM is in large part responsible for doing consults on patients with refractory pain, nausea, vomiting, diarrhea, and other issues. You will not have this capability without fellowship.

Child and Adolescent- You can definitely see adolescents without the fellowship, and nothing is really stopping you from seeing children but caveat emptor.

To a slightly lesser degree:

Forensic Psychiatry- You do not need a fellowship for doing the $400 competency evaluations, particularly in remote areas. But for building an actual career forensic practice, it’s getting harder and harder to do. Reports and testimonies of many folks without formal training is often fairly weak, and their business is being encroached by those who do better work. If folks are considering this as a career, trying to do so without the fellowship would be bad strategy. The majority of folks with good forensic practices without fellowship fall into one of two camps: a) they’re old or b) they are limited to testifying in a very, very specific field where fund of knowledge is more important to report and testimony (which is fairly rare and hard to do more than a handful of cases per year). I consider Forensic Psychiatry akin to Emergency Medicine: you can go plenty of places in the country and get ER work with a Family Practice residency under your belt, but considering a career in it would be hard to recommend someone into an emergency medicine career without recommending the EM residency.

I’d put the rest of the major fellowships (psychosomatic, public, geri, addiction, etc.) into the category of fellowship being a career enhancer. Which I think is an important and deliberately chosen term. These fellowships will enhance your career. These fellowships will potentially mean that you will get selected over someone else for a particular job. These fellowships will open up opportunities for competitive teaching jobs at academic centers. And (far and away most importantly), these fellowships will give you a strong foundation after a year of focused practice and training in a very specialized subject that will influence the quality of the work you do (and the satisfaction you get from doing it) for many years to come.

Does that make the fellowship worth it? That’s a completely personal calculus based just on you. But I wouldn’t steer someone away from a fellowship based on opportunity cost without the applicant doing a lot of navel gazing.

I agree regarding the forensics. I think the fellowship and board-certification helps with marketing and justifying your hourly rate (which can be impacted by the supply and demand). So if a forensic psychiatrist is doing expert witness work 50% time (it would be more challenging to get as many referrals for a non-forensic doc) and is able to increase the hourly by 15-30% over a general psychiatrist, a forensic psychiatrist could earn more than the average child psychiatrist. That being said, many forensic psychiatrists devote less than 20% of their time doing forensic work.

In addition, some states require it for some criminal cases. Although most of my expert witness work is civil, having criminal cases does allow me to fill up my expert witness practice with more cases. Regarding the ranking list above, I would rank Forensics 1 or 2.

 

[Daedra22]

This calculation is going to be different for everyone, which many people have outlined above. When deciding if it's "worth it" you have to consider what you're looking for financially, professionally, academically, and personally. For me there were many reasons I chose to do a CL fellowship despite the financial/time costs and knowing very well that I could work as a CL psychiatrist without doing the training. I loved CL and wanted to gain expertise and exposure to subspecialty topics I might not have access to otherwise - I may never work in an HIV clinic again, but it was professionally and personally valuable to have done it. Like so many decisions, if the benefits outweigh the risks/costs in your specific situation, it's worth considering. That analysis is not very generalizable in this circumstance unless you're looking purely at objective factors (like money, where only a few fellowships will come out ahead).

It may be useful to request a supervisor who has done the fellowship you're considering, if it's an option. Being supervised by a CL-trained doc in residency helped me clearly define my post-residency goals and figure out whether fellowship would help me reach them.

Edit - I just realized this was a very old thread just recently revived. Huh. Oh well.

 

[Psychresy]

I do wonder if it's worth it if you're trying to go into private practice. Would being " Yale/Columbia/UCSF/etc" trained allow you to increase rates and bring in more cash payers?

 

[TexasPhysician]

I do wonder if it's worth it if you're trying to go into private practice. Would being " Yale/Columbia/UCSF/etc" trained allow you to increase rates and bring in more cash payers?

Probably depends on geography and how you market yourself. In my area, I haven’t seen it to be worth anything.

 

[J ROD]

I do wonder if it's worth it if you're trying to go into private practice. Would being " Yale/Columbia/UCSF/etc" trained allow you to increase rates and bring in more cash payers?

Most patients do not care where you went to school. That prestige can be debated amongst your academia. They care what you can to do to make them feel better. If you make patients perceive betterment and improvement in their lives, they will come back and pay for a service.

Personally, I have met plenty of folks that went to "top tier schools" and yes they are great test takers, GPA, etc. Were they better physicians in terms of relating to patients and caring for them......not so much. Now do those physicians think they do....that's a different question. I guess we all hold different things in prestige.

And insurance payers could care a less. Just need to be board certified.

 

[J ROD]

As far as fellowship goes, there are only a few that really will bring extra value in terms of the monetary perspective. Now, it you want more knowledge or time in training that is a different story.

I think for child/adolescent you pretty much need to do it. You can see those populations without it but it is generally "preferred" in my opinion.
Obviously, pain and sleep medicine are basically different fields so if you want to go that route probably need that training.
Forensic, I think you would generally benefit from the additional training so you can market yourself better and get a better foothold. But, you can do it without depending on area and right situation.
C/L, Geriatrics ..... academia
Addiction, again I think it would be beneficial if you want to do strictly that. I think the additional training really allows one to treat this patient population well. You can do it without but like forensic I believe it helps make yourself more marketable and allows you to reach that specific goal quicker.

 

[AClassicRisetotheOccasion]

I think due to the ever-increasing competitive nature of psychiatry, fellowships would be beneficial if you want to be in academics or in major cities. Other benefits would include just being very good at what you do and feeling comfortable with complex cases.

 

[thepoopologist]

How competitive is it these days. Are people gouging each others eyes out? Taking 2 years of research before applying to residency?

 

[AClassicRisetotheOccasion]

How competitive is it these days. Are people gouging each others eyes out? Taking 2 years of research before applying to

How competitive is it these days. Are people gouging each others eyes out? Taking 2 years of research before applying to residency?

I was referring to jobs after residency, not getting into residency. As far as getting into residency, I have heard tales from both sides. Some people got it easily with just great scores but little research etc. while others had stellar CVs and did not match. I know doing well in interviews is important. But then again, that could be said of any residency.

 

[psyguru]

As far as fellowship goes, there are only a few that really will bring extra value in terms of the monetary perspective. Now, it you want more knowledge or time in training that is a different story.

I think for child/adolescent you pretty much need to do it. You can see those populations without it but it is generally "preferred" in my opinion.
Obviously, pain and sleep medicine are basically different fields so if you want to go that route probably need that training.
Forensic, I think you would generally benefit from the additional training so you can market yourself better and get a better foothold. But, you can do it without depending on area and right situation.
C/L, Geriatrics ..... academia
Addiction, again I think it would be beneficial if you want to do strictly that. I think the additional training really allows one to treat this patient population well. You can do it without but like forensic I believe it helps make yourself more marketable and allows you to reach that specific goal quicker.

Regarding forensics, it is possible to build an expert witness practice without the fellowship if you can target a niche and perhaps go nationwide. I have done both, done the forensics fellowship, and obtained a 3rd board certification in a litigated sub-specialty. However, not all my work is from that niche so I believe the board certification and expertise in forensics do help. I think if you plan on earning 50% or more of your income as an expert witness, it would be wise to do the fellowship. Plus the fellowship was by far the most interesting year as a trainee.

 

[Dr.MONO]

From a financial standpoint, only child. People do fellowships in psych because they are passionate about it.

 

[psyguru]

From a financial standpoint, only child. People do fellowships in psych because they are passionate about it.

I disagree. Forensics has good potential from a financial standpoint if you do expert witness work. Now if you combine forensics with child that may give an additional bump. This may not be true for most forensic psychiatrists, especially if you limit your work to clinical work. It is possible to do expert witness work without the fellowship but I believe the fellowship gave me a good edge to get referrals from a wide variety of cases.