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JamesPhilly

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Hi SDN,

PGY 3 here. From being a 'lurker' here on SDN, I have learned the following about C&A work-
- About 5% pay increase
- Probably will give more in terms of job flexibility, better hours
- Can also be miserable working with family who are unwilling or unable to change conditions at home
- Don't get paid for the extra leg work required for the population (talking to teachers, parents, etc)

I am in a unique situation in which I am legally compelled to do a fellowship. The area of the world that I want to move to (home!) requires that psychiatrists have 5 years of post graduate training. I am lucky in that I enjoy all of psychiatry, and I could do any fellowship that we're eligible for, with the exception of perhaps sleep or pain medicine. So the question is, which fellowship should I pick if I enjoy them all about equally?

Does it make more sense for me to do a C&A fellowship? I won't be able to fast track which is a bummer. However, I feel that the C&A fellowship has the most to offer in that understanding development would help me treat *everyone*. This is opposed to addiction/geriatrics which, although interesting, seem not as applicable to the population as a whole. At least on paper that's how it seems.

Also, since child psychiatry pays slightly better and allows for more flexibility, it seems like the more prudent thing to do. Again, this is assuming that I enjoy all of psychiatry equally.

Any thoughts on this, my understanding of C&A work/pay, etc?

Many thanks for your time!

EDIT: I forgot to add that the one year of additional training has to be authorized by the ACGME; I already tried to get an interesting psychodynamic year-long course approved, but it was denied.
 
If you are willing to do six postgraduate years (instead of the five that would be required for most other fellowships) and really like the idea of a being a true "generalist," able to see the whole range of patients, then C&A sounds like a great option. I think it is probably one of the most valuable fellowships in an across-the-board sense. That said, you should think about what niche most interests you in particular, and what applications you could find for each niche back home. For instance, if you find (to make something up) that there is a big demand for addiction treatment where you're from then the fellowship exposure might make you a valuable leader in that segment, going more of the "specialist" than "generalist" route.

For me, I wanted to want to do child training but just couldn't. Being as honest as you can with yourself about what you like to do day to day may also help.
 
It sounds like you wouldn't do a fellowship at all if you weren't required to. If that is the case, and you really enjoy geriatrics, addiction, and C/L just as much, why would you do two extra years of fellowship instead of one?

Does a non-GME fellowship count? If so, that opens plenty of doors - interventional psychiatry, neuropsychiatry, public psychiatry, etc. I'd rather learn more about the stuff I wasn't exposed much to in residency.
 
non-ACGME fellowships are not often recognized by the ECFMG for purposes of visa sponsorship so if someone is on a J1 visa then you can't usually do a non-ACGME fellowship - Most non-accredited psychiatry fellowships (see here) could be available for a J1 visa but the challenges are 1) a statement of need from the country for that superspecialty training which, depending on your country of origin could be problematic as they probably want generalists, not specialists. The second issue is that many non-accredited fellowships expect you to bill for your work, and you cannot bill independently if you are on a J1 visa and this is going to be a deal breaker for many fellowships. A further issue is that some fellowships that are research oriented (for example some 2-year behavioral neurology fellowships are T32 funded for all or part of it, and you cannot be on a visa in the case). I'm sure there are programs that are desperate enough and willing to overlook the billing aspect, but it is more complicated unfortunately than if you're on an H1 visa (and yet another reason why one should always try to get an H1 visa if possible)

you're being deliberately irritating and vague about your "area of the world" - however it is highly unlikely you would require 5 years of training. Residency (with ABPN board certification) +1 year of work would satisfy the 5 year postgraduate training requirement in most places (including all EU countries, and Canada - probably province dependent)

Edited to clarify mistake as pointed out by smallbird.
 
Last edited:
What's the value in keeping your home country a secret in this thread other than to hinder our ability to help you?
 
OldPsychDoc said:
What's the greatest need in the "area of the world that I want to move to (home!)"? Addiction? Gero? CAP?
Click to expand...

That's a great question, I didn't think to ask. I will this coming week.

Bartelby said:
Being as honest as you can with yourself about what you like to do day to day may also help.
Click to expand...

That's tough; I mean psychiatry is so versatile. What I like about child is that if I choose not to treat kids, it seems still to be very useful.

cookymonster said:
It sounds like you wouldn't do a fellowship at all if you weren't required to. If that is the case, and you really enjoy geriatrics, addiction, and C/L just as much, why would you do two extra years of fellowship instead of one?
Click to expand...

Because child seems the most practical; if I'm already in for a year I might as well go all in and bolster my knowledge of development. Maybe that's a mistake though.

So let me ask you cookmonster a question that I should have asked before: is there a general consensus on psych fellowships and how demanding they are? Obviously programs will vary a lot, but is there a trend that everyone agrees on?

cookymonster said:
Does a non-GME fellowship count? If so, that opens plenty of doors - interventional psychiatry, neuropsychiatry, public psychiatry, etc. I'd rather learn more about the stuff I wasn't exposed much to in residency.
Click to expand...

No, the response I got back was that it had to be accredited. I had wanted to do psychodynamic training, but it didn't count.

splik said:
you're being deliberately irritating and vague about your "area of the world"
Click to expand...

Goodness. Is not telling you my hometown, which would effectively give you my identity, offensive to you?

I'll be honest splik: I was active on SDN back in medical school, but I deleted by account. There was a lot of vitriol here, and in this sub-forum specifically: literally, there was a person with the username 'vitriol' who was just awful. There were some cool people, I remember old psych doc and whooper being very kind. Anyway, overall it wasn't fun anymore as the camaraderie that drew me to this profession was absent here, and in its place was a lot of unnecessary arguing and drama.

I do appreciate strangers such as yourself taking the time to help me in a big life decision. But I won't apologize for attempting to keep some level of anonymity.

And also your statements regarding accreditation as a psychiatrist across the globe are incorrect, which would not be helpful to other foreign-born psychiatrists living in the US. As in all things, it is helpful only to give advice about that which you are knowledgeable. If a person reading this is also contemplating a move back to a foreign country after training in the US, I would advise them to contact the accrediting body directly for your country/providence as requirements vary considerably

wolfvgang22 said:
Well to be fair, Psychiatry is a small world and he could be the only resident from Albania. Nothing wrong with a little privacy.
Click to expand...

That is exactly right. However "irritating" it is for me to keep my identify anonymous, certainly people here can at least understand why that is, otherwise our usernames would be actual names, which honestly my username comes pretty close to already

hamstergang said:
What's the value in keeping your home country a secret in this thread other than to hinder our ability to help you?
Click to expand...

How exactly would you knowing where I come from help you to help me? The name of my country of origin has absolutely no bearing in this at all: the licensing requirements are simply a matter of fact and there is nothing you can do to change it. As you can see by the edit I made a few seconds after I posted this thread, I am already in contact with the accrediting authorities, so I'm not basing this all on Google searches.
 
Just curious, which area of the world is this?
 
JamesPhilly said:
So let me ask you cookmonster a question that I should have asked before: is there a general consensus on psych fellowships and how demanding they are? Obviously programs will vary a lot, but is there a trend that everyone agrees on?
Click to expand...
I can only tell you how it was at my program. 1st year of CAP was fairly busy with several months on the inpatient unit. You also had to take home call, but would almost never get paged. Second year was largely an easy waste of time, much like fourth year in adult training. The addiction and geriatrics fellowships were cush.

JamesPhilly said:
There was a lot of vitriol here, and in this sub-forum specifically: literally, there was a person with the username 'vitriol' who was just awful.
Click to expand...
:laugh:🤣
He hasn't been missed.
 
cookymonster said:
I can only tell you how it was at my program. 1st year of CAP was fairly busy with several months on the inpatient unit. You also had to take home call, but would almost never get paged. Second year was largely an easy waste of time, much like fourth year in adult training. The addiction and geriatrics fellowships were cush.
Click to expand...

That's good to hear, thank you! I will research this more (difficulty and demands of fellowships), and if anyone else would share their experience with their fellowship I would be grateful

cookymonster said:
He hasn't been missed.
Click to expand...

🙂 Indeed!
 
I suggest that we now refer to our extra strength Diphenhydramine poster as “Voldemort”. That way we will not accidentally say his name three times.
 
FlowRate said:
Are you certain that those benefits hold true in your home country? (Australia?)
Click to expand...

Yes, as I said I am talking with the accrediting body back home. I am certain about the requirements. I wouldn't know about Australia though
 
JamesPhilly said:
Yes, as I said I am talking with the accrediting body back home. I am certain about the requirements. I wouldn't know about Australia though
Click to expand...
Are you certain that those benefits hold true in your home country? By "those benefits" I meant the increased salary and flexibility which is probably true in the US, but wasn't sure if it was true elsewhere.
 
I'm not doing CAP, but I've always been impressed with the perspective they bring to adult patients. Hearing someone's story in the context of their development seems really valuable.
 
FlowRate said:
Are you certain that those benefits hold true in your home country? By "those benefits" I meant the increased salary and flexibility which is probably true in the US, but wasn't sure if it was true elsewhere.
Click to expand...

Ah, I apologize, I did not notice the keyword 'benefits'. The hours would be more flexible, but the pay as I understand it would be about the same. Good point.
 
JamesPhilly said:
Hi SDN,

PGY 3 here. From being a 'lurker' here on SDN, I have learned the following about C&A work-
- About 5% pay increase
- Probably will give more in terms of job flexibility, better hours
- Can also be miserable working with family who are unwilling or unable to change conditions at home
- Don't get paid for the extra leg work required for the population (talking to teachers, parents, etc)

I am in a unique situation in which I am legally compelled to do a fellowship. The area of the world that I want to move to (home!) requires that psychiatrists have 5 years of post graduate training. I am lucky in that I enjoy all of psychiatry, and I could do any fellowship that we're eligible for, with the exception of perhaps sleep or pain medicine. So the question is, which fellowship should I pick if I enjoy them all about equally?

Does it make more sense for me to do a C&A fellowship? I won't be able to fast track which is a bummer. However, I feel that the C&A fellowship has the most to offer in that understanding development would help me treat *everyone*. This is opposed to addiction/geriatrics which, although interesting, seem not as applicable to the population as a whole. At least on paper that's how it seems.

Also, since child psychiatry pays slightly better and allows for more flexibility, it seems like the more prudent thing to do. Again, this is assuming that I enjoy all of psychiatry equally.

Any thoughts on this, my understanding of C&A work/pay, etc?

Many thanks for your time!

EDIT: I forgot to add that the one year of additional training has to be authorized by the ACGME; I already tried to get an interesting psychodynamic year-long course approved, but it was denied.
Click to expand...


I'm on J1 visa, and I have same type of legal requirement, 5 years.

But you got me concerned, why can't we do Sleep or Pain? I'm hoping to do one of those fellowships, which is why I ask!

can anyone clarify this?!

Thanks!
 
splik said:
non-ACGME fellowships are not recognized by the ECFMG for purposes of visa sponsorship so if someone is on a J1 visa then you can't usually do a non-ACGME fellowship. It's fine if you're on an H1 visa (and yet another reason why one should always try to get an H1 visa if possible)
Click to expand...

This is incorrect. The ECFMG will sponsor for a long list of fellowships, and although this won't cover all fellowships it definitely goes beyond the list of ACGME accredited ones. Furthermore, it is onerous but very possible to get them to add another fellowship to their list - a friend of mine just got a 3 year research fellowship approved by the ECFMG for this purpose.

http://www.ecfmg.org/evsp/nonstandard-index.html
 
SmallBird said:
This is incorrect. The ECFMG will sponsor for a long list of fellowships, and although this won't cover all fellowships it definitely goes beyond the list of ACGME accredited ones. Furthermore, it is onerous but very possible to get them to add another fellowship to their list - a friend of mine just got a 3 year research fellowship approved by the ECFMG for this purpose.

http://www.ecfmg.org/evsp/nonstandard-index.html
Click to expand...


This is correct.

BUT people should also realize that certain countries may not sponsor statement of need for Non-ACGME fellowships (like Statement of Need from Canada). So while ECFMG may greenlight a non-ACGME fellowship, your home country may not. Just a heads up.

Like For Canada:

http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/postgrad-postdoc/cat_b-list-liste-eng.php

As per Psychiatry:
  • 1-year ACGME accredited, such as Forensic Psychiatry or Geriatric Psychiatry
 
Blitz2006 you are correct. I think the problem here is that a few of the above commenters know one or two foreigners and think that what they know is generalizable to everyone, when clearly it is not. Although I was glad to see Splik's edit that admitted Canada does its medical licensing by providence, that of course applies to the EU as well.

Flowrate: In regards to: 'will the benefits of CAP apply to your home country?', as it turns out having that extra training will probably get me *nothing* in terms of extra income. Bummer.

OldPsychDoc: 'What sub-specialty is in most demand?' - it sounds like in the future they predict geriatrics will be big. Which certainly would be less time, and probably easier to match into.

Thanks again for the replies, I can't be the only one in this position so hopefully this helps others as well
 
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