Path to child and adolescent psychiatry

[MrChance2]

Hello,

I'm an M3 interested in child and adolescent psychiatry but am having a bit of trouble understanding all the paths to get there.

I know I can match general psych then do a fellowship? Would that be 5 or 6 years total training after medical school? How difficult is it to get these? Would I start a fellowship 3 or 4 years after medical school?

I know the 5 year combined programs exist as an option. Are these more competitive than general psych?

Is it possible to do a 4 year general psych program and just do a lot of electives/CME in child and adolescent then go right into practicing with that age group?
Thanks.

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[wolfvgang22]

You can do a 4 year general psychiatry (just called Psychiatry) residency, and then 2 year Child fellowship. That's 6 years total training after med school.
The other option is you can do what is often called the "fast track", which is 3 years of general psychiatry residency, and then 2 years of Child fellowship, which is 5 years total after med school. The first year of the Child and Adolescent fellowship counts as your 4th year of Psychiatry residency if you fast track. This is really no different than going somewhere that has a 5 year combined program, only you are already accepted into the Child fellowship and stay at the same University for the whole 5 years in the 5 year combined programs and these combined programs tend to prepare you more for working in academia.

You can serve children and adolescents in a community or in private practice without having done a fellowship, but you may have difficulty getting hospital privileges or on insurance panels as a psychiatrist that treats children and adolescents without being board certified in Child and Adolescent Psychiatry. Many psychiatrists in the community will treat older teenagers (15 or 16 and up), but will leave treatment of children to Child Psychiatrists if any are available.

 

[prok]

Along these same lines, how competitive are these fellowships? It seems like there's an increase in interest recently, so is there any concern that getting a spot might not be guaranteed a few years down the line? I'm only asking because it would make the combined/triple-board programs a lot more desirable.

 

[wolfvgang22]

Doing a non-combined fellowship (either after 4 years of general psychiatry or "fast tracking") is not very competitive at all.
Combined programs where you are accepted to the child program when you first match are a little more competitive, because these are a little more academic, and med students trying to Match for the first time always show a lot of interest in Child fellowship initially.
Many med students say they want to do a Child fellowship because they think it sounds more impressive on interviews and to their friends.
After 3 years of residency, most of these people will change their minds and are just ready to be finished and out working. You are then left with residents who are truly interested in serving children and adolescents and further learning to become more of a complete psychiatrist, and maybe a few who just aren't ready to be done with residency quite yet and want to stay in the learning environment a little longer.

 

[SmallBird]

Along these same lines, how competitive are these fellowships? It seems like there's an increase in interest recently, so is there any concern that getting a spot might not be guaranteed a few years down the line? I'm only asking because it would make the combined/triple-board programs a lot more desirable.

Echoing whats been said, these fellowships are not competitive at all, and will likely remain uncompetitive. Although I am a child psych fellow, and absolutely love my work, the fellowship is really tough. Its like being an intern all over, and is significantly more onerous that a typical 4th year, or any other fellowship. And, talking to colleagues at other programs, it only sounds worse for them. So this is something of a barrier for some folks.

 

[MrChance2]

So if I want to "fast track" into a child + adolescent psych program I just try to match for residency at a program that has a child and adolescent fellowship and then tell them I'm interested in child + adolescent psych then ultimately reapply to fellowship at the same place during residency where they will change me into that program for 4th year and extend my total training there to 5 years?

Do they need to have a special program or will any place with both Psych residency + Child and Adolescent fellowship do it?

 

[wolfvgang22]

So if I want to "fast track" into a child + adolescent psych program I just try to match for residency at a program that has a child and adolescent fellowship and then tell them I'm interested in child + adolescent psych then ultimately reapply to fellowship at the same place during residency where they will change me into that program for 4th year and extend my total training there to 5 years?

Do they need to have a special program or will any place with both Psych residency + Child and Adolescent fellowship do it?

You don't have to tell anybody anything until you decide to apply to a fellowship in PGY3 or PGY4. You don't have to make up your mind about fast tracking or even doing a fellowship at all until PGY3.
You don't have to do residency at a program that has a Child fellowship.
Many residents leave after 3rd year and Match into a Child Psych fellowship at another institution. You start the process of applying about half way through your PGY3.
Every child psych fellowship I know of allows you to fast track and finish residency and fellowship in 5 years total. You don't have to do your fellowship in the same institution you do residency.

Example: I did 3 years of psych residency in one state out west, but all my friends in my psych program (all 6 of us in PGY3) applied to the Child fellowship at my program during PGY3, so my home child program ran out of spots (this is uncommon). So, during PGY3 I applied to a child psych program down the road at another University in another state during PGY3 and matched there. I then did my 4th and 5th years at the University in the eastern state. Voila!

 

[MrChance2]

You don't have to tell anybody anything until you decide to apply to a fellowship in PGY3 or PGY4. You don't have to make up your mind about fast tracking or even doing a fellowship at all until PGY3.
You don't have to do residency at a program that has a Child fellowship.
Many residents leave after 3rd year and Match into a Child Psych fellowship at another institution. You start the process of applying about half way through your PGY3.
Every child psych fellowship I know of allows you to fast track and finish residency and fellowship in 5 years total. You don't have to do your fellowship in the same institution you do residency.

Example: I did 3 years of psych residency in one state out west, but all my friends in my psych program (all 6 of us in PGY3) applied to the Child fellowship at my program during PGY3, so my home child program ran out of spots (this is uncommon). So, during PGY3 I applied to a child psych program down the road at another University in another state during PGY3 and matched there. I then did my 4th and 5th years at the University in the eastern state. Voila!

Sounds great. Thanks a lot for your help.

 

[TexasPhysician]

Just a couple of additions to already great information above:

Not all psychiatry residency programs allow residents to fast-track. The only programs that don't allow this that I am aware of do not have a child fellowship program and have mandatory 4th year rotations that need staff.

If you skip the C&A fellowship, I wouldn't recommend treating this population. If an adverse event happens, you are more likely to be sued and less likely to effectively defend yourself.

 

[Merovinge]

You don't have to tell anybody anything until you decide to apply to a fellowship in PGY3 or PGY4. You don't have to make up your mind about fast tracking or even doing a fellowship at all until PGY3.
You don't have to do residency at a program that has a Child fellowship.
Many residents leave after 3rd year and Match into a Child Psych fellowship at another institution. You start the process of applying about half way through your PGY3.
Every child psych fellowship I know of allows you to fast track and finish residency and fellowship in 5 years total. You don't have to do your fellowship in the same institution you do residency.

Be a little careful about this. You do need certain ACGME requirements to be completed early if you fast-track and depending on your program it is imperative that your PD knows prior to setting your pgy3 rotations. Most of the time if you let them know you even have an interest in fast-tracking (which the majority of CAP fellows do), they can easily accommodate you.

 

[MrChance2]

Not all psychiatry residency programs allow residents to fast-track. The only programs that don't allow this that I am aware of do not have a child fellowship program and have mandatory 4th year rotations that need staff.

Just a couple of additions to already great information above:

Not all psychiatry residency programs allow residents to fast-track. The only programs that don't allow this that I am aware of do not have a child fellowship program and have mandatory 4th year rotations that need staff.

If you skip the C&A fellowship, I wouldn't recommend treating this population. If an adverse event happens, you are more likely to be sued and less likely to effectively defend yourself.

If they don't have child psych should I just ask programs this before ranking them? I'm def going to go more for programs with child psych programs but I definitely don't want to get to 3rd year and have them say "oops, turns out we need you for 4th year, sorry".

 

[OldPsychDoc]

If they don't have child psych should I just ask programs this before ranking them? I'm def going to go more for programs with child psych programs but I definitely don't want to get to 3rd year and have them say "oops, turns out we need you for 4th year, sorry".

That would be appropriate. Most of us (in good programs at least) would openly boast about our desire to facilitate fast-tracking for residents who make that choice.

 

[hamstergang]

If they don't have child psych should I just ask programs this before ranking them?

Then having a child program is irrelevant. The general psychiatry program needs to be sure that your 3 years cover what they need to if you'll be going to any child program. Some are already set up fine, some need a little tweaking.

Edit: seems I misread the thread a little. Still, just ask every program about it, and definitely let wherever you match know your plan.

 

[masterofmonkeys]

About 10% of all child spots didn't fill last year. The number of prestigious programs that had to scramble to fill child fellowship spot last year was quite high.

 

[ahi74]

Anyone here about child psych at Cornell? If the program is good? What about general psychiatry there as well?

Thanks for your time.

 

[splik]

technically they do not have a child psychiatry residency program - there is a combined residency program with columbia. it is much less well regarded than the general residency program at either (which doesn't mean it's bad - they tendto have a fair few people stay on to complete their child training).

 

[Amygdarya]

Anyone here about child psych at Cornell? If the program is good? What about general psychiatry there as well?

Thanks for your time.

Cornell's general psych program is one of the very top. It has a strong emphasis on psychodynamic therapy, which is not everyone's cup of tea; conversely, if you're seriously interested in therapy, Cornell provides some of the best training available.

NYU's child psych program is traditionally considered the strongest in NYC. Which is not to say Cornell's child psych program is weak, as splik has explained.

 

[Leo Aquarius]

There are about 5 competitive Child fellowships out there. The rest are easy breezy.

 

[Auvelity]

Ok. Would you guys mind giving me some insight into this program?
http://medicine.buffalo.edu/departments/psychiatry/education/residency/curriculum/tracks/child.html
they say the start right after PGY2 and you apply through eras once applying to Psychiatry. So idk how you let them know you want that specific path if ERAS don't give that option. So I assume its only for the people that get matched into that residency that have that option

 

[hamstergang]

Ok. Would you guys mind giving me some insight into this program?
http://medicine.buffalo.edu/departments/psychiatry/education/residency/curriculum/tracks/child.html
they say the start right after PGY2 and you apply through eras once applying to Psychiatry. So idk how you let them know you want that specific path if ERAS don't give that option. So I assume its only for the people that get matched into that residency that have that option

I don't know, but I imagine the people running the program would know the answers to your questions.

 

[Not_a_psychic]

There are about 5 competitive Child fellowships out there.

Which ones are those?

 

[Blitz2006]

Which ones are those?

I'm curious to know as well.

I think I read somewhere that UCLA is #1? True?

 

[notdeadyet]

The rude awakening is for folks expecting that #1 program stuff to exist.

There are some great CAP programs, of which UCLA is one. Ranking is just plain silly and doesn't exist outside of folks who can't let USN&WR go.

I believe there is a correlation between folks who believe in psychiatry "rankings" and folks who continue to fear that things are going in their "file."

 

[nowaysanjose]

Apologies for bumping this thread, but does anyone know if you become board eligible for general adult psychiatry after the first year of C/A fellowship? For instance, if some life event happens and you’d want to get on with practicing, could you then sit for the general boards and avoid the last year of the fellowship?

 

[Attending1985]

Echoing whats been said, these fellowships are not competitive at all, and will likely remain uncompetitive. Although I am a child psych fellow, and absolutely love my work, the fellowship is really tough. Its like being an intern all over, and is significantly more onerous that a typical 4th year, or any other fellowship. And, talking to colleagues at other programs, it only sounds worse for them. So this is something of a barrier for some folks.

In terms of hours worked? Call? Difficult attendings?

 

[clozareal]

Apologies for bumping this thread, but does anyone know if you become board eligible for general adult psychiatry after the first year of C/A fellowship? For instance, if some life event happens and you’d want to get on with practicing, could you then sit for the general boards and avoid the last year of the fellowship?

If you fast-tracked, then yes. You take your board exam in the fall of your CAP2 year. If you wanted to drop out and just do adult, you could. You might be burning some bridges though but as long as it's an open discussion with your PD and you haven't signed the contract for CAP2 year yet, then I'm not aware of any violations (from GME, NRMP, etc) preventing you from doing this.

 

[TexasPhysician]

Apologies for bumping this thread, but does anyone know if you become board eligible for general adult psychiatry after the first year of C/A fellowship? For instance, if some life event happens and you’d want to get on with practicing, could you then sit for the general boards and avoid the last year of the fellowship?

Yes

 

[nowaysanjose]

If you fast-tracked, then yes. You take your board exam in the fall of your CAP2 year. If you wanted to drop out and just do adult, you could. You might be burning some bridges though but as long as it's an open discussion with your PD and you haven't signed the contract for CAP2 year yet, then I'm not aware of any violations (from GME, NRMP, etc) preventing you from doing this.

Good to know, thank you.