Pyschosomatic question

[marshmallows]

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I got accepted to fellowship already, but am having second and third thoughts about it. Seeing my colleagues get offers for jobs with real salaries and being ahead of me doesn't help. What are your thoughts, any recent fellows here that had second thoughts?
I guess my goal is to work in a mix of outpatient and inpatient but not inpatient psych, but would prefer inpatient CL, thats why I considered it.
thanks for your input

 

[michaelrack]

I got accepted to fellowship already, but am having second and third thoughts about it. Seeing my colleagues get offers for jobs with real salaries and being ahead of me doesn't help. What are your thoughts, any recent fellows here that had second thoughts?
I guess my goal is to work in a mix of outpatient and inpatient but not inpatient psych, but would prefer inpatient CL, thats why I considered it.
thanks for your input

If you are planning on a non-academic career, a psychosomatic fellowship is a waste of time and lost income, unless you have a burning love for the field.

BTW, I grandfathered into the psychosomatic certification without doing a fellowship.

 

[marshmallows]

Oh thats great you did that. I guess now its too difficult to grandfather into it.
thanks for your input. I never thought of it like that. I just like doing consults on the floors and ED, but I have no desire to do Academics after great thought about it, just like the clinical work, but wondering if residency is enough to get a job without the fellowship.

 

[michaelrack]

Oh thats great you did that. I guess now its too difficult to grandfather into it.
.

it's too late. I took the board certification test because it was available to me in 2007; I would never have done a fellowship.

A fellowship won't help with your career plans. My advice is to go out and get a job

 

[marshmallows]

thanks for the advice, I will def consider all of that.

 

[vistaril]

I got accepted to fellowship already, but am having second and third thoughts about it. Seeing my colleagues get offers for jobs with real salaries and being ahead of me doesn't help. What are your thoughts, any recent fellows here that had second thoughts?
I guess my goal is to work in a mix of outpatient and inpatient but not inpatient psych, but would prefer inpatient CL, thats why I considered it.
thanks for your input

I wouldn't do the fellowship. In fact, I'd even go so far as to say that your CV will end up being weaker in the immediate future in some ways for having done the fellowship. Most of the people that do fellowships like that have a reason why they *have* to do a fellowship or pgy-5 year.....like they have visa issues for example(not uncommon). I honestly think going out and working a year in the real world(including some consults) is going to be better for you in terms of learning and advancing your career than a 1 year fellowship in C/L.

Is there a reason you couldn't have just stacked up a bunch of electives this year in C/L work to get a better handle on this?

If you don't see yourself pursuing an academic career, this fellowship is a HORRIBLE idea.

If you see yourself pursuing an academic career, but sort of like a mix of everything right now(including consults), this fellowship would be a bad idea, but maybe not horrible.

This nonsense about the needing to do a fellowship in C/L to get board certified in C/L isn't going to have the effect some people want it to have.....people aren't going to do a whole 1 year fellowship in C/L just to be able to sit for board certification in C/L(which is already sort of dubious). The result is that the only people who do the fellowship in the future(and thus are BC in C/L) are going to not be the most select group if you know what I mean...

in fact, except for Child and maybe forensics, this whole push towards mandatory fellowships and such to be BC in addiction, C/L, even geri(but not to same extent) is stupid....it's only going to end up devaluing board certification in such things.

Go out and get a real job.....in pp, academics, govt whatever....just man up and start actually working and enter the real world. Doing a one year fellowship in C/L is just a waste.

 

[DJspreadsheet]

^what do you think about doing a fellowship for the goal of getting back to a certain geographic location? Or is it not a problem just finding a job in that desired location (I'm not talking about a place like Boston - more like Seattle or Portland).

 

[vistaril]

^what do you think about doing a fellowship for the goal of getting back to a certain geographic location? Or is it not a problem just finding a job in that desired location (I'm not talking about a place like Boston - more like Seattle or Portland).

a geri fellowship *might* make you more likely to secure some general positions that involve some % of geri.....*might*.

Your question really just depends on the specifics, but in general....doing a C-L fellowship would not help you get back to a certain location. You're not going to be able to collect more in terms of consult revenue because you did a fellowship in C-L. Additionally, employers trying to decide between someone 1 year out of general residency with 1 year of real work experience vs someone who didn't get a year of real work experience is going to give the edge to the person with 1 year of real experience out of training because they are much more ready to start working/producing...

 

[DJspreadsheet]

a geri fellowship *might* make you more likely to secure some general positions that involve some % of geri.....*might*.

Your question really just depends on the specifics, but in general....doing a C-L fellowship would not help you get back to a certain location. You're not going to be able to collect more in terms of consult revenue because you did a fellowship in C-L. Additionally, employers trying to decide between someone 1 year out of general residency with 1 year of real work experience vs someone who didn't get a year of real work experience is going to give the edge to the person with 1 year of real experience out of training because they are much more ready to start working/producing...

I'm talking doing an addiction fellowship at UW Seattle (for example) in order to get to Seattle. Or...could I easily just find a pretty standard job in Seattle being a psychiatrist (scratch the addiction thing) in some capacity? I'd prefer being able to move without having to do a fellowship to get me "connected" to the local scene.

 

[vistaril]

I'm talking doing an addiction fellowship at UW Seattle (for example) in order to get to Seattle. Or...could I easily just find a pretty standard job in Seattle being a psychiatrist (scratch the addiction thing) in some capacity? I'd prefer being able to move without having to do a fellowship to get me "connected" to the local scene.

oh I see where you are coming from now....I have no idea how easy it is to find a job in seattle. I'd imagine it is a big enough city where there is some job in some capacity you could just move there and get.

honestly, if you really want to be in seattle, you could always just move there and do locums weekend inpatient coverage, cobble together days here and there in various settings, and other stuff to make $$ and network. You would probably get more connected to the local scene doing that than at an addiction fellowship.

Because doing an addiction fellowship, unless you want to work for bradford or something(and even then it isn't required) isn't going to help you secure a job in general at all.

 

[DJspreadsheet]

oh I see where you are coming from now....I have no idea how easy it is to find a job in seattle. I'd imagine it is a big enough city where there is some job in some capacity you could just move there and get.

honestly, if you really want to be in seattle, you could always just move there and do locums weekend inpatient coverage, cobble together days here and there in various settings, and other stuff to make $$ and network. You would probably get more connected to the local scene doing that than at an addiction fellowship.

Because doing an addiction fellowship, unless you want to work for bradford or something(and even then it isn't required) isn't going to help you secure a job in general at all.

Cool, thanks. Working at a slick addiction center does sound appealing to me. Starting one sounds even better. I'm guessing it's easier said than done.

 

[vistaril]

Cool, thanks. Working at a slick addiction center does sound appealing to me. Starting one sounds even better. I'm guessing it's easier said than done.

Starting one is very hard.....the market is already pretty saturated and there are numerous obstacles. Basically, a lot of your revenue is going to come from impaired professionals(lots of health professionals but also pilots, lawyers, etc) who need to get formal treatment as a condition to enter a monitoring program. The biggest thing then becomes getting your program(which isnt going to have any track record) on the approved list by your states nursing board/monitoring board, medicine, pharmacy, law, etc.....and that is not going to be trivial as these monitoring boards already have comfortable relationships with the programs already on the approved list.

 

[DJspreadsheet]

Starting one is very hard.....the market is already pretty saturated and there are numerous obstacles. Basically, a lot of your revenue is going to come from impaired professionals(lots of health professionals but also pilots, lawyers, etc) who need to get formal treatment as a condition to enter a monitoring program. The biggest thing then becomes getting your program(which isnt going to have any track record) on the approved list by your states nursing board/monitoring board, medicine, pharmacy, law, etc.....and that is not going to be trivial as these monitoring boards already have comfortable relationships with the programs already on the approved list.

Maybe start with an addiction-geared PP and get a word-of-mouth reputation as being a good doc. Then build on that reputation. A solid resume wouldn't hurt things.

EDIT: I should add, I'm considering C&A as well. So it would be adolescent addiction. I'm guessing this increases the feasibility??

 

[billypilgrim37]

I interviewed for addictions fellowships this year as I was finishing the child fellowship. After a ton of deliberation, I barely decided it wasn't worth it to do it. The program I was most interested in wasn't going to offer any slots until they finished interviewing everybody, and I just couldn't wait that long with job offers pending. If they'd offered me within a few days of the interview, I'd have taken the slot.

I think not doing it was the best good choice. My knowledge base in addictions would be much better, but the professional opportunities probably won't be much better, and that's another 100k of salary lost. Not doing it made my wife very happy.

 

[DJspreadsheet]

I interviewed for addictions fellowships this year as I was finishing the child fellowship. After a ton of deliberation, I barely decided it wasn't worth it to do it. The program I was most interested in wasn't going to offer any slots until they finished interviewing everybody, and I just couldn't wait that long with job offers pending. If they'd offered me within a few days of the interview, I'd have taken the slot.

I think not doing it was the best good choice. My knowledge base in addictions would be much better, but the professional opportunities probably won't be much better, and that's another 100k of salary lost. Not doing it made my wife very happy.

Good to know. I'm a little fed-up with the constant pursuit of further training, so knowing that I can forgo it is welcome news.

What's the adolescent addiction job market like?

 

[vistaril]

Maybe start with an addiction-geared PP and get a word-of-mouth reputation as being a good doc. Then build on that reputation. A solid resume wouldn't hurt things.

EDIT: I should add, I'm considering C&A as well. So it would be adolescent addiction. I'm guessing this increases the feasibility??

I wouldnt think there would be a lot of money in adolescent addiction.....that sounds more of a niche academic area.

 

[billypilgrim37]

I wouldnt think there would be a lot of money in adolescent addiction.....that sounds more of a niche academic area.

Exactly. There are few locales that do adolescent addiction very well, despite the fact that it's a ripe research area. Someone probably could make a lot of money in a high-end residential program or having a practice geared towards rich kids smoking pot, but neither of those things appeals to me much. Much of the problem now is that most kids getting "dual" treatment are really just getting the drug and alcohol part addressed while their psychiatric issues are ignored, or kids getting treatment elsewhere are finding that most practitioners won't touch their substance use with a ten foot pole. Neither approach works wonderfully.

 

[marshmallows]

i see what you mean. I dont have to do any fellowship, just thought it might help in the long term, to get a position in a certain location or hospital that maybe would give preference to fellowship trained doc first.

I dont have any work or visa issues, just heard some of those things from some previous people. Thats why the past few months I have been reconsidering why I am even thinking of doing this, or any fellowship, since I dont want academia.

 

[F0nzie]

Just do the fellowship if you feel like it and don't expect anything from it. Ironically, multiple fellowships and board certifications in Psychiatry won't get your far in clinical work, but it will definitely help you climb the administrative ladder. Admins love badges, stickers, and pretty little things on paper.

 

[vistaril]

Good to know. I'm a little fed-up with the constant pursuit of further training

to me, it almost seems like you want to do a fellowship and are hoping that people will tell you it is important/beneficial/required/whatever.....it's none of those things. If you want to do a fellowship for the heck of it do it I guess, but there is certainly not a lot of benefit in doing one.

 

[DJspreadsheet]

to me, it almost seems like you want to do a fellowship and are hoping that people will tell you it is important/beneficial/required/whatever.....it's none of those things. If you want to do a fellowship for the heck of it do it I guess, but there is certainly not a lot of benefit in doing one.

Not sure where you got that.

I'm talking doing an addiction fellowship at UW Seattle (for example) in order to get to Seattle. Or...could I easily just find a pretty standard job in Seattle being a psychiatrist (scratch the addiction thing) in some capacity? I'd prefer being able to move without having to do a fellowship to get me "connected" to the local scene.

 

[vistaril]

Not sure where you got that.

becausethe fact that you are even thinking about a fellowship in something like C/L or addiction tells me a good bit about your mindset going into this thing. People who dont want to do a fellowship like this never think about doing it in thefirst place since i9t is so obviously not required or all that practical/useful

For example, stating "I'm a little fed-up with the constant pursuit of further training" is completely incompatible with the idea of pursuing an addiction or C-L fellowship, especially since you don't want a job in academia.

 

[DJspreadsheet]

becausethe fact that you are even thinking about a fellowship in something like C/L or addiction tells me a good bit about your mindset going into this thing. People who dont want to do a fellowship like this never think about doing it in thefirst place since i9t is so obviously not required or all that practical/useful

For example, stating "I'm a little fed-up with the constant pursuit of further training" is completely incompatible with the idea of pursuing an addiction or C-L fellowship, especially since you don't want a job in academia.

Dude are you surrounded by lighters and banana peels? I never said anything about C/L. I have about as much interest in pursuing that as I have being an internist. I mentioned addiction. And contrary to your notion of practicality - it would be stupendously practical if that was a necessary method of getting back to the city I want to live in.

 

[vistaril]

Dude are you surrounded by lighters and banana peels? I never said anything about C/L. I have about as much interest in pursuing that as I have being an internist. I mentioned addiction. And contrary to your notion of practicality - it would be stupendously practical if that was a necessary method of getting back to the city I want to live in.

that's sort of my point- there is no reason whatsoever to make that connection(that an addiction fellowship has anything to do at all with going back to seattle).....they are two completely unrelated things, so why bring it up if you didn't sort of just want to do an addictions fellowship anyways?

 

[DJspreadsheet]

that's sort of my point- there is no reason whatsoever to make that connection(that an addiction fellowship has anything to do at all with going back to seattle).....they are two completely unrelated things, so why bring it up if you didn't sort of just want to do an addictions fellowship anyways?

My question was pretty clear. Obviously doing an addictions fellowship is palatable enough to me that I'd do it if it was the only way to get to a specific city with certainty. Why this concept is contentious for you is beyond me.

 

[shan564]

Why this concept is contentious for you is beyond me.

Every concept is contentious for him. Don't let him get to you.

 

[vistaril]

My question was pretty clear. Obviously doing an addictions fellowship is palatable enough to me that I'd do it if it was the only way to get to a specific city with certainty. Why this concept is contentious for you is beyond me.

because you continue to make this bizarre connection between doing an addiction fellowship and getting to a specific city with certainty.

If it appears that I have been irritated or whatever, it's because you keep on repeating this even though it makes no sense. The fact that you keep on making this bizarre connection is somewhat annoying. Once more, what in the world is the connection between doing an addiction fellowship and getting to a specific city?

It's as bizarre as if I asked whether buying a new hybrid vehicle will help me get a locums inpatient job. Why the hell would a locums employer care whether I drove a hybrid or not?

One final time....no, doing an addictions fellowship will not help you in any way break into a specific market in general, especially outside of academia. It probably wont hurt you either.

 

[OldPsychDoc]

I'm talking doing an addiction fellowship at UW Seattle (for example) in order to get to Seattle. Or...could I easily just find a pretty standard job in Seattle being a psychiatrist (scratch the addiction thing) in some capacity? I'd prefer being able to move without having to do a fellowship to get me "connected" to the local scene.

DON'T do an addiction fellowship unless you really want to work with the addicted.

Does that simplify the decision?

 

[DJspreadsheet]

DON'T do an addiction fellowship unless you really want to work with the addicted.

Does that simplify the decision?

I do want to work with the addicted. My understanding is that the fellowship isn't necessary to do that. So the only reason I'd do a fellowship - and put on your big-boy pants Vistaril, because this is going to get complicated - is if it is easier to do that in the city of my choosing than it would be to just find a job.

 

[billypilgrim37]

I do want to work with the addicted. My understanding is that the fellowship isn't necessary to do that. So the only reason I'd do a fellowship - and put on your big-boy pants Vistaril, because this is going to get complicated - is if it is easier to do that in the city of my choosing than it would be to just find a job.

Really, it depends on the city and a lot of factors. It's hard to generalize. There are some places where I imagine this is helpful, other places not. And it depends on what kind of job you want. Depends on what? Who knows. You'd have to ask the locals.

 

[vistaril]

I do want to work with the addicted. My understanding is that the fellowship isn't necessary to do that. So the only reason I'd do a fellowship - and put on your big-boy pants Vistaril, because this is going to get complicated - is if it is easier to do that in the city of my choosing than it would be to just find a job.

the answer, as others and I have already told you, is no........

you also haven't told us(and this matters a lot) in what capacity do you want to do addiction. Do you want to do outpt evals and outpt suboxone? Do you want to work for an inpt dual diagnosis unit(some states have these not sure if washington is one)? Do you want to work for an large for profit drug/alcohol center which provides a lot of different services(residential rehab, IOP, maybe even outpt services, etc).........

it's not like there are ten different billion jobs in addiction. If you see yourself doing a ton of outpt suboxone and getting to your 100/month, you most certainly wouldn't benefit from an addiction fellowship. You also shouldn't have all that much trouble being allowed to join some group in the seattle area doing this under a 'kill what you eat model'.....as long as your are paying your share of the bills and aren't in some ways causing problems, you shouldn't have difficulty getting established somewhere in your own office in a practice with other providers.

But it would help if you told us what sort of setting you want to do addiction in(private practice outpt, salaried private residential, state/govt, etc).....because that matters a lot.

 

[DJspreadsheet]

the answer, as others and I have already told you, is no........

you also haven't told us(and this matters a lot) in what capacity do you want to do addiction. Do you want to do outpt evals and outpt suboxone? Do you want to work for an inpt dual diagnosis unit(some states have these not sure if washington is one)? Do you want to work for an large for profit drug/alcohol center which provides a lot of different services(residential rehab, IOP, maybe even outpt services, etc).........

it's not like there are ten different billion jobs in addiction. If you see yourself doing a ton of outpt suboxone and getting to your 100/month, you most certainly wouldn't benefit from an addiction fellowship. You also shouldn't have all that much trouble being allowed to join some group in the seattle area doing this under a 'kill what you eat model'.....as long as your are paying your share of the bills and aren't in some ways causing problems, you shouldn't have difficulty getting established somewhere in your own office in a practice with other providers.

But it would help if you told us what sort of setting you want to do addiction in(private practice outpt, salaried private residential, state/govt, etc).....because that matters a lot.

I don't want to muddy this thread up with too much nonsense about me, but to answer your question I wouldn't be searching for an addictions job. Just a good psych job. Details not yet determined.

 

[vistaril]

I don't want to muddy this thread up with too much nonsense about me, but to answer your question I wouldn't be searching for an addictions job. Just a good psych job. Details not yet determined.

then that makes it an even easier decision.....

 

[DJspreadsheet]

then that makes it an even easier decision.....

Assuming the jobs don't have regional bias, which is I guess is the essence of my question.

 

[vistaril]

Assuming the jobs don't have regional bias, which is I guess is the essence of my question.

I'm not sure what you mean here....if you feel you need to be in or near seattle to network for the 'good' psych jobs in seattle, why would you assume that moving there to do an addiction fellowship is going to allow you to network any better than if you moved to the area and took some crappy job there...or just rented some office in a practice and went to work in the community? Seattle is a big place....there has to be plenty of work you could do as a psychiatrist that would pay better and allow you to gain connections/network better than an addiction fellowship there....

I also think you are underappreciating the difference between psychiatry and most other specialties. In psychiatry the flexibility and start up costs are so low that there isn't near the same rigidity in practice setups that there is in other fields. The money coming in is a lot less too of course. The concept of 'partnership track' and associate is mostly irrelevant...these terms may be thrown around but they have a much different meaning than they do in specialties where a lot of equipment is involved, outpt surgery centers, contracts, etc.....

Just the concept of doing a fellowship somewhere to give one a better chance of being able to work there(in psychiatry) is silly.....just start working there and if you aren't working there in a capacity you are completely satisfied with continue trying to angle for better positions/contracts there.

 

[DJspreadsheet]

I'm not sure what you mean here....if you feel you need to be in or near seattle to network for the 'good' psych jobs in seattle, why would you assume that moving there to do an addiction fellowship is going to allow you to network any better than if you moved to the area and took some crappy job there...or just rented some office in a practice and went to work in the community? Seattle is a big place....there has to be plenty of work you could do as a psychiatrist that would pay better and allow you to gain connections/network better than an addiction fellowship there....

I also think you are underappreciating the difference between psychiatry and most other specialties. In psychiatry the flexibility and start up costs are so low that there isn't near the same rigidity in practice setups that there is in other fields. The money coming in is a lot less too of course. The concept of 'partnership track' and associate is mostly irrelevant...these terms may be thrown around but they have a much different meaning than they do in specialties where a lot of equipment is involved, outpt surgery centers, contracts, etc.....

Just the concept of doing a fellowship somewhere to give one a better chance of being able to work there(in psychiatry) is silly.....just start working there and if you aren't working there in a capacity you are completely satisfied with continue trying to angle for better positions/contracts there.

Alright cool. Good to know.

 

[markglt]

my 2 cents, probably not needed, or wanted.
I thought about the addiction psychiatry fellowship. Because i wanted this model for my life:
1. a cozy little position as CMD at an upscale private rehab in the SW valley...my impression is/was that you need to be BC in AP.....but then i thought, why not just get the suboxone liscense, take ASAM's board exam and hit the private rehab job market with those creds.
2. A pp, and refer those addiction patients to my practice if they have DD.

👍👎confused:

 

[billypilgrim37]

why not just get the suboxone liscense, take ASAM's board exam and hit the private rehab job market with those creds.

For one, you can't take the asam exam any more without the fellowship.

Sent from my DROID RAZR using SDN Mobile

 

[markglt]

Oh my, there goes that idea..
Well, then i suppose just get the suboxone lisc.
But i imagine as a cmd u need board cert. in a fellowship, no?

 

[vistaril]

Oh my, there goes that idea..
Well, then i suppose just get the suboxone lisc.
But i imagine as a cmd u need board cert. in a fellowship, no?

not really no. And I wouldnt be surprised if that preference wanes over the years with the new rules......because these addiction and psychosomatic fellowships are NOT FILLING. And many of the ones that do fill are filling with WEAK candidates who are just doing it for the visa or some other reason.

 

[SmallBird]

And many of the ones that do fill are filling with WEAK candidates who are just doing it for the visa or some other reason.

I was hoping you would be willing to explain this - I am not aware of any benefit of doing a fellowship because of being on a visa. On a J1 visa, where one is required to do a waiver or return to your home country, doing a fellowhip is in no way useful, as the waiver jobs are almost entirely for general psychiatrists. On H1B, most people are hoping to find jobs as soon as possible after residency, so that they can apply for green cards before their time on an H1B runs out. Doing a fellowship in this case would not be helpful as it is almost unheard of to be sponsored a green card during a fellowship.

I ask because you have mentioned this twice, and if it really is true I would love to understand why.

 

[kumar28]

R u sure that you can't take the asam exam anymore? Im not sure if you are correct about that one. I think you just need a year of addiction experience

 

[vistaril]

I was hoping you would be willing to explain this - I am not aware of any benefit of doing a fellowship because of being on a visa. On a J1 visa, where one is required to do a waiver or return to your home country, doing a fellowhip is in no way useful, as the waiver jobs are almost entirely for general psychiatrists. On H1B, most people are hoping to find jobs as soon as possible after residency, so that they can apply for green cards before their time on an H1B runs out. Doing a fellowship in this case would not be helpful as it is almost unheard of to be sponsored a green card during a fellowship.

I ask because you have mentioned this twice, and if it really is true I would love to understand why.

I'll admit I don't completely understand the visa game(Im not an img) or how it works....I just know of several people that have done fellowships for this reason.

 

[billypilgrim37]

R u sure that you can't take the asam exam anymore? Im not sure if you are correct about that one. I think you just need a year of addiction experience

I went back and looked again and you may be right. When I looked before, it said you had to have one year of addiction experience (1920 hours) in the past 5 years, and it specified it had to be between 2007 and 2012. When I read this before I thought it meant people would not be able to do this past 2012, but I think this may have been just the requirements for taking the 2012 exam. That is, it may continue in the future with those same requirements.

 

[angrywombat]

marshmallows and billypilgrim: How did it go when you told people at your residency that you didn't want to do the fellowship after all?
I applied for fellowship but now I am getting cold feet and think I might want to just get a job.
I am worried that if I back out of doing fellowship at this point that it could hurt my reputation at my residency especially since one of the fellowships I applied at is at my residency. Were the people you used as references annoyed at your change of heart?

 

[billypilgrim37]

I didn't have many problems, as I was taking a job at the same place. Being a second fellowship as well, most folks were scratching their heads as to what I was thinking in the first place. So it goes.