nerox2

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Hello,

I am a PGY4 who is currently in the middle of a forensics elective, and I have just decided that I want to pursue a career in forensic psychiatry. Unfortunately, many of the programs I have contacted have already filled their positions for 2015 and the rest say they are close to the end in terms of their interviewing cycle. My questions are:

1) Should I still attempt to get into those few programs that say they are still accepting applications but that it is getting late? Or wait to apply next year?

2) If I do apply next year, does anyone have any recommendations of what I should in the year between? Do I get a job and then resign after 1 year?

Thanks for any advice you guys can provide..
 

notdeadyet

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If you're limited to programs that still haven't filled, you are really going to be applying to a fairly small subset.

Personally, I'd figure out which programs I really wanted to go to and then find out if there are still open spots. If there are, go ahead and apply. If you don't find programs you would love to attend and are limited to programs that don't excite you, I'd wait out a year.

We get very programmed into not having gaps because of medical school and the fact that you can't do much with an MD pre-internship. You'll be a board eligible psychiatrist and can spend the year working in acute psychiatry, corrections, or some other environment with a strong forensic component. You'll come out better prepared and have some improved skills that will only help you, and you'll make nice money in your year between residency and fellowship. If you're uncomfortable with only working somewhere for a year, you can easily get a locum tenens position or the like.

I wouldn't settle for a program less than you want, as you'll have a much better chance of finding that program next year. October is very late for forensic interviews. Most of the programs I looked at filled in early-summer.
 

honsano

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I agree with the above for the most part. There is great variability in forensic training. Some places will put greater emphasis on treatment than others for starters. Some will have you drive millions of miles between sites. If you take a year and work as an attending, especially in some sort of forensic capacity like a state hospital, I imagine most people would be really interested in you as a candidate.

With that said, I think it would be really really tough to come back to a fellowship if you have been practicing for a year. Most people get pretty comfortable with the money and the autonomy. It'll be difficult to come back as a 'student'. That last part was tough for me because I had a lot of autonomy as a PGY4. When I began fellowship, I was under the microscope again and that was a little weird.

PM me if you're interested as I don't think my program has filled and I like it.
 

whopper

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Agree with the above though I would apply if a good program that fit you well had an opening but you likely don't know which ones are that.

Many forensic fellowships have a close association with a prison, jail or forensic unit. Such a place usually need an attending psychiatrist, even if it's just for a year and you can get your feet wet. That's what happened to me. U of Cincinnati told me it came down to someone else and I, and they just didn't want to tell me no because the other candidate and I were two of the best they've seen in years. They offered it to the other guy because he already had five children and was older, while offering me to be an attending where I would have exposure to forensic psychiatry and could go to all of the fellowship functions such as journal club, etc.

Most places, however, won't arrange for such things unless the PD has these types of connections with those other places and they feel it's worth it for them to take the hours to pull the right strings.

Wanted to add that where you train could be very important. Forensic psychiatry is heavily connection-based and I've seen several graduate forensic fellowship and not work in the field because they can't get a door open. Don't apply with limited options unless they are good ones.
 
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SomeDoc

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Agree with the above though I would apply if a good program that fit you well had an opening but you likely don't know which ones are that.

Wanted to add that where you train could be very important. Forensic psychiatry is heavily connection-based and I've seen several graduate forensic fellowship and not work in the field because they can't get a door open. Don't apply with limited options unless they are good ones.
I think part of this is due to motivation. Most of the board-certified forensic psychs I know don't practice forensics simply because they are too busy in their given specialty, and do not have the time, or choose not to do forensic casework, and are fine with this. Re opening doors, academic pedigree may be important, though to a certain degree- if the work shows trends where objectivity is lacking, or if reports are poorly written/thought out, attorneys and the court take notice. One way to start is to do evals for the court, and attorneys will take note, if the work is of good quality, regardless of pedigree (where in forensics, an Ivy-League forensic pedigree does not necessarily equate to good forensic training, though lawyers/jury/the courts may not be familiar with this). There's a need for formally-trained forensic psychiatrists, and in some cases, if one is not around, attorneys or the court have to rely on Dr. Joe Schmoe, who may have a limited concept of important forensic issues (cross-examinations do's and don'ts, expert testimony behavior, proper forensic report writing, etc.).
 
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whopper

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IMHO forensic psychiatry is like being an actor with a college degree but getting offered to work in something stable, paying well that is not acting. Eventually such a person stops acting other than as a hobby.

Forensic psychiatrists, if doing sizable amounts in the field, can't simply do inpatient unless the department they are in will allow them to make depositions and miss inpatient hours, often-times forcing another doctor to cover for them. If you are doing private practice, you have to free time in your schedule to do forensic work and if you have very sick patients this becomes difficult. You might be offered a very serious case that could have you working over 30 hours a week on that specific case despite your existing workload, then you might not have any work for weeks.

I did a homicide case while working 55 hours a week and having a newborn kid. My wife was ticked off because it made her a defacto single parent during that time. The case (thank God) was one where there really was no defense for the client that hired the lawyer that hired me. So it boiled down to me reading the records and telling the lawyer why I thought there wasn't a psychiatric defense. By then (and I forgot the exact amount) it came down to about 20 hours of work. Had there been a defense this could've been over 100 hrs of more work because I would've had to write a detailed report based on thousands of pages of records, driven to the opposite end of the state to testify, and prep for a cross-examination.

Doing something like this when you're already working more than a full-time job is stressful. I think most psychiatrists will simply get a full-time job, and with life taking over, just forget about forensics as a paying profession.

It is also possible to get a forensic job that is steady but those types usually end up paying just as much as a regular clinic job. E.g. in Cincinnati there is a practice called Court Clinic and the way Cincinnati's laws are, several defendants get a mental health/competency evaluation. (Most localities have little requirements for such but Cincinnati has lots of requirements). It's to the degree where psychologists and psychiatrists there can expect people to evaluate as surely as a city ER will get patients. Just that you don't make more money there either, nor likely exercise things that likely drew people into the field. (Those evals are similar to just doing an H&P, then typing a report in layman's terms).

I worked on a forensic unit for a few years and while I used my training there, again, it made no more money than had I just been a non-forensic psychiatrist. While I was held in higher regard, the politics of that situation prevented me from more money. We had a chief clinical officer that didn't want anyone making more money than others so he could avoid getting an angry phone call from a lower paid doctor.

That's where the connections help. If you have none, you have to work out of your way to get them. It can be done, but we're talking months if not years, and for most it's just easier to work your regular job.
 
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SomeDoc

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IMHO forensic psychiatry is like being an actor with a college degree but getting offered to work in something stable, paying well that is not acting. Eventually such a person stops acting other than as a hobby.

Forensic psychiatrists, if doing sizable amounts in the field, can't simply do inpatient unless the department they are in will allow them to make depositions and miss inpatient hours, often-times forcing another doctor to cover for them. If you are doing private practice, you have to free time in your schedule to do forensic work and if you have very sick patients this becomes difficult. You might be offered a very serious case that could have you working over 30 hours a week on that specific case despite your existing workload, then you might not have any work for weeks.

I did a homicide case while working 55 hours a week and having a newborn kid. My wife was ticked off because it made her a defacto single parent during that time. The case (thank God) was one where there really was no defense for the client that hired the lawyer that hired me. So it boiled down to me reading the records and telling the lawyer why I thought there wasn't a psychiatric defense. By then (and I forgot the exact amount) it came down to about 20 hours of work. Had there been a defense this could've been over 100 hrs of more work because I would've had to write a detailed report based on thousands of pages of records, driven to the opposite end of the state to testify, and prep for a cross-examination.

Doing something like this when you're already working more than a full-time job is stressful. I think most psychiatrists will simply get a full-time job, and with life taking over, just forget about forensics as a paying profession.

It is also possible to get a forensic job that is steady but those types usually end up paying just as much as a regular clinic job. E.g. in Cincinnati there is a practice called Court Clinic and the way Cincinnati's laws are, several defendants get a mental health/competency evaluation. (Most localities have little requirements for such but Cincinnati has lots of requirements). It's to the degree where psychologists and psychiatrists there can expect people to evaluate as surely as a city ER will get patients. Just that you don't make more money there either, nor likely exercise things that likely drew people into the field. (Those evals are similar to just doing an H&P, then typing a report in layman's terms).

I worked on a forensic unit for a few years and while I used my training there, again, it made no more money than had I just been a non-forensic psychiatrist. While I was held in higher regard, the politics of that situation prevented me from more money. We had a chief clinical officer that didn't want anyone making more money than others so he could avoid getting an angry phone call from a lower paid doctor.

That's where the connections help. If you have none, you have to work out of your way to get them. It can be done, but we're talking months if not years, and for most it's just easier to work your regular job.
For the very reasons mentioned above, after fellowship, I'm looking at an outpatient (full/part time to be determined) setup, with an adjunct forensic practice- I'm just hoping I'll be able to make it work and find a good balance as I build up a good reputation in the community. Fortunately, I enjoy outpatient more than inpatient, so that hopefully will work out well.

I enjoy reading your posts whopper. They've been very helpful in the fellowship-planning process.