question about forensics?

Discussion in 'Psychiatry' started by GATORANALYST, Dec 22, 2008.

  1. GATORANALYST

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    Not sure if this even exists but I'm trying to find some sort of ranking for forensic fellowship programs. I went on the APPL website but all they have is a list of all the programs. I've heard that Case Western is the best since Philip Resnic is the program director. Can anyone help me out?

    Thanks!!:D
     
  2. Doc Samson

    Doc Samson gamma irradiated
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    Not sure that you'll find an official ranking - much like residencies and other fellowships, it's all word of mouth. From this non-forensic doc's POV, the names that ring the prestige bell for me are Case Western, Cincinatti, and UMass. I know that Paul Appelbaum is now at Columbia, but honestly couldn't tell you if they had a fellowship or not.
     
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  3. masterofmonkeys

    masterofmonkeys Angy Old Man
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    These are the three I hear most about. UTSW I believe has one, which should be pretty good as they see by far most of the forensics patients in all of TX (big forensic psych hospital outside of dallas). I also have heard very good things about Denver. We are sending a resident there this fall. He's pretty excited about it.
     
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  4. NJWxMan

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    One word answer. Case.
     
  5. GATORANALYST

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    Realistically, how difficult is it to "match" into a top program. By the way, Is there a match for forensic??

    I'm looking for a program that has a strong focus on training its fellows to testify and write evaluations.

    Thanks for the advice thus far!:D
     
  6. whopper

    whopper Former jolly good fellow
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    There is no official ranking. There are perhaps only a few dozen people in America who want a forensic fellowship per year, and for that reason no one will spend the time to make a ranking. Kinda like residency--which has tens of thousands, but not even that is enough for most places to want to make a ranking.

    Case has the best word of mouth reputation, not only because it is good but because Resnick's there.

    U. Mass-Paul Applebaum used to be the PD there. No longer there, but the program is still rock solid. Biggest thing that impressed me there was that their fellowship for forensic psychology worked hand in hand with the psychiatry. That is very important in this field because even we psychiatrists need to use the psychometric testing of the psychologists but few programs use it or teach it. Several of the programs I interviewed at--when I brought up use of the MMPI or SIRS in forensic psychiatry-they were like "what are you talking about?". Clearly showed me I was going to get better training at some vs others.

    Rochester's PD is excellent, but Rochester isn't exactly a place that grabs people due to the bad weather.

    Cincinnati-Resnick teaches there too, though he's not the PD there. John Kennedy is and he's considered an AAPL top teacher. The psychology aspect is taught here too. Its a reason why I chose to go there & will start there in July. Mossman also teaches at Cincinnati and he's another giant in the field. In the meantime, I'm working as a forensic attending (without the fellowship) in the forensic hospital.
    http://www.psychiatry.uc.edu/index.php?q=node/138

    NYC's programs are all interrelated-with all the fellows going to the same lectures. Anasazi can help you there. I heard several good comments about some PDs, some bad comments about others. From word of mouth, I was reccomended that Albert Einstein's PD was the most approachable, mentor-like & helpful. NYU's PD is is a giant in the field. I chose not to go to NYC even though it was closest to my native geographical area because I didn't want to live in a small apartment for $1500/month.

    I'll post more later.
     
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  7. GATORANALYST

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    Have your heard anything about Emory. I was looking through the appl listing of all the programs and there seems to be a few programs with openings for jan 2009. Does that mean that the programs went unfilled?
    Thanks for all the responces!
     
  8. whopper

    whopper Former jolly good fellow
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    Unfortunately not. I do know some people who interviewed there but weren't impressed. That is from word of mouth and I have no first hand experience. I was also surprised to hear that because Emory's psychiatry department is one of the best in the country. So take what I said with a grain of salt.

    Unfortunately, word of mouth is going to weigh heavily on your choice because there is no official ranking. Here's the way I went about it....

    1) do you want to settle in the area--if you want to do private practice, Forensic Psychiatry is going to be heavily connection based. You can't set up a private practice without good connections. Wherever you go for fellowship will give you something of a head start in that geographical area should you choose to stay there. If you relocate, you'll be starting over again.

    A personal note, the place where I graduated from, in more ways than one hinted they'd like me back, but they have no forensic psychiatry position for me. If I went back, I'd be starting from square one forensic psychiatry-wise.

    2) Does the place teach enough psychometric tests: MMPI, SIRS, HCR-20, M-FAST are very useful and can give insight with a specific amount of statistical validity that is more accurate than simple clinical opinion. I've seen forensic psychiatrists know nothing of how to use this type of testing, and when they went up against someone in court who did have the testing, they had nothing to counter it with.

    personal note: was doing an elective with a FP who didn't know how to use the above tests, he went against someone who did. I asked him how I could learn more about those tests. The guy (who had a narcicism streak) pretty much got very annoyed with me that I wanted to know more about those tests.

    3) The quality & distance of the forensic facility: Most forensic psychiatric programs are a long distance away from the prison/forensic facility that holds the patient/client. Most places I interviewed at required I drive over 500 miles a week to get lectures at the medical campus, but have to drive about 2-4 hrs a day-each way(no kidding) to get to the prison. Some places even had a bed for the fellow to sleep in because they didn't want them driving 8 hrs a day.

    4) Does the program director or any of the staff come off as "defense whores?" There are unfortunately plenty of forensic psychologists & psychaitrists willing to say someone's schizophrenic for the right amount of money. Go to a place where you feel the faculty are intellectually honest.

    Likewise, several fellows I've kept in contact with tell me that there are several forensic psychiatrists who are very narcissistic. They earn a lot of money and they tend to be into their appearance, wear the $5000 suit, etc. Just like anyone with a cluster B-these types can be hard to get along with. Try to get a feel for the program since unlike residency, its usually only you, the PD, maybe 1-2 other fellows and the coordinator. Its easy to fly under the radar if you don't like the PD and there's 40 residents. If its only you or maybe 1-2 more and you don't get along, that's going to be a very uncomfortable year.

    5) the reputation of the program director (very important): what are this person's qualifications, publications, reputation for honesty?

    OK, Ciccone is the head of Rochester. He's considered a giant in the field & well respected.

    The PD at Albert Einstein is Merrill Rotter. I've talked to 4 fellows I know who did fellowship in NYC, all of them said they felt Rotter was the best, and 3 of them weren't under his supervision which really said something IMHO. Haven't asked Anasazi what he thought of the NYC PDs.

    The PD at NYU is Richard Rosner: another giant in the field. He writes one of the gold standard texts in the field. Rosner from what I heard word of mouth has suffered from some health problems & isn't as active anymore.
     
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    #8 whopper, Dec 23, 2008
    Last edited: Dec 28, 2008
  9. Afrikyn

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    Has anyone heard anything about Georgetown's forensics fellowship program?
     
  10. whopper

    whopper Former jolly good fellow
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    Didn't respond to the above, but I have heard some info on it. Columbia does now have a forensics fellowship which is new. Paul Applebaum is now at Columbia. Applebaum is one of the biggest names in the field (arguably the biggest though he & Resnick could have a battle of titans over that. Both however tend to be working in differing areas of forensics) , and is someone the APA will ask for guidance on forensic psychiatric issues. During my interview there I was told he did not work with the fellows, nor is he their fellowship program director, like he was at U. Mass. For that reason, I don't know exactly how much his presence at Columbia would benefit a fellow there. I was told something to the effect that he is doing pure research. (Tangentially there's another Applebaum still at U. Mass who is also a giant in the field, though he's not Paul Applebaum). Don't know the exact year it started. The PD there is Stephen Simring, who previously was faculty at UMDNJ in Newark. Of course things could change, but that's the last I heard of that, and the data is about 1 year old.
     
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    #10 whopper, Mar 28, 2009
    Last edited: Mar 28, 2009
  11. BigDrizzle

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    I can't speak for any of the other Forensic people mentioned so far in the thread, but I can tell you first hand that Dr. Resnick is one of the most down to earth guys around. He gave our residency class our first lecture on Monday morning of intern orientation week and has been visible and available ever since, even to those of us not considering forensics. His fellows (who call him Phil) are all very happy.
     
  12. whopper

    whopper Former jolly good fellow
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    I've heard nothing but good things about Dr. Resnick, and he teaches at my fellowship program which starts in July. I've seen him give lectures too--entertaining, charismatic, but more importantly highly educational, didactic, succinct, medically relevant & accurate. He had all the things you'd want in a good lecturer--was the complete opposite of boring, and you walked out of the lecture knowing far more than you did before.

    I have heard that if you are his fellow, he works you quite hard, but in a fair & professional manner.
     
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  13. PsyDGrrrl

    PsyDGrrrl Head Shrinker
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    Dr. Resnick is awesome. The consulting forensic psychiatry expert at my hospital trained under him and he is brilliant.
     
  14. phorensic

    phorensic SDN Lifetime Donor
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    I am actually interested in the answer to this question as well. Anyone know anything---rumors, bad stuff, good stuff---about the forensic fellowship or general psych residency programs at gtown? I know that gtown's forensic fellowship is fairly new. And that their gen. psych residency seems to have a lot of IMG's.
     
  15. NJWxMan

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    Honestly, what forensics psychiatrist hasn't trained under Dr. Resnick? I wanted to train at Case just so I could get a head start in forensics (my eventual goal) but could not get over the fact that A) He could retire any day and B) living in the city of Cleveland.
     
  16. whopper

    whopper Former jolly good fellow
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    I'd bet the overwhelming majority has gotten some form of training from him in some form, even if its just reading an article or seeing one of his lectures. The giants that made the modern field are for the most part still alive & active. It actually kind of reminds me of a fraternity lineage. The field is small, and several of the current forensic psychiatrists can directly trace to who trained them to the point where it all traces back to few.

    That can be good and bad. There are so few forensic psychiatrists that it makes life easier for the "defense whores" in some areas because there's not much of an established standard of care with what goes on, nor are there several forensic psychiatrists that can counter-balance such a person.
     
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  17. rpkall

    rpkall Darwin Award Winner
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    What's a "defense *****"?

    I'm new to the forensic lingo, I think.
     
  18. whopper

    whopper Former jolly good fellow
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    In short a forensic psychologist or psychiatrist who is willing to say anything for the defense for money.

    Forensic psychiatry can be a very lucractive field as a paid expert witness for the defense.

    Here's an example, someone steals a car (among several other charges), and is caught, arrested, and the person pays a psychiatrist to claim he is schizophrenic.

    And yes it happens unfortunately quite often. It can be a $5000 pop for someone doing about 5-10 hrs of work.

    One of my own patients had that happen. He got an NGRI and he clearly is not schizophrenic. When I got a hold of him, he was in the forensic psychiatric hospital for a few years, and got more charges slapped on to him for stealing a car again while on a pass. After 2 weeks of having him--and taking him off all his meds, I could tell he was not schizophrenic, and I changed his diagnosis to Borderline PD, with no Axis I DX whatsoever other than Cannabis Abuse.

    The surprising thing was that when I did this, I was expecting a big protest from him, and I was expecting him to try to malinger his way out of it, but the guy actually told me he was sick of playing the games he was, and just wanted to fix his life, face the music and be able to look himself in the mirror. Since the guy was trying to be honest, I was very supportive of him, and urged him to keep on that track, though I couldn't tell what was going to legally happen to him as a result of his honesty.

    During the month before his hearing, he was very nervous that he'd get some very serious prison time, and kept telling me that he was scared, but that he was going to face the music. The day before the actual court date, he told me he started hearing voices and after a few minutes, I stared him straight in the eye and said, "I think you're BSing me. I think you're scared since the court day is tomorrow, am I right?" He admitted to it. He was very nervous and I couldn't blame him--he could've been facing years in prison, and he could've easily tried to fake another NGRI since he figured out how to do it before & was successful.

    But getting back to the original point--the guy fessed up to me that his lawyer was able to find the right psychologist to write up the bogus report that was over 50 pages long, and that he had to pay $5000 to get it claiming the guy was schizophrenic. Of course this is only the guy's story, but it fits. Why would he admit to it if it weren't true? The guy clearly does not have schizophrenia, the report when you read it is apocryphal, and was stated as such by several legitimate forensic psychiatrists & psychologists. The guy had everything to lose by admitting that he faked an NGRI.

    In fact-the real dirty ones have this type of report down to a form letter. They just change the names using a Word program where you just have to change it once and it just changes the name throughout the report. Its a down dirty shame.

    Almost every forensic psychiatrist I've seen that's been practicing for some time has stories of "defense whores".

    And the big shame of it all is judges, juries & lawyers don't have psychiatric knowledge or training to the degree where they can tell someone is pulling this.

    Judges after seeing a "defense *****" perhaps after several times may get an inclination. Judges after all aren't stupid, and may do some psychiatric research on their own on the topics discussed. That one in particular I mentioned, I know for a fact some judges were on to what was going on because they had mentioned him as being a "*****" in discussions I've heard. However nonetheless, it goes on, it does its damage, and judges & juries will get confused & manipulated by this sort of thing.

    (but don't get an idea that fake NGRIs happen all the time. The overwhelming majority of them are not accepted. The defendant is taking a big risk with that defense, but some psychiatrists & psychologists are willing to say anything, so long as they can cook up something that a jury can buy whether or not it is medically/scientifically sound).
     
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    #18 whopper, Apr 3, 2009
    Last edited: Apr 3, 2009
  19. PsyDGrrrl

    PsyDGrrrl Head Shrinker
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    True, but god we get a number of them at my hospital.
     
  20. whopper

    whopper Former jolly good fellow
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    At my own hospital, we got plenty, but since its a forensic hospital, its a lumping effect. My hospital pretty much has all the NGRIs from one state concentrated in one area.

    The NGRI reports done by my colleagues at the hospital I'm at I'm confident are all within the standard of care to not be hacked, apocryphal reports for the money. We are all state employees, we get paid the same no matter which way we go with the reports--NGRI or not. Our reports also go through at least 2 levels of scrutiny-the forensic chair who is intellectually honest and the chief medical officer who is as well. If we write a report that is intellectually dishonest, it will be known, and I have nothing to gain in doing so, unless getting fired & blackmarked is what I want.

    Private expert defense witnesses though--they don't have to deal with this. They don't have to deal with colleagues that will heavily scrutinize their work that they will see on a daily basis. In fact from what I've been heard from others (though I haven't gotten enough experience to see this myself, though I find it very believable), if you do not sometimes do what the defense wants (and they often want the most defense a doctor can provide) they're not willing to hire the doctor again in the future. For that reason, it appears there's a type of doctor, (and the market incentive reinforces this) that'll do anything the defense wants, or is willing to try to push the arguable defense to the maximum, where it just gets to, but does not cross the line where that expert witness could suffer repercussions. That zone is not within the zone of intellectual honesty, but not in the zone where the person can be readily detected as lying.

    Defense lawyers are supposed to do everything in their power to get their clients not guilty or have the charges dropped, plea bargained to lesser ones, or have sentences minimized. Its the job of the forensic psychiatrist to offer an honest opinion, not one that simply meets the needs of his/client. However lawyers don't want to hire a FP that they know will not give them the defense the want. An FP will spend several hours and charge thousands of dollars to the lawyer (which is then charged to the client) before he/she can render an opinion that can be reported to the court, and if the opinion doesn't match the defense, that lawyer will not want to work with that FP again. Several FPs seemed to have figured this out, and know that a quick future job will be ready for them if they just do what the defense wants. No FP will do something that is readily detected as lying, but can possibly stretch or fudge several aspects of the report. Again like I said-to the point where its not intellectually honest, but not detectable by other people as a lie.

    Which is actually something I've discovered in the last few months making me think no one should go into this field for the money. That's going to lead to the dark side. You can still be an honest & highly paid expert defense witness but its going to be harder, slower and cut several oppurtunities to work with several lawyers. If its money you're after, getting to that level I'm talking about will take so long & with such hard work that money cannot be the incentive.

    If its money you're after (and I've seen several people aspire to go into forensics for the money) open a suboxone clinic or go to the midwest & open up a practice.

    Another reason to not go into this field simply for the money is several people need to work for the state to get enough credentials to be the highly paid expert witness. Working in a forensic state unit gives you just as much responsibilities as a typical clinical psychiatrist, but you have to write forensic reports (a typical one can take about 5 hrs) that you are not paid extra to do. The state pay grades in most states only pay by the number of patients, they do not factor in forensic reports because forensic psychiatry is such a small & specialized field. So my colleague a few units down who has 24 civil patients, vs me who has 24 forensic patients, and I have to spend an extra 5-10 hrs a week writing forensic reports, but we have just as much responsibility over our patients--I think you get the drift. On top of that mine are much more dangerous & require more work on the part of the treatment team. Its easier IMHO to deal with a voluntary anxiety DO patient vs a committed or NGRI antisocial, histrionic, manic person who got a hammer and bludgeoned someone.
     
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    #20 whopper, Apr 4, 2009
    Last edited: Apr 4, 2009
  21. skipandgo

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    Any other good programs?

    And, what about the application process? Do you just apply to each program individually by the info on their websites? How many programs do you recommend applying to? Any help would be greatly appreciated...
     
  22. whopper

    whopper Former jolly good fellow
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    The websites give variable data. Some programs don't even have a website.

    Your program director may be able to help you though some may not. Several programs have no forensic experience whatsoever above the bare minimum.

    I applied to 12 programs which was way overkill.

    In addition to the programs I mentioned above, a program I very much did like, but did not decide to attend was Tulane. The program director there was very approachable, friendly, and the fellows had very good things to say about it. Tulane's psychiatry department is good, and New Orleans is definitely in a stage where it needs more psychiatrists. A professor of mine reccomended I go there because I could be someone planting a flag & practicing where I'd be needed, and its a great city with great food & people.
     
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