Revoked license to addictions fellowship.. is this common?

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Gavanshir

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I'm currently rotating through an academic center and recently discovered that two of the attendings previously had their licenses revoked in other states and moved to here complete an addiction fellowship. Neither of them were psychiatrists and both moved to addictions from other fields. I was surprised to find out about two physicians who went this route in the same program, and also surprised to learn that a psychiatric residency is not required to do an addictions fellowship. Is this a common thing? Do doctors who get their licenses revoked move to another state and do an addiction fellowship? Or are there other common fellowships that doctors use to salvage their career?

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F0nzie

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Addiction medicine is open to all disciplines whereas Addiction Psychiatry is only open to psych residents.

How exactly is an Addiction fellowship salvaging their careers? Shouldn't they have an unrestricted license to practice medicine in the new state?
 

heyjack70

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I doubt the addictions fellowship was required to "salvage" their careers. More likely they had to find a job where they would no longer have access to drugs of abuse (anesthesiologists can't really do their jobs if they can't have access to benzos and opiates). Switching to addiction medicine was an option that allowed them to keep working as doctors without regular contact with abusable substances. They are probably also interested in the field due to their own struggles/success with sobriety.
 
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PikminOC

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I'm currently rotating through an academic center and recently discovered that two of the attendings previously had their licenses revoked in other states and moved to here complete an addiction fellowship. Neither of them were psychiatrists and both moved to addictions from other fields. I was surprised to find out about two physicians who went this route in the same program, and also surprised to learn that a psychiatric residency is not required to do an addictions fellowship. Is this a common thing? Do doctors who get their licenses revoked move to another state and do an addiction fellowship? Or are there other common fellowships that doctors use to salvage their career?

How can they do fellowship with revoked licensing? Is this part of the stips of the med board? Won't this follow them any state they go to?
 

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Addiction medicine is open to all disciplines whereas Addiction Psychiatry is only open to psych residents.

How exactly is an Addiction fellowship salvaging their careers? Shouldn't they have an unrestricted license to practice medicine in the new state?

Yep, addiction medicine not addiction psychiatry, which requires completion of a psychiatry residency.

I'm not sure about licensure. In my state, you need a training license as a resident or fellow, although almost all fellows have a full medical license. I guess it's possible the board would grant a training license to someone with a history like this with pretty significant restrictions. Getting licensure after the fellowship could be another issue. As far as I can tell, boards are pretty unpredictable. Don't some states not require a license at all for trainees?

On the bigger topic, there are a lot of people in recovery in addiction medicine (including addiction psychiatry). The addiction psychiatry conference includes 12 step meetings at the end of the day.
 
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keifernny2

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Sometimes, as a condition to regain licensure, one must work in a supervised setting for a period of time. What better way to do this without generating a lot of questions from patients and colleagues than by going into a fellowship?


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F0nzie

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On the bigger topic, there are a lot of people in recovery in addiction medicine (including addiction psychiatry). The addiction psychiatry conference includes 12 step meetings at the end of the day.

I think this is true. I did get board certified in Addiction medicine recently and they had a similar deal with the 12 step program at the end of the conference.

Patients ask me all the time seemingly expecting that I am a recovering addict. I have also seen a good number of addiction counselors open up about their own struggles with addiction to their patients.
 

strangeglove

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I think Addiction Medicine has a higher proportion of physicians in recovery than Addiction Psychiatry.
 
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Doctor Bagel

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I think this is true. I did get board certified in Addiction medicine recently and they had a similar deal with the 12 step program at the end of the conference.

Patients ask me all the time seemingly expecting that I am a recovering addict. I have also seen a good number of addiction counselors open up about their own struggles with addiction to their patients.

Yeah, I would guess that the majority of addiction therapists are in recovery, especially in 12 step based types of treatment facilities. Sharing this with patients seems pretty common, too. I've seen doctors in recovery share, which I'm sure is OK although is feels a little odd to me.

I would guess that most of the addiction psychiatrists I know are not in recovery but then I guess I might not know either, especially as psychiatrists versus general addiction docs might be less likely to share.
 
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smalltownpsych

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How do addiction docs in recovery/license issues handle the suboxone issue (do they tend not to do suboxone)??
I'm thinking that they would tend not to do suboxone and most people involved in the recovery movement do not agree with the use of maintenance opiates (and some of them are against all psychotropic medications). It is important to note that the research on this is skewed in the direction of using medications because twelve step groups don't participate in research. My own research in this area found that people involved in the recovery movement long-term have a fear of medications and the mental health system. They also want more education and help because of the high rates of co-occurring disorders.
 

Gavanshir

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You are all right, it's an addiction medicine fellowship, not addiction psychiatry.

How do addiction docs in recovery/license issues handle the suboxone issue (do they tend not to do suboxone)??

The attending directly in charge of the suboxone clinic here is in recovery and previously had his license revoked. He is absolutely excellent at what he does and when he speaks to addicts, he speaks with an amazing insight and connects with the patients in a truly exceptional way.
 
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HarryMTieboutMD

I'm thinking that they would tend not to do suboxone and most people involved in the recovery movement do not agree with the use of maintenance opiates (and some of them are against all psychotropic medications). It is important to note that the research on this is skewed in the direction of using medications because twelve step groups don't participate in research. My own research in this area found that people involved in the recovery movement long-term have a fear of medications and the mental health system. They also want more education and help because of the high rates of co-occurring disorders.

This is not necessarily true. Where I went to medical school, the chair of psychiatry was one of the Godfathers of addiction medicine, and the department had a huge addiction program. Most of the addiction attendings were in Recovery themselves (multiple specialties including psychiatry). And they all prescribed Suboxone (and MTD when appropriate, naltrexone, acamprosate, etc), and learning how use pharmacotherapy is a standard part of an ASAM/ABAM fellowship. Now, there are probably old time addiction doctors who are averse to all pharmacotherapy, but I think the majority see its use. I think the key is to educate people patients (and I am a huge believer in 12 Step Programs) about the role of pharmacotherapy.

And ASAM/ABAM is becoming much more powerful than AAAP just by number of doctors (for whatever that's worth). Personally I think the ASAM dimensional criteria are a great way of guiding treatment decisions and will become standard.
 

michaelrack

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what i was getting at with the suboxone question is how they would handle the issue of having suboxone in clinic for inductions, but I seem to remember from years ago when I did my training that you could give the patient a small prescription to bring to clinic- but even that could be a temptation to the doctor.
 

smalltownpsych

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This is not necessarily true. Where I went to medical school, the chair of psychiatry was one of the Godfathers of addiction medicine, and the department had a huge addiction program. Most of the addiction attendings were in Recovery themselves (multiple specialties including psychiatry). And they all prescribed Suboxone (and MTD when appropriate, naltrexone, acamprosate, etc), and learning how use pharmacotherapy is a standard part of an ASAM/ABAM fellowship. Now, there are probably old time addiction doctors who are averse to all pharmacotherapy, but I think the majority see its use. I think the key is to educate people patients (and I am a huge believer in 12 Step Programs) about the role of pharmacotherapy.

And ASAM/ABAM is becoming much more powerful than AAAP just by number of doctors (for whatever that's worth). Personally I think the ASAM dimensional criteria are a great way of guiding treatment decisions and will become standard.
I was speaking more about non-physician members perspectives and extrapolating that perhaps physicians who are members might be more judicious in their use of medications as compared to physicians who are not. Of course, I have never met the rare breed of sober psychiatrists although I have met a few sober docs of other varieties. I also see the negative effects of a reliance on pharmacotherapy and some professionals who believe that all substance abusers need medications which is not true and we have less research about this group (recovering addicts who don't take or need psychotropics) since they tend to be off the radar.
 
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Doctor Bagel

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I'm not sure doctors in recovery are less likely to prescribe buprenorphine. There was a big NYTimes article about buprenorphine a few years ago that prominently featured doctors in recovery running buprenorphine clinics.

I agree that addictions are way more complicated than a medication management issue, and I'm obviously biased, but I think addiction psychiatry has more to offer than addiction medicine because we get that. Medications help and are possibly under prescribed, but we don't have any miracle cures. I've seen long term patients on methadone who are doing way better than they'd likely be doing not on methadone, which is great. The vast majority of my buprenorphine patients have not been successful at least after several months, and I don't know what that is. Supposedly it's a pretty good treatment ... I suspect a lot more usage is going on in these Suboxone clinics than providers are picking up on, though.

Dynamically, I think the interesting thing with methadone and buprenorphine treatments is the whole dependency thing -- patients are dependent on you to not be in withdrawal, and that brings out all sorts of stuff.
 
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F0nzie

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I hear they are trying to do away with Addictionologist and go with Addictionist. Anybody else think that sounds weird? Maybe they both sound weird...
 

smalltownpsych

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I hear they are trying to do away with Addictionologist and go with Addictionist. Anybody else think that sounds weird? Maybe they both sound weird...
Yes, they both sound pretty weird. :D How about Chemical Dependence Doctor? I sort of like the term chemical dependence as it makes a distinction from addictive behaviors, disordered eating, and NSSI. All of which could be characterized as addictions, but have different populations, etiologies, biochemical mechanisms. and treatments although there can be quite a bit of overlap.
 
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HarryMTieboutMD

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1)
I'm not sure doctors in recovery are less likely to prescribe buprenorphine. There was a big NYTimes article about buprenorphine a few years ago that prominently featured doctors in recovery running buprenorphine clinics.

I agree that addictions are way more complicated than a medication management issue, and I'm obviously biased, but I think addiction psychiatry has more to offer than addiction medicine because we get that. Medications help and are possibly under prescribed, but we don't have any miracle cures. I've seen long term patients on methadone who are doing way better than they'd likely be doing not on methadone, which is great. The vast majority of my buprenorphine patients have not been successful at least after several months, and I don't know what that is. Supposedly it's a pretty good treatment ... I suspect a lot more usage is going on in these Suboxone clinics than providers are picking up on, though.

Dynamically, I think the interesting thing with methadone and buprenorphine treatments is the whole dependency thing -- patients are dependent on you to not be in withdrawal, and that brings out all sorts of stuff.

Huh? You realize the addiction psychiatrists like Bankole Johnson are the people who push pharmacologic management in the first place and insistent on a pharmacologic panacea. ASAM's entire dimensional criteria system is based on treating the entire disease. More recently ASAM has become more medication tolerant and even to some extent driven, but to say that the addiction psychiatrists have the intellectual claim to addiction being more than a medication management issue is completely untrue; in fact, quite contrary to the truth.

That said, there is a palpable antagonistic relationship between addiction medicine and addiction psychiatry, which is becoming somewhat absurd. Addiction medicine physicians have historically viewed the the substance use disorder in isolation (meaning, ignoring other psychiatric pathology), whereas addiction psychiatrists view substance disorders in the context of, or perhaps being driven by other psychiatric pathology. And of course, in reality, this concept of dual diagnosis is a huge gray area anyway. Also, a significant number of patients with substance disorders carry no co-morbid psychiatric pathology, but given enough exposure and time to lazy psychiatrists, will come away with diagnoses of primary affective and/or psychotic disorders. Ultimately, addiction medicine physicians and addiction psychiatrists have unique skill sets and perspectives, and they really should be collaborating because America's number one health problem isn't going away any time soon, and even though we have some powerful harm reduction drugs and evidence based therapies like MI, 12 step facilitation, CBT, etc, we have "made little impression upon the problem as a whole" (quote from an early 20th century psychiatrist who wrote brilliantly on the subject).
 
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Doctor Bagel

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And just some general comments on this issue
1)


Huh? You realize the addiction psychiatrists like Bankole Johnson are the people who push pharmacologic management in the first place and insistent on a pharmacologic panacea. ASAM's entire dimensional criteria system is based on treating the entire disease. More recently ASAM has become more medication tolerant and even to some extent driven, but to say that the addiction psychiatrists have the intellectual claim to addiction being more than a medication management issue is completely untrue; in fact, quite contrary to the truth.

That said, there is a palpable antagonistic relationship between addiction medicine and addiction psychiatry, which is becoming somewhat absurd. Addiction medicine physicians have historically viewed the the substance use disorder in isolation (meaning, ignoring other psychiatric pathology), whereas addiction psychiatrists view substance disorders in the context of, or perhaps being driven by other psychiatric pathology. And of course, in reality, this concept of dual diagnosis is a huge gray area anyway. Also, a significant number of patients with substance disorders carry no co-morbid psychiatric pathology, but given enough exposure and time to lazy psychiatrists, will come away with diagnoses of primary affective and/or psychotic disorders. Ultimately, addiction medicine physicians and addiction psychiatrists have unique skill sets and perspectives, and they really should be collaborating because America's number one health problem isn't going away any time soon, and even though we have some powerful harm reduction drugs and evidence based therapies like MI, 12 step facilitation, CBT, etc, we have "made little impression upon the problem as a whole" (quote from an early 20th century psychiatrist who wrote brilliantly on the subject).

I really don't know that one group is more likely to prescribe than the other and wasn't really trying to get out which group felt the most connected to medication management for addictions. I just think having a psychiatric background and understanding thoughts/feeling/defenses/and yes, sometimes psychopathology that go into addiction is beneficial. Seeing addiction as a purely biochemical issue is missing a huge component of why people start using substances, why they continue them and why they struggle when they stop.
 
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smalltownpsych

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but they also treat behavioral addictions
Oh. Well, that ruins that idea. :grumpy:
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I hear they are trying to do away with Addictionologist and go with Addictionist. Anybody else think that sounds weird? Maybe they both sound weird...

Addictionationatorologist?
 
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HarryMTieboutMD

I really don't know that one group is more likely to prescribe than the other and wasn't really trying to get out which group felt the most connected to medication management for addictions. I just think having a psychiatric background and understanding thoughts/feeling/defenses/and yes, sometimes psychopathology that go into addiction is beneficial. Seeing addiction as a purely biochemical issue is missing a huge component of why people start using substances, why they continue them and why they struggle when they stop.

You are describing an archaic dichotomy in psychiatry itself "Kraepelin vs Freud", "Biological vs Psychotherapeutic" etc etc etc. I am not sure where you got the idea that Addiction Medicine doctors solely view addiction as a "biochemical issue" in a reductionist sense. Some addiction medicine MDs I know have described it as a "brain disease requiring healing of the heart and soul" or a "medical illness with a spiritual solution." The emphasis on the "disease concept" (though it's not really a concept anymore) is to continue the charge that Benjamin Rush led in 1784- that addiction is an illness and not a moral failing (though with psychobiology of personality, e.g. some of Cloninger's work, are they really separate?) .

Anyway, a psychiatrist will do a more astute mental status exam (provided he or she isn't being lazy) and be able to manage comorbid psychopathology, but in terms of understanding a patient's thoughts/feelings/emotions/etc, psychiatrists definitely do not have exclusive domain.
 
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F0nzie

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More power to the addiction psychiatrist. You don't need to refer out for mood, anxiety, or psychotic disorders that are all so common in the addiction population. But I also I see plenty of addicts that have never had depression or anxiety. It's around a 50% overlap.

Here is where we shine though using all of our skills: The patient with Bipolar disorder, borderline personality disorder, trauma, and a substance use disorder. The sense of satisfaction turning one of these patients around is unbeatable.
 
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Doctor Bagel

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You are describing an archaic dichotomy in psychiatry itself "Kraepelin vs Freud", "Biological vs Psychotherapeutic" etc etc etc. I am not sure where you got the idea that Addiction Medicine doctors solely view addiction as a "biochemical issue" in a reductionist sense. Some addiction medicine MDs I know have described it as a "brain disease requiring healing of the heart and soul" or a "medical illness with a spiritual solution." The emphasis on the "disease concept" (though it's not really a concept anymore) is to continue the charge that Benjamin Rush led in 1784- that addiction is an illness and not a moral failing (though with psychobiology of personality, e.g. some of Cloninger's work, are they really separate?) .

Anyway, a psychiatrist will do a more astute mental status exam (provided he or she isn't being lazy) and be able to manage comorbid psychopathology, but in terms of understanding a patient's thoughts/feelings/emotions/etc, psychiatrists definitely do not have exclusive domain.

So an addiction medicine doctor coming from a primary care route does a 3 year residency in medicine/fm/whatever with pretty much no psychiatric training. Yeah, I know primary care doctors treat a lot of mental illness, but they get no formal training in it. An addiction medicine fellowship is one year and includes a lot of medication management issues. I'm sorry, but I'm missing how that's comparable with a psychiatry residency where we do all mental illness all the time. I still think our background leaves us better able to do with the emotional complexity of addiction, yes, even when there's not a clear Axis I/Axis II diagnosis.
 
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splik

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So an addiction medicine doctor coming from a primary care route does a 3 year residency in medicine/fm/whatever with pretty much no psychiatric training. Yeah, I know primary care doctors treat a lot of mental illness, but they get no formal training in it. An addiction medicine fellowship is one year and includes a lot of medication management issues. I'm sorry, but I'm missing how that's comparable with a psychiatry residency where we do all mental illness all the time. I still think our background leaves us better able to do with the emotional complexity of addiction, yes, even when there's not a clear Axis I/Axis II diagnosis.
also bear in mind that >90% of addiction medicine people don't have a fellowship. it's really easy to get boarded in addiction medicine
 
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heyjack70

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You are describing an archaic dichotomy in psychiatry itself "Kraepelin vs Freud", "Biological vs Psychotherapeutic" etc etc etc. I am not sure where you got the idea that Addiction Medicine doctors solely view addiction as a "biochemical issue" in a reductionist sense. Some addiction medicine MDs I know have described it as a "brain disease requiring healing of the heart and soul" or a "medical illness with a spiritual solution." The emphasis on the "disease concept" (though it's not really a concept anymore) is to continue the charge that Benjamin Rush led in 1784- that addiction is an illness and not a moral failing (though with psychobiology of personality, e.g. some of Cloninger's work, are they really separate?) .

Anyway, a psychiatrist will do a more astute mental status exam (provided he or she isn't being lazy) and be able to manage comorbid psychopathology, but in terms of understanding a patient's thoughts/feelings/emotions/etc, psychiatrists definitely do not have exclusive domain.
Psychiatrists also have therapy training, which non-mental health physicians do not get unless it is sought outside of residency.
 

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also bear in mind that >90% of addiction medicine people don't have a fellowship. it's really easy to get boarded in addiction medicine
It seems this is the only subspecial. Left with no fellowship requir. Hospice, pain, sleep etc. maybe TBI, informatics...who knows...hair transplant surgery....chuckle
 

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It seems this is the only subspecial. Left with no fellowship requir. Hospice, pain, sleep etc. maybe TBI, informatics...who knows...hair transplant surgery....chuckle
So now what happens if we want to get board cert in ADM, sit back and wait for ABMS to decide the criteria u need, before they make fellowship mandatory?
 

notdeadyet

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It already happened. Read the ABAM site. They are working. In developing requirements for fellowship. The no-fellowship pathway will be on its way out over the next couple years.


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Mocaman

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It already happened. Read the ABAM site. They are working. In developing requirements for fellowship. The no-fellowship pathway will be on its way out over the next couple years.


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Please tell me that with enough CME's and some arbitrary time period of treating ADM px we can sit for this exam...please...they owe us
 

notdeadyet

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Please tell me that with enough CME's and some arbitrary time period of treating ADM px we can sit for this exam...
No. ABAM was recognized by ABMS as of March of this year. They are going to be rolling out new requirements and the "experience" pathway will be retired in the coming years as requirements for fellowship are ironed out. The exact timeline hasn't become clear. Folks who have finished residency and are working on the hours requirement should be able to meet qualifications before the changes are rolled out (assuming they are working addiction jobs and not just hobbyists). Folks in residency currently? Much less likely.

This shouldn't come as a shock. When independent fellowships seek out and receive ABMS recognition, the board certification without fellowship tends to go away.
please...they owe us
What on earth do they owe you and way? That's just silly.

A board certification in Addiction is not required to practice in the field. So either don't get the certification, or get the certification. To get board certification, you will need a fellowship, like most.
 

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No. ABAM was recognized by ABMS as of March of this year. They are going to be rolling out new requirements and the "experience" pathway will be retired in the coming years as requirements for fellowship are ironed out. The exact timeline hasn't become clear. Folks who have finished residency and are working on the hours requirement should be able to meet qualifications before the changes are rolled out (assuming they are working addiction jobs and not just hobbyists). Folks in residency currently? Much less likely.

This shouldn't come as a shock. When independent fellowships seek out and receive ABMS recognition, the board certification without fellowship tends to go away.

What on earth do they owe you and way? That's just silly.

A board certification in Addiction is not required to practice in the field. So either don't get the certification, or get the certification. To get board certification, you will need a fellowship, like most.


Copernicus, it was a joke.... I know they don't owe us...ur silly. We'll im workn the hours requirment so hopefully...
 

notdeadyet

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Keep in mind that hours during residency (including moonlighting) do not count. The hours are only counted once primary residency is finished.
 

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Maybe it's putting too fine a point on it, but ABAM will continue. It will just no longer issues its board certification now that it will come from ABMS.

This is a positive development, in my mind, for Addiction Medicine. A certification that is based on "life experience" is fairly weak from a QA standpoint. I did t think much of the forensic psych board cert when they did it that way either. Which can be seen by some of the cult of personality types that dominate the field from the earlier generation as compared to the contemporary.


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Mocaman

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When does that life experience opportunity to be board-certified end? In your opinion, how long will that take? I just shelled out like 245 bucks to become a member of aSam which I hadn't been in years so I'm trying to really tally up my CME's through one of the approved but namely asam continuing medical education entities to hopefully "get in there"before the fellowship is necessary
 

notdeadyet

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When do you finish residency?


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When do you finish residency?


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I finished. I was an off cycle psychiatry res..prior I was a family medicine resident I started in the real world December 1. Just got the Suboxone lisence...so I'm hoping... Any words of wisdom? I wanted to do an addiction psychiatry fellowship, but frankly after all the training, in addition to coming from a difficult university program and family expenses to boot, I decided against it
 

notdeadyet

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You would likely be okay if you can reach the hours. If you're doing 20% substance cases, you hit the hours within about five years.

But the hours need to be post-residency. I don't think hours done for your psych residency would count. You can call ABAM and ask.
 

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You would likely be okay if you can reach the hours. If you're doing 20% substance cases, you hit the hours within about five years.

But the hours need to be post-residency. I don't think hours done for your psych residency would count. You can call ABAM and ask.


Oh that would be sweet. Thanks
 

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This is not necessarily true. Where I went to medical school, the chair of psychiatry was one of the Godfathers of addiction medicine, and the department had a huge addiction program. Most of the addiction attendings were in Recovery themselves (multiple specialties including psychiatry). And they all prescribed Suboxone (and MTD when appropriate, naltrexone, acamprosate,

Oh yes, god forbid we don't forget acamprosate. If I had a nickel for every patient that has ever been helped by acamprosate I'd only need 2 more nickels to buy a jolly rancher.
 

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I know a guy too in an addiction fellowship that also had his license suspended. I don't know if this is by coincidence. I notice that certain types are attracted to certain professions and that one of these types is the person who has the same pathology the profession treats.
 
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HarryMTieboutMD

Oh yes, god forbid we don't forget acamprosate. If I had a nickel for every patient that has ever been helped by acamprosate I'd only need 2 more nickels to buy a jolly rancher.

I'm not saying it works- and I agree with you most of the time it doesn't (666mg TID?????), and I have been less than impressed with NTX (both Revia and Vivitrol), the data notwithstanding. But it's FDA approved and available, and as you know, sometimes you just have to try everything in your arsenal.
 
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HarryMTieboutMD

I know a guy too in an addiction fellowship that also had his license suspended. I don't know if this is by coincidence. I notice that certain types are attracted to certain professions and that one of these types is the person who has the same pathology the profession treats.

This is the norm in addiction medicine, to the point where it's pathologic. Some places require two years of sobriety before doing an ASAM fellowship, but where I went to medical school, most of the people who came to do the ABAM fellowship (which was one of the first) were washed up MDs looking to professionalize their Recoveries. The training, however, was really rigorous with good teaching from the Chief of Addiction Medicine (big name in ASAM), so the fellows achieved marginal competency.
 

whopper

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This is the norm in addiction medicine, to the point where it's pathologic.
This is one of those things you see happening in real life that isn't brought up in textbooks. I know others who tell me the same. It's one of those things that should be addressed that isn't and the answer is easy-cause there's too much physician burn-out and we need to make sure we are mentally and physically healthy to do the job needed.

Now listen, most people deserve a second even third chance. I'm not interested in holding something against someone if they screw up so long as when they pick themselves up again they do better. The problem here is the guy I'm talking about who got in trouble got in trouble again and again and again and behaved like he was chasing a dopamine rush. He met patients in a parking lot, took their cash, and gave them a prescription because while working in a university if he showed up the receptionist would've had that patient in the system and the doctor wouldn't have been able to get the cash under the table. The guy also had gambling problems, a broken marriage, and fits of depression as a result of his lifestyle.
 
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vistaril

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This is why we have Health Professional Service Programs/Physician Assistance Programs.

Know your state Physician Health Program. Know how to report, how they work.

They do help--http://www.bmj.com/content/337/bmj.a2038.short

that study is the one cited ad nauseam....not saying it's useless/irrelevant completely, but there are a lot of problems with drawing too many conclusions from it. For one testing through 2001(especially for alcohol) was pretty useless. ETG in itself is a pretty poor test in terms of sensitivity after 36 hrs or so, but that was even before that was being used. peth was certainly not being used then. My guess is(and there is no way to prove or disprove it either) is that at the time these programs swallowed up good numbers of people who used off/on in a controlled fashion on weekends and whose problems weren't severe enough to allow them total lack of control(where they used in windows where they could be caught). Many of them get out and then it gets more out of control, but only some are eventually recaptured in post-5 year relapse.
 
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HarryMTieboutMD

that study is the one cited ad nauseam....not saying it's useless/irrelevant completely, but there are a lot of problems with drawing too many conclusions from it. For one testing through 2001(especially for alcohol) was pretty useless. ETG in itself is a pretty poor test in terms of sensitivity after 36 hrs or so, but that was even before that was being used. peth was certainly not being used then. My guess is(and there is no way to prove or disprove it either) is that at the time these programs swallowed up good numbers of people who used off/on in a controlled fashion on weekends and whose problems weren't severe enough to allow them total lack of control(where they used in windows where they could be caught). Many of them get out and then it gets more out of control, but only some are eventually recaptured in post-5 year relapse.

This one uses the same data but is a more thorough assessment: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(08)00182-7/abstract?cc=y=

I think the 3 of us (along with Splik) have discussed this issue multiple times on this board... yes, the ~80% abstinence rate is likely an over estimate given the above reasons, and the relapse rate after the 5 year contract is probably enormous (I talked to Lisa Merlo about this a few years ago- data is being collected, but it's all voluntary, self report). However, the ~72% successful return to work with no, major issues is really remarkable, especially when you compare people who complete the contract (91%) to people who don't (28%). Obviously every single participant adhering to PHP guidelines with 100% abstinence would be preferable, but even just constraining use for a 5 year period allows many doctors to be alive and functional, at least while under contract.
 
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