Subspecialties

[Juliet1991]

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Hey, I've read the topic about the board certified fellowships and wonder a little bit why emergency psychiatry isn't listed. I maybe should mention that I'm a pre med-school college student, so I haven't the knowledge, but on Wikipedia emergency psychiatry was also listed as a subspecialty, that's why I wonder.

On the other hand I have a question about psychiatric residency. If I'm interested on doing a fellowship in child and adolescent psychiatry and maybe another specialty, is this even possible? Like c&a psychiatry plus emergency-, neuro- or forensic psychiatry, or is this impossible and I've to stick with one subspecialty. Are there maybe only some you could combine, or…you know, I'm really curious and couldn't find the answers cause Freida only listed psychiatry and then c&a, geriatric and forensic, but there are so much more and how long would I require to do c&a and maybe one of the three above mentioned until I'm ready?

Any answer would be totally great.

 

[belle54321]

All psychiatrists must first complete a General Adult psychiatry residency, which is 4 years long. Residents can short-track into Child and Adolescent psychiatry fellowship after 3 years, but they can do 4 years of general adult psychiatry residency if they choose to. You can pursue as many fellowships as you want, but I am not sure too many that would do more than 1. There "official" subspecialities are the ones you can get board-certifications in. And you can find them on the ABPN websites.

http://www.abpn.com/psych.html

There are other subspecialities that have fellowships, but they currently do not have "official" board certifications. This includes reproductive psychiatry, etc.

 

[Juliet1991]

Oh god…what happened to my posting? I’m totally sorry. Seems like since I’ve written it in word some gaps went missing when I posted the text.

First of all thank you for all the answers.

So you’re saying I can do a 3 year general psych residency, after this 2 years of c&a makes 5 years and maybe another one with one year like forensic, neuro, or emergency. In m opinion c&a would fit perfectly with emergency, cause also teenagers, young adults and even kids can be possible emergency cases, if you understand what I wanna say and all those cases are totally my thing, but not only…I’d like a wide range if it’s possible.

And can somebody explain what maybe makes the difference if I’m certified in a specialty, or if I’m not and if it’s even realistic to say I wanna work with kids and teenagers and also people of the forensic field, cause that’s a huge difference, compared to my example with c&a and emergency.

 

[TexasPhysician]

Emergency psychiatry is not a fellowship. Yes you can do 2 fellowships though. Yes you can combine c&a with forensics. There are many minors that utilize the forensic field.

 

[tobi44]

the board certified fellowships for psychiatry are addiction, Child, forensic, geriatric, consultation-liason, and pain.

non board certified fellowships include include anxiety/mood disorders, immunology, neuroscience, psychopharmacology, epidemiology, cancer, genetics, schizophrenia, infant, and others

are you talking about doing two specialties though? For those you have to do an entire residency in psychiatry and then again in other specialty. Unless you do a dual residency program like FP/Psych ect. Thats something different.

 

[splik]

Emergency psychiatry is not a fellowship. Yes you can do 2 fellowships though. Yes you can combine c&a with forensics. There are many minors that utilize the forensic field.

Err.. yes it is. It just isn't one that the ABPN certify. emergency psychiatry is a legitimate subspecialty of psychiatry, and there are fellowships but most psychiatrists working in this area have not done the fellowship because it is not necessary. Also most of the ER psychs Ive know have not stayed in it more than 10 years as burnout is quite high.

 

[splik]

the board certified fellowships for psychiatry are addiction, Child, forensic, geriatric, consultation-liason, and pain.

non board certified fellowships include include anxiety/mood disorders, immunology, neuroscience, psychopharmacology, epidemiology, cancer, genetics, schizophrenia, infant, and others

So there are clinical fellowships which can be divided in the board-certified and non-board certified. The board certified ones are child and adolescent, geriatric, forensic, psychosomatic (and psycho-oncology), addiction, pain, sleep medicine, and hospice and palliative medicine. The last 3 can be done through other specialities other than psychiatry too (such as anesthesiology, neurology, IM etc) The non board certified ones include reproductive psychiatry, eating disorder, emergency psychiatry, community psychiatry, and neuropsychiatry/behavioral neurology.

Then there are non-clinical fellowships (which may include a clinical component) which include neuropsychiatry (again), public psychiatry, biological psychiatry, neuropsychopharmacology, health services research, psychiatric epidemiology, clinical trials, psychiatric genetics, mood disorders blah blah blah... the list is endless...

As mentioned above you can technically do as many fellowships as you like but because of the lack of compensation and the large debts most medical students accrue, most do not do any fellowships and it is even more unusual to do multiple fellowship. The people I know who have done multiple fellowships tend to be IMGs who a) do not have the ridiculous debt and b) are working their way up the greasy pole of academia, through increasingly prestigious, if thoroughly uncompetitive, fellowships.

 

[sunlioness]

the board certified fellowships for psychiatry are addiction, Child, forensic, geriatric, consultation-liason, and pain. .

There are also other multi-specialty fellowships for which psychiatry is an accepted pathway. Hospice/Palliative being the one that I know of. It takes people from psychiatry, medicine, peds, FM, EM, anesthesia, neurology and some other ones I'm missing. Sleep medicine is another one, I believe. And so is pain, for that matter.

 

[aphenomenon]

Non-board-certified Interprofessional Fellowship in Psychosocial Rehabilitation & Recovery Oriented Services is another, well, interprofessional fellowship: http://www.va.gov/oaa/fellowships/psychosocial-rehab.asp

 

[whopper]

I believe a reason for no emergency fellowships is because good exposure to emergency psychiatry is prevalent in so many residencies. After all, it's usually a tougher rotation, why not dump the residents in there to do the dirty work?

A problem with going into too many fellowships is it becomes harder and harder to be good in multiple fields and maintaining certification in all of them.

 

[aphenomenon]

it becomes harder and harder to be good in multiple fields and maintaining certification in all of them.

how is certification maintained in terms of requirement over time?

 

[Juliet1991]

Wow…thank you so much for all the answers and because tobi44 asked, I don't wanna do two residencies like psychiatry and neurology,or such combined programs. I'm only interested in doing two fellowships after I finish my general psych residency, like c&a plus emergency, or forensic. Maybe even all three of them if it's possible, cause if I'm not wrong 3 general years plus 2 c&a plus 1 emergency and 1 forensic would make a total of 7 years and since I'm also totally interested in neurosurgery (it's like my head is saying neuro and my heart psych) it would make the same, cause neuro is mostly 7 years. I know 7 years are much for psych, when you can practice general after 4 years, but because of the fact that I'm also interested in surgery I've got the worst duration case scenario figured out and that'd be 7 years…so it wouldn't make such a difference. Maybe I can combine two fellowships, dunno if this is possible, but like I said I often heard about those combined residencies, like ped and psych, neurology and psych, so maybe it is also possible to combine two fellowships.

As for me I'd be totally sure about the c&a fellowship, it's like in stone when I'll choose psych as a residency, but emergency and forensic sound also very interesting and yeah, so I thought maybe there are possibilities to combine, like c&a emergencies, or c&a in theforensic field.

But as one of you said, if it's possible that some are working in the emergency field but haven't done a fellowship, so maybe I don't need one, so I'd be trained in my general residency in emergency cases and could later do only c&a and forensic.

 

[notdeadyet]

Also most of the ER psychs Ive know have not stayed in it more than 10 years as burnout is quite high.

That might be a regional thing. Most of the Psych ERs I've looked at or worked at (all out west) are affiliated with academic universities and most of the attendings have been there for much of their careers. I don't think the burn out rate is any higher than any acute inpatient psych unit, but I'd be curious to see data that says otherwise.

That said, very few folks do full-time emergency psych. Most folks do it a couple days a week combined with work on inpatient units or with some private practice patients. It's not like EM, where you're dealing with a wide variety of pathologies every day. Emergency psych has lots more horses than zebras. You'd want to mix it up a bit.

 

[notdeadyet]

Wow…thank you so much for all the answers and because tobi44 asked, I don't wanna do two residencies like psychiatry and neurology,or such combined programs. I'm only interested in doing two fellowships after I finish my general psych residency, like c&a plus emergency, or forensic. Maybe even all three of them if it's possible, cause if I'm not wrong 3 general years plus 2 c&a plus 1 emergency and 1 forensic would make a total of 7 years and since I'm also totally interested in neurosurgery (it's like my head is saying neuro and my heart psych) it would make the same, cause neuro is mostly 7 years. I know 7 years are much for psych, when you can practice general after 4 years, but because of the fact that I'm also interested in surgery I've got the worst duration case scenario figured out and that'd be 7 years…so it wouldn't make such a difference. Maybe I can combine two fellowships, dunno if this is possible, but like I said I often heard about those combined residencies, like ped and psych, neurology and psych, so maybe it is also possible to combine two fellowships.

As for me I'd be totally sure about the c&a fellowship, it's like in stone when I'll choose psych as a residency, but emergency and forensic sound also very interesting and yeah, so I thought maybe there are possibilities to combine, like c&a emergencies, or c&a in theforensic field.

But as one of you said, if it's possible that some are working in the emergency field but haven't done a fellowship, so maybe I don't need one, so I'd be trained in my general residency in emergency cases and could later do only c&a and forensic.

Juliet- I think it's very easy to look at fellowships as a way to get qualified to do something, but that's probably not the appropriate way to look at it. Fellowships are probably best viewed as for folks who are going to dedicate their career to a particular field.

If you want to do shifts here and there on a Consult service, you don't need to do a PSM fellowship. If you want to be a consult psychiatrist, you should.

If you want to work with the elderly as part of your practice, you don't need a geri fellowship, but if you're going to dedicate your career to them and do research, the fellowship makes a lot of sense.

With the exception of CAP, you can get sufficient training in all of the fields in recognized subspecialties at the right residency (and can choose a residency that has strength in those fields when you apply) through required and elective rotations. Sufficient training to build on as you do actual work in the area to build proficiency. You don't need a fellowship for this.

If you're going to dedicate your career to a particular field, a fellowship makes sense, otherwise you're just taking time away from work to bulk up in a field you're not going to be able to maintain proficiency in. You can make a case for doing multiple fellowships if you have a very specific niche you want to fill (forensic CAP or addiction CAP, for instance), but not because you have a general interest in multiple subspecialties.