Trends in Psychiatric Subspecialities

[F0nzie]

Anybody have a general sense of the current trends and popularity of fellowships within our field?

At my program, about half of the residents go into child. Maybe 1 resident every 3-4 years will go into forensics. Nobody in the last 4 years has applied to psychosomatic medicine, addiction, or geriatrics.

I cannot decide for myself if I should complete a fellowship in either addiction or psychosomatic (both of which interest me but at this point I do not intend on practicing either exclusively) Vs. finish adult residency, start working, and come out ahead by 100k.

Student loans are high. Sadly, the capitalized interest on my deferred loans amount to more than I can afford to keep in check with my current resident salary. It gets more frustrating every year that goes by.

In addition to the financial concerns, I am also plagued by the thought of having to move to another state for a year then having to move right back. I am starting a family and it would be nice to settle down and buy a house while rates are low.

Any current residents or graduates face a similar dilemma? How did you make your decision? Is it significantly different from other areas of medicine where it seems to be increasingly more desirable to subspecialize? Any input would be appreciated.

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[pixella]

Not a resident yet, but I'm gonna have a go anyway...

I'm a little confused from your post about why you would subspecialize. It seems to me that you should do a fellowship if you want to practice in that subspecialty, if you feel that you require or desire extra training in that area in order to feel/be proficient as a psychiatrist, or for academic/research reasons. Do any of these apply to you? What kind of practice do you envision for yourself? I guess I don't see why you'd do a fellowship unless you have a compelling reason or desire to do so, i.e. not just because it seems to be a trend. Obviously, someone with more experience and expertise can share whether they think fellowship training appreciably affects one's job prospects or earning potential...

 

[F0nzie]

I want to work CL part-time (~30 hours per week) and have a part-time private practice that encompasses general adult psychiatry (med management + psychotherapy) and outpatient addiction (motivational + CBT, suboxone). I need a mixed practice because I get bored super easily. If I graduated a decade ago I'd be all over getting grandfathered into psychosomatic medicine and addiction psychiatry.

 

[pixella]

I want to work CL part-time (~30 hours per week) and have a part-time private practice that encompasses general adult psychiatry (med management + psychotherapy) and outpatient addiction (motivational + CBT, suboxone). I need a mixed practice because I get bored super easily. If I graduated a decade ago I'd be all over getting grandfathered into psychosomatic medicine and addiction psychiatry.

Gotcha. So both addiction and CL fellowships would be relevant for you. Are you contemplating fellowship primarily because you feel you would be better off as a clinician with additional training in those areas, or because you think it may impact your job prospects?

Either way seems like a tough call, given the finances. Though it's hard for me to imagine you doing a fellowship and regretting it... Hopefully someone on the other end of the career spectrum has some ideas for you.

 

[TexasPhysician]

The C&A positions are never filled. There are plenty of unused spots yearly. During a gen psych residency interview, the addiction director told me he usually only gets 1-2 good applicants willing to fill his 1 spot each year. It goes unfilled some years - I consider it a pretty strong program as well.

There seems to never be enough willing applicants. Pay doesn't increase much with a fellowship, so most graduates go straight for the $.

 

[F0nzie]

Well, I think general psychiatrists practice CL and addiction without the fellowship. But if trends are moving towards subspecializing, I have fears of being left in the dust. I feel confident in my CL training with general residency (4 months of CL) and we average around 3000 consults per year. Weekend calls I typically get 8-10 inpatient consults on a Saturday. I try to stay current with the literature. So I don't know if I need a CL fellowship to work part-time. Heck, I may even wanna do inpatient. I don't know.

 

[F0nzie]

I'm also going to focus more on CL and addiction electives during my 4th year while I serve as chief resident.... creating the call schedule and dealing with grievances...