What is the youngest patient age that a general (non–child-trained) psychiatrist can/should appropriately treat in clinical practice?

[milan95]

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thanks!

 

[Stagg737]

thanks!

Completely depends on the psychiatrists comfort level and CAP training in their general residency. Personally, I'm fine seeing kids 16 and up and fairly comfortable seeing kids as young as 14-15 if necessary (though I don't), but I would definitely not want to see kids under 12 unless it was a very straightforward situation like obvious ADHD, for example.

Legally/ethically I think you could argue that any general psychiatrist could though, given there are plenty of awful NPs or pediatricians/FM docs who are clueless treating these kids otherwise.

 

[milan95]

Completely depends on the psychiatrists comfort level and CAP training in their general residency. Personally, I'm fine seeing kids 16 and up and fairly comfortable seeing kids as young as 14-15 if necessary (though I don't), but I would definitely not want to see kids under 12 unless it was a very straightforward situation like obvious ADHD, for example.

Legally/ethically I think you could argue that any general psychiatrist could though, given there are plenty of awful NPs or pediatricians/FM docs who are clueless treating these kids otherwise.

i am back and forth as to whether I should fast track or not (current pgy-2). In terms of child populations, I really only want to work with depression, anxiety in kids, 14 and up...so if legally if I can do this with a general psych fellowship, I would love to do that.

 

[milan95]

On the other hand, would also like everyone's thoughts about something like this..

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[ObsequiousAplomb]

I'd be comfortable seeing them once they can drive themselves to appointments. My malpractice carrier asked me if I treat kids and I said no, so I won't see anyone under 18.

 

[Bartelby]

My malpractice carrier asked me if I treat kids and I said no, so I won't see anyone under 18.

As a practical matter this is the right answer. If you are going to see anyone under 18, make sure that is not excluded under your malpractice policy (it probably is).

 

[shoomer]

i am back and forth as to whether I should fast track or not (current pgy-2). In terms of child populations, I really only want to work with depression, anxiety in kids, 14 and up...so if legally if I can do this with a general psych fellowship, I would love to do that.

Legally you can, but you won't be as well equipped to work with adolescents. I personally thought I only cared for work with adolescents and now actually prefer working with kids after fellowship. Also a lot of teens are bringing much more to the table than simply anxiety and depression even when that's the chief complaint.

 

[milan95]

Legally you can, but you won't be as well equipped to work with adolescents. I personally thought I only cared for work with adolescents and now actually prefer working with kids after fellowship. Also a lot of teens are bringing much more to the table than simply anxiety and depression even when that's the chief complaint.

idk how mid levels keep doing it yet gen psychiatrists feel so limited when it comes to working with kids. a lot of the third years have a child clinic and a college mental health clinic, and additional space to work with kids and families who need CPT...surely some of this s decent enough to handle age 15 up, more basic cases.

 

[shoomer]

idk how mid levels keep doing it yet gen psychiatrists feel so limited when it comes to working with kids. a lot of the third years have a child clinic and a college mental health clinic, and additional space to work with kids and families who need CPT...surely some of this s decent enough to handle age 15 up, more basic cases.

I was responding more from the perspective of why fellowship may be a good option if you're considering it. I was on the fence too and I enjoyed it ultimately.

I would agree that a general psychiatrist is preferable to a midlevel or FM/peds doc handling these cases in areas where child psychiatrists are hard to come by.

 

[comp1]

Legally, you can do plastic surgery. The issue is whether your malpractice covers it.

 

[Merovinge]

On the other hand, would also like everyone's thoughts about something like this..

Get Certified with the American Board of Adolescent Psychiatry | Enhance Your Career Today

Join the American Board of Adolescent Psychiatry for top-tier certification. Boost your career with our adolescent psychiatry certification.

www.adolpsychiatrycertification.org

I frankly think it's a bit of a joke. CAP training with fast track is 1 extra year, if you want to take care of kids do the fellowship. There is no amount of online courses that is going to make up the training of working with CAP in structured settings with structured feedback/readings/patient populations. The only place that type of work makes sense to me is in rural areas where there are no CAP and you want to fill in that work. Even then you should still learn from CAP rather than adult psychiatrists trying to skirt doing actual training for their expertise. It's a bit like the type of training you get as an NP when you only learn from NPs.

 

[TexasPhysician]

i am back and forth as to whether I should fast track or not (current pgy-2). In terms of child populations, I really only want to work with depression, anxiety in kids, 14 and up...so if legally if I can do this with a general psych fellowship, I would love to do that.

If your plan is to regularly see those 14-17, I would do the fellowship. You can’t just work with those conditions as you’ll need to exclude all of the other stuff. Some patients come in with parents thinking it is anxiety when it is actually adhd, bipolar, depression, etc.

You can legally do anything including Botox injections or whatever. That doesn’t mean you should or that it won’t increase your odds of a lawsuit. Malpractice may or may not cover things you aren’t well trained in.

 

[Stagg737]

idk how mid levels keep doing it yet gen psychiatrists feel so limited when it comes to working with kids. a lot of the third years have a child clinic and a college mental health clinic, and additional space to work with kids and families who need CPT...surely some of this s decent enough to handle age 15 up, more basic cases.

They do it either because they're at the top of the Dunnig-Kruger curve or because there is truly no one else in the area to do it (usually rural areas) and so they're the only ones available to fill that gap. I'd agree that most general psychiatrists should receive the training in residency to handle the basic and straightforward cases, but the problem is knowing how to not miss the low-key major problems and our risk aversion to not doing things we're not experts in. Just differences in general attitude between individuals and the "average" professional in different positions.

Legally, you can do plastic surgery. The issue is whether your malpractice covers it.

This has been my argument when admins tell me not to do stuff that is "below my scope". I've heard them say "we want you practicing at the top of your scope" and I once shocked a few of them when I responded, "Great, so which neurosurgery case do you want me scrubbing in on?" Obviously I'm not doing neurosurgery, but legally we can do a lot more than what most people think.

 

[aim-agm]

This has been my argument when admins tell me not to do stuff that is "below my scope". I've heard them say "we want you practicing at the top of your scope" and I once shocked a few of them when I responded, "Great, so which neurosurgery case do you want me scrubbing in on?" Obviously I'm not doing neurosurgery, but legally we can do a lot more than what most people think.

Wait, you aren't doing the cingulotomies for your refractory OCD cases? Tsk tsk

I do love how they say "top of your scope" when they mean "top of your RVU potential"

 

[Celexa]

My institution credentials those of us without child/adolescent fellowship to see down to age 14. I could probably request that be adjusted downward, but have zero plans to and would not feel comfortable doing so. I do see adolescents in my niche outpatient practice, which requires that they already have a medical condition for which they are seeing my medical specialist colleagues. I try and keep my assessment and recommendations focused on my area of expertise, and refer them to our child and adolescent dept if longitudinal follow up is needed. I'm willing to bend that rule a bit for 17 yo if they are otherwise appropriate for my continuity panel.

Initially I was totally against seeing anyone under 18 at all, but I have softened that stance upon realizing how poor access to psychiatrists actually is in my current area.

Theres a lot of variability in the breadth and depth of child and adolescent exposure in general psych residencies. I went to one which was superb for other things but pretty bare minimum on the child side unless you specifically sought out extra exposure. Which I didn't, because my interests were elsewhere. I greatly appreciate my child and adolescent colleagues.

 

[Stagg737]

My institution credentials those of us without child/adolescent fellowship to see down to age 14. I could probably request that be adjusted downward, but have zero plans to and would not feel comfortable doing so. I do see adolescents in my niche outpatient practice, which requires that they already have a medical condition for which they are seeing my medical specialist colleagues. I try and keep my assessment and recommendations focused on my area of expertise, and refer them to our child and adolescent dept if longitudinal follow up is needed. I'm willing to bend that rule a bit for 17 yo if they are otherwise appropriate for my continuity panel.

Initially I was totally against seeing anyone under 18 at all, but I have softened that stance upon realizing how poor access to psychiatrists actually is in my current area.

Theres a lot of variability in the breadth and depth of child and adolescent exposure in general psych residencies. I went to one which was superb for other things but pretty bare minimum on the child side unless you specifically sought out extra exposure. Which I didn't, because my interests were elsewhere. I greatly appreciate my child and adolescent colleagues.

Where I'm at mostly hardlines that general psychiatrists don't see anyone under 18 as we've got a fairly robust CAP presence here. That said, in my telehealth clinic we have bent the rules a few times for patients who were seen in "big city" child units but have no one for follow-up other than their family med docs. I've seen a couple of 17 yos in those situations to make sure they got appropriate post-discharge f/up for 3-6 months until they turned 18 and the local CMHCs or private docs would see them.

 

[shoomer]

This has been my argument when admins tell me not to do stuff that is "below my scope". I've heard them say "we want you practicing at the top of your scope" and I once shocked a few of them when I responded, "Great, so which neurosurgery case do you want me scrubbing in on?" Obviously I'm not doing neurosurgery, but legally we can do a lot more than what most people think.

I was under the impression that practicing below your scope was in reference to social work, scut work, non-clinical tasks etc. that seem like a waste of time. What am I missing here?

 

[comp1]

Yes, they usually mean non-clinical tasks. Hence, the "shock" the previous poster elicited... That said, I think most of what social workers do is very, very clinical and extremely challenging. It's a good idea for psychiatrists to at least be familiar with how to do all of it, particularly inpatient and related to discharge planning.

 

[Stagg737]

I was under the impression that practicing below your scope was in reference to social work, scut work, non-clinical tasks etc. that seem like a waste of time. What am I missing here?

it is, I previously wanted to place patients into the schedule myself to manage which patients I see on what days but was told this was below my scope and to leave it to schedulers. My outpatient work is now much more limited, but there are sometimes things that are much easier to get done when the physician makes the call themselves vs non-clinical staff.

 

[slowthai]

This has been my argument when admins tell me not to do stuff that is "below my scope". I've heard them say "we want you practicing at the top of your scope" and I once shocked a few of them when I responded, "Great, so which neurosurgery case do you want me scrubbing in on?" Obviously I'm not doing neurosurgery, but legally we can do a lot more than what most people think.

That "top of your scope/license" stuff is nursing/midlevel terminology. There's no such thing. Our scope is our scope; you're either inside, or outside.

 

[comp1]

I find that it's language much more often used by physicians who don't want to deal with discharge planning details or appointment scheduling than by nurses.

 

[FlowRate]

I was under the impression that practicing below your scope was in reference to social work, scut work, non-clinical tasks etc. that seem like a waste of time. What am I missing here?

Usually when we say working "top of scope" it's in reference to non-physician staff doing things they're entirely capable of doing (but don't in some organizations), reducing busywork that physicians shouldn't be doing, and trying to have patients see primary care instead of a specialist when that's what the most appropriate next step actually is.