Why Do a Geriatric Psych Fellowship?

[BobA]

Geriatric Psychiatry seems to be popular these days. In terms of professional life and job prospects after residency, what are some of the benefits of doing a Geriatric Psych fellowship? Thanks!

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[psychattending]

The biggest advantage is more knowledge. Whether that gain really outweighs the downside of spending another year of one's life being paid at a trainee level instead of earning attending dollars is not clear to me. Insurance companies don't require it and you have to keep paying to retake the test every 10 years. The biggest use is that one can teach in a fellowship program. I usually counsel my residents to not go the fellowship route but to spend their elective months in the area. By the numbers it appears that the field agrees. In the most recent report from the ABPN the number of fellows has dropped by 23% (down to 80) and only 50% of the people who gain certification seek recertification after 10 years.

 

[Chimed]

Notwithstanding the knowledge and experience benefits, it will likely be most helpful if you're pursuing a clinical or research position in an academic center. It far easier, if not critical, to say "My niche is geriatrics" after doing a fellowship and be able to support it by your background. You may also be able to negotiate a higher starting salary in academics after having done a fellowship.

I've heard mixed things regarding whether it helps finically outside of academics. Some say that geriatrics is "the only speciality where you lose money for doing a fellowship." But I've heard attendings who used to work in a private hospital settings say that it did help in salary. How much, I don't know.

 

[Manicsleep]

Because it's there!

 

[billypilgrim37]

Because it's there!

That's actually a fabulous reason!

Other than that, there are niche opportunities like nursing homes that can be both lucrative and fulfilling when done properly. I know some of our group actually negotiated a flat rate which gives them time to do family meetings and more thorough evaluations instead of just handing every 90yo Zyprexa to shut them up. A few of the nursing homes went to private attendings for a few years because they thought they could save money, but they wound up coming back to the flat rate university program because the better care saved them money (and it was just better care).

So practically, it may not be necessary, but for lots of other less financial reasons, it may be nice enough to justify the extra year and lower salary.

 

[heyjack70]

The extra year with low pay may not be that bad however. You will be BE/BC general psych, and you will have no call (hopefully, I don't know how a fellowship could attract residents if there was call required). The increased schedule flexibility + BE/BC should allow plenty of moonlighting opportunities to help offset the salary discrepancy.

 

[Suedehead]

Because it's there!

George Mallory. Yes! Virtual high five!

And I really dig what Heyjack70 said. If the fellowship gives one enough space to moonlight, etc, then hooray.

 

[TexasPhysician]

Just because Geriatrics doesn't get you a big pay bump now doesn't mean it won't in the future. Look at anesthesia and dermatology over history.

 

[whopper]

Financially things may change for geri-psychiatrists. The baby-boomers are increasing in number that meet the senior citizen status.

If you have a passion for real psychiatry and there's a fellowship that fits an interest, not just wanting to do the job, but really mastering it, this will draw people into fellowship even if it they won't earn much more money. That's not a judgment call on those who don't do that. There's plenty of great doctors I know that didn't do fellowship.

 

[BobA]

The biggest advantage is more knowledge. Whether that gain really outweighs the downside of spending another year of one's life being paid at a trainee level instead of earning attending dollars is not clear to me. Insurance companies don't require it and you have to keep paying to retake the test every 10 years. The biggest use is that one can teach in a fellowship program. I usually counsel my residents to not go the fellowship route but to spend their elective months in the area. By the numbers it appears that the field agrees. In the most recent report from the ABPN the number of fellows has dropped by 23% (down to 80) and only 50% of the people who gain certification seek recertification after 10 years.

That's great info - thanks! . . . maybe it's just a statistical anomaly among people I know

 

[393656]

I was strongly considering a few fellowships and after deciding not to and looking at a variety of job opportunities I have realized the big difference and need to do a fellowship is if you want to work at an academic program in that area. CL, addiction, gero etc. So if you want to do academics I would definetly do something. I did not want to do that so did not matter and as it turns out there is no job I could not find just fine without any extra speciality. Jobs in CL, addiction, gero etc were all plentiful for just regular boarded psychiatrists.

I had also considered sleep and that has even less opportunity than anything else. I realize looking around country, psych-sleep positions are few and far between so unless you want to just have some extra knowledge but end up practicing pure psych, or relocating somewhere specific, certain fellowships are lower yield.

To complicate gero, there is now a growing Neuropsychiatic fellowship that is not acgme boarded but is growing strength as and is boarded in society of neuro subspecialities or something. It is what behavioral neuro was previously called and has merged with neuropsych open to both psych and neuro.

You evaluate very similar subset of people with this so its a tricker decision on what to do. I simply have an interest in the work and I would have been happy to just learn more for a year if finances and laons were not an issue Unforuntely the real world dictates I need money!

 

[michaelrack]

I had also considered sleep and that has even less opportunity than anything else. I realize looking around country, psych-sleep positions are few and far between so unless you want to just have some extra knowledge but end up practicing pure psych, or relocating somewhere specific, certain fellowships are lower yield.
!

Agree with this. Sleep is not a good opportunity for psychiatrists, unless 1) they want to try and do pure sleep or 2) are entrepeneurial and want to start their own psych practice and add a small 2-4 bed sleep lab to their psych practice.

 

[393656]

Agree with this. Sleep is not a good opportunity for psychiatrists, unless 1) they want to try and do pure sleep or 2) are entrepeneurial and want to start their own psych practice and add a small 2-4 bed sleep lab to their psych practice.

Exactly, I am not saying it is a waste by any means but I personally realized I also hated the field after rotating in it, luckily before I applied. But even if you love it, 90 percent of practices are pulmonary groups that need pulm docs for coverage for other things because they are all hospital affiliated.

I agree that you have to open your own sleep clinic and be more of a business man, which is awesome but alot of people either dont want the degree of work or just arent into their own startup.

 

[Manicsleep]

Agree with this. Sleep is not a good opportunity for psychiatrists, unless 1) they want to try and do pure sleep or 2) are entrepeneurial and want to start their own psych practice and add a small 2-4 bed sleep lab to their psych practice.

Even 100% sleep is hard. You really have to start your own lab or stay in an academic setting. I actually had a lot of opportunity in academics but the money sucked (although paid a lot better than any other psychiatrist because pay is often based on RVUs).

Your own lab may take a little bit but eventually you will do really well. Also, as the mandatory sleep fellowship takes into effect. You will see more psychiatrists and it will become pretty normal. The problem is you really have to like medicine and neurology as well as be able to work well with others...its not a field for everyone.