Hi! I am a psychiatry resident, potentially interested in pursuing forensic psychiatry fellowship. Part of my hesitation is concern for poor work-life balance during fellowship knowing I could just pursue a general psychiatry attending job for more income and gaining experience. I am very interested in Forensic psychiatry content but I am concerned about making it through another year of training. While I would like to further education in criminal realms, I am more interested in actually practicing civil work. Is anyone familiar with forensic fellowships that have a good work-life balance and/or ones that emphasize civil work more heavily than others? Any insight is appreciated! Thank you in advance.
Work life balance in Forensic Psychiatry Fellowship
- Thread starter Spcegrl5
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I'm completing my forensic psychiatry fellowship this year. When I was applying, I did not get the sense that many programs "emphasize civil work more heavily than others." A good program will expose you to the concepts (i.e., assessment of causality related to psychiatric disorders or emotional distress; disability claims; sexual and racial harassments; competency to X, Y Z, etc.) and the relevant landmark cases. An excellent program will also ask you to review mock cases and draft reports for review. You may not ever be hired for a private case. And you may not spend much more than two to three months covering the civil case material.
The work-life balance in fellowship is a thing. Honestly, you get out of the experience what you put in. Learning the forensic report writing style and adapting your writing to it can be time-intensive. The sheer amount of record review and summarizing of records can feel endless. You'll pour hours of prep into a case and then learn the deadline moved or the evaluee cancelled. You may also be on the road a lot driving to and from isolated facilities to perform your evaluations. It can be a lot, but it can also be balanced.
If you're not wanting to jump into another year of training, then you can always utilize resources like AAPL. The journal is outstanding. The annual meetings are fun too. There's usually a seminar or two each year teaching the basics, and you'll notice that many of the current fellowship PDs teach those courses.
Are you comparing any programs specifically?
The work-life balance in fellowship is a thing. Honestly, you get out of the experience what you put in. Learning the forensic report writing style and adapting your writing to it can be time-intensive. The sheer amount of record review and summarizing of records can feel endless. You'll pour hours of prep into a case and then learn the deadline moved or the evaluee cancelled. You may also be on the road a lot driving to and from isolated facilities to perform your evaluations. It can be a lot, but it can also be balanced.
If you're not wanting to jump into another year of training, then you can always utilize resources like AAPL. The journal is outstanding. The annual meetings are fun too. There's usually a seminar or two each year teaching the basics, and you'll notice that many of the current fellowship PDs teach those courses.
Are you comparing any programs specifically?
Half my year was clinical (jail, prison, forensic ACT team...) not really why I wanted to do the fellowship, but all in all pretty chill and pretty interesting. No call, nights or weekends. Also did some supervision time and asylum assessments, very laid back.
Second half was state hospital criminal assessments with lots of record review and report writing. Took a lot of work home, especially report writing in the evenings and weekends. But was still able to moonlight 1 weekend a month during this 6 month stretch.
I got essentially no exposure to civil cases outside of record review for a potential malpractice case with one of the attendings that didn't lead anywhere. Looking back I should have pushed for more of this.
I've heard Case Western with Phil Resnick is a very time intensive program.
Second half was state hospital criminal assessments with lots of record review and report writing. Took a lot of work home, especially report writing in the evenings and weekends. But was still able to moonlight 1 weekend a month during this 6 month stretch.
I got essentially no exposure to civil cases outside of record review for a potential malpractice case with one of the attendings that didn't lead anywhere. Looking back I should have pushed for more of this.
I've heard Case Western with Phil Resnick is a very time intensive program.
Most programs won't have too much exposure to civil. Maybe immigration evals or fitness for duty. Attorneys with money on the line are not going to invest in fellows. However, you can get civil work after your fellowship.
If you train well in criminal cases, then you should be able to do civil cases. Fyi there are other specialists like sugeons or PMR that do med mal, PI and disability that have no Forensic training. If you did a forensic fellowship with only criminal exposure, you are way ahead of other specialities that have no forensic fellowship. If you create a niche, you could do civil work. For example I am forensic and am board certified in another subspecialty.
The fellowship I went to had a good work life balance. 2 evals a week with no clinics for 6 months (except half day twice a month. Then 6 months all clinic with some asylum evals. No call.
If you train well in criminal cases, then you should be able to do civil cases. Fyi there are other specialists like sugeons or PMR that do med mal, PI and disability that have no Forensic training. If you did a forensic fellowship with only criminal exposure, you are way ahead of other specialities that have no forensic fellowship. If you create a niche, you could do civil work. For example I am forensic and am board certified in another subspecialty.
The fellowship I went to had a good work life balance. 2 evals a week with no clinics for 6 months (except half day twice a month. Then 6 months all clinic with some asylum evals. No call.
Not in particular. I really had no idea where to start with it so I appreciate your response. I think I am ultimately trying to decide if I want to go for it right after residency or just hanging back to see if it is something I would truly like to pursue and the content along with work life balance were important (but not only) factors .
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Check out the AAPL conference. I thought I would do a forensic fellowship until I attended. It was the worst conference that I’ve ever attended. I’m not claiming that it was poorly designed as I’m saying that it helped me to determine that I don’t want to do the fellowship. 0 interest any longer.
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I was in your position as a resident. What helped me make my decision was to follow-up with former fellows, to see what they were doing with their careers, and to look closely at the fellowship rotations. I realized (1) I had little interest in most of the rotations (e.g., not a big fan of correctional psychiatry) and (2) was turned-off on the careers of the fellows (e.g., worked in a state hospital, jail, stayed in academics). I do forensic work now. Here is what helped me.
Do a rotation in forensics during residency.
Attend the AAPL forensic psychiatry review course.
Read Melton's Psychological Evaluations for the Courts.
After residency, I took a contract position doing criminal competency and insanity evals for my state.
Had a local forensic psychiatrist look over and review some of my reports.
PM me if you'd like to discuss more.
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Couldn’t agree with this advice more.
I was debating doing a forensic fellowship, attended AAPL early in residency, and it definitely made me realize forensics was a good fit. I teach in our fellowship now and give the above advice to those considering the field.
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Regarding civil training in fellowship, all programs aren’t created equally.
Forensic fellowships tend to be kind of cult of personalities. Case Western would not be the same CW without Resnick, UC Davis would not be UCD without Scott, etc.
I would ask the leadership specific questions about exposure to civil cases in fellowship and ask how much of their practice is civil cases. There are some (outstanding) forensic fellowships in which the leaderships expertise is almost entirely criminal. These are not the best places for civil training.
I intentionally wanted to attend a fellowship with good civil exposure. Not because I prefer civil to criminal (I don’t) but because I knew it would be much harder to break into civil cases without the experience after fellowship. My practice is now about maybe 35/65 civil/criminal and it’s almost entirely from the civil cases I worked in fellowship.
Forensic fellowships tend to be kind of cult of personalities. Case Western would not be the same CW without Resnick, UC Davis would not be UCD without Scott, etc.
I would ask the leadership specific questions about exposure to civil cases in fellowship and ask how much of their practice is civil cases. There are some (outstanding) forensic fellowships in which the leaderships expertise is almost entirely criminal. These are not the best places for civil training.
I intentionally wanted to attend a fellowship with good civil exposure. Not because I prefer civil to criminal (I don’t) but because I knew it would be much harder to break into civil cases without the experience after fellowship. My practice is now about maybe 35/65 civil/criminal and it’s almost entirely from the civil cases I worked in fellowship.
Here's a question - I'm moving out of Labor and Industries / Workers' Comp cases and into expert witness work. I didn't do a forensics fellowship. Is there any specific program you would recommend I complete for when I get the inevitable query about lack of forensic educational experience from an attorney?
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The vast majority of people who do expert witness work are not forensically trained and in other specialties except pathology there is no forensic pathway. I have never had an attorney ask if I was forensically trained or board certified (though I am). I dont think most of them even know what forensic psychiatry is. They want to know about your experience with x diagnosis or type of evaluation, or your work setting (for example if you are doing an inpatient malpractice case that you practice in an inpatient setting), that you teach, and how many times you have been deposed or testified.
There are specific types of evaluations where specialized training is necessary (for example sex offender recidivism, insanity etc) but for most civil forensic evaluations no one is going to care about your forensic training more your experience both clinically (e.g. in working with trauma/PTSD or whatever), and as an expert witness.
Is there a reason you're giving up on worker's comp?
The pay in my state is pretty pitiful for Workers' Comp. I have been trying to move away from it in the past year.
Thanks for the above info - I tend to include a lot of references in my reports and do make comments on how the presentation of claimants is different in forensic settings (in discussions of motivation for report of symptoms) and am always worried I will be asked about forensic training that has lead me to make these observations. I have done a lot of reading, but have no formal forensic training background.
Thanks for the above info - I tend to include a lot of references in my reports and do make comments on how the presentation of claimants is different in forensic settings (in discussions of motivation for report of symptoms) and am always worried I will be asked about forensic training that has lead me to make these observations. I have done a lot of reading, but have no formal forensic training background.
One good area to break into without forensic training is medical malpractice. I know many would avoid that one. With your worker's comp background, you would be suited for fitness for duty, defense base act, disability, and personal injury. There are some companies that specialize in defense base act. I have not heard from them but it could be due to my rate. I heard of another company that trains you and has you do high volume IMEs but not the highest rate (more than the clinical rate but less than an expert witness rate). You could consider ABIME . I tell non-psychiatry expert witnesses to consider life care planning. However, I am not sure this is suited for psychiatrists but it may help get personal injury cases.
