Worth it to seek subspecialty board certification?

[Doctor Bagel]

So I completed a fellowship last summer in a specialty where the board exam isn't offered until next year. I'm looking at signing up, and it's $700 application + $1200 board exam fee (seriously, I think I'd be less offended they just charged me $1900 straight up). I'm not working directly in this field but want to keep that door open. The exam is probably not the hard. Hmm, can you use CME funds to pay for exams?

I hate giving more money to the ABPN, especially for something I don't directly need. This is also in a field where lots of people don't have fellowship training. Anybody forgo the subspecialty board thing and not regret it?

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[OldPsychDoc]

... Hmm, can you use CME funds to pay for exams?
...

Depends on who's giving you the funds. I've been fortunate to work for an organization that not only reimburses the expense, but does so over and above our annual CME allowance.

Personally, I'd get it done anyway. Lots easier to re-certify in 10 years than to not certify at all.

 

[F0nzie]

 

[splik]

So I completed a fellowship last summer in a specialty where the board exam isn't offered until next year. I'm looking at signing up, and it's $700 application + $1200 board exam fee (seriously, I think I'd be less offended they just charged me $1900 straight up). I'm not working directly in this field but want to keep that door open. The exam is probably not the hard. Hmm, can you use CME funds to pay for exams?

I hate giving more money to the ABPN, especially for something I don't directly need. This is also in a field where lots of people don't have fellowship training. Anybody forgo the subspecialty board thing and not regret it?

although lots of people don't do fellowship training it does seem common for people to do the addiction medicine boards. could you do that instead if you don't want to give the ABPN anymore money? Some jobs do give you a pay bump for having a subspecialty board certification or you may be able to negotiate a higher salary.

 

[F0nzie]

although lots of people don't do fellowship training it does seem common for people to do the addiction medicine boards. could you do that instead if you don't want to give the ABPN anymore money? Some jobs do give you a pay bump for having a subspecialty board certification or you may be able to negotiate a higher salary.

I have been very impressed by ABAM. They offer very good conferences and educational materials. I don't get anything out of it money wise but I like their program and I don't mind throwing money their way.

 

[wolfvgang22]

although lots of people don't do fellowship training it does seem common for people to do the addiction medicine boards. could you do that instead if you don't want to give the ABPN anymore money? Some jobs do give you a pay bump for having a subspecialty board certification or you may be able to negotiate a higher salary.

Can you do addiction medicine boards without a fellowship still?

 

[notdeadyet]

Yup. They are still allowing folks to sit for the board if they have 2000 hours of substance use/abuse post-residency.

I'm with F0nzie in liking ABAM. It's a nice way to continue education and work towards a board certification in a fascinating field for those of us whose wive's would kill them if they suggested pursuing a second fellowship.

 

[OldPsychDoc]

Yup. They are still allowing folks to sit for the board if they have 2000 hours of substance use/abuse post-residency..

Better get started drinking!

 

[HarryMTieboutMD]

From people I know (read: mentors) in the upper echelons of addiction medicine, ASAM is a much larger and more powerful organization than AAAP. AAAP is just riding on its historical identity, the "exclusiveness" (limited to only psychiatry), and its distinguished list of fellows. In any case, yes, you can take the ABAM exam without a fellowship as long as you have certification in a primary speciality. However, as the Addiction MEDICINE fellowships become more widespread (places like Yale and Stanford have them and the ASAM fellowship is ACGME accredited), I think that they will become required to be certified in addiction medicine, which is a good thing. Most AAAP fellowships are limited to VA settings, and treatment of addiction in the general public is much different than treating the VA population. Also, evaluation using the ASAM criteria and more advanced/difficult methods of detoxification/pharm treatment methods are not a standard part of most psych residencies.

FYI, from people I know who have taken both, the ABAM exam is significantly more difficult than the AAAP exam.

 

[FlowRate]

Also, evaluation using the ASAM criteria and more advanced/difficult methods of detoxification/pharm treatment methods are not a standard part of most psych residencies.

It really seems to me that psych (or at least the subspecialists) would benefit from a pivot in our training a bit back toward "medical specialty" and away from the talks I've had from senior faculty who say that feeling comfortable with the loss of role as a physician is part of becoming a psychiatrist.

 

[Doctor Bagel]

It really seems to me that psych (or at least the subspecialists) would benefit from a pivot in our training a bit back toward "medical specialty" and away from the talks I've had from senior faculty who say that feeling comfortable with the loss of role as a physician is part of becoming a psychiatrist.

Hmm, not sure where this ties in with the thread in general, but that's an interesting statement that you're hearing from your faculty. Yeah, psychiatrists don't often wear white coats and use stethoscopes (but neither do dermatologists or radiologists). It's true also that there's something that's just different about this specialty in that we do have to think about all these psychosocial things and to accept a lot of unknowns regardless of how much people talk to applicants about fMRIs and whatnot. This forum speaks to how we're different -- we're probably the only medical specialty board on SDN where non-physicians/medical students/aspiring physicians are welcomed. But we're still physicians. Subspecialists are probably the most "physician" like (whatever that means) -- psychosomatic, addiction, geriatrics all incorporate a more biological focus often working in more traditional medical settings.

 

[FlowRate]

Subspecialists are probably the most "physician" like (whatever that means) -- psychosomatic, addiction, geriatrics all incorporate a more biological focus often working in more traditional medical settings.

That's sorta where I was tying in, sorry to go OT from certification. Seems like a shame for people to come out of addictions fellowship and not be able to do ?phenobarb tapers as HMTMD was implying.* I was thinking about this more generally after I saw that psychiatry was the only medical--as in non-dental--specialty who didn't have to be ACLS certified at a certain program. Shouldn't psychiatrists be expected to be able to start management on TdP, for example?

* I am ignorant--not sure what "advanced" detox really means. Phenobarb is started in the ICU at my program, anyway, so that's probably wrong.

 

[HarryMTieboutMD]

That's sorta where I was tying in, sorry to go OT from certification. Seems like a shame for people to come out of addictions fellowship and not be able to do ?phenobarb tapers as HMTMD was implying.* I was thinking about this more generally after I saw that psychiatry was the only medical--as in non-dental--specialty who didn't have to be ACLS certified at a certain program. Shouldn't psychiatrists be expected to be able to start management on TdP, for example?

* I am ignorant--not sure what "advanced" detox really means. Phenobarb is started in the ICU at my program, anyway, so that's probably wrong.

If someone is in the ICU for severe WD, then the ICU team will know how to treat that- but I think it's worthwhile for the addiction psychiatrist/addiction med Dr to have experience using Precedex, Versed/Ativan drips, etc, but most psych residencies don't require ICU months. The addiction medicine doctor, however, should know how to use non benzo agents in EtOH WD including barbiturates (again, IV is done in the unit), Depakote, Tegretol, etc, and knowing how to dose PO phenobarb correctly/the pentobarbital challenge, etc is basic addiction medicine. Also, the addiction medicine Dr should feel comfortable using methadone as well as buprenorphine. And if someone goes into Torsades on the psych floor (which shouldn't happen bc you should be checking EKGs if parenteral haldol is repeatedly given, and hardly anyone uses Mellaril anymore anyway) , you better call an acute care team/mini code team, etc. Psych nurses probably won't be the fastest at getting quick access, and you probably will not have IV Mg readily available on the psych floor.