whopper

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I was recently offered a nice gig at a private practice. They asked me if I wanted to treat patients under 18.

I don't have a child fellowship, and under certain circumstances, I would feel open to doing so....E.g. ADHD without stimulants and psychological testing, depression of the minor sort, so long as there was very good psychotherapy and the parents were very on board and not trying to throw a pill at the problem.

Do any of the attendings here treat under-18 without a child fellowship. If you have a child fellowship, would you recommend it, or not?
 

st2205

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I've wondered this, as it seems many people would be hesitant to but I would have to assume they're much more qualified than pediatricians.
 

OldPsychDoc

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I was recently offered a nice gig at a private practice. They asked me if I wanted to treat patients under 18.

I don't have a child fellowship, and under certain circumstances, I would feel open to doing so....E.g. ADHD without stimulants and psychological testing, depression of the minor sort, so long as there was very good psychotherapy and the parents were very on board and not trying to throw a pill at the problem.

Do any of the attendings here treat under-18 without a child fellowship. If you have a child fellowship, would you recommend it, or not?
I'll accept down to 16, because there's such a shortage, and physiologically, they are more adult. But it's total med mgmt, and I generally get the kids from therapists or FPs/Peds in our group. But I generally shudder when I see them coming up for an intake...
 

ronin12

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I Agree with old psych doc. there is such a shortage of child psychiatrists refusing patients would be unfair to patients and their families. they are truly in need of help. even if you dont have therapist or behavioral intervention set up, still med management is needed for most part from psychiatrist. if you want to be more comfortable dealing with them, have patients see a therapist or intake person before you see them and refresh your reading about cheif complaint and relavent treatment.child psychiatry is evolving and now there is more evidence for medication management for various disorders.I am sure you will be more comfortbale by time.
 

Doc Samson

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I would not, but my practice is limited to the CL realm, which would require familiarity with the peds floors/staff and the laws dealing with psychiatric care/admission of a minor, etc. Fortunately, I have a child CL doc on hand who fields all those consults anyway.
 

surftheiop

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I would not, but my practice is limited to the CL realm, which would require familiarity with the peds floors/staff and the laws dealing with psychiatric care/admission of a minor, etc. Fortunately, I have a child CL doc on hand who fields all those consults anyway.
Whats the training path for a peds CL?

Does someone do the triple board Peds/Psych/C&A for that?

Or is it something like Psych -> C&A fellowship -> Child CL fellowship?
 

Doc Samson

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Whats the training path for a peds CL?

Does someone do the triple board Peds/Psych/C&A for that?

Or is it something like Psych -> C&A fellowship -> Child CL fellowship?
Psych residency -> C&A Fellowship +/- CL fellowship

The CL fellowship is required if you want to be board certified in CL. Other than that, you could reasonably just pick a C&A fellowship that's heavy on the CL front (e.g., Children's Boston or MGH).
 

michaelrack

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Back when I was doing more psychiatry (now I do mainly sleep med) I would occasionaly help provide weekend coverage for a private inpt child psych ward.

When I was a C+L attending at the local univ med center, I had to help out with child psych consults for a few months due to a shortage in the child psych faculty.

When I was a resident I did some moonlighting, mainly adults, at a community mental health center. When the child psychiatrist was on vacation, I was asked to see a 9 yo girl who with depression, whose mother was concerned because she had started masturbating after starting an SSRI. I made sure that she got in with the child psychiatrist as soon as she returned from her vacation!
 

whopper

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I've decided for myself that I'm comfortable treating children that are in the older range (15+) for simple issues. E.g. issues that may just require an SSRI or or Wellbutrin for example for ADHD. That, and I believe the parents aren't trying to have me throw a pill at a problem while they shrug off what they can do to help the child without the use of medications.

From a legal perspective, I think one can defensively and responsibly treat children if 1-it is within the standard of care within the local community. E.g. what if there were no child psychiatrists in the area? 2-the parents are informed well ahead of time that you are not as skilled as a child-psychiatrist and therefore they may wish to go to a child psychiatrist should the case become complicated.

In my case, there are no child-psychiatrists in the local area, and it seems the PCP giving out psychotropic meds to children appear to be practicing a lower standard than I would. E.g. Adderall without any psychological testing.

Ultimately, the issue may be determined by your insurance. They may or may not allow you to treat children depending on your payment plan. Insurance companies will also give far better information on treating responsibly in a manner that will not open yourself up to a lawsuit.

What I'm going to do is call my insurer and discuss the issue.
 

sunlioness

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I don't personally, but it's not solely a matter of comfort level. I also don't really like it and find a lot of child psych to be really depressing. Too much of kids acting out because of chaotic home lives and being powerless to do anything real to change that. I also feel that I got no real training in residency in treating things like autism. I had lectures on it, but wasn't really exposed to it. So that's something I would not be at all comfortable treating.