Forensic Psychiatry

[forensicmed]

New to the forum but I have some questions regarding a career in Forensic Psych! 

 

I am currently a second year med student and have stumbled on the field of Forensic Psych and really love it. Came into medicine interested in Psych to begin with and have a background in Forensics so seems like it would be a good fit!

 

That being sad I am interested in getting some insight into the field:

 

1. Is a Forensic fellowship necessary? 

2. What is the job market like?

3. Is it reasonable to set up a practice and focus solely on Forensic Psych?

4. What is the compensation like for Forensic Psych vs General Psych? I know Forensic Pathology compared to normal Surg Path is lower. 

5. Any other advice/considerations I should be taking into account?

 

Thanks in advance 

 

FM 

[BigM]

I'll attempt to give you the best answers I can about this.  I am a  psych resident but have spent no real time in forensics so hopefully a more knowledgeable answer emerges.

 

1. Forensics fellowship is not absolutely necessary to get a job in forensics.  The fellowship program is only a few years old now and many programs haven't actually established their fellowship program yet.  The vast majority of those in the field did not do fellowship training.  That said, if there are a few people applying to jobs then the fellowship program is going to make a big difference.  The psychiatry residency curriculum is pretty structured during years 1-4 which doesn't leave you a whole lot of time to get experience in something like forensics which can be quite different from the core areas of psychiatry you do in your residency.  There is no mandatory forensics time built into the curriculum.  Those interested in doing a fellowship would start the 2 year fellowship at the beginning of their 5th residency year and then do an additional 6th year giving them 24 months of forensics experience.  Prior to 5th year you may only get 1-4 months of forensics experience and that's if you choose to do your electives there.

 

2. My understanding is that the job market is very good.  The forensic mental health system is desperately lacking man power, especially in jails.  Many individuals with mental illness unfortunately end up in the jail system when they would be better served elsewhere.  Right now there is no shortage of demand for services, how much funding infrastructure is in place, I don't know.

 

3.  Yes this can be done.  From what I have seen most people who do forensics do exclusively forensics.

 

4.  I have only heard about this in passing, but what I understand forensics renumeration is higher than general psychiatry.  That said, general psychiatry is relatively low, on average its the second lowest paying specialty just behind pediatrics (depends on where you work of course).  Any medico-legal work tends to pay well if you are efficient. 

 

5.  Early exposure is a great idea.  Forensics is not a popular area and there are many training programs that would love to have more learners come out and see what they are about. I would recommend setting up a couple of observerships with preceptors that have good reputations among learners.  It won't take long before you know more about forensics than I do.

 

Hope that helps a bit.

[ploughboy]

 

5.  Early exposure is a great idea.  Forensics is not a popular area and there are many training programs that would love to have more learners come out and see what they are about. I would recommend setting up a couple of observerships with preceptors that have good reputations among learners.  It won't take long before you know more about forensics than I do.

 

 

My sum total experience in forensic psyche was two weeks as an M3, so I'm no expert.  But I would echo the above advice, which is good advice for anybody considering any specialty.  Get lots of exposure before you decide.  

 

It's the sort of field where many of your patients will not be appreciative of what you're doing.  A lot of them are not very nice people and, BigM's point #2 notwithstanding, many of them are in jail or secure facilities for darn good reasons.  So you've got to be comfortable with that doctor-patient dynamic.   

[forensicmed]

Hey Guys

 

Thanks for the great responses I appreciate the extra info! I am excited to hear the job market is so good and that solo Forensic practice is achievable! I currently have a ton of time set up with the local Forensic guys for March break and during the summer so hopefully that will give me a good idea. Like I said I used to work in Forensics so this would be a great transition for me. Guess I just have to see if I can handle having that type of relationship during these experiences! 

 

Some additional questions if you don't mind:

 

1. Why is the pay for Psych so bad? And how bad are we talking... on the CMA specialty profile website it states 255,000 as average is that up to date?

- also rumour has it that Forensic Psychs charge 5000$ per consult (info received from local Psychiatrist).. think this is the case?

 

2. Is there a difference in pay between bigger centres and Northern/Rural locations (I hope to practice in the latter)

 

The reason I am asking for clarification is because the local Psych guys seem to be doing just fine from an outsider's perspective (mansion on the water, range rovers, kids in private school)

 

I mean there is more to life than money but I do want to be able to pay off my debt in a reasonable amount of time and have a nice life for my family... Oh not to mention I am a non trad and will be exiting med school a bit later than my colleagues haha! 

[alpaca]

• Most general psychiatrists working full-time in clinical practice can make at least $300,000/year. 

It is common for psychiatrists in (semi-)rural areas (especially north of Toronto) to make between $300,000-$400,000/year. Many of these positions are salaried with pensions and benefits.

Forensic psychiatrists earn more than general psychiatrists, in part because of private billing. It is common for forensic psychiatrists to make more than $400,000/year, with some making upwards to $600,000/year.

[medicallyinclined]

Wow interesting thread. I had no idea that Forensic Psychiatrists could bill that much. 

[BigM]

Hey Guys

 

Thanks for the great responses I appreciate the extra info! I am excited to hear the job market is so good and that solo Forensic practice is achievable! I currently have a ton of time set up with the local Forensic guys for March break and during the summer so hopefully that will give me a good idea. Like I said I used to work in Forensics so this would be a great transition for me. Guess I just have to see if I can handle having that type of relationship during these experiences! 

 

Some additional questions if you don't mind:

 

1. Why is the pay for Psych so bad? And how bad are we talking... on the CMA specialty profile website it states 255,000 as average is that up to date?

- also rumour has it that Forensic Psychs charge 5000$ per consult (info received from local Psychiatrist).. think this is the case?

 

2. Is there a difference in pay between bigger centres and Northern/Rural locations (I hope to practice in the latter)

 

The reason I am asking for clarification is because the local Psych guys seem to be doing just fine from an outsider's perspective (mansion on the water, range rovers, kids in private school)

 

I mean there is more to life than money but I do want to be able to pay off my debt in a reasonable amount of time and have a nice life for my family... Oh not to mention I am a non trad and will be exiting med school a bit later than my colleagues haha! 

 

The lower pay in psych tends to go with the fact that OHIP renumerates procedures better than counselling.  Psychiatry is time-based billing which means that you have to log a certain amount of time with each patient.  If you're doing procedures, you're getting paid for the number you do regardless of how long it takes.  Psychiatrists also tend to spend more time documenting things, sitting in in multi-disciplinary rounds, and doing other things that aren't renumerated or are poorly renumerated (e.g. disability applications on complex patients)..

 

That said, most psychiatrists aren't hurting at all.  At some busy academic centers 400K+ is common as there are a lot of on-call consults done by residents and residents can run parallel clinics without a lot of (or pretty much any) extra work by the psychiatrist.  In some specialties having residents slows you down and results in lower billings, that definitely isn't the case in psychiatry.  It's time based billing and you're billing for the time spent by two MD's.  Also, the overhead in psych is lower so that $255K goes further than it would for a specialty like family medicine where you need a lot of equipment and supplies.

[forensicmed]

Thanks for the info everyone! 

 

Really looking forward to my Forensic Psych electives