1. Geographical/Time-Based Fellowships: These fellowships require your physical presence for a specified period of time at a specified location(s). Some of these fellowships are “accredited” by being officially recognized by the American Board of Psychiatry and Neurology (ABPN). Accredited fellowships have multiple-choice board exams that fellows take upon completing the time commitment of the fellowship (usually 1-2 years). As a result of these official examinations, psychiatrists (especially academic psychiatrists) usually respect accredited fellowships more than non-accredited fellowships. However, patients or the public at large might not care where a specialist gained his or her subspecialty expertise. For example, the ABPN accredits fellowships in addiction psychiatry, but the American Society of Addiction Medicine (ASAM) also has a pathway to certification in addiction medicine that involves a standardized multiple-choice test and documented experience in addiction medicine, yet does not require being present at a specific institution and geographical location. In general, the public does not seem too concerned with which path a clinician takes to addiction-treatment expertise. However, academic psychiatrists tend to be more impressed with ABPN-accredited fellowships.
Geographical/Time-Based Fellowships fellowships can be sub-divided into two types:
A. Clinical Fellowships, which usually recruit M.D.s or D.O.s (usually not called a “post-doctoral” fellowship even though they occur after having earned a doctoral degree). Currently there are five areas of sub-specialty fellowship training that are accredited by the American Board of Psychiatry and Neurology. They are: 1. Pain Management; 2. Forensic Psychiatry; 3. Child and Adolescent Psychiatry; 4. Addiction Psychiatry; 5. Geriatric Psychiatry.
B. Research Fellowships (often called “post-doctoral” fellowships) because many Ph.D.s enter into these fellowships immediately upon completing their Ph.D. degree programs. However, these fellowships are also available to M.D.s and D.O.s who have an interest in research.
2. Honorary Fellowships: These fellowships are awarded based on meritorious and/or demographic criteria, but generally do not require extended stays of time at any particular location. Instead, attendance at certain periodic meetings might be expected. Also, collaboration in ongoing projects involving research, writing, or political action might also be expected. Usually, these projects are ones that do not require being physically present for more than a few days at any one geographical location.
3. Combination of “1” and “2”: These fellowships are ones which are awarded on the basis of merit and/or demographics, but which also require work which is confined to a particular geographical area over a specified period of time.
What are the Benefits of Doing a Fellowship?
Fellowships can provide expertise in a more-specific area than a general psychiatry residency allows.
Public Relations (having a credential that communicates that you actually have expertise in a specific area.) However, it is certainly possible to gain the same level of expertise in any area despite not having done a fellowship, yet persuading the public of your expertise might be more difficult without having done a fellowship in a given area.
Doing a fellowship often, but not always, translates into greater earning power.
Note: A potential conflict of interest exists on the part of those who recruit for geographical/time-based fellowships. This conflict arises from the fact that fellows often perform labor that is cheaper than would be possible if the institution offering a fellowship had to hire someone at "faculty" rates. Consequently, recruiters for fellowships are at risk of exaggerating the pedagogical or economic value of a fellowship. I am not encouraging anyone to be paranoid or inordinately suspicious, but rather to consider potential conflicts of interests when evaluating any fellowship.
What Clinical Fellowships are Accredited by the American Board of Psychiatry and Neurology?
The American Board of Psychiatry and Neurology (www.abpn.com) accredits clinical fellowships in the following five subspecialty areas of psychiatry:
1. Pain Management
2. Forensic Psychiatry
3. Child and Adolescent Psychiatry
4. Addiction Psychiatry
5. Geriatric Psychiatry
To discover which institutions have accredited clinical fellowships, contact specific institutions or subspecialty organizations. The subspecialty organizations corresponding to the five areas of subspecialty training listed above are:
1. Pain Management: There is currently no organization containing only psychiatrists who focus on pain management. However, the American Academy of Pain Management (www.aapainmanage.org) welcomes physicians from all specialties who focus on pain management. For more specific information about Pain Management fellowships accredited through ABPN, contact the ABPN at www.abpn.com.
2. Forensic Psychiatry: The American Academy of Psychiatry and the Law (www.aapl.org)
3. Child and Adolescent Psychiatry: The American Academy of Child and Adolescent Psychiatry
4. Addiction Psychiatry: The American Academy of Addiction Psychiatry (www.aaap.org)
5. Geriatric Psychiatry: The American Association for Geriatric Psychiatry (www.aagpgpa.org)
What Specific Honorary Fellowships are Currently Available?
Which Honorary Fellowships are Considered the Most Prestigious, Competitive, or Selective?
For psychiatry residents, the Fellowship of the Group for the Advancement of Psychiatry (GAP) (http://groupadpsych.org) and the Laughlin Fellowship of the American College of Psychiatrists (ACP) (http://www.acpsych.org) are generally considered the most prestigious, competitive, and selective honorary fellowships available to psychiatry residents. GAP chooses 15 fellows every two years and ACP chooses 15 fellows every year. Thus, in terms of shear numbers, the GAP fellowship is more selective. Also, the Laughlin Fellowship is not entirely merit-based, as selection is influenced by a policy of trying to choose fellows from psychiatry programs that have not yet had Laughlin Fellows.
For any given sub-specialty of psychiatry, a sub-specialty organization’s honorary fellowship might yield more social currency. For example, the Rappeport Fellowship of the American Academy of Psychiatry and the Law (AAPL) might be more impressive than a GAP or Laughlin Fellowship to someone who was a dedicated member of AAPL, or to someone who was attentive to credentials that, by definition, specifically suggested expertise in a particular area, such as Forensic Psychiatry.
Recommendations to Residency/Fellowship Training Directors Regarding the Fair and Equitable Choice of Nominees for Honorary Fellowships and Other Awards
1. Residency/fellowship training directors have a fiduciary duty to educate all residents and fellows as to what fellowships and awards are available, and as to the benefits and implications of participating in any particular fellowship. Please see http://aadprt.org/public/educators.html for a compilation of currently available fellowships.
2. If a fellowship is advertised as being “merit-based,” it is unethical and an abuse of fiduciary duty to nominate a resident or fellow for that fellowship for any reason other than merit.
3. If a fellowship is advertised as being “merit-based”, the decision of who to nominate for that fellowship should be an independent decision not influenced by what previous fellowships or nominations a resident/fellow under consideration has received. Some have argued that this policy could allow one exceptional person to garner a substantially larger number of honorary recognitions than their peers, resulting in jealousy and/or poor morale on the part of peers. Yet, if this outcome is at risk of occurring, there are more honest ways of addressing resident behavior and morale than to dishonestly apply criteria that were intended to be merit-based.
4. The nomination of honorary fellowships and awards should NEVER be used as “carrots” to manipulate resident behavior, or as a means of boosting morale in residency programs by sprinkling awards over residents who have not demonstrated merit in the area for which an award was intended. Either of these uses of fellowships is dishonest, unethical, and an abuse of fiduciary duty.