What if you just want to run a machine of a private practice that specializes only in Independent Psychiatric Evaluations (IMEs)? Doing these in order to determine Fitness For Duty/Return To Work, Disability Claims, Personal Injury Claims, etc? Can you graduate a forensics fellowship and get right into that without having to work on a forensic unit?
I've met a lot of forensic psychiatrists at this point, and I think it's important to clarify some of the concepts being discussed.
You really do have to understand that forensics is a sort of "field within a field," and that there are many, many different things one can do with the advanced training.
AAPL recommends that all forensic psychiatrists maintain a private practice, or otherwise engage in direct patient care. This, aside from having practical benefits, prevents one from appearing as a "hired gun" which serves no bad purpose other than losing credibility in court. Depending on your political persuasion, and on the concept of absolute benficience as a physician, there is nothing inherently wrong in doing full-time forensic practice, but it carries with it a stigma of being less credible in front of a jury.
We also have to make the deliniation between inpatient forensic unit or jail psychiatry, and private or "civil" forensic practice. The two can be vastly different, as well as the pay.
On a forensic inpatient unit, you may get a few thousand above the normal psych attending salary, and your work will essentially be like a cross between inpatient and jail psychiatry. In private civil forensics, you are paid by lawyers by check, work in an office (usually), and have no treatment role. To some psychiatrists, this is a great pleasure; others have a difficult time putting their treatment hat on the rack and objectively evaluating a patient, while telling them, "we won't see each other again, and whatever we discuss is not confidential, as it will be contained in a report that will be read before the court. I won't be prescribing any medicine to you, and will not make treatment recommendations." Personally, I find this liberating at times.
Money in civil forensics can be great. You'll be paid, once you have a steady flow of cases, on the average of $250-$500 / hour, and the off-time would theoretically be spent seeing clinical patients. These evals can consist of IMEs, malpractice case reviews, wrongful death or dangerousness evaluations, will contestations (working on one right now), and many other types.
The more forensic work I do exclusively, the more I tend to miss clinical psych. However, I see around 100 patients/month in moonlighting, so that itch remained mostly scratched. If I were to do forensics full time, however, I could quickly see my clinical skills deteriorate to a degree, I would think, and it's very easy to let yourself slip out of the cutting-edge in practice. I can already feel that my knowledge base in modern psych is slightly off its game, as I've been so focused on forensics while in fellowship. I plan to rectify this after June when the fellowship ends.
It's a great career, but I can't imagine it's for everyone. You need to be a good writer. You need to have a thicker skin. You need to be comfortable seeing someone who is obviously suffering, and waving goodbye and wishing them good luck. You also need to present yourself somewhat differently, and ideally, should be cucumber-cool even on your third re-cross while on the stand. You also need to develop a legal mind - it's quite different than the purely clinical one we normally live in. It's not about justice. It's not about truth. It's all about the game that's played in our adversarial legal system, and who has the better evidence.
I think it would take a lifetime to get all these skills under control - in that sense, it's a lifelong challenge.
