university counseling psychiatrist?

[thomasina]

Is becoming a psychiatrist at a university student mental health center a viable job option for somebody in psychiatry residency these days? I know that schools/universities tend to hire psychologists and social workers for some counseling as well, but I remember there would be 1-3 psychiatrists on staff at my undergrad. What kind of training path did they take to do that? Would a child adolescent fellowship help or be required to land such a position? Is the pay not good?

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[clausewitz2]

I am sure CAP training would be useful in some theoretical sense and would no doubt help you develop more robust case formulations but you are not really going to be seeing adolescents in these jobs. None of the UHS psychiatrists I have ever encountered were formally child-trained. It seems like a reasonably good gig, though I kind of suspect I would die of boredom. Probably go to the best psychiatry program you can, do university health service electives when you get the chance, etc.

EDIT: Get really good at explaining to people why you don't think they need Adderall, etc.

 

[splik]

I am sure CAP training would be useful in some theoretical sense and would no doubt help you develop more robust case formulations but you are not really going to be seeing adolescents in these jobs. None of the UHS psychiatrists I have ever encountered were formally child-trained. It seems like a reasonably good gig, though I kind of suspect I would die of boredom. Probably go to the best psychiatry program you can, do university health service electives when you get the chance, etc.

EDIT: Get really good at explaining to people why you don't think they need Adderall, etc.

I think it would be unusual for student health to prescribe stimulants at all thankfully. The jobs pay poorly, most people do it part time, they are often very popular jobs if you like working with this population which many people do, the student population is increasingly disturbed, and it's straight med management. They will see the psychologists etc for therapy. It's pretty common for student health psychiatrists to spend much of their time in their own psychotherapy private practice

 

[clausewitz2]

I think it would be unusual for student health to prescribe stimulants at all thankfully.

Oh, absolutely rare for student health to be prescribing them. Incredibly common for the patient population to be seeking them.

 

[grapefruit17]

I was really interested in this as well, so I looked into it a bit. The pay at the places I looked was awful, like really really bad. If I didn't have insane med school debt I would have maybe looked more lol.

 

[thoffen]

I know 5 psychiatrists who work full-time at 2 universities in this town, and my residency program has a resident working in student health too. I know one other who does part-time work at another university; unsure if they employ anyone else. Dunno about stimulant prescription, but I would hope it is available to those who have clear indications.

 

[SmallBird]

There are > 500 universities in the US so I am sure that there is considerable variability in how these services are structured. But at the larger private institutions, particularly in the Northeast, there are absolutely full time psychiatrists employed in these positions, and at some institutions this will include doing some amount of therapy and intake assessments. I worked for a student health service for a year and it was an incredible experience with very diverse clinical challenges. Stimulant prescription absolutely occurs at student health services, although I don't think CAP training is necessary per se. Pay does seem to be low although it varies widely (I've seen offers of between $140 - $200 within the same region. Lower paying jobs usually don't require insurance billing and are more cush. The higher paying jobs are exclusively medication management and have more administrative burdens).

 

[wolfvgang22]

Adolescence doesn't magically end at age 18.

 

[Shikima]

Adolescence doesn't magically end at age 18.

Amen.

 

[FlowRate]

We have a PGY-4 who will be doing student mental health part-time after residency. We also have someone who is currently working in the mental health center of a nearby university as part of her selectives.

 

[clausewitz2]

Adolescence doesn't magically end at age 18.

Certainly, but our legal system in its great wisdom has decided that is a bright and shining line, so no one is going to be dinged for not being adolescent trained specifically working with an over 18 population from a regulatory standpoint. If we were going to be properly grounded from a theoretical perspective, we would be looking at a dividing line somewhere in the mid-20s, or would recognize that adolescence per se is an incredibly culturally-specific concept that is going to have vastly different ranges depending on the backgrounds, cultural upbringing, and socialization of the individuals involved.

But institutions need lines or a number, and not the kind of line or number that is radically different from person to person.

 

[digitlnoize]

Yes. Our student mental health center has a couple psychiatrists and is currently hiring more. Like most academic psych jobs, the pay tends to be lower than private gigs.

 

[thoffen]

Certainly, but our legal system in its great wisdom has decided that is a bright and shining line, so no one is going to be dinged for not being adolescent trained specifically working with an over 18 population from a regulatory standpoint. If we were going to be properly grounded from a theoretical perspective, we would be looking at a dividing line somewhere in the mid-20s, or would recognize that adolescence per se is an incredibly culturally-specific concept that is going to have vastly different ranges depending on the backgrounds, cultural upbringing, and socialization of the individuals involved.

But institutions need lines or a number, and not the kind of line or number that is radically different from person to person.

I don't think it's much of a concern regardless unless you are in an area with heavily concentrated access to CAP services, and I don't know that truly exists. Legally we are held to standard of care in our community, and from a business or regulatory standpoint, trying to enforce a higher level of training for psychiatrists treating even kids would be a nightmare.

 

[Candidate2017]

Certainly, but our legal system in its great wisdom has decided that is a bright and shining line, so no one is going to be dinged for not being adolescent trained specifically working with an over 18 population from a regulatory standpoint. If we were going to be properly grounded from a theoretical perspective, we would be looking at a dividing line somewhere in the mid-20s, or would recognize that adolescence per se is an incredibly culturally-specific concept that is going to have vastly different ranges depending on the backgrounds, cultural upbringing, and socialization of the individuals involved.

But institutions need lines or a number, and not the kind of line or number that is radically different from person to person.

Self-imposed hyperspecialization is great in theory. In reality, hyperspecialization leads to long wait times and justifies the NP, PA, RxP or shaman argument for independent practice.

 

[clausewitz2]

So @thoffen and @Candidate2017 , we seem to be agreeing very vigorously. My point is that if you are seeing mainly people over 18 there is no way on G*d's green earth that you are going to be required to have CAP training as a requirement of employment.

 

[TexasPhysician]

Undergrad jobs are readily available, but the pay is quite weak

 

[birchswing]

It took a couple of years for my university to find a psychiatrist and I was able to follow the process. Back when I was a residential student, the university had a psychiatrist who leased space in the counseling center. He was a very sick, old man, and he didn't keep most of his appointments. His wife, who was not trained, would often call me on his behalf and call in scripts to the pharmacy for him. He left the university not long after I did.

There was a very long interregnum (about 15 years) during which the university had no psychiatrist and referred students to psychiatrists in the community. Because of the scarcity of psychiatrists in the area and the poor reputation of the one or two psychiatrists actually in this town, they recommended ones out of town.

Eventually the student government started using funds to help pay for rides for students to see psychiatrists out of town.

I won't say which university this is, but they have had a national reputation for how they've dealt with mental health, disabilities, and suicide (articles mainly in the Washington Post).

So they've kind of had to do a sea-change, which led to a long process of finding an actual psychiatrist whom they employed. The most difficult factor was finding someone willing to work for the amount of money they could offer.

The psychiatrist only sees patients who have first been dispositioned by someone in the counseling center (back when I used it, they were most often trainees). They also have a blanket policy of not prescribing stimulants.

Back when I was seeing the psychiatrist who was leasing space, he prescribed me Ativan and Klonopin to take concurrently and swore up and down that Klonopin was not a benzodiazepine and was not chemically related to benzodiazepines and that it had been miscategorized. I was a mess (mentally and physically) on both and eventually dropped out (was not drug-seeking; I actually hated the effect--I was probably the only student on my floor who didn't and had never drunk alcohol--I can't imagine what dangers I would have faced had I not been so cautious). It was intimated to me by a dean (but I don't know for sure) that he was let go from whatever agreement allowed him to lease space.

Anyhow, that's just some insight into one school's journey on psychiatric care. The new psychiatrist they have is of an age you would not expect senility, graduated from a good school after the 1950s, will not prescribe stimulants (not sure about other controlled substances) and based on that I would expect is an improvement. She's by far the most pedigreed psychiatrist in this general area, although only available to a very small population.

 

[carlosc1dbz]

So they've kind of had to do a sea-change, which led to a long process of finding an actual psychiatrist whom they employed. The most difficult factor was finding someone willing to work for the amount of money they could offer.

It is interesting how coaches or some university administrators are making $500,000+, but they offer very uncompetitive salaries for physicians. I wonder if this is the same between private and public universities. I have only rotated through one public university counseling center. The staff was for the most part indifferent to residents rotating through, they mostly seemed annoyed. The clinic was run by a psychologist who was very student oriented, meaning poor boundaries when it came to students coming in late to their appointments and still wanting them to be seen for no good reason other than the fact that they are students.

I recently saw a locum position for $160 an hour for 8 hour shifts, 4-5 days per week, unclear how many students per day. Position had not been filled for 5 years or something like that.

 

[Shikima]

I applied to a job that included being a univ psychiatrist and they were offering an hourly wage of $85/hr. This was 4 years ago. I'm sure it has been increased for $89/hr.

 

[carlosc1dbz]

I applied to a job that included being a univ psychiatrist and they were offering an hourly wage of $85/hr. This was 4 years ago. I'm sure it has been increased for $89/hr.

Maybe someone has some insight to University funding and how that affects what they can offer. I know that when the school gets sued for lack of MH services, then the pay usually goes up. It is a sad thing that is for sure.

 

[DD214_DOC]

So @thoffen and @Candidate2017 , we seem to be agreeing very vigorously. My point is that if you are seeing mainly people over 18 there is no way on G*d's green earth that you are going to be required to have CAP training as a requirement of employment.

A large percentage of the students would be functionally adolescents, this is true. However, unless you plan to do lots of long-term therapy with them, the additional training and experience from a CAPS fellowship would be pretty useless.