Why Consider Fellowship Training in Consultation-Liaison Psychiatry?

Why Consider a CLP Fellowship?

Thanks to Terry Rabinowitz, MD, DDS, FACLP, former chair of the Academy’s Fellowship Education Committee, for the answer to this question.

Consultation-liaison psychiatry (CLP) is that branch of psychiatry that deals with the understanding and advancement of medical science, education, and healthcare for persons with comorbid psychiatric and general medical conditions. It is also referred to as Hospital Psychiatry. Whatever its name, it is an exciting and gratifying psychiatry subspecialty that, given the direction medicine and medical care is heading in the U.S., will be an important way new psychiatrists will be able to play an active role in the comprehensive medical care of a large portion of the population.

Training in CLP currently follows completion of a General Psychiatry residency training program; CLP fellows typically spend one additional year in training, although some training programs include an optional additional year. There are now more than 70 ACGME-accredited CLP Fellowship training programs, with numbers steadily increasing. Satisfactory completion of a CLP fellowship qualifies each graduate to sit for the subspecialty board examination in CLP administered by the American Board of Psychiatry and Neurology.

There are many ways a specialist in CLP may be helpful to an in- or outpatient and to those caring for someone with comorbid psychiatric and medical or surgical conditions. Some examples include: treatment of delirium tremens in an elderly woman with unsuspected alcohol dependence who just received coronary artery bypass surgery (CABG), consultation to an outpatient HIV/AIDS Clinic to help manage psychotropic medications for a patient about to begin a new antiretroviral regimen, co-treatment with the Maternal and Fetal Medicine Service of a young woman with bipolar disorder who is taking lithium for mania prophylaxis and who wishes to become pregnant, and inpatient consultation to the Oncology Service for a depressed middle-aged man with newly diagnosed, widespread pancreatic cancer.

C-L Psychiatry gives one the opportunity to “hold onto” a great deal of his or her medical and surgical training and to use it effectively and, in addition, the chance to work more closely with medical and surgical colleagues than is typically the case for most psychiatrists. It’s a great way to make a big difference in the lives of those with complicated medical or surgical conditions who are suffering emotionally, those in hospital whose behaviors place them or others at risk, and for those who care for them.