Addiction Psychiatry Fellowship Program

The Boston Medical Center / VA Boston Healthcare System Addiction Psychiatry Fellowship is a one year (PGY V) Fellowship program that was accredited by the Accreditation Council for Graduate Medical Education (ACGME) in 1997. Under the leadership of two nationally recognized addiction psychiatrists, Dr. John Renner, and Dr. Michael Dawes, and other outstanding faculty are at each training site. The Fellowship provides psychiatric physicians with advanced training in the recognition, diagnosis, and treatment of substance use disorders and co-occurring mental health disorders. The program is funded for six PGY 5 Fellows.

The primary training site is at VA Jamaica Plain Campus in Boston, where Fellows gain extensive experience using methadone and buprenorphine in treatment of patients with Opioid Use Disorder (OUD) and co-occurring mental health disorders (COD). An Opioid Rapid Access Clinic provides an opportunity to manage OUDs in an acute setting while the long-term management of OUD patients takes place in a continuity clinic. The continuity clinic also provides Fellows a full range of patients with other substance use disorders and co-occurring psychiatric disorders. A comprehensive series of didactic presentations that draws upon experts in the field rounds out the experience at the Jamaica Plain campus. Those didactics are complemented by a Journal Club that offers the Fellows a collegial setting to explore the extant literature on substance abuse disorders.

Expert training at other renowned tertiary care facilities in the greater Boston area ensures that graduates are not just clinically competent and knowledgeable. Graduates routinely state by the end of their training, they are comfortable in treating complex presentations that entail all aspects of addiction treatment. Clinical rotations combined with comprehensive curricula promote broad expertise and an informed perspective to pursue a career in Addiction Psychiatry. Curricula and interactive learning includes knowledge of history of substance use disorders, sociological and public policy aspects of addictions, as well as roles of mutual-support groups, spirituality, and community-reinforcement aspects of treatment of the addictions.

To complement the outpatient training experiences at VA Jamaica Plain, Fellows also rotate through the Boston Medical Center (emergency department, addiction medicine consultation, adolescent services, outpatient adult Addiction Psychiatry), Brigham and Women’s Hospital (addiction consultation services, services for pregnant women, and management of complex inpatient detoxification), and Boston Codman Square Health Center.

Opportunities to participate in research and quality improvement projects are available at all of the primary rotation sites. Fellows are provided with substantial elective time and are encouraged to pursue scholarly interests, for which a wide variety of mentors are available.

 

GOALS AND OBJECTIVES

The Addiction Psychiatry Fellowship provides outstanding training for psychiatrists interested in pursuing a career in all aspects of addiction treatment. The PGY 5 program is a comprehensive training experience that will meet requirements for eligibility for the American Board of Medical Specialties certification examination for Addiction Psychiatry. Through a series of clinical, didactic, and research experiences, Fellows will develop competence in the following four areas:

1. The clinical management of patients with substance use disorders utilizing all standard, evidence-based treatment modalities including psychological therapies, social interventions, peer/mutual support, and medication for addiction treatment: Under close supervision, Fellows will be exposed to the full range of interventions from prevention to long-term treatment for chronic populations. Emphasis will be placed on treatment interventions designed to address the needs of special populations such as the elderly, women including pregnant women, adolescents, veterans, trauma victims, and other underrepresented minority groups. There will be a special emphasis on individuals with co-occurring psychiatric disorders. Fellows will have the opportunity to follow selected patients at the VA Boston and Codman Square Health Center for the duration of their year of training. Experience will be gained utilizing APA and VA/DOD recommended treatment guidelines, and trainees will gain competence in the long-term management of the SUDs.

2. The conceptual foundations of addiction psychiatry: Based on a rigorous program of reading, review of research articles, didactic seminars, self-directed and interactive learning opportunities, and participation in post-graduate courses, each trainee will gain knowledge of the scientific and clinical literature that supports innovative and effectiveness-based addiction psychiatry practice.

3. Research skills in addiction psychiatry: All Addiction Psychiatry Fellows will learn how to critically review the scientific literature, how to utilize clinical research assessment instruments and have opportunity to assist in the implementation of research protocols.

4. Teaching skills in addiction psychiatry: Under the supervision of program faculty, Fellows will participate in the training and supervision of medical students, junior residents, physician assistants, and other professionals. Fellows will be expected to prepare and conduct academic seminars and journal club meetings, including the preparation of bibliographies and scientific presentations.

For applicants more interested in pursuing an academic career, a 2-year track exists for the VA-Sponsored Advanced Interprofessional Fellowship. These Advanced Fellows will select a mentor who will guide their career development and assist them in the implementation of a specialized clinical, management, educational or research project that can be completed during a two-year course of training. Under the guidance of senior addiction faculty, they will be expected to prepare scholarly reviews and develop and implement a research protocol, including data analysis and manuscript preparation. These experiences will serve as the foundation for a leadership career in the addictions field.

 

TRAINING SITES

BOSTON MEDICAL CENTER:

Boston Medical Center (BMC), one of the major clinical, research and teaching institutions in New England, is located 2 miles from the primary training site at the VA Boston Jamaica Plain Campus.  It was formed in 1996 by the merger of Boston City Hospital and University Hospital.  As the primary teaching institution of Boston University School of Medicine, it has extensive experience treating minority and disadvantaged populations, many of whom have SUDs. Seventy percent of BMC patients are low-income families, elders, people with disabilities, minorities, and immigrants; 150,000 patients have Medicaid, subsidized insurance, or no insurance, 30% do not speak English as a first language, and 65% are Boston residents, concentrated in neighborhoods with the greatest level of health disparities. BMC has 514 active beds and is the primary medical backup for an affiliated group of 10 neighborhood Health Centers that service the community, several of which operate outpatient substance use disorder counseling programs on site.

At BMC, Fellows rotate through a range of services under the supervision of Drs. Tae Woo (Ted) Park, Esteban Toledo and Amy Yule. Fellows will rotate through the following programs: 1) Inpatient Addiction Medicine Consult Service provides addiction consultation services to all inpatient medical and surgical units at BUMC,  2) (Center for Addiction Treatment for AdoLescent/Young adults who use SubsTances) which provides addiction outpatient services for adolescents and young adults, and 5) Faster Paths program which rapidly links patients from the ED to inpatient and outpatient treatment services, medical withdrawal services, and follow-up care. Additionally, an addiction journal club and addiction case conferences are held on a monthly basis with addiction medicine trainees and faculty at BMC.

 

VA BOSTON HEALTHCARE SYSTEM:

The VA Boston Healthcare System is the primary tertiary care referral center for five New England states, as well as a large primary care system that serves eastern Massachusetts. VA Boston comprises three main campuses – Jamaica Plain, West Roxbury and Brockton – plus six community-based outpatient clinics.  The 438 bed West Roxbury Campus is the site for the acute inpatient Medical, Surgical, Neurological and Rehabilitation Services.  Acute Psychiatry, a Spinal Cord Injury Rehabilitation Program, an inpatient hospice program, a transitional care unit, nursing home unit and specialized substance abuse programs reside within the 375 bed inpatient beds and outpatient facilities at the Brockton Campus.  Training programs are overseen by a Dean’s Committee co-chaired by the deans of Harvard Medical School and BUSM.  VA Boston is one of the primary training affiliates of the BUSM Department of Psychiatry.

 

VA Boston- Jamaica Plain Campus

Jamaica Plain campus houses primary care services along with psychiatric and subspecialty care for patients with SUDs. Jamaica Plain Psychiatry Clinic is one of the largest in the VA system and includes an Alcohol and Drug Treatment Program (ADTP) with over 25,000 visits per year and over 1,600 SUD patients and patients with co-morbid psychiatric disorders are seen in treatment each year.  John Renner, M.D., Director of the BMC/VA Addiction Psychiatry Fellowship Training Program, is based at this site.

The Jamaica Plain Campus also includes the residential Substance Abuse Recovery and Rehabilitation Treatment Program (SARRTP) and the Drug Dependence Treatment Center, which provides methadone treatment services for 120 veterans with opiate use disorder. Methadone treatment patients range in age from 27 to 76. The ADTP also provides office-based buprenorphine treatment for over 130 veterans.

The ADTP also provides same-day buprenorphine induction and home inductions through the Opioid Rapid Access Clinic (ORACL). Jamaica Plain ADTP is a site for extensive collaboration and education between trainees of multiple training levels and from multiple institutions. The ADTP is the primary addiction psychiatry training site for both the PGY III/IV general psychiatry residents from the Boston Medical Center Psychiatry Residency Training Program and is an elective addiction rotation site for the Harvard South Shore General Psychiatry Residency Training Program. JP ADTP is also a site for the Addiction Psychiatry elective clerkship for BUSM medical students.  Other trainees involved in the ADTP are physician assistant trainees from the Massachusetts College of Pharmacy and Health Sciences.  Fellows will have the opportunity to work with patients experiencing substance abuse, psychosis, anxiety disorders, depression, and Treatment approaches utilized in the ADTP include individual and group psychotherapy, motivational enhancement therapy, cognitive behavioral therapy (including relapse prevention approaches), and medication-assisted addiction treatment, including buprenorphine treatment, methadone maintenance, extended-release naltrexone treatment and disulfiram, and pharmacotherapy for co-occurring psychiatric disorders.  Faculty include full-time and part-time board-certified psychiatrists with subspecialty certification in addiction psychiatry, psychologists, social workers, and nurse clinicians. Addiction Fellows receive 1 to 2 hours per week individual supervision, and 2.5 hours seminars and case conferences per week.  All addiction psychiatry Fellows spend 8 weeks on a full-time rotation at the ADTP and its affiliate programs at the Jamaica Plain campus and then continue to follow patients for 8 hours per week for the duration of their Fellowship.

 

BRIGHAM AND WOMEN’S HOSPITAL

Fellows spend approximately 20 hours per week for 12 weeks on the Consultation-Liaison Service for Brigham and Woman’s Hospital (BWH), Division of Medical Psychiatry in the Department of Psychiatry.  BWH is an internationally known teaching hospital, an affiliate of the MGH Brigham’s Health Care System and a core teaching institution of Harvard Medical School.  Trainees work under the supervision of Joji Suzuki MD, a graduate of our addiction psychiatry residency and the Director of the BWH Division of Addiction Psychiatry. Claire Twark MD, and David Hathaway, MD, also a graduate of our addiction psychiatry residency, also provide supervision. The Division of Medical Psychiatry provides addiction consultation services to all inpatient medical units including the emergency room, ICUs, burn-trauma, orthopedics, obstetrics, and a variety of outpatient clinics including primary care, and acts as the primary addiction education service for BWH staff.  BWH treats a diverse patient population, including 55% minorities and 40% women.  The Division of Medical Psychiatry consults on 800-900 addiction patients per year. Residents gain experience in managing acute medical illnesses complicated by substance use disorders. In particular, Fellows gain considerable experience managing acute pain, and buprenorphine inductions in hospitalized patients. Residents also obtain a supervised experience learning motivational interviewing from Dr. Suzuki, a member of the Motivational Interviewing Network of Trainers. Supervision is provided by two psychiatrist board certified in addiction psychiatry and board-certified psychosomatic medicine attendings on the C/L Service. Residents are formally assigned to supervise PGY1 residents from the BWH Psychiatry Program, Harvard Medical School (HMS) 3rd year psychiatry clerks, and HMS 4th year students in their addiction elective.

 

Codman Square Health Center

Addiction Psychiatry Fellows are expected to learn to assess and treat complex care patients with SUD and COD, with co-occurring chronic medical conditions. Fellows provide treatment in a community-based longitudinal clinic, working collaboratively within multidisciplinary collaborative care primary care teams. The specific learning objectives follow:

  • To work within a developing system to enhance strengths and mitigate risk while improving SUD/COD care for their patients.
  • To gain experience assessing complex patients with SUD, COD and medical disorders, that includes input from primary care and other members of collaborative care team
  • To gain experience in treatment of complex patients, learning to balance harm reduction approach with and safe and effective psychopharmacology, psychotherapy, and case management
  • To work within a system in a Federally Qualified primary care community-based program, to enhance strengths and mitigate risk while improving SUD/COD and medical care to patients.

SCHOLARLY ACTIVITY

Scholarly activity is a major priority for Addiction Psychiatry fellowship training at BU/BUMC. All Fellows are encouraged to review the literature and research topics of interest.  Fellows are expected to conduct training seminars for junior residents several times a year. Fellows are also eligible to attend courses sponsored by the Division on Addictions at Harvard Medical School and educational meetings organized by the Committee on Addictions of the Massachusetts Psychiatric Society.

There are two major training pathways to purse scholarly activity in our BU/BUMC Addiction Psychiatry Fellowships. The first, in our one-year Addiction Psychiatry Fellowship, has been described previously. The second pathway is our Interprofessional Advanced Fellowship Program. It the latter program, fellows elect the 2-year advanced Fellowship program pathway, spending the majority of their time doing clinical research.  They may elect to do basic science, quality improvement, health services research or other clinical research experiences.

The program also provides up to $1150 dollars per year for educational allowance and travel reimbursement for Addiction Psychiatry Residents, with an additional $1000 available for conference presenters. For further information on Fellowship benefits please consult the BMC website www.bmc.org/gme/housestaff/benefits.htm .

VA funding is also available to support research activities for PGY V Fellows who elect the 2 year Interprofessional Advanced Fellowship program.

NIGHT CALL

There is no required night call for Addiction Psychiatry Fellows or Interprofessional Advanced Fellows. Residents and Fellows will be paid for elective night call at BMC during their addiction training.  These night call options are subject to the RRC mandated 80-hour work week limit, and must be approved by the training program director.  Trainees are also allowed to moonlight at other sites with approval of the training program director and DIO.

 

APPLICATION PROCESS:

For candidates interested in a start date of July 2022 and beyond, we will utilize the Electronic Residency Application Service (ERAS) to process applications. Candidates may submit their materials beginning July 7, 2021. Check back here for more information as it becomes available.

The following material is required for your application to be considered complete:

    1. Personal Statement
    2. CV
    3. Three Letter of Recommendation (One must be from your Residency Program Director)
    4. USMLE transcript
    5. Application- BU
    6. Photo
    7. Proof of MA Licensure, if applicable
    8. Grad/Medical School Diploma
    9. Residency Diploma

 

Please email Program Coordinator, Lynne Rose, to obtain the BU application. For more information about the Addiction Psychiatry Residency please contact:

Program Director

John A. Renner, Jr., MD
Director, Addiction Psychiatry Fellowship Program
VA Boston Jamaica Plain Campus
150 South Huntington Ave.
Jamaica Plain, MA 02130

Telephone: 617-833-2010
Fax: 617-638-8724
e-mail: john.renner@va.gov

 

Program Coordinator

Lynne Rose
Boston Medical Center
Department of Psychiatry
720 Harrison Avenue, Suite 7600
Boston, MA 02118

Telephone: 617-638-8670
Fax: 617-638-8724
e-mail: Lynne.Rose@bmc.org