Addiction Psychiatry Fellowship Program
The Boston Medical Center / VA Boston Healthcare System Addiction Psychiatry Fellowship is a one year (PGY 5) Fellowship program that was originally accredited by the Accreditation Council for Graduate Medical Education (ACGME) in 1997. Since the program’s inception, we have had continued ACGME accreditation, due to our strong training experiences and outstanding faculty at each training site. The Fellowship provides psychiatric physicians with advanced training in the recognition, diagnosis, and treatment for persons with substance use disorders (SUD) and co-occurring mental health disorders (COD). The program is funded for six PGY 5 Fellows.
The primary training site is at the VA Boston Healthcare System Jamaica Plain Campus, where Fellows gain extensive experience using methadone and buprenorphine in treatment of patients with Opioid Use Disorder (OUD) and 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 SUD.
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, working within complex systems of care. 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 Boston Medical Center (addiction medicine consultation, adolescent dual-diagnosis services, and outpatient adult Addiction Psychiatry), Bedford VA (partial hospitalization program and geriatric addiction treatment), Brigham and Women’s Hospital (addiction consultation services, services for pregnant women, and management of complex inpatient detoxification), and Boston Codman Square Health Center (working within a collaborative care model treating primary care patients with SUD/COD).
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.
TRAINING GOALS AND OBJECTIVES
Our Addiction Psychiatry Fellowship provides outstanding training for psychiatrists interested in pursuing careers in all aspects of addiction treatment for persons with SUD/COD. The PGY 5 program provides comprehensive training experiences that meet requirements for eligibility to taker the American Board of Medical Specialties certification examination for Addiction Psychiatry, as well as providing the foundation for leadership roles as Addiction Psychiatrists. Through a series of clinical, didactic, and research experiences, Fellows will develop competence in the following four areas:
- The clinical management of patients with substance use disorders utilizing both standard, evidence-based treatment modalities, and innovative treatments, including psychological therapies, social interventions, peer/mutual support, and medication for addiction treatment and co-occurring psychiatric disorders: Under expert supervision, Fellows will be trained to use diverse interventions, from prevention to long-term treatment, for early-onset and chronic populations with SUD/COD. Emphasis will be placed on treatment interventions designed to address the needs of special populations such as the adolescents, young adults, elderly, women (including pregnant women), veterans, trauma victims, and many other underrepresented and marginalized minority groups. Our program’s strength stems in part from our special emphasis on providing comprehensive care for individuals with co-occurring psychiatric disorders across the life span. Fellows will have the opportunity to follow selected patients at 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, AAAP training modules, and currently literature, to afford fellows a rich learning environment that produces competence to manage complex patients with SUD/COD.
- 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.
- 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.
- 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 Inter-professional Fellowship. Advanced Fellows will be paired with one or more mentors, 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, Advanced Fellows will be expected to prepare scholarly reviews and develop and implement a research protocol, including data analysis and manuscript preparation. These advanced experiences will serve as the foundation for a leadership career in the addictions field, whether in academia or other systems of care.
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 Chobanian & Avedisian 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. William Reid-Varley 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 BMC
2) CATALYST (Center for Addiction Treatment for AdoLescent/Young adults who use SubsTances) which provides addiction outpatient services for adolescents and young adults
3) BOAT (Boston Outpatient Assisted Treatment Program) which is a partnership between Boston Municipal Court and Boston Medical Center, which provides for court-involved patients to receive comprehensive psychosocial and medication treatment for SUD/COD
4) Faster Paths program, which rapidly stabilizes patients referred from the ED for withdrawal management and acute stabilization.
Additionally, an addiction webinar and addiction case conferences are held on a weekly 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. Michael Dawes, MD, Program Director, and John Renner, M.D., Associate Program Director of the BMC/VA Addiction Psychiatry Fellowship Training Program, are 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, and depression. 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 to 3 hours of seminars and case conferences per week. All addiction psychiatry Fellows spend 12 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.
Fellows spend approximately 16 hours per week for 12 weeks at VA Bedford in their Veterans Mental Health and Addiction Treatment Program (VMHAP), which is a partial-hospital program. Fellows will primarily gain experience in treating persons with SUD/COD in a comprehensive partial hospital treatment setting, and learn to treat geriatric patients with SUD/COD. Fellows will work under the supervision of Drs. Dongchan Park and Elvis Espero, expert addition psychiatrists who were trained in our fellowship. VMHAP provides comprehensive addiction services ranging from early intervention to highest intensity of care up to Partial Hospital level of care based on American Society of Addiction Medicine Patient Placement Criteria (ASAM-PPC). VMHAP treatment is primarily divided between Intensive Day Treatment Program and traditional outpatient continuity addiction care. The care is delivered by a multidisciplinary team comprised of nursing, social work, psychology, occupational therapy, and peers providing the full range of psychopharmacological and psychotherapeutic interventions for Addiction Treatment. The trainees will learn evaluation and management of dual diagnosis patients based on Veterans Affairs- Department of Defense (VA-DOD) practice guideline and evidence based psychotherapy practices specific to a level of care and learn the specifics of transition of care between different levels of care. They will also gain specialized experience with induction and maintenance of Buprenorphine, Extended-Release Buprenorphine, Extended-Release Naltrexone, and other medications for persons with SUD/COD. Fellows also get additional exposure to psychosocial treatments including contingency management and motivational interviewing. Fellows will also gain an administrative experience working with an interdisciplinary treatment team and quality and safety monitoring. Fellows will be responsible for conducting journal clubs and supervising PGY2 Psychiatry residents as well as medical students rotating through this program. The Fellows will work with attendings to provide consultation to nursing home patients residing at the Bedford VA to gain experience with addiction care in older adults and challenges specific to Geriatric Addiction treatment.
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 over the course of the year, complex primary care patients with SUD and COD, who also have co-occurring chronic medical conditions. Fellows provide treatment in a community-based longitudinal clinic, working collaboratively within multidisciplinary collaborative care primary care and behavioral health teams. Fellows will be supervised by Michael Dawes, MD and will meet with addiction medicine team weekly to discuss cases and case management.
Fellows will learn:
- To assess and treat complex patients with SUD, COD and medical disorders, that includes input from primary care and other members of collaborative care team, learning to balance harm reduction approaches with 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 outcomes for their patients.
Scholarly activity is a major priority for our Addiction Psychiatry fellowship. 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 ACGME-accredited Addiction Psychiatry Fellowship, described previously provides up to $1200 per year for educational allowance and travel reimbursement for Addiction Psychiatry Fellows. For further information on Fellowship benefits please consult the BMC website www.bmc.org/gme/housestaff/benefits.htm
The second pathway is our VA sponsored Inter-professional Advanced Fellowship Program. It the latter program, fellows who are interested, apply and are selected to complete a 1- or 2-year Advanced Fellowship program, spending the majority of their time doing clinical research, working with one or more research mentors. Advanced fellows may elect to do basic science, quality improvement, health services research or other clinical research experiences. VA funding is available to support research activities for Advance Fellows who elect the 2 year Interprofessional Advanced Fellowship program.
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.
Our Program participates in the NRMP Match (Medicine and Pediatric Specialties Calendar) and utilizes the Electronic Residency Application Service (ERAS) to process applications.
The following material is required for your application to be considered complete:
Three Letter of Recommendation (One must be from your Residency Program Director)
Medical School Transcript
Residency Diploma, when available
For more information about the Addiction Psychiatry Fellowship please contact:
Michael Dawes, MD
VA Boston Jamaica Plain Campus
150 South Huntington Ave.
Jamaica Plain, MA 02130
John Renner, Jr., MD
Associate Program Director
Boston Medical Center Department of Psychiatry
801 Massachusetts Ave., Suite 470
Boston, MA 02118