Being the C-L Service: Leaving the Ivory Tower for Community Practice. Co-sponsored by ACLP's Division Director's, and Community-Based CLP SIGs

Many graduates of C-L fellowships remain within tertiary or quaternary academic hospital systems. The established C-L services within these institutions often exist within a robust department of psychiatry which facilitates opportunities to discuss cases with colleagues, seek supervision, and develop a super-subspecialized area of expertise. This workshop, co-sponsored by the Division Director's SIG and the Community-Based CLP SIG, will describe the path less-traveled: fellowship-trained C-L attendings who have sought opportunities practicing in community-based, rural, or underserved areas, including some as a solo attending.

The shift to community-based practice presents both challenges and opportunities. Representing a breadth of practice types, locations, and career stages, speakers will discuss common concerns of those looking to shift from academic to community medicine. Themes will include changing practice patterns, finding opportunities for professional development, treating patients with limited resources, and the importance of maintaining mentorship. We will utilize audience polling to gauge beliefs, identify potential misconceptions, and elicit questions about practicing community C-L psychiatry.

Dr. Naomi Schmelzer is the director of a C-L service in a 171-bed community teaching hospital, part of a Boston academic tertiary hospital care system, with a team of C-L psychiatrists and trainees. She will discuss the integration of community hospitals into academic healthcare systems, and the benefits and challenges this poses for C-L psychiatrists throughout their career (15 minutes).

Dr. Molly Cinderella is the only psychiatrist covering the C-L service at a 628-bed community hospital in North Carolina with a new psychiatry residency program. She will demonstrate how the fast-paced environment of community C-L requires psychiatrists to learn quickly, efficiently, and function as a jack of all trades through the lens of seeing child and adolescent patients for the first time since residency (15 minutes).

Dr. Bill Scheidler took a job as the solo C-L psychiatrist at a 68-bed community hospital after completing fellowship. He will highlight the challenges of treating psychiatrically ill patients in communities with fewer resources including managing differences in hospital administration's expectations, knowing when to transfer to academic centers, and navigating insurance reimbursement which may be novel to psychiatrists accustomed to larger hospital systems (15 minutes).

As the demand for C-L psychiatrists outpaces the supply of fellowship-trained attendings, new graduates are being offered positions at community hospitals with significant administrative components directly out of training. Dr. Andrea DeSimone is the only hospital-employed C-L psychiatrist at a 316-bed community hospital in Delaware and serves as the department chair. She will discuss strategies for learning administrative responsibilities as a new attending, finding mentorship, and acknowledging system limitations (15 minutes).

Following the brief presentations, we will describe a week in the life of a community-based C-L psychiatrist highlighting the varied patient populations, breadth of clinical cases, and concurrent administrative responsibilities (10 minutes).

With the remaining time, panelists will facilitate discussion by revisiting polling questions posed during the brief talks and addressing audience-submitted questions. Additional panelist prompts will be designed to invite audience engagement and sharing of experiences (20 minutes).