Exactly. Do you want to be making 125k a year? Not me...which means psychiatrists have to bill at a higher rate or see more patients per day to make an income they deem appropriate. Neither one of those options seem viable to some here.
So again, why is a $125 10 minute med check unethically overcharging?
I don't like to give out how much I'm making, and I'm a fellow this year, but I have the opportunity to make over 230K doing outpatient at a place just working 40 hrs a week. Of course that's not the situation now because I'm a fellow.
I'm moonlighting at that place now. I spend about 30 minutes per patient. Do I do 10 minute med checks? Sort of. Some of my patients are stable, and I've already spent 2-4 sessions over half an hour getting to know them, and they feel very stable on their meds. This is about 1/3 of my patients. These same patients don't really want to talk much even though I invite them to do so.
However I do allot 1/2 an hour even for these patients. Its that these patients are electing to only spend 10 minutes because they feel fine, and don't want to talk more. Instead of seeing them monthly, I'm considering pushing up the next visits to 2-3 months later instead of monthly.
You really do need to give patients the option of wanting to spend more than ten minutes. If you push them in and out of the door, you're not going to do a great job.
Misdiagnosis in outpatient is already at substantially high levels in studies. You're going to increase your rate of misdiagnosis with 10 minute checks.
There has to be a point where the money is not so much important as the quality of the work you're doing. Yes, we all want to make more, but at >200K a year, I'm not going to focus on the money aspect, and I'd focus on the quality aspect. If I were making $125 a year, I'd still focus on the quality aspect, but in the meantime, while I'm not at work, I'd be looking for a higher paying job.
I've come to a personal decision about the work I do. I will not do mediocre work. I will always try to do my best. If a place is not paying me enough, or not giving me enough respect, I will leave that place before I passive aggressively do shoddy work. I've seen attendings do that while I was in residency, and seeing patients needlessly suffer because of their laziness. I will not do that type of work, and to do so is a violation of my Oath.
Its as much as personal mark for my ego as it is good business sense. Wherever you practice the world will be smaller than you think. Psychiatry even in a large metropolitan area is limited to a few hundred psychiatrists. Your rep will follow you if you do bad work. In smaller areas, you could be only one of dozens if not the only one in the county. You do bad work to get out of the door or make more money, people will remember you--and spread your rep around. It has paid off. I only got recommended the moonlighting gig because the fellow who had it before me thought I did excellent work. Before I started, he gave me a high recommendation. Another doctor at the state facility I worked at last year has given me the opportunity to work with him in his private practice and take a major and profitable role in that practice. He did not offer this to any other doctor at the facility.
From personal experience, I have seen lazy doctors professionally hurt. I often whine and complain of lazy doctors being able to get away with poor work. That's true due to the shortage of psychiatrists, but its also true that some of my fellow residents would not be hired from our program due to their poor work, I've seen attendings do poor work and be denied promotions, or lose positions. Even a bad doctor will be able to find work, but they will most likely not get choice jobs or respect.
By the way, Seth03 did give me the information on the specific doctor who is charging $125 for medchecks.
1) this doctor is located in an area where psychiatrists are in a severe short supply
2) this is that doctor's private practice, any person could opt to not go there
3) the 10 minute med check is an option the person could take. They could also opt for longer sessions.
It is a possibility that this particular doctor is also on the order of one of those doctors of the higher quality to merit this type of work. E.g. Henry Nasrallah, the editor in chief of Current Psychiatry privately sees extremely hard to solve cases. He will tackle these cases for a fee. I don't know the amount, but he does incredibly excellent work. E.g. he'll be able to solve cases where 6 psychiatrists all tried and failed. His expertise is definitely on the order where he can charge a higher fee than the typical psychiatrist.
Several doctors that are able to charge much more than the typical psychiatrist are able to do so because the quality of the work they do is significantly higher than the standard of care. You'll only be able to get there by doing the best work possible, and have years of experience and training over the norm.
My point is don't expect to practice doing 10 minute med checks a day as if that's it. There's much more to good practice. If its really just about the money, this was not the field to enter.
