Attendings: what's your practice setting?

[fiatslug]

I thought a thread like this might be useful for those in training to get some insight into the different opportunities out there. I'll go first:

Training: 4 yrs Gen Psych, 2 yrs Child Fellowship

Years out of training: Starting year 2.

Type of Employer: HMO (Yay benefits!)

Main practice setting: Partial hospitalization/Intensive Outpatient. Adult only. Our patients are referred primarily from the ER (acute, but not acute enough to need inpatient... or acute enough to need inpatient, but after 4 days in the ER waiting for a bed they become less acute) and after inpt psychiatric treatment, though we also get community referrals. We tend to treat a lot of relatively high-functioning people (employed/recently lost job--lots of those, sadly), though we also see a fair percentage of county patients & uninsured. Most diagnoses are anxiety spectrum/PTSD and depression/bipolar (along with good ol' Cluster B... and some C). Our work is CBT centered, primarily group work, and most of the chronic schizophrenics would be inappropriate in our setting (primarily b/c most of the other patients are cognitively high-functioning). Avg LOS is from 2-5 weeks, but many stay much longer. Many have sub abuse comorbidities. Many are referred on to DBT. Patient satisfaction with our services is high.

Best thing about job: I really enjoy the patients and the interactions with other team members. There are 4 psychiatrists and the patients are managed by therapists during tx here... they do the d/c summaries . We are able to do CBT during our work with patients individually, and we also teach medication & psychopathology groups to other patients. I really had no idea what PH/IOP work was like before I took this job, and I've been very, very happy with it. I plan on being here a long time. Oh, and I really, really like the security of working for a solvent and well-run HMO. I'm quite happy at this time to be a benefited employee . And I like that we have front office staff who deal with all the insurance stuff.

Most frustrating thing(s) about job: the level of SI in this population is quite high, and our program has had several completed suicides, unfortunately (none of my patients, but sadly, that's probably just a matter of time). That, and setting up outpatient follow up (very hard even for pts with good insurance to get this set up!). My employer is s/w stingy with vacation, and all our sick leave and vacation days come out of the same PTO (paid time off) pool.

ETA: I also miss seeing patients long term. I see a lot of tx-resistant depression, and there are many pts I'd like to try on MAOis, but it's not possible for me to shepherd that kind of change in their regimens in the limited amount of time I have them in tx. I do try and f/u with the treaters of discharged pts, and recently heard that one (who was severely depressed, we referred for ECT and it didn't go well, I was very worried about her) did end up doing quite well on Nardil. So that's great to hear, but I would like the opportunity to see it more, esp since TRD is so common in this setting!

But there are benefits to not seeing pts long term as well...

Other practice settings: My hospital's ER. Done purely for the money, though I also do enjoy the ER, about every 7th weekend. Fun, can be feast or famine in terms of business. We are also back up for the consult service, which I loathe , but that doesn't happen often, thankfully.

Other jobs considered: I really wanted a salaried/benefitted job out of training. I ultimately rejected an offer for a child/adolescent job in the area for another HMO (which has a reputation for an untamed firehose of intakes, and rhymes with "Schmaiser" ) because of many factors, including commute, and primarily the inability to do all necessary-yet-unbillable collateral needed for child cases. I miss child & adolescent work, but I am home by 4:30 most nights, and since I have children of my own, they win.

I looked hard at academics--I would have loved to stay where I trained, but the salary is close to $90K less than what I'm making now . I cannot afford that level of altruism at this time

Level of happiness with salary: very. Pinching self. No, I won't disclose it on this forum.

Dream practice: A medical home model working with SW, Developmental Pediatricians and myself, ideally working with at-risk parents and challenging kids (I prefer the littles but also like adolsecents). But... I doubt this will happen, as I'm highly unlikely to leave my current employer. I may end up seeing some kiddos in the future.

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[CTR]

As one who will be starting residency next year, I think this thread is a great idea. I hope many others will contribute to it.

 

[OldPsychDoc]

Training: 4.5 yrs Psych Research track, 1 yr Addiction Fellowship

Years out of training: 6.5.

Type of Employer: Integrated Multi-Specialty Health System (Non-profit)

Main practice setting:
50% Adult Inpatient. Midwest urban tertiary care hospital. Privately insured and publically-funded patient population. "Mood Disorders" ward, though we take all comers... (I think maybe I might have one patient with a primary 296.xx this week...) Call is 1 week/quarter--minimal phone coverage, staffing weekend admissions
30% General Adult outpatient--multi-specialty clinic, primarily insured population
20% Medical Director, Hospital-affiliated Drug & Alcohol treatment program. (Outpatient and Intensive outpatient with lodging.)

Best thing about job: My team, my colleagues, the days I make a difference with a patient.
Teaching--Site director for the MS3s & 4s who rotate from the local major university medical school; Addiction Psych rotation director for our community hospital residency program, as well as some individual resident supervision and didactics.
(Also like that almost all of the administrative stuff--billing, scheduling, support staff, compensation & benefits-- is taken care of by the organization.)

Most frustrating thing(s) about job: High volume & turnover.

Other practice settings: Got enough on my plate, I think.
[Though in retrospect, maybe I should count my exclusive, concierge-style, pro bono residential Child & Adolescent Psych practice, in which 4 select private patients are allowed 24/7 access to my time and person for management of their ADLs, educational development, and conflict resolution concerns... ]

Level of happiness with salary: quite. Also receive competitive benefits and a generous CME allowance. 4 weeks PTO, up to 2 weeks CME.

Dream practice: more of the same, maybe a somewhat slower pace, and with someone else writing my notes. Oh--and universal coverage and access for all my patients.

 

[digitlnoize]

Agreed, this is great! Keep 'em coming guys, and thanks.

 

[Daedra22]

Seriously, this is excellent. ^.^ I'm way down here as an OMS-II and the light at the end of the tunnel seems so far away.

 

[Doctor Bagel]

Love this thread! I think the downside of medical school and early psychiatry training is that we're mainly exposed to inpatient and C/L with some emergency psych thrown in, although most psychiatrists apparently don't do this stuff. What is out there? Share, please!

 

[classof2011]

I have an innocent question.....Why is it that no one likes to share their actual salaries? It seems like people think of it as a crime, especially in medicine...Is it because we feel guilty that we make (so much) more money than most others? Are we worried about competition? Making others feel humbled by how much less we make? I just never understood the fallacy of providing a number.....

 

[billypilgrim37]

I have an innocent question.....Why is it that no one likes to share their actual salaries?

Same reason you don't fart in an elevator. It's not polite, and it makes other people sick.

 

[classof2011]

Same reason you don't fart in an elevator. It's not polite, and it makes other people sick.

LOL, funny...

Whats so "impolite" about it?..If I fart anonymously and others WANT to smell it, why should I be so resistant to the idea?

To me it seems like alot of rules (in medicine) people follow and have very little reason to do so...This is one of the reasons I chose Psychiatry...it breaks many of the classic doings of Medicine.

 

[Technotronic]

 

[Doc Samson]

Training: 4 yrs Psychiatry residency, 1 yr Psychosomatic Medicine Fellowship

Years out of training: 4

Type of Employer: Large urban academic medical center

Main practice setting:
60% CL - mostly covering ICUs and wards, some ED and physical rehab center work
20% academic - clerkship director, writing
20% administrative - department chair overseeing inpatient unit and outpatient clinic

Best thing about job: All of it. Love teaching and love administration, especially since I've been able to essentially build a department from the ground up. Clinically, I love CL work, especially since our hospital sees an awful lot of zebras and unicorns.

Most frustrating thing(s) about job: Very underserved community. Can stabilize folks in the hospital only to return them to a system that will fail them.

Other practice settings: My full-time job is way more than full-time.

Level of happiness with salary: Thrilled. Very competitive benefits and CME allowance. 4 weeks PTO, 1 week CME. Can't tell you my actual salary because a) as mentioned above - it's rude, and b) we are contractually forbidden from revealing our salary to anyone except our spouse and our financial advisors.

Dream practice: I already have it. Would like to be in a city with a better public psychiatry system and would like to expand the department (perhaps add a residency program), but that'll come with time.

 

[sunlioness]

Can't tell you my actual salary because a) as mentioned above - it's rude, and b) we are contractually forbidden from revealing our salary to anyone except our spouse and our financial advisors.

That was in the contract I just signed too. Actually I'm not allowed to discuss my contract or show it to anyone aside from my legal counsel, financial adviser, and spouse. Not to derail the thread, but does anyone know the reasoning for this? My current contract doesn't have anything like that in it, though I'm still not going to say how much they pay me. I will say though that I learned a new word from the contract I have with the place I currently work, "estoppel". It's an awesome word. Say it; it's fun!

This is a really cool thread by the way. Hopefully I'll get around to contributing to it more meaningfully.

 

[2tall]

Nice thread!

 

[Chimed]

That was in the contract I just signed too. Actually I'm not allowed to discuss my contract or show it to anyone aside from my legal counsel, financial adviser, and spouse. Not to derail the thread, but does anyone know the reasoning for this? My current contract doesn't have anything like that in it, though I'm still not going to say how much they pay me. I will say though that I learned a new word from the contract I have with the place I currently work, "estoppel". It's an awesome word. Say it; it's fun!

This is a really cool thread by the way. Hopefully I'll get around to contributing to it more meaningfully.

Aren't you going to play and give a description of your current practice?

 

[sunlioness]

Oh okay. I'll play.


Training: One year internal medicine/women's health categorical internship. 3 years general psychiatry residency. [I switched specialties after my first year of residency and started psychiatry as a PGY-2. I lost a lot of PGY-4 elective time doing it this way. Thus my transcript has a lot of funky "electives" on it. Like the MICU.]

Years out of training: Starting year 4. Yikes.

Type of Employer: I work for a health system. Technically I believe I work for a physician organization that contracts with the health system. Basically, I work in a hospital, get regular paychecks and have benefits. Score.

Main practice setting:

100% general adult inpatient with ED coverage weekly and some consults thrown in every now and then to keep things exciting. I am affiliated with the residency program where I trained (though the inpatient unit has since moved to a different hospital) and am involved in the clinical teaching of both psychiatry residents and medical students.

Best thing about job: The people I work with. I work with a really amazing group of psychiatrists, nurses, social workers, etc. There's really an interesting assortment of psychopathology here, too. I'd never seen as much psychosis and florid mania before starting here. There are always new things to learn and people around who will help you learn it, which is something I really missed when I was in solo practice. I also really enjoy the teaching/mentorship aspect of my job.


Most frustrating thing(s) about job:

I get frustrated with malingering patients, but I think that's par for the course anywhere. I'm also kind of a creature of habit so I really like to know how my day is going to go before I get to work and that's hard to do on an inpatient unit when you can walk into zero new admits or several. I find that I also miss being able to follow patients over a longer period of time. I see people at their worst, get them to a point where they're at least safe, and then bid them good-bye. I also really don't like emergency psychiatry and consults, so when I cover those services I feel a bit out of my element. Also, our health system is struggling financially and was just bought. While I think we will ultimately survive, it does create a certain level of ambient uncertainty.

Other practice settings: That's it.

Other jobs considered: I got this job after I asked my former program director and chair for recommendations in support of my considering a VA job out of state. It was then that they invited me to interview for the one I have now, which is much better than the VA job. So while I was looking around at the time, this was byfar the best opportunity I had and I remain very grateful for it. It's been a really good experience for me.

Level of happiness with salary: Ecstatic.

Dream practice: Closer to the job I am leaving this one for. Outpatient, team-oriented approach, an abundance of referrals and resources in-house, still working for a health system (love that regular salary and benefits). Would kind of like to reclaim my prior women's health interest, too. My new job is not affiliated with a residency program, but is affiliated with a med school and I was invited to develop lectures on women's issues in psychiatry, which could be really cool. I also have an interest in hospice/palliative medicine, but no real desire to do an actual fellowship or ever make that the only focus of my career. It would be interesting though to see how I might incorporate that interest into a more general practice.

Hope that was helpful. Will likely do another in a few months.

 

[Doctor Bagel]

Sunlioness,
Thanks for sharing! Did you find it easier to transition from residency to inpatient work and now to outpatient work? Just wondering why the 4 years of inpatient when outpt seems more like your dream setting and based on my observations about recently graduating residents around me where most seem to pick up inpatient types of jobs.

Congrats on moving closer to the dream job situation!

 

[sunlioness]

I actually went from residency to doing private outpatient for 2 years (in a group and solo) before moving back to inpatient. So I was more geared to outpatient all along, but came back to inpatient when I started here. I think my previous outpatient settings weren't ideal for me because I didn't have the contact I have now with other docs, the intellectual stimulation, and the team-oriented approach. Of the jobs I've had since graduating, my current one has been the most enjoyable because it has these things. My new job will continue to have these things, in addition to being outpatient.

I was actually quite nervous coming back to inpatient, but I think overall I'm doing pretty well with it and I honestly don't dislike inpatient psychiatry. I'm actually leaving this position more out of desire to live elsewhere and be closer geographically to friends than anything else. It just so fortunately coincided that it's also more of what I like to do.

Thanks for the congrats.

 

[alina_s]

Training: 3 years general psych + 2 years child and adolescent fellowship

Years out of training: 1

Type of Employer: community mental health center

Main practice setting: 100% outpatient, about half adults and half kids.

Best thing about job: I like the clinic staff, and it is such a relief to not be on rotations, not always be the newest and most clueless person in a setting. Work is more organized that residency often was.

Most frustrating thing(s) about job: Very underserved community, very few resources, and some of my patients seem to feel that an antidepressant should solve lifelong depression, history of abuse, poverty...the way that antibiotics cure strep. There's not a lot of opportunity for therapy and alas, some patients aren't interested when there is the opportunity. 20 minute med check appointments and 1 hour intakes are shocking after residency. Weirdly, I kind of miss ER and inpatient.

Other practice settings: none

Level of happiness with salary: Salary is excellent, vacation is good, health insurance for every job I looked at was lousy.

Other jobs considered: I'm NHSC. I originally wanted to go to the IHS and although the sites (Navajo) were gorgeous, the work seemed interesting in lots of ways, and the salaries were good, I interviewed in September and they weren't ready to make a decision until late May! Even if it weren't for the NHSC pressuring me, I wouldn't have waited that late to sign a contract. Also, between September and May, two of the three attendings I had interviewed with resigned. I looked at another community clinic in a location that I loved, and they even got themselves added to the NHSC list, but they seemed to be significantly less organized than here and the salary was 30% less.

 

[Manicsleep]

xgl

 

[jojo100]

It would be nice to MS3s and MS4s and anyone interested in psych to give us an idea of what kind of salaries you are receiving right out of residency...gives us something, a range, anything....

 

[WhoisJohnGalt]

It would be nice to MS3s and MS4s and anyone interested in psych to give us an idea of what kind of salaries you are receiving right out of residency...gives us something, a range, anything....

How about an anonymous poll with ranges? Would you all be willing to do that (so nobody could link salary with SDN user)? It's sort of incredibly relevant to all of us to have an idea for when we start negotiations out of residency.

 

[digitlnoize]

It would be nice to MS3s and MS4s and anyone interested in psych to give us an idea of what kind of salaries you are receiving right out of residency...gives us something, a range, anything....

It can vary a lot depending on location, practice setting, etc. Most of the salary surveys (look up the Modern Healthcare article on salaries) have psych averages pegged at around $180k/yr give or take, with some surveys coming in lower, around 160k, and others coming in higher, around 220k.

Anecdotally, I know of one graduating resident who got an offer for $250k, with a pretty cush job, not too rural, but not too urban. I know of a guy who has been in practice for many years who makes quite a bit more than this...it all depends. But, for argument's sake, lets say around 200k give or take 50k.

 

[WhoisJohnGalt]

How about an anonymous poll with ranges? Would you all be willing to do that (so nobody could link salary with SDN user)? It's sort of incredibly relevant to all of us to have an idea for when we start negotiations out of residency.

There is no need to reply to this as any positive response could associate a user with a response, but in case anyone were willing to do this, such a poll is now posted in a separate thread.

 

[Doctor Bagel]

There is no need to reply to this as any positive response could associate a user with a response, but in case anyone were willing to do this, such a poll is now posted in a separate thread.

I hope people will participate in the anonymous poll. As a PGY2, I'm pretty curious about knowing what real salaries are out there. It's important for me to think about in terms of financial planning for the future. I know we don't want to individually give answers, but salaries do matter.

 

[carlosc1dbz]

I hope people will participate in the anonymous poll. As a PGY2, I'm pretty curious about knowing what real salaries are out there. It's important for me to think about in terms of financial planning for the future. I know we don't want to individually give answers, but salaries do matter.

Great thread, I really enjoy reading everyone's experience. Thank you all.

 

[milesed]

Training: 3 yrs Gen Psych, 2 yrs Child Fellowship

Years out of training: Starting year 11.

Type of Employer: CMHC - Medical Director
Main practice setting: Partial hospitalization/ Outpatient. Child and adolescent 97%, Adult SMI 3%. Our patients are referred from PCP's, schools, social services, inpt psyc hospitals, legal system, self.

Best thing about job: I love my patients. I get to see some multi-generational families, seeing the kids I've helped move on to successful lives in the community, college, etc. In a fairly small community, it feels like I have 1500 neices and nephews that I see all over when away from work (mostly a positive). I love helping a kid to be the first of the family to graduate high school and sometimes college. I love not having to worry too much about the business side of it all. I run the medical side of the office, but don't have to do much with insurance.

I have great benefits- state retirement pension, 401k, 403b and lots of sick, educational and vacation time. I take off far less that I haveavailable.

Most frustrating thing(s) about job: Some just don't really want anything better or different so changes are hard to come by- "fix it with a pill mentality" that some have, the disability-seeking parents for kids with easily treated disorders (they get a SSI check for multiple kids so there is no reason to ever get better). I have little ability to change policies/procedures, agency is huge so there are lots of non-revenue generators I support, laziness of some co-workers that a salaried position attracts (most are great).

Other practice settings:none

Other jobs considered: Private Practice

Level of happiness with salary: Currently happy

Dream practice: Private Practice with ability to see all of my Medicaid kids I work with now.

 

[Flushot]

Thank you all for sharing your experiences and current setup. I think it is sticky worthy

 

[Chimed]

Training: 3 yrs Gen Psych, 2 yrs Child Fellowship

Years out of training: Starting year 11.

Type of Employer: CMHC - Medical Director
Main practice setting: Partial hospitalization/ Outpatient. Child and adolescent 97%, Adult SMI 3%. Our patients are referred from PCP's, schools, social services, inpt psyc hospitals, legal system, self.

Best thing about job: I love my patients. I get to see some multi-generational families, seeing the kids I've helped move on to successful lives in the community, college, etc. In a fairly small community, it feels like I have 1500 neices and nephews that I see all over when away from work (mostly a positive). I love helping a kid to be the first of the family to graduate high school and sometimes college. I love not having to worry too much about the business side of it all. I run the medical side of the office, but don't have to do much with insurance.

I have great benefits- state retirement pension, 401k, 403b and lots of sick, educational and vacation time. I take off far less that I haveavailable.

Most frustrating thing(s) about job: Some just don't really want anything better or different so changes are hard to come by- "fix it with a pill mentality" that some have, the disability-seeking parents for kids with easily treated disorders (they get a SSI check for multiple kids so there is no reaso to mever get better). I have little ability to change policies/procedures, agency is huge so there are lots of non-revenue generators I support, laziness of some co-workers that a salaried position attracts (most are great).

Other practice settings:none

Other jobs considered: Private Practice

Level of happiness with salary: Currently happy

Dream practice: Private Practice with ability to see all of my Medicaid kids I work with now.

Thanks for posting this!

What does it mean to be the "medical director" and what percentage of your week are you seeing patients? How much time do you get for RV's and evals?

 

[milesed]

Thanks for posting this!

What does it mean to be the "medical director" and what percentage of your week are you seeing patients? How much time do you get for RV's and evals?

I'm in charge of all things medical for the CMHC- supervise other docs, ARNP's, RN's, clerical staff. I hire, evaluate, fire those here (administrative side of things) put in some face time with other administrative types who oversee the various programs on a state and federal level (my least favorite part). I signed on knowing I'd get 15 min RV and 30 min. new evals. All patients have been carefully screened by therapists and about 2/3 of the initial eval is essentially done before I see anyone. I spend most of the eval educating and making tx recommendations. With no-shows, it works out fine as some certainly run over the scheduled times.

 

[Chimed]

I'm in charge of all things medical for the CMHC- supervise other docs, ARNP's, RN's, clerical staff. I hire, evaluate, fire those here (administrative side of things) put in some face time with other administrative types who oversee the various programs on a state and federal level (my least favorite part). I signed on knowing I'd get 15 min RV and 30 min. new evals. All patients have been carefully screened by therapists and about 2/3 of the initial eval is essentially done before I see anyone. I spend most of the eval educating and making tx recommendations. With no-shows, it works out fine as some certainly run over the scheduled times.

Thanks. I can kinda understand a 15 min RV and maybe a 30 min eval for adult patient, but for kids??? That seems very, very tight. We do some med evals for the therapists here, but we get an hour. I typically use all that time, even if I don't staff with an attending (we get a lot of independence in our 2nd year) and with a previous H&P completed. I don't always trust the therapists diagnosis and typically want to make sure I agree that the kid needs medication. It also seems like education and reviewing side-effects and just working with the family takes a lot of hand holding and time.

 

[Manicsleep]

Thanks. I can kinda understand a 15 min RV and maybe a 30 min eval for adult patient, but for kids??? That seems very, very tight. We do some med evals for the therapists here, but we get an hour. I typically use all that time, even if I don't staff with an attending (we get a lot of independence in our 2nd year) and with a previous H&P completed. I don't always trust the therapists diagnosis and typically want to make sure I agree that the kid needs medication. It also seems like education and reviewing side-effects and just working with the family takes a lot of hand holding and time.

30 minutes for a new eval is very short because that makes you responsible for the therapist's work who are essentially acting like physician extenders. As medical director do you have any control over the therapists? You only mentioned nursing staff in your post.

 

[milesed]

30 minutes for a new eval is very short because that makes you responsible for the therapist's work who are essentially acting like physician extenders. As medical director do you have any control over the therapists? You only mentioned nursing staff in your post.

Not if I'm reviewing everything the therapist reported as i interview the patient and family. How long does it take for you to review past psyc, medical, social and sxs reported? I correct anything that is needed and move on to the rest of HPI. Most of the eval is used for education about the disorder and treatment options. I stay until all is explained and all questions are answered. Like I said, some run past the 30 min and later no-shows usually keep me running on or very close to schedule. People love coming in and being seen at or before the actual appt times (no double booking). I'm not doing any real therapy on the initial eval besides outlining basic ideas of CBT, parenting, school interventions, etc.

I was used to an hour for new evals in training and used it all. I've gotten much more efficient now with the questons I ask and all ratings have been completed and scanned into the EMR.

I'm boarded in general and child, so this was great practice for the orals (passed all on first try).

We have a large body of therapists with various types of degress. I supervise them each week and they have additional supervision from their "site admintrators". It's great to instruct them on how I want things done and they have been very good at complying.

 

[milesed]

Thanks. I can kinda understand a 15 min RV and maybe a 30 min eval for adult patient, but for kids??? That seems very, very tight. We do some med evals for the therapists here, but we get an hour. I typically use all that time, even if I don't staff with an attending (we get a lot of independence in our 2nd year) and with a previous H&P completed. I don't always trust the therapists diagnosis and typically want to make sure I agree that the kid needs medication. It also seems like education and reviewing side-effects and just working with the family takes a lot of hand holding and time.

If you are a referring to your 2nd year of residency, don't compare your current experiences to mine- very different. I used the same amounts of time you mentioned during all of my training.

You'll soon see how much easier and faster things will go as you see the same diagnosis 100, 500, then 1000 times. I also see the same patients year after year and know them and their families VERY well.

 

[Chimed]

If you are a referring to your 2nd year of residency, don't compare your current experiences to mine- very different. I used the same amounts of time you mentioned during all of my training.

You'll soon see how much easier and faster things will go as you see the same diagnosis 100, 500, then 1000 times. I also see the same patients year after year and know them and their families VERY well.

Nope. I'm in my 2nd year of child fellowship and 5th year of training. I suppose my training experience, expectations, and style are different then your own. Even our attendings get an hour for med evals (and that's after having a therapist note and eval completed). I'm not sure I would ever be comfortable doing a 30 min eval. But maybe that's my own issue. For myself, getting a clear diagnosis typically isn't the issue, but we tend to get cases from community child psychiatrists from all over the state (and even out of state if it's for ECT) who aren't sure what to do or want some additional input. And those cases can be very complicated. Plus, even in a straight forward case, it's getting to know the kid and family, developing a therapeutic alliance, dealing with the social and school issues, psychoeducation, medication explanations and side-effects, getting consents signed, etc, that takes the most time. I just don't think I can get all that done in 30 minutes. But maybe after another 5 years, things could be different as you suggest. But I think everyone has a different style and for myself, I'd have a hard time doing that.

I appreciate hearing about your experience. It's helpful to know what expectations are at different organizations. Maybe the "academic bubble" isn't so bad! Thanks!

 

[whopper]

Training: general psychiatry, last year served as Chief Resident, fellowship in forensic psychiatry.

Years out of training: 2, though I did one year as an attending fresh out of residency, then did fellowship.

Type of Employer: Forensic psychiatric facility: state of Ohio,
Forensic consultant: county mental health center that handles forensic cases and general psychiatry
Private Practice: self-hired
Expert Witness for the Court: the local county


Main practice setting:
Forensic psychiatric facility: people incompetent to stand trial that need to be restored to competency, people found not gulity by reason of insanity and not restorable to competency on cases ranging from jaywalking to murder and everything in between like assault, rape, arson, what have you.

Forensic consultant: review cases for the center when need be. Go to guy for them to ask questions their general psychaitrists can't answer.

Private practice: mostly people with a GAF of 60 or better, outpatient, mostly depression and anxiety though I also do Suboxone treatment there, and occasionally get higher functioning psychotic and bipolar patients.

Expert Witness for the Court: I drive around hospitals once a week, determine if patients need to stay involuntarily committed, then present testimony in court while two lawyers have at me.

Group home visits: I go to the group homes once a month and treat patients that are psychotic or bipolar.


Best thing about job:
Forensic psychiatric facility: I don't have to say a guy has a disorder if I don't think he has it. I can freely find people malingering and not have to worry about the billing issues this may cause. I got a vast array of testing I can use on malingerers, and see the look on their face when they realize they can't use an insanity defense. Likewise, I also enjoy it when a guy is truly mentally ill, is deserving of a mental health legal defense, and my treatment can add to this.

Forensic consultant: For the most part easy work.

Private practice: Good money.

Expert Witness for the Court: Good money. I get paid per evaluation, so if a guy is floridly psychotic and threatens to hurt me, end of interview after 30 seconds, and I get paid for an hour's work.

Group home visits: good money.

I especially love it when a patient is being treated by a terrible doctor, and I can have at them in court. The defense attorney will ask me if the patient is receiving the standard of care. I can openly say no, and point out the problems.

After years of seeing bad doctors, this is a great way to see some of then get exposed for bad treatment, though in reality nothing really happens to them other than egg-on-their-face. The doctor's bosses at the hospitals aren't at the hearing, and don't give a damn about me saying that a doctor gave the wrong medication.

Most frustrating thing(s) about job:
Forensic psychiatric facility: It's a state job, mediocre pay, and there are plenty of bad doctors here willing to say a rapist is psychotic, and therefore may get a successful NGRI defense simply because it's easier to do that than to do malingering testing.

Forensic consultant: no frustrations

Private practice: hard work. You don't work, you don't get paid. In a hospital job, you can go to your office, do a meditation break, then get back at it. PP: it's a constant grind. Another problem is staff members often times position patients not having good clinical experience. Lots of patients call up and want to talk to me, their doctor for trivial things. When I talk to them, they tell me they want to schedule a meeting. That's why there's secretary dammit! One of these isn't bad but when you get about a dozen a week it piles up to a lot of wasted time.

(Before any of you ask why the staff aren't handling this, it's because the patients tell them it's too personal and there's a medical problem, then I get on the phone with the patient, then it turns out to be bullspit).

Group home visits: the drive, about an hour there, an hour back.

Other jobs considered: see dream practice below. I also have been courted by my fellowship to join the university.

Level of happiness with salary: Overall good. On the current course, I'm making twice what most psychiatrists make for 50 hrs/week, and if I retire with 25 years with the state, I get half my salary as pension till I die. Some doctors, their last two years, max out on hours because the pension is based on your last two years of work.

I could work, for example, 60 hours a week during my last two years and get a much higher pension.

Dream practice: Don't know other than that I always wanted to work in an upscale, high quality facility that gave extremely high quality care as the norm. Got a job offer at a place that does that, but my pay will most likely go down.

 

[Manicsleep]

x

 

[nitemagi]

Training: 4 yrs Gen Psych

Years out of training: Fresh out
Type of Employer: County

Main practice setting:
Mental Health Urgent Care Center. New center and new building. Patients are referred from ER's or other clinics for evaluation. Patients are screened and evaluated by social workers or nurses, and then referred to a psychiatrist for medication evaluation if appropriate. If ongoing care is likely needed then the pt. will be referred to a community clinic for continuity, and I'll see them at the UCC until that appointment (a few months). Like a true urgent care, it's intended to be an intermediate level of care between emergency and regular outpatient.

Best thing about job:
Hours. 4/10 hour days. County benefits including health insurance, pension, paid training days off.

Most frustrating thing(s) about job:
Governmental bureaucracies creating policies that make the system less efficient. And I'm liberal!

ETA: Not much time for psychotherapy, though there is a little right now since we're just starting and our patient #'s are low.

Other practice settings: Starting up a little private practice, goal to make it at least 50% psychotherapy, all cash.

Other jobs considered: Kaiser. Met some great people actually and probably could have been happy there, but the hours flexibility wasn't available. Also thought about FT private practice right off the bat, but I'd have to take more loans and that didn't seem viable.

Level of happiness with salary: Quite. I'm making 40+k/yr more than I thought I would right out of residency.

Dream practice: Full private practice doing a lot of varied psychotherapy, plus a day a week with the county (ER or UCC).