Different practice settings in regards to quality of life/stress

[annoyedpsychiatrist]

Im just curious, is there a general consensus on which setting typically offers best quality of life/least stress? Such as community psych, private clinic, hospital based system, iop, etc, etc. Also how long have you guys typically stayed with your current/past jobs?

---

Members don't see this ad.

 

[wolfvgang22]

Im just curious, is there a general consensus on which setting typically offers best quality of life/least stress? Such as community psych, private clinic, hospital based system, iop, etc, etc. Also how long have you guys typically stayed with your current/past jobs?

Private practice cash pay seeing patients without SMI (serious mental illness like Schizophrenia, severe Bipolar, PTSD) is probably easiest from what I am told and seen.

I've been seeing SMI outpatient at the VA for a decade and a have also done C&L and emergency psychiatry. I also have a substance use disorder clinic. I find substanceuse disorder clinic much easier than my regular SMI clinic heavy with PTSD and Schizophrenia. Basically I am only still at the VA due to needing to be near family and I'm building a retirement. C&L was easier. I haven't done any inpatient since fellowship, but I think location and support staff matter a lot for any position. I've had folks tell me inpatient can be cake or can be a nightmare depending on the hospital.

 

[Sushirolls]

I have worked at a free standing psychiatric/addiction hospital that was for profit. Fled that as fast as could in like 3-6 months depending on how you count.

I worked a full spectrum Big Box Shop job [health system] fresh out of residency and did General Adult OP, IP, floor consults, ED consults, and suboxone and started an ECT service. That was maybe ~ 4 years.

Moonlighted heavily in residency different venues, including Psych ED.

I have less stress in my own solo private practice than I did with any other location or residency. I've interviewed a few times while here but just couldn't sign. Had one that is a good solid OP option... just couldn't go back.

PP until death or retirement. Maybe might expand and add more people? But that will enough of a headache probably won't.

These days I'm not working towards FI or FIRE or any of that. I'm working towards the farm/ranch.

Going to quit medicine once I build up the infrastructure on farm land, and work that until I die of an MI on the tractor.

 

[comp1]

9 years, inpatient, but it's so personal. I found outpatient so extremely isolating. I love having a team with me every day including multiple other psychiatrists and I really dislike the business side of medicine. I also adore psychopharm, but most of our meds are really approved for at least moderate or severe illness, not mild. I felt outpatient that a lot people were looking for medication solutions when they really needed long term talk therapy which frankly there are other providers better suited towards. I also really love having trainees and that's just worlds easier inpatient.

 

[Stagg737]

I think for most, outpatient cash only PP is probably the best QoL and lowest stress. Pick your patients, no call, no insurance/CMS headaches, set your own schedule, etc. Hard to beat if you like outpatient work. Even better if you don't prescribe meds as then there are no pharmacy headaches either.

Personally, I really don't like outpatient and have similar feelings as comp1. For me, I think the list from best to worst is as follows:

General inpatient* > C&L > ER > any outpatient for the "common" settings. For inpatient though, you have to have good support staff and reasonable or no call or just not give a crap about the care you give, as I've also seen plenty of inpatient positions/systems that I think would be a nightmare to work in.

 

[Celexa]

This is like asking "where's the best place to live?". The answer is so personal. There are some jobs that clearly suck--bad pay, insane volume, ****ty admin, abusive patients--but if you presume a semi-functional structure then it all becomes about personal preferences.

 

[Candidate2017]

Psych QOL and stress depend on your personality and what you negotiate.

For example, some hate inpatient, some love it. And even though inpatient is similar everywhere, the numbers (pay, patient cap, amount of call and weekends) vary greatly depending on your ability to negotiate with The Man. The numbers affect QOL and stress. It is not uncommon to run across inpatient docs who work fewer days, see fewer patients, do not do call or weekends, but get paid much more that other docs who work M-F, see more patients and consults, and do call/weekends.

Outpatient probably has the greatest variability in work and patient pop. It seems to me a good percentage of outpatient docs avoid stress simply by doing whatever patients want, namely dispense stims and benzos to 3-4 patients an hour, and seek to increase QOL with money.

There's so much variability in psych, which is our blessing and curse. I feel after 1-5 days on a med or surgical rotation in med school gave me a good idea of what to expect in those specialties. IM does IM things, ortho does ortho things, etc. Whereas psych does inpatient psych, and then who the heck knows what each psych doc does in other settings.

 

[Merovinge]

My personal experience is that PHP/IOP jobs almost always have the fewest patient encounters per week of any practice setting (other than hardcore forensic/state mental health where pt's are seen weekly to monthly). 6-8 patients per day (for 30 min apts) is pretty industry standard. You do have to staff patients and have other clinical responsibilities and clearly patients are more sick than traditional OP practice, but I do think it's a great option for folks that want to see patients get better but with less patient care hours/day.

 

[annoyedpsychiatrist]

interesting how many people prefer inpatient to outpatient. I see so many hospitalist type inpatient psych jobs on the market these days. I guess the positive is you dont have to be a benzo/adderall mill for people, though I agree in that I imagine the variability of inpatient psych jobs is pretty significant. I can only imagine the hell of seeing 30 people with no social worker support or other competent staff in general.

I wonder with the cash only clinics if theres more pressure to overprescribe stimulants/benzos from leadership, unless its your own clinic

 

[Stagg737]

My personal experience is that PHP/IOP jobs almost always have the fewest patient encounters per week of any practice setting (other than hardcore forensic/state mental health where pt's are seen weekly to monthly). 6-8 patients per day (for 30 min apts) is pretty industry standard. You do have to staff patients and have other clinical responsibilities and clearly patients are more sick than traditional OP practice, but I do think it's a great option for folks that want to see patients get better but with less patient care hours/day.

I'd throw geri-psych in there too. Where I rotated it was a VA-affiliated geri-psych unit with a lot of dementia/NCD and with some sporadic unique cases (mania in a 85 yo, Huntington's psychosis, Charles Bonnet Syndrome, terminal delirium to name a few) and we wrote notes on patients once a week. We spent some time with most patients every day, but most didn't remember it anyway. Definitely a very laid back setting if you enjoy that population and have good support staff.

 

[allantois]

What do you find stressful? I find dealing with controls to be the greatest source of stress. I am able to screen those patients out in private practice. Inpatient would be good for this as well but the setting is depressing to me. Geripsych? They are all on BZOs and opioids down here.

 

[annoyedpsychiatrist]

What do you find stressful? I find dealing with controls to be the greatest source of stress. I am able to screen those patients out in private practice. Inpatient would be good for this as well but the setting is depressing to me. Geripsych? They are all on BZOs and opioids down here.

lately thats been a bit more stressful for me. Over half of my patients are geri and I get so many after benzos/adderall/ambien. There are a lot of positives to my job too though in fairness. The patient load is very fair, and i get 30 min follow ups. Just have months where my intakes are predominantly people seeking controlled substances

 

[ObsequiousAplomb]

My list is:

Mostly psychotherapy / solo PP outpatient > general outpatient med management > outpatient substance > IOP > Corrections > state hospital > acute inpatient > ER > CL.

give me a predictable schedule, as few non-MD superiors as possible, and I'm happy as a clam.

 

[wolfvgang22]

give me a predictable schedule, as few non-MD superiors as possible, and I'm happy as a clam.

You can say that again.

 

[PikminOC]

In pp outpatient I do see quite a lot of smi

 

[TexasPhysician]

Everyone has their own preferences.

I like to be busy and efficient. I prefer an outpatient scheduled to my specifics or inpatient/addiction center in which patients can be seen at my preferred speed.

High stress to me is overnight phone calls, slow clinics that take long hours, and SMI patients that keep “forgetting” to get labs.

 

[forchinet121]

Everyone has their own preferences.

I like to be busy and efficient. I prefer an outpatient scheduled to my specifics or inpatient/addiction center in which patients can be seen at my preferred speed.

High stress to me is overnight phone calls, slow clinics that take long hours, and SMI patients that keep “forgetting” to get labs.

Why stressful if SMI forget labs? SMI much less likely to sue they should be the easiest least stressful population in theory

 

[finalpsychyear]

PP: has the potential to be the best but it requires either you doing work during off time wknds or after hours or paying more to have that stuff done. I do my own pre auths and sometime even look up the insurance info on patients as staff has screwed it up a few times. You can pay more for better staff as well but I only do part time so i can do this. In terms of control, scheduling, vacation and not putting up with any patients or staff you don't want to work there is no question. It takes time and effort to build.

Telepsych: I mean it can be also very good. You don't have to interact much with staff if you do a pure one. I do a hybrid blend. No guarantee how long your gig lasts if it's a pure role.

Academics: If residency was any indicator I would never want to be in a place like that again. Maybe a different story for attendings.
VA: I have considered this in the future as a post FI role. Less pay but pretty chill from what i have heard.

 

[whopper]

IMHO the lowest stress job I've seen if you don't give a $hit-work at a state hospital. Your patients won't get better, but you don't have to do $hit during the job and they won't fire you.

Yeah I know this is terrible but this is the answer to the question asked. Of course you not giving a $hit has to literally be to antisocial levels, but that's besides the point. I couldn't stand it. I left about 3 years. Why I stayed so long was cause it was a good learning experience and the hospital wanting to keep me, gave me the best staff members in the hospital. I loved those staff members and I'm friends with many of them to this day despite that this was over 10 years ago.

One question asked was why not stay and work on fixing it? Well aside that you could do that-spend hundreds of hours, and none of that will end up profiting you other than the self-satisfaction, the system itself needs to be fixed and most of that dysfunctional stuff going on is built into the laws and there's no way in heck you're going to get the laws changed. Another reason why is that I learned that the high up people in the hospital would stick your neck out to be chopped off if the crap hit the fan. E.g. a buddy of mine was a rank above me, crap hit the fan and he didn't do anything wrong, he was sued by a patient, and despite that the hospital was supposed to provide him with the malpractice lawyer, they refused to pay for one. When he told them they were in breach of contract they told him they're the state, go ahead and try to sue them and see what happens. So either spend the next 10 years in court trying to get them to pay for the lawyer you need here and now or pay for one yourself. Of course you could sue the state for the price of the lawyer-and that'll take over a decade while you spend 6 figures on that case. You may even win and only win what you paid the lawyer while you spent thousands of hours on that case where you didn't get paid for that time.

He paid for his own lawyer, and once that issue wrapped up he got out of that job. Then guess what? They asked me to take his job. Eff them. No way.

That same place kept advertising "yeah your pay is lower but you don't have to pay for malpractice insurance." WTF.

Now some of you will then say "well you're selfish cause you didn't want to fix the situation." Screw you. I spent hundreds of hours fixing stuff that as soon as I left pretty much fell to crap cause I couldn't get the legislation on how this hospital was dysfunctional changed. Also I got kids. I owe it to them to actually be home when I can, raise them, and be able to pay for their college tuition. I enjoyed playing the role of Hawkeye for a few years, but when I had kids, no I owe it to them to actually look out for myself cause in doing so I'm looking out for them.

Another eff you they did to me was the hospital had thing where they'd pay over $10K of your student loans a year and the first year I was there, despite that this was written into policy the hospital CEO refused to pay me the -in my contract- student loan assistance, over $10K amount. I was the first doctor where they ever did this. Why? Literally cause she was saying that cause I was a good doctor I'd be out of there ASAP, so the entire purpose of this loan-help was to retain doctors, and good doctors get the hell out of there ASAP. Well in a way she was right....

So the bottom line is state hospital is low stress if you're a selfish sociopathic doctor who doesn't care, and only work for an employer that you know will stick up for you if the crap hits the fan.

 

[finalpsychyear]

IMHO the lowest stress job I've seen if you don't give a $hit-work at a state hospital. Your patients won't get better, but you don't have to do $hit during the job and they won't fire you.

Yeah I know this is terrible but this is the answer to the question asked. Of course you not giving a $hit has to literally be to antisocial levels, but that's besides the point. I couldn't stand it. I left about 3 years. Why I stayed so long was cause it was a good learning experience and the hospital wanting to keep me, gave me the best staff members in the hospital. I loved those staff members and I'm friends with many of them to this day despite that this was over 10 years ago.

One question asked was why not stay and work on fixing it? Well aside that you could do that-spend hundreds of hours, and none of that will end up profiting you other than the self-satisfaction, the system itself needs to be fixed and most of that dysfunctional stuff going on is built into the laws and there's no way in heck you're going to get the laws changed. Another reason why is that I learned that the high up people in the hospital would stick your neck out to be chopped off if the crap hit the fan. E.g. a buddy of mine was a rank above me, crap hit the fan and he didn't do anything wrong, he was sued by a patient, and despite that the hospital was supposed to provide him with the malpractice lawyer, they refused to pay for one. When he told them they were in breach of contract they told him they're the state, go ahead and try to sue them and see what happens. So either spend the next 10 years in court trying to get them to pay for the lawyer you need here and now or pay for one yourself. Of course you could sue the state for the price of the lawyer-and that'll take over a decade while you spend 6 figures on that case. You may even win and only win what you paid the lawyer while you spent thousands of hours on that case where you didn't get paid for that time.

He paid for his own lawyer, and once that issue wrapped up he got out of that job. Then guess what? They asked me to take his job. Eff them. No way.

That same place kept advertising "yeah your pay is lower but you don't have to pay for malpractice insurance." WTF.

Now some of you will then say "well you're selfish cause you didn't want to fix the situation." Screw you. I spent hundreds of hours fixing stuff that as soon as I left pretty much fell to crap cause I couldn't get the legislation on how this hospital was dysfunctional changed. Also I got kids. I owe it to them to actually be home when I can, raise them, and be able to pay for their college tuition. I enjoyed playing the role of Hawkeye for a few years, but when I had kids, no I owe it to them to actually look out for myself cause in doing so I'm looking out for them.

Another eff you they did to me was the hospital had thing where they'd pay over $10K of your student loans a year and the first year I was there, despite that this was written into policy the hospital CEO refused to pay me the -in my contract- student loan assistance, over $10K amount. I was the first doctor where they ever did this. Why? Literally cause she was saying that cause I was a good doctor I'd be out of there ASAP, so the entire purpose of this loan-help was to retain doctors, and good doctors get the hell out of there ASAP. Well in a way she was right....

Yikes. VA sounds far better with less risk. Also, IMO the solution ultimately is to work your ass off while young and taper down as you hit your 40s. Once you got FI AKA FU money in the bank every job is great. If it's not you walk. Simple as that. That is my ultimate goal. I still need to define FI. For example if we had 5m in the market making 5-6 percent average over 5-10 years who really cares about your work income. Just need to get there someday first.

 

[whopper]

I do know some good doctors who work for the state, and they till will echo what I say. The way they handle it is yes, there's docs who suck, and those docs aren't being fired, but they stick with the job cause it's steady, they get a good pension if they work there long enough, and they try to do a good job on their own patients, while learning to accept they cannot fix the system and "let go" of worrying and being upset with the bad docs on the other units.

This is not a criticism of them. You cannot permanently fix that situation. To fix that you'd have to fix the nationwide shortage of psychiatrists, the profession-wide problem of poor compensation, and that fact that state institutions don't run efficiently, and, well ahem kill the evil in the hearts of people.

I work in private practice where the pay is great, and I don't have to deal with the BS from other doctors as much. Yes I still have to deal with it but not as much. In hospital it was daily and sometimes multiple times a day. In private practice it's about once a week to monthly.

FI AKA FU money in the bank every job is great.

My last job I walked out of, and I had my private practice during this time was as a medical director for a local addiction clinic. The owner wanted me to do stuff that I wasn't sure was legal. I told him no way. He even hired a lawyer to make sure it was legal and that lawyer, after dozens of hours of research, couldn't say if it was legal or not. So no way.

So the owner still wants this stuff done and never once did I feel any independence-pressure. I still got my practice. I don't need them. They need me. They replaced me as the medical director. Fine. I'LL LET THE DOOR HIT MY ASS ON THE WAY OUT. Now this new medical director is trying to push the medical staff to do the thing that we weren't sure was legal or not. Not my problem. I'm out of there. I already told people my opinion. Get out of there if they ask you to do anything you don't feel is right.

 

[finalpsychyear]

Like I've said the closer you get to FI it makes whatever job you have that much better. A stressful 5 day job could be easily cut back to 3 days max as you near FI. I think that is the overall solution to whatever job you have. I probably have the most job satisfaction now even though I work about 50 clinical hours a week, the most i have ever done, but the closer I get to my future goals I feel better and better. Also I have not worked a wknd, night or holiday since year 1 a few prn shifts post residency.

I will also add that I spend a lot of time learning finance, investing, etc. At least 1 hour a day 7 days/wk for many years now. I also believe after doing this for the last several years I don't invest primarily in index funds so it has expedited my path to FI. Index funds in the last 5 years like VTI from vanguard would have given you a cumulative return of 48%. I am big into the FAANG stocks and tesla so it is nothing outrageous that no one knows about.

 

[forchinet121]

I do know some good doctors who work for the state, and they till will echo what I say. The way they handle it is yes, there's docs who suck, and those docs aren't being fired, but they stick with the job cause it's steady, they get a good pension if they work there long enough, and they try to do a good job on their own patients, while learning to accept they cannot fix the system and "let go" of worrying and being upset with the bad docs on the other units.

This is not a criticism of them. You cannot permanently fix that situation. To fix that you'd have to fix the nationwide shortage of psychiatrists, the profession-wide problem of poor compensation, and that fact that state institutions don't run efficiently, and, well ahem kill the evil in the hearts of people.

I work in private practice where the pay is great, and I don't have to deal with the BS from other doctors as much. Yes I still have to deal with it but not as much. In hospital it was daily and sometimes multiple times a day. In private practice it's about once a week to monthly.


My last job I walked out of, and I had my private practice during this time was as a medical director for a local addiction clinic. The owner wanted me to do stuff that I wasn't sure was legal. I told him no way. He even hired a lawyer to make sure it was legal and that lawyer, after dozens of hours of research, couldn't say if it was legal or not. So no way.

So the owner still wants this stuff done and never once did I feel any independence-pressure. I still got my practice. I don't need them. They need me. They replaced me as the medical director. Fine. I'LL LET THE DOOR HIT MY ASS ON THE WAY OUT. Now this new medical director is trying to push the medical staff to do the thing that we weren't sure was legal or not. Not my problem. I'm out of there. I already told people my opinion. Get out of there if they ask you to do anything you don't feel is right.

What kind of stuff did he want you to do?

 

[psychemdoc]

IMHO the lowest stress job I've seen if you don't give a $hit-work at a state hospital. Your patients won't get better, but you don't have to do $hit during the job and they won't fire you.

Yeah I know this is terrible but this is the answer to the question asked. Of course you not giving a $hit has to literally be to antisocial levels, but that's besides the point. I couldn't stand it. I left about 3 years. Why I stayed so long was cause it was a good learning experience and the hospital wanting to keep me, gave me the best staff members in the hospital. I loved those staff members and I'm friends with many of them to this day despite that this was over 10 years ago.

One question asked was why not stay and work on fixing it? Well aside that you could do that-spend hundreds of hours, and none of that will end up profiting you other than the self-satisfaction, the system itself needs to be fixed and most of that dysfunctional stuff going on is built into the laws and there's no way in heck you're going to get the laws changed. Another reason why is that I learned that the high up people in the hospital would stick your neck out to be chopped off if the crap hit the fan. E.g. a buddy of mine was a rank above me, crap hit the fan and he didn't do anything wrong, he was sued by a patient, and despite that the hospital was supposed to provide him with the malpractice lawyer, they refused to pay for one. When he told them they were in breach of contract they told him they're the state, go ahead and try to sue them and see what happens. So either spend the next 10 years in court trying to get them to pay for the lawyer you need here and now or pay for one yourself. Of course you could sue the state for the price of the lawyer-and that'll take over a decade while you spend 6 figures on that case. You may even win and only win what you paid the lawyer while you spent thousands of hours on that case where you didn't get paid for that time.

He paid for his own lawyer, and once that issue wrapped up he got out of that job. Then guess what? They asked me to take his job. Eff them. No way.

That same place kept advertising "yeah your pay is lower but you don't have to pay for malpractice insurance." WTF.

Now some of you will then say "well you're selfish cause you didn't want to fix the situation." Screw you. I spent hundreds of hours fixing stuff that as soon as I left pretty much fell to crap cause I couldn't get the legislation on how this hospital was dysfunctional changed. Also I got kids. I owe it to them to actually be home when I can, raise them, and be able to pay for their college tuition. I enjoyed playing the role of Hawkeye for a few years, but when I had kids, no I owe it to them to actually look out for myself cause in doing so I'm looking out for them.

Another eff you they did to me was the hospital had thing where they'd pay over $10K of your student loans a year and the first year I was there, despite that this was written into policy the hospital CEO refused to pay me the -in my contract- student loan assistance, over $10K amount. I was the first doctor where they ever did this. Why? Literally cause she was saying that cause I was a good doctor I'd be out of there ASAP, so the entire purpose of this loan-help was to retain doctors, and good doctors get the hell out of there ASAP. Well in a way she was right....

So the bottom line is state hospital is low stress if you're a selfish sociopathic doctor who doesn't care, and only work for an employer that you know will stick up for you if the crap hits the fan.

Really appreciate you highlighting this, Whopper. Often a lot of intangible benefits that are promised aren’t nearly as good as getting it in cold hard cash right away. Important reminder for sure.

 

[untapped]

I think I've gotten pretty lucky with my 1st gig out of residency. VA outpatient, 4 days a week only 1 in person and rest tele, typically 6-10 patients a day, 30 min f/u and 1 hour new, intakes are done already by a therapist on the team so new patients have a full history already written. Great support staff - therapists, social workers, pharmacy, etc. Very easy to refer patients to individual therapy, groups, rehab, residential, etc. I'm at an ancillary site so a lot of the complex patients get referred to the main VA academic site. Very little benzo seeking since these patients already know that VA docs generally will not prescribe them.

My work stress is extremely low. Sometimes I wonder if I should have taken one of the inpatient offers where I could make 350k+, but working from home with a light schedule is so cushy. I do have 2 weekend calls a year which are very easy w/ residents doing all the notes. I realized I'm also happier working with better functioning patients with depression, anxiety, PTSD, etc, rather than SMI.

My good friend in residency stayed in MCOL midwest metro and makes 75-100k more than me working inpatient w/ call, consults, supervising NPs, some outpatient for a community hospital. Obviously a great financial decision but he's not too happy with the job but sticking it out for a few years due to the contract incentives.

Also echo what Whopper said about state hospitals. I moonlighted at one in the midwest as a resident, and there were some attendings who worked hard and did a great job, and others who clearly didn't give a single **** and were there forever, probably doing 1-2 hours of bad work a day.

 

[nexus73]

Yikes. VA sounds far better with less risk. Also, IMO the solution ultimately is to work your ass off while young and taper down as you hit your 40s. Once you got FI AKA FU money in the bank every job is great. If it's not you walk. Simple as that. That is my ultimate goal. I still need to define FI. For example if we had 5m in the market making 5-6 percent average over 5-10 years who really cares about your work income. Just need to get there someday first.

how long does it take to get 5million dollars though. That’s more than many docs have at retirement age, let alone any earlier. I doubt it’s doable by age 40. Maybe 50 to mid 50s.

 

[finalpsychyear]

how long does it take to get 5million dollars though. That’s more than many docs have at retirement age, let alone any earlier. I doubt it’s doable by age 40. Maybe 50 to mid 50s.

Doing it by age 40 would not only be tied to a consistently high income but also investments that grew considerably more than the market average so someone in neurosurgery, ortho, interventional cards could maybe get there but those guys aren't earning until hmm 32-34 if they basically had a straight run with no gaps, no research years etc. It would also require some considerable saving and investing of a high 6 figure salary with loans, family, etc on the way and maybe the doctor house with all that delayed gratification. Maybe a dual MD couple with one of them being a neurosurgery gets there but I think 50s is somewhat possible. More likely a a derm with a cosmetics practice with a only a 3 year residency and an army of midlevels could do it.

But even someone saving 300k post tax for 7 years getting 6 percent real returns only gets halfway there. You'd be 1 percent of the 1 percent to actually do that.

 

[finalpsychyear]

I think I've gotten pretty lucky with my 1st gig out of residency. VA outpatient, 4 days a week only 1 in person and rest tele, typically 6-10 patients a day, 30 min f/u and 1 hour new, intakes are done already by a therapist on the team so new patients have a full history already written. Great support staff - therapists, social workers, pharmacy, etc. Very easy to refer patients to individual therapy, groups, rehab, residential, etc. I'm at an ancillary site so a lot of the complex patients get referred to the main VA academic site. Very little benzo seeking since these patients already know that VA docs generally will not prescribe them.

My work stress is extremely low. Sometimes I wonder if I should have taken one of the inpatient offers where I could make 350k+, but working from home with a light schedule is so cushy. I do have 2 weekend calls a year which are very easy w/ residents doing all the notes. I realized I'm also happier working with better functioning patients with depression, anxiety, PTSD, etc, rather than SMI.

My good friend in residency stayed in MCOL midwest metro and makes 75-100k more than me working inpatient w/ call, consults, supervising NPs, some outpatient for a community hospital. Obviously a great financial decision but he's not too happy with the job but sticking it out for a few years due to the contract incentives.

Also echo what Whopper said about state hospitals. I moonlighted at one in the midwest as a resident, and there were some attendings who worked hard and did a great job, and others who clearly didn't give a single **** and were there forever, probably doing 1-2 hours of bad work a day.

I had a VA option right from the get go offered to me. I can't recall the comp maybe 200-220 ish ( in 2016) and i was going to build a PP on the side. I wanted the quickest path to FI so i had to turn down this route but if i was looking for a chill work for 25 year plan option this was def an option. I may circle back to the VA down the line as I think you get lifetime healthcare for you after 10 years of service?

 

[untapped]

I can't recall the healthcare benefits but the comp is higher than you were offered. 275k+ for 40 hours technically but really about 20 hours of actual work. If I could get to a fully tele VA gig, I imagine that's one of the most lifestyle friendly full time jobs. On my tele days I can get a lot of errands done, laundry, cleaning, gym, netflix, etc.

 

[whopper]

What kind of stuff did he want you to do?

Don't feel like saying it on the forum. Reason why is some people on the forum know who I am, and while I did nothing wrong there is such a thing as bad guys don't want good guys talking so they pay lawyers to try to ruin them. Believe me, what was supposed to be done by the good guys was already done with no effect with the good guys either leaving the clinic or being replaced.

 

[wolfvgang22]

I had a VA option right from the get go offered to me. I can't recall the comp maybe 200-220 ish ( in 2016) and i was going to build a PP on the side. I wanted the quickest path to FI so i had to turn down this route but if i was looking for a chill work for 25 year plan option this was def an option. I may circle back to the VA down the line as I think you get lifetime healthcare for you after 10 years of service?

5 years. Many doctors work at the VA for the last 5 years of their career, because this enables you to get FEHB (federal health insurance) for life at the same rate you would pay as an employee. Federal insurance options include about 7 insurance companies that each have 4 to 6 types of plans available. Blue Cross, Cigna, United, GEHA, APWU, just to name a few.

 

[finalpsychyear]

5 years. Many doctors work at the VA for the last 5 years of their career, because this enables you to get FEHB (federal health insurance) for life at the same rate you would pay as an employee. Federal insurance options include about 7 insurance companies that each have 4 to 6 types of plans available. Blue Cross, Cigna, United, GEHA, APWU, just to name a few.

1. Just curious how much this costs for 1 person or a family of 4 per month?
2. After 5 years do you and your family get this for life or just you?

I pay 1000/mo for my spouse and I and it keeps going up every year. Kid probably in a year or 2.

 

[wolfvgang22]

I can't recall the healthcare benefits but the comp is higher than you were offered. 275k+ for 40 hours technically but really about 20 hours of actual work. If I could get to a fully tele VA gig, I imagine that's one of the most lifestyle friendly full time jobs. On my tele days I can get a lot of errands done, laundry, cleaning, gym, netflix, etc.

The VA isn't really chill for me. I get nothing not work related done on my teleworking days with the VA because I am scheduled 30 minute follow ups and 1 or 2 new patients back to back all day. Many days I don't get a lunch or other break. The documentation burden is insane, and makes documentation for one VA patient take as long as 4 non-VA patients. Also, I am the guy all the complex patients from the outlying VA clinics get referred to. I direct a MHICM team (same thing as an ACT team.) I run a suboxone clinic. I do teleworking now because I was otherwise going to quit. I no longer do call to the ER, or medical floor as I used to do, because I was going to quit. I suffered severe burn out and compassion fatigue before due to unreasonable expectations.

Productivity at my VA gets stressed as important, with wRVU tracking not because it brings revenue but because some folks in administration don't like the idea of "lazy government workers" and demand to see wRVUs comparable to private hospital clinics for political reasons.

While our schedules are full, the VA requires our outpatient clinic to function both as a traditional outpatient clinic and as a psychiatric urgent care that will see any patient whenever they walk in for any reason, including non-urgent concerns like "I lost my meds" or "I have had insomnia for 20 years", without hiring enough staff to see these walk-in patients. So the clinic is always right on the verge of becoming a chaotic psychiatric emergency room, and some days it basically is. I refuse to see walk in patients for non-urgent matters, but it is a battle every single day for the last decade because all the support staff like nurses and front desk are strongly encouraged to never say "no" to a veteran patient for any reason. I have trained nursing how to triage and they can do it well, but the VA doesn't allow them to do their job.

I'm not saying this is the worst job or anything, I like the large array of services we have like IOP and inpatient rehab and in house therapy and social work and nursing. I like having federal holidays off, and federal benefits are decent. Like I said, I do a lot of telework now. Im still recovering from severe burnout. Most importantly, I get to live near extended family. If not for that strong motivator I might not still be here.

 

[wolfvgang22]

1. Just curious how much this costs for 1 person or a family of 4 per month?
2. After 5 years do you and your family get this for life or just you?

I pay 1000/mo for my spouse and I and it keeps going up every year. Kid probably in a year or 2.

1. I pay about $775 monthly for a family of 5. I chose a high deductible health plan because we are largely healthy and I invest a lot of my HSA funds. When I had the low deductible, no copay plan 2 years ago I think it was like $1,000 monthly for us.

2. Whole family, I think. It's usually just your spouse though because kids grow up, obviously. Also, your spouse keeps federal health insurance (FEHB) for life after you die as long as they pay the premium. You can also change insurance every year just like employees still working.

 

[untapped]

The VA isn't really chill for me. I get nothing not work related done on my teleworking days with the VA because I am scheduled 30 minute follow ups and 1 or 2 new patients back to back all day. Many days I don't get a lunch or other break. The documentation burden is insane, and makes documentation for one VA patient take as long as 4 non-VA patients. Also, I am the guy all the complex patients from the outlying VA clinics get referred to. I direct a MHICM team (same thing as an ACT team.) I run a suboxone clinic. I do teleworking now because I was otherwise going to quit. I no longer do call to the ER, or medical floor as I used to do, because I was going to quit. I suffered severe burn out and compassion fatigue before due to unreasonable expectations.

Productivity at my VA gets stressed as important, with wRVU tracking not because it brings revenue but because some folks in administration don't like the idea of "lazy government workers" and demand to see wRVUs comparable to private hospital clinics for political reasons.

While our schedules are full, the VA requires our outpatient clinic to function both as a traditional outpatient clinic and as a psychiatric urgent care that will see any patient whenever they walk in for any reason, including non-urgent concerns like "I lost my meds" or "I have had insomnia for 20 years", without hiring enough staff to see these walk-in patients. So the clinic is always right on the verge of becoming a chaotic psychiatric emergency room, and some days it basically is. I refuse to see walk in patients for non-urgent matters, but it is a battle every single day for the last decade because all the support staff like nurses and front desk are strongly encouraged to never say "no" to a veteran patient for any reason. I have trained nursing how to triage and they can do it well, but the VA doesn't allow them to do their job.

I'm not saying this is the worst job or anything, I like the large array of services we have like IOP and inpatient rehab and in house therapy and social work and nursing. I like having federal holidays off, and federal benefits are decent. Like I said, I do a lot of telework now. Im still recovering from severe burnout. Most importantly, I get to live near extended family. If not for that strong motivator I might not still be here.

Sorry to hear that wolfgang. Seems like the VA really is location dependent. I know one of my colleagues who got hired recently to a busier site has a heavier workload and has to go into the office more frequently. I don't think he's getting paid any more than I am. Personally, I'm not necessarily committed to the VA long term. If they overload my schedule or force me back in the office, I'll just quit and find another job.

 

[the5thelement]

In my experience county outpatient jobs are the best (compared to VA or state). VA - I just couldnt get any professional satisfaction as it seemed the patients with service connections would not get better no matter what i did. The notifications were annoying and never ending and I have heard they have gotten worse. Still the CPRS worked as intended and the staff were mostly great!

 

[TexasPhysician]

Why stressful if SMI forget labs? SMI much less likely to sue they should be the easiest least stressful population in theory

Personal preference. I enjoy educating/counseling patients, and I want patients that will listen and attempt to utilize new skills. I don’t expect perfection, but I do expect effort. I want those invested in their health enough to get labs and try positive lifestyle changes. The more someone doesn’t listen, doesn’t comply, or doesn’t try, the more I feel that patient would be better suited with a PCP refilling meds and doing physicals/labs there. I’d argue that you don’t need a specialist like me to just refill meds.

 

[Merovinge]

My list is:

Mostly psychotherapy / solo PP outpatient > general outpatient med management > outpatient substance > IOP > Corrections > state hospital > acute inpatient > ER > CL.

give me a predictable schedule, as few non-MD superiors as possible, and I'm happy as a clam.

Having never done solo PP but plans at some point to do so:
Solo PP> PHP/IOP > Shift ER work without nights > IP without call > employed OP on RVUs/insurance based > ER/IP with call > punching myself in the face repeatedly > CL.

 

[erg923]

The VA isn't really chill for me. I get nothing not work related done on my teleworking days with the VA because I am scheduled 30 minute follow ups and 1 or 2 new patients back to back all day. Many days I don't get a lunch or other break. The documentation burden is insane, and makes documentation for one VA patient take as long as 4 non-VA patients. Also, I am the guy all the complex patients from the outlying VA clinics get referred to. I direct a MHICM team (same thing as an ACT team.) I run a suboxone clinic. I do teleworking now because I was otherwise going to quit. I no longer do call to the ER, or medical floor as I used to do, because I was going to quit. I suffered severe burn out and compassion fatigue before due to unreasonable expectations.

Productivity at my VA gets stressed as important, with wRVU tracking not because it brings revenue but because some folks in administration don't like the idea of "lazy government workers" and demand to see wRVUs comparable to private hospital clinics for political reasons.

While our schedules are full, the VA requires our outpatient clinic to function both as a traditional outpatient clinic and as a psychiatric urgent care that will see any patient whenever they walk in for any reason, including non-urgent concerns like "I lost my meds" or "I have had insomnia for 20 years", without hiring enough staff to see these walk-in patients. So the clinic is always right on the verge of becoming a chaotic psychiatric emergency room, and some days it basically is. I refuse to see walk in patients for non-urgent matters, but it is a battle every single day for the last decade because all the support staff like nurses and front desk are strongly encouraged to never say "no" to a veteran patient for any reason. I have trained nursing how to triage and they can do it well, but the VA doesn't allow them to do their job.

I'm not saying this is the worst job or anything, I like the large array of services we have like IOP and inpatient rehab and in house therapy and social work and nursing. I like having federal holidays off, and federal benefits are decent. Like I said, I do a lot of telework now. Im still recovering from severe burnout. Most importantly, I get to live near extended family. If not for that strong motivator I might not still be here.

This really stinks. Traditionally, tele-work allows for dishes, vacuuming, errands as needed, child school events, etc. Not saying VA needs to make room for a quick 9 on the course mind you but... the 8a-4:30p thing is not really tele-work/WFH minded as it may be in many other places? Can really you not have any off hours appts from that schedule even though you are tele? That seems very wasteful for the VA?

 

[Monocles]

That same place kept advertising "yeah your pay is lower but you don't have to pay for malpractice insurance." WTF.

Whoa this place deserves a name and shame

 

[whopper]

Whoa this place deserves a name and shame

Private message me and I'll tell you.

 

[comp1]

Telework allows for child school events while on the clock? That seems like it might be reaching a bit much for a salaried position. For full time clinical positions, the VA expects 80% bookability, meaning ~64 hours in a 2 week pay period should be dedicated and scheduled for follow-ups or intakes. This might slightly vary if you have residents doing the direct patient care under you, but it's about that. Of course you can use sick leave when needed in the middle of the day. It does have to be in hour long blocks for physicians. Schedules aren't always 8-4:30 M-F outpatient. They can often be a lot of different combinations with regular days off when you extend the schedules of other work days.

 

[erg923]

Telework allows for child school events while on the clock? That seems like it might be reaching a bit much for a salaried position. For full time clinical positions, the VA expects 80% bookability, meaning ~64 hours in a 2 week pay period should be dedicated and scheduled for follow-ups or intakes. This might slightly vary if you have residents doing the direct patient care under you, but it's about that. Of course you can use sick leave when needed in the middle of the day. It does have to be in hour long blocks for physicians. Schedules aren't always 8-4:30 M-F outpatient. They can often be a lot of different combinations with regular days off when you extend the schedules of other work days.

Yes old timer, tele-work should allow for a flexible patient appt schedule. That is the whole point. This "On the Clock" mentality is gobment silliness and is on the way out. I assure you. Stop saying that.

Let's allow flexibility of schedule, please? Work when you and patients need.

 

[comp1]

I must be going demented because I'm not understanding. Slots will always be immediately filled if the schedule is opened up to be scheduled into. There is a vast backlog of patients to be seen, just like everywhere else. Are you describing some sort of part time or per diem work? We've tried scheduling patients much before 7 AM or after 6:30 PM and it just results in horrible no show rates. There has to be a schedule for outpatient...I'm just confused. I'm not sure how outpatient can be done any way other than "on the clock." You could theoretically do inpatient in some sort of when you're free way, rounding and then leaving. But outpatient...you have to schedule the patient so they know when to come...

 

[wolfvgang22]

Yes old timer, tele-work should allow for a flexible patient appt schedule. That is the whole point. This "On the Clock" mentality is gobment silliness and is on the way out. I assure you. Stop saying that.

Let's allow flexibility of schedule, please? Work when you and patients need.

Many politicians aren't really in favor of making the VA a good place to work (as they beleive private industry would do a better job) and like to "crack the whip" metaphorically speaking on federal employees. Some even believe the VA should be privatized. In fact, the democrat appointed VA secretary has recently revealed plans to limit teleworking in the Washington D.C. area to no more than 5 days every 2 weeks starting this fall with a promise to look at other regions later, and he's supposedly one of the VA's supporters.

They try every 6 months or so to have me see patients during my one break I get each day during lunch. I am supposed to get a 30 minute lunch break, but I take an hour with the clear communication that I will quit if I am scheduled patients during lunch. They do constantly send me instant messages during my lunch. I ignore them until I return to my desk. When on campus, I get curb-sided by every nurse, doctor, and social worker that sees me about some complicated patients on the way to the restroom. Which is another reason I do more teleworking now. I don't mind working hard, but I'm human with human body processes and the VA doesn't get that.

 

[erg923]

I must be going demented because I'm not understanding. Slots will always be immediately filled if the schedule is opened up to be scheduled into. There is a vast backlog of patients to be seen, just like everywhere else. Are you describing some sort of part time or per diem work? We've tried scheduling patients much before 7 AM or after 6:30 PM and it just results in horrible no show rates. There has to be a schedule for outpatient...I'm just confused. I'm not sure how outpatient can be done any way other than "on the clock." You could theoretically do inpatient in some sort of when you're free way, rounding and then leaving. But outpatient...you have to schedule the patient so they know when to come...

My weird uncle thinks the government is trying to kill him. He's nuts. The usual text from family is that is he is indeed "nuts" and should be forcibly placed into a "smelly home for the clinically goofy."

Can't say I really disagree here.

 

[comp1]

Okay, I'm probably just being messed with, but what I'm guessing is that you're describing something where you just make your own schedule and the VA just tracks your RVUs and somehow ties your pay to some sort of base RVU? That seems to more describe a contractor than an employee. You can definitely enter into a community care contract with the VA. The VA is still a very good place to work as an employee (even if apparently the future is beyond time). There are completely online positions (not subject to what is described by the VA secretary). They're coveted and competitive, but they exist. That said, the VA still has an older than average age population. Patients REPEATEDLY describe on every survey we get that they want an in person option. It's not possible to move the entire system to 100% virtual.

 

[erg923]

Okay, I'm probably just being messed with, but what I'm guessing is that you're describing something where you just make your own schedule and the VA just tracks your RVUs and somehow ties your pay to some sort of base RVU? That seems to more describe a contractor than an employee. You can definitely enter into a community care contract with the VA. The VA is still a very good place to work as an employee (even if apparently the future is beyond time). There are completely online positions (not subject to what is described by the VA secretary). They're coveted and competitive, but they exist. That said, the VA still has an older than average age population. Patients REPEATEDLY describe on every survey we get that they want an in person option. It's not possible to move the entire system to 100% virtual.

Some people just have to be dragged kicking and screaming. This is just how society progresses. Get with the times, Gramps!

 

[forchinet121]

Some people just have to be dragged kicking and screaming. This is just how society progresses. Get with the times, Gramps!

What are you talking about

 

[erg923]

What are you talking about

Talkin bout you, son.