PhD/PsyD Dueling departments

[IT514]

So I happened to be the sole neuropsych representative at a meeting between departments when a hot topic came up. It was primarily about the time it takes for a presurgical eval to be placed to the time it takes for them to be seen. We average ~20 days for folks to be seen, with a less than 10 day turnaround, which is not good enough for our colleagues and they were talking about referring elsewhere. The meeting was awkward to say the least with me being the only one there as a fellow with somewhat limited authority and insight to really do anything. I think I handled it well overall but at times I felt attacked even though my work, and particularly my efficiency, has always been well received. I read b/n the lines that some egos (big ones) have been hurt in the past year, not my doing and totally outside of my control, but this added to the overall tension.

I'm wondering if anyone has been put in a similar position during their training - how was it handled? I brought it to my supervisor in the most diplomatic way I could. Also, for folks who do presurgical neuropsych evals (for whatever reason), are you aware of any info about average time from referral to appointment? I think that two weeks would be more than reasonable, after all we cant just sit and twiddle our thumbs waiting for a neurosurg consult when slots can be filled with reg. outpt appointments.

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[Therapist4Chnge]

Two weeks seems very reasonable. My colleague mostly handles our referrals and she shoots for <2wk. Sometimes there is pressure for a wk, but thankfully the surgeons value our input and know it can take some time to review the entire case.

*edit*

This is to turn around the report, not get seen for the initial interview/testing. I book out anywhere from 3-6+ wks, which for this type of assessment (SCS, DBS, etc) should be fine. I believe our neuro surgeons schedule at least a few months (up to 6+ months) in advance.

 

[WisNeuro]

What surgery is this for? Usually the surgery process is quite lengthy and they could just as easily refer with much greater lead time for non-emergent surgical needs.

 

[AcronymAllergy]

A two-week window from referral to being seen seems fine to me. Sounds like they need to tinker with things on their end to place the referral earlier in the process. I'm sure the person could be seen earlier in a private practice-type setting, but they're likely also going to be paying more.

Given that you mentioned neurosurgery, I'm going to imagine that these are either seizure or DBS-type evals...? If that's the case, I've worked in two hospitals that provided them, and never ran into a situation where the person was moved from eval to surgery in less than 3-6 months. Those surgeries in particular, as WisNeuro mentioned, seem to have a fairly length turnaround (in part because the pre-surgical case reviews can take a while to pull together). For something like organ transplant, I could possibly see the window being smaller, but that doesn't seem to be the case here.

Perhaps if that two-week window were set, and the report turnaround was a week? In all honesty, though, I think a month from beginning to end sounds very reasonable. Did they indicate what sort of timeline they had in mind?

 

[IT514]

Mostly DBS. The timeline for one of our neurosurgeons was a week for pt to be seen and a day to write the report, which is just stupid. Some of these guys are new to our system with gigantic egos. If it were up to me, which in a way it is b/c I've put my time into the rotation and can move on to the next, I would say you can go ahead and look elsewhere for a lapdog. I'm just not sure of the ripple effect, how other fellows might be affected, etc. I agree that an earlier referral is the solution to this, but again there seems to be more going on here than wanting a solution.

 

[WisNeuro]

This sounds like a planning problem on the part of the Neurosurgery department. They know about the surgical process months in advance. Just because they want to wait until the last moment to throw out a referral for testing, it shouldn't be your problem. But yeah, neurosurgeons tend to be a bit more on the dingus side than other specialties that I've interacted with. I'd try to play up the "as soon as someone becomes a surgical candidate, refer to neuropsych" card. If that doesn't work, they can go f themselves and see if they can get the services done anywhere else faster.

 

[Therapist4Chnge]

Mostly DBS. The timeline for one of our neurosurgeons was a week for pt to be seen and a day to write the report, which is just stupid.

Do you all meet as a team with any frequency? Our DBS team meets weekly (some weeks they cancel, but typically 3 out of 4 times a month) and it really helps keep track of who is being considered and who is not. Having an e-mail w. the candidates sent out weekly can be a good start, though an in person mtg really gets things sorted.

ps. We are lucky to have a very good admin staff to support the process. Everyone is so busy that it really falls on them to keep the communication going and updated.

 

[IT514]

Thanks for the replies. The feedback is in line with what I've also heard from similar institutions. I think it's more in their best interest than ours that they work with us for a simple solution. Our department was thriving long before these guys came along. If not, I'm fine with them going elsewhere, I just don't think they will find else out there.

 

[AcronymAllergy]

Could an 8-day turnaround be possible? Of course, if they're willing to help fund a spot for a neuropsychologist dedicated solely to their service. But outside of that, it's going to be an untenable and probably unreasonable timeline.

Mind you, I think neuropsych has in the past had a bad habit of drawing things out too much. After all, there's really no reason to need a month to write up a report in the typical medical center setting. But at least IMO, a one-week turnaround is entirely fair both for us and our referral sources. Mind you, this excludes things like inpatients for whom the team might need at least informal feedback within a day or two due to pending discharge. But heck, even in the organ transplant evals I've done, where the folks are very, very sick, a one-week turnaround has generally been more than fine.

 

[WisNeuro]

Could an 8-day turnaround be possible? Of course, if they're willing to help fund a spot for a neuropsychologist dedicated solely to their service. But outside of that, it's going to be an untenable and probably unreasonable timeline.

Mind you, I think neuropsych has in the past had a bad habit of drawing things out too much. After all, there's really no reason to need a month to write up a report in the typical medical center setting. But at least IMO, a one-week turnaround is entirely fair both for us and our referral sources. Mind you, this excludes things like inpatients for whom the team might need at least informal feedback within a day or two due to pending discharge. But heck, even in the organ transplant evals I've done, where the folks are very, very sick, a one-week turnaround has generally been more than fine.

I think a short turnaround time in this case is doable. These types of evals are pretty cookie cutter and generally have a set battery. A templated report could be made. I've done things like this in the past. I can score most of the tests while I test, maybe an extra 20-30 minutes when I'm done, plug and play the results into the template, takes less than 30 mins for the report as long as there aren't a lot of complicated findings.

I'd be more worried about scheduling the evals. That's where I'd hold my ground that it's on them to provide more lead time.

 

[AcronymAllergy]

I think a short turnaround time in this case is doable. These types of evals are pretty cookie cutter and generally have a set battery. A templated report could be made. I've done things like this in the past. I can score most of the tests while I test, maybe an extra 20-30 minutes when I'm done, plug and play the results into the template, takes less than 30 mins for the report as long as there aren't a lot of complicated findings.

I'd be more worried about scheduling the evals. That's where I'd hold my ground that it's on them to provide more lead time.

Agreed. Unless the hospital/department leads are willing to let the neuropsych folks essentially block off and hold clinic spots for potential neurosurgery evals so that they can get folks scheduled ASAP.

 

[IT514]

I think a short turnaround time in this case is doable. These types of evals are pretty cookie cutter and generally have a set battery. A templated report could be made. I've done things like this in the past. I can score most of the tests while I test, maybe an extra 20-30 minutes when I'm done, plug and play the results into the template, takes less than 30 mins for the report as long as there aren't a lot of complicated findings.

That's pretty much how I operate. I'm usually able to write the first part of the report during the interview with an epic template. I don't recommend that for beginners, but as I've gotten up to speed it saves some time. Most of these are done by the end of the day as long as other consults don't pop up.

 

[IT514]

I'd be more worried about scheduling the evals. That's where I'd hold my ground that it's on them to provide more lead time.

Yep, that's where we are with them. Again i think some departmental politics are making this way more complicated than is necessary.