Income from ECT?

[heyjack70]

Does anyone on the forum do ECT? Is it a cost effective addition to an inpatient practice, or is a psychiatrist better off not doing ECT and referring it out? I'm asking from the perspective of a hospital employed doctor paid by production. I'm interested in this for a few reasons, the least of which is money. First, ECT nearby is limited and it would be nice to have it available. Second, the hospital is hiring NP's and I think getting an ECT program going is a way to hedge against them replacing psychiatrists with NP's. Third, if it is good for income that's a bonus. The only things really arguing against offering ECT would be having enough psychiatrists to cover an ECT service to allow for vacations, and if it is going to be a big time sink and money loser compared to typical inpatient work I probably wouldn't do it. I anticipate the hospital would be supportive because they compete with the larger health system nearby that offers ECT and they really hate "sending business" over to them.

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[Shikima]

I don't know about ECT or the income to be generated, but be wary of hospital administrators. They often can be quite dense and don't care about psychiatrists as long as the medicine/surgical services are happy and you are apart of that model.

 

[Bartelby]

I have worked with an ECT clinic. In that setup one psychiatrist was *the* ECT doctor for almost the whole area. Inpatients in the hospital could be wheeled down for ECT M-W-F mornings, and outpatients referred to that clinic would be brought during the same hours. The clinic runs from 8a to probably 11a and the psychiatrist, along with an anesthesiologist and nursing support, goes relatively quickly from one patient to the next. In that way in ~3 hours you could safely conduct ECT on 10-15 patients, possibly more. All of these patients are referred either by the inpatient unit or by a psychiatrist (I do not think he would accept referrals if the patient does not have a psychiatrist) and those providers have primary responsibility for the patient's overall care, although the psychiatrist does a full initial evaluation and monitors progress of the ECT specifically in tandem with the primary mental health provider(s). This allows for ECT to be offered as a service without requiring this one psychiatrist to assume full responsibility for every ECT-needing case in the region.

If you set up ECT this way I think it is probably quite lucrative, and it does provide a really valuable option for providers in your community. If you wanted to just be the person doing ECT on patients within your own panel or even for a single inpatient unit I do not think it would be worthwhile because such patients are relatively rare. You would need the volume to make up for the quite high overhead.

**One point of clarification: I did not run the clinic, just rotated through it.

 

[Dharma]

There's a pretty in depth thread somewhere here on the forum with a lot of breakdowns and a bit of back-n-forth. Give it a search.

 

[cookymonster]

I have worked with an ECT clinic. In that setup one psychiatrist was *the* ECT doctor for almost the whole area. Inpatients in the hospital could be wheeled down for ECT M-W-F mornings, and outpatients referred to that clinic would be brought during the same hours.

Sounds sustainable and safe, as long as the "ECT doctor" is working 52 weeks a year.

ECT is 2.5 RVU's. If you are part of a group, individual cases don't add up to much, but if you are doing it all morning (10 RVU's an hour), it can be quite lucrative and efficient.

 

[Shikima]

Sounds sustainable and safe, as long as the "ECT doctor" is working 52 weeks a year.

ECT is 2.5 RVU's. If you are part of a group, individual cases don't add up to much, but if you are doing it all morning (10 RVU's an hour), it can be quite lucrative and efficient.

What's the reimbursement per procedure?

 

[michaelrack]

Sounds sustainable and safe, as long as the "ECT doctor" is working 52 weeks a year.

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In real life, few in private practice takes 7 day vacations any more. But it should be possible for the "ECT doctor" to miss an occasional Monday or Friday (not both in a row and be off for 4 days at a time.

 

[Armadillos]

In real life, few in private practice takes 7 day vacations any more. But it should be possible for the "ECT doctor" to miss an occasional Monday or Friday (not both in a row and be off for 4 days at a time.

Ugh, psych needs to get back to its European roots and take a month every summer.

 

[Shikima]

Ugh, psych needs to get back to its European roots and take a month every summer.

I took 2 months this past summer, it was grand!