Prison Physician?

[andrea]

Anyone know what kind of $ a family doc would make as a physician working in a prison? I can't find much on the web about it. What would be the pros and cons of working in a prison? Thanks for your help.

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[deleted87716]

What would be the pros and cons of working in a prison?

Pun intended?

 

[dc2md]

andrea, have you been watching too much Prison Break? are you looking for a hot inmate? ;-)

 

[Tone2002]

andrea, have you been watching too much Prison Break? are you looking for a hot inmate? ;-)

 

[Apollyon]

Believe it or not, one of three tracks at UTMB in Galveston in preventative medicine is a specialty track in "corrections medicine".

http://www.utmb.edu/cmc/Publications/articles_press/ProgramAward.asp

Now, yours is an interesting question, because, traditionally and stereotypically, "prison docs" have been those that REALLY can't speak English, docs who have lost their licenses for having sex with patients or felony convictions, and only get the license back under the condition of working in prisons, or those that REALLY don't give a damn, and are just "biding their time". In reality, some-to-much of that is true, but, also, there are some that have their hearts in it.

The money isn't great, because you're a state employee. There is also the risk of assault or injury from inmates, although this is minimized for a few reasons: first is that, depending on the inmate, they will be immobilized/restrained as needed to protect you (including a club-wielding CO (corrections officer) at arm's length), because, if they lose a doc, the doc is VERY hard to replace. Another reason is that the infirmary is "holy ground" or respite for most inmates, so, they won't bite the hand that feeds them.

On the other hand, malpractice? Good luck with a prisoner lawsuit. Even if you suck at your job, as long as you are not egregiously wrong (or, even if you are), you're essentially bullet-proof. You can do whatever the heck you want, and it's OK. However, if you are diligent, it can be frustrating not being able to do the best possible for the patients.

Also, lots and lots and LOTS of HIV/AIDS and TB. Also, you may come face to face with the sickest, meanest, most vile and evil people on the face of the earth.

 

[YouDontKnowJack]

since a prison only spend $1 per prisoner per day, how much do you guess a doc will make?

 

[lloyd braun]

I am a fourth year student planning to enter the correctional health care field. I have been doing a lot of research on the subject, and I am currently doing a correctional health care elective, so I can shed some light.

Prison doctors, from what I have heard from prison docs themselves, make about 150,000 a year. They also get great benefits, including no need for malpractice insurance (prisoners can only sue the department of corrections, not physicians personally), weekends/government holidays off, pretty good hours, minimal call, and excellent retirement. I have yet to talk to a prison physician who is unhappy. Most have frustrations, but all have been happy, overall. The inmates, for the most part, are really appreciative for what you do.

The disadvantages include working in an environment where security is the number one concern. This means having to work around lockdown/count, chow, and other security events. This could make your day a little longer than expected and could cause unexpected delays. Other disadvantages include having to work with a formulary that is pretty limited. You can usually request non-formulary drugs, but you usually have to show that the inmate has failed at least two formulary drugs before requesting non-formulary. Finally, you are required to maintain a bit of emotional and physical distance from the patient-inmates. It's not a big deal, but it seems a little weird to me to be discouraged from shaking the patient's hand and you are encouraged to call them "Inmate Jones" or just "Jones" instead of "Mr. Jones."

As far as the quality of physicians in the correctional health care field, the other poster was correct that the prisons used to be staffed by foreign doctors, doctors who had their licensed revoked, etc. However, the trend is turning around. Correctional health care is a growing field, with correctional medicine fellowships starting to pop up in various parts of the country.

Many people have misconceptions about the prison environment, mostly due to the popular media. Most inmates are not in shackles, and although corrections officers are usually not present in the exam room, they are always a few feet away. The majority of inmates are very pleasant and obedient and are in there for non-violent, drug-related crimes. There certainly are exceptions (and you would have to be able to deal with possible countertransference issues), but I have yet to feel threatened by any inmate or the environment itself.

I hope this helps. I'd be happy to answer any more questions.

 

[andrea]

Hey, thanks everyone for your replies! And yes, the pun was definitely intended. The reason I was asking is that I'm on the National Health Service Corps scholarship and am in my first year of residency. I've been checking out sites but it seems that a lot of the good locations are prisons. I never would have thought initially going into med school that I would be interested in that, but the more I think about it, there are a lot of nice benefits, such as those mentioned above. I think I would be worried that other docs might think I was not "good enough" to be in private practice, but at the same time it would be such a good service to be able to help those in bad circumstances (I am probably too naive). Thanks for the info.

 

[iatrosB]

Anyone know what kind of $ a family doc would make as a physician working in a prison? I can't find much on the web about it. What would be the pros and cons of working in a prison? Thanks for your help.

Cons...

TB infection is a big one!

 

[iatrosB]

I am a fourth year student planning to enter the correctional health care field. I have been doing a lot of research on the subject, and I am currently doing a correctional health care elective, so I can shed some light.

Prison doctors, from what I have heard from prison docs themselves, make about 150,000 a year. They also get great benefits, including no need for malpractice insurance (prisoners can only sue the department of corrections, not physicians personally), weekends/government holidays off, pretty good hours, minimal call, and excellent retirement. I have yet to talk to a prison physician who is unhappy. Most have frustrations, but all have been happy, overall. The inmates, for the most part, are really appreciative for what you do.

I hope this helps. I'd be happy to answer any more questions.

$150,000 seriously? Is this federal pens, state prisons, maxium/minimum security?

 

[FamilyMD]

$150,000 seriously? Is this federal pens, state prisons, maxium/minimum security?

I've seen many ads for $150k for prison docs, HOWEVER, private FP's average $169k. The only adv to being a prison doc would be lifestyle issues.

 

[f_w]

A lot of the prison systems actually contract the correctional healthcare out rather than hiring physicians and nurses directly. There are a couple of larger providers that cover several states.

During my residency, our hospital system held the correctional managed care contract. Funny enough, prison is the only place where you have a 'right to healthcare'. Our prisoners actually got better care inside than out, 'retail street pharmaceutical sales' just doesn't come with a healthplan. (We had one inmate with some factor 7d deficiency who knew that he would bleed to death unless he was in prison. Medicaid wouldn't cover the stuff. His drug cost for one admission to the hospital was 1.5mil and he singlehandedly managed to bankrupt the correctional managed care plan one year. The state tried to parole him out of prison a couple of times, every time he would violate his parole and make it back in.)

 

[f_w]

Cons...

TB infection is a big one!

You are right, TB control is a major concern in institutionalized settings. (Your risk of picking up TB is probably not different from the risk a pulmonologist or ID doc would face.)

 

[deleted6669]

a lot of these positions are on call with minimal on site time required. I know a few guys who get 2k/month to carry a pager and they have to "make rounds" once/week. that can be at 2 am every tuesday. no pts then? min 4 hrs pay for showing up= 16 billable hrs/month for generally < 4 hrs work.
one guy I know has 2 of these contracts in addition to his regular full time job....4k for 8 hrs work/month + fielding a few calls the answer to which is usually "have him evaluated at the emergency dept".
I also know a few folks who do full time corrections work. these are the guys who couldn't find other jobs where they wanted to live.....

 

[lloyd braun]

$150,000 seriously? Is this federal pens, state prisons, maxium/minimum security?

The docs I have talked to were in a state facility, medium to minimum security. My sample size is small, but I do seem to see 150K quoted elsewhere as well. If you really want to make money as a prison doc, become a psychiatrist. California is paying up to 300K for correctional psychiatrists.

Another point I didn't make in my previous post is the great need to approach correctional health care as a public health issue. The correctional population continually circulates from the prison setting to the community back to the prison setting, etc. The opportunities to treat infectious disease, mental illness, and substance abuse is great, and setting released inmates up with community follow-up (though this is very difficult) can be particularly rewarding.

 

[Doowai]

I did a psyche rotation in a state max security prison. I also spent a little time with the Im doctor there. Pro's and con's.
Pro's : you don't have to hire staff - its provided (law enforcement). You have no managerial headaches of your own office such as keeping toner in the copier, hiring/firing, sending W2's to employees at the end of the year, advertising etc. People keep their appointments. You are thankful everyday when you go home and walk out into the civilian world.Steady paycheck-for those with no business acumen this is a good thing.

Con's : your schedule can get thrown off when they have a head count and lockdown. You have no control over staff (prison gaurds). Every day you have to go through a security check more complicated than airport security. Crummy decorating. Scarey to go to the bathroom as you imagine all sorts of heptitis leaping out of the toilet on you. Working on your own your paycheck can vary depending on your patient load - in the prison no matter how busy you are your paycheck is the same.

 

[loveumms]

I just saw the topic on this thread and had to read it - I am actually not going into FP but, it intrigued me b/c I actually commened on this subject the other day.

I applied for the health services, was not accepted (and am very glad now b/c I actually decided to do a specialty that isn't included and would have been screwed). Anyway, I was very hesitant to go into the NHSP b/c I was told that prisions are a place that you could work so I talked to a variety of people.

My institution has a prision floor devoted just to those who need a higher level of care than can be given in the prision and I have found that some of the prisioners are easy to deal with, others are not (I have been spit on, cused at and hit on by some of the male inmates while on the floor). In talking with some others who have some experience in prisons I've heard that they can be really abuse towards the docs in the prision, especially woman. Some of the stories I heard are really gross. One of the doctors was urinated on, another told me that when she was walking through the holding block she would walk pass some of the cells and guys would pull out their genitals and act like they were jerking off and would say some really insulting things (hey baby, you want some of this ... hey sexy you know you wanna do me ... I'm sure you can imagine some of the other things said).

I guess if you can put up with those sorts of comments and deal then it would be alirght - and I'm sure that most of the inmates are respectful however, it would be the ones who are not that would really make it difficult to go to work!

 

[f_w]

My experience with the prisoners was generally that they where happy to be in the hospital rather than the prison (the hospital was known as the 'country club'). The ones who have a chance to get paroled where typically very polite, one thing they didn't need was an 'incident' in their files when the next parole hearing comes up.

The funny thing was how they came colour coded. Depending on what level of security they needed, they had either grey, green, orange or yellow jumpsuits. Depending on their colour code, they either came with one doughnut eater or a whole 6 man entourage (with 2 guys guarding the prisoner and 4 armed guards securing the perimeter against his gang-buddies who either want him dead or out).

 

[iatrosB]

My institution has a prision floor devoted just to those who need a higher level of care than can be given in the prision and I have found that some of the prisioners are easy to deal with, others are not (I have been spit on, cused at and hit on by some of the male inmates while on the floor). In talking with some others who have some experience in prisons I've heard that they can be really abuse towards the docs in the prision, especially woman. Some of the stories I heard are really gross. One of the doctors was urinated on, another told me that when she was walking through the holding block she would walk pass some of the cells and guys would pull out their genitals and act like they were jerking off and would say some really insulting things (hey baby, you want some of this ... hey sexy you know you wanna do me ... I'm sure you can imagine some of the other things said).

I guess if you can put up with those sorts of comments and deal then it would be alirght - and I'm sure that most of the inmates are respectful however, it would be the ones who are not that would really make it difficult to go to work!

Sounds like the ER.

 

[xviii]

Sounds like the ER.

OMG, it sure does! Especially those ERs that have contractual agreements with the local PD.

 

[andrea]

I got an email back from a prison doc in Springfield, MO, and here's what he wrote:

"I am a board certified family practice DO who graduated from the
Oklahoma College in 1981. I have been with the Bureau for 3 years,
currently serving in the capacity of Chief of the Medicine Department. I
manage 65 of the Bureaus most difficult cases in a hospital setting
simuliar to a hospitalists on the street. But I supervise 4 docs and 8
PAs who provide medical care to lesser ill inmates from the work cadre
inmates upward to my level.
A typical day for my department is start at 0700, out the door to home
at 1530, 1 week call every 12 weeks, all holidays off unless on call.
Typical other things of interest would include: fair but not extravant
salary, 2- 4 weeks vacation including 10 days of CME, $1500 CME money
annually if budgeted by Congress, Federal retirement program,
significant funding of health/life/dental/vison insurance. "

Not bad.....

 

[iatrosB]

I: fair but not extravant
salary,

Not bad.....

Wonder what this means. Otherwise, doesn't sound too bad.

 

[andrea]

Just wanted to check back and see if anyone has any new insight or info on what it's like to be a prison doc.... Thanks!

 

[andwhat]

Just wanted to check back and see if anyone has any new insight or info on what it's like to be a prison doc.... Thanks!

I Know of an FM/ER doc that does this as a side gig, its nice loot actually. Its mainly a side gig.

 

[secretwave101]

Had a preliminary recruiting conversation with a doc who oversees a bunch of the prisons in my area. Based on what he told me, I can corroborate the above posts.

Salary 150ish and excellent benefits which include a nice retirement if you spend the whole 20 in the system. Easy call, holidays off. He pointed out that if you ever were interested in treating the under-served, this is an ideal population because most of the patients are short-timers who are essentially without health care elsewhere. It's fulfilling to have some resources to help them.

His standards for hiring, he said, were pretty stringent, actually. I doubt I would have had the conversation I had with him if I'd had my license revoked or if I'd been dancing around the yum-yum tree with patients. It sounds like a very good group work for him.

 

[bunnymd]

I worked in a prison in louisiana during medical school and strictly did h&p's. The pay was meager as a student. However, the biggest advantage I saw was that there is a strictly defined formulary and after a little while you nearly memorize it. For depression, there was only a few SSRI's to choose. Same with diabetic, hypertensive, and lipid med's. This makes things much easier than private practice.

Oh, somebody mentioned CA reimbursement being great for psychiatrists. This extends to fp's as well. Due to recent reforms they instituted a massive raise. In the most recent AFP journal there's an ad for a CA correctional physician job STARTING at $248,172. This includes very reasonable call and no more than 40hrs/week. I seriously considered doing this for a least a few years after residency but then I chose to do a fellowship. The drawback is usually location (there are a lot of prisons in CA deserts). However, there's a lot more free time than other jobs.

Oh, security wasn't too much of a headache. It does get a little claustrophobic when you need to get buzzed through every door in the facility though.

 

[lowbudget]

I rotated through a prison during med school and know of residents who moonlit (?) during residencies.

If you're an efficiency/speed kinda person, you're going to hate the prison. Because the word that means opposite of efficiency/speed is: security. Everything is slow in the prison. S-L-O-W. That includes nurses, staff... That said, sometimes, you can get slammed by a bus full of inmates on top of your slow nurses/staff.

TB is TB... but what's worse is converting on your PPD in the absence of TB. That means 6-9 months of INH and having to say No to that glass of wine during dinner with your friends.

Prisoners are extra nice to the doctors because clinic/hospital is better than the actual prison. Especially if hospital room has a TV, which they don't have in the prison. You'll see a lot of people who will fake illnesses just to get these little perks (including getting the bottom/top bunk). Especially during the Superbowl or NBA finals. That said, they will lie their butts off when they get into a fight talking about how they accidently fell off the top bunk onto their sandals and sustained an orbital fracture.

Prison is the ultimate universal health care system. Managed care system. Everybody gets health care. Everybody's covered. Patients don't bear any risk/responsibility in cost sharing. So there is no deterrent to them coming in for BS complaints. That said, hey, at least their covered... but you are part of a "system" where you are governed by policies, procedures, and process. If you like being a part of a system, great. But if nurses don't dispense the right meds at the right time to the patient, you have to fight the system to make it happen. And when the system needs to save money, it might take months if not years to get some elective or outpatient procedure/diagnostic done.

OR, rather than fight for your patients, you can not care...

Last issue is trust. You don't trust them. They don't trust you. Shakes up the fundamental building block in medicine: doctor-patient relationship. If you know how to practice medicine without a good history, more power to you... The advice that was given to me was never ask them why they are in prison... you can imagine why.

 

[andrea]

Fascinating posts! Thanks. It seems like such a different world, but for $248K I could definitely consider it...

 

[tacoman2493]

I'm sorry, but no female should be working in any male prison, regardless of whether they are some butch 350 lb guard or a doctor who is only in the clinic part of the prison.

There are too many lifers out there with nothing to lose and would love nothing more than to grab a woman for a few hours and have his way with her. WTF are they gonna do, give him an extra 50 years on top of his life sentence? He has nothing to lose, and he hasnt had "female relations" for the last 20 years so the thought of having a female doc all to yourself for a few hours is pretty enticing to these animals.

Even if you take way the sex/rape stuff, its still too dangerous. The inmates know that the clinic is one of the weakest security links in the prison and will use that opportunity to try and take you hostage and use as a bargaining chip.

The bottom line is that docs, ESPECIALLY FEMALE DOCS, are extremely inticing targets to these scumbags. The risks far outweigh the rewards.

 

[lowbudget]

I'm sorry, but no female should be working in any male prison, regardless of whether they are some butch 350 lb guard or a doctor who is only in the clinic part of the prison.

There are too many lifers out there with nothing to lose and would love nothing more than to grab a woman for a few hours and have his way with her. WTF are they gonna do, give him an extra 50 years on top of his life sentence? He has nothing to lose, and he hasnt had "female relations" for the last 20 years so the thought of having a female doc all to yourself for a few hours is pretty enticing to these animals.

Even if you take way the sex/rape stuff, its still too dangerous. The inmates know that the clinic is one of the weakest security links in the prison and will use that opportunity to try and take you hostage and use as a bargaining chip.

The bottom line is that docs, ESPECIALLY FEMALE DOCS, are extremely inticing targets to these scumbags. The risks far outweigh the rewards.

She can be a doc in a female prison. But the security issue is still there. You still have the HIV/TB issue. The wrinkle here is that there's a good amount of Gyn and OB. This is where I've met a few G "I lost count", P5 (under CPS), A "I lost count."

 

[elwademd]

it depends what you like, and what you want to do.

there are docs out there who staff the prison regularly. there are others who do per diem work. and others who maybe do something in between.

location will make a difference as well, as being out in the boonies isn't as attractive as being in a major city... until you look at the salary.

i know one doc who did per diem prison work in central california. she'd do a 2 week stint (five days a week, basically 9-5), see about 10 patients per half day (basically community standard for a clinic), and would net 8k.

I'm sorry, but no female should be working in any male prison, regardless of whether they are some butch 350 lb guard or a doctor who is only in the clinic part of the prison.

There are too many lifers out there with nothing to lose and would love nothing more than to grab a woman for a few hours and have his way with her. WTF are they gonna do, give him an extra 50 years on top of his life sentence? He has nothing to lose, and he hasnt had "female relations" for the last 20 years so the thought of having a female doc all to yourself for a few hours is pretty enticing to these animals.

Even if you take way the sex/rape stuff, its still too dangerous. The inmates know that the clinic is one of the weakest security links in the prison and will use that opportunity to try and take you hostage and use as a bargaining chip.

The bottom line is that docs, ESPECIALLY FEMALE DOCS, are extremely inticing targets to these scumbags. The risks far outweigh the rewards.

sounds like you may have watched too much oz/prison break/the wire/etc. while criminals/inmates aren't people you'd want to hang with everyday, you'd be surprised how normal the interaction can be. most officers have enough respect for physicians to tell you who to watch out for. officers stay in the room, unless instructed to leave.

from my experience, even though i've never worked in a prison, i've taken care of prisoners in the hospital. and the worst treatment i've ever received from patients were not prisoners. i'm not saying the prisoners were saints, but they were like any other patient... save for being shackled to the bed!

 

[Joe Richards]

I did a I month rotation at a state run facility. The physician I rotated with was very happy. He got 2 hour lunches, took vacation 4 weeks out of the year and earned equivalent hours of vacation after that for every hour he was on call. He was on call once per week and the PAs took first call.

He saw about 20 patients per day. There was a small inpatient population that he managed (about 4 to 5).

There were 2 doctors for the whole facility.

He was not allowed to bring in any electronic devices (no PDA, cell phones etc.). He was not allowed to have any internet access.

If he needed to look something up he had to do it the old fashioned way through the reference books.

He did not write for many of the new medications because the state did not want to pay for the them. He rarely wrote for any strong pain meds. As you might imagine pain meds were needed in a prison and some sold it to others so they did not like to write for these.

There were many female nurses there. At this facility there were no female docs.

I recently saw an ad in a Family Medicine or AMA journal for Prison jobs in California starting at 248,000 per year.

 

[Osteodog]

Here's some info for the California Department of Corrections

http://www.cdcr.ca.gov/Career_Oppor...edical/PDFs/PhysicianSurgeonIM-FPBulletin.pdf

 

[oreosandsake]

Here's some info for the California Department of Corrections

http://www.cdcr.ca.gov/Career_Oppor...edical/PDFs/PhysicianSurgeonIM-FPBulletin.pdf

I've seen advertisement for these jobs. "starting at 248K, with benefits"

248 + benefits, for what I'm assuming is a 40 hr work week?

to comment on the poster that wrote re psych, those rumors are true.

the psych docs are getting reimbursed very well. I spoke with one who said that many do those jobs, 40 hrs a week, and additionally moonlight on the side.