psych np out for 3 months....

[vistaril]

many of you know my plans a few months from now...signed with a practice that is letting me do low volume med mgt where Im able to spend a lot of time with patients and have a lot of freedom to do what I want. Insurance based practice. The parameters I had written out in the contract. In exchange for this, my salary is about half of what is typical.

So anyways, I got a call from the owner stating that one of their psych nps(who sees pts independently) is going to be out 3 months starting in mid August on maternal leave. He started out friendly, and then let me know that I would be expected to see many of her med mgt patients. I basically said I'll pass. I have no interest in seeing her patients as they basically 10 minute med check patients and that is most definately not in my contract. I'm not going to make 95k to whack and stack......

When I said that the owner, while still being nice, made some inferences that they were under the impression I'm a team player and then starting rambling about how he seems the practice as a total team effort.

The conversation ended cordially, but at this point I'm honestly considering just bailing after completion of residency and going full time with what I'm trying to build(owning low income residential properties and then managing them).....i have absolutely no interest in covering for this psych np for 3 months, and it could potentially be a deal breaker.

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[Addiction]

Good luck!

 

[Psychotic]

That is screwed up - clearly the owner "assumed" you would be willing to do this. This should have been spelled out in the contract.

 

[F0nzie]

This is simply another point of negotiation. Personally, I think 10 min is ridiculous considering you do not even have a relationship with these patients. If the owner is a psychiatrist he should know what you are talking about. If not, explain your rationale for requiring 30 minutes. If you want the job you can try to meet the owner in the middle and agree to see the nps patients as long as appointments are 30 minutes in length per the original agreement.

If the owner is losing a provider due to maternity leave its up to him to find the coverage not you. This has nothing to do with being a team player IMO...just another guilt trip from a business owner to place upon the omnipotent physician. Plus this np is pregnant and slowly growing a fetus... it's not like she got into a motorcycle accident and suddenly needed coverage. If the latter were the case and you refused then I'd say you weren't a team player.

 

[VMSmith]

It's reasonable for you to expect 30 minute visits if it's in your contract and you agreed to a lower salary in order to get that.

It's up to you how much and what to negotiate for and what you're willing to do. I think it's reasonable to offer to cover as many of the NP's patients as can be fit into your 30 minute visit schedule.

"Team effort" does sound like an excuse to get you to agree to do what he wants. You don't share in the revenue in this practice, so it doesn't make sense for you to accept less money in order to see patients longer just to turn around and agree to do what you didn't want to do (and it's even in your contract! ). If they really need you to make more slots available, then they need to compensate you in some way for that.

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[PikminOC]

many of you know my plans a few months from now...signed with a practice that is letting me do low volume med mgt where Im able to spend a lot of time with patients and have a lot of freedom to do what I want. Insurance based practice. The parameters I had written out in the contract. In exchange for this, my salary is about half of what is typical.

So anyways, I got a call from the owner stating that one of their psych nps(who sees pts independently) is going to be out 3 months starting in mid August on maternal leave. He started out friendly, and then let me know that I would be expected to see many of her med mgt patients. I basically said I'll pass. I have no interest in seeing her patients as they basically 10 minute med check patients and that is most definately not in my contract. I'm not going to make 95k to whack and stack......

When I said that the owner, while still being nice, made some inferences that they were under the impression I'm a team player and then starting rambling about how he seems the practice as a total team effort.

The conversation ended cordially, but at this point I'm honestly considering just bailing after completion of residency and going full time with what I'm trying to build(owning low income residential properties and then managing them).....i have absolutely no interest in covering for this psych np for 3 months, and it could potentially be a deal breaker.

What? You don't like to "grind" anymore? Where is the real vistaril and what have you done with him?

 

[nancysinatra]

Vistaril I thought you graduated last year?? And yeah, what's with this relaxed new attitude?

 

[PrideNeverDie]

Vistaril I thought you graduated last year?? And yeah, what's with this relaxed new attitude?

this gonna get good!

 

[strangeglove]

Why not find another job in psychiatry? I'm sure there's something in between this not-so-great situation and leaving psychiatry entirely. This seems like an excuse to get out of psychiatry, which is a field that you never liked in the first place. I would add that taking this job was probably a first step in the exit strategy, to "prove" to yourself that you made the right choice in ditching this career. As I've mentioned before, the constant devaluing of psychiatry on this board is also part of this complex defense mechanism.


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[TexasPhysician]

Stand up for yourself. A contract is a contract. The manager is trying to get free coverage - smart move by him. Some doctors would give in to "the man", but there is nothing wrong with saying no. This is his problem to solve, not yours.

 

[vistaril]

Stand up for yourself. A contract is a contract. The manager is trying to get free coverage - smart move by him. Some doctors would give in to "the man", but there is nothing wrong with saying no. This is his problem to solve, not yours.

oh they will pay me more if I see her patients.....but I just don't have any interest in doing so. If I get fired shortly after I start for not being a team player, oh well....

 

[Ceke2002]

Good luck with your work plans, and I hope you get things sorted out with your contract.

I have no idea why but for some reason I keep getting a mental image of you running around in a converted ice cream van clinic on wheels as you trawl the streets for patients whilst madly thumbing through a copy of the latest DSM and wondering how many of the diagnosis you can use as target practice.

 

[TexasPhysician]

oh they will pay me more if I see her patients.....but I just don't have any interest in doing so. If I get fired shortly after I start for not being a team player, oh well....

If your contract is so open-ended that they could fire you for not taking on additional work, it is your job to restrict it by changing the language.

Protect yourself properly and being abruptly fired without sufficient cause could result in a nice legal payoff for you.

 

[Therapist4Chnge]

Stand up for yourself. A contract is a contract. The manager is trying to get free coverage - smart move by him. Some doctors would give in to "the man", but there is nothing wrong with saying no. This is his problem to solve, not yours.

This.

In the owner's position I'd do the same thing and hope the employee just went along with it because that would be the easiest (and cheapest) solution for me as the business owner. That being said, you are in an excellent position to negotiate if taking on additional work is something you'd consider. Personally I'd use this instance as a litmus test to see how the owner deals with you, as a contract works both ways. I value my work/life balance too much to consider taking on a ton of extra work, particularly if it involves a change in how I practice.

ps. If they fire you the owner is an idiot…because now he'd be down two providers. Of course, there are many idiot business owners, so I'm curious to see how this shakes out.

 

[nancysinatra]

Why not find another job in psychiatry? I'm sure there's something in between this not-so-great situation and leaving psychiatry entirely. This seems like an excuse to get out of psychiatry, which is a field that you never liked in the first place. I would add that taking this job was probably a first step in the exit strategy, to "prove" to yourself that you made the right choice in ditching this career. As I've mentioned before, the constant devaluing of psychiatry on this board is also part of this complex defense mechanism.


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This is an interesting post! I haven't been on the boards in awhile so I don't know what Vistaril's been saying lately... But the concept could apply to many people. I personally feel about 2/3 of the time that I chose the wrong specialty. I would rather do ER or surgery or even IM or neuro. This morning I was thinking I would even rather do hematology because pouring over labs would be so much more interesting than hearing about people's insomnia or passive suicidal ideation. The rare patient who has a genuine interest in change and the capacity for psychotherapy or who presents a challenging psychopharm question is not enough to outweight how boring much of psychiatry can be in this day and age. I don't let the patients catch on to this, and I always try to find something interesting in each case, but there has to be some place to vent.

But the thing is, you can't really say that too openly on this board. I feel there is a lot of peer pressure to "like" psychiatry and say "nice" things about it. I felt that in residency too. Whereas talk to surgeons and you hear them bash their job a lot!

Anyway Vistaril I think the job you are describing sounds very so-so and honestly, if they're already pushing you NOW to do more than you want to, don't you see the writing on the wall? This is likely only the beginning of their encroaching upon you with more "team player" demands. I agree if you are planning to stay in this field you should find the best job you can, and preferably, something you might like.

And never make anyone feel like you have to be a "team player" if you don't want to be one. That's one of the biggest myths perpetuated in medical training. Whenever I hear that phrase I think of only one thing: labor exploitation.

 

[F0nzie]

The rare patient who has a genuine interest in change and the capacity for psychotherapy or who presents a challenging psychopharm question is not enough to outweight how boring much of psychiatry can be in this day and age.

What are your thoughts about a private practice? The motivation is exceedingly high. It's rare for me to see lack of motivation in my private practice. Even 4-6 hours a week might help with your job satisfaction.

 

[st2205]

I would rather do ER or surgery or even IM or neuro. This morning I was thinking I would even rather do hematology because pouring over labs would be so much more interesting than hearing about people's insomnia or passive suicidal ideation. The rare patient who has a genuine interest in change and the capacity for psychotherapy or who presents a challenging psychopharm question is not enough to outweight how boring much of psychiatry can be in this day and age.

Have you spent much time in the ED? The above kinda sounds like a pretty succinct explanation of it.

 

[EEGNeurofeedback]

This is an interesting post! I haven't been on the boards in awhile so I don't know what Vistaril's been saying lately... But the concept could apply to many people. I personally feel about 2/3 of the time that I chose the wrong specialty. I would rather do ER or surgery or even IM or neuro. This morning I was thinking I would even rather do hematology because pouring over labs would be so much more interesting than hearing about people's insomnia or passive suicidal ideation. The rare patient who has a genuine interest in change and the capacity for psychotherapy or who presents a challenging psychopharm question is not enough to outweight how boring much of psychiatry can be in this day and age. I don't let the patients catch on to this, and I always try to find something interesting in each case, but there has to be some place to vent.

But the thing is, you can't really say that too openly on this board. I feel there is a lot of peer pressure to "like" psychiatry and say "nice" things about it. I felt that in residency too. Whereas talk to surgeons and you hear them bash their job a lot!

Anyway Vistaril I think the job you are describing sounds very so-so and honestly, if they're already pushing you NOW to do more than you want to, don't you see the writing on the wall? This is likely only the beginning of their encroaching upon you with more "team player" demands. I agree if you are planning to stay in this field you should find the best job you can, and preferably, something you might like.

And never make anyone feel like you have to be a "team player" if you don't want to be one. That's one of the biggest myths perpetuated in medical training. Whenever I hear that phrase I think of only one thing: labor exploitation.

How did you get interested in psychiatry? Do you think your patients picked up on the fact that you don't find psych interesting? i am asking because i sometimes worry that i don't appear interested. and honestly some things that i hear over and over are not interesting. However, my patients tend to pick up on things rather quickly, especially the very sensitive ones. One actually asked, "doc do you have a countertransference toward my issue?" I sometimes get surprised by what they come up with. I didn't. I was just tired about the venting and not wanting to try anything I suggested. This post is not meant as an attack by the way

 

[hamstergang]

But the thing is, you can't really say that too openly on this board. I feel there is a lot of peer pressure to "like" psychiatry and say "nice" things about it. I felt that in residency too. Whereas talk to surgeons and you hear them bash their job a lot!

Come on, we all know psychiatry isn't for everyone. If you find it that boring, then maybe you're just in the wrong field. That doesn't say anything negative about you or psych, so I don't see why anyone else would be offended.

 

[notdeadyet]

But the thing is, you can't really say that too openly on this board. I feel there is a lot of peer pressure to "like" psychiatry and say "nice" things about it. I felt that in residency too. Whereas talk to surgeons and you hear them bash their job a lot!

Interesting post....

I think where there is tension is when folks try to generalize their negative experiences. This seems to be the trend with the posters lots of folks find a little contentious. And folks tend to generalize their negative experiences because it reduces their accountability.

Saying, "I hate my job. I find it boring. I don't find it fulfilling. I don't like my patients, they don't like me, and I feel like I'm not helping them" and you are likely to get curiosity and support on this forum.

Saying, "The psychiatry field sucks. The psychiatry field is boring. Your patients don't like you and you aren't helping them..." ruffles feathers because it's not true for everyone just because it's true for you. Generalizing like that is tempting because you then have less responsibility for what's going on and don't have to go to the effort of trying to resolve the issue. This lack of accountability can feel relieving and good.

Incidentally, career bashing is also a sign of burn-out. The reason you hear it a lot more in surgery than in psych is also likely because you get a lot more burnout in surgery than psych.

 

[SteinUmStein]

And folks tend to generalize their negative experiences because it reduces their accountability.

Bingo. If psychiatry sucks, then a person practicing psychiatry doesn't have to feel bad when they're miserable practicing it. Misery loves company - perhaps they want to feel like everyone must secretly feel as awful as they do or be in as crappy of a position.

Picking the wrong specialty (or at least not the best fit) is common. Taking responsibility and planning out concrete actions to correct their mistake (whether that be going into another field or finding a very different practice setting) is very rare. I've found people in medicine to be very good at getting stuck in a rut of their own making, trudging through the hypothetical mud while complaining every step of the way.

 

[vistaril]

Incidentally, career bashing is also a sign of burn-out. The reason you hear it a lot more in surgery than in psych is also likely because you get a lot more burnout in surgery than psych.

Apples and oranges....the career/field criticisms surgeons have are generally completely different than the criticisms some people in psychiatry have of psychiatry.

So in that respect, the 'burnout' is completely different. And I would argue feels completely different.

If you want to call what some of us have 'burnout', I think it's probably more similar, depending on the work environment, to that experienced by school teachers, some social workers, etc.....

 

[SteinUmStein]

Have you been a burned-out surgeon? If so, my apologies. If not, you're speculating like the rest of us.

 

[hamstergang]

Apples and oranges....the career/field criticisms surgeons have are generally completely different than the criticisms some people in psychiatry have of psychiatry.

So in that respect, the 'burnout' is completely different. And I would argue feels completely different.

If you want to call what some of us have 'burnout', I think it's probably more similar, depending on the work environment, to that experienced by school teachers, some social workers, etc.....

So? How does your post fit into the conversation? It seems tangential, not negating or advancing any part of the discussion. It's almost as if you just spotted a key word and used that as an opportunity to put down psychiatry without caring if it actually belonged here.

 

[notdeadyet]

Apples and oranges....the career/field criticisms surgeons have are generally completely different than the criticisms some people in psychiatry have of psychiatry.

So in that respect, the 'burnout' is completely different. And I would argue feels completely different.

Lmao... Oranges are a way better fruit.

Apples? Uh.... yeah...

 

[SteinUmStein]

Apples are just not an exciting fruit. I have never heard someone say, "I am so excited to eat this delicious apple." If they did, they were lying. You can turn apples into delicious things, but apples themselves are blah. Oranges are delicious, but I prefer their miniature cousins, clementines. Mmm...

 

[Jester25]

I can't speak for IMGs, but all of the psychiatry residents I know chose it because it was their top choice. I don't think people settle on psychiatry the way say a med student who wanted ortho but had to "settle" for gen surgery. This can obviously cause job dissatisfaction. I personally know of 2 residents that went this route because 1 couldn't match ortho and the other couldn't match neurosurg. People don't generally do this for psych so that's probably why you don't hear as much job bashing.

I for one am head over heels in love with the speciality and am thankful I was able to find something I love so much late in my medical training.


As far as Vistaril's situation, I agree with what has already been said. No way would I cover the NP's patients for 10 min med checks.

 

[michaelrack]

Apples are just not an exciting fruit. I have never heard someone say, "I am so excited to eat this delicious apple." If they did, they were lying. You can turn apples into delicious things, but apples themselves are blah. Oranges are delicious, but I prefer their miniature cousins, clementines. Mmm...

I like dried apples with cinnamon and sugar

 

[SteinUmStein]

I like dried apples with cinnamon and sugar

Mmm good point. I meant apples alone, but I think that can count since you're not really cooking with the apple, just garnishing it. To that end, caramel apples. And not whole apples covered in caramel, but slices you can dip so you aren't covered in caramel at the end.

 

[Tyrone Slothrop]

Lmao... Oranges are a way better fruit.

Apples? Uh.... yeah...

Relevant?
http://imgs.xkcd.com/comics/****_grapefruit.png

I like the methodology but I disagree with valuations. Orange has clearly been robbed. I grew up in apple country and I still can't get too excited about them. Red is definitely superior to green through.

 

[TexasPhysician]

All apples > pears

 

[SteinUmStein]

Pears are a garbage fruit. I can't imagine eating them voluntarily. And you are right Tyrone, red>>green.

 

[285963]

Pears are a garbage fruit. I can't imagine eating them voluntarily.

 

[PrideNeverDie]

my god the apple disrespect on this thread

 

[Tyrone Slothrop]

Pears are far too inconsistent. I've found only 1/50 has been worth a damn, the rest are woody disappointments or mushy slop. Apples on the other hand are reliably worth dealing with.

Of course we've neglected to mention mango, which I personally consider to be the king of fruits. Nor have we addressed coconut, a puzzle not worth solving.

 

[SteinUmStein]

Oh God mango... so good. Coconut is not a fruit to me, it's a flavor. Unless you are willing to deal with an actual coconut. Which I am not.

 

[PrideNeverDie]

mango is off the charts, but for me when it comes to ease and deliciousness; apple is king

 

[Therapist4Chnge]

Mango > all other fruit >>>>>>>>>>> coconut

 

[michaelrack]

How do you like them apples

 

[Shikima]

Oh God mango... so good. Coconut is not a fruit to me, it's a flavor. Unless you are willing to deal with an actual coconut. Which I am not.

Coconut's are good after a hard night of drinking.... used to crack open a green one while in med school, drinking the liquid and all was then right with the world.

 

[Jester25]

Banana guy here. Deliciousness without the mess. Can't go wrong.

 

[Nasrudin]

Banana guy here. Deliciousness without the mess. Can't go wrong.

Idk. Bananas have nice flavor and ample nutrition...but they're too phallic, they have a mushy texture, and turn brown too quickly.

Their peels also have an uncanny ability to cause a slip and fall in many an unsuspecting human.

But...saying the word bananas is pretty fun. It's bananas down in the ED! How do you suppose bananas came to represent pandemonium? Strange.

 

[Nasrudin]

Durian fruit is the most disgusting member of the whole fruit family. Hands down. It even made an appearance in Portlandia as some kind of alien life form.

 

[285963]

How do you suppose bananas came to represent pandemonium? Strange.

It was probably this song.

 

[Shikima]

I am a ... Banana!!


Spoon.