Bottom line is money for better or worse.
I'm a little surprised to hear this, frankly.
I'm not.
I've seen several attendings practice in a manner that puts the unit into the red--not because they're doing the right thing, but actually the wrong thing.
I however have noticed that in general, if a psychiatrist is doing the right thing, they often times can lead their units to be in the black instead of red.
E.g. in residency, the inpatient unit was a short term care facility. If the psychiatrist is truly working with the treatment team, usually by day 3, with good contact, interviews & communication with the treatment team, you'll know your patient's diagnosis & be pretty accurate in your assessment of what's going to happen.
However I knew of one particular attending who pretty much missed treatment team all the time, ignored the staff, & pretty much just signed what a PGY-1 did. Poor care will cut profits. A correct course of treatment could've been enacted from day 2 instead of day 8. The guy's psychotic & getting Zoloft, and a lazy attending is letting that happen. Managed care starts getting ticked when these cases take too long (and that attending did get some reprimands), and IMHO in such a case, they are completely justified in doing so.
The nurse manager of the unit knew this was happening & it ticked her off because when the unit went into the red, the administration went to her, not the attendings. I actually agreed with her more often than not because the expenses were being eaten often times due attendings being passive and not keeping track of things.
As for long term--now that I'm an attending in long term, I too notice similar trends. If you for example keep a patient for longer than needed it makes life easier for the attending--if you discharge, you have to write up the discharge workup which can take about 1 hr of your time. If you keep the patient, all you got to do is write 1 note a week which takes 15 minutes. Add to that, the stabilized patients are low maintenance. When you discharge, you're opening a bed that will eventually be filled with a higher maintenance patient and you'll have to do the admission work-up that take about 1.5 hrs per patient.
Reason why I bring this up is I've seen some doctors just sit on patients who are stable & no longer need to be on inpatient, but those patients still just sit there-for months. Well of course this is my opinion, but hey, no agitation, no symptoms of psychosis, complete compliance with meds, and the guy's still there for 5 months...you tell me if the guy needs to be on inpatient.
Add to that, with the lack of psychiatrists in general, it can force inpatient units to be in a position where they cannot replace the psychiatrist that might not be leading that unit effectively.
I of course acknowledge that sometimes managed care wants them out of there sooner than needed, but in general, if you're doing your job right, and trying to get the patient out sooner--not to save & make money, but to respect the patient's freedom by trying to get them stabilized sooner so they can be in charge of their life again--in general it'll lead to more profits.
