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learn how to start a private practice
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michaelrack said:
Dance therapy
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Nice to know people still remember. Maybe my greatest work? I'd love to keep writing her character but it's hard to figure out how it works without a straight foil. A bit like the Phil Hendrie show—it only works when part of the audience isn't in on it, or is at least unsure.
 
birchswing said:
Nice to know people still remember. Maybe my greatest work? I'd love to keep writing her character but it's hard to figure out how it works without a straight foil. A bit like the Phil Hendrie show—it only works when part of the audience isn't in on it, or is at least unsure.
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That thread was epic
 
Based upon my corporate meeting this week:

1. Statistical principles (that are relevant to practice AND the utilization of healthcare system services/data)
2. Logical Fallacies
3. Psychological and neuropsychological testing/evaluation (when its relevant and necessary and when its a waste of everyone's time and/or money)
 
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Depends on your definition of fun, interesting, etc. but:

-Sex offender treatment programs
-Expert witness work
-Psychoanalytic institute training
-Private addiction treatment centers
-Cash-only psychotherapy (population will differ from a University clinic)
-Corrections
-Owner/operator of a clinic with employees (therapists, mid-levels, etc)
-Suboxone for OUD maintenance
 
Is an addiction rotation not standard within residency at some point at most places? Our local State U psychiatry dept is not well known at all, but residents still do 3 months at the local VA SARRTP unit.
 
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In terms of neuropsych testing, I've noticed that when it's a major form like the MMPI psychiatrists just order out and some psychologist does it and sends a report. Do any psychiatrists actually do neuropsych testing (other than just MOCA/SLUMS) themselves or is this something that typically falls in the domain of psychologists? If so, why? Just curious because I've seen various tests ordered a few times but never actually seen a psychiatrist perform one.

erg923 said:
Is an addiction rotation not standard within residency at some point at most places? Our local State U psychiatry dept is not well known at all, but residents still do 3 months at the local VA SARRTP unit.
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1 month of an addiction psychiatry rotation is required for all psychiatry residencies as of 2017 per ACGME guidelines.
 
Stagg737 said:
In terms of neuropsych testing, I've noticed that when it's a major form like the MMPI psychiatrists just order out and some psychologist does it and sends a report. Do any psychiatrists actually do neuropsych testing (other than just MOCA/SLUMS) themselves or is this something that typically falls in the domain of psychologists? If so, why? Just curious because I've seen various tests ordered a few times but never actually seen a psychiatrist perform one.
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The MMPI is not neuropsych, but can (and often is) used within large neuropsychological evaluations to assist.

My point being that psychiatrists should probably be better informed on psychometrics and the general usefulness of psychological testing if they are referring out for this.

"On/Off" (stimulant) testing is a myth and is ridiculous on the face of it, for example.

Often it can be eye opening, and just as often it might not tell you much that you didn't know that would actually alter your treatment plan.

I would suggest having a basic knowledge base so that you are confident that your specific question is unanswerable without it. Otherwise, the ROI is very low for whoever is paying the bill.
 
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severe IDD, TBI, Forensics, corrections

I was lucky in away as I did my intern year in one program and then continued in another. I got more exposure then if I had just gone to one program.

My most "psychaliscious" (terrible word...would like to expunge it out of my vocabulary) year of training was my forensics fellowship.
 
erg923 said:
The MMPI is not neuropsych, but can (and often is) used within large neuropsychological evaluations to assist.

My point being that psychiatrists should probably be better informed on psychometrics and the general usefulness of psychological testing if they are referring out for this.

"On/Off" (stimulant) testing is a myth and is ridiculous on the face of it, for example.

Often it can be eye opening, and just as often it might not tell you much that you didn't know that would actually alter your treatment plan.

I would suggest having a basic knowledge base so that you are confident that your specific question is unanswerable without it. Otherwise, the ROI is very low for whoever is paying the bill.
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I had a couple weeks in 3rd year mostly shadowing our VA neuropsychologist. It was helpful information for my clinic today, though I admit I still will send them some cases where they aren't any more precise at getting an answer than I am (when I was pretty sure they'd be able to help me out).
 
RVUs.
 
Stagg737 said:
In terms of neuropsych testing, I've noticed that when it's a major form like the MMPI psychiatrists just order out and some psychologist does it and sends a report. Do any psychiatrists actually do neuropsych testing (other than just MOCA/SLUMS) themselves or is this something that typically falls in the domain of psychologists? If so, why? Just curious because I've seen various tests ordered a few times but never actually seen a psychiatrist perform one.
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Get used to just calling them "psychological testing." The neuropsych term is usually used inappropriately and I think just something we reach for since anything with "neuro" in front of it gives psychiatrists a more medical-y feel (watch attempts to normalize neuropsychiatry).

Most psychological testing is the domain of psychologists. It can be done well by psychiatrists with significant training, typically in the better forensic fellowships.

It's an important caveat- the whole "you don't know what you don't know" cry that we hear so often regarding expanded privilege for prescribing and NPs/PAs acting as psychiatrists also applies to us when it comes to psychological testing. You can go to a 2 day workshop and consider yourself edumacated in the use of psychological testing, but it's a false confidence and you have the capacity to do some real damage. You should ideally have extra coursework in testing and be in a supervised environment for multiple iterations of any real psychological test before you should take any comfort in using it, with a few obvious examples (I'm looking at you M-FAST). The MMPI is a great example of this.
 
notdeadyet said:
Get used to just calling them "psychological testing." The neuropsych term is usually used inappropriately and I think just something we reach for since anything with "neuro" in front of it gives psychiatrists a more medical-y feel (watch attempts to normalize neuropsychiatry).
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Exactly. I get way too many referrals for "Neuropsych testing" in which a provider wants a DA, like is this Bipolar or depression with SUD, ADHD, or whatever. That's not what I do. I can do that, but they pay me to actually answer neuro questions. Does this person have dementia, and if so, what kind? How is so and so looking after their stroke? Are there specific targets for domain specific cognitive interventions, etc. My wait list is long enough, and ever growing, that I don't need DAs to fill out my clinic schedule. Unfortunately, the conversations don't always stick with people and I get a lot of similar referral over and over from some providers.

And yes, the MMPI and like materials are not "one seminar" types of things you can pick up. You'll generally need significant training and some supervision with it to use it efficaciously in clinical contexts so that you're not merely regurgitating the scoring program report.
 
1. worker's compensation
2. disability evaluation/analysis
3. medical malpractice
4. personal injury
5. sexual harrassment
6. mediation
7. executive coaching
8. tech consulting
9. cultural consulting
10. developing psychotherapy manual, psychometric testing
11. self-help books
12. sports psychiatry
13. transplantation psychiatry
14. neuropsychiatry
15. integrative psychiatry and mind-body medicine
16. bariatric psychiatry
17. peer review
18. second opinion consultation
19. MRO
20. chemical castration
21. ADOS evals and autism assessment/treatment planning
22. "interventional" psychiatry
23. psychodrama
24. drug company whoring
25. organizational consulting
26. wellness
27. fitness for duty evaluations
28. physician health programs/impaired physicians
29. e-consultation
30. concierge psychiatry
32. telepsychiatry
33. micropsychoanalysis
34. narcosynthesis
 
splik said:
1. worker's compensation
2. disability evaluation/analysis
3. medical malpractice
4. personal injury
5. sexual harrassment
6. mediation
7. executive coaching
8. tech consulting
9. cultural consulting
10. developing psychotherapy manual, psychometric testing
11. self-help books
12. sports psychiatry
13. transplantation psychiatry
14. neuropsychiatry
15. integrative psychiatry and mind-body medicine
16. bariatric psychiatry
17. peer review
18. second opinion consultation
19. MRO
20. chemical castration
21. ADOS evals and autism assessment/treatment planning
22. "interventional" psychiatry
23. psychodrama
24. drug company whoring
25. organizational consulting
26. wellness
27. fitness for duty evaluations
28. physician health programs/impaired physicians
29. e-consultation
30. concierge psychiatry
32. telepsychiatry
33. micropsychoanalysis
34. narcosynthesis
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Dang, thanks for the thorough list! Could you clarify some of these a little more or give some ideas on where legit places to read up on them are? Specifically worker's comp, peer review, and MRO?
 
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Stagg737 said:
Dang, thanks for the thorough list! Could you clarify some of these a little more or give some ideas on where legit places to read up on them are? Specifically worker's comp, peer review, and MRO?
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worker's comp = someone is injured at work etc and now has depression/PTSD etc a qualified medical examiner needs to do the assessment to see if they qualify and what their treatment needs are. you typically have to pass an exam to get on the lest to be a QME and then get do. in certain circumstances it may also involve providing treatment which gets murky.
peer review - insurance companies deny things a lot. you are entitled to ask for a peer to review the denial who in this case would be aboard certified psychiatrist who contracts with the insurance company to review whether the treatment is medically necessary.
MRO - medical review officer. although urine toxicology screens have to be reviewed by someone who takes into account whether there are any other reasons to explain the positive results etc. you have to attend a course and pass an exam to become an MRO.
 
Stagg737 said:
Dang, thanks for the thorough list! Could you clarify some of these a little more or give some ideas on where legit places to read up on them are? Specifically worker's comp, peer review, and MRO?
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Ugh, do a forensic fellowship before approaching that stuff. The folks who practice in the compensation/disability world are often hacks even when they're properly trained. The folks that do the bare minimum hobbiest training and then set up a shingle tend to be just shills. They are the forensic equivalent of psychiatrists who set up cash only practices and buy advertisements highlight generous benzo rx and no-test-required ADHD management. These are the non-forensic folks privately doing comp/disability evals. And frankly, some of the forensic folks too.
 
notdeadyet said:
Ugh, do a forensic fellowship before approaching that stuff. The folks who practice in the compensation/disability world are often hacks even when they're properly trained. The folks that do the bare minimum hobbiest training and then set up a shingle tend to be just shills. They are the forensic equivalent of psychiatrists who set up cash only practices and buy advertisements highlight generous benzo rx and no-test-required ADHD management. These are the non-forensic folks privately doing comp/disability evals. And frankly, some of the forensic folks too.
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I was just curious becuase I don't really know anything about MRO and peer review and didn't think the google gave an adequate description of what those entailed or the difficulties of them. I know a lot about worker's comp and have some actual exposure to the field, I just haven't seen a psych diagnosis as an accepted disability in a claim and PTSD slipped my mind.
 
splik said:
worker's comp = someone is injured at work etc and now has depression/PTSD etc a qualified medical examiner needs to do the assessment to see if they qualify and what their treatment needs are. you typically have to pass an exam to get on the lest to be a QME and then get do. in certain circumstances it may also involve providing treatment which gets murky.
peer review - insurance companies deny things a lot. you are entitled to ask for a peer to review the denial who in this case would be aboard certified psychiatrist who contracts with the insurance company to review whether the treatment is medically necessary.
MRO - medical review officer. although urine toxicology screens have to be reviewed by someone who takes into account whether there are any other reasons to explain the positive results etc. you have to attend a course and pass an exam to become an MRO.
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And how to use the relevant edition of permanent disability+ODG....
 
Stagg737 said:
I know a lot about worker's comp and have some actual exposure to the field, I just haven't seen a psych diagnosis as an accepted disability in a claim and PTSD slipped my mind.
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Yep, PTSD comes up all the time. And a lot of these cases are misdiagnosed PTSD, PTSD pre-existing the index event, or trauma burden before the event that calls into question causation. The disability scene is really a racket, which is a shame since there are legitimate cases out there in which the support is helpful rather than exploitive or enforced helplessness.
 
Stagg737 said:
I was just curious becuase I don't really know anything about MRO and peer review and didn't think the google gave an adequate description of what those entailed or the difficulties of them. I know a lot about worker's comp and have some actual exposure to the field, I just haven't seen a psych diagnosis as an accepted disability in a claim and PTSD slipped my mind.
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Never underestimate legit PTSD in this day and age where there's more focus on violence against healthcare workers. There are some horrendous stories about nurses and first-line ED folks being assaulted by patients so severely that you'd be shocked if they weren't emotionally/mentally disabled.
 
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