I would like to know if it's still possible anywhere to do inpatient and not work for an enormous parcel market. I only want to do inpatient, but ISTM all hospitals have been bought up by gigantic carton emporiums at this point.
Years ago I talked with one place where the county owned and funded the hospital so was truly locally controlled and had constraints from being a larger entity. I suspect that has dampening effect on bureaucracy?
There are still a few states where there is no Certificate of Need, so in theory you could potentially open up your own small inpatient unit? But you may want a partner for coverage.
Or I suppose you could look for the places you might be willing to live, reach out to the medical staff offices, talk with them, get a copy of the bylaws, read them through and look for the hospitals that still function as hospitals. What I mean by that is that haven't become wannabe corporate HMOs that push out all the independents, have onerous conditions or draconian reinforcement of their rules. So you pick up privileges, get yourself on a call schedule and start having your own patients admitted to the unit. You do your own billing. Hopefully the hospital also has independent IM, hospitalists, and non-employed ED docs. You can then discuss with them about getting preferenced admissions if it isn't a fixed alternating list to the unit between you and the hospital employed group. Long term goals to thwart downstream politics, seek to get active in various hospital committees. *be aware there may be requirements of coverage and the existing group may not be cordial to cross cover, thus a partner is needed
The other option is to go into the belly the Big Box Shop - having read the hospital bylaws first - work there for X amount of time. Quit the job, but keep your privileges and then grow your practice. This would be needed for those places that are throwing up red flags for new entrants wanting to get privileges. You'll also want to have already got yourself on key hospital committees, like the Credentialing committee / med staff privilege's committee. This will be needed to buffer the backlash and possibly hostile politics to emerge in not leaving quietly like all the other doctors do. *be aware there may be requirements of coverage and the existing group may not be cordial to cross cover, thus a partner is needed
**If you had become the Med Dir when quit, that helps buffer the politics, but you will want to know how / who assigns the med dir role, so you don't lose and get pushed out.
There may even be some more rural hospitals that would welcome an independent psychiatrist who wants to be the med dir and simply take over for them. But those places will be hard to find, but they exist.
A less ideal option is to open a practice at a Critical Care access hospital, and do C/L and ED consults there. Even talk with the CEO about the legality of devoting 2-5 beds to Psych and sort of build a pseudo Psych unit that way? Probably need to also throw in the mix some outpatient to make it all work.
