7 on 7 off inpatient schedules

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nexus73

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I was curious to hear what others are seeing across the country. In my neck of the woods, the two inpatient psych units were 7 on 7 off for several years, then some recent changes led to departure of some of the previous docs and the hospital has returned to the standard M-F schedule with weekend coverage every 4-6 weeks.

So with the 7/7 schedules disappearing locally, I was wondering if people are seeing this elsewhere? I'm also not sure how widespread the 7/7 staffing model ever was, or if it's been a rarity with just a few places doing it.

I will say that when I was doing 7/7 we had the same basic contract as the IM hospitalists which meant there was some vacation time included, which was a very nice schedule.
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The 7/7 docs at my job love it. They do their work then head home around 1-2pm. I prefer M-F because I enjoy only working 1 weekend a month. And there are more wRVUs to be had on a M-F + 1 weekend schedule vs a 7/7 schedule. Also, our 7/7 docs do not get vacation days. Last year I took 30 days of vacation and made more than each of the 7/7 docs. The only way I am giving this up is if admin comes down and says : Switch to 7/7 or find a new job. I wouldn't like it, but I would still switch to 7/7 because the pay is still crazy.
 
psych_0 said:
The 7/7 docs at my job love it. They do their work then head home around 1-2pm. I prefer M-F because I enjoy only working 1 weekend a month. And there are more wRVUs to be had on a M-F + 1 weekend schedule vs a 7/7 schedule. Also, our 7/7 docs do not get vacation days. Last year I took 30 days of vacation and made more than each of the 7/7 docs. The only way I am giving this up is if admin comes down and says : Switch to 7/7 or find a new job. I wouldn't like it, but I would still switch to 7/7 because the pay is still crazy.
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That's good to hear. What is the pay range if you don't mind sharing!
 
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a lot of the units near me have a shift model where you can pick up days as they open. I may work 1 day here and there, whereas I may do a full week at another unit. I like not being locked in to a set schedule this way. In September I'm doing a 7 day stretch at one unit, then picking up another 2-3 days at another unit. This is all 1099, hourly pay of 280 per hour, 10 hour days. But they allow you to leave he unit when finished so I may wrap up by 1130-noon.
 
Isn’t this kind of schedule difficult in psych?

It’s not like IM where you can quickly review charts and labs, and most of the work up and treatment is standard so it’s easy to be consistent between docs.

In psych you have to know their story, build rapport, maybe do some therapy. How is all that possible when you’re switching docs every week? It’s also very likely that two docs can have different formulations and diagnoses, and tx plans.

Curious as to what those who are active in this model are handling these potential issues.
 
vanfanal said:
Isn’t this kind of schedule difficult in psych?

It’s not like IM where you can quickly review charts and labs, and most of the work up and treatment is standard so it’s easy to be consistent between docs.

In psych you have to know their story, build rapport, maybe do some therapy. How is all that possible when you’re switching docs every week? It’s also very likely that two docs can have different formulations and diagnoses, and tx plans.

Curious as to what those who are active in this model are handling these potential issues.
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Speaking for a 7/7 schedule, overall it works fine. The first day is longer because you're getting up to speed with everyone, but then is easier as the week progresses. It works best if the doctors have grossly similar practice styles. I've seen issues where one doc gave out bipolar 2 and ADHD diagnoses like they were going out of style, and the other doc was coming in and stopping the stimulants mood stabilizers because they were really BPD. That's been the exception though.
 
I think M-F with weekend call is much more common, but 7-7 does exist. There are pluses and minuses to both. I wouldn't necessarily be opposed to either as a manager. I can say that yes, you'd need to have a group with similar practice styles or 7-7 will quickly devolve to chaos which is much less likely with the business hour schedule since the goal is generally avoiding major changes on the weekend anywhere. In terms of continuity of care, that concern seems to demonstrate a somewhat idealized/romanticized view of inpatient acute care. Inpatient mental health in locked units is about acute stabilization, with length of stays often well under 5 days. Most psychiatrists, heck most social workers, psychologists and nurses, are not going to develop strong therapeutic alliances in this setting. It's not an ultimate goal and could even be paradoxically harmful depending on the extent. Long term recovery is not developed in an acute inpatient unit. These are spartan places that exist for stabilization just to the extent that a patient can participate in any lower level of care.
 
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vanfanal said:
Isn’t this kind of schedule difficult in psych?

It’s not like IM where you can quickly review charts and labs, and most of the work up and treatment is standard so it’s easy to be consistent between docs.

In psych you have to know their story, build rapport, maybe do some therapy. How is all that possible when you’re switching docs every week? It’s also very likely that two docs can have different formulations and diagnoses, and tx plans.

Curious as to what those who are active in this model are handling these potential issues.
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Psych is still medicine, so workup and treatment should be standard.

There's copious documentation (petition, ED/SW/RN notes, past hospitalizations), so patient stories are already known. If you do this long enough, patient stories are routine. Inpatients are also fraught with extreme subjectivity ("I'm not manic, I'm Jesus!"). If an inpatient can give a coherent story of what happened, they wouldn't be in a psych ward or they are ready to be discharged

Their presentations are also routine, usually some version of the letter S: sad, suicidal, substances, sychotic, and/or super elevated. Start meds, side effects assessment, stabilize, send to outpatient, substance rehab.

Inpt is not the place for therapy, as opposed to being therapeutic. If they could tolerate actual therapy, they wouldn't be on the psych ward. Rapport is a non-issue. Act with compassion, respect, and healthy boundaries, and the patient will choose to engage in rapport. Or not.

The hard part is coming in after a terrible psychiatrist. No med rec, ignoring/not ordering labs, diagnoses/meds that don't match the presentation, plans that just say, "continue meds", etc. Might as well read tea leaves.
 
I really like that concept of inpatient psych as being therapeutic, but not being therapy. There are so, so many other levels of care. If you can possibly do any of them safely, you should not be in an inpatient unit. Also definitely second that patient's stories are known. It's exceedingly rare that I have a completely unknown patient and it becomes even less common the longer I practice.
 
IP units used to be designed to actually treat most pathology, but that is certainly not the case now (of course beyond acute psychosis, mania, catatonia, severe depression, etc). I think it's largely for the better that the real treatment occurs in RTC/PHP/IOP (or rarely regular ole OP), systems that are now better structured to help support sustainable recovery in a more palatable environment. Folks wanting to do IP work, this is certainly the job these days, stabilize and get to the right level of care, rinse and repeat.
 
Imo biggest knock on 7/7 schedules is missing weekends with family. If I didn't have kids I'd love that kind of schedule and the few psychiatrists I know with that schedule love it. I'd like it because there's a lower proportion of "first days" when you have to re-orient to the unit and relearn patients (or figure out wtf the weekend/other docs were doing).

Candidate2017 said:
Psych is still medicine, so workup and treatment should be standard.

There's copious documentation (petition, ED/SW/RN notes, past hospitalizations), so patient stories are already known. If you do this long enough, patient stories are routine. Inpatients are also fraught with extreme subjectivity ("I'm not manic, I'm Jesus!"). If an inpatient can give a coherent story of what happened, they wouldn't be in a psych ward or they are ready to be discharged
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Yes, but actually reviewing the chart to find all that is what takes time in psych. For medicine patients I can read 2 lines of the H&P, check the labs, and read an imaging report in 30 seconds and have a good idea of what's happening. In psych you've got to read a story and get the context. If the H&P sucks, then you're digging to try and figure out why they're really there. Sometimes you just have to re-interview them yourself. That takes more time. Even if you're streamlined, probably going to take 3-5 minutes per patient which adds up.

I'd also push back on the bolded a bit. Plenty of patients coming in post-attempt or near attempt who are totally coherent but I'm not letting go without a darn good dispo plan. Also, figuring out what "suicidal" means isn't always straightforward without collateral.
 
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vanfanal said:
Isn’t this kind of schedule difficult in psych?

It’s not like IM where you can quickly review charts and labs, and most of the work up and treatment is standard so it’s easy to be consistent between docs.

In psych you have to know their story, build rapport, maybe do some therapy. How is all that possible when you’re switching docs every week? It’s also very likely that two docs can have different formulations and diagnoses, and tx plans.

Curious as to what those who are active in this model are handling these potential issues.
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My guess would be my hospital doesn't have worse outcomes than others that utilize standard scheduling.
 
psych_0 said:
The 7/7 docs at my job love it. They do their work then head home around 1-2pm. I prefer M-F because I enjoy only working 1 weekend a month. And there are more wRVUs to be had on a M-F + 1 weekend schedule vs a 7/7 schedule. Also, our 7/7 docs do not get vacation days. Last year I took 30 days of vacation and made more than each of the 7/7 docs. The only way I am giving this up is if admin comes down and says : Switch to 7/7 or find a new job. I wouldn't like it, but I would still switch to 7/7 because the pay is still crazy.
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Yeah, but what are the 7/7 folks doing with that off week? Even a couple of days of locums or moonlighting on a 1099 would swing the pendulum pretty hard. Doable if you're early career and playing catchup.
 
ridethecliche said:
Yeah, but what are the 7/7 folks doing with that off week? Even a couple of days of locums or moonlighting on a 1099 would swing the pendulum pretty hard. Doable if you're early career and playing catchup.
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Honestly, most of them just chill and enjoy the week off. One of them has a tele clinic on 3 of those 7 days off. To them, $450-500k is plenty for 7/7 work. They use their off weeks to travel and spend time with their young families.
 
psych_0 said:
Honestly, most of them just chill and enjoy the week off. One of them has a tele clinic on 3 of those 7 days off. To them, $450-500k is plenty for 7/7 work. They use their off weeks to travel and spend time with their young families.
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Sounds nice!
 
Problem is these jobs are very rare. I had these jobs for years but had to travel to another state to do them. I enjoyed them immensely due to being able to travel extensively on the week off. These days I just dont see them as much, at least in my home state.
 
Candidate2017 said:
If an inpatient can give a coherent story of what happened, they wouldn't be in a psych ward or they are ready to be discharged
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There's a lot of truth to that with the exception of some of the suicidal patients with MDD. Many of them on admission are fairly articulate and good historians.
 
ridethecliche said:
Yeah, but what are the 7/7 folks doing with that off week? Even a couple of days of locums or moonlighting on a 1099 would swing the pendulum pretty hard. Doable if you're early career and playing catchup.
Click to expand...
I do the 7 on/off as a hospitalist. I sometimes travel if my kids are off from school or pick up extra shifts when I am bored

I don't see myself working M-F 9a-5p ever unless I have no choice. You only have two days off in a row, and after you enjoy that Saturday off, you are already in the mindset of going back to work by Sunday.

In addition, most of these 7 on/off jobs don't expect to stay in-house until 7 pm.
 
Are you covering the night call too for all 7 days?
 
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