Addiction Practice Pathway

[zenmedic]

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Hey all,

Any word if the practice pathway will be extended, or is this really it this time? I am graduating Spring ‘27 and enjoy addiction a lot but doing a fellowship doesn’t make sense financially for me. Have you all found it’s even necessary to be boarded in addiction to be in a majority addiction role?

Thanks!

 

[comp1]

It's possible as a brand new grad you MIGHT find a job that wants this outside straight academia, but wow, would they be rare.

 

[TexasPhysician]

Most addiction jobs in my area are being taken by psych NP’s for cost savings. The places willing to pay extra want someone boarded in addiction.

 

[comp1]

I agree that if there was some sort of extra to be paid, they would want someone board certified (again, outside academia). I'm just saying that most addiction jobs for psychiatrists are going to pay about the same as most non-addiction jobs, not extra. Some might even pay a bit less because certain niche addiction jobs can be much easier than general psychiatry. The only fellowships that pay a little more than general psych are forensic and child. Child...your mileage will vary, but most pay jobs do pay a tiny bit more.

 

[moto_za]

Most addiction jobs in my area are being taken by psych NP’s for cost savings. The places willing to pay extra want someone boarded in addiction.

I have also noticed this trend lately at a lot of hospitals and correctional facilities, they are using NPs instead of psychiatrists to cut costs. Has happened now to me at 3 different facilities I was working at in the past year...

 

[comp1]

They're using NPs because they can't recruit psychiatrists at pretty much any salary in many correctional settings. That said, you will still definitely find correctional job offers for psychiatrists still available (and NPs too) at the vast majority of facilities.

 

[moto_za]

They're using NPs because they can't recruit psychiatrists at pretty much any salary in many correctional settings. That said, you will still definitely find correctional job offers for psychiatrists still available (and NPs too) at the vast majority of facilities.

It can depend on the facility, but myself and another psychiatrist were let go because we were told by admin that we "cost too much" and now the correctional facility is filled with NPs. They pay them less than half of what I made per hour. Same thing happened to me at another inpatient rural hospital.

 

[Stagg737]

They're using NPs because they can't recruit psychiatrists at pretty much any salary in many correctional settings. That said, you will still definitely find correctional job offers for psychiatrists still available (and NPs too) at the vast majority of facilities.

True. I get monthly texts (to my personal phone) from 2 prison companies asking if I’m interested in positions at several facilities in neighboring states. I would consider responding to these if any of them were closer, but the nearest one is 2 hours away.

 

[comp1]

I know people really like to keep things general, but I'd love to know at least the state that is letting correctional psychiatrists go while hiring NPs. I'm just not seeing it. Here's CA and that's just what they have gone to the trouble of posting. I bet if you called up the state MD recruiter and asked if they had an opening at any given prison or state hospital, they'd find it for you.

https://calcareers.ca.gov/CalHRPublic/Search/JobSearchResults.aspx#kw=psychiatry

 

[TexasPhysician]

They're using NPs because they can't recruit psychiatrists at pretty much any salary in many correctional settings. That said, you will still definitely find correctional job offers for psychiatrists still available (and NPs too) at the vast majority of facilities.

This is not what I’ve seen. Correctional used to pay pretty well in some areas and the demand to take those positions was quite high. Psychiatrists were lining up to absorb any openings. Then came cost cutting. In Texas, some of the correctional jobs don’t have air conditioning. They are offering pay at a rate I can do telepsych from home, so they are struggling to find people. Who wants to work in the heat 30+ minutes away at the same rate you can earn at home? Last month I inquired about a correctional job labeled as telepsych. Their response is that it is telepsych from a specific location 30+ minutes away. Their progress towards being desirable again is very slow.

The addiction jobs were VERY desired by psychiatrists here. 90% of positions have been replaced by NP’s just to cut costs. There was 0 difficulty filling the positions originally with psychiatrists.

 

[comp1]

Okay, I'm grateful for naming a state as it makes research possible. I can't comment on prison air conditioning, but that sounds cruel and unusual to me for the inmates, to say nothing of the staff. I doubt the air conditioning is an issue for the in office/out of prison telepsych job. In terms of salary, it looks like $305k for sure based on Texas Tribune salary date (possibly $340k according to some ads). That's just salary, not including any insurance/retirement benefits, malpractice, PTO, OT, etc. The benefits aren't at the federal level (lots of federal correctional jobs in Texas available too), but they're fair. Texas isn't as cheap as some places, but it also isn't CA. I would say that the pay isn't amazing, but I also think you'd have a lot of trouble getting a 100% home telepsych practice to meet this, at least at 40 hours a week. I see lots of postings on the state board for psychiatrists, but only one for a PMHNP. NPs in Texas don't even have full practice authority, so I definitely don't think they are coming for anybody's job there.