Am I Being Silly?

[TerraceHouse]

I am only a few days in working as an inpatient doc. The census is manageable: 12-15 pts/day, call is pretty standard 1x/week, and weekend rounding demand is average/above-average (2x/mo) but the second weekend is compensated. Most days we get done by 12pm. But regarding processes, everything is done in a roundabout, complicated way and not done very well (will avoid specifics to remain anonymous, just imagine things aren't done that well). Most of the docs make at least 400k this way.

Question is: am I being silly for already wanting to leave a place that pays well and the job can be done by noon?

I'm looking at jobs that pay way less 280k, require longer hours 8-5 M-F, but less stress (outpatient, no call, higher functioning pts, better staff) and I dream about it. Am I just being silly?

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[Celexa]

Waking up every day and dreading going to work is corrosive. There's a price on that, and it's not unreasonable to conclude your current job isn't worth it. There are more things in life than money (when the question is between quite a lot, and more than quite a lot). At the end of the day you get to decide what matters to you.

However, if you've committed to a lifestyle that depends on your current income, you'll need to reckon with that. Another question of deciding what matters.

 

[FlowRate]

What is it that you're finding undesirable about this setup? It's really not clear to me from your post. Things are inefficient but you're still leaving by noon?

Many/most outpatient employed gigs still will have their share of stress and liability.

 

[finalpsychyear]

If your providing good care and helping patients and still done by noon id stick it out so you can pay off some of the rules you didnt follow via wci. Hit fire then you can care less about money. That extra 100k right now will def help your scenerio.

 

[Bartelby]

I'm a big fan of outpatient and a big fan of working a job you like. In your case, though, I am also curious about what is not working with your current setup. The call schedule sounds like something I would not like, but if you are only working four hours per day M-F and making $400k you may really regret moving to outpatient. This is particularly true because you describe having a lifestyle where you may have to make hard choices, like pulling your kids out of private school or downsizing your home, if you change roles.

As FlowRate mentioned, outpatient is not stress-free either. And a nine hour day (you probably get an hour lunch or admin time, but whatever, it's still 8-5) five days per week all clinical is actually a pretty demanding role.

A key question for me would be whether you are providing high-quality care. If the systems issues mean you are providing poor care to patients, then I say move on. If you are providing care you feel good about, then based on the information you've given I have a hard time making a case to switch.

 

[jbomba]

On a related note, how bad is it to leave a job shortly after starting? I am starting an inpatient job after recently finishing residency. If the job isn't a good fit for me how bad a look is it if I leave in the first month or two? It'll be a 1099 role fwiw.

 

[TexasPhysician]

The vast majority of jobs will have aspects done in a complicated or inefficient way to you. They aren’t designed with just you in mind.

The longer you stay, the more you may gain power to make changes, or the more you may understand why it is inefficient to adapt.

If this is the only problem with the gig, I’d probably stick with it for a year and try to learn from it or change the issues. Switching to outpatient 8-5 is unlikely to help and may hurt.

If inefficiencies are upsetting you, maybe consider starting a private practice from 1-5pm. As your pp grows, quit the employed role. Now you control it all.

 

[annoyedpsychiatrist]

Probably wherever you go there will be a tradeoff. I get 30 min f/u apts here (which is great) but im also seeing community psych type patients since our local community psych basically collapsed last year. I get fairly stressed at times but i have to tell myself, pros and cons and realistically this job im currently in is leagues better than my last job. Though things can always change.

My point is to be objective. What are you searching for, and is it realistic what you're searching for? You work for a hospital system, youll likely be at the mercy of their rules. You work for a private clinic, profit will likely be the emphasis. You work for community psych, patient volume will likely be the emphasis. You start your own clinic then you have the stress of managing it all yourself but you control what you do. As long as you're an employee you will follow their rules. The key is to make sure the set of rules are at least somewhat tolerable. I think its rare youll find a job where everything aligns perfectly. Unless maybe you go to a rural setting where they're struggling to find providers, you may have more sway in that scenario

 

[wolfvgang22]

I agree with everyone else. My very first thought is that if you think outpatient will be less stressful and more rewarding than what you are doing right now, you are in for a rude awakening if you change to outpatient.

 

[heartsink]

From a financial standpoint, earning + investing more in your early career weighs more heavily on your ultimate wealth outcome than an even larger income invested later. I know you weren't asking about wealth building specifically, but it is something to consider in the calculus of leaving a less satisfying high-paying job for a more satisfying lower-paying one (and it sounds like you have a fair amount of monetary commitments already). Like others have said, sticking it out for at least a year (or two, if you can stomach it) is probably the most prudent choice right now.

 

[TheRightMedication]

If I were you I would keep the high paying job with short hours and enjoy your children. Also with free afternoons you have a great opportunity to spend time either trying to improve conditions at your job, or find satisfaction with something else.

 

[PsyDr]

I'm not a psychiatrist, but can't you just modify the processes? Or get an MA or nurse to do it your way?

"Hey, I'm Dr. Terracehouse. I will be (insert how you want things done). Please (insert what you expect staff to do). " Bring pizza the first time you do this, to get in their good graces. Then buy a pizza once per week, and gift them each $100 on Christmas, to maintain good graces.

*If this works, I would like a one time 2.5% finders fee.

 

[comp1]

It's very hard to provide advice with such vagueness about what the issues actually are. I understand wanting to maintain privacy...but there are limits. If there is some process you don't like, could you take over more of an administrative role to help fix it?

 

[Sushirolls]

Reading between the lines:

Place probably does paper charts
Limited support staff, med passes are often delayed or late, and patients are always upset no one is around
D/C instructions are boilerplate and not really setting people up with appointments or anything, just here's your list
Meds are probably rudimentary reconciled
Treatment team meetings are long, laborious, not productive, but boy are all those JCAHO forms signed by the right people!
Weekend rounding doesn't even involve a sign-out, and if it does its, garbage and doesn't help convey they plan for the patient
Admits have no criteria other than loose 'medical necessity' and insurance. If there is even a 'do not admit' criteria, its never followed.
Notes are brief from all, and at times you even wonder what you documented on a patient when they bounce back.
D/C Summaries don't help and really even aren't worth digging up for re-admits, and you'll be disappointed that the patient oscillates from Schizophrenia / Bipolar /Schizoaffective / Psychosis NOS / and further down the Dx list Meth or Crack...

Admin won't fix it, because that means money or caring; or worse both!

 

[Merovinge]

Reading between the lines:

Place probably does paper charts
Limited support staff, med passes are often delayed or late, and patients are always upset no one is around
D/C instructions are boilerplate and not really setting people up with appointments or anything, just here's your list
Meds are probably rudimentary reconciled
Treatment team meetings are long, laborious, not productive, but boy are all those JCAHO forms signed by the right people!
Weekend rounding doesn't even involve a sign-out, and if it does its, garbage and doesn't help convey they plan for the patient
Admits have no criteria other than loose 'medical necessity' and insurance. If there is even a 'do not admit' criteria, its never followed.
Notes are brief from all, and at times you even wonder what you documented on a patient when they bounce back.
D/C Summaries don't help and really even aren't worth digging up for re-admits, and you'll be disappointed that the patient oscillates from Schizophrenia / Bipolar /Schizoaffective / Psychosis NOS / and further down the Dx list Meth or Crack...

Admin won't fix it, because that means money or caring; or worse both!

I was wondering how working until noon (admittedly with q2 weekends which is awful) could be so bad for 400k and voila, now I understand how this could actually not be worth it. Making me appreciate my job even more now .

 

[G Sheb]

Short answer: you're not being silly.
4/5 hours a day, 5 days a week, is nothing to sneeze at, especially when you add 2x monthly call duties. If you hate that job, it will make your life miserable, and those extra few hours every day won't change that.