For me personally pretty much anything would be more meaningful than acute inpatient or ER psych, because for me personally developing a relationship over time is a hallmark of psychiatry.
I can understand that sentiment. However, the acute stabilization of mania and psychosis, specifically first episodes, is the thing that really got me hooked into psychiatry. That's not something you're going to see on an outpatient basis, and if you do you're not going to be managing it as you'll be admitting to an inpatient unit. Plus a lot of psychiatrists work in both inpt and outpt settings, so the opportunity to manage all aspects of patient care is an option (another thing which drew me to psych).
Also at many hospitals it’s a horrible situation where the patients who do need to be there are getting booted out by insurance/hospital admins and then the patients who don’t need to be there are refusing to leave and security is nearly dragging them off unit.
I've certainly seen this, but I've also rotated/worked in places where the teams will fight tooth and nail to get extensions to patient's stays covered by insurance. I think this is more of a cultural issue with administration than a true characterization of inpatient psychiatry, and it's one that can be fought if you document well and give proper justifications for the treatment plan.
Also completely anecdotally and small sample size, on average acute short stay inpatient psychiatrists seem more concerned with RVUs/“efficiency”/etc than actually being invested in their patients as people, so I just don’t really like that environment.
This one I'll disagree with. I actually think the outpatient docs are far more concerned with billing codes and RVUs than inpatient docs. On the inpatient unit it's pretty easy to code properly for acute mania/psychosis/suicidality/etc. On the flip side, I've seen a lot more comments come out of discussions on the outpatient side in regards to proper billing practices and RVUs. Additionally, I think the outpt docs typically receive reimbursement through models which required them to be conscious of the codes their using and their RVUs where as most inpatient docs are going to either be getting a flat salary or a base + RVU based bonus.
Use this site as an example. We see threads about coding and proper documentation all the time. Every one that I can think of is a question coming from the outpatient setting, and I don't think I've ever seen a thread in the psych forums asking about coding on the inpatient side. If inpatient docs were so concerned with the RVUs and billing, I feel like we'd see a lot more questions regarding that here (and I would in real life) than we do.
I can maybe buy the part about being invested in the patient, as outpt docs are developing long-term relationships, but again, I feel like the units which are more focused on churn control than patient care are typically a result of administrative culture and not the actual desires of the treating physician (and can be fought as stated above if one were inclined to do so)
It is fun to stabilize floridly manic or psychotic folks, but not particularly intellectually interesting for me at this point given how easy the decision making generally is
Mostly fair. However, most units will see more than just manic and psychotic patients. There's the depressed patients, substance abuse, personality disorders, along with all the other major/common co-morbidities like OCD or ADHD. I think what you're expressing is the tendency to only focus or focus heavily on the chief complaint during inpatient stays with the tendency to not address many of the comorbidities unless they're an obvious part of the reason for admission. I had an attending on a recent rotation who was extremely thorough with her psych ROS and really stressed the importance of addressing every aspect of care when possible so there's a general plan/direction in place for when the patient is seen for outpt follow-up. I think identifying unaddressed co-morbidities and underlying conditions which have been previously missed is a big part of inpatient care and can be just as intellectually stimulating as care in the outpt setting.
The major difference I see is that if you really want to incorporate psychotherapy as a major component of your treatments, it would be much harder to do on the inpatient unit beyond supportive therapy and maybe some initial psychodynamic therapy. However, I would argue that just performing pyschotherapy doesn't necessarily make treatment more intellectually interesting.
