Avoiding outpatient burnout
- Thread starter kookfu
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Getting away from employed jobs. Doing PP.
Having a quality assistant / front desk.
Not taking UHC or other insurance that routinely scat on you.
Having a quality assistant / front desk.
Not taking UHC or other insurance that routinely scat on you.
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Some things that help for me (whether in private practice or employed):
-Do 90 minute intakes and 30-minute follow ups
-Build in admin time, even if it is a lunch hour. Try to use time efficiently so that you can typically go for a walk, scroll SDN, or do whatever you want in that downtime.
-Manage your panel so that you have schedule openings for urgent cases. Having several acute patients with no way to manage them except working them in before or after-hours is stressful (and so is ignoring the issue and dealing with a bad outcome).
-If you have a niche interest consider building a practice geared toward that (for example, psychosis, trauma, substance abuse). If in private practice, consider developing a therapy panel (interesting work that decreases the overall panel size significantly).
-Maintain good boundaries. Avoid doing lots of out-of-session work or after hours work. For example, try to fill out paperwork with the patient in session where they can provide additional info and clarification.
I also recommend varying things up. If you have some time dedicated to another activity like research, leadership, or clinical care in another setting that can break up the "grind."
If I worked only outpatient clinical, I would do 0.8 FTE and work four eight-hour days if finances allowed. I think five days of a close to fully-booked schedule would likely burn me out. With a slower, gentler pace I find outpatient work to be pretty rewarding and probably the best practice setting in psychiatry.
-Do 90 minute intakes and 30-minute follow ups
-Build in admin time, even if it is a lunch hour. Try to use time efficiently so that you can typically go for a walk, scroll SDN, or do whatever you want in that downtime.
-Manage your panel so that you have schedule openings for urgent cases. Having several acute patients with no way to manage them except working them in before or after-hours is stressful (and so is ignoring the issue and dealing with a bad outcome).
-If you have a niche interest consider building a practice geared toward that (for example, psychosis, trauma, substance abuse). If in private practice, consider developing a therapy panel (interesting work that decreases the overall panel size significantly).
-Maintain good boundaries. Avoid doing lots of out-of-session work or after hours work. For example, try to fill out paperwork with the patient in session where they can provide additional info and clarification.
I also recommend varying things up. If you have some time dedicated to another activity like research, leadership, or clinical care in another setting that can break up the "grind."
If I worked only outpatient clinical, I would do 0.8 FTE and work four eight-hour days if finances allowed. I think five days of a close to fully-booked schedule would likely burn me out. With a slower, gentler pace I find outpatient work to be pretty rewarding and probably the best practice setting in psychiatry.
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Work hardest early in your career like first decade then naturally you can scale back. Nothing beats this. This is what my attending told me and too many around me were crusiing around doing 20-25 hr work weeks for a few years post residency now they are in late 30s/early 40s realizing they should have done more early on and its been more challenging to get high paying jobs vs when they were in highest demand when first out.
Compound working leads to compounded investing which leads to sub 50 FIRE and work for fun lifestyle. Good luck it def wasn't easy but 0 regrets working my tail off then the stock market further compounded all that so a little luck never hurts.
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Off the top of my head:
1. Boundaries for yourself, patients and admin
2. Clear expectations for patients about communication btwn appts, refills, fees etc (much easier in private practice v employed)
3. Schedule send all messages M-F 8-5 so no one expects an answer after hours
4. Max 6h of direct patient care in a day (5 is better)
5. Last hour of the day for admin. Never stay late.
6. Follow ups 30 minutes. Never shorter
7. Comprehensive screening of new patients to optimize doctor-patient compatibility
8. Don’t do things that make you resentful
1. Boundaries for yourself, patients and admin
2. Clear expectations for patients about communication btwn appts, refills, fees etc (much easier in private practice v employed)
3. Schedule send all messages M-F 8-5 so no one expects an answer after hours
4. Max 6h of direct patient care in a day (5 is better)
5. Last hour of the day for admin. Never stay late.
6. Follow ups 30 minutes. Never shorter
7. Comprehensive screening of new patients to optimize doctor-patient compatibility
8. Don’t do things that make you resentful
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"Burnout" is really about systemic issues rather than things you can necessarily control in a given system. Interestingly, one of the biggest determinants of burnout in physicians is the level of student debt. This is why IMGs have lower rates of burnout, because they tend to have dramatically lower levels of student debt. So one of the big factors is for students to do their best to avoid accruing high levels of debt, and for those in practice to work hard at eliminating that quickly.
Other things that seem to track with burnout are features of late capitalistic healthcare including "productivity targets", high volume practice, quality metrics, patient satisfaction scores, low levels of autonomy, documentation/EMR bloat, and moral injury from feeling like you cannot provide the standard or quality of care that patients deserve. Dealing with monotonous tasks that alienate us from the actual practice of psychiatry (like doing prior authorizations, interacting with insurance companies, pharmacies etc) can all contribute to burnout.
Always have one foot out of the door. Always keep looking at other opportunities and jobs so you don't feel trapped. Take long weekends, take vacations, pivot to what you are passionate about and find a way to focus on that. The more control you have over how you practice (e.g. appointment lengths, frequency of visits, which patients you see) and the more you can farm out things like doing PAs, the more fulfilling a career you can have. Also, don't compare yourself to others. The most miserable people are the ones who feel upset they don't make as much as such and such, or gripe about NPs taking "our jerbs" etc. Be content with your lot in life and if you want more then put in the work and make it happen.
Other things that seem to track with burnout are features of late capitalistic healthcare including "productivity targets", high volume practice, quality metrics, patient satisfaction scores, low levels of autonomy, documentation/EMR bloat, and moral injury from feeling like you cannot provide the standard or quality of care that patients deserve. Dealing with monotonous tasks that alienate us from the actual practice of psychiatry (like doing prior authorizations, interacting with insurance companies, pharmacies etc) can all contribute to burnout.
Always have one foot out of the door. Always keep looking at other opportunities and jobs so you don't feel trapped. Take long weekends, take vacations, pivot to what you are passionate about and find a way to focus on that. The more control you have over how you practice (e.g. appointment lengths, frequency of visits, which patients you see) and the more you can farm out things like doing PAs, the more fulfilling a career you can have. Also, don't compare yourself to others. The most miserable people are the ones who feel upset they don't make as much as such and such, or gripe about NPs taking "our jerbs" etc. Be content with your lot in life and if you want more then put in the work and make it happen.
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Good points here for sure. Have a vision of the roadmap of what your career will sorta look like since it wont necessarily hold. If your single, married, and/or have kids that will impact your "tank" so you have to manage with that in consideration. My first 5 years i was single and could put most of my tank into the career. My roadmap was not to be the doc that worked till 65 unless I was doing it for some reason not financially related at that point.
Once those variables were laid out, I simply mapped out my career in 3 phases. The first decade was the foundation base where investing till it hurt and working more than 1.0 FTE to have the money to invest compounded each other and would allow me to ease up in the following decades. I def live in the moment and have a ton of fun and travel thus working extra helps to have both things.
Im going to begin the 2nd phase next year where I am cutting hours and giving myself fridays off.
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Live below your means and have solid emergency savings. This gives you short-term FU money if ever needed.
For me, having a significant admin role is a huge plus. Gives me more varied and interesting work and less clinic grind.
Know when to tell patients they need an appointment rather than another round of unanswered portal questions.
I wish I could be this way, but I'm not: some of our docs who are 1.0 clinical for many years and still happy with it are relatively more permissive--they choose less battles. I imagine things feel nicer when you're making more people happy with you, even if that might not be a system, quality, or epistemologically optimal outcome.
For me, having a significant admin role is a huge plus. Gives me more varied and interesting work and less clinic grind.
Know when to tell patients they need an appointment rather than another round of unanswered portal questions.
I wish I could be this way, but I'm not: some of our docs who are 1.0 clinical for many years and still happy with it are relatively more permissive--they choose less battles. I imagine things feel nicer when you're making more people happy with you, even if that might not be a system, quality, or epistemologically optimal outcome.
