Boss trying to get me to take on more work

[samac]

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Okay.
So overall I like my academic job. I love inpatient, I enjoy working with residents and medical students.
When I started there was a second inpatient attending, splitting the 19 bed inpatient service and he was running the ECT service (2-3 cases a day) and I was running consults (usually 5-10 patients).

He is leaving. I’m going to be running the 19 bed unit, consults and take on his ECT caseload. It’s not going to be easy but I’ll manage.

I am asking that we don’t increase the ECT case load, not taking on new cases unless they’re urgent like catatonia. My CMO is pissed because he wants to expand the ECT service in general. He doesn’t seem to understand why I think running an ECT service, the unit, and a CL service is a hard ask.

Sure, I can round much much faster without a gaggle of medical students and residents but between the unit and the CL service I have 12 learners and letting them present, discuss things and run the show takes much much more time.
I don’t want to burn myself out my first year as an attending.

I’m RVU based and currently surpassing my RVU targets with only half the unit and the consult service.

Any advice on how to approach this?

 

[TexasPhysician]

I understand that the department has goals to continue expansion. Prior to Dr X leaving, I was meeting my production goals as requested for my salary. Now I am being asked to meet my goals and the goals of the departing Dr X. I am a team player and will assist, but I would also like to be compensated fairly for managing additional roles. After reviewing the numbers, I would like my salary increased to Y with RVU bonuses of Z and a change of title to ………

If this is not possible, I would be happy to help another psychiatrist at the institution to transition into Dr X’s role. I am here to help the department thrive, and am more than willing to help with either option.

Let’s set a meeting to help resolve this next week.

 

[calvnandhobbs68]

Sounds like fair compensation should be paid his entire salary on top of yours plus some since you're only one person and they don't have to pay benefits for two people right now.

The above post is the actual diplomatic way to approach it though lol.

 

[samac]

I understand that the department has goals to continue expansion. Prior to Dr X leaving, I was meeting my production goals as requested for my salary. Now I am being asked to meet my goals and the goals of the departing Dr X. I am a team player and will assist, but I would also like to be compensated fairly for managing additional roles. After reviewing the numbers, I would like my salary increased to Y with RVU bonuses of Z and a change of title to ………

If this is not possible, I would be happy to help another psychiatrist at the institution to transition into Dr X’s role. I am here to help the department thrive, and am more than willing to help with either option.

Let’s set a meeting to help resolve this next week.

Thank you!

I mean honestly I don’t know that they can pay me enough to do a fully expanded ECT service on top of my other duties

 

[samac]

Sounds like fair compensation should be paid his entire salary on top of yours plus some since you're only one person and they don't have to pay benefits for two people right now.

The above post is the actual diplomatic way to approach it though lol.

Ultimately it’s really 2.5 jobs. I’m cross covering consults because we’re trying to hire someone, that’s a full time job.
The unit should be one job to itself.
And then we also have TMS outpatient that people are cross covering, it should be a neuromodulation job for ECT/TMS.
We’re expanding service lines faster than we get bodies in them.

 

[littlefred]

Who's covering weekends and overnight?

Is it you as well?

 

[samac]

Who's covering weekends and overnight?

Is it you as well?

No, residents in house on nights and the entirety of the psychiatry department rotates and takes call.

 

[Sushirolls]

LOL. I've been there at a Big Box shop.
IP/ CL/ students / ED / solo ECT / Suboxone clinic / med check groups / OP

Be blunt. You can't have it all. I can't do it all. Get more bodies on the front line. Otherwise your only option CMO, is to pick:
1) cut the unit beds available down to 8,
2) or cap the ECT new intakes

Pick one CMO, or you'll have my resignation too.

When you mention the idea of cutting the IP beds to 8 and even your resignation, they might finally get the message - listen to your first and very reasonable demand.

 

[Merovinge]

Just for point of comparison, at my adult residency what you described is absolutely 2.5 FTE. Given academic IP beds are essentially always full, it honestly feels unsafe to me what you are trying to do. If I interviewed at a program that had one person running a 19 bed unit, a full consult service, and was doing multiple ECT cases a day I would rank them at the very bottom regardless of any other experience there. Best of luck with the upcoming talks and make sure you are putting yourself and your patients first, the buck stops with us as the attending.

 

[comp1]

This workload is unsafe. The answer should be no. It's not a matter of pay. You have physical limits. You're going to end up relying on trainees in an inappropriate manner. It's the only way to make this even superficially look like it's working and that's not right. They can eat the cost of a locums while they are recruiting.

 

[samac]

Just for point of comparison, at my adult residency what you described is absolutely 2.5 FTE. Given academic IP beds are essentially always full, it honestly feels unsafe to me what you are trying to do. If I interviewed at a program that had one person running a 19 bed unit, a full consult service, and was doing multiple ECT cases a day I would rank them at the very bottom regardless of any other experience there. Best of luck with the upcoming talks and make sure you are putting yourself and your patients first, the buck stops with us as the attending.

Yeah, I don’t know that I would have taken the job if I thought I would be in this position. I signed on with stipend in residency and when I signed on a different attending was doing consults, unit was it’s own and ECT was rare when needed on their own patients.
The consult person got a research grant and left and now with the other attending leaving it’s just like of “well ****”.

It was brought up that there were only 12 patients on the day I requested this, but that’s because I discharged 5. I had 5 new ones the next day. 💩

 

[samac]

This workload is unsafe. The answer should be no. It's not a matter of pay. You have physical limits. You're going to end up relying on trainees in an inappropriate manner. It's the only way to make this even superficially look like it's working and that's not right. They can eat the cost of a locums while they are recruiting.

I agree. I don’t want more pay. I just want to not burn out and have poor patient care.

 

[Sushirolls]

Then dictate how things are going to be. Better to risk leaving without burn out. Then leave later with burnout.
Once you're crispy, it's hard to un-crisp.

 

[calvnandhobbs68]

When you mention the idea of cutting the IP beds to 8 and even your resignation, they might finally get the message - listen to your first and very reasonable demand.

Just want to second this, your initial demand is EXTREMELY reasonable. All you're asking is that they do no more than what 3 ECT cases a day?

I mean my next line would be, fine I have to cover our own inpatient unit but I'm not seeing more than X number of consults a day, the rest can wait until the next day and when other services start b*tching about the lack of consult coverage the CMO can deal with it.

Are you in a position where you can bail on this job if you need to? Reason I ask is because you mentioned a resident stipend which makes me think you have some sort of initial obligation there. Otherwise that's your ultimate leverage.

 

[TexasPhysician]

I agree. I don’t want more pay. I just want to not burn out and have poor patient care.

Then weight the numbers in the direction you want them to go. They won’t agree to 2.5x pay and bump your title/benefits. While we could argue that it would be fair, they won’t want to do that. That gently forces their hand another direction.

 

[shoomer]

I am asking that we don’t increase the ECT case load, not taking on new cases unless they’re urgent like catatonia. My CMO is pissed because he wants to expand the ECT service in general. He doesn’t seem to understand why I think running an ECT service, the unit, and a CL service is a hard ask.

This part sounds quite concerning to me to be honest, the fact that he's pissed and not understanding of your predicament. No one should be expected to do 2.5 FTE worth of work, even with increased compensation (which is not going to happen in academia anyway).

I agree with others saying this is a recipe for burn out and you need to really be ready to leave. Not making an empty threat, but putting forward your dissatisfaction with the new arrangement and being ready to walk out if they don't acquiesce. That also means starting to look at open positions elsewhere now, both as a contingency plan and a negotiating point.

 

[Stagg737]

Okay.
So overall I like my academic job. I love inpatient, I enjoy working with residents and medical students.
When I started there was a second inpatient attending, splitting the 19 bed inpatient service and he was running the ECT service (2-3 cases a day) and I was running consults (usually 5-10 patients).

He is leaving. I’m going to be running the 19 bed unit, consults and take on his ECT caseload. It’s not going to be easy but I’ll manage.

I am asking that we don’t increase the ECT case load, not taking on new cases unless they’re urgent like catatonia. My CMO is pissed because he wants to expand the ECT service in general. He doesn’t seem to understand why I think running an ECT service, the unit, and a CL service is a hard ask.

Sure, I can round much much faster without a gaggle of medical students and residents but between the unit and the CL service I have 12 learners and letting them present, discuss things and run the show takes much much more time.
I don’t want to burn myself out my first year as an attending.

I’m RVU based and currently surpassing my RVU targets with only half the unit and the consult service.

Any advice on how to approach this?

Several questions:

Is it the CMO or your department chair (or both) that are upset that you want to set limits? If it's the former, why is the CMO so directly involved? Go to your department chair and get them on your side if you can.

On consults, is that 5-10 new consults per day or are a bunch of those follow-ups? If they're straight new that's crazy to cover inpatient and that many new consults even with residents presenting them. That's could be 7-15 new patient evals per day. That by itself is unreasonable.

Why is this all falling on you? Is there anyone else who can cross cover? Outpatient docs? If everyone is RVU based pay, outpatient docs should be able to hit RVUs covering some of these responsibilities.

You said surpassing RVU targets, are you getting extra for RVUs above that target? If not, why not?

Already got some great advice above, but I'd be firm regardless of what options are presented. Hard cap on inpt gig (12 max if you're covering other duties), ECT cap sounds good, as well as potential hard cap on consults as someone mentioned above.

All that said, sounds like this may not happen. The fact that they're more concerned about expanding when they're short-staffed and can't hire a C/L doc should say a lot. Demand patient caps and higher pay. One of my colleagues where I'm at clears $500k, so the excuse of "academic places won't do it" is bunk. If you're doing multiple people's jobs, get paid for it. Be ready to threaten to walk if you can as well. Sounds like they're totally screwed if you leave, so now's the time to negotiate and make your demands known.

 

[finalpsychyear]

Start looking for new job while you attempt to negotiate pay and responsibilities. If they dont budge u likely know this is not a future place and pull the rip cord now.

 

[Celexa]

Okay.
So overall I like my academic job. I love inpatient, I enjoy working with residents and medical students.
When I started there was a second inpatient attending, splitting the 19 bed inpatient service and he was running the ECT service (2-3 cases a day) and I was running consults (usually 5-10 patients).

He is leaving. I’m going to be running the 19 bed unit, consults and take on his ECT caseload. It’s not going to be easy but I’ll manage.

I am asking that we don’t increase the ECT case load, not taking on new cases unless they’re urgent like catatonia. My CMO is pissed because he wants to expand the ECT service in general. He doesn’t seem to understand why I think running an ECT service, the unit, and a CL service is a hard ask.

Sure, I can round much much faster without a gaggle of medical students and residents but between the unit and the CL service I have 12 learners and letting them present, discuss things and run the show takes much much more time.
I don’t want to burn myself out my first year as an attending.

I’m RVU based and currently surpassing my RVU targets with only half the unit and the consult service.

Any advice on how to approach this?

Adding my voice that this is insane and unsafe. People above are quoting 2.5fte--at my academic institution this would be 3 fte. And I'm just as perturbed by the number of learners you're being tasked with. The max we give our attendings on either inpt or consults is 4 or 5--if 5 one of them is a fellow. 12 is ludicrous and a betrayal of the teaching mission, even if you are a god-tier clincial educator. I hope you're earning 600k bc that's probably the minimum of what the multiple people covering that workload are getting in other places in total. And each of those people would of course also be getting benefits.

I cannot emphasize how much better the offers you can get would be even if you were to limit yourself to academic teaching gigs in terms of work life balance.

My dept is open to hiring year round but peak season is basically now for a few months as the current fellows are interviewing and budgets for the next academic year are being debated.

 

[Bartelby]

It sounds like your higher-ups will dump the system's staffing problem onto you if you allow it. I agree with others that you should not. Doing 2.5-3.0 FTE for a 1.0 FTE academic salary is basically a superhighway to burnout.

I'm also curious who covers if you are sick, or on vacation, or whatever else? It sounds like you personally are the inpatient, CL, and ECT services so I wonder if anyone can/will cover.

As others have said you can set boundaries and try to save this job, but you should absolutely be looking around at plan B's. Ultimately if you are not willing to walk away then they can dictate literally any deal to you. Having a genuine other option gives you power both to push back on unreasonable demands at your current job and to bail if they don't fix these glaringly obvious problems.

 

[samac]

Just want to second this, your initial demand is EXTREMELY reasonable. All you're asking is that they do no more than what 3 ECT cases a day?

I mean my next line would be, fine I have to cover our own inpatient unit but I'm not seeing more than X number of consults a day, the rest can wait until the next day and when other services start b*tching about the lack of consult coverage the CMO can deal with it.

Are you in a position where you can bail on this job if you need to? Reason I ask is because you mentioned a resident stipend which makes me think you have some sort of initial obligation there. Otherwise that's your ultimate leverage.

Yeah. Currently there are 2 patients getting an acute index MWF. There’s about 15-30 outpatient on various schedules. Currently it comes out to a couple most days
I got a 36k stipend which I can walk if needed, I have most of it in a savings account. It would wipe my savings completely though.
Does suck though that I’ve been approved for 100k of student loan repayment from the state if I can stick it out for 2 years.

Several questions:

Is it the CMO or your department chair (or both) that are upset that you want to set limits? If it's the former, why is the CMO so directly involved? Go to your department chair and get them on your side if you can.

On consults, is that 5-10 new consults per day or are a bunch of those follow-ups? If they're straight new that's crazy to cover inpatient and that many new consults even with residents presenting them. That's could be 7-15 new patient evals per day. That by itself is unreasonable.

Why is this all falling on you? Is there anyone else who can cross cover? Outpatient docs? If everyone is RVU based pay, outpatient docs should be able to hit RVUs covering some of these responsibilities.

You said surpassing RVU targets, are you getting extra for RVUs above that target? If not, why not?

Already got some great advice above, but I'd be firm regardless of what options are presented. Hard cap on inpt gig (12 max if you're covering other duties), ECT cap sounds good, as well as potential hard cap on consults as someone mentioned above.

All that said, sounds like this may not happen. The fact that they're more concerned about expanding when they're short-staffed and can't hire a C/L doc should say a lot. Demand patient caps and higher pay. One of my colleagues where I'm at clears $500k, so the excuse of "academic places won't do it" is bunk. If you're doing multiple people's jobs, get paid for it. Be ready to threaten to walk if you can as well. Sounds like they're totally screwed if you leave, so now's the time to negotiate and make your demands known.

So it’s a weird scenario. CMO is psych, and director of inpatient services so I report directly to him. Department chair is outpatient and agrees with me. But because he’s also a CMO and weirdly in multiple places in the power chain it’s a very weird dynamic. I don’t think I ever realized how weird it was until I started working here.

Consults is also follow ups. I’d say I average 3 new most days, but consults are so unpredictable. I had 7 brand new consults on Monday.

Outpatient docs are also RVU based but I just think they have absolutely 0 interest and there’s not that pressure on them because they don’t have the CMO issue.

I do get RVU bonuses for anything past my target. I’m already like 110 RVUs up for this quarter and it’s 2 weeks into January. I’m going to get a pretty good bonus at least.

You’re right, they would be screwed if I left. I think I have support of everyone in this department except for the one person I directly answer to lol.

It sounds like your higher-ups will dump the system's staffing problem onto you if you allow it. I agree with others that you should not. Doing 2.5-3.0 FTE for a 1.0 FTE academic salary is basically a superhighway to burnout.

I'm also curious who covers if you are sick, or on vacation, or whatever else? It sounds like you personally are the inpatient, CL, and ECT services so I wonder if anyone can/will cover.

As others have said you can set boundaries and try to save this job, but you should absolutely be looking around at plan B's. Ultimately if you are not willing to walk away then they can dictate literally any deal to you. Having a genuine other option gives you power both to push back on unreasonable demands at your current job and to bail if they don't fix these glaringly obvious problems.

I don’t know that they know the answer. It was that me and the other doc would cover each other if needed. I have vacation in March I submitted early this year before he announced his departure so we’re gonna find out.

I really appreciate all the responses, it felt unreasonable to me but I wanted to make sure I wasn’t overreacting. I’m going to hold my ground. I’ll walk if I have to.

 

[J ROD]

simple rule. Know your worth. Do not take less money than your worth. Let them know how much work you want to do and pay you will accept.

 

[claypigeon]

It’s trickier to frame this as you’re RVU based so it’s not a $$$ issue but I wouldn’t make this more complicated than it needs to be. You’re being asked to take on a full time position on top of your full time position.

I’d approach that diplomatically, and as a non starter, mentioning gratitude at the opportunity but that you can’t do the work of two people. Then ask them where they’d like you to cut back to accommodate the new workload. Imo let them choose one of inpatient, ECT, or consults for you to work. Pick two of the three if you want to grind but managing three services, even without ECT expansion, is not sustainable.

 

[Geraltofrivia]

I didn't read anything but if your boss is trying to give you more work, refuses to listen to your concerns, is arrogant, talks out of both sides of his mouth, you don't like him, leave. Leave ASAP. Trust me.

 

[smalltownpsych]

Yeah. Currently there are 2 patients getting an acute index MWF. There’s about 15-30 outpatient on various schedules. Currently it comes out to a couple most days
I got a 36k stipend which I can walk if needed, I have most of it in a savings account. It would wipe my savings completely though.
Does suck though that I’ve been approved for 100k of student loan repayment from the state if I can stick it out for 2 years.

So it’s a weird scenario. CMO is psych, and director of inpatient services so I report directly to him. Department chair is outpatient and agrees with me. But because he’s also a CMO and weirdly in multiple places in the power chain it’s a very weird dynamic. I don’t think I ever realized how weird it was until I started working here.

Consults is also follow ups. I’d say I average 3 new most days, but consults are so unpredictable. I had 7 brand new consults on Monday.

Outpatient docs are also RVU based but I just think they have absolutely 0 interest and there’s not that pressure on them because they don’t have the CMO issue.

I do get RVU bonuses for anything past my target. I’m already like 110 RVUs up for this quarter and it’s 2 weeks into January. I’m going to get a pretty good bonus at least.

You’re right, they would be screwed if I left. I think I have support of everyone in this department except for the one person I directly answer to lol.

I don’t know that they know the answer. It was that me and the other doc would cover each other if needed. I have vacation in March I submitted early this year before he announced his departure so we’re gonna find out.

I really appreciate all the responses, it felt unreasonable to me but I wanted to make sure I wasn’t overreacting. I’m going to hold my ground. I’ll walk if I have to.

Watch out for that two year loan repayment agreement. I found out the hard way that it was agreed to and finalized way before I realized that it was or that made much sense. You might already be locked in and the penalty for breaking it is egregious.

 

[annoyedpsychiatrist]

no amount of money is worth hating your life, and seems like even if they pay you more its not worth it really. The worst part is leadership feels YOURE the problem, and that does not bode well for the future. Hospital systems, business, etc if they have bad leadership, it can create a bad work enviroment. If they arent supportive now, they likely wont be in future, unless leadership changes. if anything they should be kissing your butt thanking you for staying and taking on more responsbiility already, but to push you harder when someone already just left, shows both ignorance and arrogance.

 

[Sushirolls]

Case study of 1.

I used to work at a Big Box shop that was bad. Eventually left, and was one of the best things I ever did. One of the docs still at the Big Box shop, stayed in touch. Things continued to be bad. I routinely educated person on different career standards, and work environments. Took several years, but person made the leap to leave. Landed at another Big Box shop (just not a person meant for PP which is okay) and this person is much happier. Shorter commute, more money, no call, less headaches, etc. Thanked me and had wished the change was made years ago.

 

[samac]

Had a meeting today, agreed to halt ECT expansion till we get another body in the hospital, expected in july as someone is in the contract stage. Wasn’t too much of a fight and I retain discretion to start ECT on urgent cases.

Thank you all for the support. It helped me hold my backbone.

 

[samac]

Watch out for that two year loan repayment agreement. I found out the hard way that it was agreed to and finalized way before I realized that it was or that made much sense. You might already be locked in and the penalty for breaking it is egregious.

Mine is a state program, if I left they could work with me to find a different qualified facility but would probably leave me in the middle of nowhere. I’m at the only qualified site in my city.

 

[Dharma]

Okay.
So overall I like my academic job. I love inpatient, I enjoy working with residents and medical students.
When I started there was a second inpatient attending, splitting the 19 bed inpatient service and he was running the ECT service (2-3 cases a day) and I was running consults (usually 5-10 patients).

He is leaving. I’m going to be running the 19 bed unit, consults and take on his ECT caseload. It’s not going to be easy but I’ll manage.

I am asking that we don’t increase the ECT case load, not taking on new cases unless they’re urgent like catatonia. My CMO is pissed because he wants to expand the ECT service in general. He doesn’t seem to understand why I think running an ECT service, the unit, and a CL service is a hard ask.

Sure, I can round much much faster without a gaggle of medical students and residents but between the unit and the CL service I have 12 learners and letting them present, discuss things and run the show takes much much more time.
I don’t want to burn myself out my first year as an attending.

I’m RVU based and currently surpassing my RVU targets with only half the unit and the consult service.

Any advice on how to approach this?

I hope you're making 600K+ bc if not... RUN!

 

[samac]

I hope you're making 600K+ bc if not... RUN!

I’m not, but other than this one person, I’m overall happy with the job.


I’ve nearly reached my entire year’s RVU target though so the bonus will be hefty.

Then will have other folks around in July for consults. I don’t want another body on the unit. A 19 bed unit with 4 residents will be a very nicely paced job once we have someone on consults. 🙂

 

[Sushirolls]

*Bonuses can be truncated some times by citing Fair Market Value that they can't exceed 90% or whatever made up number without going to a committee, which will basically say something like no, it isn't in the budget, and we don't approve. In other words there is a real risk that your bonus won't be much of a bonus.

**Hence, if people are highly productive they do not belong in Big Box shops.

***If one works within a Big Box shop there is little incentive to be super productive, don't do it, stay in the happy medium, and don't let more work get dumped on you.

 

[samac]

*Bonuses can be truncated some times by citing Fair Market Value that they can't exceed 90% or whatever made up number without going to a committee, which will basically say something like no, it isn't in the budget, and we don't approve. In other words there is a real risk that your bonus won't be much of a bonus.

**Hence, if people are highly productive they do not belong in Big Box shops.

***If one works within a Big Box shop there is little incentive to be super productive, don't do it, stay in the happy medium, and don't let more work get dumped on you.

That’s totally fair!

I fortunately don’t have anything about fair market value in my contract.
My colleague before I started got 30k a quarter for the last 2 quarters. But the unit was capped at 14 patients at the time. He was miserable, though.

 

[finalpsychyear]

Never understood this exceed 90% rvu bs. Beyond ridicilousness. Should hospitals be allowed to see beyond 90% rvu in total volume of course they can. Rigged from the start. Cant wait to be out of the hamster wheel. ill hit u up if i get a farm maybe a green house first.

*Bonuses can be truncated some times by citing Fair Market Value that they can't exceed 90% or whatever made up number without going to a committee, which will basically say something like no, it isn't in the budget, and we don't approve. In other words there is a real risk that your bonus won't be much of a bonus.

**Hence, if people are highly productive they do not belong in Big Box shops.

***If one works within a Big Box shop there is little incentive to be super productive, don't do it, stay in the happy medium, and don't let more work get dumped on you.

 

[TexasPhysician]

Never understood this exceed 90% rvu bs. Beyond ridicilousness. Should hospitals be allowed to see beyond 90% rvu in total volume of course they can. Rigged from the start. Cant wait to be out of the hamster wheel. ill hit u up if i get a farm maybe a green house first.

While I shouldn’t be surprised, admin continues to shock me. I was just told to bill only 99213 for follow-ups because the billers can’t figure out the audits. Isn’t that what we pay admin to help figure out?

 

[finalpsychyear]

While I shouldn’t be surprised, admin continues to shock me. I was just told to bill only 99213 for follow-ups because the billers can’t figure out the audits. Isn’t that what we pay admin to help figure out?

Most are clowns. This show the resident on netflix captures exactly many of the current issues in medicine and largely the profiteerting by device, pharma, and insurance leaving crumbs for the actual docs.

I would be much more satisfied practicing in a system in a different country or maybe the va. Hope to be in a position by 2030 that work is optional and will see what happens.

 

[ridethecliche]

OP guessing that this has been settled but I'm curious what your contract says about these situations.

 

[samac]

OP guessing that this has been settled but I'm curious what your contract says about these situations.

ECT isn’t directly in my contract. I edited to remove the hospital names:


As covered earlier in this document, your appointment will be in the university's Clinical Title Series and may include responsibilities of excellence in any or all of the following effort categories: service,teaching, research, and professional development.




In regard to your distribution of effort, responsibilities and expectations, we would anticipate the following:


1. Provide psychiatric evaluation and treatment of patients at x hospital


2. Provide psychiatric evaluation and treatment of adults on the Behavioral Health Unit at other hospital


3. Provide proactive psychiatric consultation for adults


4. Participate in on-call coverage

Division approximately every 7 weeks (Subject to available staffing and overall volumedemands)


5. Participate in didactic teaching and/or resident supervision for resident physicians as determined by the Director of Training & Education

 

[ridethecliche]

So sounds like it's not in your contract. Issue of your doing it is that if you already accepted doing it then you've accepted the change.

 

[samac]

So sounds like it's not in your contract. Issue of your doing it is that if you already accepted doing it then you've accepted the change.

I really don’t mind doing it for very sick patients on my unit and picking up the 10 patients that are maintenance from 1 month - 12 weeks.

I just don’t want to increase that load.
Really even if I get rid of consults I still hate it. Dealing with the OR, unpredictable scheduling. It’s the worst.

 

[Geodont]

Okay.
So overall I like my academic job. I love inpatient, I enjoy working with residents and medical students.
When I started there was a second inpatient attending, splitting the 19 bed inpatient service and he was running the ECT service (2-3 cases a day) and I was running consults (usually 5-10 patients).

He is leaving. I’m going to be running the 19 bed unit, consults and take on his ECT caseload. It’s not going to be easy but I’ll manage.

I am asking that we don’t increase the ECT case load, not taking on new cases unless they’re urgent like catatonia. My CMO is pissed because he wants to expand the ECT service in general. He doesn’t seem to understand why I think running an ECT service, the unit, and a CL service is a hard ask.

Sure, I can round much much faster without a gaggle of medical students and residents but between the unit and the CL service I have 12 learners and letting them present, discuss things and run the show takes much much more time.
I don’t want to burn myself out my first year as an attending.

I’m RVU based and currently surpassing my RVU targets with only half the unit and the consult service.

Any advice on how to approach this?

Forgive me. How do these types of jobs still exist in psychiatry? Geography? And this isn’t even coming through today’s lens of people who enter residency primarily with the aim of a cash practice. I’m rough and tumble public sector and crap comp academic. And this still blows my mind.

 

[samac]

Forgive me. How do these types of jobs still exist in psychiatry? Geography? And this isn’t even coming through today’s lens of people who enter residency primarily with the aim of a cash practice. I’m rough and tumble public sector and crap comp academic. And this still blows my mind.

I’m in the midwest.
Overall I signed for one job. I can handle a 19 bed unit with a full team of residents and medical students no problem. That’s actually pretty easy.
It’s the other stuff that sucks a little.

 

[Stagg737]

Forgive me. How do these types of jobs still exist in psychiatry? Geography? And this isn’t even coming through today’s lens of people who enter residency primarily with the aim of a cash practice. I’m rough and tumble public sector and crap comp academic. And this still blows my mind.

What do you mean? Like how do jobs with so many different hats exist? I know plenty of docs in several states (Midwest, Colorado, WA, CA, FL) who do essentially do multiple jobs like this, both academic and private sectors.