California Prison Psychiatrist

[capsychiatrist]

Hello,
I read all the available threads on this topic, but for anyone who has worked for the prisons, could you let me know more about your experience? Does anyone have experience working at both a prison and a state hospital, and how would you say they compare?
In the prisons, how are the psychiatric services set up, and what is it like to do inpatient versus outpatient?
Since they are doing some telepsych work right now, are you able to do this work from home?

Thanks in advance!

---

Members don't see this ad.

 

[calvinhobbes]

Prison psychiatry usually may prefer a completed fellowship in forensic psych. If you haven’t done that elective yet, I highly suggest you do, to give you a better idea on what to except. It’s just like working in a state hospital or with those who have been deemed incompetent, but when they are committed its either managing prior-to-prison psychoses and depression, or new symptoms (and always new patients needing evals if you work for a detention center). Its very interesting but not for the faint of heart. Kind of like inpatient VA but there’s no hope for discharge…

 

[comp1]

Prison psychiatry, particularly in CA, doesn't really prefer anything other than a license. You do NOT need a forensic or any other fellowship for the vast majority of correctional jobs. You most likely don't even need to be pursuing board certification in general psychiatry. These are correctional, not forensic jobs. If (when) you have to testify in anything, it will be as a fact and not expert witness. They pay amazingly well and even then, they are NOT competitive because the patient population can be draining and challenging, as well as litigious. The only reason to do an elective is to find out if this is the sort of work environment you want. Telepsych to CA prisons is done at set centers. I think one is in Elk Grove and another in Santa Ana. It isn't done from home, as far as I know.

 

[rdk322]

@comp1 could you speak more about prison setting being litigious? Is this more so than other settings like the VA, private or academic practices?

FWIW I'm a PGY4 recently started moonlighting at a state prison in Midwest serving adult males and it has been pretty comparable to my outpatient VA experience - limited formulary, level of acuity obviously way more antisocial PD and substance use involved. They have 3 other staff psychiatrists and none of them have done a forensic fellowship. Interestingly though 2 of them were ex-child adolescent psychiatrists.

 

[Sushirolls]

There's a few good threads on this topic, search function should yield a good amount of info.

 

[comp1]

It's a good topic. It sounds like you have some familiarity with correctional psychiatry already. So the issue with litigiousness is that correctional patients have a good deal more time and familiarity with the legal system than the average VA or community outpatient. Assuming you don't work for a federal prison, you'll be giving up your FTCA immunity in comparison to the VA or Indian Health Service. I think you'll find the formulary MUCH more restrictive than the VA at pretty much any prison, although it might be similar to some extremely impoverished community clinics.

 

[PikminOC]

You get paid alot but then you live in California so it costs alot. Do you still come out good living in such an expensive place?

 

[Sushirolls]

You get paid alot but then you live in California so it costs alot. Do you still come out good living in such an expensive place?

That's why Californians move away like locusts. Bringing with them the equity they built up in their tiny homes to turn around and buy mansions elsewhere and with their exodus comes their politics...

 

[TexasPhysician]

@comp1 could you speak more about prison setting being litigious? Is this more so than other settings like the VA, private or academic practices?

FWIW I'm a PGY4 recently started moonlighting at a state prison in Midwest serving adult males and it has been pretty comparable to my outpatient VA experience - limited formulary, level of acuity obviously way more antisocial PD and substance use involved. They have 3 other staff psychiatrists and none of them have done a forensic fellowship. Interestingly though 2 of them were ex-child adolescent psychiatrists.

Much more so than other settings like the VA and academics. Their available time, knowledge of how systems work, and general irritability lead to more state complaints and lawsuits. While these complaints often don’t result in any disciplinary actions, they are time consuming and generally frustrating.

 

[comp1]

Yes, you can live extremely comfortably on a correctional psychiatry salary. Further, the large majority of prisons or correctional telehealth hubs are not located in particularly expensive areas, San Quentin excepted of course.

 

[Psychresy]

I've seen locums corrections gigs that are paying like high 200s to low 300s per hour. That's neurosurgery money... Crazy.

 

[robellis]

I've seen locums corrections gigs that are paying like high 200s to low 300s per hour. That's neurosurgery money... Crazy.

That’s not neurosurgery money in any sense…double it and you’re close

 

[Animal Mother]

Prison psychiatry, particularly in CA, doesn't really prefer anything other than a license. You do NOT need a forensic or any other fellowship for the vast majority of correctional jobs. You most likely don't even need to be pursuing board certification in general psychiatry. These are correctional, not forensic jobs. If (when) you have to testify in anything, it will be as a fact and not expert witness. They pay amazingly well and even then, they are NOT competitive because the patient population can be draining and challenging, as well as litigious. The only reason to do an elective is to find out if this is the sort of work environment you want. Telepsych to CA prisons is done at set centers. I think one is in Elk Grove and another in Santa Ana. It isn't done from home, as far as I know.

This is right. These places scrape the bottom of the barrel because no other doctors will take the jobs. They are greatly understaffed and desperate. Many of their employed doctors have disciplinary records. The pay is attractive, but you will be working with a lot of lazy and incompetent colleagues in environments that have reputations for being very unsafe. At some places, they average multiple attacks daily. Some places have had staff members killed or seriously injured.

 

[PikminOC]

This is right. These places scrape the bottom of the barrel because no other doctors will take the jobs. They are greatly understaffed and desperate. Many of their employed doctors have disciplinary records. The pay is attractive, but you will be working with a lot of lazy and incompetent colleagues in environments that have reputations for being very unsafe. At some places, they average multiple attacks daily. Some places have had staff members killed or seriously injured.

I know a psychiatrist who works in a prison and lives in LA. I don't think he had any of those things

 

[Psychresy]

That’s not neurosurgery money in any sense…double it and you’re close

That's 600k for 40 hours a week. No weekends, no call. Pretty sure if you were working neurosurgery hours you're making close to a mil.

 

[untapped]

Bumping this thread.

Anybody have information on California institute for Women in Chino?

I'm considering an offer but have no clue what the working conditions are like.

 

[jbomba]

Bumping this thread.

Anybody have information on California institute for Women in Chino?

I'm considering an offer but have no clue what the working conditions are like.

Would you mind pm'ing what the offer looks like? Curious what offers from facilities look like vs locums companies (which at first glance are VERY high)

 

[thepoopologist]

Bumping this thread.

Anybody have information on California institute for Women in Chino?

I'm considering an offer but have no clue what the working conditions are like.

It depends on who you ask.

Look up the Golding report CDCR

Look up the MAT program at CDCR

There a pending bill that may limit contractors to 365 days tops and afterward they're either not renewed or decide to join the gvt as civil servants.

There is a new bargaining agreement that offers a 5k bonus at 5 years and then another 5k bonus at 7 years.

If you were offered the very top of the scale and are just out of training then I totally understand.

 

[untapped]

It depends on who you ask.

Look up the Golding report CDCR

Look up the MAT program at CDCR

There a pending bill that may limit contractors to 365 days tops and afterward they're either not renewed or decide to join the gvt as civil servants.

There is a new bargaining agreement that offers a 5k bonus at 5 years and then another 5k bonus at 7 years.

If you were offered the very top of the scale and are just out of training then I totally understand.

Thanks for the information. Woman eating her own eyeball is certainly not pleasant. I guess my biggest question is, how much riskier is a job like this compared to a typical job? In terms of physical harm, professional reputation, and liability?

And yes, I was offered the very top of the scale. Jbomba, you can look up the scale on CCHCS website. Should be over 320.

 

[comp1]

State salaries are super public (as quite honestly everyone's should be). Anyone you talk to or interview with, put their names in here to see the reality of the situation: Transparent California They are probably making less than advertised.

 

[jbomba]

It depends on who you ask.

Look up the Golding report CDCR

Look up the MAT program at CDCR

There a pending bill that may limit contractors to 365 days tops and afterward they're either not renewed or decide to join the gvt as civil servants.

There is a new bargaining agreement that offers a 5k bonus at 5 years and then another 5k bonus at 7 years.

If you were offered the very top of the scale and are just out of training then I totally understand.

Are you saying there is a bill that may limit a psychiatrist from working in a prison system to no more than 365 days if going through a locums type company?

 

[jbomba]

Thanks for the information. Woman eating her own eyeball is certainly not pleasant. I guess my biggest question is, how much riskier is a job like this compared to a typical job? In terms of physical harm, professional reputation, and liability?

And yes, I was offered the very top of the scale. Jbomba, you can look up the scale on CCHCS website. Should be over 320.

What's the deal with these locums companies who are offering high 200s-low 300s per HOUR to work in these facilities? It ends up being like 5-600k a year. How does one maintain one of those gigs over many years?

 

[thepoopologist]

Are you saying there is a bill that may limit a psychiatrist from working in a prison system to no more than 365 days if going through a locums type company?

Yes. AB 657

 

[thepoopologist]

Thanks for the information. Woman eating her own eyeball is certainly not pleasant. I guess my biggest question is, how much riskier is a job like this compared to a typical job? In terms of physical harm, professional reputation, and liability?

And yes, I was offered the very top of the scale. Jbomba, you can look up the scale on CCHCS website. Should be over 320.

Physical harm. CDCR <<< DSH in terms of risk. Everyone is accompanied by a CO

Liability. State Attorney General defends malpractice cases. Nothing stops an inmate from suing for some other reason however.

Professional reputation. Both CDCR and DSH are known to pick the low hanging fruit however salaries have been high these past 10 years so your co-workers range from completely incompetent to very talented.

 

[untapped]

Physical harm. CDCR <<< DSH in terms of risk. Everyone is accompanied by a CO

Liability. State Attorney General defends malpractice cases. Nothing stops an inmate from suing for some other reason however.

Professional reputation. Both CDCR and DSH are known to pick the low hanging fruit however salaries have been high these past 10 years so your co-workers range from completely incompetent to very talented.

Thanks, that's quite helpful.

With the locums rate being higher, am I getting shafted if I take that salary vs. just work as a locums for 1 year and then decide if I want to stay on at a pay cut?

 

[jbomba]

Yes. AB 657

any sense if this is going to pass?

 

[comp1]

I mean...it could be good for physicians. Maybe the CDCR will just offer locums rates at the end of the year?

 

[Psychresy]

I mean...it could be good for physicians. Maybe the CDCR will just offer locums rates at the end of the year?

Assuming this bill applies to all prisons? One couldn't just to work for another prison in the state?

 

[ridethecliche]

Man... if anyone thinks they've done a lot of SI evals before working at a prison... think again!

 

[thepoopologist]

Thanks, that's quite helpful.

With the locums rate being higher, am I getting shafted if I take that salary vs. just work as a locums for 1 year and then decide if I want to stay on at a pay cut?

If your goal is cash on hand with the drawback being no state benefits and being let go easily then go contractor. A caveat to this is during the height of the pandemic the contractor pay wasn't cut like the state employees and they became more important than ever. If your goal is more job security and PSLF with the main drawback being less cash then go civil servant. You are working for a living, you are going to get shafted regardless of what route you take, its about what sucks less depending on your goals.

any sense if this is going to pass?

Appears to be advancing.

 

[qwerty89]

I've seen locums corrections gigs that are paying like high 200s to low 300s per hour. That's neurosurgery money... Crazy.

Not even close to neurosurgery money. Heck VA teleradiology pays up to 300/hr for weekend coverage.

 

[Psychresy]

Not even close to neurosurgery money. Heck VA teleradiology pays up to 300/hr for weekend coverage.

If we take the high figure (320/hr) at 40 hours a week then it's 650k for 4 day flex weeks. I'm sure if you wanted to work neurosurgery hours you're approaching a million a year.

 

[psyguru]

FYI, If you do corrections for a certain period of time, you can qualify to get a CCHP certification.

 

[Rickettsia]

Thank you so much, Everyone, for the great information and discussion!
It seems that each prison is different in terms of culture and how much suicide risk assessment/team involvement versus isolated medication management the psychiatrist does. Does anyone have experience with Folsom?

Also, has anyone worked in inpatient versus outpatient at these facilities?
Did you ever feel unsafe?
How common are board complaints?

 

[splik]

Thank you so much, Everyone, for the great information and discussion!
It seems that each prison is different in terms of culture and how much suicide risk assessment/team involvement versus isolated medication management the psychiatrist does. Does anyone have experience with Folsom?

Also, has anyone worked in inpatient versus outpatient at these facilities?
Did you ever feel unsafe?
How common are board complaints?

While there will be signs posted with numbers for the medical board for complaints, prisoners are more interested in filing frivolous lawsuits than medical board complaints (no money in the latter). Also the medical board of california is fairly sensible and physician friendly. They do investigate standard of care issues if the care was grossly egregious (but remember prisoners are not entitled to the same standard of care as the general public), but they are more interested in impaired physicians (substance abuse, disruptive behaviors, demented docs), sexual misconduct, inappropriate prescribing, or aiding and abetting the unlicensed practice of medicine. In short, I would not worry about board complaints or lawsuits in this setting (though the latter are common from inmates and staff including psychiatrists).

 

[PikminOC]

While there will be signs posted with numbers for the medical board for complaints, prisoners are more interested in filing frivolous lawsuits than medical board complaints (no money in the latter). Also the medical board of california is fairly sensible and physician friendly. They do investigate standard of care issues if the care was grossly egregious (but remember prisoners are not entitled to the same standard of care as the general public), but they are more interested in impaired physicians (substance abuse, disruptive behaviors, demented docs), sexual misconduct, inappropriate prescribing, or aiding and abetting the unlicensed practice of medicine. In short, I would not worry about board complaints or lawsuits in this setting (though the latter are common from inmates and staff including psychiatrists).

Not entitled to the same standard of care? How?

 

[capsychiatrist]

While there will be signs posted with numbers for the medical board for complaints, prisoners are more interested in filing frivolous lawsuits than medical board complaints (no money in the latter). Also the medical board of california is fairly sensible and physician friendly. They do investigate standard of care issues if the care was grossly egregious (but remember prisoners are not entitled to the same standard of care as the general public), but they are more interested in impaired physicians (substance abuse, disruptive behaviors, demented docs), sexual misconduct, inappropriate prescribing, or aiding and abetting the unlicensed practice of medicine. In short, I would not worry about board complaints or lawsuits in this setting (though the latter are common from inmates and staff including psychiatrists).

This is helpful, thank you.

I read a review from a psychiatrist on a site such as Indeed that by working in this setting you will be putting your license at risk on a daily basis. Do you know what they meant by this? I understand the frivolous lawsuits would be very frustrating to deal with, but wouldn't they generally get dropped and not actually put your license at risk?

 

[comp1]

This is helpful, thank you.

I read a review from a psychiatrist on a site such as Indeed that by working in this setting you will be putting your license at risk on a daily basis. Do you know what they meant by this? I understand the frivolous lawsuits would be very frustrating to deal with, but wouldn't they generally get dropped and not actually put your license at risk?

I'm guessing what they meant is that you may not have access to the resources you would need to provide the level of care expected. I don't know any specifics. It's dramatic and people like to throw around licensure stuff when they are upset at a given place.

 

[psyguru]

Most of the docs (and all the mid-levels) at the prison I worked did not do a fellowship. Also, some psychiatric expert witnesses also are not forensic psychiatrists.

 

[psyguru]

I'm talking about legally here. Obviously, we have a professional responsibility to try to provide the same level of care for everyone, be mindful when this is not the case, and have an ethical duty to do best by our patients. But from a legal perspective, while prisoners are the only class of persons in this country who have a constitutional right to healthcare, SCOTUS has said that that care need only not be "Deliberately indifferent." They are not legally entitled to the same level of care as non-incarcerated individuals.

My understanding was that both standards can apply in a correctional case...deliberately indifference and the usual SOC/medical malpractice. Also, unless I am wrong, deliberate indifference applies to non-medical duties...i.e. the prison guard's indifference and not only to a medical duty of care. FYI the standards are set not by JCAHO but the NCCHC and can be found here Standards.

To quote: In a Medical Malpractice Claim, the Inmate Must Prove That You Failed to Provide Care That Was Within the Standard of Care for Your Specialty. ... In the deliberate indifference claim, the inmate must prove that you were aware of his/her serious medical need and that you intentionally disregarded it.

 

[psyguru]

I think you are technically correct. I don't do reviews for correctional malpractice cases, but because so many of these cases are frivolous or pro se, in reality only the most egregious cases (or evidence of more systemic failings) lead to lawsuits. It will often be someone like the ACLU taking up the case, and then it real comes down to civil rights of incarcerated individuals or other constitutional claims.

Some are frivolous but I do not take pro se cases (made that mistake once). I also have been retained by the defense in correctional med mal cases.

 

[SPsych6]

2024 Update:

I started working a locums job for CDCR at CMF Vacaville, Inpatient psychiatry. I have been here just shy of 6 months. Unpopular opinion: This is possibly the best inpatient job available in the United States! (If you have a better option please attach the link)

About me, I have been out of residency for 3ish years. Board Certified. Zero disciplinary actions in my past. I was Chief Resident for two years, and all my peers would recommend me. Based on my relatively brief career, I would say I work harder and write better notes than most psychiatrists. I have previously worked community inpatient, worked bougee outpatient, cash outpatient, have done TMS and various forms of ketamine treatment. CDCR is my favorite job. If you want to do inpatient because the lifestyle is better than outpatient, but don't want to see 15-20 patient a day and discharge within 7-10 days, then this is the job for you. And you are being paid more to do it.

CMF Vacaville may be better than other prisons in CDCR. I can't comment on other facilities. My current position is an inpatient facility, taking referrals from all of CDCR. It is run relatively well for any state agency. It pays extremely well. Current rate is $350/hr. There are about 20 psychiatrists seeing patients with a couple administrators. You see on average 4-8 patients a day. Lots of Cluster B, lots of malingering, I call the psych units the Ritz Carlton of the prison system. But IMO cluster B is the bread and butter of all psychiatry. You also have true bipolar I and Schizophrenia, but they are less than 30% of your case load. Regarding the legal issues, I wouldn't worry about it if you know how to document well. There are certainly nuances to working in a prison, but overall it is so much better than community psychiatry.

Advantages of CDCR Inpatient Psychiatry
1. 100x safer than community inpatient psychiatry (So many custody officers, no free-for-all in the milieu)
2. Pay is better
3. You can use any meds you want. I ordered Vraylar, Qelbree and Caplyta in the last month
4. Average patient stay is 30-90 days in inpatient unit, giving you ample time to build you diagnosis and monitor, especially LAIs
5. No call, unless you want it. Then you can get paid for a 24hr shift x350..... if you want neurosurgery money, this is it
6. You don't have to worry about prescribing controlled substances here, it is discouraged. Nobody is getting xanax or stimulants. Nobody
7. Just like other inpatient jobs, no patient messages after you leave for the day
8. If you want benefits, Use Transparent California to see that staff psychiatrists are making 400ish + benefits for all of the above
9. Vacaville is close to Napa Valley, SF, Walnut Creek or if you so choose, Sacramento
10. Bad psychiatrists exist, but the new regime just doesn't renew their contracts.

Disadvantages:
1. If you are a contractor, you aren't seeing patients and being "available by phone" in the afternoon. You are staying the full 8 or 10hrs
2. Weird rules about what colors you can wear, (just wear black scrubs...is this and advantage?)
3. You have to ask custody to pull patients out of their cell, or they have groups you can't pull them out of (or at least shouldn't)
4. You deal with a lot of cluster B, cutting, swallowing etc.
5. You don't have your personal cell, but you have a work cell and computer access




Suffice to say, as far as the logistics of working inpatient psychiatry go, this job rules. Cluster B gets old, but it could be much worse (Like DSH).

 

[comp1]

30-90 day stays is something very different from typical inpatient work. It seems more like an IMD in California... I can see the appeal, but still not okay with no personal cell phone.

 

[sloh]

you have a work cell and computer access

How restrictive is the work cell and computer access? Will you die of boredom?

 

[SPsych6]

How restrictive is the work cell and computer access? Will you die of boredom?

You have audible, youtube, NYT, and can search most things. I do my CMEs, especially the ABPN articles. You have CDCR training as well.

Decent amount of down time, but for me it is much better than the 20 outpatient visits a day + patient messages I was dealing with. I think it depends on what you want your life to be though. I decided cash pay private practice was more work than I was interested in. This job is stress free. Getting patients on involuntary meds is pretty straightforward in CDCR compared to the community requirements in CA.

 

[Username2015]

2024 Update:

I started working a locums job for CDCR at CMF Vacaville, Inpatient psychiatry. I have been here just shy of 6 months. Unpopular opinion: This is possibly the best inpatient job available in the United States! (If you have a better option please attach the link)

About me, I have been out of residency for 3ish years. Board Certified. Zero disciplinary actions in my past. I was Chief Resident for two years, and all my peers would recommend me. Based on my relatively brief career, I would say I work harder and write better notes than most psychiatrists. I have previously worked community inpatient, worked bougee outpatient, cash outpatient, have done TMS and various forms of ketamine treatment. CDCR is my favorite job. If you want to do inpatient because the lifestyle is better than outpatient, but don't want to see 15-20 patient a day and discharge within 7-10 days, then this is the job for you. And you are being paid more to do it.

CMF Vacaville may be better than other prisons in CDCR. I can't comment on other facilities. My current position is an inpatient facility, taking referrals from all of CDCR. It is run relatively well for any state agency. It pays extremely well. Current rate is $350/hr. There are about 20 psychiatrists seeing patients with a couple administrators. You see on average 4-8 patients a day. Lots of Cluster B, lots of malingering, I call the psych units the Ritz Carlton of the prison system. But IMO cluster B is the bread and butter of all psychiatry. You also have true bipolar I and Schizophrenia, but they are less than 30% of your case load. Regarding the legal issues, I wouldn't worry about it if you know how to document well. There are certainly nuances to working in a prison, but overall it is so much better than community psychiatry.

Advantages of CDCR Inpatient Psychiatry
1. 100x safer than community inpatient psychiatry (So many custody officers, no free-for-all in the milieu)
2. Pay is better
3. You can use any meds you want. I ordered Vraylar, Qelbree and Caplyta in the last month
4. Average patient stay is 30-90 days in inpatient unit, giving you ample time to build you diagnosis and monitor, especially LAIs
5. No call, unless you want it. Then you can get paid for a 24hr shift x350..... if you want neurosurgery money, this is it
6. You don't have to worry about prescribing controlled substances here, it is discouraged. Nobody is getting xanax or stimulants. Nobody
7. Just like other inpatient jobs, no patient messages after you leave for the day
8. If you want benefits, Use Transparent California to see that staff psychiatrists are making 400ish + benefits for all of the above
9. Vacaville is close to Napa Valley, SF, Walnut Creek or if you so choose, Sacramento
10. Bad psychiatrists exist, but the new regime just doesn't renew their contracts.

Disadvantages:
1. If you are a contractor, you aren't seeing patients and being "available by phone" in the afternoon. You are staying the full 8 or 10hrs
2. Weird rules about what colors you can wear, (just wear black scrubs...is this and advantage?)
3. You have to ask custody to pull patients out of their cell, or they have groups you can't pull them out of (or at least shouldn't)
4. You deal with a lot of cluster B, cutting, swallowing etc.
5. You don't have your personal cell, but you have a work cell and computer access




Suffice to say, as far as the logistics of working inpatient psychiatry go, this job rules. Cluster B gets old, but it could be much worse (Like DSH).

Thank you for sharing your experience! What are your hours like? When do you get done for the day?

 

[Stagg737]

You have audible, youtube, NYT, and can search most things. I do my CMEs, especially the ABPN articles. You have CDCR training as well.

Decent amount of down time, but for me it is much better than the 20 outpatient visits a day + patient messages I was dealing with. I think it depends on what you want your life to be though. I decided cash pay private practice was more work than I was interested in. This job is stress free. Getting patients on involuntary meds is pretty straightforward in CDCR compared to the community requirements in CA.

This sounds like a unicorn job, but a couple of comments/questions...

Lots of Cluster B, lots of malingering, I call the psych units the Ritz Carlton of the prison system.

Average patient stay is 30-90 days in inpatient unit, giving you ample time to build you diagnosis and monitor, especially LAIs

So the average length of stay for mostly cluster B patients is 30-90 days? Is this similar to some residential programs that do intensive therapy and try to "rehabilitate" these patients or is this a typical "good" inpatient psych unit with typical therapy and med management? If it's the latter this sounds like a gross mismanagement of resources. If it's the former I could see this, but one could still argue it's poor resource management.

You can use any meds you want. I ordered Vraylar, Qelbree and Caplyta in the last month

I know people who have worked prison/jail jobs in several states and I've never heard of this. Where I did residency the prison and jail both had 9 meds on their formulary total. I can't imagine a prison spending this kind of money on meds, especially something like Qelbree...

You don't have to worry about prescribing controlled substances here, it is discouraged. Nobody is getting xanax or stimulants. Nobody

Obviously, as would be expected for any corrections position...

Weird rules about what colors you can wear, (just wear black scrubs...is this and advantage?)

Again, feel like reasoning here would be kind of obvious.

There are about 20 psychiatrists seeing patients with a couple administrators. You see on average 4-8 patients a day.

So they have 20 psychiatrists each seeing only 4-8 patients per day and are paying $350/hr? That's great for us, but I don't understand how this exists. If this job is as great as you say, why aren't psychiatrists seeing 8-10 patients per day which is still very reasonable for that pay (which is ~$650k/yr for a standard schedule). Good for you for finding this, but I honestly don't understand how this exists.

 

[solitarius]

So they have 20 psychiatrists each seeing only 4-8 patients per day and are paying $350/hr? That's great for us, but I don't understand how this exists. If this job is as great as you say, why aren't psychiatrists seeing 8-10 patients per day which is still very reasonable for that pay (which is ~$650k/yr for a standard schedule). Good for you for finding this, but I honestly don't understand how this exists.

Then you don't understand how California works. It's in the Bay, so the COL is ridiculously high. The public sector groups have big Democratic muscle in CA, and they defend their pay and benefits with the pols and the polls.

 

[Stagg737]

Then you don't understand how California works. It's in the Bay, so the COL is ridiculously high. The public sector groups have big Democratic muscle in CA, and they defend their pay and benefits with the pols and the polls.

I get that. But $350/hr in the public sector to see less than 1 patient an hour anywhere, especially in corrections, is pretty crazy.

 

[splik]

Then you don't understand how California works. It's in the Bay, so the COL is ridiculously high. The public sector groups have big Democratic muscle in CA, and they defend their pay and benefits with the pols and the polls.

Except the state does not pay this for government employed psychiatrists (though the pay for employees is competitive). Nothing to do with "democratic muscle" or defending pay. It is much lower (about $221 for inpatient, less for outpatient). 350/hr would be for CDCR inpatient locums work, no benefits. The reason why they have this is really related to various lawsuits and supreme court decisions (e.g. Coleman v Brown) that require them to conform to minimum standards (which they usually don't meet). In order to meet staffing requirements, they will pay locums agencies a lot in order to show a good faith effort to meet those requirements.

For many years there was massive prison overcrowding and really terrible access to mental health care for prisoners in California. There is still a significant dearth of psychiatrists for CDCR as a whole, however some places will be well staffed or even seemingly overstaffed.