Clinic is too work drive

[fairtrade]

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I started work in a new clinic a week ago and I am already thinking about leaving. While I understand that doing good work is paramount, the owner of this clinic takes research-based to a new level. Every Saturday we have CBT clinic where all the clinicians are required to watch Beck Institute video trainings, show the CBT case conceptualizations for their pts and then identify and pull relevant journal articles for the next week while doing an hour PP presentation. Additionally, on Friday nights we are required to watch Stahl videos and discuss the content, pull relevant articles for the next week, etc.

The clinic owner spends an hour or more on each patient and only sees 8 people/day and works 4 days/week. The fifth day is dedicated to reading about Psychiatry. He does lots of therapy with medication management but I don't even see how he earns enough money to stay open. We operate on a 70/30 split but are required to see no more than 10 people a day. Additionally, we get paid an hourly rate for all these education meetings we do.

I am really torn if I want to stay at this job -- everybody here is an amazing clinician. However, due to the patient cap, my salary will be low. On the other hand, and I say this with some guilt, I don't want to spend 20 hours a week reading the research. Any thoughts?

 

[Nudexta]

What about talking to the clinic owner about your wishes?

 

[Sushirolls]

If its not what you want, then leave.

Some people are happy with doing volume volume volume and striving to make money. Your setup would be ideal for some people and considered a dream job. Not what you want, try to go find it.

 

[Bartelby]

Spending every Friday night and Saturday away from my family would be a hard no. I would recommend talking with him, and if you can't reach an agreement about a good setup to look elsewhere.

 

[robellis]

I don’t even know what to say as I didn’t even think what you’re describing existed. You’re an attending and you have to present your patients to other people and you’re being forced to read? What in the

 

[Bartelby]

As for how the clinic stays open, 8 hour-long patient encounters four days per week could be very lucrative if you actually fill consistently.

Assuming full collection and no no-shows: $300 (likely a fair estimate in many places) x 32 h/wk x 46 weeks/yr = $441,600. Adjusting downward for open space in the schedule, less than 100 percent collections etc still leaves a very viable clinic model. Running different hourly rates can scale that up or down significantly as well

 

[Merovinge]

As for how the clinic stays open, 8 hour-long patient encounters four days per week could be very lucrative if you actually fill consistently.

If this guy takes insurance and gives each patient an hour each time, is super up-to-date on evidenced based practice, I could fill up his patient panel in a day. This is full on concierge level practice and apparently all the docs there are amazing clinicians. I have never even heard of such a practice resembling this and certainly not one that would take insurance.

Now as for the OP, if this is not the work you want to do, then don't do it. I would think there's some real learning that staying a year or two could do, but the Saturday/Friday night time is also a hard-pass for me, no amount of clinical learning/excellence is worth the time away from my family. If it were just 4 days clinical, 1 day educational (during business hours) and you got paid for the educational component, that would sound pretty amazing to me.

 

[fairtrade]

As for how the clinic stays open, 8 hour-long patient encounters four days per week could be very lucrative if you actually fill consistently.

Assuming full collection and no no-shows: $300 (likely a fair estimate in many places) x 32 h/wk x 46 weeks/yr = $441,600. Adjusting downward for open space in the schedule, less than 100 percent collections etc still leaves a very viable clinic model. Running different hourly rates can scale that up or down significantly as well

good point - however, he takes mainly Medicaid and Medicare so the rate is like $160 an hour

 

[Doctorows]

However, due to the patient cap, my salary will be low. On the other hand, and I say this with some guilt, I don't want to spend 20 hours a week reading the research.

I am curious, were these expectations (patient cap, salary limits, reading requirement) not discussed during the job interview? Did you not know what the job would be when you took it? Asking as a graduating resident about to go through this process.

 

[Mass Effect]

If its not what you want, then leave.

Some people are happy with doing volume volume volume and striving to make money. Your setup would be ideal for some people and considered a dream job. Not what you want, try to go find it.

Who would find watching lectures and preparing presentations on Friday nights and Saturday mornings part of a dream job?

If the owner wants people to be up-to-date, then they should provide paid weekly educational time during regular business hours.

 

[erg923]

I started work in a new clinic a week ago and I am already thinking about leaving. While I understand that doing good work is paramount, the owner of this clinic takes research-based to a new level. Every Saturday we have CBT clinic where all the clinicians are required to watch Beck Institute video trainings, show the CBT case conceptualizations for their pts and then identify and pull relevant journal articles for the next week while doing an hour PP presentation. Additionally, on Friday nights we are required to watch Stahl videos and discuss the content, pull relevant articles for the next week, etc.

The clinic owner spends an hour or more on each patient and only sees 8 people/day and works 4 days/week. The fifth day is dedicated to reading about Psychiatry. He does lots of therapy with medication management but I don't even see how he earns enough money to stay open. We operate on a 70/30 split but are required to see no more than 10 people a day. Additionally, we get paid an hourly rate for all these education meetings we do.

I am really torn if I want to stay at this job -- everybody here is an amazing clinician. However, due to the patient cap, my salary will be low. On the other hand, and I say this with some guilt, I don't want to spend 20 hours a week reading the research. Any thoughts?

Yikes! Is this year round? There are only so many videos too watch. Further, is this really a "requirement?" That's seems pretty paternalistic. I find it hard to believe other people in the practice aren't griping about this?

So....i take it this guy is not football fan? The Friday night (after a day of work???) and Saturday thing would be total deal breakers for me. Not healthy for the fam. More to life than work.

 

[calvnandhobbs68]

good point - however, he takes mainly Medicaid and Medicare so the rate is like $160 an hour

I agree how did you not figure this out during the job interview? Seems like something that would have been glaringly obvious talking to some of the other staff there.

Given that this is mostly public insurance, sounds like the guy is just wanting to dedicate his life for the cause of trying to provide high quality therapy/treatment to people in need. Which is awesome, don't get me wrong, but if that isn't aligned with your goals you're not going to be happy there. Also the "requirement" of educational time on the weekend is a bit much either way even if you're getting paid for it...you're an attending physician, not a resident, so outside of academic positions this is pretty unusual (and even then its usually like you have to attend grand rounds and some department meetings).

So yeah I'd either just talk to him directly about wanting to be able to see more patients a day or getting paid more or skipping out on the saturday lectures or whatever. Sometimes people get like this where they want to "mentor" you but that only works if you actually want to be mentored lol.

 

[fairtrade]

I agree how did you not figure this out during the job interview? Seems like something that would have been glaringly obvious talking to some of the other staff there.

Given that this is mostly public insurance, sounds like the guy is just wanting to dedicate his life for the cause of trying to provide high quality therapy/treatment to people in need. Which is awesome, don't get me wrong, but if that isn't aligned with your goals you're not going to be happy there. Also the "requirement" of educational time on the weekend is a bit much either way even if you're getting paid for it...you're an attending physician, not a resident, so outside of academic positions this is pretty unusual (and even then its usually like you have to attend grand rounds and some department meetings).

So yeah I'd either just talk to him directly about wanting to be able to see more patients a day or getting paid more or skipping out on the saturday lectures or whatever. Sometimes people get like this where they want to "mentor" you but that only works if you actually want to be mentored lol.

Yes, he told me about all the evidence-based CEU stuff; however, I didn't realize what it would be like to actually live it everyday. Luckily the first 3 months are contract-free, so I am free to walk. I didn't really know places like this existed. I think it is great, but great for someone who really, really is passionate about psychiatry and someone who is single or wants to soon be

 

[Nudexta]

Yes, he told me about all the evidence-based CEU stuff; however, I didn't realize what it would be like to actually live it everyday. Luckily the first 3 months are contract-free, so I am free to walk. I didn't really know places like this existed. I think it is great, but great for someone who really, really is passionate about psychiatry and someone who is single or wants to soon be

Do you think this is tailored for everyone or some people in the practice? I saw a previous post for you saying you are a prescribing psychologist. I wonder if the clinic owner is doing this to ensure that non medical prescribers are up to date.

 

[calvnandhobbs68]

Do you think this is tailored for everyone or some people in the practice? I saw a previous post for you saying you are a prescribing psychologist. I wonder if the clinic owner is doing this to ensure that non medical prescribers are up to date?

Thanks for noticing this.

OP you need to get the resident flair off your profile and either have nothing or express your credentials correctly. You might not need the Beck institute lectures but you could also probably benefit more from the Stahls reading than you realize.

 

[robellis]

the OP is a psychologist!? The plot thickens…

 

[deleted1100659]

I thought you were a physician, so if that were the case your above scenario would have been nuts. 10 patient cap, I dunno how the place keeps the doors open. Especially an hour per patient even follow ups? Even simple f/us?

But since you're a psychologist, at least hes trying to educate you and not turning you into conveyor belt medicine

 

[PsyDr]

I have substantial doubts about OP

 

[robellis]

I have substantial doubts about OP

What does this mean