CMHC

[Attending1985]

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Anyone with a positive experience working in a CHMC? I've heard mostly negative on the forum but it seems like that's related to lack of adequate time. The one I'm looking at staffs follow-ups for 30 minutes and intakes for one hour. The pay is pretty decent too.

 

[Shikima]

If I'm going to see that many per day, I want the PP billing amounts which would equal to about $500k after overhead.

 

[MacDonaldTriad]

Pros: No need to market, almost no billing issues, the patients don’t suggest that you are obligated to accept their treatment suggestions because that is what they are paying for, coverage when you vacation, working with a full spectrum of professionals and paraprofessionals, M-F 9:00 – 5:00, Government retirement.

Cons: lower money, not your own boss, no ability to choose your clinical team, charting requirements that always grow and never shrink, and all of the other things that go along with being part of big government.

I do think some people like one form of practice and others like the other form so it really depends on you.

 

[Doctor Bagel]

My CMHC job was OK although not for me. Decent pay but subpar benefits (no CME, licensure fees, poor retirement matching). Not super busy -- 30 minute follow ups, 90 minute new evals and lots of no shows. Downsides were isolation (physicians + NPs set up to focus just as "prescribers" and not truly as members of a treatment team), challenging patients, and poor supports in terms of case management as CMHCs also stretch those resources really thin (masters level grads in their first year out of school making $40k and handling 100 complex patients, meaning they quit in 4 months). I know people in CMHCs in my community who really enjoy their work and others who don't -- it's pretty individual here, but again it's also fairly benign here in that schedules are less busy than you would encounter in other locations.

 

[vistaril]

Pros: Government retirement.

Cons: lower money, not your own boss, no ability to choose your clinical team, charting requirements that always grow and never shrink, and all of the other things that go along with being part of big government.

how is community mental health arraigned in your state? Everywhere I've been it certainly doesn't feel like 'big govt'(which can be good and bad) and certainly govt retirements are not the norm. IOW it's not always a state job. At some level it's going to be under the umbrella of the state system but the employer itself will often not be the state, and thus you arent guaranteed state bennies/retirement/etc

 

[Doctor Bagel]

how is community mental health arraigned in your state? Everywhere I've been it certainly doesn't feel like 'big govt'(which can be good and bad) and certainly govt retirements are not the norm. IOW it's not always a state job. At some level it's going to be under the umbrella of the state system but the employer itself will often not be the state, and thus you arent guaranteed state bennies/retirement/etc

Yeah, my community job also did not have good retirement. Community jobs here are mainly for community mental health organizations which contract with but are not governmental. They count toward PSLF, which is good, but yeah no pension or state retirement benefits. My community job also had pretty blah health insurance benefits. PTO was OK, though.

 

[MacDonaldTriad]

The feds run VAs, The states run state hospitals and have counties as their customers, but public health tends to be granular on the county level. Sparsely populated counties can contract out a lot of their health service responsibilities because this arrangement can be cheaper and they may pay more, but have less benefits as pointed out above. In counties where this isn't the case, the contractors who do provide services to the community don't look that much like community mental health agencies. Contracted providers may take public funds to provide services to the public, but they are for profit at some level and they prefer insured patients using their services. I'm sure this is true for the CMHCs that aren't contract entities, and maybe Obama care will lessen these differences. I don't think the book is out on that one yet.

 

[sunlioness]

Yeah. My employer is a contractor. And community mental health is an afterthought for them. They're also a non profit in the process of getting bought by an out of state for profit.

I have 5.5 more work days!!!!!


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[TexasPhysician]

The one I'm looking at staffs follow-ups for 30 minutes and intakes for one hour. The pay is pretty decent too.

If you take the job, be sure every detail is in the contract. The most common scam with new grads is to verbally promise one thing, give a good signing bonus that must be refunded with less than 1-2 years worked, and then change appointment slots to 15 min FU and 45 min new evals in the first month of work. Most new grads can't repay the signing bonus to leave. The offending employer then earns tens of thousands monthly until the new grad can afford to leave or stays for the contract duration.

 

[Doctor Bagel]

Yeah. My employer is a contractor. And community mental health is an afterthought for them. They're also a non profit in the process of getting bought by an out of state for profit.

I have 5.5 more work days!!!!!


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So you wouldn't even be able to get PSLF. Why would anybody ever take that job?

 

[sunlioness]

So you wouldn't even be able to get PSLF. Why would anybody ever take that job?

Yeah. They're going to have problems. People on visas are freaking out too.

I was talking to another doc who's been there a number of years. He says that in his observation that the model is to hire people on, burn them out in a year or two, hire more on. Wash. Rinse. Repeat. It's a model that only benefits the big boss (the one who spent the Christmas party* fake complaining about the features on his Lexus), who is not so coincidentally the only one excited by this buy out.

This doc also said, "you can do whatever you want so long as your documentation justifies the billing and you don't kill anybody."

*it cost $45 to go to this party and it was more or less required. Is that a thing?


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[OldPsychDoc]

...
*it cost $45 to go to this party and it was more or less required. Is that a thing?

Hope it was open bar, at least...

 

[Attending1985]

This is a place that I worked at briefly during my residency so I'm not worried about them changing anything and the director is a good guy. I haven't had a lot of exposure to the chronic, persistent mental illness in my continuity clinic as they were at the VA and a private hospital. My only reservation is that I won't enjoy this as much. I've really enjoyed my clinic during residency, the VA less so because I don't see any women. I know that no one can tell me what patients I'll like but I really like incorporating psychotherapy into my practice and wondering how much I will be able to do this at CMHC with that population.

 

[Doctor Bagel]

*it cost $45 to go to this party and it was more or less required. Is that a thing?


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Are you kidding me? There are some scary people in mental health. My sister (also in MH) had a boss (a psychologist) who asked the employees to help her with painting her house (for free, and yes, some of the employees felt as if this wasn't voluntary).

 

[Doctor Bagel]

This is a place that I worked at briefly during my residency so I'm not worried about them changing anything and the director is a good guy. I haven't had a lot of exposure to the chronic, persistent mental illness in my continuity clinic as they were at the VA and a private hospital. My only reservation is that I won't enjoy this as much. I've really enjoyed my clinic during residency, the VA less so because I don't see any women. I know that no one can tell me what patients I'll like but I really like incorporating psychotherapy into my practice and wondering how much I will be able to do this at CMHC with that population.

You know, it's probably an OK job, but yeah, it's probably not the best job if you want to do therapy or if you want some exposure to higher functioning patients. It could be a thing to do for a while before moving on to something else or you could do it in conjunction with other work. My initial plan was to do a part-time community job in conjunction with opening a private practice. Around here, the community jobs are pretty flexible in terms of hours and schedules, so they fit nicely with that plan. It would have worked if not for me.

Of course I started my community job with a director who was also a good guy who I knew from training who quit maybe 2 months after I started. There's an interim director there now who is also a good guy, but afaik they haven't been able to find a replacement. So if there is a contract (my community job oddly didn't have one), you might want to push for more specificity.

 

[Attending1985]

Yeah I agree that it's not necessarily the perfect fit but I have basically three options: private hospital, CMHC and the VA. Financially it's pretty much a wash and all offer same time for patient care. CHMC is no call which really appeals to me as a person with kids looking to have more in the near future. Just don't want to hate my work.

 

[sunlioness]

Hope it was open bar, at least...

Nope. What a ripoff.

 

[Attending1985]

One more specific question. Any significant safety concerns those working in a Cmhc have had? Do you generally feel safe at work?

 

[sunlioness]

Ha!

No. The only thing keeping us safe here is luck. Open access building. No panic button. A patient just walked uninvited into my office right now. She just had a question about her script. But gun violence is a big thing in this neighborhood. And there's no one screening people at the door. And doctors offices aren't behind any sort of controlled access point. And they still make us see patients who have made verbal threats against us.

One time there was a patient who had some disturbing ideas about things he'd like to do to a female doctor. So he requests to see a female doctor. He gets placed on my schedule. Thank all the gods for the case manager who caught that and put a stop to it. I wouldn't have known ahead of time to stop it otherwise.

Places are different though. You gotta ask the right questions.

Who has access to the building? The offices?
What screening process do people entering the building go through?
What is the policy for dealing with patients who have made threats against staff?
Is there a panic button?
How fast does security respond to issues?

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[Attending1985]

Thanks those are all good questions to ask. I know the building does not have controlled access but the physician's offices do. There is no screening process for people entering the building. There are panic buttons, but the other questions I have no idea. Really helpful thanks.

 

[vistaril]

Yeah I agree that it's not necessarily the perfect fit but I have basically three options: private hospital, CMHC and the VA. Financially it's pretty much a wash and all offer same time for patient care. CHMC is no call which really appeals to me as a person with kids looking to have more in the near future. Just don't want to hate my work.

out of those three options(private hospital, VA, CMHC), I'd be really surprised if the VA isn't good bit better than the rest when you run all the numbers of your real salary(count things like what you pay for health insurance, student loan reinbursement opportunities, pension, incentive bonus, etc)

 

[sunlioness]

So today they scheduled me through my lunch without asking.

They did so to put an eval on my schedule. It's a person who demanded a new MD because she hasn't been seen since Oct entirely due to provider cancellations.

Apparently two weeks ago when this happened most recently, she became incensed and demanded a new psychiatrist.

So now she's on my schedule for an eval that's scheduled through my lunch. And my last day is Friday.

My plan is to tell her all of this. Leave her to go yell at them some more while I get lunch.


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[daru1]

My plan is to tell her all of this. Leave her to go yell at them some more while I get lunch.

Yep. Hasta la pasta. They're just trying to put those final screws to you. Before people get judgy here, remind them that this is during your lunch break. I had to put my lunch break in my first contract out of residency (locum), because the doc before left as he didn't get one.

 

[sunlioness]

Yeah. They've started pulling **** like this. I took Weds off to stay sane so what they've done since then is look for spaces to cram people into.

And they're allowed. My contract says forty hours and it's not above that because of Weds. And my contract doesn't say anything about lunch or breaks of any kind.

2.5 more days .....

I won't starve.


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