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heyjack70

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Our psych unit was recently closed and the docs let go so I'm looking at other jobs. Previous job was a 7 on 7 off inpatient job. Thankfully there are several options locally. Two options I'm considering are an inpatient job at large health system VS a part time outpatient job at community mental health center.

The inpatient job is 8-5 M-F, amazing group of doctors, teaching site with very manageable census, but with teaching and required availability for residents it sounds like it is not a round and go job. This is an annoyance, but the low census and great team and director offset this issue. Weekend coverage is rare, about 4 x per year and is paid on top of salary. The biggest downsides to me are this is a huge health system just like the one that let us go, and feeling like you are employed and at the whim of an MBA the rug could be pulled out from under you. It's also full time, and I have been doing occasional forensic work that would be hard to fit into this schedule.

The community mental health job could be full time at 4 days per week (4 x 8 patient hours = 32 patient hours total is full time), and pretty much everyone there works Mon-Thursday and Friday is off. I really do not enjoy outpatient like inpatient, so think full time would be too much of a grind. The clinic director is a great guy I've interfaced with over several years and is totally fine with a 2 day or 3 day week (0.5 or 0.75 FTE). The part time job would allow me to take on more forensic work, though this is sporadic and unpredictable, but also the job is ok with me doing outside work on my off days from their clinic, picking up inpatient shifts, or collaborative care with a local family med office. I doubt I will make up the money lost going part time, but the flexibility and not having all eggs in one basket would be nice.

Both jobs pay around 300K for full time. The part time outpatient job is just reduced based on FTE, benefit contribution from employer is the same for 0.75, costs me more if I go 0.5.

My main struggle is inpatient is my jam, but I also enjoy the forensic work. This was doable with a 7/7 inpatient schedule, but is relegated to evenings and weekends with a full time M-F inpatient job. The outpatient job part time allows plenty of flexibility to do side work, but the core job in a clinic is not my favorite.

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It sounds like this boils down to the forensics side work vs inpatient, with the wrinkle of whether or not you like teaching. As a core education faculty member (ie APD/clerkship director) please only take the teaching job if you like teaching and understand that all but the best residents add to your workload at least a little if you are honoring the obligation to help turn them into competent clinicians. If the patient load is reduced it sounds likely to be a place they've factored that in, which speaks to supportive leadership.

Faculty members in obligate teaching positions who don't want to teach are a bane of my existence.
 
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Have you done outpatient work as an attending? You might find it more enjoyable than in training if you have not. I left fellowship (CAP) planning on only doing HLoC work (be it IP, ED, PHP/IOP) but was forced to take an outpatient position for family reasons. It was much better than I anticipated and now if I were to ever leave my current position I would almost certainly go into cash PP.
 
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Totally get hating outpatient. Couldn't pay me enough to do it. And I think community (which translates to county Medicaid I assume?) would be the worst. Take the inpatient job. It sounds great. Staying all day is not bad. It really helps you not rush with patients and to genuinely be there to support the other staff.
 
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Totally get hating outpatient. Couldn't pay me enough to do it. And I think community (which translates to county Medicaid I assume?) would be the worst. Take the inpatient job. It sounds great. Staying all day is not bad. It really helps you not rush with patients and to genuinely be there to support the other staff.

i think with community there are extreme ends of the spectrum- malignant where you get 15 min f/u for high acuity people, huge staff turnover, etc and then the other end is theyre more inclined to keep you and are more flexible with what they offer because they need providers.

problem is you never know for sure which end it is, and with both ends youll likely see the very sick people (which actually can be rewarding albeit stressful). Another positive side is generally patient reviews are pushed less because admin understands (hopefully) these are very sick people, so theres less butt kissing.

I actually like outpatient, but i value structure and being able to plan out my day. I also value watching patients grow and get better in the long run, helps reduce burnout seeing that my job has a posive influence
 
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8 face to face patient care hours, so factor in however much admin/paperwork/calls/documentation time you think you'd need on top of that.

Right 32 patient contact hours is gonna be around 200 bucks/hour maybe with 4ish weeks of vacation/holidays a year, add on some more depending on benefits but that's not that special. And it'll end up being more like 9+ hour days after you've written all the notes for the day, responded to random messages you're getting, etc. So I wouldn't say there's anything particularly special about the second job besides the flexibility for a 4 day week maybe.
 
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