Disillusioned with Beavioral Health Field

[tsassy1]

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I'm a second-year post-doc. I was talking to the other fellows and psychiatry residents about how the prospects for patients receiving mental health looks so much different than the text books. In other words, in the text books every body improves greatly or improves a great deal, there is always a solution to every problem and every provider always knows all the evidence-based methods in-the-book

In realtiy, very ew people improve from things like personality disorders and even event those with less severe illness don't completely remit or they relapse and there are often no solutions to dilemmas we face in the treatmnet of patients. Also, when we refer out in the community, we refer to psychiatrists or PMHNPs who havent picked up a book since school and psychotherapists who say they perform all these evidence-based techniques but, during the rare times they actually do use some evidence-based interventions, they do so with a hodge-podge approach.

What are other people's biggest shocks about entering this field?

 

[Peacemaker36]

The sassy on this post is turned up to 11.

 

[Sanman]

If you think those issues are concerning, wait till you see the really bad stuff. Violent folks turned away due to a lack of inpatient beds, dumps in nursing homes, 80 year olds with new onset schizophrenia because chemical restraints for dementia are illegal, etc.

Though the biggest issue is flat rate nature of psychology. Why do more work for the same pay?

 

[R. Matey]

The sassy on this post is turned up to 11.

It actually looks like it was written by a bot or someone trying to mine responses. It's a little unbelievable to me that a second year postdoc (presuming this is a clinician) would be somehow aghast that all people everywhere don't magically get better when you do EPBs to them.

 

[psych.meout]

It actually looks like it was written by a bot or someone trying to mine responses. It's a little unbelievable to me that a second year postdoc (presuming this is a clinician) would be somehow aghast that all people everywhere don't magically get better when you do EPBs to them.

Yeah, the lamenting about lack of improvement from personality disorders was the tell for me. You're telling me that stable trait dispositions are difficult to change?!?!

 

[Psycho Bunny]

80 year olds with new onset schizophrenia because chemical restraints for dementia are illegal, etc.

Could you explain what you mean by this in more detail? I haven't heard of this before.

 

[Sanman]

Could you explain what you mean by this in more detail? I haven't heard of this before.

Briefly, there are laws and guidelines (particularly for nursing homes) dating back to the 1970s about the use of both physical restraints and chemical restraints of dementia patients ("snowing" someone on an antipsychotics/tranquilizers like depakote, klonopin, ativan, etc.). First line management for behavioral or psychological concerns is non-pharmacological management. However, the the costs of managing these symptoms non-chemically (1:1 sitters, frequent staff interventions) combined with a lack of payment for these interventions (facilities/staff are expected to provide this for free as part of care), that psychologists can not be reimbursed for completing/implementing behavioral plans (though we are quite capable providing interventions), and the lack of inpatient psych beds for dementia patients generally results in a trip to the ER and a prescription for Ativan or Depakote and dx of schizophrenia (because you can't prescribe such medications for dementia). There is significant literature on this and best practices.

https://www.alz.org/media/documents...managing-behavior-psych-symptoms-dementia.pdf
Best practice in the management of behavioural and psychological symptoms of dementia

 

[Sanman]

Yeah, the lamenting about lack of improvement from personality disorders was the tell for me. You're telling me that stable trait dispositions are difficult to change?!?!

Of course, it is difficult. Though we know that there treatments available, such as DBT for BPD patients. The question is why deal with a caseload full of borderline patients when it pays the same as a caseload full of adjustment disorders, mild anxiety, and mild depression? Plus, you get to fill out twice the paperwork with insurance to continue having them seen. Now if you could double your income by treating them...then you might see more people interested in addressing such things.

 

[tsassy1]

It actually looks like it was written by a bot or someone trying to mine responses. It's a little unbelievable to me that a second year postdoc (presuming this is a clinician) would be somehow aghast that all people everywhere don't magically get better when you do EPBs to them.

it is primarily a research-oriented fellowship. I dont understand the rude tone you're taking with me, tbh, Like many other posts on these forums (e.g., the venting threads about the V.A., etc.), I was just looiking to commiserate with other people in this field.

The fact that you think of PDs as "stable" and, therefore, unchanging, tells me about your training. Nobody is saying anything about complete remission from PDs, but all the research shows PDs to be on a continuum of severity -- so it is pretty basic to understand that I am talking about modifying the core beliefs and schemas associated with whatever PD we are talking about. Seeing PDs like a black and white phenomenon has been debunked since the 1980s... Yikes!

 

[R. Matey]

it is primarily a research-oriented fellowship. I dont understand the rude tone you're taking with me, tbh, Like many other posts on these forums (e.g., the venting threads about the V.A., etc.), I was just looiking to commiserate with other people, lol.

The fact that you think of PDs as "stable" and, therefore, unchanging, tells me about your training. Nobody is saying anything about complete remission from PDs, but all the research shows PDs to be on a continuum of severity -- so it is pretty basic to understand that I am talking about modifying the core beliefs and schemas associated with whatever PD we are talking about. Yikes!

No need to get sassy. It's pretty evident from my view as a clinician that personality disorders complicate treatment exponentially, even when using an EBP. I guess I thought it was obvious.

Are you a psychologist seeing patients or are you mainly doing research?

 

[bcliff]

I've come to appreciate the smaller and more incremental changes I'm able to facilitate in the lives of patients and their families. I agree that it's frustrating that, while there are many therapists in the community, there are few I feel comfortable referring to. Most I do feel comfortable referring to are at capacity with lengthy waitlists or don't accept insurance.

In my training supervisors did a good job normalizing and emphasizing the fact that not all evidence-based treatments work for everyone -- Both within and outside of mental healthcare. For example, it's estimated that statins (a medication considered well tolerated and highly effective) are either intolerable or inadequately effective in reducing high cholesterol for around 1/3-to-1/2 of patients with inconsistent adherence being a major contributor (link). Therefore, it seems fair to claim that I am probably at least as effective in treating mental illness as statins are in treating high cholesterol... I also have expertise in treating therapy-interfering behaviors, like non-adherence.

As a clinician, I do what I can to improve the lives of patients I evaluate and treat, and I accept the limitations associated with working in that capacity. As a researcher, I lead clinically-informed projects focused on enhancing healthcare and outcomes on a much larger scale. I think I would find the day-to-day work of being a clinician frustrating if I wasn't also leading the "bigger picture" work of being a scientist. I might also find that "bigger picture" work a little bit less invigorating if I didn't still practice actively as a clinician.

 

[aim-agm]

There is a form of survivorship bias at play, which is that the more readily a patient improves, the sooner they don't need help, which means you are less likely to see them compared to patients that have more resistant illnesses. There is correlation with severity of illness, although not as much as one might imaging.

As a rule, patients get better if they want help. It might not be fast, it might not be easy, but usually they get there. Exceptions abound, but I reasonably expect to remission or cure with most patients that walk into my office.

It can be very dispiriting when others are providing bad care (particularly when that bad care affects the care you are providing), and it is a depressing realization when you realize you can't assume that any given mental health clinician is competent.

 

[PsyDr]

it is primarily a research-oriented fellowship. I dont understand the rude tone you're taking with me, tbh, Like many other posts on these forums (e.g., the venting threads about the V.A., etc.), I was just looiking to commiserate with other people in this field.

The fact that you think of PDs as "stable" and, therefore, unchanging, tells me about your training. Nobody is saying anything about complete remission from PDs, but all the research shows PDs to be on a continuum of severity -- so it is pretty basic to understand that I am talking about modifying the core beliefs and schemas associated with whatever PD we are talking about. Seeing PDs like a black and white phenomenon has been debunked since the 1980s... Yikes!

1) Explain the difference between "stable" and "enduring".
2) As the DSM uses the term "enduring", explain how you reconcile your position with the DSM.
3) If you state that you do not believe in the DSM, please explain how you submit bills using the DSM without committing fraud.

 

[psych.meout]

Of course, it is difficult. Though we know that there treatments available, such as DBT for BPD patients. The question is why deal with a caseload full of borderline patients when it pays the same as a caseload full of adjustment disorders, mild anxiety, and mild depression? Plus, you get to fill out twice the paperwork with insurance to continue having them seen. Now if you could double your income by treating them...then you might see more people interested in addressing such things.

Right, and patients who have personality disorders and other severe mental health problems are also more likely to be lower SES, unemployed, have fewer resources; less likely to be insured; etc., which cause further problems for their mental health and prevent them from being able to pay for their desperately needed treatment.

Personality disorders, SMI, etc. have the highest cost and burden on the system, but the pay incentives aren't there to prevent, manage, or alleviate these conditions. Well, at least not outside of the criminal justice system, that is...

it is primarily a research-oriented fellowship. I dont understand the rude tone you're taking with me, tbh, Like many other posts on these forums (e.g., the venting threads about the V.A., etc.), I was just looiking to commiserate with other people in this field.

The fact that you think of PDs as "stable" and, therefore, unchanging, tells me about your training.

Stable does not mean "unchanging." It means that personality characteristics are consistent over time, but still possible to change, though they are more difficult to change and occur over a longer span of time than other phenomena (e.g., behaviors).

Nobody is saying anything about complete remission from PDs, but all the research shows PDs to be on a continuum of severity -- so it is pretty basic to understand that I am talking about modifying the core beliefs and schemas associated with whatever PD we are talking about. Seeing PDs like a black and white phenomenon has been debunked since the 1980s... Yikes!

Whole lotta of projection and putting words in people's mouths in your posts.

 

[smalltownpsych]

Second year is about when the naïveté starts to crumble for many of us. We had a discussion about that dynamic in our group supervision and if I recall correctly it was early in the second year. Also, many of my colleagues spent first year at our in-house clinic so didn’t see the bad stuff out in the real world.

 

[deleted1129370]

I mean....**** happens. You can't and won't be able to help everybody who comes to see you. Maybe it's your skillset and approach, maybe not. A lot of times it's due to factors largely out of your control. You do the best you can. Set realistic expectations when you goal and treatment plan. Even if you had been working with someone with severe depression for a month of so and the most you accomplished with them was getting them out of their bed to go to breakfast once or twice a week....that still represents progress for them. We can't approach our patients with our personal views of what may constitute clinically significant improvement. It varies. For me, I pretty much set the bar pretty low, and if my patient achieves it, that's progress.

 

[Sanman]

Second year is about when the naïveté starts to crumble for many of us. We had a discussion about that dynamic in our group supervision and if I recall correctly it was early in the second year. Also, many of my colleagues spent first year at our in-house clinic so didn’t see the bad stuff out in the real world.

Are you talking about second year of grad school or second year of post-doc? OP, is a second year post-doc. However, I think the dillusionment has more to do with the fact that research does not inform practice in many cases. The simple fact is that science and the healthcare industry are two different things and what the science shows often does not translate into practice.

 

[tsassy1]

Yes, very well said. I feel like research doesn't inform practice and I always feel that there is so much I don't know the answer to that I am always going home and reading and reading. Although in some ways being thorough is good, I find it also somewhat self-destructive because I am using quite a bit of my free time researching and trying to improve my skills, to the detriment of my personal life.

However, when I am at work, so little of our time is actually used to improve our skills. Rather it is taken up with routine paperwork for research trials, writing articles, et cetera, that if I don't go home and do the extra work, I don't feel like I will ever improve enough.

Exacerbating the above, I notice most others don't really become that engaged in their work and improving their skills outside of work. While I completely understand work-life balance and see how in a lot of ways taking that stance is actually healthier, I always feel so guilty for not being skilled enough.

A lot of times I will look at all these books written by renowned applied psychologists and tell myself I need to read many of these books to do a better job, but I hen look around and beat myself up because nobody else really seems to want to actually do that -- i guess i feel maybe my life just isnt that fulfilling. But then I just feel like I'm not helping others enough with my work but also feel like I will have to devote a ton of my free time to reading on the weekends, et cetera to get to that point.

I try to form reading groups after work using things like meetup or asking other providers at the medical school, post-docs, and nobody really seems to want to do that, even for an hour twice a week. Then that makes me wonder if my life is super boring or something! lol

Anybody else neurotic like me?

 

[aim-agm]

Yes, very well said. I feel like research doesn't inform practice and I always feel that there is so much I don't know the answer to that I am always going home and reading and reading. Although in some ways being thorough is good, I find it also somewhat self-destructive because I am using quite a bit of my free time researching and trying to improve my skills, to the detriment of my personal life.

However, when I am at work, so little of our time is actually used to improve our skills. Rather it is taken up with routine paperwork for research trials, writing articles, et cetera, that if I don't go home and do the extra work, I don't feel like I will ever improve enough.

Exacerbating the above, I notice most others don't really become that engaged in their work and improving their skills outside of work. While I completely understand work-life balance and see how in a lot of ways taking that stance is actually healthier, I always feel so guilty for not being skilled enough.

A lot of times I will look at all these books written by renowned applied psychologists and tell myself I need to read many of these books to do a better job, but I hen look around and beat myself up because nobody else really seems to want to actually do that -- i guess i feel maybe my life just isnt that fulfilling. But then I just feel like I'm not helping others enough with my work but also feel like I will have to devote a ton of my free time to reading on the weekends, et cetera to get to that point.

I try to form reading groups after work using things like meetup or asking other providers at the medical school, post-docs, and nobody really seems to want to do that, even for an hour twice a week. Then that makes me wonder if my life is super boring or something! lol

Anybody else neurotic like me?

The actually important question is: Are you going to be an adequate psychologist?
If no, it doesn't matter what everyone else is doing, find a reasonable path to achieving adequacy before you begin independent work.
If yes, it doesn't matter what everyone else is doing, find a reasonable amount of time to devote to further improvement while also enjoying your life and the fruits of your labor (remember this is, at the end of the day, a job).

Remember: better is better but good enough is good enough.

 

[thebalmofhurtminds]

Yes, very well said. I feel like research doesn't inform practice and I always feel that there is so much I don't know the answer to that I am always going home and reading and reading. Although in some ways being thorough is good, I find it also somewhat self-destructive because I am using quite a bit of my free time researching and trying to improve my skills, to the detriment of my personal life.

However, when I am at work, so little of our time is actually used to improve our skills. Rather it is taken up with routine paperwork for research trials, writing articles, et cetera, that if I don't go home and do the extra work, I don't feel like I will ever improve enough.

Exacerbating the above, I notice most others don't really become that engaged in their work and improving their skills outside of work. While I completely understand work-life balance and see how in a lot of ways taking that stance is actually healthier, I always feel so guilty for not being skilled enough.

A lot of times I will look at all these books written by renowned applied psychologists and tell myself I need to read many of these books to do a better job, but I hen look around and beat myself up because nobody else really seems to want to actually do that -- i guess i feel maybe my life just isnt that fulfilling. But then I just feel like I'm not helping others enough with my work but also feel like I will have to devote a ton of my free time to reading on the weekends, et cetera to get to that point.

I try to form reading groups after work using things like meetup or asking other providers at the medical school, post-docs, and nobody really seems to want to do that, even for an hour twice a week. Then that makes me wonder if my life is super boring or something! lol

Anybody else neurotic like me?

Work already takes up the majority of peoples' lives. I have a toddler and a husband, hobbies I enjoy, and chores to do and I'd prefer to spend that extra hour twice a week with them/doing those things rather than doing more work that never ends.

 

[WisNeuro]

Work already takes up the majority of peoples' lives. I have a toddler and a husband, hobbies I enjoy, and chores to do and I'd prefer to spend that extra hour twice a week with them/doing those things rather than doing more work that never ends.

Yeah, with two young kids, I'm trying to maximize my free time for family stuff and things like gym/sports/socializing. There's always more work that can be done, another IME case I could squeeze in, but nah. I make plenty, and I'd rather have the time than the income from another 10+ hours week.

 

[tsassy1]

Yes, I completely agree with wanting more time for your family and yourself.

This may sound like a strange question, but I wonder who buys all these books on things like advance-practice cognitive therapy or cognitive therapy for PD. A lot of these books are definitely not directed at graduate students and the authors, such as Christine Padesky, advertise themliek they are something you read for fun on the weekends....

Does anybody know anybody who buys these books and reads them for fun? I mean someone must purchase them

 

[WisNeuro]

Yes, I completely agree with wanting more time for your family and yourself.

This may sound like a strange question, but I wonder who buys all these books on things like advance-practice cognitive therapy or cognitive therapy for PD. A lot of these books are definitely not directed at graduate students and the authors, such as Christine Padesky, advertise themliek they are something you read for fun on the weekends....

Does anybody know anybody who buys these books and reads them for fun? I mean someone must purchase them

I mean, I enjoy reading neuropsych and PTSD lit. It helps that I also need to review these things frequently for legal work and can bill for that time, though.

 

[psych.meout]

Yes, very well said. I feel like research doesn't inform practice and I always feel that there is so much I don't know the answer to that I am always going home and reading and reading. Although in some ways being thorough is good, I find it also somewhat self-destructive because I am using quite a bit of my free time researching and trying to improve my skills, to the detriment of my personal life.

However, when I am at work, so little of our time is actually used to improve our skills. Rather it is taken up with routine paperwork for research trials, writing articles, et cetera, that if I don't go home and do the extra work, I don't feel like I will ever improve enough.

Exacerbating the above, I notice most others don't really become that engaged in their work and improving their skills outside of work. While I completely understand work-life balance and see how in a lot of ways taking that stance is actually healthier, I always feel so guilty for not being skilled enough.

A lot of times I will look at all these books written by renowned applied psychologists and tell myself I need to read many of these books to do a better job, but I hen look around and beat myself up because nobody else really seems to want to actually do that -- i guess i feel maybe my life just isnt that fulfilling. But then I just feel like I'm not helping others enough with my work but also feel like I will have to devote a ton of my free time to reading on the weekends, et cetera to get to that point.

I try to form reading groups after work using things like meetup or asking other providers at the medical school, post-docs, and nobody really seems to want to do that, even for an hour twice a week. Then that makes me wonder if my life is super boring or something! lol

Anybody else neurotic like me?

It's going more than a bit too far to say that research doesn't inform practice. It's more like a Venn diagram influenced by politics, healthcare systems, economics, etc.

 

[Shiori]

I have a long commute, and it's been productive to listen to relevant books while I drive. Training other trainees and staff has been great too.

 

[AcronymAllergy]

Yes, I completely agree with wanting more time for your family and yourself.

This may sound like a strange question, but I wonder who buys all these books on things like advance-practice cognitive therapy or cognitive therapy for PD. A lot of these books are definitely not directed at graduate students and the authors, such as Christine Padesky, advertise themliek they are something you read for fun on the weekends....

Does anybody know anybody who buys these books and reads them for fun? I mean someone must purchase them

I suspect there are some psychologists who buy them and never read them. And others, including folks in this thread, who enjoy reading work-related literature (among other topics) in their down time.

Plus, with some jobs, you occasionally have time to review some materials at work. And various employers will sponsor workshops or one-off talks and such that can quickly bring folks up to speed on the basics, so they can then further supplement afterward.

And there are plenty of folks in private practice willing to shell out for additional training (empirically-supported or not).

 

[ccpsych16]

I used to be a book reviewer for a library and they sent me free psychology books in exchange for a 200 word review. Sometimes they were very timely and I learned a lot. I usually put psych books on wishlists for holidays/birthdays and have gotten a good number of them that way. I do enjoy reading them, and depending on caseload I have a couple in arms reach at my desk so I can glance through before a particular session.

 

[clausewitz2]

Does anybody know anybody who buys these books and reads them for fun? I mean someone must purchase them

I mean, I document the time I spend reading them because it counts for CME in my state, but yes I am to the point that I have to set myself a strict budget for how much I am allowed to spend every month on acquiring these things. I am primarily self-employed so it is a deductible expense, at least.

I totally think it's valid to prioritize family and other interests, but clinical work is essentially a craft. I feel like everyone should aspire to always be getting just a little bit better at it and it's not something you're ever "done" learning, really.

 

[Sanman]

Yes, very well said. I feel like research doesn't inform practice and I always feel that there is so much I don't know the answer to that I am always going home and reading and reading. Although in some ways being thorough is good, I find it also somewhat self-destructive because I am using quite a bit of my free time researching and trying to improve my skills, to the detriment of my personal life.

However, when I am at work, so little of our time is actually used to improve our skills. Rather it is taken up with routine paperwork for research trials, writing articles, et cetera, that if I don't go home and do the extra work, I don't feel like I will ever improve enough.

Exacerbating the above, I notice most others don't really become that engaged in their work and improving their skills outside of work. While I completely understand work-life balance and see how in a lot of ways taking that stance is actually healthier, I always feel so guilty for not being skilled enough.

A lot of times I will look at all these books written by renowned applied psychologists and tell myself I need to read many of these books to do a better job, but I hen look around and beat myself up because nobody else really seems to want to actually do that -- i guess i feel maybe my life just isnt that fulfilling. But then I just feel like I'm not helping others enough with my work but also feel like I will have to devote a ton of my free time to reading on the weekends, et cetera to get to that point.

I try to form reading groups after work using things like meetup or asking other providers at the medical school, post-docs, and nobody really seems to want to do that, even for an hour twice a week. Then that makes me wonder if my life is super boring or something! lol

Anybody else neurotic like me?

The bolded are really all we needed to know. You don't feel confident in your skills and so this is how you cope with your anxiety. The truth is that any decent graduate program at the doctoral level should make you competent at the base level and you will have decades to perfect your craft. Accept that you will make mistakes and learn from them. Pace yourself. It is something to work on as part of your personal growth. Finding work life balance is part of the job as well. Burn out is real and many people choose not to do this full-time because they never develop the skill of letting go a bit.

The actually important question is: Are you going to be an adequate psychologist?
If no, it doesn't matter what everyone else is doing, find a reasonable path to achieving adequacy before you begin independent work.
If yes, it doesn't matter what everyone else is doing, find a reasonable amount of time to devote to further improvement while also enjoying your life and the fruits of your labor (remember this is, at the end of the day, a job).

Remember: better is better but good enough is good enough.

This is a job and in any job there are those who are great and the terrible.

 

[PsyDr]

1) If you guys keep prioritizing family and treating your kids well, our field will lose future patients.

2) I feel attacked by these comments about professional books. hint: citing a book is a great forensic tactic, and bringing them to court is even better. Which is why I own anesthesia textbooks.

3) While @tsassy1 hasn’t answered my question, I will point out that there are many many many different areas of practice. The normative practice is therapy. But there are other niches. Tests are created by someone. The Netflix algorithm was created by a psychologist. Etc etc etc. Competence is dependent upon the job. Innovation is also a thing.

*I’m still waiting for @msc545 to answer my question from a year ago.

 

[deleted1129370]

Yes, very well said. I feel like research doesn't inform practice and I always feel that there is so much I don't know the answer to that I am always going home and reading and reading. Although in some ways being thorough is good, I find it also somewhat self-destructive because I am using quite a bit of my free time researching and trying to improve my skills, to the detriment of my personal life.

However, when I am at work, so little of our time is actually used to improve our skills. Rather it is taken up with routine paperwork for research trials, writing articles, et cetera, that if I don't go home and do the extra work, I don't feel like I will ever improve enough.

Exacerbating the above, I notice most others don't really become that engaged in their work and improving their skills outside of work. While I completely understand work-life balance and see how in a lot of ways taking that stance is actually healthier, I always feel so guilty for not being skilled enough.

A lot of times I will look at all these books written by renowned applied psychologists and tell myself I need to read many of these books to do a better job, but I hen look around and beat myself up because nobody else really seems to want to actually do that -- i guess i feel maybe my life just isnt that fulfilling. But then I just feel like I'm not helping others enough with my work but also feel like I will have to devote a ton of my free time to reading on the weekends, et cetera to get to that point.

I try to form reading groups after work using things like meetup or asking other providers at the medical school, post-docs, and nobody really seems to want to do that, even for an hour twice a week. Then that makes me wonder if my life is super boring or something! lol

Anybody else neurotic like me?

This thinking will be the death of you.

 

[clausewitz2]

2) I feel attacked by these comments about professional books. hint: citing a book is a great forensic tactic, and bringing them to court is even better. Which is why I own anesthesia textbooks.

While it may be wishful thinking on may part, if I'm considering making a treatment decision that colors outside the lines a bit, I do feel better about it from a liability standpoint if I am able to find an authoritative book that says "in circumstances XYZ, this is a reasonable approach." Hard(er) to be accused of not meeting standard of care if you can show it's not just you being a cowboy and some other eminent authority does it as well.

 

[WisNeuro]

While it may be wishful thinking on may part, if I'm considering making a treatment decision that colors outside the lines a bit, I do feel better about it from a liability standpoint if I am able to find an authoritative book that says "in circumstances XYZ, this is a reasonable approach." Hard(er) to be accused of not meeting standard of care if you can show it's not just you being a cowboy and some other eminent authority does it as well.

Yeah, clinically, I don't bring in many citations unless it's a weird case. For run of the mill stuff, like a classic Alzheimer's presentation that postdocs would easily spot, doesn't really matter, there's usually pretty unanimous agreement on the Dx. But say we get into a not quite typical possible FTD variant, or there is a lot of ambiguity about some parkinsonism that doesn't fit any of the usuals (PD, CBD, PSP, etc). Then I may have a few in there to discuss differentials. Of course, different story in IME work. Shortest citations I've had recently has been about 25.

 

[psyched-applicant]

Some of the most hateful and bigoted people I have ever met have been my fellow co-workers and supervisors in this field. For this and additional reasons, I actually switched to a corporate job in marketing. It ended up not being the right role for me so I'm back in mental health but despite the jokes about corporate culture destroying people's mental health, I was so much happier and supported in my work environment than in my previous mental health jobs. I now work in a slightly different psych setting but MH (especially community MH) is surprisingly toxic.

 

[Sanman]

Some of the most hateful and bigoted people I have ever met have been my fellow co-workers and supervisors in this field. For this and additional reasons, I actually switched to a corporate job in marketing. It ended up not being the right role for me so I'm back in mental health but despite the jokes about corporate culture destroying people's mental health, I was so much happier and supported in my work environment than in my previous mental health jobs. I now work in a slightly different psych setting but MH (especially community MH) is surprisingly toxic.

Community MH is generally underfunded and understaffed. Anything corporate is not because there is a profit. It turns out that when you put money into things, they are better. It sounds nice to help the poor and those with few resources, until it becomes your problem. I have worked many "jobs" along the way to getting my degree and the average office job with nice bathrooms, free coffee, and a building cafeteria is better than most of the underfunded facilities I have worked in my early MH career. I have learned that I can't fix that stuff. Sometimes you just have to move on.

 

[R. Matey]

Community MH is generally underfunded and understaffed, Anything corporate is not because there is a profit. It turns out that when you put money into things, they are better. It sounds nice to help the poor and those with few resources, until it becomes your problem. I have worked many "jobs" along the way to getting my degree and the average office job with nice bathrooms, free coffee, and a building cafeteria is better than most of the underfunded facilities I have worked in my early MH career. I have learned that I can't fix that stuff. Sometimes you just have to move on.

+1

@psyched-applicant It's really not that surprising. Medicaid pays beans in many states so CMHCs rely heavily on volume to cover costs. The wages for therapist positions are low because Medicaid reimbursements are low so execs often have to hire either fresh face (unlicensed) M.A./MSW grads or those, for one reason or another, who can't or won't get a job anywhere else. And because patient acuity is high and the organization needs you to see buckets and buckets of patients, clinician stress can also run high.

In other words, high acuity + high volume + low wages = burnout.

 

[smalltownpsych]

Are you talking about second year of grad school or second year of post-doc? OP, is a second year post-doc. However, I think the dillusionment has more to do with the fact that research does not inform practice in many cases. The simple fact is that science and the healthcare industry are two different things and what the science shows often does not translate into practice.

I was thinking of grad school. I must have misread it. My business is getting a bit busier and I’m having less time to peruse these boards which is a good problem. 😊

 

[deleted1129370]

I was thinking of grad school. I must have misread it. My business is getting a bit busier and I’m having less time to peruse these boards which is a good problem. 😊

Same. I just hired on a full time psychologist, so now there are 5 of us in my practice. I see 30 people a week, I am booked about 3 weeks out, and I am filling up my other psychologists' schedules, and still growing the business.

 

[smalltownpsych]

Same. I just hired on a full time psychologist, so now there are 5 of us in my practice. I see 30 people a week, I am booked about 3 weeks out, and I am filling up my other psychologists' schedules, and still growing the business.

That’s awesome. I have two counseling interns ready to start seeing patients next month who are already providing case management and support services and a postdoc starting next month. We just signed a lease for two offices next door so are definitely expanding. I think you might be getting to the place I am where the clinician load might be a bit much, but I am also the prime revenue generator. One challenge I have is how to use my reputation and referrals to feed others in my practice.

 

[deleted1129370]

That’s awesome. I have two counseling interns ready to start seeing patients next month who are already providing case management and support services and a postdoc starting next month. We just signed a lease for two offices next door so are definitely expanding. I think you might be getting to the place I am where the clinician load might be a bit much, but I am also the prime revenue generator. One challenge I have is how to use my reputation and referrals to feed others in my practice.

Exactly. I try to have my assistant screen referrals and delegate to my other providers, but many of them insist on working with me and will wait to do so. I am the primary income generator, but my goal by the end of this year is to be earning half of my income via passive means, then hopefully by end of next year I will be earning nearly 100% of my income via passive means. From that point I would want to work on growing my passive income. I set regular benchmarks to determine how I will scale (i.e., when to hire on a second assistant, another provider, etc.). My biggest obstacle is a constant flow of new referrals. For example, I am to onboard about 1-3 new patients a week for just myself to account for attrition. I would need to aim for about 10 new referrals per week to remotely make a dent in keeping my other providers' schedules constantly filled.