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Federal Prison
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Not sure what you mean by "amazing benefits" but I'll leave it to others to ironically speculate on what those might be...
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By "amazing benefits" I mean vested healthcare after 5 years, retirement with pension after 20yrs, federal holidays in addition to vacation, 40hr work week, no weekends, etc. I have not seen such benefits at other practices or job offers. Hence, I refer to them as "amazing." Maybe they are not amazing to you, in which case I implore you to share some of the benefit packages out there that you find impressive because I'd love to see them.
Bunny,
Sorry, didn't mean to peeve you off. I meant "amazing benefits" in a more juvenile sense (i.e. dropping the soap in the shower, being fatally stabbed by a toothbrush filed into a shiv, getting discounts on illegal drugs, etc). Didn't think I'd have to spell it out ... it's less funny that way too ... but there you have it.
I'm in Canada, so healthcare is not an issue (although certain services, like PT, dental, optometry are not covered by the Ontario plan).
I guess you'd get the retirement with pension in academic / university positions, perhaps as a salaried employee in a hospital (mostly rads and path, I think), or in a few other areas (e.g. the military).
As for the 40 hour work week, weekends, etc., that is largely within one's own control, depending on the practice type and location, of course.
Again, no offence was intended.
Sorry, didn't mean to peeve you off. I meant "amazing benefits" in a more juvenile sense (i.e. dropping the soap in the shower, being fatally stabbed by a toothbrush filed into a shiv, getting discounts on illegal drugs, etc). Didn't think I'd have to spell it out ... it's less funny that way too ... but there you have it.
I'm in Canada, so healthcare is not an issue (although certain services, like PT, dental, optometry are not covered by the Ontario plan).
I guess you'd get the retirement with pension in academic / university positions, perhaps as a salaried employee in a hospital (mostly rads and path, I think), or in a few other areas (e.g. the military).
As for the 40 hour work week, weekends, etc., that is largely within one's own control, depending on the practice type and location, of course.
Again, no offence was intended.
UTMB in Galveston actually has one of 3 tracks in preventive medicine that is "corrections medicine". Yep, you can do a residency in prison doc.
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I remember seeing a Cali post in AAFP awhile back w/ starting salary at $248k, but w/ their current budget I suppose that may have disappeared.
I would talk to some folks in the USPHS if you're serious about corrections. They would be able to hook you up w/ some experience so you can see what it's like firsthand.
I'd also spend some of my educational time w/ the infectious disease folks and make sure you're comfortable w/ some of the more common ID in corrections. Also that you're comfortable w/ some of the really crappy medical care in some US facilities (you may be the only MD serving several thousand inmates, some of whom will be really sick). The Washington Post ran several articles on ICE and their lack of care. It would be hard to stick it out for that pension if you spent all your time banging your head against the wall.
I would talk to some folks in the USPHS if you're serious about corrections. They would be able to hook you up w/ some experience so you can see what it's like firsthand.
I'd also spend some of my educational time w/ the infectious disease folks and make sure you're comfortable w/ some of the more common ID in corrections. Also that you're comfortable w/ some of the really crappy medical care in some US facilities (you may be the only MD serving several thousand inmates, some of whom will be really sick). The Washington Post ran several articles on ICE and their lack of care. It would be hard to stick it out for that pension if you spent all your time banging your head against the wall.
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No offence taken (Sarcopenia). I have a sense of humor but felt obligated to protect the post and get genuine responses. I appreciate the feedback that was given. I do have experience working in a correctional facility that was in a significantly impoverished region and have seen most of the negative aspects of correctional medicine. Honestly though, the patients were not much different than the patients I treated in residency; demanding, drug-seeking, etc. I really liked working in the confines of a restricted formulary in the correctional facility and it was quite easy to establish boundaries within that system. I have seen a job opportunity that is alluring, but I want to hear from doc's that have done this a while and can lend some advice from experience.
Thanks for the links that were offered. Please continue to give feedback.
Thanks for the links that were offered. Please continue to give feedback.
I have been a correctional physician for about 12 years. I take call about once a week, which means staying in the prison for 24 hours. I usually get about 4-5 hours of good sleep, since after 10 pm things are really slow. I work a 40 hour week, plus call. Salary is around 200,000 a year. I get extra pay for call. I have a defined benefit retirement plan, which gives 2.5% of the highest salary times the number of years worked. E.g. 20 years times 0.025 times 200,000 equals 100,000 a year pension. You vest into the pension program after 5 years. 1000 dollars a year for CME. Health and dental plan.
Patients are very similar to those you see during residency at a county hospital. I work in a male prison, so you do not get gyn experience. No pediatrics, but lots of geriatrics. Age range is 19 to 80 and above.
Job satisfaction is excellent. You get to diagnose and treat a lot of conditions. Since prisoners often come from sectors of society poorly served by the medical community, you are often the first to diagnose a condition. If you need a specialist, you just fill out a referral form. These are then screened by a committee. Trivial stuff will be denied, but I have no trouble getting consultations for serious, life threatening, conditions.
You are treated with respect by staff, custody and non-custody. But be careful: if you are seen as being a "prisoner advocate", you may get some negative feedback. I walk a thin line: I make sure prisoners get fair and proper care, but I will not pursue trivial issues, like someone wanting athletic footwear. (any special clothing or items of daily living have to be approved by custody for security reasons. If you think a prisoner needs some item, you have to be sure it is medically necessary, not just because the inmate wants it.)
Lots of paperwork, but you hardly ever work more than 40 hours a week. Here, we work 4 ten hour days, then get 3 days off. Only rural prisons seem to have this perk.
Lots of lawsuits, but the attorney general handles them. You just have to answer a few interrogatories. Prisoners will sue for anything. They do not need a physician to declare negligence to start the suit. They usually sue for "deliberate indifference." I have been sued at least 30 times. This means that it may be hard to buy malpractice insurance if you ever leave the system. Even if the suit is thrown out of court (most are), it mars your record and you may have to buy "high risk" insurance once you re-enter private practice. It is best to stick with correctional medicine until retirement once you start, because leaving might be difficult. It is said commonly, "this is your last job."
If you are interested, it is probably OK to try it for a year, then you can leave without much damage to your record. If you stay a long time, like me, you may become "difficult to insure", even if you are a great doctor and never committed malpractice (you just made some inmates mad because you didn't give them what they wanted). Of course, if you stay with the system, you have no worries: all your liability is covered by the government.
Patients are very similar to those you see during residency at a county hospital. I work in a male prison, so you do not get gyn experience. No pediatrics, but lots of geriatrics. Age range is 19 to 80 and above.
Job satisfaction is excellent. You get to diagnose and treat a lot of conditions. Since prisoners often come from sectors of society poorly served by the medical community, you are often the first to diagnose a condition. If you need a specialist, you just fill out a referral form. These are then screened by a committee. Trivial stuff will be denied, but I have no trouble getting consultations for serious, life threatening, conditions.
You are treated with respect by staff, custody and non-custody. But be careful: if you are seen as being a "prisoner advocate", you may get some negative feedback. I walk a thin line: I make sure prisoners get fair and proper care, but I will not pursue trivial issues, like someone wanting athletic footwear. (any special clothing or items of daily living have to be approved by custody for security reasons. If you think a prisoner needs some item, you have to be sure it is medically necessary, not just because the inmate wants it.)
Lots of paperwork, but you hardly ever work more than 40 hours a week. Here, we work 4 ten hour days, then get 3 days off. Only rural prisons seem to have this perk.
Lots of lawsuits, but the attorney general handles them. You just have to answer a few interrogatories. Prisoners will sue for anything. They do not need a physician to declare negligence to start the suit. They usually sue for "deliberate indifference." I have been sued at least 30 times. This means that it may be hard to buy malpractice insurance if you ever leave the system. Even if the suit is thrown out of court (most are), it mars your record and you may have to buy "high risk" insurance once you re-enter private practice. It is best to stick with correctional medicine until retirement once you start, because leaving might be difficult. It is said commonly, "this is your last job."
If you are interested, it is probably OK to try it for a year, then you can leave without much damage to your record. If you stay a long time, like me, you may become "difficult to insure", even if you are a great doctor and never committed malpractice (you just made some inmates mad because you didn't give them what they wanted). Of course, if you stay with the system, you have no worries: all your liability is covered by the government.
D
deleted87716
^ That's one of the best overviews of correctional medicine I've seen. Thanks for posting! 🙂
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Paiute,
You mention referrals in your post as going through a screening committee, and I'm curious if this influences your practice significantly? I.e., do you send someone for an initial Alzheimer's consult (or choose your medical specialty malady), but then do the follow-up yourself, or would that person still get routine visits to a neurologist? Transplant would be another area where I can see people usually going to a transplant specialist usually, but maybe not happening there. Similarly, do you feel you have a higher tolerance for stuff that might otherwise get sent out to a specialist, like an eye problem or whatever? Finally, how are codes and urgent problems handled? Are those sent out to an ER immediately if you give the go-ahead? Thanks!
You mention referrals in your post as going through a screening committee, and I'm curious if this influences your practice significantly? I.e., do you send someone for an initial Alzheimer's consult (or choose your medical specialty malady), but then do the follow-up yourself, or would that person still get routine visits to a neurologist? Transplant would be another area where I can see people usually going to a transplant specialist usually, but maybe not happening there. Similarly, do you feel you have a higher tolerance for stuff that might otherwise get sent out to a specialist, like an eye problem or whatever? Finally, how are codes and urgent problems handled? Are those sent out to an ER immediately if you give the go-ahead? Thanks!
Yes, any physician can call a code 3 ambulance at anytime. In fact, sometimes we tell the nurse to call 911.
Finally, its an exciting job. Hardly ever a dull day.
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Thanks again! I really appreciate the time and info. One final question, how many jobs are there available like yours? I've shadowed a doctor who worked in a county jail, but he only work for about 4 hours a week as the Medical Director. He rounded on the people in the infirmary at the time and saw any especially vexing patients. But, rest of the time it was staffed by NPs. I looked at the NHSC and USAjobs.com and it had plenty of VA spots open, but no federal prisons that I could see. Is it locationally limited?
I work for the State prison. I know nothing about the Federal system. I believe that there are still a few openings left here in California, but all are in rural areas (high desert, central valley). Google "California Department of Corrections and Rehabilitation"
