Financial incentive to get board certified in addictions?

[Mass Effect]

Didn’t hear it. I’ve seen it.

In Texas? How can any state mandate a fellowship?

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[TexasPhysician]

In Texas? How can any state mandate a fellowship?

I can’t tell you whether some negotiation took place or not. “Over-prescribing” of controlled meds +/- poor documentation can lead to extra CME, license restrictions, or anything in between. I could easily see a doc facing a potential license restriction volunteering to do an addictions fellowship instead to make “better future decisions”.

 

[Mass Effect]

I can’t tell you whether some negotiation took place or not. “Over-prescribing” of controlled meds +/- poor documentation can lead to extra CME, license restrictions, or anything in between. I could easily see a doc facing a potential license restriction volunteering to do an addictions fellowship instead to make “better future decisions”.

Ah, possibly as compromise instead of losing DEA license. That makes sense.

 

[futuredo32]

Why do you need to be BC in addictions?

I don't particularly like psychiatry. I was hoping maybe this may be a niche I do like. I want to do a FP residency, but I have a red flag of a CV all of which are explainable except the low board scores, and additionally it is really not easy to do a second residency due to funding.

 

[SourceOfDenial]

I don't particularly like psychiatry. I was hoping maybe this may be a niche I do like. I want to do a FP residency, but I have a red flag of a CV all of which are explainable except the low board scores, and additionally it is really not easy to do a second residency due to funding.

I guess all of those being said, I’m still not sure why there is so much pressure to do the practice pathway. None of the things you listed seem like the answer to the question of why get board cert in addictions. Does it make you a better FM candidate? Unlikely. Does it improve your red flags? No. And getting BC seems like a strange way to figure out if you like something or not.

 

[futuredo32]

I guess all of those being said, I’m still not sure why there is so much pressure to do the practice pathway. None of the things you listed seem like the answer to the question of why get board cert in addictions. Does it make you a better FM candidate? Unlikely. Does it improve your red flags? No. And getting BC seems like a strange way to figure out if you like something or not.

FP doesn't pay well. Addictions does. My PCP does both and he makes a great living- I owe 400k in student loans and mentioned how much I made at prior jobs, he needs his BC in addictions to work at hospitals. And it is VERY unlikely with my red flag of an application that I will match in FP, I have tried everything else in psych and from the small amount of addictions work I have done, it's not bad. It would be different from the norm.

 

[splik]

I am assuming one would need a letter from a former PD For addictions? I don't have that.

You need a boiler plate letter saying you completed residency requirements, but given you are several years out in practice and are board certified, I dont think an LoR from your residency director matters as it would if you were still a resident. I think most places would be excited to have someone who has years of real world experience and the fact you would be willing to take a pay cut for the fellowship shows dedication. I can see why you want to get the certification, but of course it is also not required to work in addictions though if you did not get good addictions training in residency it's not a bad idea. Regardless, might not be a bad idea to attend a review course in addictions (for example ASAM offers one).

 

[futuredo32]

I have addressed the liability issue with my current position with two of the other locums psychiatrists, both who have no interest in whether I stay or leave. They don't see any liablity issues . Can someone clarify for me? I am saying that during the visit I see them they are stable and at this time these are my recommendations.

 

[futuredo32]

You need a boiler plate letter saying you completed residency requirements, but given you are several years out in practice and are board certified, I dont think an LoR from your residency director matters as it would if you were still a resident. I think most places would be excited to have someone who has years of real world experience and the fact you would be willing to take a pay cut for the fellowship shows dedication. I can see why you want to get the certification, but of course it is also not required to work in addictions though if you did not get good addictions training in residency it's not a bad idea. Regardless, might not be a bad idea to attend a review course in addictions (for example ASAM offers one).

Without the BC in addictions, I couldn't work in a hospital part time on an addictions unit though, correct?

 

[downwithDTB]

I remain confused as to why you need to be boarded in addictions. I don't get the impression that board certification is a prerequisite for practice in psychiatiry at all, with the exception of MAYBE child < 12 and very academic positions. Why not just get your bupe waiver and open shop somewhere?

(No, I don't have any specific jobs for you because I won't reveal myself, but Google gave me a lot of hits in some big cities).

 

[downwithDTB]

Without the BC in addictions, I couldn't work in a hospital part time on an addictions unit though, correct?

Have you tried? Have you emailed a bunch of dept chairs or med directors? Have you called a detox and checked to see if the doc are bc/be in addition?

 

[futuredo32]

Have you tried? Have you emailed a bunch of dept chairs or med directors? Have you called a detox and checked to see if the doc are bc/be in addition?

No. I was hoping to work part time in a small hospital based inpatient detox center. I did try to get a position at a hospital before I was BC and I was BE and the reply was that they only granted privileges to BC psychiatrists and I was BE. Don't hospitals use locums or advertise if they need a physician? I have applied to local addictions centers in Michigan but they all wanted BC in addictions.

 

[TexasPhysician]

I have addressed the liability issue with my current position with two of the other locums psychiatrists, both who have no interest in whether I stay or leave. They don't see any liablity issues . Can someone clarify for me? I am saying that during the visit I see them they are stable and at this time these are my recommendations.

The physician is considered captain of the ship. As captain, you are ultimately responsible if the ship sinks as you should have managed the staff better, researched the weather, or whatever to prevent disaster.

In your setting, you appear to be dependent on data far removed from the patient. The nurses collect data and then you have NP’s involved and then you with the least interaction. If the nurses get incorrect data, it is your fault. If the nurses aren’t properly trained and you allow this care to continue, your fault. Depending on the state, anything the NP does is your fault. The education of the NP can be your responsibility. Something gets missed and you didn’t regularly evaluate the patient consistent with standard of care, your fault.

At the inpatient level of care in addictions, I met with every patient daily. At PHP/IOP, 1-2x/week. This all in addition to daily discussions with nurses.

No one here knows exactly what you do. It may be fine, but anytime midlevels are involved, liability is higher. They don’t know what they don’t know.

 

[futuredo32]

Thank you , Texas Physician. That's how I saw it as well. But one of the locums psychiatrists who is leaving next month to care for her mom said it is no different than moonlighting at the hospital. Even if I did nothing wrong or contributed to a bad outcome, because I cared for the patient at one point during the stay, I was just as liable as the full time physicians.

When I worked part time at a clinic, the idea of having me be the medical director was vaguely mentioned but I am not comfortable for the care others provide and all the medical director did was 10 chart reviews pulled at random by everyone who worked in the clinic every 6 or 12 months.

What I am doing is literally seeing all therapy and medication management patients once per year and documenting medical conditions, allergies, reconciling medications and possibly changing current medications. Occasionally I will do a new evaluation if someone calls in sick or will see patients in observations, which is run by an NP if the usual psychiatrist can't do it for some reason. I am just a warm body with the right letters after my name. The facility says they do things this way because of the shortage of psychiatrists and perhaps that is true, I am working in a very undesirable location and some patients travel an hour to get here and although I don't love psychiatry, I especially don't like this. If liability weren't an issue, I would have stayed for the money (apparently I have been grossly underpaid) if I couldn't find an addictions position, but with your input which was what I was thinking, I will stay until I find a new position and I am looking. I kept my micro practice (which I want to get rid of because it is so far from where I live in Michigan but practice there because malpractice in that county is far less than any counties near me) as well as my once a month weekend hospital moonlighting job and started a once a month telepsych position that doesn't pay well at all. Thank you again.

 

[TexasPhysician]

The other physician is incorrect. Many physicians don’t understand liability, especially locum physicians that work in multiple states (different laws). When moonlighting, you essentially hand off the patient to the FT psychiatrist when they return. The passenger is boarding another ship with a new captain. Errors by the new captain aren’t your fault. If the mistake happens after the FT psych returns, you are unlikely to be found at fault. You may be initially named in the lawsuit along with many others at the beginning, but you will likely be dropped as the case is sorted. In your case, you aren’t handing off the patient to another physician/captain. You are delegating your role to lesser trained subordinates. Essentially you trained a crew member less qualified to manage a new ship that you are trying to captain from across the sea. The more crew members you train and manage from afar, the more likely 1 will eventually sink. You are the captain of all the ships, and it is your fault when it happens.