Floater Gigs

[clement]

I’m curious to get opinions on floater gigs.
I struggled to find a true ER psych position in SoCal and landed on a jail position that approximates it.
In the meantime, I’m looking. I really want to live in San Bernardino but the only available options are outpatient Kaiser, outpatient county, or other random undesirable outpatient offerings (undesirable for me, at least).

I was curious about Vituity being a possibility—but sounds like they are trying to hire floaters that do a little of this and a little of that. That’s probably because they have people grandfathered in the ER.

As a side, a large part of why I can’t find ER work that isn’t just offering scraps of shifts they can’t cover- is due to older psychiatrists staying in their seat.

For me, floating positions are a heck no. I would dread getting constant f/u CL pages about holds while I’m covering inpatient or the psych ER. How do others feel about this setup? I’m guessing it’s something private groups and Kaiser like to do in order to maximally churn out patients.

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[comp1]

I'm confused. What do you mean by "floating?" I always viewed that term like how nurses use it, you usually work on the psych unit, but for this shift you are "floating" to work on the medical floor instead. Obviously we can't really do that exactly... Are you talking about doing CL while you also do inpatient and ER? That's pretty common (universal?) in the VA. It works well because you have a tour of duty and you just get stuff done as it comes in with the inpatient stuff in between. You just triage. Almost everything can wait for at least a couple of hours, even sometimes until the next day. The volume of all three is usually low enough that you wouldn't really stay busy with just one. I wouldn't want to do it anywhere I was being paid by the patient or didn't have a set tour of duty where I needed to be working. Honestly, I wouldn't want either of those arrangements regardless because I need relatively firm external boundaries on how my work day is structured/compensated or I'd end up doing too much. And yeah, it kinda sucks how most jobs are outpatient. I knew after my first day of 3rd year in the residency outpatient clinic that I'd never be doing that again. It was inpatient that (solely) attracted me to psychiatry right from my clerkship, but I find CL (ED and med floor) tolerable, particularly compared to outpatient.

 

[clement]

I'm confused. What do you mean by "floating?" I always viewed that term like how nurses use it, you usually work on the psych unit, but for this shift you are "floating" to work on the medical floor instead. Obviously we can't really do that exactly... Are you talking about doing CL while you also do inpatient and ER? That's pretty common (universal?) in the VA. It works well because you have a tour of duty and you just get stuff done as it comes in with the inpatient stuff in between. You just triage. Almost everything can wait for at least a couple of hours, even sometimes until the next day. The volume of all three is usually low enough that you wouldn't really stay busy with just one. I wouldn't want to do it anywhere I was being paid by the patient or didn't have a set tour of duty where I needed to be working. Honestly, I wouldn't want either of those arrangements regardless because I need relatively firm external boundaries on how my work day is structured/compensated or I'd end up doing too much. And yeah, it kinda sucks how most jobs are outpatient. I knew after my first day of 3rd year in the residency outpatient clinic that I'd never be doing that again. It was inpatient that (solely) attracted me to psychiatry right from my clerkship, but I find CL (ED and med floor) tolerable, particularly compared to outpatient.

It might be regional terminology but floater positions are where they hire you as someone who covers, (for example), CL a few days a week, then some inpatient, outpatient or ER days. It tends to be crafted in a way that less desirable roles in the hospital (like the CL person getting 20 consults a day), less desirable shifts (think overnight weekend ER), or vacations among other psychiatrists, are then covered by the new person.

In layman’s terms, it’s known as “dumping on the new guy/girl.” This is often while marketing the position as some kind of “flex” role. A lot of groups make it appear like, “everyone pitches in” with such setups…but you know it’s only you pitching in while others have well-defined and grandfathered-in roles.

 

[Celexa]

It might be regional terminology but floater positions are where they hire you as someone who covers, (for example), CL a few days a week, then some inpatient, outpatient or ER days. It tends to be crafted in a way that less desirable roles in the hospital (like the CL person getting 20 consults a day), less desirable shifts (think overnight weekend ER), or vacations among other psychiatrists, are then covered by the new person.

In layman’s terms, it’s known as “dumping on the new guy/girl.” This is often while marketing the position as some kind of “flex” role. A lot of groups make it appear like, “everyone pitches in” with such setups…but you know it’s only you pitching in while others have well-defined and grandfathered-in roles.

Ew. Basically like being a resident again, constantly ripped away from something just as you get comfortable and thrown into a new role. No thank you.

 

[comp1]

Ew. Basically like being a resident again, constantly ripped away from something just as you get comfortable and thrown into a new role. No thank you.

Concur, ew. I would only take that if it was the only inpatient job I could get at all. It IS still better than outpatient, but getting close to worse and that is saying a heck of a lot. You want something stable where you can really become an expert. That's the point of attendinghood. I've never seen a job like this.

 

[clement]

Concur, ew. I would only take that if it was the only inpatient job I could get at all. It IS still better than outpatient, but getting close to worse and that is saying a heck of a lot. You want something stable where you can really become an expert. That's the point of attendinghood. I've never seen a job like this.

Maybe if so many jobs weren’t outpatient, there’d be less of a psychiatrist shortage. Anyway, this floater model does target naive newer grads. The place I’m looking at is probably doing it due to being over staffed. Or rather too many quasi retirees there want to cover 12-hour ER shifts and not do anything else. Guess ER is the perfect gig if your kids are all grown up. But if you’re too old to chase a toddler, ER gigs cant be a cakewalk either. Just sitting in a chair for that long beats you down. I’m seeing a lot of people come out of retirement and do locums jail or county ER work.
Tops walking into your outpatient office every morning with a bunch of borderline voicemails (at least those of us who still have public service to fulfill). And actually I don’t mind the VM’s, it’s the SW’s enabling them that I can’t with.

 

[clausewitz2]

Tops walking into your outpatient office every morning with a bunch of borderline voicemails (at least those of us who still have public service to fulfill). And actually I don’t mind the VM’s, it’s the SW’s enabling them that I can’t with.

The problem here is your agency and its institutional culture, not the fact that the job is outpatient.

 

[clement]

The problem here is your agency and its institutional culture, not the fact that the job is outpatient.

Correct. That’s 98.2% of county “mental health” settings around here. Not a medical model of care. It’s psychiatry getting puppeteered by SW.

 

[sloh]

Correct. That’s 98.2% of county “mental health” settings around here. Not a medical model of care. It’s psychiatry getting puppeteered by SW.

What about taking an outpatient job with Kaiser?

 

[comp1]

What Clement described was the outpatient culture pretty much everywhere I rotated. Even at Kaiser, the MDs didn't have to answer voicemails, but my goodness did they get a lot of direct messages and that was WITH non-MDs screening. The panels were just so large it didn't matter.

 

[ObsequiousAplomb]

What Clement described was the outpatient culture pretty much everywhere I rotated. Even at Kaiser, the MDs didn't have to answer voicemails, but my goodness did they get a lot of direct messages and that was WITH non-MDs screening. The panels were just so large it didn't matter.

I heard that a full day at Kaiser is 6 hours clinical with 2 hours admin time, presumably for inbox management. At least, that's what the recruiter said.

 

[comp1]

I saw the MD mostly doing inbox management in between ECT sessions. It was definitely a very full work day.

 

[clement]

What about taking an outpatient job with Kaiser?

I thought about Kaiser recently. Never thought I would. Swore them off years ago (not just because they didn’t qualify for PSLF until 2023)…Their general outpatient mill model sounded like hell. You might know they hire admin who are exclusively dedicated to filling no show spots in real time.

I know only a few people that have managed to craft transplant and er roles with them. Those spots are rare and often require a component of general outpatient time.
The closest I ever got to niche outpatient with them was a gero offering. I saw many a former Kaiser borderline in the county setting- including one with actual SJS who wanted to sue me if I didn’t re trial Lamictal ASAP.

 

[clausewitz2]

What Clement described was the outpatient culture pretty much everywhere I rotated. Even at Kaiser, the MDs didn't have to answer voicemails, but my goodness did they get a lot of direct messages and that was WITH non-MDs screening. The panels were just so large it didn't matter.

I don't have anyone screening my direct messages. Over the long weekend I didn't look at a darn thing and came in this morning to literally two messages. One of them was thanking me for having done something else. Another was just confirming an appointment reschedule.

Outpatient =!= huge panel

Like how many people say "if you've seen one VA, you've seen one VA," there is a vast variety of outpatient setups and experiences. I'm sorry your rotations were relatively homogenous in this negative way.

 

[Celexa]

including one with actual SJS who wanted to sue me if I didn’t re trial Lamictal ASAP.

Wanting to restart Lamictal after having a rash truly concerning for SJS certainly counts as one of the more unique and poorly thought out self harming methods I've heard of.

The SJS and equivalent reactions where your skin melts off are some of the CL cases that haunt my nightmares. Especially when the team consulted for 'depression' and you walk into a room where the patient is screaming in pain because they don't have skin anymore.

 

[psych_0]

What is this "floater" job offering pay-wise? Salary only? Per shift flat fee? wRVU bonus incentive?