For profit psych hospitals

[Medic741]

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Seriously wondering — there are jobs out there where you don’t have to do this kind of shady care right?

 

[Sushirolls]

Seriously wondering — there are jobs out there where you don’t have to do this kind of shady care right?

Yes. You are a professional so maintain your standards.
Standards can still be maintained individually even when those around you are dipping their toes in, or perhaps clearly swimming in the backwaters.
There are jobs out there where standards just don't blend well, and will be a quick transition out.

The fall back and default is still to just open your own practice. You then become the QA person.

Don't forget though, that although the for profit psych hospitals are getting criticized here, not-for profit hospitals, community mental centers, VAs, etc all can be bad, too. No one service/clinic structure is 'pure' or perfect. Happy hunting.

 

[alina_s]

I'm skeptical of for-profit hospitals but a broad judgment about for-profit and non-profit doesn't work. I've seen non-profit CMHC's that were well run and ones that were terribly run. Where I live now, there are 4 general hospitals within 50 miles, plus the state psych hospital and a free-standing psych hospital. One general hospital is IHS and not an option for most people, plus it has no psych unit. The state has handed over management of its psych hospital to a for-profit company and they are having trouble staffing, have far fewer beds, and shut down their child and adolescent unit. Two general hospitals have no psych services at all. That leaves one general hospital that has a psych unit, plus the free-standing for-profit psych hospital. The psych unit is run by a multi-state non-profit hospital chain and while they are non-profit, they are by no means a safety net hospital and the admission criteria for the psych unit are so strict that I rarely send anyone there and rarer still get anyone admitted. That leaves the free-standing for-profit hospital. Do they have better trained staff and better staff ratios at the non-profit unit? Probably, but it isn't useful to me or my patients most of the time. So I'm glad we have the for-profit hospital. I've worked there in a limited capacity and while the budget was tight, I liked the staff and didn't feel any pressure about length of stay.

 

[Sushirolls]

Something else not brought up about the for profit hospitals is how they have draft their Hospital Medical Staff Bylaws.

One place I had worked at, leaves all the final power with the CEO. Medical Director wants to cap a unit, or reduce a unit census for patient safety for XYZ reason or for XYZ duration, can't. CEO gets to make that decision.

So I encourage those who do work at these hospitals, read the bylaws, yes, the whole darn thing. You'll see some things in that that reflect clinical power, no CEO should have, but that's the way they want it.

 

[mojetter]

Former unnamed for-profit hospital psych doc (all of a total of 4months) via locums...heres how it works in most places:

-Set up shop in a region with little competition (ie workers cant freely quit because no other facility to work)

-Hire under-qualified admin and let them run a culture of fear with the RN's, Techs, Medical records, and utilization review

-Demonize and publicly criticize the doctors and have the staff know the doctor is not "the boss"

-Train the staff to second guess, backstab, and badmouth anyone who isnt in the right clique

-hire drug reps as hospital CEO's, social workers as UR coordinators, CNA's as directors of nursing (yes you read that correctly), basically anyone underqualified who wont challenge the authority of the CEO because of "clinical concerns"

-refer to patients by their insurance status as "funded" or "unfunded" (Mr Jones is an unfunded 35yo male with depression, EtOH abuse and.....)

-have 2-3 people from UR in your patient rounds asking you when Mr. Unfunded is going home and if we can keep Ms. Funded 3 more days because her insurance company authorized those many days


At first you resist but the hostility from patients (and the staff) gets to you and if you need the $$$ like the rest of the staff needs their jobs, you as a doctor have drank the kool-aid...they say "youre the doctor you decide" but then tell you how the CEO is upset with you because you discharged Ms. Funded 3 days before her auth ran out.


They call it leaving money on the table


#NeverAgain

 

[Mass Effect]

Former unnamed for-profit hospital psych doc (all of a total of 4months) via locums...heres how it works in most places:

-Set up shop in a region with little competition (ie workers cant freely quit because no other facility to work)

-Hire under-qualified admin and let them run a culture of fear with the RN's, Techs, Medical records, and utilization review

-Demonize and publicly criticize the doctors and have the staff know the doctor is not "the boss"

-Train the staff to second guess, backstab, and badmouth anyone who isnt in the right clique

-hire drug reps as hospital CEO's, social workers as UR coordinators, CNA's as directors of nursing (yes you read that correctly), basically anyone underqualified who wont challenge the authority of the CEO because of "clinical concerns"

-refer to patients by their insurance status as "funded" or "unfunded" (Mr Jones is an unfunded 35yo male with depression, EtOH abuse and.....)

-have 2-3 people from UR in your patient rounds asking you when Mr. Unfunded is going home and if we can keep Ms. Funded 3 more days because her insurance company authorized those many days


At first you resist but the hostility from patients (and the staff) gets to you and if you need the $$$ like the rest of the staff needs their jobs, you as a doctor have drank the kool-aid...they say "youre the doctor you decide" but then tell you how the CEO is upset with you because you discharged Ms. Funded 3 days before her auth ran out.


They call it leaving money on the table


#NeverAgain

Tell it like it is. Been there, done that, have the scars to prove it. These places need to be completely reformed.

 

[yanks26dmb]

Why do doctors work here? Is the money just that much better?

 

[MBBSMOM]

Why do doctors work here? Is the money just that much better?

The money is better but at these hospital you’re an RVU factory. Also some people have visa obligations so they take these jobs.

 

[mojetter]

Why do doctors work here? Is the money just that much better?

I think its better but in the end you lose, I showed up one saturday and they expected me to see like 24 patients...I would just stare at the wall in disbelief sometimes wondering when it would get better

On the flip side the acuity was very low, tons of bread and butter mood issues with substance abuse co-occurring

 

[Mass Effect]

Why do doctors work here? Is the money just that much better?

Yes. Also, they allow their docs to work as many hours as they need to check the boxes on the paper chart and head out to their private practice.

 

[Mass Effect]

I think its better but in the end you lose, I showed up one saturday and they expected me to see like 24 patients...I would just stare at the wall in disbelief sometimes wondering when it would get better

On the flip side the acuity was very low, tons of bread and butter mood issues with substance abuse co-occurring

Or substance-induced mood disorder from med-seeking patients. That was my experience. They have to fill the beds after all. These places are not doing a humanitarian service by providing mental health beds for those who are ill. They're providing mental health beds for anyone who has insurance and if they get some ill people, great, but the charade of this being for the greater good of helping the mentally ill has to end.

 

[mojetter]

Or substance-induced mood disorder from med-seeking patients. That was my experience. They have to fill the beds after all. These places are not doing a humanitarian service by providing mental health beds for those who are ill. They're providing mental health beds for anyone who has insurance and if they get some ill people, great, but the charade of this being for the greater good of helping the mentally ill has to end.

I absolutely positively 100% agree with you, bogus admissions and very few (less than 10%) if any manic, psychotic, or even intellectual disability/neurocog issues. ...they only care about their bottom-line.



Packed with substance induced mood issues, withdrawal, "bipolar" aka borderline or bad attitude anger mgmt, and "my mom kicked me out."

You really have to not care about the practice of what you do or your career to work there

 

[downwithDTB]

I

Packed with substance induced mood issues, withdrawal, "bipolar" aka borderline or bad attitude anger mgmt, and "my mom kicked me out."

You really have to not care about the practice of what you do or your career to work there

I complain about having to justify the one patient in 15 with SI that I admit to insurance for 40 minutes in order to get a 2 night authorization, but clearly there is a reason why insurance companies are skeptical when these revolving door places exist.