fresh into practicing

[icebreakers]

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Could some of the fresh out of residency psychiatrist discuss and talk about how they've been starting their careers.

any concerns/obstacles that come up for psychiatrists? is it hard to get a job? is it hard to build a practice? do you ever feel pressured into practicing in a way that you necessarily dont prefer (ie more medical management than you would like, say if you were more interested in other treatment modalities?)

anyone ever feel bored with psychiatry? as far as scope is concerened?

 

[OldPsychDoc]

Could some of the fresh out of residency psychiatrist discuss and talk about how they've been starting their careers.

any concerns/obstacles that come up for psychiatrists? is it hard to get a job? is it hard to build a practice? do you ever feel pressured into practicing in a way that you necessarily dont prefer (ie more medical management than you would like, say if you were more interested in other treatment modalities?)

anyone ever feel bored with psychiatry? as far as scope is concerened?

I'm about 1.5 years out now. I chose (and always kind of knew I would--I'm not the entrepenurial solo-practice type) a salaried job in a large organization. I thought I'd be doing more outpatient, but when I was hired, there was an interesting looking 1/2 time inpatient job, and much to my surprise, I took it and have enjoyed it very much. My other 1/2 time is split between general adult outpatient and dual diagnosis/substance abuse.

I will say that there are plenty of jobs. You may not necessarily find THE job you want in the place you want right away, but I had NUMEROUS options to explore. Most of my friends have had the same experience. I'd say that all of us had the luxury of asking "what's the best situation for my family?" as opposed to having to take whatever came along.

I've only had one day so far that I was bored with psychiatry--and that was a week that all of my beds were occupied by "long-termers" who were relatively stable and awaiting placements of various sorts. Usually though my turnover is faster. I will say though, that I spend much more time on documentation than I would like--but I think that's true in all disciplines in medicine. As far as "scope" there's always more I could learn, more I could know...so I'm a long way from having exhausted the possibilities yet.

 

[icebreakers]

thanks.

have any of your colleagues tried opening their own practices? especially self-pay practices (where they could practice any treatment modality they want...ie psychotherapy or analysis-the fun stuff-w). have they had any trouble getting patients?

how does one start a practice likie that ? i would assume that you would need to do part time hospital job for some money to come in, but how would you get referrals if you only took patients who could pay? i'm curious b/c a lot of psychiatrist have told me that a lot of the financial freedom associated with psychiatry is due to the fact that you can choose what population that you work with (and i guess this also determines your freedom in deciding which treatment to use).

I'm about 1.5 years out now. I chose (and always kind of knew I would--I'm not the entrepenurial solo-practice type) a salaried job in a large organization. I thought I'd be doing more outpatient, but when I was hired, there was an interesting looking 1/2 time inpatient job, and much to my surprise, I took it and have enjoyed it very much. My other 1/2 time is split between general adult outpatient and dual diagnosis/substance abuse.

I will say that there are plenty of jobs. You may not necessarily find THE job you want in the place you want right away, but I had NUMEROUS options to explore. Most of my friends have had the same experience. I'd say that all of us had the luxury of asking "what's the best situation for my family?" as opposed to having to take whatever came along.

I've only had one day so far that I was bored with psychiatry--and that was a week that all of my beds were occupied by "long-termers" who were relatively stable and awaiting placements of various sorts. Usually though my turnover is faster. I will say though, that I spend much more time on documentation than I would like--but I think that's true in all disciplines in medicine. As far as "scope" there's always more I could learn, more I could know...so I'm a long way from having exhausted the possibilities yet.

 

[Doc Samson]

thanks.

have any of your colleagues tried opening their own practices? especially self-pay practices (where they could practice any treatment modality they want...ie psychotherapy or analysis-the fun stuff-w). have they had any trouble getting patients?

how does one start a practice likie that ? i would assume that you would need to do part time hospital job for some money to come in, but how would you get referrals if you only took patients who could pay? i'm curious b/c a lot of psychiatrist have told me that a lot of the financial freedom associated with psychiatry is due to the fact that you can choose what population that you work with (and i guess this also determines your freedom in deciding which treatment to use).

Still have fellowship ahead of me, but my classmates that are striking out into the real world seem to be following the same template as those who have gone before us. Folks interested in prvate practice start with a 3/4 time slaried job, and dedicate 1/4 time to their private practice (oftentimes taking some pts from training with them). if they're staying in the area, they let attendings know that they're going into practice, what insurance they do/don't take, and what type of pt they're looking for in order to get some referrals. Over the course of ~5 years, the plan to taper down on the time in salaried work, and titrate up the time spent in private practice. Seems to work pretty well here, but bear in mind that (depending on geopraphy) they'll be varying numbers of people looking for meds/therapy.

 

[needinformation]

In private practice, you can essentially do whatever you want. If you do not take insurance, it will take longer to build up a practice since you won't have the automatic insurance referrals, but you get to charge whatever you want. (Whether people will pay or not, that is another issue entirely.) If you do take insurance, you automatically get lots of calls. You can also get referrals from PCPs, but be careful there, because some PCP will routinely give lame referrals, and some will give great referrals. Keep in mind that if you take insurance, you make less $ each hour. Most psychiatrists end up doing quite a bit of med managment initially because it pays more. You can see 3 20-min med checks in one hour, but you can really only see 1 50 min therapy patient in one hour. Insurance gives you a bigger check for seeing 3 med check patients than 1 therapy patient. Then, insurance often limits how many sessions they are willing to pay, and though some people will gladly fork over $200 each hour for therapy, week after week after week, most people can't. amd therefore, after insurance stops paying for therapy hours, therapy often simply ends. Therefore, it isn't so much that insurance won't 'let' psychiatrists do more therapy, but that med management pays more.