High-paying psychiatry residency program?

[vistaril]

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You know, I was chasing this white rabbit the other day, and he went in this hole, and... 😉

Folks in non-psychiatric fields moonlight a LOT less than we do (for lots of good reasons), QUOTE]

in most fields this is true just due to the nature of the field(ie if there isn't inpatient coverage neccessary such as procedure based outpt fields there is no avenue for reimbursement).....but there are many IM residents who do some *serious* moonlighting. They can do that because lots of IM coverage jobs involve overnight coverage during the week where one can get some sleep.

 

[bradycakes]

sounds like the PD lives a productive and meaningful life with that kind of poitnless, blind retaliation. I just don't see the end gain for them.

 

[bradycakes]

You know, I was chasing this white rabbit the other day, and he went in this hole, and... 😉

Folks in non-psychiatric fields moonlight a LOT less than we do (for lots of good reasons), and even the very good program at my medical school allowed very little moonlighting (at least, there wasn't much available that didn't involve a long drive, and even then, not much). There have been people at my program who have seriously pushed the limits of what they should be able to do and almost ruined it for the rest of us by being idiots. So when I say it's a privilege, I'm talking to the people who were moonlighting 50-60 hours a week despite being given multiple warnings and violating duty hours left and right.

You're out of your depth.

Its a right, not a "privilege" or whatever that means because a program or PD can't take away from a person, who has passed step 3 and received an unrestricted medical license in their state, what wasn't theres to give in the first place. They have no ownership of that "privilege" to give and not give to whom they like.

A PD can choose not to recommend a pgy2-4 if the moonlighting employer asks for it and the home institution doesn't cover malpractice, which is already stipulated for programs that allow moonlighting. But that can be purchased by the outside employer or individual.

For any physician or even dentist, once they are granted a medical license any and all contracts with an employer that have "no competition clauses" or "no outside employment" is just words. Lots of cases were tried but they are now recognized as unprosecutable let alone winnable in a court because your medical license is not anyones else's to control. Thats why its called unrestricted. And we are talking about working poor residents in a life time of debt (fraudulent as well) so theirs not even money to go after for a breach of contract, although it would not be held up in court anyway.

A PD also "could" make that residents last couple of years crap if they wanted, but thats retaliation and harassment which puts them and their institution as liable parties in court. Huge sums of money come out of workplace behavior like that, which is unprofessional in any and all settings of employment, in court or settlements.

And if a one year contract isn't renewed than it needs to be justified that this resident did not fulfill their duties, not because of some made up PD power trip. As long as they stick to 80 and take care of onces expected of others in their class its hard to prove.

But in the end, does a PD want to lose a good resident or at least a competent one? thats more work for them and everyone else as well as bad reputation for the program. As well as lost revenue because every and all residents earn their wages and then some by the end of residency through increased hospital production.

Everyone should realize that ACGME money really never ends up funding their wages or education, its just bookkeeping and a way for the fed to flex over states cause it comes from their end of taxes. Do the math for yourself and figure what it would cost to replace you with a mixture of attendings and midlevels to cover your clinical production, teaching juniors, and knowledge base averaged over your PGY years plus med school.

So no one really needs anyone else sticking another thorn in the side of well meaning residents with threats or imaginative gifts of "privileges" that have no legal basis. Its more like fraud and harassment which doesnt increase productivity or learning

And I'm not arguing for those few bad apples who work 60 hours moonlighting that you are referring to and violating the 80 hr rule or who are grossly incompetent cause they only put 20 hours of clinical education outside moonlighting snooze gig. Dont generalize people like that.

 

[OldPsychDoc]

bradycakes--You do not know what you don't know. (Hmm--guess that's another way of saying "you're out of your depth"...)

Speaking as a PD, I'm happy to have my senior residents moonlighting a reasonable amount--it can be a learning experience (it was for me) as well as taking some pressure off of the family budget.

BUT--if you exceed 80 hours, or insist too strenuously on making your own rules, that's a real problem--and not just because I have some narcissistic need to control my residents' lives, as appealing as that prospect is to me. 🙄 (Really. No.)

I'm not the ultimate boss here. I report to department chairs, DIOs (designated institutional officials), hospital GME committees, the ACGME (which accredits our program to allow it to continue training you), the ABPN (which requires that I certify that you are indeed worthy to sit for Boards), your state licensing agency, etc. They all have a vested interest in the outcome of your training, and I'm the guy who is supposed to certify that fact.

The end result of all this is that if you are more interested in moonlighting than in completing your program's requirements, your program will receive citations from the ACGME (an accrediting, not financing agency--you confuse that in your post). This ultimately can affect program accreditation and the institution's eligibility for Medicare GME funding--which is paying for ~90% of resident education in this country. (If you think this is a fiction, google 'GME funding', 'Medicare', and 'sequester' and see what's already at stake!) In addition, it will affect my ability to write that letter to the ABPN to allow you to sit for your Boards, the one to your state Board of Medicine to support your licensing, etc., all of which may affect your ability to one day get a job and be reimbursed for your services.

So please believe me, rules are there to be followed, and it's part of my job to make sure you do, for the sake of your future patients, yourselves, your program, and your institutions. At some point along the way from medical school to residency you need to leave adolescent attitudes to authority behind and join the grown up world of policies and procedures. Sorry to be a buzzkill.

 

[bradycakes]

bradycakes--You do not know what you don't know. (Hmm--guess that's another way of saying "you're out of your depth"...)

Speaking as a PD, I'm happy to have my senior residents moonlighting a reasonable amount--it can be a learning experience (it was for me) as well as taking some pressure off of the family budget.

BUT--if you exceed 80 hours, or insist too strenuously on making your own rules, that's a real problem--and not just because I have some narcissistic need to control my residents' lives, as appealing as that prospect is to me. 🙄 (Really. No.)

I'm not the ultimate boss here. I report to department chairs, DIOs (designated institutional officials), hospital GME committees, the ACGME (which accredits our program to allow it to continue training you), the ABPN (which requires that I certify that you are indeed worthy to sit for Boards), your state licensing agency, etc. They all have a vested interest in the outcome of your training, and I'm the guy who is supposed to certify that fact.

The end result of all this is that if you are more interested in moonlighting than in completing your program's requirements, your program will receive citations from the ACGME (an accrediting, not financing agency--you confuse that in your post). This ultimately can affect program accreditation and the institution's eligibility for Medicare GME funding--which is paying for ~90% of resident education in this country. (If you think this is a fiction, google 'GME funding', 'Medicare', and 'sequester' and see what's already at stake!) In addition, it will affect my ability to write that letter to the ABPN to allow you to sit for your Boards, the one to your state Board of Medicine to support your licensing, etc., all of which may affect your ability to one day get a job and be reimbursed for your services.

So please believe me, rules are there to be followed, and it's part of my job to make sure you do, for the sake of your future patients, yourselves, your program, and your institutions. At some point along the way from medical school to residency you need to leave adolescent attitudes to authority behind and join the grown up world of policies and procedures. Sorry to be a buzzkill.

No I don't think I am

Moonlighting is clearly a benefit to someone else or the job wouldnt exist. The hospital has certain staffing requirements and can't get an attending to fill the shift or its lightens the load for an attending who is exempt from OT. These jobs don't exist as gifts to residents so lets not make it seem like one.

I made it pretty clear at the end I was not arguing for above 80 hours nor that I am more considered about moonlighting. Just the legality of the situation, which you cherry picked around. My stance was after step 3 and state licensing. But I'm not sure what reasons you withhold a persons letter to be recommended for the specialty board. Maybe you can explain more definitively, rather than you perceive them to be too concerned with so at the end of 4 years you dont let them sit

You seem to see the situation very black and white. A person can only be totally concerned with moonlighting and neglect his education, become an incompetent physician and jeopardize lives.

Enough with the straw man arguments, I wasnt even trying to get into this but try to explain the legal rights rather than a PDs perceived rights. I understand the power structure as well and reporting, but thats not any kind of explanation.

And yea I know how the GME works, they also got this thing called social security that was a fund people put their retirement savings into and it was supposed to be there when they reached that age. Just cause it adds up at the end of the financial statements doesn't mean the money went to where it was supposed to.

Rules are made to be followed, thanks

 

[Dharma]

Best be showing OPD some proper respect! Disagree with class.

 

[digitlnoize]

Best be showing OPD some proper respect! Disagree with class.

OPD is right here, sorry. Also, I wish I'd applied to his residency program. I bet it rocks.

 

[OldPsychDoc]

...
You seem to see the situation very black and white. A person can only be totally concerned with moonlighting and neglect his education, become an incompetent physician and jeopardize lives.
...

You didn't read my 2nd paragraph if you believe that.

Speaking as a PD, I'm happy to have my senior residents moonlighting a reasonable amount--it can be a learning experience (it was for me) as well as taking some pressure off of the family budget.

 

[Dharma]

OPD is right here, sorry. Also, I wish I'd applied to his residency program. I bet it rocks.

Oh, I don't disagree at all either. That said, I don't know jack about moonlighting besides it being an 80s TV show with a hot Cybill, a minute before McClane was yippie-ki-yaying mofos with funny accents!

But I do know that OPD is SDN OG! Respect!

 

[shan564]

OPD ftw!

 

[michaelrack]

And yea I know how the GME works, they also got this thing called social security that was a fund people put their retirement savings into and it was supposed to be there when they reached that age. Just cause it adds up at the end of the financial statements doesn't mean the money went to where it was supposed to.

Rules are made to be followed, thanks

Legally the payment of social security taxes and the payment of social security benefits are separate matters. IN other words, the fact that you are paying social security taxes does not entitle you to collect benefits- Congress can change the rules at any time regarding social securit benefits.

Rules regarding moonlighting are generally set forth in the residency contract- and they are made to be followed. If a resident doesn't like the rules, he is free to leave residency.
Residents are basically serfs- but better treated serfs than when I was a resident.

 

[michaelrack]

For any physician or even dentist, once they are granted a medical license any and all contracts with an employer that have "no competition clauses" or "no outside employment" is just words. Lots of cases were tried but they are now recognized as unprosecutable let alone winnable in a court because your medical license is not anyones else's to control. QUOTE]

That's not what my attorney, a specialist in healthcare law, told me in 2010 when she was reviewing some contracts for me. Many jurisdictions will limit the scope (especially geographic limitations) of non-competes, but they are generally allowed:http://www.gklaw.com/news.cfm?action=pub_detail&publication_id=842

And even if a resident wins an employment law case, that doesn't give them academic credit or a letter to the ABPN. I guess that a resident who is fired for moonlighting could try to sue the residency program, but the most they would get is a year or so of salary (and even this is unlikely)... a court can't order credit for rotations.

 

[michaelrack]

That's because you're supposed to go to your interviews acting like you are eager to work for absolutely free, you are so enthusiastic about learning the essentials of psychiatry and providing care to patients that the thought of compensation hasn't even crossed your mind and to be honest you'd feel more comfortable just not discussing that part of it, and maybe not even being compensated seeing as that could corrupt the purity of your learning experience.

There are definitely programs that will accommodate this wish.

A similar groveling attitude is required to get a lot of jobs today. Most Americans don't have a real choice in the matter. Individual doctors, however, can get to the point in their careers where they are either solo, the boss, or a combination of both- it does require some sacrifice to get to that point, however.

 

[vistaril]

No I don't think I am

Moonlighting is clearly a benefit to someone else or the job wouldnt exist. The hospital has certain staffing requirements and can't get an attending to fill the shift or its lightens the load for an attending who is exempt from OT. These jobs don't exist as gifts to residents so lets not make it seem like one.

I made it pretty clear at the end I was not arguing for above 80 hours nor that I am more considered about moonlighting. Just the legality of the situation, which you cherry picked around. My stance was after step 3 and state licensing. But I'm not sure what reasons you withhold a persons letter to be recommended for the specialty board. Maybe you can explain more definitively, rather than you perceive them to be too concerned with so at the end of 4 years you dont let them sit

You seem to see the situation very black and white. A person can only be totally concerned with moonlighting and neglect his education, become an incompetent physician and jeopardize lives.

Enough with the straw man arguments, I wasnt even trying to get into this but try to explain the legal rights rather than a PDs perceived rights. I understand the power structure as well and reporting, but thats not any kind of explanation.

And yea I know how the GME works, they also got this thing called social security that was a fund people put their retirement savings into and it was supposed to be there when they reached that age. Just cause it adds up at the end of the financial statements doesn't mean the money went to where it was supposed to.

Rules are made to be followed, thanks

I suspect you two are more in agreement than you think.

I can't speak for other programs that have may have stricter requirements(although I do know a ton of other pgy3 and 4 residents who moonlight as much as me freely), but I think what you are wanting is a 'if I am competent and making progress in the program and am not breaking any work hour rules or laws I don't want to be limited by my program"....I agree with that, and I really don't think OPD said anything to suggest he would limit you.

the reality is that it would be really hard for a pgy3/4 resident who wants to moonlight a lot to go over the hours requirements. Assuming 40 hrs a week for the program(a guy who wants to moonlight a lot probably isnt going to be getting there at 630 and leaving at 6 ha), that leaves 40hrs a week to moonlight....and keep in mind you can go over 80 some weeks and still slide under the work hour rules because it's an average.

Another reality is that I know lots of people(mostly family medicine and im people) who do moonlight to such an extent that they go well over 80 hrs. Their programs know they work there, but they just underreport the hours significantly. And when you think about it, there really isn't any way for the program to find out exactly how many they work. But in psych there arent as many nightly moonlighting gigs where one could get way over 40 extra hours on average per week......

basically bradycakes, if you do psych I wouldn't go into residency with this oppositional attitude, because I don't think there will be a need. As long as you arent horribly incompetent and pass your rotations, your program is going to let you moonlight a ton and make a bunch of money if you want to...as long as you stay within the 80. It's all good🙂

 

[toothless rufus]

Anyone know of programs that do not allow moonlighting, or restrict it in some way so its not really a possibility (say for instance that you are required to have three eyeballs or that there are no moonlighting opportunities at your home program and you are only allowed to moonlight at that program?)I wonder if they exist...that would be an unfortunate situation.

 

[bradycakes]

I suspect you two are more in agreement than you think.

I can't speak for other programs that have may have stricter requirements(although I do know a ton of other pgy3 and 4 residents who moonlight as much as me freely), but I think what you are wanting is a 'if I am competent and making progress in the program and am not breaking any work hour rules or laws I don't want to be limited by my program"....I agree with that, and I really don't think OPD said anything to suggest he would limit you.

the reality is that it would be really hard for a pgy3/4 resident who wants to moonlight a lot to go over the hours requirements. Assuming 40 hrs a week for the program(a guy who wants to moonlight a lot probably isnt going to be getting there at 630 and leaving at 6 ha), that leaves 40hrs a week to moonlight....and keep in mind you can go over 80 some weeks and still slide under the work hour rules because it's an average.

Another reality is that I know lots of people(mostly family medicine and im people) who do moonlight to such an extent that they go well over 80 hrs. Their programs know they work there, but they just underreport the hours significantly. And when you think about it, there really isn't any way for the program to find out exactly how many they work. But in psych there arent as many nightly moonlighting gigs where one could get way over 40 extra hours on average per week......

basically bradycakes, if you do psych I wouldn't go into residency with this oppositional attitude, because I don't think there will be a need. As long as you arent horribly incompetent and pass your rotations, your program is going to let you moonlight a ton and make a bunch of money if you want to...as long as you stay within the 80. It's all good🙂

Agreed

But someone should make a thread or sticky with a list of programs that restrict outside that scope of doing well, within 80 hours, not a pill mill, and restrict moonlighting to only the home institution. As well as malignant programs, as a PD that expects some extra kissing up or extra work at homw for the "privelege" is something people shouldnt have to stomach

 

[notdeadyet]

But someone should make a thread or sticky with a list of programs that restrict outside that scope of doing well, within 80 hours, not a pill mill, and restrict moonlighting to only the home institution. As well as malignant programs, as a PD that expects some extra kissing up or extra work at homw for the "privelege" is something people shouldnt have to stomach

I respectfully disagree with some of the other posters who mention how it's necessary to "grovel" and "kiss ass" when applying for residency or jobs.

You need to show respect during this process, but anyone who takes a knee and kisses the ring did so on their own initiative. It isn't necessary to grovel during the process, but it is necessary to show respect and humility, because programs want respectful and humble people. It's better patient care. Anyone who find that they had to beg or go through the process with puckered lips misread things.

The thread you're looking for, babycakes, would be so small as to be inconsequential. Do your homework when you interview. I asked about moonlighting everywhere I went and didn't get any resistance or ruffle any feathers.