How much per bed?

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vistaril

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So I'm looking to fit some inpatient work into what I'm doing now to make more cash and have more money to invest in outside interests. I'm talking to a hospital system that has three different sites in an area, but I would only be at 2(and they are about 5 mins apart so not a huge inconvenience). They want me to do 6 beds at one and 9 at another. These are your typical inpatient psych units. Average stay is 7-8 days, median stay a bit less I think. I wouldn't be billing, but instead I would be on contract for 15 beds doing contract work(no benefits, no w2).

The details are:
- I can round absolutely whenever I want, just as long as I see and write a note on each patient daily. If I want to come in before my regular job, I can do that. If I want to swing by and lunch and knock me out, I can do that. If I want to come by in the evening, I can do that. I just need to see them and write a note everyday at some point.
-of these 15 beds they say expect to average about 2 admissions daily, but again obviously you don't need to see the patient that day. If the patient is admitted Monday at 5pm, you have until Tuesday evening to see the patient.
-no weekends ever(it's purely m-f rounding) and no evening call at all. If my patient tries to elope or whatever at 10pm, someone else is called. And of course I won't be admitting my patients assigned to me over the phone either.
-no medical issues at all to deal with(every patient gets a medicine consult automatically on the bmu and a medicine np handles all that stuff daily)
-good sw support so I will supposedly never be bothered while at work on other jobs to discuss things
-no vacation or sick days. You don't round, you don't get paid.
-they will provide medmal for this. With tail. No other stuff paid for.

So given this setup, how much should I ask per week? I'm thinking 2700-3000? I think the way the units are set up I can do the 6 patients in the morning on the way to work and then the 9 on the way home....maybe 3 extra hours per day, which would be 15 hrs per week more.
 
The title of this thread held so much promise.....

Nevermind.... getting people out of bed at an hour to suit is a potential problem here..... not many people want to be seen circa 5. am..... otherwise it looks fool proof....
 
Ibid said:
The title of this thread held so much promise.....

Nevermind.... getting people out of bed at an hour to suit is a potential problem here..... not many people want to be seen circa 5. am..... otherwise it looks fool proof....
Click to expand...

Oh it wouldn't be 5....I'd probably round from 645-8 at the first place(writing notes as I go). Leave by 8 and be at work by 815
 
If you want to bill by the week, I'd say $3000 would be about the going rate assuming you actually get the numbers you listed.

I prefer to bill by the patient or bill at a worst case scenario basis.

If you bill per week, the facility will want to fill your quota daily. If you have a failed discharge and 3 open beds, it wouldn't be unusual to me to get 4 new admits and carry 16 patients that day. What if the facility wants to discharge and you refuse, will they still pay you? A 7 day average stay with no primary on weekends means likely 3 new admits per weekday. Can you realistically plan a discharge on weekends safely without eyes on patient? I wouldn't, especially since staff is usually lower on weekends as well. If the weekend admit person does a crap job, you may end up doing long follow-ups on weekend admits on Mondays.

Who covers you on weekday holidays? You can't just abandon your patients without potential legal issues. Is there planned coverage?

You obviously know the facility better than I. If you are certain of how great the job is, $3000 is fair. Based on the numbers and what I would expect, I'd push for $4000 or billing by the patient.
 
Thanks tp good post and good things to think about....through some channels I know now that they are using locums(Barton associates) to cover these beds(the same ones I am covering now) under the same conditions there all in cost to them is about 3200(not what the barton guy is getting but what they are paying to barton), so I think if I got 3k that's aiming high. I do think they are switching from locums to a contract guy because they want a little more stability, so they may pay almost as much. If I got 3k Id be getting a bunch more than the locums guy now, and 95% of what their total all in cost to locums is now(almost unheard of I think). I think it takes him about 4 hrs per day to do this, but Im faster than him and honestly since he is being paid by the hour it doesnt surprise me if he is milking it a bit.

I think I can put it in the contract to make the 15 beds firm. I dont anticipate any cases where the facility wants to discharge a patient but I don't want to(I usually am pretty adamant about getting these patients out anyways). But if that came up, perhaps i should put it in the contract that the patient is then moved to another psych and counts towards their numbers(so they could move one more to me). I certainly dont ever anticipate less than 15....but hey if it happens thats fine too. Either way I need to get paid based on 15.

Who covers weekdays holidays would be me if I want to be paid for it. The only weekday holidays that I would really care about is thanksgiving and christmas, and those are now 11 months away. This contract may not even last that long so I'm not worried about it yet.

As for weekends, this is a facility that admits a steady number of patients friday evening through overnight sunday. Ill see them monday and have no intention of reinventing the wheel(even if the weekend person half assed it) because most of the time consuming info is obtained by others anyway.

But yeah, me doing 3-4 new admits per day is going to happen sometimes. I think based on all the other stuff in place though(NO medical mgt of any kind at all being a big one) that will help the efficiency and still let me get it done.
 
Put in the contract for a daily rate rather than weekly, so you can put these terms in the contract. Maybe u get 3-4 a day and do them cause you are a team player, but if its based on a weeks rate and production might be on u. "2 admits a day on average" and you get hit with 14 admissions a week over 5 days.

Or ask to renegotiate the contract in 6 months
 
Fifteen inpatients sounds like a full-time job to me, but I'm just a resident and I suppose things may be a lot different outside of the academic world. This setup seems possible but also there seem to be lots of room for derailment such as:
-needing physician order and review of physical and chemical restraints
-patients demanding to leave (I assume staff would contact you during the business day?)
-needing to gather additional collateral
-occasional family meetings
-court commitment hearings
-as mentioned above, multiple discharge and admit days
-complicated coordination of care (though this would be helped by full-time medicine assist)

Feel free to ignore this post since it's a divergence from the topic, but is it usual for psychiatrists to work this kind of volume (15 inpatients + another full time job)? It seems like this combo should pull in somewhere in the 300k/yr range (assuming 3k/week from inpatient plus another full time salary), but I wonder if it can be done safely and whether it would turn into 80+ hour workweeks all the time.
 
Bartelby said:
Fifteen inpatients sounds like a full-time job to me, but I'm just a resident and I suppose things may be a lot different outside of the academic world. This setup seems possible but also there seem to be lots of room for derailment such as:
-needing physician order and review of physical and chemical restraints
-patients demanding to leave (I assume staff would contact you during the business day?)
-needing to gather additional collateral
-occasional family meetings
-court commitment hearings
-as mentioned above, multiple discharge and admit days
-complicated coordination of care (though this would be helped by full-time medicine assist)

Feel free to ignore this post since it's a divergence from the topic, but is it usual for psychiatrists to work this kind of volume (15 inpatients + another full time job)? It seems like this combo should pull in somewhere in the 300k/yr range (assuming 3k/week from inpatient plus another full time salary), but I wonder if it can be done safely and whether it would turn into 80+ hour workweeks all the time.
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The answers are too dependent on the facility and patient base. Assuming quality support, private insured patients, minimal geriatrics, no one under 18, etc. then most of your list would rarely occur. This would still take me about 4 hours/day as a fair estimate that includes 2-4 new admits. I'm not the fastest person I know but not close to the slowest either.

I have a colleague doing this same job but add q3 weekday (home call for problems/admits) + q3 weekends (rounding on everyone + accepting admits). He is paid as an employee at 220k + benefits and considered full time. He enjoys it, but it's not for me.
 
Yea it really is alot and no residents either? Just one shrink to drop 15 notes in 2 locations and 2 admit h/ps and orders

150k year as 1099 is like 100k as salaried employee with benefits. You're why physician salaries on an hourly basis are declining
 
If you are averaging two new admits a day, wouldn't that be about two hours a day? Then about 10-15 minutes for each of the other 13 patients = another two to three hours. That sounds like more than the 15 you are thinking. I would tend to err on the side of overestimating the time than underestimating. If you can crank out the documentation and keep the sessions short, then that will maximize your revenue, but it's nice to build in some cushion. In other words, if you negotiate a pay rate at a slower pace that is more typical of the average psychiatrist, then the fact that you are more expedient will reward you. If you factor in your expedience first, then you will actually be penalizing yourself. I have always worked quickly in any job I have ever done so know that from experience. 😡
Although I am happy now because my production compensation is based on a comparison to years of having slow-paced old-school Freudian types. 😀
 
TexasPhysician said:
The answers are too dependent on the facility and patient base. Assuming quality support, private insured patients, minimal geriatrics, no one under 18, etc. then most of your list would rarely occur.
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exactly....a lot of people who've never worked outside of their residency program or outside of a state hospital or academic program in general don't understand this. It's not at all uncommon for community practitioners to have an inpatient/outpt mix in the real world of 15-20 each daily with good support.
 
ferning said:
150k year as 1099 is like 100k as salaried employee with benefits.
Click to expand...

this is not even close to true for most people....for one the benefits are often found in the other job(if not there are definite advantages to going with sep accounts anyways) and arent as valuable in a duplicative sense anyways. Second, while you do lose out on the other half of ss/medicare completely(about 7%), there are certain above the line tax advantages you can take advantage of as well if you have a second job on 1099.

In my situation, I'd probably give up 5-8k on a yearly basis for this job to be converted to a w2, but certainly not more than that.
 
Bartelby said:
Feel free to ignore this post since it's a divergence from the topic, but is it usual for psychiatrists to work this kind of volume (15 inpatients + another full time job)?.
Click to expand...

its very common in true private practice group settings, but it's usually part of the same job. What happens is a psych hospital gives one group access to the unit/s, and they split amongst themselves the inpatients and then do all their outpt stuff after they round.

what's gained popularity in the last 10 years is moving away from this traditional private practice group model to have full time salaried hospitalists. This is going to be an exclusively inpatient position typically, but it's going to be salaried, you are going to have a ton of other responsibilities, they are going to try to get you to do non-psychiatrist duties, it's probably going to come with various clauses, and you will have bosses who can pressure you to meet certain things.

There are advantages and disadvantages to both.
 
ferning said:
Yea it really is alot and no residents either? Just one shrink to drop 15 notes in 2 locations and 2 admit h/ps and orders

150k year as 1099 is like 100k as salaried employee with benefits. You're why physician salaries on an hourly basis are declining
Click to expand...

Without knowing specifics, you can not make a fair comparison. Some salaried jobs have REALLY good benefits which makes the job more valuable. Others provide poor quality insurances, years to vest in matching retirement contributions, and access to high expense mutual funds. Not to mention that the irs tax code favors 1099 earners heavily.

One salaried job a colleague of mine considered takes 5 years to vest, $$ penalties for leaving before 2 years, etc. That's abuse in my book.
 
My question is about vacation and sick days. I understand you won't be paid for those days, but is there coverage for days that you want to take off or will you have to find someone yourself (this happened to one of my mentors who took a contractor position and was forced to find his own replacement when he needed time off)? You mentioned holidays being only Christmas and Thanksgiving, but surely you take vacations. What happens when you're gone for two weeks?
 
TexasPhysician said:
Not to mention that the irs tax code favors 1099 earners heavily.
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this is really dependent on the individual. A lot of people arent in a position where it would be practical to use some of these advantages(leasing cars to the business, home office use, etc). The extra money you can put in a retirement account tax sheltered is huge though, and everyone can take advantage of it.

If someone was going to pay me X(with benefits, even crappy ones) on an employed salary position or X(with no benefits except medmal paid) on a 1099, I take the employed salaried/w2 gig everytime. but if the salary difference grows to a nonnegligible amount, then I probably take the 1099. I cant think of ANY situation(short of maybe a ridiculously good defined pension plan that requires little input) where 100k on a w2 would be worth 150k on a 1099. Maybe 115k-120k depending on the situation.
 
Mass Effect said:
My question is about vacation and sick days. I understand you won't be paid for those days, but is there coverage for days that you want to take off or will you have to find someone yourself (this happened to one of my mentors who took a contractor position and was forced to find his own replacement when he needed time off)? You mentioned holidays being only Christmas and Thanksgiving, but surely you take vacations. What happens when you're gone for two weeks?
Click to expand...

The group and facility will arrange coverage(with one of them) if Im sick or want to take a preplanned vacation. Thats not at all uncommon in the real world.
 
vistaril said:
Oh it wouldn't be 5....I'd probably round from 645-8 at the first place(writing notes as I go). Leave by 8 and be at work by 815
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OldPsychDoc said:
Where I'm at, 15 beds is full time. But then again, we like, plan treatments and provide care...extra stuff like that.
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DItto OPD's sentiments.

Vistaril- if I'm reading your math right, you're talking about rounding on 15 beds in 75 minutes. Assuming you have them lined up like a Ford plant, this is 5 minutes per patient. Of course, these are inpatient units, so that won't happen. And this is also two locations. So you're looking at glancing over a patient's chart, going into the patient's room, interviewing and moving on to the next patient all in about 4 minutes? So maybe 3 minutes talking with each patient to evaluate for suicide, violence, grave disability, medication side effects, insight, and symptoms? And this allows no time for your 2 intakes per day?

I have a tough time viewing plans like these with your talking about being careful to find work that accommodates your desire to spend more time with patients so that you can do quality work.
 
vistaril said:
this is really dependent on the individual. A lot of people arent in a position where it would be practical to use some of these advantages(leasing cars to the business, home office use, etc). The extra money you can put in a retirement account tax sheltered is huge though, and everyone can take advantage of it.
Click to expand...

It all depends on how you structure your business too. I use home office deductions, deduct car expenses by mileage, office expenses, telephone usage, deduct business trips, events with potential clients, etc. All of these are not deductible as a w2 employee.
 
vistaril said:
The group and facility will arrange coverage(with one of them) if Im sick or want to take a preplanned vacation. Thats not at all uncommon in the real world.
Click to expand...

Don't bet on it. Unless the coverage is specifically written into the contract, don't count on them keeping your back safe.
 
notdeadyet said:
DItto OPD's sentiments.

Vistaril- if I'm reading your math right, you're talking about rounding on 15 beds in 75 minutes. Assuming you have them lined up like a Ford plant, this is 5 minutes per patient. Of course, these are inpatient units, so that won't happen. And this is also two locations. So you're looking at glancing over a patient's chart, going into the patient's room, interviewing and moving on to the next patient all in about 4 minutes? So maybe 3 minutes talking with each patient to evaluate for suicide, violence, grave disability, medication side effects, insight, and symptoms? And this allows no time for your 2 intakes per day?

I have a tough time viewing plans like these with your talking about being careful to find work that accommodates your desire to spend more time with patients so that you can do quality work.
Click to expand...
To be fair to Vistaril, he's talking about only rounding at one facility in 75 minutes (and spending about 3 hours on all fifteen patients), one before and one after the day job.

The appeal of this kind of setup is hard for me to fathom as well. I do full-time inpatient, see maybe half this number of patients, yet make almost $4,000 per week (plus fantastic benefits), as may pay is entirely RVU-based (so I'm incentivized to do full assessments and follow-ups, spend a lot of time with my patients, don't have to rely on ancillary staff to gather history, and have the luxury of knowing fewer patients relatively well). Including review of records, checking controlled substance databases, calling outpatient providers, changing orders, and dictating an admission report, new patients not uncommonly take up to 90 minutes. I'm not exactly fast, but I work in a group of 10 docs, and all of them spend far more than 3 hours on site a day, and none of them do much outpatient work.

Still though, with 15 patients, I imagine there are going to be Mondays where 5+ patients are going to want to leave (not sure what the commitments laws are in his state or how many show up committed, which could allow more flexibility). I'm planning for 5 of my inpatients to leave tomorrow once we have the full weekday team to facilitate discharge planning.

If this is the typical patient load of a contract job, I can tell it's not for me. I think it would be extremely tough to handle the turnover of an average short-term unit and to find the time to provide care I consider to be high quality.
 
I have no idea if such a job makes sense or not, or exists or not, but people should keep in mind that Vistaril has made up stuff before.
 
notdeadyet said:
DItto OPD's sentiments.

Vistaril- if I'm reading your math right, you're talking about rounding on 15 beds in 75 minutes. Assuming you have them lined up like a Ford plant, this is 5 minutes per patient. .
Click to expand...

you aren't reading it right- I plan to spend about 3 hours total(not counting commute times) at the two sites. for people who do private practice traditional community practice, that's not particularly fast or particularly slow.....it's somewhere in the middle. A lot of the things we do as residents or a lot of the things staff psychs do at academic hospitals or state facilities other people do in community psych hospitals......

I know people who see 40 inpatients in the morning and then do their afternoon clinic. fitting 15 inpatients in a day at two sites is cake.
 
cookymonster said:
. I think it would be extremely tough to handle the turnover of an average short-term unit and to find the time to provide care I consider to be high quality.
Click to expand...

that's a decision each individual has got to make for themselves.....Im satisfied that the care I provide is high quality, and that I give as much as I can for my patients. Salaried community inpatient jobs have their advantages like I said, but they also have their disadvantages- loss of autonomy, often various forms of no compete, having to follow rules you may not agree with, having bosses who are non-clinicians, and many more. Many people have lamented the shrinking of traditional pp models for this model popping up.
 
vistaril said:
Thanks tp good post and good things to think about....through some channels I know now that they are using locums(Barton associates) to cover these beds(the same ones I am covering now) under the same conditions there all in cost to them is about 3200(not what the barton guy is getting but what they are paying to barton), so I think if I got 3k that's aiming high. I do think they are switching from locums to a contract guy because they want a little more stability, so they may pay almost as much. If I got 3k Id be getting a bunch more than the locums guy now, and 95% of what their total all in cost to locums is now(almost unheard of I think). .
Click to expand...

I'd offer $3100 and accept $3000. Possibility you are debating salary with an administrator? If so, they might just want to demonstrate some cost savings and have regular help. At $3k/week, they save about 12k/year and can fill their beds without worrying about coverage. Win/win.
 
TexasPhysician said:
I'd offer $3100 and accept $3000. Possibility you are debating salary with an administrator? If so, they might just want to demonstrate some cost savings and have regular help. At $3k/week, they save about 12k/year and can fill their beds without worrying about coverage. Win/win.
Click to expand...

that's what I just did...we'll see how it goes.
 
You should be asking for more than $3000. This is easily $4000 worth of work each week.
 
For me the number to look at is not the total beds as much as the average admits per day which would also be the average discharges per day, too. It just seems that being able to do two admits a day and two discharges a day and check in on the other ten patients in three hours is unrealistic.
 
smalltownpsych said:
For me the number to look at is not the total beds as much as the average admits per day which would also be the average discharges per day, too. It just seems that being able to do two admits a day and two discharges a day and check in on the other ten patients in three hours is unrealistic.
Click to expand...

This is inpatient work in a non-academic setting. We aren't talking hour long detailed evals. This is strictly determining how to get patients stable enough to go back to their outpatient psych. New evals aren't but 30 min at most sometimes. Documentation is often just enough to bill for it.

3-4 hours is probably about right. I know a local psych who sees double in that time frame. My patients are directed away from this person.
 
heyjack70 said:
You should be asking for more than $3000. This is easily $4000 worth of work each week.
Click to expand...

they aren't paying close to this now for locums(not what the locums is getting, what their total payout is). I've never heard of a case where the stable person gets significantly more than what a place pays for locums coverage(not to locums guy).
 
TexasPhysician said:
This is inpatient work in a non-academic setting. We aren't talking hour long detailed evals. This is strictly determining how to get patients stable enough to go back to their outpatient psych. New evals aren't but 30 min at most sometimes. Documentation is often just enough to bill for it.

3-4 hours is probably about right. I know a local psych who sees double in that time frame. My patients are directed away from this person.
Click to expand...
I have worked in settings where the psychiatrists have this type of limited interaction with patients and the facility and it seems that they tend to get marginalized to a role of "med management". I don't know if this serves the field well. When I have worked collaboratively with psychiatrists in the past I have found that they generally have a lot to offer conceptually and diagnostically, but this type of setup precludes that.
 
smalltownpsych said:
I have worked in settings where the psychiatrists have this type of limited interaction with patients and the facility and it seems that they tend to get marginalized to a role of "med management". I don't know if this serves the field well. When I have worked collaboratively with psychiatrists in the past I have found that they generally have a lot to offer conceptually and diagnostically, but this type of setup precludes that.
Click to expand...

well med management and let's not forget the MOST IMPORTANT role in an ACUTE INPATIENT facility- deciding when the pt is stable enough to be discharged safely(and to where). Inpatient units in 2014 are not(and should not be) places which provide residential like experiences where poets, philosophers, and the like debate the meaning of life hehe. The key terms here- acute, stabilization......
 
vistaril said:
well med management and let's not forget the MOST IMPORTANT role in an ACUTE INPATIENT facility- deciding when the pt is stable enough to be discharged safely(and to where). Inpatient units in 2014 are not(and should not be) places which provide residential like experiences where poets, philosophers, and the like debate the meaning of life hehe. The key terms here- acute, stabilization......
Click to expand...
I didn't think that discussions about meaning of life would be pertinent in an acute inpatient facility, just questioning how to effectively make that decision about how stable a patient is, where to discharge them, and who is making that decision.

Also, you would be surprised how much information can be gathered and crucial care can be provided in the seven day average stay. Anyone who doesn't think anything of moment is happening other than the passage of time and the effects of medications is going to end up marginalized.
 
smalltownpsych said:
I didn't think that discussions about meaning of life would be pertinent in an acute inpatient facility, just questioning how to effectively make that decision about how stable a patient is, where to discharge them, and who is making that decision.

Also, you would be surprised how much information can be gathered and crucial care can be provided in the seven day average stay. Anyone who doesn't think anything of moment is happening other than the passage of time and the effects of medications is going to end up marginalized.
Click to expand...

oh I don't think medications(with rare exceptions) in the course of the stay are doing much of anything. I also don't think patients are 'getting better' in a meaningful longterm sense from inpatient psychiatric stays, and that's why their use should be minimized when possible and stays should be short. The best thing we can do for patients as MH providers is to:

1) keep them out of the hospital
2) when they do go to the hospital, get them out quickly
 
smalltownpsych said:
Also, you would be surprised how much information can be gathered and crucial care can be provided in the seven day average stay. Anyone who doesn't think anything of moment is happening other than the passage of time and the effects of medications is going to end up marginalized.
Click to expand...

Too long.
 
st2205 said:
Too long.
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I was referring to OP's description of the facility. Length of stay is also determined by other factors such as services in the community and makeup of the population. Our own crisis stabilization unit length of stay is just under 2 days. If we don't anticipate patient being stable in a few days then we transfer to longer-term facilities in other communities.
 
vistaril said:
exactly....a lot of people who've never worked outside of their residency program or outside of a state hospital or academic program in general don't understand this. It's not at all uncommon for community practitioners to have an inpatient/outpt mix in the real world of 15-20 each daily with good support.
Click to expand...

Are we to assume you've "sold out", then?
 
vistaril said:
well med management and let's not forget the MOST IMPORTANT role in an ACUTE INPATIENT facility- deciding when the pt is stable enough to be discharged safely(and to where). Inpatient units in 2014 are not(and should not be) places which provide residential like experiences where poets, philosophers, and the like debate the meaning of life hehe. The key terms here- acute, stabilization......
Click to expand...
vistaril said:
oh I don't think medications(with rare exceptions) in the course of the stay are doing much of anything. I also don't think patients are 'getting better' in a meaningful longterm sense from inpatient psychiatric stays, and that's why their use should be minimized when possible and stays should be short. The best thing we can do for patients as MH providers is to:

1) keep them out of the hospital
2) when they do go to the hospital, get them out quickly
Click to expand...
I'll be interested to see how out of 15 patients you manage to keep your admissions and discharges to an average of two a day if this is how you feel and you're seeing each of them in just a few minutes a day. I feel like 2/3 of my patients come in after some kind of crisis that resolves within 3 days, and they'll tell you they have all kinds of external pressures to get out. You have to dig deeper (or buy time with safety planning, family meetings, therapy) or else you must get inundated.
 
15 patients may not sound like a lot... but man you need to hustle. Esp if your EMR steals your thunder. All sorts of crap will get in your way...ie. nurses paging you, pt on the phone, pt in group, pt in the bathroom, pt eating, random pt trying to talk to you in the halls, doc to doc, discharge paperwork, crisis on the unit. Don't burn yourself out man.
 
vistaril said:
huh no why in the world would you think that.
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IMO the type of work a doctor can do for 15 patients in 3 hours is essentially worthless. The doctor won't really have any idea what is going on with these patients. 12 minutes per patient isn't enough time to do a good job. Some patients actually do get stable/better in the hospital. This sounds like the last place anyone would want to be admitted for treatment.
 
heyjack70 said:
IMO the type of work a doctor can do for 15 patients in 3 hours is essentially worthless. The doctor won't really have any idea what is going on with these patients. 12 minutes per patient isn't enough time to do a good job. Some patients actually do get stable/better in the hospital. This sounds like the last place anyone would want to be admitted for treatment.
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I do not think he can get out the unit in 3 hours if he spends 12 min per pt. More like 1-3 min per pt. Rest of the time is documentation and other stuff.
 
heyjack70 said:
IMO the type of work a doctor can do for 15 patients in 3 hours is essentially worthless. The doctor won't really have any idea what is going on with these patients. 12 minutes per patient isn't enough time to do a good job. Some patients actually do get stable/better in the hospital. This sounds like the last place anyone would want to be admitted for treatment.
Click to expand...

I do think 3 hrs is a little fast; 4-5 hours sounds more reasonable. How much time pts need varies a lot depending on diagnosis and length of stay. A patient who has been waiting 5 weeks for a bed at the state hospital may not require that much time. A lot also depends on what happens during the weekends. If you have someone like me covering the weekends, the weekend admits will have reasonable treatment plans, and a patient or 2 may have been discharged over the weekend- this will lessen the time required for the regular psychiatrist.
 
vistaril said:
oh I don't think medications(with rare exceptions) in the course of the stay are doing much of anything. I also don't think patients are 'getting better' in a meaningful longterm sense from inpatient psychiatric stays, and that's why their use should be minimized when possible and stays should be short. The best thing we can do for patients as MH providers is to:

1) keep them out of the hospital
2) when they do go to the hospital, get them out quickly
Click to expand...

I like this argument. Its like when Republicans are running all branches of the government and the country goes down in flames. Then they just shrug their shoulders and offer it as proof that government doesn't work.

Of course, some patients are actually made worse with prolonged hospitalization, or abuse the system. But figuring out who those people are by obtaining collateral, tracking records, observing behavior, taking a thorough history probably takes AT LEAST 7 minutes.
 
Salpingo said:
Of course, some patients are actually made worse with prolonged hospitalization, or abuse the system. But figuring out who those people are by obtaining collateral, tracking records, observing behavior, taking a thorough history probably takes AT LEAST 7 minutes.
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Well, he said there's "good sw support" so they'll probably figure it out for him (and not bother him while he's at work at his real job).
 
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