How to get quality supervision?

[hippopotamusoath]

I’m several years out of residency. Working at a corporate big-box place in the center of the country.

I want to keep improving, but it’s become hard to get quality supervision at this stage in the game. My colleagues are not a realistic option for a variety of reasons.

For my fellow big-box warriors, what were the highest-yield things you did to improve your game in this kind of environment?

I read a lot from quality resources, I post questions here, and get wonderful and helpful feedback.

But I have a sense that I need to integrate in-person, 1 on 1 supervision to elevate my practice further. Unfortunately, it seems like most options are in the context of psychotherapy training programs, and I am doing mostly psychopharmacology at this point.

I am also nervous that if I seek out one person for regular supervision, I’m getting one person’s biases vs. seeking out multiple people and having more of a broad perspective.

Any concrete strategies to find this type of relationship when you’re a few years out and work in corporate medicine?

Thank you to anyone with ideas.

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[nexus73]

I haven’t done this but I’d think if there was a good attending in your residency you could call them and ask about setting up a supervision relationship

 

[hippopotamusoath]

I haven’t done this but I’d think if there was a good attending in your residency you could call them and ask about setting up a supervision relationship

Thanks…does that type of thing count towards academic productivity for them? I’d feel self-conscious about taking an hour a week of someone’s time unless they were getting paid or otherwise compensated, but that’s a good idea.

 

[vespers]

Thanks…does that type of thing count towards academic productivity for them? I’d feel self-conscious about taking an hour a week of someone’s time unless they were getting paid or otherwise compensated, but that’s a good idea.

That would be on them to figure out. You would offer to pay them an hourly rate if they couldn’t arrange for it to be part of their usual daily work under their academic umbrella.

 

[Celexa]

Thanks…does that type of thing count towards academic productivity for them? I’d feel self-conscious about taking an hour a week of someone’s time unless they were getting paid or otherwise compensated, but that’s a good idea.

It would not count as academic productivity.

The thing is, you're asking for something of value and it seems like you have the right sense that it can't easily, or possibly at all, be obtained for free. In residency, you are paying with your labor for that supervision.

If you want a supervisor-supervisee relationship, and you are working at a big box shop and don't view your colleagues as helpful peers, then you may need to pay for it.

An alternative is to network and find more peers you do respect. I communicate frequently with my peers from residency. We all have different interests and focuses. It's a relationship of equals in which knowledge flows both ways.

The isolative sense you've identified is also why it's not uncommon for people to spend at a few years in academics; the pay is lower, but the collegiality higher, and generally you are expected to contribute to the community and seeking counsel from colleagues is culturally normal. Being able to walk down the hall or text a dozen experienced colleagues, some of whom are national experts, is one of the compensations for the lower pay. You also sharpen yourself against the questions from the trainees; there's nothing like having to justify why you do certain things to keep your clinical reasoning acute. I'm not necessarily recommending you do this, but just pointing out that it's something that exists in one place and doesn't exist in another, and picking one type of job always means giving up certain things. In academia it's money. In big box jobs it's other things--like easy access to supervision.

I've thought about offering paid supervision. As you say, I've only traditionally heard of it outside of residency in terms of psychotherapy. I'm curious if anyone does do this and what they charge. I imagine it would need to approach a private practice patient rate to be worth it. And what would liability be? Would you need to be licensed in the same state?

 

[hippopotamusoath]

It would not count as academic productivity.

The thing is, you're asking for something of value and it seems like you have the right sense that it can't easily, or possibly at all, be obtained for free. In residency, you are paying with your labor for that supervision.

If you want a supervisor-supervisee relationship, and you are working at a big box shop and don't view your colleagues as helpful peers, then you may need to pay for it.

An alternative is to network and find more peers you do respect. I communicate frequently with my peers from residency. We all have different interests and focuses. It's a relationship of equals in which knowledge flows both ways.

The isolative sense you've identified is also why it's not uncommon for people to spend at a few years in academics; the pay is lower, but the collegiality higher, and generally you are expected to contribute to the community and seeking counsel from colleagues is culturally normal. Being able to walk down the hall or text a dozen experienced colleagues, some of whom are national experts, is one of the compensations for the lower pay. You also sharpen yourself against the questions from the trainees; there's nothing like having to justify why you do certain things to keep your clinical reasoning acute. I'm not necessarily recommending you do this, but just pointing out that it's something that exists in one place and doesn't exist in another, and picking one type of job always means giving up certain things. In academia it's money. In big box jobs it's other things--like easy access to supervision.

I've thought about offering paid supervision. As you say, I've only traditionally heard of it outside of residency in terms of psychotherapy. I'm curious if anyone does do this and what they charge. I imagine it would need to approach a private practice patient rate to be worth it. And what would liability be? Would you need to be licensed in the same state?

Good point. As I’ve read your comment, it occurred to me that I’m looking for a way to basically pay for a service that replicates the supervision/culture of inquiry in academics without having to leave my big box job, which I need to keep for other reasons.

The idea of offering this supervision as a service is interesting. I’d sign up, but only if I got an hour a week from a big selection of experts, so I could run cases and decision-making past a specific expert for each one. Maybe it’s a good business idea! High-end supervision for professionals who want to excel…

 

[splik]

I provide this kind of thing - it’s more “case consultation” rather than supervision at this level. It’s more common for people to seek consultation to discuss a few specific cases. I’m sure there are people in your area who would be happy to provide this and if not it’s easy enough to zoom with people these days. You’ll have to pay for it unless it’s someone you know. I’ve sometimes consulted with my attendings from residency and they’ve never charged for it and been generous with their time.

If you are looking for a diversity of opinions (which isn’t necessarily a good thing) then you may wish to join a case consultation group or start one up! This would be more learning from peers. Traditionally these have been more therapy based but that’s no longer the case these days - I’ve been part of several.

 

[Stagg737]

It would not count as academic productivity.

The thing is, you're asking for something of value and it seems like you have the right sense that it can't easily, or possibly at all, be obtained for free. In residency, you are paying with your labor for that supervision.

If you want a supervisor-supervisee relationship, and you are working at a big box shop and don't view your colleagues as helpful peers, then you may need to pay for it.

An alternative is to network and find more peers you do respect. I communicate frequently with my peers from residency. We all have different interests and focuses. It's a relationship of equals in which knowledge flows both ways.

The isolative sense you've identified is also why it's not uncommon for people to spend at a few years in academics; the pay is lower, but the collegiality higher, and generally you are expected to contribute to the community and seeking counsel from colleagues is culturally normal. Being able to walk down the hall or text a dozen experienced colleagues, some of whom are national experts, is one of the compensations for the lower pay. You also sharpen yourself against the questions from the trainees; there's nothing like having to justify why you do certain things to keep your clinical reasoning acute. I'm not necessarily recommending you do this, but just pointing out that it's something that exists in one place and doesn't exist in another, and picking one type of job always means giving up certain things. In academia it's money. In big box jobs it's other things--like easy access to supervision.

I've thought about offering paid supervision. As you say, I've only traditionally heard of it outside of residency in terms of psychotherapy. I'm curious if anyone does do this and what they charge. I imagine it would need to approach a private practice patient rate to be worth it. And what would liability be? Would you need to be licensed in the same state?

I'll disagree slightly with this. Where I'm at a mid-career psychiatrist supervising a relatively new attending as a mentor is something that would go onto the CV and could be counted toward promotion as an academic activity (mentorship). However, like many academic places it's something that the chair would have to approve (which I think they likely would).

 

[Celexa]

I'll disagree slightly with this. Where I'm at a mid-career psychiatrist supervising a relatively new attending as a mentor is something that would go onto the CV and could be counted toward promotion as an academic activity (mentorship). However, like many academic places it's something that the chair would have to approve (which I think they likely would).

Supervising someone not connected to the dept at all would count as productivity? Everywhere I've been they would say, we need you mentoring people IN the dept (which def could count). Or being a research mentor for someone in another dept.

 

[Stagg737]

Supervising someone not connected to the dept at all would count as productivity? Everywhere I've been they would say, we need you mentoring people IN the dept (which def could count). Or being a research mentor for someone in another dept.

Yes. We have a couple sub-specialists who have given seminars and individual mentoring to individuals in our state outside of our health system who put it on their CVs. I was in the room when our chair told our reproductive psychiatrist to make sure she included it on her internal CV for promotion as she was doing so as a specialist associated with our medical center. I have also informally discussed doing this for my telehealth clinic for referring prescribers with the chair. Was told I wouldn't be paid for it unless the clinics we contract with want to pay me but that I could put it on my CV for promotion purposes.

Where I'm at part of promotion is determined by contributions in 4 domains. For our "clinical services" domain 2 of the possible contributions are "consulting on a regional basis" and "Spokesperson for the School of Medicine or University on areas of expertise." There's also several in the "teaching" domain that would qualify, and the activities aren't limited to being within the health system for promotion reasons.

 

[Celexa]

Yes. We have a couple sub-specialists who have given seminars and individual mentoring to individuals in our state outside of our health system who put it on their CVs. I was in the room when our chair told our reproductive psychiatrist to make sure she included it on her internal CV for promotion as she was doing so as a specialist associated with our medical center. I have also informally discussed doing this for my telehealth clinic for referring prescribers with the chair. Was told I wouldn't be paid for it unless the clinics we contract with want to pay me but that I could put it on my CV for promotion purposes.

Where I'm at part of promotion is determined by contributions in 4 domains. For our "clinical services" domain 2 of the possible contributions are "consulting on a regional basis" and "Spokesperson for the School of Medicine or University on areas of expertise." There's also several in the "teaching" domain that would qualify, and the activities aren't limited to being within the health system for promotion reasons.

Ah OK that makes more sense to me if you're talking about being a recognized expert in a particular subfield and providing expertise in that vein. And of course seminars count. The OP seemed to be describing more generalized 1:1 support, and I am sure that type of time and effort would get a response along the lines of 'shouldn't you be spending time developing your niche or teaching our own residents and fellows?' in the places I've worked.

 

[FlowRate]

It's fine if you don't want to go into it but one of the advantages of a good employed position is having quality colleagues. I solicit the opinions/advice of several of my colleagues on a regular basis, including our super excellent psych clinical pharmacy specialist. I am also part of a consultation group outside of work.

I wish I had stayed in closer touch with residency colleagues and attendings but that's a little harder to do when you move away from the city and have basically no in-person, or even time zone, connection.

 

[Stagg737]

Ah OK that makes more sense to me if you're talking about being a recognized expert in a particular subfield and providing expertise in that vein. And of course seminars count. The OP seemed to be describing more generalized 1:1 support, and I am sure that type of time and effort would get a response along the lines of 'shouldn't you be spending time developing your niche or teaching our own residents and fellows?' in the places I've worked.

Where I'm at what OP and you are talking about would still count toward promotion. The system wouldn't pay me for it, but I would include it on my internal CV. There's a push here for the system to be recognized as a regional powerhouse and we've bought out several hospitals in our state as well as a neighboring state. So being able to say that our staff provides supervision to physicians and mid-levels in the community across the state (and beyond) is something advertised to the community. Something along those lines in addition to working with residents and med students is expected depending on what tenure track you're on.

 

[Merovinge]

I do a zoom with several local attendings senior to me once a month to discuss cases/pharmacologic ix. You could even make a thread on SDN about potentially starting one or see if any of your classmates in residency are part of one. This is so much more doable now with video conferencing technology.

Hopefully at some point you get a job with peers that you can do this work with. I also meeting with all the CAP for supervision through my job, although I lead that one.

 

[comp1]

When I hear supervision outside residency...I think psychotherapy supervision. It doesn't sound like the OP is looking for that, or even primarily doing psychotherapy. So...med management supervision? I'm not sure how common this is outside of an academic setting. You definitely do give up that cool academic stuff with the higher pay of a big box shop. I'm guessing you could find someone to pay to do weekly supervision with you. Or maybe reach out to your residency class and see if anyone wants to do weekly meet ups to discuss cases. I'm not sure how much interest you're going to find...