I want out

[meow1985]

---

Members do not see this ad.

This will be a weepy post. You have been warned.

In the last two days, I've dealt with the following junk:

1. been involved in kafkaesque discussions with my lawyer in a malpractice case
2. got yelled at for prescribing controlled substances by our resident controlled substance Nazi attending - got scared about being sued again
3. got yelled at for NOT prescribing controlled substances by patient and outside PCP - got scared about being sued again
4. got yelled at by parents who can't agree on a kid's medication regimen - got scared about being sued again
5. got 10+ emotionally wrecked patients' emotions become mine, all while being expected to actually use my brain to solve problems

I often feel like patients just treat me as a dispenser of their make-my-problems-go-away substances with a person incidentally attached. Every attending has something different to say and there are no easy answers. Patients are unpredictable and make me feel abused and unsafe.

And it's only Wednesday.

I got into this business naively trying to help people. And I do enjoy solving problems and think people are fascinating. I still have a lot of respect for medicine and psychiatry in particular. In fact, psychiatry actually does pretty well compared to other specialties in trying to give us the tools to set boundaries, take care of ourselves, and navigate thorny interpersonal situations.

But it's not enough. I'm only a resident and already I wish I could retire. But I crunched the numbers and I need 5 years of an attending's salary and frugal living to save up enough to achieve FIRE (see Mr. Money Mustache). FIVE YEARS OF THIS. I doubt it will get better when I'm an attending, because then the buck will really stop with me.

I don't know what I need right now from this post. Maybe perspective? There is no one I can talk to in my residency because I've earned the reputation of being anxious, and everyone's sick of my complaining. That's probably why my PD encouraged me to take a mental health break earlier, and I want to finish my program without attracting further attention. So I have to pretend I'm ok.

 

[Ironspy]

Residency is horrible. Being an attending is better. If your jobs sucks you can just leave and get a new one. Anywhere.

 

[Fan_of_Meehl]

This will be a weepy post. You have been warned.

In the last two days, I've dealt with the following junk:

1. been involved in kafkaesque discussions with my lawyer in a case where I'm being sued for doing my job (being involved in the care of a patient who was involuntarily hospitalized and treated)
2. got yelled at for prescribing controlled substances by our resident controlled substance Nazi attending - got scared about being sued again
3. got yelled at for NOT prescribing controlled substances by patient and outside PCP - got scared about being sued again
4. got yelled at by parents who can't agree on a kid's medication regimen - got scared about being sued again
5. got 10+ emotionally wrecked patients' emotions become mine, all while being expected to actually use my brain to solve problems

I often feel like patients just treat me as a dispenser of their make-my-problems-go-away substances with a person incidentally attached. Every attending has something different to say and there are no easy answers. Patients are unpredictable and make me feel abused and unsafe.

And it's only Wednesday.

I got into this business naively trying to help people. And I do enjoy solving problems and think people are fascinating. I still have a lot of respect for medicine and psychiatry in particular. In fact, psychiatry actually does pretty well compared to other specialties in trying to give us the tools to set boundaries, take care of ourselves, and navigate thorny interpersonal situations.

But it's not enough. I'm only a resident and already I wish I could retire. But I crunched the numbers and I need 5 years of an attending's salary and frugal living to save up enough to achieve FIRE (see Mr. Money Mustache). FIVE YEARS OF THIS. I doubt it will get better when I'm an attending, because then the buck will really stop with me.

I don't know what I need right now from this post. Maybe perspective?

Trying to send virtual support over the internet 🙂

Mental health is full of 'double-binds' these days (damned if you do/don't, such as you describe).

 

[Dharma]

This will be a weepy post. You have been warned.

In the last two days, I've dealt with the following junk:

1. been involved in kafkaesque discussions with my lawyer in a case where I'm being sued for doing my job (being involved in the care of a patient who was involuntarily hospitalized and treated)
2. got yelled at for prescribing controlled substances by our resident controlled substance Nazi attending - got scared about being sued again
3. got yelled at for NOT prescribing controlled substances by patient and outside PCP - got scared about being sued again
4. got yelled at by parents who can't agree on a kid's medication regimen - got scared about being sued again
5. got 10+ emotionally wrecked patients' emotions become mine, all while being expected to actually use my brain to solve problems

I often feel like patients just treat me as a dispenser of their make-my-problems-go-away substances with a person incidentally attached. Every attending has something different to say and there are no easy answers. Patients are unpredictable and make me feel abused and unsafe.

And it's only Wednesday.

I got into this business naively trying to help people. And I do enjoy solving problems and think people are fascinating. I still have a lot of respect for medicine and psychiatry in particular. In fact, psychiatry actually does pretty well compared to other specialties in trying to give us the tools to set boundaries, take care of ourselves, and navigate thorny interpersonal situations.

But it's not enough. I'm only a resident and already I wish I could retire. But I crunched the numbers and I need 5 years of an attending's salary and frugal living to save up enough to achieve FIRE (see Mr. Money Mustache). FIVE YEARS OF THIS. I doubt it will get better when I'm an attending, because then the buck will really stop with me.

I don't know what I need right now from this post. Maybe perspective? There is no one I can talk to in my residency because I've earned the reputation of being anxious, and everyone's sick of my complaining. That's probably why my PD encouraged me to take a mental health break earlier, and I want to finish my program without attracting further attention. So I have to pretend I'm ok.

It will get better. I have had my days of feeling like "yeah, F this... how long do I have to do this?" But there have been enough wins along the way that inspire further inquiry and elicit enthusiasm from the depths within. Not sure if you are a fan of sports, but sounds like a bit of a slump... one that will end at some point.

Big ups for the Mr. Money Mustache reference fellow mustachian 😉 BTW a bit jealous that you can pull off FIRE in 5! Not too many loans I'm guessing.

 

[Fan_of_Meehl]

Trying to send virtual support over the internet 🙂

Mental health is full of 'double-binds' these days (damned if you do/don't, such as you describe).

I work for the VA.

Wanna co-author a peer support book/manual entitled 'Directives, Dilemmas, and Double-Binds in Mental Health Care: A Survival Manual?'

 

[lyla]

Attending life, at least for me, is MUCH more chill and less stressful than residency. And attending pay >>>>> resident pay.

Things will get better.

 

[TexasPhysician]

Attending life is much better. Don’t like a patient - fire them. Don’t like a job - quit. No end to opportunities.

 

[PsychApp777]

You’re in good company. MOST residents feel like this, regardless of whether they verbalize it. As others have alluded to, you go from having no power as a resident (they fire you and your career ends) to having all the power as an attending (you leave and the facility loses a precious commodity which may not be replaced for months/years). This makes all the difference. Hang in there, your future self will be grateful that you did.

 

[Monocles]

But it's not enough. I'm only a resident and already I wish I could retire. But I crunched the numbers and I need 5 years of an attending's salary and frugal living to save up enough to achieve FIRE (see Mr. Money Mustache). FIVE YEARS OF THIS. I doubt it will get better when I'm an attending, because then the buck will really stop with me.

OP willing to share your tips? I am all about that FIRE life as well and projected needing at least 10 years of attending salary before I can peace out. Are you some sort of investment genius or do you plan on living out of a cave? 😛

Also look on the positives! The YTD returns for S&P 500 is FREAKIN 24%. If you're this early into FIRE and have some investments already wouldn't this move up your retirement by nearly a year??

*internet hugs*

 

[meow1985]

OP willing to share your tips? I am all about that FIRE life as well and projected needing at least 10 years of attending salary before I can peace out. Are you some sort of investment genius or do you plan on living out of a cave? 😛

Also look on the positives! The YTD returns for S&P 500 is FREAKIN 24%. If you're this early into FIRE and have some investments already wouldn't this move up your retirement by nearly a year??

*internet hugs*

Sorry to disappoint, I don't have any unique tips. I just got very lucky in that I don't have a lot of loans. My parents were Mustachians before Mustachians existed, so they were able to put me through med school despite being regular, non-1% folks. I also got a full scholarship to college.

 

[meow1985]

Question for everyone who says that attendinghood is better, though.

I can still get sued as an attending. There can still be complaints to the board. Right now my resident status sort of protects me, but that'll go away. Those are the biggest things that make me feel unsafe to be honest.

 

[PsychApp777]

Question for everyone who says that attendinghood is better, though.

I can still get sued as an attending. There can still be complaints to the board. Right now my resident status sort of protects me, but that'll go away. Those are the biggest things that make me feel unsafe to be honest.

Very unlikely to get sued as a psychiatrist. And if you were unlucky enough to get sued once, it’s very unlikely you will get sued again. If this fear overwhelms you, though, you can always work at the VA.

 

[AcronymAllergy]

I haven't looked, but I'd imagine the rates of being successfully sued for malpractice are lower for psychiatry than just about any other medical specialty. So at least there's that. I can't imagine there are large swaths of substantiated board complaints, either.

The way I see it, if you work in mental health (or healthcare in general) and don't want to quit at some point, you probably aren't doing it right.

 

[ksharp33]

I agree with everyone else. Being an attending is SO much better. Residency can just suck. You are not alone - I'm sure most of us felt that way at some point during residency. Keep your head down and get through it. This is only temporary. It really does get better and it will be worth it in the end.

I am VERY HAPPY at my job now and am glad I did psychiatry.

 

[meow1985]

I haven't looked, but I'd imagine the rates of being successfully sued for malpractice are lower for psychiatry than just about any other medical specialty. So at least there's that. I can't imagine there are large swaths of substantiated board complaints, either.

The way I see it, if you work in mental health (or healthcare in general) and don't want to quit at some point, you probably aren't doing it right.

I guess my co-resident and I are just unlucky. 🙁

We're not even out of residency yet and we both got named in suits.

At the same time, docs do **** like co-prescribe opiates and benzos to old people and stimulants in pregnancy - stuff I'd get strung up for in residency - and get away with it.

And my controlled substance Nazi attending regularly puts the fear of god into us about catastrophic things that can happen like brain hemorrhages in premature babies that were premature because the mother was on a medication, and the doc being on the hook for something a patient did even though they weren't seen in clinic for six months.

The world is a strange place, and I'd rather be peddling overpriced groceries at Whole Foods some days.

 

[meow1985]

I work for the VA.

Wanna co-author a peer support book/manual entitled 'Directives, Dilemmas, and Double-Binds in Mental Health Care: A Survival Manual?'

I wish, but I don't have enough bandwidth. I don't have enough bandwidth for anything except keeping myself barely alive.

 

[downwithDTB]

Question for everyone who says that attendinghood is better, though.

I can still get sued as an attending. There can still be complaints to the board. Right now my resident status sort of protects me, but that'll go away. Those are the biggest things that make me feel unsafe to be honest.

Yes, being the subject of a lawsuit is terrible; you can be sued regardless of whether you're in medicine. I assume this doesn't stop you from driving. As long as you have enough insurance... the feared outcome is no longer being allowed to practice medicine... So all you get from quitting medicine is the feared outcome sooner.

 

[futuredo32]

What about seeing a therapist for awhile?

 

[meow1985]

What about seeing a therapist for awhile?

I see one. He's great, professionally and personally. And I'm on meds. But I'm still struggling.

At the end of the day my therapist just says the same CBT based things over and over, which I already know from my training but don't actually believe. And the meds just turn down the volume. Nothing I've tried yet has helped address the deep existential dread that everything I have will be taken away.

 

[meow1985]

the feared outcome is no longer being allowed to practice medicine... So all you get from quitting medicine is the feared outcome sooner.

Yes, but if I quit it's my choice. If my license is revoked or I'm unemployable, the choice is made for me. It's a matter of control. And I hardly ever feel like I'm in control.

 

[yanks26dmb]

I see one. He's great, professionally and personally. And I'm on meds. But I'm still struggling.

At the end of the day my therapist just says the same CBT based things over and over, which I already know from my training but don't actually believe. And the meds just turn down the volume. Nothing I've tried yet has helped address the deep existential dread that everything I have will be taken away.

Once your done why not do a few days of telepsych a month and maybe a weekend and call it a day? What other job will let you work five days a month and live a comfortable low six income lifestyle?

Will you be able to find happiness with all that free time?

 

[meow1985]

Once your done why not do a few days of telepsych a month and maybe a weekend and call it a day? What other job will let you work five days a month and live a comfortable low six income lifestyle?

I could try that. I already have a full time job lined up for next year, so I'll at least give it a try. I could always quit.

Will you be able to find happiness with all that free time?

Maybe. Can still get sued though.

 

[erg923]

I see one. He's great, professionally and personally. And I'm on meds. But I'm still struggling.

At the end of the day my therapist just says the same CBT based things over and over, which I already know from my training but don't actually believe. And the meds just turn down the volume. Nothing I've tried yet has helped address the deep existential dread that everything I have will be taken away.

Why are you seeing a therapist who doesn't share your theoretical orientation of pathology and behavior/behavior change?

That said, that stated fear seems ripe for examining ones intermediate and core beliefs.

 

[meow1985]

Well, my therapist is perhaps more versatile than I originally indicated. He does trauma work with people too. He prefers the "change your behavior to change your core beliefs approach," but it's not like he rejects direct intermediate and core belief work. Except I've done core belief work before and that's generated insight but hasn't led to change.

 

[yanks26dmb]

I could try that. I already have a full time job lined up for next year, so I'll at least give it a try. I could always quit.



Maybe. Can still get sued though.

And what happens if you get sued? Isn't this what malpractice is for?

And what are the odds of a successful lawsuit in psychiatry? Roughly 50% of all physicians are sued at some point in their career. How many do you think really lose their licenses?

 

[TexasPhysician]

Residency can be tough. No control. Tons of bosses. High expectations and sometimes high hours.

I too read Mr Money Mustache and thought about FIRE. I did plenty of moonlighting in residency to start the process.

As an attending, everything changes. You can choose your path, and the right choices can make your work-life quite enjoyable. Now I don’t think I’ll ever fully retire. If a gig gets old, boring, or admin gives me trouble, I just walk away. One gig added an EMR that was slow and bulky. It may have helped with billing, but admin didn’t care how it effected the physicians. I quit. Had a new opportunity the next day.

It’ll get better.

 

[finalpsychyear]

what year of residency are you in? In my class we were mostly all ready to have days, weeks, months when we were ready to leave. It wasn't until 4th year until it was truly blissful. Every year is a new type of transition during the first 3 especially. It sort of mimics the medical school except with the match aspect in 4th year other than you are applying for jobs etc.

Hang in there. We all chatted about how close we were to calling it many times during our final months in 4th year. Every single person was super grateful they didn't.


Also attending life is so different. If you happen to have a side gig you are truly in control in any and every way you want. That is how medicine was meant to be. Don't let the hierarchical structure of residency get the best of you. You will only appreciate attending status even more with the way your residency seems to have been.

 

[meow1985]

And what happens if you get sued? Isn't this what malpractice is for?

And what are the odds of a successful lawsuit in psychiatry? Roughly 50% of all physicians are sued at some point in their career. How many do you think really lose their licenses?

Each time you settle a lawsuit or have a judgment against you, it gets reported to the licensing board. Get sued too many times and the board comes to investigate. Then your license can be disciplined or revoked. Also, every time you go to a new job or apply for a license you will have to talk about your lawsuits. Heck, some places even ask whether you've ever been *named* in suit, regardless of merit or ultimate disposition.

 

[meow1985]

what year of residency are you in? In my class we were mostly all ready to have days, weeks, months when we were ready to leave. It wasn't until 4th year until it was truly blissful. Every year is a new type of transition during the first 3 especially. It sort of mimics the medical school except with the match aspect in 4th year other than you are applying for jobs etc.

Hang in there. We all chatted about how close we were to calling it many times during our final months in 4th year. Every single person was super grateful they didn't.


Also attending life is so different. If you happen to have a side gig you are truly in control in any and every way you want. That is how medicine was meant to be. Don't let the hierarchical structure of residency get the best of you. You will only appreciate attending status even more with the way your residency seems to have been.

Thanks.

I'm a 4th year. I should be feeling good.

But it's hellish because I'm on pins and needles. I'm also trying to get licensed in another state for my job next year.

And the pressure's high because every time I run into a tough clinical case or a tough interpersonal situation with patients, I think to myself - this time next year I won't have attendings to ask for help. The buck will stop with me. How is that better? 🙁

 

[calvnandhobbs68]

You're really catastrophizing about this lawsuit thing. As was noted in your original thread about this, the lawsuit is most likely meritless from the get go considering it's a "pro se" suit that not even an ambulance chaser was willing to take up. Even if it had merit, you had 20 people in the other thread reassuring you that perfectly competent doctors get sued every day and go on with their lives.

It's clouding your perception of everything else. Your competence, your happiness, your current work, your future work. You've now extrapolated this out to "oh no, I'm going to get possibly sued for one of the many decisions I make every day and then I'll have another lawsuit and then another one and then I'll probably have 10 patients suing me and then I'll get reported to the licensing board and then they'll pull my license!!!!". I mean you could extrapolate this out to many jobs that have any sort of responsibility. I bet the McDonald's employee that made that super hot coffee never thought there was gonna be a lawsuit about that...

I mean, you're a 4th year psychiatry resident right? What would you tell one of your patients if they came to you with this kind of situation-> thought-> emotion-> behavior response....

 

[calvnandhobbs68]

And the pressure's high because every time I run into a tough clinical case or a tough interpersonal situation with patients, I think to myself - this time next year I won't have attendings to ask for help. The buck will stop with me. How is that better? 🙁

So you're incompetent? What prior proof do you have of this supposed incompetence? How many of your hundreds of patients have you seriously harmed?

 

[finalpsychyear]

Thanks.

I'm a 4th year. I should be feeling good.

But it's hellish because I'm on pins and needles about having been named in a lawsuit by a patient I cared for intern year. I'm also trying to get licensed in another state for my job next year. I won't go into it, but almost all of my posts on this account are about that process and how it feels like a giant inquisition into everything that's ever not been 100% stone cold "normal" in my life.

And the pressure's high because every time I run into a tough clinical case or a tough interpersonal situation with patients, I think to myself - this time next year I won't have attendings to ask for help. 🙁

Also, think about it in this way. You can definitely have some type of colleagues in the area you practice and can always run some cases by them so you can create your own type of discussion group. If you in a some company or group you will always have senior attending to chat cases with.

A few more months and maybe some vacation here and there you'll get through this. This is the final lap of a 100,000 lap race and all you've got to do is cross the finish line and you win the grand prize.

 

[MBBSMOM]

I just read a medscape poll today on top 10 most sued specialties. Psychiatrists were nowhere on the list. Surgical specialties like gen surg and OB/GYN are most commonly sued. Medscape Malpractice Report 2019. If you fear being sued so much or fear that you are incompetent therapy would help. On a side note attending life is a whole lot better.

 

[meow1985]

So you're incompetent? What prior proof do you have of this supposed incompetence? How many of your hundreds of patients have you seriously harmed?

That depends on how you define serious harm.

There have been severe side effects and bad outcomes. But those were caught and addressed by me or others before anything REALLY bad happened. I could've made different decisions that might have prevented some of those things, but the decisions I did make were still reasonable and in good faith in the moment. Some of the bad outcomes couldn't have been prevented or anticipated at all. And I always try to counsel patients on all serious risks of any intervention.

So none, I guess. Yet. Thanks to the swiss cheese model.

 

[clausewitz2]

Why are you seeing a therapist who doesn't share your theoretical orientation of pathology and behavior/behavior change?

That said, that stated fear seems ripe for examining ones intermediate and core beliefs.

I actually think for some people it can be useful to have a therapist of a very different theoretical orientation. If you know you're someone whose failure mode is to intellectualize the heck out of everything (...what, no, of course that doesn't apply to me, let me tell you the five reasons why...) it can be hard sometimes to engage with work where you can sort of see the seams as it were. That is to say, if you have a good grasp of the underlying model they are working from its much easier to focus on nitpick-y arguments about why their intervention is actually totally off-base. Whereas if you are working with someone where you don't really know the details of the underlying model of pathology and behavioral change, it can be easier to engage with the process instead of trying to turn it into a journal club.

So OP, maybe find a therapist coming from a theoretical background you're not trained in. Don't go see a quack, so pick a reasonably well-established school, but once you pick one I would recommend that you very deliberately not do any research or reading about their orientation to avoid falling into this trap. I know several people who are dyed-in-the-wool cognitive-behavioral types professionally who are seeing very dynamic or even Gestalt-y people for their own personal work for similar reasons.

If you know how the sausage is made, maybe go eat a gyro.

 

[yanks26dmb]

Each time you settle a lawsuit or have a judgment against you, it gets reported to the licensing board. Get sued too many times and the board comes to investigate. Then your license can be disciplined or revoked. Also, every time you go to a new job or apply for a license you will have to talk about your lawsuits. Heck, some places even ask whether you've ever been *named* in suit, regardless of merit or ultimate disposition.

I think you really need to find better or more compatible mental health care for yourself. I genuinely mean that.

 

[TexasPhysician]

Each time you settle a lawsuit or have a judgment against you, it gets reported to the licensing board. Get sued too many times and the board comes to investigate. Then your license can be disciplined or revoked. Also, every time you go to a new job or apply for a license you will have to talk about your lawsuits. Heck, some places even ask whether you've ever been *named* in suit, regardless of merit or ultimate disposition.

Assume you are right. You are a below average psychiatrist that is sued more frequently than other psychiatrists. 1 lawsuit every 4 years or so which is high. It’ll take 3-4 lawsuits for a medical board to consider investigating. Then add time for investigation. If you document well, avoid opiates, and avoid midlevels, it’ll likely take criminal activity to actually pull your license. I’ve seen plenty of incompetence continue practicing, but that it for another thread. So worst case scenario for you is a board investigation in about 10 years. You’ve got 10 years to save money, evaluate your future, etc. That’s plenty of time to FIRE if you want too.

Intern year is your least experienced year. Also it’s the highest risk with medical months and inpatient psych. Odds are a lawsuit Q4 years is unlikely to continue because you are gaining experience and working in less frequently sued environments.

I’ve dealt with more legal issues owning a business than anything malpractice related, so alternatives won’t avoid lawsuits. It may actually increase your odds of being sued.

The only psychiatrists that I’ve heard of lose their license involved opiates, sexual activity with patients, selling controlled meds, federal fraud, and midlevel supervision. Otherwise board actions may involve added cme. That means you’ll get another 4 years before another complaint and evaluation from already having a board action.

So likely worst case scenario at your current trajectory has you enjoying the field for 14+ years. If so, congrats on a fairly reasonable career.

 

[WisNeuro]

Heck, if I don't get a patient advocate complaint at least every couple of years, I feel like I'm not doing my job. In mental health in general, complaints are commonplace, lawsuits less likely, lawsuits in which the provider loses, even that much more less likely. I've actually only been aware of one case in which a MH provider lost a lawsuit and subsequently a license, and they were selling scripts for controlled substances to addicts, so, yeah.

 

[nrmp]

Assume you are right. You are a below average psychiatrist that is sued more frequently than other psychiatrists. 1 lawsuit every 4 years or so which is high. It’ll take 3-4 lawsuits for a medical board to consider investigating. Then add time for investigation. If you document well, avoid opiates, and avoid midlevels, it’ll likely take criminal activity to actually pull your license. I’ve seen plenty of incompetence continue practicing, but that it for another thread. So worst case scenario for you is a board investigation in about 10 years. You’ve got 10 years to save money, evaluate your future, etc. That’s plenty of time to FIRE if you want too.

Intern year is your least experienced year. Also it’s the highest risk with medical months and inpatient psych. Odds are a lawsuit Q4 years is unlikely to continue because you are gaining experience and working in less frequently sued environments.

I’ve dealt with more legal issues owning a business than anything malpractice related, so alternatives won’t avoid lawsuits. It may actually increase your odds of being sued.

The only psychiatrists that I’ve heard of lose their license involved opiates, sexual activity with patients, selling controlled meds, federal fraud, and midlevel supervision. Otherwise board actions may involve added cme. That means you’ll get another 4 years before another complaint and evaluation from already having a board action.

So likely worst case scenario at your current trajectory has you enjoying the field for 14+ years. If so, congrats on a fairly reasonable career.

What risk is involved with midlevel supervision if they are billing and seeing patient independent on their schedule and if you didn't co-sign notes? What federal fraud we should be worried about? Thanks

 

[Monocles]

You're really catastrophizing about this lawsuit thing. As was noted in your original thread about this, the lawsuit is most likely meritless from the get go considering it's a "pro se" suit that not even an ambulance chaser was willing to take up. Even if it had merit, you had 20 people in the other thread reassuring you that perfectly competent doctors get sued every day and go on with their lives.

Ohhhh OP is that dude! Haha I didn't recognise him with the new pic but yeah I absolutely agree with you.

 

[MedMan80]

I can tell you being an attending is worlds better, of course this depends on where you are and the culture there.."you cant stop the clock" this saying got me through..

 

[downwithDTB]

What risk is involved with midlevel supervision if they are billing and seeing patient independent on their schedule and if you didn't co-sign notes? What federal fraud we should be worried about? Thanks

The serious risk with midlevels is saying that you are supervising them when you are not.

The federal fraud is billing people that you clearly have not seen, billing for procedures that you didn't do, ect.

The point they were trying to make is that you have to be completely running a scam or doing something that 999/1000 doctors would say is clearly wrong or illegal to get in trouble.

 

[deleted736562]

Just reading this thread gives you a hint how toxic medical - especially residency - culture is. You're not alone.

 

[TexasPhysician]

What risk is involved with midlevel supervision if they are billing and seeing patient independent on their schedule and if you didn't co-sign notes? What federal fraud we should be worried about? Thanks

My state considers your midlevels as equivalent to you performing all of their actions. You are liable for everything whether you see the patient or never knew they existed. High liability.

Fraud can come in many ways. I know a dentist that billed for procedures that he never did.

 

[calvnandhobbs68]

Just reading this thread gives you a hint how toxic medical - especially residency - culture is. You're not alone.

I don't know if that's what I take away from this thread....

 

[PsychApp777]

My state considers your midlevels as equivalent to you performing all of their actions. You are liable for everything whether you see the patient or never knew they existed. High liability.

Which is exactly how it should be IMO. Best way of controlling runaway growth of mid-levels.

 

[deleted736562]

I don't know if that's what I take away from this thread....

Almost every poster mentioned that it's common to feel that way in residency and that things will get better as an attending.

I was actually taken aback by how people felt this can be normalized based on their experiences.

I guess toxic and denial are all relative after all.

 

[Mass Effect]

I see one. He's great, professionally and personally. And I'm on meds. But I'm still struggling.

At the end of the day my therapist just says the same CBT based things over and over, which I already know from my training but don't actually believe. And the meds just turn down the volume. Nothing I've tried yet has helped address the deep existential dread that everything I have will be taken away.

Maybe it's time to try some psychodynamic and explore the source of all this?

 

[Mass Effect]

Almost every poster mentioned that it's common to feel that way in residency and that things will get better as an attending.

I was actually taken aback by how people felt this can be normalized based on their experiences.

I guess toxic and denial are all relative after all.

The OP is struggling and the toxic culture of residency has little to do with it. Let's not hijack this thread.

 

[deleted736562]

The OP is struggling and the toxic culture of residency has little to do with it. Let's not hijack this thread.

Oh I am sorry that comment did not fit with your talking points. You can just let it sit and leave it there, if you are worried about the thread "being hijacked".