Inpatient mornings, outpatient afternoons. How do I achieve this?

[Psychresy]

I want to do both inpatient and outpatient. I want to find an inpatient job that allows me to get in early, round, leave by lunch, then do clinic in the afternoon and finish by 5ish.

How do I approach inpatient jobs like this or what should I look for? Is the ability to leave after rounding something that can be negotiated? Are these jobs advertised in such a way? I had a couple attendings in med school who were rounding on 2-3 different hospitals each (and making loads of money, though level of care was questionable) and I've always wondered how one might get the freedom to leave after rounds. Any advice is appreciated.

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[robellis]

I want to do both inpatient and outpatient. I want to find an inpatient job that allows me to get in early, round, leave by lunch, then do clinic in the afternoon and finish by 5ish.

How do I approach inpatient jobs like this or what should I look for? Is the ability to leave after rounding something that can be negotiated? Are these jobs advertised in such a way? I had a couple attendings in med school who were rounding on 2-3 different hospitals each (and making loads of money, though level of care was questionable) and I've always wondered how one might get the freedom to leave after rounds. Any advice is appreciated.

This is very normal I’m not sure what you’re asking, when your work is done you leave that’s it, yes there may be some jobs that want you to stay until 5pm or whatever and you can simply tell them no and then they will agree or they won’t and you won’t take that job

 

[Psychresy]

This is very normal I’m not sure what you’re asking, when your work is done you leave that’s it, yes there may be some jobs that want you to stay until 5pm or whatever and you can simply tell them no and then they will agree or they won’t and you won’t take that job

Gotcha. For some reason I thought this wasn't that common. And generally inpatient jobs are paying 250-300k these days?

 

[nexus73]

Gotcha. For some reason I thought this wasn't that common. And generally inpatient jobs are paying 250-300k these days?

median salary for inpatient from one of the salary survey companies was about 284 last someone told me.

I know if you look for a UHS hospital, they are for profit and I don't think really care about quality of care too much. When I interviewed at one of their psych hospitals (pretty sure almost all are free standing), every doctor I met came in the morning and rounded on some number of patients (10-20 depending on how "efficient" they were) and then they all went off to other jobs in the afternoon, trying to start cash practice etc.

there are also a lot of inpatient jobs at general hospitals where it's the norm for the inpatient docs to work in the morning and do clinic in the afternoon.

 

[robellis]

median salary for inpatient from one of the salary survey companies was about 284 last someone told me.

I know if you look for a UHS hospital, they are for profit and I don't think really care about quality of care too much. When I interviewed at one of their psych hospitals (pretty sure almost all are free standing), every doctor I met came in the morning and rounded on some number of patients (10-20 depending on how "efficient" they were) and then they all went off to other jobs in the afternoon, trying to start cash practice etc.

there are also a lot of inpatient jobs at general hospitals where it's the norm for the inpatient docs to work in the morning and do clinic in the afternoon.

UHS is horrible though they make you see so many patients for much worse pay than other hospitals

 

[J ROD]

What you are describing is a pretty normal setup. Not that hard to find.

 

[nexus73]

UHS is horrible though they make you see so many patients for much worse pay than other hospitals

Agreed

 

[Psychresy]

What you are describing is a pretty normal setup. Not that hard to find.

Average annual psychiatrist salary made me think it wasn't. In this set up you are essentially working 2 full time jobs which I would imagine pay 500+ combined. I'd think average annual psychiatrist salary would be higher if this sort of thing were more common. Am I missing something?

 

[robellis]

Average annual psychiatrist salary made me think it wasn't. In this set up you are essentially working 2 full time jobs which I would imagine pay 500+ combined. I'd think average annual psychiatrist salary would be higher if this sort of thing were more common. Am I missing something?

Yes..you’re missing the fact that most people work 1 job and not 2 lol

 

[Psychresy]

Yes..you’re missing the fact that most people work 1 job and not 2 lol

Ha okay fair enough..but if we're still talking 45ish hours a week, I don't see why more don't do this.

 

[psych_0]

Ha okay fair enough..but if we're still talking 45ish hours a week, I don't see why more don't do this.

Several reasons:
1) We don't want the liability of seeing 40 -50 a day
2) Family life
3) Your day doesn't end when your notes are done. Pages from nurses. Families wanting to talk. Peer to peers, etc.
4) What about the days you're on call at hospital #1? You're getting pages for admissions and orders all afternoon while you're trying to finish work at hospital #2.
5) Each hospital usually wants you to work on-call 1 weekend a month. Working more than 1 job means more than 1 weekend a month. No thanks.

Etc, etc

 

[Bartelby]

You also should consider professional satisfaction as part of the equation. Ripping through 3 inpatient admissions, two discharges, several acute issues and then 12 follow-ups plus care coordination and then racing out to a double-booking 15-min "med check" practice could be lucrative but sounds intensely stressful. I would also feel bad about the garbage quality of care I would need to provide in order to keep that all within roughly the bounds of a 9-5 job (I have a hard time imaging high-quality care for 20 acute inpatients occuring between 8-noon). It is hard to imagine sticking with it for long.

 

[psych_0]

You also should consider professional satisfaction as part of the equation. Ripping through 3 inpatient admissions, two discharges, several acute issues and then 12 follow-ups plus care coordination and then racing out to a double-booking 15-min "med check" practice could be lucrative but sounds intensely stressful. I would also feel bad about the garbage quality of care I would need to provide in order to keep that all within roughly the bounds of a 9-5 job (I have a hard time imaging high-quality care for 20 acute inpatients occuring between 8-noon). It is hard to imagine sticking with it for long.

Yea, it's a recipe for burnout. It sounds much easier on paper than in reality. If you're single with no ties, more power to you. But it's grind. And no matter how "efficient" (lol) you think you are, reality is you're providing ****ty care and seeing most people for < 1-3 min/day. Adverse outcomes will catch up to you.

 

[comp1]

I do think people do this, but I'll definitely stick to salaried inpatient only. Nurses and patients can get pretty needy. I wouldn't want to be interrupting a therapy session with all of that.

 

[Psychresy]

Yea, it's a recipe for burnout. It sounds much easier on paper than in reality. If you're single with no ties, more power to you. But it's grind. And no matter how "efficient" (lol) you think you are, reality is you're providing ****ty care and seeing most people for < 1-3 min/day. Adverse outcomes will catch up to you.

Over a career, yes I agree. My plan is to work really hard and maximize my salary the first 4 years after residency. I'd like to eliminate my student debt and put away about 200k a year. Would rather do this at the beginning of my career so it can grow over 25 years. Hoping stringing together a couple jobs like this and maybe mixing in the occasional weekend would bring in the necessary income to allow this to happen (I'm estimating I'd need about 700k a year)

 

[clozareal]

I've interviewed for several jobs with this type of structures and know of several of my colleauges who have setups like this. They typically carry anywhere between 2-6 patients in the morning (they get to decide with the intake coordinator before a new patient is put on their roll), and then have outpatient evals in the afternoon.

I've seen only community hospitals have this setup though so it might be worth it to say this is what you want in your cover letter when looking at different community inpatient psych units in the area you want.

Alternatively, you can put yourself up on linkedin, practicelink, etc and have recruiters contact you about these positions. I feel like I get at least one recruitment email or message a day now that I'm actively searching for a job.

 

[Sushirolls]

An issue with these set ups is what happens in the afternoon. Patient XYZ wants discharged, nursing is requesting PQRS, new patient just arrived on unit and has issue MNOP that wasn't articulated well in the ED transfer notes?

Docs who are part of an actual medical group (i.e. not 1099, but same W2 employer) could drop the ball and push the work on to whoever was the last person with the hot potato, i.e. the person who starts their clinic at 3PM instead of 2PM is the person who gets dumped on.

My experience at the for profit hospitals, nursing staff intuitively flock to the nicer, responsible doctors who are there a little bit longer, "I know you are the doctor for patient XYZ, but....." and you will need to get very used to saying, no, I am not the doctor for this patient, page the doctor who is.

The doctors who looking to churn thru patients are more likely to be unscrupulous in their attempts to further dump their work on others.

Personally, I got tired of doing clean for other members of the work - which costs me wRVUs - to facilitate their going to clinic. Or continually watching poor care happen right before my eyes because the other doctor simply wasn't there.

So glad I'm not doing inpatient anymore. So glad.

 

[Sushirolls]

I wish we had a more flexible system. One that was more conducive to allowing a doctor open their own inpatient unit, similar to other foreign countries. I.e. I would consider having my own 4-8 bed unit, with adjacent ECT suite and TMS suites, attached offices. One that can be more readily managed by 2 docs. However, governments laws favor the creation of these large conglomerates - like a UHS.

 

[clausewitz2]

I wish we had a more flexible system. One that was more conducive to allowing a doctor open their own inpatient unit, similar to other foreign countries. I.e. I would consider having my own 4-8 bed unit, with adjacent ECT suite and TMS suites, attached offices. One that can be more readily managed by 2 docs. However, governments laws favor the creation of these large conglomerates - like a UHS.

And that's how we got insurance to pay for trap houses private unlocked short stay residential ketamine clinics.

 

[robellis]

I've interviewed for several jobs with this type of structures and know of several of my colleauges who have setups like this. They typically carry anywhere between 2-6 patients in the morning (they get to decide with the intake coordinator before a new patient is put on their roll), and then have outpatient evals in the afternoon.

I've seen only community hospitals have this setup though so it might be worth it to say this is what you want in your cover letter when looking at different community inpatient psych units in the area you want.

Alternatively, you can put yourself up on linkedin, practicelink, etc and have recruiters contact you about these positions. I feel like I get at least one recruitment email or message a day now that I'm actively searching for a job.

You’re not gonna make the OPs desired 700k seeing 2-6 patient in the morning lol

 

[michaelrack]

in the old days hard working psychiatrists made 750k. Now you got to work hard to make 500k (I don't work this hard)

 

[robellis]

in the old days hard working psychiatrists made 750k. Now you got to work hard to make 500k (I don't work this hard)

What changed? Didn’t reimbursement get better?

 

[Psychresy]

Doesn't @Shufflin work hard doing inpatient psych and make well over 500k?

 

[clausewitz2]

Doesn't @Shufflin work hard doing inpatient psych and make well over 500k?

The fact that they are very deliberate about not disclosing exactly what setting they do this in should tell you that that sort of position is something of a rare commodity.

 

[jbomba]

in the old days hard working psychiatrists made 750k. Now you got to work hard to make 500k (I don't work this hard)

If we're talking 275-300 for an inpatient job and the ability to leave whenever you're finished, I would imagine a "hard working" (or shortcut taking) psychiatrist could round on 2 or likely even 3 units. How would this no longer translate to 600-900?

 

[michaelrack]

Those working multiple inpatient units are generally independent contractors, and stipends/reimbursement per patient have dropped

 

[AD04]

Alternatively, you can put yourself up on linkedin, practicelink, etc and have recruiters contact you about these positions. I feel like I get at least one recruitment email or message a day now that I'm actively searching for a job.

Didn't you just start a job? Why are you jumping ship already?

Doesn't @Shufflin work hard doing inpatient psych and make well over 500k?

He makes more than that. CA has inflated payments as COL is inflated. Possibly he's aggressive with billing codes on top of that.

If we're talking 275-300 for an inpatient job and the ability to leave whenever you're finished, I would imagine a "hard working" (or shortcut taking) psychiatrist could round on 2 or likely even 3 units. How would this no longer translate to 600-900?

It's doable. One of my attendings when I was a resident makes in your range, working multiple hospitals, working 7 days / week -- full days. Residents were the workhorses and generated the bulk of her income. It's a pretty sweet setup.

Personally, I got tired of doing clean for other members of the work - which costs me wRVUs - to facilitate their going to clinic. Or continually watching poor care happen right before my eyes because the other doctor simply wasn't there.

That's horrible. I don't mind covering for my partners as I get paid for my work.

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To this day, I'm still wonder at how phorensic generated the numbers he did. Or was it all made up?

 

[robellis]

Didn't you just start a job? Why are you jumping ship already?



He makes more than that. CA has inflated payments as COL is inflated. Possibly he's aggressive with billing codes on top of that.



It's doable. One of my attendings when I was a resident makes in your range, working multiple hospitals, working 7 days / week -- full days. Residents were the workhorses and generated the bulk of her income. It's a pretty sweet setup.



That's horrible. I don't mind covering for my partners as I get paid for my work.

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To this day, I'm still wonder at how phorensic generated the numbers he did. Or was it all made up?

Phorensic would see 80-100 patients per day at times and was making supposedly 100k+ per month, he also supervised NPs in different states I believe

 

[Stagg737]

You also should consider professional satisfaction as part of the equation. Ripping through 3 inpatient admissions, two discharges, several acute issues and then 12 follow-ups plus care coordination and then racing out to a double-booking 15-min "med check" practice could be lucrative but sounds intensely stressful. I would also feel bad about the garbage quality of care I would need to provide in order to keep that all within roughly the bounds of a 9-5 job (I have a hard time imaging high-quality care for 20 acute inpatients occuring between 8-noon). It is hard to imagine sticking with it for long.

Yea, it's a recipe for burnout. It sounds much easier on paper than in reality. If you're single with no ties, more power to you. But it's grind. And no matter how "efficient" (lol) you think you are, reality is you're providing ****ty care and seeing most people for < 1-3 min/day. Adverse outcomes will catch up to you.

@Psychresy , agree with above. I'd consider it for a couple years if I could have an inpatient cap of 10-12 and was trying to build my own PP from scratch in the afternoons as it would take a while to get a consistently full schedule. The idea of doing a full 15-20 inpt load in the morning, then going to see 12-15+ outpatients in the afternoon would be very stressful. The big issue is how the inpatient unit is covered after you walk out the doors and having to take calls between patients in the afternoon. The couple of docs I know who have set ups like this all do a fair amount of charting after they go home, no thanks.

It would be more feasible if you could find an inpt position at a non-acute facility (most patients staying >30 days) where you rarely get calls after you leave, but on most acute units that's not going to be the case.

It's doable. One of my attendings when I was a resident makes in your range, working multiple hospitals, working 7 days / week -- full days. Residents were the workhorses and generated the bulk of her income. It's a pretty sweet setup.

This caveat can make a huge difference, imo. One of the docs I rotated with in med school would have us see patients and write the core symptoms directly into his note, which he would then go in and edit when he saw the patients. Made things much more efficient for him and capable of hitting those really high income numbers.

 

[Psychferlyfe3000]

Phorensic would see 80-100 patients per day at times and was making supposedly 100k+ per month, he also supervised NPs in different states I believe

Ummm, how was he able to take on that risk and continue practicing? That sounds disastrous!

 

[nexus73]

Ummm, how was he able to take on that risk and continue practicing? That sounds disastrous!

Well psych is the least likely specialty to get sued. I'd assume you'd need the right system with hospital units really being run by the social workers and you're just dropping in to "manage meds", but not running the team (which really isn't how it should be but anyways). And probably have reasonable discharge options direct to mental health clinics with psych and therapy within 7 days, so if something goes wrong in a month the liability will have been transferred to the outpatient team.

 

[Sushirolls]

Well psych is the least likely specialty to get sued. I'd assume you'd need the right system with hospital units really being run by the social workers and you're just dropping in to "manage meds", but not running the team (which really isn't how it should be but anyways). And probably have reasonable discharge options direct to mental health clinics with psych and therapy within 7 days, so if something goes wrong in a month the liability will have been transferred to the outpatient team.

LOL. I wonder if this even exists anywhere?

 

[Psychresy]

As a new grad, do I just call human resources (?) at various hospitals and ask them if they have an opening for someone who can round on their units?

 

[comp1]

As a new grad, do I just call human resources (?) at various hospitals and ask them if they have an opening for someone who can round on their units?

Psych hospitals generally have websites that have who to contact. My bet is no matther where you are...they have openings.

 

[michaelrack]

They have openings for doctors to round on patients and bill themselves...
Some have employed positions available

 

[clozareal]

Didn't you just start a job? Why are you jumping ship already?

No, I'm still in CAP fellowship but I am moonlighting for outpatient and inpatient.

 

[Stagg737]

LOL. I wonder if this even exists anywhere?

It does, and I rotated through it in med school. Kind of incredible how much more control over churn there was when secure dispo could easily be achieved.

 

[Psychferlyfe3000]

LOL. I wonder if this even exists anywhere?

I have seen this setup as well actually, but it was a unit with patients with high socioeconomic status largely, which created its own different set of problems.

 

[psyduck1990]

I round on roughly 20 inpatients per day, but it takes me at least 5 hours to see everyone in person, then another 5 to get all the orders, notes, and care coordination done. No way would I do this if I also had outpatients in the afternoons. It's a hospitalist job too so I have a good amount of (needed) time off to recharge between shift blocks.

 

[Marasmus1]

I know an attending who manages 2 full time inpatient jobs at HCA Hospitals + running private practice 2 times a week. I don`t know how much he makes but I know he drives ferrari and his house is probably worth around a couple of million if not more. He had volunteers, externs and nursing students do his notes ( one of the inpatient unit was paper chart) to save time. He tends to round around 10 pm in one of these units and generally done by 11 pm. He starts his days around 1 pm though except the days he does private practice. I know he does not work on weekends.

 

[psych_0]

I know an attending who manages 2 full time inpatient jobs at HCA Hospitals + running private practice 2 times a week. I don`t know how much he makes but I know he drives ferrari and his house is probably worth around a couple of million if not more. He had volunteers, externs and nursing students do his notes ( one of the inpatient unit was paper chart) to save time. He tends to round around 10 pm in one of these units and generally done by 11 pm. He starts his days around 1 pm though except the days he does private practice. I know he does not work on weekends.

This is nuts if real and not just a troll. I know you're obviously not going to say what city he works in but what general area is this in? Small city in the middle of no where? Only place I've heard of this happening consistently is Miami, but that was a while back.

 

[Marasmus1]

One of the major urban areas of the US. I was quite surprised as well. I don`t think he is doing anything illegal (the ethics part of it is whole different discussion). The patient care provided in one of these hospitals is bad but definitely not worse than many hospitals I have seen.

Where he works, an average full time adult psychiatrist makes around 230k. So it is very likely that he is pulling around 600k working somewhere around 50 hours a week. OP asked for inpatient mornings and outpatient afternoons. This is the standard for 50% psychiatrists I know. This attending`s situation is uncommon but not unheard of and quite doable with a little bit of extra work.

 

[Splenda88]

This is nuts if real and not just a troll. I know you're obviously not going to say what city he works in but what general area is this in? Small city in the middle of no where? Only place I've heard of this happening consistently is Miami, but that was a while back.

I was gonna say the same thing. I know one psych doc who works like that in south FL (45 minutes outside of Miami).
.
I think IM/FM/psych docs can make 400k+ without killing themselves. As a IM doc who just graduated, I should be able to make that working ~50 hrs/wk

 

[Psychresy]

One of the major urban areas of the US. I was quite surprised as well. I don`t think he is doing anything illegal (the ethics part of it is whole different discussion). The patient care provided in one of these hospitals is bad but definitely not worse than many hospitals I have seen.

Where he works, an average full time adult psychiatrist makes around 230k. So it is very likely that he is pulling around 600k working somewhere around 50 hours a week. OP asked for inpatient mornings and outpatient afternoons. This is the standard for 50% psychiatrists I know. This attending`s situation is uncommon but not unheard of and quite doable with a little bit of extra work.

I guess it depends how many patients hes rounding on at each hospital. 12-16 at each doesn't seem that crazy... esp considering they are only doing pp two days a week.

 

[Ellomate]

For those that leave in the early afternoon after finishing with rounds & notes, are these employeed doc or contractors/locum docs?
How likely it is for am employer/hospital to ask (or make) the doc stay until 5pm.
What is the norm out there?

 

[psych_0]

Employed. No one can "make" you stay. That is resident speak. As an attending they are lucky to have you employed and will do what it takes to keep you unless you are a huge @$shole or do things that are completely egregious. I know 0 inpatient doctors who stay past 2pm.

Now if you choose to slave away at the VA then yea, they may expect you to stay logged into Skype until 5pm every day. But that's your choice to work at the VA. It is far from the norm in the inpatient world.