Inpatient psych call rate

[Asklepian]

Working at a 16 bed inpatient psych unit. Call is based on 12-hour units (7a-7p and 7p-7a). Currently paid at $150/12 hours. We take admissions 24 hours a day and have pretty high turnover (sometimes 6 discharges in one day) which leads to often 3-6 or more calls per overnight. Overnight calls are mostly patients being presented for possible admission and take several minutes but a few calls coming from on the unit re: existing patients. A lot more communication from unit staff during day call.

I am wondering what rates people are seeing/think are reasonable with this in mind?

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[psych_0]

As a resident, we got paid $200/night for the exact thing you are describing. But this was in-house moonlighting.

 

[comp1]

Eh, it's not horrible. It's not something I'd be actively seeking out, however. Seems a lot more appropriate for a resident moonlighter than an attending, however.

 

[FlowRate]

It's more than what we get paid to take UM/lite CL home call overnight and probably proportionally busier, on average, as well.

Edit: Thought you meant $150/hr for 12 hours. We get about $600 for light overnight call (typically 0-2 short/easy calls but can theoretically be much more.)

 

[Stagg737]

Eh, it's not horrible. It's not something I'd be actively seeking out, however. Seems a lot more appropriate for a resident moonlighter than an attending, however.

Disagree. For 12 hours of overnight call where you're getting 5+ calls per shift, $150 is awful. That's $12.50/hr. Academic unit associated with our hospital pays attendings $300/night and from talking to attendings they might get 2-4 calls per night, and that's still not enough for me to consider picking up those call shifts as an attending.

"Reasonable" rates will depend on the actual work. How many calls are coming in between 10pm-5am? Do they batch them? Can you decrease those calls by making sure everyone has PRNs in at 9pm and telling staff no prns for sleep after midnight? If this position is take calls until 10pm and then almost never get called, then fine I guess. If you're actually being woken up to screen admits and place orders multiple times overnight, I probably wouldn't touch this for less than $500/night.

 

[Bartelby]

I agree with Stagg. At those rates does anyone actually *want* to take these shifts, or are you voluntold to take them? I can't imagine wanting to give up quality sleep and manage acute issues/admissions overnight for $150. There are so many better ways to make money if that's the goal.

 

[hebel]

Per night or per hour? I still wouldn't even do this for $150 per hour unless the nighttime was super slow.

 

[Stagg737]

Per night or per hour? I still wouldn't even do this for $150 per hour unless the nighttime was super slow.

I'd take $150/hr for home call overnight in a second unless I was going to be up all night. That would be $1800/night for the above, and that's more than what some people make covering inpatient units during the day on weekend shifts....

OP said $150/shift, which is something I didn't even accept as a resident.

 

[Merovinge]

You are giving up your health/years off your life taking calls every 1-2 hours over night for $150. Seems actively preposterous to me as an attending, I wouldn't have even taken those rates as a resident.

 

[hebel]

I'd take $150/hr for home call overnight in a second unless I was going to be up all night. That would be $1800/night for the above, and that's more than what some people make covering inpatient units during the day on weekend shifts....

OP said $150/shift, which is something I didn't even accept as a resident.

I misinterpreted the OP. Them mentioning multiple admissions overnight made me assume there was some in person involvement.

That rate is still definitely not being woken up for.

 

[kelminak]

Legit laughed out loud when I realized it was $150 the whole night. Your health is so much more important than that.

 

[Orgone]

Count me in as one more who read it as 150/hr and still thought nope, not worth it. Insulting and/or laughable for the whole night.

 

[Asklepian]

Yes, it is $150 for the WHOLE NIGHT.

"Reasonable" rates will depend on the actual work. How many calls are coming in between 10pm-5am? Do they batch them? Can you decrease those calls by making sure everyone has PRNs in at 9pm and telling staff no prns for sleep after midnight? If this position is take calls until 10pm and then almost never get called, then fine I guess. If you're actually being woken up to screen admits and place orders multiple times overnight, I probably wouldn't touch this for less than $500/night.

Calls overnight are not typically batched. They are probably 1:10 ratio of the unit calling vs. having cases presented for possible admissions. You are being woken up to screen admits several times per night unless you get the rare night that the unit somehow has no discharges. And it's a high turnover unit so typically 3-6 discharges per day which means at least as many calls overnight, and maybe more as not all patients are accepted as appropriate for the unit.

$12.50/hour to be woken up several times per night, especially several nights in a row feels absolutely insulting to me, and I do not pick up any shifts above what is in my contract as bare minimum. They have to pay out locum docs an exorbitant rate so I am trying to reach a compromise so that those of us on staff will be willing to pick them up.

I am trying to find a fair rate with that in mind.

 

[soundnin]

Yes, it is $150 for the WHOLE NIGHT.


Calls overnight are not typically batched. They are probably 1:10 ratio of the unit calling vs. having cases presented for possible admissions. You are being woken up to screen admits several times per night unless you get the rare night that the unit somehow has no discharges. And it's a high turnover unit so typically 3-6 discharges per day which means at least as many calls overnight, and maybe more as not all patients are accepted as appropriate for the unit.

$12.50/hour to be woken up several times per night, especially several nights in a row feels absolutely insulting to me, and I do not pick up any shifts above what is in my contract as bare minimum. They have to pay out locum docs an exorbitant rate so I am trying to reach a compromise so that those of us on staff will be willing to pick them up.

I am trying to find a fair rate with that in mind.

What's the exorbitant rate they are paying locums? They should start there because it sounds atypical to do so much work overnight. If it's auto-admit that's one thing but to expect to do multiple safe discharges every night, you're basically working an ED shift overnight while managing the unit.

 

[shoenberg3]

Even as a resident, this sounds ludicrous. I'd imagine that when I become an attending, I would not even bother being woken up even ONCE a night for 150 dollars.

 

[Stagg737]

Per night or per hour? I still wouldn't even do this for $150 per hour unless the nighttime was super slow.

I'd take $150/hr for home call overnight in a second unless I was going to be up all night. That would be $1800/night for the above, and that's more than what some people make covering inpatient units during the day on weekend shifts...

Yes, it is $150 for the WHOLE NIGHT.


Calls overnight are not typically batched. They are probably 1:10 ratio of the unit calling vs. having cases presented for possible admissions. You are being woken up to screen admits several times per night unless you get the rare night that the unit somehow has no discharges. And it's a high turnover unit so typically 3-6 discharges per day which means at least as many calls overnight, and maybe more as not all patients are accepted as appropriate for the unit.

$12.50/hour to be woken up several times per night, especially several nights in a row feels absolutely insulting to me, and I do not pick up any shifts above what is in my contract as bare minimum. They have to pay out locum docs an exorbitant rate so I am trying to reach a compromise so that those of us on staff will be willing to pick them up.

I am trying to find a fair rate with that in mind.

It's an embarrassment that they'd even suggest that and it should be a huge red flag. Like I said, our academic center's unit pays double that for half the calls or less. I wouldn't even entertain discussions here for less than $500/night. How often are they wanting you to cover?

 

[Asklepian]

How often are they wanting you to cover?

At least q4

 

[mistafab]

I would not touch answering a phone overnight for less than $500.

Even then I wouldn’t touch it, but I’ve at least been offered that.

 

[Candidate2017]

$12.50/hour to be woken up several times per night, especially several nights in a row feels absolutely insulting to me, and I do not pick up any shifts above what is in my contract as bare minimum. They have to pay out locum docs an exorbitant A FAIR rate so I am trying to reach a compromise GET PAID FAIRLY TOO so that those of us on staff will be willing to pick them up.

I am trying to find ALREADY KNOW, BASED ON LOCUMS, a fair rate with that in mind.

 

[Merovinge]

Whoa Fair Market Rate is Fair!? Excellent post by Candidate2017.

 

[clozareal]

Who is setting that rate? Is it an MD/DO? This is the problem with admins who aren't physicians. They really devalue our time in the name of profit for themselves. That's below minimum wage in my area.

 

[Asklepian]

Whoa Fair Market Rate is Fair!? Excellent post by Candidate2017.

There is no shot they will do close to the locum rates. They are also nearly impossible to replicate because of the way they're structured which doesn't apply here.

Who is setting that rate? Is it an MD/DO? This is the problem with admins who aren't physicians. They really devalue our time in the name of profit for themselves. That's below minimum wage in my area.

I am not sure who initially set this rate. It has been like this for some time and none of the shifts get picked up and then they wonder why they have to pay locum docs. The current rate is entirely unsustainable and even double that wouldn't make me consider doing it tbh. I am just trying to get an idea of rates other people are seeing for overnight workloads so I can compare and figure something out.

Feeling like $600 for 7p-7a is probably reasonable but even that feels low deep down when you're up several times a night.

 

[aspiringdoc09]

A company I moonlight for pays $400/night and made it sound like there were little to no calls. That was completely inaccurate. I told them I wouldn't cover the unit with the call attached anymore due to multiple night-time awakenings. It's a poor rate and not worth the headache.

 

[ObsequiousAplomb]

There is no shot they will do close to the locum rates. They are also nearly impossible to replicate because of the way they're structured which doesn't apply here.



I am not sure who initially set this rate. It has been like this for some time and none of the shifts get picked up and then they wonder why they have to pay locum docs. The current rate is entirely unsustainable and even double that wouldn't make me consider doing it tbh. I am just trying to get an idea of rates other people are seeing for overnight workloads so I can compare and figure something out.

Feeling like $600 for 7p-7a is probably reasonable but even that feels low deep down when you're up several times a night.

We have had a number of similar posts on this forum. These come up in anesthesia forum a lot too. They always seem suspicious, because the OP asks what the fair rate is, they get told a number, then the OP spends the rest of the thread defending the abusive employer and saying they think they will ask for a rate lower than what every single post in the thread says.

These posts tend to read a lot like administrators justifying poor rates. They don't tend to sound like doctors who are making rational career decisions. What are your thoughts on that?

 

[Asklepian]

We have had a number of similar posts on this forum. These come up in anesthesia forum a lot too. They always seem suspicious, because the OP asks what the fair rate is, they get told a number, then the OP spends the rest of the thread defending the abusive employer and saying they think they will ask for a rate lower than what every single post in the thread says.

These posts tend to read a lot like administrators justifying poor rates. They don't tend to sound like doctors who are making rational career decisions. What are your thoughts on that?

I think it's pretty clear if you actually read the entirety of my posts that I'm a) not pleased with the current rate and b) not defending the employer. However, the locum rates are not something that I think nearly any hospital would agree to on a long-term basis.

With that in mind, what I am doing is trying to find something that is reasonable (meaning likely attainable to improve QOL for the providers who will be subject to this agreement, including myself).

This information is not readily available, and I figured SDN would be probably the best place to crowdsource.

I've been a SDN member since I've been a Pre-Med and have a post history dating as long, so the conspiracy theory is a bit imaginative. If you have anything useful to contribute though, feel free.

 

[Asklepian]

A company I moonlight for pays $400/night and made it sound like there were little to no calls. That was completely inaccurate. I told them I wouldn't cover the unit with the call attached anymore due to multiple night-time awakenings. It's a poor rate and not worth the headache.

Thanks, that's helpful to know that even DOUBLE our current rate wouldn't attract you for a fraction of the phone calls. I wish there were a more accessible repository for this information so that we could all help one another negotiate these waters better.

 

[Stagg737]

There is no shot they will do close to the locum rates. They are also nearly impossible to replicate because of the way they're structured which doesn't apply here.



I am not sure who initially set this rate. It has been like this for some time and none of the shifts get picked up and then they wonder why they have to pay locum docs. The current rate is entirely unsustainable and even double that wouldn't make me consider doing it tbh. I am just trying to get an idea of rates other people are seeing for overnight workloads so I can compare and figure something out.

Feeling like $600 for 7p-7a is probably reasonable but even that feels low deep down when you're up several times a night.

If you're legit waking up multiple times overnight to put in orders, then I still probably wouldn't touch it at $600/night. If this is a hospital you regularly work at during the day and could potentially train night staff to minimize calls (no new PRNs after 10pm, batch admissions calls, etc) to limit being woken up overnight, then it could be worth negotiating. I might consider it if I was rarely woken up more than twice a night. If that can't happen, I'd tell them good luck with locums.

 

[ObsequiousAplomb]

I think it's pretty clear if you actually read the entirety of my posts that I'm a) not pleased with the current rate and b) not defending the employer. However, the locum rates are not something that I think nearly any hospital would agree to on a long-term basis.

With that in mind, what I am doing is trying to find something that is reasonable (meaning likely attainable to improve QOL for the providers who will be subject to this agreement, including myself).

This information is not readily available, and I figured SDN would be probably the best place to crowdsource.

I've been a SDN member since I've been a Pre-Med and have a post history dating as long, so the conspiracy theory is a bit imaginative. If you have anything useful to contribute though, feel free.

You are a legitimate poster. I believe you. I never said you were a shill. I said that what you're writing sounds like someone who sounds like a shill. Interesting that you went conspiratorial. I was hinting at a martyr complex, given the repeated desire to work at a lower rate than your peers. I don't believe that you're doing yourself any service by pretending that the amount doctors are paid by a third party is somehow unreasonable. If you just ask for what the locums doctors are getting, then you're still saving the hospital 30-50% by cutting out the middle man.

Hospitals CAN AND SHOULD afford to shell out thousands of dollars to cover every shift. If they have somehow manipulated you into thinking otherwise, I'm sorry. Please at least try to pick a number that someone in this thread said, instead of a number so low that it offends everyone here.

If you have something useful to add, please do. You haven't yet.

 

[brazilianpsych]

This type of posts make me low key regret going into psych. I wonder if anyone is even considering offering $150/night for a cardiologist or something like that. Wild. I would start a practice right away after hearing that offer and quit as soon as possible, based on principle.

 

[Merovinge]

This type of posts make me low key regret going into psych. I wonder if anyone is even considering offering $150/night for a cardiologist or something like that. Wild. I would start a practice right away after hearing that offer and quit as soon as possible, based on principle.

This is an atypical setup. It's rare to field 3-6 calls/night for $150 including staffing decisions on admission/discharge. Most docs are making several hundred to a thousand percent more for that type of coverage.

 

[clozareal]

I would do base $500/night and then $150 per call for admit. That way I don't feel so resentful for each call.

 

[SmallBird]

I love to complain about pay (and had renewed frustration this week when an attorney quoted $425/hour for some will related paperwork!) but I've been an inpatient doc for everyday since leaving fellowship and I've never gotten paid very much for being 'on call' this way. I agree waking up sucks, but when I was getting $400/night for this, it was probably about 8-10 minutes of work total. The nurse would call, we would go over some basics, they take a telephone order for the admit orders. The next day I'd see the patient most likely.

 

[Stagg737]

I would do base $500/night and then $150 per call for admit. That way I don't feel so resentful for each call.

Idk that it would work, but a per admit call rate would also incentivize batching of calls and make an overnight shift more reasonable. Honestly, you could even try and get the hospital to not accept overnight admits. I work mostly out of an ER and unless they're going to our own psych unit, it is exceptionally rare for an outside psych hospital/unit to accept a patient overnight. I know at least 2 hospitals in my area where the overnight docs don't review any admits until the next morning. I wonder if there's some reason OP's unit couldn't do the same.

 

[clozareal]

Idk that it would work, but a per admit call rate would also incentivize batching of calls and make an overnight shift more reasonable. Honestly, you could even try and get the hospital to not accept overnight admits. I work mostly out of an ER and unless they're going to our own psych unit, it is exceptionally rare for an outside psych hospital/unit to accept a patient overnight. I know at least 2 hospitals in my area where the overnight docs don't review any admits until the next morning. I wonder if there's some reason OP's unit couldn't do the same.

The ED hates this. They get docked on how long a patient stays there. I don't think they're doing a full intake with these calls, just to be aware of it and to place orders (the nurses will sometimes do this), but there are acute issues that pop up right when the patient hits the floor such as acute agitation, etc that would be annoying to handle overnight.

Why wouldn't it work?

 

[Stagg737]

The ED hates this. They get docked on how long a patient stays there. I don't think they're doing a full intake with these calls, just to be aware of it and to place orders (the nurses will sometimes do this), but there are acute issues that pop up right when the patient hits the floor such as acute agitation, etc that would be annoying to handle overnight.

Why wouldn't it work?

Yes, the ER hates it, it depends on if the OP's unit is connected to a medical hospital with an ER or is free standing though. Like I said, I'm mainly in the ER and it's the exception when a patient gets accepted to any other hospital in the city other than ours overnight. However, the ER has no control whatsoever as to whether other psych hospitals accept a patient, especially overnight. It sucks for us in the ER, but psych hospitals have no obligation to review outside patients in a timely manner, so it's common for our patients to sit in the ER overnight just waiting for psych units to even review the charts.

 

[Asklepian]

You are a legitimate poster. I believe you. I never said you were a shill. I said that what you're writing sounds like someone who sounds like a shill. Interesting that you went conspiratorial. I was hinting at a martyr complex, given the repeated desire to work at a lower rate than your peers. I don't believe that you're doing yourself any service by pretending that the amount doctors are paid by a third party is somehow unreasonable. If you just ask for what the locums doctors are getting, then you're still saving the hospital 30-50% by cutting out the middle man.

Hospitals CAN AND SHOULD afford to shell out thousands of dollars to cover every shift. If they have somehow manipulated you into thinking otherwise, I'm sorry. Please at least try to pick a number that someone in this thread said, instead of a number so low that it offends everyone here.

If you have something useful to add, please do. You haven't yet.

You must be fun at parties.
Seriously though, your armchair pontification is not helpful nor accurate. I will not be responding to any further ad hominems.

Where I do agree is that hospitals should pay us fairly. I know exactly what the locum docs make and it is not something realistic to ask for. It's nice to get on here and vent and scream that we deserve thousands of dollars per night, but it's another thing to work in the real world with hospital administrators and find something that is practical and achievable to improve the lives of ourselves and our colleagues.

Idk that it would work, but a per admit call rate would also incentivize batching of calls and make an overnight shift more reasonable. Honestly, you could even try and get the hospital to not accept overnight admits. I work mostly out of an ER and unless they're going to our own psych unit, it is exceptionally rare for an outside psych hospital/unit to accept a patient overnight. I know at least 2 hospitals in my area where the overnight docs don't review any admits until the next morning. I wonder if there's some reason OP's unit couldn't do the same.

Batching of calls is not really possible in this system. The good news is I don't have to get up and put in orders as I can verbal these. So, overnight I shouldn't have to touch a computer unless I want to dig in the chart for some particular reason prior to admission. The bad news is that it is still several calls that last several minutes each and it's not always possible to instantly fall back asleep on each of 6 overnight calls.

I would do base $500/night and then $150 per call for admit. That way I don't feel so resentful for each call.

I like this conceptually, but I'm unsure how easy it would be to implement. It might be worth at least broaching this idea.

I love to complain about pay (and had renewed frustration this week when an attorney quoted $425/hour for some will related paperwork!) but I've been an inpatient doc for everyday since leaving fellowship and I've never gotten paid very much for being 'on call' this way. I agree waking up sucks, but when I was getting $400/night for this, it was probably about 8-10 minutes of work total. The nurse would call, we would go over some basics, they take a telephone order for the admit orders. The next day I'd see the patient most likely.

This is similar to my model with nurse call - review the patient - telephone orders. I don't have to login or place orders myself.

 

[mistafab]

I tell recruiters/CEOs for inpatient “no” to any mention of night call, night work, lol. It’s like I spoke an alien language to folks sometimes with their reactions.

Often they get flustered but most are willing to drop night call completely. In the end, do they want high turnover in the job or not? They can pay a single NP to cover the whole floor / hospital overnight and that would help them retain physicians as well as save on night costs to locums folks.

That IS the sustainable, realistic model. That IS what np’s are able to do. $500 to locums at 365 days a year is 182k, for which they could completely staff a NP to hold a phone. They can put in a verbal order for míralax at 3am. They can put skeleton orders at 4am for a patient I will see at 7.

These hospital shills are penny smart, dollar dumb. And they wonder why we scoff at those jobs.

 

[Stagg737]

Batching of calls is not really possible in this system. The good news is I don't have to get up and put in orders as I can verbal these. So, overnight I shouldn't have to touch a computer unless I want to dig in the chart for some particular reason prior to admission. The bad news is that it is still several calls that last several minutes each and it's not always possible to instantly fall back asleep on each of 6 overnight calls.

Why? Because admins say so? Is the psych hospital associated with an ER that demands immediate responses? I'm genuinely curious as this sounds like this is not a "can't be done" thing, it's that someone else "won't" adjust to make this happen. Either way, this shouldn't matter. There is no legal reason why admits cannot be batched. There should be no reason why you can't call at 11pm and have them batch calls at 2:30 or do 2 batches at 1am and 4am if they want more frequency.

Again, if they're paying locums so exorbitantly that it's not sustainable then you have a major advantage. You said "thousands per night", so if they're paying locums at least $2,000 per night then there is no good reason they cannot pay you half that or significantly change overnight call policy to make it reasonable.

 

[J ROD]

It depends for me. Used to have an understanding between 12 AM and 6 AM calls should be limited to emergency. Staff admits before and after. Something within this reason I would do for $300 a night. For half a dozen calls or so. Now, if they waking me up every couple of hours., double it and I would not be doing it often.

 

[calvnandhobbs68]

It depends for me. Used to have an understanding between 12 AM and 6 AM calls should be limited to emergency. Staff admits before and after. Something within this reason I would do for $300 a night. For half a dozen calls or so. Now, if they waking me up every couple of hours., double it and I would not be doing it often.

I still think this is totally not worth it. I always think about this stuff relative to other ways you’re making money, for close to or at 300 bucks I can see a couple outpatients and never have to worry about being woken up at all overnight.

I think @mistafab idea is the actual good idea here. Basically hire a night NP to deal with this stuff and you likely still break even and don’t have to deal with the doctors bitching about it all the time or scrambling to find locums. I absolutely think you could find people to take that deal, basically don’t have to have a day job and answer phone calls over night for some psych floor RN who is now an NP.

 

[J ROD]

Yeah I agree hiring the NP at night is a good idea as they could admit from ED and discharge. Handle unit issues. Basically, what I did as a resident overnight. So far out of training, I never had a place that admitted overnight. We just had to field unit issues or a rare medical floor issue. I did not mind that at night.

 

[michaelrack]

A psych hospital that I used to work at, and still have privileges at; has psych NP's do call at night for the child and adolescent wards. The NP's accept admissions/referrals and take care of minor problems on the unit. There is a psychiatrist on call (unpaid) at the same time who is rarely called. The psychiatrist gets the patients the NP admitted overnight. The big disadvantage of the system is that the psychiatrist may get some patients he does not desire, but with EMTALA it's not like there is much choice anyway.

 

[TheRightMedication]

The advantage of the administration not valuing call is that if you tell them you're not taking call anymore, the pay cut is small. That was my experience, anyways.

 

[Mad Jack]

I got paid $640 for overnights like that in the past. Unfortunately two of them a month are currently folded into my current job, but that's a whole annoying story that would be too specific to get into on here

 

[Merovinge]

A psych hospital that I used to work at, and still have privileges at; has psych NP's do call at night for the child and adolescent wards. The NP's accept admissions/referrals and take care of minor problems on the unit. There is a psychiatrist on call (unpaid) at the same time who is rarely called. The psychiatrist gets the patients the NP admitted overnight. The big disadvantage of the system is that the psychiatrist may get some patients he does not desire, but with EMTALA it's not like there is much choice anyway.

I really didn't have problems with that when I worked IP. Most kids are not medically unstable and if they are, you get them transferred ASAP when you see them the next morning (I think this happened once in a year at a high volume IP hospital). If the admission was on the light end, LOS is so short anyway that it's hardly a huge issue holding them for a few days then discharging and trying to find something positive to take from that time. I'd much rather deal with that then get called at night, if I was ever to work IP again it would only be in a setting where I was not taking call. It's just not worth the years off your life and the bothering of your significant other to be woken up every 1-2 hours at night for the amount any administrator wants to pay you.

 

[Stagg737]

I still think this is totally not worth it. I always think about this stuff relative to other ways you’re making money, for close to or at 300 bucks I can see a couple outpatients and never have to worry about being woken up at all overnight.

I think @mistafab idea is the actual good idea here. Basically hire a night NP to deal with this stuff and you likely still break even and don’t have to deal with the doctors bitching about it all the time or scrambling to find locums. I absolutely think you could find people to take that deal, basically don’t have to have a day job and answer phone calls over night for some psych floor RN who is now an NP.

Biggest potential problem there eis getting a bad NP who accepts inappropriate patients. A guy died at one of the VAs my residency rotated through because the medical floor refused to accept him for medical detox (alcohol) and admins forced it to psych. I could absolutely see NPs (or just weak/bad psychiatrists) getting bullied by admin into accepting inappropriate patients.

 

[calvnandhobbs68]

Biggest potential problem there eis getting a bad NP who accepts inappropriate patients. A guy died at one of the VAs my residency rotated through because the medical floor refused to accept him for medical detox (alcohol) and admins forced it to psych. I could absolutely see NPs (or just weak/bad psychiatrists) getting bullied by admin into accepting inappropriate patients.

Yeah but I think that's just a function of the person. There's definitely lazy ass psychiatrists who will just admit anyone overnight too. Esp if it was a prior psych floor RN they should have a pretty decent idea of floor capabilities in terms of admissions (in fact the RNs are usually the ones who complain about accepting people with literally any medical problem lol).

 

[Therapist4Chnge]

It depends for me. Used to have an understanding between 12 AM and 6 AM calls should be limited to emergency. Staff admits before and after. Something within this reason I would do for $300 a night. For half a dozen calls or so. Now, if they waking me up every couple of hours., double it and I would not be doing it often.

You are far more understanding than I would be working with the economics of $300/night v. alternatives.

The NP coverage is probably the best compromise. Making administrative changes in a hospital system can be Herculean....or sometimes it can be really easy if the right people are on board. The ED impact would likely cause more internal political flareups, but administrators do far worse and force trash policies down through the ranks all of the time. After the initial grumbling, staff sucks it up. I'm not saying that is right, but that is the reality in 98% of places.

For an outside perspective, I don't consider any "extra" work that isn't at least $350/hr bc I value my time and flexibility above all else. Thankfully, it sounds like most folks on here are sensible about things. There is also consideration about how accepting low overnight pay can impact local and regional rates. It's not collusion to look at a trash rate and call it out; same for bad policies in any system.

 

[comp1]

NP coverage for overnight admissions and prn needs is absolutely excellent and I would recommend it to any system. It's a really appropriate use of NPs. Certainly for any system that isn't fee for service, like county, VA or an HMO, they can save many times their cost in unnecessary care over nights and weekends.

 

[Candidate2017]

Any of the above proposed solutions are quite effective and simple. Anyone with half a brain could come up with such solutions. And yet, why hasn't OP's institution arrived at any of these solutions, and would likely resist such solutions? Quite simply, OP's institution is dysfunctional.

With all things institutional, it's the power and the money that effects real change. While we do bring in money for The Man, it's not on the level of ortho, cards, etc. It's not institution-changing money. Ortho bro or cards wants new equipment to make their work flow better? Done. Psych wants to replace that workstation chair that smells funny and has weird stains? Keep waiting.

At the end of the day, the reality is no one cares about our opinion on how things should be done in psychiatry. Hospitals, admin, social workers, therapists, government, insurance, patients and public all highly value their opinion over ours (i.e., see the thread about no seclusion rooms). But none of these people have, or dare have, an opinion on which sutures or staples ortho bro should use.

It also takes two to tango in a dysfunctional relationship. While people have gotten divorced over less, OP will likely continue to throw up obstacles and provide resistance to getting out of this dysfunction, even though a better job is across the street.