Our inpatient unit has a couple of staffing problems. We're attached to a community hospital, with an adult psych unit and child psych unit. Our docs work a 7 on 7 off schedule and are on straight RVUs with no guaranteed salary (there is enough work this is not an issue).
One problem is on our child unit. We only have 2 doctors and 26 beds. The unit census can swing significantly depending on time of year (in general heavy through the school year Fall/Winter/Spring, light in the summer). It can get down to a low of 10, and up to a max of 26 on the psych unit, with boarded kids in the ED or in medical beds waiting admission to psych. It is expected psychiatrists consult on all the boarded patients. This means each child psychiatrist could be responsible for 13 on the unit plus off unit boarded patient consults. The child psychiatrists tell me the heavy days are not reasonable. I've tried proposing to admin that we need a patient cap, saying above a certain number of patients the doctors can't cover everyone adequately and there are concerns for safety and burnout. The child docs want a cap of 10 patients per day, and either cap the total unit at 20, or hire a half time doc or NP to cover the other beds (this was apparently the schedule a few years ago before I came on, but is now considered by hospital admin to be overstaffed). The discussion about setting a patient cap went no where. The issue is the unit average for the whole year is 16 patients per day, so each doctor on average, over the year, has 8 kids per day. The hospital admin is saying we need to staff to this average and accept there will be heavier days and lighter days. Has anyone been through a similar issue? Any suggestions? Is this just the way it is?
Another issue is the hospital wants the 7 day week to be 7 days of 12 hours each. So if a consult comes in at 6pm, they are expecting the on call psychiatrist to be in the hospital to see the patient. If a patient is transferred from an outside hospital and arrives at 6pm, they want the doc available to do the admission that day. This is interesting because being on straight wRVUs for pay, there is no reimbursement to stay in the hospital waiting until 7pm for more work. If a doc is finished at 5pm they leave, but the hospital admin is not happy about this. There is no on call pay. The administration does not understand why we object to this expectation. Our contracts do not stipulate a day requires you to remain in the hospital or even to come back to see consults. Our hospital bylaws allow up to 24 hours to see a consult, and 18 hours to admit a transferred patient, unless there is an urgent issue requiring us to actually see the patient face-to-face (which is fairly rare in psychiatry). If an urgent issue exists we do return to the hospital to see them, but most consults requested late in the day or at night can be safely pushed to the following morning.
I'm wondering about other's experiences with a 7 on 7 off schedule and being bound to the hospital for the full 12 hour day, or being obligated to return for consults that are requested within that 12 hours regardless of urgency. I'm running into issues as there are no psychiatrists in administration. There are internists, nurses, and MBAs, and they seem to look at inpatient psychiatry the same as surgery or internal medicine, where the patient issues are frequently much more life/death, and the hospital is actually staffed with doctors expected to routinely be available 24 hours a day for urgent/emergent issues. I've tried to explain that psychiatry is a completely different specialty with different patient care needs, and that we're not getting paid for the kind of availability they're wanting. Again, these conversations have not be very useful.
I think if they want the doctors to be this available they'd need to provide a fairly significant guaranteed base salary. The issue is none of the doctors are all that interested in getting paid more and doing more work. They want a good work-life balance.
Thanks in advance for any replies. I'm interested in any and all thoughts on these issues. If anyone has good resources for advice about running an inpatient psych service, or good professional organizations with psych physician leadership training conferences, videos, courses, or anything like that, I'm very interested in that too.
One problem is on our child unit. We only have 2 doctors and 26 beds. The unit census can swing significantly depending on time of year (in general heavy through the school year Fall/Winter/Spring, light in the summer). It can get down to a low of 10, and up to a max of 26 on the psych unit, with boarded kids in the ED or in medical beds waiting admission to psych. It is expected psychiatrists consult on all the boarded patients. This means each child psychiatrist could be responsible for 13 on the unit plus off unit boarded patient consults. The child psychiatrists tell me the heavy days are not reasonable. I've tried proposing to admin that we need a patient cap, saying above a certain number of patients the doctors can't cover everyone adequately and there are concerns for safety and burnout. The child docs want a cap of 10 patients per day, and either cap the total unit at 20, or hire a half time doc or NP to cover the other beds (this was apparently the schedule a few years ago before I came on, but is now considered by hospital admin to be overstaffed). The discussion about setting a patient cap went no where. The issue is the unit average for the whole year is 16 patients per day, so each doctor on average, over the year, has 8 kids per day. The hospital admin is saying we need to staff to this average and accept there will be heavier days and lighter days. Has anyone been through a similar issue? Any suggestions? Is this just the way it is?
Another issue is the hospital wants the 7 day week to be 7 days of 12 hours each. So if a consult comes in at 6pm, they are expecting the on call psychiatrist to be in the hospital to see the patient. If a patient is transferred from an outside hospital and arrives at 6pm, they want the doc available to do the admission that day. This is interesting because being on straight wRVUs for pay, there is no reimbursement to stay in the hospital waiting until 7pm for more work. If a doc is finished at 5pm they leave, but the hospital admin is not happy about this. There is no on call pay. The administration does not understand why we object to this expectation. Our contracts do not stipulate a day requires you to remain in the hospital or even to come back to see consults. Our hospital bylaws allow up to 24 hours to see a consult, and 18 hours to admit a transferred patient, unless there is an urgent issue requiring us to actually see the patient face-to-face (which is fairly rare in psychiatry). If an urgent issue exists we do return to the hospital to see them, but most consults requested late in the day or at night can be safely pushed to the following morning.
I'm wondering about other's experiences with a 7 on 7 off schedule and being bound to the hospital for the full 12 hour day, or being obligated to return for consults that are requested within that 12 hours regardless of urgency. I'm running into issues as there are no psychiatrists in administration. There are internists, nurses, and MBAs, and they seem to look at inpatient psychiatry the same as surgery or internal medicine, where the patient issues are frequently much more life/death, and the hospital is actually staffed with doctors expected to routinely be available 24 hours a day for urgent/emergent issues. I've tried to explain that psychiatry is a completely different specialty with different patient care needs, and that we're not getting paid for the kind of availability they're wanting. Again, these conversations have not be very useful.
I think if they want the doctors to be this available they'd need to provide a fairly significant guaranteed base salary. The issue is none of the doctors are all that interested in getting paid more and doing more work. They want a good work-life balance.
Thanks in advance for any replies. I'm interested in any and all thoughts on these issues. If anyone has good resources for advice about running an inpatient psych service, or good professional organizations with psych physician leadership training conferences, videos, courses, or anything like that, I'm very interested in that too.
