I get benefits as if I'm full time but no I don't get paid for 40 hours of work. The state hospital also agreed to pay my student loans (in the form of extra money attached to my paycheck that is not taxed) though my debt is miniscule.
Forgot to mention this (hence the edit).
For patients in the first example office I mentioned, I will not be able to effectively treat patients with a very low GAF. I literally told a few patients I could not provide for their needs in that private practice because IMHO they needed a case manager. That type of PP setting is in general only for someone with a GAF of at least 45 or above.
I had a patient that was suicidal several times in a week calling up that office, imposing herself on the receptionist (someone with a HS diploma and no real mental health training) about 3 hours a day, 5 days a week. With regret, I had to tell her that I could not provide the level of care she needed and I referred to the the local community mental health clinic where they had case management.
Naturally, someone with private insurance or the ability to pay out of pocket usually is of a GAF of 50 or higher. In this type of setting you usually get someone who is able to work but is suffering from excessive depression, anxiety, or may have bipolar disorder but in the level of severity where they can still hold a job. You will from time to time get patients that may not be appropriate for what you can provide in such a setting, and in that case, make sure you follow the state guidelines if you refer them to others. In my state, I have to provide that person with at least one month of emergency services should they need them after I refer them to someone else. IF that person is hospitalized, I have my staff call the hospital and ask them to refer the patient to someone instead of myself who could provide them with the appropriate care.
In the few cases where I referred the patient out, I carefully explained to the patient and sometimes their family why I made that decision, and portrayed it as an inability, not a lack of desire on my part, to treat them given the resources of the office setting. So far, every time I've done that, everyone told me they understood and even agreed with my decision. It makes sense to someone (or their family) who is chronically suicidal and seeking help to have someone check up on them in their home and maybe help out a little (e.g. witness the person take meds, provide groceries etc).
I recommend if you work in such a setting to not accept patients with a history of extreme violence while psychotic or manic, especially if they have a history of poor compliance. I'd only be willing to take such a patient in an outpatient setting if there were security that responded within seconds and case management were available. I've worked in that setting while in fellowship and on the order of about once every 2-3 months, I had a patient decompensate in the office and security had to show up.
In those offices, they literally had panic buttons that were secretly located under the desk that directly alerted not only the security in the office but also the local police.
(Hmm.....so that's why almost all of my forensic fellowship professors were armed to the teeth with guns, and why my PD looked pale when on a dare I was able to find his home address on the internet along with satellite pics of it within seconds in front of his eyes, even though he took efforts to keep himself unlisted. I'm not joking about that one.)
