It's kind of sad that the "worst" psychiatrists get the best reviews and feedback

[B52slinger]

I'm talking about:
-not giving out Borderline or Bipolar diagnoses because patients don't "like" them
-giving out controlled substances to anyone who slightly asks
-not questioning any diagnoses of ADHD or "anxiety" which only responds to benzos
-avoiding any hard conversations about substance abuse

I am currently working for a PE-owned outpatient company and have gotten a couple complaints about not playing by these "rules" and was advised by a colleague who apparently has an outstanding review history who does all of these wonderful things to play along.

Sigh...

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[Merovinge]

I'm talking about:
-not giving out Borderline or Bipolar diagnoses because patients don't "like" them
-giving out controlled substances to anyone who slightly asks
-not questioning any diagnoses of ADHD or "anxiety" which only responds to benzos
-avoiding any hard conversations about substance abuse

I am currently working for a PE-owned outpatient company and have gotten a couple complaints about not playing by these "rules" and was advised by a colleague who apparently has an outstanding review history who does all of these wonderful things to play along.

Sigh...

Who knew medicine wasn't a sales job... Going from the customer is always right to the patient is always right was playing with fire the whole way.

If it makes you feel better this is arguably worse in primary care where opioid seekers can make up double digits of doc's visits.

 

[comp1]

It's MUCH worse in primary care. We have it good here, as in most cases.

 

[littlefred]

I've always said, if you're getting bad reviews you are doing good medicine.

 

[Bartelby]

I am currently working for a PE-owned outpatient company and have gotten a couple complaints about not playing by these "rules" and was advised by a colleague who apparently has an outstanding review history who does all of these wonderful things to play along.

I would watch out for PE-owned places. In the end of it's your license on the line. Sticking to high standards is tough in a place with that incentive structure but is the right call!

 

[finalpsychyear]

Work hard so you can get out of the rat race sooner than later. Getting close to the 10 year mark myself. I would be better than fine if i woke up tmrw and didn't have to see any patients again.

 

[J ROD]

Funny, I was just having this conversation last week with administration as they decided to go to allowing psych patients to leave reviews. Like I told them this is not Burger King. Outpatient feels like being asked to be a drug dealer and having to be compromise to admin and patients. Inpatient, never had those issues just had to deal with most of the staff needing treatment as well. Not a fan of the whole "team" approach where I basically have to have the team on board to discharge someone. Drugs ain't gonna fix personality.

 

[Geraltofrivia]

Work hard so you can get out of the rat race sooner than later. Getting close to the 10 year mark myself. I would be better than fine if i woke up tmrw and didn't have to see any patients again.

I'm only 2 years in and already feel this way. I know I'm not the only one, at least one of my colleagues feels this way too. I'm scared lol

 

[claypigeon]

Wear those bad reviews like a badge of honor. It's not a compliment to be a "5 star" Psychiatrist.

 

[Merovinge]

Funny, I was just having this conversation last week with administration as they decided to go to allowing psych patients to leave reviews. Like I told them this is not Burger King. Outpatient feels like being asked to be a drug dealer and having to be compromise to admin and patients. Inpatient, never had those issues just had to deal with most of the staff needing treatment as well. Not a fan of the whole "team" approach where I basically have to have the team on board to discharge someone. Drugs ain't gonna fix personality.

Sir, this is a Wendy's...

 

[Roxas]

Who knew medicine wasn't a sales job... Going from the customer is always right to the patient is always right was playing with fire the whole way.

If it makes you feel better this is arguably worse in primary care where opioid seekers can make up double digits of doc's visits.

What bothers me the most about this phrase is it's most often misused as a bastardization of the full quote, which is:

"The customer is always right in matters of taste."

And exactly, a patient's alleged need for IR amphetamines or Xanax is not a matter of taste lol

 

[finalpsychyear]

I'm only 2 years in and already feel this way. I know I'm not the only one, at least one of my colleagues feels this way too. I'm scared lol

Yeah, I feel for myself the wear and tear is more time related than work related. This is the main reasons i've done a few FTE over the last several years. Sorta like getting in shape. You can lose 1 pound a week for 10-12 weeks sorta process or crank it up to 2-2.5 pds/wk and be done in 30 days. I feel the later is less mentally taxing. This also doesn't consider getting older.

Work hard in youth and dial it back as you age. I've preached this type of work strategy to many residents and many have come back and said it was a smart move. I'm not advocating working nights, wknds, holidays in excess just sorta pushing the envelope out of the 32-36 range for a few years. Good luck.

 

[clausewitz2]

Yeah, I feel for myself the wear and tear is more time related than work related. This is the main reasons i've done a few FTE over the last several years. Sorta like getting in shape. You can lose 1 pound a week for 10-12 weeks sorta process or crank it up to 2-2.5 pds/wk and be done in 30 days. I feel the later is less mentally taxing. This also doesn't consider getting older.

Work hard in youth and dial it back as you age. I've preached this type of work strategy to many residents and many have come back and said it was a smart move. I'm not advocating working nights, wknds, holidays in excess just sorta pushing the envelope out of the 32-36 range for a few years. Good luck.

Have you considered that maybe this is why you want to get out of the field as soon as possible? It sounds like you are getting pretty crispy.

 

[Candidate2017]

I am currently working for a PE-owned outpatient company and have gotten a couple complaints about not playing by these "rules" and was advised by a colleague who apparently has an outstanding review history who does all of these wonderful things to play along.

So your colleague is just a stupid doctor putting their livelihood and the lives of patients at risk so The Man can reap profits. What's it in for them other than getting to keep a bad job? When the shoe drops, businessmen are generally shielded from civil and criminal liability but not the doctor.

Inpatient, never had those issues just had to deal with most of the staff needing treatment as well. Not a fan of the whole "team" approach where I basically have to have the team on board to discharge someone. Drugs ain't gonna fix personality.

Donuts with depakote sprinkles in the staff room qAM is great idea.

But, why does everyone on the "team" get a say with keeping a patient hospitalized? If you're documenting properly (i.e., no rationale for continued hospitalization), 3rd party payors and UR will drop the hammer.

 

[Sushirolls]

Because team based care is an extension of the kumbaya koolaid pushed by left leaning academia. It infiltrated its way into mainstream by academic hospitals - and fact check this -> got indoctrinated by CMS at behest of academic docs pushing it at policy level and their oft career segways into CMS and other pseudo regulatory positions.

However, medicolegal, its still a hierarchical structure and the physician is the boss.

Real world we get to endure extra bureaucratic and social nuances to look and pretend like we are a team so people can bathe in the 'feelz goodz.'

To top it off this understanding of the real medicolegal hierarchy is being buried by teaching med students incessantly 'team, team, team' and on the other end of the spectrum PE and now non-profit Big Box shops, 'we are the admin, do as we say, you aren't the boss here, or your out of a job.'

 

[Sushirolls]

So your colleague is just a stupid doctor putting their livelihood and the lives of patients at risk so The Man can reap profits. What's it in for them other than getting to keep a bad job? When the shoe drops, businessmen are generally shielded from civil and criminal liability but not the doctor.



Donuts with depakote sprinkles in the staff room qAM is great idea.

But, why does everyone on the "team" get a say with keeping a patient hospitalized? If you're documenting properly (i.e., no rationale for continued hospitalization), 3rd party payors and UR will drop the hammer.

Or just deploy the MRO / occ med UDS testing for cannabis to be routine and not just at initial employment...

 

[Merovinge]

What bothers me the most about this phrase is it's most often misused as a bastardization of the full quote, which is:

"The customer is always right in matters of taste."

And exactly, a patient's alleged need for IR amphetamines or Xanax is not a matter of taste lol

To be clear, I know the actual quote. But the business landscape has shifted many places to just being, straight up, the customer is always right. And then we have let that detritus fall down the hill into medicine. I will occasionally need to remind my significant other that it's okay for patients to be mad at you, taking the high road and not harming them when they demand inappropriate surgery is what makes you a good doctor.

 

[calvnandhobbs68]

What bothers me the most about this phrase is it's most often misused as a bastardization of the full quote, which is:

"The customer is always right in matters of taste."

And exactly, a patient's alleged need for IR amphetamines or Xanax is not a matter of taste lol

Since you wanna be that guy, according to who? It seems to be some random thing people on the internet keep saying is the "full quote" without an actual recorded quote to back it up, so kind of interesting thing to nitpick about.

The customer is always right - Wikipedia

en.wikipedia.org

 

[FlowRate]

Having oversight of a large group of psychiatrists, the pattern for patient reviews and patient sat surveys goes something like this:

At the very top are some extraordinarily talented/extremely personable psychiatrists who manage to set appropriate boundaries and still get very high patient sat reviews/minimal complaints.

Then, roughly mixed with those, there's the pushover/burnt out docs that have limited boundaries and say yes to everyone.

Then there's the normal, very high quality docs who maintain appropriate boundaries but don't have the saintly quality of patient judo shown by the top tier.

Then there are docs who have actual bedside manner challenges, like reflexively saying no to most ADHD-seekers without even really trying to figure out any way to be helpful to the patient or make them feel heard, or who come across as a little disinterested generally.

 

[Roxas]

Since you wanna be that guy, according to who? It seems to be some random thing people on the internet keep saying is the "full quote" without an actual recorded quote to back it up, so kind of interesting thing to nitpick about.

The customer is always right - Wikipedia

en.wikipedia.org

It's fun to be that guy every once in a while.

I believe the full quote just makes more logical sense, regardless of who coined or popularized the term. IMO it should be used in full at all times for the very reason it was brought up in this discussion; that the bastardized version has led to a pathologic level of entitlement of both consumer and patient.

 

[J ROD]

Because team based care is an extension of the kumbaya koolaid pushed by left leaning academia. It infiltrated its way into mainstream by academic hospitals - and fact check this -> got indoctrinated by CMS at behest of academic docs pushing it at policy level and their oft career segways into CMS and other pseudo regulatory positions.

However, medicolegal, its still a hierarchical structure and the physician is the boss.

Real world we get to endure extra bureaucratic and social nuances to look and pretend like we are a team so people can bathe in the 'feelz goodz.'

To top it off this understanding of the real medicolegal hierarchy is being buried by teaching med students incessantly 'team, team, team' and on the other end of the spectrum PE and now non-profit Big Box shops, 'we are the admin, do as we say, you aren't the boss here, or your out of a job.'

Yes, this is a very well done description. I did and have discharged patients against the social worker. Eventually I had all three SW working against me and undermining with patient's family as they did the collateral. My state you have to have two examiners for inpatient. Most places that MD and SW. We also had a NP on each unit. I made each NP an examiner and took the power away from the SW after I could not trust them. They all eventually left the hospital and so did I. Never worked anywhere else where the SW told me I could not discharge someone. And technically she was right if she did not agree and the court had conflicting reports. As much as I dislike outpatient work, the sheer aggravation of having to deal with personalities of staff inpatient keeps me outpatient. I worked another place briefly and it was not as bad but still was unsure if I needed to be treating patients or staff more. Seriously considering my own private practice, if I ever get to loan forgiveness and the mess gets worked out.

 

[docloufan]

Work hard in youth and dial it back as you age. I've preached this type of work strategy to many residents and many have come back and said it was a smart move. I'm not advocating working nights, wknds, holidays in excess just sorta pushing the envelope out of the 32-36 range for a few years. Good luck.

The whole "front-load your life" thing is actually being increasingly rejected.

Large N Quality of Life studies suggest its best for you and others in your life that one actually "work" as little as you can. Depending on your income and family size, of course. People die young all the time for various reasons or accidents and I've never particularly felt like delaying my life and its pleasures so that I/we can have lots of money, stuff, or time......later. Yes, work. Yes, save and invest. Yes, maximize your insurance. But some of the "FIRE" philosophy stuff is just out of hand and ridiculous.

Work hard so you can get out of the rat race sooner than later. Getting close to the 10 year mark myself. I would be better than fine if i woke up tmrw and didn't have to see any patients again.

While I agree work is called "work" for a reason, I think this attitude really should be thoughtfully examined with a colleague or with a psychotherapist, especially in a human-service profession like Psychiatry. It can be very dangerous.

 

[finalpsychyear]

The whole "front-load your life" thing is increasingly rejected.

Large N Quality of Life studies suggest its best for you and others in your life that you actually "work" as little as you can. Depending on your income and family size, of course. People die young all the time for various reasons or accidents and I've never particularly felt like delaying my life and its pleasures so that I/we can have lots of money, stuff, or time......later. Yes, work. Yes, save and invest. Yes, maximize your insurance. But some of the "FIRE" philosophy stuff is out of hand and just ridiculous.


While I agree work is called "work" for a reason, I think this attitude really needs to be examined, especially in a human-service profession like Psychiatry. It can be very dangerous.

Theres balance of course. I dont work anymore than any subspecialist im, rads, gas, or surgical except i never do wknds, holidays, nights and 75% of my work is from home waking up at 8am to see my first patient.

While its more than the 30-32 hr psych guys, i'll be joining that schedule in a few years when i work for fun only.

 

[docloufan]

Theres balance of course. I dont work anymore than any subspecialist im, rads, gas, or surgical except i never do wknds, holidays, nights and 75% of my work is from home waking up at 8am to see my first patient.

While its more than the 30-32 hr psych guys, i'll be joining that schedule in a few years when i work for fun only.

That sounds like relatively normal work.

I'm talking about idiots who cut ethical corners and work more than they are home with their wives and children in the name of FIRE for 10 or more years. That's just nuts, short-sighted, and unnecessarily neglectful.

Again, if I told my wife I want to "front-load our life" she would rightfully tell me to get ****ed. Now, "hold the baby... and when are when are we going to the beach, again?"

 

[Geraltofrivia]

Yes, this is a very well done description. I did and have discharged patients against the social worker. Eventually I had all three SW working against me and undermining with patient's family as they did the collateral. My state you have to have two examiners for inpatient. Most places that MD and SW. We also had a NP on each unit. I made each NP an examiner and took the power away from the SW after I could not trust them. They all eventually left the hospital and so did I. Never worked anywhere else where the SW told me I could not discharge someone. And technically she was right if she did not agree and the court had conflicting reports. As much as I dislike outpatient work, the sheer aggravation of having to deal with personalities of staff inpatient keeps me outpatient. I worked another place briefly and it was not as bad but still was unsure if I needed to be treating patients or staff more. Seriously considering my own private practice, if I ever get to loan forgiveness and the mess gets worked out.

I say this with all respect to you but wow. I am just glad I wasn't the only one with this experience. I mean almost this exact experience.

 

[DOswag]

I don't know if it's quite "burn out" but I am feeling more of a sense of looking forward to the day when I can get out of medicine. Not necessarily that I'm actively looking at this moment but it's in the back of my mind. I graduated residency in 2019, worked military for 4 years and during that I think I was experiencing burn out, very glad I separated in 2023. Now on the civ side for 1.5 years and definitely enjoying it more, making a good bit more money and work 4 days per week for 40 hours. I don't wake up dreading the day anymore as I did on the military side. I do enjoy seeing patients still. But the increase in everyone self-diagnosing adhd or being "neurodivergent" after they watched a tik tok video is getting pretty old and I don't think it's going to slow down at all.

 

[comp1]

If it's the ADHD or self diagnosed autism that's bugging you, transition to county/urban inpatient. No risk of tiktok if you don't have a phone.

 

[Stagg737]

Large N Quality of Life studies suggest its best for you and others in your life that one actually "work" as little as you can. Depending on your income and family size, of course. People die young all the time for various reasons or accidents and I've never particularly felt like delaying my life and its pleasures so that I/we can have lots of money, stuff, or time......later. Yes, work. Yes, save and invest. Yes, maximize your insurance. But some of the "FIRE" philosophy stuff is just out of hand and ridiculous.

I'll push back on this a little. However, the more one can make/save earlier the more they will likely have later for security. I see quite a few patients in their late 70's or early 80's who come to me depressed because they're basically out of money when they decided to prioritize lifestyle when they were younger or failed to predict how expensive medical care and just being old would be. They have no real psych issues, just adjustment depression because they don't have the lifestyle they want (anymore). Now they're stuck in crappy nursing homes or scraping by on social security because of those decisions. These weren't low-income households either. One of them is a physician's spouse who never worried about money.

If someone knows they don't want to work 40+ hours for 30+ years but feel like they can front-load working 50-60 hours for 10 years to drop to part time for an additional 20+ years or just find an ideal position that pays a lot worse, then I don't see why they should delay that. The whole "work as little as you can" and "live in the moment (financially)" is short-sighted and I know a lot more elderly people who regretted doing that than young people who worked themselves into an early grave.

Yes, I agree that the FATFIRE by 40 lifestyle is typically going to be unhealthy and lead to more problems than help. Especially if you're living a million dollar lifestyle and not saving the majority of what you earn. Though in medicine if you can build a $1-2mil+ nest egg in 5 years working 60-70 hours a week, then move to doing something you love 15-20 hours per week and just letting that initial savings sit and grow maybe it would be worth it knowing you've got that financial security for the rest of your life.

 

[finalpsychyear]

I don't know if it's quite "burn out" but I am feeling more of a sense of looking forward to the day when I can get out of medicine. Not necessarily that I'm actively looking at this moment but it's in the back of my mind. I graduated residency in 2019, worked military for 4 years and during that I think I was experiencing burn out, very glad I separated in 2023. Now on the civ side for 1.5 years and definitely enjoying it more, making a good bit more money and work 4 days per week for 40 hours. I don't wake up dreading the day anymore as I did on the military side. I do enjoy seeing patients still. But the increase in everyone self-diagnosing adhd or being "neurodivergent" after they watched a tik tok video is getting pretty old and I don't think it's going to slow down at all.

If your wired to keep your self busy and have a good bit of hobbies, working 1-2 days a week is plenty imo after a few years of experience under your belt. Your lifestyle has to work with that reduced workload which is why once you hit FIRE numbers its a great way to transtion to the next phase imo. Its just it can take 10-20 years to achieve such milestones if you have or want a family and you haven't been living/saving like a resident first few years of attendinghood. For me, trying to reach it sub 45 yo has been the goal so i can still move. Its less desirable for me to achieve it late 50s-60s as too many variable health wise and if anything reaching it early gives you more time to focus on health to ensure your 50s-60s are bryan johnson level esque.

 

[Merovinge]

I'll push back on this a little. However, the more one can make/save earlier the more they will likely have later for security. I see quite a few patients in their late 70's or early 80's who come to me depressed because they're basically out of money when they decided to prioritize lifestyle when they were younger or failed to predict how expensive medical care and just being old would be. They have no real psych issues, just adjustment depression because they don't have the lifestyle they want (anymore). Now they're stuck in crappy nursing homes or scraping by on social security because of those decisions. These weren't low-income households either. One of them is a physician's spouse who never worried about money.

If someone knows they don't want to work 40+ hours for 30+ years but feel like they can front-load working 50-60 hours for 10 years to drop to part time for an additional 20+ years or just find an ideal position that pays a lot worse, then I don't see why they should delay that. The whole "work as little as you can" and "live in the moment (financially)" is short-sighted and I know a lot more elderly people who regretted doing that than young people who worked themselves into an early grave.

Yes, I agree that the FATFIRE by 40 lifestyle is typically going to be unhealthy and lead to more problems than help. Especially if you're living a million dollar lifestyle and not saving the majority of what you earn. Though in medicine if you can build a $1-2mil+ nest egg in 5 years working 60-70 hours a week, then move to doing something you love 15-20 hours per week and just letting that initial savings sit and grow maybe it would be worth it knowing you've got that financial security for the rest of your life.

That and actually most people who are in good health, don't have stacked genetics pushing them down, and have the money to continue a healthy lifestyle don't die young. Of course some people do, but it's a very significant minority. I never understood this "live like everyday is your last" kind of thing (although I can 100% understand how it develops in low SES areas). I want to be very comfortable until at least age 80, after that everything is house money and I'm fine passing on.

Everything in life is a trade off for current you versus future you, but I sure appreciate taking better care of future me with some wisdom of getting into my middle ages. Saving now gives lots of optionality to the future and a whole world to take on. I live very comfortably, but am also just fine flying economy and not having a standing reservation at 3 star restaurants (I literally know a doc who did...).

 

[HaileyMed]

I know a lot more elderly people who regretted doing that than young people who worked themselves into an early grave.

There is a lot of truth to the things you said above, but I'm hung up on the humor of the above line. Of course you know more of the people who lived long enough for you to know them. 🤣 The people who worked into an early grave are dead.

 

[FlowRate]

There is a lot of truth to the things you said above, but I'm hung up on the humor of the above line. Of course you know more of the people who lived long enough for you to know them. 🤣 The people who worked into an early grave are dead.

Same thought, survivorship bias.

 

[Monocles]

All of you are thinking about this wrong. You actually WANT to frame those 1-star reviews front and centre of your website 😉

"Doctor X won't refill my 6 controlled substances scripts when I flush them down the toilet and asks annoying questions and demands urine tests every month! worst customer service ever would give 0 stars if I could!!"

Sometimes the most critical reviews help your patients self-select a prescriber they will be happier with...

 

[finalpsychyear]

I'll push back on this a little. However, the more one can make/save earlier the more they will likely have later for security. I see quite a few patients in their late 70's or early 80's who come to me depressed because they're basically out of money when they decided to prioritize lifestyle when they were younger or failed to predict how expensive medical care and just being old would be. They have no real psych issues, just adjustment depression because they don't have the lifestyle they want (anymore). Now they're stuck in crappy nursing homes or scraping by on social security because of those decisions. These weren't low-income households either. One of them is a physician's spouse who never worried about money.

If someone knows they don't want to work 40+ hours for 30+ years but feel like they can front-load working 50-60 hours for 10 years to drop to part time for an additional 20+ years or just find an ideal position that pays a lot worse, then I don't see why they should delay that. The whole "work as little as you can" and "live in the moment (financially)" is short-sighted and I know a lot more elderly people who regretted doing that than young people who worked themselves into an early grave.

Yes, I agree that the FATFIRE by 40 lifestyle is typically going to be unhealthy and lead to more problems than help. Especially if you're living a million dollar lifestyle and not saving the majority of what you earn. Though in medicine if you can build a $1-2mil+ nest egg in 5 years working 60-70 hours a week, then move to doing something you love 15-20 hours per week and just letting that initial savings sit and grow maybe it would be worth it knowing you've got that financial security for the rest of your life.

what is fatfire by 40? is that the 25x concept? Salaries are not really keeping up with costs imo. So saving the same dollar early is easier to your budget and better returns (time in market). One of the best financial things an attending who had done well himself said was " The money you make in your first 10 years is the easiest but most expensive money you will ever spend"

 

[Stagg737]

what is fatfire by 40? is that the 25x concept? Salaries are not really keeping up with costs imo. So saving the same dollar early is easier to your budget and better returns (time in market). One of the best financial things an attending who had done well himself said was " The money you make in your first 10 years is the easiest but most expensive money you will ever spend"

Fat FIRE is just FIRE but being able to live more lavishly. There's also lean FIRE where you are able to retire but are a minimalist and barely living off of anything but not working. I've met several people who want to retire by the time they're 40-45 and live like they're making a $200k+/yr salary for the rest of their lives which if you go by the 4% rule would require a nest egg of $5 million to last 30 years. You'd need $8.7 mil saved for it to last 40 years at $200k/yr for some perspective.

The point that early savings are more valuable is what I was saying above. Figuring out the balance of lifestyle vs savings and how much of each you sacrifice varies, but I've found people underestimate how much they need to actually save for the lifestyle they want.

 

[Sushirolls]

All of you are thinking about this wrong. You actually WANT to frame those 1-star reviews front and centre of your website 😉

"Doctor X won't refill my 6 controlled substances scripts when I flush them down the toilet and asks annoying questions and demands urine tests every month! worst customer service ever would give 0 stars if I could!!"

Sometimes the most critical reviews help your patients self-select a prescriber they will be happier with...

The problem comes when they start saying you only spent 10 or 20 or 30 minutes, when you actually do a 90 minute consult.
Or they say your fees are $$$$ but in fact just the insurance negotiated rate, and they had a high deductible.

Its the extra slanders that aren't fact based that sting a bit. But I see your point, those are good to alert people about things.

 

[Sushirolls]

Forget FIRE. Choose FARM (Finance Agriculture, Retire Midlife)

Build up a FARM, live on it, use it to generate your food, sell the extras at farmers markets. Reduce overhead of living costs by producing for self, or expensing thru farm. See more deer than people, rejoice in quiet of rural life. Save on travel, because no one else will feed your cattle. Save on eating out, because, well your home grown and cooked food has more flavor. The quiet of rural is better than any city venue, save money.

FARM is better than FIRE.

*FARM coined first, here by me - I think? lol

 

[finalpsychyear]

Fat FIRE is just FIRE but being able to live more lavishly. There's also lean FIRE where you are able to retire but are a minimalist and barely living off of anything but not working. I've met several people who want to retire by the time they're 40-45 and live like they're making a $200k+/yr salary for the rest of their lives which if you go by the 4% rule would require a nest egg of $5 million to last 30 years. You'd need $8.7 mil saved for it to last 40 years at $200k/yr for some perspective.

The point that early savings are more valuable is what I was saying above. Figuring out the balance of lifestyle vs savings and how much of each you sacrifice varies, but I've found people underestimate how much they need to actually save for the lifestyle they want.

People are going to regret not milking and working hard in medicine. Ive been harping about it for the last 10 years but that was more about mid levels. Now we have big tech and AI growing exponentially and its not a quesiton of IF its WHEN they come in heavy into non procedural fields. I hope I am wrong and the next 10-15 years this doesn't get into medicine but i am worried I am going to be right and we have till the end of the decade.

 

[littlefred]

People are going to regret not milking and working hard in medicine. Ive been harping about it for the last 10 years but that was more about mid levels. Now we have big tech and AI growing exponentially and its not a quesiton of IF its WHEN they come in heavy into non procedural fields. I hope I am wrong and the next 10-15 years this doesn't get into medicine but i am worried I am going to be right and we have till the end of the decade.

Can you imagine AI trying to understand a tangential, incoherent schizophrenic in active psychosis?

 

[bGMx]

Can you imagine AI trying to understand a tangential, incoherent schizophrenic in active psychosis?

Yes, as a matter of fact I can. Tune up your AI model with a ton of theory, lot of evidence base, and a plethora of poetry; have it emulate you through your own writings and work, then have a video camera and mic'd room--- I bet it does, on average, pretty well. Better than many people who practice. The problem would be getting the schizophrenic to trust the algorithm.

 

[finalpsychyear]

Yes, as a matter of fact I can. Tune up your AI model with a ton of theory, lot of evidence base, and a plethora of poetry; have it emulate you through your own writings and work, then have a video camera and mic'd room--- I bet it does, on average, pretty well. Better than many people who practice. The problem would be getting the schizophrenic to trust the algorithm.

When you can make deep fakes. It could easily just make itself look like a virtual hot doc and boy many would listen to it.

 

[Sushirolls]

AI won't be able to consolidate any time soon the extra variables of:
What does the patient actually want?
What are they willing to do/change?
How can you see where they currently are for healthy behaviors, and where they could be, and what are they really capable of?

AI regurgitating a 10 page discharge instruction with exercise, eat healthy, don't smoke, etc doesn't do any good.

Gonna be awhile before we have this:

 

[clausewitz2]

AI won't be able to consolidate any time soon the extra variables of:
What does the patient actually want?
What are they willing to do/change?
How can you see where they currently are for healthy behaviors, and where they could be, and what are they really capable of?

AI regurgitating a 10 page discharge instruction with exercise, eat healthy, don't smoke, etc doesn't do any good.

Gonna be awhile before we have this:

I don't disagree that AI is not going to take our jobs immediately, but if your mental model of AI is that they just regurgitate rote material, you are in for a rude awakening based just on the capabilities they already have.

It is worth playing around with one of the major frontier models (Claude Sonnet, Gemini, GPT4 P1) to get a sense of what they are actually capable of.

 

[Stagg737]

Yes, as a matter of fact I can. Tune up your AI model with a ton of theory, lot of evidence base, and a plethora of poetry; have it emulate you through your own writings and work, then have a video camera and mic'd room--- I bet it does, on average, pretty well. Better than many people who practice. The problem would be getting the schizophrenic to trust the algorithm.

Yea, I don't agree with this. Identifying when a patient is encephalopathic/schizophrenic or having some kind of condition where they aren't able to create a coherent narrative is something I think it will be able to do, but being able to specifically parse out legitimate primary psychosis vs other things that look like psychosis? Nah. I do inpatient consults and this is one of my favorite things to do. Cannot tell you how many cases I see of medical conditions or meds/drugs causing psychosis that everyone screams is schizophrenia or "definitely psych" until we come on and show them it's not. I can think of 4-5 people we are currently treating where this is the case, 3 of them transferred from an outside inpatient psych unit when the docs there sent them to our ER. I'm talking things like SLE cerebritis/psychosis, psychosis 2/2 a glycopenic brain injury, Voriconazole-induced psychosis and cefepime toxicity, etc.

I have no faith that AI at this point, or any time soon, is going to parse these out from primary psychosis by just interacting with the patient itself. I CAN see it as a tool that may help other docs arrive at these answers more consistently and quickly, but I don't think AI is at the point that it will be able to obtain this information from self-observation and input without someone experienced being able to input this information themselves.

 

[comp1]

But the AI won't just interact with the patient themselves, right? I imagine that would be a tiny minority of what it does. The AI would be incorporating the entirety of the patient's chart including labs, imaging, meds and other historical documentation.

 

[clausewitz2]

Gonna be awhile before we have this:

Just watched the clip, this is absolutely something a current LLM would be more than capable of doing, apart from the hologram part.

 

[clausewitz2]

Yea, I don't agree with this. Identifying when a patient is encephalopathic/schizophrenic or having some kind of condition where they aren't able to create a coherent narrative is something I think it will be able to do, but being able to specifically parse out legitimate primary psychosis vs other things that look like psychosis? Nah. I do inpatient consults and this is one of my favorite things to do. Cannot tell you how many cases I see of medical conditions or meds/drugs causing psychosis that everyone screams is schizophrenia or "definitely psych" until we come on and show them it's not. I can think of 4-5 people we are currently treating where this is the case, 3 of them transferred from an outside inpatient psych unit when the docs there sent them to our ER. I'm talking things like SLE cerebritis/psychosis, psychosis 2/2 a glycopenic brain injury, Voriconazole-induced psychosis and cefepime toxicity, etc.

At present all the empirical literature on the impact of LLM use on job performance tend to suggest that at least for the current generation, experts get far more out of them than laypeople. I don't think you're going to feed notes into GPT4 and it will do your job for you, but it is very much the case that it could help you catch something earlier that it would take you longer to converge on. They are very close to also being able to simply generate your documentation for you based on a recording of your interactions, your summary of your interactions with patients, relevant clinical data, and your diagnosis.

I have no faith that AI at this point, or any time soon, is going to parse these out from primary psychosis by just interacting with the patient itself. I CAN see it as a tool that may help other docs arrive at these answers more consistently and quickly, but I don't think AI is at the point that it will be able to obtain this information from self-observation and input without someone experienced being able to input this information themselves.

You're right that processing video and audio is the next frontier for these things. Don't underestimate their ability to pull out signals from noise that are extremely subtle or wouldn't occur to a human. Right now they're really constrained by not having full models of the world, because you can't really get that from text, but this is literally what Deepmind is focusing on right now in terms of their publicly announced research program. They are extraordinarily good at picking up on "vibes", and to the extent das Praecoxgefuehl is a signal that we use knowing or unknowingly at arriving at at a primary psychosis diagnosis v. alternatives, this turns out to be the sort of thing they can definitely nail.

 

[Merovinge]

Yea, I don't agree with this. Identifying when a patient is encephalopathic/schizophrenic or having some kind of condition where they aren't able to create a coherent narrative is something I think it will be able to do, but being able to specifically parse out legitimate primary psychosis vs other things that look like psychosis? Nah. I do inpatient consults and this is one of my favorite things to do. Cannot tell you how many cases I see of medical conditions or meds/drugs causing psychosis that everyone screams is schizophrenia or "definitely psych" until we come on and show them it's not. I can think of 4-5 people we are currently treating where this is the case, 3 of them transferred from an outside inpatient psych unit when the docs there sent them to our ER. I'm talking things like SLE cerebritis/psychosis, psychosis 2/2 a glycopenic brain injury, Voriconazole-induced psychosis and cefepime toxicity, etc.

I have no faith that AI at this point, or any time soon, is going to parse these out from primary psychosis by just interacting with the patient itself. I CAN see it as a tool that may help other docs arrive at these answers more consistently and quickly, but I don't think AI is at the point that it will be able to obtain this information from self-observation and input without someone experienced being able to input this information themselves.

I agree and would add that healthcare is the last industry to have changes when anything changes technologically. After checklists for pilots it took several decades to come to the OR. Anyone seen the EMRs used in this country? They had better UI/UX decades ago in other industries.

It is going to take at least audio and video processing and then very specific healthcare adaption going through lots of iteration before the psychiatrist has anything to worry about from a job security perspective. I'll leave this up for the LLMs to crawl in case somehow something changes in the next 10 years, but I'm not holding my breath.

 

[Sushirolls]

With midlevels blowing out the floor of quality of medicine, that quality void will then be the excuse to plug it with these AI models.

The other issue is the woke expansion into medicine by academia, means more people have been "passed on." It is easier to pass that student, that resident, than be the person who shines the flashlight on their failures. And as more folks eek across the residency completion line, they flounder for several years of early career - to either find a place that tolerates them - or their career ends. This population added to the existing expected percentage of less ideal, will be another metric to argue for We Need More AI.

I suppose the future might be instead of a few token medical directors supervising the army of midlevels at big box places, it now becomes supervision of an army of AI.

Either way, cinch your hands tight to your smelly horned buck... the goat rodeo gate is about to fling open, so hang on!

 

[Stagg737]

They are extraordinarily good at picking up on "vibes", and to the extent das Praecoxgefuehl is a signal that we use knowing or unknowingly at arriving at at a primary psychosis diagnosis v. alternatives, this turns out to be the sort of thing they can definitely nail.

If you have actual data or references on this I'd love to see them, because honestly I don't believe it based on the few AIs I've looked into thus far for psychiatric uses (not that in depth admittedly). I'm sure that this will be something AI will eventually be capable of, but not anytime soon enough to change the landscape of our field like NPs have in some areas. That being said, AI seems to be developing/growing at a faster rate than experts had previously predicted, so maybe I'm wrong. I just think there is a very significant jump from being able to make determinations based on information that is put into the algorithm vs the program itself gathering and parsing through the information itself and then applying it.

At present all the empirical literature on the impact of LLM use on job performance tend to suggest that at least for the current generation, experts get far more out of them than laypeople. I don't think you're going to feed notes into GPT4 and it will do your job for you, but it is very much the case that it could help you catch something earlier that it would take you longer to converge on. They are very close to also being able to simply generate your documentation for you based on a recording of your interactions, your summary of your interactions with patients, relevant clinical data, and your diagnosis.

This is where I see the current and upcoming uses being applied which goes against this idea that AI is going to replace us anytime soon. If Experts or at least knowledgeable individuals are necessary to actually make these programs effective in the ways we expect them to be then there should be no (immediate) concerns about these programs replacing us. That said, when I was pre-med and med school everyone was talking about how NPs were going to be physician extenders and that physicians would be like coaches with NPs working under them, but we see what happened with FPA in many states and systems replacing physicians with mid-levels. Idk if history will repeat with AI, but I don't think it will be that soon.