medscape young physician comp report

[dl2dp2]

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The new medscape report for under 40 is highly positive on psychiatry...interesting...

Medscape: Medscape Access

 

[uhmocksuhsillen]

Barely above 200 is a scary thought, especially given the increasing loan amounts younger physicians are taking these days

 

[NRP]

Is the doximity one a better one to utilize? Larger sample size but it doesn't include compensation rather than salary.

 

[Stagg737]

Barely above 200 is a scary thought, especially given the increasing loan amounts younger physicians are taking these days

I'd bet a big part of this is due to being employed. Only 15% of docs under 40 are self-employed while 40% of docs over 40 are self-employed. Combine that with the financial stupidity of many physicians (especially many younger ones) and I don't think it's really that surprising. Plus keep in mind that psychiatrists work some of the lowest hours among any type of physician. Do some moonlighting or pick up extra hours to work the 60 or so hours common in many fields and going well above 200k without difficulty.

I also think something very telling about the survey is that psychiatry leads the way in both the percent of people who would choose medicine again (85%) and the percent of people who would choose the same field (78%). Even if we're not getting rich, we seem to be pretty content with our career decisions.

 

[DisorderedDoc417]

I don’t know a senior resident in my Midwest residency who signed for under 250k.

 

[yanks26dmb]

All the time on here I see docs saying you can start private practice, accepting insurance, and make 190-210/hr with no shortage of clientele beating down your door....which I completely believe given the long waits we have for psychiatrists who take insurance in my highly desirable west coast city.

Why dont more pepole do this?

 

[dl2dp2]

Why dont more pepole do this?

What do you mean, plenty of people do this. I'm confused.

 

[yanks26dmb]

What do you mean, plenty of people do this. I'm confused.

Let me clarify...why don't enough people do this such that average salaries for newer docs are higher than 200ish? I feel like there is such demand for psych, the hourly rates are quite decent, and there is tons of variability in what you can do...how are we not seeing averages around 300? It blows my mind.

How legit are these locums ads? Some of these rates seem too good to be true..

http://www.cibhs.org/sites/main/files/file-attachments/locum_tenens_providers_and_rates_3-1-16.pdf

 

[OldPsychDoc]

All the time on here I see docs saying you can start private practice, accepting insurance, and make 190-210/hr with no shortage of clientele beating down your door....which I completely believe given the long waits we have for psychiatrists who take insurance in my highly desirable west coast city.

Why dont more pepole do this?

I will venture that psych in general self-selects those of us who dislike entrepreneurship, and who are quite content in generously paid employed positions that let us go home and relax every night, without the worries of running a business. In my experience, the private practice entrepreneurs are a small minority of the actual psychiatric workforce, in spite of the high visibility of that concept here.

 

[yanks26dmb]

I will venture that psych in general self-selects those of us who dislike entrepreneurship, and who are quite content in generously paid employed positions that let us go home and relax every night, without the worries of running a business. In my experience, the private practice entrepreneurs are a small minority of the actual psychiatric workforce, in spite of the high visibility of that concept here.

Interesting. I would think more people chose this field because it allows them to be their own boss and avoid the typical hospital/employer set up. But what do I know?

 

[michaelrack]

Let me clarify...why don't enough people do this such that average salaries for newer docs are higher than 200ish? I feel like there is such demand for psych, the hourly rates are quite decent, and there is tons of variability in what you can do...how are we not seeing averages around 300? It blows my mind.

How legit are these locums ads? Some of these rates seem too good to be true..

http://www.cibhs.org/sites/main/files/file-attachments/locum_tenens_providers_and_rates_3-1-16.pdf

Those rates look like the rates Locums companies charge the hiring company, psychiatrists get only 65 to 70 % of that

 

[finalpsychyear]

The new medscape report for under 40 is highly positive on psychiatry...interesting...

Medscape: Medscape Access

So looking at inflation a salary of 150k in 2000 has the same buying power as 220k in 2018. Not sure what psych salaries were in 2000 but im not sure there has really been that much of an increase.

 

[DisorderedDoc417]

So looking at inflation a salary of 150k in 2000 has the same buying power as 220k in 2018. Not sure what psych salaries were in 2000 but im not sure there has really been that much of an increase.

In the 90s, many psychiatrists made less than 100k. Someone close to me, a psychiatrist in the early 2000s, made 500k a year during his last few years of private practice, which ended in 2004. This was an example of 90 hr work week style inpatient/outpatient/forensic/several side jobs psychiatry and he was billing for well north of 1 million.

I think $220k, depending on region, is pretty low. That being said it might be a nice outpatient practice with no call, free weekends and holidays, and very doable scheduling.

 

[DisorderedDoc417]

im making over six figures a month and im not even one year out of residency. if you are efficient, work hard, know how to negotiate, and are willing to take on jobs others arent, then the sky is the limit.

> 1.2M definitely puts you in a special category as a psychiatrist.

 

[thepoopologist]

im making over six figures a month and im not even one year out of residency. if you are efficient, work hard, know how to negotiate, and are willing to take on jobs others arent, then the sky is the limit.

Do tell?

 

[hamstergang]

Do tell?

He's deleted many of his posts, but I recall in the past he's claimed to work 365 days per year.

 

[michaelrack]

> 1.2M definitely puts you in a special category as a psychiatrist.

agree, the hard working psychiatrists I know make 750,000 ( I am not up in that league)

 

[yanks26dmb]

agree, the hard working psychiatrists I know make 750,000 ( I am not up in that league)

What kind of hours/work are these people doing?

 

[michaelrack]

What kind of hours/work are these people doing?

70-80 per week plus being on call by phone most of time

 

[dl2dp2]

im on call for several different hospitals during the week; sometimes none sometimes multiple. i work every single day (weekends and holidays included). i do very high volume inpatient work half the week, combined with a locums gig that i negotiated very high rates for, own my own private practice that i started up in residency and now has multiple locations, etc.

Well this is interesting. Let's say you make 1.2M total gross revenue on 1099, or perhaps half 1099 half W2. Your self employment tax is taken care of and you reach ceiling. Highest federal income tax is 39.6%, plus state/local. If you don't do tax planning, approximately 300-400k+ of your gross revenue will end up in taxes. Am I doing the math right?

Have you set up some kind of structured defined contribution plan then? Or have you incorporated and re-invest the excess profit by paying a corporate tax?

My impression is that personal income tax rates make it highly inefficient to gross so much by pure hourly labor. I'm curious as to your tax avoidance strategies.

 

[yanks26dmb]

im on call for several different hospitals during the week; sometimes none sometimes multiple. i work every single day (weekends and holidays included). i do very high volume inpatient work half the week, combined with a locums gig that i negotiated very high rates for, own my own private practice that i started up in residency and now has multiple locations, etc.

Good for you. That kind of work ethic is admirable.

Maybe a stupid question but could a newer doc with half as much as you and gross 600/yr?

 

[yanks26dmb]

Of course, it is possible. But, the income would not be guaranteed. For example, you could potentially make 600/yr doing locums in the middle of nowhere and work 30-40 hours a week, but you may end up being replaced after 6 months, and have to start over. Or, you could make 600/yr providing inpatient coverage/call coverage for various doctors who are desperate for it, but they may find an NP or two to replace you, and you may not be needed a year later. This is the main reason why i work about 10 different jobs and end up with gobs of money; if i lose one gig (ie if they don't need me to provide call at one hospital); then it doesn't matter, I'm still making 7 figures a year, and i'll find another gig to replace that one. However, if I had fewer gigs, and I lost one, it would provide a bit more of a shock to my income.

In summary: sorry, if you want to make a lot of money as a new doc, you need to either work very hard or take lots of risk.

This is exactly what I want to do. I'd love to do lots of locums hours while getting my own practice up and running with the occasional weekend coverage. Figure if I can do this solid for 5 years and get 7 figures saved, I should be able to chill a bit and not worry about money so much. Hearing your story is very inspirational.

 

[dl2dp2]

This is exactly what I want to do. I'd love to do lots of locums hours while getting my own practice up and running with the occasional weekend coverage. Figure if I can do this solid for 5 years and get 7 figures saved, I should be able to chill a bit and not worry about money so much. Hearing your story is very inspirational.

This is not so straightforward. He made a lot of assumptions that yielded strategy that may not be valid. In fact I would say his assumptions are overly pessimistic on some and optimistic on others. The main assumption is that tax rates will go up, income will drop, and investment return will go up. I would argue more optimistically (and realistically), if you are at an early career stage, your salary increases in time, especially in our field, where there's a notable upward trend in salary. Investment return, on the other hand, may very much be flattening out after a very long recovery. Furthermore, as you get older more tax shelters open for you (i.e. 529s, housing, dependent care etc). This argues against front loading income as an efficient strategy for net worth maximization at the end of a 10 year period (say).

There are some debates on the value of dollar cost averaging in investments. Given the very high tax rate, it creates a substantial tax drag per incremental hour of work in total investment return at the end of accumulation phase (5 years).

You can fairly easily have 7 figures saved without working this much in our field in 5 years by living in a low cost of living location. I would caution the readers to put down some real numbers in a spreadsheet before overcommitting yourself to a bunch of locums.

 

[michaelrack]

Your self employment tax is taken care of and you reach ceiling. Highest federal income tax is 39.6%, plus state/local. .

Our great President lowered the highest rate a few percentage points for 2018, to 37%

 

[finalpsychyear]

You are overanalyzing what I am doing and making too many assumptions yourself. Of course, if your goal is to make as much money as possible while doing the least work possible, it would make more sense to cut down on the hours, and extend one's work life as long as possible. That is not my goal. My goals are twofold: A) to be able to retire from medicine if I so choose, within <2 years of finishing training (I should be able to reach this goal by end of this year), B) to build up a massive outpatient practice where I (and others )can deliver high quality of care without having to answer to any administrators above me. My strategy works for reaching those goals, but is a terrible strategy for other goals.

How many hours do you do a week ? Credit to working that hard just make sure you dont sacrifice too much sleep as that will take a toll down the road. Then again you might be retired in 2 years so your basically doing surgery like hours before the 80 hr rules except without the 5 years and malignancy.

 

[AD04]

im on call for several different hospitals during the week; sometimes none sometimes multiple. i work every single day (weekends and holidays included). i do very high volume inpatient work half the week, combined with a locums gig that i negotiated very high rates for, own my own private practice that i started up in residency and now has multiple locations, etc.

Wow, that's impressive.

1. How do you deal with the commute for 10 different jobs? Are most of them by phone?

2. Any tips on negotiating? What is good $ / hr?

3. When you go 100% private practice, do you expect the income to remain the same or higher?

4. With 7 or 8 figure net worth, you'll be a prime target. Any asset protection strategies?

5. How did you choose where you wanted to practice / work?

 

[dl2dp2]

You are overanalyzing what I am doing and making too many assumptions yourself. Of course, if your goal is to make as much money as possible while doing the least work possible, it would make more sense to cut down on the hours, and extend one's work life as long as possible. That is not my goal. My goals are twofold: A) to be able to retire from medicine if I so choose, within <2 years of finishing training (I should be able to reach this goal by end of this year), B) to build up a massive outpatient practice where I (and others )can deliver high quality of care without having to answer to any administrators above me. My strategy works for reaching those goals, but is a terrible strategy for other goals.

Makes sense. Thanks! Very interesting.

 

[Merovinge]

I'm sure its clear to most that while I think phorensic is the real deal, hes at the very edge of the bell curve. More realistically, it is extremely doable to string together a few gigs, work relatively reasonable hours, take a bit of call, and make 300-400k relatively quickly out of residency. I'm doing it my first year out of training as are many I know and I get every weekend off 🤣

 

[nexus73]

I'm sure its clear to most that while I think phorensic is the real deal, hes at the very edge of the bell curve. More realistically, it is extremely doable to string together a few gigs, work relatively reasonable hours, take a bit of call, and make 300-400k relatively quickly out of residency. I'm doing it my first year out of training as are many I know and I get every weekend off 🤣

What's your basic setup?

 

[Monocles]

so even if i do burn out i'll literally be able to retire in a year if i want to

Wow. Just wanted to say I'm super royal jelly...

 

[thepoopologist]

1. Most are not by phone. There are days I drive up to 4 hours a day. Most days I drive about 2 hrs a day. The commute is aided by the fact that I negotiated my way into a very expensive luxury car that I don't pay a dime for.

2. There is no secret to negotiation. Everything is based on hard work. The only reason I was able to negotiate, is because I already had several gigs running that I had started as a resident, so I knew what I was worth, and I knew what minimum number I would work for. Most sites rejected the numbers I asked for. One was particularly desperate, so it all worked out.

3. I expect my income per hour will be higher, but who knows. There are no guarantees. You rely on so many things that involve more than your own skills: a competent billing company, excellent staff, etc. Some of it definitely depends on luck.

4. Nothing more than ensuring I have adequate life/disability/malpractice/home/umbrella insurance, which I do.

5. I chose a spot that I simply wanted to live in and made it work from there.

That is the most insane work schedule I've ever heard of, however kudos for going for it. You might as well do it now while you have the energy.

 

[AD04]

1. Most are not by phone. There are days I drive up to 4 hours a day. Most days I drive about 2 hrs a day. The commute is aided by the fact that I negotiated my way into a very expensive luxury car that I don't pay a dime for.

2. There is no secret to negotiation. Everything is based on hard work. The only reason I was able to negotiate, is because I already had several gigs running that I had started as a resident, so I knew what I was worth, and I knew what minimum number I would work for. Most sites rejected the numbers I asked for. One was particularly desperate, so it all worked out.

3. I expect my income per hour will be higher, but who knows. There are no guarantees. You rely on so many things that involve more than your own skills: a competent billing company, excellent staff, etc. Some of it definitely depends on luck.

4. Nothing more than ensuring I have adequate life/disability/malpractice/home/umbrella insurance, which I do.

5. I chose a spot that I simply wanted to live in and made it work from there.

Thanks for sharing. So basically your secret is insane work ethics combined with good negotiation skills / never dependent upon one gig.

If I may offer a suggestion, I would suggest looking into asset protection besides insurance. Move your assets to other entities. If lawyers look up your name in a database and see that you have substantial worth, you'll be a prime target. Not saying you'll lose it, but there is a chance the judgement amount can pierce through the insurance coverage. By having minimal assets under your name, you can prevent getting served as much and force the other party to settle for lower in case you are sued.

If you're looking to hire, I'll start looking for jobs in about half a year. I plan to work crazy hours too.

 

[Trismegistus4]

I'm sure its clear to most that while I think phorensic is the real deal, hes at the very edge of the bell curve. More realistically, it is extremely doable to string together a few gigs, work relatively reasonable hours, take a bit of call, and make 300-400k relatively quickly out of residency. I'm doing it my first year out of training as are many I know and I get every weekend off 🤣

I recall phorensic saying a couple of years ago that he had a weekend moonlighting inpatient gig where he saw something like fifty patients per day. If those are the kind of numbers you're billing for, it's not hard to see how you could reach the level of income he's talking about. However, not only does it require a unique type of person to be constitutionally capable of working that hard (this introvert can't imagine thinking about fifty different people per day, period,) but it's also something I suspect many of us would not be comfortable with from a liability standpoint. Now, I'm not saying that that fear is always justified, nor am I saying phorensic doesn't have all his ducks in a row, but given the near-paranoia that was instilled in us in residency about a near-OCD level of thoroughness lest you get sued, I imagine many of us couldn't live with the nightmares of an attorney intoning in front of a jury: "how well could this doctor have understood Mr. Jones's complicated case if he was only spending 2 minutes per day seeing him?"

 

[hamstergang]

I recall phorensic saying a couple of years ago that he had a weekend moonlighting inpatient gig where he saw something like fifty patients per day.

It was 40-70. Which I think requires relaxing one's ethical standards as well.

 

[PistolPete]

@phorensic , how many hours do you sleep per night? Do you do forensic work, as your name suggests? Adult only? Good for you for your work ethic. Good luck. Sounds like a great way to make a boat load of money, be FIRE, and then maybe work part-time in a PP.

 

[Trismegistus4]

Of course, it is possible. But, the income would not be guaranteed. For example, you could potentially make 600/yr doing locums in the middle of nowhere and work 30-40 hours a week, but you may end up being replaced after 6 months, and have to start over.

How do you figure? If you worked 40 hours per week, all 52 weeks per year, and made $600k/year, that would be over $288/hour. What locums company is going to pay that much when, as we see from the PDF that was posted upthread, that's the kind of rate that locums companies are charging hospitals?

 

[finalpsychyear]

@phorensic , how many hours do you sleep per night? Do you do forensic work, as your name suggests? Adult only? Good for you for your work ethic. Good luck. Sounds like a great way to make a boat load of money, be FIRE, and then maybe work part-time in a PP.

I can't imagine its good sleep when you have the ER of one hospital let alone multiple paging or calling your cell phone. I hated this when i did a weekend coverage gig where they paged you 1x every 2-3 hrs.

 

[Stagg737]

It was 40-70. Which I think requires relaxing one's ethical standards as well.

Eh, I think that depends on what setting you're in and what your patient population looks like as well. One of my mentors regularly did ~50 pts/day, but almost every one was someone he'd been seeing for 5 years, were very stable, and were basically just coming in for a refill. We also worked long days (8 am - 6 pm at the earliest) and he only took two 15 minute breaks throughout the day. So you could hit that pretty easily seeing 4 pts/hr. He also very rarely took new patients unless they were coming from the inpatient unit he went to every few weeks, otherwise it was a 4+ month wait for a new patient appointment.

If you're going to see mostly complex patients, regularly do psychotherapy, or are on an inpatient unit, then I agree with you about having to have more "flexible" ethical standards. But it's not that hard to set up an outpatient practice where you see large numbers of patients and not sacrifice quality of care given the ridiculous demand for psychiatrists in most areas.

 

[thepoopologist]

I'd really only do that sort of schedule if I was looking to get out of medicine and needed some cash for my escape to mexico.

 

[hamstergang]

Eh, I think that depends on what setting you're in and what your patient population looks like as well. One of my mentors regularly did ~50 pts/day, but almost every one was someone he'd been seeing for 5 years, were very stable, and were basically just coming in for a refill.

My comment was written more generally, but I guess I meant it more to apply in this specific scenario involving a resident moonlighting (and therefore not long-term, well-established patients).

 

[clausewitz2]

What about the ethics of continuing to see well established, stable patients, on a single ssri, for basic depression/anxiety, for q3mo checkins? I see no problems with doing this, but in training, I had an attending comment that he thought this was not ethical, as many of these pts could be discharged to their PCPs, so that room could be made for patients who desperately need a psychiatrist; however, most practices dont do this because it is easy money every 3 mo.

How is seeing 40+ pts on an inpt unit in a weekend (which is tremendously common) relaxing ethical standards while the above isnt? as i said above, i think either is fine, just trying to understand where people come up with this stuff.

Generally when discussing ethical questions "but other people do it" or "but it's really profitable" tend not to be relevant arguments.

 

[hamstergang]

What about the ethics of continuing to see well established, stable patients, on a single ssri, for basic depression/anxiety, for q3mo checkins? I see no problems with doing this, but in training, I had an attending comment that he thought this was not ethical, as many of these pts could be discharged to their PCPs, so that room could be made for patients who desperately need a psychiatrist; however, most practices dont do this because it is easy money every 3 mo.

How is seeing 40+ pts on an inpt unit in a weekend (which is tremendously common) relaxing ethical standards while the above isnt? as i said above, i think either is fine, just trying to understand where people come up with this stuff.

1) I have no idea why you're bringing up that other scenario as it has nothing to do with this thread. Whether or not seeing 70 patients in a day is ethical doesn't depend on other practices being ethical or not.

2) You said up to 70 patients, which is really the problem, not 40.

 

[dl2dp2]

Where do you draw the line? I'm genuinely curious. This volume comes from doctors/hospitals literally having nobody else to cover. If you find that hard to believe, then you have zero clue about how serious of a problem the U.S. has with a lack of psychiatrists. So, would it be more ethical to just have the patients not be seen? Because that would be the alternative. Discharges would have to be held, admissions would not be seen, etc. Ideally, I would not be doing this. It is not like I constructed a business to work this way, or am forcing hospitals to not accept any other doctors to do the work. I am doing it because the help is desperately needed and am young/healthy enough to handle the workload. If it wasn't needed I'd gladly take my weekends off!

People who bring up "ethics" in discussions about salary and lifestyle are typically simply jealous of the salary and/or lifestyle and playing a game of sour grape... if you make THAT much money you MUST be "unethical". This is a false premise.

In academics, medical ethics is a way to discuss policy/regulatory maneuver prior to advocacy. These issues are not relevant to discussions of salary and lifestyle, IMHO. It's like how research in the brain is irrelevant to practice. What is relevant is the current regulatory details/written down statues, similar to current practice guidelines on best scientific evidence. There are vague areas where you might have to make case-by-case ethics judgements, but the big picture rules are already written down.

However, an issue perhaps you could address is whether it bothers you from a MEDICAL LEGAL perspective or a regulatory perspective in seeing so many patients: 1) are you worried about exposure to higher liability? 2) are large volume practices truly compliant to coding rules? would you be exposed to civil litigations (or even an expensive remediation) of "fraudulent" coding if there's an audit? How do you risk manage this and other related issues in a high volume 1MM+ revenue base scenario?

To be fair, on an objective basis, the risk even at the said volume is probably still lower than similarly high earning practices (i.e. high risk surgical subspecialties etc)... so perhaps I just answered my own question...

 

[hamstergang]

People who bring up "ethics" in discussions about salary and lifestyle are typically simply jealous of the salary and/or lifestyle and playing a game of sour grape... if you make THAT much money you MUST be "unethical". This is a false premise.

This is just entirely fabricated. Note how I'm not calling it unethical to work 365 days per year (I think it's crazy but not unethical, guess it works for some people). I'm commenting on the 70 patients in a day part of this. My comments have nothing to do with money or lifestyle.

1) I brought up the other scenario because you cited that as being ethical

Where?

Still irrelevant anyway. One of these being unethical doesn't determine whether the other one is. Your defense is essentially, "but you're a bad person too," which isn't a defense at all.

3) I still haven't heard an answer on why 40, 70, or more patients in one day is unethical?

Because in my opinion, you can't provide appropriate care in the short amount of time needed to see 70 inpatients per day, yet the patients are being billied for such a service. Perhaps "unethical" is the wrong word, but I think the practice is wrong regardless.

 

[finalpsychyear]

This is just entirely fabricated. Note how I'm not calling it unethical to work 365 days per year (I think it's crazy but not unethical, guess it works for some people). I'm commenting on the 70 patients in a day part of this. My comments gave nothing to do with money or lifestyle.


Where?

Still irrelevant anyway. One of these being unethical doesn't determine whether the other one is. Your defense is essentially, "but you're a bad person too," which isn't a defense at all.


Because in my opinion, you can't provide appropriate care in the short amount of time needed to see 70 inpatients per day, yet the patients are being billied for such a service. Perhaps "unethical" is the wrong word, but I think the practice is wrong regardless.

With the work ethic of this guy, everyone is using asumptions on how long it takes him to do in theory 70 pts. If he is rounding 12 hrs seeing 5-6 pts per hour i dont see the problem. Plus on the wknds, it is essentially the patients who are not stable that are getting most of the time as others are seen maybe 5 min tops.

There is a ton of inefficency in every field. I could easily see 8-10 follow ups for wknd coverage in 90 min max. This is done where most of the time is spent on new admits/unstable pts. Other residents in my year it would take them 4-5 hrs bc they would spend 20-30 min per patient, chat with the nurses, meet the families etc. Not saying that doesn't have value, but wknd coverage rounding should really stick to efficiency and spend majority of time on new/unstable pts.

 

[clausewitz2]

People who bring up "ethics" in discussions about salary and lifestyle are typically simply jealous of the salary and/or lifestyle and playing a game of sour grape... if you make THAT much money you MUST be "unethical". This is a false premise.

In academics, medical ethics is a way to discuss policy/regulatory maneuver prior to advocacy. These issues are not relevant to discussions of salary and lifestyle, IMHO. It's like how research in the brain is irrelevant to practice. What is relevant is the current regulatory details/written down statues, similar to current practice guidelines on best scientific evidence. There are vague areas where you might have to make case-by-case ethics judgements, but the big picture rules are already written down.

However, an issue perhaps you could address is whether it bothers you from a MEDICAL LEGAL perspective or a regulatory perspective in seeing so many patients: 1) are you worried about exposure to higher liability? 2) are large volume practices truly compliant to coding rules? would you be exposed to civil litigations (or even an expensive remediation) of "fraudulent" coding if there's an audit? How do you risk manage this and other related issues in a high volume 1MM+ revenue base scenario?

To be fair, on an objective basis, the risk even at the said volume is probably still lower than similarly high earning practices (i.e. high risk surgical subspecialties etc)... so perhaps I just answered my own question...

Inpatient psychiatry frequently involves imprisoning people. We justify this by saying that it is necessary for them to get care they cannot get otherwise. If you feel the only relevant ethics are contained within the specifications of the Joint Commission, CMS and HIPAA, I think our world views with respect to moral behavior are much too far apart for this to be a useful discussion.

 

[Amygdarya]

Inpatient psychiatry frequently involves imprisoning people. We justify this by saying that it is necessary for them to get care they cannot get otherwise. If you feel the only relevant ethics are contained within the specifications of the Joint Commission, CMS and HIPAA, I think our world views with respect to moral behavior are much too far apart for this to be a useful discussion.

Also, legal and ethical are not the same thing. Sometimes people are confused about this.

 

[Armadillos]

Finalpsych I felt exactly same way as a burnt out resident, but my world view has changed and I remembered that I’m actually a doctor for the purpose of helping people. So just want to challenge a few points in here to see if you can consider another perspective.

Plus on the wknds, it is essentially the patients who are not stable that are getting most of the time as others are seen maybe 5 min tops.

There is a ton of inefficency in every field. I could easily see 8-10 follow ups for wknd coverage in 90 min max. This is done where most of the time is spent on new admits/unstable pts. Other residents in my year it would take them 4-5 hrs bc they would spend 20-30 min per patient, chat with the nurses, meet the families etc. Not saying that doesn't have value, but wknd coverage rounding should really stick to efficiency and spend majority of time on new/unstable pts.

1) “it is essentially the patients who are not stable that are getting most of the time as others are seen maybe 5 min tops”

-Why are you keeping such a high percentage of stable patients in the hospital?? If they are stable enough to be seen in 2 minutes you should be discharging them or spending time and effort addressing the barriers to discharge.

2) “but wknd coverage rounding should really stick to efficiency”

-The patient doesn’t care what day of the week it is, why should efficiency be the primary focus one day and not the other? The standard of care on Sunday needs to be the same as on Monday. It’s disgusting that at many psych hospitals 29% of the days of the week patients are “cared” for by a doctor who isn’t taking full responsibility for diagnosis, treatment planning and decision making because they are “someone else’s” patient.

 

[finalpsychyear]

Finalpsych I felt exactly same way as a burnt out resident, but my world view has changed and I remembered that I’m actually a doctor for the purpose of helping people. So just want to challenge a few points in here to see if you can consider another perspective.




1) “it is essentially the patients who are not stable that are getting most of the time as others are seen maybe 5 min tops”

-Why are you keeping such a high percentage of stable patients in the hospital?? If they are stable enough to be seen in 2 minutes you should be discharging them or spending time and effort addressing the barriers to discharge.

2) “but wknd coverage rounding should really stick to efficiency”

-The patient doesn’t care what day of the week it is, why should efficiency be the primary focus one day and not the other? The standard of care on Sunday needs to be the same as on Monday. It’s disgusting that at many psych hospitals 29% of the days of the week patients are “cared” for by a doctor who isn’t taking full responsibility for diagnosis, treatment planning and decision making because they are “someone else’s” patient.

Hi. I get where your coming from and agree to a large extent. The larger problem is the way the system is designed it doesn't just depend on if the patient is stable that day. Discharge planning typically starts with ancillary staff who are usually not present on the weekends to a large extent and while wknd discharges do occur they are typically already planned by the primary team. I also am not sure if it is the best decision of the covering doc to discharge pts who he is seeing for the first or 2nd time who may try to manipulate the situation of the admission. Also, a lot of information about the status of the patient doesn't always go documented from the primary teams record. So usually if the primary team has kept them there over the wknd most often it is with much more basis than the covering docs rounding allows.

 

[PistolPete]

@phorensic, can you list some effective strategies that you've used when negotiating the highest rate of pay possible when talking with locums recruiters? I'm curious.