medscape young physician comp report

[calvnandhobbs68]

@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.

Do you guys not think that the locums recruiters look at sites like this every now and then? You should probably PM this stuff.

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[Trismegistus4]

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.

I actually agree and was going to post the same thing when I saw @Stagg737's post. I wouldn't call it unethical, but I question whether someone whose only psychiatric need is getting the Zoloft they've been taking for 2 years and are doing fine on refilled, really needs to see a psychiatrist. I send patients back to their PCP all the time. If you don't, many of them ask for it. "Do I really need to keep coming back here, doc?" And if I'm honest, the answer is "no."

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.

I was wondering the same thing. Not to question the ethics of it, but more just to ask, how does one even get away with that? I wondered whether @phorensic's gig was in a state hospital, because in this day and age, I can't imagine the corporate bean counters at a private hospital being OK with not discharging patients just because it's the weekend, because that results in the last day or 2 of the patient's stay getting denied by insurance.

I also wonder how it's humanly possible to see 70 patients in one day. I know that the level of thoroughness we were taught in medical school is likely overkill that's not quite necessary in the real world, but ISTM that if you're the patient's treating doctor for that day, you have to familiarize yourself with their case and understand why they're in the hospital, which requires skimming the admission H&P or at least reading the previous progress note, know what the weekday doctor's plan is, track down the patient, find a private place to meet with them, talk with them, however briefly, and then go back and write a progress note. And if you're seeing 70 patients, assuming a 12 hour day, you have a little over 10 minutes per patient to do all that, and that's with no bathroom breaks, no lunch, nothing, just chugging along like a freight train from one patient to the next for 12 hours straight.

 

[Stagg737]

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.

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

The issue that I think people are grappling with is in regards to adequately assessing and treating patients given the time constraints that would be required to physically see 70 patients. If you're working a 12+ hour day, skipping psychotherapy, and seeing stable outpatients, I think it's easier to grasp. On the inpatient side I could see this as a possibility if you're at a hospital with all chronic patients who have been there 5+ years and you're familiar with everyone (and the biggest questions are did Mikey need any haldol for a tantrum today?), you could pull it off. However, at most hospitals rounding on 70 patients means you're going to be cutting corners somewhere (and likely in many places) which many people will say is unethical.

Of course the counter is the utilitarian point, which you made, that if you weren't providing that less-than-desirable care then nobody would. I've rotated at hospitals where the ED literally had a dozen patients in beds in the hallway because they were waiting for psych beds and there weren't any actual rooms available, so I can appreciate your point there. However, that's where we start getting into murkier ethical questions about minimal standards of care, potential for harm, and triage in a society where resource allocation problems due to shortages. I don't think there's really one right answer at this point, as it becomes an argument of quality vs. quantity and justification of practice principles.

I actually agree and was going to post the same thing when I saw @Stagg737's post. I wouldn't call it unethical, but I question whether someone whose only psychiatric need is getting the Zoloft they've been taking for 2 years and are doing fine on refilled, really needs to see a psychiatrist. I send patients back to their PCP all the time. If you don't, many of them ask for it. "Do I really need to keep coming back here, doc?" And if I'm honest, the answer is "no."

From a utilitarian point, I agree. However I've encountered many patients who don't want their PCPs managing their psych meds even after they're stable because the PCP is the person who screwed them up in the first place. In some areas PCPs just won't manage certain meds in stable patients (stimulants for those with only ADHD, antipsychotic meds, and lets not even get into narcotics or benzos in mostly stable patients), so if psychs don't do it then no one will. Plus after what I've encountered in many PCPs, I honestly have a hard time trusting some of them to even manage simple depression. Maybe that's just me being overly jaded/cynical, but I'd rather take 5 minutes to write a refill and know my stable patient will stay stable than send them out to someone who doesn't even know what an SNRI is or thinks stopping all mood stabilizers in a bipolar patient and starting them on Zoloft because they're depressed is the right treatment plan.

 

[finalpsychyear]

I actually agree and was going to post the same thing when I saw @Stagg737's post. I wouldn't call it unethical, but I question whether someone whose only psychiatric need is getting the Zoloft they've been taking for 2 years and are doing fine on refilled, really needs to see a psychiatrist. I send patients back to their PCP all the time. If you don't, many of them ask for it. "Do I really need to keep coming back here, doc?" And if I'm honest, the answer is "no."


I was wondering the same thing. Not to question the ethics of it, but more just to ask, how does one even get away with that? I wondered whether @phorensic's gig was in a state hospital, because in this day and age, I can't imagine the corporate bean counters at a private hospital being OK with not discharging patients just because it's the weekend, because that results in the last day or 2 of the patient's stay getting denied by insurance.

I also wonder how it's humanly possible to see 70 patients in one day. I know that the level of thoroughness we were taught in medical school is likely overkill that's not quite necessary in the real world, but ISTM that if you're the patient's treating doctor for that day, you have to familiarize yourself with their case and understand why they're in the hospital, which requires skimming the admission H&P or at least reading the previous progress note, know what the weekday doctor's plan is, track down the patient, find a private place to meet with them, talk with them, however briefly, and then go back and write a progress note. And if you're seeing 70 patients, assuming a 12 hour day, you have a little over 10 minutes per patient to do all that, and that's with no bathroom breaks, no lunch, nothing, just chugging along like a freight train from one patient to the next for 12 hours straight.

I once rounded on 50 patients in a day. However I did do a sign out with the attendings the day before in person just because i felt more comfortable than just getting a word document sign out.Got there at 6am and left at 11pm. Minimum breaks and used the nursing staff that was familiar with each patient as much as possible. I had them prepare the HPI and last progress note for me for each patient to make it efficient. I spent the night there and started rounds again at 8 am the next day and was out by 5pm. I had a cart and documented right after and even during the encounter at times. They considered my rounding the most thorough compared to others but whatever it was a lot of work still.

Obviously it can be done but its not my cup of tea

 

[erg923]

Not sure why @phorensic is so admirable on here? This is a "wise" financially strategy, no doubt (early planing for retirement is cool and smart), but if the narrative reality misses the mark in terms of what mental health professionals generally agree to be important psychological/psychosocial lifestyle factors, this is nothing to be admired no matter how much he/she might be saving for retirement. If you want to sacrifice partners, family, children (or at least time with all of the above), health, sleep, recreation, spirituality/faith/religion, etc. for the sake of money, be my guest (Is there a 7 cardinal sin in there somewhere????). But lets not delude ourselves about whether this creates "happiness" for the average person or physician. I would rather have my intangibles while I can, and psychological research on "happiness" supports this preference.

Are we purveyors of mental health hygiene within medicine, or just robots like some of the rest of America?

 

[finalpsychyear]

Not sure why @phorensic is so admirable on here? This is a "wise" financially strategy, no doubt (early planing for retirement is cool and smart), but if the narrative reality misses the mark in terms of what mental health professionals generally agree to be important psychological/psychosocial lifestyle factors, this is nothing to be admired no matter how much he/she might be saving for retirement. If you want to sacrifice partners, family, children (or at least time with all of the above), health, sleep, recreation, spirituality/faith/religion, etc. for the sake of money, be my guest (Is there a 7 cardinal sin in there somewhere????). But lets not delude ourselves about whether this creates "happiness" for the average person or physician. I would rather have my intangibles while I can, and psychological research on "happiness" supports this preference.

Are we purveyors of mental health hygiene within medicine, or just robots like some of the rest of America?

He is basically working like how surgical physicians who were in residency back in the 80s-90s are working except making 7 figures. Its probably like a 2 year "80s fellowship" for him except he drives a free tesla (guess). But netting 1 million or so after taxes for this 2 years of torture invested in the stock market might be equal to an avg psych working/investing if you compared them 8-10 yrs down the road. I'd be miserable trying to do the same thing and i'm sure phorensic isn't on cloud 9 but see's the end game here which i believe he will be nearly outpatient only by 2019.

 

[dl2dp2]

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.

In my experience, people (perhaps people like you) who have a hypersensitive nerve about ethics end up delivering substandard care. If community practitioners actually follow APA guidelines and CMS rules in coding and hospitals actually followed the spirits of Joint Commission requirements we likely wouldn’t be having this conversation in the first place (is a system that allows weekend coverage doctors round on 70 patients really JC compliant? That to me is a much more relevant question than some pedantic academic exercise of what is “ethical”). Furthermore, people frequently use “ethics” as a way too get out of doing their fair share of work, and use “ethics” to justify not being efficient and having other people picking up after them. People use “ethics” as a way to skirt or neglect written down rules by claiming that they are better than whatever is written down. The reality is that if you can be compliant with written down rules you are better than a lot of people out there. And if I had a choice of evaluating two clinicians, I would rather have one who follows guidelines to the T but does not do one bit more than someone who haphazardly dispenses his or her own version of what is “ethical” practice in an inconsistent way. What is really “unethical” about most of community psychiatry? Written down guidelines not being followed, shoddy (non-DSM) diagnoses, incorrect impressionistic use of medications, non evidence based psychotherapy practice.

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

No, people are not “confused” about this. The basic point is legality is more clearly defined. Legal practice is allowed and encouraged, even if it’s supposedly “unethical” in your personal book of ethics. Academic discussions of ethics have boundaries. Your personal book of ethics and virtue signaling are irrelevant (indeed detract from) to someone’s fairly credible story of how he/she can make a million dollars a year in psychiatry.

It’s like someone who’s telling you a story about how she got an abortion on the internet in terms of actual procedure and experience. Oh ok cool story. You come here and say oh abortions are unethical. Who gives a rats ass what you think is ethical and not ethical?

 

[hamstergang]

Your personal book of ethics and virtue signaling are irrelevant (indeed detract from) to someone’s fairly credible story of how he/she can make a million dollars a year in psychiatry.

It’s like someone who’s telling you a story about how she got an abortion on the internet in terms of actual procedure and experience. Oh ok cool story. You come here and say oh abortions are unethical. Who gives a rats ass what you think is ethical and not ethical?

This whole post of yours just sounds upset that we're even discussing ethics. I'm not sure I understand why such a discussion would bother you.

 

[clausewitz2]

It’s like someone who’s telling you a story about how she got an abortion on the internet in terms of actual procedure and experience. Oh ok cool story. You come here and say oh abortions are unethical. Who gives a rats ass what you think is ethical and not ethical?

In reality, it's much more like someone telling me a story on the internet about how they provide abortions in terms of actual procedure and experience, only they are doing it in the back of a van without observing any kind of sterile technique or having adequate supplies on hand for addressing common and emergent complications.

It doesn't really matter what I think, shady jobs are going to continue to be shady. I think if you do what we do and you are not thinking very carefully about how to make it consistent with your moral values on a regular basis, you are not particularly interested in leading an examined life or introspection is all.

 

[dl2dp2]

This whole post of yours just sounds upset that we're even discussing ethics. I'm not sure I understand why such a discussion would bother you.

There could be a variety of reasons why something would bother me, like for example, if I think your code of ethics is racist. Given the shortage of care, the supposed "high ethical standard" is really just a shorthand way for you to ration care to the poor and the minorities.

Not that I'm actually upset for that reason, but that would be one reason.

In reality, it's much more like someone telling me a story on the internet about how they provide abortions in terms of actual procedure and experience, only they are doing it in the back of a van without observing any kind of sterile technique or having adequate supplies on hand for addressing common and emergent complications.

It doesn't really matter what I think, shady jobs are going to continue to be shady. I think if you do what we do and you are not thinking very carefully about how to make it consistent with your moral values on a regular basis, you are not particularly interested in leading an examined life or introspection is all.

There's not enough information to evaluate whether the care described is shady or not--did you audit the charts? Did you do a comparative effectiveness study? It's fairly clear that it's not about the *delivery* of care at all---that's not the discussion. The discussion is a personal one: what kind of job someone can have, what it's like and how to make it work. It's much closer to getting an abortion than giving an abortion. It is clear that you are unwilling to even entertain that it's possible to deliver very high volume care "ethically" (to be more precise, by the books) to alleviate shortage AND make a tremendous salary in psychiatry. Indeed, if every psychiatrist is working like that perhaps we wouldn't have a shortage. You are the one who comes up here take one look at one sentence and say categorically this is not ethical and like back ally abortions. If there's someone who lacks introspection and open-mindedness, it is you not me.

On a larger point, what I do find wanting on these forums is that every time someone (likely brown or some other shade of immigrant) comes up here to talk about the business side of psychiatry at any level of honesty some likely already wealthy (white) entitled person comes here accuses someone of doing something unethical while this said person sits there on their mommy-daddy paid for diploma treating 5 worried-wells a week. Really, #no1cares about your racist ethical opinions. Please be more aware of your privilege in your random assumptions about people. (See, I can do it too!)

 

[hamstergang]

There could be a variety of reasons why something would bother me, like for example, if I think your code of ethics is racist. Given the shortage of care, the supposed "high ethical standard" is really just a shorthand way for you to ration care to the poor and the minorities.

Not that I'm actually upset for that reason, but that would be one reason.

So why don't you tell us your real reason instead of this fake reason? Seems really odd to give an example that's not true instead of just telling us the truth.

It is clear that you are unwilling to even entertain that it's possible to deliver very high volume care "ethically" (to be more precise, by the books) to alleviate shortage AND make a tremendous salary in psychiatry.

I don't know why you don't believe us that this isn't about money for all of us. You're just fabricating that this is why we're concerned when we give other reasons.

On a larger point, what I do find wanting on these forums is that every time someone (likely brown or some other shade of immigrant) comes up here to talk about the business side of psychiatry at any level of honesty some likely already wealthy (white) entitled person comes here accuses someone of doing something unethical while this said person sits there on their mommy-daddy paid for diploma treating 5 worried-wells a week. Really, #no1cares about your racist ethical opinions. Please be more aware of your privilege in your random assumptions about people. (See, I can do it too!)

This is just crazy.

 

[dl2dp2]

So why don't you tell us your real reason instead of this fake reason? Seems really odd to give an example that's not true instead of just telling us the truth.


I don't know why you don't believe us that this isn't about money for all of us. You're just fabricating that this is why we're concerned when we give other reasons.


This is just crazy.

I gave you the "real" reason ("what I do find wanting...") in the "crazy" paragraph. It bothers me because you are trying to detract from the content of the thread with your questionable books of ethics. I do believe it's not about money for you...because you (or your family) already HAVE money. This is the whole point, people need to be more "introspective" about their own privilege before proselytizing their ethics on a thread about money and lifestyle, and then come here and lecture me to be "introspective" about my lack of moral compass, and then gaslight me on being "crazy". Gimme a break lol.

 

[clausewitz2]

There could be a variety of reasons why something would bother me, like for example, if I think your code of ethics is racist. Given the shortage of care, the supposed "high ethical standard" is really just a shorthand way for you to ration care to the poor and the minorities.

Not that I'm actually upset for that reason, but that would be one reason.



There's not enough information to evaluate whether the care described is shady or not--did you audit the charts? Did you do a comparative effectiveness study? It's fairly clear that it's not about the *delivery* of care at all---that's not the discussion. The discussion is a personal one: what kind of job someone can have, what it's like and how to make it work. It's much closer to getting an abortion than giving an abortion. It is clear that you are unwilling to even entertain that it's possible to deliver very high volume care "ethically" (to be more precise, by the books) to alleviate shortage AND make a tremendous salary in psychiatry. Indeed, if every psychiatrist is working like that perhaps we wouldn't have a shortage. You are the one who comes up here take one look at one sentence and say categorically this is not ethical and like back ally abortions. If there's someone who lacks introspection and open-mindedness, it is you not me.

On a larger point, what I do find wanting on these forums is that every time someone (likely brown or some other shade of immigrant) comes up here to talk about the business side of psychiatry at any level of honesty some likely already wealthy (white) entitled person comes here accuses someone of doing something unethical while this said person sits there on their mommy-daddy paid for diploma treating 5 worried-wells a week. Really, #no1cares about your racist ethical opinions. Please be more aware of your privilege in your random assumptions about people. (See, I can do it too!)

Dude and/or dudette, you are the one who brought up abortion. This conversation is officially ludicrous.

 

[hamstergang]

I gave you the "real" reason ("what I do find wanting...") in the "crazy" paragraph. It bothers me because you are trying to detract from the content of the thread with your questionable books of ethics. I do believe it's not about money for you...because you (or your family) already HAVE money. This is the whole point, people need to be more "introspective" about their own privilege before proselytizing their ethics on a thread about money and lifestyle, and then come here and lecture me to be "introspective" about my lack of moral compass, and then gaslight me on being "crazy". Gimme a break lol.

I'm not saying I don't care about money in my life, I'm saying I'm not bothered by phorensic making a lot of money. Claiming that this stems from me being rich and privileged (which you don't know to be true or not) is patently absurd and doesn't even make sense.

I honestly dony even know how you're turning this into an issue of race when no one else has yet mentioned race. Race hasn't once crossed my mind in this thread. This doesn't make any sense to me.

 

[dl2dp2]

I'm not saying I don't care about money in my life, I'm saying I'm not bothered by phorensic making a lot of money. Claiming that this stems from me being rich and privileged (which you don't know to be true or not) is patently absurd and doesn't even make sense.

I honestly dony even know how you're turning this into an issue of race when no one else has yet mentioned race. Race hasn't once crossed my mind in this thread. This doesn't make any sense to me.

That's the whole point: the validity of your book of ethics is modulated by your background to which we are not privy and with which we can only make hyperbolic assumptions to demonstrate how ludicrous bringing in ethics is in the first place. It detracts from legit discussions about procedures, finances, possible lifestyle considerations, etc. things we actually care about.

 

[Amygdarya]

On a larger point, what I do find wanting on these forums is that every time someone (likely brown or some other shade of immigrant) comes up here to talk about the business side of psychiatry at any level of honesty some likely already wealthy (white) entitled person comes here accuses someone of doing something unethical while this said person sits there on their mommy-daddy paid for diploma treating 5 worried-wells a week. Really, #no1cares about your racist ethical opinions. Please be more aware of your privilege in your random assumptions about people. (See, I can do it too!)

I don't know what you're basing these ridiculous assumptions on. If anything, I'm an immigrant from a "non-first world" country (though not brown, but I'll live with the white guilt - sarcastic, as not everyone who's ever had a hard life is brown) and, considering that I don't have any family in the US at all and my family back in the motherland is poor even by that country's standards, it's all "me, myself and I" in terms of my financial situation. So check your assumprions and the chips on your shoulders.
Yet, I still don't think providing crappy medical care is justifiable (to make sure, I'm talking about providing crappy medical care in general, not about phorensic specifically, whose quality of care I have little information about).

And please don't be so hypocritical as to justify one's priority of making lots of money by mentioning concerns about care access. If you care so much about the poor and the downtrodden your should make 100% of your income from community mental health care centers while spending your free time volunteering with the homeless etc. Yet clearly that's not the kind of work psychiatrists seeing 70 patients a day do.

And yeah, it sounds like this discussion upsets you a lot. You may want to take a deep breath and/or take a break from this thread before you write another nonsensical angry post.

 

[deleted736562]

I think the discussion got out of hand. I think the point sluox is making is that ethics, if not written down and codified, can be quite arbitrary and vary significantly with personal circumstance and is not very fruitful in a discussion like this one. At the end of the day we don't know how phorensic is seeing his 70 patients a day. And there's a point to be made: if the jobs are available then someone is looking for people to work. Are these patients better in the hands of an NP? I'm not sure... At the end of the day, what we do have is our codified code of ethics as standard of care, and this does not include, afaik, number of patients seen.

 

[WisNeuro]

 

[Trismegistus4]

I gave you the "real" reason ("what I do find wanting...") in the "crazy" paragraph. It bothers me because you are trying to detract from the content of the thread with your questionable books of ethics. I do believe it's not about money for you...because you (or your family) already HAVE money. This is the whole point, people need to be more "introspective" about their own privilege before proselytizing their ethics on a thread about money and lifestyle, and then come here and lecture me to be "introspective" about my lack of moral compass, and then gaslight me on being "crazy". Gimme a break lol.

That was a "crazy" thing to bring up considering that this is a pseudonymous message board where you don't know anyone's race or ethnicity. Besides, in my experience, if anything it was my "brown" classmates who had the "mommy-daddy paid for diplomas." I come from a white working-class family while I can't think of a single one of my South Asian-origin classmates who did not have professional parents.

 

[lovanima]

An Asian coming to the US a couple years ago, and my mother is working as a janitor. She worked at a kindergarten before we came here, and we have always struggled. I'm also the first person in my family to go to college. No one in my family ever finished high school. Still, I don't feel the need to make 7 figures. I just don't want to barely survive paycheck by paycheck or have to borrow money from others like before.

My point is: people grow up poor can have different perspectives about money and ethics. I think race and poverty might result in certain behaviors, but they should not be excuses for not giving pts their deserved care and attention.

On the other hand, we have a psychiatry who spends like 5 mins with each patient and his notes are no more than 3 sentences. He gets consults done at the speed of light, and he makes more than surgeons do here. No one wants to consult him, but we're in shortage of psychiatrists. He's probably one of the reasons why people at my institution think psychiatrists are lazy. I don't know how poor he was before, but I believe his pts deserve more of his time and more complete assessments.

 

[finalpsychyear]

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

If you had to ball park the hours those guys are working what's your guess.... 80?

 

[michaelrack]

If you had to ball park the hours those guys are working what's your guess.... 80?

70

 

[uhmocksuhsillen]

70

What type of jobs are they taking? Or is this pp?

 

[michaelrack]

It's private practice, mostly inpatient, with some hospital subsidies, covering multiple inpatient units

 

[MedMan80]

For what its worth in residency 1-2 years ago we had to cover around 30-40 patients on the weekends..12 consults plus about 18-25 followups that we were expected to see and this was a 12 hour shift which included rounding with the attending, it sucks but if we didn't have attending rounding we could probably safety see another 10 or so patients. What im saying is if a residency program considered a resident seeing that many patients ethical, then a seasoned attending could safely see more IMO, again, it SUCKED but when there's a need there's a need.

 

[DisorderedDoc417]

For what its worth in residency 1-2 years ago we had to cover around 30-40 patients on the weekends..12 consults plus about 18-25 followups that we were expected to see and this was a 12 hour shift which included rounding with the attending, it sucks but if we didn't have attending rounding we could probably safety see another 10 or so patients. What im saying is if a residency program considered a resident seeing that many patients ethical, then a seasoned attending could safely see more IMO, again, it SUCKED but when there's a need there's a need.

As long as you’re giving those consults adequate time (30 minutes a piece) and can blow through 4-5 follow-ups an hour seems reasonable. Adding another 10 patients to a resident workload and you might “get through it” but would start to wonder about the quality. Documentation being outside of the outlined time above.

 

[Salpingo]

For what its worth in residency 1-2 years ago we had to cover around 30-40 patients on the weekends..12 consults plus about 18-25 followups that we were expected to see and this was a 12 hour shift which included rounding with the attending, it sucks but if we didn't have attending rounding we could probably safety see another 10 or so patients. What im saying is if a residency program considered a resident seeing that many patients ethical, then a seasoned attending could safely see more IMO, again, it SUCKED but when there's a need there's a need.

I think ethical is the wrong word - it’s a question of value. Do you really add value when you’re burning through so many patients? Are you making meaningful interventions or just copying forward the plan and mental status? As an earlier post mentioned, if we see a patient for 5 minutes and leave a three sentence note, the rest of the hospital isn’t go to see us as anything more than the gatekeepers to get their problem patients onto a psychiatry inpatient floor, and for the inpatient unit just to be a dumping ground for malingerers to wait out the days until their social security clears.

 

[Mapplicant]

Do you guys not think that the locums recruiters look at sites like this every now and then? You should probably PM this stuff.

So?

The locum industry thrives on information asymmetry. I've had locum recruiters quote me rates of 110-120/hr simply because I was a "new" grad and that "in time" I will earn the "big bucks."

I'm all for people earning a living and obviously locum companies deserve a profit for their services. But the more information is shared with docs, whom are commonly known as whales and are not the most financially savvy (see WCI), the better it is for everyone.

Nothing specific to deal with locum people on negotiations. Similar tactics to regular business negotiation applies. Main thing is to not be afraid to ask and be firm and always negotiate where-ever you can.

One thing I notice is many ads will quote a seemingly large amt of dollars/day or dollars/shift or dollars/month. Always calculate the hourly rate and negotiate from there.

From last year's conversations with few of my former colleagues, outpt rates should be in the range of 170+/hr and inpt rates should be in the range of 200+/hr.

 

[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.

For you non-private practice work, do you go through staffing agency for your gigs? Or do you find them yourself? If you find them yourself, how do you do so?

 

[FlowRate]

BTW aside from the current thread topic, the comp report this year is more in line with what I'd expect. Medscape: Medscape Access

 

[Shufflin]

Slide 12 is unexpected. Didn't think there's such a disparity between satisfaction rates of older vs younger psychiatrists. Incomes have trended up, so why the net negative? I know I'm very satisfied with income (albeit N of 1).

 

[FlowRate]

Medscape says its confidence interval is pretty tight but the report is highly discordant with the one from last year. (for psych) I'd bet it's a different cohort of people polled/responded this year.