Moonlighting in telepsychiatry as a resident

[toothless rufus]

Is this possible?

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[mkeguy]

i know it is possible at iowa (and pays reallyyyy well)

 

[brodaiga]

any more details available?

 

[TexasPhysician]

Sure - why not?

 

[Lauraaa]

http://www.caltelepsych.com

I'm wondering if anyone has worked with this company; or know of anyone who did and what kind of experience was had. I wasn't clear from the website, but it looks as though the system can be set up that they would contract with county mental health community clinics for you for a set up where the patients would go to the clinic and you would see them from you home. They never used the word 'skype' but I wonder what kind of platform they use and the logistics and security behind it.

 

[LimbicResponse]

Not only possible, but it is being done already at a couple of places.

 

[BobA]

What are the legal problems people run in to with this?

 

[toothless rufus]

Not only possible, but it is being done already at a couple of places.

Would be interested in any details, thanks.

 

[kindasorta]

Would be interested in any details, thanks.

You'll need a camera.

 

[toothless rufus]

You'll need a camera.

Ah. The mystery is solved. Thank you.

 

[notdeadyet]

Any of the companies who are worth working for supply you with all the hardware you need.

You really need a high end camera/monitor/audio set-up. I did six months of telepsych work and the difference between good and great in terms of this is phenomenal. It's a good lesson in how much we rely on the subtleties in our jobs.

You should really defer to the telepsych company for equipment and security. If they let you do it, you're assuming liability in the case of security issues. I personally wouldn't want the headache.

 

[Lauraaa]

Any of the companies who are worth working for supply you with all the hardware you need.

You really need a high end camera/monitor/audio set-up. I did six months of telepsych work and the difference between good and great in terms of this is phenomenal. It's a good lesson in how much we rely on the subtleties in our jobs.

You should really defer to the telepsych company for equipment and security. If they let you do it, you're assuming liability in the case of security issues. I personally wouldn't want the headache.

Can I ask what telepsych company you worked with when you did this for six months? And what were the other pros/ cons about the work that you found?

 

[F0nzie]

I looked into telepsychiatry last year and I was not able to find a company willing to hire me as a resident. Most recently, I found a telepsych job that would require me to drive to their facility and use the camera on site. I will point out the obvious flaw that this approach defeats the purpose of performing evals remotely while wearing a suit jacket and pajama pants.

 

[notdeadyet]

Can I ask what telepsych company you worked with when you did this for six months? And what were the other pros/ cons about the work that you found?

I did a VA telepsych clinic. It was done from an office with the set-up and another camera was set up in rural clinics, where there was a psych tech with training available if needed. Patient's came to the appointment, I treated them, and they left. Depending on what transpired, I'd occasionally call the psych tech to provide them written instructions, walk them to pharmacy, etc.

Pro's:
- The main pro of telepsychiatry is that you are able to provide psychiatric services to underserved communities.
- There is the therapy-in-your-boxers aspect F0nzie pointed out if you go with one of the privates, and most of the privates have fairly flexible schedules.

My Con's:
- There will ALWAYS be connection issues. Your end may be lightning fast on your end, but your clients will often be in rural areas with dodgy computer networks. Even rural EDs have some bandwidth issues here and there (hell, the urban ones do too). And when bandwidth is tight, image degredation can get laughably bad.
- It feels like boxing with one sprained wrist. If you set the camera up the way most folks do, you pretty much get a head and shoulders shot. You miss a lot when you can't see a patient twisting a wedding ring when talking about a woman at work, or sudden foot tapping on certain topics. If you push the camera back to get their full body sitting in the chair, you miss lots of nuances of expression. You can't even tell if they are quietly crying. And this was using top notch equipment (the stuff the mom-and-pop telepsych companies provide is not so nice). I'm sure you learn to adapt to this with time, and I certainly got a lot better after six months, but I don't think I ever was as effective as I would have been had I been in the room.

Prospective Con's:
- Rural EDs and health systems are desperate for psychiatrists and telepsych seems to be the answer to their prayers. And whenever there are prayers, there will be false prophets. Telepsych companies are the ultimate fly-by-nights. Setting up contracts are easy and if you want to go with cheap equipment, the equipment is cheap. So it seems like everybody is setting up a telepsych company and I'd be reluctant to work for most of them. Strong chance of their overselling, underdelivering, and you're left holding the bag.
- Legal situation is questionable. You have to be licensed in the state you're practicing (except at the VA or in the military), unless things have changed. Even if they loophole this, I would not do it otherwise. Telepsych is too new for a lot of case law, but a lot of people will watch for the next bad outcome. I would not want to be the psychiatrist with the next telepsych suicide. And I would carefully look at what the malpractice looks like when offered by the telepsych companies (see false prophets and doing it on the cheap above).

If you go to APA, wander around the vendor area and I'll bet you'll see a lot of telepsych companies. Last year there were 2 that I noticed and if there's not at least double that this year, I'll eat my hat.

But caveat emptor.

 

[vistaril]

I looked into telepsychiatry last year and I was not able to find a company willing to hire me as a resident. Most recently, I found a telepsych job that would require me to drive to their facility and use the camera on site. I will point out the obvious flaw that this approach defeats the purpose of performing evals remotely while wearing a suit jacket and pajama pants.

Im not all that impressed with the potential of telepsychiatry long term......I think telepsychiatry has already exploded and will continue to explode in some areas(neurology, derm), but for psychiatry I just don't see it.

 

[notdeadyet]

Im not all that impressed with the potential of telepsychiatry long term......I think telepsychiatry has already exploded and will continue to explode in some areas(neurology, derm), but for psychiatry I just don't see it.

Interesting. Opposite impression here from doing it and research.

Psychiatry is largely a verbal enterprise, which makes the audio-visual limitations of telehealth less impactful.

Derm is literally tactile. If you've ever done a rotation with them, you know that they get as much from touching the rashes and whatnot as they do from any other modality. Also, they differentiate between a lot of nuances that require either in person evaluation or higher resolution than telehealth would really provide ("put your groin up to the camera... closer... closer...").

I'm sure there is some telehealth with derm, but given psychiatry shortages and its audio-verbal nature, telepsych will get a lot more traction than most any other specialty.

 

[deejayshakur]

yes, pgy-iv hired by a private company. paid malpractice, business cable line, laptop, HD camera, 2 LCDs, work from home in pajama pants. plan to continue with them after residency.

 

[Dogdaysofsummer]

yes, pgy-iv hired by a private company. paid malpractice, business cable line, laptop, HD camera, 2 LCDs, work from home in pajama pants. plan to continue with them after residency.

Interesting. What company?