Multi-part question: what do psych attendings do all day?

[BiscoDisco]

I'm doing the same. Front loading my work hardcore for 2-3 years then letting the power of compounding work over the next 20 years.

Should probably clear 800 this year and honestly not killing myself too badly in the process.

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[psychmd03]

I used to think like this but then i realized time is priceless. I hope you get a week vaca every few months. Sure it may make a mild difference in ur bottom line but def enjoy the process of getting to all ur financial goals. You never know when ur number gets called or those around you aren't around or you or so health is taken for granted. Live in the moment to a large degree. Won't matter if you reach 6,7,8, 10, 12m really you likely wont ever spend through any of it if you were disciplined enough to get there so quickly.

I don’t actually disagree with this that much even though right now I’m making a sprint of a marathon. But at this time it doesn’t detract from our enjoyment of present. I have a lot of enjoyment right now even with the work. Each day I have the time to get a long workout plus a long walk and normally some reading plus tv time. Weekends normally means eating out and drinks with friends, wandering the city doing random things like a painting class or something. But I overall agree you should enjoy the process of getting to the destination as much as you enjoy the destination

 

[psychemdoc]

Roll in at 830. Usually finish rounding and notes around 1130-12, an hour or less to finish up any calls/paperwork, gone by 1.

Usually run errands, play videogames, take naps. Recently I picked up doing extra inpatient work 2 days of the work for extra money.

It's a good life.

How much does your main gig pay for that relaxed schedule? How much call burden if you don’t mind me asking? Cause that sounds incredibly nice to me. Is this a rural undesirable area too or what? Sorry for all the questions feel free to answer any or none of it!

 

[Mad Jack]

I knew a guy who left around 6am each morning to commute to an IP unit 50 minutes away, saw 15-20 IP patients (only attending on the unit, half the notes written by his NP but he saw all of them). Saw 20-30 patients in afternoon clinic then stopped by nursing homes on the way home and saw however many patients. 13 ish hour day plus 24/7 call 365 days a year. I am sure he cleared 7 figures. For what reason I have absolutely no idea as it was a LCOL area and he already had the most expensive house in the entire region.

That sounds like hell, I can't imagine safely practicing like that. Not a week goes by that I don't have some inpatient that has significant medical or psychosocial issues that eat up hours of my week individually. To get more efficient do people just turf all of that to others and focus on med management?

 

[TheRightMedication]

That sounds like hell, I can't imagine safely practicing like that. Not a week goes by that I don't have some inpatient that has significant medical or psychosocial issues that eat up hours of my week individually. To get more efficient do people just turf all of that to others and focus on med management?

Yes

 

[comp1]

Personally, I view outpatient doctor calls as also more of a resident thing unless there is some sort of extremely complicated or weird thing going on with the patient. It often turned into more of a processing session for the stressed out outpatient doctor in my experience. If I do get roped into one, I very gently remind outpatient MDs that any time they are feeling worried or stressed out about a patient...PHPs and IOPs exist to hopefully avoid future inpatient admissions. Now family calls, that can actually be a core med student thing, definitely for the first call and then the residents can clean up the missing information.

 

[clausewitz2]

Personally, I view outpatient doctor calls as also more of a resident thing unless there is some sort of extremely complicated or weird thing going on with the patient. It often turned into more of a processing session for the stressed out outpatient doctor in my experience. If I do get roped into one, I very gently remind outpatient MDs that any time they are feeling worried or stressed out about a patient...PHPs and IOPs exist to hopefully avoid future inpatient admissions. Now family calls, that can actually be a core med student thing, definitely for the first call and then the residents can clean up the missing information.

I care much less about processing anxiety I have about my patients and a lot more about making sure a) the inpatient folks actually have some idea of what was going on at the time of the admission and possibly salient things that had been tried in the past that might have gone very well or very poorly and b) that I have some idea what you all plan to do. If I don't do this, a non-trivial proportion of the time I get my patients back with zero information about the hospitalization beyond the garbage patient discharge handouts institutions love to give out and not infrequently on a medication they hated and didn't tolerate in the past. It seems like it's in everybody's interest to avoid these outcomes.

I'm happy to talk to the resident and you don't need to be the OP doc's therapist but the conviction that their outpatient course is irrelevant to their inpatient treatment and vice versa remains baffling to me.

 

[comp1]

Oh I'm in a single unified system (best way to practice). I typically have immediate access to 25+ years of past documentation on a given patient if the patient is old enough. Unless it's a very frequent admit, I usually spend a lot more time reviewing the chart than with the patient because patients tend to be quite horrible historians, particularly about medications. The outpatient providers who reach out to me know I already know what is going on with the patient from the chart. They generally want to discuss more how the patient's behavior is impacting them since that part isn't charted on. And vice-versa, the outpatient providers have complete access to my documentation and why any changes or decisions were made.

 

[Candidate2017]

How much does your main gig pay for that relaxed schedule? How much call burden if you don’t mind me asking? Cause that sounds incredibly nice to me. Is this a rural undesirable area too or what? Sorry for all the questions feel free to answer any or none of it!

Everyone's version of relaxed is different, and there's selection bias so people forget to mention call and other duties. One psychiatrist may think 30 inpatients in the AM, weekend rounding q4 weeks, and call q3 days is a breeze, while another may think that's hell. And work burden is different with academic/residents vs. community vs. state hospital, support by NPs vs. supervising NPs, etc.

I care much less about processing anxiety I have about my patients and a lot more about making sure a) the inpatient folks actually have some idea of what was going on at the time of the admission and possibly salient things that had been tried in the past that might have gone very well or very poorly and b) that I have some idea what you all plan to do. If I don't do this, a non-trivial proportion of the time I get my patients back with zero information about the hospitalization beyond the garbage patient discharge handouts institutions love to give out and not infrequently on a medication they hated and didn't tolerate in the past.

Outpatients end up hospitalized for 3 reasons: some version of SI/attempts, mania/psychosis, and +/- substances. The majority of these reasons are precipitated by poor patient choices (poor coping mechanisms or unilaterally stopping meds in the absence of any intolerable side effects) rather than outright medication failures.

Whether the patient comes back with good discharge papers, as long as they have a list of their meds (which can also be pulled from their pharmacy), there is some clue as to what the inpatient doctor is thinking. It's more important to me to assess whether the patient is stable, free of side effects and contraindications, and wants to continue the inpatient regimen. If yes, I may continue them. Or I may change everything immediately or slowly over time, if I disagree.

Anecdotally, it doesn't seem to make a difference. I believe it's because their decompensation is generally due to a failure in their judgment rather than a failure of their original meds.

 

[psych_0]

7on-7off, or

I have colleagues who are 7/7....they all leave around the same time I do from work. Find yourself a 7/7 job that just wants you to see patients & write notes for 7 days, not live in the hospital for 7 days. They exist. I have seen plenty.

we want you here from 8-5pm regardless if you finished your duties

This is the VA. This is also why I would never even consider a VA job. They just watch the clock and want you to "be there" even though you're twiddling your thumbs in your office.

outpatient which is usually a fixed schedule with some allotting only for 15 mins follow up which is a hard pass.

Regular outpatient med management is just not my speed. Don't even get me started on the train wrecks who show up late. It also pays significantly less, unless you own your own outpatient practice taking cash only...or you've signed on for a terribly negotiated inpatient job.

 

[Trismegistus4]

Where do you guys find these jobs As I am finishing up residency all I hear is 7on-7off, or we want you here from 8-5pm regardless if you finished your duties, or outpatient which is usually a fixed schedule with some allotting only for 15 mins follow up which is a hard pass.
Are you guys talking about academics?

Probably not what you want to hear, but I just got lucky. That is, when I took my current job, I didn't ask if I was required to be there during any particular hours, and they didn't volunteer anything about the topic either. I just started working there, and noticed all the other psychiatrists just leave whenever they're done, so I realized I could do the same.

Not academics, but non-profit. I wonder if you're looking at mainly for-profit hospitals? It's getting tougher with UHS, HCA, and Tenet buying up all the hospitals, but if you can find a non-profit place, it may be a bit better in that regard.