My Plan to become a Multi-Millionaire Barista/Surf Instructor/Deadbeat

[Stagg737]

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How does a SW "man" the ER when they can't order medications, like say an IM for an agitated patient? These places have dedicated nursing teams and mental health workers, so we're not talking about the occasional psych patient in the ED. Is a SW going to run that place? Do you think ER attendings have time to deal with that or restraints..etc?

Already stated, but the SW just evaluates and provides dispo recs. No, SW doesn't run that place, ER docs do and receive recommendations from SW and base their decisions on that. Of course ER docs have time to deal with agitation meds, restraints, etc. Agitation management is a major part of EM physician training. I think you're failing to recognize that a huge number, perhaps the vast majority, of ERs don't have psychiatrists readily available. Even if a psychiatrist is present, do you think an ER doc is waiting 10 minutes for psych recs for the patient who just came in throwing punches and trying to assault staff?

I have certainly come across places that expect attendings to "supervise" SW or NPs without actually being on site or seeing the patients. I run from these setups like the plague, cause it is inviting a lawsuit, and I think at least in my region they realize that, and don't want that risk either. I'm sure it happens in some places especially with low volume, but I doubt they are providing good care.

Outside of the really low-volume places, I generally agree. I wouldn't want to supervise a SW or NP, though would actually probably prefer SW. Regardless, the main job of psych ERs is to evaluate safety and aid with resources which is something every social worker should be able to do (yes, I realize this is often not the case).

I supervise SW, and let's just say, I wouldn't want a relative to be dispo'ed by anyone without a medical license.
You actually do need a medical background and training in psychiatry to properly assess, diagnose and treat patients in the ER.

100% agree with you here, but will point out that residents do meet the criteria for the second statement. Especially those more than 1.5 years in who should frankly be competent enough to mostly function as an attending in terms of basic skills.

 

[psychmd03]

I'm with you, but I can see why people would do it, especially if they're single or their spouse is also in a high-paying position with no kids. There's a big appeal to having total financial independence by 40-45 and never having to work again if one doesn't want to. Plus some people just legitimately enjoy the work and don't mind putting in 10-12 hour days or working in longer stretches (14/14 setups).

Kids change everything though, and I've met plenty of docs and other professionals who worked long hours and regretted doing that later because of the toll it took on their family life.



True, but the flip side of this can happen too. Sure, there are extreme arguments like dropping dead at 40 or having a kid die. But much more likely is significant marital strain d/t the job leading to divorce and/or resentment from one's children. Not only does it screw up family relationships, but one can kiss half of that hard-earned money goodbye in the settlement or through child support. So 3-5 years of busting your butt gone up in smoke and now you have to keep working for that FI. Sure, maybe things change down the road, but plenty of other things can happen irl outside of job market/pay shifting that could ruin those retirement plans. To each their own, but if there's one thing I learned from my PM&R rotation in med school it's that I would be hesitant to fall into a false sense of security because one reaches "financial independence".



Uh, wut? Idk if the job OP described even exists (24 patients with only 1-2 new intakes per day...) outside of rehab programs. If it does I'd be genuinely interested to see it. Realistically carrying 24 patients (aka 4-5 new per day) is more like 28-30 encounters per day when including intakes and discharge. There's no way someone is providing decent care to those patients working 50 hours a week, and their documentation is most likely going to be garbage too.

The only ways to make bank with clinical work in psych is through high volume, which will undoubtedly sacrifice the quality of care, or being niche enough that you can charge a high premium for your services. At 50 hours per week, one would have to charge $400/hr to make $1mil in a year and work 50 weeks. That's also only if all 50 hours are spent seeing patients meaning either you're going to be spending significantly more time when you account for admin work or you'll need to charge a much higher rate (at least $500/hr) if you want total work hours per week to be 50.

I'm surprised at how people are coming to the conclusion that OP's first post is actually feasible as laid out and absolutely baffled that people are suggesting he could do it in even less time. And now I'm sad that the 'mind blown' emoji is gone.

I just genuinlely disagree with the fact that you cant provide good care to people on the inpatient units while seeing a decent volume. Some of that will be dictated on volume. But a large chunk is also your personal goals with a patient but if they are inpatient they are supposedly acute and decompensated. You aren't doing therapy with them daily. You are acutely managing their medications to interrupt whatever process has them so far from their baseline. If therapy is what they need then they dont need to be inpatient get them out and to the appropriate level of care. That job is feasible because I have almost that identical job. I have plenty of time each day to go to the gym. Read. And relax. On weekends even more time. It is flexible and I round when I want based on my schedule outside of work and what else I am doing. Yes I see my patients quite quickly but I also do not get any patient complaints about not being seen long enough or having poor care. I get the opposite they want to follow with me OP and sometimes when i do extra coverage the patient wants to switch to me. You can make people feel quite good and very heard just by being present and knowing their concerns and addressing them. And you can save time by knowing that sitting with your psychotic or manic patients for 5-10 or more minutes because thats "good patient care" is just truly a waste of time because they cannot process that conversation on that level. Wait until they have cleared to have more in-depth conversations. So until I have patient complaining I am giving them poor care I just cannot get on board with most of this forums idea of needing to talk to every patient for seemingly very long periods of time daily while they are inpatient.

 

[psychmd03]

General investors seem to be panic selling over this in the short term, but if you look at places like boglehead forums, this news didn't even get mentioned as people are in the for the long run (decades).

It just helps create a small dip for all those DCAing in right now. I love seeing things dip some I get to buy into my VSTAX at a cheaper price than if the market was just rising. This will help my nest egg build up a lot now while I am young.

 

[finalpsychyear]

I'm a big fan of FI Calc which has more complex withdrawal methods. Last time I tested 4% while also guaranteeing close to that much as minimum withdrawal, there's about 5-10% chance of failure or near-failure with backtesting. If you're okay with living some years on much less than your initial withdrawal amount then no percentage withdrawal method will completely fail (meaning percent of current assets, not percent of starting assets.)

There is also a good chance there will be some social security in some form which makes the outcome even less likely to fail. Or like you said have a variable withdrawal rate esp early in retirement if its a esp bad few years and all should be good.

 

[clausewitz2]

Concur, social workers will most often be the person handling the legal and evaluative aspect of mental health overnight. ED physicians (or NPs/PAs) handle the only actually emergent part, ie severe agitation. Ultimately it'll likely be the social worker figuring out how and where to get the person they need to go, too. The vast majority of EDs across the country do not have an attached psych unit.

This is basically a regulatory question. In my current state anyone brought for possible involuntary commitment has to be evaluated by a physician within two hours of arriving at a facility approved to do these evaluations and only physicians are allowed to uphold or overturn the initial petition. Thus, you cannot punt to SW and there needs to be a psychiatrist nearby all the time, at least at the facilities where these evaluations can be conducted (which is a distinct minority of emergency departments).

 

[Stagg737]

I just genuinlely disagree with the fact that you cant provide good care to people on the inpatient units while seeing a decent volume. Some of that will be dictated on volume. But a large chunk is also your personal goals with a patient but if they are inpatient they are supposedly acute and decompensated. You aren't doing therapy with them daily. You are acutely managing their medications to interrupt whatever process has them so far from their baseline. If therapy is what they need then they dont need to be inpatient get them out and to the appropriate level of care. That job is feasible because I have almost that identical job. I have plenty of time each day to go to the gym. Read. And relax. On weekends even more time. It is flexible and I round when I want based on my schedule outside of work and what else I am doing. Yes I see my patients quite quickly but I also do not get any patient complaints about not being seen long enough or having poor care. I get the opposite they want to follow with me OP and sometimes when i do extra coverage the patient wants to switch to me. You can make people feel quite good and very heard just by being present and knowing their concerns and addressing them. And you can save time by knowing that sitting with your psychotic or manic patients for 5-10 or more minutes because thats "good patient care" is just truly a waste of time because they cannot process that conversation on that level. Wait until they have cleared to have more in-depth conversations. So until I have patient complaining I am giving them poor care I just cannot get on board with most of this forums idea of needing to talk to every patient for seemingly very long periods of time daily while they are inpatient.

I don't disagree with many of your points (less time on patients without cognitive awareness, focus on stabilization, minimal to no therapy if support staff is decent) but there comes a point when more patients without spending more time is just poor care. Out of curiosity, how many intakes and d/cs per day are you doing, and how much time are you spending on each (including obtaining collateral)? Do you have support staff doing therapy with patients capable of it? I agree that if therapy is all they need then 99% of the time they don't need inpatient treatment, but that doesn't mean therapy while inpatient isn't beneficial. What about the patients who are mainly severe depression or acute depression/adjustment/PTSD who you're starting an SSRI on? The benefit of inpatient for them is a safe and supportive environment, our meds won't actually do jack unless they're there for weeks. and many of them may require more than 3-5 minutes of your time, unless you're mainly just seeing manic and psychotic or demented people.

Also, documentation on 25 patients takes time to write notes that aren't completely worthless and I can't imagine anyone doing this in less than 2 hours (at least) unless their notes are all just copy/paste or they're seeing patients who don't actually need inpatient treatment anymore. I'm just curious what you're calling "good care" and how much time you're actually working.

 

[surfguy84]

I don't disagree with many of your points (less time on patients without cognitive awareness, focus on stabilization, minimal to no therapy if support staff is decent) but there comes a point when more patients without spending more time is just poor care. Out of curiosity, how many intakes and d/cs per day are you doing, and how much time are you spending on each (including obtaining collateral)? Do you have support staff doing therapy with patients capable of it? I agree that if therapy is all they need then 99% of the time they don't need inpatient treatment, but that doesn't mean therapy while inpatient isn't beneficial. What about the patients who are mainly severe depression or acute depression/adjustment/PTSD who you're starting an SSRI on? The benefit of inpatient for them is a safe and supportive environment, our meds won't actually do jack unless they're there for weeks. and many of them may require more than 3-5 minutes of your time, unless you're mainly just seeing manic and psychotic or demented people.

Also, documentation on 25 patients takes time to write notes that aren't completely worthless and I can't imagine anyone doing this in less than 2 hours (at least) unless their notes are all just copy/paste or they're seeing patients who don't actually need inpatient treatment anymore. I'm just curious what you're calling "good care" and how much time you're actually working.

In my experience, daily notes are primarily for yourself and the insurance company. I think a good and detailed intake and d/c note is important. But in reality, who is spending more than a few minutes on a daily progress note? Copying and pasting the bulk of it, then adding 2-4 sentences with relevant details/thoughts/updates seems more than sufficient.

 

[mistafab]

I am so curious about many things in this thread. One is, standard of care in EM services is to discharge without being seen by a psychiatrist. I am surprised about people saying no one gets discharged without an attending [psychiatrist] as many places are just evaluated by EM docs for dispo, with some ancillary staff support for dispo planning (typically SWs or nurses). As bad as hospitals want ED beds to be moving constantly, they're reluctant to spend money on a psychiatrist. There are very few jobs out there for full time Psychiatry ED work. Kudos to OP for stringing together a gig like that and getting all the money/free time they want.

I'm also surprised at the one hour turnaround per patient OP mentioned. In the ED I am typically 1-1.25 hours at the fastest. Most of mine are 1.5-2 hours. Perhaps OP has more ancillary staff support (i.e. SW who collect some pertinent history beforehand) than we do at our site. Admittedly, there is zero ancillary staff at my site. Throw in an involuntary form and that adds an additional 15 minutes on my encounter. Perhaps OP is straight up also just better than I am given that he's done this much more. I've only had 300+ patient encounters in the ED.

 

[voxveritatisetlucis]

It just helps create a small dip for all those DCAing in right now. I love seeing things dip some I get to buy into my VSTAX at a cheaper price than if the market was just rising. This will help my nest egg build up a lot now while I am young.

Why mutual fund. Not cost or tax efficient in most cases

 

[psychmd03]

Why mutual fund. Not cost or tax efficient in most cases

Because I maxed a backdoor Roth and my self 401k in Jan. So I need somewhere to stick money that isn’t a savings account that doesn’t break past inflation. I did max out ibonds in Feb as well. I am working on investing in a few turnkey properties to diversify a bit and for tax benefits since my tax burden is higher than I’d prefer even with my ability to have deductions from my 1099 job.

And this. VTI vs VTSAX [Returns, Fees, and Tax Efficiency] | White Coat Investor

 

[psychmd03]

I don't disagree with many of your points (less time on patients without cognitive awareness, focus on stabilization, minimal to no therapy if support staff is decent) but there comes a point when more patients without spending more time is just poor care. Out of curiosity, how many intakes and d/cs per day are you doing, and how much time are you spending on each (including obtaining collateral)? Do you have support staff doing therapy with patients capable of it? I agree that if therapy is all they need then 99% of the time they don't need inpatient treatment, but that doesn't mean therapy while inpatient isn't beneficial. What about the patients who are mainly severe depression or acute depression/adjustment/PTSD who you're starting an SSRI on? The benefit of inpatient for them is a safe and supportive environment, our meds won't actually do jack unless they're there for weeks. and many of them may require more than 3-5 minutes of your time, unless you're mainly just seeing manic and psychotic or demented people.

Also, documentation on 25 patients takes time to write notes that aren't completely worthless and I can't imagine anyone doing this in less than 2 hours (at least) unless their notes are all just copy/paste or they're seeing patients who don't actually need inpatient treatment anymore. I'm just curious what you're calling "good care" and how much time you're actually working.

It seems we agree on more than we don’t. I’ll try to hit these in order as I walk.

I do not gather collateral and have not since residency unless I feel the social worker didn’t do a good job and I don’t want to wait for them to get what I want. Even for prepping to med petition l someone I have all the questions I need written in an email draft that I copy and paste to them to get the info needed. My main social workers and I have worked together almost two years so we work pretty wel together. I need to watch a few that are newer to me. My Um also keeps an eye on things.

Intakes depends on the day today was 2. Yesterday was 5. DCs today 5 yesterday 1 tomorrow 3. DCs don’t take any time at all. Intakes depends. Sometimes they got prns and are out cold. Sometimes they are so psychotic they can barely piece together a sentence. So the length of time depends.

For then patients with acute depression ptsd etc isn’t normally my population unless psychotic. I get our sickest patients normally but do catch some more basic cases. And for them the safe place removal of stress almost always clears things up much quicker than the meds though they attribute to meds then my job is just fighting them for a few days so the meds actually have at least reached steady stare. They have group therapy available and most of these patients I offer 2-3x for anything they’d like to discuss or ask each day and most do not. So they still are somewhat quick. Every once in a while they want to talk then I’ll take my time. Each patient no matter what I try to sit or at minimum lean on a wall or something so they know I’m not half out the door which seems to help them feel comfort and that they visit is longer than maybe it was.

Documentation that me serves two purposes one is to get my patients covered by their stupid crap insurances for the amount of time they truly need. And second to cover my ass in case of any malpractice suit. Past that my notes are for sure garbage and I won’t even try to defend it. They aren’t copy and pasted but I’ve developed various templates for manic, psychotic, depressed patients and various templates for the subjectives that will ball park most patients and I say much if the same stuff the same way anyways. So I can puzzle piece together a few of my templates to put together a note that hits my purposes. The team knows what we are doing so my notes aren’t for them. Anyone that ever covers me (which is rare since I work most days) I will verbally or written give them a true picture of what they are working with. I do a lot of coverage and normally don’t truly care what a doctors note says other than is the note saying this patient is kinda sick ie they won’t be dced soon or is the note saying there is progress therefore this patient is close to dc. I look to sw notes and asking nursing/sw if I need to know specifics.

 

[G Sheb]

I am so curious about many things in this thread. One is, standard of care in EM services is to discharge without being seen by a psychiatrist. I am surprised about people saying no one gets discharged without an attending [psychiatrist] as many places are just evaluated by EM docs for dispo, with some ancillary staff support for dispo planning (typically SWs or nurses). As bad as hospitals want ED beds to be moving constantly, they're reluctant to spend money on a psychiatrist. There are very few jobs out there for full time Psychiatry ED work. Kudos to OP for stringing together a gig like that and getting all the money/free time they want.

I'm also surprised at the one hour turnaround per patient OP mentioned. In the ED I am typically 1-1.25 hours at the fastest. Most of mine are 1.5-2 hours. Perhaps OP has more ancillary staff support (i.e. SW who collect some pertinent history beforehand) than we do at our site. Admittedly, there is zero ancillary staff at my site. Throw in an involuntary form and that adds an additional 15 minutes on my encounter. Perhaps OP is straight up also just better than I am given that he's done this much more. I've only had 300+ patient encounters in the ED.

I’m assuming this post was directed at what I mentioned.
In my area all the top academic centers and even the community hospitals employ psychiatrists full time for ED work. That includes overnight work. By top academic programs I mean several top 20 programs. It really is the standard of care here.

As for turnaround time, I used to take two hours per case as a resident which included presenting to the attending and writing a very well detailed note. I do think I’m very efficient at this. But even , one hour a case is the average when I’m pushed to the limit (ie it rained patients) and includes patients who can’t be evaluated due to acute agitation, attesting notes (mid levels or residents)..etc sometimes I do all the work myself but usually residents and SW will help with collateral.

 

[SmallBird]

I’m assuming this post was directed at what I mentioned.
In my area all the top academic centers and even the community hospitals employ psychiatrists full time for ED work. That includes overnight work. By top academic programs I mean several top 20 programs. It really is the standard of care here.

As for turnaround time, I used to take two hours per case as a resident which included presenting to the attending and writing a very well detailed note. I do think I’m very efficient at this. But even , one hour a case is the average when I’m pushed to the limit (ie it rained patients) and includes patients who can’t be evaluated due to acute agitation, attesting notes (mid levels or residents)..etc sometimes I do all the work myself but usually residents and SW will help with collateral.

What area?

 

[mistafab]

I’m assuming this post was directed at what I mentioned.
In my area all the top academic centers and even the community hospitals employ psychiatrists full time for ED work. That includes overnight work. By top academic programs I mean several top 20 programs. It really is the standard of care here.

As for turnaround time, I used to take two hours per case as a resident which included presenting to the attending and writing a very well detailed note. I do think I’m very efficient at this. But even , one hour a case is the average when I’m pushed to the limit (ie it rained patients) and includes patients who can’t be evaluated due to acute agitation, attesting notes (mid levels or residents)..etc sometimes I do all the work myself but usually residents and SW will help with collateral.

I'm at a top 20 place and there is definitely no ED psychiatrist at all. Must be more state/region dependent. Our psychiatry ED service is completely resident run, and set up as an ED consultant. Staff are available for questions (by phone only) but patients are not staffed, nor seen, by psychiatry attendings.

 

[Stagg737]

In my experience, daily notes are primarily for yourself and the insurance company. I think a good and detailed intake and d/c note is important. But in reality, who is spending more than a few minutes on a daily progress note? Copying and pasting the bulk of it, then adding 2-4 sentences with relevant details/thoughts/updates seems more than sufficient.

Sure, I partially agree. Notes are meant to be communications to other healthcare workers, they've just been ba*****ized by insurance companies and admins to add a lot of garbage for "meaningful use" and other requirements that have led to where we are. Many daily notes can be minimal and still be fine, but relevant events should still be documented and are often just skipped when people are seeing larger volumes of patients (some med side effects, missed doses, PRNs needed, inappropriateness in groups, etc). Even if you do the bare minimum and have a decent EMR, it'll take 2-3 minutes per patient. At 20 f/ups per day like OP said that's at least an hour. Use a crappy EMR like CPRS and 20 f/up notes can easily take 2-3 hours when all the mouse clicks are accounted for.

That's not including intakes and discharges which are probably going to take 10-20 minutes for someone who is writing a decent note and is efficient. If you're truly working a job with 1-2 new patient's/discharges per day then that may only take 30-60 minutes. I'd still be interested to know where you'd work with an average LOS around 20 days and only 1-2 intakes/day. More realistically, carrying 24 patients means 4-6 intakes and d/c's. Even on the low end of that and being super efficient, you're spending at least 80-90 minutes on those notes alone. For some H&P and d/c notes will take 20+ minutes each. Writing 10 of those in a day adds 3 hours and 20 minutes to your day, and that's just writing the notes.

In your OP you said you'd be busting your butt and it sounded like you'd be working 10+ hour days to see that many patients which I think is fair. My point with all this is that some have suggested that seeing that many patients can be done in a 'typical' inpatient psych work day (6-8 hours or less) and still provide good care. I just disagree that this is typically achievable when you account for team meetings, patient encounters, writing notes, placing orders, making calls (doc to docs, insurance calls, talking to family if necessary, etc), and ensuring appropriate discharge is in place.

 

[G Sheb]

I'm at a top 20 place and there is definitely no ED psychiatrist at all. Must be more state/region dependent. Our psychiatry ED service is completely resident run, and set up as an ED consultant. Staff are available for questions (by phone only) but patients are not staffed, nor seen, by psychiatry attendings.

I'm curious. Is that the system during daytime as well? Do residents get any direct supervision for ER work?
Who is held liable in case of an adverse event? The ED attending or the psych attending?
I'm guessing this is low volume ER without a dedicated psych ER?
In my residency, our ER rotation was pretty extensive. Residents used to 'run' it at night, but there was always an in-house psychiatrist who also evaluated patients and attested notes.

Even as a med student, that was also my experience in an academic ER at the opposite coast. That was actually a very large with several psychiatrists present.
I actually find the psych ER to be a great place for medical student and resident education. We routinely have MS who participate in patient evaluation and are supervised by residents and attendings.

 

[Stagg737]

It seems we agree on more than we don’t. I’ll try to hit these in order as I walk.

I do not gather collateral and have not since residency unless I feel the social worker didn’t do a good job and I don’t want to wait for them to get what I want. Even for prepping to med petition l someone I have all the questions I need written in an email draft that I copy and paste to them to get the info needed. My main social workers and I have worked together almost two years so we work pretty wel together. I need to watch a few that are newer to me. My Um also keeps an eye on things.

Intakes depends on the day today was 2. Yesterday was 5. DCs today 5 yesterday 1 tomorrow 3. DCs don’t take any time at all. Intakes depends. Sometimes they got prns and are out cold. Sometimes they are so psychotic they can barely piece together a sentence. So the length of time depends.

For then patients with acute depression ptsd etc isn’t normally my population unless psychotic. I get our sickest patients normally but do catch some more basic cases. And for them the safe place removal of stress almost always clears things up much quicker than the meds though they attribute to meds then my job is just fighting them for a few days so the meds actually have at least reached steady stare. They have group therapy available and most of these patients I offer 2-3x for anything they’d like to discuss or ask each day and most do not. So they still are somewhat quick. Every once in a while they want to talk then I’ll take my time. Each patient no matter what I try to sit or at minimum lean on a wall or something so they know I’m not half out the door which seems to help them feel comfort and that they visit is longer than maybe it was.

Documentation that me serves two purposes one is to get my patients covered by their stupid crap insurances for the amount of time they truly need. And second to cover my ass in case of any malpractice suit. Past that my notes are for sure garbage and I won’t even try to defend it. They aren’t copy and pasted but I’ve developed various templates for manic, psychotic, depressed patients and various templates for the subjectives that will ball park most patients and I say much if the same stuff the same way anyways. So I can puzzle piece together a few of my templates to put together a note that hits my purposes. The team knows what we are doing so my notes aren’t for them. Anyone that ever covers me (which is rare since I work most days) I will verbally or written give them a true picture of what they are working with. I do a lot of coverage and normally don’t truly care what a doctors note says other than is the note saying this patient is kinda sick ie they won’t be dced soon or is the note saying there is progress therefore this patient is close to dc. I look to sw notes and asking nursing/sw if I need to know specifics.

Seems like your setup is much more amenable to being able to see more patients given your patient population, good support staff, and premade templates (good EMR?).

My biggest issue with your argument is poor notes. I consider decent notes to be part of good patient care since someone else is going to be seeing your patients once they're discharged to continue care. Good H&Ps and d/c notes can make up a lot for crappy progress notes, but bad progress notes with generic or crappy d/c summaries can have significant effects on the patient's care once discharged. Few things frustrated me more in outpt clinic than seeing patients for post-discharge f/ups and not having a clue what actually happened during the admission, especially if the patient's stability is questionable at the f/up appointment.

 

[psychmd03]

Seems like your setup is much more amenable to being able to see more patients given your patient population, good support staff, and premade templates (good EMR?).

My biggest issue with your argument is poor notes. I consider decent notes to be part of good patient care since someone else is going to be seeing your patients once they're discharged to continue care. Good H&Ps and d/c notes can make up a lot for crappy progress notes, but bad progress notes with generic or crappy d/c summaries can have significant effects on the patient's care once discharged. Few things frustrated me more in outpt clinic than seeing patients for post-discharge f/ups and not having a clue what actually happened during the admission, especially if the patient's stability is questionable at the f/up appointment.

Yes the couple hospitals seemed to be very well designed to work with doctors that for sure do much less than I do and actually aren’t really even nice to be around. But I truly like the staff overall and they easily make it the reason the overall efficient can be achieved. And yes one hospital has epic which allows for much more efficient documentation and chart reciew of med compliance and prn use.

I can understand your point on documentation but unfortunately it is very rare for any of my patients to stay in the same system for follow up. I can count on one hand how many do as well as the Op doc actually using the IP notes. I can say I did do some OP work at the clinic attached to the stand alone private hospital I work at and I never reviewed notes. Some of that is because I knew they’d be garbage but also because I don’t trust people. I didn’t as a resident really either even in a VA system where I can see everyone’s notes from everywhere. I just never found it helpful and preferred to make my own interpretation of the patient. The only thing that helped was current meds ( for me personally) but I understand your point for some systems and docs.

 

[mistafab]

I'm curious. Is that the system during daytime as well? Do residents get any direct supervision for ER work?
Who is held liable in case of an adverse event? The ED attending or the psych attending?
I'm guessing this is low volume ER without a dedicated psych ER?
In my residency, our ER rotation was pretty extensive. Residents used to 'run' it at night, but there was always an in-house psychiatrist who also evaluated patients and attested notes.

Even as a med student, that was also my experience in an academic ER at the opposite coast. That was actually a very large with several psychiatrists present.
I actually find the psych ER to be a great place for medical student and resident education. We routinely have MS who participate in patient evaluation and are supervised by residents and attendings.

level one trauma center. No direct supervision day or night. Psych consult service is extremely busy, second most consulted in the hospital. Cant give much more info without doxxing myself. Liability wise, its on the ED attending as they are the ones who own the patient.