Not sure what I want to do career wise?

[shahseh22]

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Hey all,
I'm finishing up my last year of Child Fellowship as a PGY5 and I'm totally stuck as to what I want to do as far as work is concerned. I have a young child and was originally leaning towards outpatient but am unsure. I have a ton of student debt and I want to do something that qualifies for PSLF but I also want to work with kids. Unfortunately, I'm looking for work in the LA area due to my family supports and it's hard to find something that is primarily kids (will be asked to see 50% kid and 50% adults).

More importantly, I just don't know what I want to do. I like it all. I love the speed of inpatient but I also hate when it goes south (i.e. you can't do anymore with the meds or don't know what to do with someone who is just so resistant). With outpatient, I at least have some control on my schedule and have a better sense of what to do with medications and therapy.

I worked in a PHP program as well and I hated it. I was thinking maybe working at a residential facility would be good? I feel like the reason I'm so indecisive is because I've been doing multiple things during my training (outpatinet, inpatient moonlighting).

At this point, I need something that allows me to have less hours and spend some more time being a parent, so I am ok with taking a hit to my income.

What makes it most overwhelming is that I get bombarded with recruiters calling me daily and I don't know how to answer when they ask me what do I want.

Any advice? lol

 

[Sushirolls]

Residency/Fellowship work and evening moonlighting will only give you a rough approximation of work experience. Not to be discounted, but not to be the whole truth.

Odds are you will pick wrong for this first go and you'll be looking to change it up in 6-24 months.

Time to prioritize. Paper, pen, start writing. What do you value, what do you want?

LA is big, and even if you have supports nearby, chances are you'll find a job on the other side of town, and your supports will be just as far away as if you lived in another metro. How realistic will your family truly be able to help? Are they culturally going to be practically living in your home? Or only there to help when you call up for an emergency? If your family dynamics are on the lower side of helping, then it might not be worth restricting to LA.

In theory if enrolled in PSLF it will still be there because of contractual obligations, But I wouldn't count on it. I bailed on PSLF and opting to do quality of life and better income-to-work ratio, over chaining myself to a bad job for a PSLF what if.

As a C&A, you can make a decent amount almost anywhere. Open cash only, or limited insurance, and you will exceed any employed job doing outpatient. So many options.

Inpatient, you walk out of work in theory when you are done, but you have those pesky call obligations, and DC summaries. Have a sick kid, could be harder to get coverage for yourself - especially considering all inpatient places are chronically understaffed. Outpatient is easier to accomodate child care demands, simply call in sick, schedules gets cleared. Want a better flexible schedule? Create your own with a private practice outpatient. I'm doing that now, and am the primary kid wrangler - no employer to tell you you haven't banked enough vacation time to take it off yet.

Or the other option, find a home right next door to your family and set up a Telepsych gig doing just C&A. Might take a bit to piece things together, but I'm sure there is one out there. Although unlikely to get PSLF out of it.

 

[shahseh22]

Residency/Fellowship work and evening moonlighting will only give you a rough approximation of work experience. Not to be discounted, but not to be the whole truth.

Odds are you will pick wrong for this first go and you'll be looking to change it up in 6-24 months.

Time to prioritize. Paper, pen, start writing. What do you value, what do you want?

LA is big, and even if you have supports nearby, chances are you'll find a job on the other side of town, and your supports will be just as far away as if you lived in another metro. How realistic will your family truly be able to help? Are they culturally going to be practically living in your home? Or only there to help when you call up for an emergency? If your family dynamics are on the lower side of helping, then it might not be worth restricting to LA.

In theory if enrolled in PSLF it will still be there because of contractual obligations, But I wouldn't count on it. I bailed on PSLF and opting to do quality of life and better income-to-work ratio, over chaining myself to a bad job for a PSLF what if.

As a C&A, you can make a decent amount almost anywhere. Open cash only, or limited insurance, and you will exceed any employed job doing outpatient. So many options.

Inpatient, you walk out of work in theory when you are done, but you have those pesky call obligations, and DC summaries. Have a sick kid, could be harder to get coverage for yourself - especially considering all inpatient places are chronically understaffed. Outpatient is easier to accomodate child care demands, simply call in sick, schedules gets cleared. Want a better flexible schedule? Create your own with a private practice outpatient. I'm doing that now, and am the primary kid wrangler - no employer to tell you you haven't banked enough vacation time to take it off yet.

Or the other option, find a home right next door to your family and set up a Telepsych gig doing just C&A. Might take a bit to piece things together, but I'm sure there is one out there. Although unlikely to get PSLF out of it.

Thanks your last option seems really sweet. Getting a C&A telepsych gig would be really sweet. My family is willing to help a lot actually, I'm very fortunate from that standpoint.

 

[AD04]

A lot of women in your position do telepsychiatry. They start out with an hourly or employed position. Some then transition to their own telepsychiatry private practice but it is hard to fill with patients if they take only cash. The cons with that is you won't make as much money and you'll pay more taxes. But if you choose this route, you are prioritizing time with family and kids over making money.

 

[Fabio001]

I'm with you on keeping the door open for PSLF. I recently learned that PSLF is a difficult thing to line-up in California, primarily due to the large non-profit hospitals not actually employing physicians; instead, they're employed by a for-profit medical group that contracts with the hospital. With that in mind, if you haven't explicitly sought out the community mental health clinics that see primarily medi-cal patients, I would reach out to them directly. Most of those clinics will have someone in HR that handles physician recruitment and that's who you need to talk to. That person may know of current openings or anticipated need for child and adolescent psychiatry that may not yet be advertised. Even if they're waffling, I'd recommend sending along a CV and trying to get a telephone appointment to talk to the medical director. Doors may open for you if you are clear in your willingness to consider a part-time position as well. Good luck!

 

[Monocles]

Out of curiosity OP why didn't you like partial? I always thought they were the easiest gigs... working ~30 hours a week seeing mostly stable patients and getting paid a full time salary. When I was rotating at partials our attendings lived the dream!

 

[dl2dp2]

Not sure. How would a biological male that identifies as a lesbian female every other Monday, Wednesday, and Friday and as a non-binary gender every Tuesday and Thursday explain?

Touche lol

 

[dl2dp2]

I'm with you on keeping the door open for PSLF. I recently learned that PSLF is a difficult thing to line-up in California, primarily due to the large non-profit hospitals not actually employing physicians; instead, they're employed by a for-profit medical group that contracts with the hospital. With that in mind, if you haven't explicitly sought out the community mental health clinics that see primarily medi-cal patients, I would reach out to them directly. Most of those clinics will have someone in HR that handles physician recruitment and that's who you need to talk to. That person may know of current openings or anticipated need for child and adolescent psychiatry that may not yet be advertised. Even if they're waffling, I'd recommend sending along a CV and trying to get a telephone appointment to talk to the medical director. Doors may open for you if you are clear in your willingness to consider a part-time position as well. Good luck!

Yeah this is your best bet if you really want to do PSLF. Academia is the other way. They'll clamp your salary below 200k. It's not without risks, and the math may or may not work out. What I would do is spend some time and money with a consultant. Check out White Coat Investor and get a student loan consultant, read through PSLF material, and do some math to see if PSLF is worth it or not. There are group practices in greater LA that pay a much better salary with LRP. And of course, if you do cash PP sky is the limit in LA.

Not sure part time is elegible for PSLF, but I think 30 hours can be counted at full time at many Medical clinics.

 

[shahseh22]

Out of curiosity OP why didn't you like partial? I always thought they were the easiest gigs... working ~30 hours a week seeing mostly stable patients and getting paid a full time salary. When I was rotating at partials our attendings lived the dream!

Oh I hated it. I hate doing therapy and a large portion of my job was dealing with parents with major axis 2 disorders hence their kids are suffering a whole lot because they aren't receiving treatment.

 

[Monocles]

Oh I hated it. I hate doing therapy and a large portion of my job was dealing with parents with major axis 2 disorders hence their kids are suffering a whole lot because they aren't receiving treatment.

Ah gotcha. The partial at my program may have had more resources so the MD was never the one doing therapy. We were told explicitly to focus only on the meds and let the PHDs, psyDs, SWs handle the therapy portion.

Maybe you should look into working at a better partial program lol? At ours we had to meet with patients 2x weekly (very quick 15 min med checks) and write 2 notes. I think cap of 16 pts so super easy to space out 32 visits during the week. (that's like... 6 med checks a day)

 

[SourceOfDenial]

Not sure. How would a biological male that identifies as a lesbian female every other Monday, Wednesday, and Friday and as a non-binary gender every Tuesday and Thursday explain?

:troll:

 

[shahseh22]

Ah gotcha. The partial at my program may have had more resources so the MD was never the one doing therapy. We were told explicitly to focus only on the meds and let the PHDs, psyDs, SWs handle the therapy portion.

Maybe you should look into working at a better partial program lol? At ours we had to meet with patients 2x weekly (very quick 15 min med checks) and write 2 notes. I think cap of 16 pts so super easy to space out 32 visits during the week. (that's like... 6 med checks a day)

I might be interested in something like this. Do you guys know of a good reputable source to look at when looking for vacancies? I've never done this type of work before so I don't know of a list of CMH's I would even find or where I would go?

 

[Shufflin]

No reputable list that I know of> I work in California. The good gigs are not posted online or found through recruiters.

 

[shahseh22]

No reputable list that I know of> I work in California. The good gigs are not posted online or found through recruiters.

Can you give me some leads at all? I'm bombarded with recruiters that are calling me and e-mailing me non-stop daily.

 

[MBBSMOM]

Just an FYI 99% of people who apply for PSLF are rejected. So I wouldn’t bank on getting it. You’re C/A so your opportunities are endless. How about a job that is a mix of inpatient and outpatient? So you can see what you like. I personally like IP better because I can spend as much time with the pt as needed.

 

[shahseh22]

Just an FYI 99% of people who apply for PSLF are rejected. So I wouldn’t bank on getting it. You’re C/A so your opportunities are endless. How about a job that is a mix of inpatient and outpatient? So you can see what you like. I personally like IP better because I can spend as much time with the pt as needed.

They are rejected due to a lot of reasons (mostly due to the applicant not being informed about the process) but there are success stories too.

 

[MBBSMOM]

They are rejected due to a lot of reasons (mostly due to the applicant not being informed about the process) but there are success stories too.

Still you have a very high chance of being rejected. I’m not sure I consider 1% to be very successful. Around 29,000 people apply and only around 100 get it. That’s not successful at all. I wish you luck but I’m just saying it’s very hard to get pslf.

 

[NickNaylor]

Just an FYI 99% of people who apply for PSLF are rejected. So I wouldn’t bank on getting it. You’re C/A so your opportunities are endless. How about a job that is a mix of inpatient and outpatient? So you can see what you like. I personally like IP better because I can spend as much time with the pt as needed.

I agree - I wouldn't make any long-term financial decisions banking on PSLF. Sure, there's a lot of theory on why people are getting rejected and what might happen in the future, but the reality is that we have no ability to predict what will actually happen. All it takes is the whim of Congress and you're planning goes out the window. If you're able to reap the benefits of PSLF, great, but I would plan in the intermediate- and long-term as if the program doesn't exist and/or won't be available to you.

 

[PikminOC]

I agree - I wouldn't make any long-term financial decisions banking on PSLF. Sure, there's a lot of theory on why people are getting rejected and what might happen in the future, but the reality is that we have no ability to predict what will actually happen. All it takes is the whim of Congress and you're planning goes out the window. If you're able to reap the benefits of PSLF, great, but I would plan in the intermediate- and long-term as if the program doesn't exist and/or won't be available to you.

Good thing Congress has been busy with other things.

 

[Monocles]

I might be interested in something like this. Do you guys know of a good reputable source to look at when looking for vacancies? I've never done this type of work before so I don't know of a list of CMH's I would even find or where I would go?

OP which part of the country are you in? If you're around Mass shoot me a PM

EDIT: ah my bad you sad LA area. Sorry I have zero reading comprehension skills