Nursing home jobs for Psychiatrists

[thelastpsych]

So, what is it like working as a psychiatrist for NHs? I've been looking around, and at least from what I've gathered, some places have time constraints, a lot of patients to be seen, low compensation. Has anyone worked in one of these jobs? What are the pros and cons?

---

Members don't see this ad.

 

[AcronymAllergy]

I can't speak for psychiatrists, but for psychologists based on what I've heard and occasionally seen, these jobs are typically anathema. Basically, excessive workload demands in exchange for below-average compensation and, at times, expectations or encouragement to practice outside one's scope (e.g., asking psychologists to make specific recommendations about medication type and dose). Based on that, I wouldn't expect psychiatry jobs to be much better, if the NH is even willing to work with a psychiatrist instead of a PCP.

Which is a shame, because there's a significant need for good MH care (pharmacological and non) in the NH population, and particularly as you move into ALFs, SNFs, and memory care facilities.

 

[TexasPhysician]

So, what is it like working as a psychiatrist for NHs? I've been looking around, and at least from what I've gathered, some places have time constraints, a lot of patients to be seen, low compensation. Has anyone worked in one of these jobs? What are the pros and cons?

Mostly all cons. NH’s don’t want to pay for specialists. Their PCP even if a NP is acceptable to them. NH’s are already expensive for residents and family members that want better will transport their family elsewhere rather than increase costs for everyone.

If you want that population, nursing homes have offered to let me come out and bill everyone’s different Medicare plans myself. They didn’t want to be involved at all. There are many different Medicare advantage plans out there, so I would need to credential with each one.

If I spent the time and $ to set this up, I would be reimbursed less per patient than typical commercial plans. I would lose time and $ traveling to the facility. NH’s aren’t generally run with clinical efficiency in mind, so expect downtime finding and bringing patients if they do it at all. The facility isn’t making $ on this so why help? Some expected me to find and assist patients to a room.

The only positive I could find is slightly better access for NH residents that don’t have supportive families to bring them to my clinic. Those that don’t have such families are likely to not have good collateral info when history doesn’t make sense. That increases liability and errors.

 

[Sushirolls]

NH is all about volume.
i.e. you go there and round, similar to an inpatient unit.
If you are fast it could be worthwhile.
Your schedule is always fixed, X beds in NH.
But after hours calls regarding violence. Or NH staff calling you because you respond to calls, and the PCP didn't, for general medical type emergencies or urgency issues.

In medical school I rounded with an FM who did NH coverage. Saw the good and bad NH homes, still left me with impression not a career aspiration I wanted.

 

[comp1]

Did a rotation in residency and it was truly, truly soul crushing. I'd pick a correctional setting over it in a heartbeat.

 

[Attending1985]

I do some nursing home work in my practice. Just one half day a month. That’s enough and after doing it for 8 years I’d like to hand it off to someone else. It’s a lot of sedation for agitation and the like. A lot of pressure from nursing to add medications which can be uncomfortable.

 

[aquatic ape]

Surprised it’s as bad as it sounds. Working consults I get a ton of delirium and dementia with agitation consults. I had thought about transitioning to private practice and thought doing a private consult service to nursing homes might be an interesting way to change things up a couple days a month.

Anybody have experience trying to do a concierge or out of network model?

 

[TexasPhysician]

Surprised it’s as bad as it sounds. Working consults I get a ton of delirium and dementia with agitation consults. I had thought about transitioning to private practice and thought doing a private consult service to nursing homes might be an interesting way to change things up a couple days a month.

Anybody have experience trying to do a concierge or out of network model?

I have an OON practice. The Geri population is a small fraction of my patients. They have the time and means to manage long wait times and travel to appointments to find someone that takes Medicare in my experience. It would be a hard niche to gain a large group of cash patients.

 

[comp1]

In my experience nursing homes are not at all like a hospital CL service even if the patient population seems demographically sort of similar. There is no general expectation that people could possibly recover or even change significantly. The whole philosophy is different and that's the soul crushing part. You're also not working with a whole team of other providers. You're all alone in this abyss.