On call forever

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LisaLou

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I am considering a job at a small hospital. It sounds great except for one thing: I would essentially be on call at all times other than vacation. I'd be first call for my patients on weekdays, then second call (backup for an NP) on weekends. It is a long-term patient population and I don't anticipate a high volume of calls, I'm more concerned about the psychological impact of always having to be available. Does this sound miserable?

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is this an inpatient job or a clinic attached to a hospital? If inpatient, who is taking calls from the ED all night during the week? I could sort of deal with always being on call for an outpatient clinic because there are much fewer calls, but if inpatient you are going to be calls regularly. It's not doable to be on inpatient call all week IMO; you will need to be admitted yourself before long.
 
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24 hours a day, 7 days a week call? Only way I'd do it is if that I'd earn an extra 25k/month in addition to my regular duties.
 
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What is the volume of calls during sleep hours? I could handle 3 night calls per week that are brief. Now if it's 2+ calls/night, I would never take the job regardless of pay.

I am currently with a company where there is 24/7 call from home. In exchange, in-house hours are less/day than average and calls average about 0-1/night.
 
I would only do it if the pay were high enough and I could sell my calls...
 
I guess it depends on you and what you do with your time. Even if you're not busy, being on call 100% of the time means you've got to be in cell phone/pager range 100% of the time. It also means you can't go out and have a few drinks (ethically, even though I'm guessing this one gets blurred all the time with very rare but existent disastrous outcomes), and you always have to be aware of the possibility of having your sleep interrupted. If the calls were pretty rare, this isn't a big deal for probably lots of people. The not ever going out of cell phone range might be intolerable for me. If you're always in town anyway, it might not be a huge deal.
 
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It's an inpatient position, but it's long-term inpatients, not acute stays. It's at a dedicated psychiatric hospital which only takes scheduled admissions from other facilities and there is no ED. The volume of calls will be quite low (1-3 per week estimated). Dr. Bagel voiced some of the concerns I'm having. I actually don't even typically go places out of cell range or drink alcohol, but despite the fact that I don't normally do these things, I wonder if I will feel really restricted when I -know- I can't. I also wonder if my usual on-call hypervigilance will eventually quiet down, or if I'd have that can-I-hear-my-pager-from-here-is-that-a-pager-is-that-my-phone? feeling permanently. The pay is high-average for the area (probably about $220k). In all other respects, by the way, this is a Super Awesome job for me.
 
It's an inpatient position, but it's long-term inpatients, not acute stays. It's at a dedicated psychiatric hospital which only takes scheduled admissions from other facilities and there is no ED. The volume of calls will be quite low (1-3 per week estimated). Dr. Bagel voiced some of the concerns I'm having. I actually don't even typically go places out of cell range or drink alcohol, but despite the fact that I don't normally do these things, I wonder if I will feel really restricted when I -know- I can't. I also wonder if my usual on-call hypervigilance will eventually quiet down, or if I'd have that can-I-hear-my-pager-from-here-is-that-a-pager-is-that-my-phone? feeling permanently. The pay is high-average for the area (probably about $220k). In all other respects, by the way, this is a Super Awesome job for me.
Even given the low volume, I'd try to negotiate that they get someone else* to cover calls AT LEAST every other weekend. You NEED that ability to "shut it off completely" every now and then for your own sanity.

*You'll have a "Boss", right? If it's really that benign, call-wise, they ought to be able to handle it, yes?
 
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$220k is too low for a job like that. $220k is similar to starting pay at the Bay Area kaisers.
 
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Ugh... Kaiser in the bay area. Talk about a megacorp that rapes physicians.
Have you worked there? I've known several who made the switch to Kaiser NorCal and quite liked it. A couple said it had a lot of the trappings of an academic center (formalized mentoring/training, etc.) with few of the stressors. They said if you didn't mind doing nearly exclusively medication management, it made for a nice compromise between an academic setting and busy private practice. In fact Kaiser NorCal has done a pretty good job at snapping up some good talent from academic centers around the state. They poached a few faculty from UCSF, UCLA, UCSD, etc.

They aren't my cup of tea and apparently aren't yours, but they don't "rape physicians." You get a lot more good psychiatrists going there than coming from there...
 
Have you worked there? I've known several who made the switch to Kaiser NorCal and quite liked it. A couple said it had a lot of the trappings of an academic center (formalized mentoring/training, etc.) with few of the stressors. They said if you didn't mind doing nearly exclusively medication management, it made for a nice compromise between an academic setting and busy private practice. In fact Kaiser NorCal has done a pretty good job at snapping up some good talent from academic centers around the state. They poached a few faculty from UCSF, UCLA, UCSD, etc.

They aren't my cup of tea and apparently aren't yours, but they don't "rape physicians." You get a lot more good psychiatrists going there than coming from there...

Perhaps times have changed since I last lived in the Bay Area. And it's good to challenge current beliefs... my experiences stem from growing up under their umbrella during the 80s and 90s.
 
Gotcha. They definitely had a bad rep back in the day but have changed management in the early 00's. And they tend to be overall pretty popular with patients particularly compared with SoCal Kaiser, at least back when.

Their push for the pseudo academic environment I think is going to pay off spades for recruitment. It will be interesting to watch (from the outside)...


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A lot of you guys don't seem to understand what is meant by 'call' in this sense(that Im guessing its used here). It's not 'call' like you may think of it from residency or from a busy inpatient unit post-residency that does lots of admissions and such. I may not may not would have wanted to do this job, but the nature of the call would very likely not scare me in the least and you certainly aren't going to get paid a lot(if any) extra for it.
 
They aren't my cup of tea and apparently aren't yours, but they don't "rape physicians." You get a lot more good psychiatrists going there than coming from there...

this may be true(about the good psychiatrists), but that doesn't necessarily guarantee that they are going to provide good care within that model. They may be good psychiatrists, but if the model isn't really set up for practicing good psychiatry it's entirely possibly these talented psychs(under a previous model) are just going to Kaiser so they can chill and have a laid back med mgt job.

You can have a mediocre psychiatrist providing well above average care in one setting vs a good psychiatrist providing mediocre to poor care in a different setting.
 
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A lot of you guys don't seem to understand what is meant by 'call' in this sense(that Im guessing its used here). It's not 'call' like you may think of it from residency or from a busy inpatient unit post-residency that does lots of admissions and such. I may not may not would have wanted to do this job, but the nature of the call would very likely not scare me in the least and you certainly aren't going to get paid a lot(if any) extra for it.
I don't think anyone is misunderstanding the situation, they just reached a different conclusion than you did. For me as well, never being off call, even if call is essentially nothing, would be very rough.
 
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this may be true(about the good psychiatrists), but that doesn't necessarily guarantee that they are going to provide good care within that model.
You're shadow boxing, V. No one was discussing the quality of care provided by Kaiser. I was just objecting to the idea that they "rape" thei psychiatrists. In the region the poster was discussing, the psychiatrists are extremely well paid, with good benefits, and they tend to be fairly sought after jobs. Nothing to do with care…


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You're shadow boxing, V. No one was discussing the quality of care provided by Kaiser. I was just objecting to the idea that they "rape" thei psychiatrists. In the region the poster was discussing, the psychiatrists are extremely well paid, with good benefits, and they tend to be fairly sought after jobs. Nothing to do with care…


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Right, it has to do with the historical context in how the profit margin matters and how care is encouraged to be delivered. I believe this lent itself to be a hostile working environment for physicians.
 
Right, it has to do with the historical context in how the profit margin matters and how care is encouraged to be delivered. I believe this lent itself to be a hostile working environment for physicians.
Not Kaiser physicians. All physicians.

And it has nothing to do with Kaiser and everything to do with for-profit healthcare. Kaiser is just good at it. Hate the game.


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Not Kaiser physicians. All physicians.

And it has nothing to do with Kaiser and everything to do with for-profit healthcare. Kaiser is just good at it. Hate the game.


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Physicians from John Muir and at other locations didn't have same disdain as they did for Kaiser. Again, historical context.
 
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