Prison Psychiatry Moonlighting

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prominence

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  1. Attending Physician
Obviously, there is some serious pathology with this patient population. Can anyone share their experiences (whether positive or negative)?

Thanks in advance.
 
It can be lucrative but it has a number of ethical questions. Some psychiatrists are actively pressured by the warden and inmates to overmedicate. Sometimes there are hidden or even outright threats to give certain meds, or else. You have to think long and hard about how you feel about dealing with a disproportionately high number of patients with ASPD.
 
I know they were having some severe shortages in the CA prison system, and had some lucrative offers out there. It seems like there are shortages all over the place (outside of big cities), so I don't think forensics will be much different.

-t
 
what's a rough range/estimate that a California moonlighting prison psychiatrist can expect with regards to hourly rate?

also, can anyone (based on experience) provide examples of safeguards that are in place to protect psychiatrists in this setting?
 
I'm on the prison rotation as a second year in my program. I can't really answer your question about moonlighting/money, though I have seen some good looking offers for post graduate positions in the prison system in many states.


As you probably know, you are treating criminals. Some of whom have raped and murdered other human beings. Others however may have committed other crimes such as fraud or have stolen/committed robbery. I find it interesting to ask some of my patients why they are in jail, most of them answer you truthfully about their circumstances. I find it to be interesting work and I may be cultivating my interest in forensics.

As to your question. YES, you are in increased danger from these individuals. Most of the patients do have an "angle" when they are seeing you voluntarily, even if they have an axis I or II diagnosis. One of the prisoners came to see me (initial visit) to try to get me to help him get out of working in the kitchen. However you do have to realize where you are and who you your patients are. There is some protection such as, when I see patient's in the prison's version of an inpatient psychiatric unit, I am in a room and the prisoner is separated off by enriched glass (hopefully unbreakable), and they are in cuffs.

The guards are also of course there to protect you, though some of the guards are not that much better off than the prisoners. As with any psychiatric facility, watch your back.
 
what's a rough range/estimate that a California moonlighting prison psychiatrist can expect with regards to hourly rate?

also, can anyone (based on experience) provide examples of safeguards that are in place to protect psychiatrists in this setting?

Outside an emergency situationa nd in my experience, the prisoners are often happy to see you, since it gets them out of their cell for a predetermined amount of time. A c/o is close by, if not next to you. No one has ever threatened or "forced" me to write an order I didn't want to write. I wouldn't take kindly to it if they did - I'll just leave it at that.

In some ways, I don't find it that different from my clinic rotation....then again, I'm in a NYC clinic - comparatively large portion of my patients have been in prison anyway. Either I see them in there or out. Not a huge difference for them.
 
I was afraid of certain patients that came over from the prison for inpatient at the state hospital - they needed one to one, would often get violent, didn't respond to the usual doses of meds and enjoyed intimidating the psychaitrists - seems they were only unsuccessful with the largest attendings, all others were fair game :scared:
 
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