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Prison Psychiatry

pick6mike

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Jun 23, 2020
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Hello,

I’ve been looking at a few Prison Psychiatry jobs in California and have come across a few positions in California that pay north of 500k. Is this something that is common for these types of jobs? I understand that they are tough positions and that could be the reason for the increased pay. I also understand that these job postings could be fake (maybe?), or very rare. But it didn’t take long for me to find them.

Could anyone expound on this?
 
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NickNaylor

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Jobs that are being publically advertised with unusually high pay almost certainly have some big downsides attached to them - if they didn't, they probably wouldn't have any problem filling the position in the first place without having to do public recruiting. I bet there are things specific to those positions that make them very undesirable. What those things might be, who knows; could be the volume, expected hours, lack of support, and on and on. I bet it wouldn't be come clear what the downsides are until you contact the recruiter/supervisor or interview.

That said, the prison psychiatry jobs in my area seem to pay pretty well given the hours that are expected - nothing approaching $500k, but at least in our system, the prison psychiatrists seem to be paid pretty well considering the responsibilities and hours.
 
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splik

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Chief Psychiatrist positions for CDCR (the california prison system) top out at around 363k for a standard work week salaried positions. For "senior" psychiatrists the salary is about 340k currently. decent benefits but the pension is not as good as it used to be for people who have been there before the state changed the pensionable compensation.

There are many agencies that contract with the prison system to provide locums (can't be done directly) and depending on the agency, the location of the prison (the more remote the higher the pay - though the most remote are maximum security facilities and pretty scary), and the type of work ("inpatient" pays more than "outpatient" level care). Rates range from $200/hr-325/hr). At the higher rates you can certainly earn in excess of 500k (possibly even closer to 600k), but it is a bit misleading to say this is the pay, since it is hourly independent contract work and not an employed salaried position. Malpractice is included. No benefits and you have to include the lack of paid vacation and sick leave in your calculations and the number of hours worked. Remember to include the cost of benefits (retirement, disability, health insurance etc), sick leave, vacation, holidays etc, when comparing salaried vs IC. As pensions die off and with the trump tax changes, IC work more often comes out better than salaried even for many physicians.

There are huge variations in prisons. In california there has been some disquiet that psychologists have been taking a leading role and subordinating psychiatrists. This came about because of recruitment issues and has exacerbated them. working in government facilities, total institutions, and correctional settings come with challenges. Working in a prison is antithetical to healthcare and the aims of the physician may be at odds with the facility. The positions with the hardest to fill positions may have a lot of work as a result or inability to meet demands and provide adequate care. The reality sadly is that the standard of care in prisons is much lower and the supreme court has ruled that medical care in prison need not meet the community standard but merely not be "deliberately indifferent."

On the flip side, prisons have become warehouses for chronically seriously mental ill individuals and those who want to care for the most truly disenfranchised can find their calling here. There is a lot of very severe psychopathology (it's not just malingering and personality disorder but yes there is a lot of psychopathy too which is fascinating if that's your jam). If you are interested in sociology (e.g. gangs, officer-inmate relationships, the sociology of institutions), the intersection of mental illness, public health, criminal justice, and law, and like the systems based, mediolegal and ethical dimensions of psychiatric practice there is a lot to sink your teeth into. You could be rapidly promoted to very senior positions because of the desperate need. This could potentially serve as a platform for other leadership/administrative positions. Some prisons are dangerous but many emergency rooms and inpatient psych hospital wards are much more dangerous.
 
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TexasPhysician

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I’m a relatively large person, and prison work is by far the only setting that has ever scared me. The lack of support is frightening. Supervisors have warned that they won’t negotiate with prisoners that attempt to take you as their prisoner and threaten to take your life. It happened before. Many have little to lose and can become agitated quickly. You do see some interesting pathology though.
 
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thepoopologist

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Thank you very much for your reply, Nick. I knew something was a little fishy. Would you say the potential stress may be worth the salary with a heavy amount of student loans to repay? Or are these jobs just rotten and not worth looking into...

You need to get as much information as possible about the work environment. Its about how much awfulness you can tolerate, government has a lot of benefits but as far as drawbacks

Violence? Can't continue a 500k contract job if you have a head injury

Office politics? Can't continue a job if a co-worker or supervisor is documenting your every move or writing to the medical board about how much you suck

Psychiatry by proxy? Yes, come be our lightning rod if things go wrong, and let us high school grads practice psychiatry by proxy otherwise.

Doctor orders followed? Place an order for lithium level in 5 days, only to have it not be drawn for another month. Liability still yours

Quality coworkers? Bring up to the IM doc that the gfr has dropped by 50% and the Cr has skyrocketed. No followup notes, no followup labs. Just a "it's fine" verbally passed along through an intermediary

It's almost like a third world country in that there are a lot of rules in place however people tend to do whatever they want, and the rules are only enforced when theres an adverse outcome and the blame needs to be assigned
 
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finalpsychyear

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Tele Prison is about as far as I would even consider and I would be called Dr. X. Also, you don't want to rub even 1 inmate the wrong way so they fixate on getting you for years. You can google many stories like that. Of course it can happen anywhere in any setting but I'd sleep better at night. Once they know your name tele or not you could always be in someone's cross hairs.
 
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Extralong

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Many of those jobs state those numbers because they calculate you working 52 weeks/52 weeks. Calculate pay based on the hours you plan on working. Also, many of the locums(not all) that deal with these systems pay like 1-2months behind, and the make “accidental miscalculations” therefore forcing you to stay on top of getting your pay. It’s sometimes a massive headache when they don’t pay on time of accidentally confuse the hours you submitted, requiring you to go back to show them their mistakes.
If you take one of those high paying 1099 job, keep amazing records for yourself to make sure you get all your money and get a CPA to properly do taxes.
 
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thepoopologist

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Covid has finally hit my government facility

-Half the PCPs called out sick when the Covid cases started to increase
-Less staff are responding to alarms for violence in quarantined sections
-Staff are refusing 1:1 assignments for the medically or psychiatrically unstable
-Admin is telling staff not to wear surgical masks over n95s because the n95s are supposed to be one time use, but then not providing daily n95s
-A lot of psychiatrist contractors are worried about their job getting cut, but then worried about their health and not wanting to see Covid patients.

I'm sure once this is all over they're going to review what happened, and conclude the best course of action will be to raise psychiatrist's rates to improve recruitment and retention but otherwise change nothing else.
 
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milesed

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Personally, I’m not really afraid of anything that’s been mentioned other than people targeting my family. To pay off loans it might be worth it for a few years idk, but the wifey has definitely been scared off from your posts!...probably will avoid.

Here is the company the psyc arnp worked for.
 
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