private practice vs cmhc vs outpt va

[PikminOC]

There are three open spots in my community - private practice, cmhc, and va outpt. I would like to work part time.

Taking the salary out of the equation, can I please get some feedback on these places? I feel the cmhc has the most support, but also has the sickest patients. The VA has chronically ill patients that suffer from PTSD, anxiety, etc and their service connectedness may depend on me. In the private practice, the patients may try to steamroll me for benzos, etc and the malpractice issues will be greater.

I would prefer to hear from people who have worked in these environments.

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[sunlioness]

I would think drug seeking would be higher in the cmhc than in the private practice. I've neve worked in the VA (other than as a resident) or in a cmhc. I did work in a pp and didn't like it, but more for reasons of philosophical differences with my boss/owner. The patients I saw there were by and large pretty cool. Sorry I don't have more useful advice.

 

[alina_s]

I'm in a CMHC and there is outstanding drug seeking. Maybe some of it is regional- several providers in the region practice retail pharmacology, one of them prescribed 100's of fioricets per month per patient, and the patients are willing to drive far for the right prescriber. States use different ways to monitor for prescription drug abuse and my state (MO) has one of the weaker systems: if the patients aren't on medicaid (or are smart enough to pay cash for controlled substances), there isn't any way to know how many different prescriptions for the same thing they fill each month. Substance abuse is an issue for a majority of my adult patients, and prescription drugs are the issue for most of them because they're subsidized and if it was prescribed, it can't be bad, right?

 

[snarfer]

There is no 'perfect' job as you undoubtedly know.

My thoughts are slightly different from sunlioness. The VA has more substance dependence issues in addition to service connection and such. County MH places also have disability, financial issues and somewhat less substance abuse problems. Private practice is a mix bag and generally more entitlement issues. Academic jobs pay the least but likely the least caseload.

Have you looked at county MH jobs connected to a county teaching hospital? These places usually have ample ancillary support, competitive pay/benefits, reasonable workload, evidence base practice, grandrounds/CMEs you can attend and there are more options w/i the system for extra pay. At one place, carrying a pager after hours for phone consults equals $30 per hour plus your base salary ($90-100/hour).

 

[PikminOC]

I worked at an inpt county mental health unit - there was waaaay too much violence. I worked at a private hosp consults and outpatient - too far from my home (I had to live away from my family for all the weekdays) and the complex hierarchy annoyed me - alot. It was also mostly public aid patients, so while the violence was minimized, the disability paperwork and compliance was not great.

I am financially secure for a while, and I really want to be happy and feel like I can make a difference.

The PP option I am referring to is run by a laid back SW and includes psychologists and therapists.

I will be able to live at my house at any of these locations, which is huge.

Thanks for any input.

 

[vistaril]

I would think drug seeking would be higher in the cmhc than in the private practice..

yes, but it's much easier to shoot down