Pros and Cons of Psych Hospitalist

[EagerToBeMD]

Hey there gang. Here's my situation. I'm really interested in Psych (almost became a psychologist in undergrad) and I know it's one of the specialties where you don't have to work insane hours which is a plus for me too as I plan to have kids. But I'm hearing more and more about hospitalists being better than going into private practice or joining a group. What do you guys think? Is it better? And if so, what makes it better? Pay? Hours? What?

I'm also thinking of doing a C&A fellowship after residency. Can a C&A psychiatrist be a hospitalist or do they traditionally hire a general psychiatrist? I'd like to live in a somewhat rural area in the northeast if that makes any difference. We have family in New England so Vermont, NH, and Maine looks good to me.

Any advice/pros-cons/tips are welcome!

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[kugel]

unfortunately, there are lots of answers.
Inpatient psychiatrists can have more finite work hours than private practice, if you work directly for the hospital - most likely when working for a gov't entity or for a large healthcare system like Kaiser. In those situations where you are paid a salary for your work, no matter how many patients, your hours are more likely a specific time, like 8-5. But if your compensation is based on your billings, then it is entirely up to you how much you work. And if billing systems (payors) tighten up (stop paying as much as easily), then you may have to work quite a bit harder to make the same income.

Hospitals will definitely hire a C/L psychiatrist for inpatient psych, but they will pay you the same as a generalist psychiatrist. If you want to do some inpatient work and some C/L, there are many hospitals that will hire specifically for that, because many hospitals don't think they need a full-time C/L psychiatrist.

Beware, hospitals that don't currently have a real C/L service think that they only have a few patients per week in Med/Surg/OB/peds that need a psych consult. Once the rest of the staff know they have a psych to consult, the consult requests will come flying in. If we just think about the fact that at least 10% of elderly patients experience delirium at some time during a hospital stay, there is PLENTY for a psychiatrist to do in a hospital of 100-200 beds. If you and the hospital are comfortable providing a consult and recommendations, and then signing off the patients without actually following most of them through the stay, then a part-time C/L gig can work.

In a teaching hospital, a real C/L service is enormously valuable, and IMHO this is where nonpsych residents get the most bang for the buck. After all, the psych they will use for the rest of their careers is on that line between psych and medicine. If done efficiently, it can also usually pay for itself through the billings.

I'm sure others will have lots to say on this topic, since it comes up every few months in this forum.

 

[EagerToBeMD]

I meant child and adolescent psych, not consultation/liason. Does the above still apply for C/A? Sorry for the confusion.

 

[kugel]

sorry, my fault for not reading carefully.
However, the all the stuff I wrote is still basically true.
If you are an inpatient psychiatrist at a general hospital, you will likely get called to do some consults on pediatric patients in med/surg wards in addition to your other duties. If you don't ever want to do that, you should make that clear to the admin right up front. If you are willing to do that, make some decisions about how/when you would and set some rules up front about it - including compensation- or you might get overrun.

Basically, any additional skill you have is likely to be considered a plus. But like anything else in life, if you don't decide how you are used, someone else will. Don't mean this to sound cynical, just practical. It really does give you additional choices in your career.