Psychiatry Hospitalist Schedule Options (7on7off vs. mon-fri with call?)

[peppy]

I have seen a few job postings for psychiatrist hospitalist jobs out there that offer schedules similar to our IM colleagues who do hospitalist work. For example, some jobs now offer the option to work 7days straight in exchange for having 7 days off (or even 2 weeks on, 2 weeks off). Has anyone here actually worked that type of schedule on a psych unit? How did you feel it compares to the more common type of schedule where you work Mon-Fri but also have call?
I get the impression this type of schedule is used by places that are having a hard time recruiting to try to lure people in, but is it really better?

Would those of you who work a Mon-Fri schedule feel that you would prefer having the option to do 7on/7off or 14on/14off if it was feasible?

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[vistaril]

I have seen a few job postings for psychiatrist hospitalist jobs out there that offer schedules similar to our IM colleagues who do hospitalist work. For example, some jobs now offer the option to work 7days straight in exchange for having 7 days off (or even 2 weeks on, 2 weeks off). Has anyone here actually worked that type of schedule on a psych unit? How did you feel it compares to the more common type of schedule where you work Mon-Fri but also have call?
I get the impression this type of schedule is used by places that are having a hard time recruiting to try to lure people in, but is it really better?

Would those of you who work a Mon-Fri schedule feel that you would prefer having the option to do 7on/7off or 14on/14off if it was feasible?

yeah there are occasionally jobs like this....and yeah they tend to be at places that are having more trouble finding people.

A couple points about these jobs:
1) the pay tends to be a bit less than the M-F jobs(even the M-F jobs without call)...think 20% less
2) there is no vacation, so it's important to consider that it's 183 days compared to (52x5) - 28 days or whatever. That's a factor when doing the math. its still fewer total days, but the difference isn't as much
3) census tends to be a bit higher(think 20 vs 15)

So when you combine points 1-3, the jobs aren't quite as sweet as they seem because each put a little ding in them. Oh, also you are working 50% of all weekend days...compared to ZERO weekends in some inpatient M-F jobs.

 

[OldPsychDoc]

At the place I know of doing it, it was preferred for a number of reasons: 1) all patients are seen every day, 2) more facility to discharge on weekends, therefore fewer "pile-ups" in the ER of people waiting for beds, 3) no need for outpatient-only docs to cover on-call on weekends. (They do use a combination of house officers and moonlighters to cover overnight admissions and cross-cover issues.)
The staff they have doing this have chosen it, so I'd guess there's some selection bias as far as doc satisfaction, but it seems to work well for them. They kind of see themselves as "pairs", so they may choose to switch to a 14/14 or 10/10 now and then to facilitate longer vacations for each other, etc.

 

[peppy]

Thank you for the input! I hope if anyone else has impressions or experiences with this they will add their two cents too.

The staff they have doing this have chosen it, so I'd guess there's some selection bias as far as doc satisfaction, but it seems to work well for them. They kind of see themselves as "pairs", so they may choose to switch to a 14/14 or 10/10 now and then to facilitate longer vacations for each other, etc.

So it sounds like you aren't seeing a lot of turnover or burn out in these docs? That is encouraging. How much heavier is the work load for the docs you have on this schedule typically compared to docs on the more typical schedule?
I feel like I am the type of person who might enjoy working an unconventional schedule, but it is hard to be sure until you've actually experienced it, and it seems like there aren't many role models for this in psych the way there are in IM.

 

[heyjack70]

My problem with the 7 on 7 off would be not knowing the patients. You're either starting the 7 days and getting to know people, or approaching the end of the 7 days and getting ready to leave. What do you do if someone has been in the hospital for 8 days, you come on service and they are planned for discharge on your first day back? You don't know this patient at all. You can read the notes and talk to them, but what if something feels a little off to you? What if they seem sort of gamey, or there is a spike in their borderline coping and they start to sabotage the discharge? Are you still going to discharge them? Is a slight bit of concern enough to place them on a hold if they decline to stay? It's your name on the chart as the last doctor to see them if something goes wrong after discharge. I know this can happen with the typical M-F schedule as well because people take vacations, and there are occasionally discharges on weekends, but the 7 on 7 off schedule would be facing this problem constantly.

 

[OldPsychDoc]

Thank you for the input! I hope if anyone else has impressions or experiences with this they will add their two cents too.

So it sounds like you aren't seeing a lot of turnover or burn out in these docs? That is encouraging. How much heavier is the work load for the docs you have on this schedule typically compared to docs on the more typical schedule?
I feel like I am the type of person who might enjoy working an unconventional schedule, but it is hard to be sure until you've actually experienced it, and it seems like there aren't many role models for this in psych the way there are in IM.

No, sounds like the staff is pretty stable. They said it is 20 beds for a doc + PA or 14 beds for a doc alone. This hospital doesn't have any M-F docs on inpatient.

My problem with the 7 on 7 off would be not knowing the patients. You're either starting the 7 days and getting to know people, or approaching the end of the 7 days and getting ready to leave. What do you do if someone has been in the hospital for 8 days, you come on service and they are planned for discharge on your first day back? You don't know this patient at all. You can read the notes and talk to them, but what if something feels a little off to you? What if they seem sort of gamey, or there is a spike in their borderline coping and they start to sabotage the discharge? Are you still going to discharge them? Is a slight bit of concern enough to place them on a hold if they decline to stay? It's your name on the chart as the last doctor to see them if something goes wrong after discharge. I know this can happen with the typical M-F schedule as well because people take vacations, and there are occasionally discharges on weekends, but the 7 on 7 off schedule would be facing this problem constantly.

I heard that the "switch day" is pretty rough, but they do a good job of signing out, and the teams (RN/SW/OTs) provide a lot of continuity. The doc coming on is in charge, and can (and does) certainly change plans if warranted, but they're all pretty experienced about discerning Axis 2 games. I was skeptical, but it seems to be working OK there.

 

[michaelrack]

My problem with the 7 on 7 off would be not knowing the patients. You're either starting the 7 days and getting to know people, or approaching the end of the 7 days and getting ready to leave. What do you do if someone has been in the hospital for 8 days, you come on service and they are planned for discharge on your first day back? You don't know this patient at all. You can read the notes and talk to them, but what if something feels a little off to you? What if they seem sort of gamey, or there is a spike in their borderline coping and they start to sabotage the discharge? Are you still going to discharge them? Is a slight bit of concern enough to place them on a hold if they decline to stay? It's your name on the chart as the last doctor to see them if something goes wrong after discharge. I know this can happen with the typical M-F schedule as well because people take vacations, and there are occasionally discharges on weekends, but the 7 on 7 off schedule would be facing this problem constantly.

I cover psych wards on weekends. Sometimes patients are scheduled for discharge on weekends (on average 1-2 patients on the 30 bed psych ward I usually cover), and some ask to leave. I deal with it. Not a huge issue.

 

[OldPsychDoc]

A friend of mine just posted this. She is at the hospital I mentioned above.
http://blogs.hospitalmedicine.org/B...hiatry-patients-hospitalists-my-kindred-soul/

 

[peppy]

A friend of mine just posted this. She is at the hospital I mentioned above.
http://blogs.hospitalmedicine.org/B...hiatry-patients-hospitalists-my-kindred-soul/

Thanks for sharing that. It does help to see "a day in the life". Seems like without having any extra hands on deck like a resident or midlevel that this type of job could be quite intense, which is causing me to question if I want to go for it in the setting that I'm currently looking at.

 

[Flushot]

A friend of mine just posted this. She is at the hospital I mentioned above.
http://blogs.hospitalmedicine.org/B...hiatry-patients-hospitalists-my-kindred-soul/

Thank you for the link. It's a nice read and easy to envision oneself doing the actual work.