PhD/PsyD Psychologists working in inpatient psych units

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pediatric_psydoc

Board Certified Child and Adolescent Psychologist
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Is anyone here currently working in acute inpatient psychiatric hospitals? I did on child and adolescent units during internship but have not since then. An opportunity came up that I’m considering and as I’m getting more information, I’d love to hear from others their experiences. My experiences may have been different having been an intern and not a licensed psychologist at that point. Thanks.

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I do (at least for most of my day). It's honestly the most fun job in the world, and I legit can't believe I get to go to work to do what I do. Never ever boring. You get to meet some of the most interesting people and help some in the process. Working with an interdisciplinary team. Also...from a liability standpoint, you don't have to worry about the hospitalization thing as you would in an outpatient setting, as you already are there. You do have to have your head on a swivel, but you get used to that real quick.
 
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I used to (acute inpatient at a VA) and really enjoyed it and only left because a much better opportunity came up with room for increased professional development and personal growth.

I loved the flexibility and autonomy involved in my role since my 2 supervisors were just happy the position was filled. And there's no way to compare the depth of interdisciplinary work in a medical setting compared to an outpatient mental health clinic/setting.

When things were really busy, tight timelines for reports were tough but that wasn't all that often in my experience.

One downside for me was seeing repeat/high frequency users of inpt services for non-medically required reasons (e.g., homelessness, trying to get VA service connection) who generally aren't the most engaged in treatment. But there were usually plenty of other people to work with.
 
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I used to cover inpt units, psych and med/surg, in my old position. I actually liked it, usually a break from the usual. Unless it was a BS capacity case from a physician who should know better.
 
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I do, and I second everything Buckeye Love said. I can't believe I get to do what I do for a living, it's phenomenal. If you are boredom-averse, inpatient psych work is amazing. You will see the most unusual presentations, and have countless opportunities to witness humanity and grace at its finest. If you play your cards right, you'll also be able to guide the culture of the staff and improve patient care in most places. The people I work with absolutely love it.
 
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I used to cover various psych & (physical) rehab units, and they were a nice break from sitting in front of a computer doing record reviews & report writing. I enjoyed the rapid assessment, acute intervention, and quicker turnover. A lot of communicating & coordinating w a multi-disc team.

It's important to also acknowledge some of the downsides. One area least considered, especially by early career folks is how billing impacts things. Billing for in-pt services can be low yield, so it's important to understand your cost, productivity expectations, and hopefully understand what the bosses & administrators value.

In some places your services are bundled, this isn't ideal if a bean counter is looking to cut costs. Billing your services independently produces a revenue streams to offset your costs, and this is preferred. If you are a contractor to the hospital, this is *really important* to understand. There can be big differences in what is billed and collected. Being paid hourly can be a great option if negotiated effectively. Having metrics based on pts seen v. RVUs v. $'s...the devil is in the details.

If I were looking to do contract work for in-pt coverage/consultation, billing the hospital dept directly for an hourly rate would be my route. Relying on a hospital billing dept to collect your $ usually isn't a great idea and could easily lead to working a lot for not much in the end.
 
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I think it'd be nice to get to discharge people for sure, haha. I did an inpatient rotation on internship and LOVED it.
 
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I used to cover various psych & (physical) rehab units, and they were a nice break from sitting in front of a computer doing record reviews & report writing. I enjoyed the rapid assessment, acute intervention, and quicker turnover. A lot of communicating & coordinating w a multi-disc team.

It's important to also acknowledge some of the downsides. One area least considered, especially by early career folks is how billing impacts things. Billing for in-pt services can be low yield, so it's important to understand your cost, productivity expectations, and hopefully understand what the bosses & administrators value.

In some places your services are bundled, this isn't ideal if a bean counter is looking to cut costs. Billing your services independently produces a revenue streams to offset your costs, and this is preferred. If you are a contractor to the hospital, this is *really important* to understand. There can be big differences in what is billed and collected. Being paid hourly can be a great option if negotiated effectively. Having metrics based on pts seen v. RVUs v. $'s...the devil is in the details.

If I were looking to do contract work for in-pt coverage/consultation, billing the hospital dept directly for an hourly rate would be my route. Relying on a hospital billing dept to collect your $ usually isn't a great idea and could easily lead to working a lot for not much in the end.

So for this position in particular, it’s salaried and the employer is a non-profit healthcare organization that owns the hospital. I am assuming there’s productivity expectations.

From what I remember from internship, the psychologists usually would have 4-5 therapy patients at a time (sessions were 20 minutes each and you were encouraged to see your patients daily). Once one of their patients left, they would do an intake on a new one and that one would fill the space of the one that was discharged. Then they would run probably 2-3 hourly groups a day. Supervise 1-2 interns. And then do testing (short consults ordered by the attending psychiatrists). And attend treatment team meeting that met 3x a week.

Again, I was an intern at the time and these are just the observations I recall of what the psychologists did.
 
I am assuming there’s productivity expectations.
Productivity should be adjusted to account for time spent in ID team meetings, providing consultation, etc. You’ll likely still be documenting and billing for those things but they will accrue less RVUs than if the same amount of time was spent doing a traditional therapy session. If your productivity targets aren’t adjusted well for the role, that can cause problems during performance review time and you may start getting asked to cover things outside of your supposed duties (speaking from personal experience).
From what I remember from internship, the psychologists usually would have 4-5 therapy patients at a time (sessions were 20 minutes each and you were encouraged to see your patients daily). Once one of their patients left, they would do an intake on a new one and that one would fill the space of the one that was discharged. Then they would run probably 2-3 hourly groups a day. Supervise 1-2 interns. And then do testing (short consults ordered by the attending psychiatrists). And attend treatment team meeting that met 3x a week.
That certainly sounds like a model that could work. Do you know if you will be the only psychologist on this unit or not? Other considerations will be whether other disciplines provide group therapy (like social work or occupational therapy) and whether that hospital has prac, internship, or fellowship programs.
 
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Productivity should be adjusted to account for time spent in ID team meetings, providing consultation, etc. You’ll likely still be documenting and billing for those things but they will accrue less RVUs than if the same amount of time was spent doing a traditional therapy session. If your productivity targets aren’t adjusted well for the role, that can cause problems during performance review time and you may start getting asked to cover things outside of your supposed duties (speaking from personal experience).

That certainly sounds like a model that could work. Do you know if you will be the only psychologist on this unit or not? Other considerations will be whether other disciplines provide group therapy (like social work or occupational therapy) and whether that hospital has prac, internship, or fellowship programs.
So I am in talks with the medical director currently, and he was the child attending psychiatrist when I was an intern and we had great rapport. We do lectures and talks together sporadically.

There’s still a lot of information I need to get from him, but before we go further I need to know that I can get it in writing that I am just a child and adolescent psychologist. When I was an intern, they seemed to make most of the psychologists rotate around the units but let the social workers stay on their assigned units. I do not know if they were thinking that the psychologists should be trained enough to work with all ages and presenting problems, but I think that best practice is we should have an area of specialization and stick with it. I haven’t worked with an adult since 2015 (practicum) and I don’t think now is the time to start. It’s not my area and the adult psychologists do it better, just like I work with children better than the adult psychologists do. It makes sense to me but I know as interns they very much pushed “generalist” training on us and I think that’s basically saying you don’t know a lot of anything, but know a little about a lot of things. I won’t be doing that….so we will see. The medical director is open to my idea and very much wants me there but I don’t know if the director of clinical staff (who is technically directly above psychologists) would be open to this. There are no trained child psychologists there. They are all “generalists.” When I was an intern, I begged to specialize in child and adolescent; I was told no but it ended up that 96% of my internship clinical hours are children and adolescents because the adult unit was closed for remodeling when it was my time to rotate on it.

The site is within an APA accredited internship consortium so there are interns galore there. They do a lot of the grunt work (speaking as a former intern at that site). There is one social worker per unit (3 units: one pre-ad, one adolescent, one adult). I know of at least 4 psychologists but there may be more now.
 
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I'm in an inpatient unit at a VA and love it. Bulk of my job is running groups, with some adjunct individual therapy and testing as needed. I have more autonomy than I had doing outpatient work, and it seems less focus on productivity metrics too as it's all bundled, so I actually don't generate any RVUs. Way more engaging for me to be real doing team based care with every day being different and exciting in its own way. And you often get to see patients make rapid improvements that I didn't in VA outpatient care at least.
 
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