question about inpatient jobs

[annoyedpsychiatrist]

Havent done inpatient in a while and my skills are definitely rusty compared to outpatient. Are inpatient jobs more chill compared to outpatient? Are people essentially rounding 3-4 hours then going home, and they get called if someone has a question? I guess it also depends on the unit as well. I remember when I was a resident multiple attendings would do inpatient in morning and leave by like 12 and in the state hospital, rounds were incredibly fast and patients werent even seen every day, since there wasnt even a daily note requirement. Seems like it would be a wide spectrum with some of these jobs being very cush if you have a solid support staff and others sucking if you are the support staff.

---

Members don't see this ad.

 

[Merovinge]

The big cons to IP work are:
1) Patients are very sick, meds changes are expected to be very fast (i.e. before they can even reasonably be expected to work).
1a) Higher liability, higher likelihood to be threatened/harmed etc
2) Most require call, night calls are awful for physical/mental health in a field where you don't have to take call
3) Many hospitals are either for-profit and carry huge caseloads or are academic/state where the pay is lower

I do agree that there are still cush IP jobs like at state hospitals, but those do carry their own bureaucracy and slow rate of improvement for the patients. It's good and honest work though, and clearly something that needs the skills of a well-trained and diligent psychiatrist.

 

[annoyedpsychiatrist]

The big cons to IP work are:
1) Patients are very sick, meds changes are expected to be very fast (i.e. before they can even reasonably be expected to work).
1a) Higher liability, higher likelihood to be threatened/harmed etc
2) Most require call, night calls are awful for physical/mental health in a field where you don't have to take call
3) Many hospitals are either for-profit and carry huge caseloads or are academic/state where the pay is lower

I do agree that there are still cush IP jobs like at state hospitals, but those do carry their own bureaucracy and slow rate of improvement for the patients. It's good and honest work though, and clearly something that needs the skills of a well-trained and diligent psychiatrist.

makes me want to stick with OP, lol

 

[comp1]

So I have a huge bias as I'd take even a junk inpatient job over pretty much any outpatient job. I find outpatient boring in terms of patients and lonely in terms of interaction with other staff. It also tends to require major pre-planning for any leave as you have to cancel patients whereas with inpatient, it just requires making sure there's coverage It probably could all be fixed with the right outpatient job, but you're rarely bored with inpatients and the staff interaction is non-stop. As the OP suggested, there's huge variety in inpatient. Yes, there are some where you round in the morning and then go play golf or see outpatients in the afternoon. I'm not into this kind of job, quite honestly. I don't life golf or outpatient. I like set tours of duty during business hours where I'm available for anything the patients or nurses need, but I'm also available for staff or family meetings and needs. It also prevents me from always feeling like I need to rush out. My amount of time at work is set, it's just a matter of me figuring out how best to use it for patients and staff. I'm obviously a huge proponent of VA because you have soooo many resources and so much of inpatient work is connecting with resources. However, I could see how prison work could be both financially and intellectually interesting. Also, inpatient is really THE place to provide resident and med student education. I can't quite see myself working for a private hospital as the whole system can sometimes seem a bit sketchy, but I'd still take it over anything outpatient. A good system will primarily utilize NPs (or residents) as first call nights and weekends, but yeah, you'll probably have a bit more call in the average inpatient job. Pay should reflect that. I guess there's more liability inpatient? I don't know for sure. For me, inpatient seemed more comforting because I got to observe patients for a lot longer than a 15 minute med check. I really know the patient, got collateral, etc. It always seemed scary to just check in on a person for 15 minutes and feel confident about their safety around themselves or others.

 

[Merovinge]

So I have a huge bias as I'd take even a junk inpatient job over pretty much any outpatient job. I find outpatient boring in terms of patients and lonely in terms of interaction with other staff. It also tends to require major pre-planning for any leave as you have to cancel patients whereas with inpatient, it just requires making sure there's coverage It probably could all be fixed with the right outpatient job, but you're rarely bored with inpatients and the staff interaction is non-stop. As the OP suggested, there's huge variety in inpatient. Yes, there are some where you round in the morning and then go play golf or see outpatients in the afternoon. I'm not into this kind of job, quite honestly. I don't life golf or outpatient. I like set tours of duty during business hours where I'm available for anything the patients or nurses need, but I'm also available for staff or family meetings and needs. It also prevents me from always feeling like I need to rush out. My amount of time at work is set, it's just a matter of me figuring out how best to use it for patients and staff. I'm obviously a huge proponent of VA because you have soooo many resources and so much of inpatient work is connecting with resources. However, I could see how prison work could be both financially and intellectually interesting. Also, inpatient is really THE place to provide resident and med student education. I can't quite see myself working for a private hospital as the whole system can sometimes seem a bit sketchy, but I'd still take it over anything outpatient. A good system will primarily utilize NPs (or residents) as first call nights and weekends, but yeah, you'll probably have a bit more call in the average inpatient job. Pay should reflect that. I guess there's more liability inpatient? I don't know for sure. For me, inpatient seemed more comforting because I got to observe patients for a lot longer than a 15 minute med check. I really know the patient, got collateral, etc. It always seemed scary to just check in on a person for 15 minutes and feel confident about their safety around themselves or others.

First of all, if I was ever sick, you'd be a doc I would want to take care of me, I'm glad folks like you are serving our vets at the VA.

I will say your description of OP is a bit jaded. Not everyone is running 4 patients an hour, I personally know a number of adult general psychiatrists who see 2 patients/hour on a 99214 + psychotherapy add on model and do well financially (or 2 an hour at a cash practice, similar deal). You can have a lot more impact in people's lives in the outpatient space because your panel is so much larger and you can assist them through real change over time. IP work is so stabilization focused, that while essential, you often feel stuck on a hampster wheel with folks who are not getting appropriate PHP/IOP support, SUD support, housing support, etc (your experience being the exception rather than the rule at the VA). I'm probably in the minority but I think great IP > great OP > decent IP >decent OP > junk IP > junk OP, which is a clunky way of saying that many other qualities of the job matter more than IP vs OP despite the jobs being radically different.

 

[michaelrack]

The big cons to IP work are:
1) Patients are very sick, meds changes are expected to be very fast (i.e. before they can even reasonably be expected to work).
1a) Higher liability, higher likelihood to be threatened/harmed etc
2) Most require call, night calls are awful for physical/mental health in a field where you don't have to take call
3) Many hospitals are either for-profit and carry huge caseloads or are academic/state where the pay is lower

I do agree that there are still cush IP jobs like at state hospitals, but those do carry their own bureaucracy and slow rate of improvement for the patients. It's good and honest work though, and clearly something that needs the skills of a well-trained and diligent psychiatrist.

I agree that general adult IP work, epecially call, can be tough. I've been transitioning to doing more C+ A inpatient work; it's a lot better, in my opinion. With kids I don't get calls at 2 am at night for a blood pressure of 190/120- I get calls at 7 pm that they hurt their knee in the gym, and usually I can advise some simple measures until the medical consultant can see them the next day.

 

[J ROD]

I was all about inpatient but did some outpatient and found it is not a bad thing to be bored. Less variety in the day and have to be set on a schedule and cannot leave early etc. But, I do prefer not having the amount hospital politics and RN managers who obviously have more clinical knowledge telling me what to do. Having to deal with SW, CM, midlevels. I just come in fix my panel, answer messages, and leave. For myself, it has been much less drama and similar money. And overall I do feel like I am making more of a difference. Inpatient is more a revolving door.

 

[abpn2025]

I am fourth year resident. I am seeing week on/off jobs in the Midwest starting around 400 K. Not sure if there is a catch but it does seem that Midwest and the south pay higher.

 

[annoyedpsychiatrist]

I was all about inpatient but did some outpatient and found it is not a bad thing to be bored. Less variety in the day and have to be set on a schedule and cannot leave early etc. But, I do prefer not having the amount hospital politics and RN managers who obviously have more clinical knowledge telling me what to do. Having to deal with SW, CM, midlevels. I just come in fix my panel, answer messages, and leave. For myself, it has been much less drama and similar money. And overall I do feel like I am making more of a difference. Inpatient is more a revolving door.

Thats what i felt like when I did inpatient forever ago. generally I felt burnt out.

So I have a huge bias as I'd take even a junk inpatient job over pretty much any outpatient job. I find outpatient boring in terms of patients and lonely in terms of interaction with other staff. It also tends to require major pre-planning for any leave as you have to cancel patients whereas with inpatient, it just requires making sure there's coverage It probably could all be fixed with the right outpatient job, but you're rarely bored with inpatients and the staff interaction is non-stop. As the OP suggested, there's huge variety in inpatient. Yes, there are some where you round in the morning and then go play golf or see outpatients in the afternoon. I'm not into this kind of job, quite honestly. I don't life golf or outpatient. I like set tours of duty during business hours where I'm available for anything the patients or nurses need, but I'm also available for staff or family meetings and needs. It also prevents me from always feeling like I need to rush out. My amount of time at work is set, it's just a matter of me figuring out how best to use it for patients and staff. I'm obviously a huge proponent of VA because you have soooo many resources and so much of inpatient work is connecting with resources. However, I could see how prison work could be both financially and intellectually interesting. Also, inpatient is really THE place to provide resident and med student education. I can't quite see myself working for a private hospital as the whole system can sometimes seem a bit sketchy, but I'd still take it over anything outpatient. A good system will primarily utilize NPs (or residents) as first call nights and weekends, but yeah, you'll probably have a bit more call in the average inpatient job. Pay should reflect that. I guess there's more liability inpatient? I don't know for sure. For me, inpatient seemed more comforting because I got to observe patients for a lot longer than a 15 minute med check. I really know the patient, got collateral, etc. It always seemed scary to just check in on a person for 15 minutes and feel confident about their safety around themselves or others.

coverage isnt a big deal. Theres 4 other psychiatrists in the OP practice i work. Generally we cover for each other fairly easily. One guy has had to call out 3-4x this year for life issues, and hes able to call out, have his patients rescheduled and i cover his patient messages. Perhaps the downside of coverage is im covering for half the psychiatrists this week which is well over 1000 patients so that can sometimes be interesting, lol. However my clinic tbh is insanely fair about coverage. For each provider you cover for, they block 30 mins off your schedule for that day to allow adequate time to respond to messages or in case you need to see a patient. So I really cant whine

Im sure a ton of OP jobs suck, probably over half, but so far I cant really whine about mine. They have been pretty good to me. The only downside i hate is a downside thats just becoming more of a trend: patient reviews, and patient satisfaction

 

[Stagg737]

you often feel stuck on a hampster wheel with folks who are not getting appropriate PHP/IOP support, SUD support, housing support, etc (your experience being the exception rather than the rule at the VA).

I've felt the same way about my outpatient experiences as well. I'd argue the majority of outpatients I've dealt with had primary needs that I could not help with or where extended therapy was what would really help. At least on the inpatient unit there is support staff to help them find those services. Outpatient just feels like too much of an island.

I am fourth year resident. I am seeing week on/off jobs in the Midwest starting around 400 K. Not sure if there is a catch but it does seem that Midwest and the south pay higher.

From talking with multiple groups (Merritt Hawkins, MGMA, Sullivan) midwest and south generally have higher physician income than the coasts, though 400k is well above average anywhere.