Regretting the offer I signed

[meow1985]

In the wake of this pandemic, I worry about the financial solvency of institutions. When I was picking an offer for my first attending job, I heard rumblings about how the institution I ultimately signed with changed management several times in recent years. I didn't think that was going to matter for me. It seemed like they were investing in mental health, and had recently merged with an insurance company. Those seemed like good things. Now, I look them up and they have cash on hand worth 120 days per 2-year-old date. I can't find anything more recent. The average for a good health system is 200 days or more. I talk to my family in the area, and hear - third hand information, I grant - that they are laying off ortho and other specialty surgery nurses. Of course, laying off non-essential staff is not necessarily unique at this time. But it seems that investing into stuff may have left them ill-prepared for a situation like this. If a hospital drops below 60 days cash on hand, they will not be able to get loans and would have to rethink their financial strategy, maybe downsize or sell assets. Now, a week ago they told me I was on track to start my job still in a few months, but right now a few months could mean a lifetime of change.

The idea of looking for a new job feels terrifying. I have a nonsensical lawsuit trailing me around from intern year, and I am not one of psychiatry's best and brightest with a ton of publications and leadership. I was planning a move and maybe buying a house, but the latter doesn't seem like a good idea anymore.

I don't know what I need right now. Support? Someone to tell me I'm overreacting? But in COVID-19 there is no such thing as overreaction when everything gets worse every day.

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[TexasPhysician]

You are an employee. Thinking about their financial health is above your pay grade. Do what you do best. If they fail, there will be 1,000 other jobs available.

 

[hebel]

In the wake of this pandemic, I worry about the financial solvency of institutions. When I was picking an offer for my first attending job, I heard rumblings about how the institution I ultimately signed with changed management several times in recent years. I didn't think that was going to matter for me. It seemed like they were investing in mental health, and had recently merged with an insurance company. Those seemed like good things. Now, I look them up and they have cash on hand worth 120 days per 2-year-old date. I can't find anything more recent. The average for a good health system is 200 days or more. I talk to my family in the area, and hear - third hand information, I grant - that they are laying off ortho and other specialty surgery nurses. Of course, laying off non-essential staff is not necessarily unique at this time. But it seems that investing into stuff may have left them ill-prepared for a situation like this. If a hospital drops below 60 days cash on hand, they will not be able to get loans and would have to rethink their financial strategy, maybe downsize or sell assets. Now, a week ago they told me I was on track to start my job still in a few months, but right now a few months could mean a lifetime of change.

The idea of looking for a new job feels terrifying. I have a nonsensical lawsuit trailing me around from intern year, and I am not one of psychiatry's best and brightest with a ton of publications and leadership. I was planning a move and maybe buying a house, but the latter doesn't seem like a good idea anymore.

I don't know what I need right now. Support? Someone to tell me I'm overreacting? But in COVID-19 there is no such thing as overreaction when everything gets worse every day.

Anything is possible, but in my opinion you're overreacting. I've seen many of your posts and think in general you need to chill, man!

 

[clausewitz2]

Nurses are a cost center. RNs cannot bill. If the system needs to save money, out go the nurses and up go the staffing ratios. If they fire you, they take a crank they can turn every twenty minutes to generate $200 or whatever and break it for no good reason.

But yeah, they might go under. There are no institutions you can work for that this is not true of apart from maybe the VA or even better, the Indian Health Service because that has to exist by treaty. Even those big government departments could still decide to push you out.

If I was your therapist, I'd ask something like "What exactly would it be like to have your contract cancelled all of a sudden and scramble for a new job?" But I'm not and just want to say as a notional colleague: don't be dumb. Don't throw away a gig you were otherwise happy with because your anxiety told you to do it.

 

[meow1985]

Nurses are a cost center. RNs cannot bill. If the system needs to save money, out go the nurses and up go the staffing ratios. If they fire you, they take a crank they can turn every twenty minutes to generate $200 or whatever and break it for no good reason.

But yeah, they might go under. There are no institutions you can work for that this is not true of apart from maybe the VA or even better, the Indian Health Service because that has to exist by treaty. Even those big government departments could still decide to push you out.

If I was your therapist, I'd ask something like "What exactly would it be like to have your contract cancelled all of a sudden and scramble for a new job?" But I'm not and just want to say as a notional colleague: don't be dumb. Don't throw away a gig you were otherwise happy with because your anxiety told you to do it.

Obviously I am not going to reject the contract now. That would indeed be dumb. But if it were taken away after a couple months, that would really suck, especially since we don't know what state hiring will be in after COVID-19. And I am not starting a private solo practice this early in my career, sorry.

 

[clausewitz2]

Obviously I am not going to reject the contract now. That would indeed be dumb. But if it were taken away after a couple months, that would really suck, especially since we don't know what state hiring will be in after COVID-19. And I am not starting a private solo practice this early in my career, sorry.

It sure would suck. It would probably be terrible and make it hard to focus on anything else for a while. It'd also be really uncomfortable and distressing to have to find a new job, like, yesterday with a new mortgage. And nobody can stop that from happening if it does any more than anyone here can tell you that it definitely won't happen or that things will be alright.

I would take the counter-bet in a heart beat, but all of us with employers could find ourselves without a job PDQ. Question is, how should that change how you act, given working for yourself is off the table?

 

[Nines]

I’m in a somewhat similar situation although I’m not a graduating 4th year resident. I recently signed a contract for a new job to start in July. Interviewed and signed before the COVID-19 crisis really got going in the US. Now I am currently employed and have not put in my 4 week required notice so I do have the backup option of just staying at my current job if things somehow fell through but still this whole situation is stressful. I do think, though, that the chances of an organization retracting a job offer (especially when a contract was signed) is pretty low. They have put a lot of effort into recruiting a psychiatrist they no doubt very much need and most hospital systems are not going to have the luxury of ignoring the ongoing demand for mental health treatment that will continue despite the pandemic. I will say that my inpatient unit is as full as ever and my outpatient colleagues have been continuing to see patients via telepsych. Of course, the biggest and most anxiety provoking thing is that it is very hard to predict how long this crisis will last and what the long term effects will be, which makes it hard to plan or anticipate what will happen. This stuff is just so hard to predict. Oddly, I seem to be getting more recruitment calls and emails than ever. I’m guessing because all the recruiters are working from home and bored....

 

[meow1985]

I’m in a somewhat similar situation although I’m not a graduating 4th year resident. I recently signed a contract for a new job to start in July. Interviewed and signed before the COVID-19 crisis really got going in the US. Now I am currently employed and have not put in my 4 week required notice so I do have the backup option of just staying at my current job if things somehow fell through but still this whole situation is stressful. I do think, though, that the chances of an organization retracting a job offer (especially when a contract was signed) is pretty low. They have put a lot of effort into recruiting a psychiatrist they no doubt very much need and most hospital systems are not going to have the luxury of ignoring the ongoing demand for mental health treatment that will continue despite the pandemic. I will say that my inpatient unit is as full as ever and my outpatient colleagues have been continuing to see patients via telepsych. Of course, the biggest and most anxiety provoking thing is that it is very hard to predict how long this crisis will last and what the long term effects will be, which makes it hard to plan or anticipate what will happen. This stuff is just so hard to predict. Oddly, I seem to be getting more recruitment calls and emails than ever. I’m guessing because all the recruiters are working from home and bored....

Yeah, that makes sense. My worry is that the hospital will go the way of Hahnemann in PA or something. Not that it's currently headed in that direction, but its finances are not as robust as they could be, and maybe they're being dumb in trying to hire me and others.

Off topic, but where do you have to leave your credentials to get recruitment calls and emails. I get a careermd bulletin every week or so but that's about it. And other people on this forum are at a loss as to how and where to look for jobs. I personally had to ask people and simply google to find places to apply to.

If you sign a contract, what actually can happen if you contact them and tell them you want to back out?

I'm kind of thinking I could back out and just approach one of the other people I turned down again. The jobs are still there, I checked. One of them is in my own community and I know through the grapevine.

 

[wolfvgang22]

Off topic, but where do you have to leave your credentials to get recruitment calls and emails.

I've found that simply having a LinkedIn account will have you drowning in recruiter emails. Worse, talk to a recruiter or two on the phone or online and you'll never hear the end of them, years later. Finding jobs is easy. Unless you are geographically restricted to NY or Boston there seems to always be 10 open jobs in every area.
Hospitals and clinics aren't suddenly going to need less psychiatrists, given the existing shortage. If anything, the pandemic will increase the need in the long run.

If you want out of a contract, most places will let you out of it if you haven't even started yet. They don't want a malcontent, and won't care so much if you are going to another city. They could pursue you for breach of contract, of course, but it probably isn't worth the effort. That said, why not give it a try and fulfill the contract, and leave on good terms if necessary later? Your reputation is worth it.

 

[Nines]

Yeah, that makes sense. My worry is that the hospital will go the way of Hahnemann in PA or something. Not that it's currently headed in that direction, but its finances are not as robust as they could be, and maybe they're being dumb in trying to hire me and others.

Off topic, but where do you have to leave your credentials to get recruitment calls and emails. I get a careermd bulletin every week or so but that's about it. And other people on this forum are at a loss as to how and where to look for jobs. I personally had to ask people and simply google to find places to apply to.

If you sign a contract, what actually can happen if you contact them and tell them you want to back out?

I'm kind of thinking I could back out and just approach one of the other people I turned down again. The jobs are still there, I checked. One of them is in my own community and I know through the grapevine.

Yeah its hard to really know an employer’s financial situation and how well they can withstand a financial hit. When I met with the CEO of the hospital where my new job is he assured me that “our financials are great” but I imagine they all say that! That said my current employer has just implemented a hiring freeze (with exception for people who have already been hired) so who knows?!

If you want to get contacted by recruiters you could put your CV on practicematch.com just be prepared for an onslaught of them reaching out to you. I kind of regret doing it but I’ve only worked at places local to my residency so I didn’t really need their help finding places to work but could be helpful for out of state opportunities. What you could do is use limited info they give in the job listings they send you to try to figure out the name of the practice/facility they are representing and just apply directly yourself. They usually won’t say the name of the facility but often you can figure it out. Practicelink.com has a decent number of listings for jobs in my experience. You don’t need to register or work with a recruiter to search or use the website. That’s where I found the job I got.

The consequences of backing out of a contract depend on the terms of the contract itself. Could be a financial penalty though most of the time I don’t think there would be but read the contract to be sure. The bigger issue would be that you risk burning that bridge with regards to having a chance of working for them in the future and since psych is a small world it’s possible word could get out and negatively affect your reputation. That said, a friend of mine backed out of a job she accepted and the employer still hired her later when she applied a second time around!

 

[Monocles]

OP as a psychiatrist you literally have one of the most pandemic-proof jobs possible, even in the medical field. While every other department is hemorrhaging money and downsizing from loss of elective procedures, etc etc, psychiatry is booming because of telepsych and loosening of HIPPA. If you look in your email spam folder you probably have at least a dozen job offers right now.

 

[meow1985]

OP as a psychiatrist you literally have one of the most pandemic-proof jobs possible, even in the medical field. While every other department is hemorrhaging money and downsizing from loss of elective procedures, etc etc, psychiatry is booming because of telepsych and loosening of HIPPA. If you look in your email spam folder you probably have at least a dozen job offers right now.

Ok, but if the whole health system goes down, psychiatry probably goes down with it, no? And there will be fewer employed positions afterwards.

Though I guess it takes a lot for a health system to actually go bankrupt. You have to be hemorrhaging millions of dollars a month and it has to be all but irreversible.

 

[zolof]

The whole health system will not go down. Mental health and general health acute and non acute will never go away. There will be more positions and more patients than ever and if anything clinics, hospitals will be overburdened and understaffed.

 

[meow1985]

The whole health system will not go down. Mental health and general health acute and non acute will never go away. There will be more positions and more patients than ever and if anything clinics, hospitals will be overburdened and understaffed.

I meant the particular health system that I will be working for. But in general, yeah, there's not going to be a massive collapse or shrinking of the healthcare system. Probably.

 

[thepoopologist]

It doesn't seem like any amount of reassurance is enough. Let anxiety dictate your future, or let it not

 

[meow1985]

It doesn't seem like any amount of reassurance is enough. Let anxiety dictate your future, or let it not

Yeah, maybe it's not. But by dint of sitting with this for long enough, I am done with being distraught about this. I'll just plan to work for my current employer until I can't anymore - for whatever reason. It would be supremely foolish and not good for my reputation to back out at this juncture for reasons that are barely rational.

 

[InterventionalSpacePsych]

I think 200 days cash on hand is a lot. some system have 17....
The 60 days stuff = no loans is odd to me since they could line up credit prior to this 60 day mark.

 

[clausewitz2]

I think 200 days cash on hand is a lot. some system have 17....
The 60 days stuff = no loans is odd to me since they could line up credit prior to this 60 day mark.

Yeah presumably they have successfully gotten a lot of loans to date, it's not like they built a hospital by having the CFO hock his Ferrari and hitting up the Chief of Medicine's parents for cash.

 

[meow1985]

I think 200 days cash on hand is a lot. some system have 17....
The 60 days stuff = no loans is odd to me since they could line up credit prior to this 60 day mark.

Idk, the 60 days is just something I read about *another* health system—they were at 110 and brought in some consultants to try and fix things. The 60 days figure was mentioned as one that was needed to qualify for most loans. But with COVID-19 a lot of the government rescue loans will likely not have that stipulation.

 

[meow1985]

It sure would suck. It would probably be terrible and make it hard to focus on anything else for a while. It'd also be really uncomfortable and distressing to have to find a new job, like, yesterday with a new mortgage. And nobody can stop that from happening if it does any more than anyone here can tell you that it definitely won't happen or that things will be alright.

I would take the counter-bet in a heart beat, but all of us with employers could find ourselves without a job PDQ. Question is, how should that change how you act, given working for yourself is off the table?

I'm not sure it would change how I act, but I might be a bit more careful with money. I've now decided to put off buying the house and rent or live with family for a while. Or buy a cheaper house and pour only half my savings into the downpayment, so I still have a cushion. Oh, and RIP Bimmer that I wanted to get as an attending.

 

[Mad Jack]

In the wake of this pandemic, I worry about the financial solvency of institutions. When I was picking an offer for my first attending job, I heard rumblings about how the institution I ultimately signed with changed management several times in recent years. I didn't think that was going to matter for me. It seemed like they were investing in mental health, and had recently merged with an insurance company. Those seemed like good things. Now, I look them up and they have cash on hand worth 120 days per 2-year-old date. I can't find anything more recent. The average for a good health system is 200 days or more. I talk to my family in the area, and hear - third hand information, I grant - that they are laying off ortho and other specialty surgery nurses. Of course, laying off non-essential staff is not necessarily unique at this time. But it seems that investing into stuff may have left them ill-prepared for a situation like this. If a hospital drops below 60 days cash on hand, they will not be able to get loans and would have to rethink their financial strategy, maybe downsize or sell assets. Now, a week ago they told me I was on track to start my job still in a few months, but right now a few months could mean a lifetime of change.

The idea of looking for a new job feels terrifying. I have a nonsensical lawsuit trailing me around from intern year, and I am not one of psychiatry's best and brightest with a ton of publications and leadership. I was planning a move and maybe buying a house, but the latter doesn't seem like a good idea anymore.

I don't know what I need right now. Support? Someone to tell me I'm overreacting? But in COVID-19 there is no such thing as overreaction when everything gets worse every day.

If they go under, you're free little guy. Chill

 

[Mad Jack]

I'm not sure it would change how I act, but I might be a bit more careful with money. I've now decided to put off buying the house and rent or live with family for a while. Oh, and RIP Bimmer that I wanted to get as an attending.

Dude, just get a 3 series, I could afford one on my middle class job prior to med school. Save up for the M series later.

 

[meow1985]

If they go under, you're free little guy. Chill

Being your own boss / on your own seems to be quite prized on this forum, but I don't feel that way, for myself.

 

[meow1985]

Dude, just get a 3 series, I could afford one on my middle class job prior to med school. Save up for the M series later.

A 3 series was what I was planning to get, lol. A 3-series is a splurge for me because I've only ever owned cheap Toyotas and Hondas.

 

[Mad Jack]

Being your own boss / on your own seems to be quite prized on this forum, but I don't feel that way, for myself.

You can find a new boss. If things get as bad as you suspect, there will be plenty of openings, based on the average age of psychiatrists and the projected deadliness of the virus

 

[Mad Jack]

A 3 series was what I was planning to get, lol. A 3-series is a splurge for me because I've only ever owned cheap Toyotas and Hondas.

I say this as someone that always owned economical cars and then splurged on something fast in residency

It is worth every penny. It is an antidepressant on wheels. You will spend more time in that car than you do with most people you love, so spend the 600 bucks or so a month out of your $12,000 post-tax salary. It's nothing.

 

[meow1985]

I say this as someone that always owned economical cars and then splurged on something fast in residency

It is worth every penny. It is an antidepressant on wheels. You will spend more time in that car than you do with most people you love, so spend the 600 bucks or so a month out of your $12,000 post-tax salary. It's nothing.

Finally someone understands. I've driven a 3-series and ridden in a 7-series... I think it was a 7 series. It was big and everybody was staring at it. I totally get you about the antidepressant on wheels. And if times get tough the car can be my house, too.

 

[Mad Jack]

Finally someone understands. I've driven a 3-series and ridden in a 7-series... I think it was a 7 series. I totally get you about the antidepressant on wheels. And if times get tough the car can be my house, too.

And after a rough day you can just drive. Feel the speed take you, whip around a corner, weave through some backroads. You can afford one, trust me. Everything else is up in the air, but do yourself that solid.

 

[finalpsychyear]

I'm not sure it would change how I act, but I might be a bit more careful with money. I've now decided to put off buying the house and rent or live with family for a while. Or buy a cheaper house and pour only half my savings into the downpayment, so I still have a cushion. Oh, and RIP Bimmer that I wanted to get as an attending.

while i used to like the 3 series the 4 series coupe or gran coupe is killa.
Just don't buy new. Shocked at the low prices you can get for a 2017-2018 with under 10k miles. The prices are going to be rock bottom over next few months given current economics.


Edit: after hearing a bit about some of my docs friends having pay cuts and temporary layoffs i would advise perhaps wait till end of year before making a splurge like this due to the unknown time frame and global economic standstill which have never occurred. Even if your job status is safe your close family members may not be. As much as I was ready to splurge on a purchase i am taking my own advice. Thank that WCI site for the whole live like a resident mantra among other valuable advise.

 

[meow1985]

while i used to like the 3 series the 4 series coupe or gran coupe is killa.
Just don't buy new. Shocked at the low prices you can get for a 2017-2018 with under 10k miles. The prices are going to be rock bottom over next few months given current economics.


Edit: after hearing a bit about some of my docs friends having pay cuts and temporary layoffs i would advise perhaps wait till end of year before making a splurge like this due to the unknown time frame and global economic standstill which have never occurred. Even if your job status is safe your close family members may not be. As much as I was ready to splurge on a purchase i am taking my own advice. Thank that WCI site for the whole live like a resident mantra among other valuable advise.

Yeah, agreed. I'll probably still get it, but simply wait a few months. They also changed the engineering between 2018 and 2019, and I think the 2019 is much better. Those will soon be available at deep discounts.

What specialties are your friends in, if you do not mind sharing?

 

[J ROD]

There are plenty of folks that are anxious and depressed etc right now. Sounds like you included. Relax and go to work. Don’t like job get another one. It is a good idea not to buy a house in an area if you are not familiar with it and just starting a new job. And get a decent car and don’t worry about having to live in it lol

 

[meow1985]

There are plenty of folks that are anxious and depressed etc right now. Sounds like you included. Relax and go to work. Don’t like job get another one. It is a good idea not to buy a house in an area if you are not familiar with it and just starting a new job. And get a decent car and don’t worry about having to live in it lol

I'm not sure that when the dust settles there will be employers hiring. I might have to go into solo practice. I don't know that that's ideal for *any* new residency grad. Plus, I'd have to break ground on how to run a private practice on my own, and the economy in general will be in an uncertain state.

 

[J ROD]

I get 10+ offers sent to me daily after I asked them to stop sending me all these emails from recruiters. Psychiatry is in huge demand still and this virus will not slow that down. People are anxious and depressed even suicidal. We are not elective we are essential.

 

[clausewitz2]

I'm not sure that when the dust settles there will be employers hiring. I might have to go into solo practice. I don't know that that's ideal for *any* new residency grad. Plus, I'd have to break ground on how to run a private practice on my own, and the economy in general will be in an uncertain state.

I get why you don't want to do a solo private practice, but I would be very interested in hearing your rationale for why it is "inappropriate" as you said in another post for -anyone- graduating from residency to hang out their shingle.

 

[psyguru]

Yeah, that makes sense. My worry is that the hospital will go the way of Hahnemann in PA or something. Not that it's currently headed in that direction, but its finances are not as robust as they could be, and maybe they're being dumb in trying to hire me and others.

Off topic, but where do you have to leave your credentials to get recruitment calls and emails. I get a careermd bulletin every week or so but that's about it. And other people on this forum are at a loss as to how and where to look for jobs. I personally had to ask people and simply google to find places to apply to.

If you sign a contract, what actually can happen if you contact them and tell them you want to back out?

I'm kind of thinking I could back out and just approach one of the other people I turned down again. The jobs are still there, I checked. One of them is in my own community and I know through the grapevine.

I get way too many calls and email about FT jobs I have zero interest in. I send them my Expert Witness fee schedule to deter them. Currently, I work part-time (2 jobs) as a clinician and part-time for myself as a forensic psychiatric expert witness/ Independent Medical Examiner (which is very interesting work that happens to be well paying). I am planning on some passive income opportunities. I think if you had some additional income streams you would have some more options. There are quite a few non-clinical income streams that could be done from the comfort of your home, in your boxers and on your own time. I enjoy seeing patients but I like the variety of not having to do the same thing for 5 days in a row. It insulates against the burn-out of a 40 hr- 5 day work week. My Wednesdays are like Fridays and Tuesday is over the hump day for me.

One of my clinical jobs I got thru networking. I get benefits through this one. The other was online. I think they gave me an excellent hourly since I did not need benefits. Sending them my expert witness fee schedule helped in the salary negotiation and they were desperate and still are (PM me if you are interested in a job in Texas).

 

[meow1985]

I get why you don't want to do a solo private practice, but I would be very interested in hearing your rationale for why it is "inappropriate" as you said in another post for -anyone- graduating from residency to hang out their shingle.

It boils down to the fact that the transition from being a resident to an attending is a challenging one. You have to learn to be emotionally ok with the fact that the buck stops with you and you have to decide where your limits are. Chances are you'll also be hitting your limits faster because you simply don't know as much. You'll have to develop referral networks because they won't be pre-existing in your institution. You'll still have to be learning and building your knowledge base, but now with no one there to guide you in acquiring that knowledge. Add to that the fact that residencies don't really teach you how to do solo practice - and why would they when they're usually based at large institutions? - and suddenly you're breaking a lot of ground without much real-time supervision or guidance. It's a lot for anyone to handle, and as a result patient care can suffer. I believe it's best to practice with a group first while you learn to be an attending, and then go out on your own. Not everyone needs to be in a big box practice, but when finding your attending-legs you need to be with other psychiatrists.

 

[clausewitz2]

It boils down to the fact that the transition from being a resident to an attending is a challenging one. You have to learn to be emotionally ok with the fact that the buck stops with you and you have to decide where your limits are. Chances are you'll also be hitting your limits faster because you simply don't know as much. You'll have to develop referral networks because they won't be pre-existing in your institution. You'll still have to be learning and building your knowledge base, but now with no one there to guide you in acquiring that knowledge. Add to that the fact that residencies don't really teach you how to do solo practice - and why would they when they're usually based at large institutions? - and suddenly you're breaking a lot of ground without much real-time supervision or guidance. It's a lot for anyone to handle, and as a result patient care can suffer. I believe it's best to practice with a group first while you learn to be an attending, and then go out on your own. Not everyone needs to be in a big box practice, but when finding your attending-legs you need to be with other psychiatrists.

I think if you have not had much experience of autonomy and self-guided learning, I agree going solo right our of the gate is probably a bad idea. I would hope people gungho about private practice have been seeking out those experiences. Similarly, if you are in an area where higher levels of care are not mostly contained within the place you trained, knowing where to refer could be really tricky. I think you underestimate the utility of informal peer consultation given modern communications technology.

That said, many graduating residents have had many opportunities for autonomy, have consistently been pursuing their own learning objectives in the absence or in addition to attending recommendations, and are comfortable arranging peer supervision. Your objections seem not to apply in those cases.

 

[Mass Effect]

I think if you had some additional income streams you would have some more options. There are quite a few non-clinical income streams that could be done from the comfort of your home, in your boxers and on your own time

What types of jobs are these?

Do you need a forensic fellowship for expert witness work?

 

[Mass Effect]

I think if you have not had much experience of autonomy and self-guided learning, I agree going solo right our of the gate is probably a bad idea. I would hope people gungho about private practice have been seeking out those experiences. Similarly, if you are in an area where higher levels of care are not mostly contained within the place you trained, knowing where to refer could be really tricky. I think you underestimate the utility of informal peer consultation given modern communications technology.

That said, many graduating residents have had many opportunities for autonomy, have consistently been pursuing their own learning objectives in the absence or in addition to attending recommendations, and are comfortable arranging peer supervision. Your objections seem not to apply in those cases.

I also wouldn't have felt comfortable in solo practice after graduating general psych residency. That said, I would have jumped at the chance at a group private practice with some of my psychiatry friends. We didn't go through with it. I think if you have like-minded colleagues (especially if they're in various stages of training/attendinghood) and can get past the pitfalls of mixing business and friendship, a private practice sounds ideal, especially if people are fellowship trained and/or can offer various services - addiction psych, general psych, reproductive psych, neuropsych, etc.

 

[psyguru]

What types of jobs are these?

Do you need a forensic fellowship for expert witness work?

Although I think it is helpful to have board-certification in Forensic Psychiatry, it is not required, particularly for non-criminal work. Some criminal evaluations in some jurisdictions may require it or have alternative requirements. 70-90% of my expert work can be done from home. Additional income streams could be other types of medico-legal consulting, setting up and managing an expert witness panel, medical surveys, UR, etc. For example, some of the expert witnesses I have noticed doing tobacco cases are not forensic psychiatrists but have expertise in addictions.

 

[Sushirolls]

Transition from resident to attending is not hard. Moonlighting is the excellent catalyst to light that fire. I and most of my co-resident colleagues were silently banging our heads against the wall by start of 4th year wondering when the residency shackles would drop. My residency did very well for preparing for attending.

There are some benefits to picking up a job post residency, but if you know deep down you will end up in your own private practice, you won't need more than one year at that first job to learn the nuances of involuntary commitments for that state or the subtleties of E&M coding or local referral options for things like ED clinics, neuropsych, etc.

Even once you finally open your own private practice you are still facing a learning curve of stuff. It's definitely a peak in the first 6 months from my experience, and trickling down after those first 6 months. Its more of a whack a mole after that, something pops up and your like 'Huh...' and you then need to learn something about that issue or simply solve it.

Opening a private practice fresh out of residency is doable, just make sure you got some friends or mentors you can pick a phone up and call for HYPOTHETICAL patient situations.

 

[meow1985]

Transition from resident to attending is not hard. Moonlighting is the excellent catalyst to light that fire. I and most of my co-resident colleagues were silently banging our heads against the wall by start of 4th year wondering when the residency shackles would drop. My residency did very well for preparing for attending.

There are some benefits to picking up a job post residency, but if you know deep down you will end up in your own private practice, you won't need more than one year at that first job to learn the nuances of involuntary commitments for that state or the subtleties of E&M coding or local referral options for things like ED clinics, neuropsych, etc.

Even once you finally open your own private practice you are still facing a learning curve of stuff. It's definitely a peak in the first 6 months from my experience, and trickling down after those first 6 months. Its more of a whack a mole after that, something pops up and your like 'Huh...' and you then need to learn something about that issue or simply solve it.

Opening a private practice fresh out of residency is doable, just make sure you got some friends or mentors you can pick a phone up and call for HYPOTHETICAL patient situations.

By 4th year, I also definitely felt like staffing was superfluous much of the time. The times it wasn't, I just wanted a "vote of confidence" from the attending. There were relatively few times when I was truly "out of ideas" and needed someone else to help with he way forward.

That said, I'm not entirely sure where the disconnect comes from being wary of solo practice. I wouldn't mind being part of a small psychiatry only group practice, though I didn't look into any of those during my job search. Maybe it's the fact that you basically have to create your own mini infrastructure. And as much as I've disliked my residency clinics' infrastructure at times, at least it was *there* without having to be built from scratch. My ideal practice is actually one where I see patients and write notes, and someone else does everything else. But unless you can afford support staff, that's not going to happen in solo practice. I also like to work seamlessly with other services and specialties, which is more likely to happen in a big box multi-specialty conglomerate.