Role of psychiatrist in outpatient setting?

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Yeah, I just re-read my comment and realized that it might look like I'm trying to say that you can't provide good care to 25 patients a day... I just meant that it may be "distressing" for some people. I'm only a PGY3, so I don't have enough experience to see that many patients (also, our clinic population is on the more severe end of the spectrum), but I've seen people do it well. Also, I'm still at the point where every patient has to be educational, so I have to do more therapy and psychosocial management just because I need to learn how to do it well. But 40 is probably pushing it.

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Yeah, I just re-read my comment and realized that it might look like I'm trying to say that you can't provide good care to 25 patients a day... I just meant that it may be "distressing" for some people. I'm only a PGY3, so I don't have enough experience to see that many patients (also, our clinic population is on the more severe end of the spectrum), but I've seen people do it well. Also, I'm still at the point where every patient has to be educational, so I have to do more therapy and psychosocial management just because I need to learn how to do it well. But 40 is probably pushing it.

I'm honestly still questioning whether you can really provide good care to 25 patients in a day. I can't, and I really don't think most people can unless you're doing the most basic, simplest of follow up type of stuff. As you mentioned, though, that number includes no shows, which maybe makes it more feasible. What is everyone shows up, though?
 
I've assumed my psychiatrist sees 32 a day since it's obvious from the sign-in sheet that each appointment is scheduled 15 minutes apart. I'll ask the next time I see her.
 
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I've assumed my psychiatrist sees 32 a day since it's obvious from the sign-in sheet that each appointment is scheduled 15 minutes apart. I'll ask the next time I see her.

It sounds like you're not too satisfied with her care, either. Wow, that sounds like a miserable job.
 
3 per hour x 8 hours = 24 patients. Busy busy. Handwritten notes would be the way to go if you were this "efficient".
 
It sounds like you're not too satisfied with her care, either. Wow, that sounds like a miserable job.
She gets by, but I don't envy having a job like that. I would think it would be very stressful. It's not unlike the tech support I did for Apple (you have to fix the customer and problem with a target time of 15 minutes), except you have to see the customer face to face and can't do it from home lounging in your pajamas. Not to beat a dead horse, but as I've mentioned before, she'll occasionally take and respond to text messages during session and will sometimes go on about her children. Now that I see from your perspective the stress of her job and thin about it more, I can see why she might do that even if she shouldn't. She must like her job OK because she's moved offices 4 times since I've seen her and this is the one she has stuck with. She says it's because they have the best office staff (they are certainly good sentries: no calls go through!).

Sometimes I really do see her for just 15 minutes, sometimes more.

What I dislike is that there is a bell that goes off at the 15 minute mark (sometimes sooner it seems to me) that comes from the front desk. The bell comes from the secretary to keep her on time. Sometimes she'l keep talking through the bell for another minute or so, and then its frequency increases. I say bell, but it's an electronic sound. I'm not sure where the sound comes from.

In her defense of seeing so many patients, I don't think she gets paid very much relative to other doctors. I just saw my cardiologist the other day and I asked him how he's always on time and never stops me from asking questions. And he said, "I know you. We schedule you that way." He had a student observing him (and me) who had finished medical school but hadn't started residency. I was telling her I thought cardiology seemed like a great profession in that my doctor never seemed rushed, and he corrected me and said "Terrible lifestyle, great pay." I thought of this forum because you all talk about the lifestyle aspect often. I mentioned psychiatry to him as something that might have a better lifestyle and he said he thought ophthalmology has the best. At least to me, it seems like his job has a better lifestyle than psychiatry. It seems like we almost spent an hour together talking (I have a number of issues: dilated aortic root, POTS, orthostatic diastolic hypertension), and he was so relaxed, like he had all the time in the world. He bills way more than my psychiatrist, though (not that I self-pay--I'm lucky to have very good insurance).

I woud have to ask my dad what the exact numbers are since he deals with all that stuff, but it's a pretty big difference from what I recall.
 
She gets by, but I don't envy having a job like that. I would think it would be very stressful. It's not unlike the tech support I did for Apple (you have to fix the customer and problem with a target time of 15 minutes), except you have to see the customer face to face and can't do it from home lounging in your pajamas. Not to beat a dead horse, but as I've mentioned before, she'll occasionally take and respond to text messages during session and will sometimes go on about her children. Now that I see from your perspective the stress of her job and thin about it more, I can see why she might do that even if she shouldn't. She must like her job OK because she's moved offices 4 times since I've seen her and this is the one she has stuck with. She says it's because they have the best office staff (they are certainly good sentries: no calls go through!).

Sometimes I really do see her for just 15 minutes, sometimes more.

What I dislike is that there is a bell that goes off at the 15 minute mark (sometimes sooner it seems to me) that comes from the front desk. The bell comes from the secretary to keep her on time. Sometimes she'l keep talking through the bell for another minute or so, and then its frequency increases. I say bell, but it's an electronic sound. I'm not sure where the sound comes from.

In her defense of seeing so many patients, I don't think she gets paid very much relative to other doctors. I just saw my cardiologist the other day and I asked him how he's always on time and never stops me from asking questions. And he said, "I know you. We schedule you that way." He had a student observing him (and me) who had finished medical school but hadn't started residency. I was telling her I thought cardiology seemed like a great profession in that my doctor never seemed rushed, and he corrected me and said "Terrible lifestyle, great pay." I thought of this forum because you all talk about the lifestyle aspect often. I mentioned psychiatry to him as something that might have a better lifestyle and he said he thought ophthalmology has the best. At least to me, it seems like his job has a better lifestyle than psychiatry. It seems like we almost spent an hour together talking (I have a number of issues: dilated aortic root, POTS, orthostatic diastolic hypertension), and he was so relaxed, like he had all the time in the world. He bills way more than my psychiatrist, though (not that I self-pay--I'm lucky to have very good insurance).

I woud have to ask my dad what the exact numbers are since he deals with all that stuff, but it's a pretty big difference from what I recall.

We certainly don't have cardiology incomes, but if she's seeing 4 patients/hour who are all private pay with decent insurance, she's probably doing pretty well. I'm not worried about her paying for her kids to go to college or anything like that. I guess it's also possible that she accepts insurance programs that other psychiatrists don't accept because they don't pay well.
 
She gets by, but I don't envy having a job like that. I would think it would be very stressful. It's not unlike the tech support I did for Apple (you have to fix the customer and problem with a target time of 15 minutes), except you have to see the customer face to face and can't do it from home lounging in your pajamas. Not to beat a dead horse, but as I've mentioned before, she'll occasionally take and respond to text messages during session and will sometimes go on about her children. Now that I see from your perspective the stress of her job and thin about it more, I can see why she might do that even if she shouldn't. She must like her job OK because she's moved offices 4 times since I've seen her and this is the one she has stuck with. She says it's because they have the best office staff (they are certainly good sentries: no calls go through!).

Sometimes I really do see her for just 15 minutes, sometimes more.

What I dislike is that there is a bell that goes off at the 15 minute mark (sometimes sooner it seems to me) that comes from the front desk. The bell comes from the secretary to keep her on time. Sometimes she'l keep talking through the bell for another minute or so, and then its frequency increases. I say bell, but it's an electronic sound. I'm not sure where the sound comes from.

In her defense of seeing so many patients, I don't think she gets paid very much relative to other doctors. I just saw my cardiologist the other day and I asked him how he's always on time and never stops me from asking questions. And he said, "I know you. We schedule you that way." He had a student observing him (and me) who had finished medical school but hadn't started residency. I was telling her I thought cardiology seemed like a great profession in that my doctor never seemed rushed, and he corrected me and said "Terrible lifestyle, great pay." I thought of this forum because you all talk about the lifestyle aspect often. I mentioned psychiatry to him as something that might have a better lifestyle and he said he thought ophthalmology has the best. At least to me, it seems like his job has a better lifestyle than psychiatry. It seems like we almost spent an hour together talking (I have a number of issues: dilated aortic root, POTS, orthostatic diastolic hypertension), and he was so relaxed, like he had all the time in the world. He bills way more than my psychiatrist, though (not that I self-pay--I'm lucky to have very good insurance).

I woud have to ask my dad what the exact numbers are since he deals with all that stuff, but it's a pretty big difference from what I recall.

I cannot imagine seeing my Psychiatrist on a regular basis for just 15 minutes. For the past year or so our session times have reduced from around 45-50 minutes down to 30, but that's just because after a certain length of time we kind of ended up putting a system in place that allows us to do that without compromising the quality of therapy. If I needed a longer amount of time, or an extra session at any point though, all I'd have to do is ask and that'd be fine too. And my Psychiatrist has never answered the phone or texted during session, the most he's ever done is excuse himself for a moment and quickly check his text messages after the phone has rung without being answered, and then declared that it's not important so they can wait until he has time to get back to them - and that's with me sitting there going, 'No, it's okay, you can answer the phone if you need to, I don't mind, really'.

As much respect as I have for the guy if my Psychiatrist started behaving like yours (15 minute appointments, rushing me through, answering phone calls/text messages, prattling on about his family when I haven't enquired after them, and so on) I wouldn't be remaining his patient for very long (it'd be a definite case of 'shape up or ship out').
 
We certainly don't have cardiology incomes, but if she's seeing 4 patients/hour who are all private pay with decent insurance, she's probably doing pretty well. I'm not worried about her paying for her kids to go to college or anything like that. I guess it's also possible that she accepts insurance programs that other psychiatrists don't accept because they don't pay well.
Well she takes Medicaid, so maybe that makes a difference. I have Medicaid but for me it's secondary and covers what my primary doesn't, so I'm not sure if she gets any less because of it. I would imagine she does well. She also has a very high profile client who is court-ordered to see her, so I imagine she makes a good deal from that. I only know because it's in the news often and she testifies on his behalf fairly regularly, but I've never mentioned it to her. I figure it should be private information but because of the situation it's not.

Edit: The cardiologist takes Medicaid as well. In fact, it seems there are very few providers who don't--my therapist doesn't, though.
 
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I cannot imagine seeing my Psychiatrist on a regular basis for just 15 minutes. For the past year or so our session times have reduced from around 45-50 minutes down to 30, but that's just because after a certain length of time we kind of ended up putting a system in place that allows us to do that without compromising the quality of therapy. If I needed a longer amount of time, or an extra session at any point though, all I'd have to do is ask and that'd be fine too. And my Psychiatrist has never answered the phone or texted during session, the most he's ever done is excuse himself for a moment and quickly check his text messages after the phone has rung without being answered, and then declared that it's not important so they can wait until he has time to get back to them - and that's with me sitting there going, 'No, it's okay, you can answer the phone if you need to, I don't mind, really'.

As much respect as I have for the guy if my Psychiatrist started behaving like yours (15 minute appointments, rushing me through, answering phone calls/text messages, prattling on about his family when I haven't enquired after them, and so on) I wouldn't be remaining his patient for very long (it'd be a definite case of 'shape up or ship out').
Yeah, I can see that, on the other hand, there aren't many good options. I didn't mention her positives: she's bright and benzo-knowledgable. There are a lot of weird characters practicing psychiatry near me, and she's about as normal and above board as it gets.
 
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Yeah, I can see that, on the other hand, there aren't many good options. I didn't mention her positives: she's bright and benzo-knowledgable. There are a lot of weird characters practicing psychiatry near me, and she's about as normal and above board as it gets.

I can see the quandary you're in, still I think you deserve better and it sucks that you don't seem to have access to that.
 
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