Satisfaction in Psychiatry

[ObsequiousAplomb]

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Re: UHS. Two anecdotes of very solid psychiatrists (like very competent and efficient, but not efficient bad) from two different UHS hospitals. I assumed these types of docs would be perfect fits because they are sort of no nonsense practical guys who understand it's a business. One lasted 1 year because he was as he put it "one of the four D's: dumb, desperate, divorced, or in debt." And UHS paid the most in the region. The other doc lasted 3 months before bailing saying it wasn't a safe place to work. And this was a guy who would see 20 adults and 10 child patients per day on weekend cross cover at his previous hospital and he thought UHS was bad So, I can't imagine ever working at UHS personally. I've also had patients go there and tell me the groups were just a nurse giving them a handout to read about DBT skills, and the patients all sat in silence in the group room reading to themselves.

In residency we rotated at a UHS hospital. Every single attending billed for at minimum 40 patients a day, frequently up to 60, and 80+ on weekend coverage. One of them would see 40 inpatients in the morning and then run the IOP in the afternoon. The PGY-2 covered a 12 patient unit for the attending, the rest were allegedly only seen by the attending. One nurse per unit. Social workers were covering just as many patients as the attendings.

When thinking about the fact that $100 per patient was their going rate, it makes a lot of sense that they would be willing to see that many patients. I would agree that they all met at least one of the four Ds.

 

[Fabio001]

Not to detract from the UHS passion, but to the original post, I find myself incredibly satisfied by my decision to go into psychiatry. I find the work to be intellectually rewarding, I feel respected, and most days I get to go home with a conviction that I'm seriously making a difference in young peoples lives. I'm also compensated well for the work that I do, though this is obviously relative. However, as others, I need to qualify that by saying that I don't love psychiatry. There isn't anything within the practice of psychiatry that I have grown to feel truly passionate about, other than my disdain for mental illness. The work can be emotionally challenging, and this aspect doesn't seem to get better as an attending, and might actually get worse. People do tend to get better, but some don't respond to the limited tools we have.

Psychiatry is a specialty where taking time off isn't a luxury, but a necessity, and thinking you can practice psychiatry for 60 hours a week is a recipe for burnout. You could do it if you were practicing surgery, but you probably can't do it practicing psychiatry.

 

[Merovinge]

I agree these are not the most ethical entities, to put it mildly.

We see decent margins at our hospital system (without fraud for inquiring minds).

UHS hospitals are actually reimbursed quite poorly per day compared to most private insurance or other fields of medicine. They make up for this based on raw quantity of beds filled, limited staffing, only providing covered service, and low MD per pt pay.

I know some locations can achieve reasonable reimbursement for well setup systems but this is certainly not the automatic reality of any place looking to setup or expand psych IP hospital beds that accept insurance, particularly public insurance.

 

[comp1]

Honestly, if you have to bring up UHS as an example, the argument is lost. Psychiatry is great and I love doing it, but it is not as profitable for the practitioner or the hospital systems as orthopedic surgery, GI or cardiology. Also, I enjoyed the comment describing these "profitable" psych systems as being efficient as cancer.