Slow works day at new gig

[Doctor Bagel]

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So I started a community MH part-time job at a place that's known for being busy and working people. My schedule just opened for me to see patients this week, and it's been super slow. I saw 2 patients Monday, 3 patients yesterday and don't have anyone scheduled today. I think part of it is that I'm stepping into jobs that have been vacant for a long time, so the position has been routed around.

I'm assuming (hoping) things will pick up, and me being me, I'm started to think ahead about what if it turns out there really isn't enough need for me, which could mean me being asked to work at sites with a much worse commute for me (my commute is awesome right now after a year of hell commutes!). Yes, I'm neurotic.

It's interesting that there's such a shortage of psychiatrists, including with this one employer, and yet there's all this inefficiency in connecting psychiatrists and patients.

 

[smalltownpsych]

So I started a community MH part-time job at a place that's known for being busy and working people. My schedule just opened for me to see patients this week, and it's been super slow. I saw 2 patients Monday, 3 patients yesterday and don't have anyone scheduled today. I think part of it is that I'm stepping into jobs that have been vacant for a long time, so the position has been routed around.

I'm assuming (hoping) things will pick up, and me being me, I'm started to think ahead about what if it turns out there really isn't enough need for me, which could mean me being asked to work at sites with a much worse commute for me (my commute is awesome right now after a year of hell commutes!). Yes, I'm neurotic.

It's interesting that there's such a shortage of psychiatrists, including with this one employer, and yet there's all this inefficiency in connecting psychiatrists and patients.

Make sure to post back in a couple of months, if you have the time. They trickle in at first, then it's a flood. It took me about six months to fill my schedule. This summer has been a bit slow for me, but that just means I'm only booked out for a month as opposed to two. I get a bit neurotic when my schedule starts shrinking, get a few no-shows in a row and then the paranoia begins to creep in. If I did a thought record on those days, it would be a bit embarrassing. 😀 I can almost hear Albert Ellis's voice chiding me for the irrational catastrophizing.

 

[Doctor Bagel]

Make sure to post back in a couple of months, if you have the time. They trickle in at first, then it's a flood. It took me about six months to fill my schedule. This summer has been a bit slow for me, but that just means I'm only booked out for a month as opposed to two. I get a bit neurotic when my schedule starts shrinking, get a few no-shows in a row and then the paranoia begins to creep in. If I did a thought record on those days, it would be a bit embarrassing. 😀 I can almost hear Albert Ellis's voice chiding me for the irrational catastrophizing.

Glad to hear I'm not alone in the catastrophizing about slow days. 🙂 The efficiency thing is going to be interesting when it gets busy. My training didn't include a lot of super busy outpatient clinics, which I think is good because it gave us flexibility, but it also means I've never had to see 14 patients in a day in a clinic.

 

[F0nzie]

There is something seriously wrong with you. Hit the lights off in your office and take a snooze. 😉

 

[F0nzie]

Congrats on the PT job btw. That's the way to go.

 

[WingedOx]

...Same boat, sort of.

I'm getting a lot of referrals from the inpatient unit who don't tend to show up or the previously lost to followup patients wishing to re-establish care. I think I've had a 40% show rate this week including only seeing two 90792s in the last two days (waiting on my last patient to show up as we speak. Not holding my breath).

I think it's just the nature of being the new guy. It'll fill up in the next couple weeks.

 

[Doctor Bagel]

There is something seriously wrong with you. Hit the lights off in your office and take a snooze. 😉

Yeah, I've got issues. Looking ahead, it looks like my schedule is starting to fill in, and I'll miss these slow days.

 

[heyjack70]

Are you still inpatient now with added part time?

 

[Shikima]

BTW, if it's any consolation, my schedule has sucked all summer long with many recent cancellations and no shows. It's summertime. Don't worry, once school starts the histronics and drama will return and you'll be busy.

 

[milesed]

"Winter is coming"

Relax and get other stuff done, because we always get flooded as they days shorten.

 

[xlithiumx]

Yeah, I've got issues. Looking ahead, it looks like my schedule is starting to fill in, and I'll miss these slow days.

Cherish these days. 2 years into a traditional combined inpatient/outpatient practice in a relative shortage area and I'm so mega swamped.

 

[Doctor Bagel]

Are you still inpatient now with added part time?

Inpatient is just on call stuff with a variable schedule.

 

[PikminOC]

It's interesting that there's such a shortage of psychiatrists, including with this one employer, and yet there's all this inefficiency in connecting psychiatrists and patients.

Cut out the middle men.

 

[Doctor Bagel]

Cut out the middle men.

Not with these patients. All pretty ill Medicaid type patients where you definitely need someone in the background to work the administrative angles.

 

[PikminOC]

Not with these patients. All pretty ill Medicaid type patients where you definitely need someone in the background to work the administrative angles.

Then that is Medicaid throwing up the roadblocks isn't it?

 

[mojetter]

...when the winter hits the days get colder and shorter and all the SAD and holiday blues kick in youll be plenty busy...lol

 

[Doctor Bagel]

Still so slow! All my patients are no showing today. I guess that means my SDN post count will keep on increasing.

 

[vistaril]

One day this week in my clinic job: Eight 90792s and thirteen 99214s/90833s

And I still left at 345 after arriving at 910

 

[Doctor Bagel]

One day this week in my clinic job: Eight 90792s and thirteen 99214s/90833s

And I still left at 345 after arriving at 910

Wow, that's insane. How do you document for that many visits in that short of a period of time?

 

[vistaril]

Wow, that's insane. How do you document for that many visits in that short of a period of time?

Well it's 6 and a half hours....that seems like a good chunk of time. At this particular office We use an emr that, while annoying, dies a pretty good job of making sure we can document to that extent.

But doing the math- probably averaged 18 mins each on the 99214/90833s....so that's right at 4 hours. A practice more geared towards maximizing dollars would pass on the 90833(or cheat the time) to fit in more 99214s, but oh well. Which left 3 hrs(I probably undershot by 30 mins) for the intakes....thinking about the intakes individually, 2 were straightforward ADHD and NO other concerns or pathology and recent testing done and sent over. Those took almost no time. Another was a SEVERELY neurologically impaired adult who was nonverbal and the Only thing we can target is agitation and stuff. Again, very little time. The documentation with the right emr for all three of those visits is pretty much going to do itself.

One of the intakes was sort of a mess time wise, but the other 3-4 weren't.

I know people a lot slower, and a lot faster. Obviously your speed is going to be limited if you can bill for 90833s(can't in many settings), unless you want to forge times....which I would never do.