So miserable at job

[Yellow mellow]

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This is my first job out of residency and I was so excited up until one month into the job. I love working with patients and I feel like I've tried really hard to adhere to the demands of my job but somehow my boss is absolutely not satisfy with my performance. My suggestions for patients are met with resistance and ridicule, although the patients and family are completely happy with the outcome. Even the nurses are telling me that I'm given the worst cases and I do see the unfair distribution of patients. At this point, I feel so defeated and spirit crushed. I've signed on for one year with sign on bonus but every minute of being under the supervision of this particular boss and his sidekick is killing me. Help.

 

[Ceke2002]

Hey there, I'm so sorry to hear things are so difficult for you right now. I'm not a medical professional, so I can't offer any real advice, but I just wanted to say I really hope things get better, and please make sure you practice good self care during such a stressful sounding period of time.

Sending some positive energies your way. 🙂

 

[TexasPhysician]

What is your boss concerned about performance wise? Are patient loads detailed in your contract? What type of practice setting are you in?

 

[Yellow mellow]

Patient loads are between 8-10. Besides, I have been given more than ten patients. But it's not the number of patients necessarily, it's the difficulty of each patients cases.
It's a hospital setting. My evaluation after 3 months was unsatisfactory because of late documentation. He also disagreed with me on my medication regimen....not high enough dosage or not recommended drug. However, my treatment plan has yielded positive results. I understand that doctors there have years of experience over me and I have articulated that to my patients and her family when I had to convince them that my boss wanted to change the treatment plan. The family as well as patient refused and wanted to stick to my plan citing that they have seen a positive change with my plan. I don't know what to do. I don't know why I was hired when everything I do is being criticized. This is by far worst than any bad residency experience. I always knew where to improve and why. Here at this new job, I feel like I'm being subjected to opposition just because and my soul is crushed . Nurses have come up to me worried that I will quit . This was my dream but now it's a complete nightmare.

 

[Yellow mellow]

Thanks Ceke2002

 

[zolof]

if your unhappy with the setting then your unhappy and shouldn't stay at the job too long. This is not residency and you can quit, depending on the contract, you might have to give a month or two notice but even that is debatable. Everything is negotiable. You should begin looking for other jobs there are tons of them out there. IF you are unhappy it is unlikely to change. But be aware that many jobs in the outpatient are often like that, very busy with high demand of difficult patients.

 

[thepoopologist]

I echo that statement. It's not residency, and you are your own person. You can choose to tough it out, you can choose to talk to your supervisor about it, or you can choose to leave. It sounds like your boss is an asshat and is supervising you like a resident when you are an attending. **** him.

 

[Yellow mellow]

I echo that statement. It's not residency, and you are your own person. You can choose to tough it out, you can choose to talk to your supervisor about it, or you can choose to leave. It sounds like your boss is an asshat and is supervising you like a resident when you are an attending. **** him.

I am under contract for one year plus I was given a sign on bonus that will have to be returned should I break my commitment. So I m screwed I guess ...at least until my contract ends.

 

[digitlnoize]

I would at least talk to an employment or contracts lawyer. Depends on your state and your contract, but you do usually have options.

 

[Shikima]

Now you know what you're looking for in terms of workplace environments and obligations. The first job is often the worst.
There are plenty of other jobs and look for a new employer in your area, that also gives you a higher sign-on bonus, where you can leave the job after the obligatory period of time that you tell them but also can repay the bonus as agreed upon.

Lastly, don't take the evaluations to heart. They mean nothing. Just improve that your documentation is completed at the end of the day, other than that, he can't touch you. It's a JACHO issue.

There are many other fisheses in the sea, and you'll find the right practice environment.

 

[whopper]

1-In most areas psychiatrists are in great demand. If you don't like the job consider leaving.
2-Most places I've seen treat their psychiatrists very well due to the shortage.
3-I've seen some places where haze the new docs. Of course it's not shaving cream in your hair or anything like that. It's more on the order of giving the new docs the worst cases and more scutwork. On some level I'm not against this. Older docs, for example, should not be given the extremely violent patients. A 63 year old doc getting punched is worse than a 33 year old. But on another level it really is the management being unfair.
4- Is there anything about this job that forces you to be there other than the contract? You should honor your contract but many have loopholes on getting out without violating it. Look them up. Look into new jobs now that you already know you don't like your job.

Now I'm making the assumption that the boss is being unfair. Consider that maybe you're doing something wrong by talking to colleagues about it and ask them what they think. I will say, however, that being met with ridicule is pretty much crossing the line.

 

[TexasPhysician]

Patient loads are between 8-10. Besides, I have been given more than ten patients. But it's not the number of patients necessarily, it's the difficulty of each patients cases.
It's a hospital setting. My evaluation after 3 months was unsatisfactory because of late documentation. He also disagreed with me on my medication regimen....not high enough dosage or not recommended drug. However, my treatment plan has yielded positive results. I understand that doctors there have years of experience over me and I have articulated that to my patients and her family when I had to convince them that my boss wanted to change the treatment plan. The family as well as patient refused and wanted to stick to my plan citing that they have seen a positive change with my plan. I don't know what to do. I don't know why I was hired when everything I do is being criticized. This is by far worst than any bad residency experience. I always knew where to improve and why. Here at this new job, I feel like I'm being subjected to opposition just because and my soul is crushed . Nurses have come up to me worried that I will quit . This was my dream but now it's a complete nightmare.

Inpatient settings make more money with quick turnover. I doubt your supervisor is upset about your medication regimen because of patient satisfaction, but instead because he/she wants quicker discharges. Documentation is vital to complete early because of not only regulations, but the highest risk is immediately homicidal/suicidal patients. I have multiple attorneys in my family, and if someone hurt themselves just out of a hospital, they would try to get records that day. Also, my memory on every patient is not great, and I find that my documentation is better the day of.

At least some inpatient settings allow physicians to reject certain patients. Are your colleagues aware of certain difficult/repeat patients and refuse them?

Maybe I'm completely off base, and it's just a bad gig. If you want out early, expect to return the signing bonus and follow other termination clauses in the contract.

If you haven't already been doing this, negotiate good termination clauses in the future.

 

[MacDonaldTriad]

Just know that very few psychiatrists stick to the first job they get out of training. The demand is so high; you probably don’t have to worry too much about the quality of their references. On the few occasions I have to give a bad reference, I have tried to say everything negative possible within the limits of what HR will allow and in almost every case, the potential employer rationalizes and feels they can structure the bad behaviors and hires them anyway. It is really quite remarkable. Sometimes they flat out tell me; “I know you are trying to save me a lot of trouble, but I really need this guy”. Kind of makes you wonder why they bother to call me.

 

[vistaril]

This is my first job out of residency and I was so excited up until one month into the job. I love working with patients and I feel like I've tried really hard to adhere to the demands of my job but somehow my boss is absolutely not satisfy with my performance. My suggestions for patients are met with resistance and ridicule, although the patients and family are completely happy with the outcome. Even the nurses are telling me that I'm given the worst cases and I do see the unfair distribution of patients. At this point, I feel so defeated and spirit crushed. I've signed on for one year with sign on bonus but every minute of being under the supervision of this particular boss and his sidekick is killing me. Help.

a few thoughts...

1) 'more than 10' inpatients per day(especially if you have no outpt load) is not much. Or excessive. if your frustrated with a census of more than 10 and you don't have a ton of other responsibilities, then maybe community inpatient psychiatry is just not for. On weekends at one place I routinely see 25 patients per day(including several admissions and a few consults) without missing a beat. That's the nature of community inpatient psychiatry. If I told them I was only going to see 10 inpatients per day they would say see ya.

2) I think it's likely this setting just isn't for you. Consider inpatient(or outpt?) work at the VA somewhere. Census numbers there may be much more to your liking.

3) Finally, and I don't really know on this point, maybe this just isn't the right field for you. I wouldn't throw in the towel after one bad post-residency experience, but nobody is going to make you practice psychiatry forever. people change careers all the time. Maybe you could go into business, accounting, IT, etc(I don't know what your background is). I realized some time ago I wasn't going to be satisfied practicing only psychiatry my life so I made changes to try to diversify into other areas. It hasn't worked out so far, but that's why you have to keep pushing and working towards your goals.

 

[F0nzie]

It sounds like your boss has an agenda. Try to let go of that. Here are my recs:

1. Always do what is best for the patient.
2. Follow evidence based practice.
3. Complete your documentation before the day is over.
4. Look at feedback as an opportunity for growth and try out new things.
5. Stand up for yourself.
6. Do not stay in a bad relationship.

There are a lot of good jobs out there, you just need a larger sample to choose from. You placed all your eggs in 1 basket...which isn't a bad thing but you put all your money in the safety of bonds when the stock market is on fire.

If you have already done #1-6 above and still feel like crap, pay the money back and leave. Heck you can work 1 day a week and earn 50k (residents salary). That gives you 4 more days out of the week to do whatever you want. Do private practice 1 day a week, work at the jail 1 day a week, do Telepsych from home 1 day a week, do CL one day a week...

Here's how it goes down man:

Employer: "we want you fulltime". You seem like a really good candidate.
You: "I only want to work 1 day"
Employer: "Ok"

 

[smalltownpsych]

Almost any position that you would take is going to have an issue with late documentation. When I was interviewing for my current position their number one concern was that I would complete my documentation in a timely fashion. The psychiatrist who was leaving was about 6 months behind and although she provided a great service to patients, the administration didn't shed too many tears.

 

[milesed]

Another employer may be willing to pay back your bonus for your- when looking for jobs, everything is negotiable. I didn't get a signing bonus but did negotiate being paid about 25% of the year's salary paid up front.

 

[vistaril]

Almost any position that you would take is going to have an issue with late documentation. When I was interviewing for my current position their number one concern was that I would complete my documentation in a timely fashion. The psychiatrist who was leaving was about 6 months behind and although she provided a great service to patients, the administration didn't shed too many tears.

exactly. BY FAR, the most important things most employers(outside of academia) are going to look for in hiring/keeping candidates are:

1) efficiency
2) documentation
3) professionalism and 'getalongability'
4) not prone to creating medicolegal troubles

things like whether or not someone has a good grasp on the current literature for various types of PTSD treatment(just to pick one) is WAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAY behind all these things(and no #4 doesn't overlap too much with that)

By far imo, the most important thing one can learn in residency is to gain efficiency while not losing too much in the way of safety.

 

[whopper]

doubt your supervisor is upset about your medication regimen because of patient satisfaction, but instead because he/she wants quicker discharges.

Only way I can see this as legit on the part of the boss is if the patients are happy cause they're getting all the meds of abuse they want up the wazoo and if they are staying as long as they want when anyone with experience in this field knows that in inpatient settings especially in urban areas we'll encounter a lot of resistance from patients that don't get the Xanax they want and the length of stay they want from us.

I'm not saying that's happening, just that we don't know the full story.

 

[wolfvgang22]

To be fair, the latest evidence based treatment protocols for PTSD are quite straight forward. 😉

 

[Yellow mellow]

I totally own my deficiency in documentation and that is what I need to accomplish first. As far as patient load goes, I really don't mind the number, it's the oversight of every treatment plan and the disdain for what methods that I want to execute that bothers me. I can literally say white and he'll say black. When I started at this work place I was told by multiple staff that he was very difficult and had a nasty attitude. But I wanted to form my own opinion, well I have one now. Btw, it's not discharge that he wants, he literally doesn't care cause I will just be blasted with new admits if I keep patients. My diagnosis are met with snickering remarks while my regimen is fiercely opposed. And yet my patients are doing better. I have worked with difficult attendings and nurses during residency but not like this.
I love doing what I do. I wanted to be a psychiatrist and work with these particular patients. And I always appreciate constructive criticisms. I've just never been in this humiliating circumstance.
I don't know what will happen but these inputs have certainly helped so thank you all.

 

[smalltownpsych]

I totally own my deficiency in documentation and that is what I need to accomplish first. As far as patient load goes, I really don't mind the number, it's the oversight of every treatment plan and the disdain for what methods that I want to execute that bothers me. I can literally say white and he'll say black. When I started at this work place I was told by multiple staff that he was very difficult and had a nasty attitude. But I wanted to form my own opinion, well I have one now. Btw, it's not discharge that he wants, he literally doesn't care cause I will just be blasted with new admits if I keep patients. My diagnosis are met with snickering remarks while my regimen is fiercely opposed. And yet my patients are doing better. I have worked with difficult attendings and nurses during residency but not like this.
I love doing what I do. I wanted to be a psychiatrist and work with these particular patients. And I always appreciate constructive criticisms. I've just never been in this humiliating circumstance.
I don't know what will happen but these inputs have certainly helped so thank you all.

Ahh. I had a supervisor like that during my internship and they were my primary clinical supervisor. The problem was their own incompetence and when my conceptualization and treatment plan diverged from their own, it was interpreted as me being incompetent. What was particularly mind blowing was that the supervisor told me I had a real weakness with case conceptualization and for the past three years during my various clinical placements, supervisors had consistently praised my conceptualization skills as one of my greatest strengths. When dealing with this supervisor I felt like I had gone through the looking glass. Halfway through my internship year the supervisor was literally banned from the premises because of another interpersonal conflict so the rest of they year went smoothly and I ended up being the defacto psychological consultant on the unit. Good luck with your own situation. In the words of one of my best supervisors whenever I had a particularly difficult case, "it sounds like a great training case for you!"

 

[TexasPhysician]

If this is only about micromanaging Rx preferences, I'd personally handle this differently.

The next time there is a concern about a patient, I would graciously offer to transfer care of this patient to the supervisor for proposed care. If he agrees, I get a lighter census and more time with other patients. If the supervisor declines my offer, I would say that if my preferences were poor enough to warrant this discussion that he should take the patient to minimize liability to the facility. Since this isn't the case, I would mention that it would be best to practice the way I was trained. If he is still upset, I would be happy to attend any 100% facility paid CME conference event of his choosing.

Just my way of dealing with poor criticism......

 

[wolfvgang22]

... When I started at this work place I was told by multiple staff that he was very difficult and had a nasty attitude.

Yep, that's a huge red flag, alright!
I'd rather work in northern Alaska and ride a dog sled to work 7 days a week than ever take a job where the supervisor has "a nasty attitude."
Most of the time it's not so much what you're doing, but who you're doing it with.

Do you have a non-compete clause in your contract?

 

[endrun]

Patient loads are between 8-10. Besides, I have been given more than ten patients. But it's not the number of patients necessarily, it's the difficulty of each patients cases.
It's a hospital setting. My evaluation after 3 months was unsatisfactory because of late documentation. He also disagreed with me on my medication regimen....not high enough dosage or not recommended drug. However, my treatment plan has yielded positive results. I understand that doctors there have years of experience over me and I have articulated that to my patients and her family when I had to convince them that my boss wanted to change the treatment plan. The family as well as patient refused and wanted to stick to my plan citing that they have seen a positive change with my plan. I don't know what to do. I don't know why I was hired when everything I do is being criticized. This is by far worst than any bad residency experience. I always knew where to improve and why. Here at this new job, I feel like I'm being subjected to opposition just because and my soul is crushed . Nurses have come up to me worried that I will quit . This was my dream but now it's a complete nightmare.

You are not a good fit as a Psychiatrist inasmuch as you are unable to remove yourself sufficiently from your environment, ie, what we commonly refer to as "numb out", and therefore should choose a field more suitable.

 

[wolfvgang22]

You are not a good fit as a Psychiatrist inasmuch as you are unable to remove yourself sufficiently from your environment, ie, what we commonly refer to as "numb out", and therefore should choose a field more suitable.

Are you being sarcastic? I hope so.

 

[Yellow mellow]

Has anybody here had any experience with telepsych? If so, what are the pros and cons aside from the obvious. Thks

 

[milesed]

I use telepsyc once a week for a clinic that is an hour away.Staff there measure them and escort them to and from the room. I see them for the visit and it's about the same as a regular visit. Tech is the limiting issue. Last week, we had 30 minutes where we could not connect. I did one visit by phone (free due to insurance regs) and then we got it back up. We also have issues if both are trying to talk at then same time or if someone goes out of the area the cam is on (kids crawling under the table). It save me a 2 hour drive for a 3 hour long clinic.

You need a fast internet connection, good video card, fast computer and decent webcam.

Some patients do not like it and have the option to drive to a clinic where a provider will see them in person.

 

[TexasPhysician]

I use telepsyc once a week for a clinic that is an hour away.Staff there measure them and escort them to and from the room. I see them for the visit and it's about the same as a regular visit. Tech is the limiting issue. Last week, we had 30 minutes where we could not connect. I did one visit by phone (free due to insurance regs) and then we got it back up. We also have issues if both are trying to talk at then same time or if someone goes out of the area the cam is on (kids crawling under the table). It save me a 2 hour drive for a 3 hour long clinic.

You need a fast internet connection, good video card, fast computer and decent webcam.

Some patients do not like it and have the option to drive to a clinic where a provider will see them in person.

How do you deal with the Ryan Haight Act?

 

[the5thelement]

Having a supervisor who is kind/supportive esp. in your 1st post residency job is vital. They can screw up your references/future job prospects so tread lightly and tip toe the **** out of there ASAP. Make sure you give adequate notice. It may be uncomfortable but in the long run much better for your own mental health.

 

[Yellow mellow]

I have been told by previous docs that he has a tendency of giving poor references so I don't know how to dodge that bullet even if I treaded lightly. I thought I had skills for interacting with even the most difficult characters but his one is just pure evil. Gonna do my best till then.
Also, any more thoughts from anyone about telepsych? I saw an ad that is hiring for telepscyh and I need the extra money to pay huge student loans.

 

[Yellow mellow]

I use telepsyc once a week for a clinic that is an hour away.Staff there measure them and escort them to and from the room. I see them for the visit and it's about the same as a regular visit. Tech is the limiting issue. Last week, we had 30 minutes where we could not connect. I did one visit by phone (free due to insurance regs) and then we got it back up. We also have issues if both are trying to talk at then same time or if someone goes out of the area the cam is on (kids crawling under the table). It save me a 2 hour drive for a 3 hour long clinic.

You need a fast internet connection, good video card, fast computer and decent webcam.

Some patients do not like it and have the option to drive to a clinic where a provider will see them in person.

So do you work physically at this clinic four days a week and do telepsych for the same clinic once a week?

 

[Yellow mellow]

My program director and past attendings have given me great references but I suspect that this supervisor here at my current job will not be doing the same. So I am going to be looking at other job prospects and will probably be applying soon. Any suggestions on how I should deal with the possible poor recom. ?

 

[TexasPhysician]

My program director and past attendings have given me great references but I suspect that this supervisor here at my current job will not be doing the same. So I am going to be looking at other job prospects and will probably be applying soon. Any suggestions on how I should deal with the possible poor recom. ?

Why get a recommendation from him at all? I do independent contract work (non-salary), so maybe that is different. I wouldn't want employers to contact this person.

 

[Yellow mellow]

Why get a recommendation from him at all? I do independent contract work (non-salary), so maybe that is different. I wouldn't want employers to contact this person.

I wouldn't want to use him either. However, future employers will want to speak with my current employer although before med school I remember that I had the option to say no to contact but I don't know if that is still a wise option being a physician.
Ideally I would just use my PD and past attendings only . But how do I get around this evil boss? My patients and staff nurses would be great references but that's not an option.

 

[Shikima]

Don't use him unless necessary. Simple.

 

[michaelrack]

The answer to your problem is to find a job without a (clinical) supervisor, or one in name only. YOu can have administrators who look at productivity and senior colleagues to advise, but avoid any non-academic job in which someone is going to tell you how to practice psychiatry.

 

[trophyhusband]

So I'm not a psychiatrist but my wife is and from what we've seen in her recruitment is that people are desperate for psychiatrists. I don't know how easy it is for your place to find docs but if it's like most places I'd guess it's not that easy.

At any rate, if she was in your position and thinking of resigning anyway this is what I would tell her. Go to the administrative person above your supervisor and say if they do not move you out from under his supervision you will be resigning as soon as your contract allows. You also do not want any direct reporting relationship to this person. I doubt you'll have been the first one to complain about him and they may be more than happy to do it to stop the revolving door of docs that it sounds like they currently have going on there. The again they may call your bluff and let you leave but at least you tried.

If you can be moved out from under him you'll still have to deal with him but it won't be as a supervisor. Also, if your department is expecting to expand you can offer to take up the supervision duties of new docs so as to keep people away from this person.

Anyway just my thoughts.

 

[milesed]

Yellow Mellow,

Yes. I stay at one clinic all week, but connect to another satellite clinic one day/week.

 

[Yellow mellow]

So I'm not a psychiatrist but my wife is and from what we've seen in her recruitment is that people are desperate for psychiatrists. I don't know how easy it is for your place to find docs but if it's like most places I'd guess it's not that easy.

At any rate, if she was in your position and thinking of resigning anyway this is what I would tell her. Go to the administrative person above your supervisor and say if they do not move you out from under his supervision you will be resigning as soon as your contract allows. You also do not want any direct reporting relationship to this person. I doubt you'll have been the first one to complain about him and they may be more than happy to do it to stop the revolving door of docs that it sounds like they currently have going on there. The again they may call your bluff and let you leave but at least you tried.

If you can be moved out from under him you'll still have to deal with him but it won't be as a supervisor. Also, if your department is expecting to expand you can offer to take up the supervision duties of new docs so as to keep people away from this person.

Anyway just my thoughts.

Thanks I was thinking about doing this but like you said they can call this bluff and I may be stuck with this nightmare for awhile and may even reap a far worst retaliation . I have to get out from underneath my own deficiency before I bring up the topic of malignant behavior on my supervisor part. But thank you for your thoughts.

 

[vistaril]

So I'm not a psychiatrist but my wife is and from what we've seen in her recruitment is that people are desperate for psychiatrists. I don't know how easy it is for your place to find docs but if it's like most places I'd guess it's not that easy.
.

this is one of the great myths of mental health imo. That there is this tremendous shortage of available mh practitioners and because of it we hold all the cards. Are there jobs open in many/most areas? Sure. Most be/bc psychiatrists could pick an area they want to live and without any connections just start searching around and within several months get a job in that area. And perhaps we should be thankful for that......

but ease in getting a job and ease at getting a *good* job are very different things.

Im not saying the latter is impossible, but if you aren't interested in working in academics and don't want to be an independent contractor or work for yourself in your own practice....that really limits things in terms of available good openings.

 

[Armadillos]

This thread got me thinking, psychiatry may possibly have the best geographic freedom of any profession making 150k+ that isn't a pure work from home venture. I mean you literally could throw a dart at a map of USA (so long as you dont hit some desert) and be able to either find a job within a 45 minute commute or start a private practice.

 

[trophyhusband]

this is one of the great myths of mental health imo. That there is this tremendous shortage of available mh practitioners and because of it we hold all the cards. Are there jobs open in many/most areas? Sure. Most be/bc psychiatrists could pick an area they want to live and without any connections just start searching around and within several months get a job in that area. And perhaps we should be thankful for that......

but ease in getting a job and ease at getting a *good* job are very different things.

Im not saying the latter is impossible, but if you aren't interested in working in academics and don't want to be an independent contractor or work for yourself in your own practice....that really limits things in terms of available good openings.

I mean it sucks that you live in a place where these things aren't possible and all but it doesn't have anything to do with the reality that is my wife's recruitment. I tend to bypass your comments because they are rife with your personal biases and broad generalizations. You don't seem to understand that not all places in the US are like wherever it is you are now. I can only assume that you're in the south somewhere based on where you did your residency but there are other areas of the country that take mh and general health more seriously than the southern US.

I have no idea whether the OP lives in a place such as where you live or a place that is more like where we're looking. I was just giving my thoughts on what I would advise my wife to do if she was going to quit anyway but wanted to make a last ditch effort to stay.

 

[OldPsychDoc]

Part of it depends on who is defining "good". I remember sharing the details of my first job with my fellowship mentor, and his response was "Yeah, that's a good job, but not a Great job." Well, it had everything I wanted, in a place I wanted to be, and it has evolved into the job I have now, which is better than I could have scripted for myself 20 years ago. For me, it was Great then, has kept getting better for 10 years, and looks to continue being Great. I don't know what my mentor felt it lacked (or if he didn't like that I would be making more money than him, or what...) but it has never mattered to me.

 

[TexasPhysician]

Im not saying the latter is impossible, but if you aren't interested in working in academics and don't want to be an independent contractor or work for yourself in your own practice....that really limits things in terms of available good openings.

That's like asking you to pick the NCAA football champion right now, but you can't choose any of the current top 4 teams. You may get lucky, but you need serious insight to win the bet.

Academic gigs are often cushier than others.
Independent contractor jobs give you more flexibility, diversity, retirement options, and better tax deductions.
Your own practice lets you structure everything.

A salaried job comes with supervisors, more rules, strict hours, limited retirement options, etc. it may come with office drama or incompetence out of your control. Some of these jobs will be great for one individual and awful for another. It is too dependent on multiple variables.

Until I know the job well, I don't sign contracts without them having an easy out.

 

[vistaril]

I mean it sucks that you live in a place where these things aren't possible and all but it doesn't have anything to do with the reality that is my wife's recruitment. I tend to bypass your comments because they are rife with your personal biases and broad generalizations. You don't seem to understand that not all places in the US are like wherever it is you are now. I can only assume that you're in the south somewhere based on where you did your residency but there are other areas of the country that take mh and general health more seriously than the southern US.

I have no idea whether the OP lives in a place such as where you live or a place that is more like where we're looking. I was just giving my thoughts on what I would advise my wife to do if she was going to quit anyway but wanted to make a last ditch effort to stay.

I think:

1) you have a lot of the issues at work here confused. Part of this is because you aren't a psychiatrist. That said, even if one does take the ridiculous notion that the south 'doesn't take MH seriously'(an absurd overgeneralization imo), that's not necessarily connected to what makes a good job for most people in psych anyways. In fact, I would wager that in many situations the south is a fairly good job market right now relative to most of the rest of the country. The Midwest seems to pay slightly more, but I'd rather be searching for a job in the south(in terms of the factors most people look for in jobs.....salary, patient loads, total hours, work environment, etc) than anywhere right now except possibly the Midwest. All in all though, I've looked at plenty of jobs in every quadrant but one of the country and there just isn't a tremendous amount of difference from region to region in the setup of psychiatry positions that don't fall into cash pay psychiatry(be it as an inpatient psychiatrist, an IC, an hourly employee, a salaried employee with benefits, etc). You do have environments that are are unique upon themselves(VA, academics), but that's not so much a region thing. And if you want to talk cash pay psychiatry and the regional differences there(which are grant may be more pronounced), well that's not a 'job' anyways.....that's just someone doing cash pay. So that's off the table for this discussion. But this idea that the typical inpatient community psych hospital model in say....Arizona or Texas or Ohio is different than the typical inpatient community model hospital in Louisiana just isn't true. I've talked about enough such jobs in those places to know that.

2) you seem to be under the impression I am only familar with one particular place. That's not true. I have nothing tying me down(I have two kids but they don't live me now anyways and I rarely see them) now, and no area I 'have to be'. I suspect I'm much more familar with jobs in a variety of areas than you are. Oh wait Im sorry than someone you know is who tells you what his description of a good job is.....

3) all that said, a good job means different things to different people. For me a good job would be something with a nice guaranteed salary with benefits, not connected to govt work or academics, no bs, low patient load, interesting patients, nice work environment. Now the key there is low patient load.....I suspect that is where disagreement comes up on here with different people on what a 'good' job is. If you remove one or two things from that list, are good jobs easier to find? Sure, and that's fine and life goes on.

 

[trophyhusband]

I think:

1) you have a lot of the issues at work here confused. Part of this is because you aren't a psychiatrist. That said, even if one does take the ridiculous notion that the south 'doesn't take MH seriously'(an absurd overgeneralization imo), that's not necessarily connected to what makes a good job for most people in psych anyways. In fact, I would wager that in many situations the south is a fairly good job market right now relative to most of the rest of the country. The Midwest seems to pay slightly more, but I'd rather be searching for a job in the south(in terms of the factors most people look for in jobs.....salary, patient loads, total hours, work environment, etc) than anywhere right now except possibly the Midwest. All in all though, I've looked at plenty of jobs in every quadrant but one of the country and there just isn't a tremendous amount of difference from region to region in the setup of psychiatry positions that don't fall into cash pay psychiatry(be it as an inpatient psychiatrist, an IC, an hourly employee, a salaried employee with benefits, etc). You do have environments that are are unique upon themselves(VA, academics), but that's not so much a region thing. And if you want to talk cash pay psychiatry and the regional differences there(which are grant may be more pronounced), well that's not a 'job' anyways.....that's just someone doing cash pay. So that's off the table for this discussion. But this idea that the typical inpatient community psych hospital model in say....Arizona or Texas or Ohio is different than the typical inpatient community model hospital in Louisiana just isn't true. I've talked about enough such jobs in those places to know that.

2) you seem to be under the impression I am only familar with one particular place. That's not true. I have nothing tying me down(I have two kids but they don't live me now anyways and I rarely see them) now, and no area I 'have to be'. I suspect I'm much more familar with jobs in a variety of areas than you are. Oh wait Im sorry than someone you know is who tells you what his description of a good job is.....

3) all that said, a good job means different things to different people. For me a good job would be something with a nice guaranteed salary with benefits, not connected to govt work or academics, no bs, low patient load, interesting patients, nice work environment. Now the key there is low patient load.....I suspect that is where disagreement comes up on here with different people on what a 'good' job is. If you remove one or two things from that list, are good jobs easier to find? Sure, and that's fine and life goes on.

You certainly love your appeal to authority debate technique I'll give you that. At least you're consistent. At any rate none of this is helping the OP. I've said my piece and the OP seemed to find it helpful so I'm good with that.

 

[vistaril]

You certainly love your appeal to authority debate technique I'll give you that. At least you're consistent. At any rate none of this is helping the OP. I've said my piece and the OP seemed to find it helpful so I'm good with that.

pointing out that a psychiatrist may be better equipped to comment on what we consider a 'good job' to be vs people who aren't in mental health is hardly the sort of appeal to authority which should be called out. I'm someone who is generally quite unimpressed with authority though(especially in psychiatry, as my posting history suggests I quite frequently side with non-psychiatrists vs psychiatrists in discussions on mental health)

That said, if you want to give examples of jobs that your husband has been offered that you believe to be great jobs, that would be a useful discussion. Be specific with salary, hours, patient loads(most important), etc as without specifics the concept of a good vs bad job is meaningless(and I suspect that is a lot of the problem....people differ on what a good job is based on what they view as important)

 

[trophyhusband]

pointing out that a psychiatrist may be better equipped to comment on what we consider a 'good job' to be vs people who aren't in mental health is hardly the sort of appeal to authority which should be called out. I'm someone who is generally quite unimpressed with authority though(especially in psychiatry, as my posting history suggests I quite frequently side with non-psychiatrists vs psychiatrists in discussions on mental health)

That said, if you want to give examples of jobs that your husband has been offered that you believe to be great jobs, that would be a useful discussion. Be specific with salary, hours, patient loads(most important), etc as without specifics the concept of a good vs bad job is meaningless(and I suspect that is a lot of the problem....people differ on what a good job is based on what they view as important)

Why would I even bother? It doesn't help the OP and not once in any thread that I've seen you post in have you ever had any interest in listening to another point of view or maybe learning something new. You've always just argued for arguments sake. There's no point in trying to convince you otherwise. As far as your siding with non-psychiatrists vs psychiatrists I'm well aware of your jock sniffing and/or trolling in other forums. SDN is a great resource for non--physicians who need to keep abreast of structural changes in organization/funding of other specialties... sometimes they bring up things that I missed and need to be aware of for what I do.

My wife has found her dream job and accepted it. Low patient volumes more than adequate pay, the exact patient population she wants to work with, and a boss she loves. But it's in *gasp* academia... though the clinic she'll be working in is completely self sufficient with its own funding outside of the University. There were plenty of non-academic positions that would have been fine as well and opening a private practice was also considered. At any rate, she's happy and that's all that really matters.

 

[vistaril]

well good for your wife.....some people have different requirements for a good job than others. My guess is that I want to make more money than your wife, so that's one factor that distinguishes a good job from me and her.