State Forensic Rehabilitation Facilities / Hospitals

[AD04]

From what I have encountered, these pay in the low to mid $200k. You see only 3 - 5 patients a day. You get state benefits, government holidays, and sovereign immunity.

What is the catch? Pay to work ratio is pretty good.

Are these types of places dangerous for psychiatrists?

With the patient load, I can write the note and do medication management in 3 hours or less each day. What do people do after they see their patients for the day?

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[wolfvgang22]

A lot of these facilities are in towns doctors don't want to live in, working with patients that may not be very cooperative, and are in a prison like institutional environment with a lot of paperwork and bureaucracy. They are a little more dangerous, too. And possibly boring.

 

[dl2dp2]

I find dealing with forensic patients day in day out extremely tedious, even if it's only 3-5 hours.

If I go for a state hospital job, I'd go for a pure low functioning long term psychosis job ANY DAY. I find that type of case far less draining. But otherwise your assessment is correct. These jobs are exactly what you describe. No particular catch other than you are dealing with some of the most unpleasant, antisocial, sickest people on earth and very few of your interventions will ever be effective. I don't enjoy that kind of life. Some people LOVE it. Some people LOVE dealing with child molesters, etc (This btw will be a substantial portion of your case load, due to some of the more recent laws). Your milage may vary greatly.

As to what people do outside of that job, a lot of people just go home. Some people run a private practice on the side. It varies.

 

[Ahamis]

A lot of these facilities are in towns doctors don't want to live in, working with patients that may not be very cooperative, and are in a prison like institutional environment with a lot of paperwork and bureaucracy. They are a little more dangerous, too. And possibly boring.

I work in a State Hospital in California.
They have Hospital in cities like San Bernadino and Napa (1 hour from SF).

There is a lot of paperwork but VA is not less paperwork.

No particular catch other than you are dealing with some of the most unpleasant, antisocial, sickest people on earth and very few of your interventions will ever be effective. I don't enjoy that kind of life. Some people LOVE it. Some people LOVE dealing with child molesters, etc (This btw will be a substantial portion of your case load, due to some of the more recent laws). Your milage may vary greatly.

I work in an 'acute unit' and many patients do get better and regain competency and are sent back to court (discharge from the hospital) but it can take months for that to happen. Those that don't get better are transferred to 'chronic unit'.
You see few patients per day (weekly note for the the first 60 days, monthly note after 60 days).
I don't deal with insurance and can spend as much time as needed with the patients.
In California there is a specific facility for sexual predators thus we don't receive those kind of patients in our hospital.
Basically, I am 'busy' in the morning (seeing patients and writing notes) and in the afternoon there is not much to do (most of the days). Court reports are done by the forensic department. I get between 1-3 admissions per week (2 most of the weeks). No calls, no weekends. 285k
I don't regret my choice so far.
Contact me directly if you would like to hear more details.

 

[psyguru]

I used to work in a prison. In some ways felt safer then current job in private practice. Pm if u like.

Sent from my SM-G965U using Tapatalk

 

[whopper]

1) As mentioned above many of these facilities are in the middle of nowhere. So if you like Cletus with the missing teeth who has the local rep of spitting in your sandwich and you got no other choice with restaurants go for it. Why does this happen? Local residents don't want the psych facility in their community so like prisons they put them in the middle of nowhere.
2) Facilities are often on the order of a dungeon. Your office will likely be a piece of crap office with steel drawer desks that don't open without a screech, no sunlight, walls painted over poorly 10x over, bathrooms with urine all over the seat, not to mention with contents akin to brownies floating in lemonade that no one flushed....
3) Expect to get punched at least once a year. Seriously. I used to work in one and I got punched.
4) Many of your colleague physicians will be of the lowest rung of quality.
5) Many of the nurses will be terrible.
Concerning 4 and 5 it's the same problem with the VA. These institutions don't tend to fire even bad employees and you're stuck with working with them. How bad? I saw psychiatrists have violent psychotic patients on their unit and put them on say Risperidone 1 mg PO Q BID and they never upped the dosage. The patient would be there for say even 10 months with no change in dosage. Or someone with severe Borderline PD and the psychiatrist's treatment is large dosages of Throrazine with no consideration of psychotherapy.

There are some advantages.
1) A likely very good pension.
2) You just might be lucky and have good nurses and doctors though I'd bet against it.
3) You get to see seriously bad pathology. E.g. Clozapine resistant patients.

I used to work at Summit Behavioral Healthcare in Ohio that is a forensic facility. Despite everything I've said I would actually love to go back there but this was an exception. That place was built during the budget surpluses of the 90s and is a beautifully build hospital. It's likely the best built forensic facility in the country. Also because of the forensic fellowship in the same city it does have actually a much better percentage of good psychiatrists because many of them work there after they graduate. Its also not in the middle of nowhere. There were some great restaurants in the area and it was a 10 minute drive from my house while I lived in that area. Due to the U of Cincinnati psychiatry program, where many of the graduates stay in the area, the doctors running the place are very good. It also helped that the governor while I was there had a Ph.D. in psychology and the next governor was serious about his commitment to funding mental health despite being a Republican. I remember a serious case we had in court and the judge called the Governor's office cause it was serious and they worked with us immediately and took the case seriously.

Despite the above I've also seen forensic psych units in other states and all of them were horrendous. E.g. a patient on a Three to one committing suicide! The staff were so incompetent 1 to 1s weren't good enough so they made 2 to 1s and that even wasn't good enough because of incompetent staff so 3 to 1s and the staff were so incompetent the patient still committed suicide!

 

[wolfvgang22]

So, location, location, location.
I have worked and trained at several VA hospitals, and the saying is "If you've seen one VA, you have seen one VA." I bet this is also true in community mental health, forensics, academics, and so on. There are always some similarities and sometimes guarantees (mind numbing paperwork and checklists at the VA, for example), but a lot depends on who your colleagues are and the particular site environment. It's good to know what to watch out for. Nothing beats visiting yourself and talking to other staff and patients.

 

[dl2dp2]

I work in an 'acute unit' and many patients do get better and regain competency and are sent back to court (discharge from the hospital) but it can take months for that to happen. Those that don't get better are transferred to 'chronic unit'.
You see few patients per day (weekly note for the the first 60 days, monthly note after 60 days).
I don't deal with insurance and can spend as much time as needed with the patients.
In California there is a specific facility for sexual predators thus we don't receive those kind of patients in our hospital.
Basically, I am 'busy' in the morning (seeing patients and writing notes) and in the afternoon there is not much to do (most of the days). Court reports are done by the forensic department. I get between 1-3 admissions per week (2 most of the weeks). No calls, no weekends. 285k
I don't regret my choice so far.
Contact me directly if you would like to hear more details.

Yes! Very state dependent. I heard recent new gigs at the CA systems are sweet--higher salary too since hard to attract people. I'm talking in generalities.

 

[Merely]

Do these places require you to be there all day? Can someone like round on their 5 patients in 3 hours, write all their notes, then go to their outpatient office later in the day? I mean are you essentially being paid 200k for 3 hours of work or do they force you to stay there doing nothing for like 8 hours?

 

[whopper]

Yes true about the location and generalities.

While the majority of forensic units have the problems I mentioned above if you live in the area of a good one it doesn't matter if 90% of them follow what I said. The one in your area is 100% for all the things that concern you.

(I have the same saying with meds. Even if the risk of less than 1% for a bad side effect, if you get it, it's 100% as far as you're concerned).

 

[AD04]

Thanks for the replies.

My original plan when looking at these types of positions was to come in at 8 AM. Leave for my next job by noon. But after talking with the medical director, I find that my plan won't work. I'm expected to be there for the whole 8 hours per day. I don't think I can work there long-term.

I'll be bored out of my mind.

I'm not fond of being punched (even if it is once a year).

I dislike bureaucracy.

And if you're not under sovereign immunity, you'll be exposed to lots of frivolous lawsuits (antisocials with too much time on their hands).

I work in an 'acute unit' and many patients do get better and regain competency and are sent back to court (discharge from the hospital) but it can take months for that to happen. Those that don't get better are transferred to 'chronic unit'.
You see few patients per day (weekly note for the the first 60 days, monthly note after 60 days).
I don't deal with insurance and can spend as much time as needed with the patients.
In California there is a specific facility for sexual predators thus we don't receive those kind of patients in our hospital.
Basically, I am 'busy' in the morning (seeing patients and writing notes) and in the afternoon there is not much to do (most of the days). Court reports are done by the forensic department. I get between 1-3 admissions per week (2 most of the weeks). No calls, no weekends. 285k
I don't regret my choice so far.

Not a bad salary for a very chill gig.

Do these places require you to be there all day? Can someone like round on their 5 patients in 3 hours, write all their notes, then go to their outpatient office later in the day? I mean are you essentially being paid 200k for 3 hours of work or do they force you to stay there doing nothing for like 8 hours?

You're expected to stay.

 

[whopper]

Well I will say this for these types of facilities and this is a problem in any institution.

Many institutions will say they will pay for you malpractice insurance and/or provide malpractice coverage.

But some places, if you are sued will throw in some type of excuse to not provide you coverage. I've seen it happen. It's to the degree that many advise that you get malpractice insurance separate from any institution you work at even though they promised to cover you.

A good friend of mine was promised coverage so he didn't pay for malpractice insurance. A few years into the job he was sued and the institution refused to pay for his legal fees forcing him to do so. He was forced to either sue them for violating their contractual agreement with him or accept it. He accepted it cause it he figured it was too much cost and effort to sue his employer but he resigned from his job shortly afterwards.

Another place I worked at a different buddy of mine was sued and the department paid $300K in legal fees. They had his back. This is definitely a huge reason to like that employer.

 

[Ahamis]

Do these places require you to be there all day? Can someone like round on their 5 patients in 3 hours, write all their notes, then go to their outpatient office later in the day? I mean are you essentially being paid 200k for 3 hours of work or do they force you to stay there doing nothing for like 8 hours?

Many places expect you to be there for 8 hours. U r being paid for 8 hours.
Leaving early may be considered fraud and you can be under investigation...Do it on your own risk.

When I was looking for jobs, the majority of the employers would NOT allow me to leave earlier, especially if it was an outpatient position.
Also, keep in mind that the employers that let you leave early have a big case load, night calls and weekend calls...So, at the end of the day you end up working 40 hours or more...

 

[whopper]

In Ohio you could work minimum 20 hrs a week and still get full benefits but in terms of racking up the pension you get 1/2 credit. E.g. you worked 20 hours a week instead of 25 years for a full pension you now need 50 years. You could, however, in your later years work more than 40 hrs a week and get more credit and less years.

 

[Armadillos]

Well I will say this for these types of facilities and this is a problem in any institution.

Many institutions will say they will pay for you malpractice insurance and/or provide malpractice coverage.

But some places, if you are sued will throw in some type of excuse to not provide you coverage. I've seen it happen. It's to the degree that many advise that you get malpractice insurance separate from any institution you work at even though they promised to cover you.

A good friend of mine was promised coverage so he didn't pay for malpractice insurance. A few years into the job he was sued and the institution refused to pay for his legal fees forcing him to do so. He was forced to either sue them for violating their contractual agreement with him or accept it. He accepted it cause it he figured it was too much cost and effort to sue his employer but he resigned from his job shortly afterwards.

Another place I worked at a different buddy of mine was sued and the department paid $300K in legal fees. They had his back. This is definitely a huge reason to like that employer.

I thought in most of these jobs your a state government employee, so you legally can’t be liable for malpractice claims. Or are more of the jobs making you a contractor from some other 3rd party?

I haven’t worked in many states so never sure if other states do things a lot differently.

 

[whopper]

Well that's what you thought, and guess what? My friend was still sued, still had to pay his own lawyer and the state backstabbed him by abandoning him. He wasn't a contractor. In fact he had the #2 clinical position in the hospital he worked in.

Institutions have their own lawyers who do "lawyering" and will try to find a way to not cover you if they are devious and it's going to save them money. It's not like they will tell you upfront that they will abandon you in your time of need. Often times even if they know they're wrong, know if it's put through court they will ultimately lose if the process is brought to it's completion (that literally could take decades with the right stall tactics), but they know you can't fight them cause they got virtual-unlimited funds to fight them legally they'll still do it.

Many institutions have lawyers on staff who get salaries so doing this type of tactic actually isn't an added cost for them. Heck some of them will argue, "that lawyer is just sitting there so here's some work," making them fight a war of attrition they know they'll win over a guy that can't afford a lawyer or can't afford one for an indefinite period of time.

 

[AD04]

Well that's what you thought, and guess what? My friend was still sued, still had to pay his own lawyer and the state backstabbed him by abandoning him. He wasn't a contractor. In fact he had the #2 clinical position in the hospital he worked in.

Institutions have their own lawyers who do "lawyering" and will try to find a way to not cover you if they are devious and it's going to save them money. It's not like they will tell you upfront that they will abandon you in your time of need. Often times even if they know they're wrong, know if it's put through court they will ultimately lose if the process is brought to it's completion (that literally could take decades with the right stall tactics), but they know you can't fight them cause they got virtual-unlimited funds to fight them legally they'll still do it.

Many institutions have lawyers on staff who get salaries so doing this type of tactic actually isn't an added cost for them. Heck some of them will argue, "that lawyer is just sitting there so here's some work," making them fight a war of attrition they know they'll win over a guy that can't afford a lawyer or can't afford one for an indefinite period of time.

Is there a way to spot these institutions before signing the contract?

 

[whopper]

No unless you have inside information of people there who can attest to whether or not the institution protected their employee in a such a situation.

 

[Armadillos]

I’m still a little puzzled how a state employeed psychiatrist can get personally sued. In my state you legally can’t sue a state employee, you have to sue the state. Like if the governor botched a natural disaster response or someone in the highway department employee did a crappy job fixing a bridge, nobody can sue the individual state employee no matter if its the governor, a janitor or a psychiatrist.

I guess not all states are like this?

 

[whopper]

It happened in the state of Ohio.

 

[AD04]

I’m still a little puzzled how a state employeed psychiatrist can get personally sued. In my state you legally can’t sue a state employee, you have to sue the state. Like if the governor botched a natural disaster response or someone in the highway department employee did a crappy job fixing a bridge, nobody can sue the individual state employee no matter if its the governor, a janitor or a psychiatrist.

I guess not all states are like this?

If you're considering working for the state, always ask the medical director if you'll get sovereign immunity or not. It varies. One job in one state told me yes. Another job in another state told me no. I can't explain why.

 

[splik]

I’m still a little puzzled how a state employeed psychiatrist can get personally sued. In my state you legally can’t sue a state employee, you have to sue the state. Like if the governor botched a natural disaster response or someone in the highway department employee did a crappy job fixing a bridge, nobody can sue the individual state employee no matter if its the governor, a janitor or a psychiatrist.

I guess not all states are like this?

First, there are variations on sovereign immunity for individual states and municipalities. Secondly, sovereign immunity applies to governments not individual employees. It is the state that cannot be sued, not the individual. Under these circumstances, the state has to consent to being named as a party to a lawsuit, and must consent to substituting an individual employee in a lawsuit. so really what people are talking about is not sovereign immunity at all, but defendant substitution. This only occurs in certain circumstances. For example, if the psychiatrists conduct was so egregious, e.g. they encouraged a patient to commit suicide, or raped a vulnerable patient, then it is likely that the government would not replace the individual as the defendant in the lawsuit. The government could still be liable and named as defendant if the cause was negligent hiring but that would be a separate cause of action.

In general, plaintiffs are always going to prefer to go after a hospital, government entity, or other faceless corporation than an individual because the pockets are deeper and juries are more likely to be willing to award damages when the defendant is an incompetent organization than an individual.

 

[psych md jd]

What is the catch?

5 Years After A Murder, Calif. Hospital Still Struggles With Violence

A violent place we call a hospital

Inside a Hospital for the Criminally Insane

 

[whopper]

One angle I've noticed in two lawsuits with colleagues involved is they can sue you outside of malpractice. Yes they can. They can sue you claiming you violated their civil rights.

If this happens the institution can claim, "yeah we cover your malpractice but we don't cover civil rights cases." This is despite that practice and the civil rights issue are tied together. E.g. let's say you work to involuntary commit someone. They can sue you from a civil rights angle.

 

[psych md jd]

One angle I've noticed in two lawsuits with colleagues involved is they can sue you outside of malpractice. Yes they can. They can sue you claiming you violated their civil rights.

If this happens the institution can claim, "yeah we cover your malpractice but we don't cover civil rights cases." This is despite that practice and the civil rights issue are tied together. E.g. let's say you work to involuntary commit someone. They can sue you from a civil rights angle.

With involuntary commitment, wouldn't the plaintiff claim an infringement of their civil liberties, rather than their civil rights?

Civil liberties arise from the Bill of Rights and the Constitution, or from the courts.

Civil rights are based on protected characteristics or classes usually involving housing, discrimination, access to public facilities, etc..


The civil rights cases involving physicians I am familiar with occurred in correctional settings where inmates claimed a violation based on deliberate indifference. Malpractice carriers see this as an "illegal act" and excluded from coverage. Likewise, employers disclaim vicarious liability. Often, as you mentioned above, the end result is the physician is left paying all the litigation costs and damages.

 

[calvnandhobbs68]

So, location, location, location.
I have worked and trained at several VA hospitals, and the saying is "If you've seen one VA, you have seen one VA." I bet this is also true in community mental health, forensics, academics, and so on. There are always some similarities and sometimes guarantees (mind numbing paperwork and checklists at the VA, for example), but a lot depends on who your colleagues are and the particular site environment. It's good to know what to watch out for. Nothing beats visiting yourself and talking to other staff and patients.

Yeah some VAs are really nice (esp the newer ones). The VA I had the experience rotating at had very nice facilities and the nurses were actually decent (certainly no worse than the academic hospital floor nurses). Getting labs was always a pain in the ass though...

 

[honsano]

Im in the process of transitioning from prison to state hospital so I appreciate the discussion above.

Regarding the deliberate indifference suits. I have heard similarly that you pay for the suits litigation and if there are findings of guilt. Practically speaking I haven't seen that. I work for a private entity that is contracting prison healthcare for the state. I spoke to my employer's attornies and was told that litigation is covered. Also if there is a finding of deliberate indifference it is covered by your malpractice up to a certain amount. Our malpractice is likely different and has a rider fr this.

I've known a few doctors get deposed and they didn't pay the attorney. The cases were not taken to trial.

Ultimately it makes sense you aren't on the hook for most costs associated with 42USC cases as they are common and if employees had no coverage, there would literally be no treatment providers.

 

[whopper]

You are correct regarding the civil rights vs the civil liberties. Same thing applies. They can sue you based on a non-malpractice angle despite that it was directly involved with practice. I'm not saying it's right or they should but courts often times don't think medically, they think legally. Person held against their will? Courts just like many MDs still don't see psychiatry and behavioral sciences or medicine as those things but as separate things despite that this is not correct thinking.

I've seen cases where a psychiatrist or nurse was viciously attacked by a non-mentally ill antisocial person but because it happened in a hospital the lawyer asked it be dismissed stating that "psychiatry is a profession where one expects to be assaulted by patients" and literally the court dropped the case despite that this is not what is supposed to happen. I also know a specific forensic psychiatrist high up in AAPL that even argued on that point. (The guy would never openly admit it to his AAPL colleagues but in that private case where he was paid big money he was willing to use any angle, I mean any angle, as if he was the defending lawyer which is a violation of professional ethics). What happens in a courtroom isn't exactly publicly broadcast to all including the other members of AAPL.

 

[whopper]

Regarding the deliberate indifference suits.

This issue hasn't been attacked as far as I know legally, but a physician operating on such an ethical standard is violating professional ethics. I'm not saying this in a judgmental sense. Various professional organizations have stated that physicians must offer care or strive to offer care to inmates no worse than that offered in the community. "Deliberate indifference", despite being validated by case law is not a professional standard.

Now this said, I doubt any repercussions will happen. The "deliberate indifference" standard was brought about by the SCOTUS, further whether professional societies want to admit it or not, jails and prisons across the country offer poor care compared to that in the community (although for some it's some care, many inmates otherwise would've gotten no care), and professional society declarations have no teeth unless they're backed by the law and this time it's not.

I will say, just person-to-person, that if you got a heart, the deliberate indifference standard is one that'll eat away at you. Working in a place that's offering poor care and you can't do much if anything to fix upon it, well feast on that as a career.

 

[Trismegistus4]

Do these places require you to be there all day? Can someone like round on their 5 patients in 3 hours, write all their notes, then go to their outpatient office later in the day? I mean are you essentially being paid 200k for 3 hours of work or do they force you to stay there doing nothing for like 8 hours?

Many places expect you to be there for 8 hours. U r being paid for 8 hours.
Leaving early may be considered fraud and you can be under investigation...Do it on your own risk.

I've wondered about this too. I thought I heard, years ago, of a state hospital psychiatrist who was prosecuted for this; that the hospital actually had a timeclock-card type system and she was leaving the hospital without clocking out, going and working somewhere else, and coming back to the hospital and clocking out at 5pm.

But what do you actually do while they're forcing you to stay there if there are so few patients to see? Can they force me to do something related to psychiatry? Are they going to post a guard to stand over my shoulder and make sure I'm reading AJP articles? Can I bring a cot into my office and take a nap? How about a PS4 and TV, so I can sit around playing video games all afternoon? Or get on the computer and run an online business or trade financial securities? Seriously, what do you do all day?

 

[Ahamis]

I've wondered about this too. I thought I heard, years ago, of a state hospital psychiatrist who was prosecuted for this; that the hospital actually had a timeclock-card type system and she was leaving the hospital without clocking out, going and working somewhere else, and coming back to the hospital and clocking out at 5pm.

But what do you actually do while they're forcing you to stay there if there are so few patients to see? Can they force me to do something related to psychiatry? Are they going to post a guard to stand over my shoulder and make sure I'm reading AJP articles? Can I bring a cot into my office and take a nap? How about a PS4 and TV, so I can sit around playing video games all afternoon? Or get on the computer and run an online business or trade financial securities? Seriously, what do you do all day?

They can't force you to do stuff related to psychiatrist once you are done with your tasks. Some people surf the internet. Some socialize...Some read books. Some stay in their office. But you can't take a PS4 to the hospital because that would be considered 'contraband'.
The campus is big and there is a gym there that you can use.
Nobody is on your shoulder checking the time you are in and out but if they observe a pattern (everyday you live early) you might be investigated...
I heard that as long you are in the campus you are fine.

 

[Merely]

They can't force you to do stuff related to psychiatrist once you are done with your tasks. Some people surf the internet. Some socialize...Some read books. Some stay in their office. But you can't take a PS4 to the hospital because that would be considered 'contraband'.
The campus is big and there is a gym there that you can use.
Nobody is on your shoulder checking the time you are in and out but if they observe a pattern (everyday you live early) you might be investigated...
I heard that as long you are in the campus you are fine.

So can I sit on the computer and watch Netflix, day trade, etc? Not too bad of a gig. Also lol at ps4 being contraband

 

[whopper]

While I worked in a state hospital I had about 20 hrs a week with nothing to do. This is with me doing my job very well and better than most of the other doctors in the hospital (again ever why I complain so much about how there's such poor care around?). E.g. I had all my commitment papers, involuntary med reports, progress notes done with about 20 hrs to spare. What I did was most of the day just watch HBO shows like Deadwood on my laptop (the hospital's network blocked them so I burned them onto DVD).

Another guy on a unit across from mine would only write about a progress note a month (minimum was supposed to be 1 a week) and did everything possible to get out of doing those things but the hospital let him get away with it and he was hardly ever in the hospital despite that his butt needed to be in there 40 hrs a week. It was pretty obvious he'd literally check in then walk out of the hospital then at 5 PM come back and check out.

 

[Merely]

While I worked in a state hospital I had about 20 hrs a week with nothing to do. This is with me doing my job very well and better than most of the other doctors in the hospital (again ever why I complain so much about how there's such poor care around?). E.g. I had all my commitment papers, involuntary med reports, progress notes done with about 20 hrs to spare. What I did was most of the day just watch HBO shows like Deadwood on my laptop (the hospital's network blocked them so I burned them onto DVD).

Another guy on a unit across from mine would only write about a progress note a month (minimum was supposed to be 1 a week) and did everything possible to get out of doing those things but the hospital let him get away with it and he was hardly ever in the hospital despite that his butt needed to be in there 40 hrs a week. It was pretty obvious he'd literally check in then walk out of the hospital then at 5 PM come back and check out.

Is it illegal to do what he did? I think it’s ridiculous to force someone to sit there and do nothing or watch movies so I really don’t blame the guy

 

[Ahamis]

Is it illegal to do what he did? I think it’s ridiculous to force someone to sit there and do nothing or watch movies so I really don’t blame the guy

As far as I know it is illegal because your contract is for 40 hours. However, some hospital don't enforce this policy. But an investigation from the government can happen and you might get in trouble. That happened in California...

Also, you are supposed to be there in case there is an emergency.

 

[thepoopologist]

Is it illegal to do what he did? I think it’s ridiculous to force someone to sit there and do nothing or watch movies so I really don’t blame the guy

Is there a price point where it would not be ridiculous?

 

[Trismegistus4]

They can't force you to do stuff related to psychiatrist once you are done with your tasks. Some people surf the internet. Some socialize...Some read books. Some stay in their office. But you can't take a PS4 to the hospital because that would be considered 'contraband'.
The campus is big and there is a gym there that you can use.
Nobody is on your shoulder checking the time you are in and out but if they observe a pattern (everyday you live early) you might be investigated...
I heard that as long you are in the campus you are fine.

I worked a locums inpatient job where the hospital just paid me for 8 hours a day no matter what (which could be a bad thing because since I was punctilious about notes, a day often took me more than 8 hours, and I found out as I was leaving that limiting me to 8 hours of pay was not what the locums company wanted) and would often leave the hospital to do stuff in the middle of the afternoon, as long as I had nothing but notes left to do. For example, once I was done seeing patients and putting in orders, I'd go get a haircut, or get my eye exam, then go back to the hospital to finish my notes. Or if I was worried about beating the after-work gym rush, I'd leave at 4, then finish my notes from home later. To me, being able to do that kind of thing was one of the great advantages of inpatient. It would suck to be chained to your desk for nonsensical, bureaucratic reasons.

 

[whopper]

Is it illegal to do what he did? I think it’s ridiculous to force someone to sit there and do nothing or watch movies so I really don’t blame the guy

Yes.

But guess what? If laws aren't enforced they're useless.

I kid you not another psychiatrist did the same a few years before and someone called the local news who literally bought a camera crew (in secret) who taped her checking in with her ID card, walking out, then they followed her and she did office hours in a private practice, then drove back in at 5 PM and swiped her ID card and went home. It was broadcast on the local news in a segment "your taxpayer dollars at work!" Then and only then did the administration confront her and then fire her, but she had literally been doing this for years.

I saw the video but no one put it up on Youtube and I can't find it now cause it was on the local news channel.

Again, this is the type of incompetent care you can likely expect to see working in certain facilities. Sometimes when you're working next to units like these the staff on the other unit come to you and beg for you to take a look at their patients despite that it's not your responsibility.

Often times places I've worked at raved about me and I found it shocking. Of course yeah I like the ego-boost but many times it was cause the other psychiatrists who previously or were still working there were giving the type of quality I've been talking about. To have a guy just doing his job was a new thing for them.

And this is why I frequently whine about psychiatric care being so bad. It's not the actual science itself despite what our critics may say. It's a combination of the lack of pay increases to our field adjusted for inflation which lowered the amount of people wanting to go into the field which creates a shortage and a specific type of psychiatrist that does a bad job but his employers won't fire him/her cause they can't replace that idiot among other factors (e.g. medschools often times downplay the important of mental health).

 

[Trismegistus4]

I kid you not another psychiatrist did the same a few years before and someone called the local news who literally bought a camera crew (in secret) who taped her checking in with her ID card, walking out, then they followed her and she did office hours in a private practice, then drove back in at 5 PM and swiped her ID card and went home. It was broadcast on the local news in a segment "your taxpayer dollars at work!" Then and only then did the administration confront her and then fire her, but she had literally been doing this for years.

I saw the video but no one put it up on Youtube and I can't find it now cause it was on the local news channel.

No offense, but did they run a hidden camera "your tax dollars at work" expose on you sitting around watching Deadwood? Yeah, I realize that's not quite the same because if her contract or terms of employment are that she's getting paid her salary for being there 8 hours a day then technically she was double-dipping, but that doesn't change the fact that it's really stupid that the terms of employment are for you to sit there 8 hours a day when there's only at most 4 hours a day of work to do. If someone can spend their afternoon binge watching TV shows, I fail to see why I couldn't go get my hair cut or go to the dentist at 3 p.m., or even just sneak out of there at 3:30 and go home, when I've been finished with my work since noon and there is literally nothing else to do.

 

[Ahamis]

I have been in one of the state hospitals in California for the last 6 months and as a whole I'm happy with my decision.

I am aware of some colleagues who needed green card sponsorship and because of their vulnerable situation they were exploited by employers.
I never felt like that in my current job. I get basically the same amount of work of my colleagues:
- I see 3-4 follow-ups per day.
- 1-2 admissions per week (sometimes none)
- No weekends. Plus 1 day-off per week
- No compete
- total case load 17 patients. Salary 293k.

 

[MedMan80]

I have been in one of the state hospitals in California for the last 6 months and as a whole I'm happy with my decision.

I am aware of some colleagues who needed green card sponsorship and because of their vulnerable situation they were exploited by employers.
I never felt like that in my current job. I get basically the same amount of work of my colleagues:
- I see 3-4 follow-ups per day.
- 1-2 admissions per week (sometimes none)
- No weekends. Plus 1 day-off per week
- No compete
- total case load 17 patients. Salary 293k.

Happy you were able to find something reasonable. It absolutely sounds like a sweet gig

 

[psyguru]

I would highly recommend the Oregon state hospital in salem... about 70 miles from Portland. Some of the psychiatrists car pool from Portland. Half the psychiatrists are forensic psychiatrists.

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