I'm back after a long time away. Had my baby in 2023 and lots of flexibility to nurse my baby which is one of the reasons I went PP. Life has changed so much and I'm getting a divorce too lol. Everyone already said what was on my mind. I'm now taking a bigger role in teaching residents. I've hit the goal of feeling like I have a good level of expertise attracting and retaining patients and wanted to try other things for variety. So now have my own practice of prescribers and psychotherapists. It's been doing reasonably well but is a full time job just managing it. And no one is giving you a stipend to do things like
-negotiate with insurance
-hire and fire people (and this happens a lot, the work force predominantly is so unmotivated--and people try to do things behind your back)
-keeping up with regulations
-I do my own billing and collections because most billing services epically suck
I've reached a point where I am satisfied with my practice and wanted to try other endeavors yet again. So teaching is where I turned, to the local residency program that I actually graduated from. There is an elective here now and I'm now in the regular didactics on teaching residents PP! It's morally refreshing. I can't emphasize enough what a nightmare HR is on a regular basis. Most people working here are fine, but there's always a train wreck situation you need to clean up. It's like wack a mole. From therapists committing insurance fraud in your business, to psychiatrists (committing medical negligence and trying to be 100% work from home but intentionally not keeping up on AIMs, high acuity cases, labs, etc. -- one such provider was bold enough to repeatedly do stuff like this, a naive young grad who thought psychiatry was so hot meaning they could do anything since how dare a family owned practice assert their boundaries?), catty front desk staff that trigger bad google reviews, etc etc. So many employees you will see could care less about the wellbeing of your practice and are only here to try to mine your practice hollow to collapse. Your employees won't understand how many hours of uncompensated back office work there is to keep a practice in good standing, beating out the competition and the marketing alone (for SEO, so patients even know you exist) is a full time job that I pay a crew of people over 30k a year to do. I digress. End of the day, I prefer this over the chaotic broken healthcare systems most work settings are entrenched in. At least you can influence how work flows, who is in the space, and I have the most work life balance here than any other option available. So what I'm saying is we all need to find the work setting that works for our personality type.
@Sushirolls said it well. And hello to
@splik @hamstergang @Stagg737 !
@TexasPhysician @PsyDr I missed you guys and actually being on this forum helped me so much. I started here fresh after graduation and learned so much good info here.
What now is keeping me going most is the teaching. Knowing I am helping society create hopefully better providers for themselves and their quality of life and to serve the community. It's so awesome to see their eyes get wide and venture out having better insight on how employers think, how to negotiate, where money comes from, how to optimize their pay which starts with being a good and well sought out provider in the first place. I do find in the majority of medical education, young physicians are completely clueless about PP. Actually, in all specialties and just as clueless about career advancement and how to negotiate this corporate, capitalist jungle. Especially young psychiatrists, I hate to say this but many are under the impression that after graduation we are set. We are in fact not. It's only just started. Just another chapter. The competition is fierce for the better positions. And every young psychiatrist that joined my practice behaved as if there were endless referrals (and therefore you don't have to care about your attitude or reputation) and like they were celebrities (because openings for med management were assumed to be so scarce anyways, patients would have to return to see you). But they also learned overtime that any PCP, NP, even pharmacist can dispense a script. And if you don't want to be replaced, you need to offer something that makes you harder to replace. I'm hoping (for those willing to accept the reality of the world) that being involved in the residency will better equip physicians to know what is out there, realistic compensation numbers, how to optimize their professional reputation and advance effectively to meet their goals. I hate to say this but I've met my share of young grads who were so pompous, entitled, asked for ridiculous compensation numbers at 100% work from home no less, treated nice patients at my office like they were replaceable transactions, worsened the clinic reputation, worsened clinic atmosphere with their attitudes -- all from overconfidence that they must be in so much demand that an employer would not dare call them out or *gasp* terminate the working relationship.
One of the chief residents is in an elective at my office and he's seeing a similar pattern in the more junior residents. He said the resident clinic, residents are trying to work remotely more and more. And they are opting to do remote sessions even though patients were not satisfied with this. The outcome? Less patient traffic. Actually, so bad now that the resident clinic is being evicted because they cannot pay the rent. And residents are having a hard time filling their case logs because there just aren't enough referrals coming through except the occasional benzo or stim seeker which you can only learn so much from. My colleague has residents at the VA and people are coming in underdressed and trying to go home at early times. Which, we understand the desire for work-life balance, but people need to learn to be tactful about broaching these areas. There's an effective way to approach these situations--and that certainly was not it.
We are in a very good position in society, don't get me wrong. We never have to worry about job security and will be paid far better than most Americans. But most of the psychiatry jobs in my opinion suck (if you break it down by pay per hour and all the training we had to do with loans and all). Moral of the story, letters behind your name don't grant us a lifetime of free lunch. Or any free lunch. So if the provider is ok with a crappy job, that is their life. But it is certainly possible to be a big enough pain (even as a physician) that people do not want to work with said person and good luck finding new employment because the first place a prospective employer will contact is the last employer. Physicians would benefit learning about navigating employment dynamics. As a fellow psychiatrist and physician, on graduation, we are not on the top of the food chain. But it is definitely within our reach if we are willing to put in what is necessary. We can make our dreams come true, but we gotta use the tools and our smarts. It's like graduating from a world class culinary school. The dish won't prepare itself. If someone graduated from said culinary school but opened a restaurant with crummy food, it doesn't matter, no one is coming back. Likewise, things won't be handed on graduation.
So...my longwinded digression is about, I want to help youngsters not make mistakes I have seen. Some are willing to get ahead of the curve and learn, some will want to cling on to the fantasy and will need to learn the hard way. But the faster we accept facts, deal with the reality of things, the faster we advance. The physicians I have seen the most unhappy and paid the least are precisely the ones who stayed rigid in their beliefs (which I find odd since we do therapy) and stay in denial. They resist the cognitive restructuring and being adaptable. But the most adaptable ones win!
Ok, hopefully no one hates me for this post. But it comes from a place of love. There is nothing more I wish for than to see us succeed collectively. We've worked so hard. But we need to be willing to not be in our own way and face the situation of the market for what it is. I do fantasize about helping the local residency offer something unique in the program that will perhaps increase recognition of the program--as more grads hopefully accomplish some super awesome things post graduation and move along in their careers more seamlessly. The program director expressed excitement and said I brought up an area of a knowledge gap--an area physicians could really find useful. I'm thinking of offering moonlighting opportunities here too, once I figure out how it fits with insurance billing, statutes, regulations and more. So, moonlighting here, elective, as well as didactics is where I'm headed.
