Thoughts on this job?

[jbomba]

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This is an IMD, patient load of 20. They are paying 16 hours per week for this load. Patients must be seen once a month. Many are there for months-years. You are responsible for your patients and will field after hour calls, however I'm told they are minimal. If that's not the case, obviously that would be a deal breaker.

So essentially looking at 16 hours per week at $260/hr for 20 patient encounters a month. I imagine you may end up seeing more if there are med changes, issues, etc. But even still, at 16 hours a week it seems like more than enough time to get done even if you were seeing them once a week each, which I doubt each patient will need.

Thoughts on this?

 

[ObsequiousAplomb]

Is this going to be in addition to your cobbled-together jobs or will it replace one of them?

Admittedly, I am not familiar with the abbreviation IMD. It sounds like some kind of long-term care based on your description? And you are being paid for 4 hours for each encounter. How in-depth do they need you to go?

 

[comp1]

IMD is a California thing, Institute for Mental Disorders. It's a long term locked psychiatric unit, no short term stays, everyone is on a conservatorship. They are typically paid for by Medicaid and it's patients who are highly non-responsive to treatment. As close as we get to asylums excepting the state mental hospitals, which are a sort of IMD. Generally patients...don't improve much, but also haven't yet been convicted of any crime. They might have been accused of one depending on the IMD (Murphy's conservatorship), but those conservatorships are rarely accepted since IMDs are private and will cherry pick. Theoretically you would be called less than on an acute unit, but only theoretically, highly depends on the culture of the IMD. This isn't quite adding up for me. How big is the IMD? Are you the only MD? Are you on 24/7 call for these patients always? You are right that typically these sort of patients are only seen monthly by a psychiatrist...so why are they paying you for 16 hours a week to see them? Is it 20 new patients every week or do you just carry a panel of 20 patients and other doctors carry a different panel? Are you reimbursed for court time and costs? There will be a lot with these patients, they are all involved with court in some way. I personally would find this job soul crushing since the improvement is really quite minimal and you are fairly explicitly warehousing people, but it would still beat outpatient...

 

[calvnandhobbs68]

Yeah I'm trying to figure out why they'd be willing to pay you $832 per patient per month if you only have to see them once a month.

 

[comp1]

Yeah I'm trying to figure out why they'd be willing to pay you $832 per patient per month if you only have to see them once a month.

It's either too good of a deal or way too bad of a deal. And since these are highly profitable corporations involved, I think the OP can assume the latter. I still like hearing about how these IMDs work, though. I only ever get to see the admission side of things, which is horrible as it is.

 

[jbomba]

Is this going to be in addition to your cobbled-together jobs or will it replace one of them?

Admittedly, I am not familiar with the abbreviation IMD. It sounds like some kind of long-term care based on your description? And you are being paid for 4 hours for each encounter. How in-depth do they need you to go?

This would take the place of a job. I have discharged patients to this facility in the past so I'm familiar with it, I read discharge summaries from here when they come back to my regular inpatient hospital from time to time. It doesn't seem particularly more in-depth than what I'm currently doing with the exception of some wonky med regimens as you might expect in this type of facility / state hospital setting.

 

[jbomba]

IMD is a California thing, Institute for Mental Disorders. It's a long term locked psychiatric unit, no short term stays, everyone is on a conservatorship. They are typically paid for by Medicaid and it's patients who are highly non-responsive to treatment. As close as we get to asylums excepting the state mental hospitals, which are a sort of IMD. Generally patients...don't improve much, but also haven't yet been convicted of any crime. They might have been accused of one depending on the IMD (Murphy's conservatorship), but those conservatorships are rarely accepted since IMDs are private and will cherry pick. Theoretically you would be called less than on an acute unit, but only theoretically, highly depends on the culture of the IMD. This isn't quite adding up for me. How big is the IMD? Are you the only MD? Are you on 24/7 call for these patients always? You are right that typically these sort of patients are only seen monthly by a psychiatrist...so why are they paying you for 16 hours a week to see them? Is it 20 new patients every week or do you just carry a panel of 20 patients and other doctors carry a different panel? Are you reimbursed for court time and costs? There will be a lot with these patients, they are all involved with court in some way. I personally would find this job soul crushing since the improvement is really quite minimal and you are fairly explicitly warehousing people, but it would still beat outpatient...

I suppose I'm attracted to this job because it, by definition, will involve some really tough cases. There's more creativity for thinking outside the box, using clozapine, doing what you can to get someone better. I realize a lot of these people will likely never get better though. I also like that I'm not under the gun to get people out before they're ready as I am in my current inpatient job with insurance demands, etc.

It's carrying a panel of 20. There are other docs with similar panels so I'm not the only one there.

 

[Meyer-Overton]

Would this interfere with any of your other cobbled jobs?

 

[lol.psych]

I’ve been at similar sounding places… “seeing patients” was a small fraction of the actual job. Mostly it was team meetings, team meetings to fill out specific forms together, team meetings with the patient, team meetings to debrief after other team meetings, team meetings with admin, team meetings with other teams… (and spending time with the nurses and staff so they like and trust you, and reading old (often unsearchable) record systems. But mostly team meetings)

Edit: also, where I worked, the “monthly” designation just meant how often the policies required a note of a certain format. Many of my “monthly” patients needed to actually be seen every week or every other week (sometimes a few times a week, if decompensated or in crisis). This might be different in the facility you’re talking about.

Another edit: I probably sound salty about all the meetings, but I really did love that job.

 

[jbomba]

Would this interfere with any of your other cobbled jobs?

Nope it wouldn't.

 

[comp1]

I’ve been at similar sounding places… “seeing patients” was a small fraction of the actual job. Mostly it was team meetings, team meetings to fill out specific forms together, team meetings with the patient, team meetings to debrief after other team meetings, team meetings with admin, team meetings with other teams… (and spending time with the nurses and staff so they like and trust you, and reading old (often unsearchable) record systems. But mostly team meetings)

Edit: also, where I worked, the “monthly” designation just meant how often the policies required a note of a certain format. Many of my “monthly” patients needed to actually be seen every week or every other week (sometimes a few times a week, if decompensated or in crisis). This might be different in the facility you’re talking about.

Another edit: I probably sound salty about all the meetings, but I really did love that job.

Concur, this should be a salaried job because it will be as described above.