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Lately, I'm getting more and more burnt out. I work in a rural area with lots of poverty and substance abuse. A lot of patients come to me extremely overmedicated, using drugs and alcohol and being prescribed things like Klonopin. After decades of being treated like this change is not happening. I work with a lot of bleeding hearts who don't hold patients accountable and just feel sorry for them. This is reflected in patients' attitudes towards treatment.

Motivated patients that I work with tend to recover fairly quickly and then no longer need me. This is satisfying but these patients are not coming through my door as often lately. Patients are mostly chronic, unmotivated and not interested in any lifestyle changes. I feel like what I do has no impact and I'm starting to feel bitter towards patients and co-workers.

I only work part time, the job has great benefits and I'm treated very well so it's hard to leave but also hard to say for reasons mentioned above.
 

WisNeuro

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Lately, I'm getting more and more burnt out. I work in a rural area with lots of poverty and substance abuse. A lot of patients come to me extremely overmedicated, using drugs and alcohol and being prescribed things like Klonopin. After decades of being treated like this change is not happening. I work with a lot of bleeding hearts who don't hold patients accountable and just feel sorry for them. This is reflected in patients' attitudes towards treatment.

Motivated patients that I work with tend to recover fairly quickly and then no longer need me. This is satisfying but these patients are not coming through my door as often lately. Patients are mostly chronic, unmotivated and not interested in any lifestyle changes. I feel like what I do has no impact and I'm starting to feel bitter towards patients and co-workers.

I only work part time, the job has great benefits and I'm treated very well so it's hard to leave but also hard to say for reasons mentioned above.

I'm not sure if you're going to get away from this in most institutional settings. Maybe PP or a group of like-minded providers is the way to go?
 
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Apr 1, 2014
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I'm not sure if you're going to get away from this in most institutional settings. Maybe PP or a group of like-minded providers is the way to go?
That's what makes me hesitant to leave that I will be facing the same problems elsewhere with worse administration.
 
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randomdoc1

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coming from someone who's built up a great panel of folks in PP, it IS doable. Just make sure you market well, and network a lot well with good therapists and you will start to form a niche. Word will get out that you are an ethical and smart psychiatrist who is effective at what they do. I've recently gotten someone off of SSDI, another person off their Medicaid since they landed a great job with benefits, and another person who was on disability for a long time but is now on social security due to their age, well...he got his first job in decades and looks like a whole different person. This is what psychiatry is about, restoring function and quality of life (it ain't no pill shoppe).
 

whopper

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I've left several jobs. I worked at a state forensic facility, 2 universities, a local community mental health center, private practice (2 of them), ran a PACT team, ER, expert witness (not just a pay-per-case, but also as a usual court officer with regular hours 2 days a week) and a jail.

All of the jobs had pros and cons I was willing to live with except 1 of the universities and the jail. Those latter two had issues that crossed my ethical lines plus they just flat out were bad jobs.

I needed to try a few before I felt that I had a good internal gauge of what was good or not as a job for me. When you graduate residency, just IMHO, you will not have a good internal gauge unless you try your hand at a few things.
 
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coming from someone who's built up a great panel of folks in PP, it IS doable. Just make sure you market well, and network a lot well with good therapists and you will start to form a niche. Word will get out that you are an ethical and smart psychiatrist who is effective at what they do. I've recently gotten someone off of SSDI, another person off their Medicaid since they landed a great job with benefits, and another person who was on disability for a long time but is now on social security due to their age, well...he got his first job in decades and looks like a whole different person. This is what psychiatry is about, restoring function and quality of life (it ain't no pill shoppe).
wow that sounds wonderful good for you
 
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whopper

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The problem I got in private-practice is you're more out on your own, less collegiality (e.g. I used to enjoy my lunches, dinners, coffee breaks with some of the top minds in psychiatry just having very in-depth discussion), not really part of a team (well your receptionist helps out but not part of a team of providers), out of academia keeping you out of the latest cutting edge stuff and people good enough to push that edge.

The pros are independence, accountability (it's on you and you don't have to deal with the ineptitude of incompetent team members), you don't have to deal with workplace politics as much (can still happen if you work in an office with other providers), usually more money, and the emotional satisfaction of being able to see patients long-term.

For me the biggest pro was not having to deal with other's incompetence, the biggest con was less exposure to some truly genius and hard working team-members.
 

randomdoc1

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The problem I got in private-practice is you're more out on your own, less collegiality (e.g. I used to enjoy my lunches, dinners, coffee breaks with some of the top minds in psychiatry just having very in-depth discussion), not really part of a team (well your receptionist helps out but not part of a team of providers), out of academia keeping you out of the latest cutting edge stuff and people good enough to push that edge.

The pros are independence, accountability (it's on you and you don't have to deal with the ineptitude of incompetent team members), you don't have to deal with workplace politics as much (can still happen if you work in an office with other providers), usually more money, and the emotional satisfaction of being able to see patients long-term.

For me the biggest pro was not having to deal with other's incompetence, the biggest con was less exposure to some truly genius and hard working team-members.
I agree. One way I have tried to help some of the cons is that my residency is still nice enough to let me come to their didactics and their psychopharm lectures are incredible. That and I will encourage other providers I am recruiting into my practice to attend grand rounds. I am thinking of incorporating 1-2 didactic hours into my practice, of course, I won't pressure people to come, but it will be encouraged. If able, I'll try to come up with a way to compensate people for their time for coming where we bring in talks ourselves or I find lectures we can watch briefly then discuss. That or even discuss just more challenging cases. I have a psychiatrist joining with me and we plan to be more involved with the local residency at some point, offering a rotation, etc.

Lookin' forward to buildin' up that dream ;).
 
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livin the dream...I give the finger to jobs that just suck and proud of it!

Why not join up with a county/state/federal based job for the bare minimum time per week for benefits and build up PP on the side?
That's what I've been thinking about, taking on minimal work at the VA to get benefits and working a private practice job on the side
 
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I don't want to see any of the chronic depression and anxiety patients shifted to me from primary care. Ninety percent of the time there's nothing that I can do to help them, they don't want to help themselves and it's not related to any underlying psychiatric illness. I dread seeing them on my schedule.
 

randomdoc1

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I don't want to see any of the chronic depression and anxiety patients shifted to me from primary care. Ninety percent of the time there's nothing that I can do to help them, they don't want to help themselves and it's not related to any underlying psychiatric illness. I dread seeing them on my schedule.

Especially when I still see I good chunk of primary care going to Xanax as first line treatment for anxiety. Then after further history gathering turns out to be PTSD...then pt doesn't want to hear what you have to say or pursue evidence based treatment. Yup...that's when we say, well, I don't think this will work, but you're welcome to come back when you're ready...

That's what I've been thinking about, taking on minimal work at the VA to get benefits and working a private practice job on the side
That's what I did. One thing I learned though, VA does not like to adjust the number of hours you work a week. They often say, either keep your schedule (in VA terms, your "tour") or quit. I was two days a week but when I got busier I wanted to go to one day a week, which you can still qualify for benefits. But I ended up having to quit, which I'm okay with at this point as I'm busy enough now anyways. I just worked into evenings to pack up my panel then quit the VA.
 
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Especially when I still see I good chunk of primary care going to Xanax as first line treatment for anxiety. Then after further history gathering turns out to be PTSD...then pt doesn't want to hear what you have to say or pursue evidence based treatment. Yup...that's when we say, well, I don't think this will work, but you're welcome to come back when you're ready...

Yeah I have no problem with confrontation regarding controlled substances but it's just no fun to do all day
 

alina_s

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livin the dream...I give the finger to jobs that just suck and proud of it!

randomdoc1 and Whopper- any regrets about leaving jobs? I had one job that fell apart completely within a year of my hire- the company brought me on and then closed the clinic- and another CMHC job that was just scary. I was glad to move on from both of those, but eight years out of residency, I've averaged 2 years per job and I'm starting to wonder how this looks to new potential employers. I'm trying to do at least some community psychiatry but haven't found the strongest organizations to work for, which seems to be a general symptom of our health system.
 

whopper

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Some regrets.

One of my mentors told some top guys in the field that I would've been on track to possibly be a heavyweight and used to brag about me to the top guys at U of Cincinnati. When I left he wrote a great letter of recommendation to my next boss who is a brand-name in the field telling the guy that he had a duty to cultivate me because I was too good and one of his best students in years. I knew when I left academia and told that guy he would've been disappointed. Another one of my mentors, my former PD, died of cancer about a year ago and I knew also felt he wanted me to continue in academia. The fellowship asked me to take over as the new PD.

I didn't want to leave Cincinnati, I left, hated the next job, started private practice, and the private practice had just attained that sweet spot where it was doing incredibly well financially when I was offered the new PD position. My wife also loves her current job, and my kids now are at ages where moving again would've caused some psychological effects. While I miss academia, the extra time with my kids really is a bonus that academia can't fill. Had I taken the job as the new PD I would've, like a samurai, devoted myself to working till I dropped even though it wouldn't rake in more cash out of devotion to my old PD and the pure respect and love of the field, but I know from my current perspective it would've seriously hurt my family life.

So yes I do miss academia, but I do consider my family more important than working till I drop. Also, I'm now in my mid 40s and doing things like working 80 hrs a week has some repercussions. I was pre-diabetic despite that I work out 3-4 days a week and I'm not overweight. I figure it was cortisol-induced from working long hours. My last job (not at U of Cincinnati, the next place) really ticked me off so much that I think it was having some bad effects on my health.

It reminded me of a guy I met while in Cincinnati who wanted me to take over his private practice. At that point in time I was planning on staying in academia. The guy was telling me, very nicely and respectfully, that I would never make as much money vs private practice, after decades of doing it I might regret it cause of the lost time with the family, and that the way life is it's not like you're on a road from 1 end to another but more like sailing a ship, you had a plan, but storm comes and you have to adjust and sometimes it brings you on a new path that could've been better.

The place I work now is a private practice made up of psychiatrists who worked years in academia, or have extra training and were only allowed to work here if they were showed to be of high quality. I only got in here based on a word-of-mouth recommendation from a Ph.D. psychologist who knew the psychiatrists. It's known as the place doctors including psychiatrists, themselves want to go to if they got a mental health problem. So my current private practice does offer me some self-respect I wouldn't have at plenty of other places and does somewhat fill the gap. I'm also not just another doctor i.e. a cog in the machine that many doctors are at so many places.
 

whopper

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Another piece of advice. Always do a good job. Aside that you have an ethical duty to always provide good care, doing so always opened several doors for me. Plenty of places I left begged me to stay, tried to keep him in their good graces, and I could use those as bargaining chips if I worked elsewhere. E.g. I'm working at a place and when they know the other place wants to hire me, the employers know they better give me good pay cause I could leave them for someone else.
 

randomdoc1

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randomdoc1 and Whopper- any regrets about leaving jobs? I had one job that fell apart completely within a year of my hire- the company brought me on and then closed the clinic- and another CMHC job that was just scary. I was glad to move on from both of those, but eight years out of residency, I've averaged 2 years per job and I'm starting to wonder how this looks to new potential employers. I'm trying to do at least some community psychiatry but haven't found the strongest organizations to work for, which seems to be a general symptom of our health system.
So far no regrets, but I'll keep folks posted about how things progress along. I figure if things just totally blow up in my face, the deepest rock bottom I can hit is being a general contractor for another PP. Which isn't terrible. But I'm pretty sure I can sustain my own PP and the freedom is so wonderful, not to mention far higher earning potential. I plan to try to make the place somewhere nice to work where good folks are recruited and retained and hopefully that will grant me more family time as well.
 

alina_s

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Another piece of advice. Always do a good job. Aside that you have an ethical duty to always provide good care, doing so always opened several doors for me. Plenty of places I left begged me to stay, tried to keep him in their good graces, and I could use those as bargaining chips if I worked elsewhere. E.g. I'm working at a place and when they know the other place wants to hire me, the employers know they better give me good pay cause I could leave them for someone else.
Thanks. I find it easier to do good clinical work than to engage in the political game. So frustrated with our mental health system, but I think I see private practice in my future.
 

alina_s

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So far no regrets, but I'll keep folks posted about how things progress along. I figure if things just totally blow up in my face, the deepest rock bottom I can hit is being a general contractor for another PP. Which isn't terrible. But I'm pretty sure I can sustain my own PP and the freedom is so wonderful, not to mention far higher earning potential. I plan to try to make the place somewhere nice to work where good folks are recruited and retained and hopefully that will grant me more family time as well.
Thanks- I’ll PM you.
 

Crayola227

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It's known as the place doctors including psychiatrists, themselves want to go to if they got a mental health problem. So my current private practice does offer me some self-respect I wouldn't have at plenty of other places and does somewhat fill the gap. I'm also not just another doctor i.e. a cog in the machine that many doctors are at so many places.

Really worthy place for psychiatrists to be. All lives matter, but every physician life we save has so much potential to ripple forward. Keeping one another well, and especially dealing with the challenges to mental health and stigma that we face, I think is one of the most noble things we can do. It's such a relief as a doc to find another doc that can help you navigate all that. Life saving.
 

Nasrudin

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Some regrets.

One of my mentors told some top guys in the field that I would've been on track to possibly be a heavyweight and used to brag about me to the top guys at U of Cincinnati. When I left he wrote a great letter of recommendation to my next boss who is a brand-name in the field telling the guy that he had a duty to cultivate me because I was too good and one of his best students in years. I knew when I left academia and told that guy he would've been disappointed. Another one of my mentors, my former PD, died of cancer about a year ago and I knew also felt he wanted me to continue in academia. The fellowship asked me to take over as the new PD.

I don't know what particular immunity I have towards this the type of sappy ideas of greatness that exists in the hallowed halls of shrinkdom, but I guess I just am. It has always had zero pull for me.

I think the greats of psychiatry are little men. Motivated to mind conquer. And position themselves in a particular kind of monastic hierarchy. Don't get me wrong, there's some important ideas that came from them, it's just not alluring as an occupation, or as a reward.

Every time someone waxes poetic about it. I just think.... why all the nut riding? Why not enjoy the swing of your own junk, making your own way.
 
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