- Joined
- Mar 24, 2006
- Messages
- 926
- Reaction score
- 85
I joined an outpatient clinic which despite being a setting with many indigent/uninsured patients, has extremely limited access to case management and even nursing for that matter.
I also live in a vary populous state where revolving door psychiatric care is more common due funding issues. Take your guesses.
Getting people linked with ACT takes upwards of six months etc. So when I joined, the plan was for me to take on the "neutral" (mixed bag) caseload of someone who'd left. Instead, I have inherited that caseload plus those who still practice w/ me were allowed to transfer 30-50 of their cases to my load. You guessed it.
They're shipping over their sickest SMI cases that require polypharmacy to maintain stabilty (i.e. 3+ antipsychotics, 2+ mood stabilizer, no labs in nearly a decade)... and some of their sickest borderlines (which I prefer to former). This SMI population isn't a hugely prevalent in our practice, but it's who they're transferring over.
Aside from not having managed this population in the outpatient setting with bare bones nursing in nearly a decade, no one wants to be the new psychiatrist getting the toughest of everyone else's case load. When I brought it up to leadership, I was told, "We have some tough cases. Sometimes they get symptomatic. Sometimes they get hospitalized."
I thought the goal of tx in the outpatient setting was to prevent hospitalization and not play musical chairs with liability. Shifting pts from caseload to caseload when opportune isn't helping such patients (seriously, some havent had a BMI recorded in nearly a decade). The excuse is that, "they need to be seen sooner and you have time since your load is still small."
How have others joining a clinic as the newest member handled this? Some of these pts are the damned if you do, damned if you don't variety...Liability if you keep prescribing, and liability based on a hx of violence and SA's if you don't.
I also live in a vary populous state where revolving door psychiatric care is more common due funding issues. Take your guesses.
Getting people linked with ACT takes upwards of six months etc. So when I joined, the plan was for me to take on the "neutral" (mixed bag) caseload of someone who'd left. Instead, I have inherited that caseload plus those who still practice w/ me were allowed to transfer 30-50 of their cases to my load. You guessed it.
They're shipping over their sickest SMI cases that require polypharmacy to maintain stabilty (i.e. 3+ antipsychotics, 2+ mood stabilizer, no labs in nearly a decade)... and some of their sickest borderlines (which I prefer to former). This SMI population isn't a hugely prevalent in our practice, but it's who they're transferring over.
Aside from not having managed this population in the outpatient setting with bare bones nursing in nearly a decade, no one wants to be the new psychiatrist getting the toughest of everyone else's case load. When I brought it up to leadership, I was told, "We have some tough cases. Sometimes they get symptomatic. Sometimes they get hospitalized."
I thought the goal of tx in the outpatient setting was to prevent hospitalization and not play musical chairs with liability. Shifting pts from caseload to caseload when opportune isn't helping such patients (seriously, some havent had a BMI recorded in nearly a decade). The excuse is that, "they need to be seen sooner and you have time since your load is still small."
How have others joining a clinic as the newest member handled this? Some of these pts are the damned if you do, damned if you don't variety...Liability if you keep prescribing, and liability based on a hx of violence and SA's if you don't.