Update...I'm doing private practice

[whopper]

Haven't been on this forum for about 2 years. I figure a lot of the gang that knew me while I was on may have stopped coming as do many after graduating or leaving their academic position.

As I've always seen, working in one area-the psychiatric viewpoints, approaches, and types of cases highly differs from other types. IMHO psychiatrists get locked up in just one area and think all psychiatry works the way it does in their vantage. I've worked in a forensic unit, the ER, outpatient office in an inner city treating Medicaid, private inpatient facility (usually wealthy patients), university hospital, private outpatient office, IOP, consult, and county jail.

I don't want to talk about this in detail but I wasn't planning on getting out of academia but felt I had to do so because where I last worked it wasn't living up to my expectations.

Private practice is working well. It's a hell of a lot less stress, I make a lot more money but I miss teaching and being part of the cutting edge.

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[TexasPhysician]

Congrats and welcome to the good life!

 

[wannabie]

Good luck!

 

[whopper]

I still am very proud and glad I did work in academia and had I stayed in Cincinnati I would've stayed in academia. I see it this way. You do it cause the money and/or cause you love the work. At U of Cincinnati the love aspect were there big time and the money was better than most academia cause I got awesome private cases. The more recent job-less money, hardly any love.

Private practice? Love it-but liked U of Cincinnati more but I'm not in that area anymore so that can't be helped. The money is great.

I've said this before and I still believe it-I didn't graduate knowing enough from my residency training despite that my performance there was very good. I still needed to learn. I recommend all residents to strongly consider fellowship and/or something that'll keep them learning at a strong pace such as working in academia for at least 2-4 years before considering private practice. Yes learning can be life-long and there's CMEs but in an academic environment you're going to learn every day and from top people (unless the academic place isn't good).

I also am working in the private practice in town with the most amount of respect. Everyone in my practice are former professors, did fellowship and are on the cutting edge. That made leaving academia a bit easier.

 

[Daedra22]

It's good to hear from you, as one of the folks who read a lot of your posts over the years. It's always interesting to hear how careers evolve over time... the flexibility is one of the things I appreciate about this field.

 

[Doc1401]

I still am very proud and glad I did work in academia and had I stayed in Cincinnati I would've stayed in academia. I see it this way. You do it cause the money and/or cause you love the work. At U of Cincinnati the love aspect were there big time and the money was better than most academia cause I got awesome private cases. The more recent job-less money, hardly any love.

Private practice? Love it-but liked U of Cincinnati more but I'm not in that area anymore so that can't be helped. The money is great.

I've said this before and I still believe it-I didn't graduate knowing enough from my residency training despite that my performance there was very good. I still needed to learn. I recommend all residents to strongly consider fellowship and/or something that'll keep them learning at a strong pace such as working in academia for at least 2-4 years before considering private practice. Yes learning can be life-long and there's CMEs but in an academic environment you're going to learn every day and from top people (unless the academic place isn't good).

I also am working in the private practice in town with the most amount of respect. Everyone in my practice are former professors, did fellowship and are on the cutting edge. That made leaving academia a bit easier.

Did you ever consider working in a correctional facility?

 

[OldPsychDoc]

Welcome back--still hanging out.
Surely there are some med students or residents in your local area that could benefit from your store of wisdom?

 

[whopper]

U of Cincinnati still is a great place and I'd go back there in a second if my wife weren't so happy with her current work situation but it has seen better days. Three top people are no longer there-Henry Nasrallah, Steve Strachowski (by the way vote for him for President of the APA-he's a great psychiatrist, a great guy, and a great leader, used to head the dept at U of Cincinnati), and Doug Mossman. It still has powerhouse researchers such as Paul Keck and Mike Keys and still offers very powerful diverse clinical settings-adult, ER, private inpatient, outpatient, forensic, geriatric, addiction, and several fellowships.

Mossman was my program director and unfortunately recently died of pancreatic cancer. He was in the list of top 100 physicians in the country for his introduction of Bayesian Statistics into the field of predicting human behavior in regards to violence, but that cracked the door for it to be used in several aspects of medicine not yet used before.

Again, still a great program overall but kind of like a great football team that's still great losing some key players.

 

[michaelrack]

what happened to Dr. Nasrallah, did he retire? I knew him briefly when he was at the Univ of MS Medical Center in Jackson Mississippi.

 

[PistolPete]

Congrats on your decision, I’m glad PP is working out so well!

 

[splik]

what happened to Dr. Nasrallah, did he retire? I knew him briefly when he was at the Univ of MS Medical Center in Jackson Mississippi.

He's chair of SLU now

 

[birchswing]

I miss teaching and being part of the cutting edge.

I know answering this would be long but maybe you could pick one or two things: What did you see that was on the cutting edge? And is it different from what you can do in private practice?

 

[notdeadyet]

Good to see you, whopper. Many old timers still drop in now and again. Glad to see you surface.

RIP to Doug Mossman. He was always a welcome face at AAPL.

Have you considered volunteer faculty roles? Residents would welcome your experience and teaching efforts, but without your enduring the stress and politics of academic life.

 

[Nasrudin]

Good to hear from you. Thanks for the update. And ideas about career progress and development. I'm with the camp that hopes you'll continue teaching in some way. But I'm happy you like PP and are doing well. Hope you continue to share here.

 

[Alemo]

How is U Cincinnati btw? I'm debating between it and U Wisconsin-Madison as the top choice on my rank list.

Didn’t you apply last year?

 

[whopper]

Cutting Edge?
At U of Cincinnati I was regularly exposed to top people in the field either through the department or visiting. E.g. Nasrallah is friends with several of the top minds in the field, they'd come over, he'd even invite me to his office and we'd have a chat....which was awesome though at times I'd feed like I was a newbie/poseur. My old fellowship director was a Guttmacher award winner, the top honor in the field, and was always working on new things to push the field forwards. I remember a few times walking in his office and he'd be dissecting an article for publication in the Green Journal (he was an editor). Strachowski, Keck, Micheal Keyes-I was on a first name basis with them. While it wasn't usual I sometimes would hang out with them for lunch.

On occasion one of the psychiatrists would have a case that was just out of nowhere in terms of it's presentation. E.g. we had a patient who violently struck himself in the face involuntarily about once every few minutes. The clinical doctors had a very difficult time figuring out what to do to treat him. So then a meeting occurred with these guys, literally 5 doctors ranked in the top 100 doctors in the country in the same table going over this case and all in the same department.

So that's what I meant by cutting edge. Also the nursing staff, the facilities were top-notch and the ability to possibly have a hand in so many areas was there. E.g. if I thought up a research idea the ability to make it come a reality was completely there it was just a matter for someone to want to do the work.

 

[hamstergang]

I was regularly exposed to top people in the field
...literally 5 doctors ranked in the top 100 doctors in the country

Do you actually think such a ranking means anything? What do you mean by a "top" person in psychiatry, and how is that measured?

 

[randomdoc1]

Do you actually think such a ranking means anything? What do you mean by a "top" person in psychiatry, and how is that measured?

patient's opinions of you, which is directly proportional to how much xanax and Adderall you give. (just kidding). I don't know that much about rankings either but I know the patient "reviews" should be taken with a grain of salt.

 

[birchswing]

patient's opinions of you, which is directly proportional to how much xanax and Adderall you give. (just kidding). I don't know that much about rankings either but I know the patient "reviews" should be taken with a grain of salt.

I was going to give a just-kidding response also that the ranking is based on how much a doctor has taken in payments from pharma. I don't mean it to be adversarial which is partly why I didn't post it, but after you did it occurred to me it's interesting where the mind goes doctor vs patient. You see pharma-drug seeking patients and I see pharma-money seeking doctors (as initial mental images when posed with this question).

 

[SeniorWrangler]

It's nice to see you back.
Was it difficult to make the switch from academic psych to PP in terms of the pace and coding and so on?

 

[FlowRate]

Do you actually think such a ranking means anything? What do you mean by a "top" person in psychiatry, and how is that measured?

Have you ever met people who earned their big names? The chair of medicine around here is a good example. Humble, caring, eidetic memory, AND smart. You can learn so much from these people in a sitting. I think that's what whopper was saying.

I don't think whopper was actually referring to those "top" lists of doctors.

 

[splik]

So then a meeting occurred with these guys, literally 5 doctors ranked in the top 100 doctors in the country in the same table going over this case and all in the same department.

you do realize they are not actually the "top 100" doctors in the country (though you keep saying this). there are thousands of "top 100 doctors" it's all a bit of scam. which is not to say that they are not well reputed, mossman was a mensch but little known outside of the forensics field. he was one of the rare for forensic psychiatrists who was actually nice. nasrallah is a disgrace and i never much cared for strachowski (i'd be very surprised if he didn't come dead last in the APA president race), but keck i'll give you. was one of the most highly cited psychiatrists in the world for his bipolar research along with mcelroy.

 

[hamstergang]

I don't think whopper was actually referring to those "top" lists of doctors.

Then you've not seen enough of Whopper's old posts.

 

[Merely]

you do realize they are not actually the "top 100" doctors in the country (though you keep saying this). there are thousands of "top 100 doctors" it's all a bit of scam. which is not to say that they are not well reputed, mossman was a mensch but little known outside of the forensics field. he was one of the rare for forensic psychiatrists who was actually nice. nasrallah is a disgrace and i never much cared for strachowski (i'd be very surprised if he didn't come dead last in the APA president race), but keck i'll give you. was one of the most highly cited psychiatrists in the world for his bipolar research along with mcelroy.

Why do you consider nasrallah a disgrace?

 

[splik]

Why do you consider nasrallah a disgrace?

well i dont want to be unfair, but nasarallah has accepted a huge amount of money from pharmaceutical companies. he is one of several other leading figures (e.g. schatzberg, biederman, nemeroff) who did this and brought our profession into disrepute. not only did he take blood money from drug companies he has also proposed that we should use atypicals over typicals because typicals like haldol are more neurotoxic. well the evidence from the pharmaceutical companies (eli lilly) have found that atypical antipsychotics are just as toxic to the brain as the typical antipsychotics. given how much money he received from the makers of atypical antipsychotics, one would be forgiven with making a correlation with his dubious findings.

 

[whopper]

Mossman-introduced Bayesian statistics into psychiatry (later spilled into other medicine). Keck seems we all agree on. Strachowski's authored several research articles, is brillliant, ran a highly respected department and ran it well.

Nasrallah-hasn't had the dishonor you mentioned Splik. Yes he does get money from pharm companies but he wasn't in the same category as Nemeroff who was found openly omitting/lying about it. As long as I've known Nasrallah, he's never ever pushed a med based on the money factor---except the affordability for the patient and the cost to society. Further, when CATIE first came out he even, for years, brought up that perhaps we should be prescribing more typical antipsychotics. He changed his opinion later on when the neurotoxicity was found with typicals.

Splik-this is where I disagree with you but you may have found some data I'm not aware of (so please inform me if I'm not informed enough). The basis of the theory that atypicals are better than typicals is the blockage of the 5HT2A receptor which allegedly is anti-inflammatory and creates neuroprotection. I am aware that there's data showing olanzapine was associated with shrinkage of brains in monkeys (is that the data you mentioned?).

 

[erg923]

Mossman-introduced Bayesian statistics into psychiatry (later spilled into other medicine).

To be fair, Paul Meehl tried to this about 40 years prior....

 

[whopper]

True.

 

[heartsink]

Great to see you on the forums again whopper. I've followed a lot of what you posted over the years and its been very enlightening.

You mentioned PP is "a lot" less stressful. What makes it particularly less stressful compared to your past experiences?

 

[Doc1401]

Haven't been on this forum for about 2 years. I figure a lot of the gang that knew me while I was on may have stopped coming as do many after graduating or leaving their academic position.

As I've always seen, working in one area-the psychiatric viewpoints, approaches, and types of cases highly differs from other types. IMHO psychiatrists get locked up in just one area and think all psychiatry works the way it does in their vantage. I've worked in a forensic unit, the ER, outpatient office in an inner city treating Medicaid, private inpatient facility (usually wealthy patients), university hospital, private outpatient office, IOP, consult, and county jail.

I don't want to talk about this in detail but I wasn't planning on getting out of academia but felt I had to do so because where I last worked it wasn't living up to my expectations.

Private practice is working well. It's a hell of a lot less stress, I make a lot more money but I miss teaching and being part of the cutting edge.

Whopper, have you ever thought of working in the prison system?

 

[TexasPhysician]

Us private practice psych docs should consider a thread on the Attending forum that slowly looks into ancillary income streams like TMS, labs, etc. Our small group is growing!

 

[MacDonaldTriad]

Do you actually think such a ranking means anything? What do you mean by a "top" person in psychiatry, and how is that measured?

A few hundred bucks will get you on those top 100 doctors lists. Personally, I'm waiting for someone to ask for thousands. I want to get on a really good list.

My favorite is in the united Airlines Magazine. I like the best hair transplant guy with absolutely no hair. I guess you need some hair to transplant hair. I also guess that if you are the best, someone worse would be doing it to you.

 

[WisNeuro]

My favorite is in the united Airlines Magazine. I like the best hair transplant guy with absolutely no hair. I guess you need some hair to transplant hair. I also guess that if you are the best, someone worse would be doing it to you.

In a town with only 2 barbers, always choose the one with the bad haircut.

 

[michaelrack]

A few hundred bucks will get you on those top 100 doctors lists. Personally, I'm waiting for someone to ask for thousands. I want to get on a really good list.

My favorite is in the united Airlines Magazine. I like the best hair transplant guy with absolutely no hair. I guess you need some hair to transplant hair. I also guess that if you are the best, someone worse would be doing it to you.

you can't transplant what you don't have

 

[OldPsychDoc]

you can't transplant what you don't have

 

[WisNeuro]

#FAKENEWS #DEEPSTATE #COMBOVERGATE

 

[Ceke2002]

Haven't been on this forum for about 2 years. I figure a lot of the gang that knew me while I was on may have stopped coming as do many after graduating or leaving their academic position.

As I've always seen, working in one area-the psychiatric viewpoints, approaches, and types of cases highly differs from other types. IMHO psychiatrists get locked up in just one area and think all psychiatry works the way it does in their vantage. I've worked in a forensic unit, the ER, outpatient office in an inner city treating Medicaid, private inpatient facility (usually wealthy patients), university hospital, private outpatient office, IOP, consult, and county jail.

I don't want to talk about this in detail but I wasn't planning on getting out of academia but felt I had to do so because where I last worked it wasn't living up to my expectations.

Private practice is working well. It's a hell of a lot less stress, I make a lot more money but I miss teaching and being part of the cutting edge.

Great, so now I can add you to the list when I finally save up enough money to do my world therapy tour. J/k, congrats and all the best with the change of direction, it's good to hear from you again.