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I wish more physicians would realize there are in fact many options. Working together to improve conditions, compensation and morale also serves to benefit the patients and hospital system.
Weekend Call Schedules
Started by NJWxMan
I wish more physicians would realize there are in fact many options. Working together to improve conditions, compensation and morale also serves to benefit the patients and hospital system.
Agreed. There are always options.....unless you are military.
Yes, but there are downsides to every job, and there are externalities involved. I like inpatient work, enjoy inpatient work, and want to continue to do inpatient work. The downside is that weekend call is part of that responsibility. Sure, I'd rather not do it, but it's a trade off that I'm willing to take.
No job is perfect. It's called a job, and not fun, for a reason. I'm happy with the arrangement and am fine with the downsides. Don't worry, you don't need to be a martyr for me.
It sounds like you like your job and that's great. It is true that all jobs have pros and cons.
I would like to add that there are plenty of inpatient jobs that do not require weekend call. They either have optional call for $ or cover those shifts with locums. I interviewed at several such jobs.
Are these jobs easily found - locums, cold calling? And by easily found, I mean if one were open to traveling (assuming expenses paid), could you fill 15-20 weekends a year like this?
No. They're not. and many times, it's geography based. Frustrating that so many supposedly psychologically minded folks in this thread make it seem like getting up and moving to another locale is an option for everyone or that taking a stand against admin will make things better. Some are failing to accept that in certain regions, its next man up: don't want the low pay? We'll find someone tomorrow (maybe a locum) who will take your job.
So as long as one is willing to take weekend jobs that come with travel sounds more doable...
What year are you in residency? Somewhere around the start of PGY 3 year, you'll be inundated with recruiters for jobs and locums offers. Alternatively, you can find locums companies by searching the Internet for your area (example: NYC, psychiatry locums). Alternatively still, you can call inpatient psych hospitals/EDs in your area and ask if they're looking for psych locums. The for-profit hospitals pay more, but then you have to get over the slimey feeling of working with a for-profit hospital and all the ickiness that comes with that.
What area of the country are you in?
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That isn't necessarily true. What region of the country are you in?
How is moving ever not an option (military exempt)? Everyone makes sacrifices eventually for someone else, but it is a choice we accept.
I’ve many times talked to admin and received raises. I’ve also walked out to not return. Even living in the same place, I’ve taken a job requiring myself living in a hotel for a couple days for more money. Telepsych jobs are readily found at $160/hr anywhere in the USA.
Locum companies retain revenue. If a hospital pays $130/hr to a locum psychiatrist, they are actually paying around $170+/hr. A locum psychiatrist costing a company $130/hr is retaining <$100/hr which is hard to believe.
This. I did locums once. Never again because the locum company gets a cut. I now find my own moonlighting through contacts. Another way to do this is to get in touch with physician recruiters and ask if they're looking for moonlighters.
There are people who make a living off working with a locum company and traveling the country to provide coverage - two weeks here, two weeks there. They make a fortune. The weekend moonlighting/locum money is generally good, but the money you make providing vacation coverage is insane -- spend the 10 days around Christmas and New Year's at a facility in Wyoming or North Dakota? You can make 30K. And they usually pay for housing.
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That is so true. I now work in one place where I'm covering the Ed, consults, and inpatient (40 beds) where in getting paid 1600 per day. New consults are like 100 bucks. Hours of when are 9 to 5 pm.... This is in NJ
you’re rounding on 40 pt per day?
Dear God. This should be like $4000 per day at least.
I mean I hope you’re not actually rounding on all 40 patients but getting paid 1600 for a 9-5 day is 200 bucks an hour....so not 130. But yeah rounding on 40 patients a day is insane.
Northeast inpatient: low hourly wage, high patient volume.
Northeast outpatient: high hourly wage, low patient volume.
I know what I'd choose.
I learned this lesson a few months into intern year watching my internal med attendings and senior residents show up for a couple hours and disappear.
I have been part of a team of physicians who successfully supported each other and took a stand against admin for better conditions. There is power in unity but that takes a willingness to be transparent with your colleagues and balls.
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On average 30 pts not including admissions.
you’re rounding on 30 patients per day plus new admissions for 1600 dollars? LOL
You can laugh all you want but that's what offered in this area.
I can't help but think that if no one accepted these types of offerings employers would be forced to pay a decent rate.
Its not even funny I shouldn’t be laughing..it’s abuse..
Someone has to make the shareholder's money!
As long as he is happy I don`t see any issue.
I personally would not accept any gig less than 2k. over the weekend but that`s me.
The issue for me is that as long as people are willing to pick up $#!+ offerings the hospitals have no impetus to offer appropriate compensation.
Midwest; the resident's get about $4500 (in that amount is the stipend for gas/airfare/hotel). For the most part the gigs are Follow Ups ONLY and roughly 50 need to be seen between Saturday & Sunday
Could be a supply/demand thing but those number sound awful unless it is for a midlevel
Could be a supply/demand thing but those number sound awful unless it is for a midlevel
Is it 1600 per day or for the whole weekend?
I just saw a weekend job -- 14 patients a day, no admissions (admits done by NP to be staffed by psychiatrist on Monday), can leave when all 14 pts are seen, but must be available by pager 8 - 5 Saturday and Sunday. It pays $2400 for the weekend.
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Which seems way more reasonable. 14 inpatients none of which you’re discharging and no whole new admits means you’re out of there by early afternoon. Able to go home, eat dinner with your family, take random calls until 5PM (which there shouldn’t be too many of if you did things right that morning). Probably only physically on the unit for 5-6 hours if that. I’d do that for 1200 bucks a day.
Airfare and hotel??? They fly people in for a weekend of that??
Per day 9 to 5pm....no pages or calls after 5 pm. Not required to do both days. Most places require pager call over night and to come in for restraints after hours.
14 inpatient follow-ups? None of whom are new patients or discharges?
I could start at 7am and be out of the hospital by 9am.
Ok let’s calm down there a bit lol
PM me where you work so I can avoid your hospital. In all sincerity, people fail to realize that patients on the psych unit often get real bills, and some are very expensive. I saw a new outpt a few years ago who was in tears because she had to pay $250 out of pocket (that she could not afford) for professional services during inpt. She claimed that the inpt psychiatrist saw her for 10 min.
14 pts x 15 min/pt (see pt and document) = 210 min = 3.5 hrs
It seems like people forget that our job isn’t just to generate documentation for billing but to take care of patients. I am all for efficiency but do not think I could provide good care to patients if I were averaging 10 min/patient in most settings. YMMV
No one can lol..but it’s very difficult to stay in the hospital for 15 hours to see 30 patients so people cut corners..solution - don’t agree to see 30 patients in a day
And depending on how cumbersome the EMR it can take me 5+ minutes to review labs, vitals and the previous Doc's note.
Your job as the covering psychiatrist on the weekend is to cover. Not reinvent to wheel. It was stated these were all follow-ups. It doesn't take very long to do that. You're not the primary psychiatrist. I suspect your upset patient had a 10 min initial encounter with the psychiatrist and was rightfully upset about that. I'm a big proponent of spending enough time with the patient during an initial encounter to make the right diagnosis and formulate a good treatment plan. But weekend follow-ups on a psych unit don't need to take very long. If you disagree I accept that. Some patients do require more time on the weekends, but many don't. If they're psychotic, or manic, or getting ECT, I don't believe a prolonged conversation or therapy is likely to be necessary or useful. A few relevant questions to assess for side effects or new complaints is sufficient. And documentation can be very basic and quick if there's no change to the treatment plan.
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The idea of just being the “covering” weekend psychiatrist and not taking full ownership of overall treatment seems almost fraudulent in current era of short hospital stays. It’s one thing if your doing this where the length of stay is months, but if 30-60% of a patients hospitalization is by someone who is “just covering” then the psychiatrists shouldn’t be billing on the weekends IMO.
how did we change from stays of months to days? Did the evidence show no benefit to month long stays?
Nah, it's mainly financial. There are no financial incentives for the hospital to keeping patients longer -- only disincentives. Insurance companies will not cover longer stays either. We sometimes call them micro-hospitalizations. The only purpose is stabilization in the broad sense of the word, and they actually be harmful to some patients, leading to what we all know as the revolving door syndrome.
Disagree. Short hospital stays are the fault of insurance companies, not psychiatrists. When the primary has a plan and is following it, deviating from the plan without cause can result in increased costs. The primary can change the plan back and extend the stay. If the stay can’t be extended, a discharge may need to occur prematurely due to the covering psych pausing the plan.
Covering psychiatrists provide care by monitoring execution of the plan and adjusting if needed. That’s quite a valid reason to bill.
This was already answered eloquently so I'll refer you to @TexasPhysician 's post. But I just want to add that most psych hospitals don't discharge anyone on the weekend. That means the primary psychiatrist will be back on Monday to determine discharge. If you've changed the plan started on Friday, the primary will likely change it back on Monday and you've unnecessarily exposed a patient to an alternate treatment plan (which likely included alternate meds with their own risks) and possibly extended his/her stay.
The only time it would be necessary/beneficial to change a treatment plan is if acute issues come up (prolonged QTc on Saturday morning's EKG, pt develops a rash, etc). If what you're seeing is frankly dangerous (a patient on 3 different antipsychotics or pt with pneumonia and COPD on outrageous doses of Ativan) and you can't bring yourself to sign off on it, then it would make sense to make a change for patient safety purposes only, not because you have a better idea. Also, if you know the primary, you can always text him/her and set up a time to talk it out.
I agree that weekend staff that are covering, should be covering and not trying to deviate from the plan set by the primary without clear reason (i.e. new information, patient safety, etc.). Even if new information arises that may point to a change in treatment/diagnosis, like say new info from collaterals, even then I would hesitate to change the treatment course if it didn't affect patient safety. I would certainly document it well and hand it off to the primary though on Monday morning.
That's a lot of patients to follow-up on, but $3200/weekend is a bit more normal. I think most people were shocked at the prospect of getting $1600 total rounding for the whole weekend on 30 pts/day + consults/admits.
That's a lot of patients to follow-up on, but $3200/weekend is a bit more normal. I think most people were shocked at the prospect of getting $1600 total rounding for the whole weekend on 30 pts/day + consults/admits.
Not sure how we got from 10 minutes per patient to totally changing their regimen. Of course weekends are not about reinventing the wheel however reviewing meds, diagnostics, brief discussion with staff, mental status exam and concise charting should be considered an appropriate standard of care. Unless it is a unit entirely comprised of patients who are floridly psychotic or manic, which I have worked, it generally takes a bit longer to illicit suicidality, medication concerns etc. on 30 patients. FWIW I have found concerning labs that were missed on Friday, meds that were documented as going to be added/dc'd/increased/lowered but weren't, had to speak with family because that is when they were available etc. Not reinventing the wheel but being thorough enough to continue the intended plan of care and ensure everyone is alive on Monday morning.
Outside of discussions of side effects/risks of meds or meaning of diagnosis, I don't hold family meetings on the weekend if I'm not primary. I also do everything you mentioned above and think 10 minutes is absolutely crazy. I'm just responding to the post saying we should be taking full ownership of the treatment plan. The job on the weekends, IMO, is to keep the patient safe and advance care in the context of new information/safety concerns.
I do better moonlighting as a resident. This is sad.
Certain regions may need a cultural shift. We're in demand and do not need to settle. Let the locums take those $#!+ jobs. Have fun. Plenty of great places to live with better compensation and lifestyle.
How up front are you about the work volume with your applicants? I've been on interviews where medical directors make it sound like they breeze through the work covering inpatient, CL and ED on a typical Saturday but dodge dropping any real numbers. (BS alarm going off)! I'm skeptical of the ability to provide quality care when seeing high numbers. Then I wonder if (ie doubt) quality is really of any concern. (Churn out those RVUs kids). Putting it all together, the reason why they need perpetual locums coverage to staff their needs becomes more evident. Bush leagues.
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