What to do on 7 off?

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Psych25

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Just took a 7 on 7 off position in the Southeast. I am looking for extra work during my week off. Thought would be to pick up 2-3 days during the week. I've tried looking for PRN telepsych positions and couldn't find any specific ones. Also thought about correctional positions that are flexible. I don't see how starting my own outpatient telehealth would work because of my limited availability. Outpatient is not my preference either. The hospital I am working at has occasional extra shifts that can be picked up (not often). Any other thoughts of what I could do for work during this time other than this? Or anyone know of any specific companies? TIA
 
I’d first be vocal to coworkers you’re willing to pickup extra shifts.

I’d look into disability evals/IME as one off visits so no continuity and availability isn’t an issue.
 
Pick up extra shifts if they offer any incentive. I got $445 extra per day when I pick up extra shifts as a hospitalist.
 
Splenda88 said:
Pick up extra shifts if they offer any incentive. I got $445 extra per day when I pick up extra shifts as a hospitalist.
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Per hour you mean?
 
I've always thought 7 on 7 off sounded just horrible. Not only figuring out what to do with the other 7 days like the OP describes, but also 12 hour days on the weeks you are working. You also come back to the unit and, if it's functioning like it should, you don't even know most of the patients so you have to start all over learning everybody.
 
I would never do 7 on 7 off - I enjoy a day with the right amounts of work, family time, exercise, and relaxation per day. A regular job facilitates that. Pretty boring, as intended.

The guys I know enjoying 7 on/off don't have families and can spend those off weeks well with intensive hobbies. If you ski, hunt, hike, camp, sail, climb, ect. you can fill those weeks with various excursions.

If you're going to spend your youth working 7 on 7 off to work more in the off days, you could set yourself nicely financially, but that sounds even more boring than my 9 to 5 four days a week.
 
TheRightMedication said:
I would never do 7 on 7 off - I enjoy a day with the right amounts of work, family time, exercise, and relaxation per day. A regular job facilitates that. Pretty boring, as intended.

The guys I know enjoying 7 on/off don't have families and can spend those off weeks well with intensive hobbies. If you ski, hunt, hike, camp, sail, climb, ect. you can fill those weeks with various excursions.

If you're going to spend your youth working 7 on 7 off to work more in the off days, you could set yourself nicely financially, but that sounds even more boring than my 9 to 5 four days a week.
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Wish I had that 4 day work week. Like a unicorn I haven't been able to find. Looks like you work 32 hrs instead of the regular 4 10?

Jealous.
 
comp1 said:
I've always thought 7 on 7 off sounded just horrible. Not only figuring out what to do with the other 7 days like the OP describes, but also 12 hour days on the weeks you are working. You also come back to the unit and, if it's functioning like it should, you don't even know most of the patients so you have to start all over learning everybody.
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There are people working 7o/7off that work closer to 8-5 with availability by phone from 7-7 that still have plenty of time to be human's on the days on. That said working 1/2 weekends when you have children is brutal on the spouse. You definitely need to have decent coworkers compared to a M-F, but you also get to avoid the plague of bad weekend coverage that is common for IP units.
 
Oh from a manger's perspective, 7 on/7 off is absolutely amazing. It definitely addresses weekend coverage well and those evening hours where everybody shows up after after work (or when the hangover wears off) in the early evening seeking admission. It's from the clinician's perspective, just...no.
 
littlefred said:
Wish I had that 4 day work week. Like a unicorn I haven't been able to find. Looks like you work 32 hrs instead of the regular 4 10?

Jealous.
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Built it my gosh darned self. Private practice, baby! You could join an extant private practice, either W2 or employed, and work 4 days a week.
 
The hours for the 7 on is from 7:30am to around 2pm. Not 12 hr shifts. M-F inpatient jobs that I looked at prior to signing on usually required 1 weekend a month or every other month. That 12 day stretch would seem more brutal than 7 days. I agree it's not for everyone, but, if you find the right one, it can be pretty sweet.
 
I appreciate all the input. I will look check the availability for extra shifts as well as the ED work. If anyone is aware of any telehealth companies that are prn, I would appreciate the info. Thanks all!
 
Psych25 said:
The hours for the 7 on is from 7:30am to around 2pm. Not 12 hr shifts. M-F inpatient jobs that I looked at prior to signing on usually required 1 weekend a month or every other month. That 12 day stretch would seem more brutal than 7 days. I agree it's not for everyone, but, if you find the right one, it can be pretty sweet.
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I agree that it's not for everyone. My 7 days on/off amount to ~65 hrs total. 3 (short calls) out of these 7 days, I am home between 1-2 pm and the other 4 days (long calls), I am home by 6:15 pm.

A few people at my job would go home around 1pm every day but come back by 5 pm on long call days to do their admissions (~2 admits) and then leave again by 6:00pm.

I don't think I can ever work outpatient M-F 9-5 pm (or 8-4 pm). To each their own
 
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reca said:
Per hour you mean?
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Per day
$1920/day for my regular pay and they add another $445 to it. So I make $2365/day for any extra day I work above the 15 days/month stipulated in my contract.
 
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nexus73 said:
take flying lessons
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Just became interested in flying and might buy "The Doctor Killer" in 5 yrs.

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I've kind of wondered about the whole 7 on 7 off schedule before. I like my weekends so that would be difficult with my wife and 4 kids. I currently work 4 10's Mon-Thur and have a 3 day weekend every weekend. Gonna be real hard to give that up. Though 4 8's do sound better in outpatient world. I just don't think I'm at the point that I want to open my own practice.
 
DOswag said:
I've kind of wondered about the whole 7 on 7 off schedule before. I like my weekends so that would be difficult with my wife and 4 kids. I currently work 4 10's Mon-Thur and have a 3 day weekend every weekend. Gonna be real hard to give that up. Though 4 8's do sound better in outpatient world. I just don't think I'm at the point that I want to open my own practice.
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The most important factor for 7on/7off is if it's round and go, or if you're bound to the hospital until a certain time. If you can round and leave, the weekends can be pretty efficient and you might even get out before noon if you start early. Which means not missing the whole weekend with kids. I'm surprised more places aren't going to 7on/7off. Talking to my friends who do locums make it sound like fewer 7on/7off jobs are around over the last year, but maybe that's because they're better able to hire and retain people than typical M-F and don't need locums?
 
I could see it being okay for the provider if you left in the early afternoon. It just seems bad for patients and other staff. If you don't have a set tour of duty, you're really motivated to get through things as quickly as possible and to do the absolute minimal amount of work. I think it's reasonable and standard for weekends and holidays since pretty much everything is barebones, but it kinda sucks for patients if that's how you do your weekdays. Being available for home call is working...but it's not working as much as being in the office meeting with social workers, medical students, residents, nurses, OTs, etc.
 
comp1 said:
I could see it being okay for the provider if you left in the early afternoon. It just seems bad for patients and other staff. If you don't have a set tour of duty, you're really motivated to get through things as quickly as possible and to do the absolute minimal amount of work. I think it's reasonable and standard for weekends and holidays since pretty much everything is barebones, but it kinda sucks for patients if that's how you do your weekdays. Being available for home call is working...but it's not working as much as being in the office meeting with social workers, medical students, residents, nurses, OTs, etc.
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Not much happens most of the time after 2 pm in these community hospital on weekdays. It's pretty much dead on weekends
 
Splenda88 said:
Per day
$1920/day for my regular pay and they add another $445 to it. So I make $2365/day for any extra day I work above the 15 days/month stipulated in my contract.
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Is this for IP? That’s a good rate
 
comp1 said:
I could see it being okay for the provider if you left in the early afternoon. It just seems bad for patients and other staff.
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AM rounds and leaving is standard practice, same as any other specialty. Round, take care of business, leave for clinic or OR (or golf course), answer any urgent pages.

Unless called in for restraints etc., staying on the psych ward after rounding is usually counter-productive. "Hey doc, you think I can get some Adderall?" "Hey doc, can I talk to you again about getting of here?"
 
DOswag said:
I've kind of wondered about the whole 7 on 7 off schedule before. I like my weekends so that would be difficult with my wife and 4 kids. I currently work 4 10's Mon-Thur and have a 3 day weekend every weekend. Gonna be real hard to give that up. Though 4 8's do sound better in outpatient world. I just don't think I'm at the point that I want to open my own practice.
Click to expand...

Personally, I'd love a 7/7 position if I didn't have kids. Imo the loss of weekends without kids is nbd since you're only working 182-183 days/yr as opposed to the more standard 260 days/yr (before PTO) in a M-F job without working any weekends. Even 4 day weeks are 208 days/yr before PTO. Yes, it is harder to take longer vacations, but you can still switch with someone and do 14 straight for a month. Plus imo the worst part about inpatient or consults in the M-F arrangement is the first day back and learning all the new patients that were admitted over the weekend. That happens 52x per year as opposed to 26 in a 7/7 model.

Agree that kids change everything though. I value that weekend family time way too much to miss that much time.
 
Stagg737 said:
Personally, I'd love a 7/7 position if I didn't have kids. Imo the loss of weekends without kids is nbd since you're only working 182-183 days/yr as opposed to the more standard 260 days/yr (before PTO) in a M-F job without working any weekends. Even 4 day weeks are 208 days/yr before PTO. Yes, it is harder to take longer vacations, but you can still switch with someone and do 14 straight for a month. Plus imo the worst part about inpatient or consults in the M-F arrangement is the first day back and learning all the new patients that were admitted over the weekend. That happens 52x per year as opposed to 26 in a 7/7 model.

Agree that kids change everything though. I value that weekend family time way too much to miss that much time.
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Even if you have kids, it can be a great schedule if the the place is flexible where you can pop up on weekend at 8 or 9am and leave around 12 noon
 
comp1 said:
Oh from a manger's perspective, 7 on/7 off is absolutely amazing. It definitely addresses weekend coverage well and those evening hours where everybody shows up after after work (or when the hangover wears off) in the early evening seeking admission. It's from the clinician's perspective, just...no.
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That's not how a lot of them work. I have had two 7 on 7 offs and both were the usual come in at 7am and leave around 12/1 and usually its ok and very rarely something happens and you have to come back.
 
comp1 said:
I could see it being okay for the provider if you left in the early afternoon. It just seems bad for patients and other staff. If you don't have a set tour of duty, you're really motivated to get through things as quickly as possible and to do the absolute minimal amount of work. I think it's reasonable and standard for weekends and holidays since pretty much everything is barebones, but it kinda sucks for patients if that's how you do your weekdays. Being available for home call is working...but it's not working as much as being in the office meeting with social workers, medical students, residents, nurses, OTs, etc.
Click to expand...
Except it works like that almost everywhere.
 
Splenda88 said:
Even if you have kids, it can be a great schedule if the the place is flexible where you can pop up on weekend at 8 or 9am and leave around 12 noon
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Sure, most of my kids weekend events are in the mornings though, so traditional rounding times I'd miss a ton. My current position I'm on call Q6 weeks and I come in late morning to early afternoon so typically don't miss much.

SmallBird said:
That's not how a lot of them work. I have had two 7 on 7 offs and both were the usual come in at 7am and leave around 12/1 and usually its ok and very rarely something happens and you have to come back.
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SmallBird said:
Except it works like that almost everywhere.
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Yea, sometimes I think Comp fails to realize that the whole "tour of duty" thing is pretty exclusive to the VA and that it's less common to require docs to physically be on campus in the inpatient setting than they realize.
 
I'm aware of the inpatient morning, outpatient afternoon split that a lot of inpatient doctors have. I just think the VA's practice is superior for patient care and was greatly attracted to it. In terms of 7 on 7 off somehow being easier because you don't deal with the weekend influx as often, it's a matter of amount. My average length of stay is 5.5 days. When I come back on Monday after a weekend, sure, there will be a couple of new patients, but I'll be familiar with the vast majority of the patients and have plans in place. However, if I come back a full week later, almost all of the patients will be new. That seems overwhelming to me to do on a regular basis. It's like starting a new job 26 times a year.
 
comp1 said:
I'm aware of the inpatient morning, outpatient afternoon split that a lot of inpatient doctors have. I just think the VA's practice is superior for patient care and was greatly attracted to it. In terms of 7 on 7 off somehow being easier because you don't deal with the weekend influx as often, it's a matter of amount. My average length of stay is 5.5 days. When I come back on Monday after a weekend, sure, there will be a couple of new patients, but I'll be familiar with the vast majority of the patients and have plans in place. However, if I come back a full week later, almost all of the patients will be new. That seems overwhelming to me to do on a regular basis. It's like starting a new job 26 times a year.
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I think you get used to it. My friends who are hospitalists do the same thing, come onto service with 12-20 new patients and find a way to make it work (mind you different pathology but certainly not insignificant pathology). I never hear them being overwhelmed each day back, they have good signouts and know their colleagues who are passing the patients off to them.
 
comp1 said:
I'm aware of the inpatient morning, outpatient afternoon split that a lot of inpatient doctors have. I just think the VA's practice is superior for patient care and was greatly attracted to it. In terms of 7 on 7 off somehow being easier because you don't deal with the weekend influx as often, it's a matter of amount. My average length of stay is 5.5 days. When I come back on Monday after a weekend, sure, there will be a couple of new patients, but I'll be familiar with the vast majority of the patients and have plans in place. However, if I come back a full week later, almost all of the patients will be new. That seems overwhelming to me to do on a regular basis. It's like starting a new job 26 tiemes a year.
Click to expand...

Most patients aren't really new. Chart review is a relatively painless and will tell you 95% of what's going on. That's why we write notes in the EMR. And why we talk to people (social workers, nurses, and the patient). Staying on the unit all day is only helpful to residents who are learning and for OCPD/control tendencies.


Merovinge said:
I think you get used to it. My friends who are hospitalists do the same thing, come onto service with 12-20 new patients and find a way to make it work (mind you different pathology but certainly not insignificant pathology). I never hear them being overwhelmed each day back, they have good signouts and know their colleagues who are passing the patients off to them.
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IM docs have no problem coming in and managing 20 patients who are new to them, some of whom are trying to actively die, without having to hang around all day. As specialists, we deal with less conditions than IM and should be able to be thorough but efficient.
 
comp1 said:
I'm aware of the inpatient morning, outpatient afternoon split that a lot of inpatient doctors have. I just think the VA's practice is superior for patient care and was greatly attracted to it.
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I know docs who just do the inpatient mornings and chill in the afternoons. Some people don't want to hustle for extra outpatient side jobs and just enjoy having shorter days. Agree to disagree (sometimes) on the bolded. Compared to the for-profit churn and burn places where docs are seeing 25 patients per day, absolutely. VA is often far superior. But I rotated through non-VA (and non-academic even) where inpatient attendings saw 8-12 patients/day and I would send my family there over any of the VAs I worked at. My biggest issue with the VA in that regard isn't on the psychiatrists, it's on admins pandering and coddling to fully grown adults. Some patients need that, but it does more harm than good for patients with PDs and often those with SUDs too. I'd estimate that any given day at least 30% of my patients were PD/SUD patients who said the magic word (SI) in the ER and were whisked away to their inpatient bed for "3 hots and a cot" for a couple of days because admin would freak out any time we tried to d/c them from the ER.


Candidate2017 said:
Most patients aren't really new. Chart review is a relatively painless and will tell you 95% of what's going on. That's why we write notes in the EMR. And why we talk to people (social workers, nurses, and the patient). Staying on the unit all day is only helpful to residents who are learning and for OCPD/control tendencies.




IM docs have no problem coming in and managing 20 patients who are new to them, some of whom are trying to actively die, without having to hang around all day. As specialists, we deal with less conditions than IM and should be able to be thorough but efficient.
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Devil's advocate, if you're seeing 20 patients on an inpatient unit and leaving by noon you're either coming in crazy early or doing a garbage job unless the patients are all catatonic or so sick spending more than 3 minutes with them is pointless. If it's just 8-10 patients then I agree, out by noon/early afternoon is completely reasonable. But for 20 patients no way you're leaving in 4 hours and providing decent care.

Psych is also completely different from medicine. I trust the charts I review in psych about as far as I can throw them. What some ER SW or doc says is only accurate about 50% of the time and even then isn't the full story and we have to spend time actually talking to patients. Medicine may not even need to actually see someone for more than a minute. Less if they're intubated or delirious. Labs and physical findings can completely guide treatment in medicine, which is almost never the case in psych. Refer to Dr. Glaucomflecken's on call psych video: "sometimes we have to talk to our patients!"
 
I didn't go into IM specifically because I hated how inpatient IM worked. It did seem extremely overwhelming and kind of dangerous to try to keep track of all that was going on on a medical ward. And quite honestly, a lot of IM attendings I saw did indeed look really overwhelmed and certainly overworked. I completely agree that the VA can coddle patients and greatly worsen personality pathology. There is a lot of seeming power when a patient can write directly to Congress which can in turn demand a written response to any perceived slight. However, it's just seeming power. If you stick around the VA long enough, you get the systems down and how to respond to inquiries quickly and efficiently. Further, the structure of the day gives you time to REALLY deal with the boundary setting, including in other (ED) providers, needed for long term success with a severely personality disordered patient. I think the VA frustrates physicians most who stick around for training or for 1-2 of years of attendinghood. You only see the problems without learning the solutions.
 
comp1 said:
I didn't go into IM specifically because I hated how inpatient IM worked. It did seem extremely overwhelming and kind of dangerous to try to keep track of all that was going on on a medical ward. And quite honestly, a lot of IM attendings I saw did indeed look really overwhelmed and certainly overworked. I completely agree that the VA can coddle patients and greatly worsen personality pathology. There is a lot of seeming power when a patient can write directly to Congress which can in turn demand a written response to any perceived slight. However, it's just seeming power. If you stick around the VA long enough, you get the systems down and how to respond to inquiries quickly and efficiently. Further, the structure of the day gives you time to REALLY deal with the boundary setting, including in other (ED) providers, needed for long term success with a severely personality disordered patient. I think the VA frustrates physicians most who stick around for training or for 1-2 of years of attendinghood. You only see the problems without learning the solutions.
Click to expand...


I would point anyone looking for further back and forth about this towards this thread on the Psychology forum:

forums.studentdoctor.net

VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

Post all your concerns, frustrations, ideas, and experiences as a VA mental health provider of any discipline.
forums.studentdoctor.net forums.studentdoctor.net

I will note that the thread has been going on since 2019 and has 2K+ replies to date.
 
It's a good thread, very psychologist focused, but does go over how the VA kinda got too popular last year. It's still easier for psychiatrists to secure a job than psychologists, they just all got more competitive.
 
comp1 said:
I didn't go into IM specifically because I hated how inpatient IM worked. It did seem extremely overwhelming and kind of dangerous to try to keep track of all that was going on on a medical ward. And quite honestly, a lot of IM attendings I saw did indeed look really overwhelmed and certainly overworked. I completely agree that the VA can coddle patients and greatly worsen personality pathology. There is a lot of seeming power when a patient can write directly to Congress which can in turn demand a written response to any perceived slight. However, it's just seeming power. If you stick around the VA long enough, you get the systems down and how to respond to inquiries quickly and efficiently. Further, the structure of the day gives you time to REALLY deal with the boundary setting, including in other (ED) providers, needed for long term success with a severely personality disordered patient. I think the VA frustrates physicians most who stick around for training or for 1-2 of years of attendinghood. You only see the problems without learning the solutions.
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That's fair, but also will depend on the culture and admins of specific VAs. As much as I sometime rail on the VA system, there are a lot of pluses and great physicians that work there and give excellent treatment. However, that can all be completely negated by having poor or malignant admins that constantly put in road blocks. Example:

One of my attendings in residency had worked at that VA for 35+ years and during my second year the admins came down hard that we weren't allowed to d/c patients from the ER or medical floors if they claimed SI with plan. Patients figured it out and we saw a huge uptick in malingering. Even that attending who knew how to play the game with admins was basically told fall in line or get out. It only changed the following year because COVID hit and they were having malingerers with SI taking up beds of patients with COVID needing vents. If that hadn't happened who knows if this would have even changed as those admins dug their heels in pretty hard with their "zero suicide" policies.

To the original point, the whole "tour of duty" thing isn't necessary for docs working on smaller units. If an inpatient attending only has 4-5 patients one day (which wasn't uncommon at my residency) there is no reason to force them to sit around until 4pm twiddling their thumbs, especially if their cap is 8 or 10 patients total and the VA has a decent SW staff.
 
Some non-clinical admins admittedly went in bizarro directions with suicide policies. I literally saw posters up that said suicide was always preventable and had to explain that's like saying cancer is always curable. They need to stop saying that as there's good evidence that telling patients they can't kill themselves is harmful to genuinely suicidal people as opposed to just offering help. It is better now and much more realistic.
 
nexus73 said:
I’d first be vocal to coworkers you’re willing to pickup extra shifts.

I’d look into disability evals/IME as one off visits so no continuity and availability isn’t an issue.
Click to expand...
How do you break into this area? Any special training (i.e. forensics fellowship) needed, or any resources to self-learn?
 
DrPembleton said:
How do you break into this area? Any special training (i.e. forensics fellowship) needed, or any resources to self-learn?
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There are companies that hire doctors for disability evaluations, sorry I don't have specific names. They typically pay okay, and usually set you up to be pretty efficient, seeing 3-4 people per day and I think making upwards of 2000/day or a little more. I believe they train you and provide templates so it's pretty easy to produce a nice looking report. I've not done this, but from what I hear there are often a ton of records to review for each eval.

You can also contact your local department of disability determination services and do evals for people applying for SSI/SSDI. This usually requires you to do more leg work, rent an office space, malpractice, etc. And pay is not as good as the above job, but usually the records to review are very limited if any (like 4 notes from PCP prescribing Prozac over a year)
 
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