which inpatient unit is the fastest to round on?

[finalpsychyear]

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I have the options of choosing a psychosis unit or depression/anxiety combined unit or Dual dx unit for an upcoming inpt job I am seriously considering. The units have 24 beds and an NP available to see up to 8 pts that the facility pays for but you would be responsible to supervise or they are fine if you want to see everyone.

1. This is a side gig and i plan on having outpt in the afternoons so i make my own hours. It is also a paper chart facility with template boxes you can check off or circle for daily progress notes and they allow u to dictate admits and discharges.

2. which units do you think rounding would be the fastest on if I plan to round from 6am-lunch ? My hunch is probably psychosis. I am thinking I could easily round on 16-18 pts in 6 hrs especially after the first day or two right?

 

[clausewitz2]

I have the options of choosing a psychosis unit or depression/anxiety combined unit or Dual dx unit for an upcoming inpt job I am seriously considering. The units have 24 beds and an NP available to see up to 8 pts that the facility pays for but you would be responsible to supervise or they are fine if you want to see everyone.

1. This is a side gig and i plan on having outpt in the afternoons so i make my own hours. It is also a paper chart facility with template boxes you can check off or circle for daily progress notes and they allow u to dictate admits and discharges.

2. which units do you think rounding would be the fastest on if I plan to round from 6am-lunch ? My hunch is probably psychosis. I am thinking I could easily round on 16-18 pts in 6 hrs especially after the first day or two right?

How acute is the psychosis unit? Is this a unit aimed at chronic folks who are largely waiting on openings at a supported housing complex or residential facility? Step-down of folks who in olden days would have been in a state hospital? Or mostly people who have acutely decompensated and are going to be hustled back out when they reach a minimum level of functioning?

 

[Mass Effect]

Working 6 a.m. - lunch to round on a 24-patient unit (no matter which one) on a side job before outpatient clinic sounds miserable to me.

 

[finalpsychyear]

How acute is the psychosis unit? Is this a unit aimed at chronic folks who are largely waiting on openings at a supported housing complex or residential facility? Step-down of folks who in olden days would have been in a state hospital? Or mostly people who have acutely decompensated and are going to be hustled back out when they reach a minimum level of functioning?

I don't know the answer but it is a private hospital and 80% of the patients are commerical insurance/medicare so that is the population we will have. It is def not super acute for the most part. Average length of stay is 8 days i believe. Most pts i was told were non compliant with meds and just need to have that back. The facility doesn't do mechanical restraints in general. Let us assume it is not the pending placement things because it is an upscale type of facility.

 

[clausewitz2]

I don't know the answer but it is a private hospital and 80% of the patients are commerical insurance/medicare so that is the population we will have. It is def not super acute for the most part. Average length of stay is 8 days i believe. Most pts i was told were non compliant with meds and just need to have that back. The facility doesn't do mechanical restraints in general. Let us assume it is not the pending placement things because it is an upscale type of facility.

What sort of intensive outpatient SMI services are available in the area, i.e., is there some reasonable level of care to send them out to, or are you streeting folks who just very recently got hospitalized after flushing their haldol? Might not impact your workflow, but good god the later scenario would be dispiriting to me.

 

[finalpsychyear]

Working 6 a.m. - lunch to round on a 24-patient unit (no matter which one) on a side job before outpatient clinic sounds miserable to me.

I don't trust the future of medicine. With amazon and walmart using the NP model it is only a matter of time that they push enough $$$ to politicians to make them fully autonomous everywhere. I must work hard now as psychiatry is in a good place right now and only maybe the next 5 years I can say are going to be like this. Regardless, this hospital won't require me to do call and i only round on my own unit 1 wknd a month. Not sure how many let you do that. I am contract only though. This thinking drives me harder but i almost have it too easy right now with my current set up.

 

[finalpsychyear]

What sort of intensive outpatient SMI services are available in the area, i.e., is there some reasonable level of care to send them out to, or are you streeting folks who just very recently got hospitalized after flushing their haldol? Might not impact your workflow, but good god the later scenario would be dispiriting to me.

Due to most of the insurance being private, they don't have issues getting a provider. They have their own outpt run by NPs who can get most patients in within 7 days post discharge.

The facility was not taking medicaid until this year due to some state mandates. They screen violent psychotic patients and usually do not take those cases.

 

[clausewitz2]

Due to most of the insurance being private, they don't have issues getting a provider. They have their own outpt run by NPs who can get most patients in within 7 days post discharge.

The facility was not taking medicaid until this year due to some state mandates. They screen violent psychotic patients and usually do not take those cases.

I am really curious how they filled a psychosis unit w/o taking Medicaid. Regardless that suggests a lot of these folks will be more interested in talking, which means lightning rounds may be challenging.

 

[TexasPhysician]

16 bed unit + supervising 8 with a NP in most areas is a FT job or more so. 8 day LOS means average 2 Intakes/day, but they probably aren’t discharging on weekends. That increases it to 3 Intakes/day for you plus supervising 1-2 Intakes with the NP. That’s average. Some days you may have 6 direct and 3 supervising. Being in charge of 5 Intakes/day would be miserable in my opinion, much less 9. The psychosis unit is possibly more likely to have involuntary patients. You’ll need time to review commitment paperwork and attend court sessions sporadically.

Seems unsustainable with a 1-5pm pp work wise, but I’m not you.

 

[finalpsychyear]

16 bed unit + supervising 8 with a NP in most areas is a FT job or more so. 8 day LOS means average 2 Intakes/day, but they probably aren’t discharging on weekends. That increases it to 3 Intakes/day for you plus supervising 1-2 Intakes with the NP. That’s average. Some days you may have 6 direct and 3 supervising. Being in charge of 5 Intakes/day would be miserable in my opinion, much less 9. The psychosis unit is possibly more likely to have involuntary patients. You’ll need time to review commitment paperwork and attend court sessions sporadically.

Seems unsustainable with a 1-5pm pp work wise, but I’m not you.

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Long term yes probably not sustainable. However, it seems all the docs there do this while building their own PP on side and most sustain it. Some leave while others hire their own NP to cover more and more of the unit over time as they train and become more comfortable with them. I am brand new to the area and thought it would be great indirect advertising of myself to the community and start gaining a good reputation. I also feel " bored" in outpt/tele medicine and the further i get away from not doing inpt which its been 2017 summer since i did a handful of shifts i start feeling like my confidence for inpt psych seems to be slipping and that is what I feel i need to do this. I feel one can leave if or cut back if it is too much so what do you really lose?

 

[Armadillos]

I don't trust the future of medicine. With amazon and walmart using the NP model it is only a matter of time that they push enough $$$ to politicians to make them fully autonomous everywhere. I must work hard now as psychiatry is in a good place right now and only maybe the next 5 years I can say are going to be like this. Regardless, this hospital won't require me to do call and i only round on my own unit 1 wknd a month. Not sure how many let you do that. I am contract only though. This thinking drives me harder but i almost have it too easy right now with my current set up.

If you were playing the percentages, I would rate probability of picking up a nasty lawsuit trying to rush to work two full time jobs as much higher than probability a psychiatrist can’t make a decent living in 15 years.

 

[finalpsychyear]

If you were playing the percentages, I would rate probability of picking up a nasty lawsuit trying to rush to work two full time jobs as much higher than probability a psychiatrist can’t make a decent living in 15 years.

Hi. I def won't "rush" the patients and if it becomes to a point where i can't provide the quality i am comfortable with then of course I would realize it is too much. 6-8 hrs would be my expectations per day not counting monday which is probably longer and yes i may have to come back after 5pm for 1-2 hours to start off the week.

In residency we were required to round on at least 8 inpt follow ups when on call during wknd. I was able to almost always do this in 90 min esp when I was already following those patients during the week.