Why do the ca state prison jobs pay high and are always available ? Whats the catch?

[the5thelement]

I have never worked for a prison. Recruiters consistently tell me that the work load is very low, and its a dream job . Yet the jobs are consistently being advertised so I would guess its high turnover (for psychiatrists). Making $300/hr in a stress free low patient load job sounds tempting but literally anyone I have spoken to has nothing but discouraging words to say. The cons range from "not being able to check your phone, feeling locked in like you are in a prison too, the ever present potential for violence, prisoners having nothing but time on their hands so all they do is strategize on how to fool the doctor, etc.." One of these was from a psychiatrist who worked in a federal prison for 12.5 years. Another was a RN who recently was working at the state prison. I am on the verge of starting a small telepsych private practice but the constant temptation makes me think the prison route would be better. Anyone here with a similar dilemma?

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[splik]

Most of the prisons are in undesirable areas. The volume of patients to be seen will vary on the prison and the level of staffing. However, the slowness of the custody staff is a rate limiting factor in how many patients you can see so it usually is much lower volume than say outpatient. Since you are have to stay there to whole time, won't have your phone with you, the computers are limited in what you can access, it could be quite boring if you don't have much to do. You could also be stuck there if there's a lockdown due to a prison riot etc. It can also be a depressing environment for some people to work in. You can't just come and go as you like. $300/hr+ would be for locums positions typical for inpatient not an outpatient or employed prison position.

There is a lot of politics and there have been concerns about the outsized power that psychologists wield in the system and the negative effects of that. There have been several psychiatrist filed lawsuits and whistleblowers over the years. As a contractor you probably wouldn't be too bothered about that.

California prisons are generally much safer than working in an ER or inpatient unit. Most inmates are grateful for psychiatric care, even the antisocial/psychopathic ones and will be nice to people they want something from. It is a potentially interesting job if you are interested in the systems based aspects and sociological dimensions of corrections and working in a total institution. Some people find it especially rewarding caring for some of the most marginalized patients.

 

[B52slinger]

One of my attendings in residency worked in a CA prison for 8 years. During this time he was assaulted 6 times by patients, the last time very seriously and causing him to quit and switch to a non-prison job. He could have been killed had the guards not intervened in a timely manner.

Most people only do short-term contracts, work 6 months at a prison and then say that it's safe because nothing happened to them. I have spoken with other former CA prison attendings who have been gassed (feces squirted out of a bottle), slapped, had their hair pulled and otherwise assaulted over the course of working at a prison for several years. A female attending I worked with quit her prison locums job after less than 1 month because of inmates repeatedly pulling out and showing their genitalia to her without her consent and making sexual remarks.

Safety does vary by location but at certain locations if you are small female psychiatrist I would absolutely not recommend working there. If you're a 6'5 250 pound male then this might be less of an issue.

 

[TexasPhysician]

Let’s ignore the threat of assault - quite possible.

I do different jobs to keep entertained. My rate varies based on what I do. With such a job, you are asking me to be in an environment with likely no windows, no decor, disgruntled patients, support staff with no incentive to be efficient or helpful, prevent total access to my phone, and allow myself almost no forms of entertainment between patients. This is almost worst case scenario. In Texas, many of the prisons don’t have air conditioning, so that would be worse. I’m not sure I could be paid enough to take this job.

 

[vanfanal]

Seems ripe for virtual care. I wonder why that’s not more available.

 

[TexasPhysician]

Seems ripe for virtual care. I wonder why that’s not more available.

This is a better discussion for its own thread, but virtual care is clearly deficient when compared to in-person. It is hard to evaluate tremors, cogwheeling, EPS, and non-verbal cues on current technology cameras. Legal minds agreed which often results in facilities/organizations needing to have quotas for in-person access like exists publicly.

I have discussed virtual with a similar population, and the entity essentially said that such a thing is impossible, even if I provided all of the equipment free of charge. I have to be on-site for them to be in legal compliance.

 

[jbomba]

I work corrections and love it. I have my phone, I come and go as I please. My colleagues and the staff who work there are great. I do consider myself lucky to have this position and I can't say all corrections is the same.

 

[ObsequiousAplomb]

I work corrections and love it. I have my phone, I come and go as I please. My colleagues and the staff who work there are great. I do consider myself lucky to have this position and I can't say all corrections is the same.

The more you describe your job the more I'm certain it's the Beverly Hills jail that Eddie Murphy orders a pizza in.

 

[TexasPhysician]

I work corrections and love it. I have my phone, I come and go as I please. My colleagues and the staff who work there are great. I do consider myself lucky to have this position and I can't say all corrections is the same.

Wow. My buddy works corrections. The building has no air conditioning. He shows up in essentially Under Armour gear and prepares to sweat profusely in the summer. 100+ degrees outside is common in the summer. Part of the job is weeding through malingering as inpatient psych has a/c.

 

[comp1]

So sticking to California corrections in specific, which does have air conditioning throughout as far as I'm aware, I think it's mostly the phone thing to be quite honest. By phone thing, I mean the security that you have to go through. Not only are you cut off from the rest of the world yourself, but also it adds on at least half an hour to your commute each way. And yes, you are a salaried government employee, so even inpatient, this is not a job you're going to leave when you're done or pop out for lunch. Now telework, I think it's absolutely appropriate for corrections and so does CDCR. Sure, something MIGHT be lost in the video, but it would seriously be a minimal. I mean how often do you all do cogwheeling exams on even your inpatients, much less OUTPATIENTS. That said, CDCR has a kind of weird telework setup where you still have to drive in to an unsecured facility (not a prison) to do it. Then you see patients throughout the state. I know one is in Elk Grove (Sacramento). It'd be a nice area to live and I know several people who have done this. I think there might be another site somewhere in the state, but that is the main one for telework. Anyways, here's the pretty much always open listing: SENIOR PSYCHIATRIST (SPECIALIST)

 

[Roxas]

I'm moonlighting in corrections at a large county jail on the weekends while doing CAP fellowship and my experience doesn't seem to match anyone else's here except apparently @jbomba (however I'm not in CA). I get that jail may be different from prison, but corrections environment nonetheless. I get to have my phone. I don't have to go through any security when I get there, and can come and go as I please. The other moonlighting gig offered to me was at a high-acuity psych ED with high volume for significantly less money. I figured my chance of getting assaulted was equivocal or lower in the corrections setting. It doesn't hurt that I'm a pretty large dude, although I worry that may come across as a challenge to some in that setting. The support staff and custody here has been phenomenal, but I'm told by a lot of the people here that this is a uniquely good environment. I can see not wanting to make a career out of corrections, but either as PRN gig or doing it for a few years to pay off loans doesn't seem to be the worst option either. And it's a hell of a lot more stimulating than outpatient where it'd be 15-20 patients a day of titrating Prozac and telling 40 yo adults they didn't just suddenly develop ADHD and ASD.

 

[splik]

One of my attendings in residency worked in a CA prison for 8 years. During this time he was assaulted 6 times by patients, the last time very seriously and causing him to quit and switch to a non-prison job. He could have been killed had the guards not intervened in a timely manner.

This probably says more about him than it does working in a prison. It's always the same people who get assaulted again and again. There are some scary people in prison but in general CDCR prisons are much safer to work in for psychiatrists than acute hospitals.

 

[comp1]

I don't think safety is generally the issue in prisons or jails. They are safer than pretty much any other setting. State mental hospitals might be a bit different in terms of risk, but that's more technically psych inpatient as opposed to corrections. On site corrections where you got to keep your phone and didn't have to go through major security could indeed be nice. I've never seen it, but it appears to exist per the poster above. I definitely wouldn't count on it at CDCR. Some sort of podunk Mayberry type jail somewhere? I just don't know where they could dispense with the security and allow phones free floating around.

 

[splik]

I don't think safety is generally the issue in prisons or jails. They are safer than pretty much any other setting. State mental hospitals might be a bit different in terms of risk, but that's more technically psych inpatient as opposed to corrections. On site corrections where you got to keep your phone and didn't have to go through major security could indeed be nice. I've never seen it, but it appears to exist per the poster above. I definitely wouldn't count on it at CDCR. Some sort of podunk Mayberry type jail somewhere? I just don't know where they could dispense with the security and allow phones free floating around.

Usually county jails aren't so restrictive so you can usually bring your phone in (or sneak it in if not officially allowed), but prisons tend to be more restrictive.

 

[jbomba]

I'll also add, there is currently a lawsuit pending that would allow outside phones into facilities. A couple of the attorneys I bump into coming to and from the non contact rooms told me about that.

 

[Stagg737]

I mean how often do you all do cogwheeling exams on even your inpatients, much less OUTPATIENTS.

Just want to point out that if you're meeting standard of care then at least yearly for any patient on an antipsychotic. This is even more relevant for outpatient docs chronically prescribing patients antipsychotics...

 

[SPsych6]

CDCR Vacaville is a diamond in the rough.

Great place to be. Pay is the best in CDCR, live close to Napa, Walnut Creek, Sacramento, and Berkely isn't too far. Overall, this location is run really well IMO.

I think people struggle with Cluster B and malingering. They just want inpatient to be psychosis, so if this is you too, this is not your place. It is at least 50% cluster B, if not more. But the patient load is low, length of stay is long, formulary is anything you want, and you don't have to prescribe controlled substances. Some people can't deal with asking custody to pull patients out of their cell, but to me the safety advantage of that is much, much better. I think this job is great if you have strong boundaries. Also people hate that they don't have their personal cell to check their Instagram accounts. You get a work phone and laptop, EMR is Cerner, and you have access to youtube, your emails, etc. You just won't be able to do social media.

 

[FN9]

Most of the prisons are in undesirable areas. The volume of patients to be seen will vary on the prison and the level of staffing. However, the slowness of the custody staff is a rate limiting factor in how many patients you can see so it usually is much lower volume than say outpatient. Since you are have to stay there to whole time, won't have your phone with you, the computers are limited in what you can access, it could be quite boring if you don't have much to do. You could also be stuck there if there's a lockdown due to a prison riot etc. It can also be a depressing environment for some people to work in. You can't just come and go as you like. $300/hr+ would be for locums positions typical for inpatient not an outpatient or employed prison position.

There is a lot of politics and there have been concerns about the outsized power that psychologists wield in the system and the negative effects of that. There have been several psychiatrist filed lawsuits and whistleblowers over the years. As a contractor you probably wouldn't be too bothered about that.

California prisons are generally much safer than working in an ER or inpatient unit. Most inmates are grateful for psychiatric care, even the antisocial/psychopathic ones and will be nice to people they want something from. It is a potentially interesting job if you are interested in the systems based aspects and sociological dimensions of corrections and working in a total institution. Some people find it especially rewarding caring for some of the most marginalized patients.

Having worked for years in CDCR and other facilities, I agree with the above ESPECIALLY the politics, most people including myself eventually quit because of the politics inside, just not worth it, you become miserable not because you dont have your phone or some boring decor but rather from some staff or psychologist on a power trip making you think, I dont care if they pay 750/hr, Im out of here. Every Single Time.

 

[annoyedpsychiatrist]

in residency i rotated at the local prison for a while. Inpatient probably wasnt great, but outpatient was ridiculously easy/low stress. In my current clinic my no show rate is <10%. At the prison it was probably around 30%. Sometimes people would be in moods and just refuse to come. However, because it was easy it was also disheartening- it was paper documentation, the staff wasnt consistent with med aministration/didnt always read the orders correctly, limited options at times for treatment, and everyone always asked for artane. But for depression most people were pretty realistic with expectations given the setting. Some people just wanted to be snowed. There were times for sure i didnt feel safe though. Most people were fairly respectful though

 

[dl2dp2]

Just want to point out that if you're meeting standard of care then at least yearly for any patient on an antipsychotic. This is even more relevant for outpatient docs chronically prescribing patients antipsychotics...

Interestingly. Is it possible to do remote cogwheeling test?

 

[Merovinge]

Interestingly. Is it possible to do remote cogwheeling test?

IMO it's more than just cogwheeling I am testing for on physical exam with antipsychotics. I have found dystonia that was not voiced on ROS on several occasions, after the finding when you directly ask the patient they are often like "oh yeah, I am stiff there and having discomfort/trouble doing things". Even in exclusively child/adolescent psychiatry I have seen a few cases that really needed 0.5mg of Cogentin BID based on physical exam rather than patient report.

 

[dl2dp2]

IMO it's more than just cogwheeling I am testing for on physical exam with antipsychotics. I have found dystonia that was not voiced on ROS on several occasions, after the finding when you directly ask the patient they are often like "oh yeah, I am stiff there and having discomfort/trouble doing things". Even in exclusively child/adolescent psychiatry I have seen a few cases that really needed 0.5mg of Cogentin BID based on physical exam rather than patient report.

Do you think then standard of care for anyone on antipsychotics should come in once a year.

 

[Stagg737]

Interestingly. Is it possible to do remote cogwheeling test?

Only if there is some healthcare professional present doing it. Some of my telehealth patients go to their local clinics for the appointments, so I could have a doc there do it but I wouldn't trust a tech or a nurse unless they were specifically trained.

Do you think then standard of care for anyone on antipsychotics should come in once a year.

I do not see anyone for that clinic in person as they physically are 4-8 hours away. I do document for patients on antipsychotics that PCP should do an AIMS yearly as I do think it is absolutely standard of care to perform AIMS yearly if at all possible. If that's not possible, then it should at least be documented that risks were discussed with the patient/guardian/caretaker and that they were agreeable to continuing the med despite the risk.

 

[Merovinge]

Do you think then standard of care for anyone on antipsychotics should come in once a year.

Yes or have an AIMS done by someone else. It's very clear that is the standard of care.

 

[dl2dp2]

Only if there is some healthcare professional present doing it. Some of my telehealth patients go to their local clinics for the appointments, so I could have a doc there do it but I wouldn't trust a tech or a nurse unless they were specifically trained.


I do not see anyone for that clinic in person as they physically are 4-8 hours away. I do document for patients on antipsychotics that PCP should do an AIMS yearly as I do think it is absolutely standard of care to perform AIMS yearly if at all possible. If that's not possible, then it should at least be documented that risks were discussed with the patient/guardian/caretaker and that they were agreeable to continuing the med despite the risk.

Yes or have an AIMS done by someone else. It's very clear that is the standard of care.

Very interesting! Thank you for the impromptu QA of the day. I'm gonna start doing that now. I have a handful of patients maintained on antipsychotics.

 

[comp1]

I know the AIMS is standard of care. I get that. I'm just questioning if it should be. I once asked the pharma company reps from companies that had developed all these TD drugs if any of the scales they used in their studies were subjective, as in the patient reporting how much they noticed the symptom or being impaired it. Not a one. All of them were AIMS like instruments. I've yet to see any studies on TD that focus on patient's own reports. This seems really weird in mental health. It's been rare that I've had a patient with TD (already quite rare) who reported it bothering them or that they even noticed it. Families or other providers might notice it, but it just doesn't seem to be a problem for patients. I do often wonder who we are treating with the AIMS or tetrabenazine analogs, it seems mostly ourselves.

 

[Stagg737]

I know the AIMS is standard of care. I get that. I'm just questioning if it should be. I once asked the pharma company reps from companies that had developed all these TD drugs if any of the scales they used in their studies were subjective, as in the patient reporting how much they noticed the symptom or being impaired it. Not a one. All of them were AIMS like instruments. I've yet to see any studies on TD that focus on patient's own reports. This seems really weird in mental health. It's been rare that I've had a patient with TD (already quite rare) who reported it bothering them or that they even noticed it. Families or other providers might notice it, but it just doesn't seem to be a problem for patients. I do often wonder who we are treating with the AIMS or tetrabenazine analogs, it seems mostly ourselves.

May be exposure difference, but I've seen several patients with TD severe enough that they can't hold food on utensils to eat. I see plenty where it's less severe but still bothersome. That's the whole point of AIMS, to detect more mild TD before it becomes severe enough to become a problem.

 

[PsychYourMind2025]

Having worked for years in CDCR and other facilities, I agree with the above ESPECIALLY the politics, most people including myself eventually quit because of the politics inside, just not worth it, you become miserable not because you dont have your phone or some boring decor but rather from some staff or psychologist on a power trip making you think, I dont care if they pay 750/hr, Im out of here. Every Single Time.

Examples of the power trips? Are there midlevels you have to interact with?

 

[comp1]

As far as I'm aware, CDCR mental health is run by psychologists, not NPs.

 

[Atreides]

Another point, CDCR's hiring practices are completely dysfunctional. I had a friend, forensic trained, who applied for two different CDCR positions via the official route. They never got back to him, despite obviously having plenty of positions open. He ended up responding to a lucrative locums offer.....that placed him in one of the facilities he had applied to but was "vacant." Ended up making more money doing the same work (minus the benefits, of course).

 

[Merovinge]

I know the AIMS is standard of care. I get that. I'm just questioning if it should be. I once asked the pharma company reps from companies that had developed all these TD drugs if any of the scales they used in their studies were subjective, as in the patient reporting how much they noticed the symptom or being impaired it. Not a one. All of them were AIMS like instruments. I've yet to see any studies on TD that focus on patient's own reports. This seems really weird in mental health. It's been rare that I've had a patient with TD (already quite rare) who reported it bothering them or that they even noticed it. Families or other providers might notice it, but it just doesn't seem to be a problem for patients. I do often wonder who we are treating with the AIMS or tetrabenazine analogs, it seems mostly ourselves.

I am just going to file this away as something only a psychiatrist could say. We demand more subjective measures, down with objective findings!

But in all seriousness, a significant number of patients that are actually struggling with TD (so have had a high antipsychotic burden) are not going to be reliable narrators. I am very glad they found a way to make the AIMS as reliable and objective as possible. If only I didn't need to perform it on a 16 year old taking 6 months of Abilify for a severe depressive episode and then being titrated off, but that's another talk show.

 

[FN9]

Examples of the power trips? Are there midlevels you have to interact with?

social workers who are usually head of units/supervisors are the worst, psychologists tend to be better and defer to psychiatrists on their decisions, social workers have no understanding of a physician's work and if you get a micromanager or someone on a power trip, they will make it unpleasant, second guessing how often you see the patient, why you admit/discharge, even medication decisions, adding meeting after meeting with no purpose etc.

Most non medical people are great but all it takes is one or two people and you will not care how much they pay you. These dynamics happen everywhere in life but are very amplified in CDCR for some reason and when you are cut off from the world and as someone said working with cluster Bs, it wont take long to say enough is enough, that is why the turn over is huge, they cant keep doctors long term if their life depended on them even as they pay some of the highest salaries and per hour 1099 rates, its just not worth it most of the time.

 

[Stagg737]

Very interesting! Thank you for the impromptu QA of the day. I'm gonna start doing that now. I have a handful of patients maintained on antipsychotics.

Update for this.

One of my patients who has been on LAI for 6-7 years just informed me they’ve been having a new tremor for the past 5-6 months. I’d been helping manage their Parkinsonism which we previously resolved, but from what she was able to show me via tele this movement is different and looks more consistent with possible TD. Called FM and they’re not comfortable with AIMS, so we’re referring her to a neurologist for exam and possible management of new TD. I decreased LAI dose slightly, but last time it was stopped she was in and out of the state hospital for 6 months getting stabilized. Wish I could see them in person, but they live 6 hours away.

Relevant because if patient hadn’t asked their pharmacist who told them to ask me, I wouldn’t have known. Holding their arm up to the camera it was really obvious though. Great example of things missed via telehealth that would never be missed in person (by a decent doc).

 

[brosa]

I have the opposite example actually. Had a patient stable on a first generation (forgot which one, let's say Risperidone) with TD. I did not want to change because symptoms were mild, but attending wanted it. We changed to Abilify, pt started having AH again, which bothered he. Pt had good insight btw. Then we switched to something else, again worsening symptoms.

At this point patient voiced directly to my attending that she hated all these changes, said she had only even mentioned the tremors because a family member told her to talk about it. She said they never bothered her and said we appeared more bothered than her (I thought that was funny lol), asking to go back to the first med. We went back and she kept living well with a small tremor.

 

[Stagg737]

I have the opposite example actually. Had a patient stable on a first generation (forgot which one, let's say Risperidone) with TD. I did not want to change because symptoms were mild, but attending wanted it. We changed to Abilify, pt started having AH again, which bothered he. Pt had good insight btw. Then we switched to something else, again worsening symptoms.

At this point patient voiced directly to my attending that she hated all these changes, said she had only even mentioned the tremors because a family member told her to talk about it. She said they never bothered her and said we appeared more bothered than her (I thought that was funny lol), asking to go back to the first med. We went back and she kept living well with a small tremor.

It’s a risk/benefit conversation. Tremor may not be TD. My patient previously had tremors that we treat with low dose clonazepam and it works really well for her (was falling and having memory issues with anticholinergics).

New tremor is more consistent with TD and has gotten much worse in 6 months. I don’t want to change her antipsychotic as she had a horrible decompensation when she came off it last time, but this tremor is very distressing to her and worsening. So again, gotta weigh the risks and benefits.

 

[joshmir]

I have friends that work at CDCR

I heard that the reason that there are so many Psychiatrists is because the prisoners have nothing to do all day, so they file tons of lawsuits, and it’s much easier for the government to refute the lawsuits by pointing to the fact that the inmate has had care by a provider with the highest level of training

And that is a greater driver of the salaries than simple supply, demand economics

Two suicides among the Psychiatrist working there while my ex was there

I saw the toll the constant hypervigilance took on my friends who are providers there

And some of them were scared to leave and go into the real world after being in an artificial scenario for so long

As an MD friend of MDs and psy Ds who work there, I really recommend trying your best to find an alternative, but if someone tries it and they like it, maybe a different story.

 

[Pumpkin1234!]

I have friends that work at CDCR

I heard that the reason that there are so many Psychiatrists is because the prisoners have nothing to do all day, so they file tons of lawsuits, and it’s much easier for the government to refute the lawsuits by pointing to the fact that the inmate has had care by a provider with the highest level of training

And that is a greater driver of the salaries than simple supply, demand economics

Two suicides among the Psychiatrist working there while my ex was there

I saw the toll the constant hypervigilance took on my friends who are providers there

And some of them were scared to leave and go into the real world after being in an artificial scenario for so long

As an MD friend of MDs and psy Ds who work there, I really recommend trying your best to find an alternative, but if someone tries it and they like it, maybe a different story.

Do you know if such lawsuits ever become successfully litigated against the MDs. I imagine it would be very difficult to say MDs provided gross negligence etc if they didn’t. Does it just come down to over documenting CYA language?

I ask because I’m considering CDCR as I’m interested in forensics and debating between LA county jails vs SoCal CDCR sites. So I would love to hear of any other insights you may have heard from your friends.

Like is there a stereotype of which sights are better, is it paper charts or EMRs, inpatient vs outpatient work, scheduling, work life balance of in person vs tele days, honestly any details as information is limited and I feel like the recruiters only say the things you want to hear.

Thanks!

 

[FatherPsychiatry]

Do you know if such lawsuits ever become successfully litigated against the MDs. I imagine it would be very difficult to say MDs provided gross negligence etc if they didn’t. Does it just come down to over documenting CYA language?

I ask because I’m considering CDCR as I’m interested in forensics and debating between LA county jails vs SoCal CDCR sites. So I would love to hear of any other insights you may have heard from your friends.

Like is there a stereotype of which sights are better, is it paper charts or EMRs, inpatient vs outpatient work, scheduling, work life balance of in person vs tele days, honestly any details as information is limited and I feel like the recruiters only say the things you want to hear.

Thanks!

I only have experience with the LA County Jails (as a psychiatrist, not an inmate as of yet), so happy to answer any questions about working here. I have several colleagues here that have worked for So Cal CDCR sites in the past (Lancaster, and CIW) and they like it here more, but I can't comment specifically on them. You're asking good questions - recruiters truly know very little about anything relevant, from what its like working here, or even what you will be paid, so its best to talk to people that work there to get the real info.

Regarding lawsuits, more common in prison by far vs jails (prison is longer stays, typically more higher functioning inmates). However, even then, the risk is a bit overblown IMO.

 

[Pumpkin1234!]

I only have experience with the LA County Jails (as a psychiatrist, not an inmate as of yet), so happy to answer any questions about working here. I have several colleagues here that have worked for So Cal CDCR sites in the past (Lancaster, and CIW) and they like it here more, but I can't comment specifically on them. You're asking good questions - recruiters truly know very little about anything relevant, from what its like working here, or even what you will be paid, so its best to talk to people that work there to get the real info.

Regarding lawsuits, more common in prison by far vs jails (prison is longer stays, typically more higher functioning inmates). However, even then, the risk is a bit overblown IMO.

If you don’t mind me asking, what type of work do you do in the LA jails (inpatient vs urgent care vs clinic format etc). What your average day is like (patient load, notes, admin work. How strict are they will work hours (is it like prison where you have to be there the full 40 hours onsite or can you round and go earlier or have WFH days). Are certain sites more burnout heavy etc. Also, cell phone policy for doctors?

Honestly, anything you think you wish or knew earlier pros and cons. I’m familiar with California laws as I trained here so that’s nothing new.

Feel free to DM me if you would prefer private. Thanks!

 

[annoyedpsychiatrist]

working in the outpatient section of a medical prison during residency was super easy. Usually no show rate was 30-50% in the outpatient section. many just wanted medications to sedate themselves. Notes were hand written and basicallly useless. There was no standard of care which was sad, so doing a decent job put you way ahead of everyone else.

you really had limited options on what you could prescribe which sucked but that reduced drug seeking at least.

you dont have to worry about patient reviews.

it was boring for sure. at times and seemed to drag on. And i couldnt order food delivery, which sucked.

 

[FatherPsychiatry]

If you don’t mind me asking, what type of work do you do in the LA jails (inpatient vs urgent care vs clinic format etc). What your average day is like (patient load, notes, admin work. How strict are they will work hours (is it like prison where you have to be there the full 40 hours onsite or can you round and go earlier or have WFH days). Are certain sites more burnout heavy etc. Also, cell phone policy for doctors?

Honestly, anything you think you wish or knew earlier pros and cons. I’m familiar with California laws as I trained here so that’s nothing new.

Feel free to DM me if you would prefer private. Thanks!

Sure. Each jail (even in this system) is very different. Generally, for most of us, which is "outpatient level of care", the expectation is one hour per patient. Since most of us do 10 hours days, four days a week, this would be 10 patients a day. Many of us work in the high observation area so even though its "outpatient", many of the patients are smearing feces, yelling, banging, hostile, so would qualify for inpatient psych, but there are only so many beds. No real admin work, meetings etc, but our supervisors are generally good and handle all that stuff. No after hours call (supervisors handle that). Hours are strict - need to clock in and out, so can't leave early if you finish your work, but at least here, what happens between those two times is mostly up to you. We get one WFH day a week, seeing less acute patients (12 patients) through a telehealth system. No cell phones in the secure area of the jail, but in some of the jail facilities, the psychiatrists' office is outside the secured part so we have our phones.

What I wish I knew earlier - not much - I rotated here as part of fellowship so I had some familiarity with how things worked already. What I learned about these settings is: a big part of your experience is who your supervisor is and what they're like. I got lucky and ended up with a great supervisor, and it taught me that if I were to look for another job at some point, I would try to talk to the staff that actually work there, and try to get into an area with a good supervisor.

 

[Pumpkin1234!]

Sure. Each jail (even in this system) is very different. Generally, for most of us, which is "outpatient level of care", the expectation is one hour per patient. Since most of us do 10 hours days, four days a week, this would be 10 patients a day. Many of us work in the high observation area so even though its "outpatient", many of the patients are smearing feces, yelling, banging, hostile, so would qualify for inpatient psych, but there are only so many beds. No real admin work, meetings etc, but our supervisors are generally good and handle all that stuff. No after hours call (supervisors handle that). Hours are strict - need to clock in and out, so can't leave early if you finish your work, but at least here, what happens between those two times is mostly up to you. We get one WFH day a week, seeing less acute patients (12 patients) through a telehealth system. No cell phones in the secure area of the jail, but in some of the jail facilities, the psychiatrists' office is outside the secured part so we have our phones.

What I wish I knew earlier - not much - I rotated here as part of fellowship so I had some familiarity with how things worked already. What I learned about these settings is: a big part of your experience is who your supervisor is and what they're like. I got lucky and ended up with a great supervisor, and it taught me that if I were to look for another job at some point, I would try to talk to the staff that actually work there, and try to get into an area with a good supervisor.

Thanks! Super helpful

That doesn’t sound too bad. I’m insurance based outpatient right now and am tired of the admin associated with it. I also have a small private practice and although that’s nice, I just want one main gig and my community psych experience in residency has always been easier for me tbh. I prefer inpatient work but LA options are limited for inpatient.

Recently discovered correctional pay is so much higher than I thought and I can just live off of one main job if I were to do correctional. The trade off is the 3/10s being locked up literally haha and doesn’t seem too flexible compared to other jobs.

I guess I have three more questions for now.

Do you feel like your days are exhausting and you have no energy when you get home given the 10hr shifts in jail?

For the 1 day WFH, are you just mindlessly sitting at your computer waiting for 1 patient per hour or can you churn through them super fast and just be done?

Also for recruitment, how are things for full time positions these days? Which sites seem more popular than others? Or which are more in need because they’re burnout heavy?

 

[TexasPhysician]

For the 1 day WFH, are you just mindlessly sitting at your computer waiting for 1 patient per hour or can you churn through them super fast and just be done?

One of the more agitating things for me about prison work is that it is extremely inefficient. A prison can go into “lockdown” in which no one is able to move around. There are limited guards. When some prisoners are being transported for other reasons, your guard can’t transport your patient back to the cell or get a new patient. There isn’t enough guards and space to line up patients safely to increase efficiency. Your guard has no incentive to increase efficiency. If anything, the system incentivizes them to move slowly. Safety is of highest importance, so everything is scrutinized and delayed to ensure protocols are met.

 

[clement]

Another point, CDCR's hiring practices are completely dysfunctional. I had a friend, forensic trained, who applied for two different CDCR positions via the official route. They never got back to him, despite obviously having plenty of positions open. He ended up responding to a lucrative locums offer.....that placed him in one of the facilities he had applied to but was "vacant." Ended up making more money doing the same work (minus the benefits, of course).

This was my personal experience. Over the span of my career, I’ve been treated like a very desirable candidate at institutions I’ve applied to (academic, county, corporate pyramid etc). I was surprised that the CDCR came on really strong and then “cancelled” the position hours after sending interview dates. They later came back and offered the same position on a limited term capacity (12 months but *can* become perm ). On this forum people were guessing that telework is just competitive- but I suspect it’s a funding thing and that they’re gauging whether these positions are worth keeping in the post COVID era. The few times I looked at tele with them over the years, their hiring practices indeed seemed mercurial. I will say these positions seem to be supervised by psychiatrists.

 

[FatherPsychiatry]

I guess I have three more questions for now.

Do you feel like your days are exhausting and you have no energy when you get home given the 10hr shifts in jail?

For the 1 day WFH, are you just mindlessly sitting at your computer waiting for 1 patient per hour or can you churn through them super fast and just be done?

Also for recruitment, how are things for full time positions these days? Which sites seem more popular than others? Or which are more in need because they’re burnout heavy?

1. not at all. I have small kids so i consider my weekend to be my days in the office 🤣. Yes the 10 hour day is long but a lot of the day is downtime especially if you're efficient, so if you like to read or yap on forums like I do, its actually kind of rejuvenating. But yeah, not as much as if I were to just finish the day at home (and not pick the kids up from daycare LOL)

2. At least for us, they just bring the patients in as soon as we finish the last one. the face to face for each patient can be anywhere from 3min to 15+ min, usually more often in the 5-10 minute range, especially if they're stable followups. I typically finish the face to face time within 2.5-3.5 hours, and most of the documentation is done within that also or between patients. Like TexasPhysician posted, there are things inherent to carcereal systems such as lockdowns, custody issues etc that might slow things down. A few weeks ago, I saw two or three patients, then suddenly the technician that rooms patients/sets up the video stopped responding for about an hour and a half. Turns out they found a shank on an inmate and went on lockdown, and there was no way to communicate that. Luckily we have Teams on our phone for communication, so I didn't have to be sitting at the computer the whole time waiting to find out when they were back up. That kind of lockdown isn't very common at least at my facilities (by far the longest I've had, but 5-10 minute delays are not uncommon), but every place is different.

3. Recruitment - used to be very desperate, but they hired a bunch over the past couple years so things slowed down. If you want full time employee position, you're in easy, probably to any of the facilities. I doubt they're allowing in any more contractors (in fact, they started letting some go).