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[forchinet121]

Maybe I missed it in the thread you shared, but how exactly does one get started doing snf work?

He’s not a psychiatrist he’s physical medicine and rehab

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[ObsequiousAplomb]

That's just an exaggeration. If you can go a little smaller, 1500-2000 SQ ft you can live nicely for 1.5ish.

128 Little Oaks Rd, Encinitas, CA 92024 | Zillow

128 Little Oaks Rd, Encinitas CA, is a Single Family home that contains 2297 sq ft and was built in 1975.It contains 5 bedrooms and 3 bathrooms.This home last sold for $1,450,000 in October 2023. The Zestimate for this Single Family is $1,530,100, which has increased by $4,380 in the last 30...

www.zillow.com

1705 Gascony Rd, Encinitas, CA 92024 | Zillow

1705 Gascony Rd, Encinitas CA, is a Single Family home that contains 2262 sq ft and was built in 1979.It contains 3 bedrooms and 3 bathrooms.This home last sold for $1,946,500 in September 2023. The Zestimate for this Single Family is $2,067,600, which has increased by $2,127 in the last 30...

www.zillow.com

3638 Lorimer Ln, Encinitas, CA 92024 | Zillow

3638 Lorimer Ln, Encinitas CA, is a Single Family home that contains 2559 sq ft and was built in 1985.It contains 5 bedrooms and 4 bathrooms.This home last sold for $1,950,000 in November 2023. The Zestimate for this Single Family is $2,040,600, which has increased by $11,400 in the last 30...

www.zillow.com

And what a 5M house in Encinitas can look like. Obviously not west of the 5, but still Encinitas:

3427 Via Monteverde, Encinitas, CA 92024 | MLS #230023034 | Zillow

This 5337 square feet Single Family home has 5 bedrooms and 6 bathrooms. It is located at 3427 Via Monteverde, Encinitas, CA.

www.zillow.com

It's not an exaggeration, because I searched Zillow at the square footage in my post and gave the range. You then showed some smaller homes for less. Kinda silly.

Anyway, I'll also never live in CA. I also am a Midwest 4k+ square foot for $80-110 per square foot kind of person. I just haven't bothered moving there yet.

 

[Psychresy]

It's not an exaggeration, because I searched Zillow at the square footage in my post and gave the range. You then showed some smaller homes for less. Kinda silly.

Anyway, I'll also never live in CA. I also am a Midwest 4k+ square foot for $80-110 per square foot kind of person. I just haven't bothered moving there yet.

All of those homes were within the range you gave.

 

[sloh]

I’ll answer more in depth later when I have time but SNF work is accessible for you guys. There’s a lot of politics involved but if you get past that and have a good setup no other specialty has a better ROI for dollars earned per unit of time. I have to work closely with the rehab team. Without their help, I couldn’t do this. It’d be different for you guys though. You guys even mentioned it here:

Mid Career....left inpatient job...now what?

Mid Career....left inpatient job...now what?

Hello everyone, So I am about what I'd consider mid-career as a psychiatrist. Graduated in 2011, did a Geropsych fellowship for a year, and practiced full time from 2012 to 2018 doing outpatient work for a big box shop. It wasn't bad; wasn't really good though either. RVU Basis, and there...

forums.studentdoctor.net

 

[G Sheb]

I preferred SD to LA as well. Visited there several times and considered moving after residency. It's a big city that is more manageable than LA, so it seems to strike that right balance. Having said that, it's also less dynamic, and it will get kinda old and boring pretty quick. The ocean is beautiful but you can't swim in it for 10 months a year. If surfing is your thing, then yes, I guess it's more worth it.
As upper middle class, I'm just not sure if killing yourself for SoCal is that worth it. It's beautiful but there are drawbacks besides the cost. There are much, much better deals for a beach lifestyle if you are willing to think outside the box and move away from one of the economically active, dense and exorbitant areas in the world.

 

[psychmd03]

Maybe I missed it in the thread you shared, but how exactly does one get started doing snf work?

Generally two ways to get in as a psych doc it is certainly something you can do. You can know someone that works in them whether that is another psych doc or a general doc and have an in IE networking. or the other which is a bit harder cold calling basically. Most of them talk a lot so once you get in and working make a good impression and you can start to slide into more. It can be a lucrative deal to do. I know a handful that do this type of work and they do quite well normally do either a lot of nursing homes or cover few but have main jobs as well since you normally only see patients 1 to max 3x a week.

 

[Psychresy]

Generally two ways to get in as a psych doc it is certainly something you can do. You can know someone that works in them whether that is another psych doc or a general doc and have an in IE networking. or the other which is a bit harder cold calling basically. Most of them talk a lot so once you get in and working make a good impression and you can start to slide into more. It can be a lucrative deal to do. I know a handful that do this type of work and they do quite well normally do either a lot of nursing homes or cover few but have main jobs as well since you normally only see patients 1 to max 3x a week.

Thanks for the information. Do you know if you just bill medicare/insurance or does the facility pay you?

And does the facility determine who you need to see? As in, how do you actually determine who is a psych patient and who isn't?

 

[Merovinge]

I preferred SD to LA as well. Visited there several times and considered moving after residency. It's a big city that is more manageable than LA, so it seems to strike that right balance. Having said that, it's also less dynamic, and it will get kinda old and boring pretty quick. The ocean is beautiful but you can't swim in it for 10 months a year. If surfing is your thing, then yes, I guess it's more worth it.
As upper middle class, I'm just not sure if killing yourself for SoCal is that worth it. It's beautiful but there are drawbacks besides the cost. There are much, much better deals for a beach lifestyle if you are willing to think outside the box and move away from one of the economically active, dense and exorbitant areas in the world.

It either is or isn't for any one person, it's pretty hard to making any sweeping generalizations. It's not a great "deal" or "hidden gem" (obviously), but the culture, weather, access to outdoor activities (far more than just water based, lots of impressive hiking in the area) could matter much more to someone than FIRE or having a higher net worth when they die. You assuredly pay a sunshine tax, the question is do you get a lifestyle gain that you feel is worth it. Some people might prefer a bigger home, more vacations, fancier cars, and some might prefer So Cal living.

 

[G Sheb]

It either is or isn't for any one person, it's pretty hard to making any sweeping generalizations. It's not a great "deal" or "hidden gem" (obviously), but the culture, weather, access to outdoor activities (far more than just water based, lots of impressive hiking in the area) could matter much more to someone than FIRE or having a higher net worth when they die. You assuredly pay a sunshine tax, the question is do you get a lifestyle gain that you feel is worth it. Some people might prefer a bigger home, more vacations, fancier cars, and some might prefer So Cal living.

I totally agree. I mean I'm living in an area that is even more costly than SoCal, lol. I value my life now more than any kind of FIRE in 15 years.
I'm just saying from my perspective, I wasn't entirely sold on it (even though it was always a dream to live there as I grew up on the coast in similar weather).

A few things that people also didn't mention that are worth mentioning:
1) Earthquakes. The risk is real.
2) Fire hazard
3) Water problems
4) Don't underestimate UV. It's sunny and comfortable, but for some reason the UV absolutely burns you there. Quite a few of the locals have some of the worst skin I've seen. If you live there, you might actually want to avoid being out for long.

Could argue every area has stuff like this, but I think the situation in California when it comes to the environment/natural disaster is a bit more tenuous.

 

[sloh]

Thanks for the information. Do you know if you just bill medicare/insurance or does the facility pay you?

And does the facility determine who you need to see? As in, how do you actually determine who is a psych patient and who isn't?

You bill Medicare. If the facility has to pay you, it’s coming out of their pocket and they won’t want you there. You also need to sell your services in a convincing way that you can cut down on hospital readmissions, loop in PDPM diagnoses so the facility gets reimbursed more (often missed from OSH records), ease stress off nurses and staff (don’t go randomly slapping on schizophrenia diagnoses and snowing patients with antipsychotics though, CMS is onto this). Admin, medical director, and DON will usually weigh in on who they are willing to refer to you. For PM&R, the DOR has a significant say as well but you guys aren’t doing rehab.

Wrt determining who is a psych patient or not, how many patients in SNF’s don’t have a psychiatric diagnosis? Hahaha

There are also some SNF’s that are psych heavy. This wounld likely be a goldmine for you guys. One of my SNF’s is psych heavy and it’s quite interesting rounding there as PM&R lol

 

[forchinet121]

You bill Medicare. If the facility has to pay you, it’s coming out of their pocket and they won’t want you there. You also need to sell your services in a convincing way that you can cut down on hospital readmissions, loop in PDPM diagnoses so the facility gets reimbursed more (often missed from OSH records), ease stress off nurses and staff (don’t go randomly slapping on schizophrenia diagnoses and snowing patients with antipsychotics though, CMS is onto this). Admin, medical director, and DON will usually weigh in on who they are willing to refer to you. For PM&R, the DOR has a significant say as well but you guys aren’t doing rehab.

Wrt determining who is a psych patient or not, how many patients in SNF’s don’t have a psychiatric diagnosis? Hahaha

There are also some SNF’s that are psych heavy. This wounld likely be a goldmine for you guys. One of my SNF’s is psych heavy and it’s quite interesting rounding there as PM&R lol

How many patients on average do you see per day and how many days per week do you work

 

[psychemdoc]

You bill Medicare. If the facility has to pay you, it’s coming out of their pocket and they won’t want you there. You also need to sell your services in a convincing way that you can cut down on hospital readmissions, loop in PDPM diagnoses so the facility gets reimbursed more (often missed from OSH records), ease stress off nurses and staff (don’t go randomly slapping on schizophrenia diagnoses and snowing patients with antipsychotics though, CMS is onto this). Admin, medical director, and DON will usually weigh in on who they are willing to refer to you. For PM&R, the DOR has a significant say as well but you guys aren’t doing rehab.

Wrt determining who is a psych patient or not, how many patients in SNF’s don’t have a psychiatric diagnosis? Hahaha

There are also some SNF’s that are psych heavy. This wounld likely be a goldmine for you guys. One of my SNF’s is psych heavy and it’s quite interesting rounding there as PM&R lol

I’m curious how many psychiatrists have you seen doing this and are they sought after/appreciated for their services in these cases? Pmr makes sense to me round and go but patient selection and Psych takes more time with patients, etc. seems to me like it would be harder.

 

[TexasPhysician]

While it has been awhile since I looked into this, the last time I evaluated SNF’s they were absolutely not worth my time. Reimbursement was quite low per the amount of time required. I would take a pay cut to work there compared to generic outpatient. This may be a specialty difference.

 

[psychmd03]

Thanks for the information. Do you know if you just bill medicare/insurance or does the facility pay you?

And does the facility determine who you need to see? As in, how do you actually determine who is a psych patient and who isn't?

Two different models depending on facility. Some give you a monthly stipend 5-10k a month for 1-2 visits a week. Some where you are seeing more you would bill the insurance yourself with a biller and you’d generate a good chunk of money.

Depends on the facility. Some facilities are psychiatric nursing homes so you’d be primary. In SNFs or SAR it’s determined by the primary doc who needs to be seen. You’re like a CL service would be in a medical hospital.