Going into Psychiatry but have little patience...

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jack.jaret

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I was previously going to pursue Trauma Surgery. However, I fell in love with my Psychiatry rotation. It was by far the only rotation that I didn't mind going to + easiest to interact with patients + most interesting + the list goes on and on. However, I still have the "surgeon metnality." In other words, I'm very quick with patients. 10 minutes with a patient is ideal for me. How much will this hurt me?
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LOL if this is not a troll: you're the ideal insurance cashcow RVU PP guy, who will make 1MM a year doing 10 min psychopharm visits. 6x$175 (99213+90833) *20 hours a week * 48 weeks = 1MM. Bam!
 
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It really sounds like you'll be a bad psychiatrist. Interesting patients are less common than bread and butter ones, and you'll probably never really get to the heart of your patient's problems if you can only stand them for ten minutes. There is a reason a standard intake is nearly an hour.
 
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With new patients that's really bad news. If you can't spend at least 30 minutes with your patients there's no way you're going to get the info you need, and that's only if they're straightforward and cooperative with questions. Good luck with the cooperative but circumferential patient with delirium/psychosis, I literally spent an hour with one last week and only asked 4 questions...

For follow-ups in PP it's more reasonable. Had more than a few patients I saw who were stable and just there for their 3 month visit to get their scripts re-filled. Obviously you'll need to spend more time with some of them, especially if they're showing symptoms that may send them inpatient, but on my PP rotation I saw a lot of patients who only needed about 5 minutes of conversation about their actual condition and then just chatted for another 10 minutes or so.
 
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Now everyone, JJ asked how much this would hurt him/her. The answer is not at all. It will not be good for patients however.
 
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On the one hand you say that you like the interactions with patients, but on the other you say that you prefer the limited interactions that a surgeon would have. I actually can relate somewhat as I also enjoy briefer interventions and am frustrated that I have to see someone for 18 minutes before I can bill for my services. If you are fine with the necessary longer interactions for intakes and such, then the 10 minute follow-ups will be no problem for you.
 
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Am currently on an inpatient geriatric unit, and approximately half of my list is a very well-tended rock garden of people who really don't need to be inpatient but definitely do need to be placed somewhere else long term. These people are either extraordinarily stable from a psychiatric perspective or are very demented and nonverbal. For these people, ten minutes on the daily may even be a bit too long. Likewise, when my list was all profound catatonia all the time, after the first few neuro examinations and catatonia assessments, ten minutes is about right as interview is not really happening and it is more a matter of checking on whether ECT is helping very much.

I can't imagine spending only ten minutes with someone who actually has meaningful psychiatric symptoms, though, and the capacity to talk about them. OP, I guess my question to you is: what do you find interesting about your patients on your rotation? Whatever it is, do you only discuss it if patients bring it up? If so, why don't you ask everyone about it?
 
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sluox said:
LOL if this is not a troll: you're the ideal insurance cashcow RVU PP guy, who will make 1MM a year doing 10 min psychopharm visits. 6x$175 (99213+90833) *20 hours a week * 48 weeks = 1MM. Bam!
Click to expand...
90833 requires at least 16 minutes in addition to some time spent in the E&M component.
 
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Many employers expect you to see patients every 15 minutes.
I think you would fit in.
 
sluox said:
LOL if this is not a troll: you're the ideal insurance cashcow RVU PP guy, who will make 1MM a year doing 10 min psychopharm visits. 6x$175 (99213+90833) *20 hours a week * 48 weeks = 1MM. Bam!
Click to expand...

That's a good way to get into a lot of trouble. Can't bill 90833 with 10 min visits.
 
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You should be ok.

This about it this way:

Instead of providing really good care to a few patients, you provide mediocre care to many patients. Which is better depends on your point of view.
 
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One of the biggest learning curves I needed to adjust from was not taking all the issues at once with each appointment. It's ok to identify them and work on them one by one. There is no rush.
 
jack.jaret said:
I was previously going to pursue Trauma Surgery. However, I fell in love with my Psychiatry rotation. It was by far the only rotation that I didn't mind going to + easiest to interact with patients + most interesting + the list goes on and on. However, I still have the "surgeon metnality." In other words, I'm very quick with patients. 10 minutes with a patient is ideal for me. How much will this hurt me?
Click to expand...

the times when a new pt interview for me is <10 mins (real example)
"so whats been going on, I hear today has been a little rough?"
"its top secret"
"Ok, can you tell me your name?"
"its top secret"
"so you were in the military then?"
"its top secret"
"hmm..anything you'd like to tell me today?"
"no. its top secret"

progress note: Pt answers every question with "its top secret". Will need further collateral information.
 
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I'm no analyst (not a doctor or medical student etc), but I wonder if it's possible that this 10-minute thing you like is a defense mechanism regarding your ambivalence toward psychiatry or wanting to control it rather than it controlling you. Or ambivalence toward your future more generally. It's not necessarily an unhealthy one. As a fantasy it's nearly realistic (and kind of is): "If only these 15 minute med-checks were 5 minutes shorter, I could envision my future."
 
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I suggest pathology, then you never have to talk to patients.
 
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do you have little patience (i.e. empathy) or little attention? The former would mean you are totally unsuitable to psychiatry, the latter is something you can work on (r/o ADHD etc). OTOH it maybe you have little patience because you overly identify with patients and find it too overwhelming to sit with that level of affect for longer than a short space of time. This too is not insurmountable, but requires you to work through whatever issues you have (which you've previously alluded to) before and during embarking on this career path.
 
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Is it common for inpt followups to get more than 10 min of psychiatrist time each encounter? They generally get less at my program/all the programs I've rotated at.
 
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MrChance2 said:
Is it common for inpt followups to get more than 10 min of psychiatrist time each encounter? They generally get less at my program/all the programs I've rotated at.
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I will spend 30 minutes+ with inpatients where necessary (or if they are interesting). But maybe this is why I suck at inpt moonlighting. Level 3 inpt billing on time is 35mins so it's not like this is not like you cant bill for it. The only reasons to spend less than 10mins with pts is because you're not doing anything for them (e.g. awaiting placement), they refuse to engage, they are too psychotic, or they are too depressed/manic/disorganized/behaviorally dysregulated to cope with it. If you are on a Psych ICU then probably none of your visits will be 10mins. If you're working on a personality disorder unit then most of your visits will likely be 20 mins+. Also more inpt units are working to incentivizing satisfaction which can be improved if pts and families feel you are investing appropriate time in them. I see inpt units are horribly toxic places and it is often extremely traumatic for patients to find themselves in such environments. If the patient is with it enough to understand what's going on, then they deserve some of my time, otherwise what is the point of them being there.
 
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sluox said:
LOL if this is not a troll: you're the ideal insurance cashcow RVU PP guy, who will make 1MM a year doing 10 min psychopharm visits. 6x$175 (99213+90833) *20 hours a week * 48 weeks = 1MM. Bam!
Click to expand...

what kind of set up pays 175 for a 10 min visit? cash pay?
 
to expand - what sluox was suggesting (was a joke i assume) would constitute fraud in an insurance practice as explained above to use the 90833 psychotherapy add-on code you would have to spend at least 16minutes in addition to the E&M portion - i.e. bare minimum visit length of 20 minutes. In a cash practice people pay for convenience and to spend MORE time with their therapist, not less. The only way you'd have a viable cash practice doing 10 min visits is if you're the local candy man dishing out benzos, stimulants, and suboxone no questions asked.
 
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This is one of the stupidest things I've ever seen and I am dumber for having read it. Don't blame your laziness and lack of respect for people on a 'surgeon mentality'.

My surgeons both spend more than 10 minutes with me every time I see them. They dont have to. They just care about their patients.

For that matter, peds surg and burn surg were the two non-psych groups who have been most enthusiastic about improving c/l services. The burn surgeon is actively collaborating with me on a PTSD project. In fact, it was his idea.

Please for the love of all that is good in this world go path or rads
 
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jack.jaret said:
I was previously going to pursue Trauma Surgery. However, I fell in love with my Psychiatry rotation. It was by far the only rotation that I didn't mind going to + easiest to interact with patients + most interesting + the list goes on and on. However, I still have the "surgeon metnality." In other words, I'm very quick with patients. 10 minutes with a patient is ideal for me. How much will this hurt me?
Click to expand...

It will hurt you a lot.
 
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I was going to answer this, but in all honestly I have to take this as you being serious about considering psychiatry as a career. In which case, you need to get some answers from people in your med school who have worked with you clinically and particularly in psychiatry. Most people are offering tongue-in-cheek responses to potential productivity, but reality is that many providers do have integrated practices or inpatient units with a large degree of administrative support and spend little time with established patients.
 
While I appreciate your candor/inquiry (and the sweet, sweet anonymity of the interwebs) you should NEVER ever say this outloud...In your career, you will encounter many different physicians. Some of them good/bad, some hate their job/others live to work. HOWEVER, even the most short-tempered surgeon or schizoid pathologist will say a)that they do it to help people b) that they will take as much time as necessary to do their job correctly (including talking to patients :vomit::vomit::vomit:- jk jk). Whether they genuinely believe in this/actually follow-thru is neither here nor there. Our vernacular is now full-blown PC (we even invented the euphemistic treadmill-yay!). So as soon as you start to meditate on parts a/b above (via TM, natch) the easier whatever field you go into will be. Saying you've got only 10 minutes of patience (the amount of time it takes to watch the before of a hgtv show...f that I only want to see afters!) sounds like you don't give a :spam:.

That being said...No matter what you go into, if you take your job seriously you will be shocked at how much you change and learn to adapt to less than ideal situations. Hell, you may even realize you like things like spending MORE time with patients (vs foley checks). Best advice i ever got--go into what you enjoy reading about. As someone who did psychiatry after finishing a road residency, it was worth it. And for the record, I would do it again.
 
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mopsych said:
While I appreciate your candor/inquiry (and the sweet, sweet anonymity of the interwebs) you should NEVER ever say this outloud...In your career, you will encounter many different physicians. Some of them good/bad, some hate their job/others live to work. HOWEVER, even the most short-tempered surgeon or schizoid pathologist will say a)that they do it to help people b) that they will take as much time as necessary to do their job correctly (including talking to patients :vomit::vomit::vomit:- jk jk). Whether they genuinely believe in this/actually follow-thru is neither here nor there. Our vernacular is now full-blown PC (we even invented the euphemistic treadmill-yay!). So as soon as you start to meditate on parts a/b above (via TM, natch) the easier whatever field you go into will be. Saying you've got only 10 minutes of patience (the amount of time it takes to watch the before of a hgtv show...f that I only want to see afters!) sounds like you don't give a :spam:.

That being said...No matter what you go into, if you take your job seriously you will be shocked at how much you change and learn to adapt to less than ideal situations. Hell, you may even realize you like things like spending MORE time with patients (vs foley checks). Best advice i ever got--go into what you enjoy reading about. As someone who did psychiatry after finishing a road residency, it was worth it. And for the record, I would do it again.
Click to expand...

if you're double boarded, can you update your SDN status to accurately reflect where you are in your studies? it's part of the TOS to represent yourself accurately in this regard and it helps people to weigh your advice. I assume it's just an oversight that your status still says MD/PhD student.
 
Crayola227 said:
if you're double boarded, can you update your SDN status to accurately reflect where you are in your studies? it's part of the TOS to represent yourself accurately in this regard and it helps people to weigh your advice. I assume it's just an oversight that your status still says MD/PhD student.
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Noted. I wasn't aware that was apropos to the topic at hand. Nonetheless, I'm genuinely flattered you took the time to check my online forum credentials. And since you're interested, I'm looking for someone who enjoys long walks on the beach, keeping up with the kardashians, and prix fixe sushi dinners. Only 6'2 and above please (no achondroplastic dwarfs need apply). Keep up the hardcore sleuthing, inspector clouseau. It's sexy.
 
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mopsych said:
Noted. I wasn't aware that was apropos to the topic at hand. Nonetheless, I'm genuinely flattered you took the time to check my online forum credentials. And since you're interested, I'm looking for someone who enjoys long walks on the beach, keeping up with the kardashians, and prix fixe sushi dinners. Only 6'2 and above please (no achondroplastic dwarfs need apply). Keep up the hardcore sleuthing, inspector clouseau. It's sexy.
Click to expand...

I'm a woman and I can't stand Kardashians, but if you're a speculative fiction fan we can compromise the tv, I'm sure. I like short walks on the beach and can eat sushi for breakfast. I'm 6'3" - but only in 7" platform stripper heels. If that works for you, slide into my DMs. ;)

It's become a pet peeve of mine when someone's status doesn't match their posts - particularly when they are uniquely qualified. That I singled you out was because I thought you were and I didn't want that lost on this forum. :)
 
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I believe it was Coco Chanel who said "a woman without stripper heels has no future." Into it.
 
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michaelrack said:
What is mopsych double boarded in? Md/PhD is double-degreeed.... I am double boarded (more if you count my subspecialties)
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it was implied in the post that they completed a psychiatry residency after a ROAD one, they might not be double boarded, I took liberties with the shorthand to say, you did 2 residencies, you ain't a student

michaelrack I would love to read your list
 
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michaelrack said:
What is mopsych double boarded in? Md/PhD is double-degreeed.... I am double boarded (more if you count my subspecialties)
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Who knew SDN is better than bumble. Dr. Rack (great last name--i guess breast surgery was too on the *nose* lol). Sorry to disappoint no md/phd here (crayola guessed it, I legit clicked the wrong item). My other specialty was anesthesia. Wasn't my cup of poppy tea ;) . I am not yet double boarded, taking the psych exam in a hot minute, but I promise you'll be the first to know. Do you like the kardashians? What about stripper heels?
 
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I think this thread has taken an unusually saucy turn. Mating rituals are fun but secondary. We all need to try and remember who the real victim is here--our OP, JJ. He could probably use a date.
 
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Crayola227 said:
it was implied in the post that they completed a psychiatry residency after a ROAD one, they might not be double boarded, I took liberties with the shorthand to say, you did 2 residencies, you ain't a student

michaelrack I would love to read your list
Click to expand...
Like crayola I would also love to see your rack...of accomplishments. lolololol (6th grade humor for the win!).
 
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No on the Kardashians. I am certified by the ABIM in internal medicine and sleep medicine. I am certified by the ABPN in psychiatry and Psychosomatics (I don't value this last one very highly). I do plan on going for the new addiction boards next year (through the preventitive board).
I am up to date in MOC points for everything and am taking the psychiatry and sleep recert exams later this year; we'll see how that works out.
 
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michaelrack said:
No on the Kardashians. I am certified by the ABIM in internal medicine and sleep medicine. I am certified by the ABPN in psychiatry and Psychosomatics (I don't value this last one very highly). I do plan on going for the new addiction boards next year (through the preventitive board).
I am up to date in MOC points for everything and am taking the psychiatry and sleep recert exams later this year; we'll see how that works out.
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Boy, you fancy. Have you considered going on the Bachelor? Also, did you know that if you switch to GEICO you can save 15% or more on car insurance?
 
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What in the actual **** happened to this thread...lolll
 
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Merely said:
What in the actual **** happened to this thread...lolll
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Maybe it's an example of how to deal with boring patients. Just go tangential and have fun with it. I seriously do that at times, although some of that is intentional to try to derail automatic cognitive patterns which is what really bores me. "My life sucks. Everyone hates me. I can't do anything right. Blah. Blah. Blah." :rolleyes:
 
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Trying to match into psych this year--unfortunately I can't do stripper heels. Maybe if I read about stripper heels???
 
sluox said:
LOL if this is not a troll: you're the ideal insurance cashcow RVU PP guy, who will make 1MM a year doing 10 min psychopharm visits. 6x$175 (99213+90833) *20 hours a week * 48 weeks = 1MM. Bam!
Click to expand...

How do you charge a 90833 in a 10 minute visit?
 
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