How to explain and/or avoid explaining inpatient psych schedule to admin

[nexus73]

Let's say you're employed by a non-profit hospital doing an inpatient job seeing 10 patients per day. You come in at 8 and leave between 1pm to 3:30pm most days, but available by phone or to come back if needed, but that never happens. The hospital environment is very flexible, not a rigid clinic schedule, so some people get done earlier, some later, but you're working like 6 hours a day and getting median salary. How do you explain this to hospital admin when they try to compare you to hospital medicine working all day? Don't people know this is just how psych works? Some days are longer, but it's not uncommon to get paid full time and be out early afternoon.

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[SmallBird]

Let's say you're employed by a non-profit hospital doing an inpatient job seeing 10 patients per day. You come in at 8 and leave between 1pm to 3:30pm most days, but available by phone or to come back if needed, but that never happens. The hospital environment is very flexible, not a rigid clinic schedule, so some people get done earlier, some later, but you're working like 6 hours a day and getting median salary. How do you explain this to hospital admin when they try to compare you to hospital medicine working all day? Don't people know this is just how psych works? Some days are longer, but it's not uncommon to get paid full time and be out early afternoon.

Volume is benchmarked, and so they shoudlnt give you more patients without more money. It is more difficult if hospitals decide they want a physician there in the afternoons for some reason. When we encountered this at one hosptial, we told them yes, and then divided it up so each doctor had one late day to work on other things till 4pm and the hospital had the coverage they wanted.

 

[Sushirolls]

"Things are different in Psych." Leave it at that.

"You change my work requirements then we change my contract." "I will be paid extra for being onsite, and for being idle. Time is money."

Be ready to walk if they get snarky...

 

[psychmd03]

When I left the VA I said partly was because I sat around for 4 hours with nothing to do they asked if I wanted more to do. I asked if they’d pay me for more…….they looked confused. Safe to say I left where if I worked more I got paid more. Don’t do more work for free. Stand your ground it’s not your fault some days are quicker than others.

 

[whopper]

Some days are longer, but it's not uncommon to get paid full time and be out early afternoon.

Depends. Some jobs are easy. Others aren't. I don't see a common barometer where it's all easy everywhere. The state job I had-it was easy. I was pretty much done by noon if I started 9 AM, but it paid crap, you were surrounded by physicians and nurses who weren't doing a good job etc.

 

[comp1]

So...how do they even know if you are physically on site or not? Is somebody looking for you? How did this topic even get raised? Also, is the job more geared towards having a certain number of patients you carry or a certain number of hours you work? You lead with the number of patients, so I thought the former, but perhaps your bosses think the latter? A lot of places, like the VA, care a great deal more about the hours than the number of patients. They don't collect revenue directly, so your RVUs aren't important. Having someone immediately available is important and having at least some minimal coverage when people call out sick or on vacation is even more important. Thus, there will be times of feast and times of famine in terms of workload. This all doesn't matter a lot for outpatient because patients=hours there and outpatients can be cancelled, but inpatient can be very different which can make it super attractive. If your facility is billing directly, I'm not sure why they would care where you are unless there are other parts of your job like seeing new admissions or consults in the afternoon that end up pushed to the evening person?

 

[Candidate2017]

Why are they comparing psychiatrists to IM hospitalists? We admit patients, round, and then leave to see our outpatients, answer pages, and/or golf. Although this is the physician model, many employed clinicians still follow it.

However, it is 100% understandable for The Man to seek to impose typical employee requirements on you because you are employed. It's up to you to insist you are a physician despite signing an employment contract. Your mileage will vary depending on leverage. If you choose to abandon the professional independence of our elders and take up the yoke of employment, then you must serve two masters, medicine and The Man.

 

[FlowRate]

Is this actually happening or are you contingency planning?

 

[whopper]

How do you explain this to hospital admin when they try to compare you to hospital medicine working all day? Don't people know this is just how psych works?

Tell them psych is BS and you shouldn't be expected to work for real, while having a dreadlock hairstyle, wearing a Chavez t-shirt.
Of course you shouldn't do that, but if you tell them "this is how psych works" as if it's supposed to be easy, I wouldn't be motivated as a hospital administrator to give you big bucks.

 

[clausewitz2]

Tell them psych is BS and you shouldn't be expected to work for real, while having a dreadlock hairstyle, wearing a Chavez t-shirt.
Of course you shouldn't do that, but if you tell them "this is how psych works" as if it's supposed to be easy, I wouldn't be motivated as a hospital administrator to give you big bucks.

Do you mean Che?

 

[comp1]

I'm guessing whopper meant Che, unless he's recommending to unionize the inpatient attendings like the UFW.

 

[whopper]

Yes you are correct!

Or maybe Paulie Shore. Of how about a cannabis leaf on the t-shirt? Also don't shower that day and don't put on your deodorant.

 

[Merovinge]

All the hospitalists I know work 1/2 the days of the year, they sure better be working for more than 6 hours a day during their shifts or their jobs are unbelievably amazing, particularly off of a 3 year residency.

 

[clausewitz2]

I'm guessing whopper meant Che, unless he's recommending to unionize the inpatient attendings like the UFW.

Or nationalize their oil like Venezuela

 

[nexus73]

Is this actually happening or are you contingency planning?

Not happening yet. But had a comment from admin in a meeting several months ago about being available to admit patients until 7 pm (as in it's a 7on7off job, we expect you to work 7am to 7pm), to which I said no we don't stay just waiting for admissions, we have up to 24 hours to get admits done though rarely approach that limit. So 4pm admit or later likely rolls to next morning. BTW, found out today that IM hospitalists don't actually stay until 7pm, they leave when done and sign out to cross cover person, and this administrator 100% knows it because they're IM trained and are all over the hospitalist group and how they function.

Tell them psych is BS and you shouldn't be expected to work for real, while having a dreadlock hairstyle, wearing a Chavez t-shirt.
Of course you shouldn't do that, but if you tell them "this is how psych works" as if it's supposed to be easy, I wouldn't be motivated as a hospital administrator to give you big bucks.

I mean big bucks, it's median salary not a $400K job. But for median pay it is a pretty good job. We are probably the lowest paid doctors in the hospital after peds.

All the hospitalists I know work 1/2 the days of the year, they sure better be working for more than 6 hours a day during their shifts or their jobs are unbelievably amazing, particularly off of a 3 year residency.

The tradeoff is you work every other weekend which does not work for many people, especially with kids. Interestingly our outpatient docs (this is not just psych but across all non surgical specialties) work a 4 day week which is considered full time, plus vacation and holidays off if the clinic is closed. Half the days of the year is a 3.5 day week.

 

[whopper]

Hate saying it but you and they are getting what they paid. If you can end early they're likely wise to the job not needing to pay much, but if this is the case, then certainly adding responsibilities should merit more pay.

 

[comp1]

Okay, yeah, the OP is being paid for a set work schedule. Yes, they expect you to be available to admit. I fully understand the standard of care is within 24 hours and I support that. It's not particularly relevant here, however, as the OP is not a contractor. The OP is being paid for a standard work schedule. That means they do the work if it comes in during their schedule. There is a benefit to the doctor immediately seeing the patient and putting in orders or heck even discharging the patient if it was inappropriate. There's also definitely a benefit to having the doctor on site for nurses to reach out in person. That's, specifically, what the hospital is paying for.

 

[Sushirolls]

Nurses can use a phone and page. Doesn't require onsite.

 

[Stagg737]

But had a comment from admin in a meeting several months ago about being available to admit patients until 7 pm (as in it's a 7on7off job, we expect you to work 7am to 7pm), to which I said no we don't stay just waiting for admissions, we have up to 24 hours to get admits done though rarely approach that limit. So 4pm admit or later likely rolls to next morning.

Wait, is this 7/7 as in work 7 days and then off 7 days or a schedule from 7am to 7pm, because 7 on/7 off means days you're working, not time of day like the bolded implies...

I'm confused by the info you're giving, what do you mean by "up to 24 hours to get admits done"? I think it's completely reasonable that a 4pm admit can wait to be seen for the H&P until the next morning, but it's not reasonable to wait to accept the patient and actually place admit orders. To be placed in a room at a hospital, orders need to be in. That's a CMS regulation and technically the patient is not considered an inpatient until your order is placed. No, you don't need to be on site for that, but you do need to be available during the hours you're contracted for to place the order like you said in the OP.

The tradeoff is you work every other weekend which does not work for many people, especially with kids. Interestingly our outpatient docs (this is not just psych but across all non surgical specialties) work a 4 day week which is considered full time, plus vacation and holidays off if the clinic is closed. Half the days of the year is a 3.5 day week.

How long are those days though? If 40 hours if FTE, then working 4 days at 10 hrs/day instead of 5 days at 8 hrs/day is equivalent FTE. Standard FTE is ~260 days per year at 8 hrs/day, so ~2,100 hrs/yr. So working 3.5 days a week comes out to a full day being 11.5 hours. If it's production-based pay, then time doesn't matter at all other than what you agree to cover in your contract.

 

[comp1]

I mean you can do an entire inpatient job virtually. That doesn't negate the benefits of being on site during your given shift time.

 

[nexus73]

Wait, is this 7/7 as in work 7 days and then off 7 days or a schedule from 7am to 7pm, because 7 on/7 off means days you're working, not time of day like the bolded implies...

I'm confused by the info you're giving, what do you mean by "up to 24 hours to get admits done"? I think it's completely reasonable that a 4pm admit can wait to be seen for the H&P until the next morning, but it's not reasonable to wait to accept the patient and actually place admit orders. To be placed in a room at a hospital, orders need to be in. That's a CMS regulation and technically the patient is not considered an inpatient until your order is placed. No, you don't need to be on site for that, but you do need to be available during the hours you're contracted for to place the order like you said in the OP.


How long are those days though? If 40 hours if FTE, then working 4 days at 10 hrs/day instead of 5 days at 8 hrs/day is equivalent FTE. Standard FTE is ~260 days per year at 8 hrs/day, so ~2,100 hrs/yr. So working 3.5 days a week comes out to a full day being 11.5 hours. If it's production-based pay, then time doesn't matter at all other than what you agree to cover in your contract.

It is 7 days on 7 days off, and expectation to be available to physically come in from 7 am to 7pm on days you're working for emergent needs. Admin was suggesting we stay in house full 12 hours 7a-7p, regardless of need, in case an admit arrived in the late afternoon or evening, and we would be expected to see them for H&P.

24 hours to see the patient and have H&P in the chart. Accepting the patient, admit orders, restarting meds, etc are done on the fly any time of day or night if on call.

 

[Stagg737]

It is 7 days on 7 days off, and expectation to be available to physically come in from 7 am to 7pm on days you're working for emergent needs. Admin was suggesting we stay in house full 12 hours 7a-7p, regardless of need, in case an admit arrived in the late afternoon or evening, and we would be expected to see them for H&P.

24 hours to see the patient and have H&P in the chart. Accepting the patient, admit orders, restarting meds, etc are done on the fly any time of day or night if on call.

That makes more sense. If they're looking at this as a time-based thing with FTE being yearly hours, then technically working 7 days straight for 12 hours a day comes out to FTE (~2,100 hrs/yr). Being physically present at all hours isn't standard in psych though. Ask them why you should physically stay the whole shift if they don't have in-house overnight call (I'd be shocked if they do).

If they want to pull crap like comparing you to other fields though, ask them why ER docs working 12-15 shifts per month that are 10-12 hours (so anywhere from 1,440-2,160 hrs/yr) average $350-$375k/yr and when you can expect your raise.