Prison Job - Worth the Risks?

[jbomba]

So I've been talking to a recruiter and I've been told about a prison job in a state prison system. It will be locums, 1099. No benefits. 2 weeks off a year unpaid. No sick time. Luckily I have a spouse who gets healthcare and full benefits for us through her non-medical job. BUT, the pay is high. 4x10s seeing 10-15 patients a day, 12 month contract with option to renew, $335/hr. Works out to 670k a year. I would completely be able to pay off my 300k in student loans in one year. I'm sure the working conditions suck. I'm sure the staff are not good. I'm sure the formulary is limited. But at least the workload isn't unbearable and I'd have almost 40-60 min per patient if I wanted.

I also have lined up another job that's about 8 hours a week (spread over the week) for 140k a year. That would put me about 800k my first year out. I'm seriously considering taking this prison but I have a couple questions.

Might this be so bad that it's not worth the money? I really don't want to take a job and then bail on them within a couple of months.
Would taking this kind of correctional job right out of residency sully my reputation and look bad on a resume? I really have no idea so maybe this isn't an issue at all. Thanks for the input.

---

Members don't see this ad.

 

[Bartelby]

1- I do not think working in a prison will look bad on your CV. I would not worry about future employability concerns from having worked in a prison.

2- I doubt that safety will be the major concern. Often, prisoners who want to target prison staff prefer to target guards or others who they view as more antagonistic. In my experience (having done some work in a couple of correctional settings) patients are often appreciative that someone who actually seems to care has come to see them. With that said, be ready for drug seeking behaviors. If the prison has already established a culture of avoiding prescriptions with a higher risk for abuse, this mitigates the concern about drug-seeking somewhat (though be ready for drug seeking behaviors to switch to medications you might not suspect such as remeron, quetiapine, or gabapentin).

3- rather than safety concerns, I think the biggest concern has to do with what quality of care you will be able to provide. Occasionally correctional settings provide pretty good care, but in other instances you will find yourself significantly under resourced and you may need to participate in very low quality care. If something goes wrong, you of course can still face liability even if the system was not providing adequate support (and corrections can be a pretty litigious environment).

My overall take: if you are interested in the job, try to talk to some of the people who currently work there or who have worked there in the past. If they seem generally positive, give it a try. If you find that you are being forced to practice below your own standard of care, you should be ready to walk.

 

[DOBound2019]

A close attending of mine worked the prison system in Connecticut for years and if you talk to any psychiatrist who has worked in those settings they will tell it’s actually typically safer than most other inpatient places we practice if that helps.

 

[nexus73]

Many prison jobs are telepsych, so avoid entering the prison at all.

 

[adiradirim]

I did a prison psychiatry rotation in medschool. It will greatly depend on the security level of the prison on how you'll be seeing patients and the culture at the prison. Medium/low security prisons you will do visits where the patient will come to your office with a guard outside or inside the room. Supermax you will likely be talking to patients through a metal cage with plexiglass in a holding area with guards nearby. There will also be a "suicide watch" area where people will be sent which you will have to round on. You might be doing telehealth visits to other prisons.

The actual quality of care is not terrible and people get better due to having structure and a controlled environment. Patients will see you if they want and you will will know their exact medication adherence because the prison pharmacy will document how many days they picked up their meds and they do mouth checks to encourage them actually taking them. Formulary is limited so you will be using medications you might not have had much exposure to in the community, but that is good experience too. Prisons usually have a mental health team and a medical team which will be your immediate coworkers, but the rest of the employees will mostly be correctional officers. There is a lot of bureaucracy in prisons just like in hospitals.

However, it is not forensic psychiatry. You might have access and read forensic evaluations but your main job is treating mental illness. You will also see the full spectrum of mental illness. However, severe mental illness patients cannot be in supermax prisons in my state. Obviously you will see antisocial personality, malingering, and drug use too.

I hated the environment and did not like it enough to do more than the month, but the psychiatrist stationed there loved it. YMMV

 

[calvnandhobbs68]

I mean there’s a reason nobody’s taken this job yet at that hourly rate or they’ve had to jack up the rate to that level to get someone to consider the job (through a recruiter no less). You just have to figure out what that is and if you can tolerate it. But I’d highly suspect there’s some reason they can’t fill this job for 670k/year.

 

[FN9]

at that rate, its most likely CDCR, it should not be a problem working in the prison, develop good relations with the correctional officers and the nurses and its an easy job. Your biggest problem is getting from your car to where patients are seen, good 15-20 min walk but a good exercise

 

[TexasPhysician]

I didn’t particularly enjoy my prison experience. Some patients can be quickly agitated. Always be outside of arms reach and able to escape the room before they do. Guards are often just outside, but you need to get beyond them first.

Fair amount of manipulation and malingering. In summer, there is a psych inpatient unit with great a/c. Patients had incentive to get admitted.

 

[thepoopologist]

So I've been talking to a recruiter and I've been told about a prison job in a state prison system. It will be locums, 1099. No benefits. 2 weeks off a year unpaid. No sick time. Luckily I have a spouse who gets healthcare and full benefits for us through her non-medical job. BUT, the pay is high. 4x10s seeing 10-15 patients a day, 12 month contract with option to renew, $335/hr. Works out to 670k a year. I would completely be able to pay off my 300k in student loans in one year. I'm sure the working conditions suck. I'm sure the staff are not good. I'm sure the formulary is limited. But at least the workload isn't unbearable and I'd have almost 40-60 min per patient if I wanted.

I also have lined up another job that's about 8 hours a week (spread over the week) for 140k a year. That would put me about 800k my first year out. I'm seriously considering taking this prison but I have a couple questions.

Might this be so bad that it's not worth the money? I really don't want to take a job and then bail on them within a couple of months.
Would taking this kind of correctional job right out of residency sully my reputation and look bad on a resume? I really have no idea so maybe this isn't an issue at all. Thanks for the input.

Sounds like its worth trying. Also, don't worry about bailing on them. If they actually offered a decent workplace they wouldn't be offering you these rates because they would be retaining psychiatrists.

 

[untapped]

That's an impressive rate. Highest I saw was like 260 per hour for CDCR in Corona. As long as it's not physically dangerous, I would think it's worth trying at least for 1 year. I ended up taking the telepsych option because they said I couldn't have my phone at work in the prison. Is it in a decent location?

 

[jbomba]

That's an impressive rate. Highest I saw was like 260 per hour for CDCR in Corona. As long as it's not physically dangerous, I would think it's worth trying at least for 1 year. I ended up taking the telepsych option because they said I couldn't have my phone at work in the prison. Is it in a decent location?

There's actually numerous openings all over the state. Some within 30 minutes of major socal cities as well as the east bay in NorCal.

 

[G Sheb]

I'm getting routine locum offers for $250-$230/hr so I'm not surprised they are paying this much.
Numbers have really gone up in the last 6 months.

 

[moto_za]

If end of doing this please let us know how your experience was like! It's a lot of money for sure.

 

[reca]

There's actually numerous openings all over the state. Some within 30 minutes of major socal cities as well as the east bay in NorCal.

Are you planning on taking it? I think I got the same offer but am finishing up another job until July. Seriously considering doing this. Let us know how it goes.

 

[hallowmann]

That's an impressive rate. Highest I saw was like 260 per hour for CDCR in Corona. As long as it's not physically dangerous, I would think it's worth trying at least for 1 year. I ended up taking the telepsych option because they said I couldn't have my phone at work in the prison. Is it in a decent location?

There's actually numerous openings all over the state. Some within 30 minutes of major socal cities as well as the east bay in NorCal.

There are straight telepsych options? Was Corona telepsych? Did you guys just reach out to any specific recruiters to look at those jobs?

You can only do 1 year corrections locums per CA laws right? My understanding was that after that you either have to leave for a period or sign on as employed at lower rates.

 

[jbomba]

Are you planning on taking it? I think I got the same offer but am finishing up another job until July. Seriously considering doing this. Let us know how it goes.

Yeah I think I am going to take it. Just a pgy3 so just trying to plan ahead a little but I'm fairly certain I'll end up doing this. Will report back in the future. If you end up there before me I'd be curious what you think too.

 

[jbomba]

There are straight telepsych options? Was Corona telepsych? Did you guys just reach out to any specific recruiters to look at those jobs?

You can only do 1 year corrections locums per CA laws right? My understanding was that after that you either have to leave for a period or sign on as employed at lower rates.

I was told no telepsych options.

 

[PsyDr]

The risk of frivolous malpractice suits would seem to be the most concerning issue.

 

[jbomba]

I'm getting routine locum offers for $250-$230/hr so I'm not surprised they are paying this much.
Numbers have really gone up in the last 6 months.

Where are these located?

 

[Stagg737]

If the prison has already established a culture of avoiding prescriptions with a higher risk for abuse, this mitigates the concern about drug-seeking somewhat (though be ready for drug seeking behaviors to switch to medications you might not suspect such as remeron, quetiapine, or gabapentin).

This brings up a great point, @jbomba , have you asked what their specific formulary is? At the jail near us, they do not prescribe seroquel or gabapentin because of drug-seeking and the formulary is very limited. Probably worth asking just so you know what exactly you'll have available to work with if they're willing to provide it.

 

[Stagg737]

Often, prisoners who want to target prison staff prefer to target guards or others who they view as more antagonistic. In my experience (having done some work in a couple of correctional settings) patients are often appreciative that someone who actually seems to care has come to see them.

A close attending of mine worked the prison system in Connecticut for years and if you talk to any psychiatrist who has worked in those settings they will tell it’s actually typically safer than most other inpatient places we practice if that helps.

It's interesting because we actually had the psychiatrist in charge of Connecticut's state correctional psychiatry system at our grand rounds a couple years ago and he said almost exactly what Bartelby said. Most of the prisoners are just happy to talk to someone who will actually try and help them and were very pleasant with the psychiatrists. Maybe it's a NE thing, as one of my co-residents who moonlights at a local prison has not had that experience. She's a female though, which likely changes the dynamic.

 

[nexus73]

This brings up a great point, @jbomba , have you asked what their specific formulary is? At the jail near us, they do not prescribe seroquel or gabapentin because of drug-seeking and the formulary is very limited. Probably worth asking just so you know what exactly you'll have available to work with if they're willing to provide it.

Most correctional facilities still allow a lot of meds, but Seroquel, Wellbutrin, Gabapentin, and obviously benzos or stimulants are pretty much not on the table. You still have the gamut of SSRIs, SNRIs, mirtazapine, typical and most atypical antipsychotics, lithium, depakote. And it's obviously to prevent the patient from saving up meds and abusing them, or using them to barter and increase the contraband market in the prison. But also, if an inmate can be targeted by others, they can threaten an inmate with violence if they don't get psych give them Wellbutrin for example. So it's safer all around to just ban the meds that cause these sorts of dynamics.

 

[Merovinge]

Keep in mind a job that sucks for most people may not suck for you. If you are young and fine w/ the conditions/grind/what have you (not that this particular job sounds like a grind) and it makes since for your family financially, seems very reasonable to me to consider. If you like working at universities for college mental health, get ready to make terrible pay, if you like working in jails, you can definitely expect to be on the higher end of earnings.

 

[jbomba]

Keep in mind a job that sucks for most people may not suck for you. If you are young and fine w/ the conditions/grind/what have you (not that this particular job sounds like a grind) and it makes since for your family financially, seems very reasonable to me to consider. If you like working at universities for college mental health, get ready to make terrible pay, if you like working in jails, you can definitely expect to be on the higher end of earnings.

For my first few years I want to do absolutely everything I can do make the most money possible. I'd love to pay down my six fig loans and put an equal amount in securities. The way I look at it I should be able to close in on a mil a year which would be amazing. I think unless this job requires morally questionable things I'll be able to tolerate just about anything.

 

[untapped]

There are straight telepsych options? Was Corona telepsych? Did you guys just reach out to any specific recruiters to look at those jobs?

You can only do 1 year corrections locums per CA laws right? My understanding was that after that you either have to leave for a period or sign on as employed at lower rates.

Sorry should have clarified, I'm doing telepsych as a CDCR employee, not locums, and not necessarily seeing patients in Corona. The staff psychiatrist salary ranges are available online and are fine but locums pays much more. For prioritizing income, I would have done corrections locums like jbomba is considering. I still may do a little extra hourly corrections work in person, but after visiting a prison environment I didn't want to commit to 40 hours in there.

 

[jbomba]

Anyone know how time off works with locums generally speaking? If I wanted, say 4 weeks off a year (unpaid of course) is this typically something that can be negotiated?

 

[Merovinge]

For my first few years I want to do absolutely everything I can do make the most money possible. I'd love to pay down my six fig loans and put an equal amount in securities. The way I look at it I should be able to close in on a mil a year which would be amazing. I think unless this job requires morally questionable things I'll be able to tolerate just about anything.

That makes total sense to me. Just be mindful with working multiple jobs at a time, especially if you are expecting questionable ability to help patients at one or more of the jobs. It's far better to make $300k/year for 25 years then 800k/year for 5 years and then be burnt out and miserable. Even more so if the jobs you take teach you to practice bad medicine. There is no universe in which someone focused on keeping lifestyle inflation low is going to struggle to make ends meet on 600k/year, even in a HCoL area.

 

[Stagg737]

Anyone know how time off works with locums generally speaking? If I wanted, say 4 weeks off a year (unpaid of course) is this typically something that can be negotiated?

Anything is negotiable. Whether they're actually willing to negotiate a point is a different story.

That makes total sense to me. Just be mindful with working multiple jobs at a time, especially if you are expecting questionable ability to help patients at one or more of the jobs. It's far better to make $300k/year for 25 years then 800k/year for 5 years and then be burnt out and miserable. Even more so if the jobs you take teach you to practice bad medicine. There is no universe in which someone focused on keeping lifestyle inflation low is going to struggle to make ends meet on 600k/year, even in a HCoL area.

I generally agree with this sentiment, but when we're talking about life-changing amounts of money I think the rules of balance shift. I could be miserable for a year if it meant making 800K to get out of debt, sock a nice chunk into retirement, and be able to feel comfortable taking a job paying 200k for the rest of my career.

 

[sloh]

This is nuts your specialty can cobble together jobs and clear 1 million per year. Kudos to psychiatry!

 

[jbomba]

That makes total sense to me. Just be mindful with working multiple jobs at a time, especially if you are expecting questionable ability to help patients at one or more of the jobs. It's far better to make $300k/year for 25 years then 800k/year for 5 years and then be burnt out and miserable. Even more so if the jobs you take teach you to practice bad medicine. There is no universe in which someone focused on keeping lifestyle inflation low is going to struggle to make ends meet on 600k/year, even in a HCoL area.

That compound interest tho...

But overall, I hear you. Will keep these things in mind.

 

[hallowmann]

Sorry should have clarified, I'm doing telepsych as a CDCR employee, not locums, and not necessarily seeing patients in Corona. The staff psychiatrist salary ranges are available online and are fine but locums pays much more. For prioritizing income, I would have done corrections locums like jbomba is considering. I still may do a little extra hourly corrections work in person, but after visiting a prison environment I didn't want to commit to 40 hours in there.

Part time telepsych doable at CDCR, even at lower rates?

Out here (midwest) residents moonlight in corrections a half day a week and do OK. I'm relocating and I'd open to that for at CDCR as a side gig to get an idea of what it's like there. Gotta find a way to manage the COL difference.

 

[jbomba]

Part time telepsych doable at CDCR, even at lower rates?

Out here (midwest) residents moonlight in corrections a half day a week and do OK. I'm relocating and I'd open to that for at CDCR as a side gig to get an idea of what it's like there. Gotta find a way to manage the COL difference.

If you want rural there are plenty of locales in central valley California with the high end of those rates. Absolutely horrific place to live, but low col.

 

[untapped]

If you want rural there are plenty of locales in central valley California with the high end of those rates. Absolutely horrific place to live, but low col.

I would need to make over 1 million a year to consider working in central california, and would probably spend every weekend driving back to LA or Bay Area. And I would probably only do it for a year or two at most.

 

[jbomba]

Yeah, couldn't even do it for a mil. Would rather just work more hours and live in LA, SF, SD...

 

[FlowRate]

With mega pay it might not be completely terrible to drive in central cal and stay for 4 days then spend the other 3 living 2-3 hours away. Or someone into aviation with an IFR rating could probably commute into work more quickly that way while enjoying their hobby.

 

[jbomba]

With mega pay it might not be completely terrible to drive in central cal and stay for 4 days then spend the other 3 living 2-3 hours away. Or someone into aviation with an IFR rating could probably commute into work more quickly that way while enjoying their hobby.

If I were single, I would totally consider this

 

[Eudaimania]

Can anyone with experience in correctional psychiatry comment on the legal liability related to a position like this? I would imagine its considerable to justify these rates. What is the nature of the liability risk? High suicide rates? Lack of resources? Negligent staff? Litigious population?.... Reminds me of a prisoner we treated at my county hospital who ultimately died as a result of catatonia. He had been seen by the prison psych NP who failed to diagnose and treat him appropriately for a prolonged period of time before he was transferred to us.

 

[splik]

Yeah, couldn't even do it for a mil. Would rather just work more hours and live in LA, SF, SD...

It is not difficult to find a job in those markets that pays similar or more than that prison locums though these jobs are not always advertised. Look at jobs based on production or eat what you kill

 

[Monocles]

Yeah, couldn't even do it for a mil. Would rather just work more hours and live in LA, SF, SD...

Really?? Not even during a pandemic where most of the benefits of being in metropolitan cities are reduced anyway?

You could work two years in a middle of nowhere rural place, get that 2 mil (okay closer to like 1.2 after taxes) but invest it and live off the dividends or a 4% WR and be done

Can't imagine it would be worse than the most malignant of psych residencies, plus if it has the potential to be your "terminal" job then it doesn't matter.

 

[jbomba]

Really?? Not even during a pandemic where most of the benefits of being in metropolitan cities are reduced anyway?

You could work two years in a middle of nowhere rural place, get that 2 mil (okay closer to like 1.2 after taxes) but invest it and live off the dividends or a 4% WR and be done

Can't imagine it would be worse than the most malignant of psych residencies, plus if it has the potential to be your "terminal" job then it doesn't matter.

Living in the perpetual aroma of the manure of 10 million cattle might end in me becoming one of the psych patients.

Give me a 70 hour week for the same salary and a beach and no manure smell and I won't complain.

 

[deleted1100659]

im pretty sure I saw this job advertised

I worked at the state medical prison (outpatient settting) 3-4 months during residency. It wasnt terrible to be honest. The bar is set extremely low (not by choice) because the documentation system and orders was all paper charts and it was very hit or miss if they even administered the medications...that part did bother me quite a bit.

I never really felt unsafe most were fairly approachable. it was a male prison too. Half the people tried to get stuff like artane and seroquel, lol.

Really it was kind of an easy job, I just thought it was annoying the standards werent high and I want to give quality care regardless of social status.

Also a lot of the times you get no shows (ironically) because theyll just refuse to go to the appt. And they usually all kind of arrive together so its fast and streamlined.

At the medical prison i worked at they stopped hiring psychiatrists and now do telehealth nps...

 

[Candidate2017]

Fair amount of manipulation and malingering. In summer, there is a psych inpatient unit with great a/c. Patients had incentive to get admitted.

Well, to be fair, it is hard to sleep in the summer heat without AC. Seems like you are well positioned to do a head to head study of great AC vs Remeron as to improvement in SIGECAPS symptoms.

 

[Candidate2017]

This is nuts your specialty can cobble together jobs and clear 1 million per year. Kudos to psychiatry!

We're talking about prison, which is soul sucking for most people, whether inperson or telepsych. Prison is not the usual working environment for most psychiatrists. It's always been the case for psychiatrists (and plumbers and waste haulers too!) that the surest route to the highest income is cobbling together jobs that most people don't want to do (multiple inpatient units with lots of call, prison, 25 outpatients/day, etc).

 

[90sportsfan]

This is an enormous amount of money for the work. The only potential red flag (good or bad depending on how you view it), is the fact that they are offering a deal like that. Is it a great deal or is there a reason they are offering that much (i.e. maybe the conditions/job is really draining and they haven't been able to hire anyone, and thus have to give an offer like that)?

 

[Splenda88]

Would do it for a year and if it's an ok gig, would renew.

 

[comp1]

I just do not get these rates. They could build a telehealth system and have it totally covered at half these rates. I get that there is some benefit to in person interactions, but not if it's costing the system this much...

 

[deleted1100659]

I just do not get these rates. They could build a telehealth system and have it totally covered at half these rates. I get that there is some benefit to in person interactions, but not if it's costing the system this much...

which is what they did at the prison I worked at. Stopped hiring the psychiatrists after current ones retired. Hired telehealth NPs at less than half the rate. Easy cost savings for them. It was obvious they didnt really care, quite sadly

Believe it or not, the prison population really wasnt that bad. Looking back most of the people were people who had zero help growing up, made bad choices that just spiraled. Its easy for someone with very little guidance/resources to make the wrong choice. Also it was very sad, because some were clearly schizophrenic and its very likely they were not in the right state of mind during their criminal act. But, they also dont have money/families to advocate for them so they just ended up there. I remember one guy was there because he robbed a gas station and stole all the refrigerator magnets...Another one was a guy who thought he was pregnant with baby jesus and wanted to refuse medications out of concern for the fetus.

Sure there are bad people there as well, but i still encounter those people in regular outpatient settings, lol.

 

[deleted1100659]

Oh and I just want to point out, the ones with personality disorders who would get mad when you didn't give them what they want, they would usually refuse to go to the appt anyways, lol.

OP, guessing the catch is its probably very disorganized in terms of them getting the medications, and even recording when the meds are given. And probably something like paper charts or ancient EMR. Still the pay is surprising, but the stigma alone probably scares a lot of people away. Perhaps also its that high because they want you to supervise midlevels, may want to make sure of that...

 

[comp1]

They don't have to hire NPs. They could get telehealth MDs at half these rates. As I recall, CDCR had a somewhat bizarre telehealth setup where you couldn't do it from home and had to drive to a location in Elk Grove or some city in SoCal.

 

[Splenda88]

This is nuts your specialty can cobble together jobs and clear 1 million per year. Kudos to psychiatry!

Yeah...

Psych seems to be good though. Most I can make as a IM doc cobble jobs together is ~600k.