There’s always money in the banana stand: what’s your plan B if medicine doesn’t work out?

[hippopotamusoath]

I believe it was @Sushirolls who made an interesting comment in one of the recent threads here. A new attending was anxious about the possibility of a lawsuit or loss of licensure, and Sushirolls suggested having a plan B knocking around in case you have to, or choose to, stop practicing psychiatry.

I thought it was a really interesting premise. So what’s everyone’s plan B?

Sometimes I think about learning a trade. Prior to medical school, I did some blue-collar jobs. It was hard work and taxing on the body, for sure. I also had a lot more fun, spent more time outdoors, and saw the physical proof of a job well done when I was finished. So maybe I’ll learn plumbing if I quit medicine—what about you?

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[Bartelby]

My plan B is financial independence. In other words, saving enough to live on about 4% of my total assets per year if I really downsize my lifestyle and pinch every penny. That would let me move on to other work without as much financial worry, at which point I think I would try to write novels or possibly freelance articles etc.

This is mainly possible (within the next five years) because I have a high earning spouse, but it's a good reminder that money takes off a lot of pressure if you somehow don't want to / can't work as a psychiatrist down the road.

 

[calvnandhobbs68]

Sometimes I think about learning a trade. Prior to medical school, I did some blue-collar jobs. It was hard work and taxing on the body, for sure. I also had a lot more fun, spent more time outdoors, and saw the physical proof of a job well done when I was finished. So maybe I’ll learn plumbing if I quit medicine—what about you?

I think this is fun to learn/do and I'm a really DIY kind of person but I do think people really underestimate how taxing this stuff is on you physically to do full time 5 days a week. There's a reason so many laborers/tradesmen end up at ortho/pain for their bad backs and knees or even just various on the job injuries. If I spend a full day out doing a project I get reminded of that really quick.

I'm not sure why people would really NEED a plan B from psychiatry. People freak out about the lawsuit/licensing stuff but it's extremely rare for someone to actually lose a medical license unless they're doing something overtly criminal/extremely unethical (ex. giving patients meds for sex or something....not even the sexual interaction part by itself results in permanent license revocation always). You have to be pretty disabled to not be able to do psychiatry permanently...you could probably do most of it blind or with limited visual acuity, could even be missing a limb or two and be able to listen to people and dictate notes. If you're so disabled you can't do psychiatry, hopefully you have disability insurance cause you probably can't do many other jobs either.

Any other profession comparable on a $/hr basis is typically just not feasible to pivot into. On a pure dollars per hour basis, it's almost always going to be more profitable to do something medical very part time rather than try to work as a plumber full time for 80K a year or something. That's not really a plan B, I could literally make that working one day a week outpatient and then whatever I want the other 6 days a week.

 

[Orgone]

I'm not sure why people would really NEED a plan B from psychiatry. People freak out about the lawsuit/licensing stuff but it's extremely rare for someone to actually lose a medical license unless they're doing something overtly criminal/extremely unethical (ex. giving patients meds for sex or something....not even the sexual interaction part by itself results in permanent license revocation always). You have to be pretty disabled to not be able to do psychiatry permanently...you could definitely do it blind and could even be missing a limb or two and be able to listen to people and dictate notes. If you're so disabled you can't do psychiatry, hopefully you have disability insurance cause you probably can't do many other jobs either.

Thank you for reminding us of the above. Like some of the other posters here, I also like to plan for some version of "financial independence" well before typical retirement age. But it is good to remember that even if you grow to hate practicing psychiatry, you could still find some tolerable one day/week or one weekend/month coverage job that allows you to live comfortably but not lavishly in most parts of the country.

An active psychiatrist in my city is part of a group with seemingly respectable other psychiatrists ... but has had his license put on probation twice. Once for a sexual relationship with an active patient. And another for clearly and extremely negligent care in a patient that ended up completing suicide.

I find this knowledge both disturbing and comforting; disturbing that it occurs and the individual still practices, comforting that my own license to practice appears to be quite safe.

 

[Sushirolls]

I'm working on my plan B.
I'm in the middle of nowhere now.
Got a large tract of land. Going to build a house. And get the land fenced off.
Slowly build up the machine shed, monoslope deep pit beef barn, pig barn, goat barn, chicken barn. Apiary.
Become a breeder for heritage stock.
Grow own feed and biodiesel on farm, reduce overhead.
Hunt/fish when I can.
Leave retirement funds alone, and live off the farm income. Goal is 50k in pocket after taxes. Enough to pay property taxes, go out to eat once in awhile, etc.

Farming is fun. Hunting is fun. Fishing is fun. So I'll be 'recreating' every day. Enjoying the fruits of your own labor at meal time - priceless. Wild turkey Biriyani? Elk roast? Moose stew? the list goes on. Backyard chicken... can't ever go back to store chicken... just can't. Grow my own wheat, corn, beets, tomatoes, etc, etc

To others points on money, true, highly unlikely we can beat physician income/effort without extra effort for the start up of a new business. For me the love of ag/ranching is enough to pursue this new business line. Monetarily, I'd be better off not farming or ranching at all. Just a small 1 acre garden, and simply lease the land to adjacent farmers. Put the money in stocks, that wasn't spend on Ag buildings, and leave it alone. That is the wise choice, similar to @Bartleby_

...but, meh, YOLO, and I'd rather be taking a shot at a yote 300yds off, from my tractor, with an AR-15, custom reloads, as the darn thing approaches my goat herd, with cold hands, ice breathing, and melting snow on the ground. That's a good day at the office. Yote down. Skin it, sell it at closest hide market, get enough money to pay for a half a dinner outing for the family another night. Then that evening, enjoy some home made mead blend made from home grown hops, and home harvested wheat, with bread made from own harvested wheat, adorning madrasi seasoned lentils also home grown, with a side of deer seasoned with an ethiopian flare, and a nice beet salad from your own garden. And let's not forget the wood fire place roaring from the wood, you endeavored to buck up from your own stand of timber. First thing in the morning, that cup of coffee while looking at the frosty fog slowing drifting over the hills, the cows bellering for more hay, is far better than any hospital cafeteria coffee at 4AM while call or post call... The vibration of the tractor seat as it first turns over and the black thick smoke plume is such a positive sight. The roar of the RPMs as the diesel engine is throttled up. Don't need a suit and tie for this job. Mud. Manure. Diesel engines. Noisy animals. Commute time... only based on how much mud on the ground with the tractor. Ahhh. That's the life.

And when the tractor breaks? Doesn't start? Snow needs plowing? Animal is sick? Chicken butchering day? Bank account just dropped for farm expenses? Still a good day.

 

[Sushirolls]

*Males, all it takes is one patient to accuse you of something.
*Females, I've had a colleague who was physically assaulted on a unit; all it takes is one physical beating to walk away.
*Make one comment about covid or how it was/is handled and some state medical boards will yank your license.
*Soon, if we misgender, that too could be a loss of license, I'm willing to predict.

 

[Merovinge]

Thank you for reminding us of the above. Like some of the other posters here, I also like to plan for some version of "financial independence" well before typical retirement age. But it is good to remember that even if you grow to hate practicing psychiatry, you could still find some tolerable one day/week or one weekend/month coverage job that allows you to live comfortably but not lavishly in most parts of the country.

An active psychiatrist in my city is part of a group with seemingly respectable other psychiatrists ... but has had his license put on probation twice. Once for a sexual relationship with an active patient. And another for clearly and extremely negligent care in a patient that ended up completing suicide.

I find this knowledge both disturbing and comforting; disturbing that it occurs and the individual still practices, comforting that my own license to practice appears to be quite safe.

It's actually pretty hard to lose a license once you have it in the US, very different experience for doctors in other countries. I've never heard of a single case of someone losing their license where it was some BS thing. Now the number of lawsuits that got settled for BS things, that list is a mile long.

 

[comp1]

I mean, I guess teach biology? There's definitely nothing that comes close monetarily and I'm not someone who would be happy in "financial independence."

 

[the5thelement]

The future is abundance. Just like information is now abundant, i see a future where nano technology will enable us to make most of the things we need as needed ushering in a new era of local manufacturing.
While waiting for it, i heard UPS drivers are making $170,000 working 60 hours/week.

UPS says drivers to make $170,000 in pay and benefits following union deal

The carrier's new labor contract will increase full-time drivers' compensation roughly 17% over five years, UPS' CEO said in an earnings call.

www.cbsnews.com

 

[calvnandhobbs68]

The future is abundance. Just like information is now abundant, i see a future where nano technology will enable us to make most of the things we need as needed ushering in a new era of local manufacturing.
While waiting for it, i heard UPS drivers are making $170,000 working 60 hours/week.

UPS says drivers to make $170,000 in pay and benefits following union deal

The carrier's new labor contract will increase full-time drivers' compensation roughly 17% over five years, UPS' CEO said in an earnings call.

www.cbsnews.com

That top line number is including benfits and pension contributions, it's around $49/hr base salary. And one of their big negotiating points is that they FINALLY get AC in all their vehicles starting in 2024

We have to try not to get the glasses tooo rose tinted when looking at other professions. On a $/hr basis, that's still like less than 1/4 of what I could make seeing two 99214s an hour sitting in a nice air conditioned office on my ass in front of a computer.

 

[annoyedpsychiatrist]

pharmaceutical rep. bring doctors food all day, kiss ass, talk about drugs i know.

but hoping to last another 18 years or so lol

 

[clausewitz2]

*Males, all it takes is one patient to accuse you of something.
*Females, I've had a colleague who was physically assaulted on a unit; all it takes is one physical beating to walk away.
*Make one comment about covid or how it was/is handled and some state medical boards will yank your license.
*Soon, if we misgender, that too could be a loss of license, I'm willing to predict.

A psychiatrist in my area is back in practice after a long hiatus - namely, doing a 5 year bit in the state penitentiary for sexually assaulting a patient.

It takes way more than an accusation.

 

[WisNeuro]

A psychiatrist in my area is back in practice after a long hiatus - namely, doing a 5 year bit in the state penitentiary for sexually assaulting a patient.

It takes way more than an accusation.

Yeah, I routinely read through the med and psych board actions in my state. I am usually pretty shocked at the things providers do without losing their licenses. Usually all they have to do is stop practicing until they get some consultation or take a CEU or something. I am zero percent worried about losing my license after a few years of reading board actions.

 

[clozareal]

I think this is fun to learn/do and I'm a really DIY kind of person but I do think people really underestimate how taxing this stuff is on you physically to do full time 5 days a week. There's a reason so many laborers/tradesmen end up at ortho/pain for their bad backs and knees or even just various on the job injuries. If I spend a full day out doing a project I get reminded of that really quick.

The other thing about trades and physical labor for these sorts of things is that it's not just the making of those items, but it's actually being a salesman and business person to make it profitable. When people say they want to be a photographer, woodworker, make jewelry or soap or whatever, I tell them that their success doesn't depend on the quality of their product, but rather their business skills. People are usually shocked how much customer service is in these trades and also in medicine, dentistry, pharmacy, etc.

My plan B would be to start a business. I don't really have skills outside of medicine unfortunately. A few ideas off the top of my head:

1. Open up a coffee shop. Learn how to roast beans myself, learn how to do espresso art, do single serve pour overs, offer natural process coffee and single origin. Coffee is just beans, hot water, and a way to grind them so the expenses wouldn't be super high outside of the lease, furniture, and employees although I would probably want to just be solo at first.
2. Summer camp for kids. As a child psychiatrist, these camps and after school programs seem extremely fun and would pay okay. You get a bunch of kids and just do activities with them. Toddler soccer camp is just little kids kicking bubbles all day at the park.
3. Start a daycare or preschool. These are also lucrative in my area. $20-30k per kid per year. Of course, the startup and operating costs would be high, but I would imagine many families would want their kid to go to a school designed by a child psychiatrist.
4. Have an experiential activity in the middle of businesses where they want off sites. This could be an escape room, axe throwing, obstacle course, something where the people can bond. Offer food and alcohol to increase the revenue. These companies throw a ton of money for their employees to connect with each other.

 

[Sushirolls]

Interesting. That has me thinking about plan C, stemming from your experiential concept.

Hunting guide. But less guide, and more instructional. This is how you hunt. The next step for people after they do their obligatory hunters education course. To say, this is how you can do it, in a supportive teaching manner, for those who are coming from the city with no prior family or hunting exposure. It's a daunting task for people with no prior hunting experience to enter the hobby/sport/way of life.

 

[sloh]

I believe it was @Sushirolls who made an interesting comment in one of the recent threads here. A new attending was anxious about the possibility of a lawsuit or loss of licensure, and Sushirolls suggested having a plan B knocking around in case you have to, or choose to, stop practicing psychiatry.

I thought it was a really interesting premise. So what’s everyone’s plan B?

Sometimes I think about learning a trade. Prior to medical school, I did some blue-collar jobs. It was hard work and taxing on the body, for sure. I also had a lot more fun, spent more time outdoors, and saw the physical proof of a job well done when I was finished. So maybe I’ll learn plumbing if I quit medicine—what about you?

1. Not unusual tying passion and livelihood together spoils the former.

2. Psychiatrists are too neurotic about lawsuits and loss of licensure. Cmon now:

Unstoppable: This Doctor Has Been Investigated at Every Level of Government. How Is He Still Practicing?

Medical boards, a health department and even federal investigators have scrutinized Dr. James McGuckin’s vascular clinics. Today he still practices, despite a decadelong string of sanctions, fines and lawsuits.

www.propublica.org

 

[Merovinge]

I think this is fun to learn/do and I'm a really DIY kind of person but I do think people really underestimate how taxing this stuff is on you physically to do full time 5 days a week. There's a reason so many laborers/tradesmen end up at ortho/pain for their bad backs and knees or even just various on the job injuries. If I spend a full day out doing a project I get reminded of that really quick.

I'm not sure why people would really NEED a plan B from psychiatry. People freak out about the lawsuit/licensing stuff but it's extremely rare for someone to actually lose a medical license unless they're doing something overtly criminal/extremely unethical (ex. giving patients meds for sex or something....not even the sexual interaction part by itself results in permanent license revocation always). You have to be pretty disabled to not be able to do psychiatry permanently...you could probably do most of it blind or with limited visual acuity, could even be missing a limb or two and be able to listen to people and dictate notes. If you're so disabled you can't do psychiatry, hopefully you have disability insurance cause you probably can't do many other jobs either.

Any other profession comparable on a $/hr basis is typically just not feasible to pivot into. On a pure dollars per hour basis, it's almost always going to be more profitable to do something medical very part time rather than try to work as a plumber full time for 80K a year or something. That's not really a plan B, I could literally make that working one day a week outpatient and then whatever I want the other 6 days a week.

Completely agree with above. It's easy to romanticize other work, but it's called a job for a reason regardless of what you do to pay the bills. Dollar per dollar it's very hard to beat the returns of being a US psychiatrist. I don't think there's anything wrong with an escapist fantasy or thinking about this stuff on an online forum (in fact, I would encourage it), but if you have a conversation like this with 99.99% of the world's population it would come across terribly (e.g. what else can I do if I want to stop talking to people and making $250+- per hour).

 

[psychemdoc]

Completely agree with above. It's easy to romanticize other work, but it's called a job for a reason regardless of what you do to pay the bills. Dollar per dollar it's very hard to beat the returns of being a US psychiatrist. I don't think there's anything wrong with an escapist fantasy or thinking about this stuff on an online forum (in fact, I would encourage it), but if you have a conversation like this with 99.99% of the world's population it would come across terribly (e.g. what else can I do if I want to stop talking to people and making $250+- per hour).

I honestly laughed thinking about it. Thanks for that perspective. Probably true for most medical specialties but doubly so for psych.

 

[clausewitz2]

Completely agree with above. It's easy to romanticize other work, but it's called a job for a reason regardless of what you do to pay the bills. Dollar per dollar it's very hard to beat the returns of being a US psychiatrist. I don't think there's anything wrong with an escapist fantasy or thinking about this stuff on an online forum (in fact, I would encourage it), but if you have a conversation like this with 99.99% of the world's population it would come across terribly (e.g. what else can I do if I want to stop talking to people and making $250+- per hour).

'Man, I wish I could find a better job than this one where I can make 300k per year working four days per week from home' is not a relatable complaint.

 

[hippopotamusoath]

Completely agree with above. It's easy to romanticize other work, but it's called a job for a reason regardless of what you do to pay the bills. Dollar per dollar it's very hard to beat the returns of being a US psychiatrist. I don't think there's anything wrong with an escapist fantasy or thinking about this stuff on an online forum (in fact, I would encourage it), but if you have a conversation like this with 99.99% of the world's population it would come across terribly (e.g. what else can I do if I want to stop talking to people and making $250+- per hour).

Hey man, I don't just talk to people for $250/hr, I ALSO have to type up little stories about it.

 

[hippopotamusoath]

I think this is fun to learn/do and I'm a really DIY kind of person but I do think people really underestimate how taxing this stuff is on you physically to do full time 5 days a week. There's a reason so many laborers/tradesmen end up at ortho/pain for their bad backs and knees or even just various on the job injuries. If I spend a full day out doing a project I get reminded of that really quick.

I'm not sure why people would really NEED a plan B from psychiatry. People freak out about the lawsuit/licensing stuff but it's extremely rare for someone to actually lose a medical license unless they're doing something overtly criminal/extremely unethical (ex. giving patients meds for sex or something....not even the sexual interaction part by itself results in permanent license revocation always). You have to be pretty disabled to not be able to do psychiatry permanently...you could probably do most of it blind or with limited visual acuity, could even be missing a limb or two and be able to listen to people and dictate notes. If you're so disabled you can't do psychiatry, hopefully you have disability insurance cause you probably can't do many other jobs either.

Any other profession comparable on a $/hr basis is typically just not feasible to pivot into. On a pure dollars per hour basis, it's almost always going to be more profitable to do something medical very part time rather than try to work as a plumber full time for 80K a year or something. That's not really a plan B, I could literally make that working one day a week outpatient and then whatever I want the other 6 days a week.

I think for me, and the point of the person who originally broached the idea in the other thread, is that it's a nice exercise for those of us with an anxious temperament. I know logically that I'm probably at least an average psychiatrist. I don't use drugs or do anything illegal, I bill ethically, and I maintain appropriate boundaries with my patients. Things would have to go massively sideways in an unpredictable way for me to lose my license.

Still, it's impossible to predict the future, and it's very comforting to have the option of a plan B, even if I never use it.

I do think it's more likely for most of us that we might choose to throttle back and do part-time psychiatry and part-time...something else. I could definitely see myself spending 2 days a week doing psychiatry for The Man and 3 days building custom guitars or something else fun but unprofitable, once these damn loans are paid off.

 

[hippopotamusoath]

I'm working on my plan B.
I'm in the middle of nowhere now.
Got a large tract of land. Going to build a house. And get the land fenced off.
Slowly build up the machine shed, monoslope deep pit beef barn, pig barn, goat barn, chicken barn. Apiary.
Become a breeder for heritage stock.
Grow own feed and biodiesel on farm, reduce overhead.
Hunt/fish when I can.
Leave retirement funds alone, and live off the farm income. Goal is 50k in pocket after taxes. Enough to pay property taxes, go out to eat once in awhile, etc.

Farming is fun. Hunting is fun. Fishing is fun. So I'll be 'recreating' every day. Enjoying the fruits of your own labor at meal time - priceless. Wild turkey Biriyani? Elk roast? Moose stew? the list goes on. Backyard chicken... can't ever go back to store chicken... just can't. Grow my own wheat, corn, beets, tomatoes, etc, etc

To others points on money, true, highly unlikely we can beat physician income/effort without extra effort for the start up of a new business. For me the love of ag/ranching is enough to pursue this new business line. Monetarily, I'd be better off not farming or ranching at all. Just a small 1 acre garden, and simply lease the land to adjacent farmers. Put the money in stocks, that wasn't spend on Ag buildings, and leave it alone. That is the wise choice, similar to @Bartleby_

...but, meh, YOLO, and I'd rather be taking a shot at a yote 300yds off, from my tractor, with an AR-15, custom reloads, as the darn thing approaches my goat herd, with cold hands, ice breathing, and melting snow on the ground. That's a good day at the office. Yote down. Skin it, sell it at closest hide market, get enough money to pay for a half a dinner outing for the family another night. Then that evening, enjoy some home made mead blend made from home grown hops, and home harvested wheat, with bread made from own harvested wheat, adorning madrasi seasoned lentils also home grown, with a side of deer seasoned with an ethiopian flare, and a nice beet salad from your own garden. And let's not forget the wood fire place roaring from the wood, you endeavored to buck up from your own stand of timber. First thing in the morning, that cup of coffee while looking at the frosty fog slowing drifting over the hills, the cows bellering for more hay, is far better than any hospital cafeteria coffee at 4AM while call or post call... The vibration of the tractor seat as it first turns over and the black thick smoke plume is such a positive sight. The roar of the RPMs as the diesel engine is throttled up. Don't need a suit and tie for this job. Mud. Manure. Diesel engines. Noisy animals. Commute time... only based on how much mud on the ground with the tractor. Ahhh. That's the life.

And when the tractor breaks? Doesn't start? Snow needs plowing? Animal is sick? Chicken butchering day? Bank account just dropped for farm expenses? Still a good day.

I really pity people who will never know what it's like to fire up a tractor on a crisp winter morning to blow 2 feet of fresh snow.

Also, I used to love re-loading for my .30-06. I started doing it because I was poor, but I ended up having a semi-autistic fascination with the process. It's really a lot of fun to get everything dialed in. I can already see my wife rolling her eyes, but I'm tempted to buy some absurd obsolete caliber and get it going again.

 

[clozareal]

Interesting. That has me thinking about plan C, stemming from your experiential concept.

Hunting guide. But less guide, and more instructional. This is how you hunt. The next step for people after they do their obligatory hunters education course. To say, this is how you can do it, in a supportive teaching manner, for those who are coming from the city with no prior family or hunting exposure. It's a daunting task for people with no prior hunting experience to enter the hobby/sport/way of life.

I think a lot of people would pay to have a hunting experience or a farming experience. I went to a resort that had "junior ranch hands" experience where kids feed goats and walk horses and give milk to calves and learn how to lasso. It was $145 per child for 2.5 hours...

 

[splik]

I know of one psychiatrist who, knowing he was about to lose his license for aiding and abetting the unlicensed practice of medicine, trained as a psych NP.

I know of a few psychiatrists who moved to Wyoming after losing their licenses. apparently they are more forgiving because they needed physicians.

I know of another psychiatrist who surrendered his license to avoid disciplinary action (he was liberal at prescribing benzos to addicts) became a life coach. Many of his patients followed him into his life coach practice. Another very prominent psychiatrist who lost his license for sexual misconduct now has a coaching and counseling practice.

Another psychiatrist became a counselor. Another still a hypnotherapist.

 

[deleted1162863]

Maybe join Wagner? I heard there is an open position in their leadership.

 

[Tangerine123]

I've had fleeting thoughts of being an Aquarist or Zoologist of some sort. Going to work daily to feed the penguins or seals, and get to interact and bond with them, sounds like a dream.

Also, marine biology with emphasis on field work. Diving to collect samples, tagging animals, marine photography etc.

 

[clausewitz2]

I've had fleeting thoughts of being an Aquarist or Zoologist of some sort. Going to work daily to feed the penguins or seals, and get to interact and bond with them, sounds like a dream.

Also, marine biology with emphasis on field work. Diving to collect samples, tagging animals, marine photography etc.

At least in this country this would involve going back to get another graduate degree and then competing fiercely for a fairly limited pool of jobs. The pay is also not great.

 

[annoyedpsychiatrist]

There is a primary care doctor in our area who is infamous for handing out benzos/adderall. Not uncommon well get patients of his on 10mg xanax, 6mg klonopin, 60mg adderall and some ambien or lunesta. He was even sued at one point for missing clinical sx of colon cancer in a patient who had clear cut symptoms (blood in stool, huge weight loss, smoker, family hx, etc, etc), he lost the law suit, and all he got was a board fine, and he still practices. The pharmacists in our area refuse to refill his prescriptions for controlled substances..

 

[PsyDr]

'Man, I wish I could find a better job than this one where I can make 300k per year working four days per week from home' is not a relatable complaint.

I believe that's called Only Fans.

 

[LeaveNoTrace]

you could probably do most of it blind or with limited visual acuity, could even be missing a limb or two and be able to listen to people and dictate notes

I know of an attending psychiatrist who is legally blind and a psychologist who lacks the use of her left hand due to a birth defect, so I've seen it done. What was remarkable was that she managed to go to college, med school, and residency with limited vision. Good on her.

 

[Candidate2017]

Hey man, I don't just talk to people for $250/hr, I ALSO have to type up little stories about it.

That's really rough compared to rads. They don't have to talk to people or type. Just look at pics and dictate. I guess telepsych is our version of rads, but the pics talk back and try to dictate.

I know of an attending psychiatrist who is legally blind and a psychologist who lacks the use of her left hand due to a birth defect, so I've seen it done.

The important question is: Are they able to assess and fill out all nine elements of an MSE to be able to hit all required inpatient coding elements?

 

[Stagg737]

As some mentioned above, I don't have a plan B because it's not really all that necessary in psych. My plan B would just be to cut back to part-time practice, maybe 15-20 hours a week, and still likely pull in 6 figures.

Other actual back-up plans:

Figure out how to get into the area of psychological autopsies. I do enjoy learning about forensics and just find them fascinating. True crime has always been a hobby and being a psychiatrist with a psychologist in the family gives a unique skillset the general public doesn't have. If I had the means to not work right now, I'd consider looking into specific training for this and setting up a company to do this.

Being a pharm rep is something I've thought about. One of my acquaintances has been one for 20+ years and said at this point he only goes to clinics 3-4x per month. He's basically just on retainer so other companies don't poach him since he really knew his stuff. If you know enough about drug laws and the industry I imagine an actual physician could easily get hired and which is what he said.

I also love teaching and wouldn't mind teaching at a med school or university. I've thought about reaching out to a local cc about teaching an abnormal psych course, but also know I don't have time now. I've got a graduate level degree in basic sciences before med school, so could probably break in somewhere in a more biological role if I really wanted to and was willing to move, but for now am happy to just work with med students and residents.

You have to be pretty disabled to not be able to do psychiatry permanently...you could probably do most of it blind or with limited visual acuity, could even be missing a limb or two and be able to listen to people and dictate notes. If you're so disabled you can't do psychiatry, hopefully you have disability insurance cause you probably can't do many other jobs either.

I know of an attending psychiatrist who is legally blind and a psychologist who lacks the use of her left hand due to a birth defect, so I've seen it done. What was remarkable was that they managed to go to college, med school, and residency with limited vision. Good on her.

I was actually just joking about this with nursing this morning as part of the reason I went into psych instead of a surgical field. Moderate injuries could end a surgeon's career. Meanwhile, I could basically be Stephen Hawking and still be able to practice psych if I really wanted to. Having really good disability insurance in medicine is a must though. In my current position with my insurance through employer and supplemental disability, I'd actually make more if I was seriously disabled for the rest of my life than I do now.

I've had fleeting thoughts of being an Aquarist or Zoologist of some sort. Going to work daily to feed the penguins or seals, and get to interact and bond with them, sounds like a dream.

Also, marine biology with emphasis on field work. Diving to collect samples, tagging animals, marine photography etc.

It would be fun, but like Clause said requires a lot more education and is actually pretty competitive. One of my close high school and college friends is a seal trainer at the Shedd Aquarium in Chicago and she had to do a lot to break into the field even with some pretty rare internship opportunities she had (Vancouver Aquarium). If you just want to be one of the old people who volunteers at the zoo, I don't think it's too hard, but to actually be hands on with the animals at a legit facility requires a lot more work and education.

It's actually pretty hard to lose a license once you have it in the US, very different experience for doctors in other countries. I've never heard of a single case of someone losing their license where it was some BS thing. Now the number of lawsuits that got settled for BS things, that list is a mile long.

It's rare but does happen. I know of one doc who had to go back to their home country after losing their license in the US right after residency. More often, ridiculous claims are made and the doc is placed on some kind of probation or monitoring until investigations are complete. One of my preceptors in med school practiced with their brother who wasn't allowed to prescribe any controlled substances for 6-9 months after a pissed off patient ran to the board and claimed he was a local drug dealer peddling prescription opiates. No actual evidence whatsoever and the doc was actually pretty anti-opiate. Every time the guy wanted to prescribe a controlled substance he had to have my preceptor sign the Rx for him. Board cleared him from any wrong-doing, but one a-hole patient made his work life hell for the better part of a year.

 

[clozareal]

If I knew in college what I knew now about the business of health care delivery, I probably would have been more into entrepreneurship. Not necessarily selling an object, but rather some sort of aid or solution to mental health issues that come up for people. Any qualm I have about the practice of psychiatry could have a business solution to make it easier. Some of these below probably already exist.

1. There's a company in my area that contracts with schools to connect students who come to their high school counselor to psychiatrists and therapists in the area. They have been referring patients to me and it's actually a really nice service that seems like it's a win for the schools, win for the parents, and win for the psychiatrist/therapist for more referrals.
2. Starting a company that job trains and hires people with autism to do specific tasks that are repetitive and restricted in nature and do not require minimal social interaction that would lean into the core symptoms of autism. These would be things like stocking shelves, running medications from the pharmacy to the floor, checking if all the doors are locked in a company, etc.
3. Starting a company that does network gap exceptions if the insurance company cannot find an in network psychiatrist or provider and reaches out to local providers to do this for them.
4. Creating a centralized secure barcode system or something that checks the inventory of stimulants in different pharmacies so that you know if it is in stock or not rather than having to make us send the med to different pharmacies, call different pharmacies, or have the patient be delayed in getting this care.
5. Company that does prior auths for you for a fee.
6. Creating a centralized bed tracking system for psychiatric beds and insurances so that emergency rooms have an easier time referring for admission to outside hospitals.
7. Creating a company that collects all the physician licensing requirements for each state and then you can put your information and documents into one portal, which sends it to each state that you want to get licensed in, including fingerprinting and verification of documents and whatnot. I had to do this by paper mail for my state which is ridiculous. This would make it easier to get licensed in multiple states for telehealth. Also, hospitals can use this for contracting/credentialing new hires from out of state, especially with residents/fellows/trainees.

 

[Ellomate]

It's actually pretty hard to lose a license once you have it in the US, very different experience for doctors in other countries. I've never heard of a single case of someone losing their license where it was some BS thing. Now the number of lawsuits that got settled for BS things, that list is a mile long.

What happens if in inpatient or CL and your clinical judgement deems the patient safe for discharge but ends up taking life? would our license be in jeopardy?

 

[Sushirolls]

If I knew in college what I knew now about the business of health care delivery, I probably would have been more into entrepreneurship. Not necessarily selling an object, but rather some sort of aid or solution to mental health issues that come up for people. Any qualm I have about the practice of psychiatry could have a business solution to make it easier. Some of these below probably already exist.

1. There's a company in my area that contracts with schools to connect students who come to their high school counselor to psychiatrists and therapists in the area. They have been referring patients to me and it's actually a really nice service that seems like it's a win for the schools, win for the parents, and win for the psychiatrist/therapist for more referrals.
2. Starting a company that job trains and hires people with autism to do specific tasks that are repetitive and restricted in nature and do not require minimal social interaction that would lean into the core symptoms of autism. These would be things like stocking shelves, running medications from the pharmacy to the floor, checking if all the doors are locked in a company, etc.
3. Starting a company that does network gap exceptions if the insurance company cannot find an in network psychiatrist or provider and reaches out to local providers to do this for them.
4. Creating a centralized secure barcode system or something that checks the inventory of stimulants in different pharmacies so that you know if it is in stock or not rather than having to make us send the med to different pharmacies, call different pharmacies, or have the patient be delayed in getting this care.
5. Company that does prior auths for you for a fee.
6. Creating a centralized bed tracking system for psychiatric beds and insurances so that emergency rooms have an easier time referring for admission to outside hospitals.
7. Creating a company that collects all the physician licensing requirements for each state and then you can put your information and documents into one portal, which sends it to each state that you want to get licensed in, including fingerprinting and verification of documents and whatnot. I had to do this by paper mail for my state which is ridiculous. This would make it easier to get licensed in multiple states for telehealth. Also, hospitals can use this for contracting/credentialing new hires from out of state, especially with residents/fellows/trainees.

#7 sort of exists, CAQH, however, each state still has their own supplemental forms. So it completely negates that data repository.

#6 sort of seen the before in a large health system in one state [and a small hospital in another state]... but doing so cuts down on the autonomy of a hospital for who they admit... and then they squawk about being on the receiving in of worst payer mix from area A to area B. Or as most states are large, there is the transport of patients from one location to another 8 hours is feasible in some states - that doesn't even include inclement weather. Then at discharge, that hospital has to ship that patient back to where they came from... Insurance doesn't pay that cost. Then, what happens, local counties/community health agencies start striking up deals with local hospital to 'reserve' beds. Or hospitals conceal beds to ensure their own EDs have ability to directly admit with fast discharge. Or what happens, the unit will not update on the system that the bed is indeed vacant... knowing there is a patient in their own ED who likely needs an admission, then *magically* the discharge and its new admit happen within minutes! Oh, and we haven't even gotten into unit differences and acuity...
The small hospital in one state had a system where the SW would call all the hospitals in the state to share and inquiry about each others bed availabilty, typically done twice a day, but oh, huh, patients would typically be discharged after those phone calls, to service the local ED needs...

Hence, I've learned to somewhat recommend to patients that if their own acuity isn't super high when in crisis and needing admit, to drive to the places that have units ... as it might ensure they get admitted compared to if they went to 'the closest emergency department' we usually tell patients.

#5 who will pay? Then also need that one special HIPAA agreement form, what's it called... shucks, can't think of it... 'something agreement.'

#3 LOL. Insurance companies don't want to pay or expand access... if they did they would pay more. Don't foresee Disjointed Death Care, or Stigma doing that anytime soon.

 

[Bartelby]

What happens if in inpatient or CL and your clinical judgement deems the patient safe for discharge but ends up taking life? would our license be in jeopardy?

Not likely. A lawsuit is always possible when they can allege wrongful death, but with good documentation showing that you exercised reasonable clinical judgment even that would probably be low-value / unlikely to prevail at trial.

 

[Merovinge]

What happens if in inpatient or CL and your clinical judgement deems the patient safe for discharge but ends up taking life? would our license be in jeopardy?

There is a broad array of situations that can lead to said decision and it would only be in the most flagrant disregard for life where that even might be on the table and even then I think it would highly unlikely. Lawsuits are much much more likely in these situations but even then are very unlikely to be successful and if they do settle will be for at or below policy limits in almost all cases.

Discharging a recently suicidial patient is among the bigger decisions made for psychiatrists (even if you do it multiple times per day with a specific job position) so certainly do your due diligence with the decision, but I would never in a million years consider losing your license if you are doing that.

 

[comp1]

You're more likely than not to have some sort of suicide completion during the course of your psychiatric career regardless of practice area. In certain practice area like inpatient, you're likely to have multiple to many depending on your specific patient population. 50,000 people a year kill themselves in the US alone. I'm sure it's possible, but I've never seen a physician lose or even have their license sanctioned related to a suicide. There are sometimes (although not always) lawsuits, but lawsuits are not directly related to a license. You're also more likely than not to be involved in some sort of lawsuit during your clinical career and statistically that lawsuit will most likely be about medication side-effects, not suicide. Ultimately, we do not have control over what our patients do and the licensing bodies tend to recognize that. Otherwise, every PCP would lose their license over patients still going off and dying from a heart attack after being counseled to change their diet. Suicide is high stakes, but the same practice rules apply as with anything else. You document your decisions and why you made them.

 

[TexasPhysician]

Some professional sports teams have begun hiring a FT counselor to manage anxiety, performance, and other drama. That could be fun for awhile.

 

[mistafab]

Male stripper.

End of story

 

[AcronymAllergy]

Some professional sports teams have begun hiring a FT counselor to manage anxiety, performance, and other drama. That could be fun for awhile.

There's a whole niche in psychology for sports psychology. Some folks begin moving in that direction in grad school. Sometimes it has to do with maximizing performance and the like, but other people focus on the more standard stuff (like you've mentioned), just specifically in athletes. Players' associations also often have lists of participating providers for current and former athletes looking for MH services, if that's something a person's interested in doing (might be a good way of getting a foot in the door).

For me, based on another thread and how many emails and mailers I get, I'd probably just start a sham CE company and get creative with what we offered. "Supplement your practice" by learning how to do combined Autism and ADHD evals in adults in under 15 minutes through TikTok via a half-day workshop? You bet!

 

[TexasPhysician]

There's a whole niche in psychology for sports psychology. Some folks begin moving in that direction in grad school. Sometimes it has to do with maximizing performance and the like, but other people focus on the more standard stuff (like you've mentioned), just specifically in athletes. Players' associations also often have lists of participating providers for current and former athletes looking for MH services, if that's something a person's interested in doing (might be a good way of getting a foot in the door).

For me, based on another thread and how many emails and mailers I get, I'd probably just start a sham CE company and get creative with what we offered. "Supplement your practice" by learning how to do combined Autism and ADHD evals in adults in under 15 minutes through TikTok via a half-day workshop? You bet!

True, but most sports psychologists aren’t employed by a team FT with field/clubhouse access.

 

[Stagg737]

True, but most sports psychologists aren’t employed by a team FT with field/clubhouse access.

This, one of my colleagues is directly associated with 2 professional teams in our city. Her inclusion in the organizations is surprisingly disconnected despite the hospital system being heavily associated with these teams. I'm talking our health system logo all over the background of pre/post-game interviews on national television level of association. Meanwhile the orthopods who do offseason surgery got championship rings in the last 10 years. MH involvement at the pro level is a weird relationship, and not what I expected. Sources are team psychiatrists and psychologists for 2 NFL teams and an MLB team I've directly worked with.

 

[Candidate2017]

What happens if in inpatient or CL and your clinical judgement deems the patient safe for discharge but ends up taking life? would our license be in jeopardy?

This has been answered many times before.

You are required to give up your crystal ball and magic wand because you obviously suck at reading crystal balls and clueless as to how to use magical words to prevent suicide. On the plus side, you won't have to participate in MOC, pay ABPN dues or read their 30-40 dumb articles every cycle.

MH involvement at the pro level is a weird relationship, and not what I expected. Sources are team psychiatrists and psychologists for 2 NFL teams and an MLB team I've directly worked with.

The advantage to being a psychiatrist for sports teams is it really isn't clinical work. You are a consultant to the coaches, and the athletes aren't your patients per se. It is quite remarkable how motivated coaches and athletes are in compared to the average functional psychiatry patient. The downside is you must be very available, and the power differential lies with the client. Overall, I don't find it appealing.

This is different from having athletes as clinic patients. The liability is higher. There's a reason why malpractice carriers ask if you treat athletes or celebrities. Pro athletes love controlled substances. They also can afford to sue frivolously if they don't get what they want. I know a psychiatrist who discharges all pro athletes from their panel due to these issues.

One's malpractice limits also do not come close to an athlete's lost earnings (if your state does not limit economic damages). There was an orthopod who jumped out a window after getting a judgment against him in the tens of millions in favor of his NFL patient's lost earnings, even though the consensus among fans was that the NFLer was not worth anywhere close to that money and would have lost his job regardless of any surgery or injury.