Types of work schedules in psych?

[deleted849476]

Going in to 3rd year soon and wanting to flesh out some questions, especially about work schedules and types of jobs in psych. For example, I find IM hospitalist shift work really appealing based on 7-on 7-off schedule and/or nocturnist positions that work ~10 nights/month and that’s it for 1 FTE, but is there anything similar for psych? Maybe for in patient? Or locums or PP?

Part of me says I’d be more likely to enjoy the day-to-day work of say, typical outpatient M-F psych regardless of schedule and would have the best chance of sticking to that specialty choice for 40+ years, but another part says, wow, one less year of residency and i could do my other interest in hospital medicine, and at least for a few years out of residency be a 1 FTE doc with similar pay to a psychiatrist as well, but be traveling the world on my off week, and traveling is something I am dying to do and feel like I might only have this chance while I’m young and still single (no plans to get married any time soon). But the downside to IM would be, I think I’d be more prone to burnout or just wanting to make money and retire early if I did that, vs having a more fulfilling, longitudinal career in psych at the cost of what I think would have to be a slightly less dynamic or interesting work schedule.

In other words, is 7-on 7-off (or similar) a thing in psych, and if not are there any work arrangements that might be more conducive to frequent travel? Because another perk of IM or even FM hospitalist would be that if I weren’t traveling one week, I could pick up urgent care shifts or more hospital shifts and drastically increase pay (but maybe this would be true for psych ED or in patient shifts as well…?)

thanks, sorry, late night ramblings..

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[Celexa]

Oops responded way too fast and realized you're a medical student.

Most psychiatry is outpatient. 7 on 7 off is a niche scheudle that seems way more appealing when you're young. Think about what type of patients you want to see most often and what colleagues you want.

 

[Merovinge]

Hospitalist type schedules (7 on 7 off) have grown significantly in popularity for inpatient psychiatric work. I know that psychiatric hospitals are even struggling to hire new grads without offering this type of schedule. If you wanted to do inpatient while you were young and then transition to traditional outpatient, I dare say this would make you a better psychiatrist then only doing OP work and it's super feasible these days.

Nocturnist shifts are much more rare, this work is either done by a telepsychiatrist/crisis team in the ED, taken as a phone call by the daytime attending inpatient, or in an academic center it's covered by residents. If you really want to do nighttime cross-cover, IM is 100% the way to go. This work sounds miserable to me for so many reasons but I'm glad there are people who want to do it.

 

[TexasPhysician]

Psych has every schedule you can imagine.

 

[nexus73]

I think IM hospitalist 7 on 7 off is typically more flexible. Our inpatient psych 7 on 7 off is fairly rigid. If you want to take 9 off you have to trade with someone, and there's only a few psychiatrists/np's not already working. I find the psychiatrists are more insistent on their 7 off and not interested in picking up an 8th or 9th day for more money. For IM, you will probably have a group of 20 or more docs and some are fine working 14 days in a row. IMO the nature of IM is less emotionally draining, probably harder in other ways, but in psych for me working beyond 7 days is pretty rough. So IM hospitalist say you want to front load your month with 14 shifts and take the next 16 days off to go to Europe, it's much more likely this will be possible. In psych to do the same thing you'd either need a large pool of docs willing to pickup extra work, an outpatient clinic associated with the hospital with docs will to pickup inpatient shifts, or an administration willing to hire locums to cover extended vacations.

If you're set on psych and really want to travel I'd suggest locums, especially because you can take 7 on 7 off jobs in locations you want to visit in the US at least. Then if you want 2 months off to see Australia, just take 2 months off which you can do as a locums.

 

[clozareal]

There's an employer in my area that is offering a W2 job for 9 days per month of 16 hour shifts in psych emergency for $300k with full benefits. People fly in for it and then do it (because it's in a VHCOL area), then go somewhere else for the remaining 3 weeks for vacation/travel.

 

[Bartelby]

I would agree with others that many different schedules are possible. I think the traditional 7 on 7 off is still easier to find in IM though.

As an aside, as an MS3 7 on 7 off sounded amazing. By the time I graduated residency, though, I was married and had a young child. At that point the traditional M-F schedule looked way more appealing (especially with a working spouse). Just be aware that a lot can change in five years. Overall, though, I think the lifestyle in psychiatry tends to beat the lifestyle in IM.

 

[comp1]

Definitely second the whole if you can dream it, the schedule exists in psych. Psychiatrists are so in demand, employers, particularly inpatient and correctional, will work around your schedule. 7 on and 7 off would be...unusual for psych, but definitely not impossible. 4-10's or 9-80's are much more common. Psych inpatients aren't always seen every day every where. There can even be insurance limits on this, but the work is still there if you are super tied to this idea as not many psychiatrists like to spend their weekends on a unit. Honestly, part time is the MOST common. I do think the OP is going to be a lot less motivated for that sort of schedule after residency.

 

[deleted849476]

Great info everybody, future looks bright! Thanks

 

[Stagg737]

Just another one to add to the N. I'm PGY-4 looking at jobs now, specifically inpatient and consult/CL positions. Of the 20ish positions I've seriously looked at, 7 or 8 either explicitly stated a 7/7 schedule or said "possibility of 7/7". What I'm seeing at the moment is that a 7 on and 7 off schedule is pretty easy to find if you want it. I've also seen 2 positions that were for 14 on and 14 off, so while they're uncommon they exist. Many postings also say "flexible hours", and at least one or two were open to 7/7 scheduling (not sure about most though).

Locums is also a great option. You can contract for anywhere from 2 weeks to a year from what I've seen and some places will extend the contracts past that. If you're open to moving a lot and not tied to one location, you can work X months at a time then take X time off.

I haven't gotten any postings specifically for overnight positions, which I'm perfectly fine avoiding.

On the outpatient side I've mostly seen the typically M-F jobs, but I've also seen a few 10 hours 4 days a week positions and know a few psychiatrists with that schedule. One of my wife's friends is married to a psychiatrist who does this, and apparently they regularly jet off to some place every other weekend for 2-3 days or just whenever they feel like it. Keep in mind that a 4 day schedule should still be offering vacation and sick days, so you also don't have to take as many days off to have a 9 day vacation while still having regular 3-day weekends.

You can also just work part-time or as 1099 and have plenty of time off. You can also run your own private practice, decide your own schedule, and take a week off whenever you want, though that obviously takes time to build up. I think overall psych is actually more flexible than IM in terms of work schedule and you can do whatever you want.

TL: DR, see TexasPhysician's post

 

[Mass Effect]

Put it this way, just about anything you want is available in psych. There are many inpatient jobs with 7 on/7 off. There are also locums jobs where you decide how often you work. I have a friend right now doing locums work and he works for 2 months, takes 1 month off to travel with the wife who works remotely. Works another 2 months, takes another 1 month off. With locums, you're an independent contractor so you don't get benefits, but you decide what assignments you take and in which part of the country. My friend rented an RV and drove to more rural hospitals over holidays to provide coverage. He made bank from Nov 1 - New Years this year and hasn't gone back to work yet since early January.

 

[painballer27]

Of the 20ish positions I've seriously looked at, 7 or 8 either explicitly stated a 7/7 schedule or said "possibility of 7/7". What I'm seeing at the moment is that a 7 on and 7 off schedule is pretty easy to find if you want it. I've also seen 2 positions that were for 14 on and 14 off, so while they're uncommon they exist. Many postings also say "flexible hours", and at least one or two were open to 7/7 scheduling (not sure about most though).

Do you know what the schedule's are like for the 7 on weeks? Would you be expected to be on call the whole time?

 

[Stagg737]

Do you know what the schedule's are like for the 7 on weeks? Would you be expected to be on call the whole time?

A lot of the jobs I've seen are either saying 8-10 hour days on the unit or not specifying physical time there. For overnight, the postings I have either say it's covered by someone else (like telehealth) or just don't specify, so not sure. I do know places that do have you on call the whole time, but the one or two people I know that held jobs like that went home in the early afternoon and just handled most things from there.

I would not take a 7 on and 7 off position where I was expected to be on 24/7 for a whole week unless it was a relatively small unit like <12 patients. Covering 20+ patients 24/7 just sounds awful, even if you get a full week off afterward. I honestly don't know though since I haven't interviewed at one of those facilities yet.

 

[TexasPhysician]

Do you know what the schedule's are like for the 7 on weeks? Would you be expected to be on call the whole time?

Call depends on the site.

On days can be quite long. Many programs I’ve seen would likely have you there 10-12 hours each day if no call expectations.

This schedule typically involves similar hours averaged over a month to a typical 9-5 job.

 

[DOswag]

Sorry I know this thread is almost a year old but I was searching for discussions on psychiatrist schedules. I'm currently active duty but separating this summer and have a job lined up already. I've dreamed of working less than 5 days per week pretty much since med school and my job will allow me to have that opportunity. Pretty much it's required 40 hours but you can spread them out over monday-saturday 6am-8pm (I'm told we are to work one saturday per month but a physician I talked to there said he works monday-friday 8 hour days, never saturday). Considering 4 10 hour days mon-thursday 7-5, or 3 12's and a 4 hour day, something like that. I know this is a personal decision and some people can't/don't want to work more than 8 hours in a day and others enjoy more days off of work by stacking hours on less days. Pre-med school I worked ER as a tech and worked 12 hour shifts 3 days per week and really liked that schedule. I was also early 20's and didn't have 4 kids at the time (now I'm late 30's lol) so just wondering if my perspective is skewed by previous experience (also considering it was ER work as a tech and not psychiatry as the provider of the patient). Thoughts, ideas, things I may not have considered?

The thought of having a 3 day weekend every weekend is extremely appealing to me. Someone above also mentioned a 4 day work week would allow you to take less days off when taking leave, get more time off because of the 3 day weekends, and I realized I had not thought of that yet so yay, another positive for working less than 5 days per week.

Also this job is outpatient, no nights or call.

 

[Merovinge]

Sorry I know this thread is almost a year old but I was searching for discussions on psychiatrist schedules. I'm currently active duty but separating this summer and have a job lined up already. I've dreamed of working less than 5 days per week pretty much since med school and my job will allow me to have that opportunity. Pretty much it's required 40 hours but you can spread them out over monday-saturday 6am-8pm (I'm told we are to work one saturday per month but a physician I talked to there said he works monday-friday 8 hour days, never saturday). Considering 4 10 hour days mon-thursday 7-5, or 3 12's and a 4 hour day, something like that. I know this is a personal decision and some people can't/don't want to work more than 8 hours in a day and others enjoy more days off of work by stacking hours on less days. Pre-med school I worked ER as a tech and worked 12 hour shifts 3 days per week and really liked that schedule. I was also early 20's and didn't have 4 kids at the time (now I'm late 30's lol) so just wondering if my perspective is skewed by previous experience (also considering it was ER work as a tech and not psychiatry as the provider of the patient). Thoughts, ideas, things I may not have considered?

The thought of having a 3 day weekend every weekend is extremely appealing to me. Someone above also mentioned a 4 day work week would allow you to take less days off when taking leave, get more time off because of the 3 day weekends, and I realized I had not thought of that yet so yay, another positive for working less than 5 days per week.

Also this job is outpatient, no nights or call.

Everyone does PTO based on hours these days, so it's no different with a 4 day week vs 5 day week (40 hours either way). I think 4 10's is doable depending on how many patients/hour you see and your mindset. You do save a little on commuting with 1 less work day, and it would certainly be easier to get things done that occur during business hours. Outpatient psychiatry can certainly be a slog, I know very few (if any) that would want to work 12 hour days, completely different ballgame being someone's mental health home then being a tech on shift work.

 

[DOswag]

Everyone does PTO based on hours these days, so it's no different with a 4 day week vs 5 day week (40 hours either way). I think 4 10's is doable depending on how many patients/hour you see and your mindset. You do save a little on commuting with 1 less work day, and it would certainly be easier to get things done that occur during business hours. Outpatient psychiatry can certainly be a slog, I know very few (if any) that would want to work 12 hour days, completely different ballgame being someone's mental health home then being a tech on shift work.

Yes ER tech and Psychiatrist for a patient are completely different, and 12 hour days of each I'm sure would look very different which was my concern powering through psych patients for 12 hours.

I meant the time off in saying if I take a week off work (assuming I'm working 4 10's), having that first friday before the weekend as a day off, then weekend and the whole week off, then next weekend would equate to an extra day off though that's just built into my schedule since I'm still working 40 hours per week. If I was working 5 8's, then a week off would be the weekend, then the full week, then the weekend after. 10 days off vs 9 days off but both would be equal to a week of paid leave.

 

[DOswag]

I see what you're saying, I worded it wrong above and should've said more time off instead of taking less days off. My bad.

 

[hebel]

Sorry I know this thread is almost a year old but I was searching for discussions on psychiatrist schedules. I'm currently active duty but separating this summer and have a job lined up already. I've dreamed of working less than 5 days per week pretty much since med school and my job will allow me to have that opportunity. Pretty much it's required 40 hours but you can spread them out over monday-saturday 6am-8pm (I'm told we are to work one saturday per month but a physician I talked to there said he works monday-friday 8 hour days, never saturday). Considering 4 10 hour days mon-thursday 7-5, or 3 12's and a 4 hour day, something like that. I know this is a personal decision and some people can't/don't want to work more than 8 hours in a day and others enjoy more days off of work by stacking hours on less days. Pre-med school I worked ER as a tech and worked 12 hour shifts 3 days per week and really liked that schedule. I was also early 20's and didn't have 4 kids at the time (now I'm late 30's lol) so just wondering if my perspective is skewed by previous experience (also considering it was ER work as a tech and not psychiatry as the provider of the patient). Thoughts, ideas, things I may not have considered?

The thought of having a 3 day weekend every weekend is extremely appealing to me. Someone above also mentioned a 4 day work week would allow you to take less days off when taking leave, get more time off because of the 3 day weekends, and I realized I had not thought of that yet so yay, another positive for working less than 5 days per week.

Also this job is outpatient, no nights or call.

Extended days are particularly draining in outpatient psych unless you have a ton of admin time.

I also wanted a four day workweek and was able to get four 9 hour days (8a-5p) which feels much more like a "normal" work day than four 10's. I also have no call.

We are in demand, so it doesn't hurt to ask. I also do not think 36 vs 40 hours is that drastic of an hours difference to present to an employer, but it does make a big quality of life difference for you.

If it has to be 40, you could even try 4*9's, with an 8 hour Friday every other week. That way you get a three day weekend every other week.

*As a caveat to all of the above, I would maybe consider 10 hours days if they were work from home.*

 

[luckybuck]

Extended days are particularly draining in outpatient psych unless you have a ton of admin time.

I also wanted a four day workweek and was able to get four 9 hour days (8a-5p) which feels much more like a "normal" work day than four 10's. I also have no call.

We are in demand, so it doesn't hurt to ask. I also do not think 36 vs 40 hours is that drastic of an hours difference to present to an employer, but it does make a big quality of life difference for you.

If it has to be 40, you could even try 4*9's, with an 8 hour Friday every other week. That way you get a three day weekend every other week.

*As a caveat to all of the above, I would maybe consider 10 hours days if they were work from home.*

How much do you make?

 

[hebel]

How much do you make?

305k

 

[dl2dp2]

Sorry I know this thread is almost a year old but I was searching for discussions on psychiatrist schedules. I'm currently active duty but separating this summer and have a job lined up already. I've dreamed of working less than 5 days per week pretty much since med school and my job will allow me to have that opportunity. Pretty much it's required 40 hours but you can spread them out over monday-saturday 6am-8pm (I'm told we are to work one saturday per month but a physician I talked to there said he works monday-friday 8 hour days, never saturday). Considering 4 10 hour days mon-thursday 7-5, or 3 12's and a 4 hour day, something like that. I know this is a personal decision and some people can't/don't want to work more than 8 hours in a day and others enjoy more days off of work by stacking hours on less days. Pre-med school I worked ER as a tech and worked 12 hour shifts 3 days per week and really liked that schedule. I was also early 20's and didn't have 4 kids at the time (now I'm late 30's lol) so just wondering if my perspective is skewed by previous experience (also considering it was ER work as a tech and not psychiatry as the provider of the patient). Thoughts, ideas, things I may not have considered?

I think 12-hour days as outpatient clinical are tough unless you have a lot of no-shows. 3 patients an hour so you are seeing 40-50 patients a day.

 

[Merovinge]

I think 12-hour days as outpatient clinical are tough unless you have a lot of no-shows. 3 patients an hour so you are seeing 40-50 patients a day.

It's funny, my wife sees 4-5 patient's an hour without breaking a sweat and she is overly diligent compared to most people in her specialty. Whereas I feel like I move through material faster than 75% of my peers and cringe at the idea of seeing more than 2 patients in an hour (although I only see CAP population). 3 patients/hour for a 12 hour day sounds absolutely gross.

 

[When is graduation again?]

Sorry I know this thread is almost a year old but I was searching for discussions on psychiatrist schedules. I'm currently active duty but separating this summer and have a job lined up already. I've dreamed of working less than 5 days per week pretty much since med school and my job will allow me to have that opportunity. Pretty much it's required 40 hours but you can spread them out over monday-saturday 6am-8pm (I'm told we are to work one saturday per month but a physician I talked to there said he works monday-friday 8 hour days, never saturday). Considering 4 10 hour days mon-thursday 7-5, or 3 12's and a 4 hour day, something like that. I know this is a personal decision and some people can't/don't want to work more than 8 hours in a day and others enjoy more days off of work by stacking hours on less days. Pre-med school I worked ER as a tech and worked 12 hour shifts 3 days per week and really liked that schedule. I was also early 20's and didn't have 4 kids at the time (now I'm late 30's lol) so just wondering if my perspective is skewed by previous experience (also considering it was ER work as a tech and not psychiatry as the provider of the patient). Thoughts, ideas, things I may not have considered?

The thought of having a 3 day weekend every weekend is extremely appealing to me. Someone above also mentioned a 4 day work week would allow you to take less days off when taking leave, get more time off because of the 3 day weekends, and I realized I had not thought of that yet so yay, another positive for working less than 5 days per week.

Also this job is outpatient, no nights or call.

Is being full-time a requirement for you? I've seen 3-4 day, part-time work weeks offered, particularly in community settings, but I'm sure there are others out there. I work 32 hours per week (4 days) in an ACT setting as a 1099, which has a lower absolute salary than full-time, but the tax benefits from maxing out my self-employed 401k and income from not needing as many vacations still provides me with healthy pay. I personally don't think I'd be able to do 10 hours of outpatient in a day.

 

[forchinet121]

I think 12-hour days as outpatient clinical are tough unless you have a lot of no-shows. 3 patients an hour so you are seeing 40-50 patients a day.

Why would anyone agree to 3 patients per hour? There are a lot of 2 patients per hour jobs where you can actually provide good solid care

 

[Merovinge]

Why would anyone agree to 3 patients per hour? There are a lot of 2 patients per hour jobs where you can actually provide good solid care

As of a year ago (and thus I suspect still) Lifestance required a certain percentage of patients seen in 20 min blocks. Welcome to private equity owned healthcare.

 

[Stagg737]

Why would anyone agree to 3 patients per hour? There are a lot of 2 patients per hour jobs where you can actually provide good solid care

If you don't use psychotherapy add-ons and your compensation is based on RVU production, then seeing 3/hr vs 2/hr can make a huge difference in what you take home.