Thursday, March 12, 2015

How Psychiatrists Spend Their Time and Why the Agency Demands Contribute to the Shrink Shortage

Over on Clinical Psychiatry News this week, I wrote an article called Addressing the Psychiatrist Shortage: What Keeps us from seeing More Patients?.  Please check it out and tell me what you think. 


Alicia said...

At least all that paperwork is figured into your salary. Check out requirements for special ed teachers continuing ed, licensing, required trainings, paperwork, authorizations, recommendations, documentation, legal document writing, liaising with with medical and other professionals and family members, ACS, police departments and courts...(and I won't even mention the sheer amount of time and money spent on basic preparation - at least you can walk into a session and take your client's lead. We don't get to do that.) I spend well more then the figure you quoted.....and on my $50,000 annual salary. And I don't get to turn away difficult students, schedule bathroom breaks between classes, or write off my supervision and consultations on my taxes. And yes, before you say it, we do work 12 month years in special ed.

I love my work. But your post reads like griping to me, well past #firstworldproblems. If all the teachers in the world walked away from teaching on your logic that some things suck, well, there wouldn't be any shrinks anymore, either, because none of y'all would be able to read.

Dinah said...

Alicia: Thank you for teaching special ed, we need you in the world. I agree that you should get paid more. And I think it's ridiculous that anyone in any profession should be spending their time on activities or paperwork that isn't furthering the work they do to in a relevant way towards their jobs. The world in general has become totally nuts with mandating busy work. I wrote about this with regard to the psychiatrist shortage, but perhaps if everyone wasn't so stressed out spending hours a day meeting irrelevant requirements, we might need fewer shrinks? And everyone in every job should be allowed to go to the bathroom when nature calls.

Thanks for reading my griping article, and thank you again for the work you do and the children you teach. I've had several special ed teachers as patients and I know it's a really hard job with really long hours, lots of documentation, and lots of family issues. I know I couldn't do it.

Joel Hassman, MD said...

Thank you so much for your column, I hope you don't mind that I used it as a link in my last post at my blog that motivates me to just pine for 2018 when my board cert status ends and I "can slide on the ice!"

Sorry, you'll have to read the post and watch the Youtube link in the middle to appreciate what that means!!!

But, you laid it out perfectly for me, and why no one who really wants to practice psychiatry as appropriately trained can do it much longer.

These antipsychiatry folk don't realize they will succumb to the adage "careful what ya wish for!".

Happy Spring to you and all!

Anonymous said...

Thanks Dinah. This is a blog about psychiatry so I think it is fair to gripe about the "extra" work we do (and everyone everywhere is pressed to do more and more and more and more with less and less, etc). Let's support one another rather than get into a pissing match about who has it worse.

Alicia's comment that at least paperwork is figured into the salary is not entirely correct. When I was salaried, I worked well past my 28 salaried hours a week (i could never work 40 hours since that is 60-80 real hours). Paperwork time has disappeared from most salaried jobs -- if it ever existed.

As a doctor or as a teacher you work until the work is done. When I was salaried I could not turn away ANY patient and took all comers. I had zero control over my schedule or who I saw or when I took vacation. I was frankly miserable but tried my best to never take it out on my patients. So instead I tool it out on myself and my family. It took someone dying (not at work) for me to realize that life is short (sometimes) and I did not want to be miserable anymore.

I now have a private practice where I still estimate that for every patient hour there is an hour of paperwork but at least it is my choice who I see and when I work. I am much happier. I know that I am no longer seeing some of the sickest patients and I am contributing to the psychiatry shortage on one level. But I am less than 10 years from retirement and I do not want to drop dead from stress and misery one day after I leave my job (yes, it happens).

Anyway, thanks for letting me vent.

Alicia said...

@anonymous -

If you're working 28 salaried hours a week (let's say that's 40 hours total) and getting paid $150K and I'm working 35 salaried hours a week (let's say that's 90-100 hours total) and getting paid $50K, your paperwork is counted into your salary.

Sure, some aspects of psychiatry suck, but let's be real about the privilege of psychiatrists overall when compared to the rest of the working world, especially those in the "helping professions."

Dinah said...

I love my job and feel it is an honor to be able to work with people in the way I do. Also nice to be paid well for it, and if that isn't enough, people effusively express their appreciation. My point wasn't to qvetch in a world where so many people hate their work, feel unappreciated, labor physically, and get paid much less, nor was it to create an environment of "I suffer more than you."

I was trying to make the point that when there is a shortage field like psychiatry, then docs could see more patients if their time wasn't spent doing documenting things that don't matter and watching videos on elevator service. The world as a whole would be better if people could do their jobs with relevant requirements, these things wear everyone down at some level.

Alicia said...

I hear you, Dinah. I agree less paperwork would be beneficial in all fields. Something to keep in mind, however, is that a post like yours further emphasizes the very real difference between psychiatrists way of life vs. much of the rest of the world, often those who are struggling to come up with therapist fees. That seemed, to me, to be the takeaway from the article much more so then a paperwork sucks message.

I love my work, my job, and my career, but it's hard to hear psychiatrists complaining about the negatives of paperwork when I spend such a huge percentage of my salary to pay for their therapy.

I'm also not so sure your point that docs could see more patients if less paperwork. I spoke to my shrink, and my psychiatrist-who-does-therapy-in-a-private-practice-and-does-not-accept-insurance limits her patient caseload to a set number of hours per week. More then that, she feels inundated with peoples' needs and that she can't meet them. This is not, she says, tied to paperwork, but more tied to quality of care and preventing burnout.