A psychiatrist retires after being told to spend less time with patients:
On March 8, Kraft was notified by her supervisor that the time allotted for her to see patients would be reduced from 60 minutes for a new patient to 45 minutes, and 20 minutes for a return patient down to 15 minutes. Incorporating paperwork and dictation, Kraft would only be allotted 30 minutes of face time for a new patient and 10 minutes for a return patient, she said.The alteration in the time with patients would raise the number of patients she would meet on a daily basis from 18 return patients to 24.
(via Shrink Rap)
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I quit a job back in residency, when I was moonlighting at a mental health clinic. The administrator (a social worker) wrote me a note, stating “You’re spending way too much time talking to patients. I talked to some of the patients and found that you are talking to them about their problems. That’s the therapist’s job. Please just stick to the meds.”
After writing a letter with my objections, I voted with my feet, and told my fellow residents what the deal was at this place.
The time being alloted in the new schedule given her is not adequate for quality care. Been there, done that, have the T-shirt–and will not do it again. I too once let other’s financial objectives impose a similar schedule (except that I still had 60 minute for new paients–but never actually finished the dictation in less than 75) with clearly identifiable adverse personal and clinical consequences and will never go there again.
I now apply the principle that I knew to be true but did not at first have the courage to stand up for, that frequency and duration of visits in psychiatry is an important clinical decision that can only be made by the doctor in collaboration with the patient. The “dose” of doctor-pateint contact time should no more be made by a non-clinical third party than they should decide the dose or type of medication. I resolved to never again let others control my schedule as long as I practice. If I am ever unable to do so, then I will not practice. I would rather be former physician than an unethical physician.
One often hears of a shortage of psychiatrists, but the reality is that most institutions with chronic personel shortages have them because they present unethical and unbearable working conditions and/or pay 25 year old pay scales. In private practice, there is a shortage of doctors who will agree to the idiocracy of the third party payers, but no problem getting quality care for those willing to pay what any decent CPA charges.
And since when, I wonder, is “the other schools are doing it” and adequate excuse? I don’t accept “the other kids are doing it” from my children? I bet those administrators don’t either.
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