IPS 2012 - Finding Ideal Job in Psychiatry

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Course Faculty

IPS 2012

Course 07

Finding Your Ideal J ob in Psychiatry

Robert S. Marin, M.D.

Wesley E. Sowers, M.D.


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FRIDAY, OCTOBER 5, 2012

1:00 PM-5:00 PM

COURSE 7

FINDING YOUR IDEAL JOB IN PSYCHIATRY

EDUCATIONAL OBJECTIVES:

At the conclusion of this session, the participant should be able to: 1) Identify corevalues and goals for personal and professional life; 2) Identify resources and limitationsthat will influence the ability to realize these goals; 3) Appreciate career opportunities inpublic service psychiatry and 4) Understand key strategies for seeking a job, evaluating

job opportunities, and negotiating a desirable job contract.


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C05 Creating Your Ideal Job in Psychiatry

Time Schedule/Agenda

1:00 - 1:10 Introductions and Observations of Typical Career Planning Processes

1:10 - 1:30 The Changing Environment for Health Care Services

1:30 - 1:50 The Impact of Health Care Reforms and Finances on Career Planning and Options

1:50 - 2:20 The Rise of Public/Community Psychiatry: Scope and Opportunities

2:20 - 2:50 Career Planning Exercise: Creating a Personal Life Vision

2:50 -3:00 Break

3:00 - 3:15 Career Planning Exercise II: Articulating Your Vision

3:15- 3:30 Lessons Learned: Relevance of Vision to Career Planning

3:30-4:20 Getting Down to Business: Negotiating Your Vision

4:20-5:00 Reflections, Questions, and Strategies


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Course Instructors: Wesley Sowers, MD (WS) and Robert Marin, MD (RM)

1:00 - 1:10 Introductions and Observations of Typical Career Planning Processes (WS)

How most of us get our first job What we are told about career planning The value of self-advocacy

1:10- 1:30 The Changing Environment for Health Care Services (RM)

Systems Transformation Person-Centered, Recovery Oriented Services Financing Reform, ACA Integration of Services Preparation

1:30 - 1:50 The Impact of Health Care Reforms and Finances on Career Planning and Options (WS)

Privately Funded Practice Publicly Funded Services Academics Subspecialty Practice Administration and Leadership Clinical Practices

1:50 - 2:20 The Rise of Public/Community Psychiatry: Scope and Opportunities ( WS and RM)

Funding and Shifts in Practice Community Based Practice and Deinstitutionalization Training Opportunities Diversity of Options and Experience Value Based Job Satisfaction

2:20 - 2:50 Career Planning Exercise: Creating a Personal Life Vision

Participants will complete a brief questionnaire related to elements to beconsidered in creating a life vision and then discuss it with a partner in the class.

3:00 - 3:15 Career Planning Exercise II: Articulating Your Vision

Participants will report on their partners vision and their reaction to it.


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Wesley Sow

Director, Center for Public Service Psyc

Western Psychiatric Institute and

Robert Ma

Associate D


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Course Objectives

Identify core values and goals forpersonal and professional life

Identify resources and limitations thwill influence the ability to realize th

goals Appreciate career opportunities in p

service psychiatry Understand key strategies for seek

jobs, evaluating job opportunities, a

negotiating a desirable job contract


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In Practical Terms

Enable you to clearly articulate youlifes vision, both professionally andpersonally

Obtain a broad view of our field, ho

changing and how it can accommoyour vision Appreciate the scope of potential

opportunities and how to tap into th Basic skills of self advocacy and va

behind it.


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Traditional Concerns

Will anyone really want to hire me?

Do I really know what Im doing?

Who will be there to help?

How will I manage in a new system

How will I figure out what is needed

How much money will I be making?

What will it be like to finally be a reaDoc?


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Staying Put

Many of those concerns lead us towthe familiar

For those who like gradual transitio

find other strong attractions to whethey have been, this is a good choiBut

Still can make a big difference if yo

able to structure you job to meet cldefined career objectives


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Preparation

For the most part, residency trainingprovides very little practical informatioabout finding jobs or negotiating skills(Conflict of interest?)

Generally do not encourage a diversitexperience outside the training system

Learn by experience? Big Gamble

Conditioned to be embarrassed by seconcernsupposed to be altruistic


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Value of Self Advocacy

Self Advocacy is not inconsistent waltruistic values

We have to take care of ourselves order to take care of others

Burning out and breaking down helone

We should advocate for ourselves scan advocate for others

This means much more than mone


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The Morning

The Changing Environment for HealthServices

The Impact of Health Care Reforms a

Finances on Career Planning and OpThe Rise of Public/Community Psych

Creating a Personal Life Vision

Business: Negotiating Your Vision

Questions and Answers


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The Private Sector

It has become increasingly difficult a solo practitioner

Significant administrative expenseshave contributed to the limited scoppractice

Larger practice groups face many osame forces and must adopt a busplan to stay afloat

Contracting and employment comm Consultation to PCPs may be an

important future option ACA relief?


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Public Sector Practice

Impact of managed care and margprivate benefits

Typically a more captive population

mobility Most psychiatrists will spend at leas

portion of their time in publicly fundpractice.

Growing demand to be discussed infollowing section


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Academics

No longer subsidized to the extent tthey once were

Faculty generally expected to genesalary support

Teaching is not typically compensawell or valued within departments

Research support is highly compet

Stress? Security? Compensation?Satisfaction?


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Subspecialty Training

Psychiatry as primary care?

Specialization has been increasing inPsychiatry as in other medical discipli

Growth of PG fellowships

Growing emphasis on primary care anintegration will discourage specializatand likely reduce incentives

Politics aside, makes economic and p

health sense to reduce prevalence


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decompressorare needed to see this picture.


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Administration and Leadersh

Role of psychiatry has diminished irecent years

Limited training and opportunity fee

one another Few compensation mechanisms, m

create added value to organizationjustify cost

Recent increase in training opportuand creativity in expanding influenc


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Clinical Practices

Biomedical reductionism?

Fee for service, managed care, misplpriorities have narrowed the scope of

clinical practice Lack of creativity, diversity in job crea

Acquiescence to financial pressures

Significant opportunities to improve q

Impact of current scrutiny of evidence


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The Scope of Practice and Opportunities


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Factors Influencing Shift to Public

Sector Service

Financing Shifts:

Limited Private Benefits

Growing Reliance on MA Dollars

Growing Demand for Services: Deinstitutionalization

Social Drift/Health Care Access in PrivSector

Hassel Factor: Decline of Private Prac Expanded Public/Community Services


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Deinstitutionalization

Influenced by a variety of factors overpast sixty years (expense, meds, pubawareness)

Increases states access to federal futhrough MA

Expanded demand for community baservices

Olmstead Act- least restrictive environ

Civil Rights of People with SMI


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Community Based Practic

Desire for diverse practice

Distaste for business aspects ofprivate work

Economic Security (shifting locus orisk)

Social Consciousness?

Opportunity

Controlled Schedule Focus on Health


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Diversity of Practice

Community Mental Health Centers

Addiction Treatment Programs

Correctional Psychiatry

Homelessness- street, shelter, hou Residential Services

Treatment Team Orientation

Full recovery spectrum

System based interventions


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Experience

Never boring

Manageable

Adventure

Balance of work and private life

Cultural diversity

Public Service

Insight


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Satisfaction

Influence

Autonomy

Valued

Compensated

Secure

Challenging


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Getting Started

Know yourself

Geography

Social context and activity

Family needs Economic needs

Work conditions and nature


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Geography

Climate

Urban vs. Rural

Exiting the urban chain everything cu

Family proximity Geographic culture


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Social Context

Hobbies and activities

Religious heritage

Vacation / Holiday needs

Work Schedule

Work Culture


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Family Context

Health and welfare of family of orig

Spousal social and employment ne

Education opportunities

Special needs children


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Work Environment

Practice preferences

Special interests

Diversity preferences

Compatibility with practice environm

Compatibility with agency values


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Non-Monetary Compensat

Professional

Education/CME

Teaching/Research

Administration Benefits

Insurance

Retirement

Family


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Pre-Interview Screening

Geographic preference

Social / cultural special needs that deal breakers

Work preferences and need for div


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Rules for Onsite Interviews

Always take your spouse or significanother

Take your time

Explore community on your ownTalk with other psychiatrist in the

organization or who work with theorganization.

Talk with other potential team membe Pay attention to organizational culture


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Rules for Onsite Interviews

Understand the financial situation of tagency

Ask to see last years financial statement?

Meet with financial officer

Get contact info for key staff you mayto follow up with later

Ask for any forthcoming offer to be inwriting

Be clear about your decision timetabl


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Establish Compensation Issu

How do you want to be compensat

Figure out how much revenue you generate for the organization

How much will it cost the organizathire you?

This will be the basis of negotiationthe contract-


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Key Elements of Negotiati

Define the mutual benefit or contribto mission

Responsibilities of each party to the

other Benefits & monies to be exchange

Expectations of behavior

Reporting responsibilities

Terms & termination


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Topics

What is a contract

Types of contracts

Key elements of a contract

Legal nuances for caution


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What is a contract?

An Agreement between two or moreparties in which the agree to do or ndo specific things

Normally produces a mutual benefi

Frequently defines clearly the termrelationship

Usually legally binding


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Developing the Contract:

Often have a standard format

Alterations of contract may require

Since they are not easily altered,

specifics of the position should bewritten into an attached job descrip

If special arrangements are agreedupon, get them in writing!


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Employment agreement

Generally define the terms of emplo

Should reference a job description

Always have the following:

An effective date: hire, benefits, proba

Reporting relationship

Responsibilities

Benefits & compensation

Termination conditions


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Conditions for Termination

Employer may terminate for goodcause, bad cause, or no cause at-a

Employee may terminate as well Notification period is usually specifi

the contract, same for both parties

Unique termination requirements?


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Flexibility of An Employment

Agreement

Should be broad enough toaccommodate changing circumstan

Cannot be so specific that changes

work environment require contractchanges they will not happen!

Attention to termination restrictionsespecially important in this regard!


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Independent Contracting

Agreement with an agency to provispecified services

Designated compensation arrangem

Usually no benefits, including healtmalpractice insurance

Be aware of these expenses whennegotiating the rate


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Business standards

Severability

Records & documents manageme

Reporting

Non-discrimination Compliance with applicable law

Assignment

Entire agreement clause


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Caution areas:

Indemnify & hold harmless clause

Third party relationships & sub-contracting

Non compete


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Value of Negotiation

Remember that in most cases, theyneed you more than you need them

Dont be afraid to questions and ma

requests When everything is clear at the out

is less likely that there will be confliahead

You will feel more secure and value


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Background Articles:

AACP, Keystones for Collaboration and Leadership: Issues and Recommendations for the

Transformation of Community Psychiatry, Sowers, W.E., MD and Thompson, K.S. (Eds.),

www.communitypsychiatry.org 2007

Ranz, J. et al, The Role of the Psychiatrist: Job Satisfaction of Medical Directors and Staff Psychiatrists.

Community Mental Health Journal, vol. 37, no. 6, Dec. 2001

Ranz, J. et al, The Role of the Community Psychiatrist as Medical Director: A Delineation of Job Types.

Psychiatric Services, vol. 51, no. 7, July 2000

Garfield, R.L. et al, Health Reform and the Scope of Benefits for Mental Health and Substance Use

Disorder Services. Psychiatric Services, vol. 6:1081-86, 2010
http://www.communitypsychiatry.org/http://www.communitypsychiatry.org/http://www.communitypsychiatry.org/


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References:

Garfield, R.L. et al, Health Reform and the Scope of Benefits for Mental Health and Substance Use

Disorder Services. Psychiatric Services, vol. 6:1081-86, 2010

Sowers, W.E., Transforming Systems of Care: The American Association of Community Psychiatrists

Guidelines for Recovery Oriented Services. Community Mental Health Journal, vol. 41, no.6, December

2005

Peebles, S., et. al., Immersing Practitioners in the Recovery Model: An Educational Program

Evaluation, Community Ment Health J, vol. 45, p 23-45, 2009

Willing, C.E., et al, Transforming Administrative and Clinical Practice in a Public Behavioral Health

System: An Ethnographic Assessment of the Context of Change, Journal of Health Care for the Poor

and Underserved, vol 20, 2009

Aarons, G.A., Transformational and Transactional Leadership: Association with Attitudes Toward

Evidence-Based Practice. Psychiatric Services, vol. 57, no. 8, Aug. 2006

Ranz, J. et al, The Role of the Psychiatrist: Job Satisfaction of Medical Directors and Staff Psychiatrists.

Community Mental Health Journal, vol. 37, no. 6, Dec. 2001

AACP: Guidelines for Psychiatric Leadership in Organized Delivery Systems for Treatment of Psychiatric

and Substance Disorders,http://www.wpic.pitt.edu/aacp/finds/leadership.html

Ranz, J. et al, The Role of the Community Psychiatrist as Medical Director: A Delineation of Job Types.

Psychiatric Services, vol. 51, no. 7, July 2000
http://www.wpic.pitt.edu/aacp/finds/leadership.htmlhttp://www.wpic.pitt.edu/aacp/finds/leadership.htmlhttp://www.wpic.pitt.edu/aacp/finds/leadership.htmlhttp://www.wpic.pitt.edu/aacp/finds/leadership.html


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Self Assessment Questions:

1. Career opportunities in psychiatry are changing as a result of:a. Health care reform and financingb. Recovery principles and patient centered clinical practicec. Incentives for integrating physical and behavioral health care.d. All of the above

2. Service integration in the mental health system is important for all of the following except:a. Addictions and co-occurring disordersb. Physical and behavioral health carec. Adolescent and adult Cared. Forensic care and financial reform

3. Health care reform will probably:a. Eliminate private practice as a career pathb. Increase the emphasis on chronic care and health homesc. Decrease the importance of health maintenance and preventiond. Reduce the emphasis on objective measures of mental health services

4. Career satisfaction in the public sector is associated with:a. Opportunities for leadership and consultationb. Integrating personal life goals with professional life goalsc. Understanding the culture and structure of the employer organizationd. Learning to negotiate broader and more flexible job descriptionse. All of the above

5. Which of the following is NOT an important element in evaluating a job opportunity?a. The culture of the prospective employer organizationb. The employers contributions to a political partyc. The previous years budget statement of the employerd. Location

6. In evaluating a job opportunity, its a good idea to:a. Visit the employer community with your spouse or partnerb. Avoid questions about the employers overall budgetc. Meet only with the prospective supervisor and physician colleaguesd. None of the above

7. Which of the following is a common mistake made by persons entering the job market for thefirst time?

a. Wearing inappropriate clothingb. Relying too heavily on non-monetary forms of compensation.c. Accepting offers without negotiating for what they really would like


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IPS 2012 - Finding Ideal Job in Psychiatry

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