Unexpected time off--what to do?

[sophia502]

Hello, all--

I'm a long-time SDN user, but created a throwaway as there are personal details here.

I'm an early career psychiatrist. Employed for 3 years, then this year (after getting married, feeling good about savings, securing health insurance, and feeling more secure with my partner's income), took the leap to start a small cash-pay PP. I got a part-time job as a medical director for an IOP (1099) which paid well and made me less nervous about the finances.

Several weeks ago, I was given a 30-day termination notice at the IOP (where I worked on-site) and told they were replacing me with a tele nurse practitioner. (This was for a UHS facility; I know they are garbage, but I was being paid hourly and well so ignored it.) I understand this was a stupid corporate decision and not a reflection on my doctoring skills, but still feels kinda bad to be honest.

Typically, I would hustle and start looking for another part-time job to supplement, but I am pregnant (first time) and would likely take my maternity leave in the fall through the end of 2023. If I'm seeing this wrong tell me, but I don't feel like starting a job search for an employed part-time position, waiting for the credentialing process, and then taking maternity leave 2 months later. I'm also at the end of my first trimester and have felt like death for several weeks, and the idea of starting a job search right now makes me want to cry. Maybe that will change. The extra $ would certainly help, but we are okay right now on mainly just my partner's income.

The problem--I am bored to tears. I can and am putting the time into my PP but it's quite part-time (office is rented one-day a week) and like I said, it's slow. And I expect this--I'm cash pay, my rates are commensurate with where I live (coastal metro city) but high as hell, and I'm new to this city, so I've got a lot of ground to cover with getting my name out there. Luckily my overhead is quite low. I'm also not THAT motivated to grow it quickly right now as, again, pregnant.

So: if you had 6-ish months with a LOT of time on your hands, anything you would do educationally/professionally? Any online trainings you've wanted to do, conferences, etc? Any time-consuming PP tasks I could start on now? I realize that at some point I will look back at all this free time and think: wtf was wrong with you??? But honestly, it's too early in my career for a sabbatical and I'm not there yet mentally. l feel like I *need* to be doing something to better myself professionally.

Any and all ideas and thoughts welcome, including telling me to chill out.

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[B52slinger]

Hello, all--

I'm a long-time SDN user, but created a throwaway as there are personal details here.

I'm an early career psychiatrist. Employed for 3 years, then this year (after getting married, feeling good about savings, securing health insurance, and feeling more secure with my partner's income), took the leap to start a small cash-pay PP. I got a part-time job as a medical director for an IOP (1099) which paid well and made me less nervous about the finances.

Several weeks ago, I was given a 30-day termination notice at the IOP (where I worked on-site) and told they were replacing me with a tele nurse practitioner. (This was for a UHS facility; I know they are garbage, but I was being paid hourly and well so ignored it.) I understand this was a stupid corporate decision and not a reflection on my doctoring skills, but still feels kinda bad to be honest.

Typically, I would hustle and start looking for another part-time job to supplement, but I am pregnant (first time) and would likely take my maternity leave in the fall through the end of 2023. If I'm seeing this wrong tell me, but I don't feel like starting a job search for an employed part-time position, waiting for the credentialing process, and then taking maternity leave 2 months later. I'm also at the end of my first trimester and have felt like death for several weeks, and the idea of starting a job search right now makes me want to cry. Maybe that will change. The extra $ would certainly help, but we are okay right now on mainly just my partner's income.

The problem--I am bored to tears. I can and am putting the time into my PP but it's quite part-time (office is rented one-day a week) and like I said, it's slow. And I expect this--I'm cash pay, my rates are commensurate with where I live (coastal metro city) but high as hell, and I'm new to this city, so I've got a lot of ground to cover with getting my name out there. Luckily my overhead is quite low. I'm also not THAT motivated to grow it quickly right now as, again, pregnant.

So: if you had 6-ish months with a LOT of time on your hands, anything you would do educationally/professionally? Any online trainings you've wanted to do, conferences, etc? Any time-consuming PP tasks I could start on now? I realize that at some point I will look back at all this free time and think: wtf was wrong with you??? But honestly, it's too early in my career for a sabbatical and I'm not there yet mentally. l feel like I *need* to be doing something to better myself professionally.

Any and all ideas and thoughts welcome, including telling me to chill out.

This is exactly what I am planning to do (made my own thread about locums stability), but am worried about this exact situation happening. How long did you last at the IOP before you were replaced?

 

[PikminOC]

"8 months. I was brought on because they had a (fantastic) telepsychiatrist during COVID but wanted someone on-site. Then a few months later a new “clinical director” is hired and she terminated all contract therapists and replaced my medical director position with a tele NP so she can look innovative to UHS corporate folks I guess. It was gross"

To save $$$, it's all about that.

 

[forchinet121]

To save $$$, it's all about that.

Where did you quote the quote you quoted from, I don’t see it in this thread

 

[TexasPhysician]

I’d probably network and attend some therapy workshops.

 

[michaelrack]

I assume you will only take a few weeks off from the cash pay pp during maternity leave? Otherwise you
are going to lose a lot of those patients

 

[littlefred]

Maybe I misunderstood, but you still have a full time job? Or did you stop the full-time to pursue IOP+PP?

My advice is take your time, enjoy being a mother and then start looking for jobs once you're ready.

 

[Merovinge]

Local locums if available would be a reasonable option if your body can handle it, always good to meet people and put your name out there as doing private practice. Otherwise, there's absolutely nothing wrong with taking a little time away, your skills will not decay and you will be just fine when you get back to things.

 

[MacDonaldTriad]

Locum work makes a lot of sense since you will be not working soon. Rest assured that when you decide to get back to real work, full time, you will easily find something full time with benefits. If your SO covers this and you don't need health or pension stuff, you are now experiencing the consequences of choice. Being a free agent makes you free in many ways, but working for the factory has other benefits that provide stability. I don't think the question is so much what you will do for the next 6 months, but what you will match up with for then next 3 decades.

 

[smalltownpsych]

I’d probably network and attend some therapy workshops.

I was thinking develop some therapy skills, but that is pretty predictable since its my own personal favorite 😉
In addition to workshops, you could get some supervision from a local psychologist or psychiatrist who has a solid skill set and experience in psychotherapy. If you are going private pay, the patients are going to want high end therapy with their medication even if they don’t know that explicitly.

 

[annoyedpsychiatrist]

I think you're superwoman basically and while i admire your drive, which is very evident, i think you should take things in stride. Im finishing my second year as an attending soon, and the amount ive learned in those few years is crazy, just from my own reading, looking things up, etc. But its a long term gradual process. Youve earned some time to give birth and rest. You have a lot of obvious stress right now, i think its OK if you dont spend too much time leanring/reading. Networking would probably be a great idea, as mentioned previously

 

[PikminOC]

Where did you quote the quote you quoted from, I don’t see it in this thread

It was by op. Looks like they took it down

 

[PikminOC]

Locum work makes a lot of sense since you will be not working soon. Rest assured that when you decide to get back to real work, full time, you will easily find something full time with benefits. If your SO covers this and you don't need health or pension stuff, you are now experiencing the consequences of choice. Being a free agent makes you free in many ways, but working for the factory has other benefits that provide stability. I don't think the question is so much what you will do for the next 6 months, but what you will match up with for then next 3 decades.

Now experiencing the consequence of choice?

 

[TheRightMedication]

I think you should just take it easy.

If, however, you must be busy, I have something even more heretical to suggest- consider taking an insurance or two and spend your time on that.

There are some insurances where I live that beat my cash rate by a large margin for two 99214s + therapy add ons per hour. The extra admin around this is something to consider, but I chose insurances who paid well AND had a reputation for minimal hassle.

For me, personally, I also didn't think I could sustain 50 min therapy focused visits for every clinical hour, emotionally and intellectually. Having some med management appointments in there is a nice break.

 

[Sushirolls]

You are in the eye of the storm.

Don't do locums.

Look at your state(s) license CME requirements. Get them all done now. Get as much of your board certification done now.

Optimize your private practice. Work flow, intake documents, everything. Get them all polished, 100%. Get biz cards made, get letterhead made, everything. Get your envelopes purchases, stamp them all, address the all, etc. Stock up on all your supplies.

Soon as baby comes you will be missing these days of boredom. You will be tired, more than call. Because you won't get catch up sleep.

Go meet your best referral sources in person, buy them lunch.

Create templates on word documents for out of office VM, or vacation VM, etc.

Create referral sheets for local IOP, local ED, local detox, etc. Have those ready to go print, and hand. Or Electronic send to patients.

 

[MacDonaldTriad]

Now experiencing the consequence of choice?

"Choice" means having multiple part time jobs, but none of them invested in not losing you and not having to pay retirement or health benefits. It is nice to have the ability to decide how much you want to work for whom, but getting all in to one employer is better in ways that become more evident with time. How much per hour is a key measure, but there are other things. One of those things might include maternity leave.

 

[PikminOC]

"Choice" means having multiple part time jobs, but none of them invested in not losing you and not having to pay retirement or health benefits. It is nice to have the ability to decide how much you want to work for whom, but getting all in to one employer is better in ways that become more evident with time. How much per hour is a key measure, but there are other things. One of those things might include maternity leave.

Lots of larger places have decreased retirement benefits significantly

 

[sophia502]

Thanks, all, for your advice and kindness. Very helpful and reassuring. To answer a couple questions, part-time IOP job is now terminated, and I had stopped my full-time employed job to start PP + side gigs for some guaranteed monthly cash.

And I’m not sure yet how I’ll handle PP postpartum. This pregnancy was unexpected and came on the heels of some fertility struggles—starting a PP while pregnant wasn’t my goal, but here we are. Grateful of course, just complicated. Thank you again.

 

[MacDonaldTriad]

Lots of larger places have decreased retirement benefits significantly

It is clear that corporate loyalty to employees has plummeted as much as employee loyalty to their jobs have. It is still true that if you make an organization money in a reliable and consistent way, their attempts to keep you will be balanced by their difficulty in replacing you.

 

[clozareal]

I think working much less is a huge adjustment for someone who has been in school, in training, then employed all of which requires a ton of effort and developing a work ethic that is hard to break. I was in your boat not that long ago as I started a private practice after fellowship, then took new parent leave only a few months months after starting my PP. Money isn't the only thing that is keeping us working as a lot of our purpose and identity comes from our profession, especially since your financial situation seems stable. Don't do locums or try to get a job before you have a baby.

A lot of it depends on your personality and work ethic. I am not a chill person overall but I do love to chill. Here are some of the things I considered to keep me sane with all that time off:

1. Marketing: working on my website, learning about SEO, watching Private Practice Skills on YouTube, listening to the Enlightened Practice and EntreMD podcasts, reading Money in Outpatient Psychiatry (I'm sure there's a ton of other books out there but this was the most helpful in terms of mindset albeit outdated in many of the logistical aspects), making business cards, going on different online directories and putting my name and contact information on there, going on listservs, networking with therapists and psychiatrists in my area, going on all the Facebook groups for psychiatrists/therapists in my area/state, making sure my Google Maps and Apple Maps was set up and correct.
2. Parenting: reading Expecting Better and Cribsheet by Emily Oster, reading How Not To Hate Your Husband After Kids, reading Precious Little Sleep, figuring out which prenatals had 100% of the recommended vitamins/minerals for pregnancy according to ACOG and AOM (hint: none of them have everything in one pill, you need to combine 2-3 to get close to the recommended levels unless your diet incorporates all of them), going to physical therapy, going to acupuncture, exercising more since this can help with the pregnancy, learning how to eat healthier, preparing the home and nursery, planning to baby shower and babymoon, hanging out with friends, hanging out with my spouse alone and going on dates (only happens rarely now without the baby), taking the Taking Cara Babies class or any other class on how to soothe your baby and get them to sleep, watching the Harvey Karp video The Happiest Baby On The Block, lots of labor/delivery and newborn classes, tour some daycares to get a sense of what you want to do for childcare after, if you haven't gotten into personal therapy yet then that could be helpful to help with matrescence. Take these next few months as a remediation of OB/GYN rotation, then after you deliver, it's a Pediatrics rotation.
3. Clinical skills: reading review papers on conditions you want to know more about (autism, borderline personality disorder, adult ADHD, insomnia, dissociative disorders, disorders of sexual functioning, etc.), UpToDate articles if you have access still, learning new psychotherapy techniques (I read the books on mentalization based treatment and schema therapy), learning about how to use different medications I rarely used in training such as MAO-Is or DORAs, learning how to use integrative options such as supplements and lifestyle interventions (Carlat is a great resource on this), attending conferences that I've always wanted to attend or getting certifications such as the NEI master psychopharmacology certification, learning how to do a good cognitive exam and how to differentiate the different areas of executive functioning skills, learning a bit of executive functioning coaching or doing CBT for ADHD, reading Maudsley in full.
4. Private practice: having all forms optimized and ready, making dotphrases/snippets, making referral documents for specific indications, making lists of what to do for each indication in terms of diagnosis and treatment including therapies and lifestyle interventions, reading a bunch about what your current patient's are struggling with and how to help, learning about accounting and how to do that in QuickBooks, figuring out whether you want to incorporate. Figure out when you're going to stop taking on new patients (I stopped 2 months before my leave), who is going to cover you for your patients and for how long (people tend to only want to cover for one week at a time at the most), and when you'll be taking new patients on again which is impossible to anticipate before the baby comes (I tried to take on new patients a month after returning from leave but that was too much, so I delayed taking on patients for a few more months).
5. Hobbies: learning a new sport that is pregnancy friendly or honing your skills with your current sport, improving your cooking or baking skills (I watch a lot of YouTube cooking channels), travel (we traveled several times a month including into the third trimester abroad with clearance from our OB), learning how to knit for the baby, taking a class at the local community college like getting your real estate license, personal finance classes such as Fire Your Financial Advisor by the White Coat Investor, figuring out your retirement age and how much you need to save up by then, figuring out how you'll do retirement with a PP (solo 401k, SEP IRA which is not recommended if you're doing a backdoor Roth IRA), figuring out if you want to do a 529 or UTMA/UGMA for your kiddo.

Since this hasn't been said above yet, congratulations on the pregnancy and starting a new family!! Feel free to DM me if you have any personal questions related to new parenthood and private practice that you don't want to post publicly.

 

[Merovinge]

I think working much less is a huge adjustment for someone who has been in school, in training, then employed all of which requires a ton of effort and developing a work ethic that is hard to break. I was in your boat not that long ago as I started a private practice after fellowship, then took new parent leave only a few months months after starting my PP. Money isn't the only thing that is keeping us working as a lot of our purpose and identity comes from our profession, especially since your financial situation seems stable. Don't do locums or try to get a job before you have a baby.

A lot of it depends on your personality and work ethic. I am not a chill person overall but I do love to chill. Here are some of the things I considered to keep me sane with all that time off:

1. Marketing: working on my website, learning about SEO, watching Private Practice Skills on YouTube, listening to the Enlightened Practice and EntreMD podcasts, reading Money in Outpatient Psychiatry (I'm sure there's a ton of other books out there but this was the most helpful in terms of mindset albeit outdated in many of the logistical aspects), making business cards, going on different online directories and putting my name and contact information on there, going on listservs, networking with therapists and psychiatrists in my area, going on all the Facebook groups for psychiatrists/therapists in my area/state, making sure my Google Maps and Apple Maps was set up and correct.
2. Parenting: reading Expecting Better and Cribsheet by Emily Oster, reading How Not To Hate Your Husband After Kids, reading Precious Little Sleep, figuring out which prenatals had 100% of the recommended vitamins/minerals for pregnancy according to ACOG and AOM (hint: none of them have everything in one pill, you need to combine 2-3 to get close to the recommended levels unless your diet incorporates all of them), going to physical therapy, going to acupuncture, exercising more since this can help with the pregnancy, learning how to eat healthier, preparing the home and nursery, planning to baby shower and babymoon, hanging out with friends, hanging out with my spouse alone and going on dates (only happens rarely now without the baby), taking the Taking Cara Babies class or any other class on how to soothe your baby and get them to sleep, watching the Harvey Karp video The Happiest Baby On The Block, lots of labor/delivery and newborn classes, tour some daycares to get a sense of what you want to do for childcare after, if you haven't gotten into personal therapy yet then that could be helpful to help with matrescence. Take these next few months as a remediation of OB/GYN rotation, then after you deliver, it's a Pediatrics rotation.
3. Clinical skills: reading review papers on conditions you want to know more about (autism, borderline personality disorder, adult ADHD, insomnia, dissociative disorders, disorders of sexual functioning, etc.), UpToDate articles if you have access still, learning new psychotherapy techniques (I read the books on mentalization based treatment and schema therapy), learning about how to use different medications I rarely used in training such as MAO-Is or DORAs, learning how to use integrative options such as supplements and lifestyle interventions (Carlat is a great resource on this), attending conferences that I've always wanted to attend or getting certifications such as the NEI master psychopharmacology certification, learning how to do a good cognitive exam and how to differentiate the different areas of executive functioning skills, learning a bit of executive functioning coaching or doing CBT for ADHD, reading Maudsley in full.
4. Private practice: having all forms optimized and ready, making dotphrases/snippets, making referral documents for specific indications, making lists of what to do for each indication in terms of diagnosis and treatment including therapies and lifestyle interventions, reading a bunch about what your current patient's are struggling with and how to help, learning about accounting and how to do that in QuickBooks, figuring out whether you want to incorporate. Figure out when you're going to stop taking on new patients (I stopped 2 months before my leave), who is going to cover you for your patients and for how long (people tend to only want to cover for one week at a time at the most), and when you'll be taking new patients on again which is impossible to anticipate before the baby comes (I tried to take on new patients a month after returning from leave but that was too much, so I delayed taking on patients for a few more months).
5. Hobbies: learning a new sport that is pregnancy friendly or honing your skills with your current sport, improving your cooking or baking skills (I watch a lot of YouTube cooking channels), travel (we traveled several times a month including into the third trimester abroad with clearance from our OB), learning how to knit for the baby, taking a class at the local community college like getting your real estate license, personal finance classes such as Fire Your Financial Advisor by the White Coat Investor, figuring out your retirement age and how much you need to save up by then, figuring out how you'll do retirement with a PP (solo 401k, SEP IRA which is not recommended if you're doing a backdoor Roth IRA), figuring out if you want to do a 529 or UTMA/UGMA for your kiddo.

Since this hasn't been said above yet, congratulations on the pregnancy and starting a new family!! Feel free to DM me if you have any personal questions related to new parenthood and private practice that you don't want to post publicly.

My god, what an insanely comprehensive and great answer. I'm not sure where else on the internet you can get advice this good and personalized to your situation. Absolutely agree with the Emily Oster work and hard-core babymoon. You definitely lose intimacy time with your partner following the baby and it's going to be tough on everyone regardless of how good of a relationship you have.

 

[PikminOC]

It is clear that corporate loyalty to employees has plummeted as much as employee loyalty to their jobs have. It is still true that if you make an organization money in a reliable and consistent way, their attempts to keep you will be balanced by their difficulty in replacing you.

They'll just replace you with a nurse as they did this op. It's happening everywhere.

 

[annoyedpsychiatrist]

How to not hate your husband, lol, i think ill give that to my fiance

 

[FlowRate]

I'd assume you've already thought of this, but if you're in a coastal metro I'd imagine there are opportunities for more simple moonlighting shifts to feel like you're keeping up clinical skills and would also think moonlighting would allow you to titrate to whether your body is feeling up for it, without the commitment of more formal part time work?

 

[mistafab]

I'd assume you've already thought of this, but if you're in a coastal metro I'd imagine there are opportunities for more simple moonlighting shifts to feel like you're keeping up clinical skills and would also think moonlighting would allow you to titrate to whether your body is feeling up for it, without the commitment of more formal part time work?

I came in to say this. Who says you need a job besides your PP? Moonlight as much as you want, and be as picky as you need. Covering weekend days is easy, and would be a nice cashflow boost while feeling like you’re doing something.

 

[Shikima]

Hello, all--

I'm a long-time SDN user, but created a throwaway as there are personal details here.

I'm an early career psychiatrist. Employed for 3 years, then this year (after getting married, feeling good about savings, securing health insurance, and feeling more secure with my partner's income), took the leap to start a small cash-pay PP. I got a part-time job as a medical director for an IOP (1099) which paid well and made me less nervous about the finances.

Several weeks ago, I was given a 30-day termination notice at the IOP (where I worked on-site) and told they were replacing me with a tele nurse practitioner. (This was for a UHS facility; I know they are garbage, but I was being paid hourly and well so ignored it.) I understand this was a stupid corporate decision and not a reflection on my doctoring skills, but still feels kinda bad to be honest.

Typically, I would hustle and start looking for another part-time job to supplement, but I am pregnant (first time) and would likely take my maternity leave in the fall through the end of 2023. If I'm seeing this wrong tell me, but I don't feel like starting a job search for an employed part-time position, waiting for the credentialing process, and then taking maternity leave 2 months later. I'm also at the end of my first trimester and have felt like death for several weeks, and the idea of starting a job search right now makes me want to cry. Maybe that will change. The extra $ would certainly help, but we are okay right now on mainly just my partner's income.

The problem--I am bored to tears. I can and am putting the time into my PP but it's quite part-time (office is rented one-day a week) and like I said, it's slow. And I expect this--I'm cash pay, my rates are commensurate with where I live (coastal metro city) but high as hell, and I'm new to this city, so I've got a lot of ground to cover with getting my name out there. Luckily my overhead is quite low. I'm also not THAT motivated to grow it quickly right now as, again, pregnant.

So: if you had 6-ish months with a LOT of time on your hands, anything you would do educationally/professionally? Any online trainings you've wanted to do, conferences, etc? Any time-consuming PP tasks I could start on now? I realize that at some point I will look back at all this free time and think: wtf was wrong with you??? But honestly, it's too early in my career for a sabbatical and I'm not there yet mentally. l feel like I *need* to be doing something to better myself professionally.

Any and all ideas and thoughts welcome, including telling me to chill out.

Have you thought about working part-time for a telehealth company?

 

[psychemdoc]

Just came to say congrats to OP! Motherhood is very underrated by a good bit of society! You may be replaced by a NP at your job but you cannot be replaced at home as a wife or mother. Invest wisely. Cherish the time. Good luck on whatever you decide!