curiousMD

Thanks! It's only 2.5 years old and was just me. Now there's a total of 10 providers. We more than quadrupled our suite. And we're teaching students here too. We're all super grateful and thank you to all of you guys who followed the thread :)!!

Appreciate the response. Anyways this is an old thread and I've long established longterm employees. My office now does offer retirement, insurance, dental vision and more thanks to the growth and something called, good management. Oh, and it's more than quadrupled in size.

It's definitely gone down. In my area it tends to be 10k at the most but a lot of insurances have brought it down to 3-5k for the full 36 sessions.

I thought that "To" meant people you are engaging in direct conversation with and "cc" stands for carbon copy. So if this was like paper letters, you'd send postage to the "to" people and the "cc" people get sent a copy. I always interpreted as CC meaning that you're keeping people in the loop. Impossible to say what is on her mind. Could be passive aggressive, could be her just keeping you in the loop. Work conflicts/politics are not that uncommon. I'd say the best you can do is try to put on your best face, keep everyone in the loop on any communications so people don't interpret it as you going behind people's backs, and try to look like an enthusiastic team player focused on finding resolutions versus coming across as defensive even if the other party is wrong. As an above poster said, take the high road.

That is also a drag and it ruins things for those who are motivated.

My thoughts, but I can't say for sure that as far as HIPAA is concerned, your medical records can't be accessed without your consent. I can only speak from my licensing as a physician and getting jobs as a physician but RNs may be subject to a similar process. You could be asked about any conditions you have that you feel could affect your ability to do your duties. I've always been puzzled at the best way people go about answering this, for example, someone with well managed major depressive disorder (which is very common)...do they say yes but they are well managed? Theoretically, if a case of MDD decompensates you can certainly lose your ability to perform at your job. There are plenty of healthcare professionals be it physicians, RNs and more who have struggled with addiction. As long as you stay sober and follow what is recommended, there are plenty of people who are doing excellent in recovery and it would be discrimination to put on a blanket statement for all people in recovery. One of my psychiatrist colleagues struggled with an addiction to stimulants, but she's done excellent in recovery and she had no issues with getting her licensure and a job. She did have to present in person to the board because of her history (I think when MDs get their license the application does ask something along the lines of an addiction history) but I think they can generally smell if there are still persistent red flags or not. Recovery is more common than most people think. In my area the psychiatrist who was found smoking pot with his patients is still practicing but I won't comment on that... I also wanted to add, I'm really thrilled to hear that you decided to get professional medical assistance with this. Especially a detox which can be downright dangerous, some patients don't always listen to my advice about that and still try to detox at home...fortunately that is very rare (2 cases in my career so far).

As a psychiatrist, I cannot emphasize a holistic approach enough. There's such a mentality of "there's a pill for that" that all parties are guilty of. Good quality therapy as well as other lifestyle factors are powerful augmenting agents and minimize polypharmacy. I'm also outraged at the stigma towards mental illness. I hear it in the tones of healthcare workers, even physicians and people in general. In the process of establishing my practice, I was looking for office space and after I disclosed I am a psychiatrist, you could tell some people were not thrilled to rent the space. Well news broadcast to all of you, psychiatric illness is VERY prevalent and if anything, those with a psychiatric condition have been statistically demonstrated to more likely be VICTIMIZED than be predators due to their vulnerability. It's a shame... I love advocating for my patients. There should be CME for psychiatrists with how to work with insurance companies and obtain affordable medication for patients. Not to toot my own horn, but I've gotten good at doing PAs. Even the ones that rejected, for cases where I felt the medication was necessary, I kept sending letters (I've generated some templates so I'm not always starting from scratch) and persistence does pay off. There's also many other ways to get medications affordably. For example, did you know that brand name Abilify is actually cheaper than generic? If you go to the brand name website, use the $5 copay card and then buy larger tabs to cut in half, that's $2.50/month which for many insurance companies is cheaper than what the insurance pays for generic. There's also charity/low cost copay programs for people who have a household income of less than 100k for those working, but don't get great insurance coverage .

Interestingly risk of a seizure from TMS versus from taking an antidepressant, the latter is actually higher. And that's if you include the TMS seizure cases from TMS experimental days, people who were drinking heavy but not disclosing that, and the psychogenic seizures. The Clinical TMS Society deemed it not necessary to have IV access, oxygen, suction, etc. available for safe practice of TMS (page 342 from 2016 guidelines) in an outpatient setting and most treatments are done in outpatient psychiatric clinics. I plan to have protocols established though.

I'm actually very supportive of this. Actually, I can think of two RNs who went into recovery and were recruited into private settings. Both loved it and did well, both actually decided to stay, moved up in the clinic and assumed additional admin duties. As a psychiatrist I understand a core piece to recovery is restructuring a sober lifestyle with as little access to the substance of choice as possible. Having a job they enjoy and find meaning in is a powerful augmenting agent to the treatment and open time is a powerful risk factor for relapse. I understand also from an employers standpoint their hesitance to hire someone with history, but it is also a vicious negative cycle for the person who is genuine about their recovery. Ive started drafting a job posting and plan to give as detailed a job description as possible at interview. Frankly, I believe in being...well...frank even at the interview. I want the prospective employee to know what they are in for and I want to know what I'm potentially in for if I hire them. Now, I know we are both still trying to put our best faces on at the interview, but my philosophy is if one of us know it won't work, best to say so earlier than later.

That is so tremendously sweet! If only we lived near each other. Bill (the RN I spoke about) and you sound like you'd make a great team :). To bugya90, balance indeed. Everyone has different needs and are in different stages in life. I could join a lucrative healthcare system and have a panel of all high risk folks, but I can't do that all the time. I could be more lucrative working as a private pill mill, basically a legalized drug dealer and give people all the Adderall and Xanax they want. But that's not why I went into medicine. Sure, my practice built up slower because I'm careful about my controlled substances and practice evidenced base care like CBT for sleep instead of just throwing sedatives at people, but it's about balance and practicing in a manner that works for you. Same reasons some people like a lower key pace. It doesn't pay big dollars but some of the higher paying places have downright malignant and abusive atmospheres. I think I'd lose my soul as a pill mill even though that could easily multiply my income. Evidenced based medicine and lifestyle changes seem to be an increasingly dying art despite their demonstrated efficacy.

I did.

Thanks HelloWish! Since I'll be at the clinic 4 days a week, I was thinking of hiring a tech to do treatments during times I am in the office. I'll be seeing patients, to help generate more income for the practice and I'd literally be in the next room available for any emergencies. For that 5th day I'm at the VA, perhaps then I can hire a more qualified individual. The Clinical TMS Society says the MD only needs to be available by phone in case of an emergency. But I am also aggressively trying to recruit a psychiatrist and ideally, have him on site when treatments are administered. The fortunate thing is that statistically based on more recent data gathered in the community, risk of a seizure is less than 1 per 30,000 treatments, all were self limiting and I also plan to have IMs on site if needed.

The math is 40 hours a week. At the end of the day it boils down to what 1) works for the prospective employee and what they'd like to do (in my practice in psychiatry, I see a lot of retired professionals go on to do other lines of work, not for the money but to keep structure in their day, some found full retirement to just be too boring and even depressing and some even volunteer. I especially see it in individuals who decided not to have children or live too far away from other family, most of my patients found that too much idle time was not healthy for them.) and 2) what the employer can even afford. As I said before, I'd love to pay more but I don't have that kind of money which is why I am looking into other options.

Thanks for the input. That is actually really helpful. I only recently got that news from my attorney and am awaiting a response where I've proposed other staff I can hire without exposing unnecessary liability. In the meantime, I wanted to get an idea of what the market looks like and what people on the other end reading the job descriptions on these job boards would be thinking. It would make no sense to invest in putting up a listing no one cares for, might as well brainstorm now and have a better thought out recruiting strategy.

I don't think anywhere in that post I specifically said you were thinking anything. Or referencing my work. I was actually referring to this humorous post below.

Thanks to those who were helpful! It's been tremendously helpful indeed!! I was pretty sure I had a conundrum on my hands but the ideas have been great! I'm glad to see there are plenty of RNs who don't assume all MDs are sworn enemies. I'm sure it shines in your work as well.

My attorney is less than 2 grand, benefits and higher salary is magnitudes higher.

Please actually read my posts. I don't have that kind of money and was not interested in hiring an RN in the first place due to cost. This is my attorneys advice. I'd pay more if I could but I simply can't. My overhead is already over 100k. Just google how much psychiatrists make. Fortunately there is actually some helpful input here like looking for part timers and ideas to help me sweeten the deal. Plus, it seems like no one here has experience with TMS. The work itself is far less stressful, so please don't actually judge the work until you actually know what it looks like. to shed some light, I encourage people to look up the TMS tech jobs. They generally pay far less and don't even ask for an RN. I'm not sure why my attorney keeps telling me to get a nurse. Either she's ultra conservative or most TMS practices are taking a huge load of risk,

Please actually read my posts. I don't have that kind of money and was not interested in hiring an RN in the first place due to cost. This is my attorneys advice. I'd pay more if I could but I simply can't. My overhead is already over 100k. Just google how much psychiatrists make. Fortunately there is actually some helpful input here like looking for part timers and ideas to help me sweeten the deal. Plus, it seems like no one here has experience with TMS. The work itself is far less stressful, so please don't actually judge the work until you actually know what it looks like. Also, to shed some light, I encourage people to look up TMS tech jobs. Most pay far less and don't even ask for a nurse. I'm not sure why my attorney says a nurse is needed. She's either very conservative or most TMS practices are taking on a whole lot of risk.

Wisconsin. I know... not great :/.

Look, in private practice, my overhead is already over 100k. I don't have deep pockets and I work at the VA for my benefits. I'm likely looking for a retired nurse or someone with no children. Basically in a setting where there is less financial pressure. My question was already leaning towards how exactly do I go about finding someone at that stage in their life. most days I will be there. To answer a question someone said above. Most TMS techs are medical assistants or even have a bachelors in a non medical field. I've seen plenty of MDs even go on vacation while the tech does everything but that I think is just too much liability and unethical. I personally have never heard of needing to hire a nurse to be the tech. But I trust what my attorney advises. I may need to ask her if a medical assistant suffices and I just be in the clinic seeing pts but available in rare event of an emergency. The treatment is very straightforward and I've seen practices more than several years old never have a seizure. And yes, I have seen EMTs work as techs, so there are people who take up the offers. I appreciate the helpful input that has been offered so far. If only there was I way I knew how to find people who have less financial pressure. I remember one nurse told me to look into the bls and acls refresher courses as there are medical staff often there who've been out of work for awhile but want something laid back or even part time. the point one person made above is spot on. I understand bills need to be paid, I have a family and incredible student loans too. But I managed to make private practice work out by getting my benefits on the side. I serve more severely ill pts at the VA. But even in psychiatry, there is burnout. I could not chronically have screaming borderlines calling me several times a day or have a panel of all chronically suicidal or homicidal people. I'm grateful to be working in a less stressful setting on the side although it means I get paid less than major healthcare systems. Working in an abusive environment and somewhere you are not happy also comes with a hefty price. But, at this point I already have one taker from a retiring nurse I work really well with at the VA. Just trying to find out where I can find more folks like him. great point some made about getting some part timers.

Thanks! That's reassuring! I'm still in the very early stages. Just filed paperwork to set up the entity. My attorney said standard of care is to have an RN. But that's the first I heard of that. Most TMS providers don't do that. I figured if seizure was the biggest concern may make more sense to get an EMT. I will try all the major job sites like indeed, ziprecruiter, etc. I just wasn't sure if the pay especially since I can't afford benefits would be a barrier to people being interested. But it is a pretty sweet gig, relaxing tempo and low pressure.

Hello everyone! I am a psychiatrist and in the process of starting my own practice, it will deliver transcranial magnetic stimulation, an FDA approved treatment for major depression. It's very safe, well tolerated, and only in extremely rare cases can be associated with a seizure during a treatment. Only 25 or so documented cases of the tens (maybe hundreds) of thousands treatments to date. Some were in people actively drinking heavily and others were from the experimental days of TMS when the treatment intensity was too high. So the likelihood of seizure is very low. I'm looking for advice on how to recruit 1-2 RNs to deliver the treatment. It is a very chill job description, just apply the coil and deliver an 18 minute treatment to the patient (no IVs, draws, nothing). It will be first shift, 0800-1600 and the rest of the time is spent answering the clinic phone, following up phone calls, medical records, etc. I won't be able to offer benefits and the hourly wage I can really offer is $20/hr, for working 50 weeks a year, that is 40k. However, there is a bonus that I am thinking of offering for each billed patient encounter, of $3. I'm projecting about 45 patient encounters billed a week, that's an extra 11k or so and as the practice grows, so does that bonus. Anyone have any input on what population may be interested in this type of opportunity and how I can market this? I have no idea how to find well qualified nurses (good sites to post the listing, or maybe good places to find nurses who are interested in a more chill job description but maybe less competitive pay) and especially someone who can be reliable since the treatments are 5 days a week. There is also the bonus that the nurse can have flexibility in their hours too. Thank you for all the input!