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I just graduated and have been considering going into correctional medicine. Anyone here work in correctional med. What do you guys think? How are the salaries/benefits? How many inmates do you see a day? What are the hours like? If anyone can elaborate on their experience, that'd be great! I did do a search but wanted to know more about it. Thanks!!

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miss bananapeppers.......have been a PA for 30+ years....have been doing locums for about 5 years now..have worked with federal bureau of prisons as well as corrections depts at city level (new york) as well as state (ga/fl)....i would not recommend you, as a new graduate, to work in that environment.....you need a place to grow your clinical acumen.......the doc's i have worked with were at best poor clinicians (usually foreign trained/can't find/keep jobs in civilian sector/etc.) that would/could not mentor you....all this probably to a lesser degree with the feds.....i do that kind of work every now and then because the money is good and i know i'm not there long term.....to note, have never met a PA that has done corrections as a "career".......hope this helps....12153dad

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as a new grad with no experience i started at 135K with full benefits, 4 weeks vacation, 2 weeks sick, 401 K etc.. Worked 12 hr shifts about 42 hrs per week, every other weekend, night shift, although day was available. Was only there for not even 2 yrs. Was the only provider for a couple thousand inmates. Saw about 15-20 new inmates every day plus any walk in/emergent calls from medical (number varies greatly for this, as it really helps to have a great triage nurse. Lots of verbals). SP was on call if I needed anything but honestly couldn't really help. Would talk to him maybe 1x/month. All serious stuff we would send out 911. You will learn a ton with meds and side effects, dosages, how to assess someone with almost no equipment (very limited resources, even getting a BP cuff was difficult). You learn that almost nothing is an emergency. If anything you get really good at talking to people and wading through all the bs. You start to know who really needs help and who doesn't. You will have mostly mental health and drug addicts, all seeking meds. They will ask you for everything. This will be every day. Day after day. This drains on you, jades you. No stat x-ray, labs. EKG machine worked 50% of the time, and even when it did i never trusted it.You will get good at suturing, however forget about sterile technique.

 

The atmosphere is horrible. Artificial lighting for 12 hrs, dark, dreary, cursing every 5 seconds from guards, security check points/locked doors every 50 feet. Guards who didn't even graduate high school and hate life and hate you even more for trying to make something of yourself. Inmates can't move without security getting them for you, so you will be waiting long times just to see someone. One day it took an hour just to get an inmate to my office. It smells. You can't bring anything into the prison with you (contraband, this means phone, lunch, even simple equipment, books etc..).

 

There were a decent amount of RN's and midlevels who made it their career. These people I felt just gave up on life/ their career. For me I couldn't get anything more from it after 2 years....and even that was a stretch. But I refuse to babysit and waste those insane years of PA school knowledge.

 

You get from what you make of it really, as with most things. For me I made those 2 years count. Plus I banked a ton of cash to pay down my loans. I even could have squeezed another 10K/yr from them to keep me from leaving but I just didn't care about money anymore. PA's get paid well no matter what. I was fine with a cut. I don't regret taking the position, but you have to know when to move on.

 

i could go on forever....

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Thanks for all the tips, it was very informational.

 

The reason I applied for a correctional facility was because I got to work in a county hospital on one of my rotations, at which they placed me in the correctional area. It seemed like it was where all the students/docs avoided but to be honest, I really enjoyed rotating and treating the inmates in the ER - though most of them were respectful, there were a handful of inmates who had psych problems made it difficult for me to assess.

 

Myiron, I know you discussed about the darklighting, crappy enviroment, and the lack of equipment there - can anyone else say its like this for other correctional facilities? I'm applying to a big correctional facility in California and if it is like that, maybe I won't go for it. I think the biggest deciding factor for me is whether or not there will be a SP because if I am running things on my own, there's no way I'm confident enough if a SP was not there.

 

Is there a reason why correctional jobs are higher paying? Is it because they are jobs that no one wants to do?

 

Anyone here with any positive correctional experience?

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as a new grad with no experience i started at 135K with full benefits, 4 weeks vacation, 2 weeks sick, 401 K etc.. Worked 12 hr shifts about 42 hrs per week, every other weekend, night shift, although day was available. Was only there for not even 2 yrs. Was the only provider for a couple thousand inmates. Saw about 15-20 new inmates every day plus any walk in/emergent calls from medical (number varies greatly for this, as it really helps to have a great triage nurse. Lots of verbals). SP was on call if I needed anything but honestly couldn't really help. Would talk to him maybe 1x/month. All serious stuff we would send out 911. You will learn a ton with meds and side effects, dosages, how to assess someone with almost no equipment (very limited resources, even getting a BP cuff was difficult). You learn that almost nothing is an emergency. If anything you get really good at talking to people and wading through all the bs. You start to know who really needs help and who doesn't. You will have mostly mental health and drug addicts, all seeking meds. They will ask you for everything. This will be every day. Day after day. This drains on you, jades you. No stat x-ray, labs. EKG machine worked 50% of the time, and even when it did i never trusted it.You will get good at suturing, however forget about sterile technique.

 

The atmosphere is horrible. Artificial lighting for 12 hrs, dark, dreary, cursing every 5 seconds from guards, security check points/locked doors every 50 feet. Guards who didn't even graduate high school and hate life and hate you even more for trying to make something of yourself. Inmates can't move without security getting them for you, so you will be waiting long times just to see someone. One day it took an hour just to get an inmate to my office. It smells. You can't bring anything into the prison with you (contraband, this means phone, lunch, even simple equipment, books etc..).

 

There were a decent amount of RN's and midlevels who made it their career. These people I felt just gave up on life/ their career. For me I couldn't get anything more from it after 2 years....and even that was a stretch. But I refuse to babysit and waste those insane years of PA school knowledge.

 

You get from what you make of it really, as with most things. For me I made those 2 years count. Plus I banked a ton of cash to pay down my loans. I even could have squeezed another 10K/yr from them to keep me from leaving but I just didn't care about money anymore. PA's get paid well no matter what. I was fine with a cut. I don't regret taking the position, but you have to know when to move on.

 

i could go on forever....

 

Thank you for your post. Descriptive, informative, extremely useful.

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Know a PA who did this for a short bit after graduating to help pay off loans. I am considering doing it part time and working a 3 12's gig in the ER or urgent care type setting.

 

Has anyone worked PT for this and if so how does it compare in helping you pay off loans to just taking a part time gig in the ER or elsewhere (since you might learn more there)? Do they qualify for loan reimbursement working per diem or PT?

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Know a PA who did this for a short bit after graduating to help pay off loans. I am considering doing it part time and working a 3 12's gig in the ER or urgent care type setting.

 

Has anyone worked PT for this and if so how does it compare in helping you pay off loans to just taking a part time gig in the ER or elsewhere (since you might learn more there)? Do they qualify for loan reimbursement working per diem or PT?

 

How did he like the correctional facility?

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I did this for a while and would not recommend it at the federal system. Many of them are contract positions, so no student loan repayment. State systems tend to be much better controlled and the state legislature in Texas determines what is acceptable care. None of the USPSTF garbage; federal inmates are supposed to have the same standard of care as medicare patients from what I understand, but I can't swear to it.

 

State systems are pretty well controlled and the states sets the rules. I have only worked in minimum security federal institutions and there are lot fewer rules IMHO; inmates often have open privileges during the day, so they can travel at will around the institution and only have to be present for counts and lockdowns. They frequently don't show up for physicals or appointments and the medical staff always got blamed. The guards don't care either way. I had one inmate who had 6 stents, HTN that was always 160/100+ and was medically non-compliant, we were powerless to enforce his medications but would have gotten blamed for him stroking out.

 

We had 1350 inmates for two PA's (40 hours each a week, plus call) and one MD who only came in once a week to audit charts. In minimum security there were not supposed to be patients with type I diabetics, extensive coronary histories, or multiple chronic issues that required specialty care, but there were. Couldn't get rid of them either no matter how much of a pain they were for the staff. The most common medical complaints were chronic pain, didn't like the diet they were served and wanted kosher or diabetic meals (never knew so many Mexican nationals that claimed to be Jewish!) , wanted special shoes and bottom bunks. Some psych patients, most depressed, some with bipolar and schizophrenia (these should not have been there...) some HIV (allowed, with the exception of the guards, medical staff treated these are the medical patients they were, I have no problem dealing with HIV inmates or patients since I used proper precautions, but it's something to think about), most minimum security inmates don't bother others (think rape) so there isn't much milky diarrhea when you get to work in the morning because that gets them transferred to a max security pronto. We did have one inmate with breast implants and the others built him a wall along the showers so he could have some privacy. In minimum security I saw many inmates kind to others because what comes around goes around, and this goes for the staff as well. Don't ask what they are in for, you don't want to know or create a bias you never knew you had, an they will lie to you most of the time anyway.

 

I worked at an ICE prison, so all my inmates were illegals and would be deported upon release. Lots of complaints to their consulate, the State of Texas and anyone who would listen about substandard "care." I told them if they wanted care they could see their mothers, I was there to provide the treatment dictated by law. Out of the 1350 inmates I had about 150 frequent flyers, same patients day after day, week after week for the same complaint that wasn't getting better or something new. The other 1200 I never even met unless they were really sick. Several of my inmates who turned critical were turned in my other inmates out of concern; guards caring about inmates are hit or miss.

 

I was in the Army for 9 years, was Seattle Police officer for four years, and have multiple tours working overseas as a private contractor in the Middle East. For me, this wasn't a big deal, but there was a turnover measured in days for some of the nurses and PA's who didn't think seriously about the work environment. I NEVER felt like I was in danger and felt the inmates treated me with respect if I treated them with respect. If you let them know you are afraid of them they will try to push you around and try to get you to give them things or do them favors, it's easy to want to be nice and do a favor, but you can't because they can use it against you later; manipulation is a survival tool in prison. Everyone gets treated 100% equally for your safety and theirs.

 

I know these comments comes across strange and all over the board, but these are people and deserve to be treated with respect; some of them I actually liked and thought we could have been friends on the outside, but would never let them know that or gave them favors for the reason's listed above. Other times you wish you could strangle them with your stethoscope.

 

I believe that this is a job for PA's with some time under their belts dealing with difficult patients or those that have been trained to work with difficult people. The medicine is no different than you would see outside, but the environment in the institutions, strict adherence to rules and frustration at not treating the patients the way you want to treat them can make it frustrating for a new provider. I also had minimal supervision, if you need an MD to run questions by, you might not be ready for this yet.

 

Hope this helps,

 

John

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  • 7 months later...

Correctional medicine has been at the top of my list of settings to work in for a while (even back when I was considering going to medical school). It actually seems like this would be an amazing job for someone who wants to work with underserved, complex populations. Also, correctional medicine qualifies for NHSC loan repayment. So, if it is true that those jobs pull down such high salaries, adding loan repayment to that makes the job earnings pretty incredible. I think I can deal with dim lighting and misanthropic co-workers for two years to get $60,000 in loan repayment on top of >$130K salary, plus great benefits.

 

I shadowed a PCP at a prison a year or so ago, and he went on and on about all the procedures he gets to do and the broad scope of practice he has. He said it was one of the benefits of a prison clinic in that he had to provide a broad scope of care since the prisoners were not going to be shipped off via a referral to somewhere else. He was reading imaging, reducing fractures/dislocations, performing excisions and other cool skin procedures, working with patients in the on-site hospice and quarantines, and so on and so forth. When the PA is on duty, he/she would be doing all of this stuff as well (except reading the images, perhaps).

 

Anyway, he talked about the independence a practitioner has there, the scope of practice, the good pay and great benefits, and limited call duties overall.

 

The downsides detailed on here are really not so bad when weighed against the benefits. Thanks for all the info, everyone.

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I had a patient who was a correctional NP.

 

She called her job "a soul-sucking vortex of frustration and despair."

 

She's now very happy in a pain management job.

 

We take care of a lot of inmates in my ED job because my hospital is in the same town as the prison. While I'm a fierce advocate for the underserved, and have enjoyed working with populations usually deemed "undesirable", I do find working with the prison providers very challenging. Yes, the inmates are very difficult. But it always seems that the providers are detached, uninvested, and their knowledge of medicine seems very narrow.

 

This is just my experience with a single prison though. Certainly not data, just anecdote.

 

Can you do an informational interview at a correctional facility to see what the working conditions are?

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Correctional medicine has been at the top of my list of settings to work in for a while (even back when I was considering going to medical school). It actually seems like this would be an amazing job for someone who wants to work with underserved, complex populations. Also, correctional medicine qualifies for NHSC loan repayment. So, if it is true that those jobs pull down such high salaries, adding loan repayment to that makes the job earnings pretty incredible. I think I can deal with dim lighting and misanthropic co-workers for two years to get $60,000 in loan repayment on top of >$130K salary, plus great benefits.

 

I shadowed a PCP at a prison a year or so ago, and he went on and on about all the procedures he gets to do and the broad scope of practice he has. He said it was one of the benefits of a prison clinic in that he had to provide a broad scope of care since the prisoners were not going to be shipped off via a referral to somewhere else. He was reading imaging, reducing fractures/dislocations, performing excisions and other cool skin procedures, working with patients in the on-site hospice and quarantines, and so on and so forth. When the PA is on duty, he/she would be doing all of this stuff as well (except reading the images, perhaps).

 

Anyway, he talked about the independence a practitioner has there, the scope of practice, the good pay and great benefits, and limited call duties overall.

 

The downsides detailed on here are really not so bad when weighed against the benefits. Thanks for all the info, everyone.

PAs read xrays...

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I had a patient who was a correctional NP.

 

She called her job "a soul-sucking vortex of frustration and despair."

 

She's now very happy in a pain management job.

 

might want to take anything she says with a grain of salt....I think I would rather do prison medicine than pain management or occupational med...talk about soul sucking vortexes...

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might want to take anything she says with a grain of salt....I think I would rather do prison medicine than pain management or occupational med...talk about soul sucking vortexes...

But that's my exact point. If pain management, which to me would be the epitome of soul sucking, is making her happy by comparison, then correctional must have been really, really, really bad!

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  • 5 months later...

Has anyone done Federal prisons and State Prisons?  I am thinking about applying for both right now.  I would be applying for California prisons or federal throughout the USA.  I also would like to know how pay worked out.  If you look at the postings for federal it says you make less than 100K.  For California the cap is like 120k'ish.  Did you have to negotiate to make more money or did they "Offer it up"?   Lastly I have "heard" that you have a very limited scope of medications and services you can do in the prison.  In PA school I sat in on video conferences for the CA prisons with ortho problems.  It was to see if the inmate should come in and be eval for specialty care or eval for surg.  If anyone could help me out with this I would appreciate it.

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State systems tend to pay a lot more than federal. they are hiring for both in my neck of the woods. job descriptions/hrs/benefits the same but state pays > 20k more/yr for the same work. The bihg money to be made in correctional med is when you are a per diem non-benefited contractor getting $ + malpractice only. a lot of those jobs pay 75/hr or big money/hr to take call if you live nearby. buddy of mine gets 2k/mo to be on call to 2 local prisons. if they call him he has 2 answers:

"That doesn't sound serious, I will be in next week to check it out"

"that sounds serious, call 911 and have him go to the ER for evaluation immediately".

he actually spends only 4 hrs at each facility every month(contract requirement) + carrying the pager. that's $250/hr for time actually on site and maybe a few phonecalls/mo as above.

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I posted several years ago about working at a federal peniteniary.  I've been off the forum for a while but I just got a message about any advice I could give.  I'm into my fourth year working at the pen.  The salary at the BOP is BAD if you're a new PA with no experience.  If you have experience, they will try to match your salary.  Some localities have a bump up in salary to be competitive.   I won't get rich working here but I leave exactly when my shift ends.  No staying late.  And no big deal to call in sick.  Great work-life balance!   

 

I am fully responsible for my panel of patients, as any other family practice PA would be.  A physician is on site but I don't ask for his input too often.  The BOP only hires certified PAs, NPs and physicians, all who have a license to practice in the US.  Foreign medical grads without a license no longer qualify. From what I've seen, the BOP attracts a mixture of quality providers and some who are just here to get the paycheck.  Some are uncaring but others are doing a great job.   

 

The formulary has pretty much anything you would need to prescribe.  It may not have the hottest and newest if there is a tried and true medication that will do the same thing, but it that really a bad thing?  In this, as in all of our decision making, we have to meet community standards.    

 

I started working here to get my loans reimbursed through the NHSC.  I was $120,000 in debt and yesterday I just paid off my last student loan!   I'd say that's a pretty good deal.

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I have anecdotal experience working in corrections as a PA, 2006 to 2007..

I had worked in an low volume ED solo for 6 years, prior to that 3 years in a moderate volume ED with attending present.

So 9 years prior ED experience.

Worked at state prison, max security, saw most patients in clinic, a few in various lockdown units, the rest as inpatient in 10 bed infirmary.

No onsite lab or xray, ekg machine that worked all the time. Reasonably stocked formulary. Paper documentation. Internet access.

Pay was not good, $45/hr, company took $5 an hour for malpractice. I was part time, promised them 16 hours a week. Health services no longer through state but with private correctional health service so may explain why low. I also did not do any negotiating b/c I did not want to sink myself deeper into an obligation I may not want to keep.

Upside was that this place was in town next door, I lived about 10 minutes away so very easy commute. Plus I dictated when I worked and I did call out sick a couple times, something I am loathe to do at my ED gig.

I basically did this to save up money over a year to build a garage. Prior to doing this we sold the house and moved 30 minutes further north from the place. That was the deal breaker.

I actually enjoyed the autonomy and independence, didnt mind the security aspects of the job and quickly accepted that many of the patients were either mentally ill or cognitively and intellectually challenged or substance abusers and used this to maintain my perspective. I got very good at dealing with difficult patients. I found the staff to be a mix, same with the docs, I found the mental health workers to be overworked and underappreciated and the corrections officers were a mixed bag.

I dont think that this is the job for a new grad, I think a few years at least in FP, UC, ED prior to.

If you can negotiate that >100k salary with bennies and get loan repayment, I think you have a good deal there.

Good luck.

G Brothers PA-C

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  • 3 weeks later...

I posted several years ago about working at a federal peniteniary.  I've been off the forum for a while but I just got a message about any advice I could give.  I'm into my fourth year working at the pen.  The salary at the BOP is BAD if you're a new PA with no experience.  If you have experience, they will try to match your salary.  Some localities have a bump up in salary to be competitive.   I won't get rich working here but I leave exactly when my shift ends.  No staying late.  And no big deal to call in sick.  Great work-life balance!   

 

I am fully responsible for my panel of patients, as any other family practice PA would be.  A physician is on site but I don't ask for his input too often.  The BOP only hires certified PAs, NPs and physicians, all who have a license to practice in the US.  Foreign medical grads without a license no longer qualify. From what I've seen, the BOP attracts a mixture of quality providers and some who are just here to get the paycheck.  Some are uncaring but others are doing a great job.   

 

The formulary has pretty much anything you would need to prescribe.  It may not have the hottest and newest if there is a tried and true medication that will do the same thing, but it that really a bad thing?  In this, as in all of our decision making, we have to meet community standards.    

 

I started working here to get my loans reimbursed through the NHSC.  I was $120,000 in debt and yesterday I just paid off my last student loan!   I'd say that's a pretty good deal.

 

I think I'll throw my .02 in here as well. Like emfdj, I also work for the BOP. While he works at a pen, I work at a medical center; this is a very different environment. The medical centers are somewhere in-between a SNF and a hospital. My facility has, for the most part, great staff. The COs (correctional officers -- NOT guards) are happy to work there, there's a nice mix of nursing (new grad to the indispensable nurse you always hope is working), and our docs and midlevels are all very competent and approachable. In my opinion, it's a great place to work. But, like any job, there are high points and low points.

 

Things I like:

  • No coding. I use ICD-9 to track my diagnoses but I don't have to bill level of service or worry about reimbursement.
  • My patients are going to be there tomorrow. No rush to discharge. If I get to you today, great... if not, I'll get to you tomorrow.
  • If my patient starts getting inappropriate I can order him out of my exam room and there will be consequences for him.
  • I feel very safe. Some of the inmates will have shanks on them but I don't need to worry about a gun coming into my exam room. And there's always a CO or two just down the hall. And I have a radio. And wicked ninja moves.
  • If you get in trouble, everyone will run to help you. Even that guy that won't give you the time of day outside work.
  • Lots of opportunities for non-healthcare collateral duties.

Things that are frustrating:

  • It's the federal government. You are a cog in the machine. Don't expect that your ideas for process improvement will be welcomed with open arms.
  • Co-signs required for all controlled substances, most abusable substances, and anything that costs money. I can write for vancomycin all day long, but I need a cosign for Augmentin and omeprazole!
  • Outside of a medical center you will be flying solo or close to it. I have lots of support at my facility but I've covered a pen before. When I showed up for my first day at the pen, I was the only one in medical. Good thing I remembered where the EKG leads went...  ( I <3 nurses)
  • Pharmacy has a lot of control over your treatments. There are many rules for when you can and cannot prescribe certain medications and they are the enforcers of those rules.
  • Just like the inmates, you can become institutionalized as well. I'm going to try to pick up a retail clinic gig on weekends just so I remember how to act appropriately with people who aren't felons.
  • The pay is atrocious for new graduates. If you want to do correctional medicine, go work somewhere else for 1 - 2 years and then call up BOP. You'll get a MUCH better salary than if you start at the prison and work there for those 1 - 2 years. It's just how the GS pay scale works. Even better, do what I did: www.usphs.gov

I'll say that my experience has been amazing so far. I've worked behavioral health, "family medicine" as much as you can call it that in a prison, urgent care, long term care, and now I'm on an internal medicine rehab floor. I've taken care of two patients with Hansen's Disease, have a large panel of chronic HCV and HIV guys, many paraplegics, etc. Many of these guys have never had healthcare before they came to prison and it shows. I also get to work with some amazing people inside my facility (wound care consultant for the BOP for example) as well as learn from some of the top specialists in one of the highest rated hospitals in the country. For me, this was an excellent job to take right out of school.

 

Feel free to message me with any questions about correction medicine or commissioning with the USPHS.

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