Corrections Medicine

[emfdj]

In a recent post on NHSC I mentioned that I worked in a federal prison to qualify for loan repayment. I received several PMs requesting more information. I thought I'd share some of my experiences here on the general forum to give others an idea of what its been like for me at the penitentiary.

 

I worked in a community clinic in an underserved area before I started work in the prison. The population is basically the same, except you presume that the patients aren't carrying guns in prison. And it's rare when I have to check a BP on someone whose arm isn't covered with gang tatoos. Seriously, the population is what you would see anywhere. Lots of DM, HTN, headaches, sports injuries, etc. But we do have a high proportion of Hep C, some HIV, ex-IV drug abusers. I've seen some very interesting cases in the 4 months I've been here.

 

With the BOP, the PAs/NPs see the chronic care patients every 3 months and the doc sees them every 6 mos. The doc is primary for Hep C, HIV, and CAD. PAs have Sick Call most mornings for the acute/urgent problems. We deliver medications to the inmates in segregated housing. After every altercation, we do injury assessments. We also do restraint checks. I did one NG feeding on an inmate who refused to eat. Where I am there aren't any MAs so the PAs do the vitals, room patients, call housing units for noshows, etc. Medics (EMTs) and nurses do the EKGs, PPDs, run pill line and the EMTs do emergency response with PA/doctor help when needed. We work four 10 hour days, no weekends.

 

The PAs have their own panel of patients and are quite autonomous but the doc is always available. We have EMR so it's easy for the doc to co-sign the charts when he needs to (chronic care patients, outside medical trip returns, if we're prescribing narcotics and psych meds).

 

The interactions with the inmates are very professional, for the most part. They are grateful to have someone listen to them and treat their illnesses. I treat them with respect (it's helpful not to know what they did to be imprisoned). Some are very medically illiterate. For instance, I had to explain to a 32 yo why a patent foramen ovale caused his stroke when he didn't even know the heart had 4 chambers. Others are highly educated and you can speak to them on a different level. Emotionally, some of the inmates are very needy and immature. Lots of mental illness; depression, schizophrenia, personality disorders.

 

Yes, in the Bureau of Prisons you are always a Correctional Officer first. You always have to be alert to the inmates around you. We run to the site if an officer radios a distress. Someone stays back in Health Services to man the Urgent Care Room, just in case its needed. At any time, you could be called upon to do some custody duty, such as search cells, run the metal detector, even sit in the tower with a shot gun. In fact, though, I have not been asked to do any of this in my 4 months there. (If you do volunteer to sit in the tower since your job requires the use of a gun, you are then able to carry concealed outside the prison.)

 

The custody/non-medical part of my job pretty much equals what I did in the community clinic with insurance, med refills, school forms, and medical needs forms. So even though it can be annoying at times, it really isn't a major downer. And of course since its the federal govenerment, you have to follow policy and go through proper channels.

 

Yes, nasty things can happen in prison. These are men who have not made the best life decisions and some of them continue to make poor decisions. I've had 2 inmates locked in their cells in segregated housing call me over to ask a medical question and then start masturbating. A medic was punched in the Health Services waiting area just before I started working there. You have to stay alert and stay aware of your surroundings. We all have radios and, as I said, are trained in self defense. Most inmates are just trying to serve their time and not cause trouble.

 

In order to keep your job, when you first start you go to Glynco, a federal training facility, for 3 weeks. You have to pass a physical abilities test, firearms and physical defense. There's is also annual refresher training. CME money is available too, but not as much as you could get on the outside. Salaries aren't as good as on the outside, either, but with the NHSC its a pretty good deal. If you're planning on making a career of the BOP, the retirement package is good. My co-workers are very happy to be there for the long term.

 

I hope this gives everyone some idea of what it's like working in a prison. Let me know if anyone has any other questions. And hopyfully others can put in their comments too.

[marilynpac]

Thank you for the thread emfdj. I think it's safe to say you've had baptism by fire!!! I only had a vague idea of what serving inmates would be like but I've always known it probably wasn't for me. Good luck to you. Stay safe, you're doing a job that most PA-Cs wouldn't do. You add professionalism to the PA profession.

[EMEDPA]

I have several friends who are public health service officers working full time for the BOP. it's a great career if you enjoy the work , as they do. I've done some "shadowing " of a friend of mine who does this(he was trying to talk me into working there part time and got me in to observe). the upside is a lot less bs. you don't need to cater to silly requests or take crap from anyone...on the downside, it's prison....I could see part time in a min security prison as a side job but for me the acuity is too low and I would get bored. solid/stable career though for those who are interested and part time it pays well. out here per diem or part time without benefits pays 75/hr....but the shifts are short, 4-6 hrs...

[EMEDPA]

yes, there is. it's great being able to tell someone to their face that their request makes no sense and that they won't get fentanyl patches for their chronic ankle pain following sprain 3 yrs ago....and have no fear of a bad press-ganey score for being"insensitive".

[emfdj]

In the community clinic I worked at, every other person asked for percocet. In the prison, they know the strongest they can get is ibuprofen 800 mg. It makes life a lot easier! And I don't prescribe antibiotics for colds. No threats of going to the doc down the street who always gives them antibiotics. They don't get it. Period.

[winterallsummer]

Good post, thanks for the info. One thing I love about the PA field is there are so many different work environments, seems like you can never get bored.

[d2305]

I couldn't do it. I did juvenile correctional medicine for a few years part time, and that was bad enough.

[klb48]

Thanks for posting this and for the PM with information. It's definitely an interesting field and a good opportunity!

[jeffahammer]

I worked in a county prison for 2.5 years. That was about 20 years ago. I enjoyed it for the most part, as others previously stated, I did not have to deal with requests for narcotics, they knew they wound not recieve any. I did not at anytime feel my physical being was in danger. The inmates pretty much appreciated me for what I did for them.

The only downside I experienced was the threat of finding myself named in petty lawsuits. That happened to some of my co-workers on staff, seems the inmates had free access to the legal system and abused it.

I was fresh out of PA school at the time and too green to deal with the threat of lawsuits so I left correctional medicine. I am older and wiser now and in fact I am considering returning to correctional medicine by doing locum tenens

[HLReed]

I have several friends who are public health service officers working full time for the BOP.

 

Emed,

 

Are your friends on the forum? I am very interested in a BOP job through the USPHS and would appreciate the opportunity to speak to some officers (who aren't recruiters). Thanks!

 

H

[Guest guthriesm]

Very interesting! Will you qualify for further federal/state retirement benefits while there or are there restrictions since you are a loan repayment person?

[emfdj]

The loan repayment provisions from the NHSC are entirely separate from your salary and benefits from where you are working. So I would qualify for any retirement benefits if I would qualify otherwise.

[EMEDPA]

Emed,

 

Are your friends on the forum? I am very interested in a BOP job through the USPHS and would appreciate the opportunity to speak to some officers (who aren't recruiters). Thanks!

 

H

 

Nope, none of them post here. they are all on the east coast.

for folks with prior military service bop/phs is a great deal because it adds to your prior retirement. a buddy of mine was navy for 20 yrs, went to pa school, worked for the bop/phs for 10 yrs and got a 30 yr full time pension at highest rank(commander) at age 50.

[rev ronin]

How is correction medicine for new grads? I'm most interested in finding a job with an SP who is willing to teach me what I need to know, rather than autonomy or money, for immediately following graduation.

[Guest ral]

I did it at the state level for about a year. Work wasn't bad. You can't take anything personal. These guys are master manipulators. Noncompliance is a big issue. You're dealing with a population that has trouble following rules, so don't expect them to show up for an insulin shot every morning. Frivolous lawsuits are usually tossed in the trash before you even get asked about the incident. My biggest complaint? Felt like I was being incarcerated right along with the inmates. No cell phones, no walking in with a McDonald's coffee, all telephone calls go through the main switchboard and are subject to eavesdropping. Security comes first. I think that's a good thing, it just burned me that I had lost my own freedom once inside the gates. I would definitely consider doing some part time work for them, if I could find some time to do it.

[emfdj]

Rev ronin: It's tough to make a blanket statement about SP's willingness to teach--it's is so dependant on what your particular SP is like. Mine is good that way; he's willing to answer questions. The other PAs are helpful too, especially with BOP policy and the EMR. One good thing about the BOP is that no one is as concerned about your productivity as they are on the outside. You can see fewer patients in the beginning while you are getting your feet wet. And no practice owner is hanging over you checking your billings.

[emfdj]

An interesting quote: "I've been stabbed several times and I've been shot, but that hemorrhoidectomy was the worst!" Not many people can say that!