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Cherokee PA Fellowship

Guest TerryF

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Guest TerryF

Has any one here participated in the Cherokee Psychiatric Fellowship, in Cherokee, Iowa?


If so, what was it like? Were you pleased?


Would you recommend others to participate in it,also?


Share anything else about the program that would help me decide if I want to apply or not.



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  • 1 month later...


Well, probably better than average: 25 yrs in practice, masters in epidemiology, ~ 50 publications, 8 years as PA School faculty, etc. The thing that killed it was the secretary's unsolicited sounding off about how disorganized the place was, gastly leadership, continual turnover of personnel, etc. So, what would you do if you applied to a post grad training program, got a phone call from a secretary announcing you had been admitted without even a phone interview with the director or faculty and the secretary twists off about how bad the place is? Would you quit your job, sell your house and move 2,500 miles? I think not. 'nuff said.



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... [Last response]...


Thanks for the response/elaboration...

All points I agree with...


Consider a alternate route into psychiatry.

Inpatient Psych is a "cake-walk" for older seasoned clinicians with very little liability as long as you account for the 3 things psychiatrists get sued for (EPS/TD, Metabolic Syndrome, Suicide).... and thus far... the pay has been great.

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MikeFox... you must do your own research...


Hint: Basically, ~78% of all prescriptions written for psych disorders are written by PCPs. Since Psychiatry is usually secondary to primary care and generally requires a referral from a PCP, all patient's we see mostly have a PCP of some sort who is responsible for ALL "medical" needs/issues that are not psych related.


The Adult Psych provider/prescriber will generally only be dealing with/managing: suicidal ideation, psychosis, mood disorders, anxiety disorders, substance use/abuse, dissociative disorders, personality disorders, eating disorders, sleep disorders, and sexuality/gender identity issues... the medications used to treat some of these things... and the side effects of those medications we use.


So it really should not be difficult to see how liability for all the other common bad stuff that happens through comission/omission by healthcare providers is limited for the psychiatrist... IF they stick to functioning as a "consultant on Psych issues" to PCPs. This is quite often why the psychiatrists you encounter in and around hospitals and other settings avoid "medicine" like the plague... and rather than adjust a sliding scale and add Lantus... will send a otherwise stable type 1 DM patients to the ED because they have FSBG level of 400...:heheh:


There ARE seminars/lecture series targeting psych providers that discuss this and actually encourage psychiatrists to avoid general medical issues as a liability limiting strategy... by deferring All these issues to PCPs.


So if a Psychiatrist is doing this... then the only real "landmines" are:

1.) un-recognized suicidality

2.) un-recognized and un-treated medication induced EPS--> SS/NMS and/or permanent TD

3.) the newest one being un-planned for/recognized/mitigated medication induced metabolic syndrome (patients taking long term antispychotics) which basically sets the patient up for early onset hyperlipidemia-->CAD/DM and all the problems this entails.


The easy way out is:

1.) Ask every patient about suicidality and clearly document that you asked.

2.) Have a Nurse perfom a pre-medication and quarterly AIMS (or any other movement disorder test you deem valid) testing on all your patients on antipsychotics and document the results in the chart.

3.) Baseline and quarterly Lipid panels and Hgba1c on your patients anticipated to be on long term antipsychotics (especially young Schiz & Mood Disorder patients) and the use of statins and metformin.


Alleycat... Yes... $87k is "great" when you step back, consider what you have to do each day to make that... and then compare it to what you would be expected to do in a "Primary Care" setting for the same money. There is NO such thing/such expectation as seeing a patient every 15min in psych.


Simple fact is... psychiatric medicine is MOSTLY listening and writing.

Remember... the MSE actually replaces the physical exam in a typical psych encounter... which is why most of the established, seasoned, experienced psychiatrists you meet won't remember which end of the stethescope is supposed to touch the patient and reflexively want to turf any/all "medical" issues more complex than diarrhea/constipation. moderate pain... unless of course they are relatively newly trained providers.


But then again... those are all generalizations applied across a diverse group of professionals so....






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Mr. Contrarian, thank you for the answer.


It is difficult to get our hands around generalities, but specifics are much easier to handle.


If it is my opinion, it is my opinion. If it is based on my experiences, so be it.


I like numbers and studies. They prove things. I was just asking for your numbers.

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Contrarian,thanks. perhaps just a wee bit more than listening...but you nailed it when you put psych vs primary care daily case loads. however, being an official "geriatric citizen", I'm no longer miffed by a slower pace. :;;D:


the psychiatrists I worked for were also knew to "clear !" the gurney during ECT. and please, what means YMMV ?? I enjoy your posts.

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