Correctional Medicine is a Great Job! Who Knew?

I have a confession to make.  Before I knew anything about Correctional Medicine, I had a bad opinion about it.  I’m not proud of this.  I even turned down my first opportunity to get into Correctional Medicine because of my preconceived prejudice. Thank goodness I got a second opportunity, because Correctional Medicine changed my life! Who knew that Correctional Medicine was such a great job and a great career?

Certainly not my colleagues.  Back when I made the mid-life career change to jail medicine, my physician friends asked me, bewildered, “Why in the world would you want to work in a jail?”  Without knowing anything about it, they had a preconceived notion of Correctional Medicine as being low skill and basically without redeeming features.

What a difference 15 years makes! careersprisondoctor

I recently ran into an acquaintance, an anesthesiologist, at a community function.

“How are things going in the jail?” he asked.

“Great!” I said.  “I was never unhappy as an ER physician, but I have much more job satisfaction now than I did then. I have a great job!”

“You’re lucky.  I hate my job.” He went on to discuss hassles with billing, reimbursements, fights with hospital administrators, boredom, on and on.

Now this was not an unusual occurrence.  I have had similar conversations with several physician friends.  I know an orthopedic surgeon who hates his job and wants to retire—but can’t afford to.  Another acquaintance is an internist: “Insurance and billing is killing me! I am forced to see many more patients an hour than I like.  I can’t give my patients the time or attention they deserve.” Another internist and a family practitioner I know gave up their longstanding practices to become hospitalists—but they don’t love that job, either. The list goes on and on.

I think I can safely say that a large percentage of physicians in the outside medical world are basically unhappy in their work.  This is borne out by several physician satisfaction surveys.  Typically, a third of practicing physicians would not choose a career in medicine if they were offered a “Do-over.”  Half would NOT recommend medicine as a career to their children! Only a third rate their morale as “good or excellent.”physician-satisfaction-500x349

Yet a switch to Correctional Medicine is not on any of these physician’s radar!  Just like I did, outside physicians tend to have a distrust of Correctional Medicine.  They don’t know anything about it, but they don’t like it! That is the key:  They don’t know anything about Correctional Medicine!

And that’s too bad because, as I myself found out, Correctional Medicine is a great career.  We just need to get the word out.  As I was thinking about what specifically makes Correctional Medicine a great career, I came up with the following:

Correctional Medicine frees you from coding, billing, and insurance companies! 

Outside physicians can spend more than 15% of their gross revenues just on coding, billing and collections. Not to mention the hassles and headaches of dealing with recalcitrant insurance companies.  One of my friends calls this “The Tyranny of the Blues (meaning Blue Cross and Blue Shield, with whom he has had plenty of disagreements and frustrations).” Total overhead for a primary care practice can be as high as 70% of gross revenues.

My own personal experience practicing in an Emergency Medicine partnership was similar.  Over twenty years, billing became more complicated (have you seen the size of DSM-10?), insurers became more aggressive, and revenues fell.

But Correctional Medicine is different.  Correctional Medicine is a Fee-for-Access model rather than the Fee-for-Service model in the outside world.  This means there is no DSM-10 coding.  We don’t bill insurance companies.  We don’t do “wallet biopsies” and we don’t send patients to collections.  We’re free, free, free!  I don’t know about you, but I personally found this to be a huge benefit when I made the transition.  I would never want to go back to the coding and billing world.

You will get to see much more medical pathology in corrections than you do now!

In jails, we see lots of acute pathology.  One example is that jail physicians are the true experts in assessing and treating acute withdrawal syndromes, like alcohol and heroin.  I bet that I personally have treated more patients for acute withdrawal than all of the non-correctional physicians in Idaho put together.  Jails also see many people who are disenfranchised from outside medicine.  These are the patients have no insurance, no money–maybe they’re homeless–and many never go to a doctor no matter how sick they get.  The jail medical clinic may be the very first medical care that they have had easy access to. And, of course, they bring an impressive array of untreated maladies. I’ve newly diagnosed everything from cancer to diabetes to rheumatoid arthritis in patients who have no doctor on the outside.

Prisons present another unique opportunity compared to outside medical practice.  In outside medical practice, it is rare to be able to follow a patient’s progression over many years.  Medicine has become so specialized that patients are passed from doctor to doctor depending on what disease they develop.

Take for example, the case of a primary care doc in a local community who has been taking care of a particular patient, “Joe,” for 20 years.  Then let’s say that Joe develops lung cancer and renal failure.  There is a good chance that Joe will be now be cared for by the oncologist and nephrologist.  The primary care doctor probably will never see him again!

However, in a prison, Joe (and patients like him) will always return to his primary correctional physician after each visit to a specialist.  As a result, we get to watch the course of disease progression and response to therapy in a way not done in the outside world. Couple that with the fact that every type of weird pathology that you can imagine is found in our prison population, and we can confidently say that we in corrections get to see much more interesting medical pathology than most other physicians.

For the most part, Correctional Medicine is 9-5, weekends and Holidays off.

 This was a big deal for me, the ex-Emergency Physician.  For the first time in 25 years, I rediscovered regular, circadian sleep.  Who knew that that would be so great?  Also, I was no longer gone every other Christmas and Thanksgiving. Lovely!

Remember those primary care doctors who gave up their primary care practice to become hospitalists?  They gave up their private practice due to coding, billing and insurance hassles.  But now, as hospitalists, they sacrifice their sleep and holidays.  That is one reason that they are still not happy.  (Plus they miss having long term relationships with patients).  If only there was a career path that had it all.

But there is!  Correctional Medicine!  They just have never been told.  It is up to us to get the word out.

Are you happy in your Correctional Medicine career?  What do you see as the main advantages of medical practice in corrections?  Please comment!

This article was originally published in CorrDocs, Winter 2017, Volume 19, Issue 4.

15 thoughts on “Correctional Medicine is a Great Job! Who Knew?

  1. Al Cichon

    Oh! Oh! You’ve done it – given away the best kept secret of medicine 😉

    Although in full disclosure – those of us with administrative duties have some grief – it is generally much less than in other settings

    Great as usual

    Reply
  2. integral grid

    The public eye usually judges the patient-doctor relationship with an unfair bias towards the patient. The doctor seems always more guilty than the patient in case of negative health outcomes. This happens because, one the one hand, a patient’s role and involvement in the process of his own healing is quite obscure and less likely to be well documented (as medical records reflect mostly the doctor’s input), and on the other hand anyone who’s not a doctor will more readily identify with the patient’s position. Therefore, when facing patients’ complaints, doctors on the outside are usually left in a vulnerable position, with nothing more to defend themselves than the evidence of their own records regarding the patient: they do not know how their patient behave, in which risky behavior was he involved, what did he eat, if he really took the right medication in the way it was prescribed and so on.

    Be that as it may, the controlled environment of a prison makes the physician better equipped to respond to allegations of medical negligence or misconduct, as the patient’s life is recorded to an amazing degree of detail, even in the absence of continual visual supervision. While our fellow colleagues outside the walls struggle to know their patients the best they can in the little time they spend together, in a prison setting a doctor may come across over a host of illuminating details about what caused a less favorable outcome, which most people (judges and prosecutors included) would normally consider to be the doctor’s fault.

    This is why there’s a greater chance for a prison doctor to successfully defend himself in court, as opposed to a practitioner tried based on a free patient’s allegations. Not to mention that, ultimately, a prisoner would rather side with his physician and try to make of the doctor an ally, than try to antagonize him.

    However, all these being said, I don’t think it’s very likely to ever change this misperception regarding correctional medicine. Dissatisfaction usually breeds a superiority complex, which is then fed with convenient reasons, such as the low level of scientific sophistication and/or the technically outdated clinical practice. It is as unlikely to happen as to imagine how quiet and nice life would be in the absence of mobile phones…

    Reply
      1. paul borlongan

        may i ask if there is an organization or association or group of prison doctors?
        thanks
        im a prison/jail doctor in the philippines, and i love my job..im satisfied doing my function as a physician, challenging because of one of the many factors (namely over crowding and less nutritious food) but with strong links with health partners somehow we can address the health needs of our inmates though not meeting the standards most of the time but in time when we have already organized the health care system i believe we can make it there for the health benefits of our inmates.

        Reply
  3. Cissy Lowery

    The best kept secret! As a physician recruiter for the federal prison system, testimonies such as these are what motivates me to spread the good news. Thank you for sharing this and for your service.

    Reply
  4. Angela Walters

    In correctional medicine, and I imagine this is County or State dependent, is it harder to treat patients with the tests or meds you would if in private practice? I am fully aware of wallet-insurance checks, overmedication, and unnecessary testing of patients in world of unicarcerated. Do prison docs have to fight to get outside medical testing or treatment done? Are restrictions on certain ‘free-world’ drugs often an inhibitor that you disdainty?
    Also, what of psychiatric prison professionals? Usually MD or MA? Do you serve as both?

    Reply
  5. Richard Rowe MD, CCHP

    Based on the 8th Amendment to the US Constitution, prisoners are the only group that is guaranteed medical and mental health care by the Constitution. That said, the government entities that run jails and prisons, must provide funding for that care. My career in Correctional medicine over the past 18 years, (providing hands on care to the inmate patients and now as a medical consultant) at a large state prison, have been quite rewarding. Having worked in private practice of medicine prior to working in correctional medicine, I know of the “hassle factors” in providing care in the “free world”. Correctional Medicine has offered me the opportunity to care for my patient without having to worry about their ability to pay. Also, in the long run, those of us who work in correctional medicine can have an impact on public health as a whole in that we get the opportunity to treat diseases that can spread to others, by treating the offender prior to their release into the community. It has been a great career choice for me.

    Reply

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