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!
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.”
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.
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
My baby brother is in ada county. He just finally got a rotting, painful tooth extracted. We thank you for all you do!!!
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…
Excellent point! Thank you.
may i ask if there is an organization or association or group of prison doctors?
Most of the prisons in the US are contract, so corporations staff them. We have placed several physicians in correctional medicine. Many of whom go perm. There is always a bit of hesitancy and worry initially, but after experiencing it, they realize it is a nice full time position.
Our locums company, Cross Country Locums has several short term correctional medicine needs that allow you to try it our first. They always have perm positions available, so it does allow you to “date before marriage”. I would recommend this option prior to uprooting your family.
may i ask if there is an organization or association or group of prison doctors?
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.
Yes, Paul! There is an organization of jail and prison doctors. It is the American College of Correctional Physicians (ACCP). You can find information here: http://societyofcorrectionalphysicians.org
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.
You are welcome, Cissy! Keep up the good work!
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?
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.
Great post, Dr. Rowe! Thank you.
love reading your discussion sir.
dr. lee here from slan ramon prison and penal farm zamboanga city philippines.
Thanks, Dr. Lee! I’m glad you have joined us
Part time correctional nurse here in Hawaii and I enjoy it! My nurse friends from the hospital think I’m crazy but they have no idea. Most of them hate their jobs too.
Thank you for helping me learn more about correctional medicine. My son is looking into nursing. Maybe he would be interested in know more about correctional medicine a good filed to go into.
Thanks for sharing your experiences and for the helpful information. I’m a DO considering correctional medicine and have enjoyed your insight.
I am currently exploring this field. Thank you for your post!
Thanks for commenting, Cecilia!
Hi Dr. Keller. I am a GP who just completed an ACGME PGY1 registered at the ABFM, and currently thinking of switching to correctional medicine as a place to practice meaningful medicine that can actually satisfy my nee need of being a true healer to my patients.
I am, to be honest, very disappointed with what I experienced through residency regardless of the health care system, working at a 3rd level major regional institution. All the political and insurance pushing, attendings doing nothing and exploiting everyone below them, the pressure of the coding, the bullying going with different specialties, and the lack of respect for what we do or for diversity in people. I had to deal with homophobia, racism due to my national origin, and many other little details. A friend of mine who was a correctional physician for a while (currently not on it because is doing a master’s in public health) told me about the respect on the work environment of this type of job, and how misconceived most people are regardless of what it is like to be a correctional physician. She said I could work as one with the level of education I already have, with an unrestricted license and without having to be board certified at the moment, which I confirmed through online research.
I just want to find a place where I can practice medicine with the real purpose of helping people regardless what the CEO of the hospital wants you to do so you can give him even more revenue and make him richer, where I receive respect for being what I am, a physician, regardless of my personal characteristics or preferences. I don’t discard finishing residency in the future, but as of right now I think I need some work environment that makes me see that medicine can give me that satisfaction of helping the most vulnerable and with real intentions and passion to make a difference, without having to fight against everyone else to do what is right to do.
What would be your opinion in regard to me thinking correctional medicine is a path where I can truly find those particularities in the professional aspect of medicine that I am looking for?
Hi Dr. Perez!
The short answer is that YES! correctional medicine can be a highly rewarding, highly satisfying field of medicine. That is not to say that Correctional Medicine is perfect–it is not. You may well still experience prejudicial behaviors in Corrections. But you get to escape all of the Fee-for-Service hassles and you get to deal with an underserved and disadvantaged population, who mostly will appreciate your efforts.
i hope your good office can accommodate international/foreign participants for training/immersion this will help in the management of jails/prisons particularly on the subject of health for persons deprived of liberty PDL or inmates, particularly in setting we have (in Philippines).
Is there a way to apply to correctional facilities in Texas, Colorado or California as ABEM certified ER doctor without using a staffing agency?
You should consider checking the Federal Bureau of Prisons. We are in great need of physicians. Check out the USA jobs website. I am a physician assistant in the BOP for 16 years now. I will retire after 20 years and move on to my next career. We have great benefits and retirement.