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.
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.