Those who've been Attendings for 7+ years and primarily chose Lifestyle for their specialty, would you base it off Lifestyle again if you were to re-do it?

Anecdotally from some of my friends in primary care, it's the constant seeing 25-30+ patients a day, managing a huge patient panel that also uses the EMR portal to ask many questions in between appointments, and the insurance and paperwork stuff. It definitely varies by practice, but 15-20 minute appointments are the standard including time to document.

I'm also psych. I don't have appointments less than half an hour and that's for straightforward medication follow-ups in stable patients. Patients that are difficult to wrangle, chronically have a lot of social needs to problem solve, or always have many concerns and questions get booked as hour appointments. The business people don't lose sleep over it because it gets billed as a medication visit with a supportive psychotherapy add-on, not as taking longer to do the same thing. My intakes are usually 90 minutes. So I typically see closer to 10 patients a day. I could knock that down even further if I insisted on having some consistent weekly hour psychotherapy cases as some of my colleagues do, but that's not really my thing.

There are definitely places that have higher productivity expectations for psychiatrists and will try to push things like only doing 15-30 minute med visits all day long, but that's not as common by a long shot. Maybe only because psych may be one of the last areas of medicine (especially now with telehealth) where you can just get fed up with the business folk, quit, find a space to see patients, let the local EDs know you're taking referrals, and have a profitable practice within the year. Or join an already established small private practice. In major cities, even dealing with insurance is generally optional - many private practices are cash only and have patients figure out reimbursement from their own insurance company.

That's not my ideal practice setting right now and I can't imagine it ever being what I want to do full time, but knowing it's floating out there as an option whenever I'm over the stress of what I'm doing now is a nice daydream (and backup plan).

/r/Residency Thread Parent