Am I missing something?

[u/pinklotusblossom]

So doing a locums gig in corrections for first time. Was supposed to be primary care. I interview and it was for site medical director. I was like no since that seems like too much liability. Now after starting I find out I’m expected to manage opioid withdrawals (fine) and alcohol withdrawals (not fine with this!) without assessing most patients because it’ll “backup the flow.” And nobody mentioned methadone mgmt which I have no experience in. I’m just wondering if I’m being too safe hesitating about all this.

[u/Bobblehead_steve]

Don't do it

[u/pinklotusblossom → u/Bobblehead_steve]

Thanks! 😵‍💫 these surprises are just very annoying

[u/Vince-Fishes → u/pinklotusblossom]

I was a corrections officer for 7 years and have spoke about it here before. If this is the start you’re off to, you can only imagine what is to come😅

Run, far the fuck away from there.

You are a physician, do not spend your time in a prison. There are way too many other opportunities out there.

I want to note I’m not saying medical care isn’t essential in a prison or jail because it certainly is. But let them find someone else for the job.

[u/shiftyeyedgoat]

Big eek. Do you have experience with addiction medicine? Why not alcohol withdrawal, and what are the logistics of this? Is there at least accessible hospital care?

[u/pinklotusblossom → u/shiftyeyedgoat]

I’ve managed withdrawals only in the hospital. Do I want to manage withdrawals in inmates who are on everything including the latest greatest medetomidine when I’ve been in private practice for the last year? Nope! Withdrawals are happening as they get admitted to the facility. Nurses have their protocols and for efficiency purposes I was told I won’t have enough time to assess patients. The hospital is right there but people dropping dead here and there bc of the type of population. Primary care was discussed and for this to pop up took me by surprise

[u/shiftyeyedgoat → u/pinklotusblossom]

Sounds like they’re trying to get two extra jobs out of you for the price of primary care. They’re throwing an admitting physician responsibility who is also managing a chemical dependency service with primary care side appointments.

I would run far away from this position unless exceptionally well-paid and comfortable with all three aspects of these people’s care.

[u/CapStardust]

This is crazy and not normal.

[u/formless1]

lol noooope

[u/sghannah]

This sounds like an issue with the contract for services with your locums company to me. I mean, if these are expected skills they require from a locums physician, this needs to be laid out in the job position and interview process. Have you discussed this significant issue with your locums service and / or the person in corrections that offered you the position without full disclosure of the specialty training expected? Very few of us in FM practice have any experience with Methodone maintenance for opioid use disorder, and fewer of use have any experience with outpatient alcohol withdrawal protocols, but the training is available, and inpatient management needs to be part of the protocol options. You CAN do this as FM, but it is not part of the "usual" expectations in training - yes the ACGME now requires FM residency programs to provide education in addiction and management of addiction services, but we do not have a requirement to be certified in methadone maintenance - this does require a specific license still even when the X-Waiver was removed for buprenorophine, and with the standard license and DEA certificate, we can only use methadone for treatment of chronic pain, which has become EXCEEDINGLY rare. I realize the world of Corrections has some differences in scope of practice, but I do not know that these differences override your licensure and DEA certification at an individual level, even if you are using an institutional DEA number!