Addictions med: family or psych?

[mononoke]

What is the difference between doing addictions from family med or psych? For example, is there a big difference in billings or scope of practice?

How big of an issue are no-shows when it comes to this patient population?

[LostLamb]

Just coming off of a rotation in addictions, I met both psychiatrists and family mds working in the field. 

All the psychiatrists work in multiple areas of interest, ie. some sort of inpatient and/or other consultative practice so if there are no shows they can attend more to inpatient matters. If they don’t work inpatients, they have busy outpatient practise in a related but not strictly addictions population. 

The family docs seemed to be involved in multiple outpatient practises (detox centres, concurrent disorders) in addition to outpatient addictions consults. 

In terms of scope, I’d say the family docs dealt mostly with pure addictions management (medical and psychosocial and psychotherapy) and if there was a psych comorbidity they’d consult or liaise with psychiatrists. 

There’s lots of opportunity in FM plus 1 yr addictions training. If you’re more interested in psychiatric comorbidities in addition to  addictions medicine, and want deeper training in psychotherapy, psychotherapeutics, then it is worthwhile to build those skills through a 5 year (plus, if you want to do a fellowship—don’t know how important this is given there’s lots of elective time in psych) program. 

I think billings vary based on what you’re doing/seeing and split of time—more medical consults are faster and thus can see volume vs more psych consults which are longer but pay commensurately. 

No show is variable—anywhere from 5-25% is my guess—that means having a diverse practise to compensate for variability. 

[ellorie]

If you do it from psych you will probably feel much more comfortable managing concurrent disorders and doing psychotherapy. If your interest is more suboxone, methadone, withdrawal management kind of stuff, either path is probably equally fine. 

[medisforme]

I plan on doing a moderate amount of addictions work now that I am graduated.  The key I have found is to get hired on by health authorities to do sessionals (usually they are 3.5  hours) for both OAT and withdrawal management/detox assessments (I think it works out to $133/hr).  This way you get paid per hour and so it doesn't matter if a patient shows up or not.  There are also mixed models where you are guaranteed a sessional payment but if you manage to bill above that for the time, you keep the difference.  I did some training with docs who were in the midst of trying to build up a methadone/suboxone practice from scratch.  This is a massive money loser, as you are paying 1-2 staff as well as office space to often just sit around until the practice builds up (which takes a decent amount of time). Some clinics charge patients a monthly fee ($50 or so) as part of the care they provide. The field of addictions from a family medicine standpoint is not very lucrative to begin with.  The only way you would make a good living is to build up a large practice of stable patients (200-300+).

The family medicine addiction billing fees just got updated, I assume to attract more docs to this area.  You now get paid an initial evaluation fee as well as a suboxone induction fee on top of the regular 00039 weekly fee.

Typical OAT clinic/community detox assessments don't take an R3 level of training IMO.  I worked with several family docs who learned as they went.  Addictions fellowships are more important if you want to do in-patient hospital consults or work in medical in-patient detox facilities (ie. Creekside, St. Paul's)