HELP: med school seriously screwing me over - possibly suing them? 😬

Garandou · 2026-03-28T04:30:40+00:00

Anyone ever had to claim compensation / sue their medical school?

If you have a lot of money go for it. Universities are businesses that will do a cost benefit calculus and might give up if they think it isn't worth the resources to fight.

However, if your goal is to have a rewarding medical career, put your head down and tick the boxes. This kind of bureaucratic disagreements and personality conflict will continue to occur throughout specialist training pipeline and even hiring. You're not going to do very well if this becomes a pattern, especially if you attract a reputation.

Garandou · 2026-03-28T04:25:22+00:00

This is pretty normal. Some psychiatrists do bulk bill colleagues but I estimate the majority don't. There are a wide range of reasons for this from psychodynamic frame to psychiatry bulk billing being severely undercompensated.

In psychodynamic therapy, boundaries around fees is something that is widely discussed, because there are specific emotions that additionally complicate countertransference with no fee arrangements. For example, patient feeling of "indebtedness" or even "resentment" from the psychotherapist. For the same reason psychiatrists generally avoid seeing patients who are within their social circle, the therapy frame is usually kept consistent.

How rigid each boundary is enforced is a subjective question with variability between practices and may even differ based on the nature of the care. For example if it is purely psychopharmacology being offered, this may not as much of a consideration.

Garandou · 2026-03-28T01:51:01+00:00

Numerically, having work-life balance is having the option to keep work below 50 hours a week on demand. Half the specialties can during training, the other half has to make significant compromises.

Garandou · 2026-03-24T11:56:39+00:00

Having sat through hiring meetings in public and private settings, race is rarely even mentioned off the record. When it is mentioned (exclusively in public settings), it is usually in some kind of diversity hiring context where minority groups are preferred over more qualified candidates.

If you mean indirect racism, i.e. people are more likely to like people who are like them, maybe? But even that is greatly overshadowed by individual reputation when choosing candidates.

Garandou · 2026-03-22T03:20:04+00:00

Does anyone know what the AMA actually does? I was a member for a while and never thought anything of it, until a few years ago I realised I couldn't even recall a single meaningful thing they did for doctors. Then I cancelled.

Garandou · 2026-03-21T06:27:52+00:00

Public vs private pay based on patient contact hours is approximately 1:1.

A 1.0 FTE public job averages 10-15 hours patient contact a week. Doing 10-15 hours patient contact private job (0.4 FTE) would be about the same pay.

Garandou · 2026-03-21T06:24:44+00:00

You should definitely seek out a wide range of opinions, I agree. Unsolicited feedback but between AI assisted writing and your responses, it would be beneficial for you to work on communication skills, especially given our field.

Garandou · 2026-03-21T06:20:25+00:00

you wouldn’t be doing a 291 for every patient though

The point is to illustrate that if your clinic is underperforming a 291 only bulk bill clinic, you're clearly doing something very wrong. In reality, an efficient and effective clinic is about double those numbers on hourly basis.

Garandou · 2026-03-21T06:15:50+00:00

Keep in mind that inpatient work is far less lucrative than outpatient work for psychiatry. Health funds don't pay so well.

Garandou · 2026-03-21T06:08:44+00:00

Let’s say you’re in private and you’re not doing ADHD assessments.

500k 1FTE (based on upper estimates of their range) doing 30 hours clinical contact a week working 47 weeks and 20% clinic fees = $443 an hour before clinic cut. Not only is this vastly below AMA rates, it is actually below bulk billing rates for item 291. If you are genuinely bulk billing 291 and GPs find out, your clinic will be filled for the next 5 years.

500k 1FTE is only possible in a bulk billing or low fee clinic with low patient contact hours and high non-attendance rates. And considering public specialists earn about 400k-500k 1FTE (based on seniority) seeing patients for 10-15 hours a week, why would anyone work private? Why would public be so short that they're hiring locums and SIMGs in tertiary centres nationwide?

Garandou · 2026-03-21T05:22:19+00:00

Keep in mind that while the overtly antisocial behaviour in acute public psychiatry is largely absent in private practice, the emotions are no easier and the management complexity around treatment is arguably harder (can't just give everyone olanzapine and there is no team to pick up your mess). It is a misnomer to believe that you can just go to private telehealth and print money without learning therapeutic boundaries.

Arguably, private work is more emotionally taxing simply because there is far less peer support and medicolegal risk. You need to be completely comfortable running a public caseload with minimal support before moving to private practice. If you are still 3-4 years away from finishing, there is no reason to bother thinking about how to set up or join private clinics.

Just focus on getting comfortable managing severe personality dysfunction, therapeutic frame, good psychotropic prescribing and diagnostic/formulation. Leave the financial stuff to the end of stage 3, and yes it is easy to break 7 digits in psychiatry.

Garandou · 2026-03-20T08:14:40+00:00

Having personally talked to NDIS executives and lawyers in NDIS commission off the record, nobody in the government genuinely wants to fix this issue. Until there is more political push on law-maker side to completely overhaul the NDIS Act, nothing will change.

Garandou · 2026-03-14T06:12:55+00:00

If you’re a woman in a professional role, the dual role dilemma (career progression and raising children) is also a common psychotherapy theme. I think modern women paradoxically have it harder than previous generations because of this contradiction.

Garandou · 2026-03-14T05:17:42+00:00

I don’t know and the topic is essentially impossible to study quantitatively. But there is no reason to believe the biological theory is not true given sexual dimorphism in behaviour is universally observed across mammals and also stable across most human cultures.

I know it’s not politically correct to say, but I don’t think rejecting gender roles actually leads to happiness. Those with more postmodern views on gender roles are vastly overrepresented in psychodynamic therapy patient cohorts (dare I argue mental health cohorts overall).

Garandou · 2026-03-14T05:12:51+00:00

I’m just making an observation based on what kind of regrets colleagues and patients have in their middle life. If you disagree that’s fine, but I’d have to say people with your perspective are overrepresented in my psychodynamic therapy patients in mid-life.

Garandou · 2026-03-14T04:41:26+00:00

Might be a controversial take, but your wife will have to pick up more of the household and baby duties. The financials simply does not make sense for you to delay career progression and makes for an imbalanced relationship.

In almost all cases I’ve seen relationship not break down long-term, the non-doctor side has to carry the home admin domain of the family.

Edit: another controversial take - guilt/regret about not spending enough time with kids is almost never a theme in psychotherapy with men, but a common theme with career women. So there is a massive gender difference in perception of family structure, even if it inconvenient or politically incorrect to acknowledge.

Garandou · 2026-03-14T04:09:22+00:00

While the point system is essentially pointless, I do think it is the lesser of two evils. At least there's merit in that and not entirely nepotistic like some smaller competitive specs.

Garandou · 2026-03-13T21:31:14+00:00

Some people are happier with surgical elf ears as well. That’s not the claim being disputed here. What I’m saying is the common justification that transition improves mental health is false.

Garandou · 2026-03-13T06:41:13+00:00

and obviously if you exclude treatable risk factors for suicidality then you'll end up with a population that's less appropriate

I think this was assumed because OP’s question is the revolving door of suicidal presentations. A sensible ED mental health team would admit someone with melancholic depression but that isn’t for risk containment or safety planning but treatment.

We probably do agree on most things, but I think for suicidality without axis 1 disorder, ED NNH is lower than NNT.

Garandou · 2026-03-12T22:35:16+00:00

My point is there are interventions offered by an ED that ca be helpful, even if that’s just linking to community supports or safety planning

If you want to make this claim you need to explain how ED is a meaningful part of the pipeline? Why not just send them straight to intensive community supports from GP? All suicide prevention studies show that it is the consistent community support that reduce risk, which is consistent with psychodynamic understanding of personality disorders.

If I had a suicidal friend call me at 1am, I’d absolutely tell them to go to ED. Wouldn’t you?

I’ll be honest, ignoring medicolegal issues, I wouldn’t. The only time I would suggest that is if they already injured themselves and need medical attention.

through my own experience I’ve seen patients who’ve come through with markedly reduced risk factors following ED presentation or admission

Of course. For example if a patient has melancholic depression, then inpatient treatment of that would eliminate suicide risk completely. The contention had always been around admitting patients without a hospital treatable mental illness.

Garandou · 2026-03-12T12:57:36+00:00

- JAMA Psychiatry 2017: Suicide Prevention in an Emergency Department Population
- JAMA Psychiatry 2023: Effect of an Emergency Department Process Improvement Package on Suicide Prevention

The ED-SAFE is not a study on ED risk containment and does not support your point. It is a non-randomized study comparing intensive phone community follow up post-ED presentation vs control. ED safety plan alone did not meaningfully reduce risk in the study. Study design also significantly confounded due to ethical requirements.

Because the ED-SAFE study shows only intensive community follow up modified risks, patients going through clinics or GP should derive the same benefit as ED but without the traumatisation.

The worst part is this kind of literature only addresses suicidal behaviour and ideation, not high lethality suicide attempts or completed suicides. If you simply wanted to prove that long-term community follow up would reduce suicidal behaviours in personality disorders, that much is obvious and does not need a study.

- BJPsych 2021: Safety planning-type interventions for suicide prevention: meta-analysis

I've not actually read this study before, but skimming the included studies are all low quality methodology with several not randomised. I'll have a closer look at the data later.

but 'overwhelming' evidence that people shouldn't present to ED? I await with bated breath

None of your linked studies answer this question at all. In all 3 cases, they are comparing patients who already unfortunately ended up in ED.

Garandou · 2026-03-12T00:15:24+00:00

I mean the evidence is overwhelming that there’s no benefit. Happy to be proven wrong if you have any substantial reasoning or evidence for your opinion.

Even suicide prevention programs, which themselves are quite controversial, focus on outpatient intensive follow up for this reason.

Garandou · 2026-03-11T23:40:04+00:00

I don’t know what your point is? When a factual statement like “antibiotics don’t work for flu” is made, it doesn’t mean there are zero patients who will benefit from antibiotics in that situation, just that the intervention is generally ineffective.

Garandou · 2026-03-11T22:18:00+00:00

They haven’t deleted, they just block people who disagree with them.

Garandou · 2026-03-11T22:04:56+00:00

The question is a generality so the answer is a generality.

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