Graduating psych residents…Job offers

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The only other current doc I don’t think wants me because he doesn’t want to split any of it. He takes 4 week days of call and 3 weekends and a locum does 1 week day at 1 weekend currently. He makes over 600k I know, but basically tried to tell me he doesn’t want to split the inpatient and that I need to just do outpatient but I refused to take an all outpatient job.
Hospital wants more psychiatrists though.
I’m waiting to see what my offer looks like from my home institution before going further with this contract.
Well then the bolded is a very good sign. Seems like this is a hustle position where you can make bank if you want to, but you'll be earning it. I'm sure he doesn't want to split his inpatient gig if he's making $600k+ doing that alone and very little to no outpatient, I wouldn't want to split that either!

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Thoughts on this job?

ER consults, full tele from home, full sw support. 8am-8pm or pm to am. 1900/shift + 180/consult over 9 consults. The kicker is the average is 6 consults a shift, so probably not getting more than 1900 very often. On the plus side, I could schedule outpatient appts during the day and likely work around ER consults.

Wondering how this offer sounds as is. Seems I might be able to negotiate a little bit. I'd love 2500 a day
 
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Thoughts on this job?

ER consults, full tele from home, full sw support. 8am-8pm or pm to am. 1900/shift + 180/consult over 9 consults. The kicker is the average is 6 consults a shift, so probably not getting more than 1900 very often. On the plus side, I could schedule outpatient appts during the day and likely work around ER consults.

Wondering how this offer sounds as is. Seems I might be able to negotiate a little bit. I'd love 2500 a day
Pretty low hourly you'd need to see a few over 9 to make it decent hourly. I personally hate sitting around feeling like I am a captive I like more flexibility and ability to control my schedule. But, if you use this to grow a PP doing OP work on the side it could be lucrative and create some steady income while you grow your other practive.
 
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Pretty low hourly you'd need to see a few over 9 to make it decent hourly. I personally hate sitting around feeling like I am a captive I like more flexibility and ability to control my schedule. But, if you use this to grow a PP doing OP work on the side it could be lucrative and create some steady income while you grow your other practive.
Kind of my thought. I'm pretty sure I can bump this a bit higher. So if at 2200/shift, I could work 3 shifts a week and turn this into a 300k/year job. I'd have an hour to respond to any consult request, so I could theoretically stagger an outpatient schedule and double dip during the day. Figure three days of chillin at home, knocking out a bunch of outpatient appointments and clearing 2k a day on top of that..doesnt seem bad. That set up seems like it would be good for 600k a year.
 
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My colleague earns $3400 a day!

Inpatient job finishes by noon: $1200 per day, W2, no overnights, no weekends, 5 weeks paid vacay + benefits

Telepsych job: noon to 8pm, 1hr for intakes that usually only take 30min, 30min followups that take 10 to 15min, no-shows are paid. 5 days a week. no call. $2200 per day

That's really the dream set-up right there. Surgeon salary.
 
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My colleague earns $3400 a day!

Inpatient job finishes by noon: $1200 per day, W2, no overnights, no weekends, 5 weeks paid vacay + benefits

Telepsych job: noon to 8pm, 1hr for intakes that usually only take 30min, 30min followups that take 10 to 15min, no-shows are paid. 5 days a week. no call. $2200 per day

That's really the dream set-up right there. Surgeon salary.
Probably more than general surgery.
 
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My colleague earns $3400 a day!

Inpatient job finishes by noon: $1200 per day, W2, no overnights, no weekends, 5 weeks paid vacay + benefits

Telepsych job: noon to 8pm, 1hr for intakes that usually only take 30min, 30min followups that take 10 to 15min, no-shows are paid. 5 days a week. no call. $2200 per day

That's really the dream set-up right there. Surgeon salary.
This is absolutely not the norm and kind of pointless to talk about since it’s very far outside the norm. Your friend is making 275/hr guaranteed to see 2 patients an hour telepsych. That is not the norm at all. Furthermore you friend works 12 hours a day, I wouldn’t call that the dream. He’s essentially doing a little more than 2 full time jobs in one day, again not the norm at all
 
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This is absolutely not the norm and kind of pointless to talk about since it’s very far outside the norm. Your friend is making 275/hr guaranteed to see 2 patients an hour telepsych. That is not the norm at all. Furthermore you friend works 12 hours a day, I wouldn’t call that the dream. He’s essentially doing a little more than 2 full time jobs in one day, again not the norm at all
I'm getting more than this as a resident moonlighting in a clinic. It's not hard.

I bill 90% 99214, I use therapy add on 90% of the time. The clinic I work for gets ~215 for this combo. Do this x2 and you're at 430. 70% cut and I'm getting 300/hr for this combo. Factor in the occasional 99213 and/or the few who don't want even 16 minutes of supportive therapy and you're at 280ish an hr.

If/when I have my own practice, I'll be generating as much if not more per hour just taking insurance. With a tele-hybrid practice, overhead is quite low, call it 20%. That's 345/hr once you're full and largely doing follow ups.

But I agree about the hours. 60 hours a week is far from ideal. And I'm curious about these inpatient jobs that finish by noon. What happens when you go to court? Does court always happen before noon? And you still have time to finish all the rounding?
 
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My colleague earns $3400 a day!

Inpatient job finishes by noon: $1200 per day, W2, no overnights, no weekends, 5 weeks paid vacay + benefits

Telepsych job: noon to 8pm, 1hr for intakes that usually only take 30min, 30min followups that take 10 to 15min, no-shows are paid. 5 days a week. no call. $2200 per day

That's really the dream set-up right there. Surgeon salary.
Agree with above, the salary sounds like a dream but the set up sounds pretty miserable to me. 12 hour days 5 days a week sounds awful.

the inpatient job seems fairly typical. The outpatient job seems to be more inline with a cash only PP and I'd be very curious to know what company this is or if this is a PP they converted to telehealth. I would also be concerned about outpatient docs where 30 minute evals are the norm. Either these are very straightforward patients who probably don't even really need to see a psychiatrist, or there's corners getting cut.

But I agree about the hours. 60 hours a week is far from ideal. And I'm curious about these inpatient jobs that finish by noon. What happens when you go to court? Does court always happen before noon? And you still have time to finish all the rounding?
Why do you assume the psychiatrists are going to court. SW can do that and plenty of inpatient units don't take involuntary patients. Also, after COVID many courts moved to Zoom or teleconference, so can be done remotely.
 
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Agree with above, the salary sounds like a dream but the set up sounds pretty miserable to me. 12 hour days 5 days a week sounds awful.

the inpatient job seems fairly typical. The outpatient job seems to be more inline with a cash only PP and I'd be very curious to know what company this is or if this is a PP they converted to telehealth. I would also be concerned about outpatient docs where 30 minute evals are the norm. Either these are very straightforward patients who probably don't even really need to see a psychiatrist, or there's corners getting cut.


Why do you assume the psychiatrists are going to court. SW can do that and plenty of inpatient units don't take involuntary patients. Also, after COVID many courts moved to Zoom or teleconference, so can be done remotely.

In my neck of the woods, blue state, they converted back to in-person about 6 mos ago and court is definitely still happening. Sometimes its a 2hr thing for 1 patient depending on what's going on.
 
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In my neck of the woods, blue state, they converted back to in-person about 6 mos ago and court is definitely still happening. Sometimes its a 2hr thing for 1 patient depending on what's going on.

I'm in a mostly red state but a mostly blue area and as far as we've heard telecourt is here to stay permanently.
 
But I agree about the hours. 60 hours a week is far from ideal. And I'm curious about these inpatient jobs that finish by noon. What happens when you go to court? Does court always happen before noon? And you still have time to finish all the rounding?

At my program, psychiatrists do not go to court. The social workers do. Same situation back when I was a med student on psych pre-COVID and the social worker would accompany the patients to in-person court. From what I've seen the average virtual court case is 15-20 minutes (I've sat in on quite a few) so it wouldn't add much time doing a few virtual court cases a couple times a week, at least at my hospital.
 
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My colleague earns $3400 a day!

Inpatient job finishes by noon: $1200 per day, W2, no overnights, no weekends, 5 weeks paid vacay + benefits

Telepsych job: noon to 8pm, 1hr for intakes that usually only take 30min, 30min followups that take 10 to 15min, no-shows are paid. 5 days a week. no call. $2200 per day

That's really the dream set-up right there. Surgeon salary.
Finishing at 8 PM every day sounds rough. Though I suppose the 800k/year and mostly virtual set-up somewhat makes up for it...
 
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telecourt where I'm at as well, all virtual

I'd work from home seeing 1 to 2 patients an hour for 800K any day... 8pm wouldn't bother me especially with no overnight call and weekends free
 
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Finishing at 8 PM every day sounds rough. Though I suppose the 800k/year and mostly virtual set-up somewhat makes up for it...
Yeah... Would not mind finishing around 8pm in the comfort of my home while getting paid 750-800k/yr for it. I think that person has a great job especially if one is 1099 that will allow him/her to decrease its tax burden.
 
Yeah... Would not mind finishing around 8pm in the comfort of my home while getting paid 750-800k/yr for it. I think that person has a great job especially if one is 1099 that will allow him/her to decrease its tax burden.
Sounds good until you have kids or a spouse and you're missing dinner every single weeknight.
 
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Sounds good until you have kids or a spouse and you're missing dinner every single weeknight.

Right, surgeon salary for surgeon hours. I mean, most people don't get that yeah you can absolutely do that in psych...if I worked 12 hour days 5 days a week just with my outpatient job I have right now I would also be in the 700K+ range with a full panel. But I don't want to.

Isn't one of these jobs telemedicine (at home)?

You gonna have a family dinner with your kids while you're in the middle of appointments with patients? Also, bedtime for younger kids is like 8PM...so basically you don't see them except I guess for little stints between no shows.
 
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Right, surgeon salary for surgeon hours. I mean, most people don't get that yeah you can absolutely do that in psych...if I worked 12 hour days 5 days a week just with my outpatient job I have right now I would also be in the 700K+ range with a full panel. But I don't want to.



You gonna have a family dinner with your kids while you're in the middle of appointments with patients? Also, bedtime for younger kids is like 8PM...so basically you don't see them except I guess for little stints between no shows.
I am a hospitalist (IM). I have not done telemedicine but I heard they are flexible, so taking 30-60 minutes breaks to do family business should no be out of the norm.

Or you can choose to finish at 6:30pm and make 600-650k/yr, which is also good IMO.
 
I am a hospitalist (IM). I have not done telemedicine but I heard they are flexible, so taking 30-60 minutes breaks to do family business should no be out of the norm.

Or you can choose to finish at 6:30pm and make 600-650k/yr, which is also good IMO.

Right but what I'm saying is that job isn't that super unusual, you're just increasing the hours worked. Like I could also just do the same thing in my outpatient job right now if I wanted to work 8AM-6PM and also hit around 600K. I'd just rather work 4.5 days 9-5 with an hour lunch break lol.
 
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It is, but if you're seeing two patients an hour for 8 hours how much down time are you going to have?

I have quite a good amount of downtime. Mine is a bit different since its hybrid and I've got a mature and stable panel over several years. My evening is almost always wrapped up by 530ish but i get paid well past that since i negotiated admin time end of day. Bankers hours and close to surgeon's pay is probably the best balance imo. I
 
I had a chance to talk to my friend and he is like loving his jobs. He says the tele cases are mild, low stress, mostly anxiety and ADHD cases, acute cases are screened out, always gets 1 or 2 no-shows a day which opens up like 1 to 2 hrs and he goes for a long jog. He has time for family, plays with his kids in-between tele cases at home. The inpatient job is 10 patients, in around 9am. Guardianship hearings and med panel hearings are very rare, virtual only, and the social worker sits in for him until he is called or he can do it remotely after work. Social worker sits next to him all morning and handles all family contact/calls, paperwork, aftercare, everything other than doctor work. He writes the legal holds and notes. He's looking at $850K a year. I asked him to hook me up lol.
 
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I had a chance to talk to my friend and he is like loving his jobs. He says the tele cases are mild, low stress, mostly anxiety and ADHD cases, acute cases are screened out, always gets 1 or 2 no-shows a day which opens up like 1 to 2 hrs and he goes for a long jog. He has time for family, plays with his kids in-between tele cases at home. The inpatient job is 10 patients, in around 9am. Guardianship hearings and med panel hearings are very rare, virtual only, and the social worker sits in for him until he is called or he can do it remotely after work. Social worker sits next to him all morning and handles all family contact/calls, paperwork, aftercare, everything other than doctor work. He writes the legal holds and notes. He's looking at $850K a year. I asked him to hook me up lol.
Are you working as well? What’s your setup?
 
I have quite a good amount of downtime. Mine is a bit different since its hybrid and I've got a mature and stable panel over several years. My evening is almost always wrapped up by 530ish but i get paid well past that since i negotiated admin time end of day. Bankers hours and close to surgeon's pay is probably the best balance imo. I
How many patients are you seeing over how long a period of time?
 
My colleague earns $3400 a day!

Inpatient job finishes by noon: $1200 per day, W2, no overnights, no weekends, 5 weeks paid vacay + benefits

Telepsych job: noon to 8pm, 1hr for intakes that usually only take 30min, 30min followups that take 10 to 15min, no-shows are paid. 5 days a week. no call. $2200 per day

That's really the dream set-up right there. Surgeon salary.
Is it me or does 30 min for an intake feel like it's bordering on subpar care? Not judging, just wondering if I'm the only one who thinks this is too quick.
 
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I had a chance to talk to my friend and he is like loving his jobs. He says the tele cases are mild, low stress, mostly anxiety and ADHD cases, acute cases are screened out, always gets 1 or 2 no-shows a day which opens up like 1 to 2 hrs and he goes for a long jog. He has time for family, plays with his kids in-between tele cases at home. The inpatient job is 10 patients, in around 9am. Guardianship hearings and med panel hearings are very rare, virtual only, and the social worker sits in for him until he is called or he can do it remotely after work. Social worker sits next to him all morning and handles all family contact/calls, paperwork, aftercare, everything other than doctor work. He writes the legal holds and notes. He's looking at $850K a year. I asked him to hook me up lol.

I will say that unless this is a cash private practice telemedicine outpatient setup, there may be significant inappropriate upcoding going on if he's seeing intakes in 30 minutes and scheduled 30min followups in 10-15 minutes because they're "mostly anxiety and ADHD cases" but this place can somehow afford to pay him a guaranteed $275/hr. He should be doing approximately 0 psychotherapy add-ons.
 
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I will say that unless this is a cash private practice telemedicine outpatient setup, there may be significant inappropriate upcoding going on if he's seeing intakes in 30 minutes and scheduled 30min followups in 10-15 minutes because they're "mostly anxiety and ADHD cases" but this place can somehow afford to pay him a guaranteed $275/hr. He should be doing approximately 0 psychotherapy add-ons.
Wait can you explain that a little? If the patients are scheduled for 30 min follow up couldn’t they all be psychotherapy add ons?
 
Wait can you explain that a little? If the patients are scheduled for 30 min follow up couldn’t they all be psychotherapy add ons?

Not if you're not actually seeing them for at least 16+ minutes and at least trying to pretend that at least all 16 of those were psychotherapy...it's been talked about before on here but even 20 minute appointments with "psychotherapy add ons" are a stretch, at least 99214+90833 since you're basically saying you did a "moderate" level of MDM in 4 minutes.

Anyway, it's actually fraud in that case if you're not actually seeing the patient for 16+ minutes of face to face time and billing a 90833. Is it going to amount to anything? Probably not because someone would have to try to prove you didn't spend that time with them somehow. However, this gets easier with tele visits since total time connected on a call is pretty easy to track.
 
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Not if you're not actually seeing them for at least 16+ minutes and at least trying to pretend that at least all 16 of those were psychotherapy...it's been talked about before on here but even 20 minute appointments with "psychotherapy add ons" are a stretch, at least 99214+90833 since you're basically saying you did a "moderate" level of MDM in 4 minutes.

Anyway, it's actually fraud in that case if you're not actually seeing the patient for 16+ minutes of face to face time and billing a 90833. Is it going to amount to anything? Probably not because someone would have to try to prove you didn't spend that time with them somehow. However, this gets easier with tele visits since total time connected on a call is pretty easy to track.
I think moderate mdm is pretty easy to do in a stable patient in 2-3 minutes.
 
I think moderate mdm is pretty easy to do in a stable patient in 2-3 minutes.

It's been debated elsewhere on here so it's really not the point here...my point is that if you're not even seeing the patient for 16 minutes, you can't use 90833 and guaranteed $275/hr is pretty generous for 2pph without any therapy add on codes, which you should not be using if you're only seeing these patients for 10-15minutes of your 30 minute time slots.
 
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I had a chance to talk to my friend and he is like loving his jobs. He says the tele cases are mild, low stress, mostly anxiety and ADHD cases, acute cases are screened out, always gets 1 or 2 no-shows a day which opens up like 1 to 2 hrs and he goes for a long jog. He has time for family, plays with his kids in-between tele cases at home. The inpatient job is 10 patients, in around 9am. Guardianship hearings and med panel hearings are very rare, virtual only, and the social worker sits in for him until he is called or he can do it remotely after work. Social worker sits next to him all morning and handles all family contact/calls, paperwork, aftercare, everything other than doctor work. He writes the legal holds and notes. He's looking at $850K a year. I asked him to hook me up lol.

Hook you up? I’m packing my bags and heading to airport to buy a one way ticket to anywhere in this country where this guy is! Northern Alaska here i come! Assuming there is nothing illegal and he is happy with his job and location then he really won the lottery in the game of Life psychiatry edition.
 
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How many patients are you seeing over how long a period of time?
On the tele days I see 2 pph scheduled. 9 clinical hours but paid for 11. see 13-15 total avg. Again, this is a hybrid role. Compared to my PP days this is a retirement job as I am seeing double the volume so it balances out.
 
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Right but what I'm saying is that job isn't that super unusual, you're just increasing the hours worked. Like I could also just do the same thing in my outpatient job right now if I wanted to work 8AM-6PM and also hit around 600K. I'd just rather work 4.5 days 9-5 with an hour lunch break lol.

Another thing that gets overlooked is spending with a high salary. I doubt many making 600k are only spending 100k or under. With high tax states you could be in similar place financially making 400k vs the 600k earner who is spending closer to 200k/yr vs the 100k or under lower earner.
 
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Telecourt is definitely 100% permanent in my county, but it's not universal. I know some other counties aren't. It's bizarre, you would think the judges and lawyers and everyone would want it.
 
In my neck of the woods, blue state, they converted back to in-person about 6 mos ago and court is definitely still happening. Sometimes its a 2hr thing for 1 patient depending on what's going on.
I am in a blue state and we do zoom court for medication petition I have never gone for involuntary stays. We do inperon court now only if a patient requests it. I do a lot of involuntary med petitions unfortunately for me. And I still normally can wrap up a day by 2.

I'm getting more than this as a resident moonlighting in a clinic. It's not hard.

I bill 90% 99214, I use therapy add on 90% of the time. The clinic I work for gets ~215 for this combo. Do this x2 and you're at 430. 70% cut and I'm getting 300/hr for this combo. Factor in the occasional 99213 and/or the few who don't want even 16 minutes of supportive therapy and you're at 280ish an hr.

If/when I have my own practice, I'll be generating as much if not more per hour just taking insurance. With a tele-hybrid practice, overhead is quite low, call it 20%. That's 345/hr once you're full and largely doing follow ups.

But I agree about the hours. 60 hours a week is far from ideal. And I'm curious about these inpatient jobs that finish by noon. What happens when you go to court? Does court always happen before noon? And you still have time to finish all the rounding?
You can still get done if you do court especially if you only have one inpatient job with the court and be done at a decent time normally if I get the am slot I can be done before noon with my inpatient and court for the day.
At my program, psychiatrists do not go to court. The social workers do. Same situation back when I was a med student on psych pre-COVID and the social worker would accompany the patients to in-person court. From what I've seen the average virtual court case is 15-20 minutes (I've sat in on quite a few) so it wouldn't add much time doing a few virtual court cases a couple times a week, at least at my hospital.
That seems so bizarre to me why would SW ever be going to court when you are the one filling out the paper work and it is your order holding someone either inpatient or ordering involuntary meds
Sounds good until you have kids or a spouse and you're missing dinner every single weeknight.
Literally working 12 hours days being held to having to sit and work even if it is at home. Find a better way to mash together jobs with full autonomy and get efficient with good teams in place to allow you to be done and have time to yourself. 5-6hrs of work in a day is my sweet spot. Enough work to have fun and be semi busy but not pulling my hair out but easily enough time to workout and relax
 
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This is one I'm interested in getting feedback on.
Academic position, I actually opted for a lower salary + RVUs to spend 50% of my time on a teaching service than spending all my time at a state hospital.
245k base.
30k start bonus + 3k/mo last year of residency for 3 year commitment.
50% of my time will not generate RVUs at a state hospital.
50% of my time will, 19 bed unit resident teams, may have to split with another attending. RVU target of 2327.
Weeknight call q7 weeks, residents in house calling to dc from ED or with major concerns.
Weekend call also q7, rounding on unit pays 2k/weekend.
Holidays off. 26 vacation days.
Benefits are great. Includes own occupation disability insurance, dirt cheap health insurance, free dental, retirement match is doubles, so we put in 5 and they put in 10.

I know salary isn't great but it's an academic position. If I gave up the resident teaching side it would go to 290k no RVUs.
I also like the people I'd be working with.

Am I insane for wanting to sign this?
 
This is one I'm interested in getting feedback on.
Academic position, I actually opted for a lower salary + RVUs to spend 50% of my time on a teaching service than spending all my time at a state hospital.
245k base.
30k start bonus + 3k/mo last year of residency for 3 year commitment.
50% of my time will not generate RVUs at a state hospital.
50% of my time will, 19 bed unit resident teams, may have to split with another attending. RVU target of 2327.
Weeknight call q7 weeks, residents in house calling to dc from ED or with major concerns.
Weekend call also q7, rounding on unit pays 2k/weekend.
Holidays off. 26 vacation days.
Benefits are great. Includes own occupation disability insurance, dirt cheap health insurance, free dental, retirement match is doubles, so we put in 5 and they put in 10.

I know salary isn't great but it's an academic position. If I gave up the resident teaching side it would go to 290k no RVUs.
I also like the people I'd be working with.

Am I insane for wanting to sign this?
Not insane no. The RVU target is high if you are splitting the unit and going every other week (obviously that's 4654 RVUs for full time). Unless you are able to bill psychotherapy add-on codes with the inpatient codes. Conversely, 19 beds is a lot for one attending even with multiple residents, I cannot imagine any academic center I know that would staff in that manner except if someone was sick/on vacation.

I'd much rather make 290k no RVU bonus with the above setup, that's actually very good academic/state hospital pay when you figure in another 20k year from the start/last year bonus and another 12k from weekends plus a 10% match.

If you want the RVU model the biggest thing would be seeing how many RVUs are actually generated by the current staff, what the bonus is above the target and how realistic it is to get there. If they gave you the no RVU pay and 50/50 state/academic unit, I would just sign that thang ASAP (baring reasonable non-competes and termination clauses etc).
 
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Not insane no. The RVU target is high if you are splitting the unit and going every other week (obviously that's 4654 RVUs for full time). Unless you are able to bill psychotherapy add-on codes with the inpatient codes. Conversely, 19 beds is a lot for one attending even with multiple residents, I cannot imagine any academic center I know that would staff in that manner except if someone was sick/on vacation.

I'd much rather make 290k no RVU bonus with the above setup, that's actually very good academic/state hospital pay when you figure in another 20k year from the start/last year bonus and another 12k from weekends plus a 10% match.

If you want the RVU model the biggest thing would be seeing how many RVUs are actually generated by the current staff, what the bonus is above the target and how realistic it is to get there. If they gave you the no RVU pay and 50/50 state/academic unit, I would just sign that thang ASAP (baring reasonable non-competes and termination clauses etc).
I wish I could do the split job for 290k straight, but working in the academic unit automatically puts me in the RVU group. The RVU target did seem on the higher end from the quick math I was doing but it is consistent with the current attending's full time target but he is within his first year so doesn't have a clear picture of the RVUs.
Non compete and termination clauses are pretty boiler plate.
 
I wish I could do the split job for 290k straight, but working in the academic unit automatically puts me in the RVU group. The RVU target did seem on the higher end from the quick math I was doing but it is consistent with the current attending's full time target but he is within his first year so doesn't have a clear picture of the RVUs.
Non compete and termination clauses are pretty boiler plate.
Is there a cap on the 401k match amount?

290k is not bad depending on total value of other compensation (hence the question about match cap.)
 
Sounds like a decent job. Kind of mixing together two jobs and meeting somewhere in the middle.

Im just wondering about the rvu target. What happens if you dont hit it? are there others doing the gig currently who are hitting this target? What if the target is exceeded, is there additional bonus - and at what rate?

Also, is the call 24 hours, or is there a night system in place.

Given the noncompete… how easy is it for you to get those weekend shifts? are people nipping at the bit for them, or can you essentially work as many as you want.

Also, depending on your situation, I would rather not have a sign on bonus than to give a 3 yr committment. with a noncompete, it is risky to not have an exit available. 3 yrs is a long time. you’d essentially get 64k for 3 yr hand cuffs. Better to have 30 k for 2 years, or 15k for 1 yr with a relocation allowance or something. Maybe you know more about this place from word of mouth and are comfortable, but definitely talk to people working there or those that recently left.
 
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Sounds like a decent job. Kind of mixing together two jobs and meeting somewhere in the middle.

Im just wondering about the rvu target. What happens if you dont hit it? are there others doing the gig currently who are hitting this target? What if the target is exceeded, is there additional bonus - and at what rate?

Also, is the call 24 hours, or is there a night system in place.

Given the noncompete… how easy is it for you to get those weekend shifts? are people nipping at the bit for them, or can you essentially work as many as you want.

Also, depending on your situation, I would rather not have a sign on bonus than to give a 3 yr committment. with a noncompete, it is risky to not have an exit available. 3 yrs is a long time. you’d essentially get 64k for 3 yr hand cuffs. Better to have 30 k for 2 years, or 15k for 1 yr with a relocation allowance or something. Maybe you know more about this place from word of mouth and are comfortable, but definitely talk to people working there or those that recently left.
Just spoke with a current attending, they’re full time with a 5600 target, covering 8-12 patients and said they reached it no issue.
No concern with the weekend shifts. From what I’m getting fairly easy to get at least 6-7 a year and more if you want it. There’s also moonlighting at the state hospital we can do if we want in admissions at the state hospital, none of the current attendings do it and leave it to the residents.
The weeks of call are nights.
 
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Im starting to get more boots on the ground interviews with people in town. I've done a lot of build up networking and casual conversations with people over PGY2-3. Now I'll be talking with actual employers and getting more firm proposals starting this month (several scheduled).

Wish me luck.

Mid-long term I'm planning to do some of these gigs while building a practice on the side. I will be firm about noncompetes. I like to work and will plan to do several gigs. I don't want to give up my ability to moonlight where I want. There is something deeply satisfying to me to go in for a shift, and walk out knowing I got a check for it. An adrenaline bolus that I just don't get from my salary checks.
 
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Thoughts about this offer that one of my colleagues has?
OP. Pay per CPT, not collections. NP supervision is paid (guaranteed monthly), + a cut of their billing. 2 minimum NP to supervise, and they can supervise more if wanted. No call; someone is taking all calls after hours, even in case of an emergency. 30-35 clinical hours.
Can do 20min-30min follow-ups.
Numbers- mid 300s guaranteed the first year, then you depend on the number of pts you see.
Standard PTO and CME getting to 6 weeks off in total.
You can make 250ish per hour assuming you see 2-3 pts (99214 +/- 98032)

Thoughts?
 
Thoughts about this offer that one of my colleagues has?
OP. Pay per CPT, not collections. NP supervision is paid (guaranteed monthly), + a cut of their billing. 2 minimum NP to supervise, and they can supervise more if wanted. No call; someone is taking all calls after hours, even in case of an emergency. 30-35 clinical hours.
Can do 20min-30min follow-ups.
Numbers- mid 300s guaranteed the first year, then you depend on the number of pts you see.
Standard PTO and CME getting to 6 weeks off in total.
You can make 250ish per hour assuming you see 2-3 pts (99214 +/- 98032)

Thoughts?
I think you need to be more granular in the dissection of what the offer is. This is a common mistake I see among doctors (usually younger) where they just look at projected overall comp and leave it at that.

How much is paid for NP supervision, how much of their billing do you get? Can you force a change in supervisor if you do not agree with the practice of the NP?
How much per 99213, 99214 and 99215. How much per 90832. Initial evals matter very limitedly if your first year is guaranteed but would be good to know as well.
Can you control who you see? Can you fire patients? Can you decline patients based on their psychopathology and your areas of expertise (or lack thereof), or abilities of the clinic? Do you have support staff to assist with refills, prior auths, vitals/utox for pts, etc.

I would generally say a practice that has >2 NPs per MD is focusing heavily on the bottom line and certainly has some reasons to be weary but I would also want to know the numbers and then run what it pays, if you want a high paying OP job with no call without running your own practice then it might be a fit.
 
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Thoughts about this offer that one of my colleagues has?
OP. Pay per CPT, not collections. NP supervision is paid (guaranteed monthly), + a cut of their billing. 2 minimum NP to supervise, and they can supervise more if wanted. No call; someone is taking all calls after hours, even in case of an emergency. 30-35 clinical hours.
Can do 20min-30min follow-ups.
Numbers- mid 300s guaranteed the first year, then you depend on the number of pts you see.
Standard PTO and CME getting to 6 weeks off in total.
You can make 250ish per hour assuming you see 2-3 pts (99214 +/- 98032)

Thoughts?

Lol is this a Lifestance job? Cause it sounds like a Lifestance job, especially with the 1 year guarantee in that salary range and the pay based on billing vs collections.

Yeah you need a lot more detail, Merovinge hit a lot of that up top already, this has way too little detail to give an opinion on it. There are plenty of jobs out there like this or similar to it in terms of pay structure if someone's looking for a straight collections based job.
 
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Not Lifestance. I would say you have some control and can fire pts when appropriate. Full support staff dealing with all stuff. You take your vitals but there is an assistant to deal with utox and other stuff (PAs, screening calls etc.).
99214 is 80s. New evals is 150s.
I think the NP piece is something that needs more details but I think it is in the realm of mid-high 20s per NP.
 
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