1099 part-time TMS job

[hypnorpheus]

Hello!

I have been speaking with a TMS clinic for some 1099 contract work. They have offered to pay $800/patient - it's a one time fee for my services for the patient's full TMS treatment course, which will include:

- initial eval+mapping by me (they are saying it would, at most, take a combined total of 90 mins for both - Brainsway machine)

- follow-up visit with me at around treatment #20 for SOME patients (those who are doing fine will see midlevels and not me), and

- further visits for any complicated issues that may arise such as remapping, change in protocol etc. (They say this does not happen frequently)

It seems that if everything were to go well in the treatment course, it would be a nice deal - I will essentially be seeing the patient once for an initial eval and mapping.

However, if there were any issues or complexities, there may need to be more visits - at least 1 additional for follow-up, perhaps 1-2 more for remapping or change in protocol.

What are your thoughts about this offer? Is this a fair offer? I am just out of training, so I am not too sure what to think about the numbers. I would really appreciate your insights!

P.S. this is in a large Midwest metropolitan city and I will be covering 2 city locations for 3-5 days a month (at least for the evals, mapping and follow-ups).

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[Candidate2017]

So, if "all goes well," you will spend 2 hours per patient = $400/hour. But how often does all go well in psychiatry? I assume these are treatment resistant patients because they are doing TMS? What about time spent on collateral or communicating with their primary psychiatrist? The midlevels seeing your "simple" patients, are you responsible for supervising?

I know nothing of the TMS market, but I do know the termination clause in your contract is of utmost importance. The notice required for termination should be as short as possible so you can terminate and renegotiate if $800 ends up being a raw deal. And what are the medicolegal requirements to avoid abandonment for your TMS patients? Is it abandonment if you leave after 2 TMS sessions?

Personally, for a bundled all-inclusive rate, I would cap the number of visits per patient, so that the hourly rate is at least equivalent to what other psychiatrists are getting.

 

[comp1]

This seems like too complex of a position to take right out of training, to be honest. If you are going for it, concur with above that you need an extraordinarily short agreed upon separation notice clause as I could see this going upside down pretty fast. Or...less likely, it could go great. You didn't give us the state, so we can't check if the NPs have independent practice authority. That would be a huge important thing. You want zero responsibility for their work built into the contract, ideally.

 

[Stagg737]

I'm not well-versed in the actual TMS office procedure, but is it normal to see a patient for the initial and then not have a physician involved during each session? What happens if a patient has an adverse reaction during a session? Who gets called? If it's an NP for these sessions, are you supervising as questioned above?

Maybe I'm just ignorant but this seems like a lot of gray area and risk. As in you're being paid to do fairly little work but shoulder the liability if things go south.

 

[calvnandhobbs68]

- initial eval+mapping by me (they are saying it would, at most, take a combined total of 90 mins for both - Brainsway machine)

- follow-up visit with me at around treatment #20 for SOME patients (those who are doing fine will see midlevels and not me), and

- further visits for any complicated issues that may arise such as remapping, change in protocol etc. (They say this does not happen frequently)

It seems that if everything were to go well in the treatment course, it would be a nice deal - I will essentially be seeing the patient once for an initial eval and mapping.

However, if there were any issues or complexities, there may need to be more visits - at least 1 additional for follow-up, perhaps 1-2 more for remapping or change in protocol.

Bud I think the first thing to ask is, how much TMS have you actually done? Like, shouldn't you know how frequently remapping or changes in treatment protocol typically happen if you've been doing it enough to do it independently or how much you need to be involved if "everything were to go well in the treatment course"?

I would hope that if you were trying to do TMS straight out of residency you'd have been doing a TMS elective for the last year or something so you'd already know the answer to all this. Otherwise, you probably need to get some more training.

 

[hypnorpheus]

This seems like too complex of a position to take right out of training, to be honest. If you are going for it, concur with above that you need an extraordinarily short agreed upon separation notice clause as I could see this going upside down pretty fast. Or...less likely, it could go great. You didn't give us the state, so we can't check if the NPs have independent practice authority. That would be a huge important thing. You want zero responsibility for their work built into the contract, ideally.

Thank you for your input. Agreed about figuring out the NP supervision part.

 

[hypnorpheus]

Bud I think the first thing to ask is, how much TMS have you actually done? Like, shouldn't you know how frequently remapping or changes in treatment protocol typically happen if you've been doing it enough to do it independently or how much you need to be involved if "everything were to go well in the treatment course"?

I would hope that if you were trying to do TMS straight out of residency you'd have been doing a TMS elective for the last year or something so you'd already know the answer to all this. Otherwise, you probably need to get some more training.

Thanks making some good points. I did do a couple of TMS electives and in my limited experience most folks did not need a remapping. Most folks did not experience any major side-effects. But this was a snapshot in time during half-a-day per week rotations and I agree I will need more training. There are other psychiatrists in the same practice who have been doing this for years and I was hoping to learn from them while on the job.

 

[clozareal]

I considered a position like this but declined them even when they offered me $25/session and $300 for each initial eval and $200 for each remapping, which comes out to about $1200-1400 per patient. I would come out ahead if I got my own device and it would break even after a year or two if I had >1 patient per chair for the whole year.

Here's the breakdown if you got paid by productivity:

90867 Transcranial Magnetic Stimulation; Initial. 1 session at $250
90868 Transcranial Magnetic Stimulation; Subsequent. 36 sessions at $250 (USA average, Medicare is $150/session) = $9,000
90869 Transcranial Magnetic Stimulation; Re-determination. 1 session at $300

Total = $9,550

Your portion $800/$9,550 = 8% per patient.

I would try to negotiate for more if I were you and you really wanted to do this. The clinic that tried to 1099 me initially promised me more but then came back with a much lower offer, then was unwilling to negotiate.