Can we make a sticky for job critiques?

[surfguy84]

I feel like I have a job almost every week now that I am approaching the second half of PGY4 that I would love everyone's feedback on. I don't want to clog the forums with a new thread for every job. Just wondering if a stick could be created or if there's a better way to do this?

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[TexasPhysician]

There are a lot of jobs out there, and it doesn’t make sense to debate them all. It would probably make some good sense to narrow the list down to your top few and then discuss them. Everything is negotiable, so starting at a bunch of jobs doesn’t make sense for you or us to comment on.

 

[forchinet121]

There are a lot of jobs out there, and it doesn’t make sense to debate them all. It would probably make some good sense to narrow the list down to your top few and then discuss them. Everything is negotiable, so starting at a bunch of jobs doesn’t make sense for you or us to comment on.

I think a sticky would make a lot of sense, having a sticky would allow people in 5 years to come back and review all the hundreds of jobs posted and all the different permutations of ways employers try to screw us

 

[surfguy84]

Well just to throw a job I am considering out there..

Emergency psychiatry unit at a county facility. 1099. 8 hour shifts which can be stacked. 230/hour for 8am-12am, 12am-8am shift pays 255/hr. volume is 8-12 patients per shift. To me this feels not bad considering the academics at my hospital are working for about half of this in the ER.

 

[Stagg737]

Well just to throw a job I am considering out there..

Emergency psychiatry unit at a county facility. 1099. 8 hour shifts which can be stacked. 230/hour for 8am-12am, 12am-8am shift pays 255/hr. volume is 8-12 patients per shift. To me this feels not bad considering the academics at my hospital are working for about half of this in the ER.

At 40 hrs/wk for 46 weeks per year that's $423k/yr if you work only the 230/hr shifts. Not bad hours, but 8-12 patients per shift is a lot, so you'll definitely be earning that money.

 

[TexasPhysician]

At 40 hrs/wk for 46 weeks per year that's $423k/yr if you work only the 230/hr shifts. Not bad hours, but 8-12 patients per shift is a lot, so you'll definitely be earning that money.

This would be a busy outpatient job, but for ER you don’t necessarily need to be as detailed. It isn’t like you need to do the most thorough eval here. The frequency of THC use, type of anxiety, adhd, etc is not important. This is probably an admit or not admit type of thing.

 

[Merovinge]

This would be a busy outpatient job, but for ER you don’t necessarily need to be as detailed. It isn’t like you need to do the most thorough eval here. The frequency of THC use, type of anxiety, adhd, etc is not important. This is probably an admit or not admit type of thing.

No but you are deciding to hold people against their will, needing collateral for that in many cases, and seeing people on the worst day of their lives. Liability and death threats aside, ED psychiatry is no joke. I remember being completely drained after seeing 10-12 cases a shift in residency, and while I am a bit more knowledgable and efficient now, this is certainly earning one's paycheck.

 

[ObsequiousAplomb]

This would be a busy outpatient job, but for ER you don’t necessarily need to be as detailed. It isn’t like you need to do the most thorough eval here. The frequency of THC use, type of anxiety, adhd, etc is not important. This is probably an admit or not admit type of thing.

Agreed.

Some psych ER evals can be dispositions. If other people are doing the legwork for collateral, records are readily accessible, and the workflow is good, 8-12 in a shift is nothing.

If you don't have much in terms of SW support, have an unhelpful records system, have to get all your collateral, have less clear dispositions, and the workflow sucks, you might be busy most of that shift.

Depending on the setup of the facility this could be a relatively easy gig with good pay all the way up to a mildly challenging gig with good pay.

 

[psych_0]

At 40 hrs/wk for 46 weeks per year that's $423k/yr if you work only the 230/hr shifts. Not bad hours, but 8-12 patients per shift is a lot, so you'll definitely be earning that money.

I'm sorry 8-12 patients spread out over that time period is not a lot. I cover the ER from time to time and most of the time it is:
- 30-40% frequent flyer (homeless, hungry, cold/hot outside, etc). These encounters take <10 min if that (including your note).
- 20-30% repeat admission to some degree (whether they've been admitted in last 3 months or last 3 years, we've seen them before)
- 40% brand new admission, a lot of which are meth related or ETOH related. Maybe 10% of these are head scratchers where you have no idea what is going on and are likely just going to admit anyway to be safe and see how things shake out over time.

In my opinion, the role of ER psych is admit vs not admit & "should this person go to psych or medicine service." Gathering collateral is the responsibility of the inpatient team or mental health screener, especially if OP is working the night shift. I'm not calling collateral at 3am to decide whether to admit a drunkisuicidal patient or the agitated patient who refuses to answer questions about why the police wrote "threatening to stab themselves with a knife" on their involuntary form. They're getting admitted and it will be sorted out by the inpatient team.

OP, in my opinion this sounds like an easy job, especially for $420k+ a year. Good luck finding a 420k/year outpatient job that isn't grinding you to the bone with 15 min follow-ups.

 

[annoyedpsychiatrist]

ER Psych...CIWA, PRN B52 for agitation, collateral solves most of the issues..where I agree, there is that 10% where you just have no idea what is causing what. Getting people dispoed out of the ER is the not so fun part, depending on your resources

 

[G Sheb]

Well just to throw a job I am considering out there..

Emergency psychiatry unit at a county facility. 1099. 8 hour shifts which can be stacked. 230/hour for 8am-12am, 12am-8am shift pays 255/hr. volume is 8-12 patients per shift. To me this feels not bad considering the academics at my hospital are working for about half of this in the ER.

Pay seems good. 8/12 patients in 8 hours is busy definitely.
The devil is in the detail though.
Is anyone helping you with collateral, writing notes?
What is the staffing like at that ER? Do you have enough security? is it a safe environment?
Psych ER can be very draining full time, so know what you're getting into.

 

[Merovinge]

Well just to throw a job I am considering out there..

Emergency psychiatry unit at a county facility. 1099. 8 hour shifts which can be stacked. 230/hour for 8am-12am, 12am-8am shift pays 255/hr. volume is 8-12 patients per shift. To me this feels not bad considering the academics at my hospital are working for about half of this in the ER.

The real plus of this job is that there is zero ramp up and zero patient abandonment when you leave (not just the job itself, I mean leave your shift). You can work the job for 3 months or 3 years and it is what it is. When you sign out, you don't ever have to deal with an emergency. If you are a young attending that doesn't have family commitments, I think it would be a great place to work for a bit and if you happen to like it you can make a career out of emergency psych. You can even over stack a week and then take long weekends, or over stack a few weeks and take a vacation while still making great money.

 

[G Sheb]

I'm sorry 8-12 patients spread out over that time period is not a lot. I cover the ER from time to time and most of the time it is:
- 30-40% frequent flyer (homeless, hungry, cold/hot outside, etc). These encounters take <10 min if that (including your note).
- 20-30% repeat admission to some degree (whether they've been admitted in last 3 months or last 3 years, we've seen them before)
- 40% brand new admission, a lot of which are meth related or ETOH related. Maybe 10% of these are head scratchers where you have no idea what is going on and are likely just going to admit anyway to be safe and see how things shake out over time.

In my opinion, the role of ER psych is admit vs not admit & "should this person go to psych or medicine service." Gathering collateral is the responsibility of the inpatient team or mental health screener, especially if OP is working the night shift. I'm not calling collateral at 3am to decide whether to admit a drunkisuicidal patient or the agitated patient who refuses to answer questions about why the police wrote "threatening to stab themselves with a knife" on their involuntary form. They're getting admitted and it will be sorted out by the inpatient team.

OP, in my opinion this sounds like an easy job, especially for $420k+ a year. Good luck finding a 420k/year outpatient job that isn't grinding you to the bone with 15 min follow-ups.

Do you admit intoxicated people who say stupid s***?
We've had that debate a while ago. Standards of care apparently vary enormously from place to place in the States. I don't think this would fly in a dedicated psych ER. Would never happen where I am.
I think collateral is imperative for good care. Almost all the mistakes that I've seen in the ER happen either because collateral was not taken or the psychiatrist overvalue their 10 minute evaluation in comparison to a concerning collateral. Especially for discharges.

 

[TexasPhysician]

Do you admit intoxicated people who say stupid s***?
We've had that debate a while ago. Standards of care apparently vary enormously from place to place in the States. I don't think this would fly in a dedicated psych ER. Would never happen where I am.
I think collateral is imperative for good care. Almost all the mistakes that I've seen in the ER happen either because collateral was not taken or the psychiatrist overvalue their 10 minute evaluation in comparison to a concerning collateral. Especially for discharges.

Maybe different populations, but I find collateral with adults useless 99% of the time. That 1% is amazingly helpful though. The 99% have a horse in the race or are just uneducated on the issue. It’s like getting ADHD rating scales from teachers. It’s nice to know you are headed in the right direction, but diagnostically worthless.

The misses around me are from a lack of doing a thorough eval, too little time, or just not good at their job.

 

[BiscoDisco]

Ive got another emergency psych job. 10 or 12 hour shifts available. 175/hr + 35 per consult for daytime shift, 200/hr + 35 for nighttime. ED and some C/L consults. Tele. 1-1.5 consults per hour.

 

[forchinet121]

Ive got another emergency psych job. 10 or 12 hour shifts available. 175/hr + 35 per consult for daytime shift, 200/hr + 35 for nighttime. ED and some C/L consults. Tele. 1-1.5 consults per hour.

How can anyone tell you how many consults to do per hour?

 

[psych_0]

Ive got another emergency psych job. 10 or 12 hour shifts available. 175/hr + 35 per consult for daytime shift, 200/hr + 35 for nighttime. ED and some C/L consults. Tele. 1-1.5 consults per hour.

$35/consult? Lol. No. Is this a troll post? Even if you did 4 consults in an hour, which is doable for sure (though people on this forum would say you're a ****ty doctor), is your time really only worth $140/hour? Come on...

 

[Psychdoc29]

I think he meant $200 per hour for just showing up, and additional $35 for each consult.

 

[psych_0]

Do you admit intoxicated people who say stupid s***?
We've had that debate a while ago. Standards of care apparently vary enormously from place to place in the States. I don't think this would fly in a dedicated psych ER. Would never happen where I am.
I think collateral is imperative for good care. Almost all the mistakes that I've seen in the ER happen either because collateral was not taken or the psychiatrist overvalue their 10 minute evaluation in comparison to a concerning collateral. Especially for discharges.

Oh course you admit people who say dumb ****. Does your hospital allow patients to stay down in the ER 8 hours until they're not drunk and can give you a coherent story? Mine does not and I imagine most don't. What about the psychotic patient the police brought in high on meth thinking the cartel is after them? Your hospital allow you to just give them agitation meds and let them sober up all night holding up a bed in the ER with the hopes they'll wake up coherent and not psychotic on meth? No.

My point is that these make up a lot of the ER psych patients. Should they be admitted? Probably not. But the alternative isn't viable either. So instead you admit them overnight, keep them in a safe place to sober up without overcrowding the ER and taking up beds for real emergencies. Then if their story checks out, the inpatient team discharges them the next day. Maybe I'm completely out of touch but this seems like common sense to me...

To your last part, collateral can be important but if no one answers the phone when my screeners call and I don't have any additional info to go on, they're getting admitted.

 

[psych_0]

I think he meant $200 per hour for just showing up, and additional $35 for each consult.

If that's the case I'd 100% take on that job, if ER shift work is what you want of course. If it is a busier ER, even better. If it is a slow ER, that may still be low compared to what you could make doing inpatient only (in a salary + wRVU bonus type structure).

 

[Stagg737]

This would be a busy outpatient job, but for ER you don’t necessarily need to be as detailed. It isn’t like you need to do the most thorough eval here. The frequency of THC use, type of anxiety, adhd, etc is not important. This is probably an admit or not admit type of thing.

Maybe different populations, but I find collateral with adults useless 99% of the time. That 1% is amazingly helpful though. The 99% have a horse in the race or are just uneducated on the issue. It’s like getting ADHD rating scales from teachers. It’s nice to know you are headed in the right direction, but diagnostically worthless.

The misses around me are from a lack of doing a thorough eval, too little time, or just not good at their job.

I'm sorry 8-12 patients spread out over that time period is not a lot. I cover the ER from time to time and most of the time it is:
- 30-40% frequent flyer (homeless, hungry, cold/hot outside, etc). These encounters take <10 min if that (including your note).
- 20-30% repeat admission to some degree (whether they've been admitted in last 3 months or last 3 years, we've seen them before)
- 40% brand new admission, a lot of which are meth related or ETOH related. Maybe 10% of these are head scratchers where you have no idea what is going on and are likely just going to admit anyway to be safe and see how things shake out over time.

In my opinion, the role of ER psych is admit vs not admit & "should this person go to psych or medicine service." Gathering collateral is the responsibility of the inpatient team or mental health screener, especially if OP is working the night shift. I'm not calling collateral at 3am to decide whether to admit a drunkisuicidal patient or the agitated patient who refuses to answer questions about why the police wrote "threatening to stab themselves with a knife" on their involuntary form. They're getting admitted and it will be sorted out by the inpatient team.

OP, in my opinion this sounds like an easy job, especially for $420k+ a year. Good luck finding a 420k/year outpatient job that isn't grinding you to the bone with 15 min follow-ups.

My current position is primarily ER psych. On average, I probably see a new patient every 1.5-2 hours, it's also very common to need to check in on patients who have been sitting in our ER for 2-3 days because either beds aren't available or no one will accept them. It's not uncommon for me to see 3-4 follow-up patients in the ER per day. If those are included in the 8-12 per hour, then that actually makes things easier. If not, then it could be pretty miserable, especially if support staff and resources suck as those are the patients that are usually more time-intensive for dispo. ER is also going to have higher liability potential and notes can take time to write if you're actually going to document well and CYA. Writing 8-12 notes that meet criteria to bill decently and would stand up in court takes time.

Sure, assuming resources are good, beds are available, and patients can be moved easily 8-12/hr may be very manageable, especially the 8/hr. I'd suspect that if things were that straightforward this place would not be looking to hire a psychiatrist at a minimum of $230/hr. They'd just hire a SW or NP at 1/2 to 1/5 the price or include the responsibility as part of another psychiatrist's duties. What happens when your dispo is that a patient requires inpatient psych but nobody will accept them? You really think dropping a consult note and saying "good luck" is going to be all that's expected? What happens when patients have to go involuntary and can't be transferred because no one will accept them? Are the ER docs going to be doing all the management and not calling you? Doubtful.

I think the percent breakdown for patients is fair. I'd say collateral is necessary more than 1% of the time, probably closer to 10-20% of the time, though that collateral often comes in as a police report or others who are present. The collateral is typically necessary when you're deciding whether someone needs involuntary admission, which happens quite frequently where I'm at.

 

[forchinet121]

My current position is primarily ER psych. On average, I probably see a new patient every 1.5-2 hours, it's also very common to need to check in on patients who have been sitting in our ER for 2-3 days because either beds aren't available or no one will accept them. It's not uncommon for me to see 3-4 follow-up patients in the ER per day. If those are included in the 8-12 per hour, then that actually makes things easier. If not, then it could be pretty miserable, especially if support staff and resources suck as those are the patients that are usually more time-intensive for dispo. ER is also going to have higher liability potential and notes can take time to write if you're actually going to document well and CYA. Writing 8-12 notes that meet criteria to bill decently and would stand up in court takes time.

Sure, assuming resources are good, beds are available, and patients can be moved easily 8-12/hr may be very manageable, especially the 8/hr. I'd suspect that if things were that straightforward this place would not be looking to hire a psychiatrist at a minimum of $230/hr. They'd just hire a SW or NP at 1/2 to 1/5 the price or include the responsibility as part of another psychiatrist's duties. What happens when your dispo is that a patient requires inpatient psych but nobody will accept them? You really think dropping a consult note and saying "good luck" is going to be all that's expected? What happens when patients have to go involuntary and can't be transferred because no one will accept them? Are the ER docs going to be doing all the management and not calling you? Doubtful.

I think the percent breakdown for patients is fair. I'd say collateral is necessary more than 1% of the time, probably closer to 10-20% of the time, though that collateral often comes in as a police report or others who are present. The collateral is typically necessary when you're deciding whether someone needs involuntary admission, which happens quite frequently where I'm at.

If a patient needs psych inpatient and there’s no beds, what do you expect the psychiatrist to do?

 

[surfguy84]

My current position is primarily ER psych. On average, I probably see a new patient every 1.5-2 hours, it's also very common to need to check in on patients who have been sitting in our ER for 2-3 days because either beds aren't available or no one will accept them. It's not uncommon for me to see 3-4 follow-up patients in the ER per day. If those are included in the 8-12 per hour, then that actually makes things easier. If not, then it could be pretty miserable, especially if support staff and resources suck as those are the patients that are usually more time-intensive for dispo. ER is also going to have higher liability potential and notes can take time to write if you're actually going to document well and CYA. Writing 8-12 notes that meet criteria to bill decently and would stand up in court takes time.

Sure, assuming resources are good, beds are available, and patients can be moved easily 8-12/hr may be very manageable, especially the 8/hr. I'd suspect that if things were that straightforward this place would not be looking to hire a psychiatrist at a minimum of $230/hr. They'd just hire a SW or NP at 1/2 to 1/5 the price or include the responsibility as part of another psychiatrist's duties. What happens when your dispo is that a patient requires inpatient psych but nobody will accept them? You really think dropping a consult note and saying "good luck" is going to be all that's expected? What happens when patients have to go involuntary and can't be transferred because no one will accept them? Are the ER docs going to be doing all the management and not calling you? Doubtful.

I think the percent breakdown for patients is fair. I'd say collateral is necessary more than 1% of the time, probably closer to 10-20% of the time, though that collateral often comes in as a police report or others who are present. The collateral is typically necessary when you're deciding whether someone needs involuntary admission, which happens quite frequently where I'm at.

This is a county job fwiw.

 

[Stagg737]

Ive got another emergency psych job. 10 or 12 hour shifts available. 175/hr + 35 per consult for daytime shift, 200/hr + 35 for nighttime. ED and some C/L consults. Tele. 1-1.5 consults per hour.

If this is also 1099 the other position sounds better. If you see 1 person per hour here then it's basically $210/hr and $235/hr. If W2 with benefits, sounds great. Again, depends on what resources are available and what the expectations are. As G Sheb pointed out, there are going to be varying expectations from hospital to hospital.

If a patient needs psych inpatient and there’s no beds, what do you expect the psychiatrist to do?

Make medication recommendations, reassess to see if inpatient is still necessary or if patient can leave if demanding, etc. ER psych is an extension of triage and purgatory for patients awaiting inpatient admission. There's no reason to make them sit there (potentially for days) without starting treatment, just like you're not going to delay treatment to a medical patient in the ER requiring admission while they're waiting for a bed to be available.

 

[psychmd03]

I am honestly genuinely curious about what people also consider "good" jobs. Every job it seems that gets dropped in the forum has a mass of pepole come in and say oh no pay is too low, too many patients, etc etc. Good inpatient jobs seem to max at 10 patient cap and are expecting over 350 based on a lot of the posts I have seen. OP is more variable but I am curious how many of these great jobs are out there since they are rarely if ever posted about and where in the country are they? Are they in the sticks in the SE or MidWest? Are these major metropolitan jobs?

I think the idea of a sticky for job critiques or just posting jobs with salaries/income, perks is a great idea. Doctors have very little idea of what they are worth especially coming out of residency and a large thread with details (also including the location of the country and if it is a big city or not) would be a very helpful resource.

 

[hamstergang]

Oh course you admit people who say dumb ****. Does your hospital allow patients to stay down in the ER 8 hours until they're not drunk and can give you a coherent story? Mine does not and I imagine most don't.

I actually have seen it more common to make patients stay in the ED to sober up than to admit them. The patients aren't even seen by the SW until their BAL is calculated to have fallen to 100 or less.

 

[surfguy84]

I actually have seen it more common to make patients stay in the ED to sober up than to admit them. The patients aren't even seen by the SW until their BAL is calculated to have fallen to 100 or less.

MTF = metabolize to freedom

This is a very common thing in our level one trauma center

 

[annoyedpsychiatrist]

back in residency they used to call psych when their BAL was well over 300 then they realized it only made things worse for them because if theyre drunk and throwing out that they're SI, it likely makes their ER stay much more longer rather than just letting them metabolize, have them admit they said stupid things while drunk and having a family member come pick them up

 

[psych_0]

I am honestly genuinely curious about what people also consider "good" jobs. Every job it seems that gets dropped in the forum has a mass of pepole come in and say oh no pay is too low, too many patients, etc etc. Good inpatient jobs seem to max at 10 patient cap and are expecting over 350 based on a lot of the posts I have seen. OP is more variable but I am curious how many of these great jobs are out there since they are rarely if ever posted about and where in the country are they? Are they in the sticks in the SE or MidWest? Are these major metropolitan jobs?

I think the idea of a sticky for job critiques or just posting jobs with salaries/income, perks is a great idea. Doctors have very little idea of what they are worth especially coming out of residency and a large thread with details (also including the location of the country and if it is a big city or not) would be a very helpful resource.

You're not going to get a good answer here. Only anecdotes and opinions.

Here are mine based on job interviews and keeping up with friends from residency:

- Inpatient (salary + wRVU bonus):

- If 10-12 patients/day with normal 48-72hr length of stay = ~350k total compensation​

- If 12-15 patients/day with normal 48-72hr length of stay = 400-450k​

- If 20-30 patients/day, I have several inpatient friends making 500-550k+​

- Add on ECT averaging 5 pts/day, 3 days/week, 47 weeks/year and that's an extra ~1760 wRVU which should equate to an extra $100k/year​

​

Fresh out of residency the jobs I've actually seen + heard about from friends start $270-300k base + wRVU bonus. The target wRVU is around 4300-5000/year depending on how you negotiate and how desperate they are. The multiplier for wRVU after your target is hit ranges around $50-65/wRVU. You can work out the math from here. Sign on bonuses I have seen/heard of range from $10-30,000. Vacation ranges from 2 weeks to 5 weeks + 5 extra days of CME. Reimbursement for CME ranges $1000-5000/year and most places won't let you spend it on electronics (though I imagine you could negotiate for that if you're looking at a full-tele job).

I would avoid the places that try to convince you to get paid per patient or the ones that offer things like "we'll pay you $42 per patient if you see more than 12 a day." You're getting ripped off and they'll soon have you seeing way more than you wanted to see. I personally would never take an inpatient job without an wRVU bonus structure, because if you have extra patients to see you still get paid the same. With wRVU bonus in mind, you will likely not care how many extra patients you have to see here and there because you know you'll be getting paid well for extra work.

Disclosure:
- I know nothing about outpatient jobs, jail/prison jobs, IOP/PHP jobs, pay differences between adults/child units or state hospital jobs (though I did moonlight in residency for like $2300/day seeing 24-28 pts total over a weekend).
- I'm very biased towards inpatient work because I value free time and afternoon naps.

 

[whopper]

No matter what you do, you do one area of psychiatry you can get mentally locked into that mode and not in a good way.

E.g. you do emergency psychiatry you forget how to do long-term psychiatry, you do long-term you forget how to do emergency psychiatry, you do only forensic psychiatry you forget how to do clinical.

For this reason, while in academia, I sometimes switched what I did every few months with another doctor to keep things fresh. After about 2-3 years of it it got to the point where it really filled in any not-then-noticeable voids. I only got out of this when I entered private practice. Now that I'm in PP I'm happily locked in. Took too long to invest time into this thing and it's doing too well for me to want to leave, but the learning curves I had in academia were well worth it.

 

[BiscoDisco]

No matter what you do, you do one area of psychiatry you can get mentally locked into that mode and not in a good way.

E.g. you do emergency psychiatry you forget how to do long-term psychiatry, you do long-term you forget how to do emergency psychiatry, you do only forensic psychiatry you forget how to do clinical.

For this reason, while in academia, I sometimes switched what I did every few months with another doctor to keep things fresh. After about 2-3 years of it it got to the point where it really filled in any not-then-noticeable voids. I only got out of this when I entered private practice. Now that I'm in PP I'm happily locked in. Took too long to invest time into this thing and it's doing too well for me to want to leave, but the learning curves I had in academia were well worth it.

Definitely - this is why I want to do inpatient or ER + outpatient pp.

 

[calvnandhobbs68]

No matter what you do, you do one area of psychiatry you can get mentally locked into that mode and not in a good way.

E.g. you do emergency psychiatry you forget how to do long-term psychiatry, you do long-term you forget how to do emergency psychiatry, you do only forensic psychiatry you forget how to do clinical.

For this reason, while in academia, I sometimes switched what I did every few months with another doctor to keep things fresh. After about 2-3 years of it it got to the point where it really filled in any not-then-noticeable voids. I only got out of this when I entered private practice. Now that I'm in PP I'm happily locked in. Took too long to invest time into this thing and it's doing too well for me to want to leave, but the learning curves I had in academia were well worth it.

I mean I think this is true but this also gets misconstrued to new grads at times as a reason to "stay in academia for a while". Which is fine if that's what you actually want to do, get continued exposure to a variety of settings for a few years, but some people (cough myself cough) would be perfectly fine if I never stepped foot in an ER or inpatient unit ever again and knew that immediately after graduating.

You can also expose yourself to a variety of things in private practice too if you actually want to do this. Plenty of places look for weekend coverage for their inpatient units or ED that their regular docs don't want to cover or will be happy to contract out with you to see some of their patients every week at their IOP/PHP.

 

[whopper]

You're not wrong Calv,
I've stated before that in general I recommend to stay in academia for awhile but this isn't right for everyone and had I stayed where I did residency I don't think it would've been right for me.

I stayed where I did fellowship surrounded by some of the best people in the field including Henry Nasrallah, Doug Mossman, and Paul Keck. Had I stayed where I finished general residency I would've already peaked. I needed to be at a place that took me further along. IF you stay in academia, where you did residency, you may have already learned all they could offer.

A problem with where I did residency was our then-program director had much deserved reverence and was the end-all-be-all of what we sought to achieve, but by your 4th year you were going to take most of what that thing offered. Many of the attendings were graduates of the same program. The best they knew of was what he offered, and while great, staying there would've limited my learning opportunities.

So, let's say you do stay in academia, as I've often times stated is a good move at least right out of residency? The academic institution you may have joined might not be enough to keep your intellectual interests fulfilled. IT depends too on the institution. Add to this many people after graduating residency aren't looking to just temporarily live in a place even if it is for a temporary drink of academia, they want to settle down.

 

[yoloswagpoop42069]

Finishing residency off cycle in Florida in Dec, most likely heading to a fellowship in June/July 2023.

Have my full Florida license. Looking for locums jobs / Telepsych opportunities, but currently limited to Florida.

Locums in Florida seems a bit more rare than other places. I’m comfortable with outpatient/ER/inpatient.

Been talking to recruiters and anyone I can find.

Any other ideas you guys can think of to work a job from Dec - June?

 

[Stagg737]

I am honestly genuinely curious about what people also consider "good" jobs. Every job it seems that gets dropped in the forum has a mass of pepole come in and say oh no pay is too low, too many patients, etc etc. Good inpatient jobs seem to max at 10 patient cap and are expecting over 350 based on a lot of the posts I have seen. OP is more variable but I am curious how many of these great jobs are out there since they are rarely if ever posted about and where in the country are they? Are they in the sticks in the SE or MidWest? Are these major metropolitan jobs?

I think the idea of a sticky for job critiques or just posting jobs with salaries/income, perks is a great idea. Doctors have very little idea of what they are worth especially coming out of residency and a large thread with details (also including the location of the country and if it is a big city or not) would be a very helpful resource.

Psych_0's post is fairly consistent with what I've seen with recent searches over the last 8 months the people I've talked to who have been open about their jobs and compensation. I don't think asking what a "good job" looks like is the right question because everyone is looking for something different. I think the better question is what would be considered "fair" compensation for the work performed.

A lot of the jobs that get criticized here are because they either don't give adequate compensation for the wRVUs produced/duties performed or they expect docs to see an unreasonable volume of patients for the given time. A job paying $150k per year to "work" 40 hours may sound awful, but if you only see 3 patients a day then it may be completely fair. Conversely, you could get paid $500k to work 40 hours a week, but if you're seeing 50 patients a day, you're getting completely screwed. Some people are fine getting 2 weeks of vacation per year, while others would rather take a lower salary to get more guaranteed PTO.

If you're asking purely about reimbursement, then just look up the CMS physician fee schedule tool, calculate the RVUs and encounter numbers, and plug the numbers in. That should give a general idea of what the low end of "fair" compensation will look like.

 

[G Sheb]

Maybe different populations, but I find collateral with adults useless 99% of the time. That 1% is amazingly helpful though. The 99% have a horse in the race or are just uneducated on the issue. It’s like getting ADHD rating scales from teachers. It’s nice to know you are headed in the right direction, but diagnostically worthless.

The misses around me are from a lack of doing a thorough eval, too little time, or just not good at their job.

I get collateral to know how the person has been behaving recently, outside the ER - not to get an opinion of what they are doing.
I can still sort out the bs from the non-bs.
I find that a pretty small minority of collateral that is completely unreliable. That does happen, but rarely. After all, the patient in the ER is the one with the mental illness.

I've certainly had cases where a suicidal patient smiles through their evaluation and tell you all the right things only to discover the horror stories from the collateral.
Or the organized, but highly delusional (though with some awareness not to tell you what they're thinking) psychotic patient who is likely a danger to self or others if released.
Are these case common? No. But that's exactly what you don't want to miss. The 5% that get you in trouble.

It's actually hospital policy where I am to get collateral on ALL patients. I do find that a bit excessive, but that's the case because mess ups occurred when no collateral was taken, and in that case, you are absolutely and completely liable since this is the standard of care.
I would not advise anyone to get flimsy with collateral in the ER, especially if they are doing this full time. This is the highest risk environment you're going to be working in psychiatry, with probably the least amount of direct patient contact.

 

[ObsequiousAplomb]

I get collateral to know how the person has been behaving recently, outside the ER - not to get an opinion of what they are doing.
I can still sort out the bs from the non-bs.
I find that a pretty small minority of collateral that is completely unreliable. That does happen, but rarely. After all, the patient in the ER is the one with the mental illness.

I've certainly had cases where a suicidal patient smiles through their evaluation and tell you all the right things only to discover the horror stories from the collateral.
Or the organized, but highly delusional (though with some awareness not to tell you what they're thinking) psychotic patient who is likely a danger to self or others if released.
Are these case common? No. But that's exactly what you don't want to miss. The 5% that get you in trouble.

It's actually hospital policy where I am to get collateral on ALL patients. I do find that a bit excessive, but that's the case because mess ups occurred when no collateral was taken, and in that case, you are absolutely and completely liable since this is the standard of care.
I would not advise anyone to get flimsy with collateral in the ER, especially if they are doing this full time. This is the highest risk environment you're going to be working in psychiatry, with probably the least amount of direct patient contact.

While I agree with what you're saying, wouldn't it be very weird for a patient to be smiling throughout a psych ER evaluation? Sure, they might smile at jokes. But throughout the eval?

 

[G Sheb]

While I agree with what you're saying, wouldn't it be very weird for a patient to be smiling throughout a psych ER evaluation? Sure, they might smile at jokes. But throughout the eval?

I mean, I'm exaggerating a bit, but I agree if they do it the whole evaluation it's weird.
The point is that some are able to keep it together very well and give you a reasonable story.
Overconfidence in one's impressions imo is one of the quickest roads to disaster. One should always maintain healthy doubt, gather as many facts as they can and cover their grounds. it is human behavior after all. It's only predictable to a certain extent.

 

[yoloswagpoop42069]

Anyone else looking for locums positions?

I’m a bit surprised that locums pays about 200/hr for Miami and all of Florida. Florida isn’t the best market for locums due to saturation and nice weather, but I was hoping for 250/hr like that one guy from Singapore was mentioning in a different thread.

Spoke to one recruiter who said the highest position he’s seen recently was in rural TX for 225/hr, and that she was happy making 400K+ for the year. Not sure how senior of a recruiter he was.

That one surprised me a bit since I thought rural Tx would pay a lot more, at least 250/hr or 300/hr in real rural spots.

Quit sad. I feel like we are undercompensated for the work we do, especially if we put quality into our evaluations.

Plenty of terrible docs out there though, who can’t differentiate BPD from BD or psychosis.

And yes I know the potential to independently contract with facilities without recruiter sharks is a possibility, but I’m on a bit of a time crunch, and that requires a significant amount of leg work without a guarantee hospital admins will come to the table with you.

 

[Merovinge]

Anyone else looking for locums positions?

I’m a bit surprised that locums pays about 200/hr for Miami and all of Florida. Florida isn’t the best market for locums due to saturation and nice weather, but I was hoping for 250/hr like that one guy from Singapore was mentioning in a different thread.

Spoke to one recruiter who said the highest position he’s seen recently was in rural TX for 225/hr, and that she was happy making 400K+ for the year. Not sure how senior of a recruiter he was.

That one surprised me a bit since I thought rural Tx would pay a lot more, at least 250/hr or 300/hr in real rural spots.

Quit sad. I feel like we are undercompensated for the work we do, especially if we put quality into our evaluations.

Plenty of terrible docs out there though, who can’t differentiate BPD from BD or psychosis.

And yes I know the potential to independently contract with facilities without recruiter sharks is a possibility, but I’m on a bit of a time crunch, and that requires a significant amount of leg work without a guarantee hospital admins will come to the table with you.

Locums through a recruiter often have upwards of a 50% charge on your rate. If they are paying you $225, then it's costing the hospital $325-350/hour. This makes rates of $300+ pretty hard to come by in a field like psychiatry. If you need a locums to shoot laser beams at cancer and risk not running the center, of course rates can be sky high, but outside of failing to provide a bare minimum for an IP unit the locums are often net negative for the system hiring you.

 

[yoloswagpoop42069]

Yeah makes sense. Thanks for the input. Most people I’ve talked to said recruiters usually get 50/hr. So if the locums is offering 200/hr, hospital is paying 250/hr.

Although I have yet to directly ask a recruiter about this rate. Next time I talk to one that will be my question.

 

[littlefred]

Recruiters make so much money by just cold calling? No wonder they spam the crap out of docs.

 

[the5thelement]

Yeah makes sense. Thanks for the input. Most people I’ve talked to said recruiters usually get 50/hr. So if the locums is offering 200/hr, hospital is paying 250/hr.

Although I have yet to directly ask a recruiter about this rate. Next time I talk to one that will be my question.

At the county, my boss told me they paid locum companies $300/hr (yet the psychiatrist was getting only $150/hr).

 

[yoloswagpoop42069]

At the county, my boss told me they paid locum companies $300/hr (yet the psychiatrist was getting only $150/hr).

Yeah I don’t doubt this but at the same time this rate is pretty insane.

Help 3 clients get jobs at 100/hr and you’re getting 300/hr?

Granted locums positions are temporary, and so you’re constantly hustling to find job placements. And also competition from other recruiters and limited jobs available, but seems lucrative.

 

[surfguy84]

What would you all consider a good inpatient job done on 1099 basis in terms of pay?

 

[yoloswagpoop42069]

Here’s a 1099 locums inpatient job from a recruiter in FL

• Specialties: Psychiatry
• Primary Worksite City: Daytona Beach
• Primary Worksite State: FL
• Reason for Coverage: Perm Replacement
• Work Schedule: 1 week on call and 1 weekend per month
  6 month commitment required
  Locums will need to on remain on site for 8 hours
  Locums can start 6:30am-8am every day
• Staff Information: Full support staff
• Patient Information: Adult + Geriatric
  Inpatient + Consults
  54 beds total (3 Inpatient units then crisis beds and observation unit in ED)
  Weekends: Locum Tenens will split the patients with other Psychiatrists and NP covering the unit
• Required Procedures/Skills: Inpatient
• Daily Rate: $1600 per day, OT: $220
• EMR: Meditech Expanse
• License State: FL
• DEA Required: Yes
• Selling Points/Community Information: Less than an hour from Orlando, FL and less than 2 hours from Tampa, FL

To be honest kind of **** pay to cover 3 inpatient units and consults, although I’m not sure how many patients are expected per day.

Or I don’t know. Maybe my expectations for pay are too high, and my cynicism for patient load at these kind of jobs too cynical.

 

[Shefa Rahman]

I feel like I have a job almost every week now that I am approaching the second half of PGY4 that I would love everyone's feedback on. I don't want to clog the forums with a new thread for every job. Just wondering if a stick could be created or if there's a better way to .

 

[surfguy84]

Here’s a 1099 locums inpatient job from a recruiter in FL

• Specialties: Psychiatry
• Primary Worksite City: Daytona Beach
• Primary Worksite State: FL
• Reason for Coverage: Perm Replacement
• Work Schedule: 1 week on call and 1 weekend per month
  6 month commitment required
  Locums will need to on remain on site for 8 hours
  Locums can start 6:30am-8am every day
• Staff Information: Full support staff
• Patient Information: Adult + Geriatric
  Inpatient + Consults
  54 beds total (3 Inpatient units then crisis beds and observation unit in ED)
  Weekends: Locum Tenens will split the patients with other Psychiatrists and NP covering the unit
• Required Procedures/Skills: Inpatient
• Daily Rate: $1600 per day, OT: $220
• EMR: Meditech Expanse
• License State: FL
• DEA Required: Yes
• Selling Points/Community Information: Less than an hour from Orlando, FL and less than 2 hours from Tampa, FL

To be honest kind of **** pay to cover 3 inpatient units and consults, although I’m not sure how many patients are expected per day.

Or I don’t know. Maybe my expectations for pay are too high, and my cynicism for patient load at these kind of jobs too cynical.

Thats **** pay.

 

[yoloswagpoop42069]

Had a interview with a recovery center medical director here in Florida through a recruiter.

6 month contract for 300k.

Supposedly all outpatient M-F, 9-5, 1 hour for new evaluations, 30 min for follow-ups. No call.

I wanted to ask “what’s the catch,” but didn’t know how to phrase that immediately during the interview.

No contract with exact job obligations yet. What do you guys think? Too good to be true?

In a job like this the red flag question would be how many patients are you seeing per day, but 9-5 with 1 hr new and 30 min f/u seems average.

Another thing would be insurance fraud and using my license for upbilling, but seems to be a reputable company with National locations. Started by MDs has MDs on the board.

2 NP and one physician there currently. Not going to be supervising NPs I don’t believe.

 

[yoloswagpoop42069]

Thats **** pay.

I wonder if the no Florida state tax makes pay so **** here compared to like rural NY? Not sure. Going rate for locums seems 200/hr