comparing moonlighting gigs - psychiatry resident in south

[curiousmindset]

I am an upper level psychiatry resident in the south trying to gauge several moonlighting offers and would really appreciate your thoughts. They are as below:

1. outpatient telepsych: flexible hours (nights and weekends an option). compensation is 60% of billing and $110/hr for work outside of appointments. Strong clinical support staff.
2. inpatient weekend gig: round on 20-24 patients (1-2 new pts), no overnight call. $1500 per weekend day.
3. overnight inpatient coverage: basically everything over telephone, 0-15 calls per night including assessment of admission appropriateness and orders. $30 per hour, each shift 14 hrs.


All offers are 1099. Trying to get a sense if these provide fair compensation for someone in my position.

Thanks!

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[Merovinge]

Definitely number 2 if you don't mind giving up someone weekends. Particularly if you can do Sat/Sun and get paid 3k (it's much easier the second day when you know the patients).

Overnight call with 10+ calls is just murdering your sleep (which is terrible for physical/mental health), doing this for less money than most hair stylists make seems unwise. There is also a much larger liability risk with making these decisions sleep deprived and potentially without the full medical chart/information (in contrast to #2 of actually rounding at the hospital).

Outpatient work you are likely just getting used to yourself, I would rather master what I was learning in training before jumping in and doing it without supervision. In contrast I suspect you are quite well versed with IP management if you go to 90% of programs that are IP heavy years 1+2.

 

[FlowRate]

Is the overnight $30/hr for whatever the overnight call duration is? e.g. $360 for 12 hours of coverage? Or only for time spent on the phone?

If the former and typically on the lower end of that range (of number of calls), it might be worth it. If the latter, absolutely not.

 

[Stagg737]

1. Find out how much you get paid for each code. National average for 99214 through CMS is ~$97, seeing 2 per house is about $115/hr but could make a lot more or less. Not bad for a resident, but could do better.

2. Is this 20-24 patients per day or for the whole weekend? The former would be terrible, the latter would be pretty good for a resident gig.

3. $420 per night. That's just awful. If it were 3-5 calls that were almost all before 10pm, it would still be bad for attendings but not bad as a resident. Up to 15 calls per night? That's laughable. I wouldn't even consider losing a full night of sleep for less than 4 figures.

For some comparisons, my residency paid upper level residents $200/night to cover the private unit entering admit orders (after being accepted by the attending) and taking first call from the unit. Typically averaged 3-5 calls per night and I only ever got called after midnight for an issue on the unit once and it wasn't uncommon for me to not be called after midnight at all.

Outside the program, residents would moonlight at the state hospital making $5k for 48 hours to see 35ish patients over the course of the weekend. Others saw patients at a nearby prison for I believe $120/hr. This was a program in the midwest.

 

[calvnandhobbs68]

3. $420 per night. That's just awful. If it were 3-5 calls that were almost all before 10pm, it would still be bad for attendings but not bad as a resident. Up to 15 calls per night? That's laughable. I wouldn't even consider losing a full night of sleep for less than 4 figures.

I totally get this too and I would never do it these days but I could see how a resident might be tempted. You could cover your car payment or a good chunk of your rent to hang out, watch TV or play video games at home all night and lose one night of sleep a month and you might be pretty used to ruining your sleep pretty regularly anyway.

Although, OP if these are all 1099, keep in mind you pay both halves of self employment tax and medicare. You phase out of the social security part (which is the bigger part) at $147K but you're unlikely to hit that as a resident unless you're dual income or moonlighting hardcore. You'll be eligible for a pass through deduction for any 1099 income so that may balance things out a bit, but your income may be a bit less than you'd expect (like to the tune of possibly 7sh% less than you'd expect).

 

[FlowRate]

I totally get this too and I would never do it these days but I could see how a resident might be tempted. You could cover your car payment or a good chunk of your rent to hang out, watch TV or play video games at home all night and lose one night of sleep a month and you might be pretty used to ruining your sleep pretty regularly anyway.

Although, OP if these are all 1099, keep in mind you pay both halves of self employment tax and medicare. You phase out of the social security part (which is the bigger part) at $147K but you're unlikely to hit that as a resident unless you're dual income or moonlighting hardcore. You'll be eligible for a pass through deduction for any 1099 income so that may balance things out a bit, but your income may be a bit less than you'd expect (like to the tune of possibly 7sh% less than you'd expect).

Our evening/overnight call pays about $580 and tons of my colleagues voluntarily choose to pick up extra. It helps that the typical night is 0-2 calls and most of the calls are super quick ("we think this person meets admission criteria, you agree?") although very rarely someone might get a lot more than that. I personally give all of mine away because I value my sleep more than I value the extra cash.

 

[Stagg737]

I totally get this too and I would never do it these days but I could see how a resident might be tempted. You could cover your car payment or a good chunk of your rent to hang out, watch TV or play video games at home all night and lose one night of sleep a month and you might be pretty used to ruining your sleep pretty regularly anyway.

Although, OP if these are all 1099, keep in mind you pay both halves of self employment tax and medicare. You phase out of the social security part (which is the bigger part) at $147K but you're unlikely to hit that as a resident unless you're dual income or moonlighting hardcore. You'll be eligible for a pass through deduction for any 1099 income so that may balance things out a bit, but your income may be a bit less than you'd expect (like to the tune of possibly 7sh% less than you'd expect).

Sure, I took overnight shifts for $200/night as a resident, but it was also internal and we didn't need a separate license or to pay extra or anything. OP also said 0 to 15 calls per night. At 10-15 calls per night you may as well just go into the hospital and just take call on the unit. As you reference, for a 1099 position that's basically ruining their night for less than $300/night. Idk, maybe that's worth it for some residents, but I wouldn't touch that position when OP has the other 2 opportunities available.

 

[curiousmindset]

Thanks for all the thoughts all, very helpful!