I need MONEY!

[sonofthesouth]

Hi all, I’ve been out of residency for ten years now, doing various psychiatric jobs since then. I’ve been working the same job now for seven years. I enjoy helping patients but it’s getting kind of boring and I’m underwhelmed by the pay for what I do. Seems like NPs are making well over 50% of my pay, and PAs maybe 75%. Moreover, I haven’t gotten a raise (despite asking for one) in the past two years during a period of significant inflation, like over 15%. So basically I’ve gotten a 15% pay demotion since then and I’m just seeking your input on more lucrative opportunities in this field. I’m open to hearing any ideas, although I probably won’t be starting a ketamine clinic anytime soon. Thanks in advance!

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[comp1]

I don't know if I've ever seen a mental health PA, much less one making $190k... Anyways, you make money doing jobs other people don't want to do. Assuming that you're not into starting your own practice (which is definitely something people don't want to do), that generally means correctional work. Your local mileage might vary a little, but that's generally where the big money and stress is. Don't assume the grass is always greener though, there's a lot to be said for stability...

 

[Merovinge]

You need to call people up in your area, see who is hiring and what the offers actually are. That's the way to determine your worth and also a negotiating tactic if you do want to stay at your current job. You've clearly been in the same area for 7 years so hopefully you know other docs to get an inside scoop beyond what is posted online.

Not offering any CoL raise is pretty bad, I have seen jobs set in 2-3 year contracts where pay is flat during that time and then renegotiated but certainly good to work somewhere where you are getting a yearly raise. Mind you very few people will get what inflation has actually been but 2-4% a year makes a big difference over time.

 

[R. Matey]

I don't know if I've ever seen a mental health PA, much less one making $190k...

They exist in CMHCs, but for a lot less than that amount.

 

[forchinet121]

Hi all, I’ve been out of residency for ten years now, doing various psychiatric jobs since then. I’ve been working the same job now for seven years. I enjoy helping patients but it’s getting kind of boring and I’m underwhelmed by the pay for what I do. Seems like NPs are making well over 50% of my pay, and PAs maybe 75%. Moreover, I haven’t gotten a raise (despite asking for one) in the past two years during a period of significant inflation, like over 15%. So basically I’ve gotten a 15% pay demotion since then and I’m just seeking your input on more lucrative opportunities in this field. I’m open to hearing any ideas, although I probably won’t be starting a ketamine clinic anytime soon. Thanks in advance!

I don’t understand your post, what’s the question? You’re seeking higher paid work? Get paid per wrvu and see more patients, I’m not sure how your pay could go down if it’s based on the patients that you see? Are you getting a salary with no productivity bonus?

 

[TexasPhysician]

A ketamine clinic would be a good way to lose money.

 

[PikminOC]

A ketamine clinic would be a good way to lose money.

How so?

 

[TexasPhysician]

How so?

It is difficult and expensive to attract patients that can afford it to a dedicated ket clinic. Many pain docs and psychs are now implementing it in their private practice. This is resulting in a massive amount of ketamine clinics folding or about to fold. Get out now if you are in it.

 

[annoyedpsychiatrist]

It is difficult and expensive to attract patients that can afford it to a dedicated ket clinic. Many pain docs and psychs are now implementing it in their private practice. This is resulting in a massive amount of ketamine clinics folding or about to fold. Get out now if you are in it.

yea its a good point; look at the socioeconomic status of the majority of people with TRD, i would guess its not the rich people/well off with great insurance.

OP, leave your job if you arent satisfied. Sometimes grass is greener on other side. For me it was.

 

[PsyDr]

1) The person with the most power is the person who is prepared to walk away. Know where you stand.
2) Call a meeting, bring reference materials that show the current market rates through things like medscape, the cost of onboarding, and the fact that CMS rates for 99213 were ~$76 in 2020, and ~$90 in 2023. Then ask for a raise. This sequence will prevent them from saying "times are hard". If they still use that line of reasoning, ask them which evidence they are using.
3) Unless you are in an independent practice state, your ultimate power play is the option to stop "supervising" their NPs or PAs. What are they going to do? Stop the entire department? Spend a gajillion dollars with an ad that says, "Physician wanted to supervise 2 PAs and 4 NPs."?

 

[Sushirolls]

Interesting play.

Simply say you will no longer supervise, they have 5 business days offer you a contract improvement, or you send the termination letter of supervision to the state medical board (which often time lists the supervisory doc) and then CC to the hospital admin / mid management. And if a hospital the medical staff off too - which medical staff offices are supposed to be independent of the hospital and its admin.

The counter play would be to just have some other med dir or CMO then assume supervision for interim.

 

[clausewitz2]

1) The person with the most power is the person who is prepared to walk away. Know where you stand.

I think this is absolutely the most critical thing. If you aren't willing to cut back hours/move to a different job at the end of the day, your leverage is limited. If they just stonewall you and your response is "okay" and go back to work, you will get nowhere.

 

[PsyDr]

Interesting play.

Simply say you will no longer supervise, they have 5 business days offer you a contract improvement, or you send the termination letter of supervision to the state medical board (which often time lists the supervisory doc) and then CC to the hospital admin / mid management. And if a hospital the medical staff off too - which medical staff offices are supposed to be independent of the hospital and its admin.

The counter play would be to just have some other med dir or CMO then assume supervision for interim.

Giving too much time, might give allow for another physician to file supervision paperwork. I know a physician that did this, in a different situation (e.g., loss of a title). He gave limited time to fix the issue, emphasizing that everything stopped if he didn't get his way. It was as glorious as it was petty.

 

[sonofthesouth]

I don’t understand your post, what’s the question? You’re seeking higher paid work? Get paid per wrvu and see more patients, I’m not sure how your pay could go down if it’s based on the patients that you see? Are you getting a salary with no productivity bonus?

Correct, I am a salaried w-2 employee, among the most productive in my company.

 

[finalpsychyear]

Giving too much time, might give allow for another physician to file supervision paperwork. I know a physician that did this, in a different situation (e.g., loss of a title). He gave limited time to fix the issue, emphasizing that everything stopped if he didn't get his way. It was as glorious as it

Had someone do this and admin agreed since it was of similar sentiment and no time for alternate solution. 1 year later and they got rid of them. Got to be careful to be reasonable if you want longevity at the same place.

 

[forchinet121]

Correct, I am a salaried w-2 employee, among the most productive in my company.

You need to be paid on productivity, anything else is a scam

 

[randomdoc1]

A ketamine clinic would be a good way to lose money.

Not if you pair it with beauty products and get a mind, body, wellness thing goin'.

 

[TexasPhysician]

Not if you pair it with beauty products and get a mind, body, wellness thing goin'.

Anything is possible, but med spas have high up front costs and high overhead. Breaking even by month 12 would be impressive. This is a high competition market.

 

[randomdoc1]

Anything is possible, but med spas have high up front costs and high overhead. Breaking even by month 12 would be impressive. This is a high competition market.

Some "happy ending" to go with the spa package should easily earn back loses.... jk jk.

 

[mistafab]

My hope for you is you take action, then report back how it goes. Good luck!