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Exactly Vistaril.
PGY-IVs what offers are you getting?
- Thread starter Igor4sugry
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Residents! You guys need to learn how to negotiate. A newly minted doctor accepting the 1st job offer is like a person who has never been to a car dealership and pays the sticker price for a new car. Don't be that guy! Assume every employer is ripping you off (because they are). Every aspect of the job is negotiable. Fight for your worth.
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1000%.
You need to remember, it is the employers job to secure the best assets for the best price. Much like negotiating for a car, the 'seller' will want to clump everything together in a package, so make sure to outline and negotiate all of the hard and soft benefits of the offer. Invest $20-$40 in a book or two about negotiating and it can pay off in tens of thousands of dollars per year. All of my recs are from a decade ago, so I'm sure there are newer/better books…but they are out there and they are worth their weight in gold, literally.
ps. An offer is really just a "first" offer, even though most grads treat it as the "final" offer. If a place isn't willing to negotiate….look elsewhere. As a psychiatrist, you are in the driver's seat at all but a handful of places/situations. Good luck!
pss. For the hardcore ppl…I highly recommend getting all of the stats from the hospital/dept about beds, pts treated per year, etc. You need to know what you cost, what you earn the medical system (sometimes a negative amount bc of unique market demands), and what you could make elsewhere.
Thought I'd revive this for data points.
1. 200k/outpt/24hrs per week/rural/no loan repayment/contractor/Pennsylvania
2. 185k/outpt/8-5 m-f/city CMHC/no loan repayment/empolyed 401k match at 4.5% of salary after 90 days/Central Texas
3. 184k/outpt/10-7 m-f/city CMHC/no loan repayment/empolyed 401k match at 3% of salary after 1 year/Central Texas
4. 250k/outpt/8-5 24-30hrs per week/city private practice group/no loan repayment/contractor/Central Texas
5. 275k/outpt/8-5 m-f/city private practice group/no loan repayment/employed/Central Texas
6. 288k/outpt/8-5 m-f/city private practice group/no loan repayment/employed/Central Texas
More as I continue interviewing.
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Nice! Gotta love those numbers. Best of luck as you continue interviewing.
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#4 sounds freaking sweet. Maybe I could like Texas?
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Central Texas congers up thoughts of Univ. of Texas, Austin, or Baylor, but it could be nowhere near anywhere. There is even a city called “Central” Texas. Ironically it is in East Texas.
Im sure it's essentially a crappy essentially long term locums job where you are a contractor without benefits(hello both ends of that fica).....and I'll bet your essentially be doing a full time job from check in to check out. I'm also sure it's super high volume and not in some place like austin.
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and I'm sure it is an amazing job staffed with the nicest of people working with clientele that are very eager to change and do everything you ask them to without hesitation. Your job is to do the most fun aspects of psychiatry while your assigned paperwork monkey does all the boring stuff that nobody likes.
Also 3 hour catered lunches, a giant ball pit in the lounge, and 12 weeks of vacation per year.
Look, I can make stuff up too! Only I can be positive instead of a constant negative nelly.
dude Im sure because I get dozens of the same type of jobs automatically sent to me daily......after seeing hundreds upon hundreds of such jobs sent to you(and contacting tons of them), you kinda get a sense of what is what.
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Ok then, captain downer, what kind of offers can one expect out of residency?
12 bucks an hour?
depends on a lot of factors- what setting you want to work in, how many patients you want to/are willing to see, what type of populations, contract vs salaried, etc.....the best answer is around 200k, but that varies a lot with a lot of factors.
And in general(for non academic jobs) the 'coming out of residency' part isn't all that important. It's easier to get hired in tougher markets with some experience, but you generally aren't going to get paid that much more for the salaried positions. After all if I see x number of patients as part of a psych hospitalist job for some hospital and some guy with 25 years experience sees the same number of patients in the same psych hospitalist gig, he isn't generating any more money.
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Recently seen 150k 40 hr academic gigs being low end.
VA multiple locations around 200k+.
Private is 220k+.
Friend #1 took a 40 hr + call 1/week at 220k salaried with benefits. Friend #2 40 hr inpatient 1/week call at 260k contractor. Friend #3 started solo private practice 20hr/week includes admin time and clears 175k after expenses.
VA multiple locations around 200k+.
Private is 220k+.
Friend #1 took a 40 hr + call 1/week at 220k salaried with benefits. Friend #2 40 hr inpatient 1/week call at 260k contractor. Friend #3 started solo private practice 20hr/week includes admin time and clears 175k after expenses.
Pay at different locations does differ(and inpatient/outpt differs as well), but this is not common in most places for starting psych VA pay. The average VA full time employed physician made 204k last year.
Now yes it's true that the VA does employ a disproportionate number of low paying specialties(psych, IM, neuro) and contracts out some of the higher paying specialties, they still employ enough of the higher paying specialties to tilt the numbers somewhat.
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I like Friend #3, with Friend #2 being a close second.
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Wow... How many days #3 practice is open? This is unbelievable? Psych rocks! #1 is not bad IMO... I don't like #2 because as a contractor, you have to buy your own health insurance, you have no 401k contribution, no paid vacation. These alone might cost more than 50k/year...
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Considering this salary comes with benefits, this would be a perfect job for anyone who probably has little-to-no student loan... However, if one is 200k+ in the red, 110k part time job won't do it...
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50K ????? being an employee buys you nada these days.
This is what you lose by being a contractor, 7.65% of first 113k or whatever the fica max. A whopping $8600 and 99.9% of 401ks are weak as hell, like matching 1-4% that you aren't even fully vested in. Group health insurance is lame too unless you are the government maybe and with the markets for individual and small businesses you can afford your own now
As a contractor you don't have federal tax withholding and just pay FICA quarterly. As a contractor you can deduct probably 30% at least of what you are paid above the line. As an employee your taxes are pretty much established and withheld.
You can open a self employed IRA or 401k and put 50k into retirement. This money you can direct how its invested, rather than your likely corrupt employer figuring out how to keep as much as the pension fund as possible. Also as an employee you are limited to 17500 in salary deferral
It never pays to be an employee, unless the position is subsidized by taxes. This is intuitive as what would be the net benefit to your employer?
If you guys want money start looking at the federal contract openings that outsource physician services, you have preference as a "small business" and entitity not subcontracting the bulk of the work
https://www.fbo.gov/index?
not many opportunities as a solo practitioner but when they are available you can make a years guranteed salary at the best private practices paid monthly up front
This is what you lose by being a contractor, 7.65% of first 113k or whatever the fica max. A whopping $8600 and 99.9% of 401ks are weak as hell, like matching 1-4% that you aren't even fully vested in. Group health insurance is lame too unless you are the government maybe and with the markets for individual and small businesses you can afford your own now
As a contractor you don't have federal tax withholding and just pay FICA quarterly. As a contractor you can deduct probably 30% at least of what you are paid above the line. As an employee your taxes are pretty much established and withheld.
You can open a self employed IRA or 401k and put 50k into retirement. This money you can direct how its invested, rather than your likely corrupt employer figuring out how to keep as much as the pension fund as possible. Also as an employee you are limited to 17500 in salary deferral
It never pays to be an employee, unless the position is subsidized by taxes. This is intuitive as what would be the net benefit to your employer?
If you guys want money start looking at the federal contract openings that outsource physician services, you have preference as a "small business" and entitity not subcontracting the bulk of the work
https://www.fbo.gov/index?
not many opportunities as a solo practitioner but when they are available you can make a years guranteed salary at the best private practices paid monthly up front
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Is friend #3 general adult, or does it include child and adolescent, or suboxone?
s f
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C&A is about 40% of the work. No suboxone.
Great idea if I could find some federal contract jobs. Where can I find these ? I searched and can't seem to find this.
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Do you know how much he charges for 50min visits, 20 min visits and initial evals to be able to generate this level of after expenses income? How long did it take him to grow his practice to achieve this level of income? Thanks for the valuable real life info!
contact chris van tyne(or something ike that)....google him. He's a recruiter for an agency who is always trying to peddle VA locums gigs.
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I have a friend who does adult, charges $175/hr, works 24 clinical hours a week + about a 1/2 day of "office work" and takes home about the same amount. (175*24*48w-overhead). With a small, low-overhead practice like this, it's not that hard to work low hours at a high hourly rate.
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$300 per 1.5 hour eval or $150 per 30 min follow-up. Evals are also typed by the secretary. It took less than a year to fill.
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I ended up taking an outpatient only VA position, $220k annually , $10k signing bonus, $60k repayment of med school loan over 5 years in medium metropolitan area. Likely will get a small bonus a years end. This location passed recent inspections with flying colors and high Veteran satisfaction. In Texas, so there is no state income tax.
40 hours per week, flexible hours. Consult call for one week every 5 weeks, and its slow. Benefits are good. Excellent support staff. No contract since it's VA permanent job, no noncompete clauses or other such nonsense. I will probably become clinical faculty with the local University once I'm settled in.
I did negotiate, took 2nd offer presented, I may have gotten more but I wanted to live here.
40 hours per week, flexible hours. Consult call for one week every 5 weeks, and its slow. Benefits are good. Excellent support staff. No contract since it's VA permanent job, no noncompete clauses or other such nonsense. I will probably become clinical faculty with the local University once I'm settled in.
I did negotiate, took 2nd offer presented, I may have gotten more but I wanted to live here.
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Very nice. Surprised you got such a high starting salary for a VA position. Around my parts it's apparently 180-190k start (not board certified) with about 10k bump once boarded. Glad you got a good offer.
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Better than what I got from the VA. Nicely done. I knew I was being ripped on but needed a job with good benefits.
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@wolfvgang22 ...I thought VA salary was set and there is no negotiation (it's take it or leave it). How does that loan repayment work? Do they give you a separate check monthly?
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Not set at any VA I've seen.
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Loan repayment is a bit of a joke through the VA. You get $60k over 5 years ($12k/year) and you get the money after you prove you've made payments over the preceeding 12 months - the money comes as a lump sum. The process to get yourself approved for EDRP takes about 6 months as it has to go to the VISN for approval.
I, too, thought that the VA couldn't negotiate, but if they want you badly enough, they'll come at you with enough money.
So far I've taken a contract for 2 days a week, 17 weeks a year - every other-other week - for ~72-76k per year base with incentives as medical director. I'm also in negotiations with a company to cover 2 days per week (any day of my choosing per week) at some nursing facilities at ~1k per day. I know the latter is paycut rate-wise from the former, however they are allowing me a flexible schedule as well as letting me set up my own private practice). I don't ever plan on working 40 hours per week, so this was a perfect mix for me.
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I'm board certified, so I know that helped. I think we also have a psychiatric service director on a mission to provide better care to Veterans and wants to attract good doctors who will stick around and accomplish that mission.
I didn't take a VA job but talked to a bunch and that starting salary is much much higher than anything I saw out of any VA for outpt work. At all the VAs I went to that would be basically what service chiefs with 25 years would make.
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Is there a non-compete clause in these VA contracts? Are they also flexible in letting psychiatrists work 4 days/week (10 hours/day)? Are they willing to hire part time psychiatrists and give them some benefits? because some people might also want to have another job on the side so they can pay off their student loan faster....
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There isn't a contract, so no non-compete clauses. It's at-will employment. That's good and bad. It's mostly good, since there is a need for psychiatrists.
Having another job or practice shouldn't be a problem, but that depends on the service director. And you have to follow policy for federal employees (avoid conflicts of interest, basically).
If one had plans to have, say, a private practice clinic on one's days off or moonlight elsewhere, he or she should probably make that know during negotiations so there are no surprises regarding schedule.
Hours depend on the position, but remember, most things are negotiable to some degree. Don't be afraid to negotiate. There are not enough psychiatrists and plenty of good positions out there if you are a little flexible.
The VA hires lots of locums from outside companies for full or part time, and I know physicians who have also worked directly for the VA part time before. I don't know what kind of benefits they had.
Salaries for federal employees are freely available online for every VA, just google it.
no because in psych the benefits of being a partner are not the same because the structure is different. In other fields you have massive revenue from the practice itself and often a large capital investment required to generate this revenue. The most obvious example is a stand alone eye surgery center....think about all the revenue streams you have at work there- the facility fees, optos working there, optical and materials sales, kickbacks from those 2k injections, etc.....so obviously the very structure of the practice itself generates a lot of revenue that doesn't exist in psych.
In psych, basically all the revenue is just the individual practitioners churning out their patient visits.
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I wish my service chief was equally in line with this idea rather than drinking the kool-aid. I hope you don't get bait and switched like I did!
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This is how my family medicine doctor makes money. 10 to 15 min per patient. He can bill insurance for the nurse checking my vitals as well. But guess what, you can do that in psych too.
That isn't the type of passive revenue I was talking about....
That said, psychs seeing patients at that frequency can't be very satisfying. That would be a quick output psych, and not all that quick for fam med(especially if walk in clinic)...
A busy fam med clinic with a few partners should have at the very least a good bit of ancillary revenue through lab stuff btw.
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I just started googling federal employee salaries at my local VA, and see that in 2013, the chairman of the psychiatry department made $223k.
well the term chairman is misleading(VAs are not organied like academic depts.)......service chief(or some other meaningless admin jargon) is more comm Nit
The term chairman at a va is silly....nothing in common at most vas with chairman of academic depts as far as job requirements or duties.
That said that salary sounds about right. That's more than va here pays. Not uncommon for vas to pay people 155k or so to start up to like 230k for certain admin psychs.
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Depends on the practice. Some practices are larger and involve such things as psychologists, labs, real estate, 24/7 call, TMS, group therapy, ECT, speech therapists, etc. Larger practices may involve partnership possibilities that add future income.
This however is not common in psychiatry. The deal is whatever you make it. Some people partner, some take a % of collections, salary, etc.
Psych is a varied field with varied pay. It all depends on the job involved.
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Okay, so it's not typical but they are out there. This would be on par with what I hear a lot of other specialties can do with private practice. It's good to see that psych still has the option. Any ideas as to why it's so uncommon in psych?
