Please help me assess appropriate total compensation for this job

[deleted310399]

Hey guys ,

This is the situation - Outpatient only work . Rural underserved area . 5 days per week ( 8 hours Monday to Thursday and 6 hours Friday ) . Have been there over 5 years and they have a hard time recruiting people. 1 day in clinic . 4 days Tele-psych

In this setting , what would the expected total cash compensation be for 5000 Wrvus/year ?

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[Sushirolls]

5000 wRVUS? wow. Is that contract expected or just what you've been billing?
What's Medicaid percentage?
What's Medicare percentage?
Any idea what the private insurance contracts are paying this Big Box shop?

 

[robellis]

Very simple to answer, considering the national average is 65 dollars per wrvu and this is a rural place no one wants to be let’s bump that to 70 and that gives you 70 x 5000 = 350,000 per year

 

[deleted310399]

5000 wRVUS? wow. Is that contract expected or just what you've been billing?
What's Medicaid percentage?
What's Medicare percentage?
Any idea what the private insurance contracts are paying this Big Box shop?

That is what I'm expecting to bill . The hours are busy and I'm fast at typing. Over 60 percent Medicaid/Medicare . I don't know what commercial insurance is paying but since this a semi large group they probably have negotiated decent rates .

 

[comp1]

Can't argue with the $350k. Average full time psychiatrist salary is $275k and this sounds...worse than average.

 

[wolfvgang22]

I earn about $269k in a similar VA job, medium size city, $15k bonus yearly for good performance. Which for me is automatic. I average about 4,000 wRVUs or so per year. Bureaucratic VA paperwork is pain. I used to do a lot more for less in the VA. I'm probably underpaid. Just saying in case that data point helps any.

 

[robellis]

I earn about $269k in a similar VA job, medium size city, $15k bonus yearly for good performance. Which for me is automatic. I average about 4,000 wRVUs or so per year. Bureaucratic VA paperwork is pain. I used to do a lot more for less in the VA. I'm probably underpaid. Just saying in case that data point helps any.

You’re not underpaid you’re making 67 per wrvu which is good, you’re not producing much so I doubt you see many patients per day

 

[Monocles]

Very simple to answer, considering the national average is 65 dollars per wrvu and this is a rural place no one wants to be let’s bump that to 70 and that gives you 70 x 5000 = 350,000 per year

OP says they are desperate trying to recruit so you can probably start the negotiations higher. Ask for 400k and settle for 375k lol!

Also 4 days virtual? Wow that's a sweet gig.

 

[wolfvgang22]

You’re not underpaid you’re making 67 per wrvu which is good, you’re not producing much so I doubt you see many patients per day

That's good news. I may need more for pain and suffering. If I could quit I would.

 

[Sushirolls]

A 60% medicare/medicaid will likely pull down the wRVU conversion factor.
Rural doesn't always mean higher pay. Rural sometimes means the opposite. So many variables.

 

[deleted310399]

A 60% medicare/medicaid will likely pull down the wRVU conversion factor.
Rural doesn't always mean higher pay. Rural sometimes means the opposite. So many variables.

While I get what you're trying to say , the issue becomes that if rural pays lower why would anyone work there ? Some people might like it . Maybe some have families around and will stay despite the lower pay but I'm guessing these represent a very small fraction of providers . It's not just that rural areas are less attractive to live in but practicing psychiatry in a poor underserved area is a whole different ball game and is not for everyone .
I am expecting at least 70 per Wrvu which is close to median

 

[robellis]

While I get what you're trying to say , the issue becomes that if rural pays lower why would anyone work there ? Some people might like it . Maybe some have families around and will stay despite the lower pay but I'm guessing these represent a very small fraction of providers . It's not just that rural areas are less attractive to live in but practicing psychiatry in a poor underserved area is a whole different ball game and is not for everyone .
I am expecting at least 70 per Wrvu which is close to median

You likely have much more leverage than you think, always ask for more than you want and you’ll settle on what you want or maybe even more, you’re the hot commodity don’t forget that especially in rural area

 

[TexasPhysician]

Expect? I’d expect $250-275 to be the offer.

 

[deleted310399]

Expect? I’d expect $250-275 to be the offer.

Please elaborate. Did you see the part where I wrote 5k Wrvus ?

 

[dl2dp2]

While I get what you're trying to say , the issue becomes that if rural pays lower why would anyone work there ? Some people might like it . Maybe some have families around and will stay despite the lower pay but I'm guessing these represent a very small fraction of providers . It's not just that rural areas are less attractive to live in but practicing psychiatry in a poor underserved area is a whole different ball game and is not for everyone .
I am expecting at least 70 per Wrvu which is close to median

This is not how it works. Supply and demand for facility-driven jobs are not elastic like that. Very often rural facilities have a fixed budget, or they rely on Medicaid-lined funding, which doesn't respond to market forces. So what ends up happening is that they get many bottom-of-the-barrel candidates, and even those candidates don't stay long. Nevertheless, there's no incentive for the operators of the facilities to change anything, as their own jobs are not dependent on clinical outcome metrics, such as coverage gaps or waiting times. The incentives are such that things change very very slowly.

You are right that once a blue moon they get a highly qualified candidate who have connection with the local roots and are willing to stay, and that's what they are hoping to fish for... but by and large salary bands are not as wide as can be vs. a large private group with ownership potential.

 

[TexasPhysician]

Please elaborate. Did you see the part where I wrote 5k Wrvus ?

Medicaid in my state pays terribly. Producing 1,000 widgets that sell for $1 is worth less than 500 better made widgets that sell for $5 each.

Setting and insurance rates matter.

 

[deleted310399]

Medicaid in my state pays terribly. Producing 1,000 widgets that sell for $1 is worth less than 500 better made widgets that sell for $5 each.

Setting and insurance rates matter.

So here's the thing ..What you're saying is nothing terribly insightful. Everyone knows Medicaid pays terribly. The question is why is this my problem ?

They choose to keep a psychiatry outpatient practice open in this location knowing very well the demographics here.. not me . If I don't work here , the clinic shuts down . It's me and 2 LCSWs and that's it . I am a great psychiatrist and can work anywhere . I am in this location because this was my J1 waiver position and overall they have been good to me.
The waiver ended in 2019 and I have a green card now . There is nothing stopping me from going to a desirable city and making the fair market value for 5000 Wrvus . Why should I work hard and produce this much for lower than 50th percentile earnings. That is insulting .

 

[Monocles]

So here's the thing ..What you're saying is nothing terribly insightful. Everyone knows Medicaid pays terribly. The question is why is this my problem ?

They choose to keep a psychiatry outpatient practice open in this location knowing very well the demographics here.. not me . If I don't work here , the clinic shuts down . It's me and 2 LCSWs and that's it . I am a great psychiatrist and can work anywhere . I am in this location because this was my J1 waiver position and overall they have been good to me.
The waiver ended in 2019 and I have a green card now . There is nothing stopping me from going to a desirable city and making the fair market value for 5000 Wrvus . Why should I work hard and produce this much for lower than 50th percentile earnings. That is insulting .

OP do you already work here? What's your current compensation?

I think you have a very good understanding of the financial situation and can likely leverage this to your advantage. I agree in that the onus is on them to offer a reasonable enough compensation to retain you. This is a free market after all!

The way I see it is, if you know your "fair" compensation rate, you can request it. They either can OR cannot afford to pay you. If they can satisfy your asking then great. If not, then no reason to look elsewhere. Once you leave the situation will probably play out like sluox mentioned above, where they go through a slew of below-average providers until their admin decides to fork up by scraping up funds from elsewhere.

As I type all this out my next question is - why stay at all?

 

[deleted310399]

OP do you already work here? What's your current compensation?

I think you have a very good understanding of the financial situation and can likely leverage this to your advantage. I agree in that the onus is on them to offer a reasonable enough compensation to retain you. This is a free market after all!

The way I see it is, if you know your "fair" compensation rate, you can request it. They either can OR cannot afford to pay you. If they can satisfy your asking then great. If not, then no reason to look elsewhere. Once you leave the situation will probably play out like sluox mentioned above, where they go through a slew of below-average providers until their admin decides to fork up by scraping up funds from elsewhere.

As I type all this out my next question is - why stay at all?

To answer your question as to why stay at all ?

3 reasons -

- Since it's primarily Tele-psychiatry , I actually live 2 hours away in a city consistently voted one of the best cities to live in the country. My wife is a hospitalist in this city .
- The job is good . I have Zero admin interference . Can deny any referral I don't agree with . Can change my schedule anytime I want .
- The job is also currently 4 days/week . This is 32 hours of patient contact and this is considered full time. I make about 270k from this with all the benefits for a full time position . I work at a different location ( also tele-psych ) Fridays making an extra 50k per year . So I make about 320k/year working about 36-38hours/week . I want to change this because I don't like the Friday position ( it is disorganized with a bad EHR ) . I would rather just work with these guys all 5 days but expect to be compensated for it . If they don't play ball then I'll just stick with that I have .

Another thing - Till very recently , I have been producing about 3000 Wrvus per year . Starting July , I have started to bill better after doing some intensive self studying and learning the ropes . For the past 3 months , I have produced over 400 Wrvus per month at my primary job from just 4 days/week so If I go to 5 days , I should be able to cross 5000 Wrvus.

Cons -
Once a week I have to go into the clinic. This is a 2 hour drive each way ( I don't mind this too much )

So there you go.

 

[robellis]

Please elaborate. Did you see the part where I wrote 5k Wrvus ?

So here's the thing ..What you're saying is nothing terribly insightful. Everyone knows Medicaid pays terribly. The question is why is this my problem ?

They choose to keep a psychiatry outpatient practice open in this location knowing very well the demographics here.. not me . If I don't work here , the clinic shuts down . It's me and 2 LCSWs and that's it . I am a great psychiatrist and can work anywhere . I am in this location because this was my J1 waiver position and overall they have been good to me.
The waiver ended in 2019 and I have a green card now . There is nothing stopping me from going to a desirable city and making the fair market value for 5000 Wrvus . Why should I work hard and produce this much for lower than 50th percentile earnings. That is insulting .

To answer your question as to why stay at all ? 3 reasons -

- Since it's primarily Tele-psychiatry , I actually live 2 hours away in a city consistently voted one of the best cities to live in the country. My wife is a hospitalist in this city .
- The job is good . I have Zero admin interference . Can deny any referral I don't agree with . Can change my schedule anytime I want .
- The job is also currently 4 days/week . This is 32 hours of patient contact and this is considered full time. I make about 270k from this with all the benefits for a full time position . I work at a different location Fridays making an extra 50k per year . So I make about 320k/year working about 36-38hours/week . I want to change this because I don't like the Friday position ( it is disorganized with a bad EHR ) . I would rather just work with these guys all 5 days but expect to be compensated for it . If they don't play ball and I'll just stick with that I have .

Another thing - Till very recently , I have been producing about 3000 Wrvus per year . Starting July , I have started to bill better after doing some intensive self studying and learning the ropes . For the past 3 months , I have produced over 400 Wrvus per month at my primary job from just 4 days/week so If I go to 5 days , I should be able to cross 5000 Wrvus.

Cons -
Once a week I have to go into the clinic. This is a 2 hour drive each ( I don't mind this too much )

So there you go.

Excellent, you are thinking correctly, go get em!

 

[deleted310399]

Excellent, you are thinking correctly, go get em!

And this is what triggers me a little bit with this defeatist attitude I see on this board. God forbid someone just starting out looks at this thread and thinks it's ok to accept 250k for producing that much . We should be fighting for everything we can get instead of devaluing ourselves .

 

[deleted1100659]

Am I the only one who thinks 5000 wrvus is a really large number? That seems pretty high volume is it not?

One very important factor, at least for me (who also works in a underserved area, who has trouble recruiting people) is that midlevels require supervision in my state and cant practice independent, so without a doctor at the clinic they would have to shut down.

But some of the facilities in underserved areas are getting grants or other income from the government and they can pay at a good rate sometimes.

 

[wolfvgang22]

5,000 wRVUs is a lot for me, with all the accompanying documentation. I've hit that several years in a row before but it was hard work and I eventually burned out.

 

[calvnandhobbs68]

5,000 wRVUs is a lot for me, with all the accompanying documentation. I've hit that several years in a row before but it was hard work and I eventually burned out.

Meh.

It's 11 99214s a day given that a 99214 is 1.92wRVUs now in 2021.
5000/1.92= 2604
2604/48 work weeks= 54
54/5= 10.9 patient encounters a day
At a rural community center, my bet is that like 99% of the patients qualify as 99214 (add on nicotine use disorder for at least 50% of them for at least 2 chronic conditions you're addressing lol).

So not that terrible, especially if you throw a 90833 in there every now and then.

 

[deleted310399]

Am I the only one who thinks 5000 wrvus is a really large number? That seems pretty high volume is it not?

One very important factor, at least for me (who also works in a underserved area, who has trouble recruiting people) is that midlevels require supervision in my state and cant practice independent, so without a doctor at the clinic they would have to shut down.

But some of the facilities in underserved areas are getting grants or other income from the government and they can pay at a good rate sometimes.

It is around 70-75th percentile for Psychiatry so nothing to sneeze at but I'm willing to put in the work

 

[deleted310399]

Meh.

It's 11 99214s a day given that a 99214 is 1.92wRVUs now in 2021.
5000/1.92= 2604
2604/48 work weeks= 54
54/5= 10.9 patient encounters a day
At a rural community center, my bet is that like 99% of the patients qualify as 99214 (add on nicotine use disorder for at least 50% of them for at least 2 chronic conditions you're addressing lol).

So not that terrible, especially if you throw a 90833 in there every now and then.

I didn't realize 99214 is now 1.92 . Do you have the updated Wrvu list for various CPT codes for 2021 ?

 

[MedMan80]

I would see if they would do 350 k for 5 days a week, if they like you and you can grind that I don’t see what the problem would be.

 

[hallowmann]

To answer your question as to why stay at all ?

3 reasons -

- Since it's primarily Tele-psychiatry , I actually live 2 hours away in a city consistently voted one of the best cities to live in the country. My wife is a hospitalist in this city .
- The job is good . I have Zero admin interference . Can deny any referral I don't agree with . Can change my schedule anytime I want .
- The job is also currently 4 days/week . This is 32 hours of patient contact and this is considered full time. I make about 270k from this with all the benefits for a full time position . I work at a different location ( also tele-psych ) Fridays making an extra 50k per year . So I make about 320k/year working about 36-38hours/week . I want to change this because I don't like the Friday position ( it is disorganized with a bad EHR ) . I would rather just work with these guys all 5 days but expect to be compensated for it . If they don't play ball then I'll just stick with that I have .

Another thing - Till very recently , I have been producing about 3000 Wrvus per year . Starting July , I have started to bill better after doing some intensive self studying and learning the ropes . For the past 3 months , I have produced over 400 Wrvus per month at my primary job from just 4 days/week so If I go to 5 days , I should be able to cross 5000 Wrvus.

Cons -
Once a week I have to go into the clinic. This is a 2 hour drive each way ( I don't mind this too much )

So there you go.

I'm all for you asking for more. You should try, but the truth is you're going to have a tough time finding such a setup where you are only in person 1 day a week, virtual 4 days a week and getting paid $375k. If I could find that job, see 10-12 people a day and make $300-$350k doing it, I would. Now sure, if it was rural in-person 5 days a week, I wouldn't be doing it for even $375k.

You have some added flexibility and benefits from you're job that you aren't necessarily taking into account. Again, you absolutely should ask for more. Maybe making an argument for $375k means they'll pay you more than the $325k you're making now. I mean, to be fair an extra day a week should get you at least $340k there.

...
The way I see it is, if you know your "fair" compensation rate, you can request it. They either can OR cannot afford to pay you. If they can satisfy your asking then great. If not, then no reason to look elsewhere. Once you leave the situation will probably play out like sluox mentioned above, where they go through a slew of below-average providers until their admin decides to fork up by scraping up funds from elsewhere.

So, I'm near a pretty rural area. I've seen this play out a couple times. The problem is the salaries don't go up, instead what happens is NPs fill these spots for less and provide non-ideal care. Again, that's not a reason to devalue your own contribution, but I think it's worth noticing that some of these jobs either can't or simply won't get to the point of paying what physicians are worth. I actually think OPs got a nice setup though.

 

[Monocles]

The problem is the salaries don't go up, instead what happens is NPs fill these spots for less and provide non-ideal care. Again, that's not a reason to devalue your own contribution, but I think it's worth noticing that some of these jobs either can't or simply won't get to the point of paying what physicians are worth.

This might be a controversial take, but I think not all NPs provide non-ideal care. Anecdotally I've worked w/ many excellent psychiatric NPs and my own personal PCP is an NP.

If I am reading your comment right I think we are both on the same page. I would like to point out that *If* the community ends up getting worse care due to only NPs being hired, that is an unfortunate economic reality of what the healthcare system is willing or able to pay. I don't think that OP should be the stop-gap measure and settle for less than his market value out of a sense of martyrdom.

 

[hallowmann]

This might be a controversial take, but I think not all NPs provide non-ideal care. Anecdotally I've worked w/ many excellent psychiatric NPs and my own personal PCP is an NP.

If I am reading your comment right I think we are both on the same page. I would like to point out that *If* the community ends up getting worse care due to only NPs being hired, that is an unfortunate economic reality of what the healthcare system is willing or able to pay. I don't think that OP should be the stop-gap measure and settle for less than his market value out of a sense of martyrdom.

Most of the ones I've seen give higher quality care provide it in collaboration with psychiatrists. They are quick to ask the psychiatrist in their office about something they're not familiar with even if there is no official supervision. I'm talking about ones that go out of their way to work independently and don't feel they need to collaborate. Unfortunately the ones that take these jobs are often the latter (in my area).

 

[calvnandhobbs68]

I didn't realize 99214 is now 1.92 . Do you have the updated Wrvu list for various CPT codes for 2021 ?

How the E/M code RVU increases could affect family physicians’ pay

The relative value units (RVUs) for several key E/M codes increased on Jan. 1. Here’s how this could affect your payment rates.

www.aafp.org

This might work out in your favor since you're negotiating this right now but keep in mind a lot of places just responded by cranking up their "base" RVUs they expect clinicians to generate. So if your target before was 5000 for example, a lot of institutions would just average out their spread of intakes/followups and increase the base RVUs by that amount. Very lame but it happened.

 

[deleted310399]

What I find is that many junior attending especially those on J1 visa interpret "fighting" as arguing against leadership and creating problems. This is often a cultural barrier that's, fairly or unfairly, interpreted as discrimination.

You can threaten to leave, but if the clinic has no additional salary budgeted from up above to pay for you, it doesn't matter how hard you "fight", it wouldn't work out. You can quit and find a new job, but all it'll do is that they'll leave that position open for years and years and hire a locum to cover. Kicking and screaming only augments the reality that nobody likes you and prefers that you be gone sooner.

If you really want a salary raise, the "correct" way to do it is to actually understand the guts of how your particular clinic works on a systems level, and find pain points, and then work on where there's a win-win where increasing your salary, would somehow also benefit whoever is running the clinic. But these are typically soft skills that are too advanced for J1 holders. The non-intuitive thing here is that kicking and screaming itself often actually devalues you. It shows that you have no idea where the values actually are.


It is annoyingly high, but not that unusual in practice.

This might just be the stupidest , most patronizing thing I've read on this forum this year . No I don't have any " culture barriers " and have no deficiency in " soft skills " just because I was born in a different country . Unlike you though I understand basic math and fair market value . You have no idea who I am or what kind of relationship I have with the administration . Did that stop you from just making up stuff ... nope .

 

[MedMan80]

What I find is that many junior attending especially those on J1 visa interpret "fighting" as arguing against leadership and creating problems. This is often a cultural barrier that's, fairly or unfairly, interpreted as discrimination.

You can threaten to leave, but if the clinic has no additional salary budgeted from up above to pay for you, it doesn't matter how hard you "fight", it wouldn't work out. You can quit and find a new job, but all it'll do is that they'll leave that position open for years and years and hire a locum to cover. Kicking and screaming only augments the reality that nobody likes you and prefers that you be gone sooner.

If you really want a salary raise, the "correct" way to do it is to actually understand the guts of how your particular clinic works on a systems level, and find pain points, and then work on where there's a win-win where increasing your salary, would somehow also benefit whoever is running the clinic. But these are typically soft skills that are too advanced for J1 holders. The non-intuitive thing here is that kicking and screaming itself often actually devalues you. It shows that you have no idea where the values actually are.


It is annoyingly high, but not that unusual in practice.

try not to use sweeping generalizations my friend, your biases are showing

 

[wolfvgang22]

Meh.

It's 11 99214s a day given that a 99214 is 1.92wRVUs now in 2021.
5000/1.92= 2604
2604/48 work weeks= 54
54/5= 10.9 patient encounters a day
At a rural community center, my bet is that like 99% of the patients qualify as 99214 (add on nicotine use disorder for at least 50% of them for at least 2 chronic conditions you're addressing lol).

So not that terrible, especially if you throw a 90833 in there every now and then.

Yeah, those are the new RVU values, not the old ones. Plus, that doesn't take into account patient and institution acuity, lol.
Maybe I'm just a wuss, but reality on the ground is sometimes different. "Stats are like a bikini, they don't show everything."
Anyways, it's been a fun conversation. Have a great evening!

 

[deleted310399]

try not to use sweeping generalizations my friend, your biases are showing

Who is this guy and why is he so stuck on the idea of " the facility not having any money to pay me " to the point that he's willing to make up all this nonsense abut soft skills and culture barriers . It's almost like me saying I can make 5000 Wrvus offends him .
I haven't even started the negotiations yet lol

Why are some people so weird .. calm down dude.

 

[deleted310399]

I think this thread has run it's course . I did learn today that I have culture barriers and poor soft skills and will work on those. Thanks for the feedback fellas.

 

[hebel]

You likely have much more leverage than you think, always ask for more than you want and you’ll settle on what you want or maybe even more, you’re the hot commodity don’t forget that especially in rural area

Sometimes it seems like psych is needed, but not necessarily wanted (vs say Ortho).

 

[AD04]

@sluox makes some good points about how institutions work. Some places don't have the money to pay what you think you're worth unless you're able to provide value in other ways. You don't have to take the culture barrier / soft skills jab to heart but you'll prove your point more if you can roll with the punches instead of raging. Previous posts about fair compensation is on point. So the rest depends on your negotiation skills and if the facility has the means to pay.

 

[dl2dp2]

This might just be the stupidest , most patronizing thing I've read on this forum this year . No I don't have any " culture barriers " and have no deficiency in " soft skills " just because I was born in a different country . Unlike you though I understand basic math and fair market value . You have no idea who I am or what kind of relationship I have with the administration . Did that stop you from just making up stuff ... nope .

Actually the internet allows people to be radically honest. I’m telling you the facts exactly as they are. Basic math requires context to be interpreted correctly.

In reality people just talk behind your back about how you “don’t have enough mentorship” and “might be a poor fit for the role.” Learn to take what you can and reflect on where you might improve. The fact that I don’t know you is exactly why I give comments in a general way. I’ll be the first to admit that I didn’t start out with the best soft skills myself but have learned some along the way through the years.

 

[TexasPhysician]

So here's the thing ..What you're saying is nothing terribly insightful. Everyone knows Medicaid pays terribly. The question is why is this my problem ?

They choose to keep a psychiatry outpatient practice open in this location knowing very well the demographics here.. not me . If I don't work here , the clinic shuts down . It's me and 2 LCSWs and that's it . I am a great psychiatrist and can work anywhere . I am in this location because this was my J1 waiver position and overall they have been good to me.
The waiver ended in 2019 and I have a green card now . There is nothing stopping me from going to a desirable city and making the fair market value for 5000 Wrvus . Why should I work hard and produce this much for lower than 50th percentile earnings. That is insulting .

It is your problem, because you want to keep this job. It is your job to negotiate better pay. They aren’t going to offer big raises. It isn’t a lucrative job to keep, and they will never be able to compete with the best. They know they will go under if they try.

In no way am I saying that you should accept the amount I listed earlier. I said that is what I would expect them to offer. It is your job to negotiate higher and convince them you are worth it.

 

[TexasPhysician]

Meh.

It's 11 99214s a day given that a 99214 is 1.92wRVUs now in 2021.
5000/1.92= 2604
2604/48 work weeks= 54
54/5= 10.9 patient encounters a day
At a rural community center, my bet is that like 99% of the patients qualify as 99214 (add on nicotine use disorder for at least 50% of them for at least 2 chronic conditions you're addressing lol).

So not that terrible, especially if you throw a 90833 in there every now and then.

If that is the new conversion, an employer couldn’t pay $300k for this without government grant support. It is bankrupt at $300k for a psychiatrist in my area. This is PT work.

 

[deleted310399]

It is your problem, because you want to keep this job. It is your job to negotiate better pay. They aren’t going to offer big raises. It isn’t a lucrative job to keep, and they will never be able to compete with the best. They know they will go under if they try.

In no way am I saying that you should accept the amount I listed earlier. I said that is what I would expect them to offer. It is your job to negotiate higher and convince them you are worth it.

I don't know if you have read my other posts but I'm actually making 270k/year producing 3000 Wrvus at this place now . This is what's happening now . You think they will offer 20k less for 2000 more Wrvus/year ?

On the other hand , I do agree that they will try and low ball me . The main leverage I have is that I've been with them since 2016 and as long as they treat me well ( which so far they have ) , I'm willing to stay . I understand they're not particularly interested in my skills as a Psychiatrist and might just be looking for a warm body with a license but I can't imagine any warm body who has other choices would be willing to work this hard at this place unless they pay well.

 

[calvnandhobbs68]

If that is the new conversion, an employer couldn’t pay $300k for this without government grant support. It is bankrupt at $300k for a psychiatrist in my area. This is PT work.

I mean even at the old conversion that’s 13.8 99214s a day (so 7 hours of 30min followups…at a minimum time based coding would be 99214). I’m assuming if you’ve been there 3 years it’s a pretty full patient panel.If you even do 25% 90833s (another 1.5 wRVUs) you’d be able to cut that back by 25% (so 10.3 avg followups per day even under the old wRVU conversion).

So yes you’re working full time 7 hours a day but it’s not exactly insane even at the 1.5 wRVU conversion.

Of course I think it’s kind of stupid to be paid by RVUs when you’re seeing a large Medicaid/Medicare population which likely has variable show rates due to the inability to charge no show fees…so that buffer should be taken into account.

 

[TexasPhysician]

I don't know if you have read my other posts but I'm actually making 270k/year producing 3000 Wrvus at this place now . This is what's happening now . You think they will offer 20k less for 2000 more Wrvus/year ?

On the other hand , I do agree that they will try and low ball me . The main leverage I have is that I've been with them since 2016 and as long as they treat me well ( which so far they have ) , I'm willing to stay . I understand they're not particularly interested in my skills as a Psychiatrist and might just be looking for a warm body with a license but I can't imagine any warm body who has other choices would be willing to work this hard at this place unless they pay well.

I doubt they offer less for more work. My total comp estimates in my first post was a guess at the est salary based on your initial post.

As a comparison, a friend of mine works 35 clinical hours at a FQHC with 4 booked patients per hour. That is about 28 patients per day but not all show - avg around 21. He makes under $275k. There isn’t room for much more income. They won’t really care that much if he walks.

The same job in private practice could pay $500k+.

I think Wrvu’s are just a complicated conversion designed to dupe physicians. It’s not easy to convert Wrvu’s to billing codes to payment collected - overhead, etc. Wrvu does not translate directly to revenue. 1 Wrvu for one patient can be worth 30% or less of another Wrvu.

If your job is subsidized by grants, etc., they may not want to pay for another 1 day per week because they lose money on you without more grants.

 

[deleted310399]

I doubt they offer less for more work. My total comp estimates in my first post was a guess at the est salary based on your initial post.

As a comparison, a friend of mine works 35 clinical hours at a FQHC with 4 booked patients per hour. That is about 28 patients per day but not all show - avg around 21. He makes under $275k. There isn’t room for much more income. They won’t really care that much if he walks.

The same job in private practice could pay $500k+.

I think Wrvu’s are just a complicated conversion designed to dupe physicians. It’s not easy to convert Wrvu’s to billing codes to payment collected - overhead, etc. Wrvu does not translate directly to revenue. 1 Wrvu for one patient can be worth 30% or less of another Wrvu.

If your job is subsidized by grants, etc., they may not want to pay for another 1 day per week because they lose money on you without more grants.

Without knowing more details about you friend's situation it is hard for me to opine on his compensation . But an average of 20 patients , 5 days per week with total comp below 275k seems rather low . Maybe the key is that " They won’t really care that much if he walks ". Maybe that's the key to any job really.

 

[Monocles]

I think Wrvu’s are just a complicated conversion designed to dupe physicians. It’s not easy to convert Wrvu’s to billing codes to payment collected - overhead, etc. Wrvu does not translate directly to revenue. 1 Wrvu for one patient can be worth 30% or less of another Wrvu.

I don't know what an wruv is and at this point I am afraid to ask...

(Someone else in the hospital does the billing for me at work)

 

[calvnandhobbs68]

I don't know what an wruv is and at this point I am afraid to ask...

(Someone else in the hospital does the billing for me at work)

I totally agree, wRVUs theoretically make sense but in practice are typically just used to scam physicians. Much easier to just know what specific codes you're using are actually paying/collecting and base your negotiations off that but big system billing loves RVUs because it confuses anyone who isn't a biller.

 

[trophyhusband]

I don't know if you have read my other posts but I'm actually making 270k/year producing 3000 Wrvus at this place now . This is what's happening now . You think they will offer 20k less for 2000 more Wrvus/year ?

On the other hand , I do agree that they will try and low ball me . The main leverage I have is that I've been with them since 2016 and as long as they treat me well ( which so far they have ) , I'm willing to stay . I understand they're not particularly interested in my skills as a Psychiatrist and might just be looking for a warm body with a license but I can't imagine any warm body who has other choices would be willing to work this hard at this place unless they pay well.

So you're essentially saying that they're paying you $90/wrvu... which good for you but also probably bad for you in your negotiations. I say this because I highly doubt they're getting paid on a fee for service basis enough to cover that. What is probably happening is they're getting a capitation on a per patient basis and that capitation is disconnected from wrvu and will not increase just because you're capturing more wrvus.

Now if there are more patients flowing into the clinic the capitation would be paid on those new patients and the revenue would increase accordingly so there's probably some wiggle room but I wouldn't think it's as linear a progression as wrvu especially considering the coding changes.

It'd be nice if you could figure out how the clinic's revenues work so you can better get a idea of what you have to work with negotiation-wise. If they are paid FFS it'd be good for you to know why you're getting so much per wrvu and if they are getting a capitation then you'll need to know how many additional patients can flow through based on you being there for an additional day. They may be so backed up that your additional day adds nothing revenue-wise in which case I don't know that you have any real leverage other than the ability to walk away... which might be worth something but probably not $100k.

 

[dl2dp2]

It'd be nice if you could figure out how the clinic's revenues work so you can better get a idea of what you have to work with negotiation-wise. If they are paid FFS it'd be good for you to know why you're getting so much per wrvu and if they are getting a capitation then you'll need to know how many additional patients can flow through based on you being there for an additional day.

This part takes a lot of soft skills. It's rare when an employee goes to management for a salary raise with an ultimatum of quitting, management sits down and shows the employee the spreadsheet of the P&L statements and tutors the employee the intricacies of the local Medicaid financing structure. Especially employees who aren't willing to listen. LMAO

 

[trophyhusband]

This part takes a lot of soft skills. It's rare when an employee goes to management for a salary raise with an ultimatum of quitting, management sits down and shows the employee the spreadsheet of the P&L statements and tutors the employee the intricacies of the local Medicaid financing structure. Especially employees who aren't willing to listen. LMAO

Since it doesn't sound like this is being negotiated right now it's an opportune time to go to the clinic manager (or whoever) and say I'd like to better understand how the clinic functions and how I could help increase revenue (by potentially increasing my time available) and I'd like to see what that would look like. Can't do that while you're in the middle of negotiations obviously.

Edit: And you have to have shown some aptitude that would make them think you can actually help which the OP may have already shown by tightening up their billing (and assuming the increase wasn't entirely do to the coding changes that were more gobal in nature).