Pros/Cons to joining a private practice right out of training

[rjs2131]

Hi all,

Finishing training in 2021 and wanted to try and get a better understanding of the types of outpatient jobs (adult + CAP) out there and if I have reasonable expectations. Ideally want a situation where I can spend time with patients (i.e. 30 min follow-up, 1 hr new at a minimum), have reasonable compensation for a full-time position (250k+) and work no more than 40 clinical hours/week. Ideally no call, but open to working the occasional weekend for additional compensation.

From my understanding, private practice seems to hit all of the points above, but starting my own practice doesn't seem feasible right out of training (may or may not move to a different location, want something more stable to start, etc). Is joining an established practice a good option if I hope to have my own practice in the future (maybe 3-5 years down the line)? What other types of settings would be helpful to explore?

I know location can be important to these questions as well - will likely be exploring North or South Carolina.

Thanks in advance!

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[oldiebutgoodie1211]

You should definitely be able to find a job with those criteria and should not accept anything less

 

[Merovinge]

There will be plenty of employed positions or smaller PP groups that will easily fit that criteria, particularly in less competitive markets like the Carolina's. I think its helpful to see how other people practice when you are first getting out of training and get some exposure to the business side of medicine so your plan seems ideal to me.

 

[dl2dp2]

You are dichotomizing things too much. In NC/SC, large facility driven jobs are often similar to larger group PP jobs. Small group practices with partnership track are a different beast, but they also plentifully exist in NC/SC.

This all goes in a spectrum. You should think of your job as salary vs. performance/equity ownership/profit sharing. There are various mixtures of the two.

Also of note: especially in the age of COVID, it's not rare to start a solo PP and take it with you when you move somewhere else via pure telemedicine, especially it's largely psychopharm. As long as the facility job doesn't have a non-compete and you have the time and energy IMO you should open your own (small) practice REGARDLESS of whether you plan to stay or not. The learning experience along makes it worth it.

 

[rjs2131]

Thanks for the feedback everyone!

@sluox, that makes sense. I think my hesitancy with large facility drive jobs is the potential for lack of transparency/control (i.e. being presented one thing initially and later finding yourself being forced to compromise time with pts, workload, supervision of midlevels, etc --- I suppose these can all be negotiated initially but still). It seems like a smaller PP would allow for a closer relationship between employee and owner of the practice.

What would be the primary differences between a small group practice with partnership track vs large group PP? Is one more ideal for a new graduate vs another?

Open to the idea of telepsych as well (who knows where things will be 1 year from now) but would only want this to be a small part of my practice.

 

[dl2dp2]

What would be the primary differences between a small group practice with partnership track vs large group PP? Is one more ideal for a new graduate vs another?

If small group is owned by MD you should probably ask for partnership track and there will be a complicated negotiation process at the time of making partner, as the books would be open and there might be a buy-in. Large group practice typical example is Permanente Group: there is an automatic partnership track with clear milestone from day 1. In general an equity partner in a small group cannot be fired except if the owners get together and vote this person out, typically due to highly egregious behavior. In large practices, you role is similar to an employee, and can be fired at will, even though some fraction of your income will result from profit sharing. In general however, due to misaligned supply vs. demand, psychiatrists at large facilities who perform at par RARELY get fired for financial/restructuring reasons, with the only example being roles being replaced by NPs.

Whether any of these arrangements are ideal for a new graduate depends on the graduate. In general, if control and income are the most important factors for your career, the sooner you start owning equity the better. In practice, many people prefer not run their own practice for various valid reasons.

It's somewhat hard to explain what any of this means, because until you actually own your practice and file your schedule C, you don't really understand what these words really mean, unless you have previous experience running a business. This is why starting your practice is so essential even if you are fully employed.

 

[TexasPhysician]

I think the “partnership track” in most psych private practices is worthless. It would complicate accounting, increase costs, includes a buy-in, and may return nothing. Some large companies call it a “partnership” but it doesn’t work the same.

Fields that have many revenue streams are ideal for partnerships. The idea being that partners split the profit from ancillary revenue streams. Revenue could come from a surgical center, physical therapy center, lab, imaging, etc. Some groups have labs generating millions in revenue per year. None of the revenue is clinician generated. After a few years of quality service and proving to be a team player ordering in-house services, you are given the option to buy-in as a partner to split the ancillary profits.

Most psych clinics will not have substantial ancillary revenue streams. True partners split some revenue though. Splitting the total profits is a terrible idea. Admin disagreements, time, etc will kill relationships.

I think private practice is great, but I’d advise keeping it. Get paid well, work the hours you want, and enjoy life.

One of the groups that recruited me hard even bragged about a “partnership” from day 1. I’d split the revenue from the PHP’s of which 1/2 the docs rounded on. I’d be one of the ones rounding on a new PHP, developing a new PHP , etc. I asked why I’d be doing all of the work yet 50% of the group with no ancillary service support would benefit. I got some team player chat and how new things in the future may benefit me. They couldn’t provide any idea of what “new” things may be though. The lack of transparency and funny math scared me away. Had they paid me $X per hour or per patient with a PHP bonus, I may have taken the job and my life would be substantially different.

Without the bureaucracy, a pp should be able to give you clear terms and negotiate a schedule/life that you want.

 

[Sushirolls]

Open your own practice right from the start. Pick up a side gig to make ends meet. Freedom is priceless.

 

[dl2dp2]

Large practices also have the following issues that are popping up more often as of late:

Starkman: Beaumont Health Terminates More than 70 Heroic Covid Docs

TLDR: large practice groups can be sold to private equity, which often results in employed physicians being let go on very unfavorable terms. This is again rare in psychiatry for lots of reasons, but will become more common.

 

[dl2dp2]

I think the “partnership track” in most psych private practices is worthless. It would complicate accounting, increase costs, includes a buy-in, and may return nothing. Some large companies call it a “partnership” but it doesn’t work the same.

While I agree with most points (i.e. psych has few ancillary profit streams), in small private practices if you are not "partnership track" what it means is that the partner who hires you and deals with the business aspects shields all billing/accounting information from you. This means usually they take a 50% haircut off your revenue from day 1. Some people don't care about this, but it's just something to be aware of.

I think a better arrangement in psychiatry is a senior psychiatrist come up with a reasonable agreement for protected salary for X number of years in exchange for some fixed "mentorship" fee, and open all books for transparency. Alas, this is not the case in the usual.

 

[rjs2131]

Thanks again, all. Seems like an ideal situation would be joining a local, established practice with some potential for mentorship/collaboration - I know there's a greater income potential with owning my own practice but I'm okay with giving a percentage to the owner of the practice initially in exchange for learning the system/having access to an established setup.

What is the best way to reach out to practices? I've heard of people just googling and cold-calling but not sure if there's a better way to go about it.

 

[asdf123g]

I'm guessing most PP jobs require non-competition agreements or however that works?

 

[clausewitz2]

I'm guessing most PP jobs require non-competition agreements or however that works?

Yes, but what that means can vary a lot, especially since you usually have a lot more scope to negotiate. My PP gig contract says that for the term of the contract, I am not to work for or have a significant interest in any clinic advertising a specialty or focus in [Specific Patient Population] in a 10 mile radius. Beyond that, I'm free to do as I like. It turned out in negotiating with the practice owner all he was really concerned about was that I not immediately go to work for the -other- private place in town specializing in this population or start my own down the road. If I leave the job early the prohibition is in place for 60 days.

I can live with that.

 

[clozareal]

Open your own practice right from the start. Pick up a side gig to make ends meet. Freedom is priceless.

What kind of side gigs do people in private practice have that doesn't involve weekend or evening moonlighting or being on call?

 

[Sushirolls]

Methadone clinic in early AM?
VA part time?

 

[clausewitz2]

What kind of side gigs do people in private practice have that doesn't involve weekend or evening moonlighting or being on call?

I'm doing a day-ish per week being the doc for a first episode psychosis program. Money's good due to grant funding/special case rate they've negotiated with big payors locally, satisfies my sense of mission and obviously super interesting, in case I get bored with higher functioning folks...

 

[dl2dp2]

What kind of side gigs do people in private practice have that doesn't involve weekend or evening moonlighting or being on call?

The kind of part-time job that would give you benefits are extremely plentiful in psychiatry in most metro areas, going anywhere between large telepsych contractors that pay poor hourly rate but has good benefits package to a state facility associated outpatient clinic, and anywhere in between. None of which involve a weekend or evening.

That said, if you are willing to do weekend or evening, there are even more options.

 

[Psychresy]

For you guys who have experience with locums... is it reasonable to assume I could take (or start) a pp job and then pick up weekend inpatient gigs 1-2x a month for some extra cash?

 

[oldiebutgoodie1211]

For you guys who have experience with locums... is it reasonable to assume I could take (or start) a pp job and then pick up weekend inpatient gigs 1-2x a month for some extra cash?

yes weekends suck

 

[Psychresy]

yes weekends suck

What level of renumeration is provided which hopefully makes them suck less?

 

[oldiebutgoodie1211]

What level of renumeration is provided which hopefully makes them suck less?

completely dependent on location, number of patients, what you’re covering, how many calls you’re getting, etc. 3-10k for a weekend is probably the ballpark..less than that and imo It’s not worth wasting your weekend as time is very precious

 

[Psychresy]

completely dependent on location, number of patients, what you’re covering, how many calls you’re getting, etc. 3-10k for a weekend is probably the ballpark..less than that and imo It’s not worth wasting your weekend as time is very precious

10k a weekend? that's crazy money. had no idea it was so high. Do I just contact a few locums companies, tell them I'm willing to do weekends/able to travel and wait for the leads?

 

[oldiebutgoodie1211]

10k a weekend? that's crazy money. had no idea it was so high. Do I just contact a few locums companies, tell them I'm willing to do weekends/able to travel and wait for the leads?

it’s not crazy money you will be working for it seeing 40+ patients per day

 

[rhondabear]

it’s not crazy money you will be working for it seeing 40+ patients per day

from what I have seen, you have from Friday evening until Sunday evening to see about 50-70 patients, so yeah it sucks

 

[Techmed07]

Isn't the MGMA salary for child psychiatry around 270k?

 

[Techmed07]

...

 

[rjs2131]

@Techmed07 Thanks for sharing!

Curious about how these are calculated and what types of jobs they correlate too.

Anyone willing to explain how RVU's are used in the outpatient world/private practice?? Trying to get a better understanding of how to discuss compensation in a model where you join a practice and take a percentage of profits. From my understanding, a code (i.e. 99213) translates to x RVU's, and you negotiate with insurance to determine the $ amount that correlates to each RVU.

So if a follow-up med mgt appointment is 1-2 RVU's and each RVU reimburses ~$60, you can expect somewhere between $60-120 from insurance for that appointment.

Is that accurate? Am I missing something/oversimplifying?

 

[rjs2131]

bump!

 

[dl2dp2]

bump!

There's no point in obsessing over these kinds of details:
1. they vary according to geography and payer mix, so it's impossible to generalize anyway. RVUs are usually given by your job, and they will give you numbers for you to estimate your workload/bonus/partnership, etc. This will also likely change a lot in the coming decade with changes in systems of managed care. You can find RVU numbers on CMS website, but the payment for each RVU (or even CPT codes of the same RVUs) is highly variable. Very often payers have carve-outs for certain codes that has the same CMS RVUs. So these CMS numbers are worthless.

2. 50% (and growing) of PP psychiatrists don't take insurance, so this is irrelevant.

3. RVU is irrelevant for fixed salary jobs, a large number of jobs in this field.

 

[rjs2131]

There's no point in obsessing over these kinds of details:
1. they vary according to geography and payer mix, so it's impossible to generalize anyway. RVUs are usually given by your job, and they will give you numbers for you to estimate your workload/bonus/partnership, etc. This will also likely change a lot in the coming decade with changes in systems of managed care. You can find RVU numbers on CMS website, but the payment for each RVU (or even CPT codes of the same RVUs) is highly variable. Very often payers have carve-outs for certain codes that has the same CMS RVUs. So these CMS numbers are worthless.

2. 50% (and growing) of PP psychiatrists don't take insurance, so this is irrelevant.

3. RVU is irrelevant for fixed salary jobs, a large number of jobs in this field.

Thanks for the response - was just hoping for a general idea. Sure all of this varies by geography, but I imagine as with any business, the amount you take home (whether employed or not) boils down to total amount you're generating for a given practice/employer minus some percentage the practice/employer keeps.

Unless I'm missing something, you can't really negotiate a salary unless you have some idea about the above, right? Seems like any number they throw out (whether an hourly rate, percentage of profits or fixed salary) is essentially meaningless until you have an idea of how they came up with this number.

 

[dl2dp2]

Thanks for the response - was just hoping for a general idea. Sure all of this varies by geography, but I imagine as with any business, the amount you take home (whether employed or not) boils down to total amount you're generating for a given practice/employer minus some percentage the practice/employer keeps.

In general yes, but in many cases your salary is just a line item of overhead that's set by market forces or even other factors (i.e. institutional budget for a particular role). Just because you are generating $X doesn't mean that you'll automatically get paid $X * Y%. On the flip side, it also doesn't mean that if you fall woefully short of some RVU target your salary will get cut. This all depends on the specific contract.

As a very rough guide, you can use the CMS website to look up RVU/reimbursement rate for any zip code for any CPT code. Even this is tenuous, as facilities may or may not have carve-outs with Medicare advantage plans as well as complications in facilities fees. Unfortunately, this gives you very little in terms of actual $, because statistically, the actual CPT code reimbursement can vary between 30-300% of CMS reimbursement! Remember there's more than just $X per RVU, there's also billing rate (whether any encounter is billed at all)/ reimbursement rate (whether a billed code gets paid out)/code mix (99213 vs. 99214), etc. etc. etc. Many of these can vary bigly between different facilities/practices.

Unless I'm missing something, you can't really negotiate a salary unless you have some idea about the above, right? Seems like any number they throw out (whether an hourly rate, percentage of profits or fixed salary) is essentially meaningless until you have an idea of how they came up with this number.

No. Unless you are negotiating a profit-sharing agreement with a partnership, in general, the way a facility comes up your salary figures are mostly unrelated to your total billing. In fact, one might argue that that's the whole point of working for a facility: you don't have to worry about the business aspect of this. If you are joining a partnership as an equity partner because you bring in a book of business, that's different--but this is rare in psychiatry, and even then the idea is both of you would open your books during a period of due diligence, similar to how other small businesses might do so during a usual M&A. If you are partnership track, by the time you are eligible for partnership they'll open the books with the stipulation that you'll pay your buy-in (if applicable) afterwards. Then you evaluate the books and say yes vs. no.

Think about it, CMS pays facilities more at HCOL zip codes, and yet salaries are lower. Why? Supply and demand.

Facilities will not open their books to any non-equity non-executive employees (or even more premature, a pre-employee in salary negotiation). This information is generally considered a trade secret. Sometimes hiring managers might give you some numbers ("oh my god we are literally losing money on you for the first few years because we love you so much and want to invest in you!") but they are usually not trustworthy and they can make anything up without any legal consequences. If they bring you in at the C-level, possibly would have to give you real numbers for your own team to review, but it'll come with various other issues in executive compensation (i.e. NDAs, performance-based compensation, etc)

If you want a survey of the actual reimbursement people are getting for codes in private practice, you can use commercial databases like FAIRHealth. This is typically how I set my fees in private practice.





HERE is what I think you should do:
1. Google around and see if there are medium-sized MD-owned PP you want to join, and call the owner and arrange a meeting.
2. Discuss with your residency program re: placement.
3. Prepare now to start your own practice--if only for educational purposes.
4* Call a recruiter (this is not a great way to get good jobs, but it gives you "worst-case scenario" options).

 

[rjs2131]

In general yes, but in many cases your salary is just a line item of overhead that's set by market forces or even other factors (i.e. institutional budget for a particular role). Just because you are generating $X doesn't mean that you'll automatically get paid $X * Y%. On the flip side, it also doesn't mean that if you fall woefully short of some RVU target your salary will get cut. This all depends on the specific contract.

As a very rough guide, you can use the CMS website to look up RVU/reimbursement rate for any zip code for any CPT code. Even this is tenuous, as facilities may or may not have carve-outs with Medicare advantage plans as well as complications in facilities fees. Unfortunately, this gives you very little in terms of actual $, because statistically, the actual CPT code reimbursement can vary between 30-300% of CMS reimbursement! Remember there's more than just $X per RVU, there's also billing rate (whether any encounter is billed at all)/ reimbursement rate (whether a billed code gets paid out)/code mix (99213 vs. 99214), etc. etc. etc. Many of these can vary bigly between different facilities/practices.



No. Unless you are negotiating a profit-sharing agreement with a partnership, in general, the way a facility comes up your salary figures are mostly unrelated to your total billing. In fact, one might argue that that's the whole point of working for a facility: you don't have to worry about the business aspect of this. If you are joining a partnership as an equity partner because you bring in a book of business, that's different--but this is rare in psychiatry, and even then the idea is both of you would open your books during a period of due diligence, similar to how other small businesses might do so during a usual M&A. If you are partnership track, by the time you are eligible for partnership they'll open the books with the stipulation that you'll pay your buy-in (if applicable) afterwards. Then you evaluate the books and say yes vs. no.

Think about it, CMS pays facilities more at HCOL zip codes, and yet salaries are lower. Why? Supply and demand.

Facilities will not open their books to any non-equity non-executive employees (or even more premature, a pre-employee in salary negotiation). This information is generally considered a trade secret. Sometimes hiring managers might give you some numbers ("oh my god we are literally losing money on you for the first few years because we love you so much and want to invest in you!") but they are usually not trustworthy and they can make anything up without any legal consequences. If they bring you in at the C-level, possibly would have to give you real numbers for your own team to review, but it'll come with various other issues in executive compensation (i.e. NDAs, performance-based compensation, etc)

If you want a survey of the actual reimbursement people are getting for codes in private practice, you can use commercial databases like FAIRHealth. This is typically how I set my fees in private practice.





HERE is what I think you should do:
1. Google around and see if there are medium-sized MD-owned PP you want to join, and call the owner and arrange a meeting.
2. Discuss with your residency program re: placement.
3. Prepare now to start your own practice--if only for educational purposes.
4* Call a recruiter (this is not a great way to get good jobs, but it gives you "worst-case scenario" options).

Super helpful, thank you!

 

[Sushirolls]

Know the difference between tRVU and wRVU.

 

[rjs2131]

Know the difference between tRVU and wRVU.

Did some googling but care to explain how this distinction (wRVU vs tRVU) ultimately impacts the employed psychiatrist?

 

[Sushirolls]

If a contract is based on wRVU then it is the smaller number, which means you will need more clinical encounters to hit the target set in your contract. So when you look up RVU values for certain E&M codes, you'll need to focus on that number, not the tRVU.

It also helps to point out how much your employer is benefiting from you. The next level of understanding how much they benefit, is to have knowledge of the reimbursement rates from each insurance company.

Rare would be a shady contract that quotes one number, but then uses the other number in order ding you over more...

 

[rjs2131]

Circling back as I'm in discussion with a few PPs. Is it reasonable/expected to ask about what the practice has negotiated with insurance companies for reimbursement? Cash rates are clear on many websites but insurance reimbursement is less clear. I'm not really sure how else to gauge if an offer is reasonable or if the practice is taking a percentage that is significantly higher than the norm. I recognize that this changes from year-to-year but it seems like ballpark numbers would be helpful.

Also curious if anyone has experience with PP's providing a guaranteed salary the first year and what a reasonable number would be for full-time outpatient work (~30 clinical hours).

 

[clausewitz2]

Circling back as I'm in discussion with a few PPs. Is it reasonable/expected to ask about what the practice has negotiated with insurance companies for reimbursement? Cash rates are clear on many websites but insurance reimbursement is less clear. I'm not really sure how else to gauge if an offer is reasonable or if the practice is taking a percentage that is significantly higher than the norm. I recognize that this changes from year-to-year but it seems like ballpark numbers would be helpful.

Also curious if anyone has experience with PP's providing a guaranteed salary the first year and what a reasonable number would be for full-time outpatient work (~30 clinical hours).

Their contracts with the insurance companies include clauses in which they agree not to disclose details of the rates they've negotiated. It seems reasonable that they might be willing to give you an estimate of the rough percentage more or less than medicare the various insurers pay which would let you do rough calculations based on publically available data for your region. Ask anyone you know who works part-time for some private outfit what kind of fee split is customary in their experience. Then you know if they are lowballing you in their offer. If you have this information about therapists in your area then probably you should be asking for at least ten more points, i.e. if typical therapist is getting a 60/40 split then ask for 70/30 minimum, you will generating a ton more revenue than most therapists taking insurance.

Haven't heard of PPs in psychiatry offering a guaranteed salary for the most part. If you are putting in 30 hours a week consistently for ~46 weeks per year you need to be comfortably north of 200k or you need to walk.

 

[Sushirolls]

Circling back as I'm in discussion with a few PPs. Is it reasonable/expected to ask about what the practice has negotiated with insurance companies for reimbursement? Cash rates are clear on many websites but insurance reimbursement is less clear. I'm not really sure how else to gauge if an offer is reasonable or if the practice is taking a percentage that is significantly higher than the norm. I recognize that this changes from year-to-year but it seems like ballpark numbers would be helpful.

Also curious if anyone has experience with PP's providing a guaranteed salary the first year and what a reasonable number would be for full-time outpatient work (~30 clinical hours).

Look to my "practice in progress" thread. You will see a number to gauge by. But assume the insurance rates are less than the posted website cash rates.

Knowing the contracted rates with insurance, isn't as important as first knowing the payer mix and percentage of each insurance. Doesn't matter if you get amazing with insurance Z, but they make up only 2% of the patient practice.

 

[calvnandhobbs68]

Look to my "practice in progress" thread. You will see a number to gauge by. But assume the insurance rates are less than the posted website cash rates.

Knowing the contracted rates with insurance, isn't as important as first knowing the payer mix and percentage of each insurance. Doesn't matter if you get amazing with insurance Z, but they make up only 2% of the patient practice.

Yes and I have had the experience that practices will let you know their estimated payors mix and estimated avg reimbursement for certain codes. So that seems to get around the insurance company requirements that they not disclose specific code reimbursement with specific insurances since it’s an overall average.

Still no way to know though for sure unless you contract out specifically with that insurance yourself. Even then, the reason they like to keep the rates secret is that they negotiate different rates with different people based on region, how many people take that insurance in the region, how big your group is...that’s why larger groups can negotiate better rates with private insurance companies.

 

[clozareal]

Circling back as I'm in discussion with a few PPs. Is it reasonable/expected to ask about what the practice has negotiated with insurance companies for reimbursement? Cash rates are clear on many websites but insurance reimbursement is less clear. I'm not really sure how else to gauge if an offer is reasonable or if the practice is taking a percentage that is significantly higher than the norm. I recognize that this changes from year-to-year but it seems like ballpark numbers would be helpful.

Also curious if anyone has experience with PP's providing a guaranteed salary the first year and what a reasonable number would be for full-time outpatient work (~30 clinical hours).

Yep, there are several practices in my area that are guaranteeing salary for the first year followed by productivity the following years when you build up your outpatient panel, which tends to be higher than the guaranteed salary.

Follow-up questions:
What's a good $dollar amount per RVU? Is this something negotiable when you join a group private practice?

 

[rjs2131]

Thanks for the helpful replies everyone. @clozareal - what are you seeing for first-year salary guarantees? Are practices including benefits as well to some degree?

I'm not sure what a good $/RVU is but from what I've seen, it has ranged from $30-$40/RVU in my area. Depending on your coding this could be decent (i.e. if you average 3 RVU's for a follow-up, that would get you around $200/hr).

 

[Sushirolls]

$40 per wRVU with no benefits or other base income, just pure production $40 per wRVU is horrible, just horrible.

 

[Psych19]

I'm not sure what a good $/RVU is but from what I've seen, it has ranged from $30-$40/RVU in my area. Depending on your coding this could be decent (i.e. if you average 3 RVU's for a follow-up, that would get you around $200/hr).

The $/RVU range you quote is way below what you'll find in recent MGMA national surveys. That seems like a very low offer to me, but I suppose only you know what's competitive in your geographic region. That would be a non-starter for me unless it comes with an impressive base salary and a low RVU threshold to earn extra per RVU.

3 RVUs per follow up suggests you're coding a 99214+90833. With most private insurances, and even Medicare, a 99214+90833 should reimburse close to or possibly above $200. So if you're generating $400/hour and making $200/hour, that seems like a raw deal.

 

[rjs2131]

The $/RVU range you quote is way below what you'll find in recent MGMA national surveys. That seems like a very low offer to me, but I suppose only you know what's competitive in your geographic region. That would be a non-starter for me unless it comes with an impressive base salary and a low RVU threshold to earn extra per RVU.

3 RVUs per follow up suggests you're coding a 99214+90833. With most private insurances, and even Medicare, a 99214+90833 should reimburse close to or possibly above $200. So if you're generating $400/hour and making $200/hour, that seems like a raw deal.

Yup - 3 RVU's for 99214 + 90833. This specific organization/practice does offer benefits and a (low) guaranteed salary for the first year or so. Where did you get $200+ for a 99214 + 90833 for Medicare? For Medicaid I see that a 99214 is $85.15 and a 90833 is $35.55, which gets you to ~$120 for that level of follow-up. I figured the base offer for production was low as it's more like ~$30/RVU until you meet a certain RVU threshold and then it increases to $35-$40/RVU depending on adult vs CAP.

From what people are saying - it sounds like for joining a PP, you should be taking home >$200/hr +/- benefits for a practice that is taking a mix of some insurance and cash. Is that accurate? This would get you to 275-300k for 30-32 clinical hours/week.

 

[robellis]

Thanks for the helpful replies everyone. @clozareal - what are you seeing for first-year salary guarantees? Are practices including benefits as well to some degree?

I'm not sure what a good $/RVU is but from what I've seen, it has ranged from $30-$40/RVU in my area. Depending on your coding this could be decent (i.e. if you average 3 RVU's for a follow-up, that would get you around $200/hr).

The average RVU for psych is 65 dollars..30-40 means you are asking to be ripped off

 

[clozareal]

Thanks for the helpful replies everyone. @clozareal - what are you seeing for first-year salary guarantees? Are practices including benefits as well to some degree?

I'm not sure what a good $/RVU is but from what I've seen, it has ranged from $30-$40/RVU in my area. Depending on your coding this could be decent (i.e. if you average 3 RVU's for a follow-up, that would get you around $200/hr).

I'm seeing $300-350k. These practices are offering health/dental/vision insurance, 2-4 weeks of vacation to start with, retirement match of 3-10%, at 30-32 clinical hours per week with 5-10 hours of admin time per week.

 

[clozareal]

Yup - 3 RVU's for 99214 + 90833. This specific organization/practice does offer benefits and a (low) guaranteed salary for the first year or so. Where did you get $200+ for a 99214 + 90833 for Medicare? For Medicaid I see that a 99214 is $85.15 and a 90833 is $35.55, which gets you to ~$120 for that level of follow-up. I figured the base offer for production was low as it's more like ~$30/RVU until you meet a certain RVU threshold and then it increases to $35-$40/RVU depending on adult vs CAP.

From what people are saying - it sounds like for joining a PP, you should be taking home >$200/hr +/- benefits for a practice that is taking a mix of some insurance and cash. Is that accurate? This would get you to 275-300k for 30-32 clinical hours/week.

99214+90833 can be done in a 30-minute appointment. $120 per half an hour comes out to >$200 per hour.

 

[rjs2131]

The average RVU for psych is 65 dollars..30-40 means you are asking to be ripped off

I've seen that number as well, but not sure how that holds up in outpatient practice when 2-3 RVU's/follow-up is what some of these organizations are advertising. This would mean they're paying you $260+ an hour which I haven't seen anywhere...not sure where the discrepancy is.

I'm seeing $300-350k. These practices are offering health/dental/vision insurance, 2-4 weeks of vacation to start with, retirement match of 3-10%, at 30-32 clinical hours per week with 5-10 hours of admin time per week.

Wow that sounds great - where are these practices located? I haven't seen any in the southeast come close to this. I'm guessing you're not given 30 min for follow-ups/1 hour for news though? I'd sign up without much hesitation if that were the case.

99214+90833 can be done in a 30-minute appointment. $120 per half an hour comes out to >$200 per hour.

Right - but that's the total revenue for the practice, so you'd get some percentage of that. I would think with better payers you could get to >$200/hr after your contribution to overhead.

 

[Candidate2017]

I'm seeing the same thing as mentioned above. $300ish guaranteed, for 4.5 days, 0.5 day admin. These are clinics owned by organizations/hospitals, so no real say in who you accept or decline. For pure PP, I haven't run across any that offer income guarantees or benefits, just a split that's 70/30 or 80/20, averaging $400k+ with a full panel, more if hard working.

Both options seem like they're getting more out of it than I am.

 

[clozareal]

I've seen that number as well, but not sure how that holds up in outpatient practice when 2-3 RVU's/follow-up is what some of these organizations are advertising. This would mean they're paying you $260+ an hour which I haven't seen anywhere...not sure where the discrepancy is.

Probably geographic discrepancies.

Wow that sounds great - where are these practices located? I haven't seen any in the southeast come close to this. I'm guessing you're not given 30 min for follow-ups/1 hour for news though? I'd sign up without much hesitation if that were the case.

Actually, the several places I've seen give 60 min intakes and 30 min follow-ups, but flexible (for tougher cases, two intake appointments and 45-minute follow-ups).

Right - but that's the total revenue for the practice, so you'd get some percentage of that. I would think with better payers you could get to >$200/hr after your contribution to overhead.

No. This would be wRVU which you would get 100% of. You're thinking of total RVU which includes the overhead cost, which includes practice expensive RVU and malpractice RVU.