race to the bottom job offer....

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vistaril

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Hello-
I have a new outpatient psychiatry opportunity opening in xxxxxx. I have listed some practice details below for your review. Please let me know if you would be interested in learning more about this opportunity.

Practice:
•General adult outpatient clinic Monday through Friday working with the seriously mentally ill
o No Inpatient coverage or call
o Clinic coverage: one night per week with telephone call only
•New patient consultations and follow-ups. Depending on the needs of the patient: Med checks average 10 to 15 minutes & New consults are 25 to 30 minutes
•Inherit a large existing base of active patients with the full spectrum of adult Psychiatry diagnoses
•Psychiatry trained APNP works in conjunction with our Psychiatry team
•Diverse patient population and outstanding medical community for support
•Student loan forgiveness (HPSA 16)
•Quality based compensation rather than volume
•compensation from $65/hr to $85/hr depending on qualifications
•Sign on and relocation available
•Psychologists and masters level therapists on staff to assist with Psychotherapy
•Full benefits including malpractice, health insurance, retirement plans, vacation and CME
•J1 Visa compatible and sponsorship through Green Card
Members don't see this ad.
 
vistaril said:
Hello-
I have a new outpatient psychiatry opportunity opening in xxxxxx. I have listed some practice details below for your review. Please let me know if you would be interested in learning more about this opportunity.

Practice:
•General adult outpatient clinic Monday through Friday working with the seriously mentally ill
o No Inpatient coverage or call
o Clinic coverage: one night per week with telephone call only
•New patient consultations and follow-ups. Depending on the needs of the patient: Med checks average 10 to 15 minutes & New consults are 25 to 30 minutes
•Inherit a large existing base of active patients with the full spectrum of adult Psychiatry diagnoses
•Psychiatry trained APNP works in conjunction with our Psychiatry team
•Diverse patient population and outstanding medical community for support
•Student loan forgiveness (HPSA 16)
•Quality based compensation rather than volume
•compensation from $65/hr to $85/hr depending on qualifications
•Sign on and relocation available
•Psychologists and masters level therapists on staff to assist with Psychotherapy
•Full benefits including malpractice, health insurance, retirement plans, vacation and CME
•J1 Visa compatible and sponsorship through Green Card
Click to expand...

The cynic in me says the J1 visa sponsorship is the reason for such low compensation. A clinic trying to scoop up a desperate foreign doc.
 
It appears you actively search for the most negative things in all situations.
 
Members don't see this ad :)
happygilmore said:
I guess. I'd rather focus on ways to move to the top 10-20%.

You move towards what you focus on.
Click to expand...

You're somewhat right. Just a difference of perspective though, you're already committed to psychiatry. You have to focus on making the best of it. I haven't matched yet, I have to focus on making the right decisions.

I've lurked this board for quite a while. Vistaril is a relentless voice of "doom and gloom", and I'm sure it gets tiresome for those who've already made their decisions and are living with the realities. I definitely appreciate the injection of pessimism and cynicism though, it pushes me to consider things more carefully.
 
Tyrone Slothrop said:
You're somewhat right. Just a difference of perspective though, you're already committed to psychiatry. You have to focus on making the best of it. I haven't matched yet, I have to focus on making the right decisions.

I've lurked this board for quite a while. Vistaril is a relentless voice of "doom and gloom", and I'm sure it gets tiresome for those who've already made their decisions and are living with the realities. I definitely appreciate the injection of pessimism and cynicism though, it pushes me to consider things more carefully.
Click to expand...

I too haven't cemented my decision 100%. Unfortunately, if you look there are "Vistarils" for every specialty. No matter what field of medicine or really any job/walk of life there are always going to be those people that solely focus on the negatives.

In my quest to find which specialty best fits me, I usually shrug off the ridiculously pesimisstics as well as the ridiculously giddy people. I tend to focus on the middle as the formers probably have more to do with people's outlook on life.
 
These jobs have existed for a long time. A local clinic taking Medicaid patients can not pay a psychiatrist anything without 15 min FU and 30 min new evals.

They have social workers do the background info for you. You review that data and do only recent history.

This clinic is overloaded with patients and they have trouble getting even residents to moonlight there. I was offered a 75% cut of reimbursement as a PGY-3, but there are too many other better paying moonlighting gigs out there.
 
TexasPhysician said:
These jobs have existed for a long time. A local clinic taking Medicaid patients can not pay a psychiatrist anything without 15 min FU and 30 min new evals.

They have social workers do the background info for you. You review that data and do only recent history.

This clinic is overloaded with patients and they have trouble getting even residents to moonlight there. I was offered a 75% cut of reimbursement as a PGY-3, but there are too many other better paying moonlighting gigs out there.
Click to expand...

This explains my awful experiences communicating with barely English literate psychs at outside small, overrun clinics for patient histories. It is worth talking about given most of us have been sheltered by the academic environment of hospital psychiatry departments. But it's also worth noting that miserable hacks are miserable hacks. A lot of people who inhabit these gigs can't do better. The relative proportion of which type of practice environment is the issue. If you listen to V you can't do better even from his top program. Others here probably solely inhabit the interesting and rarified environment of learning centers. Opinions seem to vary.
 
I'm taking a closer look at this posting and seeing it in a potentially different light -

- $176,000/year plus a hpsa score of 16 which means probably a lot of loan repayment tax free (lets say 15000/year, which would be equivalent to 24000/year converted to pre-tax income), thus lets make the amt earned $200,000/year.


- One night of phone call per week - that could be a very good situation, especially if one values work-life balance, not being oncall for PP pt's or needing to be on call on weekends, etc.

- full benefits

- interdisciplinary team

now, imagine if this posting happens to be in a desirable location (aka place you would love to live and not have to commute too much), and lets just say you interview very well and thus are able to negotiate 1 hour intakes and 20 minute follow ups (or admin time, etc). maybe they offer 5 weeks of vaca, etc?

there is also the satisfaction of serving an underserved community which can be a really positive experience (I have worked in both public and private domains, inpt and outpt, etc.)

now this may actually be a bad job, but its possible to find some really nice gigs in places sometimes that other people wouldn't look...
 
unfortunately(I called), for most practitioners it is more like 65-70/hr. And the loan repayment was not as straightforward as I thought it would be. Oh, and they weren't interested anyways(wanted more experienced clinicians with more commununity experience)....so there is that.
 
Members don't see this ad :)
Shikima said:
Experienced at $70/hr? Race to the bottom....
Click to expand...

it wouldn't be so bad if they actually let you spend a little time with patients for those 70 bucks. But when they are funneling obscene numbers of patients to you where you only have time to glance at their med list and sign a billing sheet before the next one is rushed in.....
 
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vistaril said:
unfortunately(I called), for most practitioners it is more like 65-70/hr. And the loan repayment was not as straightforward as I thought it would be. Oh, and they weren't interested anyways(wanted more experienced clinicians with more community experience)....so there is that.
Click to expand...

So, to summarize: lowball wages, sweatshop, AND they want people experienced, and fresh out of training is not welcome? One word: PASS.

No thanks! (I'm not psych, but, in the ED, I am the "ghetto psychiatrist".)
 
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vistaril said:
unfortunately(I called), for most practitioners it is more like 65-70/hr. And the loan repayment was not as straightforward as I thought it would be. Oh, and they weren't interested anyways(wanted more experienced clinicians with more commununity experience)....so there is that.
Click to expand...

$70/hr? Hard to believe. Our PGY-2's make more than that moonlighting.....
 
Apollyon said:
So, to summarize: lowball wages, sweatshop, AND they want people experienced, and fresh out of training is not welcome? One word: PASS.

No thanks! (I'm not psych, but, in the ED, I am the "ghetto psychiatrist".)
Click to expand...

well I don't have the option of going out and demanding $250/hr like you guys do in some locations:)

You take what you can get.
 
vistaril said:
Hello-
I have a new outpatient psychiatry opportunity opening in xxxxxx. I have listed some practice details below for your review. Please let me know if you would be interested in learning more about this opportunity.

Practice:
•General adult outpatient clinic Monday through Friday working with the seriously mentally ill
o No Inpatient coverage or call
o Clinic coverage: one night per week with telephone call only
•New patient consultations and follow-ups. Depending on the needs of the patient: Med checks average 10 to 15 minutes & New consults are 25 to 30 minutes
•Inherit a large existing base of active patients with the full spectrum of adult Psychiatry diagnoses
•Psychiatry trained APNP works in conjunction with our Psychiatry team
•Diverse patient population and outstanding medical community for support
•Student loan forgiveness (HPSA 16)
•Quality based compensation rather than volume
•compensation from $65/hr to $85/hr depending on qualifications
•Sign on and relocation available
•Psychologists and masters level therapists on staff to assist with Psychotherapy
•Full benefits including malpractice, health insurance, retirement plans, vacation and CME
•J1 Visa compatible and sponsorship through Green Card
Click to expand...
I was interested in learning more about this opportunity, so I decided to google around and try to find it. Here's the closest I could find: http://www.merritthawkins.com/job-search/job-details.aspx?job=12446

Now, it is word for word identical to vistaril's post save for 3 differences:
1) Vistaril mentions "working with the seriously mentally ill" in line one while that posting doesn't have that part

2) Vistaril says "No inpatient coverage or call" whereas that listing says "Inpatient coverage only on weekend call—eight weekends per year"

3) Vistaril says "compensation from $65/hr to $85/hr depending on qualifications" whereas the listing says "$250,000 annual salary plus additional incentive opportunities."

So this nearly identical listing seems to pay a lot more without having you necessarily work with the SMI, but having 8 weekend inpatient calls per year. Doesn't seem so bad, right?

I was then curious to know if anything pays $65-$85 per hour for a psychiatrist out of residency. I googled vistaril's phrase "compensation from $65/hr to $85/hr depending on qualifications" but the only hit was this thread itself, so I don't know that any listing really advertises this.
 
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Hilarious find, I just can't understand what Vistaril's angle is with this sort of stuff
 
vistaril said:
it wouldn't be so bad if they actually let you spend a little time with patients for those 70 bucks. But when they are funneling obscene numbers of patients to you where you only have time to glance at their med list and sign a billing sheet before the next one is rushed in.....
Click to expand...
Bingo!
 
Oh, I forgot, there was a 4th difference. Vistaril advertises "Med checks average 10 to 15 minutes & New consults are 25 to 30 minutes" while the listing I posted advertises "Med checks average 20 to 30 minutes" and "New consults are 45 to 60 minute."

So not only does it pay more, but you get to spend more time with your patients too! This sounds like a rather good opportunity.
 
the vast majority of those merritt hawkins jobs posted that anyone can search for are bait and switches. At least from my experience. A listed salary, even if it says employed, is usually in reality a 'potential' listed. The last time I responded to one of those ads was an inpatient job where you were capped at a certain number of patients and were paid based on actual collections(ie not even rvu based). When I actually sat down and calculated the numbers(based on how many f/u inpatient and intake codes I could reasonably expect), even if there was 100% collections from all commercial insurance it was going to be a raw deal. Throw in some medicaid, no pays, and insurance denials for some days and it would have almost been like I'm paying them for the priv of working at their place. No thanks.

I'd gladly do the cmhc job I posted for 70 an hour + benefits(even grinding), but they made it clear they were going to go with someone with more experience in that sector.
 
vistaril said:
the vast majority of those merritt hawkins jobs posted that anyone can search for are bait and switches. At least from my experience. A listed salary, even if it says employed, is usually in reality a 'potential' listed. The last time I responded to one of those ads was an inpatient job where you were capped at a certain number of patients and were paid based on actual collections(ie not even rvu based). When I actually sat down and calculated the numbers(based on how many f/u inpatient and intake codes I could reasonably expect), even if there was 100% collections from all commercial insurance it was going to be a raw deal. Throw in some medicaid, no pays, and insurance denials for some days and it would have almost been like I'm paying them for the priv of working at their place. No thanks.

I'd gladly do the cmhc job I posted for 70 an hour + benefits(even grinding), but they made it clear they were going to go with someone with more experience in that sector.
Click to expand...

Are some gigs dreadful? Sure.
Will employers lie to get you to join? Yes.

We all need to be smart about finding and taking jobs. Get everything in writing, negotiate hard, and use an attorney.

I've walked away from jobs and negotiated huge pay increases.

Residents can easily earn $100/hr+ in metro areas. Local county mental health is even at $140/hr for PGY-4's.

There will always be employers trying to take advantage of you. This is in every field. You have to negotiate most jobs to get top $$.
 
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TexasPhysician said:
Are some gigs dreadful? Sure.
Will employers lie to get you to join? Yes.

We all need to be smart about finding and taking jobs. Get everything in writing, negotiate hard, and use an attorney.

I've walked away from jobs and negotiated huge pay increases.

Residents can easily earn $100/hr+ in metro areas. Local county mental health is even at $140/hr for PGY-4's.

There will always be employers trying to take advantage of you. This is in every field. You have to negotiate most jobs to get top $$.
Click to expand...

well Im not in texas. Those figures would be pipe dreams for me(or most people I know). If I position came with benefits, a good working environment, job security,etc I would be happy with 50 an hour.
 
One can only cry rape so many times before the laws of probability begin to indicate something vaguely if disturbingly otherwise in the best of terms.
 
vistaril said:
well Im not in texas. Those figures would be pipe dreams for me(or most people I know). If I position came with benefits, a good working environment, job security,etc I would be happy with 50 an hour.
Click to expand...

It's not just TX only.... that's anywhere. You may want to consider the federal prison system. Good benefits and a decent starting salary.
 
Shikima said:
It's not just TX only.... that's anywhere. You may want to consider the federal prison system. Good benefits and a decent starting salary.
Click to expand...

that thought did cross my mind, but the idea(and atmosphere) of working for a prison just isn't appealing.
 
vistaril said:
well Im not in texas. Those figures would be pipe dreams for me(or most people I know). If I position came with benefits, a good working environment, job security,etc I would be happy with 50 an hour.
Click to expand...

Did we ever figure out what state/city vistaril is in? If its public knowledge at this point I would like to know so I can avoid the apparent black hole of a job market doing residency there would get me stuck in.
 
Armadillos said:
Did we ever figure out what state/city vistaril is in? If its public knowledge at this point I would like to know so I can avoid the apparent black hole of a job market doing residency there would get me stuck in.
Click to expand...

well the city/area I'm looking is an entirely different area.
 
OldPsychDoc said:
Well it's sounding pretty lousy. Maybe you should be looking somewhere else.
Click to expand...

yeah I know but there are several reasons I would prefer to be in this particular area. But heck life is about compromises I guess so something will have to give. I also can't tolerate cold weather.

I just want to be able to pay off my student loans, my car payment/insurance, and a decent/safe place to live. If I can do those things I'll be satisfied. I'm thinking about just doing IBR on my med student loan as it is because the monthly payment would be so much less. As it is now I'd be looking at the principal+interest on a 10 year payment plan eating up an unsustainable amount of my salary. If I ibr it I'd have much more disposable income every month....I'd have a massive tax hit(under current rules) when it is written off, but heck that's so far in the future I am not worried about it.
 
vistaril said:
well Im not in texas. Those figures would be pipe dreams for me(or most people I know). If I position came with benefits, a good working environment, job security,etc I would be happy with 50 an hour.
Click to expand...

Not even close to just Texas. I've found tons of good jobs I've turned down. I just prefer Texas to anywhere else, except maybe a tropical island. If you hear of an excellent gig on a tropical island, think of me . :)
 
vistaril said:
yeah I know but there are several reasons I would prefer to be in this particular area. But heck life is about compromises I guess so something will have to give. I also can't tolerate cold weather.

I just want to be able to pay off my student loans, my car payment/insurance, and a decent/safe place to live. If I can do those things I'll be satisfied.
Click to expand...

Lol.

Do you honestly believe a person earning over 150k can't pay off a student loan, car payment and afford rent/mortgage?

Rich people problems!

Even if you owe 300k - your payments should be much more than 3k. And using the mean salary of a psychiatrist in the US, even in the highest effective tax bracket, you should clear 9k per month. 6k per month after taxes still puts you into the top 10% of American income earners, who are the richest people on earth - putting you into the top 1% of earners on earth in the richest time any human has ever known. Meaning, your standard of living is probably in the top 0.1% of all of human history just by the fact that you are a physician.

michaelrack said:
What happened to the Vistaril who was planning on grinding through patients at $200/hr? Did someone hijack his account???
Click to expand...

I only know the guy who constantly says every other field in medicine is better than psych. The grinder vistaril sounds much more interesting!
 
Last edited:
Armadillos said:
Did we ever figure out what state/city vistaril is in? If its public knowledge at this point I would like to know so I can avoid the apparent black hole of a job market doing residency there would get me stuck in.
Click to expand...

Yeah. He, like just nearly everyone here (myself included), has outed himself in the past. I have a hard time seeing his description fitting the area, but then again I'm not there and he does have a tendency to err on the side of hyperbole.
 
happygilmore said:
Lol.

Do you honestly believe a person earning over 150k can't pay off a student loan, car payment and afford rent/mortgage?

Rich people problems!
Click to expand...

I haven't been able to find a job paying close to that. Well I should say I haven't been able to find a job I am comfortable with from an ethical standpoint that pays close to that and:

-will hire me
-isn't at a VA or prison system
-guarantees that salary(ie not on a collections or rvu model that I don't control)

I don't want this to turn into a vistaril complaining thread though. It is what it is. I'll eventually find something and be happy with it Im sure.
 
michaelrack said:
What happened to the Vistaril who was planning on grinding through patients at $200/hr? Did someone hijack his account???
Click to expand...
vistaril said:
I haven't been able to find a job paying close to that. Well I should say I haven't been able to find a job I am comfortable with from an ethical standpoint that pays close to that and:

-will hire me
-isn't at a VA or prison system
-guarantees that salary(ie not on a collections or rvu model that I don't control)

I don't want this to turn into a vistaril complaining thread though. It is what it is. I'll eventually find something and be happy with it Im sure.
Click to expand...

I hope you find something good. Keep searching, you will find it.

Earning the mean income isn't an audacious goal. You can do it.
 
happygilmore said:
I hope you find something good. Keep searching, you will find it.

Earning the mean income isn't an audacious goal. You can do it.
Click to expand...

I agree, but in my case I think it's going to be difficult/impossible to earn mean income and do it in a way I feel ok about.

I could get a high volume grinding job that moves patients in and out like cattle and make mean income. But I'm not interested in that. I would not want to practice IM or family medicine because I don't like those things, but one way in which I am jealous of outpt IMs is that I would be ok with seeing very high volume IM in the right setting. I've seen good IM's do a good job and see 50 a day in clinic. Their outpt reimbursements suck as well, but at least they can make it up with volume. I don't think it's possible for a good psych to see anywhere near that sort of volume and do a decent job....it's just the nature of the fields.

The unfortunate thing is that I don't want to work at a VA. There I could make 150kish + benefits doing outpt, and some of the outpt VAs do have very low volumes(some don't however).
 
vistaril said:
The unfortunate thing is that I don't want to work at a VA. There I could make 150kish + benefits doing outpt, and some of the outpt VAs do have very low volumes(some don't however).
Click to expand...

Why not?
 
vistaril said:
I've seen good IM's do a good job and see 50 a day in clinic. Their outpt reimbursements suck as well, but at least they can make it up with volume. I don't think it's possible for a good psych to see anywhere near that sort of volume and do a decent job....it's just the nature of the fields.
.
Click to expand...

I think it depends on the population. In a community mental health setting with fairly stable chronic mentally ill patients a psychiatrist can do a mediocre job and see them pretty quickly. Back when I was doing IM, I can't imagine any population in which I could day after day see 50 patients and do any type of quality work. That's my own personal experience, I can't argue with what you have seen.
 
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If you can't find a suitable gig, you are either not networking well, too picky, or in a region where you should start a private practice. If the only options are grinding, there is likely plenty of need to start up your own practice. I would definitely pay more to see someone that spends time to make the correct diagnosis.
 
vistaril said:
yeah I know but there are several reasons I would prefer to be in this particular area. But heck life is about compromises I guess so something will have to give. I also can't tolerate cold weather.

I just want to be able to pay off my student loans, my car payment/insurance, and a decent/safe place to live. If I can do those things I'll be satisfied. I'm thinking about just doing IBR on my med student loan as it is because the monthly payment would be so much less. As it is now I'd be looking at the principal+interest on a 10 year payment plan eating up an unsustainable amount of my salary. If I ibr it I'd have much more disposable income every month....I'd have a massive tax hit(under current rules) when it is written off, but heck that's so far in the future I am not worried about it.
Click to expand...

Join the federal prison system, it's concidered underserved and get the public loan forgiveness going. A decent wage to live and good federal benefits with a good retirement plan.
 
Are we seriously engaging with an economic damsel in distress call with a 2 physician income household? You guys are the most empathic people I've ever met.
 
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I don't want this to turn into a vistaril complaining thread though.

Why is this Night Different from all Other Nights?
 
vistaril said:
I just want to be able to pay off my student loans, my car payment/insurance, and a decent/safe place to live. If I can do those things I'll be satisfied.
Click to expand...
You can do that easily in any market. On your own salary, let alone with a partner.
vistaril said:
I'm thinking about just doing IBR on my med student loan as it is because the monthly payment would be so much less.
Click to expand...
Keep in mind that changes radically post-residency. IBR on $150K of loans with $150K of salary is about $1660/month, per the calculator. It's do-able, but it won't be $400/month or somesuch.
 
Nasrudin said:
Are we seriously engaging with an economic damsel in distress call with a 2 physician income household? You guys are the most empathic people I've ever met.
Click to expand...

I didn't realize there were two physician incomes.

Woe is me is an elected attitude. It's rarely a symptom of circumstance.

I'm always amazed people in the top 1% of standard of living feel like they struggle or don't have enough. It's like the tv show downton abbey.
 
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