So can we talk money?

[milkncookies]

Looks like Kaiser (I believe this Kaiser) is offering a base salary of 300,000 now:

"Job Description & Requirements
Adult Psychiatry - San Francisco, CA
Start Date: ASAP
Available Shifts:
Income Potential: Up to $300,000

General Adult Psychiatry - $300,000 Year One Base Salary
Live and Work in San Francisco Proper
Outpatient Only!

Job Specifics:
Physician-owned organization with a partnership track of 3 years
Outpatient-only practice with 1-hour initial visits and 30-minute follow ups
See no more than 10 patients a day – phone call only taken twice a year
Welcoming environment consisting of a supportive team that provides the most integrated, technologically driven and compassionate care
$300,000 base salary year 1, plus up to $150,000 up front recruiting incentive/forgivable loan
Separate $10,000 in relocation
Board certification required
Interest free home loan program–10% of purchase price up to $150,000
Comprehensive health and malpractice benefits
100% paid health, dental and vision for physician and their family
2 retirement options – 401k and a pension
Excellent vacation and CME time off with a $3,000 stipend

"


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[PistolPete]

Looks like Kaiser (I believe this Kaiser) is offering a base salary of 300,000 now:

"Job Description & Requirements
Adult Psychiatry - San Francisco, CA
Start Date: ASAP
Available Shifts:
Income Potential: Up to $300,000

General Adult Psychiatry - $300,000 Year One Base Salary
Live and Work in San Francisco Proper
Outpatient Only!

Job Specifics:
Physician-owned organization with a partnership track of 3 years
Outpatient-only practice with 1-hour initial visits and 30-minute follow ups
See no more than 10 patients a day – phone call only taken twice a year
Welcoming environment consisting of a supportive team that provides the most integrated, technologically driven and compassionate care
$300,000 base salary year 1, plus up to $150,000 up front recruiting incentive/forgivable loan
Separate $10,000 in relocation
Board certification required
Interest free home loan program–10% of purchase price up to $150,000
Comprehensive health and malpractice benefits
100% paid health, dental and vision for physician and their family
2 retirement options – 401k and a pension
Excellent vacation and CME time off with a $3,000 stipend

"


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Wow, that's pretty good, except the cost of living is so high in SF.

 

[Leo Aquarius]

The "10 patients a day" clause is used-car-salesman speak. What you sign at the beginning can and will easily change when your contract is up for renewal next year.

My Kaiser mentor told me about the Kaiser vice. Basically each year she is forced to see more and more patients. Now she is at something like 4 an hour to the point where she's considering resigning. Of course, she says, she never started at this hellish pace. "It was rather reasonable at the beginning." At 300K a year, you bet they're gonna turn that vice. Caveat emptor.

 

[PistolPete]

The "10 patients a day" clause is used-car-salesman speak. What you sign at the beginning can and will easily change when your contract is up for renewal next year.

My Kaiser mentor told me about the Kaiser vice. Basically each year she is forced to see more and more patients. Now she is at something like 4 an hour to the point where she's considering resigning. Of course, she says, she never started at this hellish pace. "It was rather reasonable at the beginning." At 300K a year, you bet they're gonna turn that vice. Caveat emptor.

300k with great retirement, however you work harder and harder... definitely sounds like the "golden handcuffs" they talk about.

 

[NandeYanen]

Has anyone negotiated the max number of patients per day (e.g., 12) into their Kaiser contract? I haven't heard this is possible.

 

[Shikima]

Has anyone negotiated the max number of patients per day (e.g., 12) into their Kaiser contract? I haven't heard this is possible.

I never negotiated with them personally but it is reasonable. Be sure that you have the option to walk away if you feel you cannot negotiate effectively with the organization (which means they really don't need you) or once you start the job, you realize what the work environment is like.

 

[masterofmonkeys]

Kaiser is a Big Machine. The Big Machine really. You are a cog. I would be very very surprised if there was much if any flexibility to their contracts. You're basically interchangeable skilled labor to them.

 

[Information Underload]

The "10 patients a day" clause is used-car-salesman speak. What you sign at the beginning can and will easily change when your contract is up for renewal next year.

Sounds like that if this is the approach that is taken you could place the verbiage that this aspect of the contract (e.g., maximum 10 patient per day) will be repeated in all future contracts. I have a few such phrases in my own contract. They may not bite on that, but that would seem like the best step to take in negotiating with them.

 

[Information Underload]

The only way to live in these Western rural/frontier states is if you love the outdoors no matter how damn cold it is.

The other aspect that people mess up on is that it's not just the cold but also the inversions and cloud cover from November through at times well into June. I see so many Californians high tail it out of here when they realize that all the precious sunshine they saw when they visited in July is just not here for a good half of the year. You better be outside in that overcast and rainy/snowy weather and active, or you're not going to fare well.

 

[NandeYanen]

Shikima (or anyone else with experience working at Kaiser), can you comment on how the bonuses, incentives, and/or raises are given out/decided upon? It is unclear how much one can actually earn on top of the base salary of $300K. In my understanding there's also a separate "partners" dividend-type bonus once you're voted in as a Kaiser partner (after 3 years).

Also, if there are salary raises yearly (like ~3% I heard), is there a cap (e.g., when someone gets to 350K)?

Any thoughts about these $ questions would be appreciated!

 

[Shikima]

Shikima (or anyone else with experience working at Kaiser), can you comment on how the bonuses, incentives, and/or raises are given out/decided upon? It is unclear how much one can actually earn on top of the base salary of $300K. In my understanding there's also a separate "partners" dividend-type bonus once you're voted in as a Kaiser partner (after 3 years).

Also, if there are salary raises yearly (like ~3% I heard), is there a cap (e.g., when someone gets to 350K)?

Any thoughts about these $ questions would be appreciated!

Refer back to MoM's post about being a cog. The only saving grace you have is that Kaiser needs psychiatrists, heck, the whole country does. With this high demand and pressure to provide these services, you have bargaining power. If you can consider working in different institutions other than Kaiser, you may have more power with negotiations.

I don't think anyone can speak specifically on what to say at which moment during the discussions, or have specifics in how they arrange payments. The physician recruiter can give you specific information and details.

 

[Blitz2006]

Refer back to MoM's post about being a cog. The only saving grace you have is that Kaiser needs psychiatrists, heck, the whole country does. With this high demand and pressure to provide these services, you have bargaining power. If you can consider working in different institutions other than Kaiser, you may have more power with negotiations.

I don't think anyone can speak specifically on what to say at which moment during the discussions, or have specifics in how they arrange payments. The physician recruiter can give you specific information and details.

Shikima,

Does Kaiser allow pp on the side?

 

[Trismegistus4]

Shikima (or anyone else with experience working at Kaiser), can you comment on how the bonuses, incentives, and/or raises are given out/decided upon? It is unclear how much one can actually earn on top of the base salary of $300K. In my understanding there's also a separate "partners" dividend-type bonus once you're voted in as a Kaiser partner (after 3 years).

Also, if there are salary raises yearly (like ~3% I heard), is there a cap (e.g., when someone gets to 350K)?

There must be; otherwise, if you started at $300k and worked there for 30 years, your final year's salary would be $728,178!

 

[Blitz2006]

The "10 patients a day" clause is used-car-salesman speak. What you sign at the beginning can and will easily change when your contract is up for renewal next year.

My Kaiser mentor told me about the Kaiser vice. Basically each year she is forced to see more and more patients. Now she is at something like 4 an hour to the point where she's considering resigning. Of course, she says, she never started at this hellish pace. "It was rather reasonable at the beginning." At 300K a year, you bet they're gonna turn that vice. Caveat emptor.

But 300k in SF is still pretty amazing, no?

Here in NYC I heard Beth Israel pays 160k.....

 

[lymphocyte]

I consulted for the NCAL Permanente Medical Group (colloquially known as "Kaiser," but really the physician branch of the Kaiser ACO triad of hospital, physicians, and insurance) and did some compensation review. I'm happy to answer questions over PM (only PM).

I should add that it always pays to 1) get a written contract and 2) have an experienced attorney go over it with you. There is wiggle room, even at Kaiser. But I'd be very surprised if you could negotiate a patient cap (i.e. it's not gonna happen).

Compensation for Kaiser is competitive for the region and includes a tremendous pension (which would be like buying a $3-5 million annuity) and free healthcare for life. It's also striving to develop an academic vibe, with residencies, its own medical school, literature club, and a productive Division of Research.

But Kaiser has its drawbacks. You work hard for the money, and the golden handcuffs are very real. Also, I hope you really like med management...

If you don't mind Big Medicine (@masterofmonkeys' Cog comment being absolutely spot-on), and might want to lateral into administration... it could be a good fit.

 

[notdeadyet]

I should add that it always pays to 1) get a written contract and 2) have an experienced attorney go over it with you. There is wiggle room, even at Kaiser. But I'd be very surprised if you could negotiate a patient cap (i.e. it's not gonna happen).

Boy, that is the rub.

Folks talking about negotiating patient caps with Kaiser don't appreciate their business model.

Kaiser makes its money on volume. It expects its physicians to carry a large caseload and go through them quickly. This is why you will be doing medication-focused visits and not psychotherapy-focused visits. This is why you will spend substantially more time on email correspondence with your patients than other psychiatrists.

Kaiser has some of the best benefits in the business and some of the highest pay. But go in expecting to work fast and hard. If you have something else in mind, Kaiser will likely not be a good fit.

Great post, lymphocyte.

 

[Psychotic]

Boy, that is the rub.

Folks talking about negotiating patient caps with Kaiser don't appreciate their business model.

Won't this be "the rub" virtually everywhere? Particularly after the first contract year? Even with Kaiser, the anecdotal evidence is that they ease you in the first year with a relatively light production burden, and then ratchet it upward. How is this really any different from everywhere else?

 

[SmallBird]

Won't this be "the rub" virtually everywhere? Particularly after the first contract year? Even with Kaiser, the anecdotal evidence is that they ease you in the first year with a relatively light production burden, and then ratchet it upward. How is this really any different from everywhere else?

Well no - there are many settings where your production burden will go down over time as you accumulate other responsibilities (both systems I interviewed at recently had a model where around %15 of time was bought out for administration/teaching, and as people get more senior, became unit chiefs, site training directors, APD's, and work on other committees this percentage would go up).

 

[TexasPhysician]

Won't this be "the rub" virtually everywhere? Particularly after the first contract year? Even with Kaiser, the anecdotal evidence is that they ease you in the first year with a relatively light production burden, and then ratchet it upward. How is this really any different from everywhere else?

This is not true at many locations. Many places allow you to put in patient volume caps. Others are more incentive based, so volume is voluntary.

 

[notdeadyet]

Ditto SmallBird and TexasPhysician. Working directly for a private HMO is its own beast.

 

[Doctor Bagel]

So from my conversations with Kaiser here, they don't allow contract modifications. Work seems busy but doable. It's definitely a payment system, though, that benefits people who stay so I could see where a person might feel stuck if the particulars of their job become less favorable, and they don't want to give up all that retirement money.

 

[mgdsh]

Been away for much of the last month on vacation.

We have certain requirements like having 6 appointment slots per unit worked (1 unit = 4 hours) and 10 new appointment slots per week. For us, this is the expectation, regardless of tenure. I'd imagine each region/department is slightly different.

Really not that bad, only ~1 year in thus far. In the end of it you handle a larger case load but have a support staff to help you. Most corporate environments will want to maximize their overall efficiency. Kaiser is no different.

In many way's it's a blessing to work directly for an HMO. They know exactly how much they are bringing in with premiums, they don't have as many middlemen/women billing, they provide much of the services they cover, etc.

 

[prominence]

Here are word of mouth ranges I've heard -- they're pretty broad, and it doesn't seem like more money is tied with more experiences/skills.

Fulltime inpatient with call -- $220/year to $260/year
VA gig -- this one is easier -- $190 to $220/year
Fulltime community -- $200 to $220/year
Fulltime outpatient Kaiser type of job -- $190 to $220/year

This numbers seem to fit with job offer emails I get. Average posted salaries for psychiatrists look a lot lower than what average pay actually is. I always wonder if I'm missing something.

Every VA is different but some VA job announcements for non-administrative psychiatrists now list the maximum potential salary offered as $320,000.

Are any outpatient psychiatrists in the VA making this type of salary or is this more applicable for inpatient psychiatrists in the VA?

Anecdotally, the highest salary that I have heard for a non-administrative outpatient VA psychiatrist is in the $240,000 to $250,000 range.

Any thoughts?

 

[splik]

Are any outpatient psychiatrists in the VA making this type of salary or is this more applicable for inpatient psychiatrists in the VA?

Any thoughts?

I dont think inpt vs. outpatient makes a difference, and it would not make sense for inpt VA psychiatrists to get paid lots as it doesn't require any work and they usually aren't desperate for inpt docs whereas they are always looking for outpt docs.

location seems to make a huge difference. the other bizarre thing that seems to be causing some tension is that the VA salaries are relatively fixed, so if you come new to a VA you could be making significantly more than someone who had been working there for some years (as the increased pay points are for new hires not across the board), and this has created tension in some of the VAs I have looked at.

 

[keifernny2]

I haven't heard of any VA jobs that pay 320k to psychiatrists unless they're talking about total compensation (counting in all benefits, including what the government pays itself for your pension, which, imho, is a bit inflated due to how the pension is funded).


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[TexasPhysician]

I've seen VA gigs at $265,000. All clinical

 

[Indodo]

Are you sure about 10 patients per day?
Kaiser has this thing called 10-10s where you are scheduled 100 patients a week. 10 patients per half day.

Either way its not the patients you see at kaiser that matter. The phone calls, emails are what kills you. You are expected to manage patients without actually seeing them. You may not see a patient for years but keep refilling their medications, answering emails etc.

You will get paid more than the average employed job, but you will work more as well.

 

[TexasPhysician]

You are expected to manage patients without actually seeing them. You may not see a patient for years but keep refilling their medications, answering emails

What you describe is an attorney's dream. There is no shortage of psychiatrists willing to testify against that.

 

[keifernny2]

What you describe is an attorney's dream. There is no shortage of psychiatrists willing to testify against that.

There are a lot of state agencies pushing toward this model to save money, and the only pushback is the liability issue. If liability could be limited (e.g. State passing a law, which they are motivated to do as this will cut their Medicaid costs), this will become a more common job model. I've already been offered 2 jobs just like this in NY which are hospital based and not insurance company based.


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[PistolPete]

Interesting. Similarly, the whole VA model where the psychiatrist serves as a "consultant" to the PCP, recommending meds without actually seeing the patient, is beyond me.

 

[Shikima]

Interesting. Similarly, the whole VA model where the psychiatrist serves as a "consultant" to the PCP, recommending meds without actually seeing the patient, is beyond me.

The VA model is that the physician is responsible for most everything - clerical duties, nursing duties, treatment duties, email duties, etc.

 

[nexus73]

The VA model is that the physician is responsible for most everything - clerical duties, nursing duties, treatment duties, email duties, etc.

In residency, I remember asking a VA front desk staff to request records from a patient's prior psychiatrist. Apparently it's not within their job description.

 

[DD214_DOC]

There are a lot of state agencies pushing toward this model to save money, and the only pushback is the liability issue. If liability could be limited (e.g. State passing a law, which they are motivated to do as this will cut their Medicaid costs), this will become a more common job model. I've already been offered 2 jobs just like this in NY which are hospital based and not insurance company based.


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Wait, what? This is actually a thing? I will do some things over the phone in between appointments if necessary, but I don't have anyone who I manage solely through email or phone. Well, I don't do things over the phone personally, as my nurse is actually the in-between. This is my solution to the multiple daily attempts from patients who try to turn my return phone call to answer a question into a 20-30 minute f/u by phone.

 

[Armadillos]

Interesting. Similarly, the whole VA model where the psychiatrist serves as a "consultant" to the PCP, recommending meds without actually seeing the patient, is beyond me.

If your at the VA you don't have the specter of liability looming, so seems like could actually be a nice setup in some ways.

E-Consult: 55 yo male hx chronic back pain reports he is anxious and can't concentrate, reports 10 years ago Xanax 2mg TID and adderall was the best regimen. Should I restart?

"No"

 

[keifernny2]

It's a care model where you are less "provider" and more "treatment team manager." Think of it like your current job, but where you don't actually have to see the patient at all. You are presented their case from the SW, CM, and nurse and give instructions.


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[sweetlenovo88]

Is there really no liability here? Because it is the VA you cannot be sued or get dinged in provider database?


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[TexasPhysician]

Is there really no liability here? Because it is the VA you cannot be sued or get dinged in provider database?


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No. You can still be sued. It is a more difficult process though.

 

[TexasPhysician]

There are a lot of state agencies pushing toward this model to save money, and the only pushback is the liability issue. If liability could be limited (e.g. State passing a law, which they are motivated to do as this will cut their Medicaid costs), this will become a more common job model. I've already been offered 2 jobs just like this in NY which are hospital based and not insurance company based.


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Eliminating liability is going to be next to impossible in our society. This care model has existed for at least a decade, but few psychiatrists are willing to assume the risk.

 

[Merovinge]

No. You can still be sued. It is a more difficult process though.

Near impossible, at least where I practice. Not a single one of the VA psychiatrists had ever been named in a lawsuit where I trained (which accounted for several hundred years of practice, whereas it should be about 30 years/suit in general practice psychiatry).

 

[PistolPete]

Near impossible, at least where I practice. Not a single one of the VA psychiatrists had ever been named in a lawsuit where I trained (which accounted for several hundred years of practice, whereas it should be about 30 years/suit in general practice psychiatry).

Do you think that's because of "the system" or "the man" somehow blocking the lawsuits, or simply the population doesn't know any better or have the means to bring a suit against their psychiatrist?

 

[Merovinge]

Do you think that's because of "the system" or "the man" somehow blocking the lawsuits, or simply the population doesn't know any better or have the means to bring a suit against their psychiatrist?

Surprisingly, I believe it's the former. I had thought you had complete impunity (which is what one of the docs told me who worked 30 years at the VA spa). Texas is a smart guy though, so I suspect he knows better than I.

 

[TexasPhysician]

Near impossible, at least where I practice. Not a single one of the VA psychiatrists had ever been named in a lawsuit where I trained (which accounted for several hundred years of practice, whereas it should be about 30 years/suit in general practice psychiatry).

Anything but impossible, but that doesn't mean it happens often. Lawsuit costs are high and more complicated when suing the Federal government. Since 2001, tax dollars have paid over $700 million in malpractice related issues.

The Supreme Court even approved changes in 2015 that make lawsuits easier against federal employees. Still doesn't mean it happens often.

 

[TexasPhysician]

I had thought you had complete impunity (which is what one of the docs told me who worked 30 years at the VA spa).

I won't pretend to understand how the government places blame or assigns monetary assignment to its physicians. It may be that the VA picks up the tab rather than pay for private malpractice insurance for everyone.

My point is that there is liability at every level, even the federal government. Your actions can cause damages that result in compensation and physicians can still be reprimanded whether through loss of employment or other means.

 

[Shikima]

I won't pretend to understand how the government places blame or assigns monetary assignment to its physicians. It may be that the VA picks up the tab rather than pay for private malpractice insurance for everyone.

My point is that there is liability at every level, even the federal government. Your actions can cause damages that result in compensation and physicians can still be reprimanded whether through loss of employment or other means.

http://www.mcclatchydc.com/news/nation-world/national/article118292888.html

 

[vistaril]

The VA model is that the physician is responsible for most everything - clerical duties, nursing duties, treatment duties, email duties, etc.

must be tough to fit all that stuff in during the day....what with the 7 or so ptsd/anxiety/dysthymia med check/refills(of the pts who show up) you have to fit in during an entire day. Where do you find the time?

 

[MLT2MT2DO]

must be tough to fit all that stuff in during the day....what with the 7 or so ptsd/anxiety/dysthymia med check/refills(of the pts who show up) you have to fit in during an entire day. Where do you find the time?

This reminds me of Herpes, you completely forget they are there until you have an active outbreak...then you're like "oh $!@& not this again, can't I ever get rid of this?"

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[Shikima]

This reminds me of Herpes, you completely forget they are there until you have an active outbreak...then you're like "oh $!@& not this again, can't I ever get rid of this?"

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[clozareal]

Maybe someone could explain the nuances of this report to me since I don't have much firsthand experience, and perhaps this has been brought up on this forum before - I apologize if it's already been discussed at length. The Bureau of Labor and Statistics (https://www.bls.gov/oes/current/oes291066.htm) has data on location and pay for psychiatrists.

States with highest total number of psychiatrists: California (3,160) closely followed by New York (3,110), Ohio (1,140), Illinois (1,000), and Pennsylvania (940)
States with highest concentration of psychiatrists compared to other jobs: Rhode Island followed by Connecticut

Top paying states: California, then Wyoming, South Dakota, Indiana, and Alaska

Top paying cities: Wichita Falls TX, Vallejo-Fairfield CA, Oakland-Hayward-Berkeley CA, Los Angeles-Long Beach-Glendale CA
Top paying rural areas: Southern Vermont, then Southern Ohio, Southeast Oklahoma, and West Texas

It looks like the top pay for psychiatrists is $134.30 per hour in Southern Vermont, which if you're working 40 hours and 48 weeks, that would equate to ~$258k.

I was always under the impression that you can get paid more in rural (i.e., nonmetropolitan) areas, but my interpretation of the BLS data is that the numbers are pretty similar between rural and nonrural areas when you look at it as a whole. Looking at this data might just be a foray into my confirmation bias and for those looking at it. Of course, this is just looking at salary alone and not factoring in cost of living, where it's best to raise a family, and other factors that go into net benefit for that person looking for a job in a certain area since none of that is captured in this census data.

 

[Shikima]

These studies do not account for cost of living increases from either coast.

 

[thepoopologist]

So, after my 1st month of interviewing, I was offered jobs from all the places I interviewed, for positions ranging from $240,000 to $310,000 for the inpatient/prison/state hospital settings. Only 1 of these offers had call (the highest offer). The others offered a 40 hours work week with no call, reasonable to light workload, with the option of 4/10 hour days. Vacation was about 5 weeks, CME was about 1 week with 1k on average. I am not sure what I will be doing with all the time and money I'll have, because after 6 more years of IBR/PSLF my loans may actually be forgiven. If they aren't, well I guess I'll moonlight with the three days a week I'll have available.