weekend inpt only vs outpatient position

[skydust03]

As I'm going forward with a career decision, there are two completely different opportunities at the moment.

One would be a weekend inpatient/CL coverage from Fri PM- Mon AM, working 40 weekends, and likely occasional work during the week with their fellowship

VS

Outpatient - 40hr/week, on call for your patients, ~3 weeks vacation. Can squeeze it into a 4 day work week.

Outpatient would pay about 50k more than inpatient...

Any thoughts?

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[notdeadyet]

Do you have children, a partner, and/or friends?

 

[wolfvgang22]

I think it depends on a lot of factors, some personal off the top of my head in no particular order:

• what the actual salaries are - I might like doing weekends like that if the salary was $200K for the weekend job, but I probably wouldn't do it for 150K
• do you have family and friends that are off mostly on weekends while you'd be working, and you'd miss spending time with them, or do you like the idea of being able to travel and shop and do things during the week while it's less crowded?
• You'd be covering other people's inpatients on the weekend most likely. How many admissions do they get on the weekends - would you be doing those? I bet you would. Would you be having to discharge everyone else's patients on Friday? Will you constantly be cleaning up others messes, or are their doctors conscientious about their patient care and discharge plans? What about social work support for discharges?
• Are you on call for consults 24 hours Fri-Mon with the weekend job? Might not be a big deal, unless this is a large hospital with a very busy psych ER and you are the one they call constantly while you're covering the inpatient too. Would you be the only doctor doing this Fri-Mon gig? Are the fellows going to help you out with consults and/or inpatient?

 

[skydust03]

So, weekend is 162, and outpt would be around 200-210.

I really like that the week could be so flexible, but can definitely see the downside of missing out on certain events.
So its a child inpatient unit, which typically is full, with 14 beds. EMR is Epic
So, they discharge a lot on the weekends, so potential avg of 5 admits and 4-5 consults/day
The ER has a 24hr social worker, so they will be staffing admissions only, apparently they don't staff discharges, which is their hospital policy.

I would be the only attending, +/- a fellow, definitely will be days where I will be solo.
Currently there would only be 3 fellows in the program, and I think they're just required to do at least 1 weekend day/month.
So potentially, 1/2 the shift would not have a fellow.
Also, they do family meetings on the weekends, so 2/day, and I'm sure they will want to speak with the doctor.

Currently married without children, but hoping in the next 1-2 years for a child.

 

[OldPsychDoc]

Family meetings when you aren't the admitting physician, and haven't been on the treatment team all week?
They're not paying enough!!!

 

[heyjack70]

5 admits per day?...!!!...are you crazy? Plus 4-5 consults per day?? Please. This is a ton of work. You are going to be working 14+ hours a day. I think you could do a crappy job, and try to dodge family meetings, and dodge weekend consults to make this reasonable.

To put this in perspective. I was moonlighting on an adult unit, with an admittedly very sweet contract. It was 24 beds, covered by two psychiatrists. Discharges were uncommon, and rarely were any planned on weekends. Essentially no consults. Maybe 2 admits per day on average. Absolutely no family meetings because I'm just covering the weekend. Get paid $3000 per weekend. That's $156,000 per year if there were 52 weekends worked..

For the amount of work you're going to be doing I would figure out a per weekend rate and multiply that by 52 weekends. From an RVU standpoint, I'm thinking 10 followups per day (99231 or 232?), say 50/50 that's average of about 1 RVU per followup = 10 RVUs. Plus 4 discharges at 1.28 (99238) = 5.12 RVUs. Plus 4 admits at 2.61 (99222) = 10.44 RVUs. Not counting consults (which could add another 10+ RVUs each day) you're already at 25 RVUs per day x $60 per (What's reasonable for child psych inpatient?)= $1500 per day. Add in consults, plus the fact you're on call by phone the entire weekend, right? Plus the CPT codes I used were lower complexity/time than you might be using in reality. I think this is AT LEAST a $4000/weekend job. Which is $208,000 if you work 52 weekends each year. Unless this is a major city with child psychiatrists clamoring to work weekends I think you have significant leverage in regards to pay.

 

[skydust03]

I know, it's going to be super busy, no doubt. The current docs say you'll see on avg 19 pt/day

I do similar moonlighting at $73/hr. What they're offering ends up being 64.29/hr

I was hoping at least 190, as this is basically the job that no one wants to work, and its been listed for about 3 years.
Their inpt child doc gets around 190.

I'm talking to a contract person tomorrow, but I can't see their offer increasing substantially if the initial is so low and disappointing.

 

[Bartelby]

Honestly the inpatient setup sounds sort of appealing in a way. You will work very hard... but for two and a half days a week!

Even without a fellow, those five admits have all had a full evaluation in the ER right? That means even though of course you must do a full and competent evaluation you may not need to get as bogged down in every detail, especially when it is relatively straightforward (straightforward depression, for instance, rather than a complicated psychotic v medically ill patient). That means the five admits could take an hour each, maybe less with practice. The four to five consults I assume are floor consults which would be followed up by the day consult team? Those I think you might expect 1.5 hours for, though that can often be shaved down. Add in rounding on the fourteen inpatients with some discharges and you are up to 14+ hours per day.

BUT... that is without a fellow. Also, that assumes that a 14 bed unit discharges more than one third of its patients every day, and on a weekend no less. It also assumes that those spots fill that day. I wonder if the admit numbers will end up lower. That also assumes five consults per day, but if that is a high end estimate there is again time saved there. Getting the hard data on exactly how many admits, discharges and consults happen each weekend would help clarify these worries. But adding a fellow to the mix if the job ends up being Friday evenings, let's say ten hours Saturday, then fourteen hours Sunday followed by Mon to Thursday completely off with no beeper that is still tempting. Of course, it's only tempting if you have a spouse or significant other who has that time off as well. If you have a spouse working Mon to Friday then I think the weekend job gets an immediate stamp of disapproval. For the years before your child goes to school though (approx 7 years away by your estimate), this setup could allow for huge amounts of family and fun time with short "sprints" of work intermixed. If that is your thing this could be quite good.

 

[skydust03]

Thanks Bartelby, yes it's so tempting to have that flexibility, esp with raising kids.

My husband works from home, so I would be able to figure out some time with him during the week.
His point was that if I start on this salary, that will basically be what is my "baseline."
He wants me to go for the outpt job, potentially 8a-7p four days/week or 8-5 five days/week and about 50k more.

I really enjoy the inpatient pace, and I can see myself adapting there.
As far the outpt position, they are building a brand new child building, which is nice.
Great supportive staff, good atmosphere overall.
However, they definitely load your schedule as much as possible here. Starting caseload is ~700pt, not sure if that's average?

I'm really caught in between the two, as this will be my first job out of fellowship, and they are two completely different directions.

My husband feels that it's a no brainer, and go for the job where they show value for you, which in his opinion, the inpt offer doesn't display that.

I feel like maybe the salary difference would be worth that family time

 

[heyjack70]

I know, it's going to be super busy, no doubt. The current docs say you'll see on avg 19 pt/day

I do similar moonlighting at $73/hr. What they're offering ends up being 64.29/hr

I was hoping at least 190, as this is basically the job that no one wants to work, and its been listed for about 3 years.
Their inpt child doc gets around 190.

I'm talking to a contract person tomorrow, but I can't see their offer increasing substantially if the initial is so low and disappointing.

Do you know how they are covering the weekend currently?

 

[skydust03]

Currently, they rotate through their 3 inpatient (2 inpt, 1 CL) and 5 outpatient physicians. So about 8 physicians are in the call pool.

 

[michaelrack]

So this is a 40 weekend per year job, at 162k- approximately 4k per weekend. 14 beds. Should be about 20 hrs per weekend- about 200$/hr. Don't do as detailed consults as you are accustomed to (of course sometimes it will be necessary).

The most hours I have ever worked covering a 30 bed adult unit over the weekend is 26.5 hrs; there were less consults than you describe, however.

take the weekend job and be efficient

 

[TexasPhysician]

I'd negotiate a higher rate at inpatient job, but I'm anti 8-5.

 

[Baller MD]

I'd negotiate a higher rate at inpatient job, but I'm anti 8-5.

Why are you anti 8-5?

 

[st2205]

Why are you anti 8-5?

Because 9-3 is always better than 8-5.

 

[Baller MD]

Because 9-3 is always better than 8-5.

I didn't know those exist in psych. How much dough are you giving up though?