Advice re: Neuropsychology Productivity Requirements for Job

[neurotic_cow]

Hello all!

Happy Monday after daylight savings! 😴 I recently interviewed for a full-time outpatient neuropsychology position at a hospital and was told I would not be required to meet a specific RVU requirement, but that I would be responsible for "36 billable hours"... Can someone help translate that for me? Is that good, bad, questionable? Appreciate any and all insight/advice y'all have! Thanks in advance!

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[erg923]

Hello all!

Happy Monday after daylight savings! 😴 I recently interviewed for a full-time outpatient neuropsychology position at a hospital and was told I would not be required to meet a specific RVU requirement, but that I would be responsible for "36 billable hours"... Can someone help translate that for me? Is that good, bad, questionable? Appreciate any and all insight/advice y'all have! Thanks in advance!

Nine hour days, 5 days a week. Few breaks. Maybe time for one staff meeting. Short lunches. Pretty much no flexibility.

 

[WisNeuro]

36 is somewhat easy for neuropsych, because so much of what we do is pure billable time. However, under this productivity set for a salaried job, I would assume 1 or fewer meetings per week, and zero expectations to train prac/intern/postdoc trainees. Otherwise, I would insist on clinical hour offsets as trainees take a good chunk of time.

 

[WisNeuro]

Obviously, whether or not this is a good deal depends on your overall compensation package.

 

[neurotic_cow]

Obviously, whether or not this is a good deal depends on your overall compensation package.

The salary seemed reasonable to me (110-115 base + possible bonus for exceeding productivity), especially given the area (relatively low cost of living) and considering it is my first year out of postdoc. Would it be more beneficial to advocate for an RVU model vs. billable hours? I don't know if they'd be able or willing to change it but I've never heard of a neuropsych job with billable hour requirements, only RVU requirements. In this role, I wouldn't have any trainees, though we discussed possibly having them in the future, which makes me a little concerned. There is also no tech support, so I would do all of my own testing and scoring. I also had the thought about how that might work if I have last minute cancellations or no-shows..

 

[WisNeuro]

The salary seemed reasonable to me (110-115 base + possible bonus for exceeding productivity), especially given the area (relatively low cost of living) and considering it is my first year out of postdoc. Would it be more beneficial to advocate for an RVU model vs. billable hours? I don't know if they'd be able or willing to change it but I've never heard of a neuropsych job with billable hour requirements, only RVU requirements. In this role, I wouldn't have any trainees, though we discussed possibly having them in the future, which makes me a little concerned. There is also no tech support, so I would do all of my own testing and scoring. I also had the thought about how that might work if I have last minute cancellations or no-shows..

RVU vs. billable hours completely depends on how they compensate per RVU. Billable hour requirements are pretty common, though I have generally seen 32 or 24 floated as admin stuff can eat time like you wouldn't believe. No tech support isn't a big issue as the testing is pretty easy hours, and they only care about how many hours you bill, that's their problem for using your tine to bill some of those hours at essentially the same rate as a tech. Base is okey-ish for starting, though it really depends on how it scales up in years 1-5.

If you have trainees, I would insist in clinical offsets, otherwise I'd be wanting a sizable pay raise, or I's be looking for a new job. Trainees are a HUIGE time sink, especially at the prac and intern level.

 

[AcronymAllergy]

For 36 billable hours, depending on the type of evaluations you're conducting, you're probably looking at about 5 evals (w/feedback) per week. I agree with WisNeuro that I've more commonly seen 30 to 32 as a minimum requirement. Although a lot could also depend on how they "count" no-shows. With an RVU model, they're probably going to expect you to hit those RVU numbers regardless of no-shows and cancellations. With a billable hours model, you may still get "credit" for no-shows, since you were at least scheduled for those hours that week. Although that's probably more common in VA where the hospital getting paid for that time is of somewhat less importance. This may be something that's negotiable.

Using my handy dandy Excel spreadsheet, if your evals average 7 total hours (1 hour interview w/96116 as opposed to 90791, 3 hours testing & scoring, and 3 hours evaluation services to include feedback), at 5 evals/week for 48 weeks/year, you're making the hospital $161k/year assuming Medicare rates (private insurance may pay a bit more). Which is right at 1.4x the upper end of the salary you mentioned. So, at least IMO, it doesn't seem like a horrible deal from that perspective. But exceeding those productivity numbers is going to be tough if you're having to make up for no-shows and cancellations and you only want to be at work 40 hours/week.

 

[PsyDr]

You would never meet those expectations in a 40hr work week. A single no-show would destroy your month. So, the impetus would be to over-schedule and "dictate at home".

Additionally, you could not afford to take on any non-billable activities (e.g., phone calls, faxes, emails, or meetings.)

 

[AcronymAllergy]

You would never meet those expectations in a 40hr work week. A single no-show would destroy your month. So, the impetus would be to over-schedule and "dictate at home".

Additionally, you could not afford to take on any non-billable activities (e.g., phone calls, faxes, emails, or meetings.)

And RE: non-billable activities, they aren't exactly giving lots of time for lunch or any other breaks.

 

[WisNeuro]

And RE: non-billable activities, they aren't exactly giving lots of time for lunch or any other breaks.

Nowadays at most institutional jobs, your technical schedule is 8.5 hours, with that extra half hour being your lunch break.

 

[AcronymAllergy]

Nowadays at most institutional jobs, your technical schedule is 8.5 hours, with that extra half hour being your lunch break.

True, true. Although I've also often seen those 8.5 hour days include a one-hour lunch break. So that eats up (haha, pun) over half of the 4 hours of non-billable time.

But yeah, take home message--with a 36 billable hour expectation, your ability to do anything outside of testing patients, writing reports, and providing feedback is going to be pretty much nil unless you definitely want to be working >40 hours/week consistently.

 

[Therapist4Chnge]

Beware of "...duties as assigned" too. It's too easy for things to get added and push you to working a number of hours at home/nights/weekends. Personally I'd push back at 36 billable hours. 28-32hr/wk and then productivity bonus above that. If their payor mix is better than medicare, there is definitely room for them to still make their piece and you not be overworked.

 

[AcronymAllergy]

Beware of "...duties as assigned" too. It's too easy for things to get added and push you to working a number of hours at home/nights/weekends. Personally I'd push back at 36 billable hours. 28-32hr/wk and then productivity bonus above that. If their payor mix is better than medicare, there is definitely room for them to still make their piece and you not be overworked.

Seconded. I'd really push for 30 or 32 hours, especially if they expect you to attend any meetings and/or participate in billing in any way (e.g., follow-up calls to establish necessity or answer questions for the insurance companies).

 

[WisNeuro]

Seconded. I'd really push for 30 or 32 hours, especially if they expect you to attend any meetings and/or participate in billing in any way (e.g., follow-up calls to establish necessity or answer questions for the insurance companies).

Indeed, as a point of reference, my old hospital job was a mix of inpt/outpt where the expectation was ~30-32 billable hours, and compensation was five figures higher than quoted by OP. All depends on location, but essentially adding on almost an additional eval for less money would be a tough sell in most markets unless the non-salary compensation was primo.

 

[neurotic_cow]

Hmm interesting. As always, your discussion is extremely helpful. Do you have any recommendations for how to go about pushing for 30-32 hours vs. 36? I don't want to come across as lazy but it does seem like a lot. I'm not certain the best way to go about bringing up something like that. My supervisor said that 36 is pretty standard but what I'm getting from this discussion is that that is not entirely accurate.

Every place I've trained at thus far has not had built in hours for lunch and the last time I had built in breaks/lunch time was when I worked at Target in undergrad, so I am used to not having a lunch break... whether that is healthy or not is a discussion for another time haha

 

[AcronymAllergy]

If everything else sounds great, that's maybe how I'd approach it--if you're able to reduce the billable hours expectation to 32, everything else about the job seems great.

Although others with more experience in the area can probably do better than can I.

 

[ClinicalABA]

36 hours is a rather high billable expectation, in my experience. I do regularly bill at least that per week in assessments, so it's doable within a reasonable work week, with an few hours on evening or weekends if I am a little less efficient during the week. However, I am eligible for bonuses based on high productivity, have almost 0 no shows (and if they do no-show, its for the initial interview (one hour 90791 code, after which I can reassign the testing hours that are in the schedule for a few weeks later to somebondy on the waitlist). My actual billable requirement is much lower, though I'm expected to participate in practica/intern/BCBA supervision and training, as well as graduate instruction. Also- my productivity is reveiwed on a monthly basis, with bonuses based on quarterly productivity. This is good, in that it allows me to bill a lot for a few weeks, and then less for a few weeks (though I keep "banking" these billable hours and never having a "slow" week so that I can make a dent in my waitlist).

As far as "built in hours" for lunch, etc., I'm trusted to do what I want when I want. If my billables were low, somebody would probably say something, but my boss(es) work in a different part of the state and I'm left to set my own schedule.

 

[PsyDr]

My supervisor said that 36 is pretty standard but what I'm getting from this discussion is that that is not entirely accurate.

There is a difference between regularly doing something and being required to do something.

 

[AcronymAllergy]

There is a difference between regularly doing something and being required to do something.

Agreed 100%. It may not be unusual to consistently hit 36 billable hours per week, but being required to do such seems high.

The wRVU numbers may have changed since I entered them into my spreadsheet a year or two ago, but with the specifics I outlined above, that would equate to 2685 wRVUs per year.

 

[Pragma]

While it won’t hurt to ask, I would guess the billable hours is the norm for that department or institution. They probably won’t negotiate that if it is set that way for everyone.

FWIW, AMCs still typically are not considered 40 hour work week jobs. That’s probably more common outside of AMCs.