Advise please. Job offer

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Village

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Hi all
I have a job offer and wanted to get opinions before I accept. Graduated residency 2012. Offered full time outpatient position at a community mental health facility in Florida.
-1hr New Eval, 15/30mins f/u. 30% no show rate. Mostly medicaid.
-salary 210k
-benefits include health/dental/vision. Employee pays 486 a month towards family plan health insurance. Not sure about dental/vision.
-paid holidays (8).
-Accrue PTO up to 15days a year
-No 403b the first year. Only starts after 1year employment.
-Required to be on telephone call during weekdays 13 weeks a year. I think it's 300/week. Very minimal calls.
-Required to be onsite weekend call 13weekends a year paid at 600/day. See new admits Saturday. See new admits and insured patients Sunday.

Is this reasonable?
Thank you.
 
yes it sounds very good EXCEPT for the 13 weekends a year! that sounds like a LOT of weekend work, and if that is extra to the job, then 600/day is extremely poor depending on how many admits you would have to see and whether you would actually have to admit them. the contribution to the health plan seems quite a lot too. also how many patients would you have on your community panel, would you have any time for writing notes, will you have additional help for things like Prior Auths, getting old records, med lists, calling collateral etc, how many patients does each case manager have, will you have a nurse etc etc
 
The pay for call is poor I agree. It's a 32bed CSU unit and sometimes you can get up to 10admits. If you have 10 admits on Sunday added to insured patients for followup it can be alot of patients for 600. After taxes it like nothing left.
- Employees contribute 7788 a year towards premium. Not sure what's fair.
-They claim there is no documentation time as no show rate is high which I disagree. Notes are dictated and 15min med checks can take whole 15mins n I will be struggling to find time to dictate.
- The staff upfront takes care of prior auth, signing ROI for collateral. There is a nurse for vital signs.
-There are case coordinators for treatment plan updates and also case managers for helping clients with access to services.
- Not sure about caseload but I have 18-25 patients on my schedule depending on duration of service.



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Good question. Am not sure. Will have to check on that. It's a problem cos some patients need more than 15mins and I cannot use appropriate billable code cos of time spent.

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Village said:
some patients need more than 15mins and I cannot use appropriate billable code cos of time spent.
Click to expand...
I'm really tired so maybe I'm misreading this, but what are you saying here? Are you saying you can't bill at a certain higher level because the visit was too short?
 
I currently work at this facility as an independent contractor. Get paid 130/hr with no benefits except medical malpractice.
Looking for employed position at this time.
I have to put down code after visit and the other providers put down lower codes for 15min check no matter how symptomatic patient is. Vital signs not done on every visit. Medicare and mostly medicaid patients. So I just have to stick to lower billable codes which does not affect my compensation. I just wish I had 15mins for more stable patients and 30mins for more symptomatic patients.

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I'd suggest that you ask about how the no-show's are handled -do their case coordinators and managers reach out to reschedule or send letters, or does that fall to you to make happen? I also agree that the pay for call is very low.
 
No. Salary 225k. MINIMUM. CMHC hoppers to this organization are likely getting 235-250k.


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F0nzie said:
No. Salary 225k. MINIMUM. CMHC hoppers to this organization are likely getting 235-250k.
Click to expand...

F0nzie is on point - it sounds like they're low-balling you, Village. FL has no state income tax, so maybe they're factoring this in offering a lower salary. Also, they may bank on you taking a lower offer for the convenience of sliding into a position you're already comfortable with as a contractor. If you counter-offer, keep in mind they should pay for *their* convenience of being able to immediately higher someone they already know can do the work based on your past work for them as a contractor.

Either way, I would strongly consider haggling for a higher offer - the pay is poor and the call is bad, especially for a doc out of residency for 4 years (unless you have some dings on your professional record).
 
Member 1337 said:
FL has no state income tax, so maybe they're factoring this in offering a lower salary.
Click to expand...

Excellent points and there are a few items like this I have seen presented in a similar fashion during negotiations such NHSC loan repayment availability or the ability to write off expenses with 1099 which should have absolutely nothing to do with what the employer is offering. These type of things aren't coming out of their pocket so would get absolutely no consideration from me with regard to wage negotiations.
 
Member 1337 said:
F0nzie is on point - it sounds like they're low-balling you, Village. FL has no state income tax, so maybe they're factoring this in offering a lower salary. Also, they may bank on you taking a lower offer for the convenience of sliding into a position you're already comfortable with as a contractor. If you counter-offer, keep in mind they should pay for *their* convenience of being able to immediately higher someone they already know can do the work based on your past work for them as a contractor.

Either way, I would strongly consider haggling for a higher offer - the pay is poor and the call is bad, especially for a doc out of residency for 4 years (unless you have some dings on your professional record).
Click to expand...
No dings on my profession lol. I dread the call schedule. Outpatient docs should not be on a call schedule unless they choose to. The pay is really poor for the work. I may as well stay home than see new admits, do dictations for 600 box. I will try to negotiate higher pay and change call to PRN not as a requirement.

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Village said:
No dings on my profession lol. I dread the call schedule. Outpatient docs should not be on a call schedule unless they choose to. The pay is really poor for the work. I may as well stay home than see new admits, do dictations for 600 box. I will try to negotiate higher pay and change call to PRN not as a requirement.

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Click to expand...

And unless you have taken call there frequently in the past or have talked to other docs who have I'd be skeptical of the "very minimal calls" without first hand knowledge.
 
Jules A said:
And unless you have taken call there frequently in the past or have talked to other docs who have I'd be skeptical of the "very minimal calls" without first hand knowledge.
Click to expand...
I have been on call a few times as they have been calling and begging for me to help. This year I have been on weekend once a month since July only. I have not been on call during the week days. They pay 300week for overnight call. Whether minimal calls or not that's ridiculous. Like 40dollars per call shift

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Village said:
Hi all
I have a job offer and wanted to get opinions before I accept. Graduated residency 2012. Offered full time outpatient position at a community mental health facility in Florida.
-1hr New Eval, 15/30mins f/u. 30% no show rate. Mostly medicaid.
-salary 210k
-benefits include health/dental/vision. Employee pays 486 a month towards family plan health insurance. Not sure about dental/vision.
-paid holidays (8).
-Accrue PTO up to 15days a year
-No 403b the first year. Only starts after 1year employment.
-Required to be on telephone call during weekdays 13 weeks a year. I think it's 300/week. Very minimal calls.
-Required to be onsite weekend call 13weekends a year paid at 600/day. See new admits Saturday. See new admits and insured patients Sunday.

Is this reasonable?
Thank you.
Click to expand...

I typically read job posts and think they are pretty good based on what I see people getting here in the northeast, but even to me this seems like a not great offer. The full time outpatient CMHC job I almost took had a slightly lower base (200k) but there was no call, no employee contribution for benefits, 26 days of PTO, retirement contributions from the get go, AND, since they couldn't offer more money, was 4 days a week. I don't know how Florida compares but the Northeast tends to be the lowest paying so I'd expect you could do better?
 
Village said:
I have been on call a few times as they have been calling and begging for me to help. This year I have been on weekend once a month since July only. I have not been on call during the week days. They pay 300week for overnight call. Whether minimal calls or not that's ridiculous. Like 40dollars per call shift

Sent from my LGLS992 using SDN mobile
Click to expand...

Yeah I get $300 per night for overnight call and despite the units being fairly well run and usually staffed by competent nurses it still isn't enough.
 
SmallBird said:
I typically read job posts and think they are pretty good based on what I see people getting here in the northeast, but even to me this seems like a not great offer. The full time outpatient CMHC job I almost took had a slightly lower base (200k) but there was no call, no employee contribution for benefits, 26 days of PTO, retirement contributions from the get go, AND, since they couldn't offer more money, was 4 days a week. I don't know how Florida compares but the Northeast tends to be the lowest paying so I'd expect you could do better?
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I agree, unless you're located in Miami/Orlando/Tampa, 210k is pretty low. Even then, I would expect at least 240kish in FL...
 
Village said:
I have to put down code after visit and the other providers put down lower codes for 15min check no matter how symptomatic patient is. Vital signs not done on every visit. Medicare and mostly medicaid patients. So I just have to stick to lower billable codes which does not affect my compensation.
Click to expand...
I still don't understand fully what you mean, so maybe you already know this and it's not relevant, but you can certainly bill and 99215 for a 10 minute visit depending on what you do/document in that visit. I get that you want more time for more complicated patients, but that has little to do with how you bill for the visit.
 
hamstergang said:
I still don't understand fully what you mean, so maybe you already know this and it's not relevant, but you can certainly bill and 99215 for a 10 minute visit depending on what you do/document in that visit. I get that you want more time for more complicated patients, but that has little to do with how you bill for the visit.
Click to expand...
When I came on board they informed me most of the patients will fall in 99213 and 99214 category never 99215. N for them the codes are per time spent. I don't really want to argue cos the funds are not directly paid to me. I just would like more than 15mins for f/u. I was told 1hr for new and 30mins for f/u. Some doctors have quit and my caseload increased so most of my patients are 15min med check.

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This is an outpatient job involving a low income population with little resources. You are going to handle 4 difficult patients/hour at times and walk-in emergencies may happen.

In addition to a difficult population, you are essentially on call q4.

Salary is 210k. As a contractor at $130/hr, you currently earn $260K assuming an average of 40 hrs/week and 4 weeks vacation.

Sounds like a terrible offer and a reduction in pay per hour.
 
TexasPhysician said:
This is an outpatient job involving a low income population with little resources. You are going to handle 4 difficult patients/hour at times and walk-in emergencies may happen.

In addition to a difficult population, you are essentially on call q4.

Salary is 210k. As a contractor at $130/hr, you currently earn $260K assuming an average of 40 hrs/week and 4 weeks vacation.

Sounds like a terrible offer and a reduction in pay per hour.
Click to expand...
I agree with you.

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Just as an FYI, the median salary from the 2015 MGMA salary survey for an adult psychiatrist with 3-7 years of experience is $264,705. Does this job seem to have less than 80% of the workload of a median psychiatry job, or do you think their offer is a bit low?

I ask that knowing full-well that the workload is actually higher for this job than most with all of that call and that little vacation.
 
Last edited:
Village said:
I have been on call a few times as they have been calling and begging for me to help. This year I have been on weekend once a month since July only. I have not been on call during the week days. They pay 300week for overnight call. Whether minimal calls or not that's ridiculous. Like 40dollars per call shift

Sent from my LGLS992 using SDN mobile
Click to expand...
The call pay is absurd. I wouldn't take a moonlighting gig as a resident for that pay.

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Village said:
True. I told them I will not be helping out anymore. It's a waste of my time. Either I stay home or sign up with locums that pays better

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Click to expand...

Ive seen CMHC's move to paying tele psych companies to fill the work you are providing. The telepsych company is paying the psychiatrist about $160/hour plus their bounty/cut, which I presume is quite significant, so $130 direct to you seems low to me too.
 
Merovinge said:
Ive seen CMHC's move to paying tele psych companies to fill the work you are providing. The telepsych company is paying the psychiatrist about $160/hour plus their bounty/cut, which I presume is quite significant, so $130 direct to you seems low to me too.
Click to expand...
You are right but here in Florida the average pay for outpatient hourly work is 125 to 130 max (direct negotiation ) with no benefits except malpractice covered. Locums could pay more but no availability. No telepsych in this area either

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Shikima said:
Clearly one must go where the jobs are. $285k/yr with a nice sign on and loan repayment for outpt only, no call and 3d work week.
Click to expand...
Are there any roads, electricity and running potable water in that region? This is too good to be true.
 
There is big counseling group that needs a psychiatrist for med management and offering me a position. It's a medical director position but they are claiming it does not entail typical medical director duties (kinda weird)
New patients 45mins, f/u 15mins. See 28 to 30 patients a day. Work days as per psychiatrist. EMR is not bad. They have independent contractor and employment options. What could be a good hourly rate to propose with this schedule? 185/hr independent contractor rate? I rather not be employed. Any advise is appreciated guys. Thanks

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There are more jobs opening up because of supply and demand.
Ball is in your court, unless you live on the east coast. Then you're screwed.
 
Village said:
New patients 45mins, f/u 15mins. See 28 to 30 patients a day.
Click to expand...

This is an insane schedule. The amount of revenue they generate off of you is > 500k. If they really want you to do this I would consider ask for equity (i.e. partnership status) + RVU.

99213 makes between 100-150. If the numbers are right, revenue varies between 670k - 1.2mil

Shikima said:
... unless you live on the east coast. Then you're screwed.
Click to expand...

Even if you live on the east coast you are probably fine. see the other salary thread.
 
Village said:
There is big counseling group that needs a psychiatrist for med management and offering me a position. It's a medical director position but they are claiming it does not entail typical medical director duties (kinda weird)
New patients 45mins, f/u 15mins. See 28 to 30 patients a day. Work days as per psychiatrist. EMR is not bad. They have independent contractor and employment options. What could be a good hourly rate to propose with this schedule? 185/hr independent contractor rate? I rather not be employed. Any advise is appreciated guys. Thanks
Click to expand...

That schedule and being medical director sounds insane, it better pay amazingly well.
 
sluox said:
This is an insane schedule. The amount of revenue they generate off of you is > 500k. If they really want you to do this I would consider ask for equity (i.e. partnership status) + RVU.

99213 makes between 100-150. If the numbers are right, revenue varies between 670k - 1.2mil



Even if you live on the east coast you are probably fine. see the other salary thread.
Click to expand...

Pay per code is highly variable by location and size of group. 99213 is closer to $65 in my region.
 
Village said:
There is big counseling group that needs a psychiatrist for med management and offering me a position. It's a medical director position but they are claiming it does not entail typical medical director duties (kinda weird)
New patients 45mins, f/u 15mins. See 28 to 30 patients a day. Work days as per psychiatrist. EMR is not bad. They have independent contractor and employment options. What could be a good hourly rate to propose with this schedule? 185/hr independent contractor rate? I rather not be employed. Any advise is appreciated guys. Thanks

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Click to expand...
This is absolutely brutal and I can guarantee they're not willing to pay you anywhere near what this amount of work would really be worth (minimum 500k [I still wouldn't even take it]).
 
st2205 said:
This is absolutely brutal and I can guarantee they're not willing to pay you anywhere near what this amount of work would really be worth (minimum 500k [I still wouldn't even take it]).
Click to expand...

The caveat would be is that they pay for the malpractice insurance as an independent contractor and the salary received is 90% of the collections and 10% for overhead. The down side? No benefits include health insurance.
 
Village said:
There is big counseling group that needs a psychiatrist for med management and offering me a position. It's a medical director position but they are claiming it does not entail typical medical director duties (kinda weird)
New patients 45mins, f/u 15mins. See 28 to 30 patients a day. Work days as per psychiatrist. EMR is not bad. They have independent contractor and employment options. What could be a good hourly rate to propose with this schedule? 185/hr independent contractor rate? I rather not be employed. Any advise is appreciated guys. Thanks

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Click to expand...

This sounds like a big grind. I wonder how long someone would last in a job like that before they burn out?
 
PistolPete said:
This sounds like a big grind. I wonder how long someone would last in a job like that before they burn out?
Click to expand...

Not too bad and can be lucrative. Especially when you have an army of therapists. Grow the clinic to include a PHP or IOP program, pretty comprehensive.
 
Village said:
There is big counseling group that needs a psychiatrist for med management and offering me a position. It's a medical director position but they are claiming it does not entail typical medical director duties (kinda weird)
Click to expand...

If you're medical director, then you will be called to take care of medical director stuff at some point, what this really means is "we're not going to give you any admin time". Depending on your state, responsibilities might include compliance and supervision of mid-levels.
 
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