An Offer Letter for CAP/Assistant Professor Clinical Non Tenure Track

[Marasmus1]

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Midwest Location, University Hospital, Low COL area,

Child and Adolescent Psychiatry Outpatient
Base: 210k
Sign on: 10k
Relocation: 6k
24 days Annual Vacation
18 annual sick days
12 federal holidays
5 CME days with 3500 reimbursement
Retirement Pension plan through University ( 10% contribution annually)
403b plan through Faculty Practice with 6% match
90 minutes intakes
Flexibility to see 45 min to 60 minutes follow ups, Average 6-8 patients a day
Expect to have 1 adult resident, 1-2 med student and/or 1 child fellow to supervise ( They have their own case load)
6 weeks pager call annually, there is adult resident junior and senior NF team, On weekends you round with residents and sign their notes
No RWU expectation/bonus
Quality bonus is offered annually
No research expectation but expect me to do didactics, case presentations etc.

Could you please give me your two cents about this job? Initially I thought It was terrible but now I am having second thoughts as some of my senior faculty said this can be great work life balance job

 

[Ironspy]

Seems like good work load but the salary is really low esp for CAP. That’s common in the northeast but Midwest tends to pay better. I would try to negotiate out of call. Ask if they can do better on salary.

 

[TexasPhysician]

Anything outside of academia would pay better. If academia is your calling, that is fine, but just expect to be always underpaid. Not much you can do about that as people still do it for the few perks.

 

[calvnandhobbs68]

I get the pay is relatively low compared to PP but look at the workload. for 6-8 followups a day with 90 minute intakes and 45-60min followups with basically 7+ weeks off a year (vacation plus federal holidays plus sick days) plus a decent 403b match and probably pretty good insurance options it’s pretty good if you’re looking for a chill workload.

I mean for comparisons sake if I only saw 8 followups a day and billed them ALL 99214+90833 (which is not my current billing pattern) x 5 days a week x 45 weeks a year (take the 7 weeks of holidays out but could be more depending on sick days), it comes out to about 285k. I mean I guess I could bill them as 90836 with that amount of time but that would definitely get really suspicious really fast. You don’t have that billing concern in academics. Yeah I don’t have to supervise residents or take call but I also have to fund my own retirement plan, pay my own health insurance and don’t get CME. So relatively it’s not that terrible if the workload is truly what it is.

 

[Marasmus1]

Anything outside of academia would pay better. If academia is your calling, that is fine, but just expect to be always underpaid. Not much you can do about that as people still do it for the few perks.

But would you say that considering the amount of work and benefits , I am underpaid?

 

[TexasPhysician]

But would you say that considering the amount of work and benefits , I am underpaid?

Compared to pp, yes. Sure your patient # is low, but 45+ minutes adds 90836 therapy codes. That’s a busy day. You are also likely doing something in academia from 8-5 M-F. From teaching, signing off on residents, meetings, etc. The average pp doc will elect to see more patients per day, skip lower paying pursuits, work fewer hours per week, and take less call/weekend rounding.

 

[clozareal]

This is an equivalent/better package than what I'm seeing on West Coast HCOL academic universities for CAP. Academic settings tends to be 50-100% less in compensation than what nonacademic places are paying for CAP in this area although you're working much harder in those settings so it sounds like a great work life balance. It all depends on what is important to you and what your immediate financial needs and long-term financial goals are. There's a lot to be said about the rewards of teaching and being part of a great team of colleagues that provides meaningful benefits outside of financial compensation. There's also a lot of downsides to being part of a Big Box Shop as @Sushirolls will probably note.

Is there any chance you can negotiate down call? For me, I don't want to do any uncompensated work on weekends in the hospital anymore and doing one weekend every other month can be a bummer.

 

[Marasmus1]

This is an equivalent/better package than what I'm seeing on West Coast HCOL academic universities for CAP. Academic settings tends to be 50-100% less in compensation than what nonacademic places are paying for CAP in this area although you're working much harder in those settings so it sounds like a great work life balance. It all depends on what is important to you and what your immediate financial needs and long-term financial goals are. There's a lot to be said about the rewards of teaching and being part of a great team of colleagues that provides meaningful benefits outside of financial compensation. There's also a lot of downsides to being part of a Big Box Shop as @Sushirolls will probably note.

Is there any chance you can negotiate down call? For me, I don't want to do any uncompensated work on weekends in the hospital anymore and doing one weekend every other month can be a bummer.

Thank you for the suggestions. Actually, I have just countered it 230 k base with bonus structure above certain threshold (Which I will unlikely to reach considering teaching responsibilities). Recruiter feels the department will not make a fuzz about 20 k for a position they have been looking for to fill for a while (This is J1 Waiver area despite of being 100% Academia)

I have zero loans ( Thanks to socialized public education in my country I guess?). I do enjoy academia more than private because I do like working with learners and passionate about research. I do like money too though ( Well, who doesnt?)

Long term goals (after obtaining Green Card) is opening my own boutique shop while using my part time academic affiliation for teaching and research only.

 

[Psych19]

That's a ton of paid time off.
18 sick days?
almost 5 weeks vacation + 12 paid holidays?
Does the VA even offer that much time off?

How many weekends do you have to work per year? How many holidays?

 

[m2k]

VA have the same vacation, 26 days + 13 sick days.

I heard VA is offering $40 sign on bonus if you want to practice adult psyc.

 

[calvnandhobbs68]

Compared to pp, yes. Sure your patient # is low, but 45+ minutes adds 90836 therapy codes. That’s a busy day. You are also likely doing something in academia from 8-5 M-F. From teaching, signing off on residents, meetings, etc. The average pp doc will elect to see more patients per day, skip lower paying pursuits, work fewer hours per week, and take less call/weekend rounding.

Yeah but all day every day 99214+90836s? That's begging for an audit. Sure you're doing something during the day but it's probably more leisurely than seeing more patients. In this academic job, doesn't even sound like they care about productivity, so doesn't sound like OP will need to care about coding (probably because they're making the facility fee off these outpatients too). Like all academic jobs, floor will be higher but ceiling will be much lower than private practice (ex. there won't be the opportunity here to make 400K for seeing 14+ patients a day). But some people would rather make a guaranteed 200K/year rather than hustle to make double that, nothing wrong with that.

I think this job (esp if you could negotiate down call or negotiate up pay a bit) sounds fairly chill overall if you're looking for academics with pay that isn't crazy low given only doing 6-8 outpatients work of billable work a day. If you want to do academics, I've definitely seen worse.

 

[TexasPhysician]

Yeah but all day every day 99214+90836s? That's begging for an audit. Sure you're doing something during the day but it's probably more leisurely than seeing more patients. In this academic job, doesn't even sound like they care about productivity, so doesn't sound like OP will need to care about coding (probably because they're making the facility fee off these outpatients too). Like all academic jobs, floor will be higher but ceiling will be much lower than private practice (ex. there won't be the opportunity here to make 400K for seeing 14+ patients a day). But some people would rather make a guaranteed 200K/year rather than hustle to make double that, nothing wrong with that.

I think this job (esp if you could negotiate down call or negotiate up pay a bit) sounds fairly chill overall if you're looking for academics with pay that isn't crazy low given only doing 6-8 outpatients work of billable work a day. If you want to do academics, I've definitely seen worse.

If you aren’t committing obvious fraud, why worry about an audit? If you lose the audit, you return the $ you wouldn’t have received anyway by under coding. If anything, you are now better prepared to charge higher codes after an audit.

The academic contracts I’ve seen won’t put patient caps in there. If you are just sitting around too much or a policy changes, they can add more patients.

I wouldn’t expect to do 6 99214’s in 2 hours and be sitting around for 6 more hours.

 

[trophyhusband]

If you aren’t committing obvious fraud, why worry about an audit? If you lose the audit, you return the $ you wouldn’t have received anyway by under coding. If anything, you are now better prepared to charge higher codes after an audit.

The academic contracts I’ve seen won’t put patient caps in there. If you are just sitting around too much or a policy changes, they can add more patients.

I wouldn’t expect to do 6 99214’s in 2 hours and be sitting around for 6 more hours.

This is the real issue. If a new Chair comes in and wants to "improve community access" guess what that means? More patients for the same pay.

 

[Merovinge]

I like going for more base salary (adds to retirement bonuses). See how much $$ for quality bonus (these can be quite substantial, like 10% of base salary) and make sure you nail these metrics. This is going to be a killer J waiver setup compared to working at a meat-mill that will push you as hard as they can. Don't even try about call, it's clearly shared and part of the deal, we had a similar setup for attendings in my program and it was very reasonable for them.

I think it's a great choice and wouldn't feel bad at all about making a little less money for something that will setup your career well. After you add on value of PTO/retirement this will be quite competitive at 230k with a decent quality bonus.

The real reason this job is not filled is not likely the structure but the LCOL midwestern area. I have a few guesses and the undesirability of the area is why it's been available for so long.

 

[FlowRate]

Just as a data point regarding time off, I get 6 weeks vacation + 4 hours per week sick time accrual in my job. Private, non-academic, large medical group.