CAP job offer

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Haldol Lorazepam

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What are your thoughts on this CAP job offer?

outpatient community mental health center in rural Indiana
CAP only
Will be the only child psychiatrist with 2NP
1 hr initial eval, 20-30 min f/u
1:4 call covering 20 bed inpt unit

Compensation:
-$275k annual salary
-Potential productivity bonus in addition to base after 3 years; $63 for each WRVU each year in excess of 3750 WRVU’s
-$100k signing bonus forgiven over 5 ys or $60k for 3 ys.
-$1k/month education stipend
-$15k relocation
-$5k cme
-31 PTO
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good sign-on and relocation with education stipend but I think I would pass due to call included in the base
 
Haldol Lorazepam said:
What are your thoughts on this CAP job offer?

outpatient community mental health center in rural Indiana
CAP only
Will be the only child psychiatrist with 2NP
1 hr initial eval, 20-30 min f/u
1:4 call from, 20 bed inpt unit

Compensation:
-$275k annual salary
-$63 for each WRVU each year in excess of 3750 WRVU’s
-$100k signing bonus
-$1k/month education stipend
-$15k relocation
-$5k cme
-31 PTO
Click to expand...

That seems great. Even if you just hit median you will exceed that RVU target and the incentive rate is good.
 
How long do you have to stay to keep all the $100k?
 
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nrmp said:
good sign-on and relocation with education stipend but I think I would pass due to call included in the base
Click to expand...
Call is 1:4. take calls from home during weeknights (but you'd need to come in for restraints)+ rounding on the weekends. $175/weeknight, $1000/weekend day.
How much would be a more reasonable compensation?
 
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SmallBird said:
That seems great. Even if you just hit median you will exceed that RVU target and the incentive rate is good.
Click to expand...
Update: No productivity bonus for now. Potentially after 3 years! So, I'm currently negotiating a higher base with them.
 
Haldol Lorazepam said:
5 years, vs $60k for 3 ys
Click to expand...

That thoroughly ruins an already rough deal in my opinion. It’s not a $100k sign on as much as a $20k yearly bonus (to keep).

I don’t like call. 1:4 is high for outpatient work. 2 NP’s, and in my state they require supervision. Quality supervision includes weekly chart reviews, education, 24/7 availability even on vacation, etc. Rural location on top of that.

For comparison, I have a contractor psychiatrist that earns about the same in total compensation, works fewer hours, no call, and no supervision. No weekends either.
 
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Will they let you bill therapy add on codes to count towards your RVUs? I’d insist on getting the RVU bonus right from the start. If you’re exceeding productivity expectations you should get paid for it. My job will “true up” new providers every 3 months in their first year, so if you’are above the target RVUs you get paid the difference. If youre below you keep the base salary you’ve already been paid each month.

Don’t look at $100k as a sign on bonus. It’s a retention incentive. You only get it if you stay.

At least you’re getting paid something for call. You definitely want it clearly stated in your contract an agreed upon maximum call frequency. 1:4 for home call isn’t bad but having to go in for restraints sucks. And is that 1:4 weekend coverage as well? Just remember weekend “call” isn’t really just being on call. It’s working the 20 inpatient beds plus being on call. And working 1:4 weekends is not fun. Consider negotiating the Thursday/Friday before the weekend off to maintain your sanity. Or the Monday/Tuesday afterward. If not then every 4th weekend you’ll work 12 days straight.
 
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There are a couple of "big picture" issues with this job, and none of them has to do with the numbers. I suspect your market value is higher than what they are offering. But do they have the funds to make it work out?

Do you like rural Indiana? Have you ever lived in rural Indiana? Being someone who has lived in semi-rural Indiana, this is not for the faint of heart if you don't know what you are dealing with. How rural are we talking about here? Is it like in the middle of a smallish town, or is it like 3 hours out in farm country?

As the ONLY child psychiatrist in such a community, you are gonna see some very tough cases. Are you psychologically prepared to be wealthier than 99.9% of the individuals who live in your community, including every one you work with? Are you going to negotiate the amount of salary that's typically used for a whole family? Who will know? Believe me these numbers will spread in a small community like that. Or perhaps you'll live in Indianapolis and commute 3 hours each way?

These are much more important questions IMHO than the issue of 50k a year more on your base. These types of jobs typically attract 1) locals who come back 2) foreigners who don't know what they are getting into. 1:4 call is brutal, and the salary numbers are really not all that great overall. The fact that they are offering retention incentives means that people are leaving after 1 year. The fact that their base is low means the budget funding this facility is not flush with cash. These are bad signs.
 
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Haldol Lorazepam said:
Call is 1:4. take calls home during weeknights (but you'd need to come in for restraints)+ rounding on the weekends. $175/weeknight, $1000/weekend day.
How much would be a more reasonable compensation?
Click to expand...

if call is included in your base, I think I would make sure base is $300,000. If they are not offering RVUs then ask for maximum number of new and follow-ups in a day and have not scheduled more than that.
 
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An earlier poster said " It's not for the faint of heart ". I agree .

I currently run a rural Psychiatry clinic in a poor underserved area as part of my J1 waiver commitment . If you have not dealt with this patient population before , you could be in for a rude awakening.

- Many of your days will feel rather pointless . You will see some really low functioning people who will scoff at your obvious and often life saving advice. They will treat Psychiatric medications like a joke as in " Doc that 20 mg of Celexa was just not doing anything for me since last week when you started it so I am now taking 3 of those dagg-on things daily . It's still not doing anything ! ".

- You will be hounded for Benzos and stimulants .

- You will deal with some mind numbingly ridiculous consults from local PCPs which will make you question whether they really had any medical training at all. This will be way more common than It should be.

- Your patients will be hard to Interview and even harder to reason with. They will change dosages on their own , not do LABS and just be a nuisance to deal with.

- The Psycho social stressors will be mind blowing and often insurmountable obstacles to any meaningful Psychiatric improvement. A fairly typical example - " Doc , I am 150 pounds over weight , have 10/10 intractable pain , am piss poor , live in a drug ridden neighborhood and my disability just got denied for the 7th time " ... and you say " I see you are depressed as per my trusty DSM-5 , let me increase your Zoloft another 50 mg .. that will do the trick my friend "

I could go on and on but you get the point. Plus , I see you are doing Child so that will make a difference . I don't know whether good or bad.

But , some one has to do it , not all of us can open up a nice shop in an affluent suburb for the worried well.
 
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I was ask for 30 min f/u, higher base due to frequent call/rounding, an actual sign on, not a forgivable loan, make sure you have some admin time in there to call schools/therapists throughout the day.
 
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Would it be reasonable to ask for a total compensation at the %75tile of the MGMA survey? I believe it was around $350k for general psychiatrists.
 
Haldol Lorazepam said:
Would it be reasonable to ask for a total compensation at the %75tile of the MGMA survey? I believe it was around $350k for general psychiatrists.
Click to expand...

You can ask for the Mexican border to be shut down, doesn't mean that you will get it. I think 300 would be pretty easily obtaining..
 
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Are appointment lengths& schedule something that goes in the contract? I wanna make sure that is written somewhere.
 
Haldol Lorazepam said:
Are appointment lengths& schedule something that goes in the contract? I wanna make sure that is written somewhere.
Click to expand...

This is not useful and may be counterproductive. Think about it for a second. If it's written down 99213 is 20 min, but your admin keep scheduling you because "my boss told me to" through overbooking, etc. You go up to your boss and pull up your contract, does that make the interaction more likely to be successful in the future? If they want to "screw you" so to speak, there's no recourse whether it's written down or not, and you are not going to spend $50k to litigate over a clause 6 months into the job in arbitration. Even if you won, such decisions are not enforceable.

It sounds like you don't know the system very well still. IMG, I'm guessing? You should identify some senior mentor and get some more practical advice IRL. SDN has limits. For example, any effective negotiation requires a "BATNA". You need alternative offers.
 
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Go by the feel of a place as well, you should get your spidey senses going off if they are going to abuse you
 
Seems
ednorton said:
An earlier poster said " It's not for the faint of heart ". I agree .

I currently run a rural Psychiatry clinic in a poor underserved area as part of my J1 waiver commitment . If you have not dealt with this patient population before , you could be in for a rude awakening.

- Many of your days will feel rather pointless . You will see some really low functioning people who will scoff at your obvious and often life saving advice. They will treat Psychiatric medications like a joke as in " Doc that 20 mg of Celexa was just not doing anything for me since last week when you started it so I am now taking 3 of those dagg-on things daily . It's still not doing anything ! ".

- You will be hounded for Benzos and stimulants .

- You will deal with some mind numbingly ridiculous consults from local PCPs which will make you question whether they really had any medical training at all. This will be way more common than It should be.

- Your patients will be hard to Interview and even harder to reason with. They will change dosages on their own , not do LABS and just be a nuisance to deal with.

- The Psycho social stressors will be mind blowing and often insurmountable obstacles to any meaningful Psychiatric improvement. A fairly typical example - " Doc , I am 150 pounds over weight , have 10/10 intractable pain , am piss poor , live in a drug ridden neighborhood and my disability just got denied for the 7th time " ... and you say " I see you are depressed as per my trusty DSM-5 , let me increase your Zoloft another 50 mg .. that will do the trick my friend "

I could go on and on but you get the point. Plus , I see you are doing Child so that will make a difference . I don't know whether good or bad.

But , some one has to do it , not all of us can open up a nice shop in an affluent suburb for the worried well.
Click to expand...
Welp you've just scared me off from rural psychiatry now. Not that I was thinking about it to begin with... but this is good to know.
 
ednorton said:
An earlier poster said " It's not for the faint of heart ". I agree .

I currently run a rural Psychiatry clinic in a poor underserved area as part of my J1 waiver commitment . If you have not dealt with this patient population before , you could be in for a rude awakening.

- Many of your days will feel rather pointless . You will see some really low functioning people who will scoff at your obvious and often life saving advice. They will treat Psychiatric medications like a joke as in " Doc that 20 mg of Celexa was just not doing anything for me since last week when you started it so I am now taking 3 of those dagg-on things daily . It's still not doing anything ! ".

- You will be hounded for Benzos and stimulants .

- You will deal with some mind numbingly ridiculous consults from local PCPs which will make you question whether they really had any medical training at all. This will be way more common than It should be.

- Your patients will be hard to Interview and even harder to reason with. They will change dosages on their own , not do LABS and just be a nuisance to deal with.

- The Psycho social stressors will be mind blowing and often insurmountable obstacles to any meaningful Psychiatric improvement. A fairly typical example - " Doc , I am 150 pounds over weight , have 10/10 intractable pain , am piss poor , live in a drug ridden neighborhood and my disability just got denied for the 7th time " ... and you say " I see you are depressed as per my trusty DSM-5 , let me increase your Zoloft another 50 mg .. that will do the trick my friend "

I could go on and on but you get the point. Plus , I see you are doing Child so that will make a difference . I don't know whether good or bad.

But , some one has to do it , not all of us can open up a nice shop in an affluent suburb for the worried well.
Click to expand...

are you sure this is the same for CAP? i mean how can there be young kiddos on high dose benzos and stims? other psychosocial problems I agree, but I think rural CAP would be different from rural psych?
 
sluox said:
This is not useful and may be counterproductive. Think about it for a second. If it's written down 99213 is 20 min, but your admin keep scheduling you because "my boss told me to" through overbooking, etc. You go up to your boss and pull up your contract, does that make the interaction more likely to be successful in the future? If they want to "screw you" so to speak, there's no recourse whether it's written down or not, and you are not going to spend $50k to litigate over a clause 6 months into the job in arbitration. Even if you won, such decisions are not enforceable.

It sounds like you don't know the system very well still. IMG, I'm guessing? You should identify some senior mentor and get some more practical advice IRL. SDN has limits. For example, any effective negotiation requires a "BATNA". You need alternative offers.
Click to expand...

What does being an IMG have to do with anything?
 
This seems like an awful offer considering where I do residency inpt attendings make 300k base m-f 9-4, and $2500/night if they choose to do overnight call just to sleep while the residents do everything. This is adult community.

For outpt it’s 280 M-Th no call no weekends
 
NontradCA said:
This seems like an awful offer considering where I do residency inpt attendings make 300k base m-f 9-4, and $2500/night if they choose to do overnight call just to sleep while the residents do everything. This is adult community.

For outpt it’s 280 M-Th no call no weekends
Click to expand...
How many patients per day?
 
Need Opinion: Adult psych full-time job offer, hospital based community clinic

Base: $260, 000 with all benefits, w2, malpractice covered, 4 weeks vacation, 1 week CME, 10 hours x 4 days, no call at all, optional if you want to make more money on weekend inpatient coverage, relatively 30 miles to two big cities.
estimated 20 patients/10 hour day, roughly 2 patients/hour, they schedule 5 new/day, 30 min/new and 15 min/follow-up, scheduled patients around 25-27 to cover no shows, support available for case management, therapist, nursing
 
nrmp said:
Need Opinion: Adult psych full-time job offer, hospital based community clinic

Base: $260, 000 with all benefits, w2, malpractice covered, 4 weeks vacation, 1 week CME, 10 hours x 4 days, no call at all, optional if you want to make more money on weekend inpatient coverage, relatively 30 miles to two big cities.
estimated 20 patients/10 hour day, roughly 2 patients/hour, they schedule 5 new/day, 30 min/new and 15 min/follow-up, scheduled patients around 25-27 to cover no shows, support available for case management, therapist, nursing
Click to expand...

This is one of the worst jobs that I’ve ever seen.
 
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Thank you, your comments are always helpful. It's worse even though with good base and no calls at all? Looks like I am underestimating the market. It feels like the best thing to do is open my private
 
nrmp said:
Need Opinion: Adult psych full-time job offer, hospital based community clinic

Base: $260, 000 with all benefits, w2, malpractice covered, 4 weeks vacation, 1 week CME, 10 hours x 4 days, no call at all, optional if you want to make more money on weekend inpatient coverage, relatively 30 miles to two big cities.
estimated 20 patients/10 hour day, roughly 2 patients/hour, they schedule 5 new/day, 30 min/new and 15 min/follow-up, scheduled patients around 25-27 to cover no shows, support available for case management, therapist, nursing
Click to expand...

nrmp said:
Thank you, your comments are always helpful. It's worse even though with good base and no calls at all? Looks like I am underestimating the market. It feels like the best thing to do is open my private
Click to expand...

Agree. This is not a great job. You'll burn out very quickly. It might be a good job if 1) they have high no-shows 2) you know and are willing to try that population. They schedule 20 pts for 10 hours. what about lunch??

I would start the negotiation at 320k if you want to give that job a try. Salary for that job unless in major metros should be around 300k. They are making 30-50% profit off of you with that kind of number (20*200*4*48), and lots of insurances pay more than $100 for 99213+90833.
 
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nrmp said:
Thank you, your comments are always helpful. It's worse even though with good base and no calls at all? Looks like I am underestimating the market. It feels like the best thing to do is open my private
Click to expand...

How is 260 base pay in the rural Midwest good? If you’re willing to work in such a location you should be able to negotiate for close to twice that! (If not for this job, for another similar one.)

P.S. Let me preemptively address the “how would you know? You’re an MS4.” Well I know several psychiatrists in real life. One of them just signed for the following: adult inpatient M-F 9-5, no call, ~$400k/year, 15 min drive from a top 3 coastal city in a nice hospital. Responsible for 12 patients and he has a resident.

P.P.S Oops looks like I’m confusing two different posts. Still, I’m surprised most psychiatrist aren’t aware of how much they can make in the current market. The numbers I’m seeing here seem very low, on the surface at least.
 
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sluox said:
Agree. This is not a great job. You'll burn out very quickly. It might be a good job if 1) they have high no-shows 2) you know and are willing to try that population. They schedule 20 pts for 10 hours. what about lunch??

I would start the negotiation at 320k if you want to give that job a try. Salary for that job unless in major metros should be around 300k. They are making 30-50% profit off of you with that kind of number (20*200*4*48), and lots of insurances pay more than $100 for 99213+90833.
Click to expand...
I agree it does seem like you can burn out quickly. Good part I likes was no call at all and 4 days week. No shows could be but at the same time they schedule few more people to cover them, half an hour lunch break. I was thinking the same as negotiating at 280000-290000 if I decide to try. I doubt they can bill as 90833 because of 15 minutes follow-ups, so probably just 99213.
 
PsychApp777 said:
How is 260 base pay in the rural Midwest good? If you’re willing to work in such a location you should be able to negotiate for close to twice that! (If not for this job, for another similar one.)

P.S. Let me preemptively address the “how would you know? You’re an MS4.” Well I know several psychiatrists in real life. One of them just signed for the following: adult inpatient M-F 9-5, no call, ~$400k/year, 15 min drive from a top 3 coastal city in a nice hospital. Responsible for 12 patients and he has a resident.
Click to expand...
It's not rural and pretty close to two big cities and commutable if I prefer to live in big city. $400k/year for 12 patient/day sounds too good to be true, if it's real I guess I need to hunt more to find that kind of gig!
 
nrmp said:
It's not rural and pretty close to two big cities and commutable if I prefer to live in big city. $400k/year for 12 patient/day sounds too good to be true, if it's real I guess I need to hunt more to find that kind of gig!
Click to expand...

Locums
 
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nrmp said:
Thank you, your comments are always helpful. It's worse even though with good base and no calls at all? Looks like I am underestimating the market. It feels like the best thing to do is open my private
Click to expand...

Most outpatient jobs have no call. $260k is reasonable with 1 hr rivals and 20-30min follow-ups without double booking and 1 hr lunch.
 
I literally won't be able to keep all the new intakes straight if I only get 30 min and get 5 per day. The quality of care can't be great. Mights as well just as everyone do a PHQ-9 and give out Lexapro en masse....... It'll be literally running down some check list...
 
sluox said:
I literally won't be able to keep all the new intakes straight if I only get 30 min and get 5 per day. The quality of care can't be great. Mights as well just as everyone do a PHQ-9 and give out Lexapro en masse....... It'll be literally running down some check list...
Click to expand...

Just leave a giant bowl of zoloft and trazodone out by the front desk and patients can grab a handful at each visit, super efficient.
 
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sluox said:
I literally won't be able to keep all the new intakes straight if I only get 30 min and get 5 per day. The quality of care can't be great. Mights as well just as everyone do a PHQ-9 and give out Lexapro en masse....... It'll be literally running down some check list...
Click to expand...
Yes if all 5 new patients show up then it's like you go through quick check list, they estimate 2 patients/hour show-up, so it's possible that you may end up getting 45 minutes for new and 1 f/u per hour, still it's pretty busy. The reason I was more positive is good benefits and 4 days week so I can do my private 1-2 days/week which I am thinking to start with only cash. I can do so only if I have consistent income coming in form another place and still leave enough time to focus on private
 
nrmp said:
Yes if all 5 new patients show up then it's like you go through quick check list, they estimate 2 patients/hour show-up, so it's possible that you may end up getting 45 minutes for new and 1 f/u per hour, still it's pretty busy. The reason I was more positive is good benefits and 4 days week so I can do my private 1-2 days/week which I am thinking to start with only cash. I can do so only if I have consistent income coming in form another place and still leave enough time to focus on private
Click to expand...

After 4 days of that, there is no chance I’d want to deal with the hassles of starting a private practice.

Find any easy PT job, so that you can dedicate time to your pp. it isn’t simple to thrive cash only.
 
nrmp said:
The reason I was more positive is good benefits and 4 days week so I can do my private 1-2 days/week which I am thinking to start with only cash.
Click to expand...
And if your private patients call with issues during the week, when would you have time to get back to them?
 
MedMan80 said:
are you sure this is the same for CAP? i mean how can there be young kiddos on high dose benzos and stims? other psychosocial problems I agree, but I think rural CAP would be different from rural psych?
Click to expand...
Yes, rural CAP is just as bad as rural psych, because you will be seeing the kids of the cases ednorton describes: mom who gave the school nurse a bottle of emptied Adderall capsules, parents who get mad when you spend more than 10 minutes on each of their kids, parents who send their kid to the appointment with a cousin because the kid just needs to get fixed and they’re not part of the problem or solution, lots of CPS involvement and sadder cases where they should be involved....
Interviewing for a rural CMHC job, an insightful (and honest) director pointed out that the people with the means to move away already had.
 
nrmp said:
Yes if all 5 new patients show up then it's like you go through quick check list, they estimate 2 patients/hour show-up, so it's possible that you may end up getting 45 minutes for new and 1 f/u per hour, still it's pretty busy. The reason I was more positive is good benefits and 4 days week so I can do my private 1-2 days/week which I am thinking to start with only cash. I can do so only if I have consistent income coming in form another place and still leave enough time to focus on private
Click to expand...

Yeah you are not gonna want to work 1-2 more days a week after suffering through 10 hour days with that much throughput . At least I wouldn’t.
 
Based on the suggestions, I am convinced that I should stay away from this once unless they negotiate higher salary and I don't have to worry of doing private, enjoy benefits and 4 days of work week. If I have any more appetite, I can do their optional weekend inpatient call for around 25 beds unit and you get around 2200 for rounding both days/no phone calls involved
 
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