Characteristics of a good outpatient job

[Techmed07]

Salary?
Call?
Sign On Bonus?
Patient Load?
Non-compete?
Schedule?



I know everything is fair game but I have no idea what the market can bear in negotiation. So I just want a good baseline.

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[hebel]

Salary?
Call?
Sign On Bonus?
Patient Load?
Non-compete?
Schedule?



I know everything is fair game but I have no idea what the market can bear in negotiation. So I just want a good baseline.

Here would be my minimum requirements for a NOT BAD outpatient job:

Salary? 275k +

Call? None, unless paid extra at atleast 150/hr +.

Sign On Bonus? This wouldn't make or break a job to me. Expect 10k-20k.

Patient Load? 30 minute followups. 1 hr new visits. If you can get 90 minutes, even better.

Non-compete? Preferably none.

Schedule? 40 hours: could be four 10's if you prefer that.

 

[Techmed07]

What would be the ideal job?

 

[Shufflin]

What would be the ideal job?

a pension

 

[liquidshadow22]

Need to also consider benefits. paid time off, 401k match, health insurance etc

 

[Fuzzy08]

Here would be my minimum requirements for a NOT BAD outpatient job:

Salary? 275k +

Call? None, unless paid extra at atleast 150/hr +.

Sign On Bonus? This wouldn't make or break a job to me. Expect 10k-20k.

Patient Load? 30 minute followups. 1 hr new visits. If you can get 90 minutes, even better.

Non-compete? Preferably none.

Schedule? 40 hours: could be four 10's if you prefer that.

Where are you all finding these kinds of jobs? When I told the recruiter i was hoping for 30 min follow ups and 1 hr new evels, he laughed and said, "that will be hard to find."

 

[AD04]

Where are you all finding these kinds of jobs? When I told the recruiter i was hoping for 30 min follow ups and 1 hr new evels, he laughed and said, "that will be hard to find."

Many recruiters don't know squat about the job they're representing. If you're going to use them, their main function is to get your foot in the door. Then when you speak to the decision-makers, you negotiate your terms.

 

[Stagg737]

Where are you all finding these kinds of jobs? When I told the recruiter i was hoping for 30 min follow ups and 1 hr new evels, he laughed and said, "that will be hard to find."

Your recruiter sounds like an idiot. These jobs are relatively easy to find where I'm at and most of the recent grads from my program who went outpatient are now at jobs with the above time slots.

 

[Stagg737]

Just started my outpatient year, but I'll play. My (mostly) realistic but solid outpatient job would look something like this:

Salary- $250k+
Call- none
Non-compete- None
Sign On/relocation Bonus/loan forgiveness- Doesn't matter, but would be nice perks, would rather just take a higher salary
CME fund- Min $2000
Patient Load/schedule- For a 5-day work week, 12 patients per day max (10 f/ups +max of 2 evals)
For a 4-day 10hr/day week, 15 per day max (with max 2 evals)
No weekend days ever, no taking after hours calls from patients
Mostly low to moderate acuity with some more severe patients sparsely included to shake things up
Minimal patients on benzos/opiates
Time/pt- 30 minute follow-ups, 90 minute evals
PTO- Min 30 days (probably 15 vacay, 10 sick, 5 CME; this is what I have now and have left quite a few days on the table)
401k with 10% match (minimum 6%)
Health insurance covered with family coverage, HSA available
If you can find the above at a VA, then throw in that sweet, sweet federal pension after 5 years of work


I've seen a couple jobs which meet most of the above and one of my former chiefs basically has this job, but with slightly lower pay and seeing less patients per day (I think 10 max). My ideal outpatient would be an academic one where my clinical time would be decreased in proportion to the above and I'd have admin time for teaching and possibly research. I would also only want see patients myself 1-2 days per week and staff for residents the rest of the time (though I'd probably wait until I had a few years as an attending under my belt before taking on a heavier teaching role).

 

[tr]

Where are you all finding these kinds of jobs? When I told the recruiter i was hoping for 30 min follow ups and 1 hr new evels, he laughed and said, "that will be hard to find."

Places that need to pay recruiters to find them psychiatrists are offering terrible deals. Places that are offering reasonable deals have no trouble filling without needing to pony up for the middleman. Ergo, the middleman sees only the crap jobs. I'd stay away from recruiters.

 

[liquidshadow22]

401k with 10% match (minimum 6%)


Where have you found this? VA offers 5% match.

 

[Techmed07]

Interesting these salaries are below the MGMA medians

 

[Fuzzy08]

Also, I believe the VA pension is 1% of the highest 3 years salary now. Used to be 3%

 

[calvnandhobbs68]

Where are you all finding these kinds of jobs? When I told the recruiter i was hoping for 30 min follow ups and 1 hr new evels, he laughed and said, "that will be hard to find."

Yeah WTF is this. This is standard. Laugh back at him and tell him "well I guess F you then".

The problem I also think is that they're now getting used to filling NP spots who don't know what a quality assessment is and are willing to take jobs with 45 minute intakes and 15 minute followups.

 

[calvnandhobbs68]

Interesting these salaries are below the MGMA medians

MGMA median starting salary?

 

[Stagg737]

401k with 10% match (minimum 6%)


Where have you found this? VA offers 5% match.

VA actually totals 8% when all programs are included (at least ours does). Might dox myself, but benefits for my attendings at my academic program pays equivalent of 18% of salary into 401K and attendings don't have to provide any match, just opt in.

 

[Sushirolls]

The practice you create is the best job.

 

[clozareal]

401k with 10% match (minimum 6%)


Where have you found this? VA offers 5% match.

There's at least three places that I've seen in my area where graduates have been offered this.

There's one in the area that offers a 10% of salary into 401k without a match. Since the max combined contribution for 401k between employee + employer is $57,000, if you max out the employee contribution of $19,500, the employer could theoretically contribute the max of $37,500 if your salary is $375k (which some employees with that private group practice do make).

 

[Stagg737]

There's at least three places that I've seen in my area where graduates have been offered this.

There's one in the area that offers a 10% of salary into 401k without a match. Since the max combined contribution for 401k between employee + employer is $57,000, if you max out the employee contribution of $19,500, the employer could theoretically contribute the max of $37,500 if your salary is $375k (which some employees with that private group practice do make).

This is what the hospital associated with my program has for attendings, except it's 18% of base salary. So they're contributing somewhere around $40k/yr to 401K for attendings in our department.

 

[Techmed07]

Salary?
Call?
Sign On Bonus?
Patient Load?
Non-compete?
Schedule?



I know everything is fair game but I have no idea what the market can bear in negotiation. So I just want a good baseline.

Getting us back on topic!

Please include the characteristics of your current outpt employment and what would be the dream outpatient position.

 

[FlowRate]

@clozareal @Stagg737 are you guys in the midwest? I didn't see anything like that in the major metros I was looking at.

 

[MLT2MT2DO]

Salary?
Call?
Sign On Bonus?
Patient Load?
Non-compete?
Schedule?



I know everything is fair game but I have no idea what the market can bear in negotiation. So I just want a good baseline.

Salary: 250-300k

Call: None outside of simple phone for refills unless compensated

Sign On Bonus: Meh, really only appropriate for middle of nowhere stuff

Patient Load: 12-18 patients depending on acuity. To the dude that said 90 minute intakes come on...what a stupid request I don't even know what I'd do
with a patient for 90 minutes, maybe watch a Pixar movie? 60 minutes is more than enough unless you're seriously into therapy.

Non-compete: These are stupid, they shouldn't exist, this might be a make or break on principal alone for me

Schedule: M-F 40 hour work week

 

[Psychresy]

How common are loan repayments?

 

[nexus73]

Recruiter saying 30 minute follow ups are non existent must recruit for other specialties. Pretty standard in psych, but unlikely for anything else.

 

[dl2dp2]

Patient Load: 12-18 patients depending on acuity. To the dude that said 90 minute intakes come on...what a stupid request I don't even know what I'd do with a patient for 90 minutes, maybe watch a Pixar movie? 60 minutes is more than enough unless you're seriously into therapy.

For cash practice charging per hour (in effect) I think 90 min is common. For subspecialty care (i.e. addiction, child), my experience tells me 90 min is generally not enough, especially if you want to do combined treatment and include family meetings, etc. as part of the initial eval. Insurance based practice 90 min is in particular uncommon because you don't get paid beyond 60.

 

[splik]

to the dude that said 90 minute intakes come on...what a stupid request I don't even know what I'd do
with a patient for 90 minutes, maybe watch a Pixar movie? 60 minutes is more than enough unless you're seriously into therapy.

I have 135mins for initial visits which I negotiated. You won’t get this in the real world but if you are seeing complex patients as I am I can assure you I need all that time and sometimes more. I often complete my evaluation over several visits if I can’t get it done in the allotted time with that time being used to discuss treatment options in detail etc

even if you can do your evaluation in 60mins it doesn’t hurt to have time blocked off to finish your note, deal with coordination of care issues, gather collateral if needed, review records etc

 

[splik]

I would say that the ideal situation would be a total compensation of about 400k, with 32 clinical hours per week, 8 hrs for admin tasks and care coordination etc, 60-90mins for new pts and 30-60mins for follow ups. Minimum of 8 weeks off per yr for vacation and CME. Sick leave additional. Yes such positions do exist in many parts of the country in outpatient psychiatry group practices or multispecialty group practices. You won’t be salaried though, you’ll have to earn your keep. Compensation usually but not always inclusive of benefits.

 

[Techmed07]

I would say that the ideal situation would be a total compensation of about 400k, with 32 clinical hours per week, 8 hrs for admin tasks and care coordination etc, 60-90mins for new pts and 30-60mins for follow ups. Minimum of 8 weeks off per yr for vacation and CME. Sick leave additional. Yes such positions do exist in many parts of the country in outpatient psychiatry group practices or multispecialty group practices. You won’t be salaried though, you’ll have to earn your keep. Compensation usually but not always inclusive of benefits.

Does this extend to child psychiatry as well? Are you saying we should not shy away from primarily RVU positions? I have heard that the best deal is to find a salary position and then pick up locums which can help you go over the top.


Finding a job is harder than selecting a place for residency/fellowship. This whole process has really handicapped us! Imagine we have signed contracts for the last 4 years at least, and we have no idea what we really command.

 

[jbomba]

I would say that the ideal situation would be a total compensation of about 400k, with 32 clinical hours per week, 8 hrs for admin tasks and care coordination etc, 60-90mins for new pts and 30-60mins for follow ups. Minimum of 8 weeks off per yr for vacation and CME. Sick leave additional. Yes such positions do exist in many parts of the country in outpatient psychiatry group practices or multispecialty group practices. You won’t be salaried though, you’ll have to earn your keep. Compensation usually but not always inclusive of benefits.

How could one generate enough payments without those time slots to generate 400k?

 

[jbomba]

Does this extend to child psychiatry as well? Are you saying we should not shy away from primarily RVU positions? I have heard that the best deal is to find a salary position and then pick up locums which can help you go over the top.


Finding a job is harder than selecting a place for residency/fellowship. This whole process has really handicapped us! Imagine we have signed contracts for the last 4 years at least, and we have no idea what we really command.

How do you do locums on top of a 9-5 job?

 

[Techmed07]

Ok to summarize:

Salary: 250k base with RVU incentive ( possible to have a 400k however will be primarily RVU based)
Call: None unless compensated
Patient Load: 10-12 patients per day. 60-90 minute evaluations and 30 minutes follow ups
CME: 2K-5K
Relocation: 10k however probably best to roll it into the salary
Sign On Bonus: Not Necessary
Non-compete: None
Benefits: Health insurance, 401K with matching (6%)
Schedule: M-F (40 hours a week)
PTO- Min 30 days (probably 15 vacay, 10 sick, 5 CME
Patient Population: Low benzo/stimulant seeking


Notes: Do not go through a recruiter,

 

[MLT2MT2DO]

How could one generate enough payments without those time slots to generate 400k?

In the real world this doesn't generate enough, with the caveat "60-90min intakes" "30-60min FU" and 8 weeks of vacation and benefits. You might be able to swing this as some senior level academic person fitting a need, but you're not pulling 400k with only 32 clinical hours with this setup. That's maybe 6-8 patients a day and you definitely aren't paying your keep. No idea what you'd have to do with that 8 hours of "admin" time to actually make this worthwhile to an employer

 

[MLT2MT2DO]

I have 135mins for initial visits which I negotiated. You won’t get this in the real world but if you are seeing complex patients as I am I can assure you I need all that time and sometimes more. I often complete my evaluation over several visits if I can’t get it done in the allotted time with that time being used to discuss treatment options in detail etc

even if you can do your evaluation in 60mins it doesn’t hurt to have time blocked off to finish your note, deal with coordination of care issues, gather collateral if needed, review records etc

Do you still work in academia? If so that's a completely different playing field. Don't you also deal with complex patient that include family meetings etc? That's not the norm. For most one on one visits 90 minutes is overkill if you're not attempting some sort of therapeutic modality, which I also don't think should be the norm on an intake unless that's what was scheduled.

 

[NickNaylor]

Typical outpatient job at my academic center:

Salary: ~$200k

Call: None

Sign-on bonus: None

Load: 60-minute assessments, 20-minute follow-ups

Non-complete: Not when you leave the job, but the institution demands that you remit all money you receive for professional work outside of the institution which will be returned to you at ~50% value in CME money. ULTRA LUL - this is the biggest negative of working at this institution as you effectively have no ability to make money for anything reminiscent of clinical work outside of the institution. I'm honestly surprised this is even legal.

Schedule: 9-5, 5 days/week

Benefits: No health insurance deductible for you and deductibles for dependents are cheap (excellent PPO plan), ~7% employer contribution to retirement, other benefits are cheap

I have outpatient treatment-resistant depression evals as part of my clinical work, and we have 120-minute evals and 40-minute visits for the rare follow-up.

 

[reca]

Typical outpatient job at my academic center:

Salary: ~$200k

Call: None

Sign-on bonus: None

Load: 60-minute assessments, 20-minute follow-ups

Non-complete: Not when you leave the job, but the institution demands that you remit all money you receive for professional work outside of the institution which will be returned to you at ~50% value in CME money. ULTRA LUL - this is the biggest negative of working at this institution as you effectively have no ability to make money for anything reminiscent of clinical work outside of the institution. I'm honestly surprised this is even legal.

Schedule: 9-5, 5 days/week

Benefits: No health insurance deductible for you and deductibles for dependents are cheap (excellent PPO plan), ~7% employer contribution to retirement, other benefits are cheap

I have outpatient treatment-resistant depression evals as part of my clinical work, and we have 120-minute evals and 40-minute visits for the rare follow-up.

That’s less compensation than many NP jobs...

 

[NickNaylor]

That’s less compensation than many NP jobs...

Yup, and that’s why I wouldn’t do outpatient work ever in our system. The pay is not at all commensurate with the work.

 

[Stagg737]

@clozareal @Stagg737 are you guys in the midwest? I didn't see anything like that in the major metros I was looking at.

I am, feel free to PM me if you'd like more location details. I asked the recent grads a lot of questions about their job offers, so have a decent idea of what the general climate in this area is.

To the dude that said 90 minute intakes come on...what a stupid request I don't even know what I'd do
with a patient for 90 minutes, maybe watch a Pixar movie? 60 minutes is more than enough unless you're seriously into therapy.

I'm pretty thorough with my psych ROS and social hx. I actually do basic screens for OCD, ADHD, multiple anxiety d/o, as well as some personality questions if appropriate. I also go into past hx quite a bit if relevant. I don't do therapy other than occasional basic supportive therapy during an eval. Even with that I typically finish in 60 minutes and the other 30 are used for filling out forms, catching up on notes, sending in Rx's, call for collateral info (rarely) if appropriate. I don't work from home and I don't leave clinic until my notes and major f/up issues are done for the day. So the extra time becomes admin time to catch up so I can leave on time.

I'll add that if I were at a positions where my pay was RVU dependent, I'd might go with 60 minutes f/ups. However, if I'm straight salaried (which I'd prefer) I'd take the 90 minute evals every time.

How do you do locums on top of a 9-5 job?

Weekend or overnight coverage. One of our grads works 10hrs 4 days and then has a contract to cover a unit 1-2 weekends/month.

 

[clausewitz2]

Standard outpatient job at academic place I trained at:

Salary: ~$169k

Call: 2-4 weekend days per month. You are paid enough extra for this that you receive 200k or so in total and can make more if you take other people's call shifts.

Sign-on bonus: None

Load: 60-minute assessments, 30-minute follow-ups

Non-complete: on paper harsh, in practice it is almost never enforced and even then only if you go to work for the Other Big Health System in town. Any private practice you have, they get their beaks wet to the tune of 30% but you can use EPIC, which I guess is cool...

Schedule: 9-5, 5 days/week, pretty generous with holidays, including a couple that are made up by the university. Many of the outpatient lifers are in a constant knifefight over who gets to run one of our 73 billion (okay like 20) IOPs and PHPs, because your timesheet says six hours per week for this but it is not hard to be done before then if you see someone on a weekly basis.

Benefits: reasonable deductible with health insurance with no premiums for employee, spouse, and children , ~5% employer contribution to retirement, excellent vision and dental for nominal price, ability to get on wait list for schmancy University-affiliated daycare, decent life and disability insurance

There is attending moonlighting available but the pay is frankly insulting.

[/QUOTE]

 

[Stagg737]

Salary: ~$169k

Call: 2-4 weekend days per month. You are paid enough extra for this that you receive 200k or so in total and can make more if you take other people's call shifts.

Oof.

 

[AD04]

Standard outpatient job at academic place I trained at:

Salary: ~$169k

Call: 2-4 weekend days per month. You are paid enough extra for this that you receive 200k or so in total and can make more if you take other people's call shifts.

Sign-on bonus: None

Load: 60-minute assessments, 30-minute follow-ups

Non-complete: on paper harsh, in practice it is almost never enforced and even then only if you go to work for the Other Big Health System in town. Any private practice you have, they get their beaks wet to the tune of 30% but you can use EPIC, which I guess is cool...

Schedule: 9-5, 5 days/week, pretty generous with holidays, including a couple that are made up by the university. Many of the outpatient lifers are in a constant knifefight over who gets to run one of our 73 billion (okay like 20) IOPs and PHPs, because your timesheet says six hours per week for this but it is not hard to be done before then if you see someone on a weekly basis.

Benefits: reasonable deductible with health insurance with no premiums for employee, spouse, and children , ~5% employer contribution to retirement, excellent vision and dental for nominal price, ability to get on wait list for schmancy University-affiliated daycare, decent life and disability insurance

There is attending moonlighting available but the pay is frankly insulting.

Is this a job where residents will do 100% of the work (including call)? Because I don't see why anyone would this take job when you can make the same amount working 3 days / week.

 

[Psychresy]

Weekend or overnight coverage. One of our grads works 10hrs 4 days and then has a contract to cover a unit 1-2 weekends/month.

My impression was locums was more permanent job needs; i.e. you couldn't say I'd like to work Monday nights and every other weekend (or some variation of that). Is that not necessarily true?

Any idea what the locums assignments you described would pay ballpark? Also what does night coverage entail for the pay?

 

[nexus73]

My impression was locums was more permanent job needs; i.e. you couldn't say I'd like to work Monday nights and every other weekend (or some variation of that). Is that not necessarily true?

Any idea what the locums assignments you described would pay ballpark? Also what does night coverage entail for the pay?

The Monday night isn't true (and outside of psych ED, what psychiatrist works Monday nights?). You could get a locums or moonlighting setup to work 2 weekends a month pretty easily I think.

 

[Psychresy]

The Monday night isn't true (and outside of psych ED, what psychiatrist works Monday nights?). You could get a locums or moonlighting setup to work 2 weekends a month pretty easily I think.

Although on second thought, I've seen a fair number of telepsych companies with low monthly hour requirements.... I guess you could do a smattering of nights a month and get paid that way.

 

[clausewitz2]

Is this a job where residents will do 100% of the work (including call)? Because I don't see why anyone would this take job when you can make the same amount working 3 days / week.

Call is not for the clinics themselves but for inpatient units that fall under the same service line. And perhaps I mistyped when I called it call, it also involves weekend rounding on the unit you're assigned to. There is a resident on in the hospital over the weekend to deal with medical issues and restraint examinations etc but you do end up having to take doc-to-doc calls for transfers. So in a way it is a bit like mandatory inpatient moonlighting.

As for the OP work itself only a couple of attendings have managed to off load all of their work to residents but the salary is exactly the same for the new attendings who don't work with residents at all.

And people take the job because it's a tertiary center with super-specialized programs and is a Brand Name Fancy place (for academic psychiatry anyway, not laypeople).

 

[clausewitz2]

what do you mean by medical issues? The psych resident is dealing with medical issues?

It's a 180 bed freestanding psych hospital with a 30 bed geriatric unit that takes people on dialysis or with G/NG tubes and frankly anyone who doesn't require tele or IV push fluids. So...yes?

Don't get me wrong , the rapid response team from the medical hospital will be there in ten minutes in a crisis, but it's not used for every little thing.

 

[Sushirolls]

A Psych resident is fully capable of getting first call for most issues, and if needed doing a quick assessment triage, and then taking the next step to consult IM. This also facilitates a more appropriate presentation for the consult to those services. Pt has GI upset and standing admit orders don't have tums or zofran or whatever, then they'll fix that. Patient has headache, and can't have another motrin until 8 hr mark but its 6 hour mark, well, then try tylenol, etc. Etc

 

[clausewitz2]

you don’t have a medicine consultant that sees all the patients and is called for medical issues? Doesn’t seem safe/appropriate for a psych resident to be treating medical problems

There's a couple dedicated family medicine attendings, a resident on their medicine block, and a small army of PAs around during business hours. Technically those FM attendings are on call by phone on weekends. But nights and weekends, there are times when there are three MDs in the building (resident on floor call, junior resident in the psych ED, senior moonlighting resident in the psych ED). And that's it.

 

[Sushirolls]

as an attending psychiatrist does the nurse call you for these things? Or does she just call the medicine consultant? In my shop it would go to the latter as this is not a psych issue, obviously if there’s no medicine consult in then psych is responsible for everything and you could simply say consult medicine and let them deal with it

Depends on the shop. And even on the nurses in that shop.

 

[futureapppsy2]

Oof.

Seriously. Kind of surprised that those positions are being filled.

 

[Candidate2017]

you don’t have a medicine consultant that sees all the patients and is called for medical issues? Doesn’t seem safe/appropriate for a psych resident to be treating medical problems

This reminds me of my intern IM months where the RN would look at my coat that says Psychiatry and be like, "Wait, huh, what? I paged the IM resident, why are you here?"

It's totally appropriate for psych residents to handle medical and urgent issues. However, some places have weak IM rotations, and use FM/IM docs to round on the psych ward daily. I wouldn't feel I was an appropriately trained psychiatrist coming from those places.