Compensation question please

[Psycologieest]

Please help, this my first contact and really don’t understand the compensation model. Is thus a good offer? Outpatient and inpatient adult but with addiction fellowship

$35,000 sign on bonus.

Residency stipend of $36,000 per year for 2 years. Pay back with interest if contract is terminated

Guaranteed salary $315, 000 for 18months after it's production.

Compensation calculator $50.84 below 50% and 4114, the above 50% 64.12 and 5765 billable wRVU.

4 weeks of vacation

6 holiday days

4 cme days, $4000

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[Stagg737]

Please help, this my first contact and really don’t understand the compensation model. Is thus a good offer? Outpatient and inpatient adult but with addiction fellowship

$35,000 sign on bonus.

Residency stipend of $36,000 per year for 2 years. Pay back with interest if contract is terminated

Guaranteed salary $315, 000 for 18months after it's production.

Compensation calculator $50.84 below 50% and 4114, the above 50% 64.12 and 5765 billable wRVU.

4 weeks of vacation

6 holiday days

4 cme days, $4000

I have no idea myself and I normally just lurk on these kinds of threads, but people are probably going to want to know more details about the work. Like how many patients are you expected to cover inpatient and outpatient or is it purely based on RVUs, is there any call, are you supervising any mid-levels, are there any administrative duties, etc. I'd also just like clarification about the duration of your contract and when it would start (aka are you still a resident [residency stipend makes it sound like you are] and this is for a post-residency position?).

Always find these threads interesting as I feel like I'm still too ignorant about the legalese/breakdown of contracts as well. Thanks for posting and I'd also like to know what those who know what they're doing think about it.

 

[Psycologieest]

I have no idea myself and I normally just lurk on these kinds of threads, but people are probably going to want to know more details about the work. Like how many patients are you expected to cover inpatient and outpatient or is it purely based on RVUs, is there any call, are you supervising any mid-levels, are there any administrative duties, etc. I'd also just like clarification about the duration of your contract and when it would start (aka are you still a resident [residency stipend makes it sound like you are] and this is for a post-residency position?).

Always find these threads interesting as I feel like I'm still too ignorant about the legalese/breakdown of contracts as well. Thanks for posting and I'd also like to know what those who know what they're doing think about it.

Thanks, yes I start in 2020 after my addiction fellowship. Inpatient is 4-6 patients and then all 20-23 on the weekend you are on call. Call is 1:4. FM residents and psych residents from a different program. I have MPH so I figure out they would add some admin and/or committee stuff. Contract is for 3 years and 18 months guaranteed pay. Hope I answered all your questions?

 

[SpinDktr]

From my experience, I would not bet on getting any admin time, even with an MPH. If you want this perk from your employer, you need to get it in your contract. ALSO - I'm sure most people are practicing know this but I didn't when I started. "Vacation days" does not mean you get RVU's for those days (or use vacation days to supplement RVU's).

When I started, I did not realize that vacation days worked this way. I have 33 days of vacation plus all major holidays, which sounds nice; but in the RVU model, you "eat what you kill". I could have 180 days of vacation, I just would not be compensated much at all, because I wouldn't be working and billing those RVU's. The 18 month cushion is nice; in my situation it was 24, but it became clear I was not one of the "super high RVU stars" either, so in my case my compensation actually went down.

The one thing I wish residency prepared me better for was the business side of medicine. I think most residencies probably fail at this, but then again that really isn't their job.

 

[splik]

I think most residencies probably fail at this, but then again that really isn't their job.

I disagree that it isn't their job. The job of a residency program is to prepare trainees for independent practice. This includes the business side of medicine, be in working for an institution of in private practice. It is unfortunate that most programs do not train residents adequately in this. The better programs do provide training and mentorship opportunities for those wanting to start their own private practice. I learned a lot about billing and RVUs etc as a resident. I always try to teach my residents about the business side of medicine, including billing, negotiations, different models of compensation etc.

 

[SpinDktr]

If psychiatry residencies actually taught the business side of medicine, residents would probably jump ship into a surgical specialty pretty quickly. Maybe it is pessimistic, but that is where the billing and income really come from.

 

[hamstergang]

If psychiatry residencies actually taught the business side of medicine, residents would probably jump ship into a surgical specialty pretty quickly. Maybe it is pessimistic, but that is where the billing and income really come from.

It shouldn't surprise many in psych residencies that surgeons make more money, so I doubt this would be an issue.

 

[michaelrack]

It shouldn't surprise many in psych residencies that surgeons make more money, so I doubt this would be an issue.

I know several psychiatrists who make more than general surgeons

 

[nexus73]

I don't understand this sentence:

"Compensation calculator $50.84 below 50% and 4114, the above 50% 64.12 and 5765 billable wRVU."

 

[Psycologieest]

I don't understand this sentence:

"Compensation calculator $50.84 below 50% and 4114, the above 50% 64.12 and 5765 billable wRVU."

They divided their multiplier into two: below and above 50 percentile. For below 50th percentile they will use 50.84$ and above the 50th percentile they will use 64.12 dollars. The percentile is based on attaining a certain number of patient s seen. 5765 is the total number of rvu per year.

 

[Merely]

If psychiatry residencies actually taught the business side of medicine, residents would probably jump ship into a surgical specialty pretty quickly. Maybe it is pessimistic, but that is where the billing and income really come from.

I completely disagree. Being a businessman is much easier in psych than as a surgeon. As a psychiatrist you can make 500k+ (more than many surgeons) if you want to as an entrepreneurial thinker. Surgeons don't have the time to think business since they're stuck in the OR being paid as wage slaves. The rich own the means of production while the poor work for them. Surgeons can't own a hospital so they typically are salaried at an albeit significantly higher salary than psychiatrists. The point is the ceiling in psych is probably higher than surgery but the floor is much higher in surgery given the nature of the work.

Ps - I'm only a med student so I could be very ignorant in my view that's just what I've gathered from my limited experience

 

[nexus73]

They divided their multiplier into two: below and above 50 percentile. For below 50th percentile they will use 50.84$ and above the 50th percentile they will use 64.12 dollars. The percentile is based on attaining a certain number of patient s seen. 5765 is the total number of rvu per year.

I would prefer to just get the $64.12 for all RVUs.

 

[splik]

5765 is the total number of rvu per year.

This is equivalent to over 40 hours per week of straight clinical care in a 48 week year, assuming 3 wRVUs/hr (which is considered standard). That is a lot. This does not account for no shows, collateral, record review, charter, prior auths, coordination of care, transfers to hospital etc.

 

[SmallBird]

They divided their multiplier into two: below and above 50 percentile. For below 50th percentile they will use 50.84$ and above the 50th percentile they will use 64.12 dollars. The percentile is based on attaining a certain number of patient s seen. 5765 is the total number of rvu per year.

I still don't understand what that means (Whats the precentile? do they just mean 1/2 your RVUs are one rate and 1/2 are another). 50.84 is a low rate for straight production and 64.12 is a decent rate. 5765 is a lot of RVU's but that isn't a bad salary for that amount.

 

[Shikima]

I still don't understand what that means (Whats the precentile? do they just mean 1/2 your RVUs are one rate and 1/2 are another). 50.84 is a low rate for straight production and 64.12 is a decent rate. 5765 is a lot of RVU's but that isn't a bad salary for that amount.

It is, you're being worked pretty heavily and someone is making money off of you.

 

[Achillees]

I disagree that it isn't their job. The job of a residency program is to prepare trainees for independent practice. This includes the business side of medicine, be in working for an institution of in private practice. It is unfortunate that most programs do not train residents adequately in this. The better programs do provide training and mentorship opportunities for those wanting to start their own private practice. I learned a lot about billing and RVUs etc as a resident. I always try to teach my residents about the business side of medicine, including billing, negotiations, different models of compensation etc.

Do you know of any good online resource to learn about billing? Bonus if specific for psychiatry.

 

[splik]

The APA, AACAP, and the ny chapter of APA all have info online about this. when i was a resident we were forced to do an online module the hospital created on billing so we were maximizing revenues.

 

[QueenJames]

I completely disagree. Being a businessman is much easier in psych than as a surgeon. As a psychiatrist you can make 500k+ (more than many surgeons) if you want to as an entrepreneurial thinker. Surgeons don't have the time to think business since they're stuck in the OR being paid as wage slaves. The rich own the means of production while the poor work for them. Surgeons can't own a hospital so they typically are salaried at an albeit significantly higher salary than psychiatrists. The point is the ceiling in psych is probably higher than surgery but the floor is much higher in surgery given the nature of the work.

Ps - I'm only a med student so I could be very ignorant in my view that's just what I've gathered from my limited experience

No offense, but I REALLLY Wish you put the bolded first so that I didn't waste 30 seconds of my life reading about something that you don't have experience with.

Everybody thinks it's easy to make money....

Until they have to make money.

lol

 

[Shikima]

Only way to make money is to see more patients in medicine - this includes procedures. There is no passive income generated - even employees are a liability. This is our lot in life, especially with this specialty considering its historical low reimbursements compared to our other medical specialties.

 

[hamstergang]

Only way to make money is to see more patients in medicine - this includes procedures. There is no passive income generated - even employees are a liability.

I'm confused. Are you saying that having employees does not make you money?

 

[Shikima]

I'm confused. Are you saying that having employees does not make you money?

Employees cost you money. You (and whatever partners/therapists there are) will be the only entities bringing in revenue, everything else will cost you.

 

[Merely]

Employees cost you money. You (and whatever partners/therapists there are) will be the only entities bringing in revenue, everything else will cost you.

What about therapists, PAs, and NPs that you employ that see their own patients?

 

[hamstergang]

Employees cost you money. You (and whatever partners/therapists there are) will be the only entities bringing in revenue, everything else will cost you.

Ok, so why would having therapists employed by you not bring in passive income?

 

[calvnandhobbs68]

Wat?

Yeah everyone in a company does not directly make money. I don’t think that’s news to anyone. The secretaries and assistants at Apple don’t make them any money. Neither do the customer service reps. They still make plenty of it.

 

[hamstergang]

Wat?

Yeah everyone in a company does not directly make money. I don’t think that’s news to anyone. The secretaries and assistants at Apple don’t make them any money. Neither do the customer service reps. They still make plenty of it.

But as the 2 posts just before yours point out, there are employees that do generate income for the business. How is it not possible to have a passive income stream from them?

 

[Stagg737]

But as the 2 posts just before yours point out, there are employees that do generate income for the business. How is it not possible to have a passive income stream from them?

Depends on how you define "passive". In most states mid-levels (not therapists) will still require oversight and supervision. It's less work, but it's not really passive in the true sense of the word. I get what you're saying though, as I've worked with a couple psychiatrists who easily double the average surgeon's salary by employing other providers and managing as opposed to purely seeing patients.

No offense, but I REALLLY Wish you put the bolded first so that I didn't waste 30 seconds of my life reading about something that you don't have experience with.

Everybody thinks it's easy to make money....

Until they have to make money.

lol

He still makes some valid points. I don't necessarily agree that the ceiling for psychiatry is higher than surgery, but I do think several factors make it easier to be a "businessman" in psychiatry than surgery. Mainly the fact that it's far easier to have an independent private practice in psychiatry than surgery due to lower overhead and reimbursement for common treatments in psych.

Everybody thinks it's easy to make money because as a physician it's easy to make money. Knowing if you're being paid what you're worth and maximizing your income is a different story.

 

[Shikima]

Ok, so why would having therapists employed by you not bring in passive income?

It is, but it isn't. They're still costing you money and no-shows cost you money. They do generate income in return as the passive part. Still need managing.

 

[Shikima]

What about therapists, PAs, and NPs that you employ that see their own patients?

Same position as my other post regarding therapists.

 

[cutetendon]

It is, but it isn't. They're still costing you money and no-shows cost you money. They do generate income in return as the passive part. Still need managing.

What??

 

[nexus73]

I've heard hiring midlevels/therapists can be a real pain in the neck...e.g. managing the office, filling vacancies, payroll, taxes, malpractice...all of this has to be handled by somebody which would be the practice owner. So, it's possible they wouldn't provide passive income because it's work to manage them. As opposed to owning real estate run by a property manager where you don't really have to do anything and can make money passively.

I've heard you're better off getting a large office space and leasing out offices at a profit, while maintaining the midlevels/therapists as separate business entities so you're not in charge of anything they do, don't have payroll or other headaches.

 

[QueenJames]

Only way to make money is to see more patients in medicine - this includes procedures. There is no passive income generated - even employees are a liability. This is our lot in life, especially with this specialty considering its historical low reimbursements compared to our other medical specialties.

THANK YOU.

Some of these med student dreamers think it's as simple as "GET AN OFFICE... START SEEING PATIENTS... GET CASSSHHHH...MAKE $950,000."

Who's gonna be doing billing? Who's gonna be managing your cash and account receivables? Oh... you're not gonna be taking insurance? Oh... good luck with your 3 patient panel and your $2000 lease on the office not to mention the utilities and insurance and etc...

Who's gonna be overseeing patient scheduling and the day-to-day of your practice?

Oh... "I WILL... duhhh" says the clueless medical student dreaming about being the hotshot millionaire doctor?

When will you be seeing patients then...?

Yeah. right. You do that.

There's A LOT of behind the scenes in private practice that goes on.

How do I know?

I've worked in and managed family friends' private IM practices and FM offices. Medicare does NOT like to pay you. Patients do NOT like to pay you. Billing everything just to cover your behind because LAWYERS LOVE taking your money.

Some of you guys have been watching too much of that Gary Vee.

I bet medicare and medicaid can't wait to figure out what's going on with the bullcrap codes in DSM-5 so they can lowball the specialty even further.

Yes Psych is in demand... but doesn't mean you will be making mucho dinero unless you got great business acumen which is not something you will learn overnight.

So for those thinking psych because it's EASIER to make that surgeon money...? You guys are in for QUITE the surprise.

Be real folks.

 

[Blitz2006]

THANK YOU.

Some of these med student dreamers think it's as simple as "GET AN OFFICE... START SEEING PATIENTS... GET CASSSHHHH...MAKE $950,000."

Who's gonna be doing billing? Who's gonna be managing your cash and account receivables? Oh... you're not gonna be taking insurance? Oh... good luck with your 3 patient panel and your $2000 lease on the office not to mention the utilities and insurance and etc...

Who's gonna be overseeing patient scheduling and the day-to-day of your practice?

Oh... "I WILL... duhhh" says the clueless medical student dreaming about being the hotshot millionaire doctor?

When will you be seeing patients then...?

Yeah. right. You do that.

There's A LOT of behind the scenes in private practice that goes on.

How do I know?

I've worked in and managed family friends' private IM practices and FM offices. Medicare does NOT like to pay you. Patients do NOT like to pay you. Billing everything just to cover your behind because LAWYERS LOVE taking your money.

Some of you guys have been watching too much of that Gary Vee.

I bet medicare and medicaid can't wait to figure out what's going on with the bullcrap codes in DSM-5 so they can lowball the specialty even further.

Yes Psych is in demand... but doesn't mean you will be making mucho dinero unless you got great business acumen which is not something you will learn overnight.

So for those thinking psych because it's EASIER to make that surgeon money...? You guys are in for QUITE the surprise.

Be real folks.

I agree with everything you said.

But remember surgeons have other headaches to deal with, such as much higher malpractice premiums, baseline hours are much higher (I don't know any gen surgeons working 40 hours/week), overheads in surgery is far higher and the big limiting factor is of course, OR time.

I'm not turning this into a psych vs. surgeon battle, my point is that every specialty has its downsides. And yes, lawyers do like taking your money, but luckily for psych, its the lowest among all specialties (3-5% of psychiatrists):

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

 

[QueenJames]

I agree with everything you said.

But remember surgeons have other headaches to deal with, such as much higher malpractice premiums, baseline hours are much higher (I don't know any gen surgeons working 40 hours/week), overheads in surgery is far higher and the big limiting factor is of course, OR time.

I'm not turning this into a psych vs. surgeon battle, my point is that every specialty has its downsides. And yes, lawyers do like taking your money, but luckily for psych, its the lowest among all specialties (3-5% of psychiatrists):

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

VERY true and a point I forgot to mention.

Two totally different schools of treatment. One is more of the "to cut is to cure" while the other is more of an in-depth dwelling into the actual thoughts and motivations that makes people who they are.

Each will definitely attract different types of people.

But on a money tip... I've met more surgeons who are rolling in cash than psychiatrists. The ones who do psych are some of the happiest people I've seen as well.

Money doesn't buy happiness right...?

My point is to tell those who are so gung-ho about money to stop worrying about trying to make the most money in medicine as they can.

There is money in ALL fields in medicine.

But if THAT is the only reason somebody wants to choose this rewarding specialty... they are doing it wrong.

Thank you for your contribution! Cheers!

 

[Merely]

VERY true and a point I forgot to mention.

Two totally different schools of treatment. One is more of the "to cut is to cure" while the other is more of an in-depth dwelling into the actual thoughts and motivations that makes people who they are.

Each will definitely attract different types of people.

But on a money tip... I've met more surgeons who are rolling in cash than psychiatrists. The ones who do psych are some of the happiest people I've seen as well.

Money doesn't buy happiness right...?

My point is to tell those who are so gung-ho about money to stop worrying about trying to make the most money in medicine as they can.

There is money in ALL fields in medicine.

But if THAT is the only reason somebody wants to choose this rewarding specialty... they are doing it wrong.

Thank you for your contribution! Cheers!

Thank you for your insights, are you a physician or psychiatrist? Are you a office manager or what are you?

 

[splik]

Money doesn't buy happiness right...?

only if you don't know how to spend it properly

 

[SterlingMaloryArcher]

Thank you for your insights, are you a physician or psychiatrist? Are you a office manager or what are you?

*an

 

[Amygdarya]

are you a physician or psychiatrist?

Huh?

 

[Merely]

Huh?

You know what I mean. When you’re on board a plane and they call for a physician, they’re not asking for you...

 

[splik]

You know what I mean. When you’re on board a plane and they call for a physician, they’re not asking for you...

They don't ask for a physician... they ask for a doctor... and actually a psychiatrist is perfectly capable of dealing with most medical calls on planes (usually psychiatric anyway lol) and has sufficient knowledge to be directed by the folks on the ground for what to do.

 

[michaelrack]

I believe a psychiatrist can make more than a general surgeon if working equivalent hours, and know for an absolute fact that psychiatrists usually make more than internists/hospitalists

 

[QueenJames]

only if you don't know how to spend it properly

Very true.

Cocaine and hookers do the job for me.

 

[QueenJames]

Thank you for your insights, are you a physician or psychiatrist? Are you a office manager or what are you?

I am a 2nd year medical student who hates people but loves the punishing task of sitting on his butt for 10 hours a day doing 200 questions and reading a chapter of FA every day with the goal of reading first aid 10 times thoroughly before May comes around.

Off to read this Psych chapter!

MUAHAHAAAAAAA

 

[QueenJames]

They don't ask for a physician... they ask for a doctor... and actually a psychiatrist is perfectly capable of dealing with most medical calls on planes (usually psychiatric anyway lol) and has sufficient knowledge to be directed by the folks on the ground for what to do.

Yo Splik..

In your opinion... do you think it's worth it for a physician to even respond to such calls? What happens if you mess up and kill the dude (regardless of specialty)? I'd be too scared to lose my license at that point in order to risk something like that.

Read about cases that happened ...

Giving me the heeby jeebies just thinking about it!

 

[uhmocksuhsillen]

Yo Splik..

In your opinion... do you think it's worth it for a physician to even respond to such calls? What happens if you mess up and kill the dude (regardless of specialty)? I'd be too scared to lose my license at that point in order to risk something like that.

Read about cases that happened ...

Giving me the heeby jeebies just thinking about it!

I believe you are free from legal reprecussions if you respond in an emergency

 

[uhmocksuhsillen]

I believe a psychiatrist can make more than a general surgeon if working equivalent hours, and know for an absolute fact that psychiatrists usually make more than internists/hospitalists

So like 400-500k?

 

[DisorderedDoc417]

So like 400-500k?

No.

 

[Amygdarya]

I believe you are free from legal reprecussions if you respond in an emergency

With some caveats.

Yo Splik..

In your opinion... do you think it's worth it for a physician to even respond to such calls? What happens if you mess up and kill the dude (regardless of specialty)? I'd be too scared to lose my license at that point in order to risk something like that.

Read about cases that happened ...

Giving me the heeby jeebies just thinking about it!

Good Samaritan law - Wikipedia

 

[Amygdarya]

You know what I mean. When you’re on board a plane and they call for a physician, they’re not asking for you...

As splik explained above, psychiatrists *are* physicians who should be capable to help in this situation.
By your logic, none of the specialists - or even generalist pediatricians (because kids are apparently a different species with their own physiology) - are “physicians”.

 

[WisNeuro]

In your opinion... do you think it's worth it for a physician to even respond to such calls? What happens if you mess up and kill the dude (regardless of specialty)? I'd be too scared to lose my license at that point in order to risk something like that.

Worth it, my wife has responded to 3 such events in the past 2 years. They were all minor issues in the end and she received several hundred dollars in comp each time.

 

[calvnandhobbs68]

You know what I mean. When you’re on board a plane and they call for a physician, they’re not asking for you...

Yeah dude they probably aren’t looking for ophtho or radiology either.