Detox Job Offer Eval

[kansasprincess]

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Looking for additional guidance on job offer evaluation. New opportunity from recruiter this week with upcoming on site visit next week and I'd love some guidance on what questions YOU would ask to evaluate this offer:

Detox center currently being managed by a group of MDs but it is not their primary position and the owning corp is looking to replace group contract with on site MD and 2 NPs. The role is described as "Medical Director" but is essential the solo Doc running this facility.
Anticipated salary of $350k, located in large US southern city near desirable area, 21 days PTO, 6 sick days
Bed capacity of 30 beds, currently 17 patients in house between detox + inpatient rehab.
Inpatient rehab LOS is 30 days, facility reports about half of patient stay for rehab post detox. Facility is looking to increase these stats and has hired a management consultant to revamp facility and there is discussion of expanding into a larger space in the future as well as adding an IOP. This role would not include IOP responsibilities. They are reporting they are "overstaffed" with a clinical director, 2 therapists, case manager, a director of nursing, 4 LPNs (2 day shift/2 night shift). Google reviews from patients in last 6 months since management consultant came in are glowing.

 

[calvnandhobbs68]

Google reviews from patients in last 6 months since management consultant came in are glowing.

Ya sure the google reviews aren't planted by the management consultant or the "patients" to review them heavily cherry picked 😉

Remember these consultant companies are all about social media awareness, I highly doubt they don't know what the google reviews look like for that place right now. They're "overstaffed" with 2 therapists and 1 case manager? I guess I wonder what happens when they cut back on staff and then fill up (as they are trying to do).

 

[Bartelby]

The current setup with a maximum of 30 beds seems decent. For a residential setting, that is pretty doable especially with the help of two NPs (presuming they are good)! The salary seems pretty good.

A few thoughts:
-What kind of group programming is available during the day? You want to make sure there is enough for the patients to do (and that it meets minimum requirements)
-How will after-hours issues be handled? Can you make other team members the primary point of contact, or will you be fielding a lot of those issues?
-What kind of medical rule-outs are acceptable to this facility? For example, will you be taking heavy drinkers with a history of seizures or DTs? What about combined heavy alcohol and benzodiazepine use? Are staff comfortable administering PRNs based on frequent CIWA or CINA checks, or will you need to lean more on fixed-dose regimens? In general, how sick can patients be to enter into your "detox" (residential) setting?
-How good / experienced are the therapists and clinical director? How often do they meet with patients?
-Who will handle the "drama" of the residential setting? This consumes a lot of time. If you need to regularly take the lead on team meetings, it can become draining quite quickly. The quality of the team's response to various patient issues (and the amount of handholding you will need to do) can make or break the experience in a setting like this one.
-With only four nurses are there ever coverage gaps, and how are those handled?
-Who will cover for you when you are away? The NPs?

-You mention moving to a larger facility. What would be the new bed count then? How would your salary and responsibilities change?

The staffing seems likely about on par with comparable (30-bed) facilities, but it makes me nervous to hear that described as "overstaffed." It isn't. I do wonder if that gives an indication what direction the corporation would like for this facility to move in.

 

[littlefred]

Ya sure the google reviews aren't planted by the management consultant or the "patients" to review them heavily cherry picked 😉

Remember these consultant companies are all about social media awareness, I highly doubt they don't know what the google reviews look like for that place right now. They're "overstaffed" with 2 therapists and 1 case manager? I guess I wonder what happens when they cut back on staff and then fill up (as they are trying to do).

Good google reviews usually means it's a pill mill.

 

[TexasPhysician]

2 therapists for 30 patients with expectations of running groups, documenting, family therapy, and individual sessions is under-staffed.

2 nurses each and every shift is average.

How many techs?

Who is doing and signing off on physical exams and evals? Who is reviewing and signing off on EKG’s? Who is treating all of the chronic medical issues, STD’s, staph infections, Etc?

 

[deleted1100659]

Do not trust google reviews, and if they're all glowing, then that should actually be a red flag.

I ran into this when I almost took a job about a month ago, place had best reviews in the state for their outpatient clinics. All 5 star reviews. The clinic was basically giving patients whatever they wanted, patients could message/call providers after clinic hours whenever they wanted, and they would solicit reviews from these patients in return, and basically cherry pick reviews.

Agreed with: who treats the medical issues, do they have certain detox protocols they already use in place that you agree with, who covers the patients when you leave, is there on call coverage is an issue arises while you're gone?

 

[Merovinge]

Do not trust google reviews, and if they're all glowing, then that should actually be a red flag.

I ran into this when I almost took a job about a month ago, place had best reviews in the state for their outpatient clinics. All 5 star reviews. The clinic was basically giving patients whatever they wanted, patients could message/call providers after clinic hours whenever they wanted, and they would solicit reviews from these patients in return, and basically cherry pick reviews.

Agreed with: who treats the medical issues, do they have certain detox protocols they already use in place that you agree with, who covers the patients when you leave, is there on call coverage is an issue arises while you're gone?

Make sure you actually read the google reviews. It's very clear when it's a patient scorned who has a PD, when it's a reasonable complaint, or when it's actually a very positive experience. In my metro it's rare to see one line reviews for places, they are usually a full paragraph.

I took my job at a place with the best reviews by a fairly wide margin, certainly not all 5star but probably a full point higher than the competitors and there's certainly a reason for it. Our culture, time spent with patients, staffing ratio, etc are actually just better as it's an MD founded and led organization.

 

[littlefred]

Do not trust google reviews, and if they're all glowing, then that should actually be a red flag.

I ran into this when I almost took a job about a month ago, place had best reviews in the state for their outpatient clinics. All 5 star reviews. The clinic was basically giving patients whatever they wanted, patients could message/call providers after clinic hours whenever they wanted, and they would solicit reviews from these patients in return, and basically cherry pick reviews.

Agreed with: who treats the medical issues, do they have certain detox protocols they already use in place that you agree with, who covers the patients when you leave, is there on call coverage is an issue arises while you're gone?

It's like medical practices shouldn't be put up for reviews. But hey, who am I to say that...