ER Psych CA (esp NorCal)

[clement]

Anyone know anything about John George in San Leandro? (they seem to always have ER psych openings). Sounds like Wild West county ER psych.

In the past year Burlingame (Vituity) and Santa Clara County were recruiting, but filled.
Any good leads on CA ER psych w/ decent pay?

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[comp1]

I've never worked there, but I have certainly taken patients as transfers from John George and had some of my non-MD staff worked there previously. Wild west sounds somewhat accurate. It's a very highly acute patient population, often coming from or going to a correctional setting, with limited support and likely to get less support as Medicaid gets gutted nationally. Full time ED psychiatrist positions are quite rare in California. Most community ED work is done by social workers or in a fancy place, an NP. You might have more luck with academic places or just going to inpatient with some included ED work.

 

[clement]

I've never worked there, but I have certainly taken patients as transfers from John George and had some of my non-MD staff worked there previously. Wild west sounds somewhat accurate. It's a very highly acute patient population, often coming from or going to a correctional setting, with limited support and likely to get less support as Medicaid gets gutted nationally. Full time ED psychiatrist positions are quite rare in California. Most community ED work is done by social workers or in a fancy place, an NP. You might have more luck with academic places or just going to inpatient with some included ED work.

This is true. Cpeps don’t really exist. CSU fulltime work exists but a lot are 12hr gigs a shift. As luck would have it, I’m only looking for 24-32 hours.

 

[jbomba]

Anyone know anything about John George in San Leandro? (they seem to always have ER psych openings). Sounds like Wild West county ER psych.

In the past year Burlingame (Vituity) and Santa Clara County were recruiting, but filled.
Any good leads on CA ER psych w/ decent pay?

There's no PES openings here despite whatever they are advertising for. Docs constantly fight over shifts here. Not literally, everyone is kind, but you know what I mean.

But yes, this place is wild. The docs are good, there is fine nursing and social work support.

 

[clement]

There's no PES openings here despite whatever they are advertising for. Docs constantly fight over shifts here. Not literally, everyone is kind, but you know what I mean.

But yes, this place is wild. The docs are good, there is fine nursing and social work support.

Interesting. I’d think it’s the odds and ends shifts no one wants. I still can’t understand why ER psych is so competitive/desirable compared to other regions of the country (including other high saturation cities).

 

[calvinhobbes]

Not sure about ER psych, but what do you guys think about these really high psych salaries at Kaiser? Are they high because these locations work you to death, and the cost of living is insanely high? Salaries starting at 450k for child and as high as 500k.

Southern California Permanente Medical Group | SCPMG

One the nation’s premier medical groups, with over 8,000 multispecialty physicians delivering excellent health care to 4.9 million Kaiser Permanente members.

southerncalifornia.permanente.org

 

[sloh]

Not sure about ER psych, but what do you guys think about these really high psych salaries at Kaiser? Are they high because these locations work you to death, and the cost of living is insanely high? Salaries starting at 450k for child and as high as 500k.

Southern California Permanente Medical Group | SCPMG

One the nation’s premier medical groups, with over 8,000 multispecialty physicians delivering excellent health care to 4.9 million Kaiser Permanente members.

southerncalifornia.permanente.org

I think it’s bc they include the benefits but @FlowRate would have a better idea

 

[FlowRate]

Not sure about ER psych, but what do you guys think about these really high psych salaries at Kaiser? Are they high because these locations work you to death, and the cost of living is insanely high? Salaries starting at 450k for child and as high as 500k.

Southern California Permanente Medical Group | SCPMG

One the nation’s premier medical groups, with over 8,000 multispecialty physicians delivering excellent health care to 4.9 million Kaiser Permanente members.

southerncalifornia.permanente.org

I don't have intimate knowledge of that region's pay practices but a C&A fellow when I was in 2nd year of residency (so like 8 years ago) said he was hired at SCPMG for $400k (and implied that was salary, not total comp.) So that salary range would reflect inflation since then. I'm not sure if it's benefits inclusive or just adjusted to CA CoL. I think the low end of that range would be quite low for CA, if it was total comp inclusive.

 

[clement]

I don't have intimate knowledge of that region's pay practices but a C&A fellow when I was in 2nd year of residency (so like 8 years ago) said he was hired at SCPMG for $400k (and implied that was salary, not total comp.) So that salary range would reflect inflation since then. I'm not sure if it's benefits inclusive or just adjusted to CA CoL. I think the low end of that range would be quite low for CA, if it was total comp inclusive.

CA CoL. That’s the going rate (ish) in CA. Anything less than 365K on 40hrs and we’re talking highway robbery. Kaiser is a lot of outpatient vacancies, so 400 is typically well earned.

Getting back to ER psych, back in the day these positions were so easy to source and handsomely paid as locums. I guess I could send some CVs to academia but that’ll be like a 200K hit in annual earnings. Did all the NP’s and telemill companies do away with ER psych openings? Speaking of Kaiser, their “ER psych” load is entirely covered by SW.

 

[calvinhobbes]

CA CoL. That’s the going rate (ish) in CA. Anything less than 365K on 40hrs and we’re talking highway robbery. Kaiser is a lot of outpatient vacancies, so 400 is typically well earned.

Getting back to ER psych, back in the day these positions were so easy to source and handsomely paid as locums. I guess I could send some CVs to academia but that’ll be like a 200K hit in annual earnings. Did all the NP’s and telemill companies do away with ER psych openings? Speaking of Kaiser, their “ER psych” load is entirely covered by SW.

Thx!

 

[splik]

No, they aren't allowed to include benefits in the salary posted in CA. Also CoL is largely irrelevant to physician salaries as does not directly influence pay. If anything, physician salaries often inversely correlate with cost of living, with physicians living in lower cost of living areas usually make more money because it's harder to recruit physicians to those areas. Physicians in Alaska, Wyoming, Montana, North Dakota, South Dakota etc tend to get make a lot more than physicians in NY for example. And CoL is higher in the SF Bay Area and the kaiser pay is lower there than in So Cal. SCPMG also has a K1 rather than W2 payment model is my understanding.

The fact is that Kaiser struggles to recruit and retain psychiatrists in CA outside of the major metro areas and has to pay a premium to entice psychiatrists of which they have a higher demand for because they cover millions of insured beneficiaries and have come under significant scrutiny from the state for inadequate mental health care, multiple prolonged strikes from the non-physician mental health workforce, negligent care, various lawsuits. These factors put pressure on kaiser to show they are making an effort to hire psychiatrists. Because of similar scandals, correctional and state hospital jobs often pay well in CA too, so Kaiser has to compete with DSH and CDCR. This all has a knock on effect on other employers which has dramatically increased psychiatrist compensation in CA over the past 10 years which then in turn puts pressure on kaiser to further distinguish themselves in order to recruit.

They are a good option for some people, especially if you can work there for a large part of your career to reap the partnership and retirement benefits and work your way up leadership. Like any big organization, there is huge variation in workload and quality of life depending on location and specific jobs.

 

[calvinhobbes]

No, they aren't allowed to include benefits in the salary posted in CA. Also CoL is largely irrelevant to physician salaries as does not directly influence pay. If anything, physician salaries often inversely correlate with cost of living, with physicians living in lower cost of living areas usually make more money because it's harder to recruit physicians to those areas. Physicians in Alaska, Wyoming, Montana, North Dakota, South Dakota etc tend to get make a lot more than physicians in NY for example. And CoL is higher in the SF Bay Area and the kaiser pay is lower there than in So Cal. SCPMG also has a K1 rather than W2 payment model is my understanding.

The fact is that Kaiser struggles to recruit and retain psychiatrists in CA outside of the major metro areas and has to pay a premium to entice psychiatrists of which they have a higher demand for because they cover millions of insured beneficiaries and have come under significant scrutiny from the state for inadequate mental health care, multiple prolonged strikes from the non-physician mental health workforce, negligent care, various lawsuits. These factors put pressure on kaiser to show they are making an effort to hire psychiatrists. Because of similar scandals, correctional and state hospital jobs often pay well in CA too, so Kaiser has to compete with DSH and CDCR. This all has a knock on effect on other employers which has dramatically increased psychiatrist compensation in CA over the past 10 years which then in turn puts pressure on kaiser to further distinguish themselves in order to recruit.

They are a good option for some people, especially if you can work there for a large part of your career to reap the partnership and retirement benefits and work your way up leadership. Like any big organization, there is huge variation in workload and quality of life depending on location and specific jobs.

thx! What is K1 pay?

 

[clement]

No, they aren't allowed to include benefits in the salary posted in CA. Also CoL is largely irrelevant to physician salaries as does not directly influence pay. If anything, physician salaries often inversely correlate with cost of living, with physicians living in lower cost of living areas usually make more money because it's harder to recruit physicians to those areas. Physicians in Alaska, Wyoming, Montana, North Dakota, South Dakota etc tend to get make a lot more than physicians in NY for example. And CoL is higher in the SF Bay Area and the kaiser pay is lower there than in So Cal. SCPMG also has a K1 rather than W2 payment model is my understanding.

The fact is that Kaiser struggles to recruit and retain psychiatrists in CA outside of the major metro areas and has to pay a premium to entice psychiatrists of which they have a higher demand for because they cover millions of insured beneficiaries and have come under significant scrutiny from the state for inadequate mental health care, multiple prolonged strikes from the non-physician mental health workforce, negligent care, various lawsuits. These factors put pressure on kaiser to show they are making an effort to hire psychiatrists. Because of similar scandals, correctional and state hospital jobs often pay well in CA too, so Kaiser has to compete with DSH and CDCR. This all has a knock on effect on other employers which has dramatically increased psychiatrist compensation in CA over the past 10 years which then in turn puts pressure on kaiser to further distinguish themselves in order to recruit.

They are a good option for some people, especially if you can work there for a large part of your career to reap the partnership and retirement benefits and work your way up leadership. Like any big organization, there is huge variation in workload and quality of life depending on location and specific jobs.

Interesting observations.
I don’t totally agree on CoL and salary in CA (at least for county based public sector jobs in some high CoL counties).

It is true that scandal (DOJ related etc) has bolstered salaries in CA.

I can’t speak much for Kaiser beyond my observation from 10 years ago that they were paying better than a lot of other CA employers in SoCal (this was an OP gero role in NorCal that I looked at). Kaiser is the classic golden handcuffs model. I have worked with some of their retirees who now do locums and are living it up. If you can craft a niche role w/ Kaiser (i.e. convince a GI department to fund your transplant psych position) or score a CL/ED role, it’s not so bad (I know people who’ve done so, but very rare). The fact that most of their positions are OP mill roles where one is dolling out Lamictal to borderlines and calling it bipolar 2 is wholly unappealing.

One current trend in CA is that of 1099 contractors being phased out at DSH and other public sector employers (jail settings). This means more W2 spots filling faster. I’ve been surprised to hear that several DSH sites are near capacity with W2 recruitment of late. CDCR also let go of a lot of contractors in some desirable metros and their tele roles seem fiercely competitive (though their hiring practices are dysfunctional).

For those of us favoring part time work, academia or PP seems to be the only viable frontier here.

I really only enjoy jail or ER work and am finding that my options are slim in my desired metros.

 

[FlowRate]

The fact that most of their positions are OP mill roles where one is dolling out Lamictal to borderlines and calling it bipolar 2 is unappealing.

It's on you if you want to provide substandard care, there's nothing about the KP model that uniquely incentivizes doing so. In fact, I think the incentives are aligned toward providing good quality care better than FFS private practices that choose to maximize their profit incentive. I can get my borderline patients into an in-system DBT based IOP within a week.

 

[clement]

It's on you if you want to provide substandard care, there's nothing about the KP model that uniquely incentivizes doing so. In fact, I think the incentives are aligned toward providing good quality care better than FFS private practices that choose to maximize their profit incentive. I can get my borderline patients into an in-system DBT based IOP within a week.

The resources are there. For those of us on the receiving end of inheriting such Kaiser pts when their coverage changes (I can attest to this pattern first hand), it’s no fun. Like the VA, the pts can also most easily access notes which skews diagnoses. I had one such pt threatening to sue me when I told her she is a borderline in need of therapeutic discharge from scenarios in which she dominates management of diagnoses and perceived med needs.