Fair Value ?

[TexasPhysician]

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Let’s say a facility wanted you to provide admit orders by phone roughly 350 days/year. All calls are 9am-9pm. You get 4-10/day. How much $ would you want to do this? Assume no rounding for now. What is just the day call worth?

 

[psych_0]

Interesting. I guess I would have some follow-up questions:

1) Once they are admitted, are you responsible for questions on them the rest of the day? What if they go into restraints after admission? You putting those orders in too?
2) If they are looking for just a warm body to put in blanket admission orders, I guess my main question is why? I could see if this was an overnight 9pm-7am type of shift. But why is it during the day? Are the inpatient docs who already work there that busy (re: lazy) to put in admit orders on 4-10pts/day? At my inpatient job we cover admit orders during the day (7am-9pm) once every other week. It's is more of a mild inconvenience than anything else.
3) Are there any scenarios where patients must be seen in person? At my residency, if someone went into restraints there was a state law that said a physician had to physically see them in person within I think 1 hour. If this was the case, there is no (realistic) amount of money that would make me take this gig.

All of that being said, in residency I think they paid us $150/night to cover this type of shift overnight. I believe the NPs at my current hospital get $250 for this shift, but it's an overnight shift. One would presume you could ask for more. I still can't wrap my head around why this position is even necessary though...

 

[Stagg737]

No rounding or notes? So just straight up “will you accept this patient” and verbal orders? Or is the patient already accepted and you’re just a liability shield? I don’t understand why this position needs to exist, but given that limited info I’d consider it for $50/hr on weekdays, $100/hr on weekends assuming this is literally just calling in orders. That math comes out to about $240K-$260k per year.

For context, this is 4200 hours per year. A FT 40hr/wk job at 48 weeks is only 1920 hours per year. I realize this is just call, but it’s still hours you have to be available. Having to be available an equivalent of 38 weekends per year is a lot. No way I touch this unless I’m making near FT equivalent pay.

 

[Sushirolls]

Also need to know what's in the hospital bylaws... Can the ED doc call and force you to come in for a consult. Can the hospitalist call and force you to come in for a consult.

 

[TexasPhysician]

Not coming in for restraints, consults, or night problems. I’ll ask more about why this position is happening, because the first response I got is that other staff are busy with other jobs. I’m a warm body relatively easy to reach most days of the year.

 

[clausewitz2]

Not coming in for restraints, consults, or night problems. I’ll ask more about why this position is happening, because the first response I got is that other staff are busy with other jobs. I’m a warm body relatively easy to reach most days of the year.

The system I trained in had a job like this that was a popular call option for research attendings who needed to fill their 20% clinical time. It seemed to exist because the psych hospital was part of a larger hospital system that was geographically distributed. What would happen is that a patient would be evaluated emergently at an outlying hospital and the ED evaluator (not an MD) would decide they required inpatient psychiatric admission. Before they were transported to the mothership psych hospital from BFE, someone would have to formally accept the patient and also put in admission orders. I got the sense that this was largely a pro forma rubber stamp in terms of what the work was actually like.

 

[dl2dp2]

The only real estimate of fair value is by the market.

I would consider surveying a group of local friends I know, and get a number and add 20% margin to it and give it back to the hospital.

 

[finalpsychyear]

Start with a number higher than you think they would go for and go from there. Ask for $500/day and maybe even consider as low as 300/day if they balk at it which would amount to 100k/year if they play hardball. I don't think i'd charge hourly but rather for the coverage shift.

 

[TheRightMedication]

In my experience at both academic and community hospitals, MBA-types would view 9 to 9 call as one or two hours of work per day. You might view it as unlimited availability, nearly every waking of the day, nearly every day. And so I predict the amount of money they'll offer you is an order of magnitude less than what you'd want.

An anecdote: When I went down to part time at a community hospital, they kept my old full time q7 call duties in the contract without telling me or offering me more money. I said no and they took it out, with no change in pay.

This implies the fair market value of call is $0.00 .

I hope you get a better number than that. Maybe if you're negotiating with physician leadership, you can get the full time pay that position deserves. Please do report back if you get an offer.

 

[PsyDr]

I've had the following:

$4000/weekend, 17 bed inpatient unit, 100ish bed general hospital consult service (1-2 consults a weekend), ER dispo (3-6 patients a weekend, social worker sees, you just decide and add meds if they're boarding). Friday 5 PM-Monday 8 AM.

$3480/weekend, 18 bed inpatient unit, 200ish bed general hospital consult service (3-5 consults a weekend), ER dispo (6-12 dispos/weekend, seen by social workers, just decisions, meds for boarders). Saturday 8 AM-Monday 8 AM.

$3600/weekend, 28 bed inpatient unit, teaching service with resident seeing 10-12 for notes, no consults, no ER. Saturday 8 AM-Monday 8 AM.

$2000/weekend, 28 bed inpatient unit, teaching service with 1 senior and 1 junior resident. Residents do all notes. No consults, no ER. Saturday 8 AM-Monday 8 AM.

I don't understand how these numbers can be reconciled with what they are proposing to pay OP.

 

[Stagg737]

I don't understand how these numbers can be reconciled with what they are proposing to pay OP.

Why? The shifts MJ posted about are for coverage of individual weekends. The duties OP is talking about is continuous coverage which is equvalent to over double FT hours with time expectations of being available 2/3 of weekends for a full year and never having a weekday off. Even if you're just "on call" you have to be available to take those calls, imo that's equivalent to a FT job and should be compensated as such.

Also, this seems like a very atypical position/request. I have worked in exactly 0 places where someone who wasn't already on duty inpatient or on call overnight specifically handled admissions. I've seen a couple places where a doc would handle basic admit stuff during their outpatient hours, but they also had inpatient duties at the unit. I've never heard of somewhere trying to contract someone outside the system just to place admit orders. Given the number of hours they're asking for coverage, it sounds like either they're desperate, malignant and trying to cut corners to save money, or both.

Not coming in for restraints, consults, or night problems. I’ll ask more about why this position is happening, because the first response I got is that other staff are busy with other jobs. I’m a warm body relatively easy to reach most days of the year.

You don't have to go in, but what if you admit someone at 4pm and then they go wild at 8pm or later? Who is taking care of this? Are you going to be getting calls to fully manage these patients remotely who you haven't seen and won't see again until the primary sees them? Are you the one deciding if these people are getting admitted and can screen those potential people out or are you literally just there for orders without any control of who gets accepted? Hopefully this wouldn't be an issue, but I could see it being awful depending on what the full role actually entails...

 

[ObsequiousAplomb]

Unlike most of the comments in here, I work in a system that is set up the way it is in the OP. At our hospital I cover my 16-bed unit, which has an average census of 14. I generally admit and discharge between 1 and 3 patients every day and follow up with 10-13. I see and write an H&P for everyone who was admitted between noon the day before and noon that day.

All admissions are screened over the phone by a separate physician who is usually working virtually from somewhere not at the hospital. That doctor places admission orders and they're supposed to also place PRNs and start a CIWA protocol, etc, based on what's in the ER clinicals.

In an ideal world, it would make it a lot smoother on our workflows to not be interrupted by calls from the ED or to place admit orders, etc. It's what enables all of the unit doctors to leave before noon and go to their second jobs in the afternoon.

Usually they do something completely awful that makes me want to tear my hair out (one doctor gives EVERY SINGLE PATIENT Abilify 5 mg daily AND Thorazine 25 mg nightly regardless of reason for admission or med history) but that satisfies the need for "orders" to be in place.

Generally, this means I fix the admissions that came after I left at noon to go home before evening med administration. that's because I'm being neurotic though. Everyone else just waits until they're back at work to fix it. It's weird having orders for meds in before the med rec gets completed.

It gets very irritating on the child units, I hear, because the doctor putting in the skeleton orders doesn't call the family to get consent...

In summary, yeah, it's a silly way to set things up. It does have its perks though: doctors get more consistency in workflow and nurses get to feel like they're giving meds at every administration period.

 

[comp1]

As an inpatient manager, I've found that it's really best if, whenever possible, the person admitting is also at least vaguely involved in the patient's care while they are actually on the unit. They might not be the primary, but for example I have overnight NPs and they know if they admit a person with severe personality pathology and limited ability to benefit from an inpatient stay, they're going to have to be dealing with RNs calling them about the person all night with issues and/or complaints. It becomes very problematic when the admitting person is completely unrelated to having to manage the person on the unit for the longer term. It leads to lots of less than helpful admissions and burnt out nursing staff.

 

[TheRightMedication]

Did you ever get to a number? I'm very curious about this question.

 

[nexus73]

As an inpatient manager, I've found that it's really best if, whenever possible, the person admitting is also at least vaguely involved in the patient's care while they are actually on the unit. They might not be the primary, but for example I have overnight NPs and they know if they admit a person with severe personality pathology and limited ability to benefit from an inpatient stay, they're going to have to be dealing with RNs calling them about the person all night with issues and/or complaints. It becomes very problematic when the admitting person is completely unrelated to having to manage the person on the unit for the longer term. It leads to lots of less than helpful admissions and burnt out nursing staff.

100% agreed. I've seen this with a local child psychiatrist who thankfully helped cover call but did not work on the unit, and he accepted everyone for admission. Then the ED got a telepsych service which started accepting people, and of course those people are fuc$ing mor*ns and they accepted everyone too, but worse because it was adults and included demented and delirious patients the in-person docs had to deal with the next day.

 

[Celexa]

There is absolutely no amount of money someone could pay me to be available for all the waking hours of the day. Unless it was for six months of work and a sum that would leave me financially independent forever.

But I am bemused that only @Stagg737 has explicitly mentioned this being a liability shield issue while there was so much concern about risk in the thread about the PHP gig im considering. Placing orders on patients being admitted to inpatient, frequently, without having seen them and entirely dependent on the evaluations of others? And you're not ever the inpt doc, so any chart review to make sure you aren't putting in something very misguided doesn't even save work the next day? This sounds terrible to me. I walked into too many disasters on the inpt units as a resident...this sounds like a nightmare.

 

[calvnandhobbs68]

As an inpatient manager, I've found that it's really best if, whenever possible, the person admitting is also at least vaguely involved in the patient's care while they are actually on the unit. They might not be the primary, but for example I have overnight NPs and they know if they admit a person with severe personality pathology and limited ability to benefit from an inpatient stay, they're going to have to be dealing with RNs calling them about the person all night with issues and/or complaints. It becomes very problematic when the admitting person is completely unrelated to having to manage the person on the unit for the longer term. It leads to lots of less than helpful admissions and burnt out nursing staff.

I totally agree but what I think you mean by this is the "person who evaluates and makes the decision to admit" when you're referring to the "person admitting". That doesn't sound like the position above, this position sounds like just putting in admit orders for patients who are already accepted to the unit prior to or at arrival.

 

[Merovinge]

There is absolutely no amount of money someone could pay me to be available for all the waking hours of the day. Unless it was for six months of work and a sum that would leave me financially independent forever.

But I am bemused that only @Stagg737 has explicitly mentioned this being a liability shield issue while there was so much concern about risk in the thread about the PHP gig im considering. Placing orders on patients being admitted to inpatient, frequently, without having seen them and entirely dependent on the evaluations of others? And you're not ever the inpt doc, so any chart review to make sure you aren't putting in something very misguided doesn't even save work the next day? This sounds terrible to me. I walked into too many disasters on the inpt units as a resident...this sounds like a nightmare.

I don't disagree that this work sounds like a nightmare so we are in agreement there. Having someone so otherwise not involved in the IP process do the orders would make it really hard to understand the culture and what is actually happening on the unit. Med recs for sick adults with comorbity can also be tricky without reviewing their chart or knowing what they have and have not been compliant with.

There's a HUGE different though compared to what you posted. This is someone starting an IP stay, they are being seen daily by MDs moving forward and having literal 24/7 nursing plus a minimum of q15 min checks. There is an attending responsible for the case by the next day at the latest, and it is not you. Your post is for a PHP stay which is an OP LoC with likely 0 nurses, no technician checks, and will take place over a longer time frame without a followup MD evaluation. There is no attending coming on after to review or be responsible.