Graduating psych residents…Job offers

[mistafab]

I hate

First offer looks awful close to offer I've seen. 270k base, 10k signon bonus, 7.5 % incentive bonus in northeast, 10k retention. 40 hr workweek, no nights, no calls. Feels so middle of the road. Did you end up taking it?

Nope - looked too bad.

I’m currently considering a gig like this:

VA ED job
260k
Standard VA benefits (signing bonus, student loan, vacation, pto…)
14 ED shifts per month (scheduled, not rotating) done in clusters (I.e. I am mon-wed guy)
No call, no nights
There would be residents there to do work.

The reason I’m considering is this is quite small in a week’s footprint, and I could easily have a second job with this one’s schedule. I also like the ED. This could allow me stable income while building a PP.

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[Merovinge]

Nope - looked too bad.

I’m currently considering a gig like this:

VA ED job
260k
Standard VA benefits (signing bonus, student loan, vacation, pto…)
14 ED shifts per month (scheduled, not rotating) done in clusters (I.e. I am mon-wed guy)
No call, no nights
There would be residents there to do work.

The reason I’m considering is this is quite small in a week’s footprint, and I could easily have a second job with this one’s schedule. I also like the ED. This could allow me stable income while building a PP.

I worked in a VA ED for residency, the attendings there had a pretty good life. There is the standard VA nonsense patient's but overall I would highly recommend this as a starting point.

 

[ObsequiousAplomb]

I'm finally biting the locums bullet and figured I might as well post what I'm signing away:

First of December to last of April, M-F with voluntary call only except for Christmas and New Year's.

14 bed unit for mood and substance. It's one of 5 psychiatric units, the rest are broken down reasonably. Actually, they separate bipolar disorder from schizophrenia. I've never worked anywhere that fancy.

Pay for days M-F are at $1650 per day. Given their LOS, I'm seeing 3 admits, 3 discharges, and the rest of them as follow-ups. The unit has a discharge coordinator, two SW, etc. I can round and leave when I want.
Call is $300 to hold the pager on the weekday, $300 per hour if anything happens. I hate this and weekday call is voluntary.
Weekends are $2100 per weekend day worked, covering my unit and another unit the same size.
Christmas Day is $2400.
New Year's Day is $2400. Christmas Eve is $3000.
That's the only weekend that is mandatory, all others are voluntary.

This won't interfere with my private practice hours, as I do evenings and weekends.

I wanted more. It's a locums job less than an hour away from my house (with one of the most saturated markets in the country). Seeing my kid every night has a value greater than the difference from what I think I could get elsewhere though. All told, it's about $160k for working 4 months with time I would have spent twiddling my thumbs while my practice grows. My daughter isn't 2 yet. I don't think she will notice that I go to work on Christmas this year. She better not find out, or she'll never let me forget it.

 

[Merovinge]

I'm finally biting the locums bullet and figured I might as well post what I'm signing away:

First of December to last of April, M-F with voluntary call only except for Christmas and New Year's.

14 bed unit for mood and substance. It's one of 5 psychiatric units, the rest are broken down reasonably. Actually, they separate bipolar disorder from schizophrenia. I've never worked anywhere that fancy.

Pay for days M-F are at $1650 per day. Given their LOS, I'm seeing 3 admits, 3 discharges, and the rest of them as follow-ups. The unit has a discharge coordinator, two SW, etc. I can round and leave when I want.
Call is $300 to hold the pager on the weekday, $300 per hour if anything happens. I hate this and weekday call is voluntary.
Weekends are $2100 per weekend day worked, covering my unit and another unit the same size.
Christmas Day is $2400.
New Year's Day is $2400. Christmas Eve is $3000.
That's the only weekend that is mandatory, all others are voluntary.

This won't interfere with my private practice hours, as I do evenings and weekends.

I wanted more. It's a locums job less than an hour away from my house (with one of the most saturated markets in the country). Seeing my kid every night has a value greater than the difference from what I think I could get elsewhere though. All told, it's about $160k for working 4 months with time I would have spent twiddling my thumbs while my practice grows. My daughter isn't 2 yet. I don't think she will notice that I go to work on Christmas this year. She better not find out, or she'll never let me forget it.

She won't remember and won't care. She will appreciate you providing her financial stability (maybe not as a teen but definitely at some point). You are already seeing her on a daily basis and doing that important part of bonding. It's clearly not amazing locums pay but if it fits your life and your family, go for it.

 

[Stagg737]

I'm finally biting the locums bullet and figured I might as well post what I'm signing away:

First of December to last of April, M-F with voluntary call only except for Christmas and New Year's.

14 bed unit for mood and substance. It's one of 5 psychiatric units, the rest are broken down reasonably. Actually, they separate bipolar disorder from schizophrenia. I've never worked anywhere that fancy.

Pay for days M-F are at $1650 per day. Given their LOS, I'm seeing 3 admits, 3 discharges, and the rest of them as follow-ups. The unit has a discharge coordinator, two SW, etc. I can round and leave when I want.
Call is $300 to hold the pager on the weekday, $300 per hour if anything happens. I hate this and weekday call is voluntary.
Weekends are $2100 per weekend day worked, covering my unit and another unit the same size.
Christmas Day is $2400.
New Year's Day is $2400. Christmas Eve is $3000.
That's the only weekend that is mandatory, all others are voluntary.

This won't interfere with my private practice hours, as I do evenings and weekends.

I wanted more. It's a locums job less than an hour away from my house (with one of the most saturated markets in the country). Seeing my kid every night has a value greater than the difference from what I think I could get elsewhere though. All told, it's about $160k for working 4 months with time I would have spent twiddling my thumbs while my practice grows. My daughter isn't 2 yet. I don't think she will notice that I go to work on Christmas this year. She better not find out, or she'll never let me forget it.

It's more than that, but also 5 months. At that rate it's $8,250/wk for 22 weeks which is $181.5k without any of that call factored in. Holidays adds almost $8k. If you carry the pager every weekday that's an additional $33k in that time, and the $300/hr "if anything happens" (I'm assuming getting called to approve an admit or for PRNs) is pretty stellar. Cover a weekend per month and that's an extra $21k). Could easily gross over $220k if you want to hustle for those 5 months. Agree with Merovinge that the pay isn't fantastic, but it is pretty solid and I imagine the H&Ps/DCs are probably easier given you know it's for a "mood and substance unit" with seemingly solid support staff.

 

[Styrene]

NY metro area. 287k base + 20k RVU bonus yearly (give or take a few). 10k sign-on bonus. Pure CL. 9-5 M-F no weekends or call.

 

[MedMan80]

It's more than that, but also 5 months. At that rate it's $8,250/wk for 22 weeks which is $181.5k without any of that call factored in. Holidays adds almost $8k. If you carry the pager every weekday that's an additional $33k in that time, and the $300/hr "if anything happens" (I'm assuming getting called to approve an admit or for PRNs) is pretty stellar. Cover a weekend per month and that's an extra $21k). Could easily gross over $220k if you want to hustle for those 5 months. Agree with Merovinge that the pay isn't fantastic, but it is pretty solid and I imagine the H&Ps/DCs are probably easier given you know it's for a "mood and substance unit" with seemingly solid support staff.

I wonder if the 300/hr is if you have to come in physically, and the holding the pager is taking light/easy calls? How else would they measure the hourly pay?

 

[Stagg737]

NY metro area. 287k base + 20k RVU bonus yearly (give or take a few). 10k sign-on bonus. Pure CL. 9-5 M-F no weekends or call.

When I was looking 2 years ago there was something similar in the city I'm in now. Straight consult, $275k/yr in LCOL metro for M-F no call. One of my colleagues was in the position previously and said that after a few months they started pressuring him to pick up more and more consults. Imo for C/L positions it should either be RVU or per consult/encounter based pay or there should be a cap if salaried.

I wonder if the 300/hr is if you have to come in physically, and the holding the pager is taking light/easy calls? How else would they measure the hourly pay?

If you put in/sign orders remotely or accept a new admission. Or if there's a pager/messaging system look at time stamps of calls to see when you're actually doing something. The 300/hr "if anything happens" was curious to me too.

 

[mistafab]

NY metro area. 287k base + 20k RVU bonus yearly (give or take a few). 10k sign-on bonus. Pure CL. 9-5 M-F no weekends or call.

Honestly looks like a good gig for NY for a fresh grad. Hard to get pure C/L gigs in nice places, and if you are single or young couple that could be a lot of fun. NY doesn't pay great but 287 is better than most offers I've seen depending on where in NY you are talking. I have several friends who signed for a manhattan/brooklyn job paying 240 (*blech*) for similar work. There is definitely a 'tax' to live in NY/Cali depending on where.

 

[MedMan80]

When I was looking 2 years ago there was something similar in the city I'm in now. Straight consult, $275k/yr in LCOL metro for M-F no call. One of my colleagues was in the position previously and said that after a few months they started pressuring him to pick up more and more consults. Imo for C/L positions it should either be RVU or per consult/encounter based pay or there should be a cap if salaried.


If you put in/sign orders remotely or accept a new admission. Or if there's a pager/messaging system look at time stamps of calls to see when you're actually doing something. The 300/hr "if anything happens" was curious to me too.

My gig is less than 400 to manage calls/admissions via phone, 5PM to 8AM (light so i don't mind). No real risk to be called in, although hypothetically possible.

 

[calvnandhobbs68]

When I was looking 2 years ago there was something similar in the city I'm in now. Straight consult, $275k/yr in LCOL metro for M-F no call. One of my colleagues was in the position previously and said that after a few months they started pressuring him to pick up more and more consults. Imo for C/L positions it should either be RVU or per consult/encounter based pay or there should be a cap if salaried.

Right I suspect that's gonna happen at some point. This is why I hate the straight salary model. You either need a cap or just do a base + productivity that's reasonable so that way you don't get pissed off every time ortho consults you for an old person who's feeling depressed before their hip replacement.

Problem if there's no incentive is that the hospital loves stupid consults because you generate revenue. If you have no incentive to do them, you start hating stupid consults because you get paid the same either way.

 

[Styrene]

Honestly looks like a good gig for NY for a fresh grad. Hard to get pure C/L gigs in nice places, and if you are single or young couple that could be a lot of fun. NY doesn't pay great but 287 is better than most offers I've seen depending on where in NY you are talking. I have several friends who signed for a manhattan/brooklyn job paying 240 (*blech*) for similar work. There is definitely a 'tax' to live in NY/Cali depending on where.

I didn't mention that it's an academic position with, at minimum, one resident assigned to each attending team at all times, sometimes 2-3 residents +/- fellow per team. And yes, there are a lot of consults for sure.

 

[Styrene]

Right I suspect that's gonna happen at some point. This is why I hate the straight salary model. You either need a cap or just do a base + productivity that's reasonable so that way you don't get pissed off every time ortho consults you for an old person who's feeling depressed before their hip replacement.

Problem if there's no incentive is that the hospital loves stupid consults because you generate revenue. If you have no incentive to do them, you start hating stupid consults because you get paid the same either way.

This position will have up to 30k RVU bonus per year paid quarterly.

 

[calvnandhobbs68]

This position will have up to 30k RVU bonus per year paid quarterly.

Right but something to check would be is that a reasonable RVU bonus or not? So how easily achievable is the bonus RVU based on your average number of expected consults a day, or if you take a few weeks of vacation does it “count against” your total RVUs (so don’t divide total RVUs by 52 weeks, divide by 48 or whatever to get avg RVUs/week).

 

[Styrene]

Right but something to check would be is that a reasonable RVU bonus or not? So how easily achievable is the bonus RVU based on your average number of expected consults a day, or if you take a few weeks of vacation does it “count against” your total RVUs (so don’t divide total RVUs by 52 weeks, divide by 48 or whatever to get avg RVUs/week).

Got it, thank you

 

[Mad Jack]

Nope - looked too bad.

I’m currently considering a gig like this:

VA ED job
260k
Standard VA benefits (signing bonus, student loan, vacation, pto…)
14 ED shifts per month (scheduled, not rotating) done in clusters (I.e. I am mon-wed guy)
No call, no nights
There would be residents there to do work.

The reason I’m considering is this is quite small in a week’s footprint, and I could easily have a second job with this one’s schedule. I also like the ED. This could allow me stable income while building a PP.

Nice, I haven't seen many VA ED psych spots around

 

[EdLongshanks]

Inpatient State Hospital in Missouri with stable patient base of about 35 who require 1 note a month. 4 day week. On-site on call for
$250 k /yr + $10k for supervising 1 NP, 15 vacation days + 20 sick days (uncompensated if not used), 14 holidays/year, 8% increase once board certified. Full state benefits.
On call/on site evening/weekend pay is $109/hour with about 80 hours/month available.

 

[ObsequiousAplomb]

Inpatient State Hospital in Missouri with stable patient base of about 35 who require 1 note a month. 4 day week. On-site on call for
$250 k /yr + $10k for supervising 1 NP, 15 vacation days + 20 sick days (uncompensated if not used), 14 holidays/year, 8% increase once board certified. Full state benefits.
On call/on site evening/weekend pay is $109/hour with about 80 hours/month available.

While on the low side for state hospitals, among the one-note-a-month state hospitals, it isn't a bad rate as long as MO state benefits are what you want and you were planning on living in MO anyway. Same thing with the on-site call rates. While those wouldn't be great at more acute levels of care, knowing how completely dull those call shifts usually are ... seems fine, given the low cost of living there.

Bear in mind, this would probably pay 50 to 75% higher as a locums doctor, just no benefits.

 

[calvnandhobbs68]

Inpatient State Hospital in Missouri with stable patient base of about 35 who require 1 note a month. 4 day week. On-site on call for
$250 k /yr + $10k for supervising 1 NP, 15 vacation days + 20 sick days (uncompensated if not used), 14 holidays/year, 8% increase once board certified. Full state benefits.
On call/on site evening/weekend pay is $109/hour with about 80 hours/month available.

Lol so you have to do 2 notes a day for 250K/year? sounds pretty solid.

 

[untapped]

Inpatient State Hospital in Missouri with stable patient base of about 35 who require 1 note a month. 4 day week. On-site on call for
$250 k /yr + $10k for supervising 1 NP, 15 vacation days + 20 sick days (uncompensated if not used), 14 holidays/year, 8% increase once board certified. Full state benefits.
On call/on site evening/weekend pay is $109/hour with about 80 hours/month available.

Sounds like a great lifestyle gig if you hate writing notes lol.

 

[ObsequiousAplomb]

Lol so you have to do 2 notes a day for 250K/year? sounds pretty solid.

same job in DC pays $330k for fresh grads, people there longer than 5 years with at least one fellowship make $550k.

 

[Stagg737]

same job in DC pays $330k for fresh grads, people there longer than 5 years with at least one fellowship make $550k.

But are they really only writing a note per month on these patients? Ie, how often are they dropping brief notes for stuff like restraints, agitation meds, etc? Also, why are they there? I probably know where Ed is talking about and if so most of the patients are there as long-term patients (ie admitted for years) as Missouri's state facilities are all forensic units and only accept psych patients with legal charges.

 

[ObsequiousAplomb]

But are they really only writing a note per month on these patients? Ie, how often are they dropping brief notes for stuff like restraints, agitation meds, etc? Also, why are they there? I probably know where Ed is talking about and if so most of the patients are there as long-term patients (ie admitted for years) as Missouri's state facilities are all forensic units and only accept psych patients with legal charges.

DC's State hospital is 70% forensic. There are three forensic admission units and only one civil admitting unit.

There are multiple units of NGRIs that have been there their entire adult lives. Yes, those units are once a month notes with a template that takes less than 10 minutes.

You drop a small note for acute events, just like anywhere else. It's baked into their ordering system for restraints, the note is auto-written by the order.

The rule is one note a week for the first 3 months, then one every 30 days thereafter. They do interdisciplinary review of each case every 90 days, takes about 20 minutes.

 

[uhmocksuhsillen]

DC's State hospital is 70% forensic. There are three forensic admission units and only one civil admitting unit.

There are multiple units of NGRIs that have been there their entire adult lives. Yes, those units are once a month notes with a template that takes less than 10 minutes.

You drop a small note for acute events, just like anywhere else. It's baked into their ordering system for restraints, the note is auto-written by the order.

The rule is one note a week for the first 3 months, then one every 30 days thereafter. They do interdisciplinary review of each case every 90 days, takes about 20 minutes.

Any jobs like this in other states as far as you know of? Are most state hospital jobs like this?

 

[ObsequiousAplomb]

Any jobs like this in other states as far as you know of? Are most state hospital jobs like this?

It varies state to state. In some you have to write weekly notes forever. For some it's even less often than 30 days.

The downside is you're doing all this in a state hospital, all the coworkers are state employees, and before too long you come to realize that you, too, are a state employee. Then you realize you can never go back to acute care hospitals with lengths of stays under a month.

 

[nexus73]

It varies state to state. In some you have to write weekly notes forever. For some it's even less often than 30 days.

The downside is you're doing all this in a state hospital, all the coworkers are state employees, and before too long you come to realize that you, too, are a state employee. Then you realize you can never go back to acute care hospitals with lengths of stays under a month.

like some surreal nightmare as you slowly become part of the hospital’s apathetic architecture

 

[Splenda88]

Doesn't really matter what you "feel" like if you make 400K a year (or even if you make 200K/year), you aren't "middle class" even in New York City, much less the rest of America.

Does Your Income Make You Upper Class, Middle Class, or Lower Class?

Where does your income fall relative to your fellow Americans? Find out how much the lower, middle, and upper classes are making.

www.fool.com

What it takes to be considered ‘rich’ in New York

Have you ever wondered how your income stacks up against your neighbors? New data analysis shows how much you need to make to be considered rich in New York City.

pix11.com

I guess I am not alone.

Almost a third of millionaires in the US now say they're part of the middle class — even the 'regular rich' like doctors, lawyers don't feel well off. But here's how they really stack up

Almost 60% of wealthy Americans are stressing about money — with many feeling the need to adapt their lifestyles.

finance.yahoo.com

 

[calvnandhobbs68]

I guess I am not alone.

Almost a third of millionaires in the US now say they're part of the middle class — even the 'regular rich' like doctors, lawyers don't feel well off. But here's how they really stack up

Almost 60% of wealthy Americans are stressing about money — with many feeling the need to adapt their lifestyles.

finance.yahoo.com

Lol and with that I will refer you back to this quote which I believe sums this phenomenon up very well

This is America, 'upper class's is 'anyone who makes appreciably more than me but definitely not me'.

 

[blueforest]

Thoughts on joining an established private practice as a fresh grad with a guaranteed salary plus guaranteed annual raise?

 

[clausewitz2]

Thoughts on joining an established private practice as a fresh grad with a guaranteed salary plus guaranteed annual raise?

Depends a lot on the details of that guaranteed salary, guaranteed raise, conditions of employment, etc. You are describing a prototype of a job that could be the most fantastic cushest gig in the whole wide world or a miserable sweatshop.

 

[blueforest]

Depends a lot on the details of that guaranteed salary, guaranteed raise, conditions of employment, etc. You are describing a prototype of a job that could be the most fantastic cushest gig in the whole wide world or a miserable sweatshop.

Absolutely, I can see that. Briefly, CAP 300k for 32.5 patient hours a week. Sweatshop or reasonable?

My main dilemma is benefits. For those with families, how strongly do you consider medical benefits as a dealbreaker for a job?

Employed, academic positions tend to offer that security (good medical benefits) for my entire family. Decisions... decisions...

 

[clausewitz2]

Absolutely, I can see that. Briefly, CAP 300k for 32.5 patient hours a week. Sweatshop or reasonable?

My main dilemma is benefits. For those with families, how strongly do you consider medical benefits as a dealbreaker for a job?

Employed, academic positions tend to offer that security (good medical benefits) for my entire family. Decisions... decisions...

If you haven't priced out exchange policies for your family yet, this is how you determine how much medical benefits are worth. Just figure out the cost of replacing them on your own. It may be less than you think, especially if you are going to get paid 1099 and they don't offer benefits per se. In the absence of health insurance being offered to you as a self-employed person your health insurance premiums become tax deductible and you will be in a tax bracket where that makes a big difference.

If the marketplace is confusing consider reaching out to a health insurance broker.

 

[Stagg737]

Absolutely, I can see that. Briefly, CAP 300k for 32.5 patient hours a week. Sweatshop or reasonable?

My main dilemma is benefits. For those with families, how strongly do you consider medical benefits as a dealbreaker for a job?

Employed, academic positions tend to offer that security (good medical benefits) for my entire family. Decisions... decisions...

Sounds quite low for PP CAP to me but I'd defer to the CAP docs. @Merovinge , @clozareal ...

Also depends on how much time you're getting per patient. Seeing 50-60 patients per week in that time is much different than 100+.

 

[Merovinge]

Absolutely, I can see that. Briefly, CAP 300k for 32.5 patient hours a week. Sweatshop or reasonable?

My main dilemma is benefits. For those with families, how strongly do you consider medical benefits as a dealbreaker for a job?

Employed, academic positions tend to offer that security (good medical benefits) for my entire family. Decisions... decisions...

That's quite a few hours. I presume 30 min f/u, would it be 60-120 min for intakes (this makes a huge difference, 60 min is brutal in CAP)? Do you have access to quality therapists? Does pay drop with no shows? Good EMR for copying forward notes and eRx? Health care benefits are definitely a big deal, my employer contributes roughly 20k to insure myself, my partner, and my child. Most private companies these days actually have fairly decent health care and 401k as well as fully covering insurance w/ tail or claims based malpractice.

 

[FlowRate]

If you haven't priced out exchange policies for your family yet, this is how you determine how much medical benefits are worth. Just figure out the cost of replacing them on your own. It may be less than you think, especially if you are going to get paid 1099 and they don't offer benefits per se. In the absence of health insurance being offered to you as a self-employed person your health insurance premiums become tax deductible and you will be in a tax bracket where that makes a big difference.

If the marketplace is confusing consider reaching out to a health insurance broker.

An additional note for anyone who hasn't done this before--even the best marketplace plans are often worse than the sort of insurance you typically get from companies known for excellent benefits (academic jobs, Kaiser, etc.) This is variable by state, as well. E.g. the best gold plans in my state still have high deductibles and high MOOP and high specialty/brand Rx copayments.

 

[clausewitz2]

An additional note for anyone who hasn't done this before--even the best marketplace plans are often worse than the sort of insurance you typically get from companies known for excellent benefits (academic jobs, Kaiser, etc.) This is variable by state, as well. E.g. the best gold plans in my state still have high deductibles and high MOOP and high specialty/brand Rx copayments.

Agreed that this is something to look out for, it is very area specific. In my neck of the words there are carbon copies of most good employer-offered health plans available on the marketplace.

 

[calvnandhobbs68]

An additional note for anyone who hasn't done this before--even the best marketplace plans are often worse than the sort of insurance you typically get from companies known for excellent benefits (academic jobs, Kaiser, etc.) This is variable by state, as well. E.g. the best gold plans in my state still have high deductibles and high MOOP and high specialty/brand Rx copayments.

I would agree with the post above and say that's probably true for jobs that are known for good benefits like you mentioned. However, if you're comparing the health insurance you get from say a local private practice or PE owned group, I would be really careful with comparing actual dollars to dollars. When I looked, some of the plans offered were actually worse than what I would get on the marketplace when you actually compared how much less you'd make vs higher income and just buying health insurance yourself.

You're also limited to whatever plans the employer decides to offer (which may only be 1-2). This is especially true for things like big academic places which may totally restrict any out of network options. I pay a decent amount for a PPO on the exchange but it has out of network coverage with an OON OOP max, so at least I can be reasonably sure I won't go bankrupt if for instance someone has a serious medical problem with high costs I want to go out of network for.

 

[FlowRate]

Agreed that this is something to look out for, it is very area specific. In my neck of the words there are carbon copies of most good employer-offered health plans available on the marketplace.

That would be nice for confidence in not having to stay with an employed position if you have any sort of medical issues/take any sort of expensive med. I'd be paying an additional $8500 minimum to hit MOOP each year with all of the marketplace plans in my state, and none of the plans are PPO (all HMO.) IIRC it was a similar situation when I looked, out of curiosity, at MA marketplace several years ago as well.

 

[clausewitz2]

That would be nice for confidence in not having to stay with an employed position if you have any sort of medical issues/take any sort of expensive med. I'd be paying an additional $8500 minimum to hit MOOP each year with all of the marketplace plans in my state, and none of the plans are PPO (all HMO.) IIRC it was a similar situation when I looked, out of curiosity, at MA marketplace several years ago as well.

There are distinct advantages to being in a market where two major insurers are slugging it out for market share. It's almost like real competition tends to decrease prices.

 

[blueforest]

That's quite a few hours. I presume 30 min f/u, would it be 60-120 min for intakes (this makes a huge difference, 60 min is brutal in CAP)? Do you have access to quality therapists? Does pay drop with no shows? Good EMR for copying forward notes and eRx? Health care benefits are definitely a big deal, my employer contributes roughly 20k to insure myself, my partner, and my child. Most private companies these days actually have fairly decent health care and 401k as well as fully covering insurance w/ tail or claims based malpractice.

30-45 minute follow-ups and ~2 hour intakes. Guaranteed pay (annual salary) W-2 position.

 

[Merovinge]

30-45 minute follow-ups and ~2 hour intakes. Guaranteed pay (annual salary) W-2 position.

Time frame for visits is reasonable/good so the next question is just around all the other stuff like benefits, non-compete, PTO, CME time, etc. There's definitely something to a guaranteed flat pay job where no-shows are a breather rather than a kick in the pocket book, it just changes the way you feel day to day at work.

 

[FlowRate]

There are distinct advantages to being in a market where two major insurers are slugging it out for market share. It's almost like real competition tends to decrease prices.

Maybe interesting, there's intense competition in the insurance space here, as well, but I have no clue why that hasn't translated to more PPO/true Cadillac type insurance plans on the insurance exchange. PPO plans are very popular with large employers here so a large portion of the total insurance market (just not the public exchange) is PPO plans.

 

[clozareal]

Absolutely, I can see that. Briefly, CAP 300k for 32.5 patient hours a week. Sweatshop or reasonable?

My main dilemma is benefits. For those with families, how strongly do you consider medical benefits as a dealbreaker for a job?

Employed, academic positions tend to offer that security (good medical benefits) for my entire family. Decisions... decisions...

It depends on where you are located. It comes out to $177/hr. If the private practice is taking 40% for overhead, that would mean they're charging $295/hr, which is on the lower range for CAP in private practice. Not terrible though depending on where you're located.

For me, I probably wouldn't take that offer without benefits such as health insurance, dental, vision, retirement match, etc. unless this person was a really good mentor and you're trying to learn as much as you can from them to go out on your own eventually. That's a lot of hours to work in private practice CAP. I feel like most my PP colleagues work 20 hours a week and make at least that much.

 

[EdLongshanks]

Any jobs like this in other states as far as you know of? Are most state hospital jobs like this?

I worked in Michigan and it was similar.

 

[aspiringdoc09]

What is the typical range for academic positions? How does this change with fellowship training (non-CAP)? I understand it is region-specific. I am in the Northeast but looking all over the US. I'm interviewing and trying to gauge offers. I tried locating updated information for MGMA, Medscape, and salary websites. I can't afford $1100 for AAMC, and I'm unsure how to get a membership for $50.

 

[Stagg737]

What is the typical range for academic positions? How does this change with fellowship training (non-CAP)? I understand it is region-specific. I am in the Northeast but looking all over the US. I'm interviewing and trying to gauge offers. I tried locating updated information for MGMA, Medscape, and salary websites. I can't afford $1100 for AAMC, and I'm unsure how to get a membership for $50.

I saw anything between $180k-$240k per year base when I was looking ~2 years ago. My base is ~$220k right now, but after bonuses and call I should hit around $255-260k gross salary for this year plus benefits.

 

[mistafab]

What is the typical range for academic positions? How does this change with fellowship training (non-CAP)? I understand it is region-specific. I am in the Northeast but looking all over the US. I'm interviewing and trying to gauge offers. I tried locating updated information for MGMA, Medscape, and salary websites. I can't afford $1100 for AAMC, and I'm unsure how to get a membership for $50.

Depends.

Research or nah?

Non-research, I’ve been offered 215-250 base but that did not include any big wig cities (NY, Boston). I have colleagues who signed in NY for 240 base.

Most places I applied provided no raise for fellows. What they did was guarantee you start at assistant if you had a fellowship, rather than instructor. So that’s a pay scale ahead at most places - though depending on your CV you may have been offered assistant anyway.

Though perhaps they wouldn’t have offered the gig in the first place without the fellowship. Who knows.

I accessed AAMC data from 2021. Psych gen, instructor median was 193, assistant 208. Maybe a bit outdated at this point. I was offered nothing that low, though I have a lot of academic stuff on my CV and did not apply for research gigs.

 

[calvinhobbes]

What kind of offers (salary range) are CAP trained docs getting?

 

[aspiringdoc09]

Thanks for the replies. Discussing salaries seems "taboo". I think we should be more open about salaries in our field/medicine/in general. I was advised to compare the offers I get to better decide. It's funny because what if I'm being "low-balled" as an entry-level physician? Don't get me wrong, money isn't everything, but I deserve something more than "the low 200s" with additional fellowship training. Doctors shouldn't be offered less than $250K, in my opinion. I'm getting serious about finding something now, so I'll see how it goes.

The starting level is "Assistant Psychiatrist". No research. Mainly inpatient (cross-coverage + C/L) + some neurotherapeutics. I may have to cobble some roles together if I don't find something I like. I've been thinking about locums too.

 

[Stagg737]

18 months into my job and figured I'd share how I got it/where I'm at.

Spoiler: Getting the job

Started applying seriously around Dec of PGY-4. Was pretty sure I wanted to stay in academia and had a particular academic center in in the midwest where I knew the dept chair. Applied to 2 posted jobs there that I really wanted but was too late for both (one position they'd just offered to someone who accepted, the other they'd just interviewed someone accepted shortly after). Had previously spoken with the chair and knew they were interested in trying to develop an ER psych team, so proposed a position which was approved.

Spoiler: Job description

Assistant clinical professor
M-F 6am-2pm covering complex ER consults (~2-3/day) for large academic center, work with psych SW/RN team
Outpatient telehealth consult clinic ~6 hrs/wk in the early afternoon
ECT 3-4 mornings per month supervising residents (by choice)
Back-up main C/L team supervising residents when they're short (by choice to pad RVUs and because I enjoy it)

Weekend call Q6wks supervising residents with another ER doc, $1k/day ($2k/day if solo attending) + RVUs
Overnight call Q6wks overnight for 1 week, residents are first call. In my 8-9 weeks of call I've gotten 2 "overnight" calls total and neither were after midnight.

No mid-level supervision.
Non-solicitation agreement but no non-compete.
There some expectations of academic/research/administrative projects or roles if seeking promotion. I do have some projects/roles and would like to get more involved, but I haven't felt pressured to do anything.
Leave accumulates per 2 wk pay period, can accumulate up to 40 days of vacation and sick (each)
5 days/yr for CME

Spoiler: Compensation

Initial base of $210k/yr for first 12 months
After 12 months is RVU based and updates quarterly based on previous 12 month total, currently making equivalent of $240k/yr (~4100 wRVUs)
Weekend call added ~$25k for the past year
Bi-annual bonus totaling ~$25k/yr
Will gross ~$270k for this year, hoping to be around $280k next year

Additional 9% retirement bonus that scales up to 18% after 12-15 years (~$20k currently)
Additional $15k in benefits (health, HSA, term life insurance, etc)
Several other options for tax-deferred accounts
ETA: $5k annually for CME

Total compensation is over $300k for the past year.

Tl;dr I proposed/created an academic position in the midwest doing psych ER consults, joined ECT team by choice, and small outpt consult clinic. Salary is standard for the institution ($210k base for year 1, then RVU based), compensated call Q6wks, bi-annual bonuses, additional retirement help from institution and state benefits. Total compensation with benefits is currently a little over $300k. No mid-level supervision. No non-compete. Opportunities to take on/make admin/research roles as I'd like. Feeling pretty happy and supported with where I'm at. Team is flexible and covers for each other well. My role will be shifting next year to a more traditional C/L role with a little better schedule by my choice. Overall I like where I'm at and am hoping to be here long-term.

Good jobs are out there, and new grads shouldn't be afraid to propose positions to employers if they see a service in need.