Graduating psych residents…Job offers

[FlowRate]

standard benefits ($8-10K) = $289-294K??

Unless there's no match to the 401k and almost no money in the cash balance plan, you're probably not accounting for 5-40k in additional retirement-related compensation.

I wouldn't personally count the sign-on as part of the comp comparison, though. Maybe if you distributed over however long you think you'll be in the job.

The second job sounds better from that limited snippet, unless you have a huge amount of loans in which case that loan forgiveness looks pretty compelling. Is 3-5 years depending on amount you want forgiven? How is the timeline determined?

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[Merovinge]

As an update and reiteration, compensation is non-negotiable. There is no separate CME (time/$$). PTO seems typical 4 weeks/20day +10-11 holidays + sick. Student loan repayment is 300K (not PSLF) after 3-5 years. There are two types of retirement programs: 1 401K and other cash-balance retirement after getting vested. 30-32 total clinical hrs. Never had consult service so the volume is uncertain. Board certification added nothing but promised $1K once I board in my sub-subspecialty training. Call is on-site if I choose to do it but not a requirement since it is additional pay. So, for this role the extra pay comes from calls or seeing more than 6 pts.

Job 1: Assumed total compensation is $222K + 40K sign-on (one-time) +/-call 19,200-22,500K + standard benefits ($8-10K) = $289-294K??


Job 2 (Academics, Geriatric Inpatient, FT):
Two academic appointments. Room to grow. Opportunities for ECT/TMS services are available.
Total compensation: 305K with $10K sign-on and $10K retention bonus at the end of year 2 and 3. CME $3500/yr.
PTO 25 days (includes CME)
Call: 20 nights (home) and 6 weekends/yr (incl 3-day weekend). Extra is extra $$. For the geriatric unit and 1/2 adult unit.
Pt Census: 10 pts, can leave when done. Rotating trainees (geri-fellows, medical students, medical residents/fellows)
3 other Colleagues are amazing. I am leaning toward this position.

Both are inpatient roles in MA but different, so hard to completely compare. I do not like having to move between multiple services. Both are PSLF eligible, and both offer the same student loan repayment.


Thoughts on the best way to compare these offers?

Keep in mind with base salary + bonus vs base salary that many things are based on your base salary including: 401k/403b/401a % based matches, disability benefits, and most importantly raises are usually a % of base salary. Even if total comp is similar, if you get % based raises and stay at the job for many years, having the dramatically higher base salary will continue to then lever up higher over time.

You already wanted to do geripsych IP so why not just start with Job 2 and start where you want to be anyway. Add the interventional stuff if you like it. $315k for academic IP geripsych seems pretty darn solid to me.

 

[Stagg737]

what do yall think about this NP's income?

Not surprised considering it's NYC and it sounds like she's offering a "wholistic" psychiatric approach. There are NPs in NYC charging 4-figures per hour. At $600k/yr she's probably charging $400-500/hr, which is pretty normal/low for cash only psychiatry in NYC from the few people there I've talked to.

 

[Splenda88]

what do yall think about this NP's income?

I guess I need to work harder as a hospitalist. 401k/yr is not gonna cut it.

 

[sevo00]

I guess I need to work harder as a hospitalist. 401k/yr is not gonna cut it.

Is that your income or your 401k retirement plan

 

[Splenda88]

Is that your income or your 401k retirement plan

My income in 2023.

 

[aspiringdoc09]

Unless there's no match to the 401k and almost no money in the cash balance plan, you're probably not accounting for 5-40k in additional retirement-related compensation.

I wouldn't personally count the sign-on as part of the comp comparison, though. Maybe if you distributed over however long you think you'll be in the job.

The second job sounds better from that limited snippet, unless you have a huge amount of loans in which case that loan forgiveness looks pretty compelling. Is 3-5 years depending on amount you want forgiven? How is the timeline determined?

The match is 2% which is the same for both places. The cash balance will start at $0. I don't consider the sign-on bonus as part of yearly income. I tried to reduce the bonus and negotiate a higher base salary. I have 4 more years to complete through PSLF either way. I was given that range but I'm "assuming" Year 3 is where the loan forgiveness will start for them. Thanks.

Keep in mind with base salary + bonus vs base salary that many things are based on your base salary including: 401k/403b/401a % based matches, disability benefits, and most importantly raises are usually a % of base salary. Even if total comp is similar, if you get % based raises and stay at the job for many years, having the dramatically higher base salary will continue to then lever up higher over time.

You already wanted to do geripsych IP so why not just start with Job 2 and start where you want to be anyway. Add the interventional stuff if you like it. $315k for academic IP geripsych seems pretty darn solid to me.

You make a great point. I am leaning more that way but exploring other jobs outside this region. Thanks for your insight.

 

[uhmocksuhsillen]

I did see a position for CDCR in the last few days paying >500K. How safe is this job?

My understanding is extremely safe. I work county, so different obviously, but my job is much safer than my work in the inpatient unit. Most visits are behind glass. If I'm walking on a cell module, I have a cop with me at all times.

 

[Ellomate]

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.

How do you like it so far?
My interest in CL is growing as an intern.
Seems like a grind tho - not knowing how many patients you have, social issues, coordinating care with multiple team members can all be very time consuming.
Do you leave at 5pm everyday are able to leave when done? Do you at times leave much later due to complications/difficulties with some cases?
Also do you feel fairly compensated for the amount of work you do?

 

[Ellomate]

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

does fellowship play a role in your compensation?
Does it really have tangible leverage when it comes to negotiation?
An intern here currently going back-and-forth with fellowship
thanks!

 

[littlefred]

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

Hook me up! Moved to the area and the salaries I've seen are dismal.

 

[FlowRate]

How do you like it so far?
My interest in CL is growing as an intern.
Seems like a grind tho - not knowing how many patients you have, social issues, coordinating care with multiple team members can all be very time consuming.
Do you leave at 5pm everyday are able to leave when done? Do you at times leave much later due to complications/difficulties with some cases?
Also do you feel fairly compensated for the amount of work you do?

Highly dependent on institution. Sounds like the CL docs in our system have a much better boundaried set of expectations with consulting teams than the CL services in the academic centers where I trained.

does fellowship play a role in your compensation?
Does it really have tangible leverage when it comes to negotiation?
An intern here currently going back-and-forth with fellowship
thanks!

Fellowship can play a role. If you're hired specifically for a fellowship-related role in our system, it works out to a roughly 10% increase in compensation.

CAP is the fellowship that most consistently has a good compensation ROI.

 

[Styrene]

How do you like it so far?
My interest in CL is growing as an intern.
Seems like a grind tho - not knowing how many patients you have, social issues, coordinating care with multiple team members can all be very time consuming.
Do you leave at 5pm everyday are able to leave when done? Do you at times leave much later due to complications/difficulties with some cases?
Also do you feel fairly compensated for the amount of work you do?

I start July 1, 2024.

 

[MedJosh]

PMHNP inflate their salaries to get under MDs skin. I work in a setting with both and the MDs reimbursement is much higher per code than NPs. Even when the rates are similar, the cut is much more for NPs than MDs. I looked a Headway, Alma and the rates there much better for MDs. In order for a NP to make good money, they have to run a pill mill, 15 min appts of the sickest patients with the most co-morbidities and kill people with the poor care they provide.

 

[MedMan80]

PMHNP inflate their salaries to get under MDs skin. I work in a setting with both and the MDs reimbursement is much higher per code than NPs. Even when the rates are similar, the cut is much more for NPs than MDs. I looked a Headway, Alma and the rates there much better for MDs. In order for a NP to make good money, they have to run a pill mill, 15 min appts of the sickest patients with the most co-morbidities and kill people with the poor care they provide.

There is truth to this, in both my old hospital setting and my current specialized setting we make a good amount more than the NP's.

 

[Merovinge]

PMHNP inflate their salaries to get under MDs skin. I work in a setting with both and the MDs reimbursement is much higher per code than NPs. Even when the rates are similar, the cut is much more for NPs than MDs. I looked a Headway, Alma and the rates there much better for MDs. In order for a NP to make good money, they have to run a pill mill, 15 min appts of the sickest patients with the most co-morbidities and kill people with the poor care they provide.

This is so silly to me. Do paralegals inflate their salaries to get under lawyer's skins? Do physical therapy assistants inflate their salaries to get under PT's skins? NAs to get under RNs skins? RNs to get under NPs skins? How do we have a culture where it's a reasonable thing to act dishonestly to get under someone's skin?

 

[psychiatree]

Thoughts?
West coast
Outpatient
4.5 days/wk
~$290k salary (single; no dependents)
$250k sign on bonus for 3 years
$170k over 10 years to be used towards loan repayment (have 5 years of PSLF left)
Salary increase yearly
Expected salary 4 years in ~$390k
30 min follow up/60 min new evals
Potential to do internal moonlighting on weekends
Call about 1 day/month

 

[Merovinge]

Thoughts?
West coast
Outpatient
4.5 days/wk
~$290k salary (single; no dependents)
$250k sign on bonus for 3 years
$170k over 10 years to be used towards loan repayment (have 5 years of PSLF left)
Salary increase yearly
Expected salary 4 years in ~$390k
30 min follow up/60 min new evals
Potential to do internal moonlighting on weekends
Call about 1 day/month

That's already 390K/year starting with prorated sign on and loan repayment. Seems very solid for 30/60 min and 1 day of call/month.

 

[FlowRate]

Thoughts?
West coast
Outpatient
4.5 days/wk
~$290k salary (single; no dependents)
$250k sign on bonus for 3 years
$170k over 10 years to be used towards loan repayment (have 5 years of PSLF left)
Salary increase yearly
Expected salary 4 years in ~$390k
30 min follow up/60 min new evals
Potential to do internal moonlighting on weekends
Call about 1 day/month

Seems pretty good overall. How many hours per day are f2f with patients?

 

[icysky]

Thoughts?
West coast
Outpatient
4.5 days/wk
~$290k salary (single; no dependents)
$250k sign on bonus for 3 years
$170k over 10 years to be used towards loan repayment (have 5 years of PSLF left)
Salary increase yearly
Expected salary 4 years in ~$390k
30 min follow up/60 min new evals
Potential to do internal moonlighting on weekends
Call about 1 day/month

this Kaiser in SoCal right? Don’t forget they have 2 hours a week where they slot 15 min follow ups

 

[Stagg737]

Thoughts?
West coast
Outpatient
4.5 days/wk
~$290k salary (single; no dependents)
$250k sign on bonus for 3 years
$170k over 10 years to be used towards loan repayment (have 5 years of PSLF left)
Salary increase yearly
Expected salary 4 years in ~$390k
30 min follow up/60 min new evals
Potential to do internal moonlighting on weekends
Call about 1 day/month

Surface level this looks almost too good to be true. Salary and appt times are good and expected salary is quite high for the expected work if those 4.5 days per week are regular hours (7-8 clinical hours/day). Those parts sound good. What is the moonlighting and call if this is outpatient?

$250k sign on bonus for a 3 year contract? I've never heard of anything close to to that as a sign on bonus. Sounds like a either somewhere desperate to make sure people stay d/t other red flags. If this is Kaiser like suggested above, is that sign-on the golden handcuffs there people talk about? Also if Kaiser the inbox policy is gross, but I'm also just averse to the inbox in general.

 

[sloh]

Surface level this looks almost too good to be true. Salary and appt times are good and expected salary is quite high for the expected work if those 4.5 days per week are regular hours (7-8 clinical hours/day). Those parts sound good. What is the moonlighting and call if this is outpatient?

$250k sign on bonus for a 3 year contract? I've never heard of anything close to to that as a sign on bonus. Sounds like a either somewhere desperate to make sure people stay d/t other red flags. If this is Kaiser like suggested above, is that sign-on the golden handcuffs there people talk about? Also if Kaiser the inbox policy is gross, but I'm also just averse to the inbox in general.

250k sign on bonus isn’t unheard of for Kaiser in central cali. No one wants to live there haha

 

[Ellomate]

where does everyone get recruitment emails from?
I'm still early on my training but would like to know what's out there locally.
Are there any reputable site/company where I can put my email down (maybe a proxy email so that my personal email doesn't get flooded).
Thank you

 

[ObsequiousAplomb]

where does everyone get recruitment emails from?
I'm still early on my training but would like to know what's out there locally.
Are there any reputable site/company where I can put my email down (maybe a proxy email so that my personal email doesn't get flooded).
Thank you

the easiest way?

Do you have a linkedin account?

1. If so, update it. If not, make one.
2. Turn the "email me when I get a message" toggle off.
3. Let a recruiter or two network with you. Say you're really open to hearing about any offers.

That's all you have to do.
You will be flooded with messages from them. Ideally, messages to your linkedin, which you would only be checking when you want to read them.

 

[calvnandhobbs68]

the easiest way?

Do you have a linkedin account?

1. If so, update it. If not, make one.
2. Turn the "email me when I get a message" toggle off.
3. Let a recruiter or two network with you. Say you're really open to hearing about any offers.

That's all you have to do.
You will be flooded with messages from them. Ideally, messages to your linkedin, which you would only be checking when you want to read them.

lol and then go to the recruiters linkedin pages when they message you for a good laugh. You'll see most of them are college dropouts or barely college grads who were working at Dick's sporting goods or something until last year when they became "a dedicated mental health recruiter passionate about connecting employers with mental health professionals!!!"

and that will explain all you need to know about why 90% of them have no clue what you actually do or want out of a job.

 

[ObsequiousAplomb]

lol and then go to the recruiters linkedin pages when they message you for a good laugh. You'll see most of them are college dropouts or barely college grads who were working at Dick's sporting goods or something until last year when they became "a dedicated mental health recruiter passionate about connecting employers with mental health professionals!!!"

and that will explain all you need to know about why 90% of them have no clue what you actually do or want out of a job.

this is the only reward worth talking to a recruiter and as long as you play it safe and don't let them actually have means to contact you it's worked so far.

 

[FlowRate]

Surface level this looks almost too good to be true. Salary and appt times are good and expected salary is quite high for the expected work if those 4.5 days per week are regular hours (7-8 clinical hours/day). Those parts sound good. What is the moonlighting and call if this is outpatient?

$250k sign on bonus for a 3 year contract? I've never heard of anything close to to that as a sign on bonus. Sounds like a either somewhere desperate to make sure people stay d/t other red flags. If this is Kaiser like suggested above, is that sign-on the golden handcuffs there people talk about? Also if Kaiser the inbox policy is gross, but I'm also just averse to the inbox in general.

No, the golden handcuffs are the pension plans for the regions that still do those (or the people who are grandfathered on those plans for the regions that no longer do.) They're VERY generous... if you stick around long enough to qualify. Hence the handcuffs. Several ex-Cali regions don't do pension plans anymore for new hires. Upside for new hires is a benefit you can actually take with you without having to spend a decade+ with the same employer, downside is those benefits aren't nearly as good at retirement as the old pensions.

 

[Kalogada]

What are the salarys like in florida? Can someone chime in?

 

[calvinhobbes]

Surface level this looks almost too good to be true. Salary and appt times are good and expected salary is quite high for the expected work if those 4.5 days per week are regular hours (7-8 clinical hours/day). Those parts sound good. What is the moonlighting and call if this is outpatient?

$250k sign on bonus for a 3 year contract? I've never heard of anything close to to that as a sign on bonus. Sounds like an either somewhere desperate to make sure people stay d/t other red flags. If this is Kaiser like suggested above, is that sign-on the golden handcuffs there people talk about? Also if Kaiser the inbox policy is gross, but I'm also just averse to the inbox in general.

If this is Kaiser, they work you to the bone lol. You’re a slave to the inbox. They own you and how you practice. And the high salary is there because it’s Cali , you get taxed like hell so they have to have a high salary to make the post-tax take home pay somewhat reasonable.

 

[blueforest]

What are the salarys like in florida? Can someone chime in?

The salaries are decent, 300k ish, up to ~350k with quality bonuses etc. However, the clinics I considered were doing 15/20 minute med checks for CAP. As a new grad, I am staying away from jobs like that. That's like 20 patients a day (CHILD!). Yikes.

 

[finalpsychyear]

The salaries are decent, 300k ish, up to ~350k with quality bonuses etc. However, the clinics I considered were doing 15/20 minute med checks for CAP. As a new grad, I am staying away from jobs like that. That's like 20 patients a day (CHILD!). Yikes.

Are most grads content with this salary range? Its a great amount no arguing that coming from residency salary. But i feel like it was pretty much that amount in 2016 ish too. Are people in your class double dipping and doing side gigs like moonlighting or extra calls to get closer to 400k range or is it all about lifestyle even more now?. Don't get me wrong I'm all about lifestyle not having worked a wknd, holiday, or night in almost 8 years but I def push it during the week.

 

[calvnandhobbs68]

The salaries are decent, 300k ish, up to ~350k with quality bonuses etc. However, the clinics I considered were doing 15/20 minute med checks for CAP. As a new grad, I am staying away from jobs like that. That's like 20 patients a day (CHILD!). Yikes.

15-20 minute "med checks" for CAP is ridiculous, I had a practice try to pull that on me too when I was interviewing. By the time you talk to the kid and the parents you're 20 minutes into the appointment most times and then the parent drops some bomb on you that the kid stopped taking meds or is falling apart at school or something. Really only appropriate for your q3 month patients who are stable on one med who probably don't need to see you anyway which means you'd end up with a huge panel.

 

[FlowRate]

Are most grads content with this salary range? Its a great amount no arguing that coming from residency salary. But i feel like it was pretty much that amount in 2016 ish too. Are people in your class double dipping and doing side gigs like moonlighting or extra calls to get closer to 400k range or is it all about lifestyle even more now?. Don't get me wrong I'm all about lifestyle not having worked a wknd, holiday, or night in almost 8 years but I def push it during the week.

Median 40-hour W2 psych jobs (outside of rural/undesirable loc) were not making 300k in 2016.

 

[Merovinge]

Are most grads content with this salary range? Its a great amount no arguing that coming from residency salary. But i feel like it was pretty much that amount in 2016 ish too. Are people in your class double dipping and doing side gigs like moonlighting or extra calls to get closer to 400k range or is it all about lifestyle even more now?. Don't get me wrong I'm all about lifestyle not having worked a wknd, holiday, or night in almost 8 years but I def push it during the week.

You can find jobs that let you grind 9-5 to make good money, little harder but not impossible. People are certainly interested in someone capable of generating high RVUs/billing. It can certainly be done with a schedule appropriately packed with 99214 +90833 x 14 in a day if you have good insurance contracts, high show rates, long retention of patient's, there are setups that can make more money than cash pay psychiatrists in this way.

 

[finalpsychyear]

Median 40-hour W2 psych jobs (outside of rural/undesirable loc) were not making 300k in 2016.

Fair enough I guess im in midwest rural area. However, at least today I do see 400k offers for 40 hr weeks with some of that admin time but it includes some NP collaboration and med director role and that was 1099 money so I can't really compare it to a 300k w2 which has benefits.

 

[finalpsychyear]

You can find jobs that let you grind 9-5 to make good money, little harder but not impossible. People are certainly interested in someone capable of generating high RVUs/billing. It can certainly be done with a schedule appropriately packed with 99214 +90833 x 14 in a day if you have good insurance contracts, high show rates, long retention of patient's, there are setups that can make more money than cash pay psychiatrists in this way.

Ideally you have 30 min per encounter with the add on so x2 an hour for 7 hours. Maybe a 5-10 min 99213 adhd refill sprinkled through the day. Most of my colleges are seeing about 20 encounters in a 8 hours clinical day and don't take a lunch or just have 15 min adhd 99213 like 3-4 during their lunch hours to hit those 20 in a day.

 

[psychiatree]

i interviewed for an inpatient child job in FL covering 10 beds. close to $350k base. ~370k after incentives/RVUs. leave work once done. weekend call 1x/month with phone call 1x/wk. seemed pretty chill and in one of Florida's major bigger cities through a bigger health care system (non profit). i wouldve taken it but preferring bigger social life so had to decline unfortunately

 

[blueforest]

Are most grads content with this salary range? Its a great amount no arguing that coming from residency salary. But i feel like it was pretty much that amount in 2016 ish too. Are people in your class double dipping and doing side gigs like moonlighting or extra calls to get closer to 400k range or is it all about lifestyle even more now?. Don't get me wrong I'm all about lifestyle not having worked a wknd, holiday, or night in almost 8 years but I def push it during the week.

I would say my class is definitely prioritizing work life balance, so for the hours worked and lifestyle most of us are happy with anything around 300k.

 

[calvinhobbes]

The salaries are decent, 300k ish, up to ~350k with quality bonuses etc. However, the clinics I considered were doing 15/20 minute med checks for CAP. As a new grad, I am staying away from jobs like that. That's like 20 patients a day (CHILD!). Yikes.

Many jobs try to start you at 270k in Florida aka low-ball you, don’t fall for it!! No one should take a job below 300k in Fl

 

[aspiringdoc09]

Many jobs try to start you at 270k in Florida aka low-ball you, don’t fall for it!! No one should take a job below 300k in Fl

For base salary or total compensation?

 

[Merovinge]

i interviewed for an inpatient child job in FL covering 10 beds. close to $350k base. ~370k after incentives/RVUs. leave work once done. weekend call 1x/month with phone call 1x/wk. seemed pretty chill and in one of Florida's major bigger cities through a bigger health care system (non profit). i wouldve taken it but preferring bigger social life so had to decline unfortunately

Q4 call is quite a bit, particularly depending on the size of the unit. By rough approximation of q4 and you covering 10 beds, if you are covering 40 CAP beds on call/weekend that certainly would come with a big hit to sleep quantity (not sure FL laws but we cannot have standing psych PRNs for peds patients where I live). 370k is still reasonable but there is a huge chasm between 9-5 no call and q4 all night call in overall health/lifestyle.

 

[mistafab]

Just wanted to put out there - a lot of places have tried to convince me to sign early, sign now, etc etc etc. Don't fall for this false pressure! Hold out until you find the right gig. Especially with these ugly 2 or 3 year required "sign on bonus" loan periods...

 

[calvinhobbes]

For base salary or total compensation?

Base lol

 

[lobstar]

206k base. Academic in the south. Inpatient/CL/ED. Backup to senior resident call. Weekend rounding every 6 weeks. 80% clinical 20% admin/academic time.

It feels super low.

 

[ObsequiousAplomb]

206k base. Academic in the south. Inpatient/CL/ED. Backup to senior resident call. Weekend rounding every 6 weeks. 80% clinical 20% admin/academic time.

It feels super low.

I would never debase myself for a base that low

 

[finalpsychyear]

206k base. Academic in the south. Inpatient/CL/ED. Backup to senior resident call. Weekend rounding every 6 weeks. 80% clinical 20% admin/academic time.

It feels super low.

I remember residency offering something in the 160-180s in 2016 to all 4th years. A few accepted. I think when they did state pensions you would take a lower than average salary lets just call its 180-200 for a state psych job but do like 20-25 years there and get a 100% pension based on those numbers. Does academics do something like that or how does it even make sense financially?

 

[lobstar]

I remember residency offering something in the 160-180s in 2016 to all 4th years. A few accepted. I think when they did state pensions you would take a lower than average salary lets just call its 180-200 for a state psych job but do like 20-25 years there and get a 100% pension based on those numbers. Does academics do something like that or how does it even make sense financially?

Something like a 50% pension after 20-25 years I believe. Takes like a decade before it vests to begin with. There's also a reduction if you retire before 65...

 

[finalpsychyear]

Something like a 50% pension after 20-25 years I believe. Takes like a decade before it vests to begin with. There's also a reduction if you retire before 65...

Yeah, so from a financial standpoint wouldn't make sense if that was the driver. Lets say you can save 100k more in another job which invested for 20 years at 6-7% gets you to 3.5-4m and your early 50s. That's close to 150k per year right there indefinitely.

 

[mistafab]

206k base. Academic in the south. Inpatient/CL/ED. Backup to senior resident call. Weekend rounding every 6 weeks. 80% clinical 20% admin/academic time.

It feels super low.

Terrible.

 

[splik]

206k base. Academic in the south. Inpatient/CL/ED. Backup to senior resident call. Weekend rounding every 6 weeks. 80% clinical 20% admin/academic time.

It feels super low.

This was about my base when I was in academics up until 2022. Though there was no weekend rounding and there was 0% academic time. The pay does seem bad but I think you have to consider everything - what are the benefits like? This can make a big difference. One of my colleagues was out sick for a yr and was paid full salary during that time. That's without using the disability insurance. We had generous sick leave, vacation, almost unlimited professional leave, good health/dental/vision insurance, a pension plan and 3 retirement plans. When staffing was adequate (which was rarely) it was super chill. Sometimes I saw like 1 pt a day. When staffing was bad (which was most of the time) it was terrible. It was also a very dysfunctional system which came with a lot of advantages. I was also able to effectively double my pay with additional work. I also got a green card out of it paid by the department. They also had some good discounts which I used frequently.

My point is that for certain people academic jobs with low base pay may be okay. Especially if there is a low work load, you had residents doing a lot of the work, and you love teaching and supervising trainees. You may also get to do things in academics that you don't get in other settings (e.g. certain patients, access to certain treatments, participating in clinical trials etc). There are also the benefits of having that support from colleagues etc. Someone needing a green card, or good medical insurance, or who wants good retirements benefits, or has an illness/disability and wants to safety of generous paid leave, may be okay. There are also some places which have low base pay but have opportunities to substantially supplement your income.