Graduating psych residents…Job offers

[mistafab]

I'd say the saving grace of your low pay job is the huge chunk of admin time. I'm guessing they are grooming you for core faculty?

A big peice of info is your rank. If this is starting at instructor, and you are eligible for asst in 1-2 years then that would be good to know. If the Asst prof rank after this is 250, then all of a sudden the gig isn't too bad. The weekend rounding blows because its a bit too frequent, but hey there's always a price in academics. In this case, its around 2 brand new Lincoln MKZs per year difference between a regular psych salary.

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[MedMan80]

Def need to factor in benefits for academic places. One attending at my training place had his daughter complete med school from the same institution, tuition free. Pension was great and the residents would do most of the work, so the work was mostly sporadic for the attendings.

 

[lobstar]

I'd say the saving grace of your low pay job is the huge chunk of admin time. I'm guessing they are grooming you for core faculty?

A big peice of info is your rank. If this is starting at instructor, and you are eligible for asst in 1-2 years then that would be good to know. If the Asst prof rank after this is 250, then all of a sudden the gig isn't too bad. The weekend rounding blows because it's a bit too frequent, but hey there's always a price in academics. In this case, its around 2 brand new Lincoln MKZs per year difference between a regular psych salary.

Indeed this is grooming for core faculty and already at the assistant professor level so really no major increases in pay in sight--just the standard yearly 2-3% or whatever it is.

 

[Stagg737]

Indeed this is grooming for core faculty and already at the assistant professor level so really no major increases in pay in sight--just the standard yearly 2-3% or whatever it is.

What’s the patient load like? My first year as an assistant prof position I got $210k base but averaged less than 6 patients per day with solid benefits. There’s a huge difference between getting low pay for low patient volume and pay being bad.

Also, any bonuses or extra pay for call? I make an extra K every weekend call day I take (which is also roughly q6weekends) and made an extra $24k last year and got about the same in bonuses (general bonuses, not production). I’ve also seen low base salaries where docs make double or even triple the base after production. Need more info to know if it’s really that bad…

 

[ObsequiousAplomb]

Indeed this is grooming for core faculty and already at the assistant professor level so really no major increases in pay in sight--just the standard yearly 2-3% or whatever it is.

FTFY

 

[lobstar]

What’s the patient load like? My first year as an assistant prof position I got $210k base but averaged less than 6 patients per day with solid benefits. There’s a huge difference between getting low pay for low patient volume and pay being bad.

Also, any bonuses or extra pay for call? I make an extra K every weekend call day I take (which is also roughly q6weekends) and made an extra $24k last year and got about the same in bonuses (general bonuses, not production). I’ve also seen low base salaries where docs make double or even triple the base after production. Need more info to know if it’s really that bad…

Like 10-12 per day but with residents to do most things. There's no additional pay opportunities for call or other coverage. You know, it seemed not great but now I'm seeing just how bad it really is.

FTFY

Okay I actually chuckled to myself reading this 😂

 

[Stagg737]

Like 10-12 per day but with residents to do most things. There's no additional pay opportunities for call or other coverage. You know, it seemed not great but now I'm seeing just how bad it really is.



Okay I actually chuckled to myself reading this 😂

I'll slightly disagree with others that if this is a straight inpatient academic position with 20% admin time and you're just staffing residents that it's not that bad. The call may be frequent, but if you're just back-up to the senior residents it could basically be nothing. I take a week of overnight call every 6-7 weeks in my position and in the 12-15 weeks I've had call I've actually been called a total of 2 times, both well before midnight, and never go in. So being "on call" could be mostly a formality. On the other hand, call could be very different for the position you're looking at.

When I was applying a couple of years ago I saw some academic positions where base was as low as $175k without fantastic benefits. In my (fairly limited) experience, the positions you see on here of academic places paying a base of $240k+ are really outliers and like Splik mentioned the big financial pluses to academia are the potential benefits. $206k base is definitely not great and imo is middle/low for academic base salary, but it's not "horrible" and I've seen far worse in academia. If benefits are great and you love teaching and/or can leave shortly after noon then this is probably decent for academia. If benefits are meh, the call is bad, and you're expected to work a "full-time" schedule, then I'd probably pass unless you really want to work there.

 

[calvinhobbes]

What’s the typical starting salary range for gen psych and CAP in NYC? Thank you!

 

[Marasmus1]

Just throw out some numbers here. Before the numbers;

I am 6 months in child psych full time academic job straight out of fellowship. I run my own clinic two half days a week from 9 to 12 pm and only see 2 hours intakes and 1 hour follow ups. If they need me for only 30 minutes med management, I refer them to community mental healthcare clinics or PCP. Admin does not have any RVU expectations. I do research half a day a week, didactics for students/residents/fellows half a day every other week and supervise residents/fellows clinic 3 full days some requires being present throughout the session and some 2 minutes check in at the end (depending on the level of a trainee). My clinics are blocked by admin during my trainee clinic supervision. I would say I am enjoying the best days of my life despite of modest academic salary. my benefits are as below;

215k base
20k sign on bonus
Additional income of 30k from internal moonlighting which consist of resident/fellow supervision in the floor and ED over the weekends
External moonlighting of 25k which consists of overnight resident supervision at state hospital
10-15k honorarium from presentations in local and national conferences
5 weeks vacation, 10 days federal holidays, 5 sick days
5 days CME with 5k reimbursement. If presenting, reimbursement goes up to 10k
403b, Roth 403b, 457 plans with up to 5% match of base
Tuition assistance

 

[lobstar]

Anyone have experience with being paid a percent of charges (rather than collections) at a FQHC? What is a reasonable number for that? 60-70% of charges? I'm concerned about the no show percentage which they claim is "low". Benefits seem decent.

 

[mistafab]

Just throw out some numbers here. Before the numbers;

I am 6 months in child psych full time academic job straight out of fellowship. I run my own clinic two half days a week from 9 to 12 pm and only see 2 hours intakes and 1 hour follow ups. If they need me for only 30 minutes med management, I refer them to community mental healthcare clinics or PCP. Admin does not have any RVU expectations. I do research half a day a week, didactics for students/residents/fellows half a day every other week and supervise residents/fellows clinic 3 full days some requires being present throughout the session and some 2 minutes check in at the end (depending on the level of a trainee). My clinics are blocked by admin during my trainee clinic supervision. I would say I am enjoying the best days of my life despite of modest academic salary. my benefits are as below;

215k base
20k sign on bonus
Additional income of 30k from internal moonlighting which consist of resident/fellow supervision in the floor and ED over the weekends
External moonlighting of 25k which consists of overnight resident supervision at state hospital
10-15k honorarium from presentations in local and national conferences
5 weeks vacation, 10 days federal holidays, 5 sick days
5 days CME with 5k reimbursement. If presenting, reimbursement goes up to 10k
403b, Roth 403b, 457 plans with up to 5% match of base
Tuition assistance

Sounds like a dream. Perfect example of CAP working far less than gen psych and having an enjoyable gig. 200k+ to chill and teach. Sounds like no compulsory call. Large PTO bank. Excellent.

 

[Merovinge]

Anyone have experience with being paid a percent of charges (rather than collections) at a FQHC? What is a reasonable number for that? 60-70% of charges? I'm concerned about the no show percentage which they claim is "low". Benefits seem decent.

You would need to talk to other docs working there willing to share with you their numbers. Percentage means nothing without knowing what the actual charges are for your main billing codes (99214/99215 being the most important) and then if you are doing psychotherapy add ons and what those will charge. Evals matter but relatively little if you are doing stable work with a majority of f/us (particularly at a FQHC where I imagine most patients will have had evals that you take over by a previous doc). I would be pretty weary given this means you get essentially no PTO and no pay for no-shows with all the negatives of being employeed and not getting tax deductions.

 

[Stagg737]

Got a text this morning for inpatient CAP in upstate NY offering 48K/mo. I get texts for jobs a couple of times a month, but usually don’t specify pay. Text image below:

 

[calvnandhobbs68]

Got a text this morning for inpatient CAP in upstate NY offering 48K/mo. I get texts for jobs a couple of times a month, but usually don’t specify pay. Text image below:

lol sure covering multiple units, covering ER consults and being on call every night and every weekend I'm sure. I'd wonder what the specifics of that are.

 

[Stagg737]

lol sure covering multiple units, covering ER consults and being on call every night and every weekend I'm sure. I'd wonder what the specifics of that are.

Me too. I don't mind DM'ing the contact number if someone is actually interested, but I can't imagine this is a position that values work-life balance seeing as it was a text and most of the texts I get are for corrections positions...

 

[lobstar]

I'll slightly disagree with others that if this is a straight inpatient academic position with 20% admin time and you're just staffing residents that it's not that bad. The call may be frequent, but if you're just back-up to the senior residents it could basically be nothing. I take a week of overnight call every 6-7 weeks in my position and in the 12-15 weeks I've had call I've actually been called a total of 2 times, both well before midnight, and never go in. So being "on call" could be mostly a formality. On the other hand, call could be very different for the position you're looking at.

When I was applying a couple of years ago I saw some academic positions where base was as low as $175k without fantastic benefits. In my (fairly limited) experience, the positions you see on here of academic places paying a base of $240k+ are really outliers and like Splik mentioned the big financial pluses to academia are the potential benefits. $206k base is definitely not great and imo is middle/low for academic base salary, but it's not "horrible" and I've seen far worse in academia. If benefits are great and you love teaching and/or can leave shortly after noon then this is probably decent for academia. If benefits are meh, the call is bad, and you're expected to work a "full-time" schedule, then I'd probably pass unless you really want to work there.

I found another academic offer. Also in the south. Similar base at very low 200s. However, compensation with internal moonlighting would be around 235-245k. Benefits are good with 401k (maybe 403b I forget) employer match to some max for an additional 10-20k. Brings total compensation to 260k roughly. Also 80% clinical and 20% admin/research/whatever with similar weekend, night call/coverage, and clinical load/resident help when on service compared to the other offer. Main concern is that the internal moonlighting could evaporate at any point--although it's unlikely to. For sure better than first offer. How does it compare to other academic places y'all have seen?

 

[mistafab]

I found another academic offer. Also in the south. Similar base at very low 200s. However, compensation with internal moonlighting would be around 235-245k. Benefits are good with 401k (maybe 403b I forget) employer match to some max for an additional 10-20k. Brings total compensation to 260k roughly. Also 80% clinical and 20% admin/research/whatever with similar weekend, night call/coverage, and clinical load/resident help when on service compared to the other offer. Main concern is that the internal moonlighting could evaporate at any point--although it's unlikely to. For sure better than first offer. How does it compare to other academic places y'all have seen?

That was a ballpark I was offered at a middling academic joint though 250k (mid city NE) at Assoc prof but with less admin time (.1 fte). Another similar salary had less admin time (0.05) for same pay/rank. Both had less call. But, I made it clear to both I was NOT interested in doing more research in my career. Just teaching, clinical, and forensics for me.

I ended up accepting my ED only job. 3.5 days per week (12s) final salary 275k for day only 12hr shifts non rotating in the SW at a VA. 15k yearly incentive bonus. VA bennies. Teaching residents from a mid/top program. No nights or call. 25k per year loan repay and 30k signon. no noncompete. Planning to build forensic practice in days off. Hoping to focus on FFD, malpractice/wrongful death, disability/workers comp. Will start going to AAPL yearly when settled. Not doing a fellowship.

About to start the good life here in a few months. Cheers.

 

[Merovinge]

That was a ballpark I was offered at a middling academic joint though 250k (mid city NE) at Assoc prof but with less admin time (.1 fte). Another similar salary had less admin time (0.05) for same pay/rank. Both had less call. But, I made it clear to both I was NOT interested in doing more research in my career. Just teaching, clinical, and forensics for me.

I ended up accepting my ED only job. 3.5 days per week (12s) final salary 275k for day only 12hr shifts non rotating in the SW at a VA. 15k yearly incentive bonus. VA bennies. Teaching residents from a mid/top program. No nights or call. 25k per year loan repay and 30k signon. no noncompete. Planning to build forensic practice in days off. Hoping to focus on FFD, malpractice/wrongful death, disability/workers comp. Will start going to AAPL yearly when settled. Not doing a fellowship.

About to start the good life here in a few months. Cheers.

Heck yea, well done! The VA ED doc I worked with was one of the best psychiatrists (clinically) I have ever worked with, she was also a baller.

 

[samac]

That was a ballpark I was offered at a middling academic joint though 250k (mid city NE) at Assoc prof but with less admin time (.1 fte). Another similar salary had less admin time (0.05) for same pay/rank. Both had less call. But, I made it clear to both I was NOT interested in doing more research in my career. Just teaching, clinical, and forensics for me.

I ended up accepting my ED only job. 3.5 days per week (12s) final salary 275k for day only 12hr shifts non rotating in the SW at a VA. 15k yearly incentive bonus. VA bennies. Teaching residents from a mid/top program. No nights or call. 25k per year loan repay and 30k signon. no noncompete. Planning to build forensic practice in days off. Hoping to focus on FFD, malpractice/wrongful death, disability/workers comp. Will start going to AAPL yearly when settled. Not doing a fellowship.

About to start the good life here in a few months. Cheers.

Now that is an Ed job I would love to take. Congrats

 

[Psychferlyfe3000]

Would folks mind giving feedback on this job offer?
-Outpatient
-1099 gig with 80% cut of whatever I bring in.
-I choose what insurances I take.
-I receive office space and claims are processed for me.
-No benefits.

Thanks!

 

[FlowRate]

Would folks mind giving feedback on this job offer?
-Outpatient
-1099 gig with 80% cut of whatever I bring in.
-I choose what insurances I take.
-I receive office space and claims are processed for me.
-No benefits.

Thanks!

I estimated that, were I to start a solo practice, annual expenses would be around $30k for my metro area. Call it $45k if you want to be super conservative (or fancy.) If your show/collection rate (conversion of appointment slots to payment) is 0.8 and your schedule is for up to 30 hours of direct patient care per week, working with an insurance that pays 110% of Medicare, I estimated that I would be grossing about 355k at steady state (new patient slots accounting for about 15% of your clinical hours). So basically overhead for chillish full time clinical work being 10-20%. Does the job also have any front desk/admin staff or do you do all scheduling, phone calls, etc. yourself?

 

[Psychferlyfe3000]

I estimated that, were I to start a solo practice, annual expenses would be around $30k for my metro area. Call it $45k if you want to be super conservative (or fancy.) If your show/collection rate (conversion of appointment slots to payment) is 0.8 and your schedule is for up to 30 hours of direct patient care per week, working with an insurance that pays 110% of Medicare, I estimated that I would be grossing about 355k at steady state (new patient slots accounting for about 15% of your clinical hours). So basically overhead for chillish full time clinical work being 10-20%. Does the job also have any front desk/admin staff or do you do all scheduling, phone calls, etc. yourself?

They do scheduling for me. I think I have to answer patient inquiries though regarding anything medical.

 

[Merovinge]

Would folks mind giving feedback on this job offer?
-Outpatient
-1099 gig with 80% cut of whatever I bring in.
-I choose what insurances I take.
-I receive office space and claims are processed for me.
-No benefits.

Thanks!

If you are getting referrals or supervision I think that's very fair. 80/20 is about as good a split as you will get joining on an established practice. Big question will be any non-compete or penalty for taking your patients and starting your own practice in a few years when you have your feet under you.

 

[solitarius]

VA gigs are a pretty sweet deal for people with a lot of student loans.

 

[Splenda88]

VA gigs are a pretty sweet deal for people with a lot of student loans.

Can it be argued that you can make a lot more in the private sector and use that extra money to pay off your loan?

 

[Stagg737]

VA gigs are a pretty sweet deal for people with a lot of student loans.

Can it be argued that you can make a lot more in the private sector and use that extra money to pay off your loan?

Depends. One of the VAs I worked at in residency tour of duty was 8am-4:30pm, 35 clinical hours per week with salary of $240k. Benefits were solid, but not incredible. My current position and benefits in academia are similar with significantly higher production/bonus potential. At another VA I rotated at in residency their outpatient docs make $275k salary. I've heard of higher and lower salaries as well, so it can vary significantly.

 

[Psychferlyfe3000]

If you are getting referrals or supervision I think that's very fair. 80/20 is about as good a split as you will get joining on an established practice. Big question will be any non-compete or penalty for taking your patients and starting your own practice in a few years when you have your feet under you.

There is no non-compete. I'm not sure about taking patients with...

 

[Psychferlyfe3000]

I estimated that, were I to start a solo practice, annual expenses would be around $30k for my metro area. Call it $45k if you want to be super conservative (or fancy.) If your show/collection rate (conversion of appointment slots to payment) is 0.8 and your schedule is for up to 30 hours of direct patient care per week, working with an insurance that pays 110% of Medicare, I estimated that I would be grossing about 355k at steady state (new patient slots accounting for about 15% of your clinical hours). So basically overhead for chillish full time clinical work being 10-20%. Does the job also have any front desk/admin staff or do you do all scheduling, phone calls, etc. yourself?

What usually accounts for a conversion rate of .80? This practice has 24 hour cancellation policy where if you no-show you need to pay full appointment cost. I suppose someone could cancel before then though and it would be hard to fill?

 

[Stagg737]

What usually accounts for a conversion rate of .80? This practice has 24 hour cancellation policy where if you no-show you need to pay full appointment cost. I suppose someone could cancel before then though and it would be hard to fill?

Flow is talking about if they opened their own practice. That 0.8 conversion of clinic slots to collections includes cancellations/no-shows, inability to fill a slot, patients refusing to pay co-pays or at all, insurance down coding or non-reimbursement or even long delays in payments (12 months plus), and other errors that shouldn’t ever occur like missing billing submission. If you’re solo you either have to pay an admin to do these things or chase them down yourself. Either way costs money. Not to mention all the other admin/managerial problems that come with running a practice.

If you’re employed in a group practice they should take care of much of that for you. If they do all that along with most admin stuff then an 80/20 split is more than fair.

 

[FlowRate]

What usually accounts for a conversion rate of .80? This practice has 24 hour cancellation policy where if you no-show you need to pay full appointment cost. I suppose someone could cancel before then though and it would be hard to fill?

It's just a somewhat conservative estimate based on no-show/unfilled rate I've seen in employed practice and heard from other PP docs. Like Stagg said, there are a lot of things that can lead to not collecting payment on 100% of your planned direct patient care time.