Graduating psych residents…Job offers

[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.

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[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.

 

[rjs2131]

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?

Going into year 4 of PP this summer, there are a lot of variables that go into this BUT how business savvy + organized you are can honestly mitigate most of this.

I’ve had weeks where if I sat around and just let it happen, I’d have up to 10 no-shows/cancellations (most tend to occur at least a few days ahead of time, but not always).

How I minimize this:
- running cancellation list
- email access to patients (can let people know asap if something opens up - not hard to schedule someone virtually the same day)
- good relationships + lots of time spent with patients/family at the first visit (90-120 min) to establish trust
- 30 min follow-ups (no-show rate is higher the more slots you have)

I have 27 clinical hrs available (started with 30 but cut back in Jan because I like half days on Fridays) and my worst weeks will be 26-26.5 hrs filled.

You play a huge role in how busy/filled you are in PP.

Also to the earlier post about 35 clinical hrs at the VA - not uncommon to do that in PP and double your income (>400k). I was able to take home around 400k in year 3 with 30 clinical hrs, and that’s not including full benefits + maxing out 401k. I primarily take insurance. It all depends on the practice and your setup!

 

[calvnandhobbs68]

You play a huge role in how busy/filled you are in PP.

Sure to an extent. There's some days/weeks that just suck. For instance my past Monday I had 3 people cancel late Friday so before the deadline and 3 people late cancel (so 6 total)...so 3/7 hours of my day. Tuesday I had 3 people cancel >24hrs ahead and 1 late cancel. This past Friday I had 3 cancellations >24hrs ahead and 1 no show. I will say this was an unusually ridiculous week with this but it's just an example.

I have admin front office staff so they end up fielding all these calls initially, I supposed I could have told them to try to call up other people but that's also work to try to keep some kind of list of people who might want to be seen earlier...I rarely have people begging to get in earlier for their followups and if I do, they usually don't line up exactly with weeks with more cancellations.

Your idea is a good idea but also would require extra work to keep some kind of running list of people who you then try to contact every time there's a cancellation and this would have to have been....14 slots for me last week.

 

[rjs2131]

Sure to an extent. There's some days/weeks that just suck. For instance my past Monday I had 3 people cancel late Friday so before the deadline and 3 people late cancel (so 6 total)...so 3/7 hours of my day. Tuesday I had 3 people cancel >24hrs ahead and 1 late cancel. This past Friday I had 3 cancellations >24hrs ahead and 1 no show. I will say this was an unusually ridiculous week with this but it's just an example.

I have admin front office staff so they end up fielding all these calls initially, I supposed I could have told them to try to call up other people but that's also work to try to keep some kind of list of people who might want to be seen earlier...I rarely have people begging to get in earlier for their followups and if I do, they usually don't line up exactly with weeks with more cancellations.

Your idea is a good idea but also would require extra work to keep some kind of running list of people who you then try to contact every time there's a cancellation and this would have to have been....14 slots for me last week.

That’s definitely terrible luck to have 14 in a week, but having done the cancellation list thing for the past 2-3 years…it’s not much work at all! I don’t like relying on staff to do this because frankly…it doesn’t get done as well (and we have great staff).

Email contact with patients isn’t for everyone but honestly, I do think that has played a role in why I stay full. People appreciate having direct access to their psychiatrist - yes I spend 30-60 min responding to emails each day, but I also have 60 min of “admin” time outside of lunch each day. I also find it much more efficient to eliminate the middleman when possible and can respond to several emails in the time it would take to call someone back.

 

[EastSide]

Salary 250k
Benefits: 6% match, 5 weeks of vacation, 10 separate holidays
Patient Census: 9-11
Involuntary IP Psychiatry
No productivity bonus
Schedule M-F 830 to whenever you finish (usually around 1)
Great administration/physician leadership.

Lower pay but the schedule can't be beat.

How normal is it for inpatient to leave whenever you finish?
Are these in rural places are places as saturated as the northeast?
Do you have to come in for emergency or take orders from home? Who takes care of the afternoon admits?

 

[MusicDOc124]

Director for specialized inpatient
Loc: Northeast, non-metro but near metro, HCOL nonetheless
Total base comp: 360k for 30-32 clinical hours and 8-10 hours admin, but can leave and be available once rounding is essentially complete
Unit size: 20 beds, but not typically full. When it becomes full, a second clinician would be brought on (census typically around 14 it seems)
No required call, but all call is paid at a decent rate.
Annual bonus $25k split between 4 metrics. Most seem to take home around half every year.
Benefits: generally standard, however low match for 401k (grows with time, but lowest of all places so far that I've interviewed).
Teams seem great and sounds like there will be ample support.
Community-academic - has fellows and will have residents/students.
Private practice allowed.

For this area, clinically I've seen/been offered in the range of 315k-335k base with bonuses typically around 10k. Directors seems to get the same/similar base with director stipend. Have seen director stipends up to 80k, but mostly 40-60k, which is similar here making the total comp what it is.

 

[clausewitz2]

Director for specialized inpatient
Loc: Northeast, non-metro but near metro, HCOL nonetheless
Total base comp: 360k for 30-32 clinical hours and 8-10 hours admin, but can leave and be available once rounding is essentially complete
Unit size: 20 beds, but not typically full. When it becomes full, a second clinician would be brought on (census typically around 14 it seems)
No required call, but all call is paid at a decent rate.
Annual bonus $25k split between 4 metrics. Most seem to take home around half every year.
Benefits: generally standard, however low match for 401k (grows with time, but lowest of all places so far that I've interviewed).
Teams seem great and sounds like there will be ample support.
Community-academic - has fellows and will have residents/students.
Private practice allowed.

For this area, clinically I've seen/been offered in the range of 315k-335k base with bonuses typically around 10k. Directors seems to get the same/similar base with director stipend. Have seen director stipends up to 80k, but mostly 40-60k, which is similar here making the total comp what it is.

What kind of specialized unit? This could make a big difference in workflow in practical terms. A geri unit full of disposition rocks is a different beast at 20 than a dual diagnosis unit with therapeutic discharges happening sometimes same day. Might also be good to have more specification of when exactly that second clinician gets brought in if that is important. This seems pretty reasonable otherwise.

 

[MusicDOc124]

What kind of specialized unit? This could make a big difference in workflow in practical terms. A geri unit full of disposition rocks is a different beast at 20 than a dual diagnosis unit with therapeutic discharges happening sometimes same day. Might also be good to have more specification of when exactly that second clinician gets brought in if that is important. This seems pretty reasonable otherwise.

Eating disorders. Range from 2 weeks to 4 months it seems for length of stay, with affiliated IOP/PHP. Disposition shouldn’t be a huge issue for most, fortunately. Other specialists consult on the unit too (cards, GI).

I will inquire further about when/what timeframe to expect the other!

 

[clausewitz2]

Eating disorders. Range from 2 weeks to 4 months it seems for length of stay, with affiliated IOP/PHP. Disposition shouldn’t be a huge issue for most, fortunately. Other specialists consult on the unit too (cards, GI).

I will inquire further about when/what timeframe to expect the other!

I imagine call will be relatively busy when taken compared to your typical inpatient unit. If you actually like eating disorder work this sounds like a pretty good gig otherwise.

 

[calvnandhobbs68]

Eating disorders. Range from 2 weeks to 4 months it seems for length of stay, with affiliated IOP/PHP. Disposition shouldn’t be a huge issue for most, fortunately. Other specialists consult on the unit too (cards, GI).

I will inquire further about when/what timeframe to expect the other!

You probably want details about how easy it actually is to get timely consults. Do they have a requirement that consults need to be seen in some timeframe once you put it in and what is the workflow like in terms of consults/medical backup? Eating disorders is one thing where good medical backup is pretty important.

I remember the GI "consults" on our general psych unit was like you could put in a consult through the rando hospitalists that sometimes showed up and maybe GI shows up in a week.

 

[MusicDOc124]

You probably want details about how easy it actually is to get timely consults. Do they have a requirement that consults need to be seen in some timeframe once you put it in and what is the workflow like in terms of consults/medical backup? Eating disorders is one thing where good medical backup is pretty important.

I remember the GI "consults" on our general psych unit was like you could put in a consult through the rando hospitalists that sometimes showed up and maybe GI shows up in a week.

Will double check as well. From the discussion, it sounded like regularly rounding given the significance, and these two fields were specifically discussed.

 

[Merovinge]

Will double check as well. From the discussion, it sounded like regularly rounding given the significance, and these two fields were specifically discussed.

You'd also want to understand your scope of practice, like who is managing the refeeding, labs associated with this etc. There can be a pretty significant range in what happens on IP ED units as far as how much is done by psychiatry vs medicine/GI/RDs or even pharmacy.

 

[Ellomate]

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.

Did you complete forensic fellowship?
What is your goal for the small forensic practice?

 

[Ellomate]

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...

do most sign on bonus have a 2-3 year requirment clause?
Thanks

 

[nexus73]

do most sign on bonus have a 2-3 year requirment clause?
Thanks

can be anything, I've seen 1 year up to 7 years, and they are negotiable, as in $20K for 3 years you could ask it be kept at $20K but reduced to 2 years, or even 1 year.

 

[absentmindfulness]

Looking for thoughts on this offer. First year CAP

- 300k, 20k sign-on bonus (1 year commitment), southeast
- outpatient FQHC M-F, academic affiliated with local hospital system (residents/fellows rotating into clinic)
- 7 hours patient contact daily, average of 12 patients per day with 1-2 evals included in that. 60 minute new eval, 20 minute follow-up, extended time for certain patients by request (hospital follow-ups, complex cases)
- call at local C&A inpatient 5x per year; includes weekend rounds with new admissions, as well as phone coverage the following week for inpatient issues, screening overnight admissions, as well as staffing Psychiatry resident consults at local hospitals (ER visits mostly) by phone.
- opportunities to trade clinic time for administrative and educational activities with residents, medical students; not clear on the details of this yet
- 403b with 100% match first 1%, and 50% match for additional 5% of salary
- 23 days PTO (inclusive of sick time), 10 holidays, 5 day CME with $1500 yearly allowance
- other typical benefits (malpractice, health/dental, life insurance, disability etc)

 

[calvnandhobbs68]

Looking for thoughts on this offer. First year CAP

- 300k, 20k sign-on bonus (1 year commitment), southeast
- outpatient FQHC M-F, academic affiliated with local hospital system (residents/fellows rotating into clinic)
- 7 hours patient contact daily, average of 12 patients per day with 1-2 evals included in that. 60 minute new eval, 20 minute follow-up, extended time for certain patients by request (hospital follow-ups, complex cases)
- call at local C&A inpatient 5x per year; includes weekend rounds with new admissions, as well as phone coverage the following week for inpatient issues, screening overnight admissions, as well as staffing Psychiatry resident consults at local hospitals (ER visits mostly) by phone.
- opportunities to trade clinic time for administrative and educational activities with residents, medical students; not clear on the details of this yet
- 403b with 100% match first 1%, and 50% match for additional 5% of salary
- 23 days PTO (inclusive of sick time), 10 holidays, 5 day CME with $1500 yearly allowance
- other typical benefits (malpractice, health/dental, life insurance, disability etc)

Not great. Unless you really want to work in an FHQC or teach residents (both noble pursuits) you should be able to easily find something better that would have absolutely no call.

Residents/fellows actually cause more work for you or slow you down unless they're really good outpatient. Now, if you get credit for seeing their patients/supervision, that's a different story (the facility should be able to bill for their patients if there's any direct supervision at all even if you just pop in for 5 minutes to say hello).

CAP you really do need 30 minute followups. I'm a real believer that anything less than that is either very simple (which you're highly unlikely to see in an FQHC) or just turns into a churn and burn situation. It'll probably stress you out unless you're very efficient or write crap notes.

You sure this FHQC doesn't want you "collaborating" with NPs? Most of them do.

The 403b match only adds like 11Kish, nothing that special. PTO is nothing special.

 

[Merovinge]

Not great. Unless you really want to work in an FHQC or teach residents (both noble pursuits) you should be able to easily find something better that would have absolutely no call.

Residents/fellows actually cause more work for you or slow you down unless they're really good outpatient. Now, if you get credit for seeing their patients/supervision, that's a different story (the facility should be able to bill for their patients if there's any direct supervision at all even if you just pop in for 5 minutes to say hello).

CAP you really do need 30 minute followups. I'm a real believer that anything less than that is either very simple (which you're highly unlikely to see in an FQHC) or just turns into a churn and burn situation. It'll probably stress you out unless you're very efficient or write crap notes.

You sure this FHQC doesn't want you "collaborating" with NPs? Most of them do.

The 403b match only adds like 11Kish, nothing that special. PTO is nothing special.

Yes, 100% always yes. But particularly for a FHQC you are signing up for burnout, misery, and ineffectiveness with 20 min f/u. Patients will be late, slow to room, have a ton of problems, and not have resources to address those problems. They may not have access to any PHP/IOP. It would be utter insanity to me to consider taking a 20 min f/u FHQC position in CAP. If you need to work with that population, I would have a hardline 30 min f/u requirement.

 

[calvnandhobbs68]

Yes, 100% always yes. But particularly for a FHQC you are signing up for burnout, misery, and ineffectiveness with 20 min f/u. Patients will be late, slow to room, have a ton of problems, and not have resources to address those problems. They may not have access to any PHP/IOP. It would be utter insanity to me to consider taking a 20 min f/u FHQC position in CAP. If you need to work with that population, I would have a hardline 30 min f/u requirement.

Totally agree but then they do crap like say "well 30% of the patients no show anyway so really you'll basically end up with 30 minutes per patient on average". Which doesn't really pan out when 2 of your no shows are your first two patients of the day so you have nothing to do anyway, everyone shows up 10 minutes late and oh yeah one of your followups disclosed a reportable sexual trauma so now you have to tell the guardian you have to call CPS and do that CPS call later today so that ones gonna take you like 40 minutes total at least.

Honestly I see most FQHCs just ending up being an army of NPs with 1-2 "medical director" type psychiatry positions given the cost/benefit ratio for them. Very low risk of lawsuits in that population (and they know it) and lots of incentives to try to churn through as many patients as possible as many of them are funded based on how many "active" patients they have. They can hire 2-3 NPs for the cost of 1 psychiatrist to see at least 2x as many patients.

 

[clausewitz2]

Totally agree but then they do crap like say "well 30% of the patients no show anyway so really you'll basically end up with 30 minutes per patient on average". Which doesn't really pan out when 2 of your no shows are your first two patients of the day so you have nothing to do anyway, everyone shows up 10 minutes late and oh yeah one of your followups disclosed a reportable sexual trauma so now you have to tell the guardian you have to call CPS and do that CPS call later today so that ones gonna take you like 40 minutes total at least.

Honestly I see most FQHCs just ending up being an army of NPs with 1-2 "medical director" type psychiatry positions given the cost/benefit ratio for them. Very low risk of lawsuits in that population (and they know it) and lots of incentives to try to churn through as many patients as possible as many of them are funded based on how many "active" patients they have. They can hire 2-3 NPs for the cost of 1 psychiatrist to see at least 2x as many patients.

A psychiatrist I knew from residency took a position at one of our local FQHCs and lasted a little under a year before going back to working the jail, which struck them as a safer and more pleasant practice environment.

 

[calvnandhobbs68]

A psychiatrist I knew from residency took a position at one of our local FQHCs and lasted a little under a year before going back to working the jail, which struck them as a safer and more pleasant practice environment.

I mean it's probably actually safer, in an FQHC you're getting people discharged from the jail to you lol.

 

[MusicDOc124]

Director for specialized inpatient
Loc: Northeast, non-metro but near metro, HCOL nonetheless
Total base comp: 360k for 30-32 clinical hours and 8-10 hours admin, but can leave and be available once rounding is essentially complete
Unit size: 20 beds, but not typically full. When it becomes full, a second clinician would be brought on (census typically around 14 it seems)
No required call, but all call is paid at a decent rate.
Annual bonus $25k split between 4 metrics. Most seem to take home around half every year.
Benefits: generally standard, however low match for 401k (grows with time, but lowest of all places so far that I've interviewed).
Teams seem great and sounds like there will be ample support.
Community-academic - has fellows and will have residents/students.
Private practice allowed.

For this area, clinically I've seen/been offered in the range of 315k-335k base with bonuses typically around 10k. Directors seems to get the same/similar base with director stipend. Have seen director stipends up to 80k, but mostly 40-60k, which is similar here making the total comp what it is.

Signed the job. Couple of updates/info: Negotiated base to $375k (325k clinical, 50k directorship), reduced non-compete to 5 miles (only two hospitals within this range, and I got one as a carve-out), non-compete will cease to exist if I'm terminated without cause or if I resign for-cause, 90-day notice anytime (no no-out clause), sign-on is prorated so I keep what I've earned whenever I were to leave. I will have child fellows covering approximately half of the unit. The unit operates around 14 as mentioned. I'd still cover up to 15/16. If the unit goes more than 16, there is a float team member who will come to cover anyone above the 14 patients.

I imagine call will be relatively busy when taken compared to your typical inpatient unit. If you actually like eating disorder work this sounds like a pretty good gig otherwise.

Talked to a fellow I know who was there rotating and another attending who picked up call shifts there. Seems quite manageable. The most exhausting thing seems to be families of the child patients (consistent with other situations/units it seems).

Call is only 1 weekend each 4-6 weeks, just regular rounding. Okay base for the weekend, and extra pay for any new or follow-up consults seen. Weekend call is split with another doc (one doc covers general inpatient and ER, while the other covers ED inpatient and consults).

You probably want details about how easy it actually is to get timely consults. Do they have a requirement that consults need to be seen in some timeframe once you put it in and what is the workflow like in terms of consults/medical backup? Eating disorders is one thing where good medical backup is pretty important.

I remember the GI "consults" on our general psych unit was like you could put in a consult through the rando hospitalists that sometimes showed up and maybe GI shows up in a week.

I got this clarified. Family medicine (includes a residency here) is 24-hour in house and work closely with the unit. If something more is needed, they handle those consults, and they're seen within 24hr. If it's more emergent, patients can be transferred directly to medicine. If a patient is transferred, consult psych team picks them up to follow.

You'd also want to understand your scope of practice, like who is managing the refeeding, labs associated with this etc. There can be a pretty significant range in what happens on IP ED units as far as how much is done by psychiatry vs medicine/GI/RDs or even pharmacy.

I'd be responsible for ordering feeding tubes (the only line allowed on the unit), and it sounds like this is a once-in-a-while thing. The labs as mentioned will be co-managed it sounds like. There is a large team involved on the unit, many with many years experience in the field and on this unit in particular. 3-4 therapists, 3-4 RDs, and 3-4 nutritionists on the unit daily.


I did end up signing for this job with those updates and info above. I expect approximately $415k/year with approximately 10 call weekends/year and 1/2/-2/3 annual bonus.

 

[MedMan80]

Excellent Pay