Graduating psych residents…Job offers

[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.

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[MedMan80]

Excellent Pay

 

[FlowRate]

Recently heard about a job in Ketchikan, AK that pays $620k/yr. No clue about any of the details really but seems like a great opportunity for a really outdoorsy person who wants to jumpstart finances for a few years.

 

[Mapplicant]

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.


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).



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.



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.

Great negotiating all the way from basically 300k up to 375k. Really shows how jobs low ball you on the initial offer and always always negotiate!

Recently heard about a job in Ketchikan, AK that pays $620k/yr. No clue about any of the details really but seems like a great opportunity for a really outdoorsy person who wants to jumpstart finances for a few years.

Wow. I thought it was rural AK but Ketchikan is on another level with it accessible only via boat or plane. And I bet 620k is just the STARTING point. Someone can easily get more than that if they really want to live there and like pay your student loans off in like a year or something lol and then work for few years and FIRE in your late 30s or 40s

 

[mistafab]

Bringing this thread back to action. Great work everyone posting jobs. More information in MDs hands helps us all - especially new grads!

Medium/high COL south megametro
W2, Hybrid: 4 days tele, 1 day in person
Outpatient FQHC
100% insured patients but do take Medicaid.
13 patients a day
1 hr admin per day
30 minute lunch break
1 hr new, 30 minute F/u
If desired, each additional pt seen is $40/pt
No non competes or non solicitation
No call, weekends, or nights
Pto kinda sucks 2 weeks year 1 + 8 holidays, goes up to 3 weeks year 2
Small sign on 10 k 2 yr pro rated

 

[MedMan80]

Bringing this thread back to action. Great work everyone posting jobs. More information in MDs hands helps us all - especially new grads!

Medium/high COL south megametro
W2, Hybrid: 4 days tele, 1 day in person
Outpatient FQHC
100% insured patients but do take Medicaid.
13 patients a day
1 hr admin per day
30 minute lunch break
1 hr new, 30 minute F/u
If desired, each additional pt seen is $40/pt
No non competes or non solicitation
No call, weekends, or nights
Pto kinda sucks 2 weeks year 1 + 8 holidays, goes up to 3 weeks year 2
Small sign on 10 k 2 yr pro rated

280?

 

[Stagg737]

Bringing this thread back to action. Great work everyone posting jobs. More information in MDs hands helps us all - especially new grads!

Medium/high COL south megametro
W2, Hybrid: 4 days tele, 1 day in person
Outpatient FQHC
100% insured patients but do take Medicaid.
13 patients a day
1 hr admin per day
30 minute lunch break
1 hr new, 30 minute F/u
If desired, each additional pt seen is $40/pt
No non competes or non solicitation
No call, weekends, or nights
Pto kinda sucks 2 weeks year 1 + 8 holidays, goes up to 3 weeks year 2
Small sign on 10 k 2 yr pro rated

So either Atlanta or Miami, probably the latter since ATL is pretty dead on average for COL. That PTO doesn't "kinda suck", it just sucks. Also lol at $40/pt for extra patients. Otherwise sounds decent if the salary is right, especially for a mostly telehealth position.

 

[finalpsychyear]

So either Atlanta or Miami, probably the latter since ATL is pretty dead on average for COL. That PTO doesn't "kinda suck", it just sucks. Also lol at $40/pt for extra patients. Otherwise sounds decent if the salary is right, especially for a mostly telehealth position.

2 wks vaca should make thus a 300k+ position but I feel like offering 40/pt add'l means it's sub 300. I couldn't do this position as I take almost 2 wks just in the pre xmas to post nye stretch

 

[Merovinge]

So either Atlanta or Miami, probably the latter since ATL is pretty dead on average for COL. That PTO doesn't "kinda suck", it just sucks. Also lol at $40/pt for extra patients. Otherwise sounds decent if the salary is right, especially for a mostly telehealth position.

Yeah same for Houston, Dallas, Tampa all very average CoL. Basically saying it's Miami.

 

[Jarisch-Herxheimer]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

 

[MedMan80]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

Can only be Kasier!

 

[ObsequiousAplomb]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

Are they really saying that a 7 year commitment is only worth $100k?

 

[Jarisch-Herxheimer]

Are they really saying that a 7 year commitment is only worth $100k?

Yeah the amount is definitely disappointing compared to the sign-on bonuses I know SoCal is getting. But regardless, I'm planning to park 1/2 of it in a HYSA just in case things go downhill.

 

[ResidentAnonymous001]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

Were you able to negotiate at all?

 

[samac]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

Holy commitment Batman

 

[prominence]

Does anyone know of any good part-time options for non-outpatient Telepsychiatry positions?

 

[Jules A]

Does anyone know of any good part-time options for non-outpatient Telepsychiatry positions?

I have seen these type contracts both for ED and inpatient attendings but there are obvious limitations and the quality hasn't been good so they were cut early at two hospitals. Its a good gig if you can get it though. I know a guy across the country working as attending max 2-3h day for full salary. If you want true part time weekends would be the most common option.

 

[calvnandhobbs68]

Holy commitment Batman

Especially the 401k part, forget the sign on bonus.

That must be partially vested at least somewhat before the 5 years, I don’t think they’re allowed to not vest at all longer than 3 years.

 

[sloh]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

Is your spouse also a high earner bc that income is going to make it rough in the Bay Area if you have kids and plan on buying a house in a good school district

 

[jbomba]

Hi everyone. Here are details of my offer, starting next month!

Location: Bay Area, CA (VHCOL)
Base salary: 360K with 10K increase every year
Annual bonus starting 2nd year about $10K/year
Moving expenses: $10K
Sign-on bonus: $100K (to be forgiven in 5th, 6th, and 7th years)
Home loan repayment program: up to $250K
Outpatient, 30-min follow-up & 60-min new initials
Call about 1x/every few months
Great health & dental benefits
401K vested after 5 years, can also make post-tax contributions

If doing 40hr a week you could be earning more than double that annually taking insurance in the bay area.

If you're seeing 2 pts an hour at 40 hours a week you're making about 90 dollars per visit at that salary. I would argue this is not a good renumeration for a 30 minute appointment.

If you don't feel ready to go it alone, why not try to find a clinic where they do a share of billing? You should be getting 60-70% of billing which would still be much more than what they're offering you.

 

[samac]

Especially the 401k part, forget the sign on bonus.

That must be partially vested at least somewhat before the 5 years, I don’t think they’re allowed to not vest at all longer than 3 years.

That’s a fair point i didn’t even think about

 

[brazilianpsych]

I have seen these type contracts both for ED and inpatient attendings but there are obvious limitations and the quality hasn't been good so they were cut early at two hospitals. Its a good gig if you can get it though. I know a guy across the country working as attending max 2-3h day for full salary. If you want true part time weekends would be the most common option.

Could you give me more info about his job? I will need a remote job and have been looking with very little success.

 

[Jarisch-Herxheimer]

If doing 40hr a week you could be earning more than double that annually taking insurance in the bay area.

If you're seeing 2 pts an hour at 40 hours a week you're making about 90 dollars per visit at that salary. I would argue this is not a good renumeration for a 30 minute appointment.

If you don't feel ready to go it alone, why not try to find a clinic where they do a share of billing? You should be getting 60-70% of billing which would still be much more than what they're offering you.

I'm not too sure about the specifics of the exact no. of patients I'm seeing a day. I know it fluctuates a lot in the beginning as I'm building my panel. From what I've heard, you get 30 minutes of admin time for every 90 minutes of seeing patients. So it's about 27.5 clinical hours per 40-hr week, which is not bad in my opinion.

Oops, I forgot to add the one benefit I'm most excited about - Kaiser is PSLF eligible, which means 6 more years until all my loans are forgiven. When that rolls around, I'd be expecting a base of $420K (but most likely receiving around $450K due to being partner & getting an extra bonus check/year). I did interview for county positions but their base was on the lower end, while PAMF or Sutter are private/not PSLF-eligible with also a lower base.

 

[Jarisch-Herxheimer]

Were you able to negotiate at all?

Nope. The closest you may negotiate is the sign-on bonus: either 100 to 150K I heard.

 

[mistafab]

So either Atlanta or Miami, probably the latter since ATL is pretty dead on average for COL. That PTO doesn't "kinda suck", it just sucks. Also lol at $40/pt for extra patients. Otherwise sounds decent if the salary is right, especially for a mostly telehealth position.

2 wks vaca should make thus a 300k+ position but I feel like offering 40/pt add'l means it's sub 300. I couldn't do this position as I take almost 2 wks just in the pre xmas to post nye stretch

Yes I agree the PTO year 1 sucks. year 2 the holidays + PTO is approaching a full month per year ( 3 wk + 8 day). These positions are “lunch and admin time when you want” so you could do 6.5 hours in a row 4 x per week at home and be done. Most other telepsychs working for the man are pushing 15-20 min follow ups and 40 minute new which adds more burnout. - plus they do complicated collection / rvu targets that rarely pay you what they say.

I think for a new grad, this is a low paying but pretty chill turn-your-brain-off-and-get-paid job. a few years to figure out what you want to do next, especially if you want to move across the country and build a network there.

I definitely am not taking it myself, but I see the appeal. And 250k for telepsych 13 pt a day is not horrible workload per dollar wise.

 

[Jarisch-Herxheimer]

Is your spouse also a high earner bc that income is going to make it rough in the Bay Area if you have kids and plan on buying a house in a good school district

Yes, he’s a SWE. We don’t intend on buying anytime soon. We also have a toddler so will have a few years before settling down in a good school district.

Especially the 401k part, forget the sign on bonus.

That must be partially vested at least somewhat before the 5 years, I don’t think they’re allowed to not vest at all longer than 3 years.

Oops, yes I do believe it’s vested 50% after 3 years.

 

[Jules A]

Could you give me more info about his job? I will need a remote job and have been looking with very little success.

Since I essentially said they suck I'm not going to name names. I would start by googling ED psychiatrist telemedicine jobs or something like that as ED seems to be more plentiful than inpatient. Keep in mind although extremely small sample size 2 were excused early and the third is expensive and not especially impressive so I doubt they will make a full year. It seems to me these contracts tend toward troubled services and once local staff is obtained they are no longer desirable.

 

[B52slinger]

Since I essentially said they suck I'm not going to name names. I would start by googling ED psychiatrist telemedicine jobs or something like that as ED seems to be more plentiful than inpatient. Keep in mind although extremely small sample size 2 were excused early and the third is expensive and not especially impressive so I doubt they will make a full year. It seems to me these contracts tend toward troubled services and once local staff is obtained they are no longer desirable.

agreed, lots of issues with these positions from what I've seen and these are NOT stable long-term positions.

I have a colleague who worked one of these jobs for a few months before abruptly being fired because the contract was ended by the hospital the second they found enough in-person psychiatrists to replace the tele people

I have also encountered many in-person jobs with 2-3 hour total daily workload so I don't really see the point of doing an unstable tele-job

 

[Psychferlyfe3000]

Alright, update on the job I posted earlier:
Outpatient
No benefits
80% of $440 / hour on average
Staff does all admin except for prior auths and I handle medically related inquiries.

Thoughts?

 

[FlowRate]

Curious what everyone's current gigs look like as far as actual patient-facing clinical time vs admin/practice management time?

 

[Stagg737]

Alright, update on the job I posted earlier:
Outpatient
No benefits
80% of $440 / hour on average
Staff does all admin except for prior auths

Thoughts?

If you're actually averaging $440/hr base then that's ~$350/hr for admin to cover most responsibilities. That's very solid if staff are good without other red flags in the practice.

Curious what everyone's current gigs look like as far as actual patient-facing clinical time vs admin/practice management time?

I would guess that I average around 20 patient facing hours per week. Academic mostly supervising residents with ~6-10 clinical non-supervised clinical hours per week with an admin week every 4th week where I have probably 5 total clinical hours (non-supervising) during that week.

 

[Sushirolls]

Recently heard about a job in Ketchikan, AK that pays $620k/yr. No clue about any of the details really but seems like a great opportunity for a really outdoorsy person who wants to jumpstart finances for a few years.

Ketchikan most likely = PeaceHealth
The same organization that had IM doctors unionize in Oregon. Just imagine how bad things were for hospitalists to force a union.
I forget all the reasons why that organization popped up on the news, but it has several times in the past few years. It wreaks of the stench of Big Box shop.

Or, that's their locums price... that organization has no problem hemorrhaging money on locums.

 

[Psychferlyfe3000]

If you're actually averaging $440/hr base then that's ~$350/hr for admin to cover most responsibilities. That's very solid if staff are good without other red flags in the practice.


I would guess that I average around 20 patient facing hours per week. Academic mostly supervising residents with ~6-10 clinical non-supervised clinical hours per week with an admin week every 4th week where I have probably 5 total clinical hours (non-supervising) during that week.

Okay, great. One thing I forgot to put in the post is that I do answer any medically related patient inquiries.

 

[Psychferlyfe3000]

If you're actually averaging $440/hr base then that's ~$350/hr for admin to cover most responsibilities. That's very solid if staff are good without other red flags in the practice.


I would guess that I average around 20 patient facing hours per week. Academic mostly supervising residents with ~6-10 clinical non-supervised clinical hours per week with an admin week every 4th week where I have probably 5 total clinical hours (non-supervising) during that week.

Also, do you have any examples of red flags that might not be obvious before starting a job?

 

[brazilianpsych]

So far, best thing I got for remote would be 380k, intakes 45min and FU 15min. Outpatient, no call, no nights ofc. PTO is 19 business days, increased to 24 after a while. Not perfect, but best I have found so far. I can only do remote jobs, so it gets tricky.

Talkiatry pays 150k plus bonus. They say bonus is "up to 200k", but those are very dangerous words lol.

 

[MusicDOc124]

intakes 45min and FU 15min

sounds like... jam-packed schedule, hoping there is nothing to really talk about and that they are completely stable at every visit.

Is this a guaranteed 380k consistently, or does it change after a certain point? W-2/benefits or 1099?

 

[rjs2131]

Curious what everyone's current gigs look like as far as actual patient-facing clinical time vs admin/practice management time?

Group insurance-based PP - ~27 patient-facing hours each week, 90-min news, 30-min follow-ups. I usually take an hour lunch + hour of admin total each day (30 min in the AM, 30 min in the PM). I aim to only work 46.5 weeks/year. For time I'm seeing patients, probably average around $300/hr. W2 with great benefits and support staff (including 401k and match). This is before any partnership benefits (including yearly bonuses, which depending on the year can be 50k+). See a mix of virtual/in-person but really up to me and what my patients want how I structure this.

Pretty happy with this setup, going into year 4 next month!

 

[brazilianpsych]

sounds like... jam-packed schedule, hoping there is nothing to really talk about and that they are completely stable at every visit.

Is this a guaranteed 380k consistently, or does it change after a certain point? W-2/benefits or 1099?

It would be consistently, but honestly I have been wondering if I heard wrong and it is actually 280 lol. I will double check.

 

[mistafab]

Cush job desireable mega south metro. academic 245k base. Call is backup only to residents 1 day per quarter. Outpatient assessments, no quota. 3 hour intakes (nuts). No volume requirement. Set up as “outpatient consult” and only handful per week. All non working time is your own. 28 days pto. 3k cme, 10k onboarding bonus (no handcuff). Rank asst prof. No non compete. No non solicit. No nights or weekends

 

[brazilianpsych]

Cush job desireable mega south metro. academic 245k base. Call is backup only to residents 1 day per quarter. Outpatient assessments, no quota. 3 hour intakes (nuts). No volume requirement. Set up as “outpatient consult” and only handful per week. All non working time is your own. 28 days pto. 3k cme, 10k onboarding bonus (no handcuff). Rank asst prof. No non compete. No non solicit. No nights or weekends

It is wild how there is variation in academia. Around here is 230k seeing basically a full outpatient practice, often 20+ patients. 1h intake and 20min FU, 14 days PTO. Oh and maybe most important, there is a no compete, 1 year for the whole city. That is why you will often see me complaining about job offers around SDN lol

 

[calvnandhobbs68]

It is wild how there is variation in academia. Around here is 230k seeing basically a full outpatient practice, often 20+ patients. 1h intake and 20min FU, 14 days PTO. Oh and maybe most important, there is a no compete, 1 year for the whole city. That is why you will often see me complaining about job offers around SDN lol

The whole point of most academic gigs is that you tradeoff the low base pay for at least decent/good benefits/PTO and relativelyish chiller schedule....like most people I knew from residency would get a decent amount of admin/"research" time. I mean otherwise why are you taking a 100K/year haircut lol.

 

[manly_man246]

Finishing 4th year out of training at south metro CMHC, academic adjacent, - FT, in office only 1d/wk, $250k, 12 holiday, 24 PTO, 0 sick, 0 CME days and only $1k CME dollars. 403b, 457, already vested into 10% match with good index fund options. I qualified for state-based loan repayment and the final portion of my loans will be paid off this fall. No call, no nights, no weekends, no non-compete. I work on a small, specialty outpatient unit with low volumes - 60 min intake (I get another 30 mins for intake prep), 30-60 min f/u based on my need. About 25 clinical hours/week (significant admin time required for my job functions), capped at 9pts a day but I average 5-6 pts, with some days having far less. RVU bonus structure but between low vol practice and quite a bit of nonbillable work for the specialty services I provide there is no way to make extra. The job can be both very challenging (complex and high risk cases, high profile work, and niche interest) and very rewarding, and I find the lower volume to balance out the rigors.

I could make more, but I feel like I would have to work a lot harder when I'm on the clock. Being remote 80%, I find other useful ways to occupy my downtime when I'm not doing admin work. Trying to get pay parity with other local nonprofit agencies in which psychiatrists are making ~280k/year, which would help w/ job satisfaction. The agency requires state approval to give its employers a raise/adjustment so it's a process. Most disappointing is the lack of any bonuses or raises based on my individual performance but it just seems the agency doesn't do these things. I would like more CME money and some CME time too. Hard to consider taking a drastic hit to my QOL for ~$50k more in another employed job (which will likely give less than a 10% match). I supplement my income by moonlighting one weekend/mo on an inpatient unit and doing occasional consulting work, which adds about $60k a year as 1099 income and opens me up for useful tax deductions and solo401k savings. If I worked an average busy M-F practice I don't think I would maintain my side gigs, so I feel like my breakeven point for moving to a new job is in the mid to high 300s, especially for an employed gig where I'd lose the tax benefits of 1099.

 

[Psychferlyfe3000]

Group insurance-based PP - ~27 patient-facing hours each week, 90-min news, 30-min follow-ups. I usually take an hour lunch + hour of admin total each day (30 min in the AM, 30 min in the PM). I aim to only work 46.5 weeks/year. For time I'm seeing patients, probably average around $300/hr. W2 with great benefits and support staff (including 401k and match). This is before any partnership benefits (including yearly bonuses, which depending on the year can be 50k+). See a mix of virtual/in-person but really up to me and what my patients want how I structure this.

Pretty happy with this setup, going into year 4 next month!

Oh wow. This sounds really good tbh! What region of the U.S.?

 

[Merovinge]

Finishing 4th year out of training at south metro CMHC, academic adjacent, - FT, in office only 1d/wk, $250k, 12 holiday, 24 PTO, 0 sick, 0 CME days and only $1k CME dollars. 403b, 457, already vested into 10% match with good index fund options. I qualified for state-based loan repayment and the final portion of my loans will be paid off this fall. No call, no nights, no weekends, no non-compete. I work on a small, specialty outpatient unit with low volumes - 60 min intake (I get another 30 mins for intake prep), 30-60 min f/u based on my need. About 25 clinical hours/week (significant admin time required for my job functions), capped at 9pts a day but I average 5-6 pts, with some days having far less. RVU bonus structure but between low vol practice and quite a bit of nonbillable work for the specialty services I provide there is no way to make extra. The job can be both very challenging (complex and high risk cases, high profile work, and niche interest) and very rewarding, and I find the lower volume to balance out the rigors.

I could make more, but I feel like I would have to work a lot harder when I'm on the clock. Being remote 80%, I find other useful ways to occupy my downtime when I'm not doing admin work. Trying to get pay parity with other local nonprofit agencies in which psychiatrists are making ~280k/year, which would help w/ job satisfaction. The agency requires state approval to give its employers a raise/adjustment so it's a process. Most disappointing is the lack of any bonuses or raises based on my individual performance but it just seems the agency doesn't do these things. I would like more CME money and some CME time too. Hard to consider taking a drastic hit to my QOL for ~$50k more in another employed job (which will likely give less than a 10% match). I supplement my income by moonlighting one weekend/mo on an inpatient unit and doing occasional consulting work, which adds about $60k a year as 1099 income and opens me up for useful tax deductions and solo401k savings. If I worked an average busy M-F practice I don't think I would maintain my side gigs, so I feel like my breakeven point for moving to a new job is in the mid to high 300s, especially for an employed gig where I'd lose the tax benefits of 1099.

Do you actually enjoy doing the work remote or is it mostly so that you can work out/do chores/play video games during downtime when census is low? Particularly with high risk/high acuity patients I find remote work very challenging/less rewarding, but I may also just be on my way to dinosaur town before hitting 40...

 

[rjs2131]

Oh wow. This sounds really good tbh! What region of the U.S.?

Southeast. It's been great and that's not even including the intangibles (great coworkers, staff, autonomy, etc). I love that as I get older, I can choose to cut back my schedule as much or as little as I want without having to answer to a hospital system/organization. Of course, with PP you have to be comfortable with the business side of medicine and managing your own billing/coding, schedule, etc if you want to maximize efficiency. Some folks prefer to just have a steady paycheck without having to worry about much else, but I like the "other stuff" and it keeps things interesting.

 

[Stagg737]

It would be consistently, but honestly I have been wondering if I heard wrong and it is actually 280 lol. I will double check.

With that patient volume $380k sounds more accurate. Possibly even low depending on other benefits with that kind of PTO.

The whole point of most academic gigs is that you tradeoff the low base pay for at least decent/good benefits/PTO and relativelyish chiller schedule....like most people I knew from residency would get a decent amount of admin/"research" time. I mean otherwise why are you taking a 100K/year haircut lol.

This. My gig has very solid benefits and every 4th week for me is a full admin week. Plus around 80% of my clinical F2F hours are supervising residents and sub-is, so I don’t write most of my notes other than my 5-6 outpatient hours per week. Probably average 8-12 patients per day total. Guaranteed base for my first year was $210k, after that moved to production based on a look back and I average around $240k/yr base now. Yes, it’s low, but there are plenty of opportunities to supplement that income and with the benefits the total package is much higher.

 

[Stagg737]

Finishing 4th year out of training at south metro CMHC, academic adjacent, - FT, in office only 1d/wk, $250k, 12 holiday, 24 PTO, 0 sick, 0 CME days and only $1k CME dollars. 403b, 457, already vested into 10% match with good index fund options. I qualified for state-based loan repayment and the final portion of my loans will be paid off this fall. No call, no nights, no weekends, no non-compete. I work on a small, specialty outpatient unit with low volumes - 60 min intake (I get another 30 mins for intake prep), 30-60 min f/u based on my need. About 25 clinical hours/week (significant admin time required for my job functions), capped at 9pts a day but I average 5-6 pts, with some days having far less. RVU bonus structure but between low vol practice and quite a bit of nonbillable work for the specialty services I provide there is no way to make extra. The job can be both very challenging (complex and high risk cases, high profile work, and niche interest) and very rewarding, and I find the lower volume to balance out the rigors.

I could make more, but I feel like I would have to work a lot harder when I'm on the clock. Being remote 80%, I find other useful ways to occupy my downtime when I'm not doing admin work. Trying to get pay parity with other local nonprofit agencies in which psychiatrists are making ~280k/year, which would help w/ job satisfaction. The agency requires state approval to give its employers a raise/adjustment so it's a process. Most disappointing is the lack of any bonuses or raises based on my individual performance but it just seems the agency doesn't do these things. I would like more CME money and some CME time too. Hard to consider taking a drastic hit to my QOL for ~$50k more in another employed job (which will likely give less than a 10% match). I supplement my income by moonlighting one weekend/mo on an inpatient unit and doing occasional consulting work, which adds about $60k a year as 1099 income and opens me up for useful tax deductions and solo401k savings. If I worked an average busy M-F practice I don't think I would maintain my side gigs, so I feel like my breakeven point for moving to a new job is in the mid to high 300s, especially for an employed gig where I'd lose the tax benefits of 1099.

Sounds pretty solid for academic/academic adjacent. You said 80% remote. Is that basically coming in to round and then taking care of everything else from home? If so that’s a pretty sweet set up.

 

[manly_man246]

Do you actually enjoy doing the work remote or is it mostly so that you can work out/do chores/play video games during downtime when census is low? Particularly with high risk/high acuity patients I find remote work very challenging/less rewarding, but I may also just be on my way to dinosaur town before hitting 40...

Sounds pretty solid for academic/academic adjacent. You said 80% remote. Is that basically coming in to round and then taking care of everything else from home? If so that’s a pretty sweet set up.

It's actually outpatient so 4d WFH, 1d office. Since my caseload is mostly forensic and/or treatment-resistant SMI, +/- TBI, IDD, and ASD, there can be compelling reasons to see them in person and also to see them remotely, and I get schedule control over these decisions. As for rewarding - given the nature of my population, I tend to focus on process over outcomes. If they're doing well for about 12-16 mos we transfer them to a lower acuity outpatient service. The ones who stick around are often pretty sad cases. Chances are if I really connect w/ a client and they get what I'm doing and why it's so different/how it's helping them, they're going to want to stick with me and that usually means I'm going to have to discharge them to routine outpatient care. =|

Low scheduled volume days do mean I get to catch up on personal affairs and spend time with my family - I don't feel financially compensated highly enough for the intensity of this work to be twiddling my thumbs in the office for hours every day, so I consider this to be part of my overall comp. It'd be better if I was entirely off the clock so I could possibly pursue other work, and I'm trying to see if a 4x10 schedule can work with this gig but am dependent on other team members to coordinate patient appointments (have I stressed how low functioning this population is?) so I don't know how feasible it is.

There are rarely posted W2 jobs in my metro area which that compensate highly enough for me to lose my 1099 gig and its tax benefits (I estimate the breakeven point is mid-upper 300 and definite benefit would be at 380k+. Since I'm not interested in seeing 20-25 pts a day (9-12 is the sweet spot for me) + supervising midlevels (always a no for me) on an outpatient basis, that really does take away most employed OP positions. We just bought a home here 2 years ago but for climate/political reasons anticipate moving again in ~6 years. From everything I've read, I will be 2-3 years into that time frame to break even and then turn a relative profit for a cash practice, though I'd likely have more real off the clock time.. As much as I'd like to continue helping people with psychotic disorders since I feel I've developed a bit of a niche and reputation in my city, the overhead (staff and insurance) required and the fact that we are likely leaving the region/state in 5-6 years makes this idea seem financially unpalatable [time to spin up and wind down eats into profit on both ends of a short timetable.] My other big interest is psychodynamics and I'd probably try to return to those roots with a therapy-heavy practice focused on mood and trauma related conditions, and if possible doing some consultation/2nd opinion work.

 

[Psychferlyfe3000]

Okay I'm confused...

I had a meeting with a potential future employer today and they were showing me reimbursement rates for Medicaid that were higher than BCBS in an effort to convince me to accept some medicaid. I am unclear as to how that is the case. Can someone help clarify? I mostly trust this employer, but it just seems pretty odd to me...

 

[Atreides]

Okay I'm confused...

I had a meeting with a potential future employer today and they were showing me reimbursement rates for Medicaid that were higher than BCBS in an effort to convince me to accept some medicaid. I am unclear as to how that is the case. Can someone help clarify? I mostly trust this employer, but it just seems pretty odd to me...

Depends on the state. I’m licensed in Montana and the Medicaid rates there are higher than any commercial insurance rates in California for solo practitioners (and this is after I negotiated up). Medicaid rates aren’t hidden so you should be able to verify the rates on your own pretty easily.