Graduating psych residents…Job offers

[Merovinge]

How does this look:

Rural area in NE, undesirable location far from everything..:

~300k base, 30K sign on. Outpatient CAP, 30 min f/u and 1hr new. Medicaid/disadvantaged pop. Seems to have minimal therapy/IOP services in community.
-4 week vacation, 2 week CME
-30K retention bonus if stay 3 year, another 30K if stay 5 years
-no RVU target, place wants to implement this but speaking to others here culture is not necessarily productivity driven although they are pushing for more of a productivity model
-once every 1-2 weeks overnight light telephone coverage that is unpaid
-once 1-2 months paid weekend call which is also light

The question is if this location is undesirable to most people or undesirable to you. If it's undesirable to you, I see no reason to take it compared to working in an area you actually want to live. Establishing ties, understanding local resources/laws, and just liking where you live are all really valuable things that are hard to place a $ on but clearly are worth $.

If you want to live in the rural NE and have a chill job that does not do productivity models than I think it's a reasonable starter job. The question would be how you transition or if this would be the long-term goal. It's certainly enough money to meet most people's goals and if you want a rural medicaid population based on being a super badass person then not only more power to you but also kuddos.

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[Desired Member]

I'm in Midwest city and hardly any job openings in this 100 mile radius (only 3 that I can find that are not child/adolescent). I don't want to dox myself too much. 2 offers for salaried positions, both places 30 min follow up, 1 hr new. Offer 1 CMHC (socioeconomic nightmare patients, dangerous area, EMR awful, 140$/hour). Offer 2 LifeStance (120$/hour, bad noncompete, heard EMR is also bad).

 

[littlefred]

At those rates just pick an online gig. A lot pay more than that.

 

[surfguy84]

Have been offered a 1099 psych ER job. $240/hr for daytime coverage, $350/hr for overnights. 8 hour shifts.

 

[NeuroKlitch]

Have been offered a 1099 psych ER job. $240/hr for daytime coverage, $350/hr for overnights. 8 hour shifts.

Sounds pretty decent depending on how busy it is, do you get any resident or other physician support or just u running the entire cpep?

 

[surfguy84]

@NeuroKlitch the whole unit is split with a couple other docs. It's quite a busy psych ER, sounds like 8-12 patients per shift.

 

[MedMan80]

@NeuroKlitch the whole unit is split with a couple other docs. It's quite a busy psych ER, sounds like 8-12 patients per shift.

you're earning every penny with that volume

 

[surfguy84]

you're earning every penny with that volume

True, though I'm imaging the overnight shift is slower. Tempting to work two overnights a week, do another 10-15 hours of clinic and make just about 500k.

 

[MedMan80]

True, though I'm imaging the overnight shift is slower. Tempting to work two overnights a week, do another 10-15 hours of clinic and make just about 500k.

Ya that's legit, in my training metro NY area overnight CPEP was 75% less busy than during the day

 

[JerryMouse]

I'm in Midwest city and hardly any job openings in this 100 mile radius (only 3 that I can find that are not child/adolescent). I don't want to dox myself too much. 2 offers for salaried positions, both places 30 min follow up, 1 hr new. Offer 1 CMHC (socioeconomic nightmare patients, dangerous area, EMR awful, 140$/hour). Offer 2 LifeStance (120$/hour, bad noncompete, heard EMR is also bad).

If you want to stay in this Midwest city, why not look for a VA telepsych job? Or start a private practice seeing patients via telepsych if you feel entrepreneurial.

 

[Desired Member]

If you want to stay in this Midwest city, why not look for a VA telepsych job? Or start a private practice seeing patients via telepsych if you feel entrepreneurial.

Thanks for the suggestions. I had to work at the VA during residency and found a large number were personally disordered in ways that I found difficult to handle (lot of ASPD, NPD) and didn't care for it for those reasons. I may eventually start a private practice but would prefer to have significant savings before then as it seems the overhead could be fairly expensive.

 

[JerryMouse]

Thanks for the suggestions. I had to work at the VA during residency and found a large number were personally disordered in ways that I found difficult to handle (lot of ASPD, NPD) and didn't care for it for those reasons. I may eventually start a private practice but would prefer to have significant savings before then as it seems the overhead could be fairly expensive.

If you take the undesirable CMHC job you mentioned, it’ll be the same with regards to difficult patients. The mix you end up with at the VA can vary. I personally get a lot of addiction and borderlines, fewer ASPD and NPD. Private practice overhead is low if you have a telepsych practice.

 

[forchinet121]

Have been offered a 1099 psych ER job. $240/hr for daytime coverage, $350/hr for overnights. 8 hour shifts.

I’m person or tele?

 

[surfguy84]

I’m person or tele?

In person

 

[reca]

In person

What area of the country is this?

 

[Stagg737]

I'm in Midwest city and hardly any job openings in this 100 mile radius (only 3 that I can find that are not child/adolescent). I don't want to dox myself too much. 2 offers for salaried positions, both places 30 min follow up, 1 hr new. Offer 1 CMHC (socioeconomic nightmare patients, dangerous area, EMR awful, 140$/hour). Offer 2 LifeStance (120$/hour, bad noncompete, heard EMR is also bad).

If you're looking for positions there, feel free to DM me. I get an abundance of postings for positions in many midwest cities and I

True, though I'm imaging the overnight shift is slower. Tempting to work two overnights a week, do another 10-15 hours of clinic and make just about 500k.

Was about to suggest that. At $350/hr that's 2800/shift for overnights. Do that 2 nights a week and you're at almost $300k/yr doing that alone.

 

[Merovinge]

Have been offered a 1099 psych ER job. $240/hr for daytime coverage, $350/hr for overnights. 8 hour shifts.

Day/night switching is tough but if you could do a 5 on 9 off setup that would be a good setup.

 

[FlowRate]

True, though I'm imaging the overnight shift is slower. Tempting to work two overnights a week, do another 10-15 hours of clinic and make just about 500k.

Sounds like maybe day has multiple docs but night might be solo coverage. When I was in residency, daytime ED work was better because there were way more residents and staff around but night was solo resident doing regularly 8-12 new assessments.

 

[Merovinge]

Sounds like maybe day has multiple docs but night might be solo coverage. When I was in residency, daytime ED work was better because there were way more residents and staff around but night was solo resident doing regularly 8-12 new assessments.

But Tree Fiddy an hour!

 

[DOswag]

I think I posted this before but talked to a psychiatrist once who, at least for a limited time, was covering an inpatient job in one city where he would see 10-12 starting at 6 am. He would be done by around 8ish, then had someone drive him to another city 2 hours away (he would complete his documentation on the drive), cover another inpatient unit late morning and be done by around noonish, then had afternoon clinic from 1-4ish, then would have driver return him home and be home around 6 ish. This was when I was a resident and we were having to see our patients for inpatient at this other facility because they were renovating our home site inpatient unit. Don't know how much he was making but he indicated it was pretty substantial so I'm guessing over 500K. How do you find these jobs that allow you to cover multiple places and essentially get paid full time rate for more than one gig?

 

[Stagg737]

I think I posted this before but talked to a psychiatrist once who, at least for a limited time, was covering an inpatient job in one city where he would see 10-12 starting at 6 am. He would be done by around 8ish, then had someone drive him to another city 2 hours away (he would complete his documentation on the drive), cover another inpatient unit late morning and be done by around noonish, then had afternoon clinic from 1-4ish, then would have driver return him home and be home around 6 ish. This was when I was a resident and we were having to see our patients for inpatient at this other facility because they were renovating our home site inpatient unit. Don't know how much he was making but he indicated it was pretty substantial so I'm guessing over 500K. How do you find these jobs that allow you to cover multiple places and essentially get paid full time rate for more than one gig?

This was brought up at another point, but that kind of work should be making far more than $500k. As in close to 7 figures type of salary.

 

[surfguy84]

This was brought up at another point, but that kind of work should be making far more than $500k. As in close to 7 figures type of salary.

Yeah, 24 patients a day should bring in 750k alone. Then add in another 15 hours a week of clinic...should be close to a mil easy.

 

[surfguy84]

What area of the country is this?

CA

 

[jbomba]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

 

[SmallBird]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

That's great compensation. There are pros and cons to being paid hourly, but it means you could really deliver high quality care, talk to your team, have lunch, teach if you like, since you have an abundance of time for the assigned work.

 

[ksharp33]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

I'm assuming this is 1099/locums work?

 

[finalpsychyear]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

So if you sign up for the 15 pts/day but they fall short for volume and you get 13-14 then are you getting pd only for 8? Or is this simply a guarantee if you tell them I'll see up to 15 you get paid for 10 hrs even if you fall short on volume?

 

[Merovinge]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

What's the call like?

 

[NeuroKlitch]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

1099?

 

[NeuroKlitch]

This my second competing offer that I'm seriously considering but very torn. Neuropsychiatrist position at an Ivy league research center caring for patients in their clinical trials. Standard contract and benifits , pay however is only 180k, but have the ability to work 1 full day or two half days doing outpatient work to supplement income . Pros: ivy league , it's research I'm very interested in. Cons : other job offer pays much higher and could comfortably prob make north of 400.

 

[jbomba]

I'm assuming this is 1099/locums work?

Yep permanent work but opted for 1099 as I don't need bennies.

@finalpsychyear good question, not sure.
@Merovinge no call

 

[FlowRate]

This my second competing offer that I'm seriously considering but very torn. Neuropsychiatrist position at an Ivy league research center caring for patients in their clinical trials. Standard contract and benifits , pay however is only 180k, but have the ability to work 1 full day or two half days doing outpatient work to supplement income . Pros: ivy league , it's research I'm very interested in. Cons : other job offer pays much higher and could comfortably prob make north of 400.

Sounds like a time for soul searching. Do you want a research career or not? Is a research career worth {$200k-$3M depending on lots of factors} in lost earnings/returns?

 

[Stagg737]

I've got an inpatient offer on the table. Flat hourly rate of 245 hr. 12 patients per day. 8 hours per day. If I do 15 patients per day they'll pay me for 10 hours. Only thing is I have to stay the entire shift unless I'm doing 15, then I can leave at 8 hours if I"m done.

Works out to about 470k a year with one month off. Doesn't seem bad at all for 12 patients.

Yep permanent work but opted for 1099 as I don't need bennies.

@finalpsychyear good question, not sure.
@Merovinge no call

$470K+/yr for 12 inpatients with no call seems pretty amazing. Even if you have to be present for 8 hours. What's the catch?

 

[jbomba]

$470K+/yr for 12 inpatients with no call seems pretty amazing. Even if you have to be present for 8 hours. What's the catch?

Lol I'll report back in 6 months.

 

[SmallBird]

Lol I'll report back in 6 months.

I guess the one thing I'd wonder about (going back to a recent thread on how much time one should spend on an inpatient unit as an attending) is what expectations they have for quality and extent of care. I assume you want to do high quality work so that's not an issue. But if they expect involvement in case discussions, provision of psychotherapy where appropriate, and supporting the unit with things like restraints, seclusions, putting in admit orders for afternoon admits etc., then, although still a good deal, it is clear where the 'catch' is. An inpatient job that integrates the attending that comprehensively will likely support billing of about 36 RVUs/day for 12 patients, and for full time its in the 7000 - 8000 RVU range for which that salary is still good but not unheard of at all. If you can really just do quick med checks without expectations to do therapy, and once you are done just sit in an office till 5pm, then it is a remarkable deal.

 

[NeuroKlitch]

In places that have base salary plus incentive bonus on productivity , are these considered as true bonuses/supplemental income by the IRS and get taxed at the flat rate of 22% or do they consider it as part of your salary. Assuming the check is sent and labeled as separate as an incentive bonus by the hospital at whatever intervals .

 

[psychmd03]

I'm in Midwest city and hardly any job openings in this 100 mile radius (only 3 that I can find that are not child/adolescent). I don't want to dox myself too much. 2 offers for salaried positions, both places 30 min follow up, 1 hr new. Offer 1 CMHC (socioeconomic nightmare patients, dangerous area, EMR awful, 140$/hour). Offer 2 LifeStance (120$/hour, bad noncompete, heard EMR is also bad).

For the midwest this is quite bad IMO. So if you are stuck in this city then I would look to telepsych you can make more from your home.

 

[Psych19]

In places that have base salary plus incentive bonus on productivity , are these considered as true bonuses/supplemental income by the IRS and get taxed at the flat rate of 22% or do they consider it as part of your salary. Assuming the check is sent and labeled as separate as an incentive bonus by the hospital at whatever intervals .

It’s taxable income no matter how it’s paid. You’re ultimately going to be responsible for paying taxes to the IRS at your marginal tax rate on that bonus. I think the 22% you’re referencing just refers to the minimum federal withholding. You still have to square up with the IRS after the tax year.

 

[NeuroKlitch]

It’s taxable income no matter how it’s paid. You’re ultimately going to be responsible for paying taxes to the IRS at your marginal tax rate on that bonus. I think the 22% you’re referencing just refers to the minimum federal withholding. You still have to square up with the IRS after the tax year.

Damn thought we beat the system lol

 

[Coupd'Cat]

Northeast. Outpatient/ACT team. $215 an hour, 40 hours a week. 8-4, 45 minutes per patient, longer for home visits.

 

[Davidfromcali]

Northeast. Outpatient/ACT team. $215 an hour, 40 hours a week. 8-4, 45 minutes per patient, longer for home visits.

1099 position?

 

[MedMan80]

Ed/cl 100% tele with child focus but adults as well. 7 on 7 off with 1-1.5 patients per hour

325k with 15 days off

15 k sign on plus other benefits and retention things.

 

[clausewitz2]

Ed/cl 100% tele with child focus but adults as well. 7 on 7 off with 1-1.5 patients per hour

325k with 15 days off

15 k sign on plus other benefits and retention things.

How long are the shifts? Is it "here's your list and you're done when you see everyone" or do you have set hours during which you're responsible for the consults? 1.5 patients per hours is more or less doable depending on how long you have to keep up the pace.

 

[MedMan80]

How long are the shifts? Is it "here's your list and you're done when you see everyone" or do you have set hours during which you're responsible for the consults? 1.5 patients per hours is more or less doable depending on how long you have to keep up the pace.

12h shifts, I presume you’re not given the patients back to back and that this is a coverage model for them and based on psych coverage for ED/CL

 

[forchinet121]

Ed/cl 100% tele with child focus but adults as well. 7 on 7 off with 1-1.5 patients per hour

325k with 15 days off

15 k sign on plus other benefits and retention things.

Bad, it’s not hard to calculate just do the basic math. Let’s see what it pays. So you got 52 weeks/2 since you’re 7 on 7 off that leaves you 26 weeks but you also have 2 weeks off so that’s 24 weeks working. Each day is 12 hours so 24x7x12 is 2016 hours per year. You’re making 340k/2016= 168/hour to do only consults and ER which are the most difficult and highest liability work there is. I would not touch this for under 200/hr

 

[Coupd'Cat]

1099 position?

No, actually. I'm given a W2. I'm a "per diem" staff, but still under my employer's umbrella rather than an outside contractor. Seems to be more popular in state-run community mental health positions since they'd had a hard time filling full-time principal psychiatry positions.

 

[MedMan80]

15 days is 3 weeks off, they usually don’t include weekends but I agree with your point

 

[Mad Jack]

Those 325/hr jobs sound nice, minus paying CA taxes, and living where ever the hell Stockton is.

Always been curious about correctional jobs. I think I deal with those with ASPD pretty well.
I have always been curious about what the real risk of getting clobbered in those places are. Like real physical violence towards you the psychiatrist leading to significant bodily injury.

The real issue isn't physical violence, it's lawsuits. Inmates sue about everything because they have nothing better to do, at least in my state. Couple that with no cameras and a sense of entitlement and you end up with things like a guy with 60 concurrent lawsuits in one local facility. The state usually settles, but you're setting yourself up for a lot of annoying paperwork during credentialing and licensure applications for the rest of your life if you do it for any length of time.

 

[Mad Jack]

$280k first year, $280-298k next year onward depending on productivity. university-affiliated community teaching position. $17k retirement contribution annually. $30k sign-on. Inpatient, 8-10 patients per day with one resident. Call is mandatory but weekends are well-compensated, and with residents taking first call overnight and sharing call on weekends. 5 weeks PTO, 1 week CME annually. 403b and 457 available. If I put in one weekend call shift every other month and two nights a month and I add in the hiring bonus and retirement match, total comp sans benefits is around $358k for year one, with projected total comp sans benefits of $338k annually thereafter. Also eligible for PSLF after 5 years which will wipe out my $410k of student loans. Signed on for this one.

$238/hr, W2- prison follow-ups, state facility.

$255,000, community inpatient, 6 patients plus covering consults with approximately 2-6 consults daily. 6% 403b match. 403b but no 457 available. 4 weeks vacation, 1 week CME. 30k sign-on.

$255,000+16k retirement contribution+30k sign-on, adult outpatient. 60 minute intakes, 30 minute follow-ups. 36 hours and 4 hours of admin weekly. 403b and 457 available. 5 weeks PTO, 1 week CME.

All in the Northeast.

 

[jbomba]

The real issue isn't physical violence, it's lawsuits. Inmates sue about everything because they have nothing better to do, at least in my state. Couple that with no cameras and a sense of entitlement and you end up with things like a guy with 60 concurrent lawsuits in one local facility. The state usually settles, but you're setting yourself up for a lot of annoying paperwork during credentialing and licensure applications for the rest of your life if you do it for any length of time.

Do you think there's a difference between prison and jail in this regard?