Graduating psych residents…Job offers

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Do you think there's a difference between prison and jail in this regard?
Probably depends on the state. Here jail can go on for a long time and many people know they're going to get convicted more likely than not so they start playing the long game early

Members don't see this ad.
 
  • Like
Reactions: 1 user
$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.
This one seems particularly low. It should be at least 300 base. Is it just because it’s in the Northeast?
 
  • Like
Reactions: 1 user
Probably depends on the state. Here jail can go on for a long time and many people know they're going to get convicted more likely than not so they start playing the long game early
I'm actually considering a jail gig. Pays 3800 a day and involves about 12 follow ups. Patients are seen behind glass so it's all very safe. What exactly are they suing for? Seems it would be very difficult to prove dereliction of duty causing direct damages.
 
Members don't see this ad :)
I'm actually considering a jail gig. Pays 3800 a day and involves about 12 follow ups. Patients are seen behind glass so it's all very safe. What exactly are they suing for? Seems it would be very difficult to prove dereliction of duty causing direct damages.
Will it be a 5 days/wk job?

That is 874k job is you work 46 wks for a year.
 
  • Like
Reactions: 1 user
Will it be a 5 days/wk job?

That is 874k job is you work 46 wks for a year.

It could be, but the days are long. You are essentially on call 15 hrs a day. I would do a week a month only.
 
  • Like
Reactions: 1 users
When i was in training the prison doc was the guy who couldn't get board certified! Seems these jobs have come a long way (and a long pay)
 
This one seems particularly low. It should be at least 300 base. Is it just because it’s in the Northeast?
Yeah, it's the region. It's your cookie cutter outpatient spot in the area. The clinic does have full support staff though, so ends up not being bad. You can also get 15-30k incentive pay which can net you another chunk of cash. Not the most lucrative but fairly chill
 
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.
Hourly wage increased to ~170$/hr. Not sure if I should ask for more
 
I'm actually considering a jail gig. Pays 3800 a day and involves about 12 follow ups. Patients are seen behind glass so it's all very safe. What exactly are they suing for? Seems it would be very difficult to prove dereliction of duty causing direct damages.

You're dealing with a large number of Cluster B patients who have almost endless time on their hands, are bored out of their minds, and have no real way to make money. Many literally have nothing better to do with their time than try and make some money off of frivolous lawsuits.
 
  • Like
Reactions: 2 users
I'm actually considering a jail gig. Pays 3800 a day and involves about 12 follow ups. Patients are seen behind glass so it's all very safe. What exactly are they suing for? Seems it would be very difficult to prove dereliction of duty causing direct damages.
They sue for anything. One guy sued because they wouldn't let him have a certain pair of shoes, for instance. It's exceedingly frivolous stuff, and they'll brag about their settlements on the block or when they see you. They may claim you said something to them you didn't say or did something you didn't do (a common tactic is they will try to pull you aside for a second and then claim you said something inappropriate or gave them contraband). They will try to rile up staff with stuff like, "Oh they gave me $50,000 for the way you talked to me." Usually it's settled in bulk for like, 100 bucks total in their commissary but they like to lie to get under the skin of people. Any court appearances are paid and you get qualified immunity in my state so financially you're fine unless you stepped wayyyy outside of line.
 
  • Like
Reactions: 1 users
If you are gonna work in forensic system, you want to work for a federal prison where they have to sue the government
 
  • Like
Reactions: 1 users
Will it be a 5 days/wk job?

That is 874k job is you work 46 wks for a year.
Got to keep in mind, the days are long in jobs like this and you're literally in a prison. That means no cell phones, no reading materials, no distractions, at least where I work. There is either too much work or not enough, and when there isn't enough it's maddening because you can only do so much to keep yourself occupied
 
  • Like
Reactions: 5 users
Members don't see this ad :)
If you are gonna work in forensic system, you want to work for a federal prison where they have to sue the government
states often have sovereign immunity as well, so if you're employed by the state the same thing applies. government contractors may also have this.

They sue for anything. One guy sued because they wouldn't let him have a certain pair of shoes, for instance.
My favorite was a prisoner sued claiming violation of his 8th amendment rights against cruel and unusual punishment for getting chunky rather than smooth peanut butter. The prison litigation reform act allows prisoners only 3 frivolous lawsuits and then they are barred from bringing any further lawsuits.
 
  • Like
  • Haha
  • Wow
Reactions: 8 users
states often have sovereign immunity as well, so if you're employed by the state the same thing applies. government contractors may also have this.


My favorite was a prisoner sued claiming violation of his 8th amendment rights against cruel and unusual punishment for getting chunky rather than smooth peanut butter. The prison litigation reform act allows prisoners only 3 frivolous lawsuits and then they are barred from bringing any further lawsuits.
Unfortunately the PLRA doesn't cover state facilities, only federal. Hence why my state has piles of frivolous nonsense. Maybe I should try to get a moonlighting gig with the feds instead
 
How would a county jail factor in to this?
 
How would a county jail factor in to this?
I actually prefer working in jails than doing say general adult outpatient psychiatry (I would rather stick pins in my eyes than do the latter). Many jails are actually much safer to work in than an ER or inpatient psych unit (though many are dangerous). You indicated the jail shifts were ?16hours - $3800 isnt that great for working that long unless I misunderstood. Even if the volume is slow, you will be stuck at the jail, and usually can't have your phone or other electronics with you. So it could be very boring, and you might feel very trapped. But I find the population interesting - lots of substance use disorder, personality disorder, trauma, and severe mental illness. many jail inmates are quite acutely ill. Lots of malingering too of course. But also many people who really need care. Doesn't get more underserved than correctional populations with serious mental illness.
 
  • Like
Reactions: 5 users
I actually prefer working in jails than doing say general adult outpatient psychiatry (I would rather stick pins in my eyes than do the latter). Many jails are actually much safer to work in than an ER or inpatient psych unit (though many are dangerous). You indicated the jail shifts were ?16hours - $3800 isnt that great for working that long unless I misunderstood. Even if the volume is slow, you will be stuck at the jail, and usually can't have your phone or other electronics with you. So it could be very boring, and you might feel very trapped. But I find the population interesting - lots of substance use disorder, personality disorder, trauma, and severe mental illness. many jail inmates are quite acutely ill. Lots of malingering too of course. But also many people who really need care. Doesn't get more underserved than correctional populations with serious mental illness.
Good points splik. The thing about this position is I am free to bring in my phone, allowed to leave the building, once I see my assigned caseload of roughly 12 for the day I am allowed to leave with the caveat I may need to come back if called in for something. Though I've been told that happens rarely. The interviews all happen through glass, so I'm never in the same room with the patient, so safety isn't an issue.

I will also have an outpatient clinic, so I could see my outpatients while at the jail via telehealth.
 
  • Like
Reactions: 1 user
Good points splik. The thing about this position is I am free to bring in my phone, allowed to leave the building, once I see my assigned caseload of roughly 12 for the day I am allowed to leave with the caveat I may need to come back if called in for something. Though I've been told that happens rarely. The interviews all happen through glass, so I'm never in the same room with the patient, so safety isn't an issue.

I will also have an outpatient clinic, so I could see my outpatients while at the jail via telehealth.
Give this job a shot and report back, it sounds legit and is important work.
 
  • Like
Reactions: 2 users
Good points splik. The thing about this position is I am free to bring in my phone, allowed to leave the building, once I see my assigned caseload of roughly 12 for the day I am allowed to leave with the caveat I may need to come back if called in for something. Though I've been told that happens rarely. The interviews all happen through glass, so I'm never in the same room with the patient, so safety isn't an issue.

I will also have an outpatient clinic, so I could see my outpatients while at the jail via telehealth.

Seems like a recipe for a lot of interrupted outpatient appointments. If it really was so ridiculously rare that you would need to come back in they wouldn't be insisting that you be available to do it.
 
Good points splik. The thing about this position is I am free to bring in my phone, allowed to leave the building, once I see my assigned caseload of roughly 12 for the day I am allowed to leave with the caveat I may need to come back if called in for something. Though I've been told that happens rarely. The interviews all happen through glass, so I'm never in the same room with the patient, so safety isn't an issue.

I will also have an outpatient clinic, so I could see my outpatients while at the jail via telehealth.
Idk about this. People tend to get awful uppity when they find out doctors are double-dipping, especially high-paid contract doctors in government settings. Most correctional settings won't even let you have your phone to be on call because they're so uptight about the potential for you to be double-dipping hours.
 
  • Like
Reactions: 1 user
Idk about this. People tend to get awful uppity when they find out doctors are double-dipping, especially high-paid contract doctors in government settings. Most correctional settings won't even let you have your phone to be on call because they're so uptight about the potential for you to be double-dipping hours.

The medical director mentioned he often leaves the building and is rarely called back in once he finishes his load for the day. I'm imaging I can just leave and go home to do my appts.
 
  • Like
Reactions: 1 user
Seems like a recipe for a lot of interrupted outpatient appointments. If it really was so ridiculously rare that you would need to come back in they wouldn't be insisting that you be available to do it.
I was told by med director he's had to come back in like 3-4 times in the past year. So I'm not sure, but I will certainly find out before I start scheduling a bunch of appts.
 
  • Like
Reactions: 1 users
Hourly wage increased to ~170$/hr. Not sure if I should ask for more
Depends on many factors like how tied to that particular area are you? how many other jobs are available to you? How desirable is the location to you? Personally, you would need a lot more than that to pull me into medium size midwest cities but they are on the low desirability spectrum for me so I would need a lot of compensation to make up for that plus most larger midwest cities will over comparable wages or even have the ability to do better.
 
  • Like
Reactions: 1 users
Good points splik. The thing about this position is I am free to bring in my phone, allowed to leave the building, once I see my assigned caseload of roughly 12 for the day I am allowed to leave with the caveat I may need to come back if called in for something. Though I've been told that happens rarely. The interviews all happen through glass, so I'm never in the same room with the patient, so safety isn't an issue.

I will also have an outpatient clinic, so I could see my outpatients while at the jail via telehealth.
That's not bad at all. I'd take it
 
  • Like
Reactions: 1 user
Spoke to a big box private equity place, won’t name them. Seems like they’ll take 1/3 cut from earnings. Provide insurance and the other usual shenanigans, ramp up can be pretty quick based on demand. I’m assuming 1/3 is too much ?
 
  • Like
Reactions: 1 user
Spoke to a big box private equity place, won’t name them. Seems like they’ll take 1/3 cut from earnings. Provide insurance and the other usual shenanigans, ramp up can be pretty quick based on demand. I’m assuming 1/3 is too much ?
Not enough info to answer your question, what place are you talking about? What would your earnings be? Etc etc
 
Not enough info to answer your question, what place are you talking about? What would your earnings be? Etc etc
earnings depends on how many folks you see, they pay around 110 per 99214 minus their cut...
 
earnings depends on how many folks you see, they pay around 110 per 99214 minus their cut...
The standard that needs to be in everyone’s mind is 180/hr guarantee for outpatient telepsych. That is what the market is currently. Notice this is guaranteed hourly pay for 2 99214s per hour. I have been offered this many times now on the vast job trail I’ve been on. So compare your job to that to know if it’s average below or above and adjust accordingly for in person work.
 
  • Like
Reactions: 2 users
earnings depends on how many folks you see, they pay around 110 per 99214 minus their cut...
Around 70 minus cut

So without add-ons that's $147/hr, with an additional $47/90833. So if you're consistently billing 90833 add-ons for at least 50% of your patients to hit $195/hr**. Could be a decent gig, could be crap. Depends on a lot of other factors as well.

**Edited to correct math
 
Last edited:
  • Like
Reactions: 1 users
So without add-ons that's $147/hr, with an additional $47/90833. So if you're consistently billing 90833 add-ons for at least 50% of your patients to hit $185/hr. Could be a decent gig, could be crap. Depends on a lot of other factors as well.

Do people really only see 2 per hour when they aren't doing therapy? Feels like far too much time to refill meds.

99214: 110 x 0.67 = $74
99214+90833: 74+47= $121


74 + 121 = $195/hr (one med management and one combined)

3 x $74 = $222/hr (20 minute appointments med management only)

$121 x 2 = $242/hr (30 minute appointments meds and therapy)

Tbh I would be incredibly bored if I didn't see more than two per hour for "just meds."
 
  • Like
Reactions: 1 user
Do people really only see 2 per hour when they aren't doing therapy? Feels like far too much time to refill meds.

99214: 110 x 0.67 = $74
99214+90833: 74+47= $121


74 + 121 = $195/hr (one med management and one combined)

3 x $74 = $222/hr (20 minute appointments med management only)

$121 x 2 = $242/hr (30 minute appointments meds and therapy)

Tbh I would be incredibly bored if I didn't see more than two per hour for "just meds."

Because of all the clicks needed to order meds/labs and close an encounter in my system I don't see more than 2/hr. My clinic is also a consult clinic though and I'm seeing initial consults and then f/ups 2-4x after that to adjust meds before sending them back to PCP, so requires a bit more time than most continuity clinics where more patients may be stable and just need a "hi, bye, here's your meds". I'm also spend a fair amount of time on patient education and am just not that efficient, so takes me a bit longer than others.
 
  • Like
Reactions: 2 users
The standard that needs to be in everyone’s mind is 180/hr guarantee for outpatient telepsych. That is what the market is currently. Notice this is guaranteed hourly pay for 2 99214s per hour. I have been offered this many times now on the vast job trail I’ve been on. So compare your job to that to know if it’s average below or above and adjust accordingly for in person work.

bonus if you get them to throw in a paid lunch hour and 1 hr admin to boot.
 
  • Like
Reactions: 1 user
The right EMR is key. The one I use one is absolute crap and I struggle with 2 pph. I’ve used a different EMR before and wasn’t too stressed seeing 4 pph
 
Do people really only see 2 per hour when they aren't doing therapy? Feels like far too much time to refill meds.

99214: 110 x 0.67 = $74
99214+90833: 74+47= $121


74 + 121 = $195/hr (one med management and one combined)

3 x $74 = $222/hr (20 minute appointments med management only)

$121 x 2 = $242/hr (30 minute appointments meds and therapy)

Tbh I would be incredibly bored if I didn't see more than two per hour for "just meds."

Depends on what you’re doing. I’ve said this before but it’s pretty difficult to do <30min for child/adolescent. Even outside of that, scheduling 20min appts back to back just means you have to be comfortable with running behind because random people are going to be in crisis or try to take up 30min of your time. I guess if you set the expectation for everyone that their appt is just 20min across the board it makes it easier but if your actually trying to throw longer 30min appts in there it makes it harder.
 
  • Like
Reactions: 1 users
Depends on what you’re doing. I’ve said this before but it’s pretty difficult to do adolescent. Even outside of that, scheduling 20min appts back to back just means you have to be comfortable with running behind because random people are going to be in crisis or try to take up 30min of your time. I guess if you set the expectation for everyone that their appt is just 20min across the board it makes it easier but if your actually trying to throw longer 30min appts in there it makes it harder.
I just block certain hours on my days as either 20 minute sessions, 30 minute sessions, or 60.

For most days it looks like this:

60 minutes for the first appointment and the first appointment after lunch, that way I'm never late for my dedicated hour-long therapy patients.

Two hours of 30 minute blocks for the combined patients.

Last hour of the morning and last hour of the day for 20 minute appointments. People who are usually in-and-out are the last appointment of each day / half day. That way if they drag on then I take a slightly shorter lunch.
 
  • Like
  • Love
Reactions: 6 users
Thank you guys, this shows perspective. The job does take a nice cut from my earnings but they will fill up the schedule quick and perhaps will give me the confidence needed to eventually meander into PP!
 
Offer from an ivory tower:
225 base. No bonus structure or incentive. Full time outpatient only. 30 minute follow up, 1 hr intake. Therapy visits (1 hr) not allowed, only addons are acceptable (214+90833) but must fit in follow up slot.

Work is very low. 8-4. Half day admin time. No double books. 1 hr lunch. No residents or students. All holidays given. +5 days CME. 3 weeks vacation. PSLF eligible.
 
  • Like
Reactions: 1 user
Offer from an ivory tower:
225 base. No bonus structure or incentive. Full time outpatient only. 30 minute follow up, 1 hr intake. Therapy visits (1 hr) not allowed, only addons are acceptable (214+90833) but must fit in follow up slot.

Work is very low. 8-4. Half day admin time. No double books. 1 hr lunch. No residents or students. All holidays given. +5 days CME. 3 weeks vacation. PSLF eligible.
What would be the point of taking that job? If there's no residents/students then the fact that it is an ivory tower doesn't confer much, right? But then add on the super low vacation time, not sure why you'd go for that.
 
  • Like
Reactions: 5 users
Offer from an ivory tower:
225 base. No bonus structure or incentive. Full time outpatient only. 30 minute follow up, 1 hr intake. Therapy visits (1 hr) not allowed, only addons are acceptable (214+90833) but must fit in follow up slot.

Work is very low. 8-4. Half day admin time. No double books. 1 hr lunch. No residents or students. All holidays given. +5 days CME. 3 weeks vacation. PSLF eligible.

What does "work is very low" mean? Unless this means you're actually only working 4 hours a day instead of 7 hours a day, this offer sucks unless you want to be in an academic center for some reason.
 
  • Like
Reactions: 2 users
Offer from an ivory tower:
225 base. No bonus structure or incentive. Full time outpatient only. 30 minute follow up, 1 hr intake. Therapy visits (1 hr) not allowed, only addons are acceptable (214+90833) but must fit in follow up slot.

Work is very low. 8-4. Half day admin time. No double books. 1 hr lunch. No residents or students. All holidays given. +5 days CME. 3 weeks vacation. PSLF eligible.
P(Ass)
 
  • Like
Reactions: 1 users
Offer from an ivory tower:
225 base. No bonus structure or incentive. Full time outpatient only. 30 minute follow up, 1 hr intake. Therapy visits (1 hr) not allowed, only addons are acceptable (214+90833) but must fit in follow up slot.

Work is very low. 8-4. Half day admin time. No double books. 1 hr lunch. No residents or students. All holidays given. +5 days CME. 3 weeks vacation. PSLF eligible.
It blows my mind people work this hard and long to accept jobs like this. No way I'd touch that.
 
  • Like
Reactions: 4 users
Offer from an ivory tower:
225 base. No bonus structure or incentive. Full time outpatient only. 30 minute follow up, 1 hr intake. Therapy visits (1 hr) not allowed, only addons are acceptable (214+90833) but must fit in follow up slot.

Work is very low. 8-4. Half day admin time. No double books. 1 hr lunch. No residents or students. All holidays given. +5 days CME. 3 weeks vacation. PSLF eligible.
Garbage job.
 
  • Like
Reactions: 1 users
Yep the offer is garbage. People can see how bad the ivory towers can be these days (pure clinical). It is a wonder anyone takes these jobs.

Must be desperate for clout.
 
  • Like
Reactions: 1 user
Top