Graduating psych residents…Job offers

[forchinet121]

Have a new inpatient unit opening near me.
Public non academic hospital.
They’re offering 250k for the 10-12 bed unit. 3000/mo starting now in residency, a little over a year for me. Student loan repayment that I don’t have all the details on.

No RVU bonus for the first 2 years. But if you don’t reach their RVU targets they can decrease their salary. With it being a new unit they don’t know what to se those at.
They think that 10-12 beds won’t be enough of a workload for a doc and want 10% outpatient commitment. No idea what that looks like.
Call is written that you taken a “proportional amount” shared with other doctors. Right now there would be only the 1 doc so they could theoretically have you on call 100% of the time.
This sounds stupidly bad right?

Yes bad

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[surfguy84]

Have a new inpatient unit opening near me.
Public non academic hospital.
They’re offering 250k for the 10-12 bed unit. 3000/mo starting now in residency, a little over a year for me. Student loan repayment that I don’t have all the details on.

No RVU bonus for the first 2 years. But if you don’t reach their RVU targets they can decrease their salary. With it being a new unit they don’t know what to se those at.
They think that 10-12 beds won’t be enough of a workload for a doc and want 10% outpatient commitment. No idea what that looks like.
Call is written that you taken a “proportional amount” shared with other doctors. Right now there would be only the 1 doc so they could theoretically have you on call 100% of the time.
This sounds stupidly bad right?

Awful. My inpatient gigs I was offered have ranged from 130 per patient regardless to a flat hourly rate of 245/hr with guaranteed 8 hours per day for 12 patients.

This would range 375-450k. Jobs on the west coast.

 

[Merovinge]

Have a new inpatient unit opening near me.
Public non academic hospital.
They’re offering 250k for the 10-12 bed unit. 3000/mo starting now in residency, a little over a year for me. Student loan repayment that I don’t have all the details on.

No RVU bonus for the first 2 years. But if you don’t reach their RVU targets they can decrease their salary. With it being a new unit they don’t know what to se those at.
They think that 10-12 beds won’t be enough of a workload for a doc and want 10% outpatient commitment. No idea what that looks like.
Call is written that you taken a “proportional amount” shared with other doctors. Right now there would be only the 1 doc so they could theoretically have you on call 100% of the time.
This sounds stupidly bad right?

Q1 call for 286k the first year effectively, 250k after that, and a possibility to decrease from there? Plus having the headache of outpatient work at a tiny time slice for no extra pay. Please just cut off contact and talk to a real organization. If this is the actual offer it's too insulting to even continue a discussion. This is liking someone listing a house for 1 million and coming in with a 700,000 offer in a hot market.

 

[Splenda88]

Why so many bad offers? It is because these places think they can get away with it?

 

[forchinet121]

Why so many bad offers? It is because these places think they can get away with it?

Not they think..they can..doctors are so clueless it hurts, thankfully with the internet and new age of technology and older docs retiring people can start realizing their worth, you don’t know how many people are currently working crappy jobs and either don’t know it or just don’t care it’s really strange..the only way for profit private equity exists in this space is by exploiting doctors and they’ve done it and continue to do it with thousands

 

[samac]

Q1 call for 286k the first year effectively, 250k after that, and a possibility to decrease from there? Plus having the headache of outpatient work at a tiny time slice for no extra pay. Please just cut off contact and talk to a real organization. If this is the actual offer it's too insulting to even continue a discussion. This is liking someone listing a house for 1 million and coming in with a 700,000 offer in a hot market.

I thought it was laughably bad but wanted to make sure I wasn’t crazy.

 

[Splenda88]

Not they think..they can..doctors are so clueless it hurts, thankfully with the internet and new age of technology and older docs retiring people can start realizing their worth, you don’t know how many people are currently working crappy jobs and either don’t know it or just don’t care it’s really strange..the only way for profit private equity exists in this space is by exploiting doctors and they’ve done it and continue to do it with thousands

You just can not offer to pay someone 250k for a job that should be paid 400-450k as evidenced by some of these posts. That is criminal.

For most specialties, these people need us more than we need them.

 

[MedMan80]

Just for reference, in my non coastal, large metro area, private practice docs taking insurance would gross the following at 20 patients a day...

10*($208) 99214+90833
5*($115) 99214
4*($95) 99213
1*(305) 99204

Truthfully this is conservative. I do probably 80% add on therapy. Nonetheless this would gross 800k with one month off a year.

Hybrid tele practice to keep overhead down, one office staff at 6 hours a day at 35/hr, 7% billing fees, you're looking at about 130k a year in overhead. So you're keeping 670k.

So you tell me, does your job seem fair?

*Basing these numbers on our recent residency grads who have stayed in the area to practice.

Tasty numbers

 

[samac]

You just can not offer to pay someone 250k for a job that should be paid 400-450k as evidenced by some of these posts. That is criminal.

For most specialties, these people need us more than we need them.

I think they’re looking at surrounding hospitals and going “this is right!”
I’m talking to my residency and may sign on with them, looking at 250k + RVUs but that’s with residents in house 24/7.

 

[calvnandhobbs68]

Not they think..they can..doctors are so clueless it hurts, thankfully with the internet and new age of technology and older docs retiring people can start realizing their worth, you don’t know how many people are currently working crappy jobs and either don’t know it or just don’t care it’s really strange..the only way for profit private equity exists in this space is by exploiting doctors and they’ve done it and continue to do it with thousands

Yes this is certainly part of the issue when you get a bump up in salary so immediately and quickly. When you made 60-70K a year as a resident fellow and now you're suddenly increasing your income 4x with these 250K offers, it SOUNDS like a lot if you aren't aware that the rest of the market is paying 300K+

 

[SmallBird]

Job offer in very desirable, high cost of living location.

Full time inpatient, caseload of 6-7 with residents. No call/weekends. Pay is $305k a year plus extremely generous retirement.

 

[Splenda88]

I think they’re looking at surrounding hospitals and going “this is right!”
I’m talking to my residency and may sign on with them, looking at 250k + RVUs but that’s with residents in house 24/7.

Hopefully that is a good offer. As a new attending, I learn that these employers tend to overestimate how much people will make in RVU/incentive. I have 3 friends that their employers mislead them about how much they will make in RVU.

 

[samac]

Hopefully that is a good offer. As a new attending, I learn that these employers tend to overestimate how much people will make in RVU. I have 3 friends that their employers mislead them about how much they will make in RVU.

I’ll do the math once I have the offer in hand. I hope it’s good too. I know academics is overall less than non academics, low cost of living area.
I have 2 more coming. In. One in the middle of nowhere at 400k.

 

[Splenda88]

I’ll do the math once I have the offer in hand. I hope it’s good too. I know academics is overall less than non academics, low cost of living area.
I have 2 more coming. In. One in the middle of nowhere at 400k.

It's good you are doing that. And I am glad to see physicians in SDN are getting more transparent about salary. 5+ yrs ago, people here were reluctant to disclose or even discuss their salary.

If you look at many of my posts, I am not shy to tell people how much I make as a hospitalist. Employers don't want us do to that because they know they can take advantage of us if there is no 'transparency'. Some of them would go out of their way to tell you not to discuss salary.

 

[Mad Jack]

Easy to replace as perceive by administrators.

The thing that is going on for psych as opposed to EM is that you guys can open your own practice.

Amusingly, most places that have tried this in three of the systems I have worked in were met with disastrous results and rolling the practices back to physician-only. Take, for instance, the consult services I saw that went NP-only. You consult psych inpatient because it's a challenging question you need an answer to, it's basically a customer service position. Let's just say the customers weren't happy. The NPs got fired and replaced by telepsych docs. Both inpatient services ended up going back to psychiatrist only because of a combination of low NP productivity and high levels of required oversight and legal stuff that only psychiatrists can do, with only 1 NP staying on-board out of the several that were hired for these positions. Most NPs would quit on their own because the work was too demanding.

Plus, as you mentioned, we can always drop out of both employment and insurance schemes and work for cash for ourselves. The number of people that come through my door that are so satisfied to finally be seeing an actual doctor is staggering, with many commuting over an hour for the luxury and asking what I'll be doing when I'm done with training. Pity private practice isn't my thing, it would be easy money.

 

[surfguy84]

It's good you are doing that. And I am glad to see physicians in SDN are getting more transparent about salary. 5+ yrs ago, people here were reluctant to disclose or even discuss their salary.

If you look at many of my posts, I am not shy to tell people how much I make as a hospitalist. Employers don't want us do to that because they know they can take advantage of us if there is no 'transparency'. Some of them would go out of their way to tell you not to discuss salary.

It's silly not to discuss salary. Once the year finishes and I 100% finalize on a job I will happily share all the offers I received. If we all did this we could negotiate better.

 

[psychmd03]

Ugh. I just matched into psych and even I see the overt focus on lifestyle, hours, etc at the expense of everything else. A few people say they want to “hustle”, but they also say they want to work as little as possible. I’m unsure how to approach my colleagues and this whole situation when I do aim to be well compensated after residency is done

Nothing wrong with wanting to work as little as possible. Or going into a field because it affords you more time to spend with your family, friends, etc.

I would disagree with the "at the expense of everything else" part. I'm not sacrificing my quality of work because I want to spend less total hours at work each week. I'm also making very good money having cobbled together a couple of jobs (>500k).

My experience in talking to my very knowledgeable medical biller (over 20 years in practice, half the docs in a single hospital system I considered use him) believes psych reimbursement is going up in the coming years.

You can for sure be a hustler if you want to and you can do it well. You need to know the right people and network correctly. I feel I got lucky from my moonlighting gig plus knowing two good people from residency that also truly wanted to work. At this point I know 10 or so psych MDs out of the 25 ish that I keep at least in semi in touch with that will clear at or above the top 1% of hourly wage. I use hourly because the total work time isn't "surgery hustle" level but they still clear a very good hourly wage.

I also agree about wages not coming down soon. In my state just 1.5 years ago the medicaid rates for 99232's almost doubled.

 

[surfguy84]

D

You can for sure be a hustler if you want to and you can do it well. You need to know the right people and network correctly. I feel I got lucky from my moonlighting gig plus knowing two good people from residency that also truly wanted to work. At this point I know 10 or so psych MDs out of the 25 ish that I keep at least in semi in touch with that will clear at or above the top 1% of hourly wage. I use hourly because the total work time isn't "surgery hustle" level but they still clear a very good hourly wage.

I also agree about wages not coming down soon. In my state just 1.5 years ago the medicaid rates for 99232's almost doubled.

Ditto. State Medicaid went up a fair amount in California this year.

 

[MedMan80]

What's everyone's experience of these psych startups (lifestance/mindpath)?

 

[forchinet121]

What's everyone's experience of these psych startups (lifestance/mindpath)?

Very very bad

 

[calvnandhobbs68]

What's everyone's experience of these psych startups (lifestance/mindpath)?

Bad. I’ve talked about lifestance in another thread but all these companies basically exist to squeeze all the extra juice they can out of your billing.

 

[samac]

Hello my friends
I have another offer and another coming in a few weeks.
This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base, but there’s a clause that “Fifteen percent (15%) of Physician’s Base Compensation to be held in an at-risk pay for performance pool”
It includes a 20k sign on bonus + 1500/mo and a 20k/yr retention bonus. Also RVU targets are $79.46 per produced wRVU in excess of 941 per three-month period and paid quarterly.

Call requirements haven’t been discussed.
I’m confused by the 15%, does they mean actual compensation is around 255k?

 

[Splenda88]

Hello my friends
I have another offer and another coming in a few weeks.
This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base, but there’s a clause that “Fifteen percent (15%) of Physician’s Base Compensation to be held in an at-risk pay for performance pool”
It includes a 20k sign on bonus + 1500/no and a 20k/yr retention bonus. Also RVU targets are $79.46 per produced wRVU in excess of 941 per three-month period and paid quarterly.

Call requirements haven’t been discussed.
I’m confused by the 15%, does they mean actual compensation is around 255k?

Yes, that is what it is.

Psych in in demand right now so you should not entertain any contract that is unfair w/ BS language.

 

[samac]

Yes, that is what it is.

Psych in in demand right now so you should not entertain any contract that is unfair w/ BS language.

Like this is a non academic job and with this compensation is worst than the $290k I’m looking at from a state hospital. Unless those RVUs are reallllllly generous that I haven’t mathed yet

 

[Splenda88]

Like this is a non academic job and with this compensation is worst than the $290k I’m looking at from a state hospital. Unless those RVUs are reallllllly generous that I haven’t mathed yet

I don't know that much about RVUs since my hospitalist job is straight salary.

At face value, that job does not look any better than the state hospital job.

 

[hamstergang]

This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base

So you have to see 12-15 inpatients and then go see outpatients? That's enough work for 2 jobs, but you're only getting 1 job's salary.

 

[samac]

So you have to see 12-15 inpatients and then go see outpatients? That's enough work for 2 jobs, but you're only getting 1 job's salary.

There is another inpatient doc they’re already doing consults + unit so it would likely be ~7.
With only 2 of us on staff I imagine Call would also suck

 

[DOswag]

Bad. I’ve talked about lifestance in another thread but all these companies basically exist to squeeze all the extra juice they can out of your billing.

I interviewed with them and considered taking the offer. Seemed like it was a busy day but the compensation seemed pretty good. I ended up not taking it. Did I dodge a bullet?

 

[aquatic ape]

interviewed in a system, with talks of restructuring from a traditional M-F schedule to 7 on/7 off schedule. I liked the interview, and people and everything, and they seemed very excited about it. After the interview they have said they were interviewing another candidate, and now are telling me it will be a while to hear back about compensation, and essentially just delaying things a lot. At the interview they basically had painted it as them wanting to hire me, and that they were building this position somewhat around my interests, so I'm not sure if there is truly another applicant or if its just for another part of the system.

Anyways, how much pressure would you put on them to get back to me sooner? It is where I want to work, and I would be willing to take other positions if this doesn't work out, but don't want to be left waiting around for a while and end up with nothing.

 

[SmallBird]

interviewed in a system, with talks of restructuring from a traditional M-F schedule to 7 on/7 off schedule. I liked the interview, and people and everything, and they seemed very excited about it. After the interview they have said they were interviewing another candidate, and now are telling me it will be a while to hear back about compensation, and essentially just delaying things a lot. At the interview they basically had painted it as them wanting to hire me, and that they were building this position somewhat around my interests, so I'm not sure if there is truly another applicant or if its just for another part of the system.

Anyways, how much pressure would you put on them to get back to me sooner? It is where I want to work, and I would be willing to take other positions if this doesn't work out, but don't want to be left waiting around for a while and end up with nothing.

Demand a timeline, 2 weeks is acceptable, more than that would be irritating. And yet, the quality of the hiring experience may have little impact on the day to day of the job.

 

[aquatic ape]

Demand a timeline, 2 weeks is acceptable, more than that would be irritating. And yet, the quality of the hiring experience may have little impact on the day to day of the job.

They have kinda waffled a bit on the timeline, and have extended several times. Honestly its probably not something I'm willing to walk away from prematurely, so I guess I will try to make some demands for a timeline, and just hold out until I get a better offer if not.

 

[Merovinge]

interviewed in a system, with talks of restructuring from a traditional M-F schedule to 7 on/7 off schedule. I liked the interview, and people and everything, and they seemed very excited about it. After the interview they have said they were interviewing another candidate, and now are telling me it will be a while to hear back about compensation, and essentially just delaying things a lot. At the interview they basically had painted it as them wanting to hire me, and that they were building this position somewhat around my interests, so I'm not sure if there is truly another applicant or if its just for another part of the system.

Anyways, how much pressure would you put on them to get back to me sooner? It is where I want to work, and I would be willing to take other positions if this doesn't work out, but don't want to be left waiting around for a while and end up with nothing.

Could just be a very bureaucratic organization or it could be like a girl telling you that she can't this Friday because she has plans but maybe she will text you sometime next week...

 

[clausewitz2]

Could just be a very bureaucratic organization or it could be like a girl telling you that she can't this Friday because she has plans but maybe she will text you sometime next week...

You don't know, maybe that service line really is washing its hair that night

 

[MedMan80]

I interviewed with them and considered taking the offer. Seemed like it was a busy day but the compensation seemed pretty good. I ended up not taking it. Did I dodge a bullet?

What turned me off is the ramp up period, which means lower paychecks since one is production from day 1

 

[aquatic ape]

I'm seeing 400k for UHS facility, patient cap of 15.

what part of the country did you see this in? local UHS recruiter was saying closer to 325k for 15-20 patients

 

[Merovinge]

what part of the country did you see this in? local UHS recruiter was saying closer to 325k for 15-20 patients

Your experience is very similar to UHS hospitals in my area as well.

 

[Stagg737]

Hello my friends
I have another offer and another coming in a few weeks.
This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base, but there’s a clause that “Fifteen percent (15%) of Physician’s Base Compensation to be held in an at-risk pay for performance pool”
It includes a 20k sign on bonus + 1500/mo and a 20k/yr retention bonus. Also RVU targets are $79.46 per produced wRVU in excess of 941 per three-month period and paid quarterly.

Call requirements haven’t been discussed.
I’m confused by the 15%, does they mean actual compensation is around 255k?

The bolded is a good deal, but that's about the only part of this that is. Especially knowing there would only be 2 of you on staff. Fair would look like this:

This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base, but there’s a clause that “Fifteen percent (15%) of Physician’s Base Compensation to be held in an at-risk pay for performance pool”
It includes a 20k sign on bonus + 1500/mo and a 20k/yr retention bonus. Also RVU targets are $79.46 per produced wRVU in excess of 941 per three-month period and paid quarterly. (Plus reasonable call or additional pay for call).

 

[ObsequiousAplomb]

The bolded is a good deal, but that's about the only part of this that is. Especially knowing there would only be 2 of you on staff. Fair would look like this:

This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base, but there’s a clause that “Fifteen percent (15%) of Physician’s Base Compensation to be held in an at-risk pay for performance pool”
It includes a 20k sign on bonus + 1500/mo and a 20k/yr retention bonus. Also RVU targets are $79.46 per produced wRVU in excess of 941 per three-month period and paid quarterly. (Plus reasonable call or additional pay for call).

Agreed. 15 patients, assuming all 99232, at 1.39 rvu a pop, is ~20 rvu per day from that. 20/day x 60 days in a 3 month period, is 1,251 rvu. So almost 300 rvu over the benchmark. Could mean 300 x 79, or ~99k every 3 months. I'm assuming they want 15 to be followups, I'm not even counting the RVUs for admissions or any of the outpatient work.

It's confusing what they mean by 50% inpatient and outpatient. Do they mean the unit is 15 and he's sharing that with another doc (so cutti g that down to 600 RVU, meaning at least 120 RVU per month in outpatient to get the bonus?

Also the fact they are mandating 15% is held to account for the potential of someone not getting their benchmarks mean they expect at least 15% to not meet their benchmarks.

 

[MedMan80]

I was speaking to a place that is a big TMS clinic, they had a bonus structure that at the high end assumed 10K Wrvu! Not sure if this is standard for TMS shops, that sounds really high to me

 

[yanks26dmb]

what part of the country did you see this in? local UHS recruiter was saying closer to 325k for 15-20 patients

This was in Oregon. 130 per patient, flat rate across the board.

 

[yanks26dmb]

I've discussed with an inpatient unit to do one day of IOP for them. I would do my own billings, patients are largely medicare. The IOP is essentially a step down program that persists for months. This is very different than the IOP I am used to in residency where they are short duration; i.e. 5-6 weeks. I have been told by the medical director I would essentially do a weekly check in with 12ish patients, make sure medications are taken care of, address any issues, write a note, and be done. He told me to expect about 2 hours of work.

Based on billing reimbursements, I am looking at $1650/morning. Anything else to consider here?

 

[deleted721365]

This was in Oregon. 130 per patient, flat rate across the board.

Is this rural Oregon?

 

[samac]

The bolded is a good deal, but that's about the only part of this that is. Especially knowing there would only be 2 of you on staff. Fair would look like this:

This offer 50/50 inpatient outpatient. Inpatient census around 12-15 patients.
$301k base, but there’s a clause that “Fifteen percent (15%) of Physician’s Base Compensation to be held in an at-risk pay for performance pool”
It includes a 20k sign on bonus + 1500/mo and a 20k/yr retention bonus. Also RVU targets are $79.46 per produced wRVU in excess of 941 per three-month period and paid quarterly. (Plus reasonable call or additional pay for call).

I know I won’t be able to get rid of the 50/50 option and will have to split my time at this position do you have recommendations on how to counter?

 

[Desired Member]

What turned me off is the ramp up period, which means lower paychecks since one is production from day 1

Lifestance in my area was offering flat salary for year one

 

[calvnandhobbs68]

Lifestance in my area was offering flat salary for year one

Yeah then they switch you to a straight production model where you have to seriously hustle (16+ patients a day) to get anywhere near a similar salary year 2+. Bad deal.

 

[Desired Member]

I've discussed with an inpatient unit to do one day of IOP for them. I would do my own billings, patients are largely medicare. The IOP is essentially a step down program that persists for months. This is very different than the IOP I am used to in residency where they are short duration; i.e. 5-6 weeks. I have been told by the medical director I would essentially do a weekly check in with 12ish patients, make sure medications are taken care of, address any issues, write a note, and be done. He told me to expect about 2 hours of work.

Based on billing reimbursements, I am looking at $1650/morning. Anything else to consider here?

2 hours work for 12 patients? I get that you would be seeing them weekly long-term but still...seems disingenuous to claim it will only take 10 minutes per patient. That's like how long it takes for a stable ADHD patient on the same med for years. I have a feeling IOP patients will be more complicated. I would be interested in how much social work support there is at the program, if you are seeing largely medicare patients.
This seems like it could be a good job if one had paid off loans and just looking to work a little. One could make around 80k per year working 1 day a week. I think it may be difficult to have this as one of multiple jobs, but maybe that's just me.

 

[Desired Member]

Yeah then they switch you to a straight production model where you have to seriously hustle (16+ patients a day) to get anywhere near a similar salary year 2+. Bad deal.

True. I was just responding to the person who mentioned that there is a "ramp up period, which means lower paychecks since one is production from day 1."

 

[Stagg737]

Agreed. 15 patients, assuming all 99232, at 1.39 rvu a pop, is ~20 rvu per day from that. 20/day x 60 days in a 3 month period, is 1,251 rvu. So almost 300 rvu over the benchmark. Could mean 300 x 79, or ~99k every 3 months. I'm assuming they want 15 to be followups, I'm not even counting the RVUs for admissions or any of the outpatient work.

It's confusing what they mean by 50% inpatient and outpatient. Do they mean the unit is 15 and he's sharing that with another doc (so cutti g that down to 600 RVU, meaning at least 120 RVU per month in outpatient to get the bonus?

Also the fact they are mandating 15% is held to account for the potential of someone not getting their benchmarks mean they expect at least 15% to not meet their benchmarks.

Actually, if the hospital is using the 2023 rates for wRVUs then a 99232 is 1.59 now and a 99233 is no 2.4. So assuming you're billing 99232 and 99233 as 50/50, you're now averaging 2 wRVUs per f/up instead of 1.7 under the 2022 rates. Doesn't seem like much, but at 10 f/ups per day working 22 days a month, that's an extra 200 wRVUs per quarter. @samac , this would be something important to clarify for any inpatient billing you're going to be doing. Outpatient rates didn't really change, but inpatient f/ups are significantly more.

If it's 12-15 patients per day, that's probably ~10 f/ups and 2-3 new patients on average. So ~30 wRVUs per day. At ~22 days per month, that's 1,980 per quarter for 1,039 wRVUs in production bonus. At $79.5 per wRVU (if that's the actual rate and it's uncapped, then wow) that's an extra $86.5k per quarter or $330k/yr. Meaning $585k/yr total for salary and production bonus, which would be great. As you said, the fact that they're holding the extra 15% says this isn't the case though.

I know I won’t be able to get rid of the 50/50 option and will have to split my time at this position do you have recommendations on how to counter?

Sounds like you'd be splitting the inpatient unit. So probably more like 5-8 patients which means probably 4-5 f/ups +1-2 new per day. If 2023 rates, that probably averages about 15 wRVUs per day on the inpatient side or ~1,000 wRVU per quarter. If that's the number, then you hit your minimum and it's about $4-5k in production bonus quarterly with that alone. Then depends on what your outpatient clinic looks like. Let's say after no-shows you see 15 hours of patients per week, so 3 hours a day. Say you do 30 minute f/ups and 60 minute new which averages ~4 wRVUs per hour, that's an additional 800 wRVU per quarter that should all go towards the production bonus, so an extra $65k per quarter or ~$250k per year making your total income roughly $500k. Which would actually be very fair for this position.

You may not need to make a counter offer, but you need to hammer down some more solid numbers for this position. The $79.46/wRVU production bonus with no caps seems too good to be true, unless they're not expecting you to hit those numbers, in which case you should be asking why. Ask if your production is based on what you bill or what is collected, if it's the latter then demand it be switched to wRVUs billed or walk.

You also need to find out about how call is handled. Sounds like if it's just you and one other person, terrible call may be the catch. How often are you on weekend call? Every other weekend? Who covers overnights? What about patient messages on the outpatient side? I'd also recommend talking to the other psychiatrist working there and asking how many RVUs they make and if they're willing to share their income so you have an idea of what the position will actually look like.

I'd be interested to hear the thoughts of some of the more experienced people here.

 

[Merovinge]

Sounds like you'd be splitting the inpatient unit. So probably more like 5-8 patients which means probably 4-5 f/ups +1-2 new per day. If 2023 rates, that probably averages about 15 wRVUs per day on the inpatient side or ~1,000 wRVU per quarter. If that's the number, then you hit your minimum and it's about $4-5k in production bonus quarterly with that alone. Then depends on what your outpatient clinic looks like. Let's say after no-shows you see 15 hours of patients per week, so 3 hours a day. Say you do 30 minute f/ups and 60 minute new which averages ~4 wRVUs per hour, that's an additional 800 wRVU per quarter that should all go towards the production bonus, so an extra $65k per quarter or ~$250k per year making your total income roughly $500k. Which would actually be very fair for this position.

You may not need to make a counter offer, but you need to hammer down some more solid numbers for this position. The $79.46/wRVU production bonus with no caps seems too good to be true, unless they're not expecting you to hit those numbers, in which case you should be asking why. Ask if your production is based on what you bill or what is collected, if it's the latter then demand it be switched to wRVUs billed or walk.

You also need to find out about how call is handled. Sounds like if it's just you and one other person, terrible call may be the catch. How often are you on weekend call? Every other weekend? Who covers overnights? What about patient messages on the outpatient side? I'd also recommend talking to the other psychiatrist working there and asking how many RVUs they make and if they're willing to share their income so you have an idea of what the position will actually look like.

I'd be interested to hear the thoughts of some of the more experienced people here.

No I think you are spot on. If that's billed wRVU it's very high with no cap. It almost sounds like they want to offer a very high possible salary for someone who wants to hussle and take the miserable q2 call. If you are young/don't have family/want to make bank then it would be something to pursue pending a discussion with the other doc there and getting more info.

Most important take away is ALWAYS TALK TO THE OTHER DOCS when looking into any job. Not the CMO or med director but the other rank and file docs. Preferably the youngest/newest to the job to get the real scope.

 

[samac]

Actually, if the hospital is using the 2023 rates for wRVUs then a 99232 is 1.59 now and a 99233 is no 2.4. So assuming you're billing 99232 and 99233 as 50/50, you're now averaging 2 wRVUs per f/up instead of 1.7 under the 2022 rates. Doesn't seem like much, but at 10 f/ups per day working 22 days a month, that's an extra 200 wRVUs per quarter. @samac , this would be something important to clarify for any inpatient billing you're going to be doing. Outpatient rates didn't really change, but inpatient f/ups are significantly more.

If it's 12-15 patients per day, that's probably ~10 f/ups and 2-3 new patients on average. So ~30 wRVUs per day. At ~22 days per month, that's 1,980 per quarter for 1,039 wRVUs in production bonus. At $79.5 per wRVU (if that's the actual rate and it's uncapped, then wow) that's an extra $86.5k per quarter or $330k/yr. Meaning $585k/yr total for salary and production bonus, which would be great. As you said, the fact that they're holding the extra 15% says this isn't the case though.



Sounds like you'd be splitting the inpatient unit. So probably more like 5-8 patients which means probably 4-5 f/ups +1-2 new per day. If 2023 rates, that probably averages about 15 wRVUs per day on the inpatient side or ~1,000 wRVU per quarter. If that's the number, then you hit your minimum and it's about $4-5k in production bonus quarterly with that alone. Then depends on what your outpatient clinic looks like. Let's say after no-shows you see 15 hours of patients per week, so 3 hours a day. Say you do 30 minute f/ups and 60 minute new which averages ~4 wRVUs per hour, that's an additional 800 wRVU per quarter that should all go towards the production bonus, so an extra $65k per quarter or ~$250k per year making your total income roughly $500k. Which would actually be very fair for this position.

You may not need to make a counter offer, but you need to hammer down some more solid numbers for this position. The $79.46/wRVU production bonus with no caps seems too good to be true, unless they're not expecting you to hit those numbers, in which case you should be asking why. Ask if your production is based on what you bill or what is collected, if it's the latter then demand it be switched to wRVUs billed or walk.

You also need to find out about how call is handled. Sounds like if it's just you and one other person, terrible call may be the catch. How often are you on weekend call? Every other weekend? Who covers overnights? What about patient messages on the outpatient side? I'd also recommend talking to the other psychiatrist working there and asking how many RVUs they make and if they're willing to share their income so you have an idea of what the position will actually look like.

I'd be interested to hear the thoughts of some of the more experienced people here.

No I think you are spot on. If that's billed wRVU it's very high with no cap. It almost sounds like they want to offer a very high possible salary for someone who wants to hussle and take the miserable q2 call. If you are young/don't have family/want to make bank then it would be something to pursue pending a discussion with the other doc there and getting more info.

Most important take away is ALWAYS TALK TO THE OTHER DOCS when looking into any job. Not the CMO or med director but the other rank and file docs. Preferably the youngest/newest to the job to get the real scope.

The only other current doc I don’t think wants me because he doesn’t want to split any of it. He takes 4 week days of call and 3 weekends and a locum does 1 week day at 1 weekend currently. He makes over 600k I know, but basically tried to tell me he doesn’t want to split the inpatient and that I need to just do outpatient but I refused to take an all outpatient job.
Hospital wants more psychiatrists though.
I’m waiting to see what my offer looks like from my home institution before going further with this contract.