How does this other inpatient job sound

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nexus73

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  1. 7 on 7 off, adult psych
  2. 2 doctors covering 20 beds.
  3. off unit consults and ED covered by telepsych
  4. night call covered by telepsych who put in admit orders overnight
  5. 21 days PTO per year taken in 7 days blocks covered by locums
  6. 7 sick days per year covered by telepsych
$285k salary
 
The census seems very reasonable though the salary seems slightly low? A year ago i was seeing quite a few inpatient jobs >300k.

If you dont have to do any consults to the floor or ER then that is good. Is there any kind of hospitalist support for medical issues?
 
This job seems pretty good to me. 10 patients seems manageable, and the pay looks reasonable. You are also getting every other week off + three extra vacation weeks. I think you have found a fairly good job if you are interested in the 7 on / 7 off model.
 
If the benefits are decent and the staff is good it seems like a solid job to me. No call overnight or consults sounds like a dream. I don't think I've seen any 7/7 positions that also had actual paid vacation time (would just trade weeks for people). The salary seems good for the workload, I'd love a position like this where you get 7 days off at a time and get to leave work on the unit when you leave.
 
This sounds like a great gig. You're working 26 weeks a year + 3 weeks off for PTO meaning you're working 23 weeks a year or 161 days, which is much less than the 260 working days in a year that average workers have. Covering 10 patients a day, no ED/consults, no night call, all of that for $285k straight salary sounds great.

You should ask when the current psychiatrists usually finish and if you can do private practice on the afternoons or off weeks to supplement your salary and you can clear $400k pretty reasonably.
 
clozareal said:
This sounds like a great gig. You're working 26 weeks a year + 3 weeks off for PTO meaning you're working 23 weeks a year or 161 days, which is much less than the 260 working days in a year that average workers have. Covering 10 patients a day, no ED/consults, no night call, all of that for $285k straight salary sounds great.

You should ask when the current psychiatrists usually finish and if you can do private practice on the afternoons or off weeks to supplement your salary and you can clear $400k pretty reasonably.
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Or you can work 161 days with a chill schedule and live an awesome life and be a great partner/friend/parent while making a very livable salary.
 
What do they mean when they say 7 on 7 off? Are they 8, 10, 12, 14 hour days?

161 days * 08 hours = 1288 hours, which is the same thing as 32.2 weeks of 40 hours per week.
161 days * 10 hours = 1610 hours, which is the same thing as 40.3 weeks of 40 hours per week.
161 days * 12 hours = 1932 hours, which is the same thing as 48.3 weeks of 40 hours per week.
161 days * 14 hours = 2254 hours, which is the same thing as 56.4 weeks of 40 hours per week.

If they want you to work a full 12 hour day (which I feel like they usually mean when they say 7/7), then you're still working more hours than full time.
 
ObsequiousAplomb said:
What do they mean when they say 7 on 7 off? Are they 8, 10, 12, 14 hour days?

161 days * 08 hours = 1288 hours, which is the same thing as 32.2 weeks of 40 hours per week.
161 days * 10 hours = 1610 hours, which is the same thing as 40.3 weeks of 40 hours per week.
161 days * 12 hours = 1932 hours, which is the same thing as 48.3 weeks of 40 hours per week.
161 days * 14 hours = 2254 hours, which is the same thing as 56.4 weeks of 40 hours per week.

If they want you to work a full 12 hour day (which I feel like they usually mean when they say 7/7), then you're still working more hours than full time.
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Er, that's certainly true for some of the 7 on 7 of schedules, but this job is 10 IP with NO other responsibilities for consults or anything elsewhere in the healthcare system. There is no way this job would take 12 hours/day unless you are running a psychoanalytic IP unit.
 
Merovinge said:
Er, that's certainly true for some of the 7 on 7 of schedules, but this job is 10 IP with NO other responsibilities for consults or anything elsewhere in the healthcare system. There is no way this job would take 12 hours/day unless you are running a psychoanalytic IP unit.
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True, but they could have requirements like “must be in the hospital at all times during your shift”
 
forchinet121 said:
True, but they could have requirements like “must be in the hospital at all times during your shift”
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I would expect something like you must be present 9-5ish and be available to come back in for the 1/1000000 chance someone has a concern for NMS/malignant catatonia/5-HT syndrome between 5-7pm. Clearly would be expected to take phone calls until the night shift starts.
 
nexus73 said:
  1. 7 on 7 off, adult psych
  2. 2 doctors covering 20 beds.
  3. off unit consults and ED covered by telepsych
  4. night call covered by telepsych who put in admit orders overnight
  5. 21 days PTO per year taken in 7 days blocks covered by locums
  6. 7 sick days per year covered by telepsych
$285k salary
Click to expand...
This ended up getting negotiated to the following:

For perspective, the overall preference from the MDs was work life balance, and less focus on total comp

  1. 7 on 7 off, adult psych (4 total docs, two teams of two MDs)--168 shifts per year is full time.
  2. 2 doctors covering 25 beds each day, max 13 but more realistically 8-11 each as unit has not admitted to 25 in more than 3 years due to double occupancy rooms, acuity issues, nursing staff shortage, etc. Pushing for a cap of 10 seemed like a waste of effort as the unit naturally caps below the absolute max on its own.
  3. off unit consults and ED covered by telepsych, who put in admit orders from ED and med floor in conjunction with psych charge RN
  4. night call covered by telepsych who put in admit orders overnight, and any calls from unit for restraints, IMs, PRN trazodone etc
  5. transfers from outlying hospitals managed by telepsych 24/7 in conjunction with psych charge RN
  6. 14 days PTO per year taken in 7 days blocks covered by locums. If you don't take PTO you get paid for the extra days (about $303K if you don't take PTO and work 182 shifts)
  7. No sick days. If someone is sick and another doc comes in to cover they get day rate (280K/168=$1666) plus $600. If out sick your pay is reduced by the day rate.
  8. There is an RVU bonus structure at $69/rvu trued up quarterly, if you generate above the base. With current e/m coding rules I doubt anyone will exceed the base salary.
Good support from nursing and case management. Realistically can come in for staffing at 8:30 and be done by 2pm most days.
No requirement to stay 12 hours, but would need to come back for urgent issues.
Salary 280K--median per blend of salary surveys. Hospital in the red, negotiation on pay is fruitless. This is best deal or walk.
To me this seems like the hospital is meeting the docs halfway given desire for less work, and ok with less pay.
 
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nexus73 said:
This ended up getting negotiated to the following:

For perspective, the overall preference from the MDs was work life balance, and less focus on total comp

  1. 7 on 7 off, adult psych (4 total docs, two teams of two MDs)--168 shifts per year is full time.
  2. 2 doctors covering 25 beds each day, max 13 but more realistically 8-11 each as unit has not admitted to 25 in more than 3 years due to double occupancy rooms, acuity issues, nursing staff shortage, etc. Pushing for a cap of 10 seemed like a waste of effort as the unit naturally caps below the absolute max on its own.
  3. off unit consults and ED covered by telepsych, who put in admit orders from ED and med floor in conjunction with psych charge RN
  4. night call covered by telepsych who put in admit orders overnight, and any calls from unit for restraints, IMs, PRN trazodone etc
  5. transfers from outlying hospitals managed by telepsych 24/7 in conjunction with psych charge RN
  6. 14 days PTO per year taken in 7 days blocks covered by locums. If you don't take PTO you get paid for the extra days (about $303K if you don't take PTO and work 182 shifts)
  7. No sick days. If someone is sick and another doc comes in to cover they get day rate (280K/168=$1666) plus $600. If out sick your pay is reduced by the day rate.
  8. There is an RVU bonus structure at $69/rvu trued up quarterly, if you generate above the base. With current e/m coding rules I doubt anyone will exceed the base salary.
Good support from nursing and case management. Realistically can come in for staffing at 8:30 and be done by 2pm most days.
No requirement to stay 12 hours, but would need to come back for urgent issues.
Salary 280K--median per blend of salary surveys. Hospital in the red, negotiation on pay is fruitless. This is best deal or walk.
To me this seems like the hospital is meeting the docs halfway given desire for less work, and ok with less pay.
Click to expand...
What is the RVU target, out of interest? 168 days covering 8 to 11 patients could be 4500 - 5400 RVUs so depending on the target this could make a big difference.
 
nexus73 said:
This ended up getting negotiated to the following:

For perspective, the overall preference from the MDs was work life balance, and less focus on total comp

  1. 7 on 7 off, adult psych (4 total docs, two teams of two MDs)--168 shifts per year is full time.
  2. 2 doctors covering 25 beds each day, max 13 but more realistically 8-11 each as unit has not admitted to 25 in more than 3 years due to double occupancy rooms, acuity issues, nursing staff shortage, etc. Pushing for a cap of 10 seemed like a waste of effort as the unit naturally caps below the absolute max on its own.
  3. off unit consults and ED covered by telepsych, who put in admit orders from ED and med floor in conjunction with psych charge RN
  4. night call covered by telepsych who put in admit orders overnight, and any calls from unit for restraints, IMs, PRN trazodone etc
  5. transfers from outlying hospitals managed by telepsych 24/7 in conjunction with psych charge RN
  6. 14 days PTO per year taken in 7 days blocks covered by locums. If you don't take PTO you get paid for the extra days (about $303K if you don't take PTO and work 182 shifts)
  7. No sick days. If someone is sick and another doc comes in to cover they get day rate (280K/168=$1666) plus $600. If out sick your pay is reduced by the day rate.
  8. There is an RVU bonus structure at $69/rvu trued up quarterly, if you generate above the base. With current e/m coding rules I doubt anyone will exceed the base salary.
Good support from nursing and case management. Realistically can come in for staffing at 8:30 and be done by 2pm most days.
No requirement to stay 12 hours, but would need to come back for urgent issues.
Salary 280K--median per blend of salary surveys. Hospital in the red, negotiation on pay is fruitless. This is best deal or walk.
To me this seems like the hospital is meeting the docs halfway given desire for less work, and ok with less pay.
Click to expand...

Why did they reduce from 21 to 14 days PTO? At $1666 per day that's a pay cut of $11,662. That's huge. Add in the $600 additional for the 7 days (because you're now working those additional shifts) and that's $15,834 less pay.
 
SmallBird said:
What is the RVU target, out of interest? 168 days covering 8 to 11 patients could be 4500 - 5400 RVUs so depending on the target this could make a big difference.
Click to expand...
I don't have it official yet, but expect it to be 280K/69--4057
 
ObsequiousAplomb said:
Why did they reduce from 21 to 14 days PTO? At $1666 per day that's a pay cut of $11,662. That's huge. Add in the $600 additional for the 7 days (because you're now working those additional shifts) and that's $15,834 less pay.
Click to expand...
I think they're basing it off 168 days at "12 hours" is 2,018 hours, which falls into their definition of full time. But in reality you're not in house 12 hours. I'm trying to take the perspective to not let perfect be the enemy of the good in this negotiation.

It's a decent salary.
Work less than half the days of the year.
The days on are pretty chill.
You get two 21 day stretches off covered by locums. (7 days of PTO bracketed by your normal 7 day off weeks). So take vacay to Europe if you want. Twice a year.
There is no call at night so you get to sleep. Rarity for hospital job.

The reality of negotiating with employing hospitals is the pressure to pay "Fair Market Value". They of course want to pay as little as possible just like I want to get paid as much as possible. But the hospital can run into federal problems if they are paying "too much" outside the normal distribution. This is why the usual way to make lots of money at a hospital is to negotiate a favorable RVU rate at or near the median and then churn churn churn. Even if a psychiatrist makes $1 million/year, if it lines up with the produced RVUs everyone feels mostly okay about. The doctor is getting paid a lot, but they're getting paid for the work being done.

The problem is with the psych shortage, you'd expect the hospital to pay a premium. Like a run of the mill job would just pay $400K because they can't hire anyone. The reality is they will never do this directly. They will happily pay locums companies this and more. Or they will close services. But they will never hire a doctor at a >95% salary for doing 50%ile work volume. Too risky for OIG investigation.

I think the trade off here is we're looking at a median salary, which the hospital feels good about, for relatively less than median work volume.
 
I think this is pretty good. I work 7 on 7 off inpatient and my base is more, but I make more RVUs as we do a lot of therapy on our unit and cover consults, so RVUs more like 30 - 35 a day versus the 20 - 25 a day you might project.
 
nexus73 said:
I think they're basing it off 168 days at "12 hours" is 2,018 hours, which falls into their definition of full time. But in reality you're not in house 12 hours. I'm trying to take the perspective to not let perfect be the enemy of the good in this negotiation.

It's a decent salary.
Work less than half the days of the year.
The days on are pretty chill.
You get two 21 day stretches off covered by locums. (7 days of PTO bracketed by your normal 7 day off weeks). So take vacay to Europe if you want. Twice a year.
There is no call at night so you get to sleep. Rarity for hospital job.

The reality of negotiating with employing hospitals is the pressure to pay "Fair Market Value". They of course want to pay as little as possible just like I want to get paid as much as possible. But the hospital can run into federal problems if they are paying "too much" outside the normal distribution. This is why the usual way to make lots of money at a hospital is to negotiate a favorable RVU rate at or near the median and then churn churn churn. Even if a psychiatrist makes $1 million/year, if it lines up with the produced RVUs everyone feels mostly okay about. The doctor is getting paid a lot, but they're getting paid for the work being done.

The problem is with the psych shortage, you'd expect the hospital to pay a premium. Like a run of the mill job would just pay $400K because they can't hire anyone. The reality is they will never do this directly. They will happily pay locums companies this and more. Or they will close services. But they will never hire a doctor at a >95% salary for doing 50%ile work volume. Too risky for OIG investigation.

I think the trade off here is we're looking at a median salary, which the hospital feels good about, for relatively less than median work volume.
Click to expand...
I'm 95% certain that the "risk" of an "OIG investigation" is 95% made up by employers so that they can trick us into thinking that's an acceptable lie. If it were true, wouldn't hospitals also use it as an excuse to repeatedly lower the compensation for the non-physician administrators? Or did they all just collude so that the median was that absurdly high?
 
ObsequiousAplomb said:
I'm 95% certain that the "risk" of an "OIG investigation" is 95% made up by employers so that they can trick us into thinking that's an acceptable lie. If it were true, wouldn't hospitals also use it as an excuse to repeatedly lower the compensation for the non-physician administrators? Or did they all just collude so that the median was that absurdly high?
Click to expand...
It is, that is all total nonsense.
 
ObsequiousAplomb said:
I'm 95% certain that the "risk" of an "OIG investigation" is 95% made up by employers so that they can trick us into thinking that's an acceptable lie. If it were true, wouldn't hospitals also use it as an excuse to repeatedly lower the compensation for the non-physician administrators? Or did they all just collude so that the median was that absurdly high?
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Also how is it some surgeons are pulling in 1 mil+? Does FMV not apply to them?
 
forchinet121 said:
Also how is it some surgeons are pulling in 1 mil+? Does FMV not apply to them?
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They have a decent RVU rate and do high volume. I know psychiatrists on inpatient making about 1 million, seeing 35 patients a day and maxing out billables on RVUs plus ECT adjacent to inpatient unit. FMV can be 1 mil+ if it's based on a median RVU $ value, but you do an insane amount of RVUs. Like a psychiatrist doing 14,000 RVUs at $70 per is 980K. It can't be quality work. But it's quick. The surgeons are probably playing fast a loose with high volumes as well.
 
nexus73 said:
They have a decent RVU rate and do high volume. I know psychiatrists on inpatient making about 1 million, seeing 35 patients a day and maxing out billables on RVUs plus ECT adjacent to inpatient unit. FMV can be 1 mil+ if it's based on a median RVU $ value, but you do an insane amount of RVUs. Like a psychiatrist doing 14,000 RVUs at $70 per is 980K. It can't be quality work. But it's quick. The surgeons are probably playing fast a loose with high volumes as well.
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How does someone see 35 per day everyday? When I moonlight and have to cover this on Sat and Sunday I'm so dead after the weekend...
 
Psychresy said:
How does someone see 35 per day everyday? When I moonlight and have to cover this on Sat and Sunday I'm so dead after the weekend...
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Among the friends I know who do this type of work, they round on 30+ people a day but their hospitalization is dictated by insurance coverage. If someone comes in and utilization review says they have 5 days, they stay for 5 days. Your day to day decision making is pretty easy at that point. If you started someone on Prozac for depression yesterday and know they're not discharging today (day 2 of admission) how many changes could you realistically make that day? Maybe add a melatonin or trazodone?

Don't get me wrong, this job sounds soul sucking and I prob couldn't do it for very long, but people do it because there is a need.
 
psych_0 said:
Among the friends I know who do this type of work, they round on 30+ people a day but their hospitalization is dictated by insurance coverage. If someone comes in and utilization review says they have 5 days, they stay for 5 days. Your day to day decision making is pretty easy at that point. If you started someone on Prozac for depression yesterday and know they're not discharging today (day 2 of admission) how many changes could you realistically make that day? Maybe add a melatonin or trazodone?

Don't get me wrong, this job sounds soul sucking and I prob couldn't do it for very long, but people do it because there is a need.
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Those are real people during an acute crisis and possibly the worst time of their lives. If you just dictate your practice based on UR, never do peer to peers, you are directly responsible for the inevitable bad outcomes that will come. Anyone who has done IP/RTC or even PHP/IOP should be aware there are plenty of times patient's need more care than initial UR is able to get covered. Peer to peers are unfortunate, soul sucking, and complete time waster, but we are the ones in charge of pushing for appropriate medical care for our patients and it is 100% what you sign up for when you take the job.
 
forchinet121 said:
Also how is it some surgeons are pulling in 1 mil+? Does FMV not apply to them?
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nexus73 said:
Like a psychiatrist doing 14,000 RVUs at $70 per is 980K. It can't be quality work. But it's quick. The surgeons are probably playing fast a loose with high volumes as well.
Click to expand...

Not really. Surgical procedure codes typically have much higher wRVUs than non-surgical codes do. For example, a straightforward lap chole is about 10.5 wRVUs. If you do an exploration of the common bile duct it jumps to 18 wRVUs. That's before any kind of add-on codes are included. Additionally, fRVUs and mpRVUs are going to be higher. Those same procedures I mentioned before have tRVUs of 19.5 and 33.3 respectively and take less than 2 hours to do. The average appendectomy takes under an hour to perform. Do 3-4 of those per day and that's 30-75 wRVUs or 58-135 tRVUs per day before considering add-on codes.

In a typical workday surgeons will bring in more wRVUs than we do and A LOT more total RVUs, so it makes sense that they'd have a higher ceiling than we do by just grinding. Also keep in mind that surgeon hours are potentially much different than our hours and they're often racking up more RVUs while on call.
 
Merovinge said:
Those are real people during an acute crisis and possibly the worst time of their lives. If you just dictate your practice based on UR, never do peer to peers, you are directly responsible for the inevitable bad outcomes that will come. Anyone who has done IP/RTC or even PHP/IOP should be aware there are plenty of times patient's need more care than initial UR is able to get covered. Peer to peers are unfortunate, soul sucking, and complete time waster, but we are the ones in charge of pushing for appropriate medical care for our patients and it is 100% what you sign up for when you take the job.
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Yea, but when you sign up to work at these places, this is the understanding. No one is forcing you to work there. And honestly, I'd done maybe 1 peer to peer ever that wasn't warranted where I felt the need to really fight for an extra set of days. Most of the times I get a peer to peer is because someone inadvertently admitted a floridly demented patient who family refuses to have back home and I have no where to send them because they need a SNF and no one wants to touch them because they have dementia. Insurance will say their care is "custodial in nature" and I mean, they're right. Very rarely are they fighting me to force a discharge on someone possibly at the "worst time of their life." [And I work on an inpatient unit with an average length of stay somewhere between 24-72 hours].
 
Merovinge said:
Those are real people during an acute crisis and possibly the worst time of their lives. If you just dictate your practice based on UR, never do peer to peers, you are directly responsible for the inevitable bad outcomes that will come. Anyone who has done IP/RTC or even PHP/IOP should be aware there are plenty of times patient's need more care than initial UR is able to get covered. Peer to peers are unfortunate, soul sucking, and complete time waster, but we are the ones in charge of pushing for appropriate medical care for our patients and it is 100% what you sign up for when you take the job.
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I have never, ever worried about UR, and have been doing high volume impatient work for several years now. I just document well and don't respond to their emails and I know my hosptial only balance bills if patients are out of network and I can't fix that.
 
SmallBird said:
I have never, ever worried about UR, and have been doing high volume impatient work for several years now. I just document well and don't respond to their emails and I know my hosptial only balance bills if patients are out of network and I can't fix that.
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high volume impatient sounds about right
 
SmallBird said:
I have never, ever worried about UR, and have been doing high volume impatient work for several years now. I just document well and don't respond to their emails and I know my hosptial only balance bills if patients are out of network and I can't fix that.
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Your hospital does not make you do peer to peers for patients and just eats the cost if you keep them past the authorization? Or you never keep patient's past their authorization? The former sounds amazing, the latter is a very different story.
 
psych_0 said:
Among the friends I know who do this type of work, they round on 30+ people a day but their hospitalization is dictated by insurance coverage. If someone comes in and utilization review says they have 5 days, they stay for 5 days. Your day to day decision making is pretty easy at that point. If you started someone on Prozac for depression yesterday and know they're not discharging today (day 2 of admission) how many changes could you realistically make that day? Maybe add a melatonin or trazodone?

Don't get me wrong, this job sounds soul sucking and I prob couldn't do it for very long, but people do it because there is a need.
Click to expand...

980k per year and if you invest wisely, won’t have to do it for long haha
 
Merovinge said:
Your hospital does not make you do peer to peers for patients and just eats the cost if you keep them past the authorization? Or you never keep patient's past their authorization? The former sounds amazing, the latter is a very different story.
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I just do the right thing and explain it well in my notes so we almost never get denials - but, I have had to do about 6 or 7 peer reviews in the last five years at different hospitals I've worked at and I have lost 2. But I just keep doing my thing after that. I will say I ask about this during interviews and I declined a job in Denver because of my understanding of the insurance climate there.
 
forchinet121 said:
No one is making that in psychiatry, maybe 1 in a 1000 or something but not common at all
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Where I am at several of the older and gen x psych docs typically do an inpatient job 6am-12-1pm then go to the their PP M-F and round on their 20 bed inpt on the wknds. Maybe these are the 1 in 1000 but its fairly common mentality in this area for that generation to work like that. They obviously make close to 7 fig but nobody really envies that lifestyle.
 
finalpsychyear said:
Where I am at several of the older and gen x psych docs typically do an inpatient job 6am-12-1pm then go to the their PP M-F and round on their 20 bed inpt on the wknds. Maybe these are the 1 in 1000 but its fairly common mentality in this area for that generation to work like that. They obviously make close to 7 fig but nobody really envies that lifestyle.
Click to expand...

The numbers I've ran/offers I've been presented look like this.

12-15 inpatient rounding paying high 3s to low 400s. With an average of 15 minutes per patient you're looking at ~4hours in the hospital.

3 x 5 hours private practice. If you can generate an average of $395/hr which is very reasonable that's another ~250k a year after overhead. Add in another 5 hours a week admin.

Mix in the occasional locums weekend coverage, phone call from home, whatever else and add another 75k to the mix.

You're looking at making into the 700s for 40 hours a week with two of those week days being half days when you have no PP scheduled.

Sure you could do more to reach 1M, but I'm not sure the difference is worth it at that tax bracket. I honestly don't know of a better set up in medicine than the one above, which seems entirely doable based on my discussions with employers.
 
uhmocksuhsillen said:
The numbers I've ran/offers I've been presented look like this.

12-15 inpatient rounding paying high 3s to low 400s. With an average of 15 minutes per patient you're looking at ~4hours in the hospital.

3 x 5 hours private practice. If you can generate an average of $395/hr which is very reasonable that's another ~250k a year after overhead. Add in another 5 hours a week admin.

Mix in the occasional locums weekend coverage, phone call from home, whatever else and add another 75k to the mix.

You're looking at making into the 700s for 40 hours a week with two of those week days being half days when you have no PP scheduled.

Sure you could do more to reach 1M, but I'm not sure the difference is worth it at that tax bracket. I honestly don't know of a better set up in medicine than the one above, which seems entirely doable based on my discussions with employers.
Click to expand...

Of course if the PP fills to 5 days and then you hire anywhere from 1-5 midlevels which is what these guys have done. They send the mid levels on one or both of the wknd days and since they have sometimes 5 no one is too salty since everyone gets most of their wknds.

Also, with the way the tax system works paying close to 50 percent tax after a certain threshhold is not worth it for some even after all the deductions 401k, pension, vehicle. Its a lot of work to generate each extra 100k to have it taxed at almost half in some states.
 
finalpsychyear said:
Of course if the PP fills to 5 days and then you hire anywhere from 1-5 midlevels which is what these guys have done. They send the mid levels on one or both of the wknd days and since they have sometimes 5 no one is too salty since everyone gets most of their wknds.

Also, with the way the tax system works paying close to 50 percent tax after a certain threshhold is not worth it for some even after all the deductions 401k, pension, vehicle. Its a lot of work to generate each extra 100k to have it taxed at almost half in some states.
Click to expand...

You could certainly do more by managing others to work under you. But that comes with its own headaches. For me, 3 x 5 hour days of PP plus rounding on 12-15 inpts each morning would be enough. Particularly at the income it would generate.

I will say, setting up a defined benefits plan could make earning above and beyond 1M sensible. Depending on age you can tax defer 140-300k a year into retirement account. If you have a spouse and they can do work for you, you can double that number.
 
uhmocksuhsillen said:
The numbers I've ran/offers I've been presented look like this.

12-15 inpatient rounding paying high 3s to low 400s. With an average of 15 minutes per patient you're looking at ~4hours in the hospital.

3 x 5 hours private practice. If you can generate an average of $395/hr which is very reasonable that's another ~250k a year after overhead. Add in another 5 hours a week admin.

Mix in the occasional locums weekend coverage, phone call from home, whatever else and add another 75k to the mix.

You're looking at making into the 700s for 40 hours a week with two of those week days being half days when you have no PP scheduled.

Sure you could do more to reach 1M, but I'm not sure the difference is worth it at that tax bracket. I honestly don't know of a better set up in medicine than the one above, which seems entirely doable based on my discussions with employers.
Click to expand...
When I was a 4th year resident on inpatient, we had to work at an inpatient unit not associated with our hospital because they were renovating our inpatient unit, and we split the other inpatient unit with the docs who were originally working there. One doc was kind enough to sit down with me and some of the jr residents and discuss his work schedule and this sounds pretty close to what he did. He got up early and rounded on an inpatient unit in the city he lived (8-10 patients), then had a hired driver bring him to our city (2 hours away) where he dictated his notes on the drive, rounded on his patients in the hospital where we were (8-ish patients), then did outpatient clinic in the afternoon and had the driver return him to his city. Never told us exactly how much he was making but indicated it was upper 100's at least. Basically covered 2 inpatient units in the am and afternoon outpatient clinic. Said he wasn't planning on doing it for long though.
 
DOswag said:
When I was a 4th year resident on inpatient, we had to work at an inpatient unit not associated with our hospital because they were renovating our inpatient unit, and we split the other inpatient unit with the docs who were originally working there. One doc was kind enough to sit down with me and some of the jr residents and discuss his work schedule and this sounds pretty close to what he did. He got up early and rounded on an inpatient unit in the city he lived (8-10 patients), then had a hired driver bring him to our city (2 hours away) where he dictated his notes on the drive, rounded on his patients in the hospital where we were (8-ish patients), then did outpatient clinic in the afternoon and had the driver return him to his city. Never told us exactly how much he was making but indicated it was upper 100's at least. Basically covered 2 inpatient units in the am and afternoon outpatient clinic. Said he wasn't planning on doing it for long though.
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upper 100s? I would hope a lot more than that! lol.
 
uhmocksuhsillen said:
The numbers I've ran/offers I've been presented look like this.

12-15 inpatient rounding paying high 3s to low 400s. With an average of 15 minutes per patient you're looking at ~4hours in the hospital.

3 x 5 hours private practice. If you can generate an average of $395/hr which is very reasonable that's another ~250k a year after overhead. Add in another 5 hours a week admin.

Mix in the occasional locums weekend coverage, phone call from home, whatever else and add another 75k to the mix.

You're looking at making into the 700s for 40 hours a week with two of those week days being half days when you have no PP scheduled.

Sure you could do more to reach 1M, but I'm not sure the difference is worth it at that tax bracket. I honestly don't know of a better set up in medicine than the one above, which seems entirely doable based on my discussions with employers.
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I say 5 hours in the hospital plus a few things to tie up over phone or text. I believe that 4 hours is too fast to do a good job for 12 -15 patients if you are going to attend rounds, answer questions, support the clinical team in delivering other aspects of care besides med management, and not be away from the hospital at 11.30 am when there is a behavioral code and suddenly someone else has to take care of your patient and it isn't even lunch time. Yes I am sure you can do it in 4 hours but then "insert thread freaking out about mid level replacement". But yes that doesn't preclude your argument of doing private practice in addition and the other things you said.
 
The great thing about psychiatry is there are so many options. If you want to see 10 patients a day for 280K, likely have an early day most days, and never miss a day at the gym...do it.

If you want to double your salary, or more, by rounding inpatient on 15 patients in the morning, then do clinic afternoons, go for it.
 
forchinet121 said:
No one is making that in psychiatry, maybe 1 in a 1000 or something but not common at all
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If you know the right people you will know a much higher percentage than that.

Plus as others have pointed out it actually isn't even that hard to get that level of income if you work a little and you're efficient with good systems and good people on your teams
 
I can't speak to making into the upper six figs (800-1M) but I can say it's not seeming at all difficult to land a couple of jobs +/- PP and make into the 550-700k/year range. None of these combinations require more than 40ish hours a week either. I honestly don't get it when people say psych can't make surgery, radiology, derm, etc money. Of course the derm PP will make more than the psychiatrist. But if you're just looking for facility jobs in these other fields, theres no reason psych can't be comparable at least in my limited experience thus far.

Then again, you hire a bunch of therapists, other docs, run IOPs, etc. I don't see why PP psych can't be comparable to derm PP.
 
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