Independent Contractor

[Jester25]

So I got a job offer seeing both adults and kids. My choice, I can see either or both. Job has a large patient base and needs psychiatrists. I get 75% of the collections, they get 25%. The collection rate is mid 90%. For the 25%, I get a receptionist that does the scheduling and accepts payments from patients as well as the patient base.

Past psychiatrists that have worked there report making $125/hr while seeing 2 follow up patients per hour and 1hr evals. This is after the 25% is taken away. Since I am an independent contractor, I will have to pay for my own license, insurance, malpractice, 401k, CME, etc. I've read on this site that I should factor in 15% of my potential income as the extra costs of being an independent contractor due to not having benefits and having to pay the extra tax.

So the average child psychiatrist makes 225K at a 40hr job. Doing the calculations here, it comes out to 240K for a 40 hr job (125 x 40 x 48 weeks). But then taking out the 15% (36K) for the extra costs leaves me at 204K. This is also without an MA, nurse, etc.


Is this a decent job offer or should I be expecting more. It seems to be less than market value from what I can tell.

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[TexasPhysician]

You aren't comparing apples to apples. Typical outpatient job at $225k wants 45 min evals and 20 min follow-ups.

ADHD follow-ups could be scheduled q10 min and all children could get 25min to include therapy and complexity codes at this contractor job.

75% of a good collection rate after maximizing the schedule for coding is much higher than 240k.

This contractor set-up is better for people that will maximize coding. Both of you win. If you are looking for a cushy gig at 1-2 patients per hour, consider academia. It may pay more for similar work. No-shows could ruin your numbers at 75% and 1-2 patients/hour.

 

[Yellow mellow]

What about being an IC at an urgent care like facility that pays $130/hour. Does this mean that from what the OP say I would need to deduct 15% for malpractice, insurance, CME,etc. ? Doesn't sound that promising then, however I will be working a place I think will be fulfilling.

 

[Thewonderer]

75% split is very favorable. You can probably make more if you do 15-min med evals.

 

[Jester25]

I said the same thing. I'm good with coding and it seemed the $125 was a low number compared to what insurances reimburse. However, about 80-85% of the patients have good insurance, the other 15% or so do not and about a third of that 15% is Medicacid, that brings the hourly numbers down.

In terms of patients per hour. I'm against seeing 4 patients per hour. Personal preference. I can see 3 adults an hour, but the kid dynamic takes more time and unless they are straight ADHD, I like having 30 min for those visits. The jobs I see online for adults are typically 3 per hour and kids are 2 per hour. I guess taking 3 adult patients per hour will bump up my salary.

Their no show rate is low. Patients are mostly professionals with good jobs.

It's good to know the 75% is a good number. It's my first job out of fellowship so I wasnt sure how much is typically paid for overhead.

I'm considering academia once student loans are paid off.

 

[TexasPhysician]

I would add verbiage to the contract that states no Medicaid or limited to "x %" of patient base.

I know a colleague who took a job as a contractor at a private practice. The owner took the new patients with the best insurance and gave Medicaid patients to my friend. Medicaid destroys hourly rates which is why it is rarely taken outside of academia as they have government funding.

Academia can pay as well as the job you are posting and my colleague tells me that he is qualified for loan assistance there.

 

[Thewonderer]

MediCare in my state pays $78 for 99213 and $115 for 99214. And obviously MediCare is federal so the rates are pretty consistent across the country save some adjustment for cost of living, depending on which part of the country you are in. However, Medicaid pays $23 for 99213 and $35 for 99214. That is a huge difference. I agree with TexasPhysician. You have to limit your Medicaid patients. Obviously private insurance pays about the same as MediCare.

 

[mojetter]

I bet its a good thing right out of fellowship but once you get comfortable seeing more patients per hour you can make far more...What region is the job located?

 

[Jester25]

Yeah, salary isn't a huge deal for me. Basically just wanna make market value and have good work/life balance. I would stay academics if I could make 200K.

I agree about adding the % medicaid verbiage. Good thought.

Midwest.

 

[Thewonderer]

I was able to make over $200k in academia a few years back. The key is, "making sure the department gives you revenue sharing on the services." I know there is an argument about the revenue split in academia a few months back, but I am pretty certain most academic departments do 50/50 split because there is a lot of overhead but some other people on this board argued otherwise. But let us say you start off with a salary of $130k per year in academia. If the department wants you to run all the various services and support all or most of your salary, you may want to say "no" and gamble on a revenue sharing contract. The reasons are 1) academic centers almost always have pretty decent (i.e. high ) reimbursement rates from the insurance company) and 2) most faculty who get paid set salary don't know how to bill and often underbill (i.e. doing 99213). So if you are willing to take some chance and see lots of patients, and do mostly 99214 with some 99215, then your SVU's will be high and your salary will actually be higher than taking the "safe bet of set salary from the department."

 

[Jester25]

Interesting. Thanks!

I was able to make over $200k in academia a few years back. The key is, "making sure the department gives you revenue sharing on the services." I know there is an argument about the revenue split in academia a few months back, but I am pretty certain most academic departments do 50/50 split because there is a lot of overhead but some other people on this board argued otherwise. But let us say you start off with a salary of $130k per year in academia. If the department wants you to run all the various services and support all or most of your salary, you may want to say "no" and gamble on a revenue sharing contract. The reasons are 1) academic centers almost always have pretty decent (i.e. high ) reimbursement rates from the insurance company) and 2) most faculty who get paid set salary don't know how to bill and often underbill (i.e. doing 99213). So if you are willing to take some chance and see lots of patients, and do mostly 99214 with some 99215, then your SVU's will be high and your salary will actually be higher than taking the "safe bet of set salary from the department."

 

[TexasPhysician]

Yeah, salary isn't a huge deal for me. Basically just wanna make market value and have good work/life balance. I would stay academics if I could make 200K.

I agree about adding the % medicaid verbiage. Good thought.

Midwest.

I've seen multiple academia jobs that make 200k if you include the bonuses.