Inpatient private practice/1099?

[jbomba]

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Currently pgy3 and really love the idea of private practice to maximize income. I have a working (non medical) spouse and don't require benefits. I hate outpatient however. Is it possible to be a private inpatient doc? How would one go about this? How do you get a steady supply of patients?

Ideally I'd like to try to find myself in an eat what you kill atmosphere. Unforutnately in my program, talking finances is almost taboo, so I haven't had a lot of mentorship in this regard.

 

[MBBSMOM]

I have no clue what you mean by "inpatient private practice". I am sure you are aware of this in Inpatient you are on call and you have patients that you admit you then discharge when they are ready. You get a steady supply of patients but you won't see them again unless they get readmitted.

 

[jbomba]

I have no clue what you mean by "inpatient private practice". I am sure you are aware of this in Inpatient you are on call and you have patients that you admit you then discharge when they are ready. You get a steady supply of patients but you won't see them again unless they get readmitted.

I don't think I was clear. I essentially would like to see only inpatients as a non hospital employee. Something where I get paid based on what I bill, just like I would if I were working outpatient.

 

[splik]

I don't think I was clear. I essentially would like to see only inpatients as a non hospital employee. Something where I get paid based on what I bill, just like I would if I were working outpatient.

That makes more sense. It was confusing because you said "private practice."
You are referring to the old model of work where hospitals were places where physicians performed their work, but were not employed by the hospital. This is largely dying out and most physicians working at hospitals are employed nowadays - a trend that is likely to continue. It is highly unlikely (and impractical) that you as a solo practitioner would be able to contract with the hospital in this way. However in many areas there are private groups in psychiatry who much like EM groups (most ER docs aren't employed by hospitals), contract with the hospital to provide services like inpatient, PHP, IOP, ECT in addition to providing outpatient services. You might be a contractor with such groups on a pure "eat what you kill model" (i.e. get paid a % of collections), or on a wRVU basis, or you might be paid an hourly rate, or it might be an employed position. Typically these jobs aren't widely advertised however so its about making connections and knowing the right people. Find out if there are any groups like this in your area. This model is becoming increasingly rare.

There are also some groups that work on a shift basis and you could either be employed by the contractor (not the hospital) or be a 1099 and set up your own s-corp to be paid for the work done.

You might also consider looking for employed models that are wRVU/production based. That is another kind of "eat what you kill" in terms of getting paid more if you see more patients etc and some people really like that model. That works well for inpatient. It might also allow you to do inpatient and some outpatient/PHP/IOP/Consults/ECT or something else to diversify your practice or increase your revenue. It is important to set a reasonable RVU conversion factor. This will be influenced by payor mix. For instance, if you are seeing more medicaid/medicare patients, the conversion factor will be much lower. If there are more commercial PPO plan patients, the rate higher. In 2017, the median wRVU for psychiatrists was $67 which is highly favorable. In contrast for medicare, it is about $36.

 

[michaelrack]

Currently pgy3 and really love the idea of private practice to maximize income. I have a working (non medical) spouse and don't require benefits. I hate outpatient however. Is it possible to be a private inpatient doc? How would one go about this? How do you get a steady supply of patients?

It is possible in certain parts of the country.... usually you pick up patients by being on call for the hospital. You make $ by some combination of stipend/billing the patient/being paid by the hospital for each patient. For example, the psych doctor may get several hundred dollars each day he does call, bill Medicare patients for his services directly, and get paid a set fee by the hospital for each Aetna-insured patient he sees

 

[jbomba]

On a related note, I notice some inpatient jobs either w2 or locums which specify a 40 hour week. Anyone know if it's possible to finish the work faster and turn a standard 8 hour day into a 4 hour day? Or are they typically expecting you to be in the hospital the entire 8 hours?

I've always been a fast worker, usually finishing the note by the end of the interview. I could realistically see 18-20 patients in 4-4.5 hours. Picking up two full time jobs like this would also be something I wouldn't mind doing.

 

[downwithDTB]

Remember that w2 and 1099 has little to do with the pay model. You can be (w)rvu, % revenue, hourly, or per diem in both. The difference is primarily in that w2 may also have benefits and that for 1099 you can deduct business expenses but pay fica self employment tax.

Unless an inpatient doc/team comes up with a seperate physician billing scheme that is more efficient than the hospital's or you manage to develop such a strong reputation that a very, very fancy hospital will allow you to bill their inpatients coming specifically to see you cash... I don't really understand how being a hospitalist private contractor would be inherently different from being a employed, assuming the say pay structure and adjusted total compensation.

 

[michaelrack]

I was a contractor at a for profit psychiatry hospital until May of this year, at which time I became an employee. As a contractor I billed some of the patients and invoiced the hospital for seeing others (depending on insurance). A stipend was available in addition for some of the contractor doctors

As an employee, my compensation is mainly salary (the same amount paid every 2 weeks ) with certain bonuses also available

 

[finalpsychyear]

On a related note, I notice some inpatient jobs either w2 or locums which specify a 40 hour week. Anyone know if it's possible to finish the work faster and turn a standard 8 hour day into a 4 hour day? Or are they typically expecting you to be in the hospital the entire 8 hours?

I've always been a fast worker, usually finishing the note by the end of the interview. I could realistically see 18-20 patients in 4-4.5 hours. Picking up two full time jobs like this would also be something I wouldn't mind doing.

sure if your that fast you can just do 2 units maybe even 3 with an NP... If you round at 5am you can have 2 units done by 1pm in time for your outpatient clinic or another inpatient site but you might want an NP to help you at that point.

 

[jbomba]

sure if your that fast you can just do 2 units maybe even 3 with an NP... If you round at 5am you can have 2 units done by 1pm in time for your outpatient clinic or another inpatient site but you might want an NP to help you at that point.

Do I look for jobs that don't specify 40 hrs/week? When I'm getting hired do I just tell them I'll take a bigger load/am I paid per or seen?

Sorry I'm woefully ignorant when it comes to this stuff.

 

[finalpsychyear]

Do I look for jobs that don't specify 40 hrs/week? When I'm getting hired do I just tell them I'll take a bigger load/am I paid per or seen?

Sorry I'm woefully ignorant when it comes to this stuff.

You would be looking for jobs where you do your own billing so private psych hospital set ups. Definitely not employed although you may be able to negotiate something similar. But honestly just get started even doing 1 inpatient psych unit so you see what it actually is like in the real world. You'll have new admits, discharges, team meetings, family meetings, facility meetings, and documentation on an EMR you don't know well and all the liability as the attending doc. You can easily add more work anytime and always. Master each job efficiency wise then add more if you feel like it. 250k is still a LOT of money coming from 50k.