Is this a bad job offer?

[Ahamis]

What are your opinions about this position:

Location: Central Florida
Employed position/ Base salary: 215k / H1-b visa
inpatient- case load is 15 patients.
30 beds psych unity

You start at 8 AM, do rounds and can leave before 5PM (but needs to be available by phone for nurse calls)

1:4 night call

1 Weekend call per month

Consults for internal medicine: usually 2 consults per day.

Bonus: 5-10 k/ year

Vacation: 25 days; After 5 years: 30 days
CME: 3k

The positive aspect is that if you are fast enough you can leave before 5PM. But with 15 patients case load, night calls and weekend calls I don't know if it is a good deal.

I read on this forum that some university-affiliated hospitals are paying around that salary range.

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[wolfvgang22]

Not nearly enough money for that much work, even in academia. Minimum I'd take for that is $250k, and even then I probably wouldn't do it.

 

[SteinUmStein]

Not nearly enough money for that much work, even in academia. Minimum I'd take for that is $250k, and even then I probably wouldn't do it.

Agreed. That's a lot of call and a lot of clinical expectations for that offer. If they aren't open to major negotiations (i.e. big changes in either clinical demand or a big move up in compensation), then I'd look elsewhere. If inpatient work interests you, there will be many more options out there.

 

[clausewitz2]

To give those of us still on training a better idea of what is reasonable, how much do you generally reckon would be reasonable to ask for in the above-mentioned scenario if you refused to do weekend call?

 

[SmallBird]

What are your opinions about this position:

Location: Central Florida
Employed position/ Base salary: 215k / H1-b visa
inpatient- case load is 15 patients.
30 beds psych unity

You start at 8 AM, do rounds and can leave before 5PM (but needs to be available by phone for nurse calls)

1:4 night call

1 Weekend call per month

Consults for internal medicine: usually 2 consults per day.

Bonus: 5-10 k/ year

Vacation: 25 days; After 5 years: 30 days
CME: 3k

The positive aspect is that if you are fast enough you can leave before 5PM. But with 15 patients case load, night calls and weekend calls I don't know if it is a good deal.

I read on this forum that some university-affiliated hospitals are paying around that salary range.

By comparison, I took an inpatient job with very similar pay thats 1) In the northeast; 2) Academic; 3) 8 patients per day 4) No weeknight call, weekend rounding every 6 weeks. Also needed a visa and they paid for absolutely everything. So it seems like this is a bad deal, tbh.

 

[SmallBird]

To give those of us still on training a better idea of what is reasonable, how much do you generally reckon would be reasonable to ask for in the above-mentioned scenario if you refused to do weekend call?

Based on a back of the envelope calculation, assuming about 2/3 of income is coming from RVU's and the rest from hospital base, that job should pay about $350 000. More realistic would be the many jobs that pay about $240k but only require 10-12 patients, no consults, and no call.

 

[PistolPete]

Yea, looks like they're low balling you severely due to the H1-B requirements. Look elsewhere, there's plenty of jobs that will sponsor an H1b and will pay 220-240k with much less work/call, if you're flexible on location.

 

[clausewitz2]

Based on a back of the envelope calculation, assuming about 2/3 of income is coming from RVU's and the rest from hospital base, that job should pay about $350 000. More realistic would be the many jobs that pay about $240k but only require 10-12 patients, no consults, and no call.

Oh wow. These are primarily non-academic, I am assuming? I mean, I like teaching quite a lot, but I could deal with the narcissistic injury of not hearing myself talk constantly for that kind of set up.

 

[SmallBird]

Oh wow. These are primarily non-academic, I am assuming? I mean, I like teaching quite a lot, but I could deal with the narcissistic injury of not hearing myself talk constantly for that kind of set up.

In the northeast, the inpatient jobs at that pay level tend to be at community hospitals, which may have nursing/PA students rotating but aren't academic per se.

 

[TexasPhysician]

Based on a back of the envelope calculation, assuming about 2/3 of income is coming from RVU's and the rest from hospital base, that job should pay about $350 000. More realistic would be the many jobs that pay about $240k but only require 10-12 patients, no consults, and no call.

I think $350K + benefits is about right, not including weekend rounding but including phone call for concerns.

My friend just took a job with fewer patients to cover that would extrapolate to 350K with this volume.

 

[SteinUmStein]

While we're running numbers/set-ups by the psychiatry hive mind, here's a recent one I've seen posted (this one is outpatient) - Full-time outpatient (approx 35 clinical hours/week), Midwest medium sized metro area, standard 60 min new/30 min RV, no call, no weekend rounding, decent set of benefits with around 25 vacation days and around 7-10 CME days, starting around 200-215k with no additional bonus/wRVU's, base only. This has been close to what I've been seeing in the Midwest (metro, not rural), but would be curious as to how it compares to other regions or other outpatient jobs you're all seeing. This one isn't academic, BTW.

re: the above - agree - the first decision for the original poster is whether you want to negotiate the compensation up or the workload down (my preference would be to avoid instant burnout by dialing the call load down, but that's me.) If the employer isn't ready to make changes to the above listing, move on, they'll adjust to the market.

 

[TexasPhysician]

While we're running numbers/set-ups by the psychiatry hive mind, here's a recent one I've seen posted (this one is outpatient) - Full-time outpatient (approx 35 clinical hours/week), Midwest medium sized metro area, standard 60 min new/30 min RV, no call, no weekend rounding, decent set of benefits with around 25 vacation days and around 7-10 CME days, starting around 200-215k with no additional bonus/wRVU's, base only. This has been close to what I've been seeing in the Midwest (metro, not rural), but would be curious as to how it compares to other regions or other outpatient jobs you're all seeing. This one isn't academic, BTW.

Assuming insurance based and adult only, that is a reasonable starting point. I'd attempt to negotiate to around $240. It is relatively low volume, fair time off, and <40 hr/week.

 

[SteinUmStein]

Assuming insurance based and adult only, that is a reasonable starting point. I'd attempt to negotiate to around $240. It is relatively low volume, fair time off, and <40 hr/week.

Thanks for the input - 240 would be fantastic. Worst they can say is no. I'm guessing they would want to come down some, I think 240 is higher than most of their employed docs are making from what bits of info I can glean. Even settling at 220 or so after negotiations would feel pretty satisfying from my perspective, would actually have the time and the opportunity to enjoy it...

 

[Jules A]

As much as I love inpatient I'm not taking a major financial hit to work in that setting and have found the smaller community hospitals seem to pay the best.

As for outpatient a colleague of mine at 100% outpatient, no call or weekends, with benefits recently said they offer H1bs $250,000-$275,000. East coast just over 2 hours to DC and 4h to NYC. When I worked there they did 30 min med checks, 60 min intakes. I'm guessing they would try to push for 20 min med checks but that is probably negotiable.

 

[SmallBird]

As much as I love inpatient I'm not taking a major financial hit to work in that setting and have found the smaller community hospitals seem to pay the best.

As for outpatient a colleague of mine at 100% outpatient, no call or weekends, with benefits recently said they offer H1bs $250,000-$275,000. East coast just over 2 hours to DC and 4h to NYC. When I worked there they did 30 min med checks, 60 min intakes. I'm guessing they would try to push for 20 min med checks but that is probably negotiable.

There is no salary that 'they' offer 'H1bs'. The way you are framing it just doesn't make sense. Some employers will sponsor H1b visas for psychiatrists, others won't. This may be related to the availability of psychiatrists in the area, the size and capacity of their HR department, their prior experiences with visa sponsorship, and other factors. Places that are able to sponsor H1b visas include rural clinics offering high pay, and academic medical centers offering low pay. There is no 'special rate' that they will pay for you having an H1b and in fact this is illegal. The best approach to finding a job if you require visa sponsorship is the same as for everybody else, as is the negotiating process, with the exception that you should include in your job search at least a few places that have a clear capacity to support visa sponsorship - but don't email a recruiter saying 'I need an H1b job', that is degrading to yourself and will only become self-fulfilling prophecy where you convince everyone that you are somehow worth less than everybody else.

Two close colleagues and myself recently completed our job searches and have great jobs that are in no way characterized as 'H1b' jobs - this was something that came up later in the process once they were committed to hiring us anyway.

 

[OldPsychDoc]

You mention a "base" salary. Is there any production bonus (or might you negotiate one)? A lot of positions around here will have the base figured on a minimum RVU production, with additional pay for RVUs above that. It tends to make the call and consult parts more palatable, knowing that that extra work is going to result in extra $$$.

 

[SteinUmStein]

As much as I love inpatient I'm not taking a major financial hit to work in that setting and have found the smaller community hospitals seem to pay the best.

As for outpatient a colleague of mine at 100% outpatient, no call or weekends, with benefits recently said they offer H1bs $250,000-$275,000. East coast just over 2 hours to DC and 4h to NYC. When I worked there they did 30 min med checks, 60 min intakes. I'm guessing they would try to push for 20 min med checks but that is probably negotiable.

That is impressive! I wonder what is driving the numbers up. Tough location to recruit to, the patient population, the workplace? I could see a relatively rural or semi-rural location offering that to recruit and retain if there's not much around, or if schools aren't great. Could be a great deal for someone who fits well in that role/locale.

 

[benlinus]

That is a horrible offer.

 

[Trismegistus4]

By comparison, I took an inpatient job with very similar pay thats 1) In the northeast; 2) Academic; 3) 8 patients per day 4) No weeknight call, weekend rounding every 6 weeks. Also needed a visa and they paid for absolutely everything. So it seems like this is a bad deal, tbh.

Geez, where are you people finding these jobs? 8 patients per day on inpatient? That's like vacation compared to my current outpatient job! And in the northeast? I'm from there and would like to go back at this point, but I talked to the medical director at a hospital near Philadelphia about a job there where I could have had up to 22 patients per day!

 

[Shikima]

I'm looking for a job that pays 500k/yr (supply and demand) for 32 hrs a week seeing 12 pt's a day on split W2 and 1099 income.

 

[Jules A]

There is no salary that 'they' offer 'H1bs'. The way you are framing it just doesn't make sense. Some employers will sponsor H1b visas for psychiatrists, others won't. This may be related to the availability of psychiatrists in the area, the size and capacity of their HR department, their prior experiences with visa sponsorship, and other factors. Places that are able to sponsor H1b visas include rural clinics offering high pay, and academic medical centers offering low pay. There is no 'special rate' that they will pay for you having an H1b and in fact this is illegal. The best approach to finding a job if you require visa sponsorship is the same as for everybody else, as is the negotiating process, with the exception that you should include in your job search at least a few places that have a clear capacity to support visa sponsorship - but don't email a recruiter saying 'I need an H1b job', that is degrading to yourself and will only become self-fulfilling prophecy where you convince everyone that you are somehow worth less than everybody else.

Two close colleagues and myself recently completed our job searches and have great jobs that are in no way characterized as 'H1b' jobs - this was something that came up later in the process once they were committed to hiring us anyway.

Wow was this really necessary? Please forgive my awkward wording. "they" refers to the clinic I mentioned and I suppose I should clarified that is the salary "they" offer psychiatrists and "they" are willing to sponsor H1b visas.

 

[Jules A]

That is impressive! I wonder what is driving the numbers up. Tough location to recruit to, the patient population, the workplace? I could see a relatively rural or semi-rural location offering that to recruit and retain if there's not much around, or if schools aren't great. Could be a great deal for someone who fits well in that role/locale.

Yes semi-rural but a large area with few psychiatrists so enticing young providers to consider leaving the urban lifestyle can be challenging.

 

[SmallBird]

Wow was this really necessary? Please forgive my awkward wording. "they" refers to the clinic I mentioned and I suppose I should clarified that is the salary "they" offer psychiatrists and "they" are willing to sponsor H1b visas.

I didn't mean to attack you personally, but I do think this matters. Your clarification is perfect, thank you.

 

[honsano]

Hijack ~

Ok so I am talking to private practices in my area to diversify my work environment. Though everyone is painting psych with a rosy brush, I got to vistaril it a bit.

-One offered me an independent contractor role with 70% of collections but I would only get 60% for the first five years. If I re-sign with them, I would get the other 10% in lump sum.
Another refused to allow me to talk to any of the other psychiatrists on staff (small company that he runs with his wife).

Oye vay, tough pickens.

 

[Psychotic]

Don't walk, run away from this place...

 

[thepoopologist]

What are your opinions about this position:

Location: Central Florida
Employed position/ Base salary: 215k / H1-b visa
inpatient- case load is 15 patients.
30 beds psych unity

You start at 8 AM, do rounds and can leave before 5PM (but needs to be available by phone for nurse calls)

1:4 night call

1 Weekend call per month

Consults for internal medicine: usually 2 consults per day.

Bonus: 5-10 k/ year

Vacation: 25 days; After 5 years: 30 days
CME: 3k

The positive aspect is that if you are fast enough you can leave before 5PM. But with 15 patients case load, night calls and weekend calls I don't know if it is a good deal.

I read on this forum that some university-affiliated hospitals are paying around that salary range.

Take away the 1:4 night call, take away the consults, decrease the patient load to 8-12 patients daily and this is a $240-250k position in the area I trained on the west coast. I'd pass.

 

[Ahamis]

Two close colleagues and myself recently completed our job searches and have great jobs that are in no way characterized as 'H1b' jobs - this was something that came up later in the process once they were committed to hiring us anyway.

It seems that most of your search concentrate in academic positions and that`s why you were not very much concerned about H1-b visa.
I might be wrong, but it sounds irrational to go to interview in different cities (taking time off from your program) and take the risk to hear "unfortunately, we don't sponsor H1-b visa here."

 

[Ahamis]

Take away the 1:4 night call, take away the consults, decrease the patient load to 8-12 patients daily and this is a $240-250k position in the area I trained on the west coast. I'd pass.

Why does California pay much more than the national average? What`s the rationality?
The positions in cities with high cost of living in the east coast don't pay that much, in general.

 

[MedMan80]

What are your opinions about this position:

Location: Central Florida
Employed position/ Base salary: 215k / H1-b visa
inpatient- case load is 15 patients.
30 beds psych unity

You start at 8 AM, do rounds and can leave before 5PM (but needs to be available by phone for nurse calls)

1:4 night call

1 Weekend call per month

Consults for internal medicine: usually 2 consults per day.

Bonus: 5-10 k/ year

Vacation: 25 days; After 5 years: 30 days
CME: 3k

The positive aspect is that if you are fast enough you can leave before 5PM. But with 15 patients case load, night calls and weekend calls I don't know if it is a good deal.

I read on this forum that some university-affiliated hospitals are paying around that salary range.

It's always been my impression that FL pays lower across the board for physicians, especially visa spots that I looked into. Simple supply and demand, if there aren't very many places willing to sponsor a visa, then what incentive do places like this have to increase salary? Especially in a highly sought out state like FL?

 

[SmallBird]

It seems that most of your search concentrate in academic positions and that`s why you were not very much concerned about H1-b visa.
I might be wrong, but it sounds irrational to go to interview in different cities (taking time off from your program) and take the risk to hear "unfortunately, we don't sponsor H1-b visa here."

I wouldn't recommend interviewing at 5 private practices, knowing that they probably don't have the resources to support a visa sponsorship. But I interviewed at academic, community, and private settings. I think only one of the jobs identified at the outset their willingness to sponsor a visa, and only one place made it clear early on that they couldn't. In between where the majority of places that didn't have a specific policy on the matter, but were willing to pursue it after my interview. So I do think it is worth the risk of having one or two places shut the door on you at the end, if it allows you to explore a much broader range of opportunities. Only a small fraction of jobs are marketed as sponsoring H1b visas and you should definitely include many that don't state this clearly in your search.

 

[dl2dp2]

Why does California pay much more than the national average? What`s the rationality?
The positions in cities with high cost of living in the east coast don't pay that much, in general.

The answer is Kaiser. Kasier is paying 300k for a general adult psychiatrist and more for specialty trained. Reason being multiple fairly recent (last 5 years) lawsuits for individuals having bad outcomes while on prolonged waiting list, forcing them to increase staff. Given their generous "golden handcuff" and lots of open spots, competing facilities such as state/prison systems are forced to raise salary in their coverage area to match. If you are a "good quality applicant", you can "always go to Kaiser and make 300k", which makes your hand stronger during negotiations.

This then in turn changes regional private practice/community hospital salaries, though the trickling effect is less pronounced at that level.

What you are saying is not entirely true about NE cities. Interestingly, Kaiser's salary is now also influencing other competing facilities outside of California. For example, large MCO and public facility salaries in NY and MA have been increasing by 20% a year in the last few years, likely reflecting their competition with NorCal Kaiser. VA salaries are also affected by this development. The same group of people tend to be attracted to these types of jobs (the whole VA<->MCO<->city hospital circuit). This doesn't affect academic jobs nearly as much, since very different applicants go for MCO vs. academic. NE academic jobs continue to be pay pretty ****ty, as are the California academic jobs.

 

[Ahamis]

How much do they pay for follow-ups and intakes?

Fort Wayne, IN pays 40 dollars for follow-up; 100 dollars intake.
15-20 minutes for follow-up. 30-60 minutes for intake.
You have scribes and two offices (to increase efficiency).
:/

 

[Ahamis]

I pay 21 dollars to cut my hair (tip not included).
I believe psychiatrist deserves more than 40 dollars.

 

[MedMan80]

Amen brother

 

[JustAGuy]

I have one for critique. 40 hours a week, 15-20 pts daily. Some support staff, FNPs. No loan repayment. For profit company, so no PSLF. 20 vacation days, federal holidays, paid malpractice with tail coverage, 401k match, CME allowance. Salary starts at $300k but "is negotiable"

 

[nexus73]

I have one for critique. 40 hours a week, 15-20 pts daily. Some support staff, FNPs. No loan repayment. For profit company, so no PSLF. 20 vacation days, federal holidays, paid malpractice with tail coverage, 401k match, CME allowance. Salary starts at $300k but "is negotiable"

Are you expected to supervise family np's too? If so not enough money imo. Depends on location though.

 

[JustAGuy]

Are you expected to supervise family np's too? If so not enough money imo. Depends on location though.

No supervison. They are there to treat medical issues. Location is decently sized city in Midwest.

 

[SteinUmStein]

I have one for critique. 40 hours a week, 15-20 pts daily. Some support staff, FNPs. No loan repayment. For profit company, so no PSLF. 20 vacation days, federal holidays, paid malpractice with tail coverage, 401k match, CME allowance. Salary starts at $300k but "is negotiable"

Any call or coverage? Weekends? Length of stay (assuming this is inpatient)? Salary as base+RVU or base only?

 

[JustAGuy]

Any call or coverage? Weekends? Length of stay (assuming this is inpatient)? Salary as base+RVU or base only?

There was no mention of call. It's a position at a local jail. Unsure of length of stay, but most daily visits are follow ups. Salary is base only.

 

[SteinUmStein]

There was no mention of call. It's a position at a local jail. Unsure of length of stay, but most daily visits are follow ups. Salary is base only.

Interesting. I would clarify in an explicit way if there are any call expectations - phone call, backup call, weekends, holidays. Someone has to be covering the jail, if not this position then who. I've seen a lot of "Oh, there's no call, not really, just home back up by phone every few weeks, you hardly ever go in." Yeah, that's call. Or: "No, there's no call, no pagers or anything like that! We only call your cell phone if a true emergency comes up, it's only a few times a year." Yep, that is still a form of call in my book, and should be compensated or accounted for in some way.

It's worth asking (and is very reasonable to ask) average length of stay. Your workload and day-to-day schedule is dramatically different with LOS of 2 days on average versus 7 days versus 20 days. This goes for any inpatient/residential setting, correctional or otherwise. I find workload exponentially increases as LOS drops below 3-4 days or so, at least in the settings I've worked in.

 

[Stagg737]

I have one for critique. 40 hours a week, 15-20 pts daily. Some support staff, FNPs. No loan repayment. For profit company, so no PSLF. 20 vacation days, federal holidays, paid malpractice with tail coverage, 401k match, CME allowance. Salary starts at $300k but "is negotiable"

Side question about some of the benefits above. What's a decent 401k match or CME allowance to expect? Companies outside of medicine I'm familiar with offered 5 or 6% for 401k match, and I have no idea what a good CME allowance would look like post-residency...

 

[JustAGuy]

Interesting. I would clarify in an explicit way if there are any call expectations - phone call, backup call, weekends, holidays. Someone has to be covering the jail, if not this position then who. I've seen a lot of "Oh, there's no call, not really, just home back up by phone every few weeks, you hardly ever go in." Yeah, that's call. Or: "No, there's no call, no pagers or anything like that! We only call your cell phone if a true emergency comes up, it's only a few times a year." Yep, that is still a form of call in my book, and should be compensated or accounted for in some way.

It's worth asking (and is very reasonable to ask) average length of stay. Your workload and day-to-day schedule is dramatically different with LOS of 2 days on average versus 7 days versus 20 days. This goes for any inpatient/residential setting, correctional or otherwise. I find workload exponentially increases as LOS drops below 3-4 days or so, at least in the settings I've worked in.

Side question about some of the benefits above. What's a decent 401k match or CME allowance to expect? Companies outside of medicine I'm familiar with offered 5 or 6% for 401k match, and I have no idea what a good CME allowance would look like post-residency...

CME is $1k. There is phone call, but I'm told it's split between providers and very rare. They are saying there hasn't been a provider called in at least 4 months. No word on actual length of stay, just told that patients are non felons, so sentences are less than 1 year or they are there awaiting their trial.

 

[nexus73]

Jail work is harder than prison work with felons.

 

[dl2dp2]

Interesting....

SteinUmStein I just saw you are still checking this thread, FYI I personally think they lowballed you with that outpatient job in the Midwest. If you'd taken it I'd figure out a way to negotiate after a year. I've been chatting with people I know from Chicago, and it sounds like things are starting to start at 240+ there also for that type of job. Payer mix is important. It may be a Medicaid type of a job then it's different.

 

[dl2dp2]

How much do they pay for follow-ups and intakes?

Fort Wayne, IN pays 40 dollars for follow-up; 100 dollars intake.
15-20 minutes for follow-up. 30-60 minutes for intake.
You have scribes and two offices (to increase efficiency).
:/

This is pretty bad. I get telepsychiatry companies that pay way more than this.

I have one for critique. 40 hours a week, 15-20 pts daily. Some support staff, FNPs. No loan repayment. For profit company, so no PSLF. 20 vacation days, federal holidays, paid malpractice with tail coverage, 401k match, CME allowance. Salary starts at $300k but "is negotiable"

Not a great job. 15-20 people who showed up to the local jail. This is basically like the community psychiatric emergency room...I hope there are lots of social worker there because otherwise you'll be calling Medicaid prior auth offices all the time to get people into inpatient 3 hours a day and arranging transport to drive them 3 hours.

IMHO, whenever a facility starts the ball at 300k "base" and says it's "negotiable", it means the job has serious trouble attracting candidates or very bad turnover. The "right" way to make 300k+ is by RVU. A high base salary means you and the facilities goals are not entirely aligned and they are ... desperate ... usually for a good reason ...

 

[Jules A]

Jail work is harder than prison work with felons.

I believe the suicide rate is higher for jails than prisons also.

 

[SteinUmStein]

SteinUmStein I just saw you are still checking this thread, FYI I personally think they lowballed you with that outpatient job in the Midwest. If you'd taken it I'd figure out a way to negotiate after a year. I've been chatting with people I know from Chicago, and it sounds like things are starting to start at 240+ there also for that type of job. Payer mix is important. It may be a Medicaid type of a job then it's different.

Can you PM me Sluox? I have a few questions and would appreciate your input. Looks like I can reply to your PMs but can't start one. Thanks for your time.

 

[Ahamis]

Not a great job. 15-20 people who showed up to the local jail. This is basically like the community psychiatric emergency room...I hope there are lots of social worker there because otherwise you'll be calling Medicaid prior auth offices all the time to get people into inpatient 3 hours a day and arranging transport to drive them 3 hours.

I thought you didn't have to deal with insurance in correctional facilities.

 

[dl2dp2]

I thought you didn't have to deal with insurance in correctional facilities.

Jails typically need inpatient transfer for sicker people. If you don't need to transfer then this would feel more or less like an inpatient job, which will be completely insane at that case load. All I'm saying is expecting much higher acuity than a community outpatient. And even for community outpatient 20 visits a day 5 days a week is heavy IMHO for psychiatry and will burn you out quickly.