Is this just a typical inpatient job

[heyjack70]

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7on7off schedule. 2 docs covering a 24-bed unit so busiest day is 12 patients each, lightest day is typically 8 each. The opposite week is 2 docs, therefore total team is 4 docs. Work 182 shifts per year. Salary 303K. Days start around 8am, end between 2 and 5pm depending on meetings, court, various other issues. Part of larger health system but psych unit is off campus so med/surg/ED consults are completed by hospital consult psych team, inpatient docs cover only inpatient.

Does this sound pretty typical? Way better than average job, worse than average? Should admin be hassling us for leaving at 2? Are we getting away with anything?

 

[Yale Medicine]

I don't like the staying from 8am until, potentially, 5pm to see 8 to 12 patients. You have to be either really slow, really dumb, or really trapped, to spend 9 hours seeing 8 to 12. The 50% annual work schedule kinda makes up for it, but I'd be miserable. When I'm done with work, in anything I do, I need to move on and stay productive.

Find a $280K job seeing 8 to 12 with the freedom to leave when you're done.

 

[wolfvgang22]

Do they require any call? Do you have to cover all 24 patients if someone is out sick?

 

[forchinet121]

It’s a good job if you can leave when you’re done, forcing you to stay till 5 is a dealbreaker imo

 

[TheRightMedication]

Negotiating for more money is hard. Negotiating for things like leaving when you are done should be easy - easy as telling and not asking, basically.

It's a tempting job - on a light day you could show up at 7 and be out so early you don't know whether to get brunch or lunch. And 300 k for 14 days a week, 4 of which are weekends? Not too shabby.

I personally have no place in my life for 7 on 7 off - I enjoy and need structure through the week and I need, absolutely need, every single weekend.

These gigs make me think twice though.

Also sounds like for vacations and sick days you got yourself a 24 bed unit. Ask them how they compensate you for that so when they say "uh, we do not" you can bargain for whatever. Maybe even money.

 

[jbomba]

I have a similar job (they require you to stay) but you're paid by the hour, so you're at least compensated. I get 245/hr so ~2k/day. 8 hour days but you can make the hours. My thought is I could do some telepsych on my down time to make it a better deal. If I could do a couple telepsych hours a day I'd be able to generate >2600/day which is pretty solid.

 

[wolfvgang22]

heyjack, I'm assuming you wouldn't any holidays or vacation days off because of the 7 days on/off schedule with this job. Is that correct? Do you get sick leave? What benefits do they offer?

 

[wolfvgang22]

I have a similar job (they require you to stay) but you're paid by the hour, so you're at least compensated. I get 245/hr so ~2k/day. 8 hour days but you can make the hours. My thought is I could do some telepsych on my down time to make it a better deal. If I could do a couple telepsych hours a day I'd be able to generate >2600/day which is pretty solid.

So 182 days X $2,000 = $364,000 gross. Is this a contract job? Do you get any benefits? Do you pay for your own malpractice? What's your net take home?

 

[jbomba]

So 182 days X $2,000 = $364,000 gross. Is this a contract job? Do you get any benefits? Do you pay for your own malpractice? What's your net take home?

This is 1099 permanent. They cover malpractice. No benefits but I get those from my spouse. Big benefit is I'm s corp and fund my own pension which let's me tax defer a lot more money than a W2 could.

 

[forchinet121]

This is 1099 permanent. They cover malpractice. No benefits but I get those from my spouse. Big benefit is I'm s corp and fund my own pension which let's me tax defer a lot more money than a W2 could.

How much can you tax defer and what is your age? Isn’t it based on age how much you can defer like defined benefit plan

 

[Jules A]

I have a similar job (they require you to stay) but you're paid by the hour, so you're at least compensated. I get 245/hr so ~2k/day. 8 hour days but you can make the hours. My thought is I could do some telepsych on my down time to make it a better deal. If I could do a couple telepsych hours a day I'd be able to generate >2600/day which is pretty solid.

Is that kosher? If they are forcing someone to stay on site 8 full hours, which is a deal breaker for me, I can't imagine they would be cool with a side gig while on their clock.

 

[wolfvgang22]

Is that kosher? If they are forcing someone to stay on site 8 full hours, which is a deal breaker for me, I can't imagine they would be cool with a side gig while on their clock.

Back in the 90s when I was a social worker, the psychiatrist I worked with had a deal with the hospital. They allowed him to see his private patients in his hospital office. It was a good deal for them because whenever one of his patients needed hospitalization he would admit them there. They probably would have gotten the admits anyways, but before they had been flying a psychiatrist in from Seattle to see patients. This was in the midwest.

 

[TheRightMedication]

If you're 1099 and you let them make you stay for no reason, you shame us all.

Only half tongue in cheek on this.

 

[heyjack70]

Do they require any call? Do you have to cover all 24 patients if someone is out sick?

heyjack, I'm assuming you wouldn't any holidays or vacation days off because of the 7 days on/off schedule with this job. Is that correct? Do you get sick leave? What benefits do they offer?

Limited call during the day, no calls overnight as that's covered by community docs who get paid a stipend and choose to get woken up for the money. If other doc is sick you cover all the patients, fingers crossed census is on the lower end. You get paid double for that day plus a $700 bonus for being solo, works out to about $4000 for the day, but expect to be busy.

There are no vacations necessarily. Possible discussion to allow vacation for compensation reduction on those days away IF locums or other doc is able to cover. No sick days, just come to work sick I guess. These issues are part of the challenge with inpatient staffing. Clinic is easy, just call in sick and reschedule patients. Or vacation, just block out days off 2-3 months in advance. But outpatient clinic is my kryptonite, can only do maybe a few half days per week, more than that I want to start pulling my hair out, so inpatient it is.

 

[jbomba]

Is that kosher? If they are forcing someone to stay on site 8 full hours, which is a deal breaker for me, I can't imagine they would be cool with a side gig while on their clock.

I'd rather beg forgiveness than ask for permission. They need me more than I need them. I can't imagine them losing a psychiatrist over something like that

 

[wolfvgang22]

Limited call during the day, no calls overnight as that's covered by community docs who get paid a stipend and choose to get woken up for the money. If other doc is sick you cover all the patients, fingers crossed census is on the lower end. You get paid double for that day plus a $700 bonus for being solo, works out to about $4000 for the day, but expect to be busy.

There are no vacations necessarily. Possible discussion to allow vacation for compensation reduction on those days away IF locums or other doc is able to cover. No sick days, just come to work sick I guess. These issues are part of the challenge with inpatient staffing. Clinic is easy, just call in sick and reschedule patients. Or vacation, just block out days off 2-3 months in advance. But outpatient clinic is my kryptonite, can only do maybe a few half days per week, more than that I want to start pulling my hair out, so inpatient it is.

I would go back to inpatient but every employer around here wants psychiatrists to do overnight call from home and come for seclusion and restraints like we are residents or something. 🤮

Overnight call is my green kryptonite! Outpatient is more like red kryptonite, lol. As in, it doesn't kill me but causes mental anguish.

 

[jbomba]

I would go back to inpatient but every employer around here wants psychiatrists to do overnight call from home and come for seclusion and restraints like we are residents or something. 🤮

Overnight call is my green kryptonite! Outpatient is more like red kryptonite, lol. As in, it doesn't kill me but causes mental anguish.

I really want to pair outpatient with a pes gig. Love that I can check out and not deal with court, schedule off hour shifts to maximize outpatient, etc

 

[Yale Medicine]

I would go back to inpatient but every employer around here wants psychiatrists to do overnight call from home and come for seclusion and restraints like we are residents or something. 🤮

Overnight call is my green kryptonite! Outpatient is more like red kryptonite, lol. As in, it doesn't kill me but causes mental anguish.

I took me 7 job applications until I found an inpatient gig that didn't require any call after 5pm (and can leave when I'm done). They're out there. Ya overnight call is terrible and my green kryptonite too. I refuse to do it. I'd mow lawns or clean pools for a living before doing overnights.

 

[PikminOC]

I took me 7 job applications until I found an inpatient gig that didn't require any call after 5pm (and can leave when I'm done). They're out there. Ya overnight call is terrible and my green kryptonite too. I refuse to do it. I'd mow lawns or clean pools for a living before doing overnights.

You won't make nearly as much mowing lawns and cleaning pools tho.

 

[Candidate2017]

I would go back to inpatient but every employer around here wants psychiatrists to do overnight call from home and come for seclusion and restraints like we are residents or something. 🤮

Overnight call is my green kryptonite! Outpatient is more like red kryptonite, lol. As in, it doesn't kill me but causes mental anguish.

I took me 7 job applications until I found an inpatient gig that didn't require any call after 5pm (and can leave when I'm done). They're out there.

There are hospitals that have (pay) an NP or IM doc to handle restraints/seclusion, and have (pay) contractors to handle PM and weekend call. But it seems you have to go farther out from a metro area, and hospitals are becoming less open to arrangements conducive to QOL because more new psychiatrists are generally stupid about accepting tasks that should be outsourced. We are our own kryptonite.

It's a tempting job - on a light day you could show up at 7 and be out so early you don't know whether to get brunch or lunch.

There's always that possibility of having to come back for a restraint/seclusion hanging over one's head.

 

[Yale Medicine]

You won't make nearly as much mowing lawns and cleaning pools tho.

True that. When I was a teenager that's how I earned money. Got into chemistry that way. Funny. Then in college I taught for Kaplan and they made us present something during the application process, so I got up in front of the admin and presented on pool chemistry using the whiteboard and colored markers. Good times.

 

[Stagg737]

Limited call during the day, no calls overnight as that's covered by community docs who get paid a stipend and choose to get woken up for the money. If other doc is sick you cover all the patients, fingers crossed census is on the lower end. You get paid double for that day plus a $700 bonus for being solo, works out to about $4000 for the day, but expect to be busy.

There are no vacations necessarily. Possible discussion to allow vacation for compensation reduction on those days away IF locums or other doc is able to cover. No sick days, just come to work sick I guess. These issues are part of the challenge with inpatient staffing. Clinic is easy, just call in sick and reschedule patients. Or vacation, just block out days off 2-3 months in advance. But outpatient clinic is my kryptonite, can only do maybe a few half days per week, more than that I want to start pulling my hair out, so inpatient it is.

With no required call and if there's decent benefits, it seems like a pretty fair setup overall. If you call in sick do you not get paid for that day? Ie, does that "doubled salary" come from the other doc who is out sick?

 

[Merovinge]

With no required call and if there's decent benefits, it seems like a pretty fair setup overall. If you call in sick do you not get paid for that day? Ie, does that "doubled salary" come from the other doc who is out sick?

Yes for 1099 pay I'm sure they don't pay if you don't come in.

I agree that does seem about fair/market rate and would give someone the opportunity to practice good medicine for solid pay. No productivity concerns so you can just do a good job for your patients. I'm sure someone on here will talk about adding on an additional job to this but there's certainly something to be said about good lifestyle/good promotion of practicing good medicine with solid pay.

 

[Stagg737]

Yes for 1099 pay I'm sure they don't pay if you don't come in.

I agree that does seem about fair/market rate and would give someone the opportunity to practice good medicine for solid pay. No productivity concerns so you can just do a good job for your patients. I'm sure someone on here will talk about adding on an additional job to this but there's certainly something to be said about good lifestyle/good promotion of practicing good medicine with solid pay.

Right, but this sounds more like a W2/employed position, so wondering if that stipulation would be present here as well. If this was a 1099 position then base salary seems low unless this is an academic position, which it does not seem to be.

 

[psychmd03]

Is that kosher? If they are forcing someone to stay on site 8 full hours, which is a deal breaker for me, I can't imagine they would be cool with a side gig while on their clock.

Likely would be very frowned upon if they found out no matter what others do.

 

[mistafab]

Yo if this is a w2 then this is a pretty sweet gig if there is no noncompete.

You’d get your pay, full benefits, and on your off weeks could do private practice 2-3 days on select patients cash only, You could be selective as you want, tele only, no controlled subs.

Or you could pick up yachting. Or be a nerd and get into bird watching. This is a pretty fair deal if the terms are right.

 

[Mad Jack]

I would go back to inpatient but every employer around here wants psychiatrists to do overnight call from home and come for seclusion and restraints like we are residents or something. 🤮

Overnight call is my green kryptonite! Outpatient is more like red kryptonite, lol. As in, it doesn't kill me but causes mental anguish.

Yeah if anyone wants me coming in for restraints they can kick rocks

 

[psychmd03]

Yeah if anyone wants me coming in for restraints they can kick rocks

Literally who comes in for restraints or seclusion. One hospital I work at they will just text me to let me know it happened. If I wanted to be more involved they would be fine with it but am I truly gonna say oh nope please continue to allow the highly dangerous patient to continue their behavior until I can eval let me get dressed and drive in.

 

[Jules A]

Literally who comes in for restraints or seclusion.

No one at the hospitals where I work. Either RNs are certified to perform the post seclusion face to face or the overnight hospitalist comes to the unit to do it.

 

[Mad Jack]

Literally who comes in for restraints or seclusion. One hospital I work at they will just text me to let me know it happened. If I wanted to be more involved they would be fine with it but am I truly gonna say oh nope please continue to allow the highly dangerous patient to continue their behavior until I can eval let me get dressed and drive in.

Some states it is required that a physician evaluate restrained patients. But at the places I work, hospitalists do it on the off hours instead of psychiatrists, since they're already in the hospital

 

[Stagg737]

Literally who comes in for restraints or seclusion. One hospital I work at they will just text me to let me know it happened. If I wanted to be more involved they would be fine with it but am I truly gonna say oh nope please continue to allow the highly dangerous patient to continue their behavior until I can eval let me get dressed and drive in.

I'm in a state like MJ mentioned. Where I'm at if a patient goes into restraints it has to be reviewed by a physician or psychologist within 2 hours and they have to either be released from physical restraints or medically re-evaluated within 3 hours and every 3 hours after that.

 

[comp1]

It's very unfortunate that some states make these requirements. It seems to be based on a lack of understanding from legislators. Restraints and seclusion are, in all practical reality, a nursing decision. It's appropriate for the physician to be notified, but a physician certainly wouldn't be overruling a nurse in front of the patient in this area. Further, assessing current patient status in terms of positioning breathing, comfort, etc is literally what they do all day long. Quite honestly, an RN typically has a great deal more experience with that than the average psychiatrist.

 

[Stagg737]

It's very unfortunate that some states make these requirements. It seems to be based on a lack of understanding from legislators. Restraints and seclusion are, in all practical reality, a nursing decision. It's appropriate for the physician to be notified, but a physician certainly wouldn't be overruling a nurse in front of the patient in this area. Further, assessing current patient status in terms of positioning breathing, comfort, etc is literally what they do all day long. Quite honestly, an RN typically has a great deal more experience with that than the average psychiatrist.

Idk that I agree. I won't argue that nurses have more experience, but the point of having physicians involved is to get them out of restraints as soon as possible. If a patient is still in restraints 3 hours later, they're probably not being adequately medicated or significantly agitated, in which case we should be medically evaluating them. You could argue this would be better managed by another field, but we are physicians.

 

[calvnandhobbs68]

Idk that I agree. I won't argue that nurses have more experience, but the point of having physicians involved is to get them out of restraints as soon as possible. If a patient is still in restraints 3 hours later, they're probably not being adequately medicated or significantly agitated, in which case we should be medically evaluating them. You could argue this would be better managed by another field, but we are physicians.

Yeah I'd agree with this. There were quite a few times as a resident where I had to have the conversation with nursing of "does this patient REALLY need to still be in seclusion/restraints?". It's a tough balance but my experience was that once they were in, nursing was not enthusiastic about letting them out even if they seemed to have improved and got PRNs....have to sometimes have the conversation that by renewing a seclusion order I'm legally attesting that this patient is still an acute harm to themselves/others that could not be managed in a less restrictive way.

I totally get it from the nursing side but it's a fact that it tends to make their life much easier if a problematic patient is in seclusion.

 

[G Sheb]

There have been medical disasters for patients who are placed in restraints.
And as you can guess, the liability is almost entirely on the hospital since this is pretty much 'iatrogenic'.
Reducing restraints / seclusion is a big priority for almost every decent psych ER out there.
So of course it makes sense to get the medical professionals see the patient, for what is a fairly high risk issue from both a medical and a legal side.