Job advice

[rockyhill99]

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Hi All,

I am 3 years out of training(child fellowship) and currently living in the South. I have a few job offers(a mix of adult and child) and would appreciate your thoughts.

1) MGH outpatient with 200 K salary and RVU expectation of 3200(CMS 2019 guidelines) plus resident/student teaching. No sign-on bonus. The job will require relocation to Boston and MA license.

2) Outpatient telepsychiatry job with an academic psych department in my state with a 264 K salary with a 23 k bonus at the end of the year, Also, a 10 K sign-on bonus with equipment for home office. Does not require relocation or licensure as the job is in the same state but will require 6 in-person visits a year for departmental meetings with a 100-mile commute one way. The RVU expectation is 3747(CMS 2019 guidelines).

3) UPMC outpatient telepsychiatry with 212 K salary with a bonus of 15 K. PA state license needed. No relocation or RVU requirement but no designated admin time.

Thanks in advance!

 

[Monocles]

1) MGH outpatient with 200 K salary and RVU expectation of 3200(CMS 2019 guidelines) plus resident/student teaching. No sign-on bonus. The job will require relocation to Boston and MA license.

First of all, don't take this job. Secondly, if you have the poor judgment to work for MGB - you should know with the inflation adjustment most harvard hospitals are paying 225k starting this July. You are being low balled and should negotiate for a base pay increase + signing bonus.

Honestly job #2 sounds like a slam dunk.

 

[TexasPhysician]

I think it would be helpful to know why you are considering these 3 jobs. We all have different goals and get excited by different aspects of psychiatry. I personally wouldn’t consider any of these jobs. You may have no interest in mine as well, but it’s hard to give good advise if we don’t know what you are wanting in life.

 

[calvnandhobbs68]

OP it seems like you're leaning towards academic jobs? Is that because you want a career in research or just like being around residents or what do you find particularly enjoyable about academic jobs? For instance, number 2 will really be an academic job in name only as you're very unlikely to make much headway in the department as a 100% remote job only seeing everyone else once every 2 months.

As mentioned above, it would be very helpful to know what you're looking for in a job overall

 

[Nudexta]

Hi All,

I am 3 years out of training(child fellowship) and currently living in the South. I have a few job offers(a mix of adult and child) and would appreciate your thoughts.

1) MGH outpatient with 200 K salary and RVU expectation of 3200(CMS 2019 guidelines) plus resident/student teaching. No sign-on bonus. The job will require relocation to Boston and MA license.

2) Outpatient telepsychiatry job with an academic psych department in my state with a 264 K salary with a 23 k bonus at the end of the year, Also, a 10 K sign-on bonus with equipment for home office. Does not require relocation or licensure as the job is in the same state but will require 6 in-person visits a year for departmental meetings with a 100-mile commute one way. The RVU expectation is 3747(CMS 2019 guidelines).

3) UPMC outpatient telepsychiatry with 212 K salary with a bonus of 15 K. PA state license needed. No relocation or RVU requirement but no designated admin time.

Thanks in advance!

From a financial standpoint, all of them are poor options.

 

[BiscoDisco]

It's amazing how little academic institutions value us. I'm making more than options 1 and 3 as a resident moonlighter this year.

 

[Merovinge]

It's amazing how little academic institutions value us. I'm making more than options 1 and 3 as a resident moonlighter this year.

I think it's more like there are still many doctors who value prestige, teaching time, grand rounds, peer interactions, and less clinical care put into a nice little bow of saying "I work for MGH or xyz place". There is clearly value in that. They are just responding to the market forces. It's the same reason why pediatric subspecialities can pay less than their adult counterparts despite requiring more training, people are willing to work for less to work with kids all day. Same thing for why veterinary medicine pays so low despite the extremely competitive environment to get into the schools, etc.

 

[rockyhill99]

First of all, don't take this job. Secondly, if you have the poor judgment to work for MGB - you should know with the inflation adjustment most harvard hospitals are paying 225k starting this July. You are being low balled and should negotiate for a base pay increase + signing bonus.

Honestly job #2 sounds like a slam dunk.

MGH said that 200 is the pay for outpatient with no call 3 years out. However, they have a RVU incentive beyond 3200 around $55/RVU beyond the goal.

 

[rockyhill99]

I think it would be helpful to know why you are considering these 3 jobs. We all have different goals and get excited by different aspects of psychiatry. I personally wouldn’t consider any of these jobs. You may have no interest in mine as well, but it’s hard to give good advise if we don’t know what you are wanting in life.

Absolutely! I should have specified my goals. I want to do private practice with some academic affiliation and the ability to teach.

 

[rockyhill99]

OP it seems like you're leaning towards academic jobs? Is that because you want a career in research or just like being around residents or what do you find particularly enjoyable about academic jobs? For instance, number 2 will really be an academic job in name only as you're very unlikely to make much headway in the department as a 100% remote job only seeing everyone else once every 2 months.

As mentioned above, it would be very helpful to know what you're looking for in a job overall

I like academic spheres and the option to teach/mentor residents. However, my end goal is private practice.

 

[rockyhill99]

From a financial standpoint, all of them are poor options.

Even job 2!

 

[TexasPhysician]

Absolutely! I should have specified my goals. I want to do private practice with some academic affiliation and the ability to teach.

Only option 1 gives you much of that. Alternatively in my 8 or so years of private practice, I’ve had 2 institutions call me up and ask if I’ll teach and let students/residents rotate through my clinic.

If you want tele, I’d go with more money and offer to volunteer some teaching hours with a nearby academic program.

 

[Monocles]

I like academic spheres and the option to teach/mentor residents. However, my end goal is private practice.

Why not just go part time at MGB outpatient? Even 0.1 FTE makes you "harvard affiliated" (lol) and you can spend the rest of the time teaching and doing PP.

 

[BiscoDisco]

I think it's more like there are still many doctors who value prestige, teaching time, grand rounds, peer interactions, and less clinical care put into a nice little bow of saying "I work for MGH or xyz place". There is clearly value in that. They are just responding to the market forces. It's the same reason why pediatric subspecialities can pay less than their adult counterparts despite requiring more training, people are willing to work for less to work with kids all day. Same thing for why veterinary medicine pays so low despite the extremely competitive environment to get into the schools, etc.

I know you are right in a lot of ways, but in other ways I think institutions prey upon (some of) us and our naivety. I have co-residents (many of whom went the traditional HS>college>med school route) who just assume that average pay is whatever they see on indeed, theres no room for negotiation, and they should just be happy to make average. As we know those "averages" on some of the big job sites isn't actually indicative of worth or necessarily relative to the work requirements an employer may place upon you. It feels weird to be out earning some of the attendings at my program simply because I know how to call around, network, and not accept the first offer I see.

 

[Nudexta]

Even job 2!

Yes

 

[Merovinge]

I know you are right in a lot of ways, but in other ways I think institutions prey upon (some of) us and our naivety. I have co-residents (many of whom went the traditional HS>college>med school route) who just assume that average pay is whatever they see on indeed, theres no room for negotiation, and they should just be happy to make average. As we know those "averages" on some of the big job sites isn't actually indicative of worth or necessarily relative to the work requirements an employer may place upon you. It feels weird to be out earning some of the attendings at my program simply because I know how to call around, network, and not accept the first offer I see.

You are also entirely right, and certainly people under value themselves and don't negotiate or comparison shop enough for work. I negotiated a 30% increase compared to first offer for moonlighting, they clearly low-balled related to my age as a PGY 5 fellow despite being already adult boarded.

Averages on the job sites do tend to run low in psych compared to other specialties due to systematic underrepresentation of cash pay PP. You are fighting the good fight and making good points, there has even been some upward pay in academics, but that area will always remain suppressed due to the demand of doctors for the prestige and lifestyle.

 

[Stagg737]

MGH said that 200 is the pay for outpatient with no call 3 years out. However, they have a RVU incentive beyond 3200 around $55/RVU beyond the goal.

The RVU incentive makes a massive difference. If you see 10 patients a day at 99214 and use a 90833 add-on for 4 of those you're averaging 23 RVUs per day which is 115 per week. If you work the equivalent of 45 weeks then that's 5,175 RVUs total which is 1975 RVUs towards the incentive or an extra $108.5k per year, which sounds reasonable for that positions.

This is why more details other than base salary and bonuses are needed to give you accurate responses.

 

[Monocles]

The RVU incentive makes a massive difference. If you see 10 patients a day at 99214 and use a 90833 add-on for 4 of those you're averaging 23 RVUs per day which is 115 per week.

I was notoriously bad at figuring out billing as a trainee and chronically underbilled on my attendings' behalf (oops), so please kindly educate me on this - but isn't 99214 by default minimum of 30 min service, and with psychotherapy added on you are looking at 45 min visits? With check-ins and shuffling parents out etc, it seems challenging to get 10 encounters in the day.

 

[hamstergang]

I was notoriously bad at figuring out billing as a trainee and chronically underbilled on my attendings' behalf (oops), so please kindly educate me on this - but isn't 99214 by default minimum of 30 min service, and with psychotherapy added on you are looking at 45 min visits? With check-ins and shuffling parents out etc, it seems challenging to get 10 encounters in the day.

If you are billing 90833, then you cannot bill the 99214 component based on time. It's simply is however long it takes you to gather the necessary elements. 90833 requires 16 to 37 minutes of "psychotherapy," so the total visit being 25 to 30 minutes is entirely reasonable. Some even do 20 but I find that a little difficult

 

[mistafab]

All these jobs suck.

If your end goal is private practice, why not join a private practice?

 

[erg923]

Hi All,

I am 3 years out of training(child fellowship) and currently living in the South. I have a few job offers(a mix of adult and child) and would appreciate your thoughts.

1) MGH outpatient with 200 K salary and RVU expectation of 3200(CMS 2019 guidelines) plus resident/student teaching. No sign-on bonus. The job will require relocation to Boston and MA license.

2) Outpatient telepsychiatry job with an academic psych department in my state with a 264 K salary with a 23 k bonus at the end of the year, Also, a 10 K sign-on bonus with equipment for home office. Does not require relocation or licensure as the job is in the same state but will require 6 in-person visits a year for departmental meetings with a 100-mile commute one way. The RVU expectation is 3747(CMS 2019 guidelines).

3) UPMC outpatient telepsychiatry with 212 K salary with a bonus of 15 K. PA state license needed. No relocation or RVU requirement but no designated admin time.

Thanks in advance!

I do not comment on these kinds of threads much, but I make over 150k salary as Ph.D. And.... I don't see patients. And.... I work at home full-time! I also don't live in something like Boston. Please don't entertain the MGH offer. Jesus!

 

[Monocles]

If you are billing 90833, then you cannot bill the 99214 component based on time. It's simply is however long it takes you to gather the necessary elements. 90833 requires 16 to 37 minutes of "psychotherapy," so the total visit being 25 to 30 minutes is entirely reasonable. Some even do 20 but I find that a little difficult

TIL! Thank you

 

[dl2dp2]

Absolutely! I should have specified my goals. I want to do private practice with some academic affiliation and the ability to teach.

All 3 jobs suck for your end goal.

Relocating to Boston for a 200k a year job at MGH outpatient is absolutely the WORST decision you can make. First of all PP in Boston isn't all that great given the small size and spread out city configuration, and secondly everyone's Harvard-affliated, so you have zero competiive advantage. To get to a lucrative figure, you need to typically be higher caliber academic. LA/NYC/Miami much better. Second of all, you'll be treated like complete utter garbage as the department does not value your service. The department is oriented toward research, and you don't bring anything useful in that way to the table. Thirdly, if you want to do run of the mill PP, I don't see why you have to do it in Boston, where the concentration of psychiatrist to population is the highest in the country.

Second job has some promise, but is too intensive for you to have enough time to set up a nice PP on the side, and really gives you limited exposure to teaching.

Third job is just as garbagey as the first, and doesn't even have the MGH prestige factor. The fact that you are a telepsychiatrist affliated UPMC in a location that's not anywhere close to Pittsburgh will be of limited value in PP.

Outpatient telepsych full time salary figure should be much closer (and in fact higher) than job #2, and the reason is that job #2 is YET STILL academic.

IF you want to end up in PP, join a local PP.


I'm frankly in shock that MGH/UPMC are quoting these absurd, insulting figures for C&A-trained psychiatrists.

 

[Stagg737]

I was notoriously bad at figuring out billing as a trainee and chronically underbilled on my attendings' behalf (oops), so please kindly educate me on this - but isn't 99214 by default minimum of 30 min service, and with psychotherapy added on you are looking at 45 min visits? With check-ins and shuffling parents out etc, it seems challenging to get 10 encounters in the day.

I forgot these were likely child positions, so could change things but pay still looks generally poor.

Why would you bill 99214 based on time? You're almost guaranteed to meet criteria based on complexity which will allow you to use 90833 as an add-on. The only time I would bill outpatient based on time is if there was some reason an encounter took foooorreeeevvveeeer so I could use the 99417 add-on, and then you're billing 99215.

Doing 10 f/up encounters in a day should not be difficult for most jobs, even child psych. At 30 minutes each that's 5 hours a day. If you're stretching it to 45 minutes each, that's 7.5 hours. But let's say you're only seeing 6 follow-ups per day and using 90833 three times. Using the same calculations as before, it comes out to 3604.5 RVUs per year, which is 404.5 incentive RVUs which is an extra $22.2k per year. Not nearly enough to make that job worth it, but still worth noting.

The only reason I would consider job one would be if I wanted to work there for a year, then move somewhere else and be able to advertise on my website that I'm a former MGH psychiatrist. Something I wouldn't do, but some people just love letters and names....

 

[RevDO]

It's amazing how little academic institutions value us. I'm making more than options 1 and 3 as a resident moonlighter this year.

How are you making that much moonlighting? My program's moonlighting pay is very poor.

 

[BiscoDisco]

How are you making that much moonlighting? My program's moonlighting pay is very poor.

External. My pay rate ranges between 140-225/ hour for fixed rate work. I cover an inpatient hospital that pays based on encounters and works out to ~5k a weekend. I also do outpatient work where I'm paid 65% of all billings so this works out to ~250/hr. I work a lot too, but my 4th year schedule is so incredibly chill which let's me stay way under acgme limits. If I stay at my current pace I should make close to an extra 300k this year.

 

[forchinet121]

External. My pay rate ranges between 140-225/ hour for fixed rate work. I cover an inpatient hospital that pays based on encounters and works out to ~5k a weekend. I also do outpatient work where I'm paid 65% of all billings so this works out to ~250/hr. I work a lot too, but my 4th year schedule is so incredibly chill which let's me stay way under acgme limits. If I stay at my current pace I should make close to an extra 300k this year.

Wow, this is certainly not the norm you’re probably in the 99th percentile for moonlighting earnings

 

[Merovinge]

Wow, this is certainly not the norm you’re probably in the 99th percentile for moonlighting earnings

They are also at the 99% for hustling, covering an entire IP unit over the weekends and doing OP work in additional to their full residency program.

 

[BiscoDisco]

They are also at the 99% for hustling, covering an entire IP unit over the weekends and doing OP work in additional to their full residency program.

The ip unit is like 15 shifts a year. I do ~12 outpatient hours a week but I have like 2 days off a week from residency work. So it equals out. I honestly don't feel like I'm working all that hard.

 

[deleted456421]

They are also at the 99% for hustling, covering an entire IP unit over the weekends and doing OP work in additional to their full residency program.

Uhh. All of my external moonlighting gigs offered $125+/hr while in residency (internal moonlighting was generally $100/hr). That includes 24 hour shifts for a ritzy private hospital. I made way more providing coverage for a standalone psych hospital that required 48+ hours of onsite coverage. I easily tripled my residency pay through moonlighting.

The worst I've been paid was $3,500 a weekend for overnight call starting on Friday and rounding Saturday and Sunday. The best I got was $10k for Friday evening through Monday morning onsite. I admitted patients throughout the weekend and rounded on half the hospital.

It wasn't that hard if you were willing to work like any other resident outside psychiatry.

Unfortunately, several of those positions now accept NP coverage and dropped moonlighting reimbursement.

 

[BiscoDisco]

Uhh. All of my external moonlighting gigs offered $125+/hr while in residency (internal moonlighting was generally $100/hr). That includes 24 hour shifts for a ritzy private hospital. I made way more providing coverage for a standalone psych hospital that required 48+ hours of onsite coverage. I easily tripled my residency pay through moonlighting.

The worst I've been paid was $3,500 a weekend for overnight call starting on Friday and rounding Saturday and Sunday. The best I got was $10k for Friday evening through Monday morning onsite. I admitted patients throughout the weekend and rounded on half the hospital.

It wasn't that hard if you were willing to work like any other resident outside psychiatry.

Unfortunately, several of those positions now accept NP coverage and dropped moonlighting reimbursement.

Yeah that's a good point and what I remind myself. In psych, you can choose to work like an IM (or gasp, surgery) resident and make non academic attending salary. Finding a program with light fourth yr requirements is key. All that said, it truly is the best specialty.

 

[forchinet121]

Yeah that's a good point and what I remind myself. In psych, you can choose to work like an IM (or gasp, surgery) resident and make non academic attending salary. Finding a program with light fourth yr requirements is key. All that said, it truly is the best specialty.

I mean it’s a decent specialty but it’s not really the best in any clear way

 

[J ROD]

I would hard pass on all these. I have entertained over 8 offers last couple months. All over 265 K base. Most over 300 K base.

 

[BiscoDisco]

I mean it’s a decent specialty but it’s not really the best in any clear way

I don't know. I've seen plenty of inpatient jobs, reasonable caps, leave when you're done rounding. No reason you couldn't be in and out in 4 hours. I don't know how anyone beats this.

 

[forchinet121]

I don't know. I've seen plenty of inpatient jobs, reasonable caps, leave when you're done rounding. No reason you couldn't be in and out in 4 hours. I don't know how anyone beats this.

You clearly don’t know many people in other fields, pretty much all of the surgical specialists crush us on a per hour basis, obviously that’s a completely different field and we love psychiatry (hopefully) but talking about it purely from a financial perspective it’s not even close

 

[AD04]

External. My pay rate ranges between 140-225/ hour for fixed rate work. I cover an inpatient hospital that pays based on encounters and works out to ~5k a weekend. I also do outpatient work where I'm paid 65% of all billings so this works out to ~250/hr. I work a lot too, but my 4th year schedule is so incredibly chill which let's me stay way under acgme limits. If I stay at my current pace I should make close to an extra 300k this year.

This remind me a bit of what another poster from years ago did. I'm surprised at the opportunity you have as a resident. Is this an underserved place? Why couldn't they fill with mid-level or attending?

 

[AD04]

You clearly don’t know many people in other fields, pretty much all of the surgical specialists crush us on a per hour basis, obviously that’s a completely different field and we love psychiatry (hopefully) but talking about it purely from a financial perspective it’s not even close

You might be right if talking about averages. But some psychiatrists make above average surgical specialists pay while others make average below mid-level pay. The specialty you choose doesn't really matter as much as you think when it comes to pay. Business skills matter more.

 

[forchinet121]

You might be right if talking about averages. But some psychiatrists make above average surgical specialists pay while others make average below mid-level pay. The specialty you choose doesn't really matter as much as you think when it comes to pay. Business skills matter more.

That’s not correct, the averages do tell the story, yes you have psychiatrist making 700k but also surgical specialists making 2M+ (not uncommon)

 

[AD04]

Why stop at $700k? When it comes to outliers, it's not that predictable by using average numbers. Because those who are outliers do outlier things. But maybe you have a lot of real world experience. Can you provide real world examples? Perhaps your own experience?

 

[forchinet121]

Why stop at $700k? When it comes to outliers, it's not that predictable by using average numbers. Because those who are outliers do outlier things. But maybe you have a lot of real world experience. Can you provide real world examples? Perhaps your own experience?

I don't exactly understand what you’re asking, are you saying that the top 5 percent of psychiatrists make as much or more than the top 5 percent of surgical specialists? Because if you are saying that you’re very off base. Now if you’re saying the top 1 in 10000 psychiatrists (own multiple clinics, national brand recognition, etc) make as much as the 1/10000 surgical specialists that may be true I’m not sure. I am good friends/ family with 20+ surgical specialists and they all make way more than I can dream to make as a psychiatrist. Do you happen to know many psychiatrists making well over 700k or 1M? Because I certainly don’t but those are common numbers in other fields (not salary surveys which are a joke but actual numbers when talking with docs)..I’m definetly open to hearing your experience if you know many high income psychiatrists though…

 

[AD04]

Do you happen to know many psychiatrists making well over 700k or 1M?

I know several. Either business owners or extremely hard workers (work like surgeons) or good at what they do (so not many options to replace them) and can command a premium. The specialty doesn't matter as much as business expertise.

 

[BiscoDisco]

You clearly don’t know many people in other fields, pretty much all of the surgical specialists crush us on a per hour basis, obviously that’s a completely different field and we love psychiatry (hopefully) but talking about it purely from a financial perspective it’s not even close

Perhaps so... But are they working 3.5 hours a day? I'm not saying psych is best because it makes the most money. It's all things considered.

 

[brainmedicine]

I know several. Either business owners or extremely hard workers (work like surgeons) or good at what they do (so not many options to replace them) and can command a premium. The specialty doesn't matter as much as business expertise.

I second that.

 

[forchinet121]

I know several. Either business owners or extremely hard workers (work like surgeons) or good at what they do (so not many options to replace them) and can command a premium. The specialty doesn't matter as much as business expertise.

Can you be specific? For example, many surgical specialist can graduate residency, join a private practice group that has ownership of a surgery center, become a partner, and be automatically guaranteed an income >1MM for a typical 40-50 hour work week. Straightforward idea, how are you seeing that happen in psychiatry? There are a million psych clinics and the majority are not even grossing 1M let alone netting that. We had a thread on here of a guy who is considering closing down his clinic because it’s not profitable. Where are you seeing these million dollar psychiatrists and what are they doing?

 

[splik]

Can you be specific? For example, many surgical specialist can graduate residency, join a private practice group that has ownership of a surgery center, become a partner, and be automatically guaranteed an income >1MM for a typical 40-50 hour work week. Straightforward idea, how are you seeing that happen in psychiatry? There are a million psych clinics and the majority are not even grossing 1M let alone netting that. We had a thread on here of a guy who is considering closing down his clinic because it’s not profitable. Where are you seeing these million dollar psychiatrists and what are they doing?

I would agree with you that there are not many psychiatrists clearing a million a yr and it is more common in procedural specialties. I do know some forensic psychiatrists making this much (it is not common in forensics either). I also know some psychiatrists who have made a lot selling their multi clinic group practices to PE

 

[jbomba]

Can you be specific? For example, many surgical specialist can graduate residency, join a private practice group that has ownership of a surgery center, become a partner, and be automatically guaranteed an income >1MM for a typical 40-50 hour work week. Straightforward idea, how are you seeing that happen in psychiatry? There are a million psych clinics and the majority are not even grossing 1M let alone netting that. We had a thread on here of a guy who is considering closing down his clinic because it’s not profitable. Where are you seeing these million dollar psychiatrists and what are they doing?

But when you can clear 4-450 working 3 hours a day, why do you need to make a million dollars in a clinic?

Do your 24 hours of clinic a week and you're approaching that elusive seven figures.

 

[AD04]

Can you be specific? For example, many surgical specialist can graduate residency, join a private practice group that has ownership of a surgery center, become a partner, and be automatically guaranteed an income >1MM for a typical 40-50 hour work week. Straightforward idea, how are you seeing that happen in psychiatry? There are a million psych clinics and the majority are not even grossing 1M let alone netting that. We had a thread on here of a guy who is considering closing down his clinic because it’s not profitable. Where are you seeing these million dollar psychiatrists and what are they doing?

Are you a psychiatric resident or are you a psychiatric attending or are you neither? And if you are in the psychiatric field, why not make the most of it? For some reason, you're playing the surgical specialist skin flute really hard. If you can answer my question, I'll give you few more details of the people I have in mind.

 

[painballer27]

But when you can clear 4-450 working 3 hours a day, why do you need to make a million dollars in a clinic?

Do your 24 hours of clinic a week and you're approaching that elusive seven figures.

How do you make that much working 3 hours a day?

 

[painballer27]

The specialty you choose doesn't really matter as much as you think when it comes to pay. Business skills matter more.

Could you be more specific on how a psychiatrist can pull down that much? I know you do quite well, what is your secret?

 

[jbomba]

How do you make that much working 3 hours a day?

Plenty of inpatient jobs that let you round and leave.