Job Offer Commentary

[Sushirolls]

Rural, truly middle of no where.
Tractor traffic jams are real, and ringing of gun shots in the evening of people doing target practice are like the chimes of the church bells bellowing into the hills.
Likely only Psychiatrist with a Critical Care access hospital for a whole county/parish.
32 clinical hours denotes full time, 8 hours admin.
Salary guarantee of 300K
wRVU 'bonuses' trigger above 3800 per year, and at a rate of $56/wRVU
Outpatient only. no C/L, no call, no ED, no IP
Can set follow ups and intakes to desired time.
Can set limits on no populations; i.e. no CAP, etc
4 weeks vacation 5 weeks; and a 25K sign on
1 week CME with ~$3800
401k with some matching, (no 457 fund)
Admin and mid management consistently say, you tell us what you want to do, as not trying to burn out their doctors.
Other routine benefits of health insurance, disability, etc
Can also scale down the FTE status to 0.9 or 0.8 etc, to same ratios for wRVUs and clinical hours and salary guarantee.

What do y'all think of this job?
Is it worth leaving PP for?

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[PikminOC]

Rural, truly middle of no where.
Tractor traffic jams are real, and ringing of gun shots in the evening of people doing target practice are like the chimes of the church bells bellowing into the hills.
Likely only Psychiatrist with a Critical Care access hospital for a whole county/parish.
32 clinical hours denotes full time, 8 hours admin.
Salary guarantee of 300K
wRVU 'bonuses' trigger above 3800 per year, and at a rate of $56/wRVU
Outpatient only. no C/L, no call, no ED, no IP
Can set follow ups and intakes to desired time.
Can set limits on no populations; i.e. no CAP, etc
4 weeks vacation
1 week CME with ~$3800
401k with some matching, (no 457 fund)
Admin and mid management consistently say, you tell us what you want to do, as not trying to burn out their doctors.
Other routine benefits of health insurance, disability, etc
Can also scale down the FTE status to 0.9 or 0.8 etc, to same ratios for wRVUs and clinical hours and salary guarantee.

What do you all think of this job?
Is it worth leaving PP for?

Depends on how much you are making in pp, hours etc? Can't help without data from that side too.

 

[Sushirolls]

The PP numbers are all here:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

Relocating the practice there, will likely be able to keep 90% of current patients via telemedicine, and focus on building up rest in the new location. Office space is ~$300-1500 in new location if renting, depending on size/quality. Office buildings are $200-560K purchase. Insurance rates are much lower for biggest Comercial payer then current location. But current location is now racing to the bottom, too, and slashing their rates.

 

[forchinet121]

It depends on if there is a cap on your income, some hospital talk about “fair market value” and then try to get a cap on income at like 350k or something obscene like that. I would also look at volume, if you want to work hard are there enough patients to exceed and get the wrvu bonus?

 

[PikminOC]

The PP numbers are all here:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

Relocating the practice there, will likely be able to keep 90% of current patients via telemedicine, and focus on building up rest in the new location. Office space is ~$300-1500 in new location if renting, depending on size/quality. Office buildings are $200-560K purchase. Insurance rates are much lower for biggest Comercial payer then current location. But current location is now racing to the bottom, too, and slashing their rates.

Will your new work allow you to also do your old work?

 

[Sushirolls]

Possibly. But I'm not wanting to dabble in both worlds. Just want to pick one and focus on one.

 

[Sushirolls]

No wRVU or FMV caps that I can see.

The salary guarantee is perpetual, but I suspect if not hitting that wRVU threshold after 2-3 years eye brows might raise. I believe that wRVU threshold is quite low compared to what is more typical. My math estimates it out to be ~1.2 wRVUs per 30 min encounter, which is less than a 99213. So in theory if all I did was straight bill 99213 and nothing else for an almost full week, that wRVU threshold is hit.

 

[Bartelby]

That job seems pretty solid for a rural area. Who covers calls from your outpatients (you mentioned no call)?

I think at this point it depends on long-term goals. You mentioned before wanting to stop practicing psychiatry and become a farmer. Is that a real long-term goal for you? If so, how much money do you need banked to make that happen? This employed position can probably get you there faster, and if you don't take any side jobs it does not seem like a major burnout-prone role. I also would do the math, presuming you are able to fill your PP with 32 clinical hours how much would you bring in (compared to your total compensation including RVU bonus with those same hours full)? I suspect you do better in the employed role, and no headaches of running your own practice.

Of course, I know you have loved the autonomy of PP. If you are in a very low cost of living area, you could also work a relaxed PP schedule and take a more slow-coast to a career change if that's the plan.

Good luck with a tough decision! If it were me, I would sit down with a spreadsheet and run the numbers. I get the feeling the employed role comes out ahead but could be wrong.

 

[forchinet121]

No wRVU or FMV caps that I can see.

The salary guarantee is perpetual, but I suspect if not hitting that wRVU threshold after 2-3 years eye brows might raise. I believe that wRVU threshold is quite low compared to what is more typical. My math estimates it out to be ~1.2 wRVUs per 30 min encounter, which is less than a 99213. So in theory if all I did was straight bill 99213 and nothing else for an almost full week, that wRVU threshold is hit.

If there’s no income cap and this location has the volume, I suspect you will do very well if you wanted to

 

[Stagg737]

What's the expected no-show rate like? Knowing what you've posted in the PiP thread and SDN in general, this seems like the closest thing to ideal in terms of an employed position for you if the admin is actually as reasonable as they sound.

 

[romanticscience]

Tractor traffic jams are real, and ringing of gun shots in the evening of people doing target practice are like the chimes of the church bells bellowing into the hills.

A poetic recruiter who really has your number! lol

 

[Sushirolls]

Call will be managed by PCPs. I stated only patients who have their PCPs will get in the door. Thus, the existing call system for PCPs will be in play.

Farming long term goal is still on the agenda.

The admin at all levels seems genuine. Still, been burned enough with hospital admin to have paranoid doubts. Think I'll make sure any non-competes are minimal or non-existent before I sign anything. Have no desire to move again. Such a pain is moving. It would only take a new CEO to quickly turn things sour. Seen it too many times.

 

[dl2dp2]

So with PP supplement, you are looking at 400k+ total comp, right? I think overall there's no major red flag. Is there any room for negotiation? You might argue for a base 10% higher.

 

[Sushirolls]

No PP supplement. Either doing PP or taking this job.

29 clinical hours X ~1.92 wRVUs per 30 min follow up (blending 99215, 99214, 99213) X 2 encounters per hour x 48 working weeks =5345 wRVUs

1545 wRVUS above threshold X $56 = $86,520

$386K income, not include benefits package, usually 30K or more.

*Billing any amount 90833 will propel that higher, those figures above are without 90833 and 29 clinical hours accounts for no shows to a 32 hour schedule.

 

[Sushirolls]

What's the expected no-show rate like? Knowing what you've posted in the PiP thread and SDN in general, this seems like the closest thing to ideal in terms of an employed position for you if the admin is actually as reasonable as they sound.

This what I've been thinking, too.
But needed the sobriety of group think to temper my oscillating thoughts.
No shows will be minimal or routine. I figure 29 hours of 32 after a year will be a worthy projection.

 

[comp1]

Who is doing the ED, consult, inpatient, etc if you're the only psychiatrist in the county? Do you already live in this place? It sounds like it might be rough dealing with the more acute patients.

 

[Sushirolls]

ED docs deal with ED.
Hospitalists deal with floor.
No inpatient unit. It's a 25 bed Critical Care Access hospital.

I will be living in this place. I'm moving/ relocating no matter what. The only question is relocate the PP, continue to see existing patients by telemedicine, and top of the practice volume with the rural patients; or take an employed job and close down the PP.

 

[Stagg737]

The admin at all levels seems genuine. Still, been burned enough with hospital admin to have paranoid doubts. Think I'll make sure any non-competes are minimal or non-existent before I sign anything. Have no desire to move again. Such a pain is moving. It would only take a new CEO to quickly turn things sour. Seen it too many times.

ED docs deal with ED.
Hospitalists deal with floor.
No inpatient unit. It's a 25 bed Critical Care Access hospital.

The only concern I have with smaller rural hospitals is funding sources, aka how are they staying open? These are the hospitals that closed down after the ACA was passed and have bottom-line issues d/t payor mix being heavily reliant on CMS sourcing.

You could consider doing this 0.8 FTE like your OP said and keeping a small panel of your more reliable PP patients 4-5 hours a week for security. Idk if that's worth maintaining the overhead for that, though with that few patients you can always just use paper charts and a file cabinet, lol.

 

[Sushirolls]

Long story short, this hospital did solid during Covid with numbers and by their staff interactions. Discussion with other physicians validated this. This tiny hospital has an atypical community that skews its payer mix more positively than what one would routinely see. The community attributes won't be changing and likely to maintain.

I have looked at several of these critical access hospital communities and your concerns were more apparent in those communities.

 

[nexus73]

What’s prompting the move? Can you say more about insurance reimbursement racing to the bottom?

I know our hospital renegotiated rates up with blue cross. I’d hate to think insurance is robbing private practice Peter to pay Paul, MBA.

 

[AD04]

Rural, truly middle of no where.
Tractor traffic jams are real, and ringing of gun shots in the evening of people doing target practice are like the chimes of the church bells bellowing into the hills.
Likely only Psychiatrist with a Critical Care access hospital for a whole county/parish.
32 clinical hours denotes full time, 8 hours admin.
Salary guarantee of 300K
wRVU 'bonuses' trigger above 3800 per year, and at a rate of $56/wRVU
Outpatient only. no C/L, no call, no ED, no IP
Can set follow ups and intakes to desired time.
Can set limits on no populations; i.e. no CAP, etc
4 weeks vacation
1 week CME with ~$3800
401k with some matching, (no 457 fund)
Admin and mid management consistently say, you tell us what you want to do, as not trying to burn out their doctors.
Other routine benefits of health insurance, disability, etc
Can also scale down the FTE status to 0.9 or 0.8 etc, to same ratios for wRVUs and clinical hours and salary guarantee.

What do y'all think of this job?
Is it worth leaving PP for?

Frankly, this job is better than what you're doing now. You won't worry have to worry about running the practice, just focus on being a psychiatrist. Even with conservative coding, you'll make more then what you're making now. You should get more comfortable adding psychotherapy especially if you spend the time with the patients. You also get benefits instead of paying for your own benefit. And the hospital will pay employer portion of payroll taxes. And because you're the only psychiatrist in the hospital, you'll be treated like a VIP.

Vacation and CME are average. $ / wRVU is on the lower end. You'll find another job with similar pay easily and I think you can find one with higher $ / wRVU. But on the other hand, you have no call and can just focus on outpatient. If you bill properly, you'll make more than the base for sure. I think you can surpass $350k / year if you bill properly without having to work like a surgeon.

What will happen to your patients when you're on vacation?

P.S. I would give up your currently private practice. From a $ / hr perspective, you'll make more by working on the new job.

I’d hate to think insurance is robbing private practice Peter to pay Paul, MBA.

This is exactly what's happening. Why would a small private practice get the same reimbursement as a national chain? It's business.

 

[MedMan80]

Sushi,

I work in a similar setup to this, I do enjoy the autonomy. The downside is that you have a pretty acute population, nowhere else people can be seen, lots of complex patients. There are no IOP/PHP or ECT access near me. Hard to beat RVU target unless you see more than 2 pt an hour, no-shows are part of this problem. You will occasionally get pulled to see folks in the ED as well time to time.

 

[finalpsychyear]

My advice is if you can keep the tele in some capacity even if that is doing some wknd hours and or after 4pm or whatever since it seems like they are letting you build your schedule.... maybe use your admin time to do some tele visits. Maybe even start at 0.8 FTE.

You spent years building up the PP and now the fact that you can have it tele I would not give that up quickly till you really have a sense of the new place and even if you have to work more year 1 to really get a sense of the job it would be worth it. Would be terrible if you dump the tele then leave the job after 1 year.

I had a colleague do this and he gave up the practice and wishes he had not as a few months in he knew it wasn't going to be long term but luckily he was able to still grab a good percent of the patients back.

 

[PikminOC]

I've never heard of employment at hospitals having no cap on earnings. I've seen that they can't overpay specialists due to not wanting to get in trouble. They have to be within mgma.

 

[AD04]

I've never heard of employment at hospitals having no cap on earnings. I've seen that they can't overpay specialists due to not wanting to get in trouble. They have to be within mgma.

No cap is a thing. Maybe capping earnings is a negotiation trick from the hospital. How do you get physicians to see enough patients if there is already a shortage of them in rural areas and if you cap their earnings? If I had a cap, I would take more vacations and see less patients for sure (either by showing up later in the day or leaving home earlier in the day or being less efficient).

And in a way, OP's job has a soft cap as over the base wRVU, he's getting paid less. That should be negotiated to normal $ / wRVU after passing base wRVU.

 

[PikminOC]

No cap is a thing. Maybe capping earnings is a negotiation trick from the hospital. How do you get physicians to see enough patients if there is already a shortage of them in rural areas and if you cap their earnings? If I had a cap, I would take more vacations and see less patients for sure (either by showing up later in the day or leaving home earlier in the day or being less efficient).

And in a way, OP's job has a soft cap as over the base wRVU, he's getting paid less. That should be negotiated to normal $ / wRVU after passing base wRVU.

My friend is employed in a rural area. I guess the way they cap it is by making the Rvu targets harder to hit at the higher levels.

 

[forchinet121]

My friend is employed in a rural area. I guess the way they cap it is by making the Rvu targets harder to hit at the higher levels.

56/ wrvu is by no means capping income. If you were paid 56/ wrvu and produced 10k wrvu for the year that’s 560k which is not difficult to do if you have the correct patient population, if you see 30 minute appointments you would need to see 12 patients per day..assuming you utilize psychotherapy add on code which if you only see 12 per day you should..at my hospital and I think most places this is not possible because they literally cap your income so beyond like 350k they just won’t pay you anymore

 

[Sushirolls]

Thank you every one for the feedback so far and for the feedback yet to come.

 

[Merovinge]

Frankly, this job is better than what you're doing now. You won't worry have to worry about running the practice, just focus on being a psychiatrist. Even with conservative coding, you'll make more then what you're making now. You should get more comfortable adding psychotherapy especially if you spend the time with the patients. You also get benefits instead of paying for your own benefit. And the hospital will pay employer portion of payroll taxes. And because you're the only psychiatrist in the hospital, you'll be treated like a VIP.

What will happen to your patients when you're on vacation?

I tend to agree, but was also the only psychiatrist in a rural healthcare system (although much larger than Sushi is describing) and was not treated at all like a VIP. Psychiatry services cost the hospital money which makes the admin less than thrilled (they preferred washing their hands and referring out to community organizations) and a number of people do not like having patients with psychiatric disorders around. Small town nice is certainly true if you go to the same church, look similar, and act similar, but disappears in a hurry for those who do not fit the mold. There is a lot of mental health denial and use of substances to try and cover up problems (this part is objectively the case).

Coverage is tough, as is taking all the higher acuity patients with SMI that have no one else to go to. Not having PHP/IOP/ECT/TMS is a big thing, even bigger is not having real evidenced based psychotherapy for essentially any of your patients.

Now I know Sushi is going to find this location to be paradise, so he might have a better go if it than I did, but just an anecdote for those looking into taking a similar job.

 

[PikminOC]

56/ wrvu is by no means capping income. If you were paid 56/ wrvu and produced 10k wrvu for the year that’s 560k which is not difficult to do if you have the correct patient population, if you see 30 minute appointments you would need to see 12 patients per day..assuming you utilize psychotherapy add on code which if you only see 12 per day you should..at my hospital and I think most places this is not possible because they literally cap your income so beyond like 350k they just won’t pay you anymore

The rates my friend gets are decreased Rvu rates beyond a certain number. And her bonuses get harder to achieve every year with increased Rvu for bonus

 

[Sushirolls]

I'm in a much bigger metro.
The DBT/ eating disorder clinics are booked out 6 months or more. And only few patients go.
ECT is non-existent locally, and what there is actively tries to not do ECT.
TMS is bursting, ARNPs everywhere, finally have a Psychiatrist to refer to for it.
PHP/IOP is quite limited, often booked out a month, and limited for patients who follow up to do it.
Therapists are all booked, and just had patient today say they've called 12+, connected with one who was a poor fit.
So even though I'm in a bigger metro with more services, they sort of aren't really available here anyways?

 

[Merovinge]

I'm in a much bigger metro.
The DBT/ eating disorder clinics are booked out 6 months or more. And only few patients go.
ECT is non-existent locally, and what there is actively tries to not do ECT.
TMS is bursting, ARNPs everywhere, finally have a Psychiatrist to refer to for it.
PHP/IOP is quite limited, often booked out a month, and limited for patients who follow up to do it.
Therapists are all booked, and just had patient today say they've called 12+, connected with one who was a poor fit.
So even though I'm in a bigger metro with more services, they sort of aren't really available here anyways?

My metro has PHP/IOP/ED treatment in the few days to few weeks range (accepting most private insurances). TMS/Ketamine relatively easy to access even through insurance. Good therapists are hard to come by but we can refer and push with the good ones, having relationships and 2 way referral sources make a big difference. SUD RTCs usually accessible in 1-2 month range (wish this was shorter). Very different than having access to none of these things.

 

[SmallBird]

I've never heard of employment at hospitals having no cap on earnings. I've seen that they can't overpay specialists due to not wanting to get in trouble. They have to be within mgma.

What do you mean? Every hospital I've worked at does not have caps. As long as the number of RVUs is way above average the pay can be way above average.

 

[Sushirolls]

What do you mean? Every hospital I've worked at does not have caps. As long as the number of RVUs is way above average the pay can be way above average.

Buried in this thread are some FMV discussion points that might answer your quesiton.

wRVU Numbers

With the 2020 or 2021 wRVU changes, what's the lay of the land now for employed jobs and what thresholds they are putting out there for annual contractual requirements? I just realized my not being in wRVU land anymore, I'm getting rusty. Here is my understanding: 99204 2.6 99205...

forums.studentdoctor.net

 

[nexus73]

What do you mean? Every hospital I've worked at does not have caps. As long as the number of RVUs is way above average the pay can be way above average.

Some places have a declining RVU rate as RVU number climbs. Counter intuitive, you'd think the RVU rate would increase. For example, $62/RVU up to 4500 RVU, typically this is the amount they feel comfortable paying you ($279K) without fearing concerns of exceeding FMV. Then to limit the max to a natural log graph, they will drop the RVU rate to $45/RVU from 4500-5500, then drop to $30/RVU above 5500. Egregious, sickening, I know. I read somewhere a place just flat out capped at a certain RVU number, and never understood how they could do that, if you hit the cap in November admin better believe I'm taking the rest of the year off.

Suffice to say these compensation practices are abusive to doctors, and in the end only benefit hospitals reducing risk of OIG investigation, and also allow them to pay you less. So don't take a job like this it's bullsh%t.

 

[Jules A]

It depends on if there is a cap on your income, some hospital talk about “fair market value” and then try to get a cap on income at like 350k or something obscene like that. I would also look at volume, if you want to work hard are there enough patients to exceed and get the wrvu bonus?

A hospital tried to use Stark Law as an excuse to cap income with this dude.

Stark Law - The White Coat Investor Forum - Investing & Personal Finance for Doctors

Can I please have some feedback from the group? I am an APP and our group is in discussion with our hospital on compensation. The administration representative told me they can’t increase their offer because they have STARK law to consider. It was my understanding that the APP(NP,PA,CRNA) do not...

forum.whitecoatinvestor.com

 

[SmallBird]

Well, all of that may be, but in response to the comment of 'never heard of employment at hospitals having no cap', there are clearly several that don't have caps.

 

[PikminOC]

A hospital tried to use Stark Law as an excuse to cap income with this dude.

Stark Law - The White Coat Investor Forum - Investing & Personal Finance for Doctors

Can I please have some feedback from the group? I am an APP and our group is in discussion with our hospital on compensation. The administration representative told me they can’t increase their offer because they have STARK law to consider. It was my understanding that the APP(NP,PA,CRNA) do not...

forum.whitecoatinvestor.com

Yes my friend said an outside consult was done to make sure she was within the correct range of payment for her field

 

[PikminOC]

Some places have a declining RVU rate as RVU number climbs. Counter intuitive, you'd think the RVU rate would increase. For example, $62/RVU up to 4500 RVU, typically this is the amount they feel comfortable paying you ($279K) without fearing concerns of exceeding FMV. Then to limit the max to a natural log graph, they will drop the RVU rate to $45/RVU from 4500-5500, then drop to $30/RVU above 5500. Egregious, sickening, I know. I read somewhere a place just flat out capped at a certain RVU number, and never understood how they could do that, if you hit the cap in November admin better believe I'm taking the rest of the year off.

Suffice to say these compensation practices are abusive to doctors, and in the end only benefit hospitals reducing risk of OIG investigation, and also allow them to pay you less. So don't take a job like this it's bullsh%t.

Yes tell me more about this oig investigation. Why would they be involved?

 

[nexus73]

Yes tell me more about this oig investigation. Why would they be involved?

The appearance of paying above FMV could suggest an illegal kickback arrangement the HHS OIG may choose to investigate. Even if nothing illegal is found, a federal investigation into your hospital is not a fun day week month etc.

 

[PikminOC]

The appearance of paying above FMV could suggest an illegal kickback arrangement the HHS OIG may choose to investigate. Even if nothing illegal is found, a federal investigation into your hospital is not a fun day week month etc.

Yes that's what it was. That's why they were her hospital is strict and has this outside consultation regarding her payment.

 

[ObsequiousAplomb]

The appearance of paying above FMV could suggest an illegal kickback arrangement the HHS OIG may choose to investigate. Even if nothing illegal is found, a federal investigation into your hospital is not a fun day week month etc.

Does that mean the OIG inspects all the facilities paying the top 5-10% in every specialty? That would sound excessive and a huge waste of resources. That's why it sounds mostly like a big copout to me. Maybe if they were paying 99th+ percentile or 95th and they were receiving unsolicited complaints from people it would sound more reasonable.

But I really don't know. Does the OIG actually inspect the facilities that pay top percentiles for every specialty?

 

[Sushirolls]

No idea.
Unlikely?
But similar to Covid... or being a non-profit... why let a good excuse go to waste? If it allows a business to pocket more money and reduce their labor costs, admin will gleefully sign to make it happen.

 

[nexus73]

Can you keep the private practice going like 2 days a week, and work at hospital 2-3 days a week? Enough to access benefits through the hospital cheaper maybe. Over time see if the split works, or if you want to drop one and do the other full time. I'd assume a hospital like this is desperate enough to allow you to choose what you want to do.

 

[PikminOC]

Does that mean the OIG inspects all the facilities paying the top 5-10% in every specialty? That would sound excessive and a huge waste of resources. That's why it sounds mostly like a big copout to me. Maybe if they were paying 99th+ percentile or 95th and they were receiving unsolicited complaints from people it would sound more reasonable.

But I really don't know. Does the OIG actually inspect the facilities that pay top percentiles for every specialty?

I'm sure oig does just enough to continue their funding. If pay somewhere is high they may take a look. Maybe random audits?

 

[smalltownpsych]

I worked for a rural hospital for a couple of years and I think this post is pretty consistent with my experience.

Sushi,

I work in a similar setup to this, I do enjoy the autonomy. The downside is that you have a pretty acute population, nowhere else people can be seen, lots of complex patients. There are no IOP/PHP or ECT access near me. Hard to beat RVU target unless you see more than 2 pt an hour, no-shows are part of this problem. You will occasionally get pulled to see folks in the ED as well time to time.

In my mind, if it’s where you want to live and you’re comfortable managing complex cases without much support, then it sounds like a pretty good fit for you. I was happy with the second part, not so much about the first which is why I moved. We did have a lot of autonomy and the pay was good because the community valued what we offered and the hospital did well. Also, where I was at, a couple of the docs were getting their farming going, one was in EM and the other was a surgeon. The EM guy was growing soybeans or something like that and the surgeon was raising lots of animals and some smaller crops. If those guys could make it work, I’m sure a psychiatrist could do it too. I’m sure there is a joke in there somewhere. A surgeon, an er doc, and a shrink each started up a farm….

 

[Stagg737]

Can you keep the private practice going like 2 days a week, and work at hospital 2-3 days a week? Enough to access benefits through the hospital cheaper maybe. Over time see if the split works, or if you want to drop one and do the other full time. I'd assume a hospital like this is desperate enough to allow you to choose what you want to do.

I’ll second that idea. If you’re moving there either way, doing a trial run with the hospital for 3-4 months while maintains your PP sounds like the best way to explore the job while maintaining a financial safety net. If the hospital is great, you can scale back/stop PP and go fully employed or remain PT and start the ranch up. If the job sucks then you’ve still got your PP.

You’ve clearly dealt with a lot that you didn’t want to in the past and have had less than desirable outcome with the PP, so I get why you’d want to settle into something. But what’s another 3-4 months of annoyances if you can find your happy place longer term?

 

[PikminOC]

Do people think the hospital gets 100 percent of collections on what they bill? That's another reason for the discrepancy in what they make

 

[PikminOC]

I’ll second that idea. If you’re moving there either way, doing a trial run with the hospital for 3-4 months while maintains your PP sounds like the best way to explore the job while maintaining a financial safety net. If the hospital is great, you can scale back/stop PP and go fully employed or remain PT and start the ranch up. If the job sucks then you’ve still got your PP.

You’ve clearly dealt with a lot that you didn’t want to in the past and have had less than desirable outcome with the PP, so I get why you’d want to settle into something. But what’s another 3-4 months of annoyances if you can find your happy place longer term?

What less desirable outcomes in pp? I can't glean it from the thread

 

[ObsequiousAplomb]

Do people think the hospital gets 100 percent of collections on what they bill? That's another reason for the discrepancy in what they make

I don't think that people here think that. Your contract should specify whether the pay is based on billings or collections, shouldn't it? If it's for billings, the hospital has to eat what they don't collect and pay you anyway. So if you're submitting x RVUs then they should pay you for that cf*x, even if they collect anywhere from 0.7x to x. If they're holding your productivity hostage based on their collections system, that would suck.

I wouldn't sign on with a big system like a hospital unless it were for % of billings instead of % collections. I'm under the impression the conversion factor for your RVUs ought to be built-in expecting that they won't collect 100%, and that's why the % of collections factor is usually higher, because it doesn't consider the % bad debts.