Job offer comparison

[rockyhill99]

Oh, Wise Peeps!

Recommendation for a job?

I have two job offers and would much appreciate your advice.

1) Job 1 - Outpatient remote telepsychiatry at a community clinic in the rural mid-west (part of several clinics of a nonprofit that has been in existence for 15 yrs). The job will be exclusively outpatient with a child/adult mix for 30 hours/week ( 70% adult: 30% child-could increase to a max of 50% adult: 50% CAP) (3 hours admin time+ 2 hours lunch time/week ) for a 262 K salary. 60(adult)/90(CAP) minutes for intakes and 30 mins for follow-ups. They are offering a 30 K bonus (in two split installments, one at the beginning and one on completing 15 months and 4K in CME/yr. No productivity expectations. I will be their first and only psychiatrist catering to multiple rural health clinics via telepsychiatry. They have mid-levels and therapists already working there. No requirement for NP supervision. The supervisor will be a family practice physician. I do not have to relocate for this job from my current location in the South where I own a home. Once not on the H-1b visa, they will allow private practice with permission after I buy my own malpractice insurance. The retirement match is about 4% with immediate vesting. The medical insurance annual deductible for the family is $10,500. EMR is Epic.

2) Job 2- MGH outpatient( 80% adult: 20% child) for an annual salary of 200 K with an RVU expectation of 3200 and a $55 bonus/additional RVU. The job offers the flexibility of time for intake and follow-ups. They allow a maximum of 8 hours/week of private practice with malpractice covered by their insurance. This will require a relocation and selling of my house. The retirement match is 2% but there are other streams(cash balance and future income plan) so it is much higher in actuality(total of approx. 11% or slightly higher with vesting in 3 years). Better medical, dental, vision, and disability than Job 1. The medical insurance annual deductible for the family is none. EMR is Epic.

Which of the above two job offers makes the most sense to you if the end goal is private practice?

Thanks in advance!

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[painballer27]

Job 1.

 

[Merovinge]

It depends on where you want to live after completion of your H1B. If Boston or the NE in general is attractive to you, there's significant value in being in the location and meeting people in person. Telepsych to rural clinics while admirable, will do absolutely nothing to open any doors or make any connections with anyone anywhere. There is probably some value to advertise yourself as having worked at Harvard for a few years in an eventual private practice. If they are paying you on new RVU's, it would be easy to blow past that number and make the salaries similar although CoL is going to be markedly higher in Boston. Schools and local environment for your family is going to vary significantly between locations, it's hard to put an exact price on this but I find it has significant value. Lots of factors to weigh here, I think your life will likely look pretty different based on the path you choose.

 

[FlowRate]

How many total clinical hours at MGH? Admin time? Satellite clinic or downtown? Pure clinical or expected to teach/supervise? Feelings about living in MA/Boston/are you familiar with Boston otherwise?

Regarding the first one, 30 clinical hours, 5 admin/lunch hours, no other time expectation outside of that?

One thing about the first job, might be interesting to clarify which insurance carrier and if you'll have adequate coverage in your current location given your employer may be based out of state.

 

[painballer27]

Job advice

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...

forums.studentdoctor.net

?

 

[mistafab]

Bro you got 2 threads already asking questions about these same jobs. Do you really need a third? The advice has already been given.

 

[painballer27]

Go ahead and make a fourth, push it all the way

Or just take the first job. You know you want to

 

[rockyhill99]

How many total clinical hours at MGH? Admin time? Satellite clinic or downtown? Pure clinical or expected to teach/supervise? Feelings about living in MA/Boston/are you familiar with Boston otherwise?

Regarding the first one, 30 clinical hours, 5 admin/lunch hours, no other time expectation outside of that?

One thing about the first job, might be interesting to clarify which insurance carrier and if you'll have adequate coverage in your current location given your employer may be based out of state.

Job 2-30 plus. Downtown. Expected to teach/supervise. Not familiar with Boston.

Job 1- No expectations outside 30 hrs. Thanks for the insurance advice.

 

[rockyhill99]

Bro you got 2 threads already asking questions about these same jobs. Do you really need a third? The advice has already been given.

Thanks for your interest but the comparison I am asking for is between a new job offer not posted on that thread and one job out of the three posted there.

 

[rockyhill99]

It depends on where you want to live after completion of your H1B. If Boston or the NE in general is attractive to you, there's significant value in being in the location and meeting people in person. Telepsych to rural clinics while admirable, will do absolutely nothing to open any doors or make any connections with anyone anywhere. There is probably some value to advertise yourself as having worked at Harvard for a few years in an eventual private practice. If they are paying you on new RVU's, it would be easy to blow past that number and make the salaries similar although CoL is going to be markedly higher in Boston. Schools and local environment for your family is going to vary significantly between locations, it's hard to put an exact price on this but I find it has significant value. Lots of factors to weigh here, I think your life will likely look pretty different based on the path you choose.

Thank you for your advice.

 

[rockyhill99]

Job advice

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...

forums.studentdoctor.net

?

Job 1 here is not posted there

 

[Stagg737]

So from your previous posts it sounds like your goals are to eventually enter private practice but still have some aspect of teaching or working with med students/residents with your job.

Already been discussed in other threads, but neither of these jobs are particularly good nor are they awful. Given your situation (new attending on a H1b). The MGH position would probably pay well above that 200k after RVU bonus is considered, but the CoL in Boston is also likely much worse than in the south, so your spending power would likely be much different regardless of the similar pay.

Job 1 seems like an "easier" job in the sense of more pay for less work and responsibilities and no need to move. The patient population will likely be less diverse and involve more chronic issues with resource availability. I would definitely want to know what community resources are available for that position and how close to major metros where resources are available the patients are. No teaching here, but once you're off the visa it sounds like you can supplement that position more easily to add on things like teaching or side hustles if you choose.

Job 2 (MGH) sounds like it offers a bit more of what you want immediately with the ability to work with residents/students as well as some PP work which they will provide some assistance with (malpractice). This would also allow you to attach the MGH name to your resume which may or may not be beneficial to marketing yourself later. However, it sounds like you'd have more responsibilities to admin which could interfere significantly with reaching a decent productivity bonus and significantly impact your take-home. Given you'd have to move to a more expensive area, that may be unacceptable to you.


Things I'd be asking are what do you want/need right now vs what are you willing to delay for gratification? How important are location and finances to you? How flexible are you with your future career vs having specific things you need to accomplish? If you need the guaranteed income now and are willing to postpone teaching and other opportunities until your visa is addressed, Job 1 sounds like the better choice. It also seems to offer more long-term flexibility with your career. If you feel like you just need the academic/collegial atmosphere and don't mind being employed and making less, MGH seems better.

I would really sit down and identify your priorities and place things on a timeline. When will you no longer need the visa? How big of a deal is moving? Is getting a strong nest egg started essential to you or are you okay living more frugally? How big of a role do you want teaching to play now and 10 or 20 years from now? As someone else said, it sounds like these positions will likely lead down very different paths, so figuring these things out now seems pretty important.

 

[FlowRate]

Job 2-30 plus. Downtown. Expected to teach/supervise. Not familiar with Boston.

Job 1- No expectations outside 30 hrs. Thanks for the insurance advice.

Job 1 and Job 2 are polar opposites in terms of your lifestyle outside of work and likely at work, as well.

For that reason, I think with the MGH job it's more about doing your due diligence on how different your lifestyle would likely be there. The closer you get to downtown (and to work), the more expensive things get. Pretty much anything in the Boston metro is going to be way more expensive per square foot than what you'd get in most places in the South. I'm less familiar with MGH outpatient psych but I can tell you that the other Harvard-affiliated hospitals work their outpatient attendings pretty hard in terms of carrying a significant caseload and also likely less explicit time compensation for supervision and other ancillary duties than what is required to actually do a good job doing so. People in the South are frequently exceptionally warm/friendly/outgoing in comparison to Boston which is more reserved/terse/introverted (in a cultural way.) Plus the political differences, if those matter to you at all.

 

[Monocles]

Bro you got 2 threads already asking questions about these same jobs. Do you really need a third? The advice has already been given.

hey it's like ranked choice voting, every time OP re-posts the question at least the number of choices are going down lmao

1) Job 1 - Outpatient remote telepsychiatry at a community clinic in the rural mid-west (part of several clinics of a nonprofit that has been in existence for 15 yrs). The job will be exclusively outpatient with a child/adult mix for 30 hours/week ( 70% adult: 30% child-could increase to a max of 50% adult: 50% CAP) (3 hours admin time+ 2 hours lunch time/week ) for a 262 K salary. 60(adult)/90(CAP) minutes for intakes and 30 mins for follow-ups. They are offering a 30 K bonus (in two split installments, one at the beginning and one on completing 15 months and 4K in CME/yr. No productivity expectations. I will be their first and only psychiatrist catering to multiple rural health clinics via telepsychiatry. They have mid-levels and therapists already working there. No requirement for NP supervision. The supervisor will be a family practice physician. I do not have to relocate for this job from my current location in the South where I own a home. Once not on the H-1b visa, they will allow private practice with permission after I buy my own malpractice insurance. The retirement match is about 4% with immediate vesting. The medical insurance annual deductible for the family is $10,500. EMR is Epic.

OP is this a renegotiation of your original job #2 in your first thread? In some ways this is actually WORSE than the original offer.

- 30k "bonus" split in two installments here is effectively a sign on bonus of 15k, and a retention bonus of 15k nearing the end of the two years. This is way worse than your original 23k EOY bonus with 10k sign up.

- No NP/midlevel supervision is good! Good for you for negotiating out of this. What do you mean "the supervisor will be a FM doc?" is that for the midlevels or you? What is your liability (assuming you do some level of consultation for primary care) if you made clinical recommendations?

- Already owning a home and not relocating is HUGE. Keep in mind that buying a home in the Boston area can be a nightmare. Most MGB attendings commute in from nearby suburbs w/ 800k-1.5M homes that would be closer to 200-300k anywhere else. Good luck getting a mortgage rate under 5% in this market even as a physician. Oh, and the T (boston public transit) has been literally on fire several times this summer with pretty significant anticipated closures of several lines.

- 4% immediate vesting is HUGE. FYI unless MGB's policies have changed and I was unaware, their vesting with fidelity as of July 2022 is only 2% after ONE FULL YEAR w/ 1000+ hours.

Out of curiosity, are you just trying to get the blessing of internet strangers to tell you to go MGB or what?

 

[rockyhill99]

hey it's like ranked choice voting, every time OP re-posts the question at least the number of choices are going down lmao


OP is this a renegotiation of your original job #2 in your first thread? In some ways this is actually WORSE than the original offer.

- 30k "bonus" split in two installments here is effectively a sign on bonus of 15k, and a retention bonus of 15k nearing the end of the two years. This is way worse than your original 23k EOY bonus with 10k sign up.

- No NP/midlevel supervision is good! Good for you for negotiating out of this. What do you mean "the supervisor will be a FM doc?" is that for the midlevels or you? What is your liability (assuming you do some level of consultation for primary care) if you made clinical recommendations?

- Already owning a home and not relocating is HUGE. Keep in mind that buying a home in the Boston area can be a nightmare. Most MGB attendings commute in from nearby suburbs w/ 800k-1.5M homes that would be closer to 200-300k anywhere else. Good luck getting a mortgage rate under 5% in this market even as a physician. Oh, and the T (boston public transit) has been literally on fire several times this summer with pretty significant anticipated closures of several lines.

- 4% immediate vesting is HUGE. FYI unless MGB's policies have changed and I was unaware, their vesting with fidelity as of July 2022 is only 2% after ONE FULL YEAR w/ 1000+ hours.

Out of curiosity, are you just trying to get the blessing of internet strangers to tell you to go MGB or what?

This is a different job(0.75FTE) in a different geographic location from the one posted before(1 FTE) so bonus options are different. The one posted before was a telepsychiatry job in a psychiatry department with residency/fellowship but they are unable to do telepsychiatry anymore so that option is non existent. This one is an FQHC and I will be required to provide telepsychiatry services to 13 small clinics under its umbrella. The work does not involve consultation. I will be carrying my own patient panel. The medical director is a family physician since they do not have psychiatrists. Malpractice is covered under the Federal Tort law for FQHCs.

 

[G Sheb]

The Harvard name might help you with a private practice in Boston but you will be facing stiff competition. Telepsych can give you flexibility to go wherever you want for the PP.
Frankly those jobs sound nothing alike. Though both are giving you a decent deal. So congrats for that.

I think you need to do some soul searching to figure out your priorities.
- where you want to live
- what kind of lifestyle you want to have
- what kind of clinical work you're interested in
- do you like academia?
- does name/prestige matter to you?
etc

 

[clement]

Academic outpatient jobs tend not to be desirable, which is why they recruit desperately and with the most aggressive recruiters and/or recurring job listings. These positions will frequently have you working hard in terms of volume. This is particularly true in larger NE cities where on top of it, the pt pop will 100% be more challenging, adding insult to injury given reimbursement is the lowest (relative to cost of living). In the NE, that 200K is not 200K. You'll go back to being a renter. If for nothing else, because you need to feel the job out before buying in a much pricier market. I wouldn't touch a base of less than 249K unless you have multiple back up gigs going. With academia, outside gigs is tough; if you get benefits they will aggressively limit other job options and/or force you to give them a chunk of PP profit. That (tougher) patient volume is also not always to your advantage with bonus RVUs if they enforce a ceiling. Attaining it will further degrade quality of life. I agree that there's more networking potential than in rural Americaville, but you'll be staying in the South anyway with the other job.

The Harvard name and any affiliation with it have long been over-branded in the private practice world, to the extent that it can appear cheesy to waive around when attempting to attract the sort of patients savvy enough to know.
Dropping a better quality of life in the balmy south for "200K" in the NE would be a hard sell, but academia is a comfy starter option until people wise up. This has been reiterated on SDN often. I guess it's worth considering if you need that sense of "security" until establishing yourself, but there are other venues to achieve this. Make sure to have a lawyer review the contract w/ outpatient academic NE jobs that are incentivized by productivity metrics. These jobs are not always as secure as you hope, and can be rather toxic following the shift to make academia more profitable. Don't get lured by places resting on their laurels (name cache). At best, these positions are only worth it if you can land them with the absolute fewest number of FTE's to get health insurance.

Why not look for academic in one of the larger cities in the South, if need be?

 

[Monocles]

The Harvard name might help you with a private practice in Boston but you will be facing stiff competition.

yes and no

In Boston basically "everyone is harvard" so OP's advantage will be minimal. But! Even in the city w/ the highest psychiatrist per capita in the world, it is still near impossible to find an outpt provider (esp child which OP mentioned he is) under a 3-6 month waiting list so he would have no trouble filling regardless of his academic affiliation.

The market is overwhelmed w/ MH need that even mid-levels can get away w/ $300/h cash only rates

 

[Merovinge]

yes and no

In Boston basically "everyone is harvard" so OP's advantage will be minimal. But! Even in the city w/ the highest psychiatrist per capita in the world, it is still near impossible to find an outpt provider (esp child which OP mentioned he is) under a 3-6 month waiting list so he would have no trouble filling regardless of his academic affiliation.

The market is overwhelmed w/ MH need that even mid-levels can get away w/ $300/h cash only rates

That and I assure you around me, some people still get excited if you mention Harvard. Seems like the non-coastal areas have very real inferiority complexes. I try to fight it but I still get excited everytime I get to listen to Dr. Biederman talk.

 

[Monocles]

This is a different job(0.75FTE) in a different geographic location from the one posted before(1 FTE) so bonus options are different. The one posted before was a telepsychiatry job in a psychiatry department with residency/fellowship but they are unable to do telepsychiatry anymore so that option is non existent. This one is an FQHC and I will be required to provide telepsychiatry services to 13 small clinics under its umbrella. The work does not involve consultation. I will be carrying my own patient panel. The medical director is a family physician since they do not have psychiatrists. Malpractice is covered under the Federal Tort law for FQHCs.

Also, OP I completely screwed up. In a recent phone chat with the fidelity rep MGB had actually changed(?) their 100% vesting period to three years. So you were right to begin with, which makes job 2 an even worse deal than you had initially written.