Job offer critiques

[MedMan80]

Both jobs in desirable city in Texas

#1. Outpatient practice, growing, TMS heavy. 250K base, 16-20 folks a day, opportunity for earning more for productivity or supervising mid-levels. Moving expenses paid, 3 week PTO, 6 month notice to vacate. No in person call, rotating tele call.

#2. Eating disorder work, mix of PHP and inpatient, 250-275K. Weekend call every few months paid quite low, retention bonuses at 3 and 12 months nice chunk of change, moving expenses, no real opportunity for productivity. 3 months notice to vacate. Close to 4.5 weeks PTO.

This metro seems somewhat saturated, although there are jobs. Staying away from the venture cap companies that are posing an existential threat to MDs, although their gigs definitely exist.

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[trophyhusband]

Both jobs in desirable city in Texas

#1. Outpatient practice, growing, TMS heavy. 250K base, 16-20 folks a day, opportunity for earning more for productivity or supervising mid-levels. Moving expenses paid, 3 week PTO, 6 month notice to vacate. No in person call, rotating tele call.

#2. Eating disorder work, mix of PHP and inpatient, 250-275K. Weekend call every few months paid quite low, retention bonuses at 3 and 12 months nice chunk of change, moving expenses, no real opportunity for productivity. 3 months notice to vacate. Close to 4.5 weeks PTO.

This metro seems somewhat saturated, although there are jobs. Staying away from the venture cap companies that are posing an existential threat to MDs, although their gigs definitely exist.

Having to wait 6 months to leave a position sounds horrible. Even 3 months is a long time but 6 is an eternity based on my wife's experience. One change in leadership can drag a place down in the blink of an eye.

Giving a retention bonus after 3 months? How bad is that job that they're rewarding you for making it past the 3 month mark?

The only desirable metro in Texas is Austin so if you're looking there yes it's extremely saturated. Mostly low paying and just all 'round bad jobs unless you get extremely lucky. Most of the wife's residency class tried to stay in the area. They've all moved away now.

 

[clozareal]

They're two completely different jobs. Without knowing anything about your career aspirations, personal goals, desires, it's hard to comment personally for you.

Someone who loves outpatient and never wants call would never take job #2. Someone who hates the ongoing care and responding to messages/calls from outpatients would never take job #1.

 

[littlefred]

6 months to vacate job better come with a hefty sign-on bonus (50k at least).

 

[MedMan80]

6 months to vacate job better come with a hefty sign-on bonus (50k at least).

WIll find out soon but my understanding is no sign on, I speculate they are having it this long because folks are leaving. Perhaps being poached by said venture cap company that is making inroads in the area.

Is it common to have high sign ons for desirable metro areas?

 

[MedMan80]

They're two completely different jobs. Without knowing anything about your career aspirations, personal goals, desires, it's hard to comment personally for you.

Someone who loves outpatient and never wants call would never take job #2. Someone who hates the ongoing care and responding to messages/calls from outpatients would never take job #1.

I'd like to throw my hat into PP after a few years of employed practice. Not wanting to start one right away. I am CAP but okay taking a break from it, #1 position is mostly adults.

 

[trophyhusband]

I'd like to throw my hat into PP after a few years of employed practice. Not wanting to start one right away. I am CAP but okay taking a break from it, #1 position is mostly adults.

If this is Austin you can look at Lonestar Circle of Care. Their OP CAP jobs didn't seem too terrible... but this was 5+ years ago. This was at the Round Rock clinic and it seemed like it was mostly (all?) Medicaid so YMMV.

 

[Stagg737]

#1 is absolute garbage unless there’s a significant productivity bonus. The academic center I’m at would pay well over $300k (closer to $450k) for that patient load before bonuses and that’s without any psychotherapy add ons. 6 month notice and only 3 weeks PTO are also red flags imo. Hard pass, run away.

#2 could be not good but reasonable depending on patient volume and other factors. The 3 month retention bonus is weird, but other basic stuff you posted sounds more reasonable but not great either. Are you tied to this metro? If this is what all the opportunities look like then you’re much better off elsewhere.

 

[MedMan80]

There's not much more than this available, alas yes somewhat tied to the area due to family obligations. This is DFW area if anyone has other leads.

 

[littlefred]

There's not much more than this available, alas yes somewhat tied to the area due to family obligations. This is DFW area if anyone has other leads.

Check out the Veterans hospital or UTSW. Probably around the same ball park in money.

 

[Stagg737]

There's not much more than this available, alas yes somewhat tied to the area due to family obligations. This is DFW area if anyone has other leads.

I've gotten some messages from recruiters and may have a colleague starting in the area (can't remember if she's in DFW or Houston). I'll DM you. Following message was from a recruiter late last year:

"Do you have a passion for providing cutting edge treatment options to your patients? Do you want to work in an environment that allows for flexibility and also provides you with top notch support? What if you could have access to all this, and earn over $500,000 annually??

Practice Highlights:

• Outpatient only - ZERO CALL
• Flexible scheduling
• 30 days paid time off annually
• New locations opening in Dallas, Houston, Austin, & San Antonio!"

Not sure if this is with a VC startup (sounds like it) or if it's even still available, but also sounds much better than what you're finding.

 

[jbomba]

20 outpatients a day would be like a million a year in Austin if taking the biggest payors.

 

[trophyhusband]

20 outpatients a day would be like a million a year in Austin if taking the biggest payors.

Last I heard all of the biggest payors made you take Medicaid as well so not really.

 

[jbomba]

Last I heard all of the biggest payors made you take Medicaid as well so not really.

Wait really? I currently take only blue cross and aetna. I havent seen a medicaid patient outside of residency, ever.

 

[trophyhusband]

Wait really? I currently take only blue cross and aetna. I havent seen a medicaid patient outside of residency, ever.

Are you in Austin? Maybe they've changed it since everyone was going cash only. Our contracting folks were only taking on Psychiatrists who also took our Medicaid plan and they said that's what all the other payors with MCO's were doing as well.

 

[sloh]

Having to wait 6 months to leave a position sounds horrible. Even 3 months is a long time but 6 is an eternity based on my wife's experience. One change in leadership can drag a place down in the blink of an eye.

Giving a retention bonus after 3 months? How bad is that job that they're rewarding you for making it past the 3 month mark?

The only desirable metro in Texas is Austin so if you're looking there yes it's extremely saturated. Mostly low paying and just all 'round bad jobs unless you get extremely lucky. Most of the wife's residency class tried to stay in the area. They've all moved away now.

Wow is this really true? I thought the psychiatry job market was better than that

 

[trophyhusband]

Wow is this really true? I thought the psychiatry job market was better than that

Austin job market is bad for almost every Physician specialty compared to the rest of Texas.

DFW is bad for Psychiatry jobs as well for different reasons but good for private practice.

 

[When is graduation again?]

I agree with others that the jobs aren't very good from a salary/workload perspective.

As far as job leads go, UTSW has a bunch of open positions on their employment site (Search Jobs at UT Southwestern Medical Center). Parkland has one opening (Staff Physician - Outpatient Psychiatrist). Metrocare has an opening if you're C&A. I didn't see any openings at the Dallas, VA, but the VA has some permanent remote positions you could apply for, but they start pay at about 225K, unfortunately.

 

[Candidate2017]

If you have to ask whether a job sucks... it sucks. Both of them.

Go make your own job. Meet other psychiatrists, recruiters, clinics and hospitals, and cobble a bunch of part time jobs together. Do telepsych to other higher paying Texas cities. Get a license in another state and do telepsych or do inperson coverage. Start a cash practice. Etc, etc, etc.

 

[MedMan80]

If you have to ask whether a job sucks... it sucks. Both of them.

Go make your own job. Meet other psychiatrists, recruiters, clinics and hospitals, and cobble a bunch of part time jobs together. Do telepsych to other higher paying Texas cities. Get a license in another state and do telepsych or do inperson coverage. Start a cash practice. Etc, etc, etc.

I always wonder what the tax implications of doing tele from a state with no tax to a state would tax would be

 

[MedMusic]

This seems like very low base pay for kind of high volume? Is typically or are salaries coming down? I recall reading about much higher base with fewer volume on here over the past few years...

 

[littlefred]

I always wonder what the tax implications of doing tele from a state with no tax to a state would tax would be

You pay the taxes for the state you live in.

 

[DOhustle]

#1 is absolute garbage unless there’s a significant productivity bonus. The academic center I’m at would pay well over $300k (closer to $450k) for that patient load before bonuses and that’s without any psychotherapy add ons. 6 month notice and only 3 weeks PTO are also red flags imo. Hard pass, run away.

#2 could be not good but reasonable depending on patient volume and other factors. The 3 month retention bonus is weird, but other basic stuff you posted sounds more reasonable but not great either. Are you tied to this metro? If this is what all the opportunities look like then you’re much better off elsewhere.

Wow what city/region is academia paying that much? That sounds amazing.

 

[Stagg737]

Wow what city/region is academia paying that much? That sounds amazing.

It's really not though. If you do the math then 18 pts/day billing only 99214 is 34.5 wRVU per day. OP said the position was 3 weeks PTO so that's almost 8,500 wRVU per year billing straight 99214s. Even if there's a decent number of no-shows, you can lose 20% of that productivity and still be clearing 6,000 wRVU per year which should put you well over $300k per year in any setting.

 

[Merovinge]

My only advice is if you are just finishing CAP fellowship and want to see kids in the future definitely do not take a mostly adult job. The demand for CAP exceeds adult psych virtually everywhere, it would astonish me if you are not able to find a place to see kids. It doesn't have to be 100% of your day, but I would try to see at least like 1/2 kids to cement in your subspecialty expertise.

 

[mistafab]

If you're cap, you should either work less or be paid more than gen psych. Possibly both.

The face value of these jobs is terrible.

 

[AtlasCarraway]

Both of those are very low. I'm employed CAP in DFW and going to PM you.

 

[Stagg737]

Wow what city/region is academia paying that much? That sounds amazing.

To actually answer your question, midwest. DM if you want specific city or institution.

 

[annoyedpsychiatrist]

Both jobs in desirable city in Texas

#1. Outpatient practice, growing, TMS heavy. 250K base, 16-20 folks a day, opportunity for earning more for productivity or supervising mid-levels. Moving expenses paid, 3 week PTO, 6 month notice to vacate. No in person call, rotating tele call.

#2. Eating disorder work, mix of PHP and inpatient, 250-275K. Weekend call every few months paid quite low, retention bonuses at 3 and 12 months nice chunk of change, moving expenses, no real opportunity for productivity. 3 months notice to vacate. Close to 4.5 weeks PTO.

This metro seems somewhat saturated, although there are jobs. Staying away from the venture cap companies that are posing an existential threat to MDs, although their gigs definitely exist.

250k is low in general, 250k for 20 patients a day is pretty terrible imo. 6 month notice to vacate means your locked in for a while, and may limit changing to a new job. What if a new job doesnt want to wait 6 months for you to start? And you have to do call too? No thank you Week PTO as well. overall below average gig.

 

[Sushirolls]

I had a 90 or it was 120 day notice with one Big Box shop job in past. Never again.
60 days or less.

 

[PsyDr]

I’m super confused by the patient hour differences in the private practice thread and the patient hours in your job offer threads. Both discuss similar pay, while the PP guys are working 25-35% less despite overhead.

 

[clausewitz2]

I’m super confused by the patient hour differences in the private practice thread and the patient hours in your job offer threads. Both discuss similar pay, while the PP guys are working 25-35% less despite overhead.

There is a reason why such a huge percentage of our specialty is in private practice.

 

[Sushirolls]

I’m super confused by the patient hour differences in the private practice thread and the patient hours in your job offer threads. Both discuss similar pay, while the PP guys are working 25-35% less despite overhead.

Big Box Shops have bloat and Bureacracy. Hospital Admin gets big pay.
Poor admin policies and work culture fuel law suits from all ranks.
How do you think they pay those admin and internal (and even external lawyers!)?
Being "non-profits" with minimal taxes isn't even enough of a competitive advantage... pay people less, and then with the umph of "Fair Market Value" rules in bedded in CMS, use it to constrain wages.

 

[MedMan80]

Basically the job market in this area is less than ideal, PP excepting… I’ve had people reach out with ideas and I greatly appreciate that.

 

[Celexa]

#1 sounds terrible and it's hard to evaluate #2 without knowing a lot more about the quality of support staff, therapists, etc and how much patient facing time it actually ends up being. That kind of description could end up being a pretty sweet gig with reasonable hours and time to start building a private pracrice to utter overwork insanity and it's impossible to say with the info given.

 

[FlowRate]

I’m super confused by the patient hour differences in the private practice thread and the patient hours in your job offer threads. Both discuss similar pay, while the PP guys are working 25-35% less despite overhead.

Solo PP/small group PP patients are probably healthier and often the goal is to take only the best/highest reimbursing insurers in the area. Probably not taking medicaid. That's if insurance is taken at all. Generally more lucrative patient population.

Then there's the risk/variation piece. It's like investing. More risk = more reward. But also more potential for downside. Employment is extremely safe from day 1. Guaranteed returns. There's no guarantee insurers will pay good rates or play fair or that you'll fill with patients willing to give you $$$ per hour.

I'd imagine the same thing applies to being an employed vs PP psychologist?

 

[PsyDr]

I'd imagine the same thing applies to being an employed vs PP psychologist?

No idea. I have a HIGHLY atypical career. Clinical work is more of a charitable hobby than anything else.