Job thoughts

[WVpsych]

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Hello all,
Fresh CAP grad
Suburbs of a major MW city
IPU (up to 4), PHP/IOP, and OP simultaneously. OP and PHP are at my own pace. OP can be virtual.
The first two years guaranteed 275k with no cap on earning based on a wRVU model (34 clinical hours are required)
The wrvu model is tiered (from high 50's to 63 if you hit 4950 wrvu )
Sign-on bonus
You get 4 weeks PTO, 1 week CME (3500$), and a 401k match.
Call is 1:7 weekend/weekday.

Is it fair? Things I need to negotiate? If not, what should I expect as a fresh grad?

 

[Monocles]

IPU (up to 4), PHP/IOP, and OP simultaneously. OP and PHP are at my own pace. OP can be virtual.

Should have them set specific criteria for the PHP/IOP/OP part. What's the expected # of cases seen, etc. The 4 inpts seem very reasonable. Other than that...

The salary looks reasonable but if that's their opening offer you should always try to squeeze them more and see if you can get $300k.

Also no graduating CAP should be taking call in this market lmao. Negotiate out of that ASAP.

How much sign on bonus and what % 401k match?

 

[WVpsych]

The call is non-negotiable for sure. From what I understand it is not hectic, 12 IPU and then ED staffing, but who knows?
25K and 4%.
From what I understand, they want 34 clinical hours, so there is no set number. They expect you to work to earn more. Current providers range from 5000-8000 wrvu . Idk how easy or reasonable it is to get to 6000 wrvu for example.

 

[TexasPhysician]

I don’t like these types of jobs that expect you to do everything. If you have a rough call day, you are still managing 4 treatment levels of care. That sucks. If there isn’t caps in place, it’s a quick road to burnout. I get they are saying that they are at your own pace, but then you are managing a complicated schedule. I’d rather keep it simple.

I’d ask to eliminate call and do no inpatient, or I’d want all inpatient and leave when I’m done.

People that have the intensity to do inpatient, IOP, and OP probably make the most money of any type of psychiatry. The care may not be ideal, but this is $500k/year work.

 

[Merovinge]

Hello all,
Fresh CAP grad
Suburbs of a major MW city
IPU (up to 4), PHP/IOP, and OP simultaneously. OP and PHP are at my own pace. OP can be virtual.
The first two years guaranteed 275k with no cap on earning based on a wRVU model (34 clinical hours are required)
The wrvu model is tiered (from high 50's to 63 if you hit 4950 wrvu )
Sign-on bonus
You get 4 weeks PTO, 1 week CME (3500$), and a 401k match.
Call is 1:7 weekend/weekday.

Is it fair? Things I need to negotiate? If not, what should I expect as a fresh grad?

This is near identical to the offer of one of the major systems in my MW city. This system is not known for providing great psychiatric care because they are understaffed and use docs on heavy RVU based incentives that lead to some of the psychiatrists have neurosurgeon equivalent RVUs (this should be a huge red flag). It's actually a very different thing to provide IP, PHP, IOP, or OP care, and I think as a new grad depending on your experience thus far it may make it difficult to get expertise in any of the levels of care. If you consider yourself a real bard and want to grind hard you could do worse than this for a few years to get a diverse set of experience. I am not a huge call fan but if you are young and don't mind, this is pretty par for the course for big box shop offers.

 

[NickNaylor]

Like @TexasPhysician, the prospect of covering 3 service lines sounds stressful to me. What happens if there's some kind of emergency on the inpatient unit while you're doing your PHP/outpatient work? And what does doing PHP/outpatient work "at your own pace" mean? That sounds nice but ultimately hollow, unless there are no explicit expectations of PHP/outpatient productivity in your contract beyond the the 34 hours of "clinical time" that they expect you to have each week.

What happens after the 2 years as far as your compensation goes? Do you switch to an all-productivity model? If that's the case, do you have enough information about the size of the practice to ensure that your compensation will stay relatively stable?

You mentioned that the low-end of productivity is 5000 RVUs/year. Assuming 48 weeks of work (if you use your PTO), that's about 100 RVUs/week or 20 RVUs/day. For run-of-the-mill assessments and follow-ups, that's a good number of patients a day... probably at least 10 on average, and definitely more for the 8000 RVUs/year. Does that sound it worth it to you for the salary?

The 401k match sounds low but I doubt that there's much you can negotiate as far as that goes. Even at the atrocious employer that was the county hospital I was at during residency, we had a 6% match.

Obviously you're going to be in a better position to evaluate the situation, but the compensation seems low for the amount of work that I imagine this job being.

 

[calvnandhobbs68]

Yeah I’d max it out on 2 different settings. Like inpatient/outpatient or inpatient/PHP. If you’re only covering 4 patients on the inpatient unit what’s probably happening is that they don’t need a full FTE for the inpatient unit but they also need someone to pick up these patients.

With only 4 patients you’re covering, unlikely too many crazy things are gonna happen on a child inpatient unit (I know attendings who would definitely round on more patients than that in the morning and peace out in the afternoon for clinic/PP) but you have to expect that could happen sometimes as noted above. Also really matters how independent your nursing staff is so they aren’t paging you in clinic every time Johnny needs Tylenol or something.

Just know there are definitely pure outpatient, pure inpatient or pure PHP/IOP jobs that pay just as much as this. So you should be working much less at each of these jobs individually than typical for the same pay. This matters in terms of defining what exactly you’re expected to do in PHP or outpatient…you’ll want to lay that out as specifically as possible.

For call are you saying 1:7 days or weeks (so you take call every 1:7 days or 1:7 weeks)? Cause that makes a huge difference.

 

[rjs2131]

Agree with others that this call sounds excessive (if I'm understanding it correctly as 1/7 weekends)...that salary should correspond to full-time outpatient CAP work with no call/weekends, so if you're doing some mix of things/more than that the salary should reflect that.

The other important thing to figure out - wRVU equivalent for certain codes and how much time you have for new patients/follow-ups. 34 hours of patients/week looks very different if we're talking 20 min follow-ups vs 30-min follow-ups. If you're not allowed to use 90833 add-on codes that will also significantly change how many wRVU's you can produce. I'd definitely have a good understanding of this before jumping in.