I too am interested in hearing what is the trade off/ catch in the northern California Kaiser job market.Thanks.
One thing to keep in mind is that folks tend to use "Northern California" and "Bay Area" synonymously and they are really two entirely different entities. Since this job under discussion is actually about the
Bay Area:
Academics: UCSF and CPMC are the only games in town. Stanford and San Mateo as well, depending on your definitions of Bay Area. Typical academic lifestyle of over 40 hour weeks, 3/4 have "clinician educator" tracks where your duties are a combination of teaching and direct patient care. There are also tracks where you only provide direct services without involvement with the residents/medical students (in the case of Stanford and UCSF). Pay is poor, an actually less than many academic salaries I've heard in other locales (some of these gigs start at $150K/year), but it's offset by the ability to have a faculty practice in your office or a shared schedule office (though the university takes a cut). All are hiring, but it's dependent on what you want to do. Hiring is obviously competitive, but less so for the ones that are not academic-focused. Flexibility is key.
County: Varies a lot by county, but there are currently a lot of jobs. Pay isn't bad. SF and San Mateo are both starting at about $220K/year. These are county environments, we all know it, and some folks hate it and some folks love it. California county gigs tend to pay into CalPERS so one of the big benefits is a pension system that pays out pretty lucratively and is seen as one of the big strengths of these jobs (you don't have to hit 20 years to collect, the cliff is 5 years at the ones I interviewed with). Mental health budgets are tighter in NorCal as compared to LA and some other SoCal counties, which is counterintuitive to many of us. Lots of opportunities for jobs, particularly the further you get from SF.
VA: There are the main VA's in Palo Alto and San Francisco, both with tight affiliations with their medical schools/residency programs (Stanford and UCSF, respectively). This strong academic affiliation makes the care at these locations fairly high quality and as many-to-most of the physicians at these VAs are full-time academic appointments, your colleagues tend to be very academic minded and high quality. Patients tend to appreciate the care at these spots and staffing is... federal. Jobs are hard to come by at these two medical centers and competition tends to be pretty tight. Starting pay was very recently increased for new hires and now stands at about $200K/year. Good benefits, though the pension benefit was scaled back. Culturally the hours are pretty strictly regulated, which is helpful (e.g.: people tend to work 40 hour weeks, even with academic track). Outside of these two major medical centers, there are CBOCs, which are clinics and smaller regional locations spread around the Bay Area. At many of these places, there is no academic affiliation. Quality of physicians is extremely varied and quality of care is the same. Morale among patients tends to be lower. Jobs are much easier to come by.
Private Practice: A wide variety of gigs. If you are in SF or the Silicon Valley area, setting up your own shop immediately after residency is very possible and if you carefully select a couple of insurances, your practice will fill quickly. Folks have also done this with cash only practices, but this takes a while to fill. Folks I know how have done this tend to be UCSF grads in SF and I presume Stanford grads in the valley. Word of mouth is extremely important and many practicing docs will refer cash-only patients to previous grads from the home residency, as there is a measure of quality control there. For joining an established practice, the gigs vary widely and so do the quality. There are a couple that are always hiring that are known locally to be toxic, but folks coming from outside wouldn't. There are a couple that no one would have heard of that are choice places to work, but again, folks coming from outside wouldn't (this is another reason why location of residency is so helpful). In SF, there are several that will let you practice psychotherapy. I know of one currently interviewing that pays $275K and your panel is a mix of psychotherapy and medication management. This particular gig is made up of 75% UCSF grads though there are a few hires from east coast programs known to have good psychotherapy chops. Finding a private practice gig in the Bay Area is not hard, though the experience will vary widely (which I assume to be the case most places).
For
actual Northern California (north of the Bay Area): There are no true academic gigs. County gigs are the same as described above, though they are desperate for doctors and jobs are extremely plentiful (though with that desperation, I question what the work/life balance and quality of care might be at some of these gigs). VA gigs are all CBOC and jobs are more plentiful. The VA used to have a salary differential in which they were paying them MUCH more money for the remote areas that couldn't staff psychiatrists, though I don't know if that's still true. There is a dearth of private practices in NorCal and I've heard it's no problem setting up shop, particularly if you take MediCal (our Medicaid). Cash-only practices are likely not going to be feasible, at least not full-time, as most areas in Northern California are pretty economically depressed. There is also a shortage of psychiatrists, so the work is there.
