Leveraging an offer

[mypointlesspov]

The details (with a few minor changes to hide my identity):

• 1.5 years licensed
• 1.5 years at a group PP, therapy only and a specialized DEI role that requires 0-2 hours per week
• Fee for service split is 55% which I know is traditionally low, but I have full admin support and I do get a stipend for health insurance and 401k addition. I thought this was good at the time but now I'm not so sure? Last year I pulled about $115K (including a bonus) but live in a *very* high COL area.
• Averaging 15-16 clients/week at group PP this year, but I'd like a caseload of 22-25 scheduled weekly to account for cancels/no shows.
• Not getting enough consistent referrals at group pp despite a 150+ long waiting list which is causing financial distress (especially with student loan repayments starting again soon).
• Boss just recommended me for a special program and I think I have a good shot at it.
• Submitted a CV on a whim the other day, had a hn and got an offer for a job at a major regional hospital
• Salaried at $125k, health/vision/dental, PTO/paid holidays. No 401k but some other great benefits
• Caseload would be 6-7/day, groups, and testing. Not sure how this would balance out. I asked, but was told that the hospital would be in charge of my schedule. The person I spoke to said the person exiting the role found it manageable.
• The job isn't officially with the hospital and I'd be an employee of the staffing agency which has a contract with the hospital.
• I like my job a lot and don't really want to leave, but I am so stressed about finances half the time that I'm worried it might impact the quality of services I can provide.

My questions:

1. Have people successfully leveraged salaried offers into higher fee-for-service rates? If so, how can I broach this with my boss? I like him a lot and feel guilty about this (even though I would totally tell someone in my position not to feel guilty)
2. Is 55% a good fee split with the benefits I mentioned?
3. Has anyone worked with a staffing agency as a semi-contractor in this way?
4. How do people manage 30+ clients per week?? I feel like 25 is my upper limit, but I'm willing to be flexible in exchange for the stability of a salary.
5. Has anyone ever gone from the flexibility of a PP to a 40 hr/week organizational/agency job? If so, what was that transition like? I feel like I'm kind of moving in the opposite direction as most.

Thanks in advance.

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[PsyDr]

1) Yes. " I bring in around $170k/yr of business, and like working for you. I have an offer that increases my income by ~20%. My student loans are coming due this year. Can we do anything to bring my income in line with the market rates? I am open to nontraditional options." (Remember that the law changed, and employers can now pay off student loans as a tax free benefit)
2) No. That's like $60k in passive profit. The admin support is a non-issue. If I added 5 psychologists to my practice, I wouldn't have to hire any additional support staff. 401k may be legally required, as some set ups require you to offer that to all employees if the employer has a 401k through the company.
3) Never did it.
4) That's not hard. You run into issues with your working memory, but overcome that with charting well.
5) Not my thing

 

[summerbabe]

I haven’t personally done this but was thinking about a couple of things:
- Can you apply to more positions, especially ones that are direct with hospitals/orgs or other other PP opportunities since you’re in a high CoL area and may not know the full extent of what might be out there for PhDs? Especially if you’re not desperate to leave your current spot.
- One thing I like about working for the VA is consultation with peers, team meetings that are clinically focused, and access to resources. Is that a draw and would you have access to that as a contractor?
- My limit to max # of sessions where I can be 100% engaged versus max # of sessions where I’m merely present is very different. I have a salaried VA role where I am working with a more challenging/higher risk population but at lower quantity than typical outpatient roles and that’s a great fit for me and contributes to my intrinsic job satisfaction. Would this hospital role include work you like/dislike, patients that contribute more/less to burnout, etc? For me, those factors might be just as important as the patients booked/RVU expectations.

Good luck!

 

[AcronymAllergy]

The details (with a few minor changes to hide my identity):

• 1.5 years licensed
• 1.5 years at a group PP, therapy only and a specialized DEI role that requires 0-2 hours per week
• Fee for service split is 55% which I know is traditionally low, but I have full admin support and I do get a stipend for health insurance and 401k addition. I thought this was good at the time but now I'm not so sure? Last year I pulled about $115K (including a bonus) but live in a *very* high COL area.
• Averaging 15-16 clients/week at group PP this year, but I'd like a caseload of 22-25 scheduled weekly to account for cancels/no shows.
• Not getting enough consistent referrals at group pp despite a 150+ long waiting list which is causing financial distress (especially with student loan repayments starting again soon).
• Boss just recommended me for a special program and I think I have a good shot at it.
• Submitted a CV on a whim the other day, had a hn and got an offer for a job at a major regional hospital
• Salaried at $125k, health/vision/dental, PTO/paid holidays. No 401k but some other great benefits
• Caseload would be 6-7/day, groups, and testing. Not sure how this would balance out. I asked, but was told that the hospital would be in charge of my schedule. The person I spoke to said the person exiting the role found it manageable.
• The job isn't officially with the hospital and I'd be an employee of the staffing agency which has a contract with the hospital.
• I like my job a lot and don't really want to leave, but I am so stressed about finances half the time that I'm worried it might impact the quality of services I can provide.

My questions:

1. Have people successfully leveraged salaried offers into higher fee-for-service rates? If so, how can I broach this with my boss? I like him a lot and feel guilty about this (even though I would totally tell someone in my position not to feel guilty)
2. Is 55% a good fee split with the benefits I mentioned?
3. Has anyone worked with a staffing agency as a semi-contractor in this way?
4. How do people manage 30+ clients per week?? I feel like 25 is my upper limit, but I'm willing to be flexible in exchange for the stability of a salary.
5. Has anyone ever gone from the flexibility of a PP to a 40 hr/week organizational/agency job? If so, what was that transition like? I feel like I'm kind of moving in the opposite direction as most.

Thanks in advance.

I'd second everything PsyDr said. As well as summerbabe's thoughts and questions.

It's hard to definitively say if 55% is a reasonable split without actually knowing the practice's expenses, but my knee-jerk is that giving up 45% would typically cover a lot of admin and other support (and profit). Unless it's a small practice, their rent is ridiculous, and they've over-hired their non-revenue generating staff. The split seems like the best area to potentially target for negotiation, but like PsyDr mentioned, maybe the owner will have other equally-agreeable ideas.

You know the number you're targeting (i.e., $125k or more), and can probably ballpark what you're bringing in to the practice vs. what they're paying you. This should allow you to have an idea of the % split that gets you where you want to be. Maybe they're willing to do some sort of variable % that increases after some base amount is met.

I've not worked as a semi-contractor in that way. I wouldn't really balk at being employed by a group of healthcare providers that contracts with a hospital (physicians do this all the time, I'm pretty sure). But being employed by a staffing agency for some reason strikes me as less-desirable. If the hospital system starts losing revenue and needs to make cuts, you might be the first to go, regardless of how long you've been there.

 

[Sanman]

A few thoughts:
1. The staffing company job may increase your salary, but decrease your hourly as they will nearly double your clinical hours for $10k. Benefits sound similar.

2. Staffing companies and contractors may or may not be stable. I worked in a contracting company and often contracts ended because of the competition. We won some and lost others. Either way, it can be chaotic in the longer term.

3. You can only push the envelope so far before it is cheaper to replace you. You don't know where that line is with your boss, so be prepared to walk if you do this.

4. I have not heard what you want to do or if you have actively looked for other better paying options.

5. Negotiating out of desperation puts you at a disadvantage. Do you have your bills covered if this goes sideways?

6. If your boss asks "what do you want?" You should have a reasonable answer.

 

[PsyDr]

1) Like a lot of corporate medicine, the staffing agency job is only secure until some bean counter starts thinking there is a cheaper option.

2) Some low cost things I would ask for (but not all):

a. Show boss that he can now pay your student loans as a tax free business deduction. Ask for $5k/yr in student loan repayments. I would also point out that this is a long term move.

b. Point out that part of the split is the use of admin staff. Ask if you can select 5 pts a week from the wait list, and direct staff to schedule them to meet your goal of 22 pts/week (this is a non-issue, as it will increase boss' income. Plus he/she can't argue about this, as you are already paying for staff).

c. Request a general schedule of 4 days/week, 10hrs/day, with the understanding that you may have to come in for busy days. Hint that you'd be around more if staff would schedule you.

d. Restructure the deal. Ask to stop the bonus, and substitute for a bigger percentage after X number of billable hours. Bonuses are taxed to hell. You're essentially asking him/her to move your bonus money from one financial column to another. This move cost him/her nothing. "Can we restructure our agreement so that I get 80% of receivables after the first 10 months? This basically moves my bonus money into income instead of paying 40% tax on a bonus."

e. Look around, see if he/she gets their cell phone bill at the office. If so, ask for a cell phone stipend. "I'd really like to make this a longer term arrangement. I am having trouble with my bills and student loans. I noticed you used your business to pay for your cell phone. Can I get a line as part of my compensation?"

3) Tell the hospital staffing company that you'd feel better if the offer was $10k/yr more. Or whatever number is too good to pass up. At least you'd feel great about whatever decision you make.

 

[WisNeuro]

1) Like a lot of corporate medicine, the staffing agency job is only secure until some bean counter starts thinking there is a cheaper option.

2) Some low cost things I would ask for (but not all):

a. Show boss that he can now pay your student loans as a tax free business deduction. Ask for $5k/yr in student loan repayments. I would also point out that this is a long term move.

b. Point out that part of the split is the use of admin staff. Ask if you can select 5 pts a week from the wait list, and direct staff to schedule them to meet your goal of 22 pts/week (this is a non-issue, as it will increase boss' income. Plus he/she can't argue about this, as you are already paying for staff).

c. Request a general schedule of 4 days/week, 10hrs/day, with the understanding that you may have to come in for busy days. Hint that you'd be around more if staff would schedule you.

d. Restructure the deal. Ask to stop the bonus, and substitute for a bigger percentage after X number of billable hours. Bonuses are taxed to hell. You're essentially asking him/her to move your bonus money from one financial column to another. This move cost him/her nothing. "Can we restructure our agreement so that I get 80% of receivables after the first 10 months? This basically moves my bonus money into income instead of paying 40% tax on a bonus."

e. Look around, see if he/she gets their cell phone bill at the office. If so, ask for a cell phone stipend. "I'd really like to make this a longer term arrangement. I am having trouble with my bills and student loans. I noticed you used your business to pay for your cell phone. Can I get a line as part of my compensation?"

3) Tell the hospital staffing company that you'd feel better if the offer was $10k/yr more. Or whatever number is too good to pass up. At least you'd feel great about whatever decision you make.

Definitely ask the hospital about more money, I pretty easily got a five figure boost to the initial offer just by asking for my last hospital position. You already have a job, so it's not like you're risking all that much.

 

[mypointlesspov]

Oh wow, I feel like a bunch of heavy hitters of this forum responded to this post. Thank you all so much!

I'm gonna try to provide as much detail as possible without giving myself away too much. First of all, it's great to know that employers can provide student loan repayment. I vaguely remember reading something about that a few months ago, but brushed it off assuming I wouldn't qualify for one reason or another.

I haven’t personally done this but was thinking about a couple of things:
- Can you apply to more positions, especially ones that are direct with hospitals/orgs or other other PP opportunities since you’re in a high CoL area and may not know the full extent of what might be out there for PhDs? Especially if you’re not desperate to leave your current spot.
- One thing I like about working for the VA is consultation with peers, team meetings that are clinically focused, and access to resources. Is that a draw and would you have access to that as a contractor?
- My limit to max # of sessions where I can be 100% engaged versus max # of sessions where I’m merely present is very different. I have a salaried VA role where I am working with a more challenging/higher risk population but at lower quantity than typical outpatient roles and that’s a great fit for me and contributes to my intrinsic job satisfaction. Would this hospital role include work you like/dislike, patients that contribute more/less to burnout, etc? For me, those factors might be just as important as the patients booked/RVU expectations.

Good luck!

To answer your questions. I can definitely apply to more positions. I've been keeping an eye out on hospitals and fed jobs in the area. I'm trying to avoid moving to another PP because I realize I prefer the stability of a salaried position, but I am open to going to another one if they offer a substantial pay bump and better benefits. I also really miss having PTO which is a big draw.

Per the person I spoke to this morning, supervision/consultation would be available from other psychologists at the hospital. She specifically mentioned that I would be doing a lot of work for with anxiety and trauma (my specialities) and the population is military families/kids. I need to get more clarification about what the expectation would be in terms of productivity (e.g. am I expected to schedule 30 or actually see 30), but at least I'd be seeing people who I feel highly competent treating.

But being employed by a staffing agency for some reason strikes me as less-desirable. If the hospital system starts losing revenue and needs to make cuts, you might be the first to go, regardless of how long you've been there.

This is one of my big concerns. I think the same (or a very similar) job posting is on USAJobs so I might just decline the offer I received today and apply through the "official" channels.

A few thoughts:
1. The staffing company job may increase your salary, but decrease your hourly as they will nearly double your clinical hours for $10k. Benefits sound similar.

2. Staffing companies and contractors may or may not be stable. I worked in a contracting company and often contracts ended because of the competition. We won some and lost others. Either way, it can be chaotic in the longer term.

3. You can only push the envelope so far before it is cheaper to replace you. You don't know where that line is with your boss, so be prepared to walk if you do this.

4. I have not heard what you want to do or if you have actively looked for other better paying options.

5. Negotiating out of desperation puts you at a disadvantage. Do you have your bills covered if this goes sideways?

6. If your boss asks "what do you want?" You should have a reasonable answer.

Yeah... the hourly rate per client comes out to like $86 which is... not great lol. The benefits at the hospital are definitely better though. I'll have an actual health insurance plan through the job which is a big draw instead of getting a stipend and having to go through the incredibly expensive exchange. I also get a transit stipend, PTO/paid holidays, and a few other things that seem nice.

My boss is working hard to hire people, so I don't think he'd let me go unless something egregious happened. Worst case, I'll be okay if things don't go as planned and I think I could pivot to another PP in the area since I have good relationships with people around here.

Let's say my hourly rate was in the ballpark of $130, would it be reasonable to ask for $140 or even $145? I am due for a raise in Sept when my contract renews, so I'm wondering if he'd be open to doing that and increasing my healthcare stipend sooner. One thing my boss alluded to awhile ago is that compensation goes by senority, so I'm concerned that he'll say he "can't" raise my rate that much because it'll be more than other people who have been there longer than me. My split is 55% but I've only seen three (out of about 50) indeed listings with rates that go higher. I remember being speechless when my now-boss gave me my initial offer because I didn't expect to make that much right out of postdoc in a pure therapy position.

 

[mypointlesspov]

1) Like a lot of corporate medicine, the staffing agency job is only secure until some bean counter starts thinking there is a cheaper option.

2) Some low cost things I would ask for (but not all):

a. Show boss that he can now pay your student loans as a tax free business deduction. Ask for $5k/yr in student loan repayments. I would also point out that this is a long term move.

b. Point out that part of the split is the use of admin staff. Ask if you can select 5 pts a week from the wait list, and direct staff to schedule them to meet your goal of 22 pts/week (this is a non-issue, as it will increase boss' income. Plus he/she can't argue about this, as you are already paying for staff).

c. Request a general schedule of 4 days/week, 10hrs/day, with the understanding that you may have to come in for busy days. Hint that you'd be around more if staff would schedule you.

d. Restructure the deal. Ask to stop the bonus, and substitute for a bigger percentage after X number of billable hours. Bonuses are taxed to hell. You're essentially asking him/her to move your bonus money from one financial column to another. This move cost him/her nothing. "Can we restructure our agreement so that I get 80% of receivables after the first 10 months? This basically moves my bonus money into income instead of paying 40% tax on a bonus."

e. Look around, see if he/she gets their cell phone bill at the office. If so, ask for a cell phone stipend. "I'd really like to make this a longer term arrangement. I am having trouble with my bills and student loans. I noticed you used your business to pay for your cell phone. Can I get a line as part of my compensation?"

3) Tell the hospital staffing company that you'd feel better if the offer was $10k/yr more. Or whatever number is too good to pass up. At least you'd feel great about whatever decision you make.

At this point I think I'll say no to the staffing agency and apply via USAJobs while continuing to keep my eyes peeled for other positions.

I do have free access to the waitlist and have requested specific cases in the past. The issue is that the waitlist is 85% people who want/need afternoon and evening availability. My afternoons are PACKED and I work until 6:00 three evenings, but my mornings tend to be really slow. And since I specialized in treating kids, my colleagues who only see 18+ kind of get priority for the adult cases (who are more likely to have flexibility to meet during the day).

I do have a hybrid situation now. I'm actually one of only a handful who come into the office at all. Usually it's just me, my boss, and one other. I love the flexibility I have with this job and am torn between sacrificing that for the sake of a regular paycheck/benefits.

What do you mean by 80% of receiveables? I'm honestly not very savvy when it comes to the business side of things (which is why solo PP is *definitely* out of the question for me). Also, I looked at my tax documents and it doesn't look like my bonus was taxed at 40%... much less, actually.

I do usually check the mail at the office, but I've never seen a cellphone bill. Do you have any other sugggestions for additional forms of compensation? I'm thinking of asking for a desktop for my office because all I have to use there are my clunky 10 year old laptop or my iPad.

Definitely ask the hospital about more money, I pretty easily got a five figure boost to the initial offer just by asking for my last hospital position. You already have a job, so it's not like you're risking all that much.

I spoke to a friend about this earlier and I'm thinking of asking for $140k juuuuuuuuuuuuuuuuuust to see what happens.

 

[WisNeuro]

I spoke to a friend about this earlier and I'm thinking of asking for $140k juuuuuuuuuuuuuuuuuust to see what happens.

No reason not to.

 

[Sanman]

Oh wow, I feel like a bunch of heavy hitters of this forum responded to this post. Thank you all so much!

I'm gonna try to provide as much detail as possible without giving myself away too much. First of all, it's great to know that employers can provide student loan repayment. I vaguely remember reading something about that a few months ago, but brushed it off assuming I wouldn't qualify for one reason or another.

To answer your questions. I can definitely apply to more positions. I've been keeping an eye out on hospitals and fed jobs in the area. I'm trying to avoid moving to another PP because I realize I prefer the stability of a salaried position, but I am open to going to another one if they offer a substantial pay bump and better benefits. I also really miss having PTO which is a big draw.

So, why renegotiate if you really want a salaried position?

Per the person I spoke to this morning, supervision/consultation would be available from other psychologists at the hospital. She specifically mentioned that I would be doing a lot of work for with anxiety and trauma (my specialities) and the population is military families/kids. I need to get more clarification about what the expectation would be in terms of productivity (e.g. am I expected to schedule 30 or actually see 30), but at least I'd be seeing people who I feel highly competent treating.


This is one of my big concerns. I think the same (or a very similar) job posting is on USAJobs so I might just decline the offer I received today and apply through the "official" channels.


Yeah... the hourly rate per client comes out to like $86 which is... not great lol. The benefits at the hospital are definitely better though. I'll have an actual health insurance plan through the job which is a big draw instead of getting a stipend and having to go through the incredibly expensive exchange. I also get a transit stipend, PTO/paid holidays, and a few other things that seem nice.

My boss is working hard to hire people, so I don't think he'd let me go unless something egregious happened. Worst case, I'll be okay if things don't go as planned and I think I could pivot to another PP in the area since I have good relationships with people around here.

He may not let you go. However, if he says no and you stay I would not expect a lot of goodwill in the future. Why bother as you are a) job hunting and b) not willing to leave if your negotiation fails.

Let's say my hourly rate was in the ballpark of $130, would it be reasonable to ask for $140 or even $145? I am due for a raise in Sept when my contract renews, so I'm wondering if he'd be open to doing that and increasing my healthcare stipend sooner. One thing my boss alluded to awhile ago is that compensation goes by senority, so I'm concerned that he'll say he "can't" raise my rate that much because it'll be more than other people who have been there longer than me. My split is 55% but I've only seen three (out of about 50) indeed listings with rates that go higher. I remember being speechless when my now-boss gave me my initial offer because I didn't expect to make that much right out of postdoc in a pure therapy position.

What is the billable medicare rate for the services you provide over a week? If it is significantly lower or higher, you know how much or how little there likely is in the budget.

 

[smalltownpsych]

Make those kids come in during business hours. Half these kids are on IEPs and the school needs to be able to work around the need for treatment. There are also half days and before school slots. Having a kid on a waitlist for treatment because it’s more convenient is not something I would support. If a kid needs my help, that parent better get them in sooner rather than later. Sometimes we are too accommodating or understanding. Dentists and doctors aren’t. It is funny that my interns will schedule people after 5:00 and I don’t. My schedule is full all day long. I actually think that we end up less productive when we don’t have firm boundaries and expectations.

 

[mypointlesspov]

Make those kids come in during business hours. Half these kids are on IEPs and the school needs to be able to work around the need for treatment. There are also half days and before school slots. Having a kid on a waitlist for treatment because it’s more convenient is not something I would support. If a kid needs my help, that parent better get them in sooner rather than later. Sometimes we are too accommodating or understanding. Dentists and doctors aren’t. It is funny that my interns will schedule people after 5:00 and I don’t. My schedule is full all day long. I actually think that we end up less productive when we don’t have firm boundaries and expectations.

I definitely agree, but easier said than done. I do have some child clients who come in during the day (especially those who are looking for a specific type of tx I provide), but scrolling through the wait list I see so many people who insist on 3:00 pm on. Even those who I see during the day are always asking me when they can switch to after school. I make it clear that I'm booked solid during those times.

We actually had to close our afternoon waiting list for a few months last year because it was getting so long. There are people who (according to the notes on the sheet) have had their kids remain on the list (they have check ins ever four months) for nearly two years waiting for a 5:00 pm or later appointment. The Practice Manager really tries, but parents are insistent even when the schools are accommodating.

 

[mypointlesspov]

So, why renegotiate if you really want a salaried position?

He may not let you go. However, if he says no and you stay I would not expect a lot of goodwill in the future. Why bother as you are a) job hunting and b) not willing to leave if your negotiation fails.


What is the billable medicare rate for the services you provide over a week? If it is significantly lower or higher, you know how much or how little there likely is in the budget.

I'd like more money to make up for the instability in clients, especially as the summer approaches and clients/families are taking long term vacations, going to camp in non psypact states, etc. A higher hourly rate can let me relax a little more when I have a week with a lot of cancellations.

If I move to a new job, then I'd want to move to something salaried so I don't have to worry about rebuilding a case load/have stability off the bat.

The billable Medicare rate is about $109. The practice I work for is private pay only.

 

[Sanman]

I'd like more money to make up for the instability in clients, especially as the summer approaches and clients/families are taking long term vacations, going to camp in non psypact states, etc. A higher hourly rate can let me relax a little more when I have a week with a lot of cancellations.

If I move to a new job, then I'd want to move to something salaried so I don't have to worry about rebuilding a case load/have stability off the bat.

The billable Medicare rate is about $109. The practice I work for is private pay only.

If it is private pay only then you should know exactly what you bill out for and what you take in.

Sounds like the limitation is more on the client end than the practice end. That can just be part of the business. You may have to change hours if you want more work. I used to work noon till 10pm in private practice to make more money. Up to you what you want to do, but this part may be more on you of there is office space for you to work later.

As far as salary vs higher hourly rate, decide what you want before you approach your boss. Nothing will piss your boss off more than giving you everything you ask for and you leaving for a salaried job a month later.

 

[PsyDr]

At this point I think I'll say no to the staffing agency and apply via USAJobs while continuing to keep my eyes peeled for other positions.

I do have free access to the waitlist and have requested specific cases in the past. The issue is that the waitlist is 85% people who want/need afternoon and evening availability. My afternoons are PACKED and I work until 6:00 three evenings, but my mornings tend to be really slow. And since I specialized in treating kids, my colleagues who only see 18+ kind of get priority for the adult cases (who are more likely to have flexibility to meet during the day).

I do have a hybrid situation now. I'm actually one of only a handful who come into the office at all. Usually it's just me, my boss, and one other. I love the flexibility I have with this job and am torn between sacrificing that for the sake of a regular paycheck/benefits.

What do you mean by 80% of receiveables? I'm honestly not very savvy when it comes to the business side of things (which is why solo PP is *definitely* out of the question for me). Also, I looked at my tax documents and it doesn't look like my bonus was taxed at 40%... much less, actually.

I do usually check the mail at the office, but I've never seen a cellphone bill. Do you have any other sugggestions for additional forms of compensation? I'm thinking of asking for a desktop for my office because all I have to use there are my clunky 10 year old laptop or my iPad.



I spoke to a friend about this earlier and I'm thinking of asking for $140k juuuuuuuuuuuuuuuuuust to see what happens.

1) Do NOT reject the offer, until AFTER you have asked for a raise. What you are proposing to do... it's reckless self disclosure. At minimum, you want to use the job offer to get a bit more from your current employer. Ask for 60/40. Explain the deal to him/her. People are usually pretty reasonable. "Hey I got offered more money, can you match that?". Medium risk, you ask the staffing job for $140k citing the Sweet survey, and get a huge raise for a job you're only kinda into. If you super duper hate the staffing job, you throw a hail mary, ask for $200k. If they accept, you tell yourself you'd be crazy not to take it. If they tell you know, you're reassured that at least you tried. Plus you've skewed the data for the future staffing job offers, which helps everyone else in the future.

2) Why do you accept that your colleagues get priority? That's like saying "Gosh, they get to earn more money and I get to be poor because they have priority". That's unacceptable. You could take a very young adult patient or two. Or maybe one of the parents or grandparents of a child. Or maybe run a parenting group once a week. Out of 150 people, there is absolutely some adult who somehow fits into what you do. Two patients/week @$86= ~$680/month or ~$7k/yr, which is close to what you need to make up the difference. One parenting group of 4 people would more than double that. There are absolutely patients that admin could find for you. I would explain this to your employer. "Hey, I am not getting patients. I am really struggling financially because of it. We have a waitlist of 150 people. Is there anything we can do about that?" As an employer, if I learned that my staff were not giving work to a clinician, while there was a three figure waitlist, I would publicly tell staff that they can fix the problem by end of day or find a new job.

3) Looks like I was a bit off, because I'm not staying current on tax matters. Bonuses are federally taxed at a flat rate of 22% PLUS your state's usual income tax rate. Your tax bracket has changed since I last looked, so I'm wrong about that. My general idea was to move the money from a taxable payment into a non-taxable payment. Since your tax bracket is actually 22%, marking the money as a "bonus" vs "usual income" doesn't matter.

Another option would be to ask for a "stipend" for something like business expenses that you incur to do your work from home (e.g., your cell phone bill, your internet bill, your license fees, your CEs, some office equipment like a chair, use of your laptop, mileage from your home office to the office- it HAS to be from home office to office and no where else). Stipends are not taxable, but it might be hard to find $800/month in stipend type stuff that affects your daily life. If you moved your bonus money into a stipend, you could save approx $2k/yr.

Or you could ask for some form of match to your 401k, which wouldn't help your living situation, but it's not a bad idea.

Or some form of student loan payments from your employer, which wouldn't directly affect your immediate living situation, but could allow you to refinance your loans after a couple years for a lower monthly rate.

Or a combination of all of those.

 

[smalltownpsych]

I definitely agree, but easier said than done. I do have some child clients who come in during the day (especially those who are looking for a specific type of tx I provide), but scrolling through the wait list I see so many people who insist on 3:00 pm on. Even those who I see during the day are always asking me when they can switch to after school. I make it clear that I'm booked solid during those times.

We actually had to close our afternoon waiting list for a few months last year because it was getting so long. There are people who (according to the notes on the sheet) have had their kids remain on the list (they have check ins ever four months) for nearly two years waiting for a 5:00 pm or later appointment. The Practice Manager really tries, but parents are insistent even when the schools are accommodating.

We don’t have a waitlist. If they don’t like what we offer, they can go elsewhere. One reason I started my own practice is because I like to be able to do things that make sense from my perspective. I have also learned from working in a lot of different settings that there are a lot of ways of doing things. What is funny is how people get into a fixed functional mindset and think that the way that they do things here is the way that it should be done because that’s how we do it. In other words, it might be hard to change what they do and if it doesn’t work for you then it could be time to move on. I have worked for four different companies since being licensed and each one did things differently and had different philosophies and at each place some things worked for me and I agreed with and other things I did not. The pay structure is just one part of that which is probably why I’m keying in on some other aspects of this. Two of the companies I left primarily because of compensation and the other two primarily because of organizational philosophy and structure.

 

[eeor1006]

Looks like you already got some great answers. The only thing I have to add is in regards to #3. I work 0.6FTE as a salaried staff psychologist in a hospital. I have 7 clinical hours a day and they usually get booked pretty full. I personally find it difficult to be fully present with my patients and give them my all if I don't have 2 or more no-shows or cancellations that day. Getting notes done before the end of the day is a constant struggle. if you have never worked in a hospital before, getting used to EMR can be a steep learning curve.

In my experience, when hospitals make you an offer, they expect you to negotiate the salary. Some of my friends and myself got anywhere from 10k to 23k via clumsy fresh out of graduate school negotiation. Good luck!

 

[mypointlesspov]

Thanks everyone for the advice. I reached back out to the person who extended the offer last week with a few more questions and asking for a higher salary. I also submitted an application for the same position but through the "official" pathway of USAJobs. A few other points to add:

• The person in charge of getting clients/scheduling is a close family member of my boss/practice owner so there's not much I can really do about not getting clients other than repeatedly sending emails out saying I have availability. I know this person is trying hard and also has some personal emergencies lately, so I'm trying not to be too annoying.
• I just checked and there's only a handful of adult clients on the waitlist. The rest of the 100+ people are children. I have some adults in my current caseload, but I primarly see kids and adolescents. Two of my colleagues are looking for new clients and only see adults which is why they kind of get priority.
• I've had two intake scheduled in two weeks, but I'd need at least four to six more to get to where I want to be at this point.
• I don't want to have to work later nights, but that might end up being the move just so I can earn extra income. I tried to have firm boundaries about my work hours when I started but quickly realized that wasn't sustainable and started working until 6:00ish three days.
• Part of my issue is that I have a lot of families dropping down to biweekly or even monthly treatment. I feel like a lot of those clients still need weekly treatment and have made that clear, but the economy isn't great and most middle income families don't have the resources for $240 therapy anymore. I try to consolidate my biweekly folks to the same times so I can make sure I have consistent openings for weekly folks. I'm worried that this will only get worse, especially as student loan repayments start. The practice is strictly OON so paneling/credentialing isn't an option. I've done some SCAs with families so they can get in network benefits, but this has been more miss than hit lately.
• I brought up the last point with my boss and connected it to my lack of clients and was essentially told that I could offer lower fee or pro bono services for some people who might need financial help. That would be a lovely thing to do (and I already do this with a non-profit org that my boss is aware of), but it doesn't help my financial situation. I like my boss but it felt invalidating considering a lot of factors I won't list here for the sake of anonymitity.
• I don't think I'm asking for anything crazy. I'd just like to be able to pay my basic bills (e.g. mortgage, utilities, food, etc) and enjoy life without having to dip into my savings every month.

I'm mostly venting at this point, but I think I do need to find an out at some point in the next six months. Realizing that my fee split isn't as fair as I thought was a huge eye opener. On that note, does anyone have pointers for transitioning out of a private practice?

 

[Sanman]

Thanks everyone for the advice. I reached back out to the person who extended the offer last week with a few more questions and asking for a higher salary. I also submitted an application for the same position but through the "official" pathway of USAJobs. A few other points to add:

• The person in charge of getting clients/scheduling is a close family member of my boss/practice owner so there's not much I can really do about not getting clients other than repeatedly sending emails out saying I have availability. I know this person is trying hard and also has some personal emergencies lately, so I'm trying not to be too annoying.
• I just checked and there's only a handful of adult clients on the waitlist. The rest of the 100+ people are children. I have some adults in my current caseload, but I primarly see kids and adolescents. Two of my colleagues are looking for new clients and only see adults which is why they kind of get priority.
• I've had two intake scheduled in two weeks, but I'd need at least four to six more to get to where I want to be at this point.
• I don't want to have to work later nights, but that might end up being the move just so I can earn extra income. I tried to have firm boundaries about my work hours when I started but quickly realized that wasn't sustainable and started working until 6:00ish three days.
• Part of my issue is that I have a lot of families dropping down to biweekly or even monthly treatment. I feel like a lot of those clients still need weekly treatment and have made that clear, but the economy isn't great and most middle income families don't have the resources for $240 therapy anymore. I try to consolidate my biweekly folks to the same times so I can make sure I have consistent openings for weekly folks. I'm worried that this will only get worse, especially as student loan repayments start. The practice is strictly OON so paneling/credentialing isn't an option. I've done some SCAs with families so they can get in network benefits, but this has been more miss than hit lately.
• I brought up the last point with my boss and connected it to my lack of clients and was essentially told that I could offer lower fee or pro bono services for some people who might need financial help. That would be a lovely thing to do (and I already do this with a non-profit org that my boss is aware of), but it doesn't help my financial situation. I like my boss but it felt invalidating considering a lot of factors I won't list here for the sake of anonymitity.
• I don't think I'm asking for anything crazy. I'd just like to be able to pay my basic bills (e.g. mortgage, utilities, food, etc) and enjoy life without having to dip into my savings every month.

I'm mostly venting at this point, but I think I do need to find an out at some point in the next six months. Realizing that my fee split isn't as fair as I thought was a huge eye opener. On that note, does anyone have pointers for transitioning out of a private practice?

Does the practice you work at have a non-compete?

 

[mypointlesspov]

Does the practice you work at have a non-compete?

Yes. It says I cannot offer other psychological services/treatments for pay while I'm full time at this place.

 

[AcronymAllergy]

Yes. It says I cannot offer other psychological services/treatments for pay while I'm full time at this place.

But nothing afterward? That seems pretty reasonable, or at least comparable to what you'd see at an AMC.

 

[mypointlesspov]

Hey everyone,

I'm back with some updates and more questions in bold for the sake of clarity:

• I said "f- it" and asked the staffing agency for $140,000 and got offered $137,300 which I am happy about.
• I was also able to get details from the person leaving the position (who retired on great terms after being there 7 years) and it seems very doable.
• I applied for the same position through USAJobs and got rejected based on my apparently subpar educational qualifications -insert eyeroll here- (I have a school psychology doctorate).
• The staffing agency essentially told me to give them the go ahead when I'm ready and they'll start the paper work.
• BUT given that I was rejected for the same position via USAJobs, I am hesitant to move foward. When I initially applied for the position and had my interview, I seem to have mistakenly thought she asked if I had a license in clinical psychology (which I do), not if I had a doctorate in clinical psychology.
• Do you think I should bring this up now for the sake of transparency? Is there a chance that if I don't say anything and get through the credentialing process, the hospital will ultimately reject me because I don't have a doctorate in clinical or counseling psychology? (and will I be penalized in any way [e.g., barred from future jobs there]/will they consider it fraud?)
• I have 100% of the qualifications they're asking for except the "right" psychology doctorate. I have a variety of clinical experiences including my internships and postdocs at well-regarded AMCs (even received specialized training working with the very specific population this hospital serves) and can get excellent references from those sites as well as my current job.
• Has anyone with a school psychology degree successfully applied/received an offer for a federal job or should I give up hope?
• I do have an interview with another PP in the area this week. I was initially trying to avoid PP, but the benefits are killer and I think I'd be able to fill a caseload faster.
• I'm 99% sure I have to (unfortunately) leave my current job. I like the folks there, but feel frustated by the lack of consistency in my schedule and lack of benefits. I highly doubt they'll be willing/able to match what the other potential jobs are offering.
• This is more of a rant than anything, but my frustration came to a head this week when I looked at the waiting list of 170+ people (!!) after hearing a handful of colleagues complain about not having enough clients. It's ridiculous that people have been sitting on this waiting list for over two years yet myself and others are practically begging to see people! To their credit, the Coordinator has been sending me referrals, but a lot of them aren't panning out due to changes in clinical needs or scheduling issues. Meanwhile like four or five new people are apparently coming on in the fall so I have no idea how that's going to work.

Thanks again to everyone here who contributed. I appreciate the sage advice given and wish I could take you all out for lunch.

 

[WisNeuro]

If it's a federal job, you should definitely check on the degree requirements. Some jobs will only accept specific degrees and you wouldn't want to go through the process and get kicked at the end when the credentialing team starts looking over your materials.

 

[summerbabe]

Do you think I should bring this up now for the sake of transparency? Is there a chance that if I don't say anything and get through the credentialing process, the hospital will ultimately reject me because I don't have a doctorate in clinical or counseling psychology? (and will I be penalized in any way [e.g., barred from future jobs there]/will they consider it fraud?)

Here's the fine print from a random VA psychologist posting on USAJobs:

Have a doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA), the Psychological Clinical Science Accreditation System (PCSAS), or the Canadian Psychological Association (CPA) at the time the program was completed. The specialty area of the degree must be consistent with the assignment for which the applicant is to be employed. For the purpose of meeting this requirement, the term "specialty area" refers to the specific specialty areas recognized by the accrediting body and not to specific job duties that might require special skills. Currently, APA accredits doctoral programs in the specialty areas of clinical psychology, counseling psychology, school psychology, or combinations of two or more of those areas. PCSAS accredits doctoral programs in psychological clinical science. CPA accredits doctoral programs in clinical psychology, counseling psychology, clinical neuropsychology, and school psychology. There are no job assignments in VHA that require the skills of a school psychologist; therefore, an applicant with a degree in the specialty area of school psychology is not eligible for appointment. Strictly for the purpose of determining eligibility for appointment as a psychologist in VHA, there is no distinction between the specialty areas (with the exception of school psychology).
OR, Have a doctoral degree in any area of psychology and, in addition, successfully complete a re-specialization program (including documentation of an approved internship completed as part of the re-specialization program) meeting both of the following conditions:
(a) The re-specialization program must be completed in an APA or a CPA accredited doctoral program; and,
(b) the specialty in which the applicant is retrained must be consistent with the assignment for which the applicant is to be employed.
OR, Have a doctoral degree awarded between 1951 and 1978 from a regionally-accredited institution, with a dissertation primarily psychological in nature.

Based on this, I don't think you're eligible unfortunately.

But check the fine print for your specific posting. However, I don't know of any penalties if you apply, get flagged and rejected, current or future.

 

[AcronymAllergy]

If it's a federal job, you should definitely check on the degree requirements. Some jobs will only accept specific degrees and you wouldn't want to go through the process and get kicked at the end when the credentialing team starts looking over your materials.

I agree--I'd check the specific job requirements, if you have access to them. To be frank, it's not unusual for HR to have little or no idea what credentials a psychologist has and/or what would be acceptable or not to the department. I've routinely heard of applications being tossed by HR for not meeting requirements despite the department hiring/interviewing committee saying otherwise. But I also think there's a very real possibility the department specifically requested a doctorate in clinical or counseling psych (possibly without even thinking about a school psych doctorate), and you then technically would be ineligible. It is possible the hospital would reject you while you're going through credentialing, but I don't imagine that would penalize you for future applications (unless with that specific department/VA if you somehow irked them during the applications and credentialing process, such as by just outright lying about a degree).

 

[mypointlesspov]

Here's the fine print from a random VA psychologist posting on USAJobs:

Based on this, I don't think you're eligible unfortunately.

But check the fine print for your specific posting. However, I don't know of any penalties if you apply, get flagged and rejected, current or future.

The position itself is specifically for working with kids and adolescents at a military hospital, not a VA, which is why I'm kind of annoyed that a school psych degree is ineligible. The role involves testing and therapy, so right up my alley.

I'll reach out to the recruiter and mention the degree thing. Fortunately, I woke up to another interview offer this morning so things feel like they're generally looking up.

 

[Sanman]

The position itself is specifically for working with kids and adolescents at a military hospital, not a VA, which is why I'm kind of annoyed that a school psych degree is ineligible. The role involves testing and therapy, so right up my alley.

I'll reach out to the recruiter and mention the degree thing. Fortunately, I woke up to another interview offer this morning so things feel like they're generally looking up.

I would double check, but you might be fine as the staffing companies are not always under the same regs as the government.

 

[ClinicalABA]

... (Remember that the law changed, and employers can now pay off student loans as a tax free benefit)...

When was that change?

ETA- Nevermind- I see that it was part of the CARES act

 

[mypointlesspov]

Hey all,

Just thought I'd pop in to give an update on this situation.

First off, the military hospital ended up being a bust because of my lowly school psych degree (/s), but the people at the staffing agency were really nice about it.

After that, I ended up submitting 11 more job applications. I received eight interview offers, declined four (due to timing or not being a great fit) and went through with four interviews. I ended up with four offers on the table - three from private practices (one rescinded - see below) and one from a nonprofit organization. One PP was salaried, two were FFS, and the non-profit was salaried. In a weird turn of events, I ended up staying at my current job with a substantial raise and way better benefits and I'm honestly pretty thrilled. On the day I told my boss I intended to leave, they asked me what I was looking for, I listed everything I wanted in a position, and they said yes without hesitation. There are also some major clinic-wide changes being made in the future that they said I could be involved in. I was so pleasantly surprised. My caseload was prioritized and I've had four more intakes scheduled in the week and a half since this conversation took place. I know I'd mentioned wanting a salary for stability, but I'm *very* happy with my new hourly rate (and a retroactive raise!). I also recevied ample apologies from my boss and staff about my caseload not being where I want it to be.

Ultimately, I'm not mad I went through this process. It was pretty eye opening seeing what other practices can offer (and how that doesn't always match up to what is advertised). Having that information raised my expectations for fair compensation in this field and I'm generally feeling more confident about myself.

The downside is that I probably burned a bridge at a practice I'd initially been really interested in. Unfortunately, they low-balled me on the salary after asking what I was looking for. I offered to do more work in exchange for more money, but the figure was still lower than what I'd hoped for. I could've made it work, but it wouldn't have allowed me to save in the way that I need to at this point in my life. Still, I was ready to jump ship from my current position for the stability of a salary. When I told this practice that my boss gave me a very generous counter offer and I needed some extra time to consider my options, they implied that I was flaky and rescinded the offer. That felt pretty bad, but I've gotta prioritize myself and my finances.

Anyway, thanks to everyone who commented and offered guidance.

 

[Sanman]

Congrats, sounds like a successful negotiation. As far as the bridge being burned, I would not worry about it too much. If they lowballed you on salary, chances are they are looking or someone more desperate and it likely would not have been a good environment anyway. In the future, no need to let a future employer who provided the better offer. Just say that you received a better offer and have accepted it. At the end of the day, information asymmetry is your enemy. You want as much info as possible and you want to give your future employers as little as possible unless it is in your in your interest to do so (I once disclosed my salary and my offer was bumped $25k).

 

[mypointlesspov]

Congrats, sounds like a successful negotiation. As far as the bridge being burned, I would not worry about it too much. If they lowballed you on salary, chances are they are looking or someone more desperate and it likely would not have been a good environment anyway. In the future, no need to let a future employer who provided the better offer. Just say that you received a better offer and have accepted it. At the end of the day, information asymmetry is your enemy. You want as much info as possible and you want to give your future employers as little as possible unless it is in your in your interest to do so (I once disclosed my salary and my offer was bumped $25k).

Thank you! And you're right, I keep reminding myself that that response told me everything I needed to know about working there, even if it seemed great on paper.

Part of me was hoping for a better counter offer when I told them that I was considering staying, so I was caught off guard by having the offer completely rescinded. Normally I wouldn't have disclosed where I got the better offer from, but this person knows my current practice (and actually was very concerned about me telling my boss that I wasn't poached). I didn't want it to seem odd if/when they inevitably realize that I'm still here after doing so many interviews, if that makes sense. One of the downfalls of being in such a small field, but c'est la vie.

Also, I really wish that employers would just be honest about compensation. Going through interviews and getting vague answers about pay (despite asking straight up) really sucks and seems like a waste of everyone's time. Truthfully, I wouldn't have gone through with two of the interviews had I known up front what they were offering.

 

[Ollie123]

While I'll always recommend trying not to burn bridges, that doesn't mean it won't ever happen. And that's OK, because sometimes an interview somewhere is all it takes to be confident you don't ever want to travel over that bridge. A place that would rescind an offer because of a counter is generally not a bridge I'd be interested in traveling across.

Congrats on the new role.

 

[AcronymAllergy]

While I'll always recommend trying not to burn bridges, that doesn't mean it won't ever happen. And that's OK, because sometimes an interview somewhere is all it takes to be confident you don't ever want to travel over that bridge. A place that would rescind an offer because of a counter is generally not a bridge I'd be interested in traveling across.

Congrats on the new role.

Agreed, my initial reaction was, "good riddance."

Congratulations on getting things worked out in what sounds to be a great way.