Locums Job

[RevDO]

What is the most outrageous locums job you've seen/heard of? I recall reading about a job offering something near 800k for 6 months in Northern Alaska when there is no sunlight for a crazy number of hours/day. Skipping the fact that this would burn me out, if I were feeling particularly masochistic what other kinds of jobs like this have you heard of that I could do for 6 months, 1 year, or even 2-3 years to pay off my loans and catch up on retirement?

---

Members don't see this ad.

 

[Sushirolls]

Fairbanks is awesome. Chena Hot Springs makes it worth it.

 

[Psychresy]

What is the most outrageous locums job you've seen/heard of? I recall reading about a job offering something near 800k for 6 months in Northern Alaska when there is no sunlight for a crazy number of hours/day. Skipping the fact that this would burn me out, if I were feeling particularly masochistic what other kinds of jobs like this have you heard of that I could do for 6 months, 1 year, or even 2-3 years to pay off my loans and catch up on retirement?

Why not just work in a prison for 300/hr and work every other weekend and pull 800k? I see these jobs fairly frequently.

 

[Trismegistus4]

Fairbanks is awesome. Chena Hot Springs makes it worth it.

Not to mention that you could do this and spend the other 6 months sailing around the world, dispensing sunscreen and vitamins to the locals.

 

[robellis]

Why not just work in a prison for 300/hr and work every other weekend and pull 800k? I see these jobs fairly frequently.

Because you might get killed, literally

 

[Psychresy]

Because you might get killed, literally

But what about the killer grizzly bears in Alaska?

 

[Trismegistus4]

But what about the killer grizzly bears in Alaska?

You're legally allowed to shoot a grizzy bear if it's in self defense. Good luck with that in a prison.

 

[jbomba]

You're legally allowed to shoot a grizzy bear if it's in self defense. Good luck with that in a prison.

The trick is, kick someone's ass the first day, or become someone's bitch. Then everything will be all right.

 

[Stagg737]

Because you might get killed, literally

I've actually heard that psychiatrists taking those jobs are actually treated surprisingly well by the inmates. Sure there's a risk, but I'd guess working inpatient at a VA probably carries a similar risk given the number of APD + substance intoxication that goes through those ERs.

 

[futuredo32]

What is the most outrageous locums job you've seen/heard of? I recall reading about a job offering something near 800k for 6 months in Northern Alaska when there is no sunlight for a crazy number of hours/day. Skipping the fact that this would burn me out, if I were feeling particularly masochistic what other kinds of jobs like this have you heard of that I could do for 6 months, 1 year, or even 2-3 years to pay off my loans and catch up on retirement?

I would do this for a year!!!!!!!!!!!!!!! Best offer I have gotten for Alaska was 300k for a year. Best lifestyle locums was a week in the Virgin Islands for a 6 bed inpatient unit. You got a beachfront hotel and 2200 for the week. I wanted to do it for a paid semi-vacation , but the positions booked out way too fast. Best locums offer ever 200 an hour personally.

 

[TexasPhysician]

I would do this for a year!!!!!!!!!!!!!!! Best offer I have gotten for Alaska was 300k for a year. Best lifestyle locums was a week in the Virgin Islands for a 6 bed inpatient unit. You got a beachfront hotel and 2200 for the week. I wanted to do it for a paid semi-vacation , but the positions booked out way too fast. Best locums offer ever 200 an hour personally.

I saw that! I asked for more info on that and it seemed to book up before the recruiter could answer my question.

 

[alina_s]

What is the most outrageous locums job you've seen/heard of? I recall reading about a job offering something near 800k for 6 months in Northern Alaska when there is no sunlight for a crazy number of hours/day. Skipping the fact that this would burn me out, if I were feeling particularly masochistic what other kinds of jobs like this have you heard of that I could do for 6 months, 1 year, or even 2-3 years to pay off my loans and catch up on retirement?

I’m pretty sure 800K was apocryphal. The last I heard about Utqiagvik, they were flying someone in very part time. It’s small enough that I don’t think they would keep a FT schedule full. No grizzlies, though, it’s the polar bears you have to watch out for. In 6 months, you’d see broad spread of day length, although it would be pretty dark fall to spring equinox. The sun doesn’t rise above the horizon in winter but it doesn’t stay dark like midnight all day either.

 

[RevDO]

I would do this for a year!!!!!!!!!!!!!!! Best offer I have gotten for Alaska was 300k for a year. Best lifestyle locums was a week in the Virgin Islands for a 6 bed inpatient unit. You got a beachfront hotel and 2200 for the week. I wanted to do it for a paid semi-vacation , but the positions booked out way too fast. Best locums offer ever 200 an hour personally.

That sounds obscenely low. It seems like half the posts here say its easy to make 300k especially doing locums and half make it sound like you've landed the golden goose making 250k. I guess I went into this field expecting to make 300k+, that's why I've given up so much. Perhaps I made a bad decision. Love the science, research, and positive change a psychiatrist can make in a patient's life but geez, I need some cheese at the end of it all.

 

[bGMx]

That sounds obscenely low. It seems like half the posts here say its easy to make 300k especially doing locums and half make it sound like you've landed the golden goose making 250k. I guess I went into this field expecting to make 300k+, that's why I've given up so much. Perhaps I made a bad decision. Love the science, research, and positive change a psychiatrist can make in a patient's life but geez, I need some cheese at the end of it all.

Maybe I'm just poor but 250k a year sounds fantastic. What are you looking for?

 

[Psychresy]

Maybe I'm just poor but 250k a year sounds fantastic. What are you looking for?

I think 400 is a nice number and worth all the years and stress we put ourselves through.

Seems doable if one is willing to string together a couple jobs or do locums.

 

[futuredo32]

I think 400 is a nice number and worth all the years and stress we put ourselves through.

Seems doable if one is willing to string together a couple jobs or do locums.

locums definitely

 

[Stagg737]

That sounds obscenely low. It seems like half the posts here say its easy to make 300k especially doing locums and half make it sound like you've landed the golden goose making 250k. I guess I went into this field expecting to make 300k+, that's why I've given up so much. Perhaps I made a bad decision. Love the science, research, and positive change a psychiatrist can make in a patient's life but geez, I need some cheese at the end of it all.

And you certainly can make $300k fairly easily in the right setting. But if you're only wanting to work 3 days a week or take 4 months of the year off, it's going to be much more difficult than if you take a legit full-time position or work locums with full-time hours. I got an e-mail from a recruiter on Tuesday with 7 positions listed and 2 of them had base salary of $300k (other salaries weren't mentioned). Here's an example of one position:

Outpatient psychiatry position
Employed with full benefits
$300k base salary
Flexible hours
Telemedicine opportunities
Private insurance only no commercial payors
1 hour initial evaluations and 30 minute follow up visits
Integrative mental health approach with support staff
Academic affiliation
As a member of the multidisciplinary team, the Psychiatrist assures that the highest quality services are provided to patients and their families.
RESPONSIBILITIES
Evaluation and management of new and existing patients
Clinical oversight for all treatment services including treatment plan review
Supervision and education of ancillary providers as required
Transcranial Magnetic Stimulation*
Additional responsibilities as determined by the medical director


The above position is in a major metro (pop ~1 mil) and on the surface does not sound like a job with a predisposition for burnout. $250k can be a golden good position, but it's not the money that makes it so good, it's making $250k with a great lifestyle/low hours/unique opportunities that makes those positions so desirable. Frankly, I won't be accepting a FT position of any kind making less than $200k/yr and that's only if it sounds like a dream job. Even in my very low COL area, I'm still expecting to make well over that unless it's a PT position.

 

[robellis]

And you certainly can make $300k fairly easily in the right setting. But if you're only wanting to work 3 days a week or take 4 months of the year off, it's going to be much more difficult than if you take a legit full-time position or work locums with full-time hours. I got an e-mail from a recruiter on Tuesday with 7 positions listed and 2 of them had base salary of $300k (other salaries weren't mentioned). Here's an example of one position:

Outpatient psychiatry position
Employed with full benefits
$300k base salary
Flexible hours
Telemedicine opportunities
Private insurance only no commercial payors
1 hour initial evaluations and 30 minute follow up visits
Integrative mental health approach with support staff
Academic affiliation
As a member of the multidisciplinary team, the Psychiatrist assures that the highest quality services are provided to patients and their families.
RESPONSIBILITIES
Evaluation and management of new and existing patients
Clinical oversight for all treatment services including treatment plan review
Supervision and education of ancillary providers as required
Transcranial Magnetic Stimulation*
Additional responsibilities as determined by the medical director


The above position is in a major metro (pop ~1 mil) and on the surface does not sound like a job with a predisposition for burnout. $250k can be a golden good position, but it's not the money that makes it so good, it's making $250k with a great lifestyle/low hours/unique opportunities that makes those positions so desirable. Frankly, I won't be accepting a FT position of any kind making less than $200k/yr and that's only if it sounds like a dream job. Even in my very low COL area, I'm still expecting to make well over that unless it's a PT position.

With inflation now 200k has become a joke

 

[futuredo32]

With inflation now 200k has become a joke

In Michigan, a lot of the desirable cities to work offer 200k-250 k. It's very common. The less desirable cities pay more but those are currently locums.

 

[robellis]

In Michigan, a lot of the desirable cities to work offer 200k-250 k. It's very common. The less desirable cities pay more but those are currently locums.

I think desirable and Michigan is an oxymoron

 

[futuredo32]

I think desirable and Michigan is an oxymoron

It's home. I like the area where I live, metro Detroit, tons of stuff to do, safe. We ARE the great lakes state.

 

[jbomba]

200k to live and work in detroit? is this serious?

 

[futuredo32]

200k to live and work in detroit? is this serious?

Metro Detroit and Detroit. For Easter Seals 205k, CMH 249k, for C/L full time, and I think one weekend a month 260k ish. Offer for outpatient part time 130-140 an hour, but I worked for the parent company in the past and they negotiated with my locums company from 50k to 17k for a buy out which, if I took the position, would come out of my salary over time. A lot want to hire 1099 and do a 70/30 split. I know NY and CA pay better but high cost of living. I get a lot of offers from CA for 300 or 350, but when you consider the cost of living, not really worth it, though the weather is nicer. I don't think I would ever do cash only for multiple reasons. I would love to do private practice full time, but don't know if I would have the guts, the country where I have my mircopractice has more psychiatrists than any other county in Michigan by far. Right now, I want outpatient adult and close to home and a high salary. Medicine was a second career for me and I want to buy a house and bank money, invest money.

 

[brazilianpsych]

Random question, so I will just ask here. I already heard that inpatient gives good money, and I also heard it doesn't give money at all. Is it possible (or likely) to get >300k working only inpatient? I do not mind working long hours tbh.

 

[sloh]

I know NY and CA pay better but high cost of living. I get a lot of offers from CA for 300 or 350, but when you consider the cost of living, not really worth it, though the weather is nicer.

Agreed.

 

[Psychresy]

Metro Detroit and Detroit. For Easter Seals 205k, CMH 249k, for C/L full time, and I think one weekend a month 260k ish. Offer for outpatient part time 130-140 an hour, but I worked for the parent company in the past and they negotiated with my locums company from 50k to 17k for a buy out which, if I took the position, would come out of my salary over time. A lot want to hire 1099 and do a 70/30 split. I know NY and CA pay better but high cost of living. I get a lot of offers from CA for 300 or 350, but when you consider the cost of living, not really worth it, though the weather is nicer. I don't think I would ever do cash only for multiple reasons. I would love to do private practice full time, but don't know if I would have the guts, the country where I have my mircopractice has more psychiatrists than any other county in Michigan by far. Right now, I want outpatient adult and close to home and a high salary. Medicine was a second career for me and I want to buy a house and bank money, invest money.

Why not open up a practice, take insurance, see 2.5 patients an hour and make 450-500 before overhead? Even with Medicare rates you should hit that. Live where you want and make double the income.

 

[RevDO]

I'm going to try switching specialties if 200-250k in Michigan is "good"

 

[futuredo32]

Why not open up a practice, take insurance, see 2.5 patients an hour and make 450-500 before overhead? Even with Medicare rates you should hit that. Live where you want and make double the income.

I have a micro practice, Blue Cross and Medicare reimburse far less than that in Michigan. As a solo private practice I have NO bargaining power. I have been coding mostly 99213 with 90833 and reimbursement is usually 80 or so dollars. Would 99214 be THAT much better? Aetna pays less and Cigna pays $40.

 

[futuredo32]

I'm going to try switching specialties if 200-250k in Michigan is "good"

Other than NY and CA, where is the pay normally better? Not Florida, malpractice is horrible there and not Hawaii, cost of living is high.

 

[Psychresy]

Other than NY and CA, where is the pay normally better? Not Florida, malpractice is horrible there and not Hawaii, cost of living is high.

Texas, Oregon, Colorado to name a few.

 

[Psychresy]

I have a micro practice, Blue Cross and Medicare reimburse far less than that in Michigan. As a solo private practice I have NO bargaining power. I have been coding mostly 99213 with 90833 and reimbursement is usually 80 or so dollars. Would 99214 be THAT much better? Aetna pays less and Cigna pays $40.

I mean even if a 99214 bumped you up to 100 you'd be pulling 250 an hour seeing those 2.5 patients. That's 500k for 40 hours a week.

I'd be shocked if a 99214+90833 didn't pay better than 100.

 

[futuredo32]

I mean even if a 99214 bumped you up to 100 you'd be pulling 250 an hour seeing those 2.5 patients. That's 500k for 40 hours a week.

I'd be shocked if a 99214+90833 didn't pay better than 100.

I thought 90833 was easy med mgmt with 30 minutes of therapy. These are stable long term patients for the most part. The medical complexity is quite low.

 

[TexasPhysician]

I thought 90833 was easy med mgmt with 30 minutes of therapy. These are stable long term patients for the most part. The medical complexity is quite low.

90833 is 16+ min of therapy.
99214 is 2 or more stable chronic illnesses

 

[ElanaMD]

I came across this post and wanted to add my two cents, not about locums but about private practice.

I know the topic of the post is locums but it seems like most people's questions are along the lines of "How do I make the most as a psychiatrist while not getting burned out." I briefly considered locums but always knew my ultimate goal was private practice so just started a practice right out of residency. So I can't really speak to locums, but I can definitely speak to private practice.

I am in a high COL area (Los Angeles, CA) with a relatively high number of people of high socioeconomic status, but what I am saying is applicable to most areas of the country if you apply it correctly.

I have a cash-based integrative psychiatry private practice and made $300k a year (net, after expenses) easily working 4 days a week, seeing probably 20-25 patients a week. If you want to work more, you will make more. I paid off $200k+ of loans and saved $300k to buy a house within 4 years of graduating (including the time it took me to build my practice). I'm also a 2x cancer survivor and 2 years ago my cancer relapsed and I had to take time off to have a stem cell transplant and I rebuilt my practice from scratch, and it was much easier the second time. Now I see closer to 10-15 patients a week because I'm still recovering physically from the transplant so I make less but it's more than enough to live off of and pay the mortgage on my $1.5 million house (which is unfortunately a starter house in LA, but that's a story for another time...).

There are pros and cons of having a private practice, so let me start with the cons first:

Cons:

• It will take time to build. Not years if you're doing it right, but at least a year to year and a half. So you will make less money in the short term (although more in the long term)
• It requires guts. Someone earlier mentioned that they would want to do private practice, but don't have the guts. It's a fair point. You have to be better at not giving into doubt and fear more than your peers probably are. You have to be willing not to worry when others would, or at least not listen to the worry. You have to develop an iron will. On the other hand, this is a great opportunity for self-growth
• Everything is on you. This is a pro and a con, because there is also no bureaucracy. But you will have to figure out and develop systems to run things efficiently so you're not bogged down by admin work (billing, phone calls, emails, etc)
• You will generally working with higher socioeconomic status patients. This can be a pro or a con, depending on how you look at it. You probably won't be on the streets of Skid Row helping the masses. But you will make a huge difference in your patients lives. And if you charge the people who can afford it high (but reasonable) fees, you can offer sliding scale to those who can't. I sometimes will just see people for free or donate my time.

On the other hand, here are the pros:

Pros:

• You can make a lot while not working that many hours (excellent quality of life)
• You have total autonomy and control over every aspect of your work -- the hours you work, the types of patients you see, the amount you charge
• There is no ceiling for what you charge, as patients will pay a lot if you provide them enough value
• It forces you to grow as a clinician... you have to step up and help your patients and grow your clinical skills over time in order to justify high fees
• You have more time and bandwidth to learn and improve your clinical skills, because you're not seeing patients every 15-30 minutes.
• You can have a much greater impact with your patients because you're not limited in how much time you can spend with them, or what treatment modalities you can use
• You will generally be working with higher functioning patients, which is rewarding because you can really help them
• There's no bureaucracy, no pointless EHR checkboxes to fill out, no obsessing about CPT codes, etc.
• You can make a good living with a very small patient panel. I think my entire panel is less than 50 patients, so there's not a lot of phone calls/emails/etc that I have to deal with

One thing people have trouble wrapping their mind around is people handing them cash money for their clinical care. You need to reframe the way you think about charging patients.

It's not about extracting money from people, but providing value that justifies your fees. Value doesn't mean enabling your patients and prescribing everyone benzos or stimulants or whatever it is that people worry about they'll have to do in private practice. It's about creating a healing environment and positive treatment experience that will make your patients keep coming back to you even when they could get their care "cheaper" somewhere else.

I hope this helps and that some people will consider private practice!

- Elana

 

[sloop]

Because you might get killed, literally

This seems like a ridiculous exaggeration. I treat inmates in the DOC as part of my fellowship. Most of them are fine. Honestly, a lot of it is mundane ****. Unfortunately, it’s mostly a lot of taking people off of unnecessary medications because some NP started 10 mg of Prozac due to an adjustment disorder related to an ongoing murder prosecution.

 

[calvnandhobbs68]

Elana, I think we appreciate your couple posts on here and insight into how to run a (very) high end private practice. I think it's great that you've found a niche you're well suited to and seem to enjoy. However, as you aluded to, there's some major caveats to this:

- "You will be generally working with higher end socioeconomic status patients"-> You're working with people who are able to pay $925 an intake and $315-465 a followup (discounted to $415 for weekly psychotherapy) with an estimate of $2500-4000 to $3500-11000 over the first 3-6 months for essentially uncomplicated MDD, GAD, etc. Who are also willing to pay $75 for you to look at their screening labs and $150 to just look at their GeneSight testing (not including the actual cost of the testing)....and apparently $75 to talk to their PCP for 10 minutes. To say this "isn't Skid row" is a bit of an understatement...this is a specific fairly high SE slice of the population. The kind of people who for instance would go to a cash derm or plastics clinic and drop the same amount for their laser sculpting treatments or facelift.

Private Practice - Zen Psychiatry

I am currently accepting new patients. You can also see my referral list of integrative psychiatrists and psychiatric mental health nurse practitioners who are accepting new patients. If you’re looking for a trusted advisor to your mental health who will: …then you’re in the right place About...

zenpsychiatry.com

- Which leads me to my second point, which you alluded to a few times. You also have to be a very good salesperson. It's true, that many doctors are not particularly great salespeople (including probably myself)...for various reasons but some of this certainly for me would be that I would really need to believe in the product I'm selling.
This is a fairly common thing I see in many cash practices for various specialities but you end up "selling" both yourself and your "product" (partly your services/self but also whatever ancillary testing/treatment/whatever). I'm sure we could all debate back and forth the utility of functional nutritional testing/GI sensitivity testing/salivary cortisol "adrenal fatigue" testing...but you have to convince patients that this is value-added enough to pay $190-650 a pop for it. Which I've found often means "abnormalities" are often found on this testing (similar to various other types of testing, for example qEEG, Amen clinic SPECT mapping, etc) which seem to frequently need to be "treated" in order for the patient to justify their value. Genesight/whatever other genetic testing is often something I see pushed as well in these settings.
This isn't necessarily singling you out, as a local place I know will do things like offer people basically indefinite TMS and weekly indefinite intranasal ketamine for a cool $1000/month.

So, I think this can be a very personally financially rewarding segment of psychiatry but generally seems to be one that targets a specific high end slice of the population with selling a particular "brand" which tends to include a battery of treatment/testing options.

 

[sloh]

Homepage - Zen Psychiatry

An integrative psychiatry practice passionate about integrating Western medicine, Eastern wisdom, and holistic approaches to help people live fuller and happier lives.

zenpsychiatry.com

Herbal medicine? Functional nutritional testing? Adrenal fatigue? Gut microbiome testing? Food allergy and sensitivity testing? Genetic testing?

Perfect for the worried well in Beverly Hills.

 

[Merovinge]

Homepage - Zen Psychiatry

An integrative psychiatry practice passionate about integrating Western medicine, Eastern wisdom, and holistic approaches to help people live fuller and happier lives.

zenpsychiatry.com

Herbal medicine? Functional nutritional testing? Adrenal fatigue? Gut microbiome testing? Food allergy and sensitivity testing? Genetic testing?

Perfect for the worried well in Beverly Hills.

"Medicine = Science + Heart”

– Dr. Elana Miller (Me)

Got the self-quoted inspirational poster ready as well!

 

[ElanaMD]

Hi everyone, I didn't mean to offend people by my post. Let's also all try not to be easily offended.

People could reasonably disagree with my practice and approach. It's true I am treating a sliver of high SES patients. It's also true that I've donated my time speaking to cancer survivorship organizations and helping individual patients cope with the end of their lives because of their cancer diagnoses.

It's true you need to be able to "sell" to be successful in private practice. There's a concept of sales that goes along the lines of "sell people what they want so you can give them what they need." Ultimately what I practice is primarily relationship-based medicine. I offer a lot of treatment modalities, but the ultimate goal is not to sell someone something they don't want or need, but to build a relationship with my patients, and let good treatment come out of that.

There is a reason that private practice psychiatrists can be successful... and that's because not all patients are satisfied by the insurance model or their treatment in academic or community settings. I know because I see these patients. We need all kinds of providers, and I appreciate my colleagues who work in academic and community settings and fulfill patient needs that I don't. I'm hoping my colleagues will be open to feeling the same about practitioners like me.

Lastly, I lost 7 years of my 30's toward cancer treatment. The first time I was diagnosed I had to do a 3 year chemotherapy protocol (yes, 3 years). I took almost two years to recover, and then I relapsed. The five year survival rate with my type of cancer when it relapses is ~20%, and that's AFTER a successful stem cell transplant. Look up "relapsed T cell acute lymphoblastic lymphoma." Yet I'm still working, still trying to build something, and still trying to have a meaningful impact on my patients.

If people think I'm inspirational... that's probably why. Not because I quote myself.

So I'm going to live my life however I damn well please. It's easy to criticize... it's much harder to create.

It's easy to take a sliver of my website (which has hundreds of posts that I've written over 10+ years, by the way), quote it in a negative way and make a "clever" criticism.

Go create a business that you've worked over a decade to build (apart from medical school and residency... we've all done that) and then come back to me and we'll talk. People who create aren't usually so critical of others, because they know how hard it is.

 

[Merovinge]

Hi everyone, I didn't mean to offend people by my post. Let's also all try not to be easily offended.

People could reasonably disagree with my practice and approach. It's true I am treating a sliver of high SES patients. It's also true that I've donated my time speaking to cancer survivorship organizations and helping individual patients cope with the end of their lives because of their cancer diagnoses.

It's true you need to be able to "sell" to be successful in private practice. There's a concept of sales that goes along the lines of "sell people what they want so you can give them what they need." Ultimately what I practice is primarily relationship-based medicine. I offer a lot of treatment modalities, but the ultimate goal is not to sell someone something they don't want or need, but to build a relationship with my patients, and let good treatment come out of that.

There is a reason that private practice psychiatrists can be successful... and that's because not all patients are satisfied by the insurance model or their treatment in academic or community settings. I know because I see these patients. We need all kinds of providers, and I appreciate my colleagues who work in academic and community settings and fulfill patient needs that I don't. I'm hoping my colleagues will be open to feeling the same about practitioners like me.

Lastly, I lost 7 years of my 30's toward cancer treatment. The first time I was diagnosed I had to do a 3 year chemotherapy protocol (yes, 3 years). I took almost two years to recover, and then I relapsed. The five year survival rate with my type of cancer when it relapses is ~20%, and that's AFTER a successful stem cell transplant. Look up "relapsed T cell acute lymphoblastic lymphoma." Yet I'm still working, still trying to build something, and still trying to have a meaningful impact on my patients.

If people think I'm inspirational... that's probably why. Not because I quote myself.

So I'm going to live my life however I damn well please. It's easy to criticize... it's much harder to create.

It's easy to take a sliver of my website (which has hundreds of posts that I've written over 10+ years, by the way), quote it in a negative way and make a "clever" criticism.

Go create a business that you've worked over a decade to build (apart from medical school and residency... we've all done that) and then come back to me and we'll talk. People who create aren't usually so critical of others, because they know how hard it is.

I am in no way offended by your initial post and am glad you are able to post a way forward for docs through cash practices. I think these are an important piece of the overall health care puzzle.

The area of criticism that Sloh was referencing and I was taking a pot-shot at was in reference to the clear non-evidenced based medicine that just happens to align with trendy pseudo-science de jour. I can understand how you find this type of marking leads to more patients and how you can rationalize that it improves relationships with people and thus is part of treatment. Patients LOVE genesight testing that completely erroneously puts medications into green/yellow/red categories. The fact that patients love this does not take away from the fact that this can actually harm patients when medication decisions are done in contrast to guidelines in an effort to pursue the green. I could go on and on with other things mentioned on your site.

Now your website itself is extremely well done and I have no doubt you do help a number of patients you see. Your personal journey sounds grueling and I am thrilled you have a practice you like. That is not mutually exclusive with my opinion that MDs posting pseudo-science is detrimental to the field.

 

[Candidate2017]

You're working with people who are able to pay $925 an intake and $315-465 a followup (discounted to $415 for weekly psychotherapy) with an estimate of $2500-4000 to $3500-11000 over the first 3-6 months for essentially uncomplicated MDD, GAD, etc.

To say this "isn't Skid row" is a bit of an understatement...this is a specific fairly high SE slice of the population. The kind of people who for instance would go to a cash derm or plastics clinic and drop the same amount for their laser sculpting treatments or facelift.

- Which leads me to my second point, which you alluded to a few times. You also have to be a very good salesperson.

I want to point out that pricing one's services relative to local rent/real estate is good business practice.

LA is a high COL area. People in high COL areas willingly pay 2x the average rent, or more, for below average housing. $315-465 for a follow up seems like a lot but it's roughly 2x the avg insurance reimbursement in the U.S. So 2x is quite reasonable for LA.

People who pay $315-465 for follow ups aren't necessarily rich, but are willing to pay a lot for ALL goods and services to live in a high COL area. For example, a 22 y.o. college grad with an office job who pays $20k in annual rent to live in LA isn't rich. They are merely willing pay to an extraordinarily high percentage of their income toward rent/goods/services and sacrifice ALL middle class amenities (i.e., will share a studio with a roommate, not get married/have children, not contribute to retirement, not save for a down payment etc).

Genesight/whatever other genetic testing is often something I see pushed as well in these settings.

Medicaid pays for Genesight testing, interestingly. I've encountered more Medicaid patients with Genesight tests than insurance or self pay patients.

 

[Stagg737]

Random question, so I will just ask here. I already heard that inpatient gives good money, and I also heard it doesn't give money at all. Is it possible (or likely) to get >300k working only inpatient? I do not mind working long hours tbh.

Very possible, though patient load will likely be on the higher end of acceptable. Most inpatient docs I've discussed salary with are making well over $250k for the inpatient duties alone. The only ones who weren't were in academic settings or doing inpatient part-time.

Other than NY and CA, where is the pay normally better? Not Florida, malpractice is horrible there and not Hawaii, cost of living is high.

Throw a dart at the US map, $250k is below average in most places including most of the midwest...

 

[Psychresy]

I recently saw a 1099 offer of 220/hr for a 36 bed unit. Shift work, 10-12 hour shifts. Without knowing anything else, where does this offer stand as far as compensation goes?

 

[Nudexta]

I recently saw a 1099 offer of 220/hr for a 36 bed unit. Shift work, 10-12 hour shifts. Without knowing anything else, where does this offer stand as far as compensation goes?

36 bed?? You will cover all of it?

 

[Monocles]

I recently saw a 1099 offer of 220/hr for a 36 bed unit. Shift work, 10-12 hour shifts. Without knowing anything else, where does this offer stand as far as compensation goes?

Define "coverage". Are you responding for rounding on all 36??? or is it more to respond to emergencies as they come up?

 

[TexasPhysician]

I recently saw a 1099 offer of 220/hr for a 36 bed unit. Shift work, 10-12 hour shifts. Without knowing anything else, where does this offer stand as far as compensation goes?

So 3 FT jobs in 1?

 

[AD04]

So I'm going to live my life however I damn well please. It's easy to criticize... it's much harder to create.

It's easy to take a sliver of my website (which has hundreds of posts that I've written over 10+ years, by the way), quote it in a negative way and make a "clever" criticism.

Go create a business that you've worked over a decade to build (apart from medical school and residency... we've all done that) and then come back to me and we'll talk. People who create aren't usually so critical of others, because they know how hard it is.

Spoken like a true entrepreneur. Keep it up.

Thanks for sharing the details about your cash practice.