methadone clinic director?

[finalpsychyear]

I recently received an offer for being the medical director at a new methadone clinic in the area where I will have to commit up to 10 hrs per week being present during inductions. I have no prior experience with methadone but due to my growing interest in addiction and taking the boards in 2019/2020, I see this being a learning position and maybe good for my CV.

The initial offer was for 200/hr for 10 hrs per week so about 2k a week. I have no idea if this is on the low end for the midwest part of the country or I should counter and ask for 250/hr.

Does anyone do methadone in addition to psych and have any guidance on what to ask for and if its too risky to even be involved in?

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[Sushirolls]

There is a manual, regulated by feds that pretty much dictates what can and can't be done and how things should be done. Probably need to read that. Can't hurt to ask for more.

Why would it be risky? Some clinicians avoid it because of not liking addiction, which isn't an issue for you or others, because its too monotonous.

 

[Trouble in paradise]

There is a manual, regulated by feds that pretty much dictates what can and can't be done and how things should be done. Probably need to read that. Can't hurt to ask for more.

Why would it be risky? Some clinicians avoid it because of not liking addiction, which isn't an issue for you or others, because its too monotonous.

Initial steep learning curve. Tons of interactions. Gets much easier

 

[finalpsychyear]

There is a manual, regulated by feds that pretty much dictates what can and can't be done and how things should be done. Probably need to read that. Can't hurt to ask for more.

Why would it be risky? Some clinicians avoid it because of not liking addiction, which isn't an issue for you or others, because its too monotonous.

I asked for 250/hr. They stuck with the 200/hr but they will provide malpractice on top of that since this is 1099 work. They also said they will be getting me some supervision since i am not boarded in addiction (yet) and will be flexible with the schedule and that this will be a good professional development opportunity. I guess that is fair and maybe if i had more experience I could ask for more. Thoughts?

 

[TexasPhysician]

I asked for 250/hr. They stuck with the 200/hr but they will provide malpractice on top of that since this is 1099 work. They also said they will be getting me some supervision since i am not boarded in addiction (yet) and will be flexible with the schedule and that this will be a good professional development opportunity. I guess that is fair and maybe if i had more experience I could ask for more. Thoughts?

It’s not a bad rate, but a friend of mine fresh out of residency got $250/hr. You’ll need to spend time learning the regulations, and it is tightly monitored.

 

[Armadillos]

I think most fellows would be happy to be making 200hr in their fellowship, so if you make that and gets you to board certification seems hard to complain.

 

[finalpsychyear]

It’s not a bad rate, but a friend of mine fresh out of residency got $250/hr. You’ll need to spend time learning the regulations, and it is tightly monitored.

The methadone clinic they are creating in the area has not opened yet. I will have a max hours of up to 10 hours/wk (they pay malpractice as well) once the clinic gets going to be present for the inductions. These are done Mon-fri from 630am-9am and will be on days when i would be willing to be present.

I find it odd that I would be their "medical director" yet not have any guarantee of any hours in the start. They also mentioned having me do some supervision hours with docs who are experienced but i haven't even questioned whether I would be compensated for that time or the time I would spend reviewing the material.

1) are my concerns silly that I would have the "medical director" title yet no hours till inductions begin.

2) once the clinic is"maxed out" will i get the boot ?

3) should i just suck it up and view this as a "learning experience" leading to my addiction certification and maybe future positions rather than think this could really provide fair income.

 

[TexasPhysician]

1) are my concerns silly that I would have the "medical director" title yet no hours till inductions begin.

2) once the clinic is"maxed out" will i get the boot ?

3) should i just suck it up and view this as a "learning experience" leading to my addiction certification and maybe future positions rather than think this could really provide fair income.

1. Medical Director hours should begin before any patients are seen. You should review every policy and plan to escalate level of care if needed. You should help ensure staff know their responsibilities and when to contact you. You should ensure all regulations are being followed. You are the leader, and everyone she understand that. Anything done wrong could effect your license to practice medicine.

2. They will always need a medical director, but your hours may be cut in favor of a cheaper prescriber that you will need to supervise.

3. While it is a learning experience per se, they are getting a huge benefit. You absolutely should be compensated well. I was offered $10k to be medical director of an addiction center to cover my time pre-opening. I declined as the directors were clueless which increases liability and my time needed to plan everything out.

 

[finalpsychyear]

1. Medical Director hours should begin before any patients are seen. You should review every policy and plan to escalate level of care if needed. You should help ensure staff know their responsibilities and when to contact you. You should ensure all regulations are being followed. You are the leader, and everyone she understand that. Anything done wrong could effect your license to practice medicine.

2. They will always need a medical director, but your hours may be cut in favor of a cheaper prescriber that you will need to supervise.

3. While it is a learning experience per se, they are getting a huge benefit. You absolutely should be compensated well. I was offered $10k to be medical director of an addiction center to cover my time pre-opening. I declined as the directors were clueless which increases liability and my time needed to plan everything out.

So basically if the contract expects me to review all the policy and doesn't compensate me for that time or any prior to seeing pts and for the expected "shadowing an experienced methodone provider" and expects me to start my hours once patients begin inductions its clearly a hard pass. Thanks.

 

[st2205]

So basically if the contract expects me to review all the policy and doesn't compensate me for that time or any prior to seeing pts and for the expected "shadowing an experienced methodone provider" and expects me to start my hours once patients begin inductions its clearly a hard pass. Thanks.

You could ask for a base pay. I recently took a medical director position, and had them guarantee a base-rate as if I worked 12 hours per month, regardless, and anything that I actually saw above that was billed as such. So I’d figure out what number you’d need as a minimum and then go from there, as it prevents them from exposing you to more liability without adequate compensation.

 

[finalpsychyear]

It’s not a bad rate, but a friend of mine fresh out of residency got $250/hr. You’ll need to spend time learning the regulations, and it is tightly monitored.

You could ask for a base pay. I recently took a medical director position, and had them guarantee a base-rate as if I worked 12 hours per month, regardless, and anything that I actually saw above that was billed as such. So I’d figure out what number you’d need as a minimum and then go from there, as it prevents them from exposing you to more liability without adequate compensation.

They want me present for inductions but i will also be managing them to some degree so basically providing the service. So paying me 200/hr for inductions is one thing but also making me medical director seems like they are trying to double dip both services out of me and only pay for one?

For example under the way the original contract was sent I can get up to 12 hours per week. This clinic in theory could be open for 1-2 months with zero patients and i am letting them have me as a medical director on paper for a total of 0 compensation?!

I asked why i am not getting a medical director stipend as that has always been offered with those positions in my experience. Waiting for response as they are looking into it. Also, seems like they can terminate me 30 days without cause whereas I must give 90 days which seems a lot for a 1099 independent contractor as my current positions are 30 day notices.

Am I right about this?

 

[splik]

I asked why i am not getting a medical director stipend as that has always been offered with those positions in my experience. Waiting for response as they are looking into it. Also, seems like they can terminate me 30 days without cause whereas I must give 90 days which seems a lot for a 1099 independent contractor as my current positions are 30 day notices.

Am I right about this?

highly irregular. the notice period should be the same for you as it is for them, be that 30 or 90 days.

 

[finalpsychyear]

1. Medical Director hours should begin before any patients are seen. You should review every policy and plan to escalate level of care if needed. You should help ensure staff know their responsibilities and when to contact you. You should ensure all regulations are being followed. You are the leader, and everyone she understand that. Anything done wrong could effect your license to practice medicine.

2. They will always need a medical director, but your hours may be cut in favor of a cheaper prescriber that you will need to supervise.

3. While it is a learning experience per se, they are getting a huge benefit. You absolutely should be compensated well. I was offered $10k to be medical director of an addiction center to cover my time pre-opening. I declined as the directors were clueless which increases liability and my time needed to plan everything out.

Your absolutely right. They basically want an "a la carte" medical director. They haven't shown any flexibility when i asked for a higher rate than 200/hr or a medical director stipend. Then the contract said they have a 30 day without cause termination but for me it was 90 days notice. There are various reasons my gut is already telling me this is a hard pass. I have reached out and said 30 days and if you can't give me a stipend then there needs to be a minimum hours rather than an "up to x hours" in the agreement.

You could ask for a base pay. I recently took a medical director position, and had them guarantee a base-rate as if I worked 12 hours per month, regardless, and anything that I actually saw above that was billed as such. So I’d figure out what number you’d need as a minimum and then go from there, as it prevents them from exposing you to more liability without adequate compensation.

highly irregular. the notice period should be the same for you as it is for them, be that 30 or 90 days.

Yes, I have asked for a 30 day notice on my end which is exactly what they have on their side. I have also asked for some type of minimum hours as they are wanting me to be a medical director and provide some clinical service as being present during inductions. This is ridiculous if they are trying to compensate only for the clinical time but feel that i can be the medical director 24/7 for free?! I am 95% certain this agreement is a hard pass and will update everyone if they even budge with the above stipulations that i have asked for.

I have never seen a medical director offer without a stipend and a la carte type of hourly charge unless you were already receiving compensation from them but i am only a few years out as an attending so i could be wrong.

 

[finalpsychyear]

You could ask for a base pay. I recently took a medical director position, and had them guarantee a base-rate as if I worked 12 hours per month, regardless, and anything that I actually saw above that was billed as such. So I’d figure out what number you’d need as a minimum and then go from there, as it prevents them from exposing you to more liability without adequate compensation.

highly irregular. the notice period should be the same for you as it is for them, be that 30 or 90 days.

They agreed to 30 day notice for me as well along with 24 hr monthly minimum so i think that sounds much better. It feels weird i can bill for 24 hours even if i have not done any work. I guess they are using my title/liability for their organization 24/7 so i shouldn't feel bad.

 

[TexasPhysician]

They agreed to 30 day notice for me as well along with 24 hr monthly minimum so i think that sounds much better. It feels weird i can bill for 24 hours even if i have not done any work. I guess they are using my title/liability for their organization 24/7 so i shouldn't feel bad.

They got a steal. Don’t feel bad.

Before it opens, you need to obtain the regulations for methadone clinics, familiarize yourself with the regulations, obtain the clinic policies, ensure federal/state regulations are being met through clinic policies, ensure staff have been trained or are being trained on these policies, and regularly ensure compliance.

If the facility director just verbally tells you that everything is being handled, but they lie, it’s your license on the line.

This is a hands-on role that’ll take 100+ hours or so before open, especially if you aren’t already familiar with these strict regulations.

 

[finalpsychyear]

They got a steal. Don’t feel bad.

Before it opens, you need to obtain the regulations for methadone clinics, familiarize yourself with the regulations, obtain the clinic policies, ensure federal/state regulations are being met through clinic policies, ensure staff have been trained or are being trained on these policies, and regularly ensure compliance.

If the facility director just verbally tells you that everything is being handled, but they lie, it’s your license on the line.

This is a hands-on role that’ll take 100+ hours or so before open, especially if you aren’t already familiar with these strict regulations.

They are once again asking if I would consider going to a PRN hourly rate in a voicemail I received since they don't have any patients yet and i was already willing to move the start date back a month or two even without being comped as they were delayed in officially being open. I am not the medical director at this moment hence why i was even agreeable to moving the start date. This is a bit ridiculous correct and I will surely be walking away from this if they don't keep what is written in the contract with me having a minimum hours per week once i have started.

 

[Sushirolls]

Its business. Stick to your contract.

 

[finalpsychyear]

Its business. Stick to your contract.

Your right. However, I think its silly that this gets brought up again after a signed contract has taken place. Its like you signing a contract to work for 5 hours a week guaranteed. Then later someone saying actually we don't have any patients would you consider doing PRN hours till we get our census up? It's almost an insult and technically a breach of contract. Again, i have to keep telling myself i am doing this for the addiction experience more than anything else.

 

[Sushirolls]

Some states have double or triple damages for wage theft. So if they aren't paying you for agreed upon services that's always a possible outcome in court.

Your employed, no patients isn't your problem. If you were productivity it would be your problem.

Ultimately, methadone is on its way out and buprenorphine products are the future of MAT. Working a methadone clinic is more of an experience in federal bureacracy then it is in MAT. You want to do MAT, open a clinic and (take medicaid) and you'll get busy. Reach out to ASAM and state society for ASAM if you need a mentor.

 

[splik]

Some states have double or triple damages for wage theft. So if they aren't paying you for agreed upon services that's always a possible outcome in court.

Your employed, no patients isn't your problem. If you were productivity it would be your problem.

Ultimately, methadone is on its way out and buprenorphine products are the future of MAT. Working a methadone clinic is more of an experience in federal bureacracy then it is in MAT. You want to do MAT, open a clinic and (take medicaid) and you'll get busy. Reach out to ASAM and state society for ASAM if you need a mentor.

methadone is definitely not on the way out. many patients prefer it and is works better for certain patients than bupe. also bupe is practically banned in some states (e.g. tennessee) and that is unlikely to change in the current political climate and in fact could get worse.

 

[Sushirolls]

Yes methadone has its place for some patients and is the preferred treatment for some. I too have had many patients request bupenorphine, or request assistance in tapering off methadone to bupe. Clinically its already happening, and the expansion of midlevels to prescribe bupe (the more pressing political climate) has further accelerated this expansion. Will methadone clinics go away in the next 10 years? No.

 

[Evidence Based]

Ultimately, methadone is on its way out and buprenorphine products are the future of MAT. Working a methadone clinic is more of an experience in federal bureacracy then it is in MAT. You want to do MAT, open a clinic and (take medicaid) and you'll get busy. Reach out to ASAM and state society for ASAM if you need a mentor.

Bup is an excellent drug and I look forward to offering it in my practice. However, it consistently comes out inferior to methadone in regards to treatment retention and abstinence from street opioids in most head to head trials. If anything we should be expanding access to methadone (easing OTP regulations, making observed dosing available in pharmacies) for folks who don't do well on bup or who just prefer methadone.

 

[Sushirolls]

Would love to see some Pub Med ID #s of these publications if you know them.

 

[finalpsychyear]

highly irregular. the notice period should be the same for you as it is for them, be that 30 or 90 days.

Its business. Stick to your contract.

So usually in a contract where you and someone from the other party are both listed like ceo/director etc they have you sign and they have someone on their end who also signs before the contract is 100% in effect correct? I am asking as I have not received a copy with their signature on it.

I am ok with this as i held firm to not start PRN as a medical director/clinician for this company ( trying to save money) and it seems like when i was searching for jobs in the area their add for the position has reappeared since i stated i would only be willing to stick to what has already been written in the contract. It could be a coincidence or they are seeing who else they may find.

I am thinking of just walking but want to make sure I am not in breach of contract if they have not signed their portion. Interestingly, the start date on the contract was over a month ago so my thinking is if they try and enforce the contract they would owe me a month of wages since it required a minimum number of hours per week?

 

[Sushirolls]

So usually in a contract where you and someone from the other party are both listed like ceo/director etc they have you sign and they have someone on their end who also signs before the contract is 100% in effect correct? I am asking as I have not received a copy with their signature on it.

I am ok with this as i held firm to not start PRN as a medical director/clinician for this company ( trying to save money) and it seems like when i was searching for jobs in the area their add for the position has reappeared since i stated i would only be willing to stick to what has already been written in the contract. It could be a coincidence or they are seeing who else they may find.

I am thinking of just walking but want to make sure I am not in breach of contract if they have not signed their portion. Interestingly, the start date on the contract was over a month ago so my thinking is if they try and enforce the contract they would owe me a month of wages since it required a minimum number of hours per week?

Talk with your lawyer. Have the lawyer send them a letter that they are in need of the executed contract. If they have been communicating with you or getting services from you, i.e. answering job related questions or tasks, then you could argue they have effectively already started to treat you as an employee, and the contract was executed by their actions. Let the lawyer work the magic. It will force them to "BM or get off the pot." You'll then have your answer.

In summary, Lawyer time.

 

[finalpsychyear]

They got a steal. Don’t feel bad.

Before it opens, you need to obtain the regulations for methadone clinics, familiarize yourself with the regulations, obtain the clinic policies, ensure federal/state regulations are being met through clinic policies, ensure staff have been trained or are being trained on these policies, and regularly ensure compliance.

If the facility director just verbally tells you that everything is being handled, but they lie, it’s your license on the line.

This is a hands-on role that’ll take 100+ hours or so before open, especially if you aren’t already familiar with these strict regulations.

Update. Today was day 1 just orientation and paperwork. Getting up at 530am exhausted I nearly thought for a while to write an email saying I was not going to go in and resign. Out of guilt I went in as I thought it would be too unprofessional to do that. The place has less than a handful of patients so far all being covered my a diff med director for the time being from a sister place.

Apparently, one of the reasons I wasn't going to take this role was there was no med director stipend and they wanted a PRN med director aka who does all the admin and inductions (present for half) to boot. Essentially, trying to save money and this is a for profit organization. They refused to give me a stipend during negotiations but did agree to give me a minimum hours per week of 6 hrs of pay or so i thought. Now im finding out they would require me to come in for those 6 hours to get paid which basically makes me a PRN doc for 200/hr but I am med director 24/7? It didn't help that the hours are going to be most likely be in the 6-930am window.

My gut tells me this is a bad move and I need to initiate the 30 day notice asap as this seems like a very non lucrative with high risk position. I am exhausted and angry about this so I won't make this decision for 24 hours till i cool down and sleep well but the wisdom on this board has always led me in the right direction. Should I stick it out a few weeks longer or is this simply too little compensation for the position?

 

[TexasPhysician]

Update. Today was day 1 just orientation and paperwork. Getting up at 530am exhausted I nearly thought for a while to write an email saying I was not going to go in and resign. Out of guilt I went in as I thought it would be too unprofessional to do that. The place has less than a handful of patients so far all being covered my a diff med director for the time being from a sister place.

Apparently, one of the reasons I wasn't going to take this role was there was no med director stipend and they wanted a PRN med director aka who does all the admin and inductions (present for half) to boot. Essentially, trying to save money and this is a for profit organization. They refused to give me a stipend during negotiations but did agree to give me a minimum hours per week of 6 hrs of pay or so i thought. Now im finding out they would require me to come in for those 6 hours to get paid which basically makes me a PRN doc for 200/hr but I am med director 24/7? It didn't help that the hours are going to be most likely be in the 6-930am window.

My gut tells me this is a bad move and I need to initiate the 30 day notice asap as this seems like a very non lucrative with high risk position. I am exhausted and angry about this so I won't make this decision for 24 hours till i cool down and sleep well but the wisdom on this board has always led me in the right direction. Should I stick it out a few weeks longer or is this simply too little compensation for the position?

Quit now.

 

[Merovinge]

Update. Today was day 1 just orientation and paperwork. Getting up at 530am exhausted I nearly thought for a while to write an email saying I was not going to go in and resign. Out of guilt I went in as I thought it would be too unprofessional to do that. The place has less than a handful of patients so far all being covered my a diff med director for the time being from a sister place.

Apparently, one of the reasons I wasn't going to take this role was there was no med director stipend and they wanted a PRN med director aka who does all the admin and inductions (present for half) to boot. Essentially, trying to save money and this is a for profit organization. They refused to give me a stipend during negotiations but did agree to give me a minimum hours per week of 6 hrs of pay or so i thought. Now im finding out they would require me to come in for those 6 hours to get paid which basically makes me a PRN doc for 200/hr but I am med director 24/7? It didn't help that the hours are going to be most likely be in the 6-930am window.

My gut tells me this is a bad move and I need to initiate the 30 day notice asap as this seems like a very non lucrative with high risk position. I am exhausted and angry about this so I won't make this decision for 24 hours till i cool down and sleep well but the wisdom on this board has always led me in the right direction. Should I stick it out a few weeks longer or is this simply too little compensation for the position?

Bad jobs happen all the time. It's like buying a house, lots of hoppla before buying, easy to get too attached, but at the end of the day the people who win are those able to walk away and find the right one. Nothing for you to feel bad about, you are making the smart decision.

 

[Merely]

Update. Today was day 1 just orientation and paperwork. Getting up at 530am exhausted I nearly thought for a while to write an email saying I was not going to go in and resign. Out of guilt I went in as I thought it would be too unprofessional to do that. The place has less than a handful of patients so far all being covered my a diff med director for the time being from a sister place.

Apparently, one of the reasons I wasn't going to take this role was there was no med director stipend and they wanted a PRN med director aka who does all the admin and inductions (present for half) to boot. Essentially, trying to save money and this is a for profit organization. They refused to give me a stipend during negotiations but did agree to give me a minimum hours per week of 6 hrs of pay or so i thought. Now im finding out they would require me to come in for those 6 hours to get paid which basically makes me a PRN doc for 200/hr but I am med director 24/7? It didn't help that the hours are going to be most likely be in the 6-930am window.

My gut tells me this is a bad move and I need to initiate the 30 day notice asap as this seems like a very non lucrative with high risk position. I am exhausted and angry about this so I won't make this decision for 24 hours till i cool down and sleep well but the wisdom on this board has always led me in the right direction. Should I stick it out a few weeks longer or is this simply too little compensation for the position?

Bro you got played..quit before things get worse..

 

[Sushirolls]

Should I stick it out a few weeks longer or is this simply too little compensation for the position?

You tell us. Other personal variables and life circumstances and your personal goals and values will drive the weight of the scale. You tell us how things will measure up.

 

[finalpsychyear]

You tell us. Other personal variables and life circumstances and your personal goals and values will drive the weight of the scale. You tell us how things will measure up.

Yes, but those experienced can smell a bad set up or job almost instantly while those of us new to the game don't know much at all.

 

[downwithDTB]

I would pay a lawyer to tell me if they breached the contract, what I may be entitled to, if I can quit immediately without notice or penalty because they have breached and then get they heck out of dodge ASAP.

I would also consider whether I was 100% confident that everything was by the books if I'm the medical director and if I was not confident because I didn't have time to review things... I would object to seeing patients or having the clinic operate.

I would need basic trust to work for someone outside residency and if they aren't giving me what they agreed to, I would walk in a heart beat. Do you want to stick it out for the money? They've lied to you and cheated you in the past, why do you think you'll get paid fairly now? For the experience? I can't see how this becomes a learning experience of anything other than non MDs demanding that you cut corners with your rep on the line.

 

[AD04]

How are you treated during negotiations is an indicator on how the relationship plays out for the long-run.

Recently I had an offer for a similar amount, without being a medical director. Contract in hand for good money. But I wanted to negotiate certain clauses out because they could screw me over. And the other side could not explain why the clauses had to be there. They wouldn't budge. I stood firm and I walked away.

It seems like they are being wishy-washy during the negotiations and they will likely screw you over when things get off the ground. And if things blow up, they WILL pin it on you. Executives and administrators are no saints.

 

[finalpsychyear]

How are you treated during negotiations is an indicator on how the relationship plays out for the long-run.

Recently I had an offer for a similar amount, without being a medical director. Contract in hand for good money. But I wanted to negotiate certain clauses out because they could screw me over. And the other side could not explain why the clauses had to be there. They wouldn't budge. I stood firm and I walked away.

It seems like they are being wishy-washy during the negotiations and they will likely screw you over when things get off the ground. And if things blow up, they WILL pin it on you. Executives and administrators are no saints.

Im preparing my resignation email as we speak, my gut said this entire thing was off from the get go. Seriously, a prn med director for a clinic of this sort is penny pinching as they are a for profit clinic. I had to cut a few hours of my telepsych for the time of this clinic but luckily its normal business hours allowing great sleep. Luckily, i can easily get those hours back.

This job was not motivated primarily by money. I am hoping to sit for addiction boards this year (waiting still to get approved) and thought it would look good to have experience in this particular aspect of the field to potentially open up bigger and better doors down the line.

 

[notlucid]

Medicine in general needs some level of trust with clinic administration. This is even more true imho if working with addictive behaviors. I wouldn't work if the some trust is not there at the start of a job. Clinic director of a methadone clinic seems like lot of responsibility especially if it is not compensated.

 

[finalpsychyear]

Officially Resigned. Lesson learned. Never accept a director role without a stipend and if you even have to ask to include it your radar should be on high alert. Also, methadone for a patient is insanely annoying. I wanted to learn it but there are better more practical options with existing meds.

 

[the5thelement]

Looks like you dodged a bullet