My work options!

[SmallBird]

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I have found the advice on thinking about jobs post residency to be super helpful on this forum. In the past I asked generally, now I can get more specific. Would still appreciate any and all thoughts.

Me: Graduating fellowship in a year, need lots of time to get visa things in place. Did a ton of research in residency; liked it, hated the effect on work-life balance, and not looking to pursue a funded research career. Still enjoy academic engagement and teaching but also love my many hobbies. I love hearing about cool things people are doing and talking with them about their research and innovation; on the other hand I couldn't care less about prestige for its own sake.

Option 1: Faculty position at current institution, likely on something like a clinician-educator track but with the potential to engage in research. Likely about 35 clinical hours, all outpatient, call 5 weeks a year which is home call plus weekend rounding. Good benefits. Location is ok - if I was earning a lot I would like it more. Salary is $160k, no compensation for on call.

Option 2: Faculty position at another well regarded academic center, although this one is more of an affiliation as the institution itself has a primary clinical mission. Some teaching opportunity, research would be supported but less common. Likely about 40 clinical hours, all inpatient, call 10 weekends per month. Salary is $185k, plus another +/- $60k for call and a typical amount of RVU based compensation (could be more if I'm efficient, could be less if I do more teaching). Location is great.

Option 3: Position at community mental health center. Currently running pretty smoothly with mid-level prescribers only and extensive, well funded community based resources of every variety. 37.5 clinical hours, four days a week. 60% clinical, 40% administrative and self-directed program development/QI/research. On call is only for backup to mid-level providers, average 2-3 calls per month, having to come in about once a month. $200K, great benefits. Location is more rural but still great.

Happy to give more info, hear what other factors people think I should be considering, etc. I feel like these are all pretty great options actually. All of these are in the northeast.

 

[Doctor Bagel]

Are you sure you want to stay in the NE? Pay seems really low especially for child, but I'm not in that part of the country. How busy are each of the days going to be with these places? Inpatient can mean 10 patients, and it can mean 20 patients. CMHC can mean 15 minute follow ups or 30 minute follow ups.

 

[SmallBird]

Are you sure you want to stay in the NE? Pay seems really low especially for child, but I'm not in that part of the country. How busy are each of the days going to be with these places? Inpatient can mean 10 patients, and it can mean 20 patients. CMHC can mean 15 minute follow ups or 30 minute follow ups.

NE - yes, for now! Although I looked at CMHC's in other states not in the northeast and for four days they were offering around $175k.

In terms of how busy; the academic job will likely be quite nicely paced (3o minute follow ups). The CMHC will probably be 3 patients an hour but with time allowed for notes, other tasks built into the day. The inpatient is 8.5 adolescents per day, anything more gives you incentive pay.

 

[Doctor Bagel]

NE - yes, for now! Although I looked at CMHC's in other states not in the northeast and for four days they were offering around $175k.

In terms of how busy; the academic job will likely be quite nicely paced (3o minute follow ups). The CMHC will probably be 3 patients an hour but with time allowed for notes, other tasks built into the day. The inpatient is 8.5 adolescents per day, anything more gives you incentive pay.

With the CMHC, would you be the only non-midlevel? Why would you need to come in for calls? Being the only physician could feel a bit isolating. I might lean toward option #2, but that does leave you with more after-hours work.

 

[SmallBird]

With the CMHC, would you be the only non-midlevel? Why would you need to come in for calls? Being the only physician could feel a bit isolating. I might lean toward option #2, but that does leave you with more after-hours work.

Coming in would be if someone needed commitment to the state hospital (its an idiosyncratic process) which requires a second physician.

Yeah, the isolation is a consideration. The big draw is the lifestyle. I think $200k is pretty good for four days, at least for around here.

 

[PikminOC]

2 docs for a commitment. .interesting

 

[HarryMTieboutMD]

Just from reading your previous posts (and this one) you thrive in the academic setting, but the clinician educator track can be kind of rough. I have a friend who took a faculty position as such at Yale (and he's an MDPhD by training and did his fellowship at Yale), but he primarily works in the VA so his pay/benefits/etc are better, and he has no research obligations. I don't know John Krystal personally, but most academic chairs I know (and I know a fair number of big name ones) are more than happy to have good residents stay on as junior clinical faculty, but what they really want is people who are going to get K awards and bring in NIH money (as you know).

I like #2 because the pay is awesome (but cost of living probably sucks if it's an awesome location in NE) and you still have the academic milieu.

3 sounds pretty mind numbing tbh

 

[Doctor Bagel]

Just from reading your previous posts (and this one) you thrive in the academic setting, but the clinician educator track can be kind of rough. I have a friend who took a faculty position as such at Yale (and he's an MDPhD by training and did his fellowship at Yale), but he primarily works in the VA so his pay/benefits/etc are better, and he has no research obligations. I don't know John Krystal personally, but most academic chairs I know (and I know a fair number of big name ones) are more than happy to have good residents stay on as junior clinical faculty, but what they really want is people who are going to get K awards and bring in NIH money (as you know).

I like #2 because the pay is awesome (but cost of living probably sucks if it's an awesome location in NE) and you still have the academic milieu.

3 sounds pretty mind numbing tbh

$185k + $60k for working almost one weekend a month is awesome pay? For child? Around here, you could make that much with no evenings or weekends again for child -- as far as I can figure out, demand for child is pretty huge. Not in an academic setting, but still.

I agree that it sounds like it's probably the best option, though.

 

[smalltownpsych]

$185k + $60k for working almost one weekend a month is awesome pay? For child? Around here, you could make that much with no evenings or weekends again for child -- as far as I can figure out, demand for child is pretty huge. Not in an academic setting, but still.

I agree that it sounds like it's probably the best option, though.

It's even worse than that. Going to be tough to find any time off at all! 😛

Option 2: Faculty position at another well regarded academic center, although this one is more of an affiliation as the institution itself has a primary clinical mission. Some teaching opportunity, research would be supported but less common. Likely about 40 clinical hours, all inpatient, call 10 weekends per month. Salary is $185k, plus another +/- $60k for call and a typical amount of RVU based compensation (could be more if I'm efficient, could be less if I do more teaching). Location is great.

 

[SmallBird]

It's even worse than that. Going to be tough to find any time off at all! 😛

I'm not sure I know what you mean! What is worse than that? 🙂

 

[SmallBird]

$185k + $60k for working almost one weekend a month is awesome pay? For child? Around here, you could make that much with no evenings or weekends again for child -- as far as I can figure out, demand for child is pretty huge. Not in an academic setting, but still.

I agree that it sounds like it's probably the best option, though.

Well, that's awesome for people in your area! I have seen non-academic jobs without call that are $210k for child. I have not seen $245k that has no call.

 

[SmallBird]

Just from reading your previous posts (and this one) you thrive in the academic setting, but the clinician educator track can be kind of rough. I have a friend who took a faculty position as such at Yale (and he's an MDPhD by training and did his fellowship at Yale), but he primarily works in the VA so his pay/benefits/etc are better, and he has no research obligations. I don't know John Krystal personally, but most academic chairs I know (and I know a fair number of big name ones) are more than happy to have good residents stay on as junior clinical faculty, but what they really want is people who are going to get K awards and bring in NIH money (as you know).

I like #2 because the pay is awesome (but cost of living probably sucks if it's an awesome location in NE) and you still have the academic milieu.

3 sounds pretty mind numbing tbh

Yeah, good thoughts. Location not too expensive - I guess it depends on what you value in a location. Boston is super expensive and some people probably consider it the only awesome location in New England. I love places like Portland ME, Burlington VT, Providence RI, and even more rural locations in both states. I just need to be able to afford and house a grand piano and I'm happy 🙂

 

[Shikima]

Smallbird, #2 IMO.

 

[notdeadyet]

I'd go with door #2. A nice compromise. Low expectation for research for a new faculty is a plus in my book, as that has a very real potential for scope creep and eating into work/life balance.

 

[SmallBird]

$185k + $60k for working almost one weekend a month is awesome pay? For child? Around here, you could make that much with no evenings or weekends again for child -- as far as I can figure out, demand for child is pretty huge. Not in an academic setting, but still.

I agree that it sounds like it's probably the best option, though.

Thanks for all the replies!

It would be helpful for the collective consciousness to here about pay differences compared to other academic settings - I also get the $300k North Dakota emails, but I guess I have no idea how these offers compare to say, academic positions at good institutions in the south or Midwest...

 

[SmallBird]

It's even worse than that. Going to be tough to find any time off at all! 😛

Oh lol now I see, my bad!!

Yes, 10 weekends per year 🙂

 

[Psychotic]

#2, but that call deal is heavy.

I know you are an IMG (right?), and landed in New England. How well traveled are you in the US? Man, it is a big country, lots of great locations with better pay, lower cost of living, better weather, and plenty of opportunity for academic affiliations...unless you are tied to the northeast for other personal reasons, I would look around for opportunities outside the region.

 

[vistaril]

I would go with #2 as well. It does seem like an academic job in name only though(which could be a positive or negative thing depending on what you want). If you really want an academic job, I'd pick #1.

 

[SmallBird]

I would go with #2 as well. It does seem like an academic job in name only though(which could be a positive or negative thing depending on what you want). If you really want an academic job, I'd pick #1.

Yep, that's a good point - it allows for interaction with residents, and a platform to do some research if I want to - although it is not required, and by extension, not likely to be substantially accommodated.

 

[waldenwoods]

37.5 clinical hours, four days a week. 60% clinical, 40% administrative and self-directed program development/QI/research.

Does this mean that you will have approximately 25 hours per week of administrative duties on top of the clinical hours? If 37.5 is 60% of the total time, then I would calculate 25 hours for administrative time as 40% of the total. Also, I'm not saying that 3 patients per hour can't be done, but it seems like it might be a bit hectic if you have a child patient plus the parent(s)/guardian who all might want to have a say. Plus possible case manager who might want to talk about the child's performance in school or behavioral problems.

 

[SmallBird]

Does this mean that you will have approximately 25 hours per week of administrative duties on top of the clinical hours? If 37.5 is 60% of the total time, then I would calculate 25 hours for administrative time as 40% of the total. Also, I'm not saying that 3 patients per hour can't be done, but it seems like it might be a bit hectic if you have a child patient plus the parent(s)/guardian who all might want to have a say. Plus possible case manager who might want to talk about the child's performance in school or behavioral problems.

I phrased that extremely poorly. The job in total is 37.5 hours. 60% of that is clinical, the rest administrative.

 

[Information Underload]

Some are saying that the pay is low, but that entirely depends upon what your productivity model looks like for #2 and what your caseload will be. About 1/3 of my monetary income last year came from a productivity bonus. My base pay looks pretty low for child, as well, but I knew going into it that it was only going to stay that low for the first 6 months.

 

[SmallBird]

Some are saying that the pay is low, but that entirely depends upon what your productivity model looks like for #2 and what your caseload will be. About 1/3 of my monetary income last year came from a productivity bonus. My base pay looks pretty low for child, as well, but I knew going into it that it was only going to stay that low for the first 6 months.

Thats interesting... I am quite ignorant about how these things work. My understanding is that the base pay is based on seeing 8.5 kids for 46 weeks (5 day weeks). Productivity kicks in at that point, and there is apparently a lot of availability of extra work if desired (covering people on vacation, on call, just admitting more to your service etc.). Its super hard to guess how that will add up.