Opinions on 1099 gig

[prozacpundit]

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Hello everyone,
I’m currently completing a fellowship in CAP (Child & Adolescent Psychiatry), and I’m exploring 1099 moonlighting opportunities to continue once I graduate. I’ve already reached out to a few recruiting companies.
I just received an offer for a fully virtual, part‑time weekend gig in crisis stabilization, and I’d love your help evaluating it. Here are the details:

• Schedule: 5 PM to 11 PM, covering four separate crisis stabilization units via telehealth.
• Compensation:
  • $400 base for up to two new intake evaluations.
  • $165 for each additional new intake.
  • $30 per phone call (e.g., PRN meds, doctor‑to‑doctor consults).
  • $80 per follow‑up evaluation (not often assigned; most follow‑ups handled by NPs).
• Case volume: Typically 4–5 evaluations per shift, sometimes as low as 0 or as high as 10. Based on six‑hour shifts, the average gross pay is around $1,000/shift
• Est. hourly equivalent: ≈ $160–$175/hour, depending on caseload.

I’d appreciate any feedback from anyone who has done anything similar.

• Does this pay align with typical rates for tele‑crisis stabilization moonlighting?
• Any red flags—contractual, operational, or liability issues—that I should watch out for?
• Negotiation tips (e.g. minimum eval guarantees, call coverage support)?

Thanks in advance for your insight!

 

[comp1]

So I mean it's obviously low if your hourly calculation works out, but I think these fully telehealth things are going to become pretty darn rare, so it might be good. You don't have to calculate being paid to drive there. Being paid by the phone call is so weird, but I guess nice? You would think for a fully telehealth system they would primarily communicate by IM. Since a recruiting company is handling it I have to assume there are definite issues of some sort, but no way to know what they are at this point. You are the call coverage support, so I'm not sure what you meant by that? They appear to already be giving you a minimum eval guarantee of two.

 

[FlowRate]

10 intakes sounds like a lot--like not doable within the allotted 6 hours unless you're cutting corners. [These are CSU patients, so not the easy "florid psychosis, no interview to be had, put on a hold and start an antipsychotic" ED notes.] Also sounds like you're on the hook for relatively immediate engagement any time in those 6 hours, even if you may only be paid $400 for it. Up to you if that's worth it.

 

[comp1]

I think there are different definitions of CSU throughout the country. Around my parts they definitely will have some florid psychosis and the CSU is most often used as a holding space while they arrange for placement in a psych unit. Police can just drop people off and it's roughly like a psych ED. There's like a 24 hour limit for how long they can stay there. Hopefully the OP knows what this one will be like in terms of patient population.

 

[psydocc]

Hello everyone,
I’m currently completing a fellowship in CAP (Child & Adolescent Psychiatry), and I’m exploring 1099 moonlighting opportunities to continue once I graduate. I’ve already reached out to a few recruiting companies.
I just received an offer for a fully virtual, part‑time weekend gig in crisis stabilization, and I’d love your help evaluating it. Here are the details:

• Schedule: 5 PM to 11 PM, covering four separate crisis stabilization units via telehealth.
• Compensation:
  • $400 base for up to two new intake evaluations.
  • $165 for each additional new intake.
  • $30 per phone call (e.g., PRN meds, doctor‑to‑doctor consults).
  • $80 per follow‑up evaluation (not often assigned; most follow‑ups handled by NPs).
• Case volume: Typically 4–5 evaluations per shift, sometimes as low as 0 or as high as 10. Based on six‑hour shifts, the average gross pay is around $1,000/shift
• Est. hourly equivalent: ≈ $160–$175/hour, depending on caseload.

I’d appreciate any feedback from anyone who has done anything similar.

• Does this pay align with typical rates for tele‑crisis stabilization moonlighting?
• Any red flags—contractual, operational, or liability issues—that I should watch out for?
• Negotiation tips (e.g. minimum eval guarantees, call coverage support)?

Thanks in advance for your insight!

Seems like a lot of work, not much pay, and arguably the most undesirable time slot of the week. Basically a triad of misery. Hopefully they're covering your malpractice insurance at least? I had an offer very similar to this a few years ago and turned it down.

 

[SPsych6]

Overall pay seems low if you are averaging only 175/hr. Especially for child. Also, 165 for each ADDITIONAL intake...? What? An intake is an intake. You should ask for 400 for all of them. Or are they saying 400 no matter what? Either way seems horrible. This only seems like a good gig if you are looking for a little extra money and you end up seeing like 2-3 a shift. If you are busy it is definitely a horrible option.

 

[prozacpundit]

I think there are different definitions of CSU throughout the country. Around my parts they definitely will have some florid psychosis and the CSU is most often used as a holding space while they arrange for placement in a psych unit. Police can just drop people off and it's roughly like a psych ED. There's like a 24 hour limit for how long they can stay there. Hopefully the OP knows what this one will be like in terms of patient population.

That makes sense. I spoke with a doctor who is currently working there, and it sounds like they see a lot of indigent patients, frequent fliers, etc. But also depressed patients with SI but not entirely meeting inpatient criteria. Work does involve a good amount of holds & commitments.

 

[prozacpundit]

So I mean it's obviously low if your hourly calculation works out, but I think these fully telehealth things are going to become pretty darn rare, so it might be good. You don't have to calculate being paid to drive there. Being paid by the phone call is so weird, but I guess nice? You would think for a fully telehealth system they would primarily communicate by IM. Since a recruiting company is handling it I have to assume there are definite issues of some sort, but no way to know what they are at this point. You are the call coverage support, so I'm not sure what you meant by that? They appear to already be giving you a minimum eval guarantee of two.

How much would you say is average hourly pay for this sort of work.
By support I meant social work staff mainly since work involves a lot of holds, commitments, etc.

 

[prozacpundit]

10 intakes sounds like a lot--like not doable within the allotted 6 hours unless you're cutting corners. [These are CSU patients, so not the easy "florid psychosis, no interview to be had, put on a hold and start an antipsychotic" ED notes.] Also sounds like you're on the hook for relatively immediate engagement any time in those 6 hours, even if you may only be paid $400 for it. Up to you if that's worth it.

Thats true. 10 is definitely a lot. probably be up later finishing notes on such a night. but that would not be the usual, more so a once in a while very busy day. average load is 4-5. thats true, you have to be available in that window. although they would pay you 30$ per phone call (might not be a lot depending on what you managing over the phone)

 

[prozacpundit]

Seems like a lot of work, not much pay, and arguably the most undesirable time slot of the week. Basically a triad of misery. Hopefully they're covering your malpractice insurance at least? I had an offer very similar to this a few years ago and turned it down.

yes they are covering malpractice. forgot to mention it is also available on weekday evenings* and I would actually do more of that, and not weekends

 

[prozacpundit]

Overall pay seems low if you are averaging only 175/hr. Especially for child. Also, 165 for each ADDITIONAL intake...? What? An intake is an intake. You should ask for 400 for all of them. Or are they saying 400 no matter what? Either way seems horrible. This only seems like a good gig if you are looking for a little extra money and you end up seeing like 2-3 a shift. If you are busy it is definitely a horrible option.

yes you get 400$ up to 2 patients (so for 0,1,2 patients) and then 165$ per intake starting from your 3rd patient
average load is 4-5 patients per shift

 

[TexasPhysician]

The volume would really determine this for me. 5-11pm are prime hours. That’s prime hours for family, hobbies, friends, etc. If this job averaged 0-1 patients and I needed extra money, I think the pay is fair. The busier this gets, there is much better pay for hard work.

I hypothesize that telehealth work is going to dry up or pay will be reduced. If you need to stay telehealth, I’d start loading up on jobs where you can. The telehealth billing codes pay poorly where they are introduced, Ryan-Haight may return, and NP’s are jumping on tele jobs. The job market is worsening for tele.

 

[FatherPsychiatry]

I think there are different definitions of CSU throughout the country. Around my parts they definitely will have some florid psychosis and the CSU is most often used as a holding space while they arrange for placement in a psych unit. Police can just drop people off and it's roughly like a psych ED. There's like a 24 hour limit for how long they can stay there. Hopefully the OP knows what this one will be like in terms of patient population.

That makes sense. I spoke with a doctor who is currently working there, and it sounds like they see a lot of indigent patients, frequent fliers, etc. But also depressed patients with SI but not entirely meeting inpatient criteria. Work does involve a good amount of holds & commitments.

Agreed. The key is always to figure out what its actually like working there, and the only good way is to really talk to the psychiatrists currently on the ground. Indigent mix vs high end mix is huge - if its mostly indigent, everyone gets "REAMed" (re-evaluated in the morning by day team) and you put in an order for B52 or Zyprexa 10 + Ativan 2mg and document whatever minimum note your system requires. If that's the case, pay probably isn't that bad especially for 100% remote, and you'll have lots of downtime.

If you have a mostly insured population, you'll have a lot of patients' mothers involved, which will increase your time required per case by 10x.

 

[Dr. Pookie]

Fully telehealth opportunities will be a thing of the past before long.

I would not consider opportunities that do not have an in-person option.

 

[comp1]

I'm confused about why you wouldn't take a moonlighting job that didn't have an in person option? That seems like an odd choice just because they are going away. I do agree they are going away, however. This is not something that the OP is trying to build a life and career around.

 

[prozacpundit]

Agreed. The key is always to figure out what its actually like working there, and the only good way is to really talk to the psychiatrists currently on the ground. Indigent mix vs high end mix is huge - if its mostly indigent, everyone gets "REAMed" (re-evaluated in the morning by day team) and you put in an order for B52 or Zyprexa 10 + Ativan 2mg and document whatever minimum note your system requires. If that's the case, pay probably isn't that bad especially for 100% remote, and you'll have lots of downtime.

If you have a mostly insured population, you'll have a lot of patients' mothers involved, which will increase your time required per case by 10x.

great point. I will try to clarify more about this. makes a huge difference in the time needed for seeing the patient and documentation

 

[clozareal]

So if you have 0 intakes, then you have to wait around for nothing from 5-11pm without getting paid? That's a lot of obligated time for little to no payoff. I would try to negotiate for a base amount per shift that you're comfortable with and an additional amount above that.

Even if you had 1 intake, your hourly rate would be $66/hr for that time ($400/6 hours).

My time is worth more than that. Just build up a private practice yourself and see evening patients. Kids, parents, and teen love evening availability and you can do it all virtually if you want.

 

[FatherPsychiatry]

So if you have 0 intakes, then you have to wait around for nothing from 5-11pm without getting paid? That's a lot of obligated time for little to no payoff. I would try to negotiate for a base amount per shift that you're comfortable with and an additional amount above that.

Maybe I didn't understand the first post, but I thought it was minimum of $400, even if 0 patients, and up to two patients. Beyond that, you get the numbers presented by OP. I agree that personally I wouldn't take that rate to be "locked down", but I could see a lot of people being OK with it.

 

[Stagg737]

Maybe I didn't understand the first post, but I thought it was minimum of $400, even if 0 patients, and up to two patients. Beyond that, you get the numbers presented by OP. I agree that personally I wouldn't take that rate to be "locked down", but I could see a lot of people being OK with it.

Per OP you're correct. 0 intakes is still $400, but it's also still 6 hours during prime time that you can't go out and do anything and have to be available to jump on to see someone. $66/hr to sit at home and do nothing sounds great to me if you're getting guaranteed that, but that's not what this position is. It has the potential to be that but also the potential to be miserable (10 crisis intakes is 6 hours is brutal says the former in-person ER psychiatrist).

 

[FatherPsychiatry]

Per OP you're correct. 0 intakes is still $400, but it's also still 6 hours during prime time that you can't go out and do anything and have to be available to jump on to see someone. $66/hr to sit at home and do nothing sounds great to me if you're getting guaranteed that, but that's not what this position is. It has the potential to be that but also the potential to be miserable (10 crisis intakes is 6 hours is brutal says the former in-person ER psychiatrist).

I think every PsychER experience is different. I was picturing it like my PsychER moonlighting experience at a county hospital - basically police brining in "crisis intakes" on the evening / overnight shifts until a disposition would be figured out in the morning by day team. I could do like 15 of those evals+doc in 6 hours without too much stress. If the average truly is around $1000 that OP was told, could be a solid deal for this kind of thing - sit at home playing video games or watching Netflix while hopping off to the computer (or just switching screens!) to stamp out some mental illness, then resume what you were doing. I sure as hell wouldn't do it at a place where moms with Birkinbags are bringing in their kids for "mental health."

 

[prozacpundit]

I think every PsychER experience is different. I was picturing it like my PsychER moonlighting experience at a county hospital - basically police brining in "crisis intakes" on the evening / overnight shifts until a disposition would be figured out in the morning by day team. I could do like 15 of those evals+doc in 6 hours without too much stress. If the average truly is around $1000 that OP was told, could be a solid deal for this kind of thing - sit at home playing video games or watching Netflix while hopping off to the computer (or just switching screens!) to stamp out some mental illness, then resume what you were doing. I sure as hell wouldn't do it at a place where moms with Birkinbags are bringing in their kids for "mental health."

I agree. it all depends on what kind of cases you are getting there and how much time per patient is it going to take on average. lets see. I sent a counter offer with higher numbers especially given the acuity and timing of the shift.

 

[TexasPhysician]

So if you have 0 intakes, then you have to wait around for nothing from 5-11pm without getting paid? That's a lot of obligated time for little to no payoff. I would try to negotiate for a base amount per shift that you're comfortable with and an additional amount above that.

Even if you had 1 intake, your hourly rate would be $66/hr for that time ($400/6 hours).

My time is worth more than that. Just build up a private practice yourself and see evening patients. Kids, parents, and teen love evening availability and you can do it all virtually if you want.

Right but if you are someone who generally stays at home those hours, that could be $400 a day to live the same life you have been living.

 

[comp1]

Yeah I definitely agree with people above that this depends on the unit. I noticed that they started off saying they were CAP. If all (or most) of the intakes were CAP, this is simply unacceptable. The amount of work is too much; just to get permission to medicate the little guys could easily eat up a half hour. If most of the intakes are psychotic adults, it's acceptable in my opinion.

 

[prozacpundit]

Yeah I definitely agree with people above that this depends on the unit. I noticed that they started off saying they were CAP. If all (or most) of the intakes were CAP, this is simply unacceptable. The amount of work is too much; just to get permission to medicate the little guys could easily eat up a half hour. If most of the intakes are psychotic adults, it's acceptable in my opinion.

yes all are adults from what I know! Kids def would be hard

 

[Stagg737]

I think every PsychER experience is different. I was picturing it like my PsychER moonlighting experience at a county hospital - basically police brining in "crisis intakes" on the evening / overnight shifts until a disposition would be figured out in the morning by day team. I could do like 15 of those evals+doc in 6 hours without too much stress. If the average truly is around $1000 that OP was told, could be a solid deal for this kind of thing - sit at home playing video games or watching Netflix while hopping off to the computer (or just switching screens!) to stamp out some mental illness, then resume what you were doing. I sure as hell wouldn't do it at a place where moms with Birkinbags are bringing in their kids for "mental health."

So my question for these situations is why do they even need to be seen by you at all if they're just going to be seen by the team in the morning? If they're slam dunk admits, then the morning team doesn't need to see them after you. If they can be discharged then the morning team won't see them. Unless this is some kind of stupid state law that a patient must be evaluated by psych within a rapid time frame (in my state it's within 20 hours of patient requesting discharge). And honestly I'm not sure what is meant by crisis "intakes". If it's a crisis center, then it's either a short term 1-2 day stay with monitoring OR it's just dispoing to other facilities. If it's not one of those two, it sounds like there's misnomers happening.

Either way, the type of description above sounds like a place that wants a liability meat shield if things go south. Red flags are that they're paying $80/f/up but that NPs normally handle this and getting paid for extra calls being made (the fact that this is even necessary or mentioned would raise immediate concerns to me). This sounds like the kind of place that doesn't really care about providing quality care and just wants to meet the minimum standard, hence why they're underpaying someone to do telehealth during prime personal hours.

 

[Stagg737]

I agree. it all depends on what kind of cases you are getting there and how much time per patient is it going to take on average. lets see. I sent a counter offer with higher numbers especially given the acuity and timing of the shift.

The offer as it stands is terrible. To put it another way:

If average pay is $1k/shift then this would be the equivalent of $5k/week or ~$230k/yr at 30 clinical hours per week doing only new evals and seeing 20-25 new evals per week (potential of up to 40-50 new evals in a week). That's a hell I can't imagine ever considering, and I say this as someone who did ER psych at an academic center for 2 years.

 

[jbomba]

165 per intake does not sound like a good deal to me.

I also don't like these gigs that get full coverage but don't pay for it (the 400 notwithstanding). To have a doc fully staffing not one but 4 units should be something that is compensated more than 100 dollars per unit for 6 hours.

 

[splik]

No. Just No.

 

[clausewitz2]

So my question for these situations is why do they even need to be seen by you at all if they're just going to be seen by the team in the morning?

Can't speak for OP, but in my state once an involuntary commitment is approved by the county the patient has to be examined by a physician at an approved facility within two hours of arrival at the facility or the commitment is automatically dismissed. It doesn't necessarily need to be upheld and final decision can be deferred a bit, but there has to be some kind of exam.

If they're slam dunk admits, then the morning team doesn't need to see them after you. If they can be discharged then the morning team won't see them. Unless this is some kind of stupid state law that a patient must be evaluated by psych within a rapid time frame (in my state it's within 20 hours of patient requesting discharge). And honestly I'm not sure what is meant by crisis "intakes". If it's a crisis center, then it's either a short term 1-2 day stay with monitoring OR it's just dispoing to other facilities. If it's not one of those two, it sounds like there's misnomers happening.

Either way, the type of description above sounds like a place that wants a liability meat shield if things go south. Red flags are that they're paying $80/f/up but that NPs normally handle this and getting paid for extra calls being made (the fact that this is even necessary or mentioned would raise immediate concerns to me). This sounds like the kind of place that doesn't really care about providing quality care and just wants to meet the minimum standard, hence why they're underpaying someone to do telehealth during prime personal hours.

 

[Stagg737]

Can't speak for OP, but in my state once an involuntary commitment is approved by the county the patient has to be examined by a physician at an approved facility within two hours of arrival at the facility or the commitment is automatically dismissed. It doesn't necessarily need to be upheld and final decision can be deferred a bit, but there has to be some kind of exam.

2 hours is a really short period of time for this. I understand trying to maintain individual rights, but 2 hours is ridiculous imo unless there are carve outs for times when hours don’t count (which it sounds like there aren’t). I feel like this just encourages bad care and inadequate evals…

 

[clausewitz2]

2 hours is a really short period of time for this. I understand trying to maintain individual rights, but 2 hours is ridiculous imo unless there are carve outs for times when hours don’t count (which it sounds like there aren’t). I feel like this just encourages bad care and inadequate evals…

Realistically what happens is a physician puts eyes on someone, talks to them briefly, and then documents that someone needs to be kept for further assessment and the actual eval happens later that shift. But yes, it does not accomplish what I imagine was intended.

 

[Stagg737]

Realistically what happens is a physician puts eyes on someone, talks to them briefly, and then documents that someone needs to be kept for further assessment and the actual eval happens later that shift. But yes, it does not accomplish what I imagine was intended.

Sure, just seems like a silly law and unnecessary that a psychiatrist has to lay eyes on someone just to say, "yep, let's keep them and evaluate them later". As you said, seems like it's not doing what is probably meant to be done.

 

[nexus73]

So my question for these situations is why do they even need to be seen by you at all if they're just going to be seen by the team in the morning? If they're slam dunk admits, then the morning team doesn't need to see them after you.

I had this argument repeatedly with my formal hospital chief medical officer and she was certain a night psychiatrist would improve ED throughput. "They'll get the meds started so patients can discharge in the morning."

 

[Cath Up]

Sure, just seems like a silly law and unnecessary that a psychiatrist has to lay eyes on someone just to say, "yep, let's keep them and evaluate them later". As you said, seems like it's not doing what is probably meant to be done.

I believe I am in the same state and in my opinion this is the least of the issues with the involuntary MH laws in the state. I’ve always felt 2 hours is pretty reasonable/not hard to meet and protective as it ensures decompensated folks are at least somewhat prioritized as their rights are being curtailed.

 

[clausewitz2]

I believe I am in the same state and in my opinion this is the least of the issues with the involuntary MH laws in the state. I’ve always felt 2 hours is pretty reasonable/not hard to meet and protective as it ensures decompensated folks are at least somewhat prioritized as their rights are being curtailed.

Oh for sure there are more issues but it does mean that there absolutely has to be a physician on hand seeing people at all times, more or less.

 

[jbomba]

I had this argument repeatedly with my formal hospital chief medical officer and she was certain a night psychiatrist would improve ED throughput. "They'll get the meds started so patients can discharge in the morning."

This is how it works at my pes. I am at times that night time person. I do think it expedites care and probably gets people out of there faster

 

[nexomed]

For part-time 1099 work, you can find better options. In the last few months, I've seen one fully tele-health job for 16 hours/week that was offering $235/hour for outpatient child psychiatry that you could do from any where in the United States. Also one of the large tele-health companies is offering $185/hour for 10 hours/week where you set your own hours--imagining could be (very slightly) higher with negotiation. One place you might look into is marithealth where physicians have been anonymously posting salaries to gather more data points.

 

[nexus73]

This is how it works at my pes. I am at times that night time person. I do think it expedites care and probably gets people out of there faster

Perhaps if it’s in person. Not if it’s telepsych recommending you continue home meds and admission for everyone.

 

[FatherPsychiatry]

So my question for these situations is why do they even need to be seen by you at all if they're just going to be seen by the team in the morning?

This is how it works at my pes. I am at times that night time person. I do think it expedites care and probably gets people out of there faster

Probably this. An NP could do it just as well 95% of the time but please don't tell admin about this one money saving trick that psychiatrists HATE.

 

[Stagg737]

I believe I am in the same state and in my opinion this is the least of the issues with the involuntary MH laws in the state. I’ve always felt 2 hours is pretty reasonable/not hard to meet and protective as it ensures decompensated folks are at least somewhat prioritized as their rights are being curtailed.

This is how it works at my pes. I am at times that night time person. I do think it expedites care and probably gets people out of there faster

Imo this is pretty much the only real reason to have someone evaluated overnight. If they don't want to stay, have capacity, and don't require admission, then expediting discharge is reasonable. However, working in ER psych I would say the number of times I've encountered this in my 3-4 years of working in that setting I could count on one hand. Again, if someone is just seeing them overnight and blanket saying "patient seen, admit" or "patient evaluated, re-evaluate in the morning" then this is both unnecessary and a waste of resources as well as just following the written law without enforcing the spirit of what it's actually meant to do.

Perhaps if it’s in person. Not if it’s telepsych recommending you continue home meds and admission for everyone.

Completely agree with this as well. I'm sure most of these overnight places are doing telehealth, and I cannot express enough how inadequate a telehealth evaluation is in the ER setting. I had too many patients that were seen via telehealth overnight (during COVID) and were deemed to be "okay" but when I arrived in the morning the telehealth provider missed so many things that were beyond obvious. Rancid smells, rooms with trash or bodily fluids/feces everywhere, patients with completely disorganized appearances (unable to even put on a simple hospital gown), etc that were missed because it was just an iPad showing the patient's face. It dramatically changed my opinion on capabilities of telehealth and how it is implemented.

 

[comp1]

Until/unless reimbursement becomes dramatically less for virtual over meat space assessments, I suspect most PES assessments around the country will be virtual with the number ever increasing. There just aren't enough mental health providers to do them at current rates in person, NP, MD or LCSW. That of course doesn't excuse a poor telehealth setup. You can and should be able to zoom around the room to get a full picture and be able to talk separately to the telehealth presenter. Can't (and don't want to) help with the lack of smell.

 

[jbomba]

Probably this. An NP could do it just as well 95% of the time but please don't tell admin about this one money saving trick that psychiatrists HATE.

Lol...there are times I'm standing there at 3am, having gotten through my basic triage questions of a patient who has been medically cleared at an outside ED knowing damn well a sub-i could probably do the job equally as well. Granted not every patient who presents is like this...