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outpatient practice

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psychhog

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what's typical for outpatient practice as far as number of patients, f/u and new patient time allotted for you guys and gals in here? After completing residency I was active duty for 4 years and that was definitely not reflective of what typical outpatient practice looks like but I was miserable in the military. After military time I started with a company that I've since read on social media and other places that I often will see many people recommend to avoid. My experience hasn't been bad (I think), the pay is high, but I am starting to feel a since of burnout I suspect and I'm really wondering if I'm just getting crushed in the daily grind or am I just not cut out for outpatient. I often will have 20-25 patients on my schedule when I first show up but commonly will have no shows which will usually look like 18-23 patients in a day. Tomorrow I have 25 on my schedule as of right now and it's just gotten to a point where that seems so daunting. I'm finding myself having more trouble keeping up with the pace, finding myself worrying more when I'm at home. I get so many messages in my inbox as well. Supervise 2 NP’s and due to the state I’m in I have to send controlled meds in for them. Man as I type this out this does seem like a lot but tell me, am I the crazy one for feeling burned out? Been at it for 3 years now post military time.
 
This set up sounds really bad. I think burnout is highly likely, and you probably cannot provide good-enough care within anything like normal clinic hours. The company may tell you that you have to practice this way, but keep in mind that as a licensed provider you "can't be forced to practice below your own standard of care" and reviewers will hold you accountable for bad outcomes even if it feels like company policy forced your hand.

I would start very actively looking for another role.
 
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Criminy! That is not manageable or safe. Consider the VA! Your active duty time counts towards retirement and I promise it will be much, much, much less than 25 patients a day. VAs vary but not that much. NPs have full practice authority nationwide, so you won't be supervising them.
 
12-16 total patients a day is common with 1-4 60 min new and the rest 30 min follow up. And even then people don’t always feel it is enough time. I don’t know how you have lasted that long. Wow.
 
psychhog said:
100% honest answer is yes. Made over 700K last year and on pace to do so again this year. Just don’t know how much longer I can keep at this pace.
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You're burning out and are being underpaid for it. With that type of schedule along with the supervision of 2 NPs I would consider fair compensation for a partner-level psychiatrist to be in the $1.3-1.6 million neighborhood. Given your relatively low pay and lack of power over your ridiculous schedule, it's safe to assume you're a regular employee and not a partner. Megacorps like Serenity love to tout that psychiatrists can make $700k with them, but what they fail to mention is that you'll be handling patient volume equal to 2 FTE psychiatrists. In other words, this job is the equivalent of having two full time $350k outpatient psych gigs. It's nothing special from a work to pay ratio standpoint.
 
psydocc said:
You're burning out and are being underpaid for it. With that type of schedule along with the supervision of 2 NPs I would consider fair compensation for a partner-level psychiatrist to be in the $1.3-1.6 million neighborhood. Given your relatively low pay and lack of power over your ridiculous schedule, it's safe to assume you're a regular employee and not a partner. Megacorps like Serenity love to tout that psychiatrists can make $700k with them, but what they fail to mention is that you'll be handling patient volume equal to 2 FTE psychiatrists. In other words, this job is the equivalent of having two full time $350k outpatient psych gigs. It's nothing special from a work to pay ratio standpoint.
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I don't think most people would be able to get 7 figures for a set up like this unless they're a partner/owner and collecting a pretty large percentage of those NP earnings. Most employers pay squat to supervise midlevels and I'd be very surprised if OP is making anywhere near 6 figures off that supervision.

That said I agree with everyone else that this is not a good position. This is the kind of position people take for 2-5 years out of residency to build a nest egg to FIRE and then scale back to part time to coast and cover living expenses while their investments grow. This sounds like it would be miserable as a career and a prime path to burnout.
 
comp1 said:
Criminy! That is not manageable or safe. Consider the VA! Your active duty time counts towards retirement and I promise it will be much, much, much less than 25 patients a day. VAs vary but not that much. NPs have full practice authority nationwide, so you won't be supervising them.
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I've thought about the VA since I have the active duty time. I didn't mind working at the VA when I was in residency also and am back in the same place I did my residency so I still know some docs that work there. I may reach out to them to get a sense of the climate here but when I was in residency, I felt the VA was solid and the docs seemed relatively happy there. But this was inpatient, ED, consults and not really any outpatient time with the VA.
 
FlowRate said:
8 hours per day breaks down to: ~1.5-2 hours per day admin time (not every day gets 2), 6-6.5 hours direct patient care time. 30 minute follow ups and 1 hour news. Typically 1-2 news per day (broad average, not fixed.) Works out to about 8 or 9+2 = 10-11 patients per day on average. (Max would be 13)
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This is a typical day of outpatient at the VA? This sounds heavenly.
 
Is this a clinic owned by a doc or is it a big box private equity Amen/Serenity type gig?
A community health center I worked at was almost this level of volume, often having 22-28ish people on my schedule but a lot of no shows since there was a heavy SMI caseload. Also supervised 2 NPs. Had to leave that job though, the pay was less than half what you say your shop is dishing you. Honestly though, for 700K+, I'd have absolutely stuck it out longer.
 
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Stumpyman said:
Is this a clinic owned by a doc or is it a big box private equity Amen/Serenity type gig?
A community health center I worked at was almost this level of volume, often having 22-28ish people on my schedule but a lot of no shows since there was a heavy SMI caseload. Also supervised 2 NPs. Had to leave that job though, the pay was less than half what you say your shop is dishing you. Honestly though, for 700K+, I'd have absolutely stuck it out longer.
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It's gotta be lol
 
psychhog said:
This is a typical day of outpatient at the VA? This sounds heavenly.
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It's a lot closer to an average VA schedule than the scary situation the OP has now. Of course the pay is half... Should be roughly 20% admin time in the VA for FTE.
 
psychhog said:
This is a typical day of outpatient at the VA? This sounds heavenly.
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Kaiser Permanente. I think it's roughly the best whole package large company outpatient gig one can reasonably expect. We do have expectation of communicating with patients between appointments by message, which is part of why we have more admin time than some other departments, but it's not that bad most of the time.
 
comp1 said:
It's a lot closer to an average VA schedule than the scary situation the OP has now. Of course the pay is half... Should be roughly 20% admin time in the VA for FTE.
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I was getting so bullish on the VA but had a colleague told me she got so fed up with the onboarding she decided to decline the offer after accepting the TJO (due to multiple requests for documents she turned in, two rounds of peer references, constant delays of actual start date, and then upon seeing CPRS EMR). Are these tough pills to swallow?
 
I don't know when that was, but the VA has launched a 30 day from job posting to starting work initiative this summer. The bigger problem right now is more likely to be having to respond to an exploding offer within 24 hours than long delays in onboarding given the new time constraints. I don't know why they would need two sets of peer references. In terms of CPRS, I adore it, always have. I get that it may scare people who are more familiar with Epic. However, it is, unfortunately, not long for this world. Essentially all VAs will be on Cerner by 2029. The thing about the VA is that it has the oldest (at least graphical) EMR. This means that records go back to 1995. You don't have to rely on what patients report or try to guess. It's all there all across the country, including their time in the military. It's frankly amazing for psychiatry and I don't think really available anywhere else in terms of sheer volume.
 
TerraceHouse said:
I was getting so bullish on the VA but had a colleague told me she got so fed up with the onboarding she decided to decline the offer after accepting the TJO (due to multiple requests for documents she turned in, two rounds of peer references, constant delays of actual start date, and then upon seeing CPRS EMR). Are these tough pills to swallow?
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It can be. I joined the VA right or if residency and really had no complications with onboarding. However, I know of another psychiatrist that credentialing had already taken a month and it's expected to take a couple more months.

psychhog said:
This is a typical day of outpatient at the VA? This sounds heavenly.
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The breakdown at the VA is 30 bookable clinical hours and 10 nonbookable clinical hours by default (referred to as "admin" colloquially but admin time is a separate category). In practice it should typically be about 27 bookable hours a week (subtracting an hour for team meeting, an hour for department or psychiatry meeting, and an hour for the sum of daily huddle times). Intakes are 60 minutes, follow-ups are 30, so you should be seeing no more than on average about 8-10 patients a day.

comp1 said:
I don't know when that was, but the VA has launched a 30 day from job posting to starting work initiative this summer. The bigger problem right now is more likely to be having to respond to an exploding offer within 24 hours than long delays in onboarding given the new time constraints. I don't know why they would need two sets of peer references. In terms of CPRS, I adore it, always have. I get that it may scare people who are more familiar with Epic. However, it is, unfortunately, not long for this world. Essentially all VAs will be on Cerner by 2029. The thing about the VA is that it has the oldest (at least graphical) EMR. This means that records go back to 1995. You don't have to rely on what patients report or try to guess. It's all there all across the country, including their time in the military. It's frankly amazing for psychiatry and I don't think really available anywhere else in terms of sheer volume.
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JLV (VAs record viewer) is such a gem. Being and to easily see almost the entirety of their treatment every single medication they've been on since 1995 (at least prescribed by the VA) is so valuable. I actually had a case where someone presented for ADHD evaluation and I was able to pull up their pediatric records in JLV (parents were deployed so they got their care on base).
 
Yes, sorry, I was very much using admin colloquially. Don't use that term with a clinic grid manager since it indeed has a formal definition that will likely not apply to you as a front line employee. 🙂
 
comp1 said:
Yes, sorry, I was very much using admin colloquially. Don't use that term with a clinic grid manager since it indeed has a formal definition that will likely not apply to you as a front line employee. 🙂
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This does hint at one of the downsides of the VA - the bureaucracy. I honestly can't remember if it's the Group Practice Manager or the Clinic Practice Manager who is in charge of clinic grids...

This is also one of the elements of "if you've seen one VA, you've seen one VA" - if you have good local leadership they'll be well-versed in these things and you can live in blissful ignorance while you focus on clinical care. If not, you can find yourself combing through directives or rummaging through SharePoint (and hoping what you find is not out of date), for example trying to figure out if something should go under admin time and be subtracted from total clinical time, should be clinical but non-nonbookable and be subtracted from bookable time, or falls under nonbookable time (and use the colloquial "admin") time.

However, I suspect that we do come out ahead dealing with government bureaucracy rather than insurance bureaucracy...
 
You definitely come out ahead. The issues and barriers are at least an attempt at quality, efficiency and genuinely doing things right by people, not to make or keep more money.
 
psychhog said:
Burner account

what's typical for outpatient practice as far as number of patients, f/u and new patient time allotted for you guys and gals in here? After completing residency I was active duty for 4 years and that was definitely not reflective of what typical outpatient practice looks like but I was miserable in the military. After military time I started with a company that I've since read on social media and other places that I often will see many people recommend to avoid. My experience hasn't been bad (I think), the pay is high, but I am starting to feel a since of burnout I suspect and I'm really wondering if I'm just getting crushed in the daily grind or am I just not cut out for outpatient. I often will have 20-25 patients on my schedule when I first show up but commonly will have no shows which will usually look like 18-23 patients in a day. Tomorrow I have 25 on my schedule as of right now and it's just gotten to a point where that seems so daunting. I'm finding myself having more trouble keeping up with the pace, finding myself worrying more when I'm at home. I get so many messages in my inbox as well. Supervise 2 NP’s and due to the state I’m in I have to send controlled meds in for them. Man as I type this out this does seem like a lot but tell me, am I the crazy one for feeling burned out? Been at it for 3 years now post military time.
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I see between 10-14 patients a day, mix of 30 minute f/us, 90 minute new evals, and a few 60-minute psychotherapy cases in my private practice. I don't have paid admin time but then I don't really need it, honestly; I do get patient messages but never more than perhaps half a dozen in a day and I rigorously maintain a standard of answering them by the end of the next business day. I can knock them out in 5-10 minutes very morning for the most part.

It would be very striking to me if you weren't feeling burnt out by this. What would have made this a bad experience compared to the actual lived reality so far? Genuinely curious.
 
I do 90-minute news and anywhere from 15 - 60 minutes for follow-ups. Probably averages 8-10 patients per day. Max ever was 18, frequently have one or two mornings with only 2-3 patients.

I don't account for any admin time, but like clausewitz2 I tend to respond in a day or two and it takes almost not time at all.

Granted, I make about a third of what the OP is being paid. Granted, I work a heck of a lot less.
 
ObsequiousAplomb said:
I do 90-minute news and anywhere from 15 - 60 minutes for follow-ups. Probably averages 8-10 patients per day. Max ever was 18, frequently have one or two mornings with only 2-3 patients.

I don't account for any admin time, but like clausewitz2 I tend to respond in a day or two and it takes almost not time at all.

Granted, I make about a third of what the OP is being paid. Granted, I work a heck of a lot less.
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Is this a description for an outpatient VA psychiatrist position that you currently have?
 
VA doesn't generally post such detailed job descriptions. I'm not sure many places do. You'll have to ask during the interview for specifics, or talk to the physician recruiter about talking with an outpatient MD who works at that VA already.
 
Thanks everyone. Yeah I saw 20 yesterday and 24 the day before. In addition to numerous messages in my inbox related to sending controlled meds for the NP’s I supervise, being interrupted to verify ketamine dosage for infusion. I have “admin time” in my day but usually gets eaten up by something. It’s getting to be too much.

I’ve had several ideas floating around in my head one of them being the VA since I have 8 years of active duty time and didn’t mind the VA when I was in residency. I’ve also considered opening my own practice but I have to do a lot of research before doing this. I do like the idea of owning my schedule. I’m not really a “gotta have control” guy but the last 3 years has showed me I’d really like to have more control over my schedule. I really do love having TMS as a treatment option for patients and have seen some real significant results with it in patients that medications either did nothing or harmed them more and made them worse. I do worry about the admin side of opening my own practice and how I’ll handle that though. When I just google psych jobs all I see are the big box talkiatry, headway, serenity etc jobs. How do people find out if someone who already has a practice would be willing to hire? Just cold call?
 
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FatherPsychiatry said:
I hope you haven't fully grown into that 700k income yet lol
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Not “fully grown” into it, but probably a little more than I should’ve. Bought a house last year 600K and that got us a nice 4Kft home where we live, put a pool in this year which was the big add on, maybe should’ve waited 1 more year for that but too late now, we’ve definitely enjoyed it though. I drive paid off 2015 sequoia and plan to until it dies lol. It does worry me a little if I went VA the pay cut. Wife stays home, we have 4 kids that I’m trying to put money into their college funds and save for our retirement. Job has 401K but doesn’t match which is a bummer. The health insurance is truly great though with substantial portion of premium paid for.
 
psychhog said:
Thanks everyone. Yeah I saw 20 yesterday and 24 the day before. In addition to numerous messages in my inbox related to sending controlled meds for the NP’s I supervise, being interrupted to verify ketamine dosage for infusion. I have “admin time” in my day but usually gets eaten up by something. It’s getting to be too much.

I’ve had several ideas floating around in my head one of them being the VA since I have 8 years of active duty time and didn’t mind the VA when I was in residency. I’ve also considered opening my own practice but I have to do a lot of research before doing this. I do like the idea of owning my schedule. I’m not really a “gotta have control” guy but the last 3 years has showed me I’d really like to have more control over my schedule. I really do love having TMS as a treatment option for patients and have seen some real significant results with it in patients that medications either did nothing or harmed them more and made them worse. I do worry about the admin side of opening my own practice and how I’ll handle that though. When I just google psych jobs all I see are the big box talkiatry, headway, serenity etc jobs. How do people find out if someone who already has a practice would be willing to hire? Just cold call?
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Cold calling is definitely the say. Naturally, it won't always be successful, but the hit rate is often unreasonably high. If you have runway to build a caseload of your own even calling group therapy practices in your area and asking if they are interested in having a collaborating psychiatrist can be a good option (certainly was for me!)
 
psychhog said:
Thanks everyone. Yeah I saw 20 yesterday and 24 the day before. In addition to numerous messages in my inbox related to sending controlled meds for the NP’s I supervise, being interrupted to verify ketamine dosage for infusion. I have “admin time” in my day but usually gets eaten up by something. It’s getting to be too much.

I’ve had several ideas floating around in my head one of them being the VA since I have 8 years of active duty time and didn’t mind the VA when I was in residency. I’ve also considered opening my own practice but I have to do a lot of research before doing this. I do like the idea of owning my schedule. I’m not really a “gotta have control” guy but the last 3 years has showed me I’d really like to have more control over my schedule. I really do love having TMS as a treatment option for patients and have seen some real significant results with it in patients that medications either did nothing or harmed them more and made them worse. I do worry about the admin side of opening my own practice and how I’ll handle that though. When I just google psych jobs all I see are the big box talkiatry, headway, serenity etc jobs. How do people find out if someone who already has a practice would be willing to hire? Just cold call?
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It is helpful that you have prior VA experience, but keep in mind that it will be the polar opposite of your current environment. You should expect plenty of downtime, significant bureaucracy, and the challenge of navigating the system with entitled patients. The downtime I experienced at the VA during training was difficult for me because I prefer to be productive. At the VA, you will find that bureaucracy is often rewarded over productivity, and those who work harder do not see any difference in their pay.
 
The OP has more than just VA training experience. They have active duty attending experience. I've overseen both sorts of facilities (as a civilian) and you really need a lot of internal (ie not financial) motivation for both. A mercenary mindset won't work. There is often downtime while still totally on the clock and you need to figure out what to do with it. There are always QM and even research projects to get involved with. There is some slight external motivation with a $12k bonus, but most of the motivation really has to come from a desire to make things better and/or accomplish the mission.
 
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psydocc said:
Nothing personal but I don't see how good quality/safe psychiatric care can be provided when seeing 20-25 outpatient visits every day. Is this a benzo and adderall pill mill?
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The practice owner and/or manager has a obligation to not permit this, IMHO, regardless of the OP's opinion or capabilities. There are physiologic limits when this sort of thing is done chronically.
 
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MGMA and experience says normal outpatient is 14-16 patients a day is the typical schedule. usually 36 patient-facing hours per week for a 40 hour work week. Ballpark for the typical outpatient job is 250-350k per year depending on location, seniority, and model (PP, big box, CMHC, etc). Typically that means no call, no weekends, no nights, no supervision. Also, messages are handled during downtime/admin time around that patient-facing work load.

If you are making atypical money, you are usually doing atypical hours or work. You're feeling stress because you're basically doing two full time jobs in one job. You are allowed to do this but it is unlikely to be sustainable long term. Plan your exit. Hopefully you do not crash and burn your way out (i.e. quit without something lined up). Best of luck - you have to pay the piper somewhere.
 
lobstar said:
Going from 700k with a stay at home wife and 4 kids to a VA clinic making 300k will be palpable.
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house at least wasn't too crazy but that 100k pool add on, SAHM, plus 4 kids. I think its worth doing an extra year at the higher pay gig before that gets cut in half if you must. Also depends if he wants to FIRE in 10 years or work for 25-30 years cause 4 kids esp if helping with schools/activities/college and all should be considered.

I think the burnout talk is overrated, you need enuf vacation and admin time in your day and week to be in balamce otherwise yeah you will be miserable. Not that its easy or you wont have weeks that stink. Im just of the mindset that for me id rather work extra and be close to the FIRE territory in 10 years than the tradiional 25-30 year career due to how compoundingi and investments work vs inflation drag on your wage over that long period.
 
finalpsychyear said:
I think the burnout talk is overrated, you need enuf vacation and admin time in your day and week to be in balamce otherwise yeah you will be miserable. Not that its easy or you wont have weeks that stink. Im just of the mindset that for me id rather work extra and be close to the FIRE territory in 10 years than the tradiional 25-30 year career due to how compoundingi and investments work vs inflation drag on your wage over that long period.
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Brute forcing a high salary by working twice as much as normal as a W2 employee is by far the least efficient way to chase FIRE. If money is the goal then starting your own multi-provider private practice or joining one with a partnership track is the way to go. Yes, it takes years at the beginning to properly build up, however, once established it's the easiest way to clear 7 figures a year while working <40 hours per week as a psychiatrist. To put it another way, I could drop my clinical hours to zero and still outearn OP solely via my portion of the profit sharing from my group.
 
psydocc said:
Brute forcing a high salary by working twice as much as normal as a W2 employee is by far the least efficient way to chase FIRE. If money is the goal then starting your own multi-provider private practice or joining one with a partnership track is the way to go. Yes, it takes years at the beginning to properly build up, however, once established it's the easiest way to clear 7 figures a year while working <40 hours per week as a psychiatrist. To put it another way, I could drop my clinical hours to zero and still outearn OP solely via my portion of the profit sharing from my group.
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while true your talking about <5% of set ups like this. Of course this is ideal but not realistic for the vast majority. Also the ones around here have no interest in adding another psych md when they can add legions of NPs and keep contracting out MDs for there collaboration fees. You are in a pretty sweet set up. Planning the 4,3,2,1 transition in 2028-29 so long as no 2008/dot com. Important to know your 3-4% swr targets for everyone once you hit those then you'll truly see how much you want to work.
 
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psydocc said:
joining one with a partnership track is the way to go. Yes, it takes years at the beginning to properly build up, however, once established it's the easiest way to clear 7 figures a year while working <40 hours per week as a psychiatrist. To put it another way, I could drop my clinical hours to zero and still outearn OP solely via my portion of the profit sharing from my group.
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This is literally my ideal setup, as this is the successful model I've seen in a lot of other specialties, especially the surgical subs. The problem is that there's a very strong overlap between these practices and those that force/pressure you to supervise NPs (because they're so money hungry), and I'll never, ever do that, like ever lol
 
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slowthai said:
This is literally my ideal setup, as this is the successful model I've seen in a lot of other specialties, especially the surgical subs. The problem is that there's a very strong overlap between these practices and those that force/pressure you to supervise NPs (because they're so money hungry), and I'll never, ever so that, like ever lol
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Yeah this seems much harder to do without going NP heavy, which is something that I am not personally comfortable with. Competing to employ psychiatrists seems tricker, although not impossible. Would probably help to start off with 2 or 3 trusted colleagues. I talked with a psychiatrist who has their own practice and they said employing therapists also is pretty close to cost neutral as well, though I imagine it can help bring in business.
 
finalpsychyear said:
while true your talking about <5% of set ups like this. Of course this is ideal but not realistic for the vast majority. Also the ones around here have no interest in adding another psych md when they can add legions of NPs and keep contracting out MDs for there collaboration fees. You are in a pretty sweet set up. Planning the 4,3,2,1 transition in 2028-29 so long as no 2008/dot com. Important to know your 3-4% swr targets for everyone once you hit those then you'll truly see how much you want to work.
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This is very realistic for many. Literally half the class that just graduated is doing this and I don’t think any of them are supervising NPs. This may not be viable in your area, but in plenty of places it is.

It is also very possible to start your own practice and build it into this. However, that takes a lot of admin work over years that most don’t want to deal with. I did residency with a few people who have essentially done this and are killing it now.
 
Stagg737 said:
This is very realistic for many. Literally half the class that just graduated is doing this and I don’t think any of them are supervising NPs. This may not be viable in your area, but in plenty of places it is.

It is also very possible to start your own practice and build it into this. However, that takes a lot of admin work over years that most don’t want to deal with. I did residency with a few people who have essentially done this and are killing it now.
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How do you start?
No one I did residency was able to do their own clinic setup apart from one person (not a good example though since she did not need a higher salary and wanted to set her own schedule). Everyone has been employed by a clinic or hospital, and I'm at the point where it's not sustainable.
The advice I've gotten about multi-provider startups is that field is oversaturated and there's not much business left unless you really hustle and make your clinic a multi-state tele friendly set up. Is that not true?
 
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Stumpyman said:
How do you start?
No one I did residency was able to do their own clinic setup apart from one person (not a good example though since she did not need a higher salary and wanted to set her own schedule). Everyone has been employed by a clinic or hospital, and I'm at the point where it's not sustainable.
The advice I've gotten about multi-provider startups is that field is oversaturated and there's not much business left unless you really hustle and make your clinic a multi-state tele friendly set up. Is that not true?
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It is doable in my city. A co-resident also did it in Chicago metro and another started a telehealth clinic to NYC (lives in my city but they exclusively see patients via telehealth in NYC). Initial experiences seem fairly similar to some others in the "practice in progress thread". Variable time to launch and scale up to being a full solo clinic then once established started expanding and adding other staff. You can also sign on with an already established practice on a partner track, but I feel like unless you already know them and their practice there's a lot of intangibles or hidden risks (especially if you don't/can't read the contract details) that go along with this.

If you need full attending income now and can't do at least a fairly busy PT job while building your clinic, you're probably not going to be able to do this. There is typically a growth phase where income is limited like has been previously mentioned. Again, unless you sign on with a group this is something that takes years (sometimes decades) to build with a lot of behind the scenes non-clinical admin and business work. Building something is not easy and I think a lot of people think that if they just follow an algorithm it will happen, but it's not that simple.

So yea, it's definitely possible. It may not be everywhere or it just might be much more difficult in some places compared to others. I'd be curious who you are seeking this advice from. If it's people in academics, they're likely clueless unless they interact with community docs a lot. If it's people with their own practices, maybe take that with a grain of salt. After all, what would be their incentive to create another competitor for their market? Especially if you're talking to them about jobs and they'd consider hiring you.

I'd encourage you to check out the Practice in Progress thread. Great example of several individuals starting their own practices (with varying levels of success). @clausewitz2 , @TexasPhysician , imo would be another great thread to sticky for the forum if mods think that would be worthwhile.
 
mistafab said:
MGMA and experience says normal outpatient is 14-16 patients a day is the typical schedule. usually 36 patient-facing hours per week for a 40 hour work week. Ballpark for the typical outpatient job is 250-350k per year depending on location, seniority, and model (PP, big box, CMHC, etc). Typically that means no call, no weekends, no nights, no supervision. Also, messages are handled during downtime/admin time around that patient-facing work load.

If you are making atypical money, you are usually doing atypical hours or work. You're feeling stress because you're basically doing two full time jobs in one job. You are allowed to do this but it is unlikely to be sustainable long term. Plan your exit. Hopefully you do not crash and burn your way out (i.e. quit without something lined up). Best of luck - you have to pay the piper somewhere.
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isn’t 250-350k for 14-16 low even for big box shops ? I have been off of job market for a while now but for reference my modest outpatient academic gig compensates low 200s for a daily average census of 4-5 patients. Maybe I should stop bitching about the pay to my chair…
 
Marasmus1 said:
isn’t 250-350k for 14-16 low even for big box shops ? I have been off of job market for a while now but for reference my modest outpatient academic gig compensates low 200s for a daily average census of 4-5 patients. Maybe I should stop bitching about the pay to my chair…
Click to expand...

Yeah I will say at my insurance rates 14 people a day 5 days a week is going to clear 500k assuming at least 46 work weeks per year.
 
Median nationally is still 300-325k outpatient. That's 1 hour new visits, 30 minute follow ups with no double booking. 20-30 PTO days. 1-3k CME money. 1-3 CME days. RVU target 3.5-4.5k. Not a bad gig. That is TOTAL COMP too, not just money in your pocket. I know its a bit crazy to think about but think about some of the caveats:

More and more shrinks are employed - meaning they are fully clinical, do nothing business/admin wise, and just show up and clock out when finished. This doesn't include academia in their data. Most big box shops are favoring flat rate payment with a small RVU related bonus these days, and try to rope people in with signing bonuses or loan repayments. The exceptions to this are the profit-focused Tele business which are actually attracting new grads despite horrendus structuring. The Base + Bonus model is favoring base over bonus with each new gen of grads, who want nothing more than to hide in an office and come up with any excuse to see no patients. A few plan to churn out tele for a few years to try to earn a pile before they jump ship to something more palatable. People craving revenue for output are making more and more because generally that pool is shrinking in interest in my experience. I am making bookoo bucks for instance but no one I work with is even close; despite similar life circumstances and needs.

So I think we will see the average in psychiatry stay the same or go up, but the median will likely go down. That's my guess. People going into the field are just not as geared towards earning money these days it seems. It was already pretty much an anomaly at my original program. I'm still teaching residents at a different program several years out - and only a few grads are even close to hungry.

Edit: thinking about it more, I think a general trend is that as the required step score went up, and psych became more competitive - more of the bleeding heart nerds started showing up. They suck at business and live to be bent over it seems... starting salaries are going down as a result for the rest of us lol

Marasmus1 said:
isn’t 250-350k for 14-16 low even for big box shops ? I have been off of job market for a while now but for reference my modest outpatient academic gig compensates low 200s for a daily average census of 4-5 patients. Maybe I should stop bitching about the pay to my chair…
Click to expand...

clausewitz2 said:
Yeah I will say at my insurance rates 14 people a day 5 days a week is going to clear 500k assuming at least 46 work weeks per year.
Click to expand...
 
Last edited:
mistafab said:
up, and psych became more competitive - more of the bleeding heart nerds started showing up. They suck at business and live to be bent over it seems... starting salaries are going down as a result for the rest of us lol
Click to expand...
I don't think its just psych. All my family and friends in medicine in different fields, who are involved either directly in training or in PP trying to bring people on, express the same sentiment - more of a clock in clock out, focus on "work life balance" (with the life part really weighing hard) compared to before. I was talking to one of my wife's colleagues the other day - older guy who said back in his day, they would kill each other to take call because they wanted more procedures to themselves; now its like pulling teeth to get anyone to take call. I mean I'm the same way but I see your point boomer lol
 
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