230K guaranteed (for full duration of 3 year contract) for an old-fashioned full spectrum psychiatry job employed by a hospital. Inpatient in the morning (round on 4-6 patients), 4 hours clinic in the afternoon (60 minute evals, 30 minute follow ups). Can integrate psychotherapy as desired. 16 hours per week of clinic is required, but most in the practice see patients M-F afternoons in their clinics (probably for productivity reasons). Productivity bonus which is 100% of everything you generate beyond your base. They count physician work RVUs and then pay $60 per RVU. QUOTE]
call schedule? do you have to occasionally cover inpatient weekends?
If light call schedule and few if any inpatient weekend rounding, how are you generating that salary? Where is the money coming from? If you're doing 16 hours of clinic a week with 30 minute followups and 60 minute intakes, you're looking at maybe 22 followups and 5 intakes scheduled a week.....do the math on those accounting for a 10-15% noshow/nopay rate and 28% overhead(conservative with that low a volume I would think), and based on a 48 week year that comes out to around 90-100k a year from the outpt side of things if you have a good payor source(no medicare, no medicaid, all accepted private insurance).....which leaves 130-140k for the inpatient side of things, and I don't see how you are generating that with a cencus of 4-6 at any time....unless there is a ridiculous payer mix in that community....that seems like it would have to be a job where the psych inpt service is getting additional funding from the state to stay open, and they are dishing some of that bounty out to the psychs who agree to service the inpatient.
Call is 1 in 7 weeknights and about 1 in 5 weekends.
Payor mix is pretty much irrelevant. This is an employed position. The overhead is irrelevant to me. Productivity component is not related to collections but to physician work RVUs billed. I'm not sure whether you've looked at the RVU numbers but with a $60 per RVU conversion faction, I need to generate 3833 physician work RVUs in the year to make my base (although it's guaranteed for the duration of the contract, so I don't actually need to make it). If you divide that by 48 weeks of work per year and 5 days per week, then I need to generate 16 physician work RVUs per workday.
For outpatient: A level 3 f/u visit is 1 RVU. A level 4 f/u visit is 1.5 RVU. A level 5 f/u visit is 2.11 RVU. A diagnostic eval is now 2.96 RVU. In my current outpatient clinic, the billers and coders are recommending that the average med follow up visit for our patients is a level 4. If you do 2 of those per hour, or 1 new eval per hour, you're generating about 3 RVUs per hour of seeing patients. That's about 12 RVUs for the clinic portion of the day. The demand is such that in this clinic the no-show rates are very low because they have a fairly aggressive termination for no-shows policy.
For inpatient: A new inpatient eval is 2.61 RVU. A moderate level inpatient f/u is 1.4 RVU. A high level inpatient f/u is 2.0 RVU. Based on the throughput in this hospital system, you're typically seeing 3-4 mid level follow-ups and 1 new inpatient eval on most days. If you imagined that some of those days there will just be follow-ups and only 3-4 days of the week will have a new patient, you can come up with a number of about 5.5 RVUs for the follow up patients on an average day and most days will have another 2.61 RVUs for the new patient. That brings most inpatient days up to around 8.
Add those together and you're looking at about 20 physician work RVUs per day worked, which exceeds the base by 25%. Now, let us be conservative and assume that there will be no shows in clinic and there will be slow times in the hospital (although they essentially always run chock full), I'd be willing to cut that estimate down to 18 work RVUs per day. That's still beating the base by 12.5%.
12.5% of 230K is an additional 30K. Not a ton extra, but nothing to sneeze at. Add in the patient visits (many of them new admits) from the time on call and there's a little more to be had.
It's not clear why they would pay this way except that they can make money, or at least break even, doing so. In addition, psychiatry (in a healthcare system) is a loss leader. They take the loss on the psychiatric services provided to patients to bring them in to the system to ensure that they do require a more lucrative medical or surgical service, they will seek care at that same hospital. It's no different than offering coupons or having discounts in the retail world.
The base pay and terms of the contract are further inflated by the fact that although I consider this area desirable and this city very liveable, many people do not. There is a national shortage of psychiatrists, and there is a CRISIS shortage in the frozen tundra.
