Pondering about jobs

[DOswag]

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I'm sure there are threads somewhere around here that discuss this so sorry if there are redundant questions/answers, I have read some of them, I plan to try to go back through at some point to see if there are some other questions answered I may have as well and I this sparks a specific thread you recall then feel free to tag it here if you've already answered these questions. I currently work outpatient for a company that is in multiple states and I do enjoy my job, I work 40 hours per week, 10 hour days x 4 and get a 3 day weekend, no nights, weekends, holidays and the pay is very good. I graduated residency in 2019, paid my time back to the air force and have been on the civ side for about 2.5 years now so this is my first "real job" on the civilian side of things. I've had some thoughts recently about maybe considering something different but I'm not completely set on the idea, as the title states just pondering some things. I haven't worked inpatient since residency but I did enjoy inpatient work and it is something I could see myself doing. I know some of ya'll or others have been able to find an inpatient job that doesn't require you to stay on site for the full duration of your "shift" where you can see the patients and leave as soon as you are done, be available by phone etc if needed, and are able to do some outpatient work in the afternoon or some sort of schedule setup like that. I'm just curious how people found these types of gigs and how you got it setup.

I know some of you have discussed running your own PP. I've not really really thought about going out on my own but it has started to just kind of creep into my thoughts as I've just been thinking about the future and what my life will look like 5, 10, 15 years from now but the thought of going solo does seem a little daunting in regards to dealing with insurance, rvu's, overhead costs and everything that comes with running your own business. Do ya'll have some sort of a practice manager that helps with this or do many of you do pretty much everything on your own? All the admin stuff, paperwork, letters, accommodations etc, scheduling, billing, do yall just do it all on your own? That just seems like a big headache that I don't know if I really want to take on but I'm curious how others have been to do this and has it been successful. Just turned 41 and I think I have a number of years left in me but I also don't want to work, full time at least, up until im in my 70's. Married, have 4 kids ages 16, 12, 8, 5. I'm contributing to their college funds and am pretty confident I'll be able to at least get undergrad paid for for each of them.

I do like my schedule right now at 4 days of 10 hours and a 3 day weekend every weekend and that is hard to see giving up or going back to a 5 day schedule. If I did inpatient and was able to leave when I completed seeing patients and notes I wouldn't mind working on fridays but I do enjoy the 4 day work week right now. Just some ponderings as stated, any comments, thoughts, ideas, questions, complaints, push back welcome.

 

[mistafab]

Hey I won't answer all your questions - but since you're kind of sniffing around the idea of inpatient... I recommend you reach out to some inpatients in your area and do a weekend moonlighting a few times here and there just to see if you'd really like it. Residency inpatient is a bit different than attending inpatient in the real world. Also, local culture at your big box shops or independent inpatients can be very unique to that location - so you check out a place or two, work a shift or two, so you can know what you'd potentially be in for.

As a 1099, it would be easy to just back off and stay where you're at if you don't like it. You have a huge advantage here in that you are currently pretty pleased with your main gig. That is the best position to be in to find your next gig if you want to move on.

 

[Stagg737]

In regards to the inpatient setup, just call places you're interested in working and see if there's availability. Usually if they're interested they'll arrange some kind of initial interview or pre-interview to feel things out and to answer questions you have which would be a good time to ask that specific question. Ie, what does the work day look like? Can I see patients and then bounce and just be available by phone or do I need to be on site for longer? Something to keep in mind with inpatient work is you're almost certainly going to have to take some kind of call. That means losing some weekends.

In terms of the private practice questions, just look up the Private Practice in Progress thread. It was originally @Sushirolls thread, but plenty of others like Clausewitz, ObsequiousAplomb, and Trophy Husband have contributed. Sounds like most of them do their own admin other than Trophy Husband who does admin for their spouse. Would be good to re-read that thread and maybe tag them for questions about admin stuff.

Speaking of which, @clausewitz2 , @TexasPhysician , since we stickied the "Everything AI" thread maybe also sticky the PP in Progress thread since it's such a common topic and has so much great information? Imo it's arguably the best and most relevant thread in our corner of SDN for young physicians trying to get their feet under them as attendings.

 

[comp1]

Inpatient jobs are pretty coveted. If you can at all reconsider this whole bouncing thing (which seriously isn't ideal for patients or nursing), there might be VA inpatient positions near you. The VA, as a general rule, does not do part time inpatient (and more recently part time in general). Instead, you typically do med floor and ED consults throughout the day while also being available for inpatient needs as they arise. Occasionally a setup might have you handling outpatient walk-in's too, but that is rarer and usually separate. You might be able to find something even more unique, but generally inpatient psychiatrists are inpatient and outpatient are outpatient. This is secondary to how the VA doesn't actually bill for things and inpatient providers are exempted from most RVU expectations. It makes things too complicated if they are both inpatient and outpatient (excluding ED).
Why the VA? Well, your military time can count towards pension and retirement. As a veteran, you also have priority for hiring and a hiring official would have to specifically demonstrate with data why specifically they selected anyone else over you (which is far too much work), so you might be able to snag an inpatient position. The VA also has no restrictions on work outside your normal tour of duty and 4-10's or almost any other imaginable 2 week/80 hour schedule is often doable in VA inpatient.

 

[DOswag]

In regards to the inpatient setup, just call places you're interested in working and see if there's availability. Usually if they're interested they'll arrange some kind of initial interview or pre-interview to feel things out and to answer questions you have which would be a good time to ask that specific question. Ie, what does the work day look like? Can I see patients and then bounce and just be available by phone or do I need to be on site for longer? Something to keep in mind with inpatient work is you're almost certainly going to have to take some kind of call. That means losing some weekends.

In terms of the private practice questions, just look up the Private Practice in Progress thread. It was originally @Sushirolls thread, but plenty of others like Clausewitz, ObsequiousAplomb, and Trophy Husband have contributed. Sounds like most of them do their own admin other than Trophy Husband who does admin for their spouse. Would be good to re-read that thread and maybe tag them for questions about admin stuff.

Speaking of which, @clausewitz2 , @TexasPhysician , since we stickied the "Everything AI" thread maybe also sticky the PP in Progress thread since it's such a common topic and has so much great information? Imo it's arguably the best and most relevant thread in our corner of SDN for young physicians trying to get their feet under them as attendings.

I knew I had seen a good thread from @Sushirolls about this but haven't read it in it's entirety but thank you I'll go back and find it and work my way through it

 

[DOswag]

Inpatient jobs are pretty coveted. If you can at all reconsider this whole bouncing thing (which seriously isn't ideal for patients or nursing), there might be VA inpatient positions near you. The VA, as a general rule, does not do part time inpatient (and more recently part time in general). Instead, you typically do med floor and ED consults throughout the day while also being available for inpatient needs as they arise. Occasionally a setup might have you handling outpatient walk-in's too, but that is rarer and usually separate. You might be able to find something even more unique, but generally inpatient psychiatrists are inpatient and outpatient are outpatient. This is secondary to how the VA doesn't actually bill for things and inpatient providers are exempted from most RVU expectations. It makes things too complicated if they are both inpatient and outpatient (excluding ED).
Why the VA? Well, your military time can count towards pension and retirement. As a veteran, you also have priority for hiring and a hiring official would have to specifically demonstrate with data why specifically they selected anyone else over you (which is far too much work), so you might be able to snag an inpatient position. The VA also has no restrictions on work outside your normal tour of duty and 4-10's or almost any other imaginable 2 week/80 hour schedule is often doable in VA inpatient.

I've considered the VA as well since I can take my active duty time toward retirement with them. I did enjoy my time at the VA during residency but wanted to take a break from government work for a little bit. I've talked to other VA docs as well who were prior active duty and felt working VA was better than DoD so I have thrown that idea around as well. I'm living in the same place now I did my residency and worked at this VA and did enjoy working there so I will continue to consider VA as an option as well. I know the pay won't be as good as I'm making right now but the benefits are legit with VA.

 

[comp1]

Benefits are indeed legit. Pay is average. Literally, average for a full time salaried psychiatrist. There is a local salary review that the chief psychiatrist for each VA has to conduct every other year to adjust salaries in a given geographic area (always up).

 

[Merovinge]

I've considered the VA as well since I can take my active duty time toward retirement with them. I did enjoy my time at the VA during residency but wanted to take a break from government work for a little bit. I've talked to other VA docs as well who were prior active duty and felt working VA was better than DoD so I have thrown that idea around as well. I'm living in the same place now I did my residency and worked at this VA and did enjoy working there so I will continue to consider VA as an option as well. I know the pay won't be as good as I'm making right now but the benefits are legit with VA.

Could make up the pay with a little bit of a side hustle. I think for people who get the juicy retirement that stacks with active duty the effective pay is actually quite good. You get a LOT of street rep with the patient population as well.

 

[comp1]

Concur, street rep is not something to be minimized. It's a BIT less useful inpatient, but still can be of immense benefit.

 

[Stagg737]

The VA, as a general rule, does not do part time inpatient (and more recently part time in general). Instead, you typically do med floor and ED consults throughout the day while also being available for inpatient needs as they arise. Occasionally a setup might have you handling outpatient walk-in's too, but that is rarer and usually separate. You might be able to find something even more unique, but generally inpatient psychiatrists are inpatient and outpatient are outpatient. This is secondary to how the VA doesn't actually bill for things and inpatient providers are exempted from most RVU expectations. It makes things too complicated if they are both inpatient and outpatient (excluding ED).

The problem with this, like any salaried position, is that if you agree to cover the ER/floor consults or really anything else on top of the inpatient unit you're not getting paid extra. If they want you to do inpatient and cover the ER and there's 10 patients in the ER, sucks for you. If you get an RVU bonus or fee for service model at least you get paid for that extra work. That said, if you're on a small unit or a smaller hospital then your workload may be minimal already. Like they say, if you've worked at one VA...

Benefits are indeed legit. Pay is average. Literally, average for a full time salaried psychiatrist. There is a local salary review that the chief psychiatrist for each VA has to conduct every other year to adjust salaries in a given geographic area (always up).

This is not necessarily true at every VA. At our local VA staff psychiatrist starts at $240k/yr. That's at least 20% less than pretty much anywhere else here other than the academic centers. I have some former co-residents who work at the local VA and none of them are clearing $270k, including the ones working outpatient (which is awful for FT OP). Benefits are very solid though, especially if you stick around long enough to hit that 20 year mark.

 

[randomdoc1]

Actually, taking call, weekend coverage at the VA you do get further pay. I remember entering it on my time card. But I had to pry for it. Most psychiatrists weren’t aware you can add those hours. But…if you do pp well, you get easily double per hour and more autonomy.

 

[hebel]

You could try doing a half day of cash only private practice during your off day to see if you like it.

 

[comp1]

Pay at the VA must, by legislative statute, be the average of a geographic area. If it is not, you need to talk to the chief psychiatrist and make sure they are doing their job in regards to the biannual salary survey. This is not an optional thing. In terms of call, that is complex. Pay will be adjusted up if you are in a call pool because the average salary of a psychiatrist in a call pool is higher than that of one who is not. Historically there has not been any allowance for overtime for physicians as, unlike everyone else at the VA, overtime is prohibited for physicians by Congress. However, extremely recently and still pretty rarely they have started to allow a single physician to both be a full time employee and also get paid for fee for service outside your tour of duty. Again, this is new and rare and you won't have your baseline salary adjusted upwards in this sort of system. It is also not something that would be a choice per se, it's just be how that VA has things setup. Some VAs don't have call at all, they just have night and weekend tours of duty. In terms of salaried jobs...yes some days are busy, some very much aren't"t. It is very nice to be able to tell involuntary patients that there is no financial interest in them staying. I don't think overworking people is an extremely common complaint about the VA.

 

[DOswag]

The VA here is tied to the residency program. Inpatient docs cover IP, another doc covers consults, another covers ER with residents for each unless something has changed since I graduated in 2019. There is a call pool though for everyone so on weekends it’s a little different. When I was in residency I think the pay was about 240-ish and that was several years ago so I’d assume it’s increased but haven’t checked recently.

 

[Stagg737]

Pay at the VA must, by legislative statute, be the average of a geographic area. If it is not, you need to talk to the chief psychiatrist and make sure they are doing their job in regards to the biannual salary survey

Who participated in the survey and what resource do they use to determine “average of a geographic area”? If you look at something like zip recruiter, then it does say that 240k is the average for our area. However, if you look at more legit survey sites like MGMA the average is well above 300k. I’ve talked before about how BLS surveys are garbage too, so I’m curious how they legislated this and also why we think they’d have any idea about how to figure out the actual average when non-federal employees have absolutely no obligation to accurately report their actual salaries…

 

[NeedAdvicelol]

Good inpatient gigs- ones that let you leave after rounding or ones that have residents/support staff that write all the notes- are getting harder to come by. There are others, however, that would burn anyone out with volume or lack of support. They tend to be locums, but for the right individual, the extra pay may be worth it. Our field aint like the way it used to be, when you could put your name out there and all these nice jobs would just find their way over to you. You have to try a bit harder now to find that dream gig.

 

[finalpsychyear]

I'm sure there are threads somewhere around here that discuss this so sorry if there are redundant questions/answers, I have read some of them, I plan to try to go back through at some point to see if there are some other questions answered I may have as well and I this sparks a specific thread you recall then feel free to tag it here if you've already answered these questions. I currently work outpatient for a company that is in multiple states and I do enjoy my job, I work 40 hours per week, 10 hour days x 4 and get a 3 day weekend, no nights, weekends, holidays and the pay is very good. I graduated residency in 2019, paid my time back to the air force and have been on the civ side for about 2.5 years now so this is my first "real job" on the civilian side of things. I've had some thoughts recently about maybe considering something different but I'm not completely set on the idea, as the title states just pondering some things. I haven't worked inpatient since residency but I did enjoy inpatient work and it is something I could see myself doing. I know some of ya'll or others have been able to find an inpatient job that doesn't require you to stay on site for the full duration of your "shift" where you can see the patients and leave as soon as you are done, be available by phone etc if needed, and are able to do some outpatient work in the afternoon or some sort of schedule setup like that. I'm just curious how people found these types of gigs and how you got it setup.

I know some of you have discussed running your own PP. I've not really really thought about going out on my own but it has started to just kind of creep into my thoughts as I've just been thinking about the future and what my life will look like 5, 10, 15 years from now but the thought of going solo does seem a little daunting in regards to dealing with insurance, rvu's, overhead costs and everything that comes with running your own business. Do ya'll have some sort of a practice manager that helps with this or do many of you do pretty much everything on your own? All the admin stuff, paperwork, letters, accommodations etc, scheduling, billing, do yall just do it all on your own? That just seems like a big headache that I don't know if I really want to take on but I'm curious how others have been to do this and has it been successful. Just turned 41 and I think I have a number of years left in me but I also don't want to work, full time at least, up until im in my 70's. Married, have 4 kids ages 16, 12, 8, 5. I'm contributing to their college funds and am pretty confident I'll be able to at least get undergrad paid for for each of them.

I do like my schedule right now at 4 days of 10 hours and a 3 day weekend every weekend and that is hard to see giving up or going back to a 5 day schedule. If I did inpatient and was able to leave when I completed seeing patients and notes I wouldn't mind working on fridays but I do enjoy the 4 day work week right now. Just some ponderings as stated, any comments, thoughts, ideas, questions, complaints, push back welcome.

Dont take ur 4 day week and job u like for granted. The 3 off days lets u play around with inpt/pp or heck maybe more outpt or tele on fridays unless u already do some during the week.

For me find the easiest addition to ur week bc as much as you love the idea of change/addition u likely wont keep it long term i.e. having to be at inpt job by 7a vs rolling out of bed in tele by 9am and can take work with you if travel with the family.

Im 10 years out similar age but been working 5 days 50 ish hours for most of it and starting to burn out a touch. The additional hours has all been invested and it makes a gigantic dfference to the tune of possibly being part time by 45 yo and work optional by 50 yo but markets will lead that.


Do the addition now and test it out. If u still feel "fresh" mentally and lots of drive the next several years could compound ur retirement much earlier and added income will help. Ultimately i see u back at a 4 day week long term once most of ur kids r thru college. Not sure if ur spouse pulls a near 6 fig income as that is less pressure on u. Buddy of mine in psych has a specialist wife so he is always changing his jobs cause he can with little pressure.

 

[comp1]

Okay, I am definitely not an expert on how biannual physician market pay analyses are formally completed. I'm just aware of the legal requirement that they happen. It appears that the local chief psychiatrist uses formal Bureau of Labor statistics and recently the VA has been utilizing private data from "Sullivan Cotter" and "Payfactors."

 

[Stagg737]

Okay, I am definitely not an expert on how biannual physician market pay analyses are formally completed. I'm just aware of the legal requirement that they happen. It appears that the local chief psychiatrist uses formal Bureau of Labor statistics and recently the VA has been utilizing private data from "Sullivan Cotter" and "Payfactors."

Interesting. So sounds like one of those laws that was enacted to create some kind of standard to appease all the hand waving but doesn't actually do anything since they can use whatever standard they want. Either way, the if you've worked at one VA you've worked at one VA statement is still relevant. I've worked at 3 and the starting psychiatry salary between 2 of them was very different ($240k vs $300k), so if OP is considering the VA they should definitely do their research first. Even more important to do so since they'd be leaving a job they really enjoy that allows regular 3 day weekends and pays well.

Personally, I would not leave that to go work at a VA that is almost certainly going to pay significantly less and require OP to stay on campus until 4-5pm for their tour of duty every day which they may not enjoy as much. If OP didn't like their job or wanted a different setting (wanted to do IP instead of OP) I think it would be a valid consideration, especially with their military background. I just don't see the need to look for greener grass if you're happy with where you're at.

 

[aim-agm]

If you do want a 4 day week and don't want call, and prefer the VA, there are two that don't have call because they have no inpatient services: NH and Alaska. The former is hiring for a psychiatrist: Physician - Psychiatrist - Psychiatric Services - Full-time - Recruitment Incentive/ EDRP Authorized