Private Practice vs. Employed

[Brownpsych]

I have a difficult decision. I have two good offers both in cities that I like.

1st offer: Private practice splitting half an inpatient unit (25 beds), then outpatient in the afternoon (approximately 15-20 patients). I would have to be on consults for two different hospitals close by (avg # of consults is 3-4) and 1:3-4 weekend call. I would be paid approximately $100k base and then split 65/35 billings (I keep 65). Benefits: I would pay for everything with the exception of half of the health insurance premium (company covers approximately 400/month). I would also get a $20k commencement bonus and $10k relocation. It is a 3 year contract with the option of becoming a partner in the practice after the 3rd year. There are 6 current psychiatrist and approximately 14 other providers (psychology, LCSW, and ARNPs).

2nd offer: Hospital (non-profit) employed. Splitting a 25 bed unit and consults for the hospital (4-5 consults per day) with call being 1:4. Offer is $225k with $50k sign on bonus and potential quality bonus up to $15k. Benefits: 401k, malpractice, health, dental, vision, PTO: 15 days and 5 days of CME. Non-compete is 24 months within county (but other major metro 15 mins away in another county).

I am also about $350k in debt from medical/undergrad. I would have about 6.5 years left in IRB program if I went with non-profit hospital. Payments about 2.5-3k/month for loans. If I go private practice I would consolidate loan with a private lender and pay about $5k/month and be done in 6.5 years as well.

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[Shikima]

I think you like to work far too hard for too little and too much call. You'll burn out before 5 years.

 

[Brownpsych]

I think you like to work far too hard for too little and too much call. You'll burn out before 5 years.

Since I am coming out of residency, the work does not seem to daunting.

 

[dl2dp2]

Both jobs sound REALLY busy. 12 inpatient + 4 consults vs. 15 inpatient + outpatient is a wash. Roughly 15*$200*48*5 = 720k total gross revenue. I anticipate that your total gross billing will exceed 500k. This means that you end up netting about 360k PP. Once you are partner you can realistically expect over 400k income if you work this schedule, but the PP has the advantage that you can scale up or down after yr 3. The quality of the hospital job will depend on the benefits (i.e. how much they match with 401k, etc), but I would realistically negotiate up another 20% + reduce the noncompete to 6-12 months. I suspect you won't last more than 24 months there.

Oh oops I missed that you are doing 1:4 call at the hospital job. Is that overnight or on phone? I would count overnight call as at least $1500 per shift. So you can do the math there. The hospital job is trying to exploit you. Don't fall for it.

 

[Brownpsych]

Both jobs sound REALLY busy. 12 inpatient + 4 consults vs. 15 inpatient + outpatient is a wash. Roughly 15*$200*48*5 = 720k total gross revenue. I anticipate that your total gross billing will exceed 500k. This means that you end up netting about 360k PP. Once you are partner you can realistically expect over 400k income if you work this schedule, but the PP has the advantage that you can scale up or down after yr 3. The quality of the hospital job will depend on the benefits (i.e. how much they match with 401k, etc), but I would realistically negotiate up another 20% + reduce the noncompete to 6-12 months. I suspect you won't last more than 24 months there.

Oh oops I missed that you are doing 1:4 call at the hospital job. Is that overnight or on phone? I would count overnight call as at least $1500 per shift. So you can do the math there. The hospital job is trying to exploit you. Don't fall for it.

I am renegoiating with the hospital employed. I would consider it if I would approach 300k given I would have the remainder of my loans forgiven after 6.5 years.

 

[sunlioness]

A $50k signing bonus? Damn. That job must really really suck. Or be somewhere no one wants to live. Or both. I agree with Sluox. Sounds like they are recruiting you and planning to burn you out. Do you have to give the signing bonus back if you don't stay a certain period of time? My last contract said I had to stay for four years or pay it back. Not all of it, but prorated. And I did. I was short of four years by 1-2 months and damned if they didn't take it out of my last paycheck. Is the hospital paying you to take all that call or is it just part of the job description?

Both jobs sound awful to me, but I really intensely dislike consults and inpatient is meh. So a lot of it is probably just me.


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[Bartelby]

The first offer sounds like some kind of circle of Hell to me. You handle 12 inpatients (which should take half a day, quite possibly more), then you see 15-20 outpatients (even assuming 20 min appointments, no intakes that's about six hours of work), and then you see 3-4 consults (assuming you do a very minimal and likely insufficient job and never follow up on any of them that's about 1.5-2 hours of consult work). So you probably have about 14 hours of work there, assuming everything runs smoothly. Are there NPs etc. running most of the show and you are thus able to serve more as a director or are you doing the hands-on care for that full load every day? To me this job sounds so bad I wouldn't even consider it, unless I'm missing something about how others can shoulder a large part of that work burden.

The second job doesn't sound bad. You work your 12 inpatients (a half day), then have a half day to do your 4-5 consults. That lets you preserve some kind of quality of care along with your sanity, and you could probably wrap that up in a 10 hour day or maybe less if you're efficient. The 1:4 call is brutal but if it's mostly home phone call and it is light that may not be a deal breaker for you.

If these two are your only options I say full speed ahead on the nonprofit. Let the IBR take care of the loans and lead a life with some semblance of balance!

 

[Brownpsych]

A $50k signing bonus? Damn. That job must really really suck. Or be somewhere no one wants to live. Or both. I agree with Sluox. Sounds like they are recruiting you and planning to burn you out. Do you have to give the signing bonus back if you don't stay a certain period of time? My last contract said I had to stay for four years or pay it back. Not all of it, but prorated. And I did. I was short of four years by 1-2 months and damned if they didn't take it out of my last paycheck. Is the hospital paying you to take all that call or is it just part of the job description?

Both jobs sound awful to me, but I really intensely dislike consults and inpatient is meh. So a lot of it is probably just me.


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It is in a major city. $50k sign on bonus is paid out in 3 installments (so not really a sign on bonus)

 

[Blitz2006]

is this major city on one of the coasts?

 

[Brownpsych]

is this major city on one of the coasts?

East coast no income tax state

 

[sunlioness]

So, Florida or New Hampshire. But I wouldn't call any place in NH a "major city". :-D

 

[Brownpsych]

So, Florida or New Hampshire. But I wouldn't call any place in NH a "major city". :-D

FL

 

[Doctor Bagel]

To me, both those jobs sound super busy, but the first one sounds unmanageable. 12 to 13 inpatients in the morning followed by 15 to 20 patients in the afternoon?! That's 2 full days of work without the consults. Call every third weekend is also a lot, especially if it's a whole weekend. I'm guessing you'll generate a lot of revenue and all, but jeez, I'd burn out. I'm also not sure you could provide good care with those numbers. The 2nd job seems more doable, although those are still a lot of consults plus a full inpatient load. The pay's a little low, too, unless you're getting extra for call.

For contrast, I work an inpatient job where the goal is to cover 8 to 12 patients in a day with maybe a consult or two on the day you carry the pager for a full-time load. For those of you conceptualizing 12 inpatient as a half day job, how much turnover do you see in your hospital? If you've got a lot of rocks, I can see it, but if you're admitting and discharging, can you do a good job with seeing 12 patients in 4 hours?

 

[WingedOx]

I'm guessing this is Tampa/St Pete?

Not only do both of those sound busy, your patients are going to all be from Florida, which is its own form of psychiatric comorbidity.

 

[sunlioness]

Olllllllld. If it's Miami though, I hope you speak Spanish. If you don't, going through an interpreter or blue phone is going to slow you down. I hear Jacksonville is real nice, though very conservative which may or may not be a problem depending on if you're into that sort of thing. Orlando? I haven't been since I was 15, so I dunno.


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[Doctor Bagel]

Argh, as 12 inpatients in half a day who don't speak English and who are geriatric patients with multiple medical comorbidities. Yay!

 

[digitlnoize]

I'm guessing this is Tampa/St Pete?

Not only do both of those sound busy, your patients are going to all be from Florida, which is its own form of psychiatric comorbidity.

Could be lots of places: Jacksonville, Tallahassee, Tampa, Ft. Lauderdale, Miami, Sarasota (maybe), Orlando...

Agreed about the Spanish. Super heavy in Miami, but count on maybe 5-10% in other places...