Psych Attending Getting Low balled?

[Shikima]

When comparing W2/1099 positions, to compare apples to apples you factor in the differences in the extra taxes you are paying as a 1099 and the lack of benefits.

for instance, assuming a 250k salary - you are paying an extra $3625 in Medicare (1.45% of 250k) and $7347 in Social Security tax (6.2% of 118,500) for a total of $10,972 extra as a 1099 compared to W2
then, you have to add the extra expenses of Health insurance, malpractice, and retirement.

Those last 3 factors are variable depending on your personal health/#of people covered in your family (health insurance premiums), # of years you've been practicing (malpractice premiums), and whether the W2 position provides a match (e.g. 6% match versus no match). As a 1099, keep in mind that you can put away up to 53k as backdoor roth, which you don't pay tax on when you retire.

Or.... you can be savvy enough to find a position that pays you on W2 where you can get Benefits. Let's face it, the demand side allows for plenty of negotiating how you can derive revenue.

Conceptually when planning employment, don't think of work as an "all 1099" or "all W2". Mix and match the opportunities to fit your needs and make the most with the least amount of hours. And don't forget to find employment which nurtures and challenges you, and allows you to be you.

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[notdeadyet]

Conceptually when planning employment, don't think of work as an "all 1099" or "all W2". Mix and match the opportunities to fit your needs and make the most with the least amount of hours. And don't forget to find employment which nurtures and challenges you, and allows you to be you.

This. My happy place is a W-2 gig with enough hours to provide healthcare and benefits and 1099 gigs with enough to utilize all the write-offs.

 

[Doctor Bagel]

Or.... you can be savvy enough to find a position that pays you on W2 where you can get Benefits. Let's face it, the demand side allows for plenty of negotiating how you can derive revenue.

Conceptually when planning employment, don't think of work as an "all 1099" or "all W2". Mix and match the opportunities to fit your needs and make the most with the least amount of hours. And don't forget to find employment which nurtures and challenges you, and allows you to be you.

Even when I had 50 million different jobs, they were all W2 -- I need to rethink my strategy.

I agree a ton with your last sentence. I'm in a finding a new job place and have come across some things that are pretty lucrative but don't give much place to grow or learn. Avoiding isolation is another a big goal for me, including having colleagues I respect and can learn from.

 

[Shikima]

This. My happy place is a W-2 gig with enough hours to provide healthcare and benefits and 1099 gigs with enough to utilize all the write-offs.

Everyone will be different in what they consider to be the "right" opportunity. It's not about good or bad, far too boxy. But asking the honest question, is this right for me? Am I content where I am at right now?

Does one need to always be there. Do you have to adopt the strategy in staying in one spot the remainder of your life. For some, yes. Others, no.

 

[TexasPhysician]

This. My happy place is a W-2 gig with enough hours to provide healthcare and benefits and 1099 gigs with enough to utilize all the write-offs.

That's really the ideal situation. I'd love a 10hr/week job W2 with full benefits and the rest 1099 that maximizes pay.

W2 with full benefits is hard to find without 30+ hrs/week in my area.

 

[Shikima]

That's really the ideal situation. I'd love a 10hr/week job W2 with full benefits and the rest 1099 that maximizes pay.

W2 with full benefits is hard to find without 30+ hrs/week in my area.

Have you considered finding a medical director position for an IOP/PHP?

 

[TexasPhysician]

Have you considered finding a medical director position for an IOP/PHP?

The few I've been offered are 1099 contractor positions. Are they typically employees with benefits?

 

[Jules A]

The few I've been offered are 1099 contractor positions. Are they typically employees with benefits?

At the teaching hospital where I have privileges the IOP psychiatrist, he isn't a director but takes care of the IOP med management, is a 0.5FTE psychiatrist is on salary with full benefits who also works a side outpatient job for productivity 1099 for 90% of billing.

 

[Shikima]

The few I've been offered are 1099 contractor positions. Are they typically employees with benefits?

As above. I get benefits for being Medical Director and Director of UR in our clinic. A small stipend accompanies this position and benefits are also included. The remainder of my work and earnings are 1099. I have other side gigs which are a mix of W2 and 1099 that I complete in the evening, at home. Which then allows me to write off part of the rent, utilities, etc.

 

[Trismegistus4]

As above. I get benefits for being Medical Director and Director of UR in our clinic. A small stipend accompanies this position and benefits are also included. The remainder of my work and earnings are 1099. I have other side gigs which are a mix of W2 and 1099 that I complete in the evening, at home. Which then allows me to write off part of the rent, utilities, etc.

What kind of side gigs can you complete in the evening, at home? How did you find them?

 

[Jules A]

What kind of side gigs can you complete in the evening, at home? How did you find them?

They are starting to do more off hours telepsych in rural EDs although at this time to my knowledge are mostly utilizing social workers. I'd imagine you could get evening hours for telepsych med management in a different time zone where it was day to your evening. Although probably not your first choice I pick up overnight call 5p-8a on inpatient units and average $500 a night. All my jobs have been found via word of mouth from past and present coworkers.

 

[Shikima]

What kind of side gigs can you complete in the evening, at home? How did you find them?

I have academic appointments and work for a 3rd party company which does medical necessity reviews. Just need to hit the usual places for want ads and certainly word of mouth.

 

[dl2dp2]

They are starting to do more off hours telepsych in rural EDs although at this time to my knowledge are mostly utilizing social workers. I'd imagine you could get evening hours for telepsych med management in a different time zone where it was day to your evening. Although probably not your first choice I pick up overnight call 5p-8a on inpatient units and average $500 a night. All my jobs have been found via word of mouth from past and present coworkers.

Just to be not confusing to people: $500 a night for 5-8 is VERY low, unless you are just literally sleeping most of the time at home doing telepsych as cases get called in, and only a few cases at night at that. Most of the on-site overnight jobs are at LEAST $100-150 an hour. $500 for 5-8 is PHONE ONLY call is typical.

 

[Jules A]

Just to be not confusing to people: $500 a night for 5-8 is VERY low, unless you are just literally sleeping most of the time at home doing telepsych as cases get called in, and only a few cases at night at that. Most of the on-site overnight jobs are at LEAST $100-150 an hour. $500 for 5-8 is PHONE ONLY call is typical.

Sorry about that, my post was confusing. I do PHONE ONLY call for $500 a shift. It was meant to be two separate thoughts. #1 telepsych might be a way to make some after hours money from home or #2 taking call.

 

[Doctor Bagel]

Man, this thread is bumming me out. I get $325/night for phone pager call although that seems to be in accordance with rates in the community. I also essentially never have to come in. But still.

 

[Jules A]

Do any of you do weekend inpatient rounds/call? What are your rates? Any idea how much Locums are making on the weekends now? Most of the attendings in my area are negotiating weekends out of their contracts which is fine with me because I like working weekends and the rates are good. At my W2 job with full benefits I get $3,000 a weekend. I'm getting ready to interview for another W2 paid position but no benefits and its 60 miles away so I'm going to want more $$. Thanks in advance.

 

[nexus73]

Do any of you do weekend inpatient rounds/call? What are your rates? Any idea how much Locums are making on the weekends now? Most of the attendings in my area are negotiating weekends out of their contracts which is fine with me because I like working weekends and the rates are good. At my W2 job with full benefits I get $3,000 a weekend. I'm getting ready to interview for another W2 paid position but no benefits and its 60 miles away so I'm going to want more $$. Thanks in advance.

$3,000+ per weekend is what I've seen.

 

[Trismegistus4]

I have academic appointments and work for a 3rd party company which does medical necessity reviews. Just need to hit the usual places for want ads and certainly word of mouth.

Yeah, I guess I've long known word of mouth is the best source... just don't want to admit it to myself because I'm an introvert and I hate networking. I'm about to start a salaried, employed position, so I'm not sure how many side opportunities my salaried, employed colleagues are going to know about.

Do any of you do weekend inpatient rounds/call? What are your rates? Any idea how much Locums are making on the weekends now? Most of the attendings in my area are negotiating weekends out of their contracts which is fine with me because I like working weekends and the rates are good. At my W2 job with full benefits I get $3,000 a weekend. I'm getting ready to interview for another W2 paid position but no benefits and its 60 miles away so I'm going to want more $$. Thanks in advance.

My current locums assignment pays me $200 per hour for weekend rounding. Sundays are quick because they try not to take any admissions, so when I've done it I've billed for 8 hours Saturday and 4 hours Sunday, for a total of $2400. Obviously, if Sunday was an 8 hour day too, I'd get $3200. If you're negotiating directly with the place, I'd think you could do a little better because you're cutting out the middleman.

 

[cookymonster]

I work 36 weeks and weekends a year. I wish my hospital system would hire you guys that are dying to work weekends, which is what I did all through the last three years of residency.

All I want to do is go camping this weekend, but because I discharged 4 drunkihomelesscidal people that decided they wanted to go use on a Thursday afternoon, I'll have to admit four more of their brethren on a Friday morning. Oh the joys.

The wheel of time, it keeps on turning....

 

[st2205]

Two separate places I'm at, one pays $3,800 (1099) with the expectation that you will see 30 patients/day (new admits count for two), and another (W2) that pays essentially $3,500. Average census 15-23ish.

I think what's more important is how much work is expected for the weekend.

 

[Shikima]

Two separate places I'm at, one pays $3,800 (1099) with the expectation that you will see 30 patients/day (new admits count for two), and another (W2) that pays essentially $3,500. Average census 15-23ish.

I think what's more important is how much work is expected for the weekend.

As time and experience goes on, and as demand increases, you'll be able to negotiate better rates, either more per hour or negotiate fewer patients to round on.

I feel the days where you're expected to be the beast of burden are slowly peaking as others understand the value of service which they provide.

 

[Jules A]

Two separate places I'm at, one pays $3,800 (1099) with the expectation that you will see 30 patients/day (new admits count for two), and another (W2) that pays essentially $3,500. Average census 15-23ish.

I think what's more important is how much work is expected for the weekend.

Thank you, this is very helpful. The units I cover now vary from 24 beds with no other obligations to a 16 bed unit where I'm also required to do consults on med floors and ED so the work load is similar. Essentially I'd also like to make enough to make up for the lack of PTO and extra drive time if I take this position. I was thinking $3,750-$4,000. Historically I don't negotiate my rates especially for weekends when I know my value so I want to go in with a figure in mind. Again thank you.

 

[Trismegistus4]

Two separate places I'm at, one pays $3,800 (1099) with the expectation that you will see 30 patients/day (new admits count for two), and another (W2) that pays essentially $3,500. Average census 15-23ish.

I think what's more important is how much work is expected for the weekend.

Yikes. I have no idea how people handle such high volumes. I did a locums assignment for 5 months where my daily max was 14, and only toward the end of the 5 months did I finally learn how to usually get done by 5. Days when I did have 14 were hellish. I've talked to recruiters about inpatient jobs like Jules A mentions, bed counts in the twenties, or in the teens plus med floor and ED consults, and as soon as they toss out those numbers I tell them I'm not interested. How people handle it is beyond me, unless they're working 12 hours days, or cutting such corners that I'd be worried about liability.

 

[st2205]

As time and experience goes on, and as demand increases, you'll be able to negotiate better rates, either more per hour or negotiate fewer patients to round on.

I feel the days where you're expected to be the beast of burden are slowly peaking as others understand the value of service which they provide.

At the 1099 job it's too much work. If you calculate it out, the billing for the amount of patients is about exactly the same as the amount you're given. Then you're doing all the other stuff for free, essentially. They need to offer more and they're losing two doctors, leaving two of us moonlighters left and one staff there who does weekends. It's a disorganized mess and they'll have to offer a lot more or we're not doing it.

Thank you, this is very helpful. The units I cover now vary from 24 beds with no other obligations to a 16 bed unit where I'm also required to do consults on med floors and ED so the work load is similar. Essentially I'd also like to make enough to make up for the lack of PTO and extra drive time if I take this position. I was thinking $3,750-$4,000. Historically I don't negotiate my rates especially for weekends when I know my value so I want to go in with a figure in mind. Again thank you.

As per above, calculate how much you're billing for just for simply rounding then add in an amount they need to subsidize for all the other non-billable work you're doing.

Yikes. I have no idea how people handle such high volumes. I did a locums assignment for 5 months where my daily max was 14, and only toward the end of the 5 months did I finally learn how to usually get done by 5. Days when I did have 14 were hellish. I've talked to recruiters about inpatient jobs like Jules A mentions, bed counts in the twenties, or in the teens plus med floor and ED consults, and as soon as they toss out those numbers I tell them I'm not interested. How people handle it is beyond me, unless they're working 12 hours days, or cutting such corners that I'd be worried about liability.

I certainly wouldn't do it like that on the weekdays. The weekends the plan is mostly set. However, facility with higher volume is disorganized and the weekday psychiatrists/providers are terrible. I would much prefer a higher patient load in patient than higher outpatient load, but I certainly wouldn't want to work one of those facilities during the week.

 

[vistaril]

Yikes. I have no idea how people handle such high volumes. .

you wonder that because you don't work in the real world.

 

[Doctor Bagel]

you wonder that because you don't work in the real world.

I think he's in the real world. That volume is not typical where I work either, and I'm also in the real world. The more we accept these high volumes as the norm, the bigger disservice we do to our patients and ourselves. No one is providing good/appropriate care and seeing 20 patients a day.

 

[vistaril]

I think he's in the real world. That volume is not typical where I work either, and I'm also in the real world. The more we accept these high volumes as the norm, the bigger disservice we do to our patients and ourselves. No one is providing good/appropriate care and seeing 20 patients a day.

I don't know where you work, but I thought he works for the VA. By definition, whether he makes 20k a year or 2 mill a year, he is not in the real world because his salary is not connected to revenue/collections in any way. Thats just the way it is.

In the real world it's completely irrelevant to these things you talk about. Whether 'good care' can be provided by seeing 5, 10, 25, or 125 patients a day is irrelevant. Administrators and CEOS are hiring people to provide a service and we are generally paid as a reflection of the revenue that service brings in. We aren't paid first and then the determination of what a 'reasonable' salary is based on our title. We are paid based on what we generate in the real world.

It's not about us 'accepting' a certain number of patients. Maybe in non-real world settings to some extent it is. But in the real world this sort of thing has no meaning at all.

 

[Shikima]

I don't know where you work, but I thought he works for the VA. By definition, whether he makes 20k a year or 2 mill a year, he is not in the real world because his salary is not connected to revenue/collections in any way. Thats just the way it is.

In the real world it's completely irrelevant to these things you talk about. Whether 'good care' can be provided by seeing 5, 10, 25, or 125 patients a day is irrelevant. Administrators and CEOS are hiring people to provide a service and we are generally paid as a reflection of the revenue that service brings in. We aren't paid first and then the determination of what a 'reasonable' salary is based on our title. We are paid based on what we generate in the real world.

It's not about us 'accepting' a certain number of patients. Maybe in non-real world settings to some extent it is. But in the real world this sort of thing has no meaning at all.

And with that thought process, you'll only ever be an employee. Never a successful physician - and certainly not a successful businessman.

 

[WisNeuro]

But...but...he's seen the "real world!"

 

[notdeadyet]

I don't know where you work, but I thought he works for the VA. By definition, whether he makes 20k a year or 2 mill a year, he is not in the real world because his salary is not connected to revenue/collections in any way. Thats just the way it is.

When you equate the "real world" as being exclusively private practice model, you're demonstrating your lack of familiarity with the field of psychiatry.

Rounding on 30 inpatients a day is high by most folks yardsticks.

 

[vistaril]

When you equate the "real world" as being exclusively private practice model, you're demonstrating your lack of familiarity with the field of psychiatry.

Rounding on 30 inpatients a day is high by most folks yardsticks.

you still don't get it.....I most certainly consider working for a community hospital system on a w-2 in some form as 'real world'. But your compensation in that model is going to be tied to your revenue.

 

[vistaril]

And with that thought process, you'll only ever be an employee. Never a successful physician - and certainly not a successful businessman.

lmao...I'm not an employee now.

 

[notdeadyet]

you still don't get it.....I most certainly consider working for a community hospital system on a w-2 in some form as 'real world'. But your compensation in that model is going to be tied to your revenue.

Is the community hospital funded by Medicaid/Medicare? Or is it receiving county funds? Or is it grant-driven?

And are you practicing EM psychiatry? Or C/L psych? Or outpatient practice?

And are you delivering direct care? Or are you in a management role? Or are you also participating in clinical trials?

Not everyone's paid is tied to the revenue stream that yours is. You can lmao as much as you want, but not everyone's experience is the same as yours, so your attempt to reduce it all to one model is going to fall flat consistently.

 

[vistaril]

Is the community hospital funded by Medicaid/Medicare? Or is it receiving county funds? Or is it grant-driven?

And are you practicing EM psychiatry? Or C/L psych?

lmao....I practice some of those yes.....meaning I see patients sometimes who are on medicine floors for various reasons. I rarely go down to the ER to see patients because that would be incredibly unproductive as there is an assessment team in place down there now which I talk to concerning admissions. I typically see the patients for the first time on the floor the next day.

 

[st2205]

you still don't get it.....I most certainly consider working for a community hospital system on a w-2 in some form as 'real world'. But your compensation in that model is going to be tied to your revenue.

While this is generally true, it is not exclusively true. The position I'm taking is straight up production where whatever you generate in RVU you're given 100% of. Then up to ~20% bonus on top of that, plus 4% 401k, plus 12% pension, plus loan repayment, plus other incentives, plus many days off and light work load if you want it. How is that possible? Because straight up CPT codes don't account for salaries. At least they don't have to. There are many other incentives for employers, but whatever. If you're unwilling to accept that, you're more than happy to enjoy the options currently available to you.

 

[hamstergang]

Where I did moonlighting, they paid $100/hr. It involved 8 hours on a Saturday or Sunday, rounding on 20-27 inpatients, with 2-3 being new admits requiring full H&Ps.

Another place I know had less than 20 inpatients, but also required covering C&L and the ED at $130/hr for 10 hours on a Saturday or Sunday.

 

[st2205]

Where I did moonlighting, they paid $100/hr. It involved 8 hours on a Saturday or Sunday, rounding on 20-27 inpatients, with 2-3 being new admits requiring full H&Ps.

Another place I know had less than 20 inpatients, but also required covering C&L and the ED at $130/hr for 10 hours on a Saturday or Sunday.

Yikes! Were you in a city with multiple residencies?

 

[hamstergang]

Yikes! Were you in a city with multiple residencies?

NJ.

 

[Shikima]

lmao...I'm not an employee now.

You're right. You're unemployed and desperately seeking Susan.

 

[nexus73]

Where I did moonlighting, they paid $100/hr. It involved 8 hours on a Saturday or Sunday, rounding on 20-27 inpatients, with 2-3 being new admits requiring full H&Ps.

Another place I know had less than 20 inpatients, but also required covering C&L and the ED at $130/hr for 10 hours on a Saturday or Sunday.

Is that the resident rate? Can't imagine any attendings working for that pay, on the weekend with that patient load.

 

[hamstergang]

Is that the resident rate? Can't imagine any attendings working for that pay, on the weekend with that patient load.

The $130/hour is definitely the attending rate.
The $100/hour I believe is the attending rate as well, but they could have been lying to me/misleading me.

I didn't look very hard for these, but I know there is also great regional variation so this may be normal in NJ and low for most other places.

 

[Trismegistus4]

lmao...I'm not an employee now.

You're not a successful physician or a successful businessman, either.

See, people, this is why I argued earlier that we shouldn't engage with vistaril. Every thread he participates in gets hijacked with attempts to rebut him.

And no, I'm not at the VA.

 

[calvnandhobbs68]

Is that the resident rate? Can't imagine any attendings working for that pay, on the weekend with that patient load.

Agree 800 bucks to round on 27 inpatients with 3 new admissions does not sound worth it to me.

 

[Mad Jack]

You're right about all of that. Our program is in an expensive city and pays about 150-200/hr for moonlighting. (But the 200/hr is a 6 hr Friday night ED shift IIRC) When you factor in CoL, residents make approximately the same or more in terms of PPP in lower CoL cities. The numbers work out either way

Re: Harvard. People are usually referring to Partners/BIDMC/BCH when they talk about Harvard. I'd imagine Mt Auburn actually pays pretty well, and of course the multiple VA's pay decently, but no one thinks Mt Auburn or the VA when you say Harvard. Brigham nurses with ~10 years of experience make more than new IM attendings, but I always wonder how much of the FTE for those attendings is not RVU generating.

Why are moonlighting rates this high? Can you make this much per diem as a psychiatrist?

 

[nexus73]

Why are moonlighting rates this high? Can you make this much per diem as a psychiatrist?

Usually weekend and/or over night shifts that are harder to staff.

 

[Mad Jack]

Usually weekend and/or over night shifts that are harder to staff.

I mean, if I can make $200/hr as a board certified psychiatrist working nights or weekends, sign me the hell up lol.

 

[nexus73]

I mean, if I can make $200/hr as a board certified psychiatrist working nights or weekends, sign me the hell up lol.

What do you do now for a living? How many nights and weekends a month do you want to work? Most people want that time off for family and friends, which is why it's harder to staff and generally pays more.

 

[Mad Jack]

What do you do now for a living? How many nights and weekends a month do you want to work? Most people want that time off for family and friends, which is why it's harder to staff and generally pays more.

I'm a med student now, very interested in psych. No kids, and all of my friends work weekends and nights (bartenders, correctional officers, police, EMS, etc). Worked as a RT 28 hours every weekend for six years, lol, will gladly do it for 200/hr if given the chance.

 

[Doctor Bagel]

I mean, if I can make $200/hr as a board certified psychiatrist working nights or weekends, sign me the hell up lol.

Can someone tell me how to do that, too? 'Cause I'm a board certified psychiatrist doing inpatient, doing nights, doing weekends, and that's not happening for me. This thread is making me sad.

So based on my job and on other jobs I know of in the city and nearby, a weekend of call (rounding two days, being on call overnight one night) pays from $3500 to $4k. A weeknight of pager call pays from $275 to $400. I've heard of $150/hour for rounding on the weekends for inpatient sites with no call.

 

[Jules A]

The $130/hour is definitely the attending rate.
The $100/hour I believe is the attending rate as well, but they could have been lying to me/misleading me.

I didn't look very hard for these, but I know there is also great regional variation so this may be normal in NJ and low for most other places.

Is this for weekends? If so, very unfortunate especially in Jersey where the cost of living is high and real estate taxes are ridiculous. I'd check out Baltimore/DC in my experience attendings start in the low $300,000 range for M-F benefitted with rotating week night call. At most facilities they don't do weekends. Psychiatry is a high demand specialty at this time so I don't understand the tremendous discrepancies compensation. As the public awareness of mental health needs increases and more people realize we are making bank my guess is the trend will shift so now is the time to secure an attractive package.