keifernny2

5+ Year Member
Aug 26, 2013
259
162
Status
Attending Physician
Hi everyone,

I am just curious how others have done lately with psychiatric job negotiations.

I've been interviewing at small hospitals in an area with a psychiatrist shortage. Most of them are currently using locums to fill most of their positions, or visa candidates on long contracts.

My biggest concern is being overwhelmed with higher inpatient load /call if another psychiatrist were to leave the hospital at the end of their contract and the hospital were slow to hire locums again (especially if they had staff on salary).

In order to protect myself from this I've tried to put contract suggestions in regarding patient workload, or average number of patients carried, etc, but have gotten some pushback about this. They seem to be willing to negotiate $$ , but not the actual job details.

I've been considering putting a proposal for bonus structure with a much higher bonus rate above a certain # of RVUs to disincentivize being overworked , or am wondering if anyone else has run into a similar issue in the past.
 

Shikima

10+ Year Member
Oct 15, 2006
4,529
2,650
Status
Attending Physician
Hi everyone,

I've been considering putting a proposal for bonus structure with a much higher bonus rate above a certain # of RVUs to disincentivize being overworked , or am wondering if anyone else has run into a similar issue in the past.

That's all you can do in your case to protect yourself. Also, when you get the draft from them, you can make modifications and return it back to them with maximum number of Pt's seen per day, time allocated for said patients, and so forth. Also, lower the dollar amount you need to make to meet your salary needs before going into a production bonus. Protect yourself, don't get emotional or overly attached. It's business.
 

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,938
1,733
Visit site
Status
Attending Physician
A problem on the employers side is the more details added, the less favorable you look because one-you might not be a team player, and 2-when an employer has several employees, it becomes impossible keeping track of every single detail with each person's contracts. There needs to be some type of uniformity to a degree where an employer can manage this.

I don't, however, think your concerns are unreasonable. Several employers will be unreasonable especially with attendings that have just started out and try to work every bit out of you.

A thing I've noticed is each place has it's pros and cons that can only be qualititatively experienced. A certain place, for example, might give you more patients, but your staff is so excellent it's well worth being at that place vs a place with less patients where the staff members are terrible. The problem is that these things can only be figured out once you've been at the institution for some time or if you know someone on the inside that can give you a very honest and frank evaluation of what it's like to be there.

As an example, my job in the state hospital, when I was there, was so easy it was actually annoying how much free time I had. I put a set of weights in my office, I got caught up with all of the HBO shows I loved and missed in residency, and I felt like my brain was rotting. That's a reason why I postedon this forum a heck fo a lot more back then compared to what I do now. At the university I'm being worked hard, but I get to work with some of the top doctors in the country and that given me a morale boost-though of course, like any job, there are things here I'm seeing that I find annoying too.
error in the edit!
 
Last edited:

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,938
1,733
Visit site
Status
Attending Physician
Forgot to mention this. IMHO you really won't understand the landscape of the area until you've worked in a few of the places, have an understanding of the demographics of people in the locality, and have colleagues where you can discuss the qualitative differences of each work location. This could take a few years. Of course go into a job trying to know as much about it as you can, but on some level you have to accept that you could be walking into a job that looks good on paper but in reality doesn't live up to the impression you first had.
 

vistaril

5+ Year Member
Jun 10, 2012
3,752
304
Status
Resident [Any Field]
Hi everyone,

I am just curious how others have done lately with psychiatric job negotiations.

I've been interviewing at small hospitals in an area with a psychiatrist shortage. Most of them are currently using locums to fill most of their positions, or visa candidates on long contracts.

My biggest concern is being overwhelmed with higher inpatient load /call if another psychiatrist were to leave the hospital at the end of their contract and the hospital were slow to hire locums again (especially if they had staff on salary).

In order to protect myself from this I've tried to put contract suggestions in regarding patient workload, or average number of patients carried, etc, but have gotten some pushback about this. They seem to be willing to negotiate $$ , but not the actual job details.

I've been considering putting a proposal for bonus structure with a much higher bonus rate above a certain # of RVUs to disincentivize being overworked , or am wondering if anyone else has run into a similar issue in the past.
The biggest thing you can do to protect yourself is make sure you can easily get out of the contract. That way if you don't like it, you can leave and find someplace better. It is really hard to negotiate all these protections I would think. The bottom line is that the race to the bottom is happening, so
take what you can get now and enjoy it.
 

Armadillos

5+ Year Member
Feb 5, 2013
1,156
891
Status
The biggest thing you can do to protect yourself is make sure you can easily get out of the contract. That way if you don't like it, you can leave and find someplace better. It is really hard to negotiate all these protections I would think. The bottom line is that the race to the bottom is happening, so
take what you can get now and enjoy it.
What do you mean by this?

Relatively speaking isn't psych one of the few fields that is actually seeing CMS reimbursement increases this year? I think someone said the newly released rates have psych up 6% and pretty much every other medical specialty holding steady or decreasing.
 

F0nzie

5+ Year Member
Aug 22, 2011
1,621
1,227
Status
Attending Physician
A problem on the employers side is the more details added, the less favorable you look because one-you might not be a team player, and 2-when an employer has several employees, it becomes impossible keeping track of every single detail with each person's contracts. There needs to be some type of uniformity to a degree where an employer can manage this.

I don't, however, think your concerns are unreasonable. Several employers will be unreasonable especially with attendings that have just started out and try to work every bit out of you.
This. Especially in some of the heavy top-down organizations. Definitely get a feel for the environment and the market before you start negotiating.

But many places across the country are dying for Psychiatrists. This puts more playing cards in your deck. Use them or lose them!
 

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,938
1,733
Visit site
Status
Attending Physician
What do you mean by this?

Relatively speaking isn't psych one of the few fields that is actually seeing CMS reimbursement increases this year? I think someone said the newly released rates have psych up 6% and pretty much every other medical specialty holding steady or decreasing.
Here's some things.

Some contracts have clauses that if you want to leave the organization you must give them advance warning. Some places it's weeks, others several months. Imagine a contract saying you can't leave for at least 6 months before you give your notice.
Clauses where one cannot practice within a specific distance once you leave, cannot mention what you saw at the place of employment for a specific amount of time (e.g. what if the practice or hospital is engaging in shady practices), failure to contribute to a retirement fund if you leave before a specific amount of employment, etc.

Some of these things in the contract are understandable. Don't go into this thinking any of these clauses are unfair. If you, for example, were running psychiatric practice, a doctor leaving that destroy your economic infrastructure, so IMHO it's reasonable to have a clause saying one needs to be warned before the doc leaves, but 6 months IMHO is overkill. 3 months for me is the most I'd be willing to allow an employer.

By the way, if you ever leave an employer, always do what you can to ease your transition out. This way you will hopefully increase the likelihood of leaving on good terms, can use the employer as a future reference, and your name will be less likely to be tarnished in the very small world of mental health. There, however, is a difference between leaving like a lady or gentleman vs being exploited by the employer vs leaving in a very destructive and egocentric manner. Be reasonable, don't let them take advantage of you, but also don't be rude and not willing to help out a little in the transition.

I left my state job and they want me back with a promotion, offered to pay me way more than the state norm for the position, and I'm still on very good terms with several of the doctors and psychologists there, leaving me in a very good position should I ever want to come back or make a private practice (for referrals and business partners). Someone would have burned their bridges if they left the job leaving the door giving an EFF-You middle finger back to the institution.
 
Last edited:

TexasPhysician

Moderator
10+ Year Member
Sep 1, 2008
4,806
1,983
Status
Attending Physician
I think you are doing well. Negotiate and put details in the contract or prepare to be overworked. Some places will negotiate and others won't.

I've walked away from a potential job for unwillingness to negotiate. I have a current gig where all requests were accepted.