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psychiatrist job

Discussion in 'Psychiatry' started by Ahamis, Nov 22, 2017.

  1. Ahamis

    Ahamis 7+ Year Member

    Oct 24, 2008
    I would like to hear opinions about this job opening:
    Located in the middle-west, about an hour from a metropolitan area and international airport.
    Not-for-profit community clinic. Mostly Medicaid patients (few commercial insurance)
    Outpatient only; no calls; 40 hours
    350K: base salary (requires to see 4160 visits/year). OBS: A follow-up is equal to one visit. An intake is equal to 2 visits.
    The physician would receive 75% of revenue earned for visits in excess of 4160 per year.

    intake time: 1 hour
    med management time: scheduled every 20 min
    no show rate: 25-30%
    vacation: 6 weeks
    holidays: 10 days??

    Negative part: It seems you are required to supervisor NP. I need to get more details about it. It seems more and more jobs are requiring supervision of mid-levels.

    I wonder what kind of jobs PGY-4 are finding in the market. It would be nice if people start posting their findings.
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  3. slappy

    slappy Neuropsychiatrist Physician Faculty 2+ Year Member

    Apr 1, 2014
    4160? Bloody hell.
  4. nitemagi

    nitemagi Senior Member Physician Faculty 10+ Year Member

    Oct 15, 2001
    Los Angeles, CA
    Minus 6 weeks vacation = 46 weeks working.
    4160 visits/46 weeks = 90 visits a week = 18 visits a day (@ 8 hours a day, that's a visit every 20-30 minutes steady).

    In short, it's a grind. If there's a 25-30% no show, it's very unlikely you'll ever exceed 4160 visits (presuming no shows don't count as visits).
    Nasrudin and wolfvgang22 like this.
  5. Ahamis

    Ahamis 7+ Year Member

    Oct 24, 2008
    18 visits per day:
    if I see 2 intakes (1 hours for each intake= 4 visits) and 14 follow-ups in a day that would give 25 min for each follow-up.
    Many jobs offer only 20 minutes for follow-up. Unfortunately, I heard even 15 min...

    No show doesn't count as a visit. That`s why the clinic schedules follow-ups every 20 minutes.
    With a base salary of 350k, I would not care much about exceeding 4160 visits.
    Last edited: Nov 22, 2017
    wolfvgang22 likes this.
  6. splik

    splik Professional Cat at Large Physician Faculty 7+ Year Member

    Nov 30, 2009
    if these are medicaid patients then its a waste of time to exceed the 4160. 75% of nothing is less than nothing.

    the issue is it doesn't sound like 350k is a base salary. it sounds like this is based on you meeting 4160 visits, the point being if 25-30% of patients aren't turning up you cannot meet unless you never take vacations unless and even then you wouldn't meet it unless they overbook you. the question is then what do you get paid if you don't meet that visit requirement?

    my other question is - is this a salaried job (i.e. W2?) what are the benefits like? how can you supervise an NP without any time scheduled for supervision? does the payment include the pay for supervising the NP? how many patients are you expected to carry? do they all have case managers? what happens out of hours? do you have to do prior auths and refills, and return calls etc?
    nexus73, Jebel, aim-agm and 2 others like this.
  7. st2205

    st2205 Attending 10+ Year Member

    Oct 28, 2006
    Outside of that workload of actually seeing that many people, I’d try to find out the atrocious amount of phone calls and emails you’ll get.
    Nasrudin, aim-agm, Psychotic and 2 others like this.
  8. SmallBird

    SmallBird 7+ Year Member

    May 3, 2010
    Assuming you bill a reasonable mix of 90792s, 99213s and 99214s, thats almost 6000 RVUs. 350k is not actually too bad for 6000 RVU's but seems like a risk of burnout. I'd rather do 4500 RVU's for 275k and throw in a few weekends of moonlighting if I needed to make 350k.
  9. J ROD

    J ROD Watch my TAN walk!! Rocket Scientist Physician Pharmacist Lifetime Donor Classifieds Approved 10+ Year Member

    Aug 1, 2005
    working on my tan......
    Not bad for salary if guaranteed. But you will work for that money. Personally, I would take less money and work. Take a side job if I need money that bad.
  10. TexasPhysician

    TexasPhysician Moderator Physician 7+ Year Member

    Sep 1, 2008
    What happens if you don’t reach 4160 because it won’t happen in 40 hours with that vacation time?

    Supervising a NP will likely take a few hours per week and that is assuming just 1 NP. If a young NP, expect many hours per week.

    Where is your admin time to return calls and do refills?

    Medicaid no-shows can vary significantly.
  11. Ahamis

    Ahamis 7+ Year Member

    Oct 24, 2008
    W2. The standards benefits (health insurance, malpractice with tail, vacations). I need to verify the 401k. Do you know the standard 401k benefit?
    I will ask about NP details (time for supervision, etc). At this moment, only the director is supervising NPs. But they plan to expand that as far as I understood.

    I don't provide after hour coverage. I will check how they do it. But many communities clinic don't have coverage 24 hours. The patient goes to the public emergency psych in the city.

    patient load: The employer just said 1-hour intake and 20 min for follow-up (but expected to average around 2.2-2.3 consults per hour due to no-shows).

    They said that the staff helps you with administrative tasks like prior authorization, some calls. Also, since the no-show rate is high you would have gaps to call your patients, etc.
    I don't know about refills. Probably staff can help with that too.

    Medicaid patients usually don't call/ email that much, though. At least in my personal experience. It is more common with commercial insurance. Am I right?

    ALL GOOD QUESTIONS that I will ask the employer. Thank you!
  12. Shikima

    Shikima Physician 10+ Year Member

    Oct 15, 2006
    Negotiate. 14 ppl per day, no shows count towards the number seen, intakes count for 2 ppl. anything over your limit of 3640/year would be a 80%/20% split for OH costs as a bonus to you as an annual disbursement.
  13. Ahamis

    Ahamis 7+ Year Member

    Oct 24, 2008
    There is another possible outpatient opportunity paying around 275k.
    1-hour intake, "most of the follow-ups 30 minutes". I need to clarify what is the meaning of "most of the follow-ups"; no calls (need to check who does the coverage). administrative time: 30 minutes/ day. W-2 with standard benefits; no bonus.

    Alright. So, what would be a good balance for an outpatient job with no calls?
    What salary for what patient load? time for intakes, follow-ups and administrative time?
    OBS: VA job does NOT count. Those that own private offices don't count.

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