Psychiatrist position in private clinic

[Ahamis]

I would like to hear your opinions about this psychiatrist position- suburbs of a big metropolitan area.
Private clinic
Guaranteed Salary for only 3 months ($16,667 per month).

After that, you go to production:
91 dollars per patient (independent of being intake or follow-up. Employer created a median to simplify calculation).

"2.5 patient per hour as the total capacity. Some Dr.’s go above that number and some below but this is where we average across providers."
You can see less or more patients according to your comfort level.

Most of the patients are commercial insurance. No Medicaid. Few cases of severe mental illness (as opposed to CMHC)... I know that some psychiatrists hate CMHC.
More anxiety/depression spectrum.

Possibility to do TMS and payment is separated.

40 hours per week, flexible schedule (option to work 4 days/week). After hours you have an answering service that directs the urgent calls to your phone. I believe this is pretty standard in private practice. You are always on call for your own patients.
Vacation: only 3 weeks.

I know that the guaranteed salary period is too short. Also, the vacation is short too. I believe I could negotiate those issues.

No requirement to supervise mid-levels.

Thoughts?

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[Shikima]

It's a bad deal, they're making money off of you. Find another gig that is more transparent.

 

[futuredo32]

This sounds like a great deal to me. Depending on where you live and the reimbursement. I have a small pp and reimbursement for meds is nowhere that high, new intakes are higher but after you are there awhile ie probably the three months you should have a fairly large caseload. My analyst is a shrink and he gets 70% of what he brings in, pays his own malpractice, no vacation time ie he is an independent contractor- obviously they let him do therapy. If this were in my location and they let me do therapy I would take it in a heartbeat.

 

[michaelrack]

I would like to hear your opinions about this psychiatrist position- suburbs of a big metropolitan area.
Private clinic
Guaranteed Salary for only 3 months ($16,667 per month).

After that, you go to production:
91 dollars per patient (independent of being intake or follow-up. Employer created a median to simplify calculation).

Vacation: only 3 weeks.
. Also, the vacation is short too. I believe I could negotiate those issues.

Thoughts?

what does vacation matter if you are going to be paid entirely by production?? Also, getting paid per patient might be ok for a bonus, but if my entire salary was dependent on it I would want a separate rate for follow-ups and new patients.... probably best to do based on RVU. the salary guarantee is pretty low (both in amount and duration). Run away from this job. They are going to load you up with new patients, and $91 per patient is too low if you have a lot of new patients

 

[Ahamis]

best to do based on RVU. the salary guarantee is pretty low (both in amount and duration). Run away from this job. They are going to load you up with new patients, and $91 per patient is too low if you have a lot of new patients

I agree that the best model would be RVU.

$91 is low if you have lot of new patients. But once you have a case load stablished you will have more follow-ups and can make more money per hour. Right?

 

[Ahamis]

If this were in my location and they let me do therapy I would take it in a heartbeat.

In this model it is not advantageous to do therapy since you could see more patients doing medication management. You are paid by volume.

 

[TexasPhysician]

Some unethical practices start dumping all new evals on the new guy while redirecting FU’s. If they are confident of patient volume and helpful with retention, they should have no problem paying your minimum indefinitely. In a 40 hour week, that is 1.15 patients/hr.

Need more details on vacation time rules as you are paid based on production.

What defines an urgent call that is patched through to you? Could be abusive to providers.

After clearing those things up, seems like a reasonable gig.

 

[futuredo32]

In this model it is not advantageous to do therapy since you could see more patients doing medication management. You are paid by volume.

The ONLY thing I remotely like about psychiatry is therapy. There is more to life than money. Happiness counts too. Hopefully a miracle will happen and I will match into a FP program next year but for now I would not work for a clinic if they didn't let me do therapy. Being a prescription factory has zero appeal to me.

 

[WisNeuro]

The ONLY thing I remotely like about psychiatry is therapy. There is more to life than money. Happiness counts too. Hopefully a miracle will happen and I will match into a FP program next year but for now I would not work for a clinic if they didn't let me do therapy. Being a prescription factory has zero appeal to me.

Therapy jobs in clinics/hospital settings are becoming harder to come by even for psychologists, outside the VA. Many places are stocking in midlevels in therapy/counseling positions. PP is going to be the only option in some places soon if you're a doctoral level provider.

 

[dl2dp2]

This could be a very variable job, depending on a lot of factors including what kind of patient population it is and no show rate. In general, I don't like a system where there is very little transparency. My suspicion on that whoever runs the clinic is not an MD? I would use this job as some kind of opportunity to scope out the market (i.e. rather than jumping in 40 hours a week, try starting at 20 hours a week, and start exploring starting your own practice). If this is a suburb of a major metro, I suspect you will not have problem starting a private practice for cash. And especially if you take insurance it'll be easy to fill.

Private jobs are only worth it if you are on some kind of profit sharing plan/partner track, and you should be, because MDs have the highest profit margin for such an operation and are a major referral source.

Btw, just strictly based on numbers for commercial insurance they are squeezing you quite a bit. Roughly 99213+90833 is about $200-ish (Aetna, Cigna). Subtracting space/insurance/billing etc. I'd say they are taking a 30-40% profit margin off of you with $91 per patient.

 

[Mass Effect]

The ONLY thing I remotely like about psychiatry is therapy. There is more to life than money. Happiness counts too. Hopefully a miracle will happen and I will match into a FP program next year but for now I would not work for a clinic if they didn't let me do therapy. Being a prescription factory has zero appeal to me.

You like therapy. You're opposed to being a prescription factory, but you're re-entering the match to do FP?

 

[FlowRate]

Worst case they're paying you $92 per hour. Best case they're paying you almost $250 per hour. Curious.

 

[futuredo32]

You like therapy. You're opposed to being a prescription factory, but you're re-entering the match to do FP?

I like a little therapy- not love it but it's way better than being a prescription factory, I couldn't do therapy all day everyday. I want a job I LOVE and I think it's FP. I told my PD my first year of psych residency I wanted to switch to FP and got talked out of it. I had a spot in FP during psych residency and didn't take it and kick my self for it often. I am fine making a residents salary, I don't work a lot because I dislike psych so the salary probably wouldn't be a lot different. It's cliché but I think true that if you find a job you love, you never work a day in your life. I DREAD going to work every day. I want to be HAPPY. Money doesn't mean much to me, happiness does. I had great psych rotations as a med student and I did really well on them and I think it was the awesome attending I had who played a role in the like I had for psych at the time. I made a mistake when I picked residencies. If I have to live with it forever , it is what it is, but I am totally applying next year for FP. I miss the variety. I find psychiatry monotonous. I am glad some people love it. I think with a psychiatry residency and having practiced for a few years I would be an awesome FP doc because people see them often prior to a psychiatrist not to mention I love FP. Granted I wouldn't be doing therapy with them but I could treat their psychiatric issues as well as their physical illnesses.

 

[futuredo32]

Therapy jobs in clinics/hospital settings are becoming harder to come by even for psychologists, outside the VA. Many places are stocking in midlevels in therapy/counseling positions. PP is going to be the only option in some places soon if you're a doctoral level provider.

Which is why I have a small PP.

 

[TexasPhysician]

Roughly 99213+90833 is about $200-ish (Aetna, ......

Rates vary significantly by region. I’m cash-only in part because insurances don’t pay anywhere near that out here. Not close even as 99214+ 90833

 

[dl2dp2]

Rates vary significantly by region. I’m cash-only in part because insurances don’t pay anywhere near that out here. Not close even as 99214+ 90833

Apologies yes I realized when I saw this again that ~ $195 is actually 99214+90833. 99213 is another $30 less I think. The rate I'm quoting MAYBE a preferential rate. I think sticker BCBS rate is about $150 for the same codes with 99214. This is why nobody takes BCBS.

Maybe the profit margin isn't as crazy after all. Still with this type of job I would prefer say $200 per hour show or no-show as opposed to based on billing...

 

[Jeannie123]

This could be a very variable job, depending on a lot of factors including what kind of patient population it is and no show rate. In general, I don't like a system where there is very little transparency. My suspicion on that whoever runs the clinic is not an MD? I would use this job as some kind of opportunity to scope out the market (i.e. rather than jumping in 40 hours a week, try starting at 20 hours a week, and start exploring starting your own practice). If this is a suburb of a major metro, I suspect you will not have problem starting a private practice for cash. And especially if you take insurance it'll be easy to fill.

Private jobs are only worth it if you are on some kind of profit sharing plan/partner track, and you should be, because MDs have the highest profit margin for such an operation and are a major referral source.

Btw, just strictly based on numbers for commercial insurance they are squeezing you quite a bit. Roughly 99213+90833 is about $200-ish (Aetna, Cigna). Subtracting space/insurance/billing etc. I'd say they are taking a 30-40% profit margin off of you with $91 per patient.

Hi,

Any advice on how to negotiate with Cigna to get those rates?

Really appreciate it. 🙂

 

[futuredo32]

Hi,

Any advice on how to negotiate with Cigna to get those rates?

Really appreciate it. 🙂

I am (as usual) way behind in my billing but I guess Cigna has dropped way low in their compensation. And at least in Mich they are tied to Aetna. UGH. CAN you negotiate? I thought they paid just whatever in a certain region and that's it. I have picked up more patients without effort, fortunately BC/BS or Medicare mostly , unfortunately they start as med management and soon want to be therapy too. I am either going to start studying for the boards next month OR do what I did for the first 3 prites and all three COMLEX exams and my first NBME exam, not really study at all. I did pretty well on the prites and didn't prepare, barely passed the Comlexes but didn't study, and did better on my first NBME with minimal studying than this year when I studied way hard. If I am going to study I can't work much. Need to decide soon.

 

[dl2dp2]

I am (as usual) way behind in my billing but I guess Cigna has dropped way low in their compensation. And at least in Mich they are tied to Aetna. UGH. CAN you negotiate? I thought they paid just whatever in a certain region and that's it. I have picked up more patients without effort, fortunately BC/BS or Medicare mostly , unfortunately they start as med management and soon want to be therapy too. I am either going to start studying for the boards next month OR do what I did for the first 3 prites and all three COMLEX exams and my first NBME exam, not really study at all. I did pretty well on the prites and didn't prepare, barely passed the Comlexes but didn't study, and did better on my first NBME with minimal studying than this year when I studied way hard. If I am going to study I can't work much. Need to decide soon.

You can negotiate. I have friends who did successfully get a 10% raise out of Aetna. If you have lots of in-network patients it's more likely to happen. Again, you are case-in-point why joining panel can be counterproductive--once you are in it's hard to get out. If you want to work in-network, just moonlight at a clinic/group practice to start.