psychiatry job offer

[Ahamis]

What are your opinions on this job opportunity:

Adult outpatient psychiatry, 1 hour and 30 minutes from Washington DC. H-1b sponsor
237 base salary

Clinic with 1 nurse practitioner, 2 child psychiatry
20 minutes follow-up and 1-hour intake. No overbook.
55% medicare/Medicaid. 45% private insurances. Staff very efficient in filling no show-spot (so not much free time).

It is part of the job to cover inpatient ( 20 beds in a psychiatric hospital):
night call (take from home) every other week (400 dollars per night call)

Weekend call (from Friday night to Monday morning)- every 6 weeks , 20 beds, you round in the morning and the rest of the day you take calls from home. Approximately 9 weekends in a year. 2k dollars per weekend call
No coverage for ER or C/L. The medical doctor goes once a day to address non-psych issues.

6 holidays
28 days off (including CME, vacation and sick leave)
401k match

It seems that 2k to cover 20 beds during the entire weekend is too little. Am I right?
Time off looks sparse too.

They have the option to pay by the number of patients seen but they don't follow the CMS.
3 follow-ups are equal to one hour of work. Every intake is equal to one hour of work.
But it is hard to believe that a junior attending would be able to see more than 3 follow-ups per hour.

What do you think?

---

Members don't see this ad.

 

[Shikima]

Go to another place in the country, and that same job would likely be over 300k.

 

[Psychotic]

Every pay component seems on the low side to me - low base, low night call rate, low weekend call rate. I would not do any of the call as described for those amounts of money.

Only thing that gig will be good for is burnout.

What state is this in? The only state I would consider in that 1.5 hr radius of DC is Virginia, but YMMV...

 

[wolfvgang22]

Jobs only H-1b sponsor if they must. So why is this job offering it?

Is it rural, or are they asking doctors to do too much, or is the pay to little? Or all of these? If it is because there are no psychiatrists in the area, they should pony up the $$$. What is the cost of living there? I hear DC area and I think high cost of living.

 

[Jules A]

It would be worth knowing what city or state because in the DC/Baltimore Metro area in my opinion this would be considered low pay/heavy volume. I'd also inquire as to how "efficient" that outpatient staff is at relieving the admin burden of things like prior auths, hunting down lab results etc.

The overnight call, if you don't mind taking it, is a decent rate although it can be difficult to predict the amount of aggravation until you know the acuity of the unit and skill set of your RNs. I also consider liability issues involved with taking call on an entire unit of unknown patients.

For the weekends while it is nice that you have a dedicated hospitalist and no consult requirements the pay is horrid. In the Baltimore/DC metro weekend rates should run between $3,000-$4,000 with NPs making the lower end. If you decide to do per encounter 20 minute followups and 1 hour intakes on a weekend inpatient unit is very manageable but your hourly rate should reflect that it is weekend work.

Edited to add the above doesn't take into consideration the implications of H-1b.

 

[Ahamis]

Thank you for your comments.
The place is located in Maryland, nearby Frederick. City is about 40.000 inhabitants.
70 miles from Washington DC and 80 miles from Baltimore

"

I also consider liability issues involved with taking call on an entire unit of unknown patients.

That's a good point! Thanks for highlight it.

If you decide to do per encounter 20 minute follow-ups and 1 hour intakes on a weekend inpatient unit is very manageable but your hourly rate should reflect that it is weekend work.

If I cover the unit only during the weekends, all patients will be kind of new for me. Then, I don't believe I would need more than 20 minutes with each.

 

[Jules A]

Thank you for your comments.
The place is located in Maryland, nearby Frederick. City is about 40.000 inhabitants.
70 miles from Washington DC and 80 miles from Baltimore

If I cover the unit only during the weekends, all patients will be kind of new for me. Then, I don't believe I would need more than 20 minutes with each.

Exactly and on the weekends you aren't reinventing the wheel just hopefully keeping everyone alive until their attendings return on Monday.

Psychiatrists willing to work out there should be getting a premium in my opinion. Definitely ask around because while I haven't had contacts out that way for a couple of years it was fraught with substance abuse issues. Have you looked into the Eastern Shore of MD?

 

[TexasPhysician]

Looking for a desperate person to fill this H1b spot. Not a desirable job at all.

 

[Igor4sugry]

What are your opinions on this job opportunity:

Adult outpatient psychiatry, 1 hour and 30 minutes from Washington DC. H-1b sponsor
237 base salary

It is part of the job to cover inpatient ( 20 beds in a psychiatric hospital):
night call (take from home) every other week (400 dollars per night call)

Weekend call (from Friday night to Monday morning)- every 6 weeks , 20 beds, you round in the morning and the rest of the day you take calls from home. Approximately 9 weekends in a year.
No coverage for ER or C/L. The medical doctor goes once a day to address non-psych issues.

6 holidays
28 days off (including CME, vacation and sick leave)
401k match

What do you think?

I read this and was surprised they actually offered a compensation of $237k for this amount of work.
For comparison job in my clinic pays $215k, outpatient, insurance breakdown similar to yours, no call of any sort.
6 holidays; 5 dedicated CME days+stipend; 24 vacation/sick days, 401k.
So you can see how $237k base is quite bad (also remmember taxes that are taken out).

300k base sounds like appropriate amount.
every other week nightcall for 7 days straight can burn someone out quick.

The benefit is that you are 2 hours away from Deep Creek Lake. Beautiful place, so if you settle down in this town get a lake cabin at deep creek and enjoy it.
Deep Creek Lake Fast Facts - Garrett County Chamber of Commerce,MD
Deep Creek Lake | Deep Creek Vacation & Local Information

 

[Therapist4Chnge]

Looking for a desperate person to fill this H1b spot. Not a desirable job at all.

Agreed. Fredrick County is not a desirable area and "commuting" anywhere in the MD/DC/VA area can be a slog, so that should also be considered.

FC also has/had a poor reputation when it comes to supporting diversity (i.e. anyone non-white and/or non-Christian). They have/had an active KKK presence for a loooong time and likely still do. MD can be a decent place to live, but there are still pockets that are *very* racially segregated.

ps. FWIW, Igor4sugry is spot on. Deep Creek is gorgeous and a great spot for a cabin. I've spent some time out there and it's a hidden gem of a getaway.

 

[Ahamis]

Correction: The night call is from home once every 14 days (400 dollars extra per night call). sorry!

base salary is 237k. weekend calls every 6 weeks (2k extra per weekend)

FC also has/had a poor reputation when it comes to supporting diversity (i.e. anyone non-white and/or non-Christian). They have/had an active KKK presence for a loooong time and likely still do. MD can be a decent place to live, but there are still pockets that are *very* racially segregated.

I am less concerned about diversity and more focused on workload. If you work in Washington DC area the salary is usually low and the workload is high.

 

[Jules A]

Correction: The night call is from home once every 14 days (400 dollars extra per night call). sorry!

base salary is 237k. weekend calls every 6 weeks (2k extra per weekend)




I am less concerned about diversity and more focused on workload. If you work in Washington DC area the salary is usually low and the workload is high.

Yikes lower than this offer?

 

[sazerac]

The real question here: is an H-1b sponsorship worth $63K a year?

For some folks, the answer might be yes.

 

[Jules A]

The real question here: is an H-1b sponsorship worth $63K a year?

For some folks, the answer might be yes.

I keep forgetting the H-1b component but now I'm thinking the OP should seriously consider a previous poster's reference of KKK history and lack of diversity.

As for the lake "cabin" in 2014 the average home price in Deep Creek Lake, which is lovely, was $550,000 according to an article in the Baltimore Sun. So while a great nearby destination possibly out of reach as a second home for most new psychiatrists.

 

[Jules A]

Some people are being unrealistic. you can certainly make 300k in other jobs elsewhere including in much more desirable parts of the country (including on an H1b, many of these jobs and J1 waiver pay quite well because they're further out in the sticks) but a base salary of 300k for this job is not the market rate. The call does pay poorly though and is too frequent.

Are you sure? Its my understanding the need is fairly great out that way and I know the eastern shore which is the opposite end of the state but with a similar shortage of providers pays in the $300,000 for psychiatrists, even at the state hospital which in MD historically pay horrible, although again not sure about the H1b. I have known NPs in Frederick Co making $180,000 range which is why I figured psychiatrists would be making significantly more than the OPs offer. My intel goes back a few years but it was reported as not only in the middle of nowhere but also a rough arena and in that regard speaking only for myself they'd need to pony up the big money.

PSYCHIATRIST CLINICAL - EASTERN SHORE HOSPITAL CENTER

 

[splik]

Are you sure? Its my understanding the need is fairly great out that way and I know the eastern shore which is the opposite end of the state but with a similar shortage of providers pays in the $300,000 for psychiatrists, even at the state hospital which in MD historically pay horrible, although again not sure about the H1b. I have known NPs in Frederick Co making $180,000 range which is why I figured psychiatrists would be making significantly more than the OPs offer. My intel goes back a few years but it was reported as not only in the middle of nowhere but also a rough arena and in that regard speaking only for myself they'd need to pony up the big money.

PSYCHIATRIST CLINICAL - EASTERN SHORE HOSPITAL CENTER

You linked to an inpt job. The op was talking about an outpt job. Since you generate more rvus and insurance reimburses better for inpt AND they need psychiatrists to run the unit and the jobs are harder to fill inpt jobs should definitely command this kind of salary. Whereas outpt for non county run mostly publicly insured clinic they aren't making a huge amount off you

Also the job you linked to is a state job. These jobs will eat the cost because they are trying to avoid lawsuits.

 

[Ahamis]

OP san joaquin county and santa clara county in california both sponsor visas (with some limitations) and pay well for reasonable jobs with nice county benefits and with more time off and no required call etc.

The benefits on San Joaquin look impressive and the salary seems very good. However, I have heard many times that California is so expensive that I am afraid to live there. I also heard they have many psychiatrists in California...

You linked to an inpt job. The op was talking about an outpt job. Since you generate more rvus and insurance reimburses better for inpt AND they need psychiatrists to run the unit and the jobs are harder to fill inpt jobs should definitely command this kind of salary. Whereas outpt for non county run mostly publicly insured clinic they aren't making a huge amount off you

this inpatient state job looks pretty good for this region! Just for comparison: inpatient job (non-profit) in Washington DC is paying around 230K (PIW).

The outpatient job that I described is composed by 40-45% of patients with private insurance. Plus, I was informed that Medicaid in Maryland pays similar to private insurance.


Thank you for your opinions!!!

 

[Jules A]

You linked to an inpt job. The op was talking about an outpt job. Since you generate more rvus and insurance reimburses better for inpt AND they need psychiatrists to run the unit and the jobs are harder to fill inpt jobs should definitely command this kind of salary. Whereas outpt for non county run mostly publicly insured clinic they aren't making a huge amount off you

Also the job you linked to is a state job. These jobs will eat the cost because they are trying to avoid lawsuits.

Good point and most of the psychiatrists' salaries I know are inpt although some work 1/2 time at both and their rate is essentially the same. Interesting that state jobs in your area pay well because in Maryland the state job salary range posted has a max of $202,000. I'm not sure if they negotiate higher but would doubt it based on the amount of red tape involved in even opening a PIN. The Allegany county job, which is in the area of the OPs job, is posted as $155 an hour although contractual. I have also found for MD and DC salaries listed as well as area averages on sites like glassdoor and indeed are far lower than what the people I know are actually negotiating.

State of Maryland Job Openings - State of Maryland

 

[Jules A]

Ok so I made a call because I was kind of speaking out my arse with regard to the specifics of H1b OP rates but also because I believe if psychiatrists and NPs aren't requiring top wages it negatively affects us all. I'm forever grateful for the kindness when I was entering the field from future colleagues who were willing to disclose their rates and negotiation tips.

I talked to a former colleague in a rural area of MD. This rate is significantly lower than what they pay-for outpatient only work. FWIW the H1b rates I quickly googled are $35,000-$60,000 less than the rate this clinic pays for H1bs.

 

[TexasPhysician]

The base rate pays $123/hr without call and before benefits are added. How good are the benefits including 401k match, health insurance, etc?

Time off is low and government insurance is high meaning more potential problems/refills/etc.

County mental health jobs contract at $145/hr in my nearby metro area. I won't even consider a job below that rate unless I'm being paid to watch Netflix.

 

[Jules A]

um... you posted a state of maryland job with a 310k salary above....

Um... historically state jobs pay poorly as per my second link, the Cambridge job was an example of the higher wages being offered to entice people to consider the rural areas of the state.

 

[SmallBird]

Jobs only H-1b sponsor if they must. So why is this job offering it?

This isn't completely true although its at least half true. H1b sponsorship appears to be bimodal - there are a subset of jobs that are very hard to fill, and end up highlighting their willingness to sponsor H1b visas as a marketing tactic. This then attracts the most anxious applicants who require visa sponsorship, who may not negotiate assertively as they consider themselves to have little power in the process. I spoke to a friend just this past weekend who was told in an interview "We will pay you $100k, what alternative do you really have? It's not like you will go back to [insert home country]". And there are recruiters charging $5000 to place people in "J1 waiver jobs". This facilitates a race to the bottom where undesirable places recruit people who are working there out of desperation and nobody is really satisfied.

BUT it is also the case that a large number of H1b's are sponsored by prestigious places in desirable locations, especially medical schools with large research programs. These jobs are typically marketed without reference to visas, and yet are willing to work with applicants who require visas if they are competitive in other ways. In my own experience, I was able to get some great interviews at places where I really wanted to live, and the discussion of visa sponsorship only came up at the end when many other things had been negotiated. I was lucky to attend a good residency and do a lot of research, and colleagues of mine who have had similar training experiences have had H1b's sponsored by institutions that are certainly not 'desperate'.

 

[Ahamis]

This isn't completely true although its at least half true. H1b sponsorship appears to be bimodal - there are a subset of jobs that are very hard to fill, and end up highlighting their willingness to sponsor H1b visas as a marketing tactic. This then attracts the most anxious applicants who require visa sponsorship, who may not negotiate assertively as they consider themselves to have little power in the process. I spoke to a friend just this past weekend who was told in an interview "We will pay you $100k, what alternative do you really have? It's not like you will go back to [insert home country]". And there are recruiters charging $5000 to place people in "J1 waiver jobs". This facilitates a race to the bottom where undesirable places recruit people who are working there out of desperation and nobody is really satisfied.

BUT it is also the case that a large number of H1b's are sponsored by prestigious places in desirable locations, especially medical schools with large research programs. These jobs are typically marketed without reference to visas, and yet are willing to work with applicants who require visas if they are competitive in other ways. In my own experience, I was able to get some great interviews at places where I really wanted to live, and the discussion of visa sponsorship only came up at the end when many other things had been negotiated. I was lucky to attend a good residency and do a lot of research, and colleagues of mine who have had similar training experiences have had H1b's sponsored by institutions that are certainly not 'desperate'.

Were you able to find a academic position that pays well? More than 230k?
Most of university hospitals pay pretty bad.
I believe that academic-affiliated centers pay a little better. Am I right?

I think wolfgang is talking about real jobs. academic and academic-affiliated medical centers are different as they are exempt from the cap on H1b visas which mean they don't have to wait until Oct 1 for someone to start and can easily (under ordinary circumstances and not in our current orwellian/trumpian dystopia) sponsor these visas. Also, let's face it, academic medical centers have always relied on IMGs who for various reasons may be more disposed to working their than their American colleagues.

My experience was fairly disillusioning. This was probably exacerbated by the fact that I also need green card sponsorship immediately, and the current political climate and lack of premium processing for visas. But despite being told by multiple people what an impressive candidate I was and how I would be able to do whatever I wanted, this was far from the case. While I consider myself fortunate to have had several good opportunities and am ultimately very happy with my final pick (just signed this week), this was an extremely stressful process that dragged out for months, and I felt that several places treated me like a leper once the visa thing came up and I did not receive consideration from my top choice. I also found a lot of people were so consumed by their white liberal guilt and embarrassment that they could not even bear to tell me what the deal was.

Congratulations!!!
Is your institution h1-b cap-exempt?
Did you interview for correctional facilities? I heard the salary/benefits can be good and the workload not excessive.

 

[Merovinge]

My experience was fairly disillusioning. This was probably exacerbated by the fact that I also need green card sponsorship immediately, and the current political climate and lack of premium processing for visas. But despite being told by multiple people what an impressive candidate I was and how I would be able to do whatever I wanted, this was far from the case. While I consider myself fortunate to have had several good opportunities and am ultimately very happy with my final pick (just signed this week), this was an extremely stressful process that dragged out for months, and I felt that several places treated me like a leper once the visa thing came up and I did not receive consideration from my top choice. I also found a lot of people were so consumed by their white liberal guilt and embarrassment that they could not even bear to tell me what the deal was.

It may suck now, but once you secure your green card/citizenship, the world will open up to you so much more. You hit the last hurdle and it might have dinged your knee but now you are over it and it should be smooth track moving forward (provided non-absurd things happen in the US government, hopefully anything absurd continues to move at a glacial pace).

 

[Jules A]

Did you interview for correctional facilities? I heard the salary/benefits can be good and the workload not excessive.

I will be interesting to see others' experiences but corrections worked me like a donkey. Salary was good but negotiations took forever as they tried to dicker with me like we were at a flea market although I'm sure that depends on the company holding the contract. I eventually got weary of the liability concerns.

 

[Ahamis]

. I would avoid florida prisons like the plague.

Why?
I am thinking about interviewing in some correctional facilties there...

 

[grapefruit17]

Stupid question, is there a decent website to see psychiatrists salaries based on locations?

 

[SmallBird]

I think wolfgang is talking about real jobs. academic and academic-affiliated medical centers are different as they are exempt from the cap on H1b visas which mean they don't have to wait until Oct 1 for someone to start and can easily (under ordinary circumstances and not in our current orwellian/trumpian dystopia) sponsor these visas. Also, let's face it, academic medical centers have always relied on IMGs who for various reasons may be more disposed to working their than their American colleagues.

With the amount of healthcare consolidation going on, especially in the Northeast, a very large proportion of the jobs are now affiliated with one of the big systems that are all cap exempt (Yale New Haven probably owns half of psychiatric services in CT, Lifespan and CNE probably own 95% of RI services, and other non-profits control many of the services in Boston). And so it was not my experience in the Northeast that only 'desperate' institutions were sponsoring H1b's although I appreciate that this might be a regional phenomenon.

 

[Blitz2006]

Stupid question, is there a decent website to see psychiatrists salaries based on locations?

I use:

careermd.com
practicelink.com
merritthawkins.com

Gives you some benchmarks

 

[Jules A]

Although those sites are a benchmark, possibly most helpful to compare regions, I'd urge everyone to get peer collateral. If you are just starting out and don't have a salary to go in as your set point you are going in blind so talk to someone in the area, preferably in the group where you are interviewing. The search sites I have seen are consistently low with the occasional listing that is so high you know something is wrong.

As mentioned above the H1b rates I found on google were low and one site with the actual clinic listed their 2016 salary as $35,000-$60,000 lower than the range I was just quoted by a psychiatrist I know there. That is a significant chunk of change over the course of a few years.

 

[PistolPete]

I think wolfgang is talking about real jobs. academic and academic-affiliated medical centers are different as they are exempt from the cap on H1b visas which mean they don't have to wait until Oct 1 for someone to start and can easily (under ordinary circumstances and not in our current orwellian/trumpian dystopia) sponsor these visas. Also, let's face it, academic medical centers have always relied on IMGs who for various reasons may be more disposed to working their than their American colleagues.

My experience was fairly disillusioning. This was probably exacerbated by the fact that I also need green card sponsorship immediately, and the current political climate and lack of premium processing for visas. But despite being told by multiple people what an impressive candidate I was and how I would be able to do whatever I wanted, this was far from the case. While I consider myself fortunate to have had several good opportunities and am ultimately very happy with my final pick (just signed this week), this was an extremely stressful process that dragged out for months, and I felt that several places treated me like a leper once the visa thing came up and I did not receive consideration from my top choice. I also found a lot of people were so consumed by their white liberal guilt and embarrassment that they could not even bear to tell me what the deal was.

My experience has been very similar. The visa issue has also made me feel like a leper many times and I can't wait for the day I'll have my green card after so many years in the US!! Hey, at least I didn't have to deal with the J1 waiver nonsense. I can't wait for the world to "open up" as the other poster mentioned! Cheers!

 

[Jules A]

My experience has been very similar. The visa issue has also made me feel like a leper many times and I can't wait for the day I'll have my green card after so many years in the US!! Hey, at least I didn't have to deal with the J1 waiver nonsense. I can't wait for the world to "open up" as the other poster mentioned! Cheers!

Thats unfortunate and hopefully not the climate everywhere. The person I know said the legal fees can be high? but they are still paying in the $250-$275 range for strictly OP work.

 

[SmallBird]

Thats unfortunate and hopefully not the climate everywhere. The person I know said the legal fees can be high? but they are still paying in the $250-$275 range for strictly OP work.

Legal fees are not a negligible expense but in the context of, say, a 3 year contract, they are minor. A rough estimate would be about $5k - $7k for the initial H1b sponsorship, and a similar amount for a greencard down the line. Considering people are getting $20k sign on bonuses, it shouldn't be a major deterrent to hiring. Of course tolerating the uncertainty that comes with immigration issues may be more of a problem for employers.

 

[splik]

Legal fees are not a negligible expense but in the context of, say, a 3 year contract, they are minor. A rough estimate would be about $5k - $7k for the initial H1b sponsorship, and a similar amount for a greencard down the line. Considering people are getting $20k sign on bonuses, it shouldn't be a major deterrent to hiring. Of course tolerating the uncertainty that comes with immigration issues may be more of a problem for employers.

Having got a couple of H1 visas I can tell you the legal fees shouldn't be more than a few grand if they even use a lawyer. My current employer doesn't use one. For a renewal it's about a grand. Green card costs are more about 6k depending on the type of sponsorship and region of country. This isn't including filing fees. Employers aren't allowed to pass the costs of an H1 to the employee but they can for a green card

 

[CCHD]

What are your opinions on this job opportunity:

Adult outpatient psychiatry, 1 hour and 30 minutes from Washington DC. H-1b sponsor
237 base salary

Clinic with 1 nurse practitioner, 2 child psychiatry
20 minutes follow-up and 1-hour intake. No overbook.
55% medicare/Medicaid. 45% private insurances. Staff very efficient in filling no show-spot (so not much free time).

It is part of the job to cover inpatient ( 20 beds in a psychiatric hospital):
night call (take from home) every other week (400 dollars per night call)

Weekend call (from Friday night to Monday morning)- every 6 weeks , 20 beds, you round in the morning and the rest of the day you take calls from home. Approximately 9 weekends in a year. 2k dollars per weekend call
No coverage for ER or C/L. The medical doctor goes once a day to address non-psych issues.

6 holidays
28 days off (including CME, vacation and sick leave)
401k match

It seems that 2k to cover 20 beds during the entire weekend is too little. Am I right?
Time off looks sparse too.

They have the option to pay by the number of patients seen but they don't follow the CMS.
3 follow-ups are equal to one hour of work. Every intake is equal to one hour of work.
But it is hard to believe that a junior attending would be able to see more than 3 follow-ups per hour.

What do you think?

I am a Health Officer on the Easternshore of Maryland and have a full time , daytime position very soon that may not pay as much as others. But, the family oriented area, 8-5 job with very little weekend work might be nice for some looking for a place to call home for a while.

 

[Jules A]

I am a Health Officer on the Easternshore of Maryland and have a full time , daytime position very soon that may not pay as much as others. But, the family oriented area, 8-5 job with very little weekend work might be nice for some looking for a place to call home for a while.

Interesting, from what I know the Eastern Shore of MD pays quite well, actually better than DC and Baltimore, due to the location and shortage of psychiatrists.