Wondering what a reasonable salary is for this job: inpatient position in an urban area. Setup is M-F, 16 patients with scribe. Covering calls about my own patients in the afternoons/evenings, moonlighters round on the weekend. 20 days PTO, 5 days CME with extra $3k for CME. They are offering $275 plus $10k signing bonus--does that seem like a reasonable offer? It's very similar to other salaries I've seen in the area but not sure what the value is of a scribe since it will cut down on my workload. Thanks!
Question about job offer
- Thread starter raeka
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Does "covering my own calls in the evenings" mean all night long Monday to Friday? That makes a big difference compared to, say, a 6p cutoff.
Yes it does, however according to a couple physicians I spoke with who currently work there (including one who I went to med school with and I trust is being transparent), they will usually get <5 brief calls or texts in the afternoon or evening, and are generally not contacted overnight unless it's an emergency. There's also an internist who would handle any medical issues or emergencies.
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Horrible job if there isn’t a significant wrvu bonus
Wow, didn't realize how bad this was; this would be my first job so I'm still learning about all of this. There is no wrvu bonus. I am surprised because I interviewed for 2 other inpatient jobs in the area who were offering same salary for same number of patients, except required more call and/or weekend rounds and didn't have a scribe. What kind of salary should I be looking for?
This is a horrible job in my opinion and a straight pass for me.
I never ever rely on what other physicians say etc.. Practically, You may be contacted over the night every single night during the week based on this offer. Absolutely NO even the CEO of the hospital tells me this has never happened in the past.
Unless this is an academic position with residents/fellows, this salary is low for 16 patients daily. I would not take anything less than 320k
I never ever rely on what other physicians say etc.. Practically, You may be contacted over the night every single night during the week based on this offer. Absolutely NO even the CEO of the hospital tells me this has never happened in the past.
Unless this is an academic position with residents/fellows, this salary is low for 16 patients daily. I would not take anything less than 320k
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16 patients is quite a lot to provide good care to. 12 is considered average, and there are still jobs that have 8-10 patients as full time around. This could mean having as many as 3-4 admissions and discharges a day. 16 patients should work out as about 350k on a salaried model. Having a scribe is great though. It is also depends on the patient population. Pay may be lower if it is a non-subsidized medicaid population. If its more acute manic/psychotic type patients without families etc it may be easier to get through 16 pts quickly. If you have more personality disorder, mood disorders, addiction etc and have a more affluent population with involved family then 16 pts is a lot. Covering calls in the evenings is best done on a rotating schedule (assuming there are enough psychiatrists) rather than everyday, and should receive additional compensation. Covering calls in the afternoon is of course part of your job and I would be surprised if you could leave very early if you have 16 pts unless they are really psychotic or just rocks awaiting placement somewhere.
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On call everyday is really bad.
Even if they don’t call you, it’s very hard to disengage.
It’s crazy what people are trying to sell for what you could get with a bit more independence. I would not touch this below 400k.
Even if they don’t call you, it’s very hard to disengage.
It’s crazy what people are trying to sell for what you could get with a bit more independence. I would not touch this below 400k.
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Is this hospital owned by UHS or HCA?
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It’s not about salary, the salary could be 0 it’s about the wrvu bonus, inpatient docs who are seeing 16 patients a day should be making at least 350k+ with wrvu bonus when you add in call it’s easily 400k+..you’re clearly being exploited here
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Being on call every single week night sounds really rough. One of the great things about inpatient is being able to leave work at work knowing that your census is covered by an overnight on call person. If you have to be your own overnight on call person every night, I think the stress could wear on you pretty quickly.
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I'm looking at 265k for 12 patients with no mandatory overnights, 4 weeks vacation, 5 days sick time, 5 days CME at one job and 255k with 11 patients a day, no call, 26 days vacation, 5 days sick time, and 5 days CME at the other, both with 30k sign on in the Northeast.
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I agree the pay is too low for 16 patients. I recently have gotten two offers for similar patients loads. No scribe. But not on call every weeknight either. One was 325K with bonus up to upper 300's with seeing 24 patients with NP. 7 on/off. Weeknight call covered by NP. Other was 350K for 15 patients. One night call per week. cover every 6 weekend. If want to see more couple get production into low 400's.
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What region?
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Thanks for the replies everyone, this is very helpful. It is a primarily Medicaid population. I thought it might be fair given that I haven't seen anything higher than $300k offered in the area I'm looking for inpatient jobs with similar case loads. Most of the residents I know who have graduated or lined up jobs are going in academia or private practice so I really have no context for what to expect. I will feel more confident asking for more now that I know.
D
deleted456421
Were those other jobs strictly salaried or did they offer some form of RVU compensation? A majority of positions I've looked at have been hybrid (base + RVU) or strictly RVU (sometimes with a guaranteed 1-2 year salary). Haven't seen too many salary-only positions.
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Agree with all of the above, I don't really see any plusses to anything in this position other than no weekends. Scribes can be really hit or miss, good ones can save you hours but you've still got to review their notes. If they're not adequate you can end up re-writing significant portions of them, especially when you have patients with complex social situations and discharges.
Being on-call overnight 5 days a week every week is just awful. Even if you typically don't get called the idea that you could get called every night is something I wouldn't even find acceptable for residents. I'd personally never accept a position requiring that kind of call. PTO is bad. Patient load is mediocre, 16 can be very manageable if you've got good support staff but it can also be awful if your staff is limited or bad or if you just have a lot of socially complicated patients.
Also agree with others about the pay structure. Base salary is fine if you're getting a solid RVU bonus. If that's all you're getting though you're getting completely screwed over. One position I considered had a base salary of 250k for a similar number of patients and overall less call (1 weekday night and Q4-5 weekends), but the 3 psychiatrists already there were each hitting at least $450k after their production bonus was added in and said I could expect similar right out of the gate. The sign-on bonus is also weak here. Any bonus is nice, but job postings with sign-on bonuses I get range from $10k to $50k. $10k just seems like a number thrown on to look like an extra perk so they can cut benefits/pay in other areas.
Are there other perks to this job that haven't been mentioned?
Being on-call overnight 5 days a week every week is just awful. Even if you typically don't get called the idea that you could get called every night is something I wouldn't even find acceptable for residents. I'd personally never accept a position requiring that kind of call. PTO is bad. Patient load is mediocre, 16 can be very manageable if you've got good support staff but it can also be awful if your staff is limited or bad or if you just have a lot of socially complicated patients.
Also agree with others about the pay structure. Base salary is fine if you're getting a solid RVU bonus. If that's all you're getting though you're getting completely screwed over. One position I considered had a base salary of 250k for a similar number of patients and overall less call (1 weekday night and Q4-5 weekends), but the 3 psychiatrists already there were each hitting at least $450k after their production bonus was added in and said I could expect similar right out of the gate. The sign-on bonus is also weak here. Any bonus is nice, but job postings with sign-on bonuses I get range from $10k to $50k. $10k just seems like a number thrown on to look like an extra perk so they can cut benefits/pay in other areas.
Are there other perks to this job that haven't been mentioned?
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These jobs are designed to prey upon new grads in exactly your type of situation. Admittedly if you are really trying to get experience w/ medicaid inpatient and can negotiate this up some you might enjoy it, but at these types of pay rates you could work for a state mental health facility if SMI is your passion.
Imagine for a second that every date you go, every evening class/activity/movie/out to dinner has a chance of being interrupted indefinitely while working at this job. If you ever enjoy alcohol or THC, now you have to worried about your sobriety every weekday evening. It's a big ask to take your own call for inpatient's that will have things happen (PRNs, restraints) that do require your input.
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Right and potentially high risk stuff you're getting called for as above. Like outpatient private practice, whatever I get a call maybe every 1-2 months outside of office hours and it's actually usually something dumb, something easily addressed (med side effect) or something they should just go to the ED or call crisis cause I'm not assessing it at 8PM while I'm at home with my family (SI). Inpatient, you could get a call every night at all hours of the night for something and the buck stops with you.
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😮💨
16 is too much. It's okay for an occasional weekend on call, but unless you have residents under you, it's just too much. Honestly, I think 12 is too much for a salaried job. Aim for 8 with the occasional 10 when someone calls off. Inpatients are a lot more than seeing briefly, dropping a note and walking away. Sometimes family meetings are unavoidable, unfortunately. The times they are asking you to be available are also unusual. $275k is just not that much for this.
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I think you can round on 16 patients in ~3 hours a day if you have good support from social work. This job should pay at least 400 if you're on call everyday and even then may not be worth it. On call everyday would suck. You should ask for 350 and 1 call per week or find something else.
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So you're saying that 11 minutes all-told is what a patient gets on inpatient? Getting report from the staff who interact with them, approaching the patient / having staff bring the patient to you, talking to the patient, formulating a plan, discussing the plan, obtaining informed consent, discussing care with the relevant parties, placing orders, writing the note, submitting the billing, switching over to the next patient. All in 11 minutes? What kind of medical school do you even go to? Are you pre-clinical?
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I am a 4th year US allopathic medical student at a school that you and likely everyone else reading this has heard of. Yeah with good support you can get all that done in that amount of time on average, in my opinion.
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@painballer27
Please list out the time you think each of these tasks take so we can see how you would spend those 11 minutes
1. Getting report from the staff who interact with them:
2. Reviewing the chart:
3. Approaching the patient / having staff bring the patient to you:
4. Talking to the patient:
5. Formulating a plan:
6. Discussing the plan:
7. Obtaining informed consent:
8. Discussing care with the relevant parties (family, outpatient psychiatrist, insurance companies, internal medicine hospitalist, patient's attorney, submitting involuntary hospitalization paperwork, etc. With a 5 day admission you will almost always need to have one of these conversations / events per day):
9. Placing orders:
10. Writing the note and submitting the billing:
11. Switching over to the next patient:
Here's my summation, based on someone who's being very efficient and practicing somewhat below the standard of care, most likely annoying all the staff and with terrible rapport with patients:
1. 5+ minutes
2. 3+ minutes
3. 2+ minutes
4. 5+ minutes
5. 1-3 minutes
6. 3+ minutes
7. 2+ minutes
8. 5-10+ minutes
9. 1-2 minutes
10. 5+ minutes
11. 1-5 minutes
That's 30+ minutes. In reality it would be more than that, provided you do all of those things. And those are all things that you would need to be doing, not other staff. Realistically, you could document while talking to the patient, but that's uncommon. If you want the staff to be happy with you it usually takes longer than that.
Please list out the time you think each of these tasks take so we can see how you would spend those 11 minutes
1. Getting report from the staff who interact with them:
2. Reviewing the chart:
3. Approaching the patient / having staff bring the patient to you:
4. Talking to the patient:
5. Formulating a plan:
6. Discussing the plan:
7. Obtaining informed consent:
8. Discussing care with the relevant parties (family, outpatient psychiatrist, insurance companies, internal medicine hospitalist, patient's attorney, submitting involuntary hospitalization paperwork, etc. With a 5 day admission you will almost always need to have one of these conversations / events per day):
9. Placing orders:
10. Writing the note and submitting the billing:
11. Switching over to the next patient:
Here's my summation, based on someone who's being very efficient and practicing somewhat below the standard of care, most likely annoying all the staff and with terrible rapport with patients:
1. 5+ minutes
2. 3+ minutes
3. 2+ minutes
4. 5+ minutes
5. 1-3 minutes
6. 3+ minutes
7. 2+ minutes
8. 5-10+ minutes
9. 1-2 minutes
10. 5+ minutes
11. 1-5 minutes
That's 30+ minutes. In reality it would be more than that, provided you do all of those things. And those are all things that you would need to be doing, not other staff. Realistically, you could document while talking to the patient, but that's uncommon. If you want the staff to be happy with you it usually takes longer than that.
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In my inpatient experience having excellent, well trained staff is key. It can really streamline the process. Paper charting is probably ideal. Nursing staff performed an initial intake and had the most pertinent information written on the top line, for example "amphetamine withdrawal" or "history of schizophrenia, +AVH, paranioa, -SI/HI" with more detail below but sometimes unnecessary to read all of it. Patients are brought in one after another and asked a series of questions. They are told their diagnosis and what medication they will be started on. On to the next. I never saw the psychiatrists do #8, SW took care of that. Notes are pretty bare bones.
Ummmmm yes very possible depending on the functional level of patients. I’m honestly baffled by doctors on psychiatric inpatient units that are talking about doing 20-30min sessions daily with patients. If you want to do that get into Op work. Hospitals medical and psychiatric are to address acute issues. Not to deal with their trauma or all the little issues that therapy deals with. Identify the acute issues and address then and get them stable and get them out. If you want to do therapy like that so Op or PHP or residential treatment. Even my high functioning patients won’t talk with me past 5 maybe 10 min max. And I never get complaints the patient didn’t feel cared for. You don’t need to talk to the nurses about every patient just the ones you need a little help with clinical insight and that can be done via text.
Also I’m curious the regions of US that people are seeing a 12 patient caseload pay 300+. With a half medicaid half Medicare population and you billing the insurance directly you couldn’t pull those numbers without billing therapy codes for most. Medicaid and the like pay 43 for a 99232 around me. With 12 patients you’d barely be scratching 250 with the therapy codes. I’d love to find a W2 that paid 300 for 12. I don’t know what I’d do with my day with so little work but I’d go find myself another job I guess.
Why do you get report on each patient? Complete not needed
Chart review while you do your note you don’t do this before each patient.
Approaching patient takes 3+ min? You crawling to patients?
Talking to patient especially if psychotic or manic or just quite sick takes 30s and you already know if you’re moving in the right direction. The rest is just wrap up. 5 min max needed on inpatient 10 if you want to be very generous but only a few need that
You should already know your plan before you see the patient and have that adjusted in your head as you take in clinical data as you approach and within the first few sentences of them talking again no idea why this takes extra time.
Discussing plans is part of your talking to patient already covered above
Informed consent does not happen in depth with every interaction
Why are you discussing with all these other parties. That’s what SW and nursing are for. You are much too important to be doing that unless there are things that truly only you can dicusss or answer. Use your time more wisely.
order notes billing all done after seeing all patients along with chart review.
No wonder you can’t comprehend how to see a caseload of more than 12 you burn 3 min walking to a patient and you call every family and OP doc. And your charting and orders etc seems quite a bit too long. Also the OP said a scribe was used meaning documentation is not being done just reviewed. Once a scribe is trained you won’t need to dig through the note much at all. They will write as you do and as you want them to.
Acutely ill patients make it easier to move faster. Are you gonna sit down with the acutely manic for 30 min to discuss telepathy and the fact their neighbors are listening to them? Or maybe some CBt for the schizophrenic that is pacing talking to themselves. Or sit and argue with a patient demanding dc for 20 min repeating yourself 100x. I’d hope the answer is a no to all those. Acutely ill patients have their pathology written all over them and if you’ve done any inpatient volume at all most you can nail down before they even start speaking. In a caseload of 20 you might have 10% that require extra time. Thinking. And digging. Use the time there for those don’t burn it on the ones that don’t require that level of thinking. Be efficient and smart.
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Most of the attendings I worked with have been efficient but had one who would let the psychotic patients talk for 20 minutes about who knows what. Not to mention the fact that this attending expected me to include all the details of our "discussion" in the note, so that was wonderful. What was gained by this? Absolutely nothing. Could have seen the patient and within 30 seconds or less determined that they are floridly psychotic and increase the zyprexa. Done.
Depends on what is meant by on call. I have Never understood what on call for psych means. If the patient acutely needs tk be sent to medical it will get done without my say so. The nursing staff will make that call if they are uncomfortable. The patient gets admitted there are standard admission orders customized if you like. If restraints are needed they will do it not like they will wait for me. Prns. Same thing which I normally have a few standing so they can rotate if needed. Psych doesn’t really have emergencies that need a psych doc to respond to. I mean when we have a code on the unit when I’m there I get out of the way I certainly don’t go to it. Medically I’m far enough out to know my limits. And psychiatrically I’m not gonna go hold someone or give a shot sorry I’m not risking getting hit.
100% agreed
Sometimes I let them go for 5-10 just because I find it fascinating. But in no way did I just gain anything extra and the patient did not get therapeutic benefit.
I’d be asking myself does taking more time with patients on an inpatient basis actually add anything therapeutically beneficial to stabilizing the patient or does it make you feel good because you’ve been told you need to give people all that time.
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Obviously there are patients that can be 5 minutes or less all-told. There are going to be ones that are longer. Also, I didn't say 3+ minutes for getting the patient. I said 2+. Maybe the reading error that limited your ability to notice that says something about how great your quick encounters are.
Unless you're talking to everyone in the milieu it would take you time to walk from the room you speak to patients to the room the patient is in, convince them to come, and walk back to the interviewing room. I've seen plenty of doctors get around this by having patients line up outside the interview room. Doesn't always work out that well and is not the norm.
I left extra time for informed consent because patients always want to talk about their experience that day with the medication and if you give them the opportunity they will have questions. If you're making any changes then you should explain a little about what you're doing. Adding Depakote or increasing the dose of something, discussing the LAI injection now that they have demonstrated tolerability of PO, explaining the benefits of continued PO coverage, answering whatever questions the person has. You're almost always doing at least one or two of these. If you're not, then you're usually cutting them off.
If you noticed, I said that actually talking to the patient was only 5 minutes. Since you're saying 10 minutes but then saying that my other things should be put into the time for talking to patients, you realize that we're saying the same thing but you're arguing with me over it to tell me I'm wrong about something that we said the same thing about? Do you do that with everyone? Because nobody is going to like working with a doctor who does stuff like that.
Unless you're talking to everyone in the milieu it would take you time to walk from the room you speak to patients to the room the patient is in, convince them to come, and walk back to the interviewing room. I've seen plenty of doctors get around this by having patients line up outside the interview room. Doesn't always work out that well and is not the norm.
I left extra time for informed consent because patients always want to talk about their experience that day with the medication and if you give them the opportunity they will have questions. If you're making any changes then you should explain a little about what you're doing. Adding Depakote or increasing the dose of something, discussing the LAI injection now that they have demonstrated tolerability of PO, explaining the benefits of continued PO coverage, answering whatever questions the person has. You're almost always doing at least one or two of these. If you're not, then you're usually cutting them off.
If you noticed, I said that actually talking to the patient was only 5 minutes. Since you're saying 10 minutes but then saying that my other things should be put into the time for talking to patients, you realize that we're saying the same thing but you're arguing with me over it to tell me I'm wrong about something that we said the same thing about? Do you do that with everyone? Because nobody is going to like working with a doctor who does stuff like that.
