Should I take this job?

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clausewitz2 said:
I'd bite. If this is on the up and up it seems like a practice owner who is really not interested in squeezing every last dime out of his people and is actually fair-minded.
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I actually feel he's legit about that. Many of these things are about actually putting this into action.
 
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Seems pretty reasonable. 70% for W2 is pretty solid.

For the child intakes, are you just planning to bill that as 2x 90792s then? That’ll matter for you in terms of collections because that’s pretty much the only way insurance will pay for 2 intake appointments.

If you’re child, you should have no trouble getting patients with private insurance panels especially if you have therapists referring to you. Just as an example, I’m in a similar setup (1099 not W2), I’m about 3 months in and at around 150ish intakes…started limiting the number per day at this point. So yeah, 6 months for a completely full panel is probably realistic but a completely full schedule from the start would be pretty overwhelming.

About the phone calls, etc. stuff I wouldn’t get too bogged down in details of that making or breaking anything. Some of that you’re not going to be able to charge for anyway if you’re taking insurance (really only feasible for private pay). For instance, charging for phone calls can be dicey with private insurance since technically that’s covered by a CPT code but you can’t use that CPT code within 7 days of an appointment…it’s probably just not worth the headache.

Since you mentioned the therapists collecting CC payment during appointments. One thing you don’t want to deal with is collecting payments/figuring out copays/etc. That’s just gonna burn into your time, the therapists have an entire hour and can write a note for a 90837 In 2 minutes…so taking a couple minutes to do the payment stuff isn’t a big deal. Taking time out of a 30min followup is way more proportional time for you. So yeah someone needs to be checking patients in/collecting payments/etc….that’s part of what you’re giving them 30% for.
 
The main trick is the existence of a partnership track.

I think if there's no partnership track in a job like this, after working there for a number of years you'll leave. I can almost guarantee it. Otherwise it's a very standard gig.
 
dl2dp2 said:
The main trick is the existence of a partnership track.

I think if there's no partnership track in a job like this, after working there for a number of years you'll leave. I can almost guarantee it. Otherwise it's a very standard gig.
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Unfortunately, it doesn't have a partnership track. The thing that drew me to them was meeting someone who really cared about burn out and limiting access, as I've found that this a big issue at other places I've worked at.
 
dl2dp2 said:
The main trick is the existence of a partnership track.

I think if there's no partnership track in a job like this, after working there for a number of years you'll leave. I can almost guarantee it. Otherwise it's a very standard gig.
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I haven’t found anything resembling a “partnership track” to be super common in psychiatry. Likely because adding additional “partners” to a psych practice is rarely beneficial for the existing owner or partner. What exactly are you bringing to the table besides seeing patients? A practice owner wants to know what risk YOU are taking on in order to become a “partner”…are you going to try to expand a new office? Open a new service line (TMS, etc)? Many other specialities in true private practice partnership have some sort of “buy in” into partnership where you’re essentially making an investment in an ambulatory surgery center/imaging center/optical services/LASIK machines/etc. Or you’re expanding the overall practice profit by supervising a bunch of midlevels or directing a new office, getting new hospital contracts, etc. So your success also hinges on the success of the practice.

It’s also much too easy in psychiatry to just go open your own practice, even with taking private insurance panels. People can go stake out their own office, take 1-2 insurance panels +private pay to simplify billing and do just fine because of the minimal overhead. Partnership also makes sense in other specialities because of the larger amounts of upfront investment and overhead it takes to open up a practice for most other specialties.
 
Overall looks reasonable but I am curious to know what they do with the 30%. Does it go back to improving admin flow or perks of the clinic? Or do the original owners/partners just pocket the difference as a "tribute" because you are new. On principle this is the part that doesn't sit well with me.

Also check into their non-compete clauses etc. If they don't have one you can always work there for a year, learn the system, and then start your own private practice or something.
 
Monocles said:
Overall looks reasonable but I am curious to know what they do with the 30%. Does it go back to improving admin flow or perks of the clinic? Or do the original owners/partners just pocket the difference as a "tribute" because you are new. On principle this is the part that doesn't sit well with me.

Also check into their non-compete clauses etc. If they don't have one you can always work there for a year, learn the system, and then start your own private practice or something.
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My understanding is that the owners just get a bigger share of their own collections, but the 30% goes to admin staff, which there's a decent amount of. There isn't a non-compete in the contract.
 
StayOnTop said:
My understanding is that the owners just get a bigger share of their own collections, but the 30% goes to admin staff, which there's a decent amount of. There isn't a non-compete in the contract.
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No noncompete is actually a really good sign. Means the owners are confident you’ll be happy enough to not setup shop down the street and take all your patients with you, which is a real risk.
 
StayOnTop said:
My understanding is that the owners just get a bigger share of their own collections, but the 30% goes to admin staff, which there's a decent amount of. There isn't a non-compete in the contract.
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That's actually fairly reasonable. At least it's not like you are getting 70% of your work while the owners get 130% or something lol.

With this in light the job seems pretty reasonable overall.
 
I don't have experience with job search yet (PGY4, heading to fellowship), but can I ask....for those saying this job is 'reasonable', what could actually be better? OP describes a job where (to my inexperienced eyes) they get a)fair compensation b)good support staff c)good hours d)almost complete control over their patient population e)relatively easy access to therapists to refer to in-house f) no non-compete (!) AND g)a boss that values work-life balance and has put money where their mouth is, not just paying lip service. This sounds like a dream job from the perspective of residency. We see tons of posts on this forum of clearly abysmal jobs (see the other currently active thread with insane NP supervision and poor compensation, for example). Yes, the OP could be in private practice and make more money. But not everyone is interested in doing the private practice hustle. Are there actually employed positions out there that would be better than this? If so, what do they look like? Why all milquetoast endorsement of this position? Genuinely curious.

Also--the 30% is clearly not just admin staff, but going to paying for those days off, so you're actually getting some of it back just indirectly.
 
Celexa said:
I don't have experience with job search yet (PGY4, heading to fellowship), but can I ask....for those saying this job is 'reasonable', what could actually be better? OP describes a job where (to my inexperienced eyes) they get a)fair compensation b)good support staff c)good hours d)almost complete control over their patient population e)relatively easy access to therapists to refer to in-house f) no non-compete (!) AND g)a boss that values work-life balance and has put money where their mouth is, not just paying lip service. This sounds like a dream job from the perspective of residency. We see tons of posts on this forum of clearly abysmal jobs (see the other currently active thread with insane NP supervision and poor compensation, for example). Yes, the OP could be in private practice and make more money. But not everyone is interested in doing the private practice hustle. Are there actually employed positions out there that would be better than this? If so, what do they look like? Why all milquetoast endorsement of this position? Genuinely curious.

Also--the 30% is clearly not just admin staff, but going to paying for those days off, so you're actually getting some of it back just indirectly.
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I've learned from my time on SDN that when someone says "fair" or "reasonable" that means it's pretty good, lol. However, to play advocate here, there is also a lot of "let's actually see". This is a growing practice and it will take time to build that connection with therapists and who knows how good the support staff actually is. Good point about the 30%, BTW.
 
I'm curious what happens outside of work hours when the patients have an emergency and need to call someone. Is there no coverage at all? Is it set up as a walk in psyc clinic?
 
How is their contract rates? Also you need to know what is their net collection from billing? if billing department sucks then you may end up loosing good amount just on denials. If their net collection is 90-95% then you have to add that extra 5-10% loss meaning it's a 60/40 cut. Then you do your math based on contract rates for common codes for new and f/u patients which will tell you how much you will end up making per hour.
 
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