Side gig with same company

[aquatic ape]

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Right now I work roughly 7on 7off doing IP consults, don’t really love it, but parts of I do enjoy. Eventually considering doing OP private practice, but I want to dip my toes in, and do some now. Also think I would get more satisfaction seeing some patients actually get better longitudinally

I want to approach my boss/ employer with the idea of doing some OP through my hospital system, predominantly starting with following consult patients that I want to keep seeing. I want to have full autonomy on patients I see, number of hours, days I work, etc. basically take the interesting cases from my consult work, and then any other interesting cases. Maybe work out to 24-32 hours per month.

Anybody have experience with this? Any idea what type of pay structure to expect or what would be best? Early in the idea phase, so open to any input, and happy to hear if and why this is a bad idea. Alternative being opening a micro OON practice now, but not sure I’m ready to take the leap.

 

[comp1]

Wow this seems very complicated. I can't quite relate since my hate for outpatient psych is only rivaled by my hate for surgery and general medicine, but looking at it from the supervisor's perspective, is there sufficient coverage for you to pull out out of the consult pool partially or are you planning to try to change your consult schedule or just take these cherry picked outpatients on as some sort of quarter FTE overtime? Are you even salaried? How big is your system, eg how many outpatient psychiatrists/PMHNPs are there already? Does anyone else do a mix of inpatient and outpatient or is it all one or the other there? There are so many questions. I'll think of more and post.

 

[aquatic ape]

Would be fully on top of my current responsibilities, so no change to my typical work. I get paid per day I work consults now, w2.

I think there might only be 1 full time OP psychiatrist, a few NP, and then some administration MD who does a few days OP but limited. This is one issue I can see, is that since they don’t have a lot of physicians they would subtly add work to my schedule. My thoughts are since it’s not many hours it wouldn’t add much burden to support staff.

I don’t have a good read on whether or not I’ll like OP as an attending, so this is partially a way for me to test drive it without setting up my own practice

 

[Jules A]

Unless you want to join their current op team in a set part-time capacity which is unlikely to accommodate much if any of your wish list this sounds messy. If you are full time it may also be considered overtime. I would find a separate part-time op position, charge a higher rate for the lack of benefits and don’t muck up your full time job.

 

[TexasPhysician]

Sure there is a way to do this, but it wouldn’t be the smart thing to do. The IRS incentivizes 1099 PT work. It wouldn’t be hard in most areas to find a private practice to work PT. Plus a private practice likely pays better.

 

[Merovinge]

Would be fully on top of my current responsibilities, so no change to my typical work. I get paid per day I work consults now, w2.

I think there might only be 1 full time OP psychiatrist, a few NP, and then some administration MD who does a few days OP but limited. This is one issue I can see, is that since they don’t have a lot of physicians they would subtly add work to my schedule. My thoughts are since it’s not many hours it wouldn’t add much burden to support staff.

I don’t have a good read on whether or not I’ll like OP as an attending, so this is partially a way for me to test drive it without setting up my own practice

So unless your administration is somehow actually amazing, what will happen is you will negotiate to work 2 days on your off week and then they will fill that schedule for you. There is no way they will just let you build a panel with handpicked patients. From their perspective, they need to pay for the office space/admin or nursing staff.

I agree with above that you would be much better off doing this outside of the system, get that sweet 1099 income and actually call your own shots.

 

[aquatic ape]

Appreciate the input. I agree that a 1099 contract part time position is really what I want, but didn’t know if there was someway to do that inside the same system. Probably will be much neater doing it elsewhere.

What type of rates can be expected for 1099 OP work? Mostly only have heard about 1099 positions for hospital systems

 

[TexasPhysician]

Appreciate the input. I agree that a 1099 contract part time position is really what I want, but didn’t know if there was someway to do that inside the same system. Probably will be much neater doing it elsewhere.

What type of rates can be expected for 1099 OP work? Mostly only have heard about 1099 positions for hospital systems

No, this would be a red flag to the IRS and possibly get your employer in trouble if you are working as a psychiatrist as a W2 and 1099 simultaneously.

Insurance rates vary by state and sometimes even by the side of the street you are on. You’ll need to negotiate with each private practice. Additionally how you negotiate will relate to productivity. Outpatient is about being efficient and productive. The more work you are able to do per hour will effect ability to demand higher pay.

 

[Stagg737]

So unless your administration is somehow actually amazing, what will happen is you will negotiate to work 2 days on your off week and then they will fill that schedule for you. There is no way they will just let you build a panel with handpicked patients. From their perspective, they need to pay for the office space/admin or nursing staff.

I agree with above that you would be much better off doing this outside of the system, get that sweet 1099 income and actually call your own shots.

Idk, two of my colleagues have done exactly this with our consult service and built their own panel. We are academic, so I could see a PP not wanting to wait, especially if they’re having to provide office space and further staffing. If OP can just see them in their office or via telehealth it would be mooch more viable.

 

[aquatic ape]

Idk, two of my colleagues have done exactly this with our consult service and built their own panel. We are academic, so I could see a PP not wanting to wait, especially if they’re having to provide office space and further staffing. If OP can just see them in their office or via telehealth it would be mooch more viable.

was this “overtime” for them or part of their initial full time work? My hope being since it’s overtime that I could negotiate more autonomy

 

[Stagg737]

was this “overtime” for them or part of their initial full time work? My hope being since it’s overtime that I could negotiate more autonomy

One of them replaces a typically slow afternoon with 2-3 hours of outpatient work. Their clinic is interesting but easy-ish med-psych patients. The other does a full day on their admin week (every 4th week for us is an admin week) so they can pull in some extra RVUs on their “off” time. So more like “overtime” for them.

 

[Merovinge]

Idk, two of my colleagues have done exactly this with our consult service and built their own panel. We are academic, so I could see a PP not wanting to wait, especially if they’re having to provide office space and further staffing. If OP can just see them in their office or via telehealth it would be mooch more viable.

Historically, a lot of academic programs I have exposure to have placed almost no emphasis on productivity, which is pretty cool if not unsustainable. That said, I do see the tides shifting significantly in the past decade with more expectation around patient care encounters or RVUs in the ivory tower space.

But if you are talking a big-box-shop non profit or for profit healthcare system, the idea of them staffing a clinic for you with no assurance on the number of patients coming is not going to fly. There has to be somehow answering calls, scheduling apts, rooming patients, etc.

 

[PsyDr]

Cynical and uneducated opinion:

How long until some administrator looks at the numbers and says, "Let's just add these IOP job duties to an attending or NP. We can save a ton of money."?

I'm sure there is a way to protect yourself from this. I don't know how.

 

[Sushirolls]

OP; you are looking at this from angle of what you want and what would benefit you.

The admin at many Big Box shops don't care about you and what you want. And don't want the headache of trying to make you happy. If you are gone, they will simply pay locums to fill your space currently. They have little to interest in your dream.

Quit your job. Go work an OP gig some where for a year. Then decide what you want to do.

 

[Stagg737]

Historically, a lot of academic programs I have exposure to have placed almost no emphasis on productivity, which is pretty cool if not unsustainable. That said, I do see the tides shifting significantly in the past decade with more expectation around patient care encounters or RVUs in the ivory tower space.

But if you are talking a big-box-shop non profit or for profit healthcare system, the idea of them staffing a clinic for you with no assurance on the number of patients coming is not going to fly. There has to be somehow answering calls, scheduling apts, rooming patients, etc.

Sure, depends on space and staffing. I imagine if there is office space or staff available (like where I’m at) then they’d welcome additional volume. If they’re having to add space or staff just for OP then I agree they’ll be looking to fill those appointments ASAP. If the clinic can accommodate telehealth then the space isn’t an issue.

 

[aquatic ape]

OP; you are looking at this from angle of what you want and what would benefit you.

The admin at many Big Box shops don't care about you and what you want. And don't want the headache of trying to make you happy. If you are gone, they will simply pay locums to fill your space currently. They have little to interest in your dream.

Quit your job. Go work an OP gig some where for a year. Then decide what you want to do.

good perspective, but I’m also not entirely certain. They have tried to fill a similar position to mine and have been unable too, even with locums, resorting to a telehealth company which is truly awful.

My goal was to figure out how to pitch this as a win win, but I do appreciate your perspective and I don’t disagree that it might just be time to leave this employer

 

[aquatic ape]

Sure, depends on space and staffing. I imagine if there is office space or staff available (like where I’m at) then they’d welcome additional volume. If they’re having to add space or staff just for OP then I agree they’ll be looking to fill those appointments ASAP. If the clinic can accommodate telehealth then the space isn’t an issue.

I’m not positive but I think there is extra office space and telehealth availability, so wouldn’t really be much burden beyond scheduling, rooming. Etc

 

[FlowRate]

Some of the older CL docs at BIDMC had a setup that would accommodate this. They were allowed to use their hospital office to see private outpatients when they weren't on the clock for their ~0.6 FTE CL jobs. I don't recall the details, but hospitals that allow this usually take a hefty cut for doing so. Does your hospital already have outpatient psychiatry or psychotherapy service lines?

 

[Candidate2017]

I want to approach my boss/ employer with the idea of doing some OP through my hospital system, predominantly starting with following consult patients that I want to keep seeing. I want to have full autonomy on patients I see, number of hours, days I work, etc. basically take the interesting cases from my consult work, and then any other interesting cases. Maybe work out to 24-32 hours per month.

The only thing that counts is, "How does this make more money for The Man?" As pointed out above, it's in their best interest to dump a full load on you, or take a hefty cut from you, or hire a FT outpatient midlevel to follow up these patients.

Also, consults patients are almost always Medicaid. In addition to extra handholding that's required of this population, I can't see how Medicaid can pay to keep the lights on for a private practice.

 

[Merovinge]

good perspective, but I’m also not entirely certain. They have tried to fill a similar position to mine and have been unable too, even with locums, resorting to a telehealth company which is truly awful.

My goal was to figure out how to pitch this as a win win, but I do appreciate your perspective and I don’t disagree that it might just be time to leave this employer

I have never seen an administrator at a big box shop that gives 2 ****s about not having a position filled. They can always do the bare minimum by telewhatevernonsense or random NP/PA doing the consult service copying/pasting the same irrelevant note and billing it at the highest complexity level. Just make sure any changes protect yourself, particularly don't get roped into a noncompete if you might leave and do OP work somewhere else. The MBA managing you isn't your friend, and is actually actively working to screw you over.

 

[aquatic ape]

Some of the older CL docs at BIDMC had a setup that would accommodate this. They were allowed to use their hospital office to see private outpatients when they weren't on the clock for their ~0.6 FTE CL jobs. I don't recall the details, but hospitals that allow this usually take a hefty cut for doing so. Does your hospital already have outpatient psychiatry or psychotherapy service lines?

Yes but not a lot of psychiatrists, a few NPs

 

[aquatic ape]

I have never seen an administrator at a big box shop that gives 2 ****s about not having a position filled. They can always do the bare minimum by telewhatevernonsense or random NP/PA doing the consult service copying/pasting the same irrelevant note and billing it at the highest complexity level. Just make sure any changes protect yourself, particularly don't get roped into a noncompete if you might leave and do OP work somewhere else. The MBA managing you isn't your friend, and is actually actively working to screw you over.

Md managing me, who doesn’t seem outwardly hostile or welcoming, mostly just doesn’t want anybody rocking the boat.


Appreciate all the input. Going to consider trying to work for an outside practice or start my own if I want to do this