Straight Out of Fellowship Job Offer

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Marasmus1

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After being unable to agree on contract terms with my top choice, I received an offer from my second choice and would like to hear some feedbacks

Midwest Location, an hour drive to major metropolitan city, non profit healthcare system, Outpatient Child Psych full time
275k base compensation with wRVU bonus (base compensation not affected by productivity)
Sign on bonus of 60k paid in three years
Annual retention bonus of 25k
Relocation assistance up to 15k
401k with 50% match of up to 8%
Medical, Vision, Dental, Short term, Long term disability, Life insurance , Malpractice with tail
First year 21 days vacation, 6 paid holidays and 5 days CME with 5k stipend
1:8 weekend inpatient adolescent unit call
Full reimbursement for Licensing and Legal fees for visa assistance
Opportunities for teaching with adult psychiatry residents

Potential concerns

- Only one other child outpatient provider, which means if quits I am probably screwed
- The healthcare system is quite new with poor reviews in google
- Glassdoor reviews are pretty average with many nurses complaining of staffing issues

Members don't see this ad.
 
After being unable to agree on contract terms with my top choice, I received an offer from my second choice and would like to hear some feedbacks

Midwest Location, an hour drive to major metropolitan city, non profit healthcare system, Outpatient Child Psych full time
275k base compensation with wRVU bonus (base compensation not affected by productivity)
Sign on bonus of 60k paid in three years
Annual retention bonus of 25k
Relocation assistance up to 15k
401k with 50% match of up to 8%
Medical, Vision, Dental, Short term, Long term disability, Life insurance , Malpractice with tail
First year 21 days vacation, 6 paid holidays and 5 days CME with 5k stipend
1:8 weekend inpatient adolescent unit call
Full reimbursement for Licensing and Legal fees for visa assistance
Opportunities for teaching with adult psychiatry residents

Potential concerns

- Only one other child outpatient provider, which means if quits I am probably screwed
- The healthcare system is quite new with poor reviews in google
- Glassdoor reviews are pretty average with many nurses complaining of staffing issues
What’s the wrvu expectations and dollar amount per wrvu
 
After being unable to agree on contract terms with my top choice, I received an offer from my second choice and would like to hear some feedbacks

Midwest Location, an hour drive to major metropolitan city, non profit healthcare system, Outpatient Child Psych full time
275k base compensation with wRVU bonus (base compensation not affected by productivity)
Sign on bonus of 60k paid in three years
Annual retention bonus of 25k
Relocation assistance up to 15k
401k with 50% match of up to 8%
Medical, Vision, Dental, Short term, Long term disability, Life insurance , Malpractice with tail
First year 21 days vacation, 6 paid holidays and 5 days CME with 5k stipend
1:8 weekend inpatient adolescent unit call
Full reimbursement for Licensing and Legal fees for visa assistance
Opportunities for teaching with adult psychiatry residents

Potential concerns

- Only one other child outpatient provider, which means if quits I am probably screwed
- The healthcare system is quite new with poor reviews in google
- Glassdoor reviews are pretty average with many nurses complaining of staffing issues

- How much time are you getting for intakes? How much time are you getting for followups? You want to make sure this isn't a meat grinder where they try to make you do 45 minute intakes and 15-20 minute followups for child (even 60 minute intakes are tight for child, really should be at least 90 minutes total for a good first eval and treatment).
- How much are you getting for call? If you're not getting anything, what's to keep them from increasing your call requirement if people bail out of the system?
- NP "collaboration" requirements?
- What kind of support do you have? Do you have the ability to refer to therapists fairly easily within the system or are you on your own with all the patients expecting you to be able to fix their kid with a 30 minute appointment every 6 weeks?

Just questions off the top of my head.
 
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*Visa*

Forget money, go for quality. If you get locked into a place with visa that's bad, you are now in for years of pain.
Choose wisely, and forget the money, pick quality.
 
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After being unable to agree on contract terms with my top choice, I received an offer from my second choice and would like to hear some feedbacks

Midwest Location, an hour drive to major metropolitan city, non profit healthcare system, Outpatient Child Psych full time
275k base compensation with wRVU bonus (base compensation not affected by productivity)
Sign on bonus of 60k paid in three years
Annual retention bonus of 25k
Relocation assistance up to 15k
401k with 50% match of up to 8%
Medical, Vision, Dental, Short term, Long term disability, Life insurance , Malpractice with tail
First year 21 days vacation, 6 paid holidays and 5 days CME with 5k stipend
1:8 weekend inpatient adolescent unit call
Full reimbursement for Licensing and Legal fees for visa assistance
Opportunities for teaching with adult psychiatry residents

Potential concerns

- Only one other child outpatient provider, which means if quits I am probably screwed
- The healthcare system is quite new with poor reviews in google
- Glassdoor reviews are pretty average with many nurses complaining of staffing issues
Bolded: yuck.

For a facility driven job, it's not *horrible*.

A Midwestern location 1 hr drive from major metro is typically a very blah kind of location. Have you visited?
 
1:8 weekend inpatient adolescent unit call
Negotiate out of call. The market is desperate enough for child psychiatrists that no one should be taking call unless they are paying a pretty penny lol.

275k base compensation with wRVU bonus (base compensation not affected by productivity)
Pay looks kinda low for midwest. Ask for 300k at least.

Opportunities for teaching with adult psychiatry residents
Interesting that it is being framed as a positive lol. They are probably wonderful people but from a workflow perspective it just makes your day harder.

Only one other child outpatient provider, which means if quits I am probably screwed
No, my friend. If they quit you ask for a 30% raise on the spot because you now have the monopoly of child psychiatrists in your hospital system. Also your workload will likely increase by AT LEAST that much with all the cases being dumped on you. Remember you have feet too, and it is within their financial interest to keep their remaining child psychiatrist unless they want their entire system to collapse.


Also... is this an on site job or WFH? How many intakes/follow ups are you expected to see? What happens where there are cancelations or no shows? Do they shove someone new in that spot (likely) or do you get that time back as admin etc?
 
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What’s the wrvu expectations and dollar amount per wrvu
This is something that we have not agreed yet. I am not well versed about this RVU thing so I am doing my own research to make sure they don`t screw me. Are there any things that I should look, any suggestions?
 
- How much time are you getting for intakes? How much time are you getting for followups? You want to make sure this isn't a meat grinder where they try to make you do 45 minute intakes and 15-20 minute followups for child (even 60 minute intakes are tight for child, really should be at least 90 minutes total for a good first eval and treatment).
- How much are you getting for call? If you're not getting anything, what's to keep them from increasing your call requirement if people bail out of the system?
- NP "collaboration" requirements?
- What kind of support do you have? Do you have the ability to refer to therapists fairly easily within the system or are you on your own with all the patients expecting you to be able to fix their kid with a 30 minute appointment every 6 weeks?

Just questions off the top of my head.

- I negotiated up to 2 hours for new eval, 20 minutes for follow ups with an option to schedule 30 minutes for complicated cases.
- No extra compensation for call
- No NP in the system as of yet. All MDs
- There are therapists in the system but I heard it is almost impossible to get appointment 2 months advance
 
*Visa*

Forget money, go for quality. If you get locked into a place with visa that's bad, you are now in for years of pain.
Choose wisely, and forget the money, pick quality.

I really value your input. I mean it is obviously not Yale or Brown but what are the other metrics for quality? Having said that I also talked to top institutions in the field and was quoted 190k as base. I don`t want to make more than 100k discount just because they provide high quality care.

What are the quality metrics you would look at? To me, unless you are in the system, it is really hard to know the quality of patient care they provide.
 
- I negotiated up to 2 hours for new eval, 20 minutes for follow ups with an option to schedule 30 minutes for complicated cases.
- No extra compensation for call
- No NP in the system as of yet. All MDs
- There are therapists in the system but I heard it is almost impossible to get appointment 2 months advance
I highly recommend 30 minute follow-ups with the ability to schedule 20 minute follow-ups for less complicated patients.
 
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Bolded: yuck.

For a facility driven job, it's not *horrible*.

A Midwestern location 1 hr drive from major metro is typically a very blah kind of location. Have you visited?

I have visited. First impression was good. I will be doing waiver so my options are quite limited all of which are in undesirable locations. My goal is to work 3 years somewhere as close as possible to major city. If I can save around 100k a year ( I have no loans), once the waiver is over, will go to prime locations like NY or SF and buy a house with mortgage and settle down.
 
I highly recommend 30 minute follow-ups with the ability to schedule 20 minute follow-ups for less complicated patients.

It’s also hard to know what “up to 2 hours” means. Does that mean “when your schedule gets more tight, sorry now you do 60 min evals cause we got you locked in a visa sponsored contract”?

OP for employed positions like this you want this spelled out as explicitly as possible. I’d also be wary about them increasing the call once they have you locked in, especially if they aren’t paying you per call. 6 weekends a year isn’t terrible especially with the sign on bonus and retention bonuses bringing you up over 300k for a visa sponsoring position.
 
This is something that we have not agreed yet. I am not well versed about this RVU thing so I am doing my own research to make sure they don`t screw me. Are there any things that I should look, any suggestions?
$60+ per wrvu should be what you’re getting, the average nationally is like 65
 
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I don't like the unpaid call, if its a location with high no-shows then you basically want 30 min followups with a minimum salary. 2 hour appointments i would get in one session rather than 2 - 1 hour slots.
 
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I have visited. First impression was good. I will be doing waiver so my options are quite limited all of which are in undesirable locations. My goal is to work 3 years somewhere as close as possible to major city. If I can save around 100k a year ( I have no loans), once the waiver is over, will go to prime locations like NY or SF and buy a house with mortgage and settle down.
Interesting. Well in that scenario I think you are getting a fair offer.
 
- I negotiated up to 2 hours for new eval, 20 minutes for follow ups with an option to schedule 30 minutes for complicated cases.
- No extra compensation for call
- No NP in the system as of yet. All MDs
- There are therapists in the system but I heard it is almost impossible to get appointment 2 months advance
Keep in mind if you have no availability for therapy, even the patients that do get in are unlikely to be getting weekly evidenced based therapy and more likely to get largely worthless supportive therapy. Good luck managing the severe OCD cases with someone who hasn't even sniffed ExRP and yet you feel pressured into either watching them descent into severe functional impairment or starting a 9 year old on adjunctive atypical after getting them up to 150-200mg of Zoloft (no this totally didn't happen to me in a rural CAP job where therapy options were extremely limited).

This is only to say that I think you have to have 30 minutes with patients, you are going to be their lifeline in a sea of pediatric mental health emergencies. Access to things like IOP/PHP/IP may be very limited as well if you are an hour from a real city which is also heartbreaking and shifts more focus on you. Ideally you are in a system or have access to psychologists as testing is a huge part of CAP.

If it is 90-120 min new, 30 min f/u, no requirement to supervise NPs, then I actually think this job is very reasonable for a visa waiver job. Certainly talk to the other CAP to get an idea of what they think about it. I would not consider the job without spending 30 minutes talking to them.
 
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After being unable to agree on contract terms with my top choice, I received an offer from my second choice and would like to hear some feedbacks

Midwest Location, an hour drive to major metropolitan city, non profit healthcare system, Outpatient Child Psych full time
275k base compensation with wRVU bonus (base compensation not affected by productivity)
Sign on bonus of 60k paid in three years
Annual retention bonus of 25k
Relocation assistance up to 15k
401k with 50% match of up to 8%
Medical, Vision, Dental, Short term, Long term disability, Life insurance , Malpractice with tail
First year 21 days vacation, 6 paid holidays and 5 days CME with 5k stipend
1:8 weekend inpatient adolescent unit call
Full reimbursement for Licensing and Legal fees for visa assistance
Opportunities for teaching with adult psychiatry residents

Potential concerns

- Only one other child outpatient provider, which means if quits I am probably screwed
- The healthcare system is quite new with poor reviews in google
- Glassdoor reviews are pretty average with many nurses complaining of staffing issues
I remember you from the child psychiatry fellowship thread just last year. Are you already looking at jobs?
 
Too add another thought, having the one provider leave doesn't necessarily mean you're screwed. If you're full you're full, patients may have to wait months to see you and in the interim rely on the PCP for treatment/go elsewhere for treatment. You shouldn't have to taken on the other provider's patient's when they leave..
 
I remember you from the child psychiatry fellowship thread just last year. Are you already looking at jobs?

Yeah because I am on visa and some clinics started interviewing for 2023. Visa means you have to have signed a contract by almost a year from actual start date for waiver approval
 
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I am also getting quoted for 340k for an academic midwest job where one full day is dedicated to teaching and scholarly activity. As I talked to the internal recruiter today, he said average academic CAP Jobs pay around 290k in midwest. Is that really the norm?
 
I am also getting quoted for 340k for an academic midwest job where one full day is dedicated to teaching and scholarly activity. As I talked to the internal recruiter today, he said average academic CAP Jobs pay around 290k in midwest. Is that really the norm?
Don't split hairs over 20-40k for a visa waiver job that you are essentially locked into for 3 years. That average is probably higher than I would expect in the more desirable metros of the midwest, but there is certainly a pay bump for CAP even in academics across the country in the last several years and it's certainly higher in less desirable places. Also many academic jobs these days have relatively high clinical requirements, track RVUs, expect additional teaching/research and are not necessarily particularly cush like they were in the years of yore.
 
Interesting that it is being framed as a positive lol. They are probably wonderful people but from a workflow perspective it just makes your day harder.

Really? This is a huge plus for me and the wording of "opportunity to..." implies that you could say no if you wanted to. If you've got (decent) residents working under you writing the notes, I don't think it would add that much to their workload but just be a different kind of work. Or am I just looking through rose-colored glasses?
 
Really? This is a huge plus for me and the wording of "opportunity to..." implies that you could say no if you wanted to. If you've got (decent) residents working under you writing the notes, I don't think it would add that much to their workload but just be a different kind of work. Or am I just looking through rose-colored glasses?
I preface this with I love residents as people and believe in the duty of educating the next generation of psychiatrists etc (and thus far I have never turned down a single educational activity when asked by residents...)

BUT

Even the best residents are only half as efficient.. either through legal limitations (there are specific things that attendings have to do etc), the process of thoughtfully discussing a case and formulation, or just straight up logistics of figuring out everyone's schedules of seeing the patient together etc. On days with no residents I am easily done with my work on inpatient by like.. 11 am or noon, whereas days with residents it can run as late as 3 or godforbid 4 pm. What breaks my heart is when I see them STILL writing notes at like 4 pm when I am leaving and thus I offer to write their note for them... I've been told I am overprotective lol.

I guess from a workflow perspective I don't go out of my way to find residents (aka captive audience) to pontificate to, but when I am obligated to I try my hardest to make sure they have a positive experience with child psych.
 
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