Telepsychiatry... is this pay worth it???

[sareeb1]

I posted previously about a full time telepsych job previously that has now offered me a higher salary from $230k to $265k... if I do half ED consultative work and half community (all tele) they pay $275k. The kicker is no benefits. 10 holidays..6 weeks PTO. Malpractice covered. No call or weekends (unless I choose to). At the new salary would this at all be financially worth it as I would file as a 1099. I’m thinking 42% comes out as taxes? (Live in SC). I can get health insurance through my spouse’s job too. Any thoughts? Thanks!

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[wolfvgang22]

Is this 40 hours per week? How many patients per day? How busy is this ER?

 

[sareeb1]

It is 40 hrs/week. I get an hr for each new and 30 mins for follow-up. I am not exactly sure how busy the ER work is.. they cover multiple hospitals so I’m thinking it’s very busy. They are willing to allow just a one year contract. No non-compete.

 

[Med_WannaBee]

I'm just a med student, but I have heard of PNPs making close to 250k in psychiatry. I think you can get at least 300k.

 

[wolfvgang22]

I think this sucks as a 1099 job.

 

[sareeb1]

The other option is $215k with the VA and of course benefits. I thought that with the $265 pay 1099 it would even out with what the VA is offering.. what am I missing here?

 

[MedMan80]

I think most people tend to take side gigs rather than their main jobs on 1099, as the amount you can write off would be similar in both cases. The VA gig looks better (if you can handle the population), as you get full benefits tacked on (probably same pto?)

 

[wolfvgang22]

I think most people tend to take side gigs rather than their main jobs on 1099, as the amount you can write off would be similar in both cases. The VA gig looks better (if you can handle the population), as you get full benefits tacked on (probably same pto?)

VA give 3 weeks PTO plus 11 federal holidays...if you aren't on call.

 

[J ROD]

The salary is about right for SC. I would push VA for more money. Retention and performance bonus. They can at least get you over 230K.

Additionally, my question would be do you have experience with doing telepsych. Used to the set up etc?

 

[Trismegistus4]

Do people really do telepsych full-time? I can't imagine sitting at my computer at home for 8 hours straight video-chatting with patients. I'd go crazy. I thought telepsych was something people just did like one or two half-days per week to supplement their income, or temporarily to bring in some income between permanent jobs.

 

[splik]

I posted previously about a full time telepsych job previously that has now offered me a higher salary from $230k to $265k... if I do half ED consultative work and half community (all tele) they pay $275k. The kicker is no benefits. 10 holidays..6 weeks PTO. Malpractice covered. No call or weekends (unless I choose to). At the new salary would this at all be financially worth it as I would file as a 1099. I’m thinking 42% comes out as taxes? (Live in SC). I can get health insurance through my spouse’s job too. Any thoughts? Thanks!

If this is a 1099 job they should be offering you an hourly rate, not a salary (otherwise its a W2 job illegally marketed as a 1099 which has adverse implications for you). This works out as $156.25/hr i.e. 275000/ 40 (hrs) / 44 weeks (52-8 weeks off). I would say that is about right for non-correctional telepsych, perhaps on the lower side. You could be looking at about 160-180/hr. I would argue the hourly rate should be different for outpatient vs ER telepsychiatry work. personally, the liability of ER telepsych is too great and the quality of care too poor, for me to do that. telepsychiatry to ERs is now a big industry with companies like vituity capturing the market on the west coast. they claim that as you are just a consultant to the ER docs that liability is low, but that just is not true. I know of psychiatrists being sued for ER telepsych work even when they did nothing wrong.

 

[dl2dp2]

they claim that as you are just a consultant to the ER docs that liability is low, but that just is not true. I know of psychiatrists being sued for ER telepsych work even when they did nothing wrong.

I can second this. Their model is actually very bad to psychiatrists who are consultants, since in a psychiatric ER the admission rate is typically much higher. Compound this with the much higher liability of an emergency physician, you are looking at not having control over cases and exposed to liability that shouldn't be yours in the first place. e.g. someone missed a medical diagnosis asked for a psych consult at some point during care episode, and perhaps you "could have caught it". Avoid this like a plague. All psych consults require full medical clearance first.

The best telepsych gigs are stable CHMC facilities that are understaffed, where you essentially do maintenance med mgmt on a bunch of stable SMI. They exist and salary is on the uptrend, though typically start around $120-$150. Private clinics pay higher, but you do a lot of intakes, and few no shows. This is more demanding per hour of work. For the OP, your offer isn't bad. I might just take it and see what happens. Or maybe start the job at VA and take a few shifts.

 

[sareeb1]

I can second this. Their model is actually very bad to psychiatrists who are consultants, since in a psychiatric ER the admission rate is typically much higher. Compound this with the much higher liability of an emergency physician, you are looking at not having control over cases and exposed to liability that shouldn't be yours in the first place. e.g. someone missed a medical diagnosis asked for a psych consult at some point during care episode, and perhaps you "could have caught it". Avoid this like a plague. All psych consults require full medical clearance first.

The best telepsych gigs are stable CHMC facilities that are understaffed, where you essentially do maintenance med mgmt on a bunch of stable SMI. They exist and salary is on the uptrend, though typically start around $120-$150. Private clinics pay higher, but you do a lot of intakes, and few no shows. This is more demanding per hour of work. For the OP, your offer isn't bad. I might just take it and see what happens. Or maybe start the job at VA and take a few shifts.

Yeah in the area I live in this CMH telepsych job for $265k or around $145 and hour is pretty much as good as it gets when it comes to telepsych. What makes this position appealing in my eyes is the 1 year contract and no non-compete. I live in an area where psychiatrists are severely underpaid. My goal is to start a private practice but wondering if I'll wait a year to save up to afford to start the practice or dive in and do telepsych moonlighting. I plan on getting an LLC as a next step regardless of what I do so as to make things more favorable for me during tax season.

 

[dl2dp2]

Yeah in the area I live in this CMH telepsych job for $265k or around $145 and hour is pretty much as good as it gets when it comes to telepsych. What makes this position appealing in my eyes is the 1 year contract and no non-compete. I live in an area where psychiatrists are severely underpaid. My goal is to start a private practice but wondering if I'll wait a year to save up to afford to start the practice or dive in and do telepsych moonlighting. I plan on getting an LLC as a next step regardless of what I do so as to make things more favorable for me during tax season.

In my experience, anyone who waits on starting private practice for financial reasons will later regret it. In areas where psychiatrists are underpaid (I assume you mean, by facilities), it generally means that the apparent demand in the private sector is even greater. Also, keep in mind that telepsych moonlighting can be part of your private practice income. In fact, it defaults into your PP income unless you take the effort to create separate legal structures. Which would be odd, because presumably you would do your telepsych (sometimes) in an office that you rent, and use the same computer, etc.

 

[Armadillos]

VA give 3 weeks PTO plus 11 federal holidays...if you aren't on call.

Not sure that is true everywhere, if I remember right the VA where I trained attendings get 5 weeks PTO + federal holidays.

Plus you get a pension of 1% salary per year worked along with a gov equivalent of 401k with matching of some percent of contributions. So retiring with 30 years at 60-65 would be looking at 60k+/yr income from the pension plus your actual retirement account.

 

[zolof]

Do people really do telepsych full-time? I can't imagine sitting at my computer at home for 8 hours straight video-chatting with patients. I'd go crazy. I thought telepsych was something people just did like one or two half-days per week to supplement their income, or temporarily to bring in some income between permanent jobs.

I can agree to this. I did telepsych full time 40 hours salaried job ended up being closer to 32 to 34 hours or so, as well as 1099 consultant to ED telepysch. the idea is romanticized, being at home in front of your screen for 7 to 9 hours a day. It felt much more exhausting than a job where I was on inpatient.

 

[deleted310399]

I can agree to this. I did telepsych full time 40 hours salaried job ended up being closer to 32 to 34 hours or so, as well as 1099 consultant to ED telepysch. the idea is romanticized, being at home in front of your screen for 7 to 9 hours a day. It felt much more exhausting than a job where I was on inpatient.

Can I PM you ? I'm thinking of a full time TelePsych job .

 

[finalpsychyear]

Telepsych was cool. I have done it for over a year. It sounds nice and maybe if you are raising kids and need to be home then it would be great. For most people they need to get out of the house everyday i feel. I think a day or two might be nice for some but full time is starting to get old. There is something to staff interaction and getting up and getting ready and having to "go" somewhere that has value. As nice as it sounds to start at 9am and getting up at 830am and only needing to wear a shirt and white coat and no pants it kind of makes you lazy in some ways that may spread to other things.

 

[deleted310399]

Telepsych was cool. I have done it for over a year. It sounds nice and maybe if you are raising kids and need to be home then it would be great. For most people they need to get out of the house everyday i feel. I think a day or two might be nice for some but full time is starting to get old. There is something to staff interaction and getting up and getting ready and having to "go" somewhere that has value. As nice as it sounds to start at 9am and getting up at 830am and only needing to wear a shirt and white coat and no pants it kind of makes you lazy in some ways that may spread to other things.

I get all that but the problem is that the job I am looking at is in an underserved area and I am thinking of moving 2-3 hours away in a desirable location . TelePsych is my only option for this particular job .

 

[finalpsychyear]

I get all that but the problem is that the job I am looking at is in an underserved area and I am thinking of moving 2-3 hours away in a desirable location . TelePsych is my only option for this particular job .

Then you should do it. I have taken several vacations and taken my telepsych with me. It def has its perks. Once you settle in the desirable area many more opportunities will present itself or like i tell everyone create your own and start a 1 day PP in this location or even half a day.