Thoughts on a job?

[vistaril]

---

Members do not see this ad.

In the last year the company Traditions Behavioral Health expanded to the Geisinger Health System in Pennsylvania. They were previously only on the west coast. Was wondering what your thoughts would be on the following job. It's acute inpatient at the Geisinger Medical Center in Danville, PA seeing 22-26 (average of 25) inpatients per day during a 7am-11pm shift. The average length of stay is 8 days. No NP/PA/residents. EMR is Epic. No consult/outpatient responsibilities. 11pm-7a is covered via telepsychiatry. The days sound long, but you can work 8 of these shifts and be off the rest of the month so could live elsewhere and commute in for work. It's flexible so you could do 4 on/10off, 8 on/20 off, etc. This is considered FT and comes with good benefits.

I don't understand why you have to be there 16 hrs?

I see 35 or so inpatients a day in maybe 6 hrs.

If you can leave after you see the patients(as I do in my job), sure, I'd take it. Because I'd be there maybe 4-5 hrs and get paid for 16.

Many jobs don't care if you are 'there' or not all the time. They just want the work done.

 

[robellis]

I don't understand why you have to be there 16 hrs?

I see 35 or so inpatients a day in maybe 6 hrs.

If you can leave after you see the patients(as I do in my job), sure, I'd take it. Because I'd be there maybe 4-5 hrs and get paid for 16.

Many jobs don't care if you are 'there' or not all the time. They just want the work done.

35 in 6 hours..wut

 

[vistaril]

35 in 6 hours..wut

not that uncommon. Some of them are going to be longterm committed patients, some just nonsense frequent flier malingering patients, etc.....and the notes system is really good and quick.

And I'll take at least 45 mins for lunch too.

Sure I could demand to only see like 15 inpatients, but then I'd either have to devote half of the day to outpt or find a new job(which here would mean working for academic hospital which means lower pay)

 

[robellis]

not that uncommon. Some of them are going to be longterm committed patients, some just nonsense frequent flier malingering patients, etc.....and the notes system is really good and quick.

And I'll take at least 45 mins for lunch too.

Sure I could demand to only see like 15 inpatients, but then I'd either have to devote half of the day to outpt or find a new job(which here would mean working for academic hospital which means lower pay)

If you’re seeing 35 patients per day I seriously hope you’re making 1M per year...

 

[vistaril]

If you’re seeing 35 patients per day I seriously hope you’re making 1M per year...

lol no....there is a guy in our practice who(with nps) sees probably 140-150 per day. A lot more some days.

The thing is, our group isn't even the highest volume group around here. There used to be another group who had the contract(they are one of the largest groups in the southeast, maybe the largest) and they would see much much more.

One of the hospitals we cover has about 115 beds. There was one person in this other group(before us) who would famously cover it on weekends themselves(all 115 patients). But thats not the crazy part....the crazy part is that they did it from like 730am to 10am lol....and yes I've seen the notes and they are about what you would expect, but still lol.....he was getting a quick quick report on all those patients.

But like I saw roughly 40 + or - 3 today and I never felt rushed. Went slowly, took time with report, changed a lot, etc.....but >100(even with nps) I can't do and wouldn't do daily.

 

[robellis]

lol no....there is a guy in our practice who(with nps) sees probably 140-150 per day. A lot more some days.

The thing is, our group isn't even the highest volume group around here. There used to be another group who had the contract(they are one of the largest groups in the southeast, maybe the largest) and they would see much much more.

One of the hospitals we cover has about 115 beds. There was one person in this other group(before us) who would famously cover it on weekends themselves(all 115 patients). But thats not the crazy part....the crazy part is that they did it from like 730am to 10am lol....and yes I've seen the notes and they are about what you would expect, but still lol.....he was getting a quick quick report on all those patients.

But like I saw roughly 40 + or - 3 today and I never felt rushed. Went slowly, took time with report, changed a lot, etc.....but >100(even with nps) I can't do and wouldn't do daily.

I’m not sure what planet you’re on but in my hospital each attending sees 8-12 per day and that is considered full time, so if you’re seeing 40 and you’re not being paid in excess of 800k then you are being seriously exploited

 

[vistaril]

I’m not sure what planet you’re on but in my hospital each attending sees 8-12 per day and that is considered full time, so if you’re seeing 40 and you’re not being paid in excess of 800k then you are being seriously exploited

thanks for your concern. I don't think you really understand how things work, but whatever. This is where I have to be right now and I've actually worked hard to carve out a role better than a lot of people have it. One of my colleagues sees 30 inpatients in the morning and only gets half a day credit for it, so he still has 4 hrs of outpt to do for his base. This area is dominated by groups who bid for inpatient contracts, so there aren't a lot of choices if you need to be here(and I do...my son is here)

What kind of hospital do the psychiatrists see 8 patients a day? Govt? Academics? If the latter it's apples to oranges as I could get that too(well not 8...but 13 or so) but there are downsides to working for an academic hospital. If it's an HCA type place I wouldn't expect that to hold up for long(and most of those places the expectation is like 20-23) because eventually some motivated psych will be like "hey, these bozos are paying 4 psychs 270 each to cover their 35 bed unit. Why don't I come in and steal the contract for a stipend plus the codes?"......thats exactly what happened with a hospital employed situation that our group bought out a couple years ago. The hospital was thrilled to get out from that 7 figure albatross.....Now one guy in our group covers it with two nps but it's just half of his day.....there were some initial complaints about quality, but in the end money talks

 

[robellis]

thanks for your concern. I don't think you really understand how things work, but whatever. This is where I have to be right now and I've actually worked hard to carve out a role better than a lot of people have it. One of my colleagues sees 30 inpatients in the morning and only gets half a day credit for it, so he still has 4 hrs of outpt to do for his base. This area is dominated by groups who bid for inpatient contracts, so there aren't a lot of choices if you need to be here(and I do...my son is here)

What kind of hospital do the psychiatrists see 8 patients a day? Govt? Academics? If the latter it's apples to oranges as I could get that too(well not 8...but 13 or so) but there are downsides to working for an academic hospital. If it's an HCA type place I wouldn't expect that to hold up for long(and most of those places the expectation is like 20-23) because eventually some motivated psych will be like "hey, these bozos are paying 4 psychs 270 each to cover their 35 bed unit. Why don't I come in and steal the contract for a stipend plus the codes?"......thats exactly what happened with a hospital employed situation that our group bought out a couple years ago. The hospital was thrilled to get out from that 7 figure albatross.....Now one guy in our group covers it with two nps but it's just half of his day.....there were some initial complaints about quality, but in the end money talks

If you bill properly 8 inpatients per day get you 200k+ so I don’t even know how much 40 would get you...this is at a community hospital not academics or govt

 

[vistaril]

If you bill properly 8 inpatients per day get you 200k+ so I don’t even know how much 40 would get you...this is at a community hospital not academics or govt

lol....no. Maybe in fantasy land. Are you actually billing/coding and collecting from that on your own inpatients yourself now? I suspect from your posts the answer is no....

 

[robellis]

lol....no. Maybe in fantasy land. Are you actually billing/coding and collecting from that on your own inpatients yourself now? I suspect from your posts the answer is no....

I’m not personally doing that but splik said it

 

[splik]

I’m not personally doing that but splik said it

In an imperfect model, in a productivity based position with a median wRVU of $67 seeing 35 inpatients per day would be over $650k per year. Seeing 35 outpatients at that using 99214 for each visit (imperfect model but conservative), it would be about $1 million. unfortunately there are positions that are not productivity based or below the median which pay much less. as long as there are people willing to accept that low compensation (be it MD/DO/NP) those positions will continue to exist.

ETA: my math was wonky above, it would indeed be over $1 million for inpt as well. BTW, I very briefly did a job where we were expected to see about 24 pts per day. If I worked in that position 5 days per week (which would have been insane) every week, with 10 weeks off per yr, it would have paid $700k. Last time i checked they were offering the medical director position (which had a pt load of 14-16 or so per day which is still a lot w/ admin responsibilities) $500k.

 

[robellis]

In an imperfect model, in a productivity based position with a median wRVU of $67 seeing 35 inpatients per day would be over $650k per year. Seeing 35 outpatients at that using 99214 for each visit (imperfect model but conservative), it would be about $1 million. unfortunately there are positions that are not productivity based or below the median which pay much less. as long as there are people willing to accept that low compensation (be it MD/DO/NP) those positions will continue to exist.

Yeah that’s what I thought..so this guy above claiming to see 40 per day and making nowhere near that is getting exploited like I figured

 

[Psych19]

thanks for your concern. I don't think you really understand how things work, but whatever. This is where I have to be right now and I've actually worked hard to carve out a role better than a lot of people have it. One of my colleagues sees 30 inpatients in the morning and only gets half a day credit for it, so he still has 4 hrs of outpt to do for his base. This area is dominated by groups who bid for inpatient contracts, so there aren't a lot of choices if you need to be here(and I do...my son is here)

I'm impressed by the hustle. I'm sorry you live in a part of the country where this is the norm.

In an imperfect model, in a productivity based position with a median wRVU of $67 seeing 35 inpatients per day would be over $650k per year.

I'm not sure I'm following that math.

For a 35 pt/day position, I might make the following assumptions:
- 7 admissions per day (all 99223), 7 discharges per day (all 99238), 21 follow ups per day (all 99232). You might bill a few 99222's and a few 99233's, but they should probably balance each other out.
- 5 days per week, no weekends, 47 weeks per year

That works out to 15347.85 wRVU annually. That is, by the way, something like 3x the median annual wRVU produced by a psychiatrist in the US. The median physician in a procedural specialty (e.g., anethesia, surgery, GI, card) doesn't produce nearly that many RVUs.

Assuming reimbursement of $67/wRVU that should work out to over a million in revenue yearly, just from physician-billed services. I hope you get to keep a good chunk of that. Also, ideally I think you should receive a generous stipend from the hospital for the $35,000 in facility charges you help generate daily.

 

[Copper_Tracker]

35 patients per day should work out to about $750k+ a year, no? Now the question is if you aren't being paid that much, why are you okay with it?

 

[hamstergang]

Yeah that’s what I thought..so this guy above claiming to see 40 per day and making nowhere near that is getting exploited like I figured

His whole schtick on this forum is getting exploited. He feels Psychiatry is a terrible field that's going downhill and generally looks for the worst jobs and then tells us that's what's happening everywhere.

 

[clausewitz2]

His whole schtick on this forum is getting exploited. He feels Psychiatry is a terrible field that's going downhill and generally looks for the worst jobs and then tells us that's what's happening everywhere.

I hear if you hold up your contract to a mirror and say his name three times he appears to tell you why your job is impossible and can't exist.

 

[SmallBird]

If you bill properly 8 inpatients per day get you 200k+ so I don’t even know how much 40 would get you...this is at a community hospital not academics or govt

Yes absolutely - this is what I do currently.

 

[vistaril]

I’m not personally doing that but splik said it

why don't you come back and chime in when you actually have some experience

 

[robellis]

why don't you come back and chime in when you actually have some experience

Please see the post literally above yours 🙂

 

[vistaril]

In an imperfect model, in a productivity based position with a median wRVU of $67 seeing 35 inpatients per day would be over $650k per year. Seeing 35 outpatients at that using 99214 for each visit (imperfect model but conservative), it would be about $1 million. unfortunately there are positions that are not productivity based or below the median which pay much less. as long as there are people willing to accept that low compensation (be it MD/DO/NP) those positions will continue to exist.

first you can't equate inpatient numbers to outpt numbers. Some people can see far far more inpatients than outpts.

second I know what my group actually collects from those 35-40 patients per day I see and it is not $67 per pt encounter. That would be an idealized number that doesn't represent what is actually brought in.

There are the committed patients that they stop paying for after awhile. There are of course the uninsured/self pay patients. There are the patients insurance has cut us off on and there is always some lag in getting them out vs when we learn they stopped paying.

These three groups take a big big chunk out of what the idealized collection number would be. In fact a typical unit of 20pts may have 9 pts that fall under this at any given time.

 

[vistaril]

I'm impressed by the hustle. I'm sorry you live in a part of the country where this is the norm.



I'm not sure I'm following that math.

For a 35 pt/day position, I might make the following assumptions:
- 7 admissions per day (all 99223), 7 discharges per day (all 99238), 21 follow ups per day (all 99232). You might bill a few 99222's and a few 99233's, but they should probably balance each other out.
- 5 days per week, no weekends, 47 weeks per year

That works out to 15347.85 wRVU annually. That is, by the way, something like 3x the median annual wRVU produced by a psychiatrist in the US. The median physician in a procedural specialty (e.g., anethesia, surgery, GI, card) doesn't produce nearly that many RVUs.

Assuming reimbursement of $67/wRVU that should work out to over a million in revenue yearly, just from physician-billed services. I hope you get to keep a good chunk of that. Also, ideally I think you should receive a generous stipend from the hospital for the $35,000 in facility charges you help generate daily.

Our group does not get paid from insurance companies or medicare that way lol.

I've looked at the numbers and collections and what we actually bring in is about 35-37 dollars per patient I see inpatient. As I said we're dealing with massive numbers of uninsured people and committed people who we know longer get paid for.

You make a fair point about the stipend, but that goes to the group not me. And The reality is if I walked out tommorrow, they would just hire a psych np to cover it for 110k and the guy who sees 140 or so now would just add another 35-40 in signing off on the notes.

 

[vistaril]

Please see the post literally above yours 🙂

I responded to them about some of those assumptions, but I can't respond to someone who doesn't even work in the field in a real way yet.

 

[Stagg737]

Our group does not get paid from insurance companies or medicare that way lol.

I've looked at the numbers and collections and what we actually bring in is about 35-37 dollars per patient I see inpatient. As I said we're dealing with massive numbers of uninsured people and committed people who we know longer get paid for.

You make a fair point about the stipend, but that goes to the group not me. And The reality is if I walked out tommorrow, they would just hire a psych np to cover it for 110k and the guy who sees 140 or so now would just add another 35-40 in signing off on the notes.

Even with that many uninsured unless you're taking in a large percent of patients requiring more than acute stays that's a terrible collection rate. Idk what your pay model is, but it sounds like either the facility has crappy SW or billers or there needs to be more CMHCs that can get these patients on medicare/caid. I know of a couple psychiatrists in my area who see 25+ patients per day in a privately owned MHC and they each make at least $300k+ through that part of their job and one or two pull in >$500k...

 

[Stagg737]

35 in 6 hours..wut

To be fair, that's actually not that outrageous if this is all patient contact time and charting is done later. Doing the math that's still more than 10 minutes per patient, and realistically if SW at a facility is good then some patients don't really need more than 5-7 minutes of facetime with the physician. Others just aren't willing to participate in an encounter. If you figure that makes up 10-15 of those patients that's 15 minutes of facetime with each remaining patient.

I'm not saying this is what should be done, but I have seen it done and it's not always as poor of quality care as it may seem. The documentation of those encounters on the other hand...

 

[jbomba]

Even with that many uninsured unless you're taking in a large percent of patients requiring more than acute stays that's a terrible collection rate. Idk what your pay model is, but it sounds like either the facility has crappy SW or billers or there needs to be more CMHCs that can get these patients on medicare/caid. I know of a couple psychiatrists in my area who see 25+ patients per day in a privately owned MHC and they each make at least $300k+ through that part of their job and one or two pull in >$500k...

25 pts a day for 300k seems kind of weak sauce

 

[calvnandhobbs68]

25 pts a day for 300k seems kind of weak sauce

If a large amount of those patients are on Medicaid, then considering Medicaid tends to pay about half of what private insurance/Medicare does, could be reasonable. Otherwise, yes 25 outpatients a day for 300k would be terrible. I know for a fact it's very achievable to hit 300K at 16 patients a day if you're utilizing psychotherapy add on codes for your 30 min appointments appropriately.

vistaril's setup sounds pretty bad. Would never take that job but that's just me.

 

[robellis]

If a large amount of those patients are on Medicaid, then considering Medicaid tends to pay about half of what private insurance/Medicare does, could be reasonable. Otherwise, yes 25 outpatients a day for 300k would be terrible. I know for a fact it's very achievable to hit 300K at 16 patients a day if you're utilizing psychotherapy add on codes for your 30 min appointments appropriately.

vistaril's setup sounds pretty bad. Would never take that job but that's just me.

300k can be hit with much less than 16 outpatients per day, around 10 would probably do it again if billing correctly, his setup is just absurd slave labor wages that no one should accept, I guess he pigeonholed because of his family into one geographic region

 

[calvnandhobbs68]

300k can be hit with much less than 16 outpatients per day, around 10 would probably do it again if billing correctly, his setup is just absurd slave labor wages that no one should accept, I guess he pigeonholed because of his family into one geographic region

Agree for sure, that's with only half the followups utilizing a psychotherapy add on code in the model I was looking at.

 

[clausewitz2]

Worth bearing in mind Alabama did not expand Medicaid; thus it makes sense that there are far more uninsured people in the mix in his inpatient unit. Whereas in this neck of the woods a genuinely uninsured person is a once in a blue moon sort of event.

 

[Stagg737]

25 pts a day for 300k seems kind of weak sauce

Yes, but that specific hospital is known for admitting the patients that no one else will accept, so a fair amount of "charity" cases going through there. Even with the 25, that includes patients being seen by NPs (apparently most of the docs have one) so docs are probably only seeing 12-15 and signing off on the rest. As I said above, I knew 2 or 3 others doing the same at different hospitals and were making significantly more.

 

[Mass Effect]

Why is this a dead-end job? I would assume outpatient only jobs are dead-end jobs as it is easier to transition from inpatient to outpatient than the other way around.

100% false. In psych, you can transition inpatient to outpatient to inpatient easily. Many psychiatrists do both at the same time. This isn't like other fields.

 

[Mass Effect]

I don't understand why you have to be there 16 hrs?

I see 35 or so inpatients a day in maybe 6 hrs.

If you can leave after you see the patients(as I do in my job), sure, I'd take it. Because I'd be there maybe 4-5 hrs and get paid for 16.

I mean, some people just want to provide good care.