thoughts on job offer

[jdeep]

Hello

Received following job offer;

Inpatient job with case load of 18 (can be lower as this may vary), rural town (not an issue for me), no calls after 5pm, one weekend mandatory a month mainly to do new patient evals where as the follows up are done by midlevels, base salary 300k, 15k sign on bonus a year for first two years, 3k a month for quality assurance if meeting the criteria (this includes stuff like signing of labs, doing notes hpi and d/c on time etc..), total days off 27 this includes everything (vacation,personal,cme,sick), other perk is health insurance is covered 100% (no premium), retirement plans good as any other place

wanting to get yalls thoughts on it, if it a fair compensation/benefits for the work

thank you

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[wolfvgang22]

Case load is too high.
Vacation and sick leave being in the same pool sucks. That's a sign of a place that wants you available 24/7. If you get sick, you then get to work with no vacation and can have trouble recovering or burn out.
CME should be separate, too.

For me, I'd ask for the above changes, I'd even be open to taking a bit less money in negotiation to get more sick leave or time off. I'd rather pay insurance premium than be shorted on sick leave and CME time.
I bet they won't negotiate because they plan on driving you like a rental car. What's their turnover like? How long has the job been open? If they won't negotiate walk.

 

[robellis]

18 patients per day? Do these hospitals seriously have no shame? This is the job of 2 psychiatrists so to offer you 300k for this is absurd

 

[wolfvgang22]

These rural places often literally have no one but mid-levels and maybe family practice docs to care for patients. They offer relatively high salary for recent residency grads or locums or foreign docs on visas compared to more doable and competitive academic or city jobs, and usually have high turnover. Sometimes they had a long time psychiatrist that was a workaholic retire, causing an opening. Some gems exist out there, but be careful. Make sure support staff and therapists are available.

 

[TexasPhysician]

Are you also signing off on the midlevels?

 

[jdeep]

Case load is too high.
Vacation and sick leave being in the same pool sucks. That's a sign of a place that wants you available 24/7. If you get sick, you then get to work with no vacation and can have trouble recovering or burn out.
CME should be separate, too.

For me, I'd ask for the above changes, I'd even be open to taking a bit less money in negotiation to get more sick leave or time off. I'd rather pay insurance premium than be shorted on sick leave and CME time.
I bet they won't negotiate because they plan on driving you like a rental car. What's their turnover like? How long has the job been open? If they won't negotiate walk.

okay make sense...they have alot of 1099 workers who are seeing varies caseload of patient. This job has been open for couple months, again not sure because of the location or what. I agree if they are not open to negotiation then definitely will be looking elsewhere

 

[jdeep]

18 patients per day? Do these hospitals seriously have no shame? This is the job of 2 psychiatrists so to offer you 300k for this is absurd

actually have seen several place where the case load has varied from 14-20. There was one place that said 25 patients a day and I just kept it there and left. Now days it just seems like they want us to see a lot of patients

 

[jdeep]

These rural places often literally have no one but mid-levels and maybe family practice docs to care for patients. They offer relatively high salary for recent residency grads or locums or foreign docs on visas compared to more doable and competitive academic or city jobs, and usually have high turnover. Sometimes they had a long time psychiatrist that was a workaholic retire, causing an opening. Some gems exist out there, but be careful. Make sure support staff and therapists are available.

yes there support staff overall seems to good and available (atleast this is what they are telling me and what I saw during the tour).

 

[jdeep]

Are you also signing off on the midlevels?

yes they want us to sign off on their notes

 

[robellis]

yes they want us to sign off on their notes

Man this is a very bad job, 18 patients per day and you have to sign off and accept liability for nurses? This job should be paying around 450k

 

[wolfvgang22]

yes they want us to sign off on their notes

How many beds total is this place?
Are mid-levels seeing their own 18 patients per day? How many do they want you to supervise? Honestly, I would want a cap of 12 patients, and supervise one NP, no more. And that NP better not be seeing more patients than me. Just my limits.
Is there a non-compete clause?

 

[Old&InTheWay]

Vacation and sick leave being in the same pool sucks. That's a sign of a place that wants you available 24/7.

Not sure I agree with this. I would much rather have my PTO be able to be used for whatever reason I choose, rather than not be able to use earned time off if I'm not sick.

 

[TexasPhysician]

Man this is a very bad job, 18 patients per day and you have to sign off and accept liability for nurses? This job should be paying around 450k

Agreed. This took the job from not good to terrible.

 

[jdeep]

thanks everyone for the input, looks like definitely should pass this offer, will update if they do negotiate with case load or with no signing off NP notes.

 

[dl2dp2]

Not a great job. Eventually someone hapless will take it I think. I agree with everyone else for a job like this the starting point for negotiation should be 450k. This is the starting point for CA prison/state systems for similar number of hours and much lower acuity.

 

[Stagg737]

Vacation and sick leave being in the same pool sucks. That's a sign of a place that wants you available 24/7. If you get sick, you then get to work with no vacation and can have trouble recovering or burn out.

Why would this be a sign that they want someone available 24/7? If you're sick then you're sick, and any messages you might get can be redirected.

yes they want us to sign off on their notes

Is this just on the weekends you cover or is this all the time? How many charts are you signing off on? This would likely be a deal breaker for me either way, but for those who consider supervising it can make a huge difference.

 

[wolfvgang22]

Why would this be a sign that they want someone available 24/7? If you're sick then you're sick, and any messages you might get can be redirected.




Is this just on the weekends you cover or is this all the time? How many charts are you signing off on? This would likely be a deal breaker for me either way, but for those who consider supervising it can make a huge difference.

27 days isn't much. My personal experience is that employers who combine leave like this moan when I took any time off at all. Add it to the constellation of symptoms here or not if you wish. This job overall smells like burn out to me.

 

[clausewitz2]

27 days isn't much. My personal experience is that employers who combine leave like this moan when I took any time off at all. Add it to the constellation of symptoms here or not if you wish. This job overall smells like burn out to me.

Agreed. Places that have a healthy culture of not making you regret having taken PTO are also places that are less miserly about allowing time off in the first place. It is a sign of institutional priorities - grind first, personal well-being later.

 

[Stagg737]

27 days isn't much. My personal experience is that employers who combine leave like this moan when I took any time off at all. Add it to the constellation of symptoms here or not if you wish. This job overall smells like burn out to me.

I was more referring to the thought that having all days in the same pool was the issue, not the 27 days. I realize 27 days isn't great, but is it really that bad? Other than the VA I haven't seen any positions that with a salary component offer more than 35 days off.

 

[jbomba]

Have you guys had the experience of being able to negotiate for more time off for less pay? I'd ideally like a job that allows 8-10 weeks off a year.

 

[TexasPhysician]

Have you guys had the experience of being able to negotiate for more time off for less pay? I'd ideally like a job that allows 8-10 weeks off a year.

Sure. Join a psychiatrist owned private practice.

 

[Mass Effect]

Hello

Received following job offer;

Inpatient job with case load of 18 (can be lower as this may vary), rural town (not an issue for me), no calls after 5pm, one weekend mandatory a month mainly to do new patient evals where as the follows up are done by midlevels, base salary 300k, 15k sign on bonus a year for first two years, 3k a month for quality assurance if meeting the criteria (this includes stuff like signing of labs, doing notes hpi and d/c on time etc..), total days off 27 this includes everything (vacation,personal,cme,sick), other perk is health insurance is covered 100% (no premium), retirement plans good as any other place

wanting to get yalls thoughts on it, if it a fair compensation/benefits for the work

thank you

Bad, bad job. Caseload too high, too little time off. I don't care about it all being in the same pool, but if it's going to be, you need to be thinking 30+ days at least. That's 6 weeks total. Most of the time, we're talking one or two sick days, but if you're out for a week with COVID or even the flu, your vacay time is down to 5 weeks. I'd actually ask for 40+ if it's coming from the same pool.

Caseload should be no higher than 10 for that salary. I wouldn't take this job as it is for anything less than 400K.

 

[Mass Effect]

Sure. Join a psychiatrist owned private practice.

How does one go about finding those?

 

[TexasPhysician]

How does one go about finding those?

Call them

 

[calvnandhobbs68]

How does one go about finding those?

Google “psychiatrist in X city” and see what comes up? Or look at psychology today?

I literally found all 3 private practices i interviewed with that way.

 

[Mass Effect]

Call them

Google “psychiatrist in X city” and see what comes up? Or look at psychology today?

I literally found all 3 private practices i interviewed with that way.

That's exactly what I do to find a private practice. But how do you know it's a psychiatrist-owned private practice?

 

[Old&InTheWay]

That's exactly what I do to find a private practice. But how do you know it's a psychiatrist-owned private practice?

If you have one or more psychiatrists in a private practice, who other then the psychiatrist(s) would own it?

 

[AD04]

That's exactly what I do to find a private practice. But how do you know it's a psychiatrist-owned private practice?

It may say so on the website. Or give the practice a call and ask.

There is no guarantee a psychiatrist-owned practice will be better than a private practice owned by a non-psychiatrist in terms of jobs.

 

[TexasPhysician]

It may say so on the website. Or give the practice a call and ask.

There is no guarantee a psychiatrist-owned practice will be better than a private practice owned by a non-psychiatrist in terms of jobs.

Most all cash pp psychiatrists did it for work/life balance. They understand peers wanting to customize their schedule. Non-physicians don’t understand offering 9 weeks of vacation, flexible schedules, etc because it isn’t common in other fields.

 

[calvnandhobbs68]

It may say so on the website. Or give the practice a call and ask.

There is no guarantee a psychiatrist-owned practice will be better than a private practice owned by a non-psychiatrist in terms of jobs.

I do agree with this. The best offer I had was from a therapist owned practice. Decent amount of therapist only practices would love for an in-house psychiatrist to come on board so they don't have to keep referring people out or to their PCPs for med management. Downside is that for the in-practice patients, the therapists will likely want to keep seeing them for therapy and won't want you to be taking that over. Just talk to a few of them and compare what they're offering you.

 

[AD04]

I do agree with this. The best offer I had was from a therapist owned practice. Decent amount of therapist only practices would love for an in-house psychiatrist to come on board so they don't have to keep referring people out or to their PCPs for med management. Downside is that for the in-practice patients, the therapists will likely want to keep seeing them for therapy and won't want you to be taking that over. Just talk to a few of them and compare what they're offering you.

Was there any resistance from insurance companies if a psychiatrist and a therapist from the same practice bill for therapy on the same patient, but at different days?

 

[calvnandhobbs68]

Was there any resistance from insurance companies if a psychiatrist and a therapist from the same practice bill for therapy on the same patient, but at different days?

Idk haven't actually started there yet but the psychiatrists are technically independent contractors so they don't bill under the same info as the group so it may not be a problem.

 

[Mass Effect]

If you have one or more psychiatrists in a private practice, who other then the psychiatrist(s) would own it?

There are plenty of practices out there owned by some other company and/or some other specialty, some by therapists, some by NPs, some by PCP looking to bring in a psychiatrist, and by places like Kaiser or LifeStance which seems to be literally everywhere are the moment.

 

[Old&InTheWay]

There are plenty of practices out there owned by some other company and/or some other specialty, some by therapists, some by NPs, some by PCP looking to bring in a psychiatrist, and by places like Kaiser or LifeStance which seems to be literally everywhere are the moment.

If working as an employed physician for Kaiser counts as "private practice" I'm not sure that term has much meaning.

 

[clausewitz2]

Was there any resistance from insurance companies if a psychiatrist and a therapist from the same practice bill for therapy on the same patient, but at different days?

I have had literally zero push-back about this sort of thing provided appointments were not on the same day. Some agencies are going to have rules against this because they have negotiated contracts with various payers saying that their MDs will not be billing for therapy but as I probably have 15-20 current patients in my panel who see a therapist in the same group and I get paid for my psychotherapy add-ons every time, even for the occasional 90838 when appropriate.

 

[AD04]

I have had literally zero push-back about this sort of thing provided appointments were not on the same day. Some agencies are going to have rules against this because they have negotiated contracts with various payers saying that their MDs will not be billing for therapy but as I probably have 15-20 current patients in my panel who see a therapist in the same group and I get paid for my psychotherapy add-ons every time, even for the occasional 90838 when appropriate.

This has been my experience as well.