Thoughts on Job offer...

[Psych25]

Inpatient psych
Base: 370k for 14 pt average (4 new evals per day is the average based on previous few years)
Mixture of adolescent/adult
No production model (anything above 14 is not compensated extra)
M-F, 1 required weekend (no additional comp)
Split call with one other psychiatrist (pays out $280 a night)
2 NPs that only see F/Us
Southern state
Standard benefits
5 weeks PTO

My question is, if this was based on production model, would the salary come out higher? 4 new evals a day seems like a lot.

Is a production model worth negotiating? If so, what would target RVUs be for 370K? My guess is 5500?

Any advice would be appreciated.

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[BiscoDisco]

So you are discharging 4 people a day as well?

This plus 4 new evals would be a non starter for me.

 

[Psych25]

Roughly 4 patients would be split between either discharge or continued to be followed by NPs. This would keep average volume of 14 per psychiatrist

 

[Bartelby]

To clarify, do you mean that you will need to do one weekend for a month where you go in to cover the unit on both days? And when you mentioned splitting call with another psychiatrist, does that mean you are on call 50% of nights?

 

[Psych25]

To clarify, do you mean that you will need to do one weekend for a month where you go in to cover the unit on both days? And when you mentioned splitting call with another psychiatrist, does that mean you are on call 50% of nights?

Sorry, yes one weekend per month (12 per year).

Call would be split M-F between 2 docs. Weekends are separate coverage unless it is the required weekend which call would be expected.

Roughly 2-3 nights per week on call

 

[dl2dp2]

Call I’m assuming is by phone at home? Is that q2?

Salary is somewhat higher than average but this is a relatively busy job (perhaps top 20%ile in terms of volume). Not really my thing (I’d never do this job due to how busy it is), but if inpatient is your gig and you want to make 300k+ this seems reasonable. Not glaring red flags. If I were you I’d try to get rid of the q2 night calls. I don’t want to be woken up at night at home for someone wanting ambien.

 

[Bartelby]

300k is not unusual for a psychiatry role these days. Most such roles don't involve one weekend per month call + every other night phone coverage. This job pays (10-20%) better than average but works you at a level that seems much higher than average.

 

[Bartelby]

Though I guess with the phone call payments you would hit about 400k. Good pay, but still it sounds like too much work to me.

 

[Psych25]

Average of 4 new evals a day with 10 followup seems like, over a years time, should be valued at more than the 370. Especially with a weekend that is required.

Seems like a lot of work to me.

 

[BiscoDisco]

Fwiw I'm paid hourly and make roughly 10k a week for 40 hrs. Cap of 12 patients. No call. No weekends. 1099 so I can take off as much time as I want.

 

[Stagg737]

Roughly 4 patients would be split between either discharge or continued to be followed by NPs. This would keep average volume of 14 per psychiatrist

Do you have to supervise the NPs? Or is this just that you do the initial eval and then they take over care? Is this an FPA state? If you're supervising are they seeing some of those 14 patients or do they have their own census?

You said 14 is average, is there a cap? Imo if there's no production bonus you need a cap. At 4 new and 10 f/ups per day, that's ~35 wRVUs per day or 175 per week. A 48 week year comes out to 8,400 wRVU/yr, so roughly $44/wRVU with that math.

If the other doc is on vacation, who covers their census? Do you have to pick up all the overnight call for that week? At ~120 overnight call shifts per year, that's an extra $30k/yr. If you never get called that's not bad, but if you're having to put in admit orders overnight or frequently taking calls, that sounds awful.

Not the worst I've seen, but that's a lot of call and too much gray area for the amount of work you'd potentially be doing. Personally, I'd pass.

ETA: RVU calculation does NOT include wRVUs you would make on weekend call which could literally add thousands of wRVUs to that count if you're covering a 20+ bed unit with admissions.

 

[SmallBird]

Inpatient psych
Base: 370k for 14 pt average (4 new evals per day is the average based on previous few years)
Mixture of adolescent/adult
No production model (anything above 14 is not compensated extra)
M-F, 1 required weekend (no additional comp)
Split call with one other psychiatrist (pays out $280 a night)
2 NPs that only see F/Us
Southern state
Standard benefits
5 weeks PTO

My question is, if this was based on production model, would the salary come out higher? 4 new evals a day seems like a lot.

Is a production model worth negotiating? If so, what would target RVUs be for 370K? My guess is 5500?

Any advice would be appreciated.

If you bill reasonably then 14 patients a day comes to around 8000-9000 RVUs for a regular 5 days/45 weeks, and should pay more like $500k+. My prior job was 7 on 7 off all RVUs and I had 10 patients and the base was just under $400k. If you are going to not do any therapy add-ons and really rush through all these patients then I guess you might do closer to 30 RVUs a day but that's still 6800 RVUs a year which should pay around $430k at average $/rvu. What they are doing which is smart of them is giving you a high sticker $ to make this look good but for the amount of work you are doing it's not. I'd rather take a job paying $300k where you only see 7-8 patients and don't have the extra obligations either.

 

[Psych25]

Do you have to supervise the NPs? Or is this just that you do the initial eval and then they take over care? Is this an FPA state? If you're supervising are they seeing some of those 14 patients or do they have their own census?

You said 14 is average, is there a cap? Imo if there's no production bonus you need a cap. At 4 new and 10 f/ups per day, that's ~35 wRVUs per day or 175 per week. A 48 week year comes out to 8,400 wRVU/yr, so roughly $44/wRVU with that math.

If the other doc is on vacation, who covers their census? Do you have to pick up all the overnight call for that week? At ~120 overnight call shifts per year, that's an extra $30k/yr. If you never get called that's not bad, but if you're having to put in admit orders overnight or frequently taking calls, that sounds awful.

Not the worst I've seen, but that's a lot of call and too much gray area for the amount of work you'd potentially be doing. Personally, I'd pass.

Initial Eval, then the take over care. No supervision of NPs. My census would average 14. They would take any of my followups that would put me over that average and give to NPs. Ex: If there were 3 news that day, I would transfer 3 of my followups to NP.

No defined cap discussed.

They have locums also take call which is who would cover when provider takes PTO, at least what was told.

Thank you for you input!

 

[Mad Jack]

I make 40k less than that with 6 weeks PTO, 10 patients per day, every 4th weekend, 2 overnight weekday calls per month, and residents as first call in the Northeast. I feel like you're working quite hard for that 370k and the call burden is pretty rough

 

[hamstergang]

Inpatient psych
Base: 370k for 14 pt average (4 new evals per day is the average based on previous few years)

So the average LOS on this unit is 3.5 days? That seems really quick.

 

[Wheatbread]

That seems like too much work for the salary. No added $$$ for one weekend a month…yeah no. $280/night for call is essentially nothing after taxes, and 2-3 per week…that’s not sustainable imo. I would think if that job was on production model you’d make north of $500k.

 

[Stagg737]

So the average LOS on this unit is 3.5 days? That seems really quick.

OP would only be keeping 2 of their evals, the other two would go to an NP. So really only adding 2 patients to their team per day making average LOS closer to 6-7 days from the sounds of it.

I make 40k less than that with 6 weeks PTO, 10 patients per day, every 4th weekend, 2 overnight weekday calls per month, and residents as first call in the Northeast. I feel like you're working quite hard for that 370k and the call burden is pretty rough

Agree, it's a lot of work with high call burden for that pay. A somewhat similar sounding job in terms of patients and call responsibility I looked into paid $250k base but the docs were all making closer to $500k after production was added in.

Things that I think could make the job more worthwhile:
- Some kind of production bonus as this position is a lot of RVUs for a straight salary. At $60/wRVU (still below the average for psych) and using my math above, the annual income would be $530k for ~8400 wRVUs/yr. $370k salary with no production/bonus is more than a 30% hit from what should be reasonable.
- Increased pay for overnight call. I made almost that much as a resident during PGY-3/4 years covering our inpatient unit overnight on home call, $280/night is terrible unless this is truly a job where you almost never get calls overnight.
- OR no overnight call ever. From what I've seen, finding an inpatient position without overnight call is pretty rare and if someone loves inpatient then it could be worth taking a pay hit to never be on call (though this is a pretty massive pay hit).
- Pay for weekend call. Even just $1,000 per day would add almost $25k/yr to the salary, and that would still be terrible compensation for an attending covering what sounds like a 30+ (probably closer to 45-50) bed unit. Imo if you're not going to get paid cash for weekend coverage, you should be able to collect RVUs that can go toward production, but you can't do either for this job. That's a problem.

As said, $370k/yr is pretty bad considering the patient load and call burden here, even if you have the greatest support staff in the world. With the overnight call you're pay probably comes up to around $400k/yr, which is still too low.

If you want straight salary, I'd send a counter offer of $450k base and $400/overnight, which would put you around $498k/yr. If you can get that base up to $425/yr with overnight (and ideally weekend) pay it'd be more reasonable.

OR

Take a little lower base salary and ask for a production bonus. At $300k/yr and $50/wRVU after 6,000, you should hit $425k/yr easily and if weekend wRVUs are counted you could get around $500k and they'd probably still make good money off of you.

OR

Refuse to do those 2 extra evals that go to the NP teams. Imo the biggest issue with patient load is 4 new patients per day. Dropping that to 2 new patients would be a significant decrease in work burden but also total wRVUs (~2k less per year, so closer to 6,400). Keeping everything else the same, that would be about $58/wRVU, which is still below average but imo very reasonable. $370k/yr for 12 patients per day with 2 being new + $30k for overnight coverage would make this a position I'd consider.

 

[comp1]

This is ALOT of work for a fairly good chunk of pay. It's definitely not for me. I see it as a recipe for burnout right quick unless the clinical support and nursing staff (including the NPs) are truly exquisite. I don't think they are clearly taking advantage of you with the offer. I just think for ideal patient care, the facility should reduce the salaries and hire another psychiatrist. Also, why the heck aren't the NPs being used for overnight call? That's an ideal use of NPs and really a lot more appropriate than "follow-ups." I'm not even sure how that works, you design the treatment plan and the NP just sort of follows it? Who discharges the patient? Weird continuity of care.

 

[Merovinge]

So the average LOS on this unit is 3.5 days? That seems really quick.

It's because they are doing evals and then handing them off to NPs so LOS is not quite that bad. Still sounds like a grinder setup though. I think data on actual average LOS should be one of the first questions before ever considering an IP job. Places are getting shorter and shorter which increases work, increases liability, and decreases your ability to make a difference/practice safe medicine (with how rapidly meds are expected to be be titrated).

 

[Psych25]

OP would only be keeping 2 of their evals, the other two would go to an NP. So really only adding 2 patients to their team per day making average LOS closer to 6-7 days from the sounds of it.


Agree, it's a lot of work with high call burden for that pay. A somewhat similar sounding job in terms of patients and call responsibility I looked into paid $250k base but the docs were all making closer to $500k after production was added in.

Things that I think could make the job more worthwhile:
- Some kind of production bonus as this position is a lot of RVUs for a straight salary. At $60/wRVU (still below the average for psych) and using my math above, the annual income would be $530k for ~8400 wRVUs/yr. $370k salary with no production/bonus is more than a 30% hit from what should be reasonable.
- Increased pay for overnight call. I made almost that much as a resident during PGY-3/4 years covering our inpatient unit overnight on home call, $280/night is terrible unless this is truly a job where you almost never get calls overnight.
- OR no overnight call ever. From what I've seen, finding an inpatient position without overnight call is pretty rare and if someone loves inpatient then it could be worth taking a pay hit to never be on call (though this is a pretty massive pay hit).
- Pay for weekend call. Even just $1,000 per day would add almost $25k/yr to the salary, and that would still be terrible compensation for an attending covering what sounds like a 30+ (probably closer to 45-50) bed unit. Imo if you're not going to get paid cash for weekend coverage, you should be able to collect RVUs that can go toward production, but you can't do either for this job. That's a problem.

As said, $370k/yr is pretty bad considering the patient load and call burden here, even if you have the greatest support staff in the world. With the overnight call you're pay probably comes up to around $400k/yr, which is still too low.

If you want straight salary, I'd send a counter offer of $450k base and $400/overnight, which would put you around $498k/yr. If you can get that base up to $425/yr with overnight (and ideally weekend) pay it'd be more reasonable.

OR

Take a little lower base salary and ask for a production bonus. At $300k/yr and $50/wRVU after 6,000, you should hit $425k/yr easily and if weekend wRVUs are counted you could get around $500k and they'd probably still make good money off of you.

OR

Refuse to do those 2 extra evals that go to the NP teams. Imo the biggest issue with patient load is 4 new patients per day. Dropping that to 2 new patients would be a significant decrease in work burden but also total wRVUs (~2k less per year, so closer to 6,400). Keeping everything else the same, that would be about $58/wRVU, which is still below average but imo very reasonable. $370k/yr for 12 patients per day with 2 being new + $30k for overnight coverage would make this a position I'd consider.

That's extremely helpful! Thank you so much. I will see if they are willing to negotiate. It seems like a pass if not.

 

[Stagg737]

This is ALOT of work for a fairly good chunk of pay. It's definitely not for me. I see it as a recipe for burnout right quick unless the clinical support and nursing staff (including the NPs) are truly exquisite. I don't think they are clearly taking advantage of you with the offer. I just think for ideal patient care, the facility should reduce the salaries and hire another psychiatrist. Also, why the heck aren't the NPs being used for overnight call? That's an ideal use of NPs and really a lot more appropriate than "follow-ups." I'm not even sure how that works, you design the treatment plan and the NP just sort of follows it? Who discharges the patient? Weird continuity of care.

If there was extra pay for the weekend call or just no weekend call I think it would be more reasonable. However, it sounds like it's 2 psychiatrists + 2 NPs. If each psychiatrist as 12-15 patients that's 25-30 there. If the NPs are each only seeing 5 then that's covering 35-40 patients each weekend. It sounds like the NPs probably carry closer to 10 if they only see f/ups though, so you're looking at weekend coverage of what sounds like a ~50 bed unit. Unless locums is always there helping out, that's a huge patient volume (and a huge chunk of RVUs) to not be getting paid extra for. Plus the every other overnight call is just gross.

Like you said, seems like a formula for burnout, especially doing 4 new evals per day. I agree it would be better to just pay the NPs to take the extra overnight call, but if OP is in a state where a physician has to be involved with restrained patients, then physicians may have to be available anyway. Job seems like it has potential to be decent, but it is a lot of work and that call schedule sounds miserable.