Thoughts on Offer?

[throwaway99233]

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Throwaway as I know some people on here IRL. I wanted to get some thoughts on this gig. Been interviewing for first attending job and wanted thoughts on the one I am leaning towards. I would appreciate some feedback

Community hospital in the midwest. Full time inpatient on an 18 bed unit with currently 2 docs on the unit. One would be increasing their outpatient panel to accommodate my joining. They are ultimately creating the job for me as they were looking for an outpatient doc. Job would also include consults from the floor and the ER as needed. Call is optional and would pay for call at 2400 for the weekend and 400 for weekday call. I have asked if there is a patient cap and average amount of consults a day - waiting to here back on that. I presented a counter offer to increase the salary to 300k.

Salary: 275,000
CME allowance: 5k (really just salary as they give you the money up front, you don't have to submit any receipts for reimbursement) with 5 CME days
Time Off: 25 PTO for vacation/sick days
Benefits: Standard benefits with 401k 3% match
Sign on bonus: 20k

Does this sound reasonable?

 

[comp1]

It's not grossly inappropriate, but this job is going to be some work. 2.5 doctors with an 18 bed unit plus consults is a workload. It's really better if the other person does not take on an outpatient workload. So many more details to clarify. How are referrals handled? Do you get holidays? If call is optional...who is doing it when/if you aren't? What's the social work situation like? Is the unit always full? What's the length of stay? How big is the medical side of the hospital? What's involved with that weekend call? Are you seeing all 18 patients both days? Is there an internist/FP available to handle things like blood sugar and pressure? I'm not sure what you mean by a patient cap. There's 2.5 doctors. Sometimes one (OR MORE) of you are going to be on vacation...they all need a doctor regardless. The number of patients could apparently be as high as 18 plus consults and ED visits. Who is actually seeing patients that show up in the ED at 3 AM? Who is discharging some voluntary patient demanding to leave at the same time? I'm sure I'll have more questions, I adore comparing inpatient jobs.

 

[throwaway99233]

I know the answer to some things. I know I get 6 holidays. There are currently 3 docs in the call pool. I would just be put into rotation if I wanted to. I am not sure about social work or if the unit is always full. The hospital is a full service hospital so there would be a hospitalist to address medical concerns that arise.

I will ask some follow up questions about support staff and weekend/week night coverage. Thank you for your thoughtful response. These are all helpful questions to ask.

 

[hebel]

I personally wouldn't like the ED/CL consult aspect of the job. Makes things too unpredictable unless the consult volume is low or there is a smart system to divide them up. I don't think it would be inappropriate for you to be looking for at least 300k, unless it's a super desirable Midwest city.

Overall it's fine. Not great and not bad. Like the other poster said, I would get as much detail as possible about the call and consult coverage, as those could turn this into a bad job.

 

[throwaway99233]

Thanks for the reply. One of the current docs said that consults can range from usually 0-6 a day with the average being around 2-3. I’m going to ask if that is usually divided up evenly.

I don’t like the consult aspect either, but pretty much every inpatient job I have been looking at has that component except for a free standing psych hospital and an academic hospital with a a dedicated consult service

 

[clozareal]

Looks reasonable to me. What do the hours and days look like? Do they expect you to do any outpatient work? How are they going to split up those 18 patients? If it was an even 6 each + 2-4 consults, that sounds pretty reasonable.

 

[Psych19]

- Base is not bad at 275k for no holidays, no weekends, and no call.
- Signing bonus depends on the length of the initial contract. 20k might be okay for 1-2 years commitment, it's kinda low for 3+ years.
- You need to clarify cross-coverage--who's covering for you and who are you covering for when vacations occur. How bad can that get?
- Hospitals are often reluctant to apply hard patient caps in a contract. That said, an inpatient gig should have guardrails. What happens if the other docs leave? Are you stuck covering a whole unit? What if they decide you're not productive enough and decide to increase your share of the workload? A productivity bonus for RVUs above a threshold (RVUs billed, not RVUs collected) can sometimes be the best way to protect yourself.
- 400/day for weekday call is decent
- 2400/weekend is low if you're expected to hold the pager all weekend, and round on the entire unit, and cover all consults. That would be a busy weekend. If you're not planning to pick up any weekends, then maybe you don't care. 2400/weekend might be okay as a base rate if you're also paid an RVU bonus annually and RVUs from the weekend can count towards this.
- You should try to understand the current call coverage and relevant players in this as best as possible, even if you don't intend to participate. You don't want to be cleaning up the mess every Monday morning if you've got poor colleagues.

 

[futuredo32]

275 is great compared to jobs in Metro Detroit. I guess it's really location dependent

 

[throwaway99233]

Looks reasonable to me. What do the hours and days look like? Do they expect you to do any outpatient work? How are they going to split up those 18 patients? If it was an even 6 each + 2-4 consults, that sounds pretty reasonable.

No outpatient for me. The hours and days seem reasonable. I asked about getting out by like 5 and they said they would work with me to make that happen. I’m waiting to hear back about the split.

 

[throwaway99233]

- Base is not bad at 275k for no holidays, no weekends, and no call.
- Signing bonus depends on the length of the initial contract. 20k might be okay for 1-2 years commitment, it's kinda low for 3+ years.
- You need to clarify cross-coverage--who's covering for you and who are you covering for when vacations occur. How bad can that get?
- Hospitals are often reluctant to apply hard patient caps in a contract. That said, an inpatient gig should have guardrails. What happens if the other docs leave? Are you stuck covering a whole unit? What if they decide you're not productive enough and decide to increase your share of the workload? A productivity bonus for RVUs above a threshold (RVUs billed, not RVUs collected) can sometimes be the best way to protect yourself.
- 400/day for weekday call is decent
- 2400/weekend is low if you're expected to hold the pager all weekend, and round on the entire unit, and cover all consults. That would be a busy weekend. If you're not planning to pick up any weekends, then maybe you don't care. 2400/weekend might be okay as a base rate if you're also paid an RVU bonus annually and RVUs from the weekend can count towards this.
- You should try to understand the current call coverage and relevant players in this as best as possible, even if you don't intend to participate. You don't want to be cleaning up the mess every Monday morning if you've got poor colleagues.

the current contract is for 3 years. This is me assuming, but I would think things would operate how they are currently if I am on vacation since they are adding me in. I think in terms of how bad - I have a sneaking suspicion that when one of the current docs take vacation the other one is rounding on the entire unit. I am also trying to get clarity on weekend coverage as I imagine that is also the entire unit, which I don't like. If that is the case, I think that warrants increase call pay and/or RVU based pay. I'm definitely going to do some weekend call so it is important to figure it out. There is not currently a productivity bonus, I did ask about that. Thanks for the great questions for me to take back to them.

 

[TexasPhysician]

No outpatient for me. The hours and days seem reasonable. I asked about getting out by like 5 and they said they would work with me to make that happen. I’m waiting to hear back about the split.

Their working with you to get out by 5pm will be helping you “increase efficiency” to get your volume reached by 5pm. The solution is to put caps on inpatient. Managing 6 consults in a day is significant. If you don’t have caps on admissions and total patients on inpatient, you could be there 12 hours.

 

[Marasmus1]

I am also interviewing with my first CAP attending job in midwest.

Let`s assume that they are splitting the patient load evenly between three attendings (which I highly doubt) and the other attendings also have minimum 25 PTO each (if not more).

They will unlikely to let more than one attending take off so you are probably looking minimum 10 weeks of 9 inpatients 2-3 consults. If you dont have a resident and depending on the complexity of the consults, this is minimum 10 hours of work for good patient care.
'
Also to me, it does not make sense how this gig comes without some mandatory calls. who covers the overnight from 5 pm to 8 am once you leave? Also weekends I assume they have moonlighters? I have seen some moonlighters literally putting note without seeing patients which means you may be looking for a significant mess on Monday`s.

Also I hate most of the gigs include sick days in overall PTO. I would like them separate.

 

[Merovinge]

Thanks for the reply. One of the current docs said that consults can range from usually 0-6 a day with the average being around 2-3. I’m going to ask if that is usually divided up evenly.

I don’t like the consult aspect either, but pretty much every inpatient job I have been looking at has that component except for a free standing psych hospital and an academic hospital with a a dedicated consult service

So if you average 3 consults/day plus follow-ups this can really push up your overall census, I would be surprised if the doc doing outpatient would be splitting these with you. There's nothing like multiple acute consults in the ED, med-surg floor while having your own unit to run. This is definitely going to be a significant chunk of your day so it is not something you are interested in I would look much more closely at places that do not have consult/ED requirements (there's plenty of freestanding psych hospitals and rare cases of community hospitals that split this work off to OP or C/L docs).

 

[FlowRate]

Salary: 275,000
CME allowance: 5k (really just salary as they give you the money up front, you don't have to submit any receipts for reimbursement) with 5 CME days
Time Off: 25 PTO for vacation/sick days
Benefits: Standard benefits with 401k 3% match
Sign on bonus: 20k

Edit: decided to remove the specific details. The takeaway is that I think every single part of the offer could/should be improved (roughly by 20-30%). And I'm not a fan of mixing PTO and sick days and it's a low amount especially due to the mix.

 

[hamstergang]

Also I hate most of the gigs include sick days in overall PTO. I would like them separate.

I much prefer to just have one pot of days off. Why does it matter to my employer why I'm taking off at any given time? I plan some days in advance, and if I need a last minute emergency I can do that too. This avoids me having leftover sick days at the end of the year.

 

[comp1]

So the why as to having separate vacation and sick days is that the employer wants to theoretically reduce unscheduled absences while still demonstrating the safety measures involved with offering sick leave. I agree it's not the greatest on the employee side, but it's certainly common, probably more so than not.

 

[the5thelement]

6 consults + inpatient work sounds like busy work. They will work you to the bone.
A friend of mine does only consults and sees 2-3 consults /day max (for the same salary)

 

[throwaway99233]

Their working with you to get out by 5pm will be helping you “increase efficiency” to get your volume reached by 5pm. The solution is to put caps on inpatient. Managing 6 consults in a day is significant. If you don’t have caps on admissions and total patients on inpatient, you could be there 12 hours.

I agree wholeheartedly. Based on the conversation I just had, they can definitely work me like a dog. I know that's not their intention as they seem like nice people. However, I do worry when people go on vacation my workload will increase significantly. What would be a hard cap for you in terms of patient load? Would you increase it over time as you get use to the job? I think the most I have seen in a day was like 12 and I was quite busy and really didn't do anything in terms of true patient care as it was weekend rounding.

 

[throwaway99233]

I am also interviewing with my first CAP attending job in midwest.

Let`s assume that they are splitting the patient load evenly between three attendings (which I highly doubt) and the other attendings also have minimum 25 PTO each (if not more).

They will unlikely to let more than one attending take off so you are probably looking minimum 10 weeks of 9 inpatients 2-3 consults. If you dont have a resident and depending on the complexity of the consults, this is minimum 10 hours of work for good patient care.
'
Also to me, it does not make sense how this gig comes without some mandatory calls. who covers the overnight from 5 pm to 8 am once you leave? Also weekends I assume they have moonlighters? I have seen some moonlighters literally putting note without seeing patients which means you may be looking for a significant mess on Monday`s.

Also I hate most of the gigs include sick days in overall PTO. I would like them separate.

My understanding is that the unit would not be split amongst the 3 of us. It really split between 2 of us, with the 3rd helping out PRN. I am worried when the primary doc goes on vacation, I would be responsible for the entire unit and consults, which can be quite a lot. There isn't a psych resident at all. There is occasionally a family medicine resident so not super helpful as this isn't their wheelhouse.

So right now, the other docs and the moonlighter covers the unit overnight and the weekend. I agree moonlighters can definitely vary, but if they are follow repeat patients the docs leave me a pretty detailed plan to follow. I would be concerned about the new admissions that come in and they don't really do anything for them.

I initially wanted the sick days and vacation days split as well, but then I read a post on here about keeping them together which means I could take 5 weeks of vacation ultimately if I don't call in sick vs having only 4 weeks and then not using the other 5 days I have. I like that idea because I generally don't take sick days.

 

[throwaway99233]

So if you average 3 consults/day plus follow-ups this can really push up your overall census, I would be surprised if the doc doing outpatient would be splitting these with you. There's nothing like multiple acute consults in the ED, med-surg floor while having your own unit to run. This is definitely going to be a significant chunk of your day so it is not something you are interested in I would look much more closely at places that do not have consult/ED requirements (there's plenty of freestanding psych hospitals and rare cases of community hospitals that split this work off to OP or C/L docs).

I would like to talk to the primary doc to get better clarity on how we would split the workload as I am definitely concerned it would all primarily fall on me. There are limited places that I have interviewed that don't have the consult component unfortunately. There is a freestanding hospital that I am waiting to hear back from, but I worry about medical emergencies as a fresh grad, like I only know how to run a code in the context of ACLS training. Should that not be a huge concern? The freestanding hospital has stated they take care to do good screenings of patients they accept, but nothing is fail proof.

 

[mistafab]

I am a PGY2 but your job offer sounds awful. Why on earth should you do two jobs for the cost of one? Inpatient is a job. Consults is a job. If they want both then ask for double pay.

 

[throwaway99233]

Edit: decided to remove the specific details. The takeaway is that I think every single part of the offer could/should be improved (roughly by 20-30%). And I'm not a fan of mixing PTO and sick days and it's a low amount especially due to the mix.

How do I ask about an increase? I feel I don't have a lot of leverage without a competing offer and/or experience. Which parts would you improve? I did reach out to the recruiter today to raise concerns about the workload and therefore asking about increased compensation

 

[throwaway99233]

6 consults + inpatient work sounds like busy work. They will work you to the bone.
A friend of mine does only consults and sees 2-3 consults /day max (for the same salary)

wow! Are they at a community hospital? I just don't think this hospital has the volume to hire a full time consult doc, which is why it falls on other providers to cover the consults. My current program has a dedicated consult service so the inpatient docs don't cover consults at all.

 

[throwaway99233]

I am a PGY2 but your job offer sounds awful. Why on earth should you do two jobs for the cost of one? Inpatient is a job. Consults is a job. If they want both then ask for double pay.

HA! Definitely can't swing that. It must be a location thing as like I said the other places that I am interviewing are offering pretty much the same thing for less pay. This offer, which is why it's in the running, at least gives additional pay for call and a higher sign on bonus. The other places expect consults to be seen and weekend rounding is required all for less. The other place I am considering is only offering 265k with 10k sign on bonus with the expectation to see at least ~11 patients on the unit plus ED/floor consults with about 1:4 weekend call.

 

[FlowRate]

How do I ask about an increase? I feel I don't have a lot of leverage without a competing offer and/or experience. Which parts would you improve? I did reach out to the recruiter today to raise concerns about the workload and therefore asking about increased compensation

Your leverage is that you're a psychiatrist. We're in high demand. Are all of these jobs through a recruiter? That's likely your issue. They're taking a huge cut off the top to try and sell you jobs no one wants.

Is there a reason you're tied to this specific area? Prefer inpatient? Are you in a time crunch (no emergency fund)? Why did you go with a recruiter?

You can get 10-20% more of everything in their offer from a much easier full time employed outpatient job.

 

[throwaway99233]

Your leverage is that you're a psychiatrist. We're in high demand. Are all of these jobs through a recruiter? That's likely your issue. They're taking a huge cut off the top to try and sell you jobs no one wants.

Is there a reason you're tied to this specific area? Prefer inpatient? Are you in a time crunch (no emergency fund)? Why did you go with a recruiter?

You can get 10-20% more of everything in their offer from a much easier full time employed outpatient job.

I need your confidence! Actually, none of them are through recruiters necessarily. I cold e-mailed places so working with the in house recruiters of the hospitals. We have family in the area so we are tied here for at least the next few years. I do prefer inpatient so looking at just those jobs. There is no time crunch really, but I have reached out to pretty much all local hospitals.

I am just not a fan out outpatient work. :/

 

[hallowmann]

You need to be paid more or have caps. I know people making $325-$350k in the midwest with that kind of work. They really are getting at least 1.5 docs for the price of 1. You have a lot of reasons to be tied to the area, so you might settle for less, but honestly I would push for those things (caps on admissions, having the PRN doc cover consults, or being paid more either base or a bonus for every consult).

 

[throwaway99233]

You need to be paid more or have caps. I know people making $325-$350k in the midwest with that kind of work. They really are getting at least 1.5 docs for the price of 1. You have a lot of reasons to be tied to the area, so you might settle for less, but honestly I would push for those things (caps on admissions, having the PRN doc cover consults, or being paid more either base or a bonus for every consult).

Thanks for the feedback. I will see what they say. My partner is worried I’m pushing/rocking the boat and the hospital will rescind the offer. I’m hoping to put a cap on the number of patients I cover at the bare minimum on the unit especially if I have to do 6 consults a day

 

[Bartelby]

I think a key question is whether you are okay with what is being offered. If not, rocking the boat sounds worth it. You mentioned there will be two full-time inpatient psychiatrists (including you) for an 18-bed unit, with an unclear (though likely minimal) amount of coverage from a third psychiatrist who is going to outpatient. You will also get 0-6 consults per day for your two-person team.

On a normal day, that probably means around eight inpatients, two or three new consults, and an unclear number of followups on old consults (maybe three to six per day? who knows).

On times when the other inpatient psychiatrist is out you will cover up to eighteen inpatients and up to six new consults per day, plus the entire consult followup list. Not as a covering / weekend psychiatrist, but as the person with primary responsibility.

Will you have meaningful help with that? For example, a psychologist on your inpatient team who handles most of the notes, social workers for inpatient and C-L who can do a lot of the followup and scut work, etc.? If the system is not set up to keep you moving efficiently through your workload I think you could easily end up staying late just about every day. As others have mentioned, you may really be signing up for 1.5 FTEs for the price of one. You have to decide whether that is tolerable based on where you are in life. For example, if you don't have any kids and your partner is fine with your coming home late every day, it might work. If you have to do daycare pickup, I would be nervous taking this job. You also have to decide if it is worth taking the job with seemingly bad terms and just seeing how it goes / how you can shape it once there. That might be reasonable if you are really tied to that area and the offerings are all poor.

For me, I think I would opt for a standard outpatient job over the dual role you are describing. You never know though, maybe you will get there and find things are more manageable than they sound based on this brief description.

 

[psych_0]

Throwaway as I know some people on here IRL. I wanted to get some thoughts on this gig. Been interviewing for first attending job and wanted thoughts on the one I am leaning towards. I would appreciate some feedback

Community hospital in the midwest. Full time inpatient on an 18 bed unit with currently 2 docs on the unit. One would be increasing their outpatient panel to accommodate my joining. They are ultimately creating the job for me as they were looking for an outpatient doc. Job would also include consults from the floor and the ER as needed. Call is optional and would pay for call at 2400 for the weekend and 400 for weekday call. I have asked if there is a patient cap and average amount of consults a day - waiting to here back on that. I presented a counter offer to increase the salary to 300k.

Salary: 275,000
CME allowance: 5k (really just salary as they give you the money up front, you don't have to submit any receipts for reimbursement) with 5 CME days
Time Off: 25 PTO for vacation/sick days
Benefits: Standard benefits with 401k 3% match
Sign on bonus: 20k

Does this sound reasonable?

Salary seems fair for the job you're signing up for. 6 patients per day plus 1-2 consults is the least I've ever seen for a community hospital job. And you don't have to do weekend or week night call unless you want to?!? I have never heard of a job this easy tbh.

Lots of people here talking about consult follow-ups. If you don't want to see follow-ups, don't see follow-ups. It is far from required, especially if it is a simple case. Someone agitated in and out of restraints all day, ok see them more than once. But I would not feel obligated to see every consult more than once. I would make that the exception, not the rule.

"OMG what about when the other two doctors are both on vacation?!?" It's 18 beds. That is really not that many. Plus, didn't you say there are moonlighters that rotate in and out of there on the weekend? Admin can find one of them to help if you wanted. If you don't think you can see 18 pts/day + consults on those rare days where you're alone, then don't see consults. Or just filter them and only see emergent ones.

CME, PTO, Sign-on, benefits all seem standard but it's nice you don't have to submit receipts for reimbursement (I've never seen that).

My biggest two issues with this job:
- There is no wRVU bonus structure. If none of the other two doctors have it, they're likely not going to give it to you, but it's just a big downfall imo because most every other inpatient job I've seen has an wRVU bonus incentive. This makes those 18 pts/day days sting much less.
- $2400/weekend is a joke. If you want to work on a weekend and actually get paid, find a moonlighting gig that has a better handle on compensation averages. At my hospital we pay moonlighters >$2200/day. Extra $350 for phone-call that ends at 11pm.

Maybe I'm jaded but I'm just in shock anyone would pay you $275,000 to see between 6-9 patients per day.

 

[nexus73]

For 8–12 patients a day this may be a better RVU setup especially if you can get a rate at the top end like $70-80 per RVU. And if they won’t hassle you for billing occasional therapy add ons or extended service codes you get paid for the extra work you do. If weekend call is optional you could just ask for a small stipend, like an extra $400 on top of the regular call rate plus get the RVUs generated. If there’s a weekday with only one doc I’d probably want to have hospital agree that any off unit work is either done by the outpatient doc or it just has to wait or doesn’t get done due to short staffing. If you actually see all 18 patients in a day you’d probably be making $2500 or more off the RVUs. You have to make sure you know the coding rules to make this work or you may under code and not get paid for your actual work. A job like this where you only work weekends if you want to sounds very good to me. But I think the RVU route may be better assuming they keep the unit near capacity most of the time.

 

[FlowRate]

I need your confidence! Actually, none of them are through recruiters necessarily. I cold e-mailed places so working with the in house recruiters of the hospitals. We have family in the area so we are tied here for at least the next few years. I do prefer inpatient so looking at just those jobs. There is no time crunch really, but I have reached out to pretty much all local hospitals.

I am just not a fan out outpatient work. :/

Gotcha, internal recruiters. My bad for the wrong assumption!

Sounds like you have limited BATNA. May want to play a few of the hospitals off of each other like you mentioned already. Rocking the boat only matters if you are absolutely 100% against the alternative of doing outpatient work (because if outpatient is completely untenable then you do need to keep at least one inpatient offer on the table.)

Edit: I should add it's less confidence and more that I know such jobs exist.

 

[MedMan80]

The coverage is the one issue that strikes me here, as mentioned your vacation time options may be limited, with more senior docs taking the better days potentially. I would be much more comfortable with more NP availability to fill in the gaps, otherwise you will be pulled a lot and have to cover frequently which can lead to burnout.

Will also add that potentially seeing 18 patients yourself plus floor/ER consults per day on a weekend is easily a 8-10hr day and that 1200/day sounds low for that (120/hr), not including being woken up at night by calls.

 

[throwaway99233]

I think a key question is whether you are okay with what is being offered. If not, rocking the boat sounds worth it. You mentioned there will be two full-time inpatient psychiatrists (including you) for an 18-bed unit, with an unclear (though likely minimal) amount of coverage from a third psychiatrist who is going to outpatient. You will also get 0-6 consults per day for your two-person team.

On a normal day, that probably means around eight inpatients, two or three new consults, and an unclear number of followups on old consults (maybe three to six per day? who knows).

On times when the other inpatient psychiatrist is out you will cover up to eighteen inpatients and up to six new consults per day, plus the entire consult followup list. Not as a covering / weekend psychiatrist, but as the person with primary responsibility.

Will you have meaningful help with that? For example, a psychologist on your inpatient team who handles most of the notes, social workers for inpatient and C-L who can do a lot of the followup and scut work, etc.? If the system is not set up to keep you moving efficiently through your workload I think you could easily end up staying late just about every day. As others have mentioned, you may really be signing up for 1.5 FTEs for the price of one. You have to decide whether that is tolerable based on where you are in life. For example, if you don't have any kids and your partner is fine with your coming home late every day, it might work. If you have to do daycare pickup, I would be nervous taking this job. You also have to decide if it is worth taking the job with seemingly bad terms and just seeing how it goes / how you can shape it once there. That might be reasonable if you are really tied to that area and the offerings are all poor.

For me, I think I would opt for a standard outpatient job over the dual role you are describing. You never know though, maybe you will get there and find things are more manageable than they sound based on this brief description.

I think initially and how it was presented I was okay with it. The current inpatient doc says its really not that busy. I think the current census is 15 patients. I have carried up to 12 on a weekend, but again no real changes were being made at that time. I imagine during the day with team meetings and longer patient interviews that will take up a significant amount of my time. I think I would be okay with if I could primarily manage the unit and the other doc who will be increasing his outpatient time help with some of the consults. I plan to talk with him hopefully to get some clarity.

I definitely have a family and have to do daycare pick up which I brought up and they said that shouldn't be a problem. There are 2 social workers on the unit who can help with some of the other work throughout the day.

I am probably overthinking it at this point and should just make a decision. I am still waiting to hear back from the recruiter about my counter offer.

 

[throwaway99233]

For 8–12 patients a day this may be a better RVU setup especially if you can get a rate at the top end like $70-80 per RVU. And if they won’t hassle you for billing occasional therapy add ons or extended service codes you get paid for the extra work you do. If weekend call is optional you could just ask for a small stipend, like an extra $400 on top of the regular call rate plus get the RVUs generated. If there’s a weekday with only one doc I’d probably want to have hospital agree that any off unit work is either done by the outpatient doc or it just has to wait or doesn’t get done due to short staffing. If you actually see all 18 patients in a day you’d probably be making $2500 or more off the RVUs. You have to make sure you know the coding rules to make this work or you may under code and not get paid for your actual work. A job like this where you only work weekends if you want to sounds very good to me. But I think the RVU route may be better assuming they keep the unit near capacity most of the time.

I did ask about a RVU set up at least for the weekend. I currently moonlight at another hospital and its 60 per RVU and I would make much more than the 2400 they are currently offering. I am waiting to hear back

 

[throwaway99233]

The other job Im considering I just got some more details about is as follows:
salary: 300k
CME: 4k
time off: 4 weeks with 6 holidays (includes sick time)
didn't mention a sign on bonus --> hoping once I get a formal offer there is talk of this
benefits - standard with a 403b match
free standing psych hospital so no consults, patient cap of 11, 1:4 weekend call, part of a residency program so will carry patients with residents, social worker per each unit, has a hospitalist on staff to manage any medical issues that may come up

Each job has its pro/cons and I ultimately think both will work as my first job out of residency. Just not sure how to decide between the two.

 

[Bartelby]

That second one sounds better at first glance, mostly because it is comparable to the first one minus the consults and with resident help (which can be a plus and minus honestly).

 

[throwaway99233]

That second one sounds better at first glance, mostly because it is comparable to the first one minus the consults and with resident help (which can be a plus and minus honestly).

That's what I was thinking as well. I really don't like consults so that would be a sacrifice if I took the other one. Ahhh!! I know I am overthinking it and it really shouldn't be this hard to decide. Worse case, I don't like the job and find another one

 

[comp1]

It's really quite common to combine inpatient with consult work, particularly in a salaried job with set work hours. They are both highly variable in complexity and frequency. I understand at large academic hospitals there may be several FTEs of consultants, but this is...rare at community hospitals. I would argue at most community hospitals, there are not enough consults for a single FTE.

 

[hamstergang]

Ahhh!! I know I am overthinking it and it really shouldn't be this hard to decide.

Just turn down both jobs and then you don't have to decide.

 

[Merovinge]

The other job Im considering I just got some more details about is as follows:
salary: 300k
CME: 4k
time off: 4 weeks with 6 holidays (includes sick time)
didn't mention a sign on bonus --> hoping once I get a formal offer there is talk of this
benefits - standard with a 403b match
free standing psych hospital so no consults, patient cap of 11, 1:4 weekend call, part of a residency program so will carry patients with residents, social worker per each unit, has a hospitalist on staff to manage any medical issues that may come up

Each job has its pro/cons and I ultimately think both will work as my first job out of residency. Just not sure how to decide between the two.

How much rounding is required on the weekend? Do you need to cover a large number of patients? New admits? Other than call this sounds like a much better setup, less craziness associated w/ CL and ED.

 

[dl2dp2]

Lol, one of the recruiters just told me that a state facility is willing to pay 35k (yes you read correctly) for a weekend for an adult+adolescent unit. I'm not child-boarded, so not touching that, but they aren't even requiring a child-boarded person.

Someone I know received a recruiter call to see 7 patients a day for outpatient for 45k a month.

My opinion is both of the counters are still low. Bring it up to 350k base. Know your value guys... the market is going crazy right now, especially if you have geographical flexibility. If you don't take the job facilities are looking at a 6-12 month vacancy MINIMUM. Maybe they are willing to wait. I think if you do pure locum right now you can fashion a radiology style job in this field (i.e. 16-week vacation for ~500k). I suspect this environment won't last--the number of residency spots are increasing bigly and mostly in high need areas from local monopoloy healthcare systems, which in about 5 years will start to put a clamp on locum rates.

 

[throwaway99233]

How much rounding is required on the weekend? Do you need to cover a large number of patients? New admits? Other than call this sounds like a much better setup, less craziness associated w/ CL and ED.

Looks like it’s about 20 patients on the weekend with residents covering about half of those. There may be new admits but resident would take and staff.

 

[mistafab]

Second job sounds way better day to day. The one weekend would suck, but on actual work days if residents are doing most the work, you get to focus on being a doctor and teaching people - rather than being in a meat grinder.

 

[throwaway99233]

The final tug. The first offer the current doc got back to me and basically said I would handle the unit and he would cover consults and outpatient. However, he didn’t say this would be for the full 3 years. He states the unit is rarely full. He said he is worried that I will get bored and anticipates I would finish by work by 2-3. He says it’s just not a lot of work. Idk maybe he is very efficient ¯\_(ツ)_/¯ my brain can’t compute how that’s possible

 

[TexasPhysician]

Lol, one of the recruiters just told me that a state facility is willing to pay 35k (yes you read correctly) for a weekend for an adult+adolescent unit. I'm not child-boarded, so not touching that, but they aren't even requiring a child-boarded person.

Someone I know received a recruiter call to see 7 patients a day for outpatient for 45k a month.

My opinion is both of the counters are still low. Bring it up to 350k base. Know your value guys... the market is going crazy right now, especially if you have geographical flexibility. If you don't take the job facilities are looking at a 6-12 month vacancy MINIMUM. Maybe they are willing to wait. I think if you do pure locum right now you can fashion a radiology style job in this field (i.e. 16-week vacation for ~500k). I suspect this environment won't last--the number of residency spots are increasing bigly and mostly in high need areas from local monopoloy healthcare systems, which in about 5 years will start to put a clamp on locum rates.

Please DM me all weekend rounding jobs paying $35k/weekend.

 

[hebel]

Lol, one of the recruiters just told me that a state facility is willing to pay 35k (yes you read correctly) for a weekend for an adult+adolescent unit. I'm not child-boarded, so not touching that, but they aren't even requiring a child-boarded person.

Someone I know received a recruiter call to see 7 patients a day for outpatient for 45k a month.

My opinion is both of the counters are still low. Bring it up to 350k base. Know your value guys... the market is going crazy right now, especially if you have geographical flexibility. If you don't take the job facilities are looking at a 6-12 month vacancy MINIMUM. Maybe they are willing to wait. I think if you do pure locum right now you can fashion a radiology style job in this field (i.e. 16-week vacation for ~500k). I suspect this environment won't last--the number of residency spots are increasing bigly and mostly in high need areas from local monopoloy healthcare systems, which in about 5 years will start to put a clamp on locum rates.

Yeah, gotta keep up with inflation OP.

 

[calvnandhobbs68]

Lol, one of the recruiters just told me that a state facility is willing to pay 35k (yes you read correctly) for a weekend for an adult+adolescent unit. I'm not child-boarded, so not touching that, but they aren't even requiring a child-boarded person.

You sure it isn't 3.5K? I actually don't understand this, most "state facilities" don't even really NEED someone to truly round on the weekends. So why would they need to pay someone more than you'd pay an orthopedic surgeon for weekend coverage. Feel like this is made up either from the facility side or recruiter side or something.

The other one doesn't sound real either. So they'd be paying you (which would mean they must be collecting more than this) $321 per patient encounter? Maybe he's mixing it up with 7 HOURS per day outpatient. Again, I'd believe these when I see the actual details, otherwise it's just recruiter spam trying to hook you. "7 patients a day...with every weekend coverage for the local inpatient unit/ER".

 

[psych_0]

The final tug. The first offer the current doc got back to me and basically said I would handle the unit and he would cover consults and outpatient. However, he didn’t say this would be for the full 3 years. He states the unit is rarely full. He said he is worried that I will get bored and anticipates I would finish by work by 2-3. He says it’s just not a lot of work. Idk maybe he is very efficient ¯\_(ツ)_/¯ my brain can’t compute how that’s possible

I'm sorry this thread is insane to me lol.

I work strictly inpatient (with a rare consult shift here and there) so I'll say it. If you can't see 6-8 inpatients and be done by 2pm, you're going to drown in the real world. I think in another comment you said you have a few SW on your unit too. SW does all of your collateral after residency unless family request to speak with you. That means you see your patients, write your notes then go home and enjoy your free time.

For instance, today I saw 3 people who would not speak any words to me (one catatonic, two just wanting to detox from meth and to be left alone). One guy was there for run of the mill alcohol detox. One patient is demented and awaiting placement back at an ALF when we find him one. Another one is depressed. I talked to the depressed one for like 10 min and the others probably in 15 min total, probably less. This is common in inpatient psych. If you're looking to spend 30-45 min with each patient and do therapy, look for outpatient jobs.

I see less patients at my current job (12-14/day) than at every other job I interviewed at. In my area, I would estimate 15-22/day is the norm. And a lot of those docs also do ECT in the morning M/W/F. I don't do ECT because 2.5 wRVU (and the associated liability) isn't worth me waking up earlier than 5am to get to work.

 

[comp1]

I can understand the other attending worrying about you getting bored. On days when all MDs are there, it's possible. I haven't heard yet what the length of stay is. If it's quite long...patient interactions are going to be very, very brief. The trick of this is what things are like when the other attendings are away, as will often be the case with the leave involved. Regularly handling 15 patients a day is honestly quite a lot and unless that is some sort of forensic setting where they are all just live there for years, I would avoid that. 18 for intermittent coverage during vacations is possible, at least as long as some of these are long term boarders. If someone is doing 22...it's an unusual setting in some way or possibly the staff support is simply award worthy. Maybe you could do 22 with several residents under you, that I've seen.