Thoughts on Offer?

[throwaway99233]

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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.

No I agree 6-8 patients a day is completely manageable. It would be more like 15 a day plus consults. The unit is really managed currently by one primary doc and then an outpatient doc who helps out here and there. The current inpatient doc would increase his outpatient load if I joined. I’m just concerned about that patient load fresh out of residency. However the doc seems to think it is totally doable.

 

[throwaway99233]

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.

Realistically it’s only one MD. The other doc really only helps out periodically. If I joined I would be the main inpatient attending and the other doc would pick up more outpatient work. The average length of stay is about a week. It really will be consistently seeing a larger amount of patients plus the consults. Current doc says he has about 2-3 consult follow ups. This particular job has basically no residents. There is a family medicine resident but again they’re not psych

 

[deleted1100659]

My advice is to you is run. I personally think this offer is crap. They will likely use you to their full extent. The inpatient side seems very reasonable, but now you’re doing floor and er consults? What if you have to see that consult pt multiple times? You could easily snowball and have a a difficult unit population and difficult er and cl population. They want you to basically do 3 jobs for a salary that isn’t that great.

I have been in the job search for 3 months or so, currently in talks with one place, but I’ve had two offers already for over 300k in good locations that were way less work than what you describe

 

[nrmp]

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.

This is the best reply to your question. Job looks very unpredictable with no details on calls!

 

[dl2dp2]

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".

Maybe, but these are the numbers that are being thrown around. Given that they aren't relevant to me I didn't ask second questions.

However, I do know that certain EAPs and similar programs pay much more than $300 per encounter pre-covid. That job could be one of those.

All of that having been said, in the private cash world I'm operating I can tell you when I get an inquiry people aren't blinking about my *dramatically* increased intake fees. Inflation is for sure real. But this is only tangentially relevant.

 

[throwaway99233]

My advice is to you is run. I personally think this offer is crap. They will likely use you to their full extent. The inpatient side seems very reasonable, but now you’re doing floor and er consults? What if you have to see that consult pt multiple times? You could easily snowball and have a a difficult unit population and difficult er and cl population. They want you to basically do 3 jobs for a salary that isn’t that great.

I have been in the job search for 3 months or so, currently in talks with one place, but I’ve had two offers already for over 300k in good locations that were way less work than what you describe

I agree. On paper, it sounds horrible and definitely makes me nervous. The current attending makes it seem easy peasy, but then again he has been practicing for 25+ years. Im hoping to hear back from the recruiter with their counter offer because I don't know, in my gut it is telling me it won't really be that bad. Probably naïve thinking on my part

 

[deleted1100659]

I agree. On paper, it sounds horrible and definitely makes me nervous. The current attending makes it seem easy peasy, but then again he has been practicing for 25+ years. Im hoping to hear back from the recruiter with their counter offer because I don't know, in my gut it is telling me it won't really be that bad. Probably naïve thinking on my part

Unless the area you're looking in is very specific and you're on a time crunch I would advise you to consider multiple offers.

I took a job (first attending job) at my current facility due to location is where I needed to be due to going through a crappy divorce at the time and I did enjoy helping patients in community psychiatry. They sold it to me as not being too bad, sure supervise a couple NPs no big deal, plenty of time for patient care . Im sitting here as they try to stick a 6th np with me, absolutely miserable, poor sleep, hating every day im here. **** leadership coupled with them wanting to have as many midlevels under me as possible and filling my schedule to the brim with high acuity patients and basically no info in the EMR half the time. Being forced to be the gateway for all these controlled prescriptions..yeah, **** job. But on a positive note, they're getting my letter of resignation next week.

The current attending may not be the most reliable source of info. Ask questions, dont be afraid to scare them off. Ask very, specific questions. And then make sure those numbers are in a contract. If you have any doubt at all, then you want to agree on all the numbers and facts before you say yes. Even its just a year of your life, one year feels like a long time if it sucks. Listen to your gut, but also listen to logic. If the numbers don't make sense, then they don't make sense. Its easy to manage three areas of a hospital simultaneously if someone does all 3 poorly.

At a very least, why take a very average salary and have to work in multiple diff settings. You are worth more to them, then they are to you, because there are many of them, but very few of you.

 

[Merovinge]

I took a job (first attending job) at my current facility due to location is where I needed to be due to going through a crappy divorce at the time and I did enjoy helping patients in community psychiatry. They sold it to me as not being too bad, sure supervise a couple NPs no big deal, plenty of time for patient care . Im sitting here as they try to stick a 6th np with me, absolutely miserable, poor sleep, hating every day im here. **** leadership coupled with them wanting to have as many midlevels under me as possible and filling my schedule to the brim with high acuity patients and basically no info in the EMR half the time. Being forced to be the gateway for all these controlled prescriptions..yeah, **** job. But on a positive note, they're getting my letter of resignation next week.

Awesome that you get to share this experience with others to help them out. Sublimate/altruism this experience and become a mentor for young attendings (that's what I did at least after my last s#$%$ job). Also, celebrate after that letter of resignation hits em!

 

[michiganpsych08]

I am also considering various job opportunities. You have to ask yourself what is important to you. One thing I see between these 2 jobs is consults vs no consults. Is that a make or break for you?

 

[throwaway99233]

Unless the area you're looking in is very specific and you're on a time crunch I would advise you to consider multiple offers.

I took a job (first attending job) at my current facility due to location is where I needed to be due to going through a crappy divorce at the time and I did enjoy helping patients in community psychiatry. They sold it to me as not being too bad, sure supervise a couple NPs no big deal, plenty of time for patient care . Im sitting here as they try to stick a 6th np with me, absolutely miserable, poor sleep, hating every day im here. **** leadership coupled with them wanting to have as many midlevels under me as possible and filling my schedule to the brim with high acuity patients and basically no info in the EMR half the time. Being forced to be the gateway for all these controlled prescriptions..yeah, **** job. But on a positive note, they're getting my letter of resignation next week.

The current attending may not be the most reliable source of info. Ask questions, dont be afraid to scare them off. Ask very, specific questions. And then make sure those numbers are in a contract. If you have any doubt at all, then you want to agree on all the numbers and facts before you say yes. Even its just a year of your life, one year feels like a long time if it sucks. Listen to your gut, but also listen to logic. If the numbers don't make sense, then they don't make sense. Its easy to manage three areas of a hospital simultaneously if someone does all 3 poorly.

At a very least, why take a very average salary and have to work in multiple diff settings. You are worth more to them, then they are to you, because there are many of them, but very few of you.

I appreciate your candor. The area is specific in the sense that I really don't want over 45 min commute especially for an inpatient gig that's on some weeks 7 days. I have been spoiled because of COVID and the virtual setting.

With your job when you first signed on did they seem sincere and then hit you with the whole bait and switch? I guess that is a very high concern as well. They seem nice and all, but at the end of the day, they will do what is best for the hospital. I also find it interesting I haven't heard back from the recruiter regarding my counter offer and we spoke last week Thursday.

I think with their current work flow, the current attending is really the only one who can honestly speak to the work. It has really been him and an outpatient doc (sparingly) doing the work. I also imagine that they won't be able to come back and put in any hard numbers. Even with seeing 18 patients a day and possibly not worrying about consults - that's still a lot of patients to manage fresh out of residency in my opinion. I feel like in the beginning I would want to be very thorough and its just not enough time in the day for that. I could handle it on the weekend, but then again if they are my patients, I can't really blame it on hey im the weekend doc so I am not really here to rock the boat that people usually get when I moonlight. I definitely don't want to be in a bind since this offer is a contract for 3 years.

 

[throwaway99233]

What are people thoughts on working with residents? I know it can vary from program to program, but I'm just thinking about my attendings and they don't do a significant amount of teaching on a day to day basis, but may have teaching points as it relates to patients. For my other offer, I wouldn't have to do lectures or anything, really just work with them with some of my patients. I guess I'm a little nervous on if I "know enough" to now become the "teacher". Imposter syndrome is taking over big time

 

[deleted1100659]

I appreciate your candor. The area is specific in the sense that I really don't want over 45 min commute especially for an inpatient gig that's on some weeks 7 days. I have been spoiled because of COVID and the virtual setting.

With your job when you first signed on did they seem sincere and then hit you with the whole bait and switch? I guess that is a very high concern as well. They seem nice and all, but at the end of the day, they will do what is best for the hospital. I also find it interesting I haven't heard back from the recruiter regarding my counter offer and we spoke last week Thursday.

I think with their current work flow, the current attending is really the only one who can honestly speak to the work. It has really been him and an outpatient doc (sparingly) doing the work. I also imagine that they won't be able to come back and put in any hard numbers. Even with seeing 18 patients a day and possibly not worrying about consults - that's still a lot of patients to manage fresh out of residency in my opinion. I feel like in the beginning I would want to be very thorough and its just not enough time in the day for that. I could handle it on the weekend, but then again if they are my patients, I can't really blame it on hey im the weekend doc so I am not really here to rock the boat that people usually get when I moonlight. I definitely don't want to be in a bind since this offer is a contract for 3 years.

oh yea, they seemed nice/sincere and that they wanted a physician to come in, establish guidelines, improve protocols, do quality control, etc. One year later (nearly), know how many things they have implemented that I suggested? zero

They also did a "offer letter" with no contract, which i thought was strange. While no contract seems good in a way, the issue is they can add to your workload and make changes on a whim, theres nothing that says they can't. However, the caveat is I can also make changes on a whim and leave quite easily, which i will be.

Is the recruiter just a third party company or specific to that hospital? Depending on how they get paid is what determines their level of motivation to push counter offers. Ive found that inhouse recruiters are actually a bit easier to work with in the sense that they're less pushy, but they are usually less motivated to push a higher number or get things done (in my experience). Third party ones will do whatever it takes to get you in that job, and sell you BS quite often. Basically used car salesmen. Though I think some are compensated based on percent of sign on salary (some companies do that if i remember) so those are a little more motivated. Others don't give a **** and just want to place you and get their fee asap.

I do like inhouse recruiters more, ive had easier time working with them

 

[psych_0]

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.

Would disagree. Where I work the SW staff and pharmacy are incredible. Patients are seen by ED staff, then again by our behavioral health screeners. Screeners ask social hx, substance abuse, past psych and take a brief history. By the time I see them I just go over what has been written (psych, social, substance) and update accordingly. I take my own HPI and that's it. Takes about 10-15 minutes. Once they land on the unit patient are seen by SW who call all families to get collateral. Our hospital pharmacist will call the outpatient clinic to confirm med rec (or lack there of). Our substance abuse counselors will put in the leg work to get them into rehab and/or call places to see if they've been to rehab before.

Find yourself a job where you are comfortable that you are being paid to be a doctor, not a social worker or therapist (unless of course you plan to be doing daily psychotherapy with your inpatients and billing for it, which I have personally never seen). My job entails assessing the patient's need to be in the hospital, need for continued treatment (whether that be new meds, change in meds, etc), and assessment of medication tolerability. That's it.

If you find yourself doing all your own social work, pharmacy leg work, and psychotherapy (without being able to bill for it), that's a YOU problem. If you hate doing that, find a new job. If you don't mind doing that and fancy yourself doing a "better job" because you do it...more power to you.

 

[throwaway99233]

oh yea, they seemed nice/sincere and that they wanted a physician to come in, establish guidelines, improve protocols, do quality control, etc. One year later (nearly), know how many things they have implemented that I suggested? zero

They also did a "offer letter" with no contract, which i thought was strange. While no contract seems good in a way, the issue is they can add to your workload and make changes on a whim, theres nothing that says they can't. However, the caveat is I can also make changes on a whim and leave quite easily, which i will be.

Is the recruiter just a third party company or specific to that hospital? Depending on how they get paid is what determines their level of motivation to push counter offers. Ive found that inhouse recruiters are actually a bit easier to work with in the sense that they're less pushy, but they are usually less motivated to push a higher number or get things done (in my experience). Third party ones will do whatever it takes to get you in that job, and sell you BS quite often. Basically used car salesmen. Though I think some are compensated based on percent of sign on salary (some companies do that if i remember) so those are a little more motivated. Others don't give a **** and just want to place you and get their fee asap.

I do like inhouse recruiters more, ive had easier time working with them

It is an in house recruiter. She also seemed nice and willing to work with me. But the more I think about it, the more I’m thinking about taking the other job. Has more positives (location, no consults, patient cap) and they told me I could do internal moonlighting if wanted. Overall, the pay is the same for less work.

I’m sorry they did the bait and switch! But glad tour able to get out of there. Have you already found your other job?

 

[comp1]

Residents are great in general. I'm sure there are bad residencies out there, but they help you keep working at the top of your game and help out as well.

 

[deleted1100659]

It is an in house recruiter. She also seemed nice and willing to work with me. But the more I think about it, the more I’m thinking about taking the other job. Has more positives (location, no consults, patient cap) and they told me I could do internal moonlighting if wanted. Overall, the pay is the same for less work.

I’m sorry they did the bait and switch! But glad tour able to get out of there. Have you already found your other job?

seems like you got the right idea now.

I have a pending offer, just waiting for them to officially send it so i can review but supposedly its 280k in a state with no state tax (so that makes a huge diff), 20k sign on, 10k moving expense. Purely outpatient 8-4:30 with no call, thats why i felt like the jobs you mentioned seemed a lot more intense.