Thoughts on part-time job?

[jbomba]

Have discussed a part-time job at a reputable detox facility with the owner of this facility. Majority of their patients are very high-end, cash paying. Right now they have a non-psychiatrist med director who handles the tapers and medical management but want a psychiatrist available to do initial psychiatric intake, restart home meds if needed, help clarify diagnoses. This will be part-time 1099 work, roughly 30 patients seen per month. Offering $300 per intake (may try to negotiate higher). They will already have had staff complete a biopsychosocial and obtained other pertinent histories during initial intake. Guessing the psych eval will take about 30-60 minutes.

No non-compete. In fact owner has an incredibly difficult time referring patients on to psych after they discharge due to availability issues so he is open to me taking patients into my own private practice. The job itself seems like a decent offer but the ability to build a practice with cash paying clientele that I can initially screen seems like the real benefit here. Anything else to consider or thoughts based on any of this? Thanks.

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[Merovinge]

Have discussed a part-time job at a reputable detox facility with the owner of this facility. Majority of their patients are very high-end, cash paying. Right now they have a non-psychiatrist med director who handles the tapers and medical management but want a psychiatrist available to do initial psychiatric intake, restart home meds if needed, help clarify diagnoses. This will be part-time 1099 work, roughly 30 patients seen per month. Offering $300 per intake (may try to negotiate higher). They will already have had staff complete a biopsychosocial and obtained other pertinent histories during initial intake. Guessing the psych eval will take about 30-60 minutes.

No non-compete. In fact owner has an incredibly difficult time referring patients on to psych after they discharge due to availability issues so he is open to me taking patients into my own private practice. The job itself seems like a decent offer but the ability to build a practice with cash paying clientele that I can initially screen seems like the real benefit here. Anything else to consider or thoughts based on any of this? Thanks.

Even with prior intake done by a social worker, nurse etc, it's pretty tough to do a good job with an intake, write the note, coordinate with nursing in under 60 minutes, particularly with people expecting cash-pay level services. To that end $300/hour is quite meh for pay. That said, either try and negotiate a bit higher or consider it a small cost if it really is funneling in cash-pay patients to your PP, in which case it seems like a slam dunk.

 

[jbomba]

Even with prior intake done by a social worker, nurse etc, it's pretty tough to do a good job with an intake, write the note, coordinate with nursing in under 60 minutes, particularly with people expecting cash-pay level services. To that end $300/hour is quite meh for pay. That said, either try and negotiate a bit higher or consider it a small cost if it really is funneling in cash-pay patients to your PP, in which case it seems like a slam dunk.

Thanks for the feedback. What would you consider a "solid" rate for this level of work? Will probably ask for a bit over whatever this might be then hope to land somewhere higher than where the current offer is.

 

[Merovinge]

Thanks for the feedback. What would you consider a "solid" rate for this level of work? Will probably ask for a bit over whatever this might be then hope to land somewhere higher than where the current offer is.

That would depend entirely on what you are currently charging and how long the commute is (if you have to travel to see 1-2 pt each day, this may make up a considerable part of the effective hourly rate). Again, I think it's completely fine for this to pay less then your normal hourly if it leads to several new patients/months and you have room in your practice.

 

[dl2dp2]

Offering $300 per intake (may try to negotiate higher). They will already have had staff complete a biopsychosocial and obtained other pertinent histories during initial intake. Guessing the psych eval will take about 30-60 minutes.

Are you addiction trained?

Before you name your price, it's useful to know the model of the facility. Ask a friend/family member to call the facility to figure out how much they charge per patient per detox. Then think about how much you are providing value add to the facility.

Depending on your credentials, $300 per intake is WAY lower than market.

 

[jbomba]

Are you addiction trained?

Before you name your price, it's useful to know the model of the facility. Ask a friend/family member to call the facility to figure out how much they charge per patient per detox. Then think about how much you are providing value add to the facility.

Depending on your credentials, $300 per intake is WAY lower than market.

Not addiction trained. Still in residency and this will be my first job out of residency. My goal is to start a cash private practice in the afternoon/evenings, along with inpatient work and a 1099 side job (which is what this job would be). I guess I'm still trying to figure out my rates for pp, so I felt 300 was fair but maybe I'm undervaluing myself?

The owner of facility is actually a good friend and family member, so things are very clear to me. His clients are paying 1200-1500/night to stay. Typical stays 5-10 days. Based on that, what do you think I should be asking for?

 

[whopper]

I'm working in a very solid place so when I saw your post I thought it was the place I'm working (maybe it is!). Someone asked me how I as a psychiatrist make over twice as much as the average and only work 50 hours a week.

Answer-cause I work at the addiction clinic in addition to my private practice. The addiction clinic allowed me to force-multiply my output. My role in the addiction clinic is to act more like a Gordon Ramsay overseeing an operation instead of getting money per patient I see. I go into the place, do see a few patients to see all the cogs are working together, and offer recommendations and best practice guidelines. Several of the staff member were trained up to the point where they are very self-sufficient. Staff members can call me if ever in doubt and I'm the go-to guy and I do get calls on weekends but usually only 1-3 and only a few minutes long.

So I'd say this sounds like a good opportunity other than that you really don't know a job until you've worked there for real. Some jobs are good on paper but when on the field turn out not to be so great.

 

[Psychresy]

What's a good rate for a single psych eval as a 1099?

 

[dl2dp2]

The owner of facility is actually a good friend and family member, so things are very clear to me. His clients are paying 1200-1500/night to stay. Typical stays 5-10 days. Based on that, what do you think I should be asking for?

This is a problem. It's hard to segregate family/friends and have business contractural information. I think to start you should call around to see how much psychiatrists in the general vicinity charge per hour, and then add 30%. Realistically, based on the numbers here, they can pay you $1000+. And keep in mind, you are the bearer of the majority of the liability--if the patient gets into a bad outcome and you are the last MD who saw him, you are 100% liable.

And what would be the bad outcome here in this scenario? Someone who enters detox and decides to sign out AMA and overdose or suicide. Or someone who detoxes and does poorly (having a seizure, etc). Are you confident that you are able to manage the case in a way that would be impervious to scrutiny if these scenarios arise? And if you are, how much do you need to get paid to take that on? Realize that you have little control over the eventuality of the evaluation that you provide. Is the onsite MD addiction boarded? Is this person competent?

What's a good rate for a single psych eval as a 1099?

Highly variable depending on location, specialty, etc.
Typically, ~$300-500+ per hour. It's not unusual for child evals (even academic facilities) on the coasts to be 3 hours and $2500+.

It would be unusual for 1099 evals to be below $300 per hour (i.e. typically in this field the hourly rate for inpatient/ER is lower than outpatient).

 

[jbomba]

This is a problem. It's hard to segregate family/friends and have business contractural information. I think to start you should call around to see how much psychiatrists in the general vicinity charge per hour, and then add 30%. Realistically, based on the numbers here, they can pay you $1000+. And keep in mind, you are the bearer of the majority of the liability--if the patient gets into a bad outcome and you are the last MD who saw him, you are 100% liable.

And what would be the bad outcome here in this scenario? Someone who enters detox and decides to sign out AMA and overdose or suicide. Or someone who detoxes and does poorly (having a seizure, etc). Are you confident that you are able to manage the case in a way that would be impervious to scrutiny if these scenarios arise? And if you are, how much do you need to get paid to take that on? Realize that you have little control over the eventuality of the evaluation that you provide. Is the onsite MD addiction boarded? Is this person competent?

Thanks for your thoughts. Regarding liability, the medical director is handling the tapers and other medical management. While they are not addiction boarded they do have a number of years experience in this area. I'm curious how the level of liability would fall squarely on myself and not the medical director. Certainly someone leaving AMA and then overdosing isn't something I should be found negligent in causing I would imagine. Do you feel like the liability is so high I should avoid this role?

 

[dl2dp2]

Thanks for your thoughts. Regarding liability, the medical director is handling the tapers and other medical management. While they are not addiction boarded they do have a number of years experience in this area. I'm curious how the level of liability would fall squarely on myself and not the medical director. Certainly someone leaving AMA and then overdosing isn't something I should be found negligent in causing I would imagine. Do you feel like the liability is so high I should avoid this role?

Liability is generally very low, but the question is mainly whether it's WORTH it for you at any particular pay rate, especially if there are very complicated family relationship issues.

 

[jbomba]

Liability is generally very low, but the question is mainly whether it's WORTH it for you at any particular pay rate, especially if there are very complicated family relationship issues.

Fair point.

 

[Fabio001]

For some background, I'm a fellowship trained C&A psychiatrist and have a side-gig with a residential treatment center managing their 40 residents. I charge $300 per month for each patient I manage (which is all of them) which includes a monthly follow-up visit, and $600 for intakes. I am debating asking for $750 for intakes. The intakes I do are likely more involved than what you do; I spend an average of 30 minutes reviewing testing beforehand, 30-40 minutes interviewing the patient and their therapist, and 15-45 minutes on the phone with their parents. The intakes are the most challenging and lowest paying part of my job, and I wouldn't do them for $600 if I wasn't able to rake in the bucks through providing ongoing management afterward.

In your situation, while you're in training, I think $300 is reasonable if they are providing malpractice and a level of administrative support (ie. a nurse or MA that will track down patients for you and enter in vitals, a solid EHR, speedy processing of invoices, a comfortable workspace, etc.). I did intakes for residential adolescents throughout much of residency and fellowship (2017-2020) at an identical rate and felt fairly compensated. However, I'd make clear your intention to charge significantly more once you are board certified. Hopefully by that point you have proven yourself to be indispensable and can name your price.

 

[Merovinge]

For some background, I'm a fellowship trained C&A psychiatrist and have a side-gig with a residential treatment center managing their 40 residents. I charge $300 per month for each patient I manage (which is all of them) which includes a monthly follow-up visit, and $600 for intakes. I am debating asking for $750 for intakes. The intakes I do are likely more involved than what you do; I spend an average of 30 minutes reviewing testing beforehand, 30-40 minutes interviewing the patient and their therapist, and 15-45 minutes on the phone with their parents. The intakes are the most challenging and lowest paying part of my job, and I wouldn't do them for $600 if I wasn't able to rake in the bucks through providing ongoing management afterward.

In your situation, while you're in training, I think $300 is reasonable if they are providing malpractice and a level of administrative support (ie. a nurse or MA that will track down patients for you and enter in vitals, a solid EHR, speedy processing of invoices, a comfortable workspace, etc.). I did intakes for residential adolescents throughout much of residency and fellowship (2017-2020) at an identical rate and felt fairly compensated. However, I'd make clear your intention to charge significantly more once you are board certified. Hopefully by that point you have proven yourself to be indispensable and can name your price.

How often are you getting calls on these patients beyond their once monthly visit with you? $300/month for CAP coverage of a residential patient strikes me as very low, I imagine any PE firm would love that.

 

[robellis]

This is hilarious we have some people talking about charging 700/patient and others on here asking if they should work for 60/patient…lol

 

[Fabio001]

How often are you getting calls on these patients beyond their once monthly visit with you? $300/month for CAP coverage of a residential patient strikes me as very low, I imagine any PE firm would love that.

Probably 3-8 emails a month, with one or two texts thrown in. Usually its some pharmacy issue; probably only 1-2 actual clinical issues per month. Nobody ever calls me. I will usually respond right away, but there's no expectation that I'm available around the clock or anything like that; it's not uncommon for me to get back to them on the next business day.

Edit: The above is the extent of my calls and unpaid work for the entire program; not per client/patient.

 

[Merovinge]

This is hilarious we have some people talking about charging 700/patient and others on here asking if they should work for 60/patient…lol

It's a somewhat apples to oranges comparison although I do see your point. I have seen attendings round at for-profit IP units on new patients in 15 minutes including documentation and placing orders where they see 40-50 patients in/day (for about $60/pt). That's clearly a different product then the "365 degree" CAP eval that takes 2+ hours without including documentation which in PP cash outpatient can easily go for $1500-2000.