Hey folks, I've been looking at a few options for work on my off service weeks and wanted to get input... one option is a psych ED/urgent care environment that is well resourced and safe, and they offer $175/hr W2 to work 8am to 8pm. On the one hand that seems ok but the thought of being at work on like a Friday night at 7pm seems like something that I'd want more $ for. Thoughts?
Thoughts on psych ED compensation
- Thread starter SmallBird
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Funding for Psych ED is less about the Fee for Service model of routine care and more about subsidies from government / grants. Less so running a loss in context of tax benefits.
Admit / Discharge / Observation - that is the entirety of the job, repeat.
These facilities have no problem utilizing residents to cover nights and weekends.
$175 x 1840 hours per year = $320K; W2 jobs also have benefits, so the actual rate of pay is much higher when factored in. Possibly in $200/hr rate. Not too bad just from a numeric perspective, and knowing that 12 hour shifts, means ~3 shifts per week, i.e. 4 days offs per week.
I would be surprised if you could get higher.
Admit / Discharge / Observation - that is the entirety of the job, repeat.
These facilities have no problem utilizing residents to cover nights and weekends.
$175 x 1840 hours per year = $320K; W2 jobs also have benefits, so the actual rate of pay is much higher when factored in. Possibly in $200/hr rate. Not too bad just from a numeric perspective, and knowing that 12 hour shifts, means ~3 shifts per week, i.e. 4 days offs per week.
I would be surprised if you could get higher.
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It depends how busy it is, I’ve seen 250/hr for ED psych at a busy place
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Keep in mind it’s a full 12h shift not rounding and leaving which can easily run over based on the ability to get collateral, labs etc. I’d want a premium based on the evening shift hours.
Also ask the current psychiatrist about the level of social worker assistance you may or may not have. If they are also doing assessments you could end up having to do the admin stuff yourself.
Also ask the current psychiatrist about the level of social worker assistance you may or may not have. If they are also doing assessments you could end up having to do the admin stuff yourself.
No chance of running over, no admin - it's busy, but it's 12 hours of clinical work and the environment is very supportive.
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When I did ED psych work, it was a busy psych ED, always had patients, probably 35-45 between admissions boarding and people waiting to be seen. Everyone got a social work eval, a psych eval, we admitted directly to the unit, put in observation, or discharged. It was pretty full service.
The pay rates were something like 150/hour daytime, 175/hour nights/weekends, and 250/hour overnight. I thought it was a little undercharging, but the environment was at least supportive - part of a full hospital, social workers, nurse, good resources for discharge, etc.
The pay rates were something like 150/hour daytime, 175/hour nights/weekends, and 250/hour overnight. I thought it was a little undercharging, but the environment was at least supportive - part of a full hospital, social workers, nurse, good resources for discharge, etc.
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I'm seeing lots of er who just have sw crisis workers and then ed makes the call. No psychiatrist needed.
Does that relate to how to consider the fairness of this pay or more just a general comment?
Where I'm training the 1099 rate for ED psych is $200-225/hr as of last year when I asked some of the docs working there. One of the W2 psychs mentioned their compensated was determined in a very similar way to the ED physicians and he was on track to make around $350k/year working ~12-15 shifts/month
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Gen comment
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Another reference point: I'm W2 and get a base salary of $210k/yr for 30 hrs/week at an academic center. I see patients who need involuntary admission and when the ED docs feel SW assessment alone isn't adequate. SW and RNs do all the admin stuff. Comes out to ~$155/hr base and probably $175-180/hr with benefits not including bi-annual bonuses and on-call pay.
Is this W2 or 1099?
TheRightMedication
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I, personally, could not handle 12 hours of straight Psych ED unless I knew I was making bank AND I had a specific financial objective.
Even for a day, let alone 3 days per week.
I work 5 days per week and enjoy my life 7 days per week. I don't get why people are interested in slogging through X number of days to enjoy 7 ‐ X days of the week.
Even for a day, let alone 3 days per week.
I work 5 days per week and enjoy my life 7 days per week. I don't get why people are interested in slogging through X number of days to enjoy 7 ‐ X days of the week.
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I'm not sure how valuable others' rates are if the geographic areas are different. I think better questions would be how much are psychiatrists making in the area and how much more will Smallbird require due to the swing shift hours and no admin support? Not that they asked but the lack of social workers assistance would be a deal breaker for me.
I love that concept of "loving your life 7 days a week" as opposed to slogging through a bad job to enjoy the time off. I'm definitely one of those work light, play light kind of people too. That said, some people REALLY like emergency psych. I know I personally could never do outpatient and would definitely do ED psych over that. Our medications just aren't as effective for a lot of mild to moderate outpatient things. From a systems/managerial perspective, I tend to prefer that providers who admit from the ED also carry the patients inpatient. It's hard to implement that, but it gives a lot more ownership and responsibility. It also helps the provider know if a given person actually benefits from inpatient which is often the most important question in considering an admission. For this job in particular, the OP needs to clarify exactly what social work resources are available during their shift time. You don't want to feel pressure to admit people for housing all the time, it's soul crushing. Ideally, you want to be able to find out if the presenting issue is conditional on housing or some other need and then hand them right off when the person confirms it is.
Thanks again for all the responses!
To clarify some things: this isn't 3 days a week, that was just something someone said as they were considering what a full time position would be. This would be like once or twice a week every second week, unless I wanted more.
There are always social workers, sometimes two, it's the best of any place I've ever been from that perspective, so without describe a ton of detail that part of it (which I agree is important) is great.
I'm getting the sense that this rate is pretty good for 9-5 but not enough for weekends and that the 12 hour and swing shift hours might be a reason to expect more. I've personally felt like id want to be paid a bit more to still be at the hospital at 7pm. I've asked for that and will see what happens!
To clarify some things: this isn't 3 days a week, that was just something someone said as they were considering what a full time position would be. This would be like once or twice a week every second week, unless I wanted more.
There are always social workers, sometimes two, it's the best of any place I've ever been from that perspective, so without describe a ton of detail that part of it (which I agree is important) is great.
I'm getting the sense that this rate is pretty good for 9-5 but not enough for weekends and that the 12 hour and swing shift hours might be a reason to expect more. I've personally felt like id want to be paid a bit more to still be at the hospital at 7pm. I've asked for that and will see what happens!
I don't get that either. This would be 2 or 3 days a month in addition to my very balanced inpatient job and is because now and then my values dictate that I do a small amount of 'slog' work to support other goals.
$2100 per shift, daylight hours, off at 7pm. Could be worse. If this is psych urgent care at a community mental health center or crisis center I think it's a pretty good deal. Actual psych ED, a little light.
I think $200/hour is usually a very reasonable rate. You can do two 99214s in an hour which are 1.5 RVUs each. At $65/RVU you're at $195/hour, and if you did therapy you're beyond that. For psych ED, $200/hour seems fair to me. But depends on specifics, locale and going rate for docs, hospital demand, and how busy are you really?
I think $200/hour is usually a very reasonable rate. You can do two 99214s in an hour which are 1.5 RVUs each. At $65/RVU you're at $195/hour, and if you did therapy you're beyond that. For psych ED, $200/hour seems fair to me. But depends on specifics, locale and going rate for docs, hospital demand, and how busy are you really?
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This set up seems weird as a W2 position and seems like it would be more suited to 1099, in which case you could definitely ask for more. I’m assuming these would just be part time benefits? If not, I can’t imagine them not asking for a specific number of hours or shifts per month…
yoloswagpoop42069
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Yeah this and other jobs and what they bring in depends on location for sure. This is what I believe Miami ERs pays, and they have the audacity to dictate how many patients you need to see per hour (tele ER).
If you have a stable W2 job, why get another one? This one doesn’t seem worth it to me man.
If you’re only picking up a few shifts, find a locums 1099, 200/hr minimum. Ideally 200+.
ERs are admit/discharge/obs but they can be stressful depending on how many are always waiting to be seen, acuity, etc. They want you to crank them out, and if they don’t they’ll throw you shade.
Med ER staff constantly asking you when X patient is going to be seen or what’s the dispo, RNs on both sides upset about random poop.
F*ck doing that for peasant money $150-$175, admins ripping you off. 200 min or bust. This is my opinion. Let them use residents fine. Or NPs. Let the ER f*ck themselves with that level of care.
Value yourself.
If you have a stable W2 job, why get another one? This one doesn’t seem worth it to me man.
If you’re only picking up a few shifts, find a locums 1099, 200/hr minimum. Ideally 200+.
ERs are admit/discharge/obs but they can be stressful depending on how many are always waiting to be seen, acuity, etc. They want you to crank them out, and if they don’t they’ll throw you shade.
Med ER staff constantly asking you when X patient is going to be seen or what’s the dispo, RNs on both sides upset about random poop.
F*ck doing that for peasant money $150-$175, admins ripping you off. 200 min or bust. This is my opinion. Let them use residents fine. Or NPs. Let the ER f*ck themselves with that level of care.
Value yourself.
TheRightMedication
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Roger that. Sorry, I sometimes post according the the Three P's of online life - Project, Pontificate, Post It.
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From a personal care perspective ER psych and be more of a psychological grind especially if you're in an ER filled with cluster Bs, addicts, and malingerers. Not all ERs are like that, but many are.
The pro of psych ER is that once you're out of there with your workday or week done you're usually (emphasis, usually) out of there. With your own private practice of inpatient you carry work with you home much more with emotional baggage.
The pro of psych ER is that once you're out of there with your workday or week done you're usually (emphasis, usually) out of there. With your own private practice of inpatient you carry work with you home much more with emotional baggage.
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Here are my thoughts:
1. Would you feel fairly compensated being paid that? If so, go for it. Consider how many pts you would see, the kind of work it is, the type of hours, and the support staff and how much you need the extra money. Also factor in that more of that money is being taxed since it is extra.
2. Always ask for more. You have nothing to lose if they say no. It is common for places to pay more after 5pm, and especially for night shifts.
3. Ask if you can be paid as a 1099. You won't have extra self-employment taxes since this is a side gig, maybe they will pay more for 1099 rate, and worst case scenario, some tax write offs you wouldn't otherwise have.
4. Consider what your alternatives are in terms of other jobs. You could also consider offering some consultation services (e.g. doing one time ADHD or autism evals or evals for pts to get gender affirming surgery) or doing forensic/medico-legal work. Since you are doing inpatient work you can do malpractice cases involving inpt standards of care. Since you have been a medical director you may also have opportunities to review malpractice cases from that vantage point or failure of NP supervision etc.
5. Consider doing independent reviews for insurance company appeals etc. These do not pay well but can be done during down time during inpatient work, it's usually $150 per case which should take an hour or less once you get efficient. May be longer to begin with. Since you are willing to consider $175/hr to go into an ED, you might consider doing reviews which dont involve seeing patients, could be done from home or in down time during your regular job.
1. Would you feel fairly compensated being paid that? If so, go for it. Consider how many pts you would see, the kind of work it is, the type of hours, and the support staff and how much you need the extra money. Also factor in that more of that money is being taxed since it is extra.
2. Always ask for more. You have nothing to lose if they say no. It is common for places to pay more after 5pm, and especially for night shifts.
3. Ask if you can be paid as a 1099. You won't have extra self-employment taxes since this is a side gig, maybe they will pay more for 1099 rate, and worst case scenario, some tax write offs you wouldn't otherwise have.
4. Consider what your alternatives are in terms of other jobs. You could also consider offering some consultation services (e.g. doing one time ADHD or autism evals or evals for pts to get gender affirming surgery) or doing forensic/medico-legal work. Since you are doing inpatient work you can do malpractice cases involving inpt standards of care. Since you have been a medical director you may also have opportunities to review malpractice cases from that vantage point or failure of NP supervision etc.
5. Consider doing independent reviews for insurance company appeals etc. These do not pay well but can be done during down time during inpatient work, it's usually $150 per case which should take an hour or less once you get efficient. May be longer to begin with. Since you are willing to consider $175/hr to go into an ED, you might consider doing reviews which dont involve seeing patients, could be done from home or in down time during your regular job.
I make around that for a small psych ER (6-8 beds depending on how many nurses we have). I actually do think it's on the low side in general, but it's for a small community hospital, I've got a decent amount of downtime, and a great support staff. If I was at a large academic center where the ED is crushed with consults (like where I trained), I wouldn't do it for $175/hr.
I do per diem for psych ER. I work about 15 days and then get 14 off. I do this because I love to travel internationally every month and I don't have kids. Hourly is range 200-225 per hr. This year I will make above 550k mainly because I sometimes do night shifts too which involve the resident covering overnight. Honestly, I love psych ER. I could not and would not do anything else in the psych field. Our ER has 2-3 psych attendings at a time with a NP and/or PA and resident.
How many hours are you working to make 550k a year with 14 days off a month?
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Great example of why have diversity in practice options for the field is wonderful. There are very few attendings who would be thrilled to work: IP, OP, PHP/IOP, RTC, ED, C/L, and forensics from geriatrics down to three year olds. But someone out there is a good fit for every age and every space psychiatry is needed.
Alot. Honestly, I work many hours because I don't have many other hobbies while I'm in the states. When I'm overseas, its a different story and I'm really having a ton of fun. I could honestly work 4 days a month and make 10K-15k and go overseas but taking too much time off is boring and I want to save for retirement.
You're living the life I want to live now (but will put off until I'm in my early 50s and my kid is out of the house). Good for you.
Are you aware of any ED positions with higher than normal rates; i.e. >$250/hr?
I see locum positions for 250-300 per hour but thats inpatient psych. I heard through the grapevine one hospital pays 250 per hour for ER psych but not sure. I like my hospital because I can make my schedule however I want.
wow where are you seeing these locum positions for 250-300 for inpatient? I feel like I get hit up by recruiters daily and don't see anywhere near this. I'm looking in expensive west coast regions too.
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What does the 500k 1099 look like after taxes and such
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I was a crisis psychiatrist. Thankless job, high stress. It's even worse when you have inept SW. I will never do it again.
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I feel you. First 1.5 years out of residency I was pretty much purely ED psych. The SW and RNs I worked with were mostly really good, and even then it was still a recipe for burnout seeing as they handled all the straightforward cases themselves and I only got involved when things were complicated. As much as I love acute care, ER/crisis psych is a different kind of beast even when systems and support are set up well.
I actually love ED psych. The place I am at pays 245/hr for daytime, differential for evening, up to 330/hr for overnight. I also do some tele ED that pays a flat rate and patients seen generally range between 3-8 patients for $2300 a 12 hr shift. All 1099. Not great hourly, but its fine because some days its working out to $5-750/per consult.
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I'm not sure you could pay me enough to work in ED Psych anymore. A huge THANK YOU to all those troopers who love being down there. Just stop sending the repeat overt malingerers to my unit and we're cool. Can't be a glorified triage specialist AND be bad at your job.
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I love ED psych. 12 hours are preferred for me, 8 minimum. Hate when places want 6 hour shifts - too short to get anything done (and too little money), too long that it ruins other plans!
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I fixed the question, but the answer seems to be yes. Highest salaries are there, as well as more opportunities. For some reason, around 20-30% of the job offers I get are from California. I would go there if it wasn't, well, located in California. On the other hand, if cost of living wasn't crazily high, salaries wouldn't be either.
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Cost of living has very little impact on physician salaries. In general physicians earn more in LCOL areas than HCOL areas. NYC is very expensive and psychiatrist salaries are generally not good there. People want to live in certain coastal areas so they don’t have to pay as much to attract people. Conversely you tend to have to pay people more to live in Montana Alaska South Dakota etc and compensation reflects that.
Compensation for psychiatrists in California has been driven by lawsuits. This has been especially true for corrections and Kaiser both of which have had many scandals because of inadequate provision of psychiatric care. As a result they offered higher pay to attract psychiatrists. This exerts a pressure on other organizations to compete in the market in order to recruit and retain psychiatrists. If anything, being in California decreases rather than increases income potential and that’s not even adjusting for cost of living
How do you figure being in California decreases income potential? I'm going to make over seven figures this year in California. I can't imagine doing this anywhere else in america.
I was anxious when I moved to California, as I was able to save a lot less of my base salary than before. However, once I picked up some moonlighting and was able to save pretty much all of it, I felt like I was doing better as the rates are so good. I do some ED moonlighting for about $300/hr and it’s a good, well run facility. I must say I don’t know how the hospitals make it work as I was paid much less for this type of work in the northeast and there was more risk and higher volume involved.
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