Transparent Discussion Income

[whopper]

Anyone want to discuss salary/income?

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[randomdoc1]

Yea, just brutally honest incomes. No mythical jobs I keep hearing about : /.

Mine is just based on how much the desired income is. Without TMS it's about $300-$400/hr but that's not factoring overhead cost of the clinic. TMS reimburses anywhere from $150-$480 per treatment session. Also collect a small cut from each provider's earnings. Last year I brought home about 380k? I don't have benefits, it's through my spouse. But I only see patients 1-3 days a week and my shortest visits are 30 min long. No more than 8 patients in a day. But there's a lot of TMS running so, little bit of this, little bit of that. When not seeing patients, it's still somewhat of a full time job. Doing the medical billing, HR, administrative stuff like insurance rate negotiations, internet marketing yaddy yadda.

 

[whopper]

My private practice brings in about $500K a year gross. That's with me working 4.5 days a week 8:30 to 5 PM. About 25% of that goes into expenses such as the rent, staff etc. So when all is said and done that brings home about $375K/year.
I make another $120K a year being a doctor in an addiction clinic. I only work there about 4 hours a week in-person but I need to be available for phone consultations with NPs. This amounts to about 10 hours a week but I can often times squeeze this in between patients, lunch or after work.

The last few years made about 25%/year on the stock market with my retirement account and personal money put into an Ameritrade account. So that usually brought in at least another $100K a year but because it was for retirement I wouldn't touch it. This year however I'm expecting quite a sizeable loss there. That's okay. This is about the long-term. They say about 8% on average when all is said and done is good and I'm ahead of that so I'm okay.

 

[nexus73]

Relatively chill inpatient 8-12 patients per day (includes inpatient and med consults in hospital). 7 on 7 off schedule. Salary $285k. Medical Director $200/hr in addition at about 35 hours per month.

 

[SubzDoc]

Federal job, 40 hours/week, 4x10. Make about 275k doing this. Much of what I do is addiction. Sometimes it is not too bad but it is frequently a headache. Federal benefits but they don't make up for it.

 

[Sushirolls]

Here's mine:

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

 

[comp1]

VA and all federal/California state salaries are totally public and online (wish private employers were the same). Starts about $250k out of residency in non-Bay Area NorCal. Can go up about $20k from there depending on experience.

 

[wolfvgang22]

Federal job, 40 hours/week, 4x10. Make about 275k doing this. Much of what I do is addiction. Sometimes it is not too bad but it is frequently a headache. Federal benefits but they don't make up for it.

Same, but about $289k. $15k additional annual bonus for not sucking. Projected to hit $312k in 2024 per the VA. Low cost of living area. I'm probably going to request another raise soon, which I do every couple of years in addition to scheduled raises. Will probably get something based on past results. They have difficulty recruiting.

 

[wolfvgang22]

VA and all federal/California state salaries are totally public and online (wish private employers were the same). Starts about $250k out of residency in non-Bay Area NorCal. Can go up about $20k from there depending on experience.

My salary is listed online but about 3 years out of date.

 

[clausewitz2]

Work 3 days per week in private practice, 80/20 split in exchange for not touching anything administrative (except document completion/letter preparation, which is $300 per hour prorated in 15 minute intervals). About 15-20% cash, rest are one commercial insurance. How many I see per day can vary a lot, 8-16, but I think I average about 35 patients per week. I promise to return messages within one business day of receiving them but not necessarily sooner. Modal gross is around 20 k monthly.

Work one day per week in a specialty clinic for a local MH agency. 8 hours per week at $180 per hours, 90 minutes of which is a weekly treatment team meeting. Have to do a lengthy required annual training each year in the specialty area (that I get paid that rate for attending) over about two weeks of half-days, which neatly maxes out my Category 1 credits for license renewal. Also have a monthly supervision group and peer consultation group that are each an hour and I get paid for for this job at the same rate. I answer emails during the week about this job but nurse triages things first and crisis phone is held by other members of team who are not me.

All told on track for 300-310k this year pre-tax.

 

[Merovinge]

VA and all federal/California state salaries are totally public and online (wish private employers were the same). Starts about $250k out of residency in non-Bay Area NorCal. Can go up about $20k from there depending on experience.

Yikes that's low. Are the jobs fairly cush with throughput?

 

[rjs2131]

Insurance based PP so take-home is based on coding + hours worked. Currently looking at somewhere in the $220-230/hr range after expenses and shooting for 28-30 hrs/week of seeing patients. Goal is ~300k/year before bonuses.

 

[whopper]

Reason why I asked is cause I'm wondering if there's some angle I haven't cracked that'd make more money but still remain clinically appropriate.

I have found a possible way to bill for a 99215 while not spending a full hour with a patient. What it is involved using a neuropsych analysis program where the patient comes to the office early, spends about 20-30 minutes during the testing that my assistant can help the patient with on directions, that software provides very good neuropsych testing, and I can then bill a 99215. The company sells this as a selling angle and I've been told it offers very good clinical results.

The software is thousands of dollars and is a subscription only. I'm still considering it and haven't committed to it yet.

 

[Bartelby]

Over the past year: main job + small private practice. Main job was four days per week, eight hours per day with reasonable volume. Pay was around $240k with good benefits. One day per week was spent on a small private practice setting with a net income of about $90k. Total income last year was this around $330k without benefits factored in.

 

[comp1]

Yes, VA jobs are cush. And $250k is not low. It's the national average and does not include the excellent VA benefits. $300k is CA average, but that's heavily weighted by the extremely high costs of living in the Bay Area and Los Angeles where the VA salaries would be closer to that. VA salaries are not negotiable, but they are all adjusted roughly every 3 years during a formal local market pay analysis.

 

[whopper]

I forgot to add-doing your own private practice, at least for me, during tax time it's like an added 10-20 hour a week job for about 2-4 weeks. I am very confident in saying, at least for me, private practice is worth it, but it's not for everyone. I know a lot of docs that would hate working with their accountant doing taxes and managing other stuff in the office like hiring and firing employees.

 

[FlowRate]

HMO in desirable, relatively high COL area.

288k base salary.
6 clinical patient hours per day, 30 min f/u, 1 hour news, 2 hours dedicated administrative time per day (for patient care purposes--messages/calls/forms.)
Benefits are 100% paid by company and reasonably generous.
A couple of additional retirement related perks that are worth appx 30-40k per year.
30 days PTO.
Overnight call is typically very sparse (1-2 calls per night), shared among entire group (30ish psychiatrists), can trade/give away call, paid as one half of our daily rate.

Regarding the TMS post: we had a guy go half-time to start a TMS practice recently. He's now left the org about 6 months after going half time because he was making better money there than here despite being nowhere near full.

 

[Penguin10]

I have found a possible way to bill for a 99215 while not spending a full hour with a patient. What it is involved using a neuropsych analysis program where the patient comes to the office early, spends about 20-30 minutes during the testing that my assistant can help the patient with on directions, that software provides very good neuropsych testing, and I can then bill a 99215. The company sells this as a selling angle and I've been told it offers very good clinical results.

Have you seen guidance from any official entities on billing for time with unlicensed personnel? I had thought about a couple things that this type of model would be useful for doing, but the references I saw all said time had to be with MD/qualified health care professional which I took to mean someone able to bill for services. Very interested if you have seen other information?

 

[deleted1100659]

Making the equivalent of roughly 305-310k gross, roughly 8-4 full outpatient no call, caveat being supervising 5 NPs.

However, starting a new job in a few months thats 290k a year no call, 8-4:30 no NP supervision, with a state with no income tax so net pay will actually be a little higher

 

[Alemo]

My private practice brings in about $500K a year gross. That's with me working 4.5 days a week 8:30 to 5 PM. About 25% of that goes into expenses such as the rent, staff etc. So when all is said and done that brings home about $375K/year.
I make another $120K a year being a doctor in an addiction clinic. I only work there about 4 hours a week in-person but I need to be available for phone consultations with NPs. This amounts to about 10 hours a week but I can often times squeeze this in between patients, lunch or after work.

The last few years made about 25%/year on the stock market with my retirement account and personal money put into an Ameritrade account. So that usually brought in at least another $100K a year but because it was for retirement I wouldn't touch it. This year however I'm expecting quite a sizeable loss there. That's okay. This is about the long-term. They say about 8% on average when all is said and done is good and I'm ahead of that so I'm okay.

Whopper are you doing any forensic work in said private practice?

I’d be interested to hear how that type of work enters the calculus.

 

[whopper]

I still do forensic work from time to time but not much and I don't miss it but I do miss my program where I trained.

There's a lot of factors going on. As I got older the idea of evaluating felons, rapists, and dangerous people in general went down. I attribute it to my kids. The idea of being vulnerable went up as I got older. Being in my 30s, not having kids, and more testosterone and seeing some guy behind plexiglass threatening to kill me was not bothersome. Having kids raised my empathy to a degree where this became way more bothersome.

Other factors included being away from where I trained where I was surrounded by solid top people who did the work the right way. Being in the current city I'm at so far almost every lawyer I've worked with did something highly inappropriate. E.g. I was working on a malpractice case and the lawyer refused to follow my recommendation because his partner was working on another doctor's malpractice case and my defense recommendation would harm the other doctor. (The other doctor was at fault). The partner told me he will not endanger his partner's clients despite that this was a major conflict of interest. That lawyer is only supposed to represent his own client and not put the business interests of the firm ahead of his client. This type of BS I've seen too much in the city I'm in and didn't see it anywhere near as much as in Cincinnati although of course it does happen everywhere.

The entire justice system in the state I'm in is screwed up. Waiting times for public defenders is about 10 months. In short even if you try to do the right thing it's next to impossible to do so cause the state itself is in gross disregard of basic constitutional protections.

Add to that private work and forensic work sometimes don't mix. E.g. if someone wants me to work on a case for weeks straight this will throw a wrench into your private practice schedule. You will have recurring patients that need to be seen every month, maybe even every week. Taking on a forensic case where you have to go to court when the judge tells you really screws this up.

On top of this I find clinical work relatively easy and forensic work hard. Treating your 1,000th depression case you already got a solid algorithm in your head. Forensic work usually is like a brand new case you don't experience often enough for it to be like the back of your hand.

Forensic work can also be very unpredictable as to when the next case shows up. You might not have any major cases for weeks to months, then get several or none for more months. Again this can screw up an schedule where I've been able to maximize it to a degree where I'm happy with it and it's working on a delicate ecosystem I don't want to mess up.

 

[SubzDoc]

Yes, VA jobs are cush. And $250k is not low. It's the national average and does not include the excellent VA benefits. $300k is CA average, but that's heavily weighted by the extremely high costs of living in the Bay Area and Los Angeles where the VA salaries would be closer to that. VA salaries are not negotiable, but they are all adjusted roughly every 3 years during a formal local market pay analysis.

I think it turns out the quality of the job is very VA VISN specific. And the $ discussion is why I think this is a great topic. The published numbers don't give you a good sense of what we should actually make. There are part-timers, people doing locums and not for the full year, etc. I am sure there is a published distribution out there although I can't recall having seen a good one. I think psychiatrists working full-time and putting any effort/thought into it are making much more.

 

[Stagg737]

I make a whopping $65k/yr as a PGY-4 currently, but will be starting a non-outpatient academic position in the next few months.

Base salary of $210k, CME is $5k, ~15 days of weekend call per year at $1k per day. Potential RVU-based bonus every 3 months (easily met), department bonus every 6 months. Additional bonuses for teaching, serving on committees, publishing, etc. ~$20k contributed to retirement by employer at base (increases by a couple k every 2-3 years). Additional match available with a few other benefits. M-F, ~6-12 patients per day. Goal is to make ~$275k first year (pre-tax) on base, CME, call, and bonuses, which seems realistic after speaking with other psychiatrists there. Hoping to to get ~$300k pre-tax with all benefits and compensation included.

The other position I was considering is inpatient with 3 other physicians and 2 NPs. Base of $250k and significant RVU bonus. Would have been seeing 15-20 patients per day, but all physicians were making at least $450k after RVU bonus. Benefits were meh.

Both positions in the same midwest city with low CoL.

 

[deleted1100659]

I think it turns out the quality of the job is very VA VISN specific. And the $ discussion is why I think this is a great topic. The published numbers don't give you a good sense of what we should actually make. There are part-timers, people doing locums and not for the full year, etc. I am sure there is a published distribution out there although I can't recall having seen a good one. I think psychiatrists working full-time and putting any effort/thought into it are making much more.

medscape physician report is what I use+ doximity was working on a project where psychiatrists report their earnings and what region that actually had a lot of responses and seemed pretty accurate. National average probably closer to 270-280k now.

 

[jbomba]

Trying to predict my salary when I finish residency next year. Plan to do pp and pick up some crisis unit shifts at 225/hr. For pp it would appear private reimbursement is in the 130 range for a 99214 in my area. With 50% add on therapy codes and seeing 20 patients a day that should translate to ~150*20 =3k/day. Do this 4 days a week x 46 weeks a year for ~550k. Less 15% overhead and it comes out to 470k/year. Does this napkin math seem reasonable to you guys?

 

[randomdoc1]

Trying to predict my salary when I finish residency next year. Plan to do pp and pick up some crisis unit shifts at 225/hr. For pp it would appear private reimbursement is in the 130 range for a 99214 in my area. With 50% add on therapy codes and seeing 20 patients a day that should translate to ~150*20 =3k/day. Do this 4 days a week x 46 weeks a year for ~550k. Less 15% overhead and it comes out to 470k/year. Does this napkin math seem reasonable to you guys?

I'd be dead in a month lol. But I just don't have much stamina in general.

 

[rjs2131]

Trying to predict my salary when I finish residency next year. Plan to do pp and pick up some crisis unit shifts at 225/hr. For pp it would appear private reimbursement is in the 130 range for a 99214 in my area. With 50% add on therapy codes and seeing 20 patients a day that should translate to ~150*20 =3k/day. Do this 4 days a week x 46 weeks a year for ~550k. Less 15% overhead and it comes out to 470k/year. Does this napkin math seem reasonable to you guys?

Variables you need to consider:
- 4 days of 20 patients/day = 80 patients/week…pretty slim chance you hit that consistently within your first year
- 20 psych clinic pts/day isn’t sustainable for most people and will lead to burnout - I’d think about longevity in the PP setting vs maximizing income your first few years (unless your plan is to cut back later on)

 

[Sushirolls]

Trying to predict my salary when I finish residency next year. Plan to do pp and pick up some crisis unit shifts at 225/hr. For pp it would appear private reimbursement is in the 130 range for a 99214 in my area. With 50% add on therapy codes and seeing 20 patients a day that should translate to ~150*20 =3k/day. Do this 4 days a week x 46 weeks a year for ~550k. Less 15% overhead and it comes out to 470k/year. Does this napkin math seem reasonable to you guys?

Solid napkin math.

But lets bump it into chinete, thick paper plate, level math.
$150*15pts (no shows)*46w =414K Gross
414k *0.65 (losing 35% to overhead) =$270K Net
270K - retirement, health insurance, taxes etc = $172K post taxes in your pocket

And of course as RJS alludes to, you don't know the rate of growth, and how long it will take to get this full point.

 

[painballer27]

I'd be curious to hear from some more inpatient docs

 

[Dr. ADT]

Around 600K per year. Mix of inpatient work, clinical trials, and outpatient consulting work.

 

[hebel]

Great thread idea whopper.

Employed Adult Outpatient. 830a-430p with hour lunch. 90 min intakes. 30 min follow-ups. Allowed to carry a small panel of therapy patients. No call. $300k per year. W2 with good benefits. PSLF eligible. There's an RVU bonus ($15k), but I'm not going to reach the quota.

Good job, good pay (was better before inflation : /), but quite rural (but still east coast).

 

[jbomba]

Solid napkin math.

But lets bump it into chinete, thick paper plate, level math.
$150*15pts (no shows)*46w =414K Gross
414k *0.65 (losing 35% to overhead) =$270K Net
270K - retirement, health insurance, taxes etc = $172K post taxes in your pocket

And of course as RJS alludes to, you don't know the rate of growth, and how long it will take to get this full point.

35% overhead seems crazy high. Hybrid tele in person shouldn't require office space more than a day or two a week. Besides malpractice and emr and billing what else is there really that's a recurring cost?

 

[jbomba]

Variables you need to consider:
- 4 days of 20 patients/day = 80 patients/week…pretty slim chance you hit that consistently within your first year
- 20 psych clinic pts/day isn’t sustainable for most people and will lead to burnout - I’d think about longevity in the PP setting vs maximizing income your first few years (unless your plan is to cut back later on)

Mentors in my area indicate I'd fill within 3-4 months taking private insurance. Does this not seem realistic?

 

[calvnandhobbs68]

C+A primarily

85/15 split as a 1099 with larger therapist group (multiple locations in the area). Very few cash pay patients (and our cash pay rate is hilariously reasonable too) almost all insurance, on about 5 insurance panels. Group handles all the billing, office staff, gives me (nice) office space but I make my own schedule and do whatever I want with my patients. Office staff is solid but I do end up doing my own prior auths and stuff generally (they’ll start it for me). They already had a few psychiatrists contracting with them before I came on board so they were very familiar with billing, billers are also very good at knowing like what primary codes get covered and stuff.

Very good experience so far besides having to work on my own efficiency. It’s basically like paying someone a percentage to do your own private practice. I also live in a state where it’s pretty easy to get a halfway decent insurance plan on the exchange, so my spouse doesn’t have to work. I can take vacation whenever I want, make my own policies, etc. Currently doing 4.5 days a week. On the other side, you don’t work you don’t get paid (which is how I like it actually, I hate the feeling that not matter how many or how few patients I see I get paid the same).

If I extrapolate how much I’ve made this year so far, should come in low 300s this year (keep in mind that’s 1099 income so view it a little different than w2 income). Could make more if I wanted to work more. Also reallyyyy slowed down new patients earlier this year

 

[calvnandhobbs68]

Mentors in my area indicate I'd fill within 3-4 months taking private insurance. Does this not seem realistic?

So “full” doesn’t mean your schedule is completely full with followups. Also, think about how many intakes you’d have to do a day to get there.

Ex. 40 patient contact hours a week (what it looks like you’re trying to do lol). 80 followups a week. 4 week followups= 320 patients to be “full”. Realistically people are not gonna want to come back every 4 weeks if they’re pretty stable. So say maybe q4-8 weeks as you start getting ramped up and titrating meds (q3+ months is typical for stable patients). Now you’re looking at more like 320-640 patients to be “full”. Then you have to account for people who stop following up, no shows, etc (people still late cancel and no show with no show fees, people get sick, etc).

Seeing 40 new patients a week initially is gonna burn you to a crisp. I’d be careful about ramping up tooo quickly at the expense of patient selection and longevity.

 

[romanticscience]

From my experience,

So “full” doesn’t mean your schedule is completely full with followups. Also, think about how many intakes you’d have to do a day to get there.

Ex. 40 patient contact hours a week (what it looks like you’re trying to do lol). 80 followups a week. 4 week followups= 320 patients to be “full”. Realistically people are not gonna want to come back every 4 weeks if they’re pretty stable. So say maybe q4-8 weeks as you start getting ramped up and titrating meds (q3+ months is typical for stable patients). Now you’re looking at more like 320-640 patients to be “full”. Then you have to account for people who stop following up, no shows, etc (people still late cancel and no show with no show fees, people get sick, etc).

Seeing 40 new patients a week initially is gonna burn you to a crisp. I’d be careful about ramping up tooo quickly at the expense of patient selection and longevity.

From my experience there is a balance between being full with med management and psychotherapy patients. A therapy patient you see every 1-2 weeks has a higher show/stability rate than q1-3 med mgmt patient. The latter often reschedule or fall-off.

A caveat to this is someone who starts in therapy who graduates to med mgmt. This makes up a bulk of my panel. People OK with 30 min longer follow ups who stay bc of the positive expectancy created / alliance built earlier in their phase of illness.

So, although I do a large chunk of 45-min appointments (where with 30 min I’d make more), I can actually produce a week that you’re looking at (60ish patient encounters, “full” back-to-back, of 45 and 30 min appointments). It also helps to bet flexibility with scheduling; I allow all my patients the ability to self-schedule in their patient portal.


Also, though therapy is more clinically/emotionally “hard,” these patients (bc of follow frequency) are less administratively “hard” (lower total pt panel, less apt to request things outside of appointments).

 

[rjs2131]

Mentors in my area indicate I'd fill within 3-4 months taking private insurance. Does this not seem realistic?

Agree with what @calvnandhobbs68 said! I started in a busy market with plenty of demand ~9 months ago (was also told "you'll be full in 3-4 months") and while that held to be true, most of my days currently are 1-2 news + 6-9 follow-ups (I do 30 min follow-ups, 90 min news). I'll have maybe 1 day/week at this point of all follow-ups.

My advice to you starting out is to either live like a resident for the first 4-6 months (honestly, you should do this for longer if you're hoping to build wealth but that's a separate discussion) and/or have a good back-up plan for income (crisis work you mentioned makes sense). You'll eventually get to a point where you'll grow into the PP and that'll become most of your income.

Also - it's equally if not more important to have a solid understanding of billing/coding. Sounds like you've thought that through but be sure you understand what you need to document to meet those 99214's and 90833's. 99417 has completely changed the game for new intakes if insurance reimburses for it.

 

[calvnandhobbs68]

From my experience,

From my experience there is a balance between being full with med management and psychotherapy patients. A therapy patient you see every 1-2 weeks has a higher show/stability rate than q1-3 med mgmt patient. The latter often reschedule or fall-off.

A caveat to this is someone who starts in therapy who graduates to med mgmt. This makes up a bulk of my panel. People OK with 30 min longer follow ups who stay bc of the positive expectancy created / alliance built earlier in their phase of illness.

So, although I do a large chunk of 45-min appointments (where with 30 min I’d make more), I can actually produce a week that you’re looking at (60ish patient encounters, “full” back-to-back, of 45 and 30 min appointments). It also helps to bet flexibility with scheduling; I allow all my patients the ability to self-schedule in their patient portal.


Also, though therapy is more clinically/emotionally “hard,” these patients (bc of follow frequency) are less administratively “hard” (lower total pt panel, less apt to request things outside of appointments).

Absolutely it just didn’t sound like there was gonna be a lot of psychotherapy appointments going on with 20 patients a day haha.

And for sure, income will be decently lower if a significant portion of a panel is psychotherapy appointments with an insurance based practice. I easily lose money with 45-50 min therapy appointments. Therapy patients can tend to be more consistent if you have the right patients, although people tend to show up for their “meds” especially if they try to keep canceling appointments and I tell them I’m only filling 30 more days before I expect them to show up for an appt.

I’ve had a few weekly therapy patients (still have one) but it’s harder with kids during the school year especially because parents don’t want to pull them out of school every week for an hour and a lot of therapists have evening/weekend hours (which I don’t want to do right now anyway). EVERYONE wants the after 3PM time slots lol. Also a lot of my patients already have therapists in the practice or are referred from their therapist externally.

 

[medhead1990]

Thanks all who have contributed.

There are a lot of salary threads but I feel like this one is really letting us (residents and med students) "look under the hood" as to what comes along with the numbers being thrown around. From what I am gathering I am getting a sense that when I start at the PP that I am currently courting (one year of residency left), I should expect to collect ~300k? if I'm doing 5 days a week, with a healthy mix of MM and therapy . I think I had gotten myself excited when crunching the numbers that a 99214+99083 2x every hour (expecting to see 12-16ppd) would be the panacea and I could bill upwards of 500-600k however I'm getting a sense that this is not super reasonable (again thanks for letting me look under the hood).

Having searched the forum before I was thinking I was going to be rather aggressive by requesting a 75/25 split, however it looks like above someone is doing 80/20 and 85/15, are these unicorns or is this the norm for a 1099 (recognizing its location/market dependent).

Ive also been told I would probably "fill" in about 2 or 3 months but the above mention of what type of volume would be required to make that truly happen makes a lot of sense. My thought is I will probably do a tele gig for the first few months 10-20hr a week and then slowly phase that out as the PP picks up steam.

If yall are comfortable be curious to see the comparison between whoppers practice and calvinandhobs practice's, given both are putting in 4.5 days and Calivnandhobs is estimating low 300's and whopper is estimating ~500. Is it that calvinand hobs is taking the 30-45min "hits" that were mentioned above? I would be surprised if that made that big of a difference.

 

[TexasPhysician]

Thanks all who have contributed.

There are a lot of salary threads but I feel like this one is really letting us (residents and med students) "look under the hood" as to what comes along with the numbers being thrown around. From what I am gathering I am getting a sense that when I start at the PP that I am currently courting (one year of residency left), I should expect to collect ~300k? if I'm doing 5 days a week, with a healthy mix of MM and therapy . I think I had gotten myself excited when crunching the numbers that a 99214+99083 2x every hour (expecting to see 12-16ppd) would be the panacea and I could bill upwards of 500-600k however I'm getting a sense that this is not super reasonable (again thanks for letting me look under the hood).

Having searched the forum before I was thinking I was going to be rather aggressive by requesting a 75/25 split, however it looks like above someone is doing 80/20 and 85/15, are these unicorns or is this the norm for a 1099 (recognizing its location/market dependent).

Ive also been told I would probably "fill" in about 2 or 3 months but the above mention of what type of volume would be required to make that truly happen makes a lot of sense. My thought is I will probably do a tele gig for the first few months 10-20hr a week and then slowly phase that out as the PP picks up steam.

If yall are comfortable be curious to see the comparison between whoppers practice and calvinandhobs practice's, given both are putting in 4.5 days and Calivnandhobs is estimating low 300's and whopper is estimating ~500. Is it that calvinand hobs is taking the 30-45min "hits" that were mentioned above? I would be surprised if that made that big of a difference.

Let’s keep the thread focused on transparency. Every job is different. These brief details give some insight, but they don’t tell the whole story (vacation, perks, etc). Comparisons, criticism, and questions here may defeat the purpose of having more people share open and honestly.

 

[medhead1990]

Txphysician, i agree completely if having that nuanced of a discussion about the compensation would stop others from wanting to contribute I completely agree. I would rather hear more from more people than go down a rabbit hole.

I hope my post did not come off cheeky or as if I was Criticizing. If so I am sorry dear whopper and Calvinandhobs.

 

[randomdoc1]

I’d be careful about ramping up tooo quickly at the expense of patient selection and longevity.

So much this! I see this in new grads so much. Which I guess I'm the outlier? Money is important. But whenever there is something offered that pays very high, it makes me very suspicious no matter how good the offer looks. There's a reason I decided to not join the local big boxes. Although they need us more than we need them, longevity would be an issue. The culture, quality of life and especially patient selection. There's another aspect to this career that is hard to put a monetary value on. Many young grads jump at the money for various reasons, I understand. Now we're several years out and the burn out is obvious while I'm content. Especially especially the patient selection. I can't imagine day after day going through multiple arguments about benzos, stims, wacky ketamine referrals, severe axis II, and all sorts of...whatever. My colleague is working with an emotionally draining patient who did atrocious things to a kitten and now the family is demanding she give him a diagnosis he does not have when he's clearly antisocial.

Curious about fellow brethren here: when your office gets new calls for psychiatry patients, are the bulk of them about stims, benzos, fired from somewhere, high acuity/super complex, some combination of all of the above, with high preponderance for the first two? As a physician in general, how I wish the first two were not 80% of our calls. Our region ranks super high when it comes to the prescription drug epidemic. Most of the high paying job descriptions have zero patient selectivity. I cannot emphasize enough that it's way better to wait a bit longer for a more manageable patient than take on anyone who can end up very difficult to maintain an outpatient relationship with. It can be super time consuming, exhausting in all degrees and imho not financially worth it. Had one such case that called everywhere I worked at (met her in the resident clinic during training) and tried to get an appointment as an "established" patient. At my own PP when she kept getting told I'm not taking new patients and she realized she'd never get an appointment with me, she sent harassing long emails about how she won't go anywhere else and she may kill herself. When that didn't work she and her spouse and other family left several fake google reviews on the google my business page. Was fortunate enough to have a major SEO figure working for us, she still is, and we got them taken down. And it's my own issues and counter transference, but it's just so much better to work with patients that believe in the science, are motivated, and really about getting after the underlying problem. Although this generally recruits for a less ill, higher functioning population with more mature psychological defenses to begin with. But at this clinic I say, the only criteria is that you are truly on board with getting better, we don't care about anything else.

Maybe we've gotten too spoiled here or maybe we're doing the right thing after all. But there's something nice about being in a work environment where you really enjoy your patients, your colleagues and the atmosphere. We unfortunately have less experience in the more severe chronically ill. But the nice thing with having students doing their training is that we can take on some cases with more variety and try to keep the those skills sharp and we've carved out time for a peer consult meeting that is recurring and what we call an academic "book club" now! Anyways, it seems like a good set up for a nice balance of longevity and good pay. This office will never pay like some mega big box (but it is still pretty damn nice) but our case census isn't full of high acuity or complex cases either. The big money is paid for a reason. There truly is no free lunch lol.

Is it that calvinand hobs is taking the 30-45min "hits" that were mentioned above? I would be surprised if that made that big of a difference.

The most lucrative model includes patients who are desperate to see you be it some sort of acuity, strong therapeutic relationship, drug seeking, any reason. And you bill higher complexity med checks, back to back. The other end of the spectrum is longer visits that may have less pay per minute. There are some cash models that can be worked to offset this. But I'll be transparent. It would take me forever to build a cash only practice. I actually prefer not to for various reasons but one is that I think it affects the dynamic and makes it feel more salesy versus having insurance be a healthy boundary. Local colleagues who are thinking of making their own PP considered cash only and I don't recommend it. That was how one colleague started and after a couple years, she's decided to sign on with one insurance panel and will see how it goes. Now in this region if you start as a PP solo practitioner, it seems to have gotten harder to get paneled. This same colleague was denied being paneled on some of the higher paying ones unless she accepted Medicaid which was not the case when I started. Although I wonder if it makes a difference since I was already seeing patients under a different entity and some insurance companies worry about their members losing continuity of care. If you have good insurance rates and because psychiatrists are so desperately needed, it's still reasonably attainable, you can easily get $150s-$160s for 99213+90833. Some insurances pay $200s for that and with good networking, you can find the employers that use these insurances and BOOM you got a powerful multiplier. Now with the changes in billing, we can easily hit 99214. But yes, that sliver of time makes a DIFFERENCE. Lets say you miss out on a 99213+90833 each day at 5 days a week. In a 48 week work year that's at least $36000. That's why attendance policies are so important.

How long did it take me to build a full practice? 3 years with being on most insurance panels. But that's factoring in terrible patient recruiting with the employer I was under and I'm selective when it comes to patients. Now if I doled out benzos and stims, yes, 3-4 months sounds about right. After being with my first employer in PP for 2 years, I branched off, took the patients with. Took me less than a year to fill up with good patients for whatever space was left. So if you have strong patient recruitment and networking and are on insurance panels (a lot), starting from zero I'd guess it takes 1-1.5 years to build up a full time practice if you're shooting for 30 min visits. Also, if your name is new, it would take longer than a more established psychiatrist. Definitely highly recommend working somewhere that has promised income so you can grow into the PP. I did work at the VA while recruiting PP patients and for a stretch of time was doing tons of hours of clinical work in preparation to run full PP with as many established patients to run with to minimize income loss.

Sorry, one last caveat. We are in need but this is still a free market and there is competition. The well insured, easy to work with patients often know they are desirable patients and can go anywhere (or at least have their PCP refill for awhile). Let's say you have a professional working patient, good commercial insurance and on a simple regimen of SSRI + atypical. Refilling her scripts can keep her coming back, but if you offer a thorough visit, she feels listened to, she sees good evidence based results and the add on therapy is good, you've got someone coming back to you for a long time. Getting complacent can lead a practice to have to recruit new patients more often and the intakes are less lucrative than follow ups. This patient knows she can also see an NP who'd be sufficient to manage her case and she may find she has a better visit experience with the NP. I've had some psychologists join and most have stayed on board so far. But the ones who had the hardest time staying full, as I got to know them, imho were also not very impressive as providers. You don't have to be a sell out. But the better you perform, the better the outcome if that makes sense.

 

[untapped]

PGY4 here, decided to go w/ VA in HCOL big west coast city. 270k + 15k annual bonus for incentives, 35k per year debt repayment. All outpatient, minimal call (1 weekend per year). Had big box shop inpatient offers as high as 340k + bonus. After talking with good friends who have been practicing a few years, decided to prioritize longevity and reduce my risk of burnout. I want to clock in and out and just focus on providing good clinical care.

Another graduating resident here in the midwest is starting around 315k + RVU bonuses for inpatient work with some call. We'll see whether the job turns out to be good or not. Locums work here ranges from 180 or so per hour for slower paced state hospital work to 220 or so per hour for higher volume inpatient.

Another recent graduate who's a few years out shared their numbers with me, on pace for low 400s with a mix of cash private practice and multiple part time inpatient jobs. This person is quite savvy and driven, so I don't think they got there without hustle.

Anyways, I'm really glad I picked this specialty. There's good options for all types of people.

 

[liquidshadow22]

Reason why I asked is cause I'm wondering if there's some angle I haven't cracked that'd make more money but still remain clinically appropriate.

I have found a possible way to bill for a 99215 while not spending a full hour with a patient. What it is involved using a neuropsych analysis program where the patient comes to the office early, spends about 20-30 minutes during the testing that my assistant can help the patient with on directions, that software provides very good neuropsych testing, and I can then bill a 99215. The company sells this as a selling angle and I've been told it offers very good clinical results.

The software is thousands of dollars and is a subscription only. I'm still considering it and haven't committed to it yet.

Which company is offering this?

 

[hallowmann]

Not sure if this qualifies, but I got pretty far in first attending job interviews with offers/contracts reviewed with the following jobs:

Employed, multi-specialty group expanding to psych, 40-50hrs/wk, $330k, outpatient only, 30 min follow-ups, 60 min intakes, 1-2 midlevel supervision and 4wks of vacation.

Employed, government, union job, 4x10s (35 clinical hours a week), usually around 10-14 pts a day, outpatient community setting, 30 min follow-ups, 60 min intakes. $315k plus benefits and pension, lower than average vacation time.

Employed, very big box place, 36 pt hrs a wk/4 hr admin, 30 min follow-ups and 60 min intakes, lots of internal services, higher functioning patient population, EPIC, practically 6-figure sign-on and 2 yr retention bonuses, $290k with great benefits/retirement

1099 in well established private practice, projected ~$200/hr, primarily telepsych, 70/30 for collections, but reported collections ~95% with pretty good payer mix, additional $25-$100k depending on TMS referrals/yr, but requires being in-house for their treatments. Head made it seem like I'd easily hit $300k, but when I ran the numbers (assuming their high collections) I'd have to see 18-20 pts a day for that.

In the end I signed with one of the employed jobs because it lined up with my primary goals and came with versatility to expand my scope of practice and I will continue an on-the-side telepsych 1099, and considering my own small PP for the additional freedom of it.

Also, if I wanted to stay at my current academic institution, it would be 32 clinical hours a week, great benefits, also EPIC, $195k... but lots of opportunity to pick up additional shifts (ED, CSU, etc.) for $200-$400/hr (ridiculous system honestly).

 

[splik]

I’m in academics doing a mix of consults and inpt and outpatient neuropsych. I do about 15hrs of psychotherapy per week including a few pts for twice weekly therapy. I work longer hours than I would like but most of that is non clinical (eg writing articles, preparing talks, reviewing papers, editorial responsibilities, committee service) that isn’t compensated. The benefits are pretty good including a pension and you get health insurance in retirement if you stay for 10yrs. Lots of time off for professional leave (conferences etc) and 5 weeks vacation, 14 holidays and 6months paid sick leave. They do take a 20% cut for outside activities after the first 40k (does not include honoraria). I make a little over 400k. This includes some work consulting regarding billing and documentation, and forensic work. I don’t do that much forensic work these days it’s quite sporadic. I also used to do some insurance appeals reviews for independent review organizations during downtime but that is quite sporadic as well.

 

[J ROD]

Inpatient. Cover 22 bed unit, and see floor consults and ED at small hospital. Call about one week per night. One weekend per month. Unit usually have about 15 patients. Couple times per month have to cover GERI unit as well. About 8 patients. Have NP for inpatient units that do notes, run them basically. Work about 35-40 hour per week not counting the weekend. Weekday call is light. Do not have to come in. Might get a call, bad night is 3 calls. I do tend to get called often as the inpatient doc regardless because staff likes to call me but I also allow it. Some days consults are strong and some days I might not see any. Made 635K first year. On track to make 600K this year. Straight wrvu model. Money is great but we have strong Nursing leadership and have been forced to take patients I do not agree with, etc. Medical CEO called me first time I refused to take one they recommended so I got the picture after that if they want it to happen eventually I would have to listen. Curious if others experience similar issues with nursing admin running things so much.

 

[painballer27]

Not going to quote like you requested, but @J ROD , how common are the types of jobs you have? Was it hard to find? Seems like quite a bit of money for not a ton of work regardless of the issues that you described.

 

[painballer27]

Around 600K per year. Mix of inpatient work, clinical trials, and outpatient consulting work.

How many hours a week? Call?

 

[nexus73]

Inpatient. Cover 22 bed unit, and see floor .

Are your getting paid RVUs for supervising the np?