Ahamis

10+ Year Member
Oct 24, 2008
110
43
Status
New Jersey Coast
Outpatient- contract for 3 years
Salary: 245k; no RVU
sign-on bonus: 15k per year; total amount: 45 k in 3 years
productivity bonus: up to 15k per year.

intake time: 60 min
med management time: 15 min
No calls

PTO: 32 days (including holidays, sick days)
CME: 5 days (3.5k dollars)

It seems that 15 min for med management is kind of short-time. Anybody working in this kind of setting? How is your experience?
Also, not having RVU system makes me feel that the employer will dump as many patients as possible on you.

When you have an outpatient job, do you negotiate administrative time? Or are you suppose to see patients from 9-5 back to back and still write your notes, fill out documents, prior-authorization, during this time?
 

Psychotic

5+ Year Member
Sep 17, 2013
731
397
where the sun do shine
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Resident [Any Field]
What happens when the simple med management appt turns into something else, as is often the case?

Why a 3 year contract? I haven't actually entertained any gigs yet, but I can't imagine agreeing to anything more than a year in length, with no fault out clauses specifically spelled out, and with no "anti competitive" BS, either.
 
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wolfvgang22

15+ Year Member
Jun 15, 2004
1,360
1,684
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Attending Physician
Yes, definitely negotiate number of patients seen per day, as well as administrative time. 15 minute med management should not include documentation time. The amount of charting necessary to reach a 99213 is too much to do and still see a generally stable patient in only 15 minutes. It takes me 10 minutes to chart a 99213 or 99214, and I'm fast for psychiatry.

You are correct to be concerned they will give you 30 patients per day. If they do that you will hate your life and the fact you aren't getting RVUs. Agree to see no more than 15 patients per day, maximum, unless you see nothing but the worried well or ADHD.

10 to 12 patients per day is more realistic if you see one or two new evals each day, and have at least one "administrative" hour a day to do charting, phone calls, and other stuff and work 40 hours a week. You will have a LOT more of that stuff to do than you think. I think 10 to 12 patients a day is worth about $245K given the cost of living where you are at, if the patients are not all severely ill, and constantly in and out of the hospital.

What is their no-show rate? Average is 17 percent nationally.

Do they expect you to see walk-in patients, effectively turning your clinic into a psychiatric ER? That will invite more complex patients and require more time.

What happens if you want to leave after one year according to the contract? Will they sign you on for a trial period of one year, like a locums type deal except without the payola to a recruiter? Maybe you could offer to forego the CME money in exchange for the first year. Also, I agree with Psychotic. I myself refuse to work for anybody that makes me sign a non-compete clause, as I can always do locums or telepsych if necessary, and the VA is always hiring psychiatrists and they don't bother with contracts and non-compete BS. There is no shortage of work out there, especially if you are geographically flexible. Try to take a job that doesn't tie you down for more than one or two years. This way you can transition to a better position or even start up a side practice if you need to.
 
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Ahamis

Ahamis

10+ Year Member
Oct 24, 2008
110
43
Status
I think 10 to 12 patients a day is worth about $245K given the cost of living where you are at
I still didn't find anything similar to that.
:(

What happens if you want to leave after one year according to the contract? Will they sign you on for a trial period of one year, like a locums type deal except without the payola to a recruiter? Maybe you could offer to forego the CME money in exchange for the first year.
I need to check that.
 

SeniorWrangler

7+ Year Member
Nov 9, 2010
939
543
Status
Attending Physician
If they make you pay back the signup bonus, that's not so bad, but there are some very nasty contracts out there
 

Shikima

10+ Year Member
Oct 15, 2006
4,529
2,650
Status
Attending Physician
Word to the wise; as psych is the hottest in demand right now, do not sign any contract other than you will work there and what you negotiate on pay and # seen per day.
 

sluox

15+ Year Member
Jan 4, 2002
1,884
986
Status
Attending Physician
New Jersey Coast
Outpatient- contract for 3 years
Salary: 245k; no RVU
sign-on bonus: 15k per year; total amount: 45 k in 3 years
productivity bonus: up to 15k per year.

intake time: 60 min
med management time: 15 min
No calls

PTO: 32 days (including holidays, sick days)
CME: 5 days (3.5k dollars)

It seems that 15 min for med management is kind of short-time. Anybody working in this kind of setting? How is your experience?
Also, not having RVU system makes me feel that the employer will dump as many patients as possible on you.
Yes they will. lol. Don't even think for ONE second they won't. Unless this is a state facility, which I'm assuming it's not.

If this is a bona fide private practice, I would ask for partnership track if you sign on for 3 years. If it's a clinic I would ask for either RVU or or patient # limit. Also, are they expecting 40 hours of total clinic time? That's also way too much. If you sit at the clinic and keep seeing a continuous stream of patients billing 99214s, you'll likely bill twice as much. So the clinic makes 100k+ off you. If you like this type of arrangement I would also consider starting with a 4 day work week.
 

Shikima

10+ Year Member
Oct 15, 2006
4,529
2,650
Status
Attending Physician
Yes they will. lol. Don't even think for ONE second they won't. Unless this is a state facility, which I'm assuming it's not.

If this is a bona fide private practice, I would ask for partnership track if you sign on for 3 years. If it's a clinic I would ask for either RVU or or patient # limit. Also, are they expecting 40 hours of total clinic time? That's also way too much. If you sit at the clinic and keep seeing a continuous stream of patients billing 99214s, you'll likely bill twice as much. So the clinic makes 100k+ off you. If you like this type of arrangement I would also consider starting with a 4 day work week.
Even government entities - local, state and federal will also dump as many onto you as possible.
 

Shikima

10+ Year Member
Oct 15, 2006
4,529
2,650
Status
Attending Physician
So, a bit of education for those job seeking;

It doesn't matter if you are in PP or an employee (clinic, hospital, gov't entity, etc), productivity matters because this is how people are paid. The location you are working at has expenses, they will want you to see as many as possible. If you are in PP, you'll want to see as many as possible because you have expenses that need to be covered and want to make a living.

Long gone are the days where you could see 8-12 a day only and be on the golf course at 2 or 3pm.
 

SmallBird

7+ Year Member
May 3, 2010
737
537
Status
Attending Physician
So, a bit of education for those job seeking;

It doesn't matter if you are in PP or an employee (clinic, hospital, gov't entity, etc), productivity matters because this is how people are paid. The location you are working at has expenses, they will want you to see as many as possible. If you are in PP, you'll want to see as many as possible because you have expenses that need to be covered and want to make a living.
Its good to be aware of this, but important to also point out that productivity is not the primary way people are paid in a number of settings. A great example are jobs in partial hospital programs or intensive outpatient programs (which are a massive growth area). Physician billing is quite limited in these settings but they require an MD presence to charge > $1000 per day in facility fees. So yes, they want you to bill, but your direct billing is not going to cover your salary and many institutions are more interested in you effectively managing risk within the program, collaborating with therapists and nurses, etc. In fact you may be disincentivized to see your patients to often and this leads to a different tension. Three of my colleagues work at partial hospital programs at different hospitals and their salary is entirely based on a 'base' with little productivity revenue. The same argument applies to a variable extent in inpatient and accountable care settings.
 
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