I overheard a rumor at my hospital recently that the 1 week (7 day week x 12 hours per day) cost for a locums psychiatrist is $30K, paid to the locums company. If the doc gets $200/hour it’s $16,800. Over $13,000 to the locums company. For one week.
I overheard a rumor at my hospital recently that the 1 week (7 day week x 12 hours per day) cost for a locums psychiatrist is $30K, paid to the locums company. If the doc gets $200/hour it’s $16,800. Over $13,000 to the locums company. For one week.
I overheard a rumor at my hospital recently that the 1 week (7 day week x 12 hours per day) cost for a locums psychiatrist is $30K, paid to the locums company. If the doc gets $200/hour it’s $16,800. Over $13,000 to the locums company. For one week.
I doubt they are paying for 12 hours per day it’s more like 8?
When I cold called psych hospitals directly, one of them told me they paid Staff Care $240 an hour (can't remember exactly what they paid the doc, might have been $180 an hour).
Somehow when I tried finding work on my own without the help of an agency, the hourly rates I was quoted were usually abysmal (HCA offered me $126 an hour for weekend inpatient work). I am not sure why it is such an inefficient system that relies so much on middlemen.
There are sites (nomad health, lucidity direct) that are supposed to cut out the agencies, but they have very few listings.
Seems like there are much cheaper ways to do this. Isn't this why they pay for MGMA data? Or they could just do what we do, go online and see what jobs pay.This phenomenon is not limited to locum. There are many full-time jobs that have higher salaries via agency than when you reach out directly. While this might defy logic at first glance, what actually happens is that people you reach out to (i.e. unit chief) don't have the decisional capacity to deploy the money, and people who have the decisional capacity (hospital executives) don't have any idea of the market rate of a particular kind of clinician. So they want the agency to help them price the clinician.
This is why the most desirable jobs often don't even circulate at all, and the most desirable of all jobs involves equity ownership.
Seems like there are much cheaper ways to do this. Isn't this why they pay for MGMA data? Or they could just do what we do, go online and see what jobs pay.
can you elaborate on what you mean by this?? sorry, im really not familiar with this ughhhAlso of note: successful PP psychiatrists with equity ownership often easily outearn hospital admins who might be 5 levels above them at a large system. To a certain extent this is also a reason why top non-research clinicians in our field are generally not direct hires in large systems.
Open your own practice, expand it a bit with a few psychiatrist employees, maybe a few office locations you own the building for. Control your payer mix, or do cash only = financially doing better than many hospital executives.can you elaborate on what you mean by this?? sorry, im really not familiar with this ughhh
Where does one gain this knowledge on how to open your own PP? I'd love to, I just have no clue how to.Open your own practice, expand it a bit with a few psychiatrist employees, maybe a few office locations you own the building for. Control your payer mix, or do cash only = financially doing better than many hospital executives.
Thus, why I and a few others continue to parrot, "open your own practice."
Where does one gain this knowledge on how to open your own PP? I'd love to, I just have no clue how to.
Do you think people in that position you described don't work a full 40 hours because they just don't want to or they don't have the volume to do so?APA has a manual for members. That's where I'd start. This forum is good too, read Sushiroll's practice log. Ask around if you trained at a residency with a track record of people starting or going into PP.
For example, in my residency, there's actually a course devoted to how to run a PP for PGY4s.
The level of success in PP is also wildly variable. Someone I know who's 1 year out from fellowship grosses ~ 1M in revenue in a solo practice. Meanwhile, there are senior clinicians who are not making ends meet due to lack of savvy in marketing, patient recruitment, and knowledge of payors, etc. It's also not a job for everyone. A sizable minority of qualified people don't do well with small/solo PP, and end up going back to a facilities job. However, my impression is in general if you are 10 years out and still sustaining a PP, you are crushing it. You might not be making surgeon money in total, but you are making surgeon money on a per hour basis and have a much more flexible lifestyle. People in that kind of situation almost never work full 40 hour work weeks.
Do you think people in that position you described don't work a full 40 hours because they just don't want to or they don't have the volume to do so?
Some of this, some of that. I think if you really want to fill you can generally fill in most markets charging a lower fee, especially if you do only psychopharm. People who don't fill have certain expectations of what their practices look like, and are okay with making less money.
Someone I know who's 1 year out from fellowship grosses ~ 1M in revenue in a solo practice.
APA has a manual for members. That's where I'd start. This forum is good too, read Sushiroll's practice log. Ask around if you trained at a residency with a track record of people starting or going into PP.
For example, in my residency, there's actually a course devoted to how to run a PP for PGY4s.
The level of success in PP is also wildly variable. Someone I know who's 1 year out from fellowship grosses ~ 1M in revenue in a solo practice. Meanwhile, there are senior clinicians who are not making ends meet due to lack of savvy in marketing, patient recruitment, and knowledge of payors, etc. It's also not a job for everyone. A sizable minority of qualified people don't do well with small/solo PP, and end up going back to a facilities job. However, my impression is in general if you are 10 years out and still sustaining a PP, you are crushing it. You might not be making surgeon money in total, but you are making surgeon money on a per hour basis and have a much more flexible lifestyle. People in that kind of situation almost never work full 40 hour work weeks.
Can you elaborate any on this- types of visits, time spent for each, days/weeks worked/year, cash vs insurance, etc.?
that's awesome and says a lot about your institution. would you mind DM'ing me where you went
It's full cash. Primarily psychopharm. He "lucked out" in that he purchased an existing practice through owners financing. He's an MBA so very savvy about how to valuate business. Other details I am not privy of. He generates a revenue of 1M, but I don't think he nets 1M. Roughly I think the breakdown would be $600 per hour, 35 clinical hours a week, 48 weeks a year. Typically in this biz you have at most 1-2x revenue valuation or 4x profit. So assume an owners financing package with interest of 5% (total interest of 100k), he'd have EBITA ~ 600k. If he lives frugally for 5 years he'll then have another 200k dividend once the mortgage is done.
The rough math here is the owner derives 1M total revenue from a full time clinician, with 200-300k overhead including capital investment, then take a 50% cut, pay the employee 300k, and take in an end of year dividend of 300k. Part of the overhead will also accrue through capital investment. So a comparable employed position would max out around 300k W-2.
This lifestyle compares very favorably to a mid level banker or a legal partner at a mid sized firm, which typically have similar compensation structure (~300-450k base, everything else is dividend/performance/bonus). OTOH Very little travel. Very little nights/weekends/deadlines. You need another 5ish hours a week for admin/billing, etc. a week. Minimal overhead--don't need a secretary. Assuming 80 visits a week, one visit a month you have about 300-350 patients. This level of admin work you can usually do yourself, or at most hire a remote low cost secretary for appointments, etc.
I don't quite understand how the numbers add up. It is a solo cash practice with overhead of 20 - 30%? Are the numbers inflated to transfer self money through real estate? Is the owner employing another doctor as an employee? If so, what is to stop the doctor from leaving and opening a competing practice? Or is the owner paying himself as the employee?
I am surprised that this person purchased a cash practice. What exactly is he purchasing? The patient list and real estate?
Someone at my hospital messed up bigtime and cc'd me their agreement with the agency.
They make 67% on top of what I make per hour.
132% more for weekday 24 hour pager call.
388% more (wish I was making this up) for weekend 24 hour pager call.
Also their contract specifies that the agency gets paid extra for overtime hours (>8 hours a day), which is not anywhere in my contract.
Had no idea I was getting hosed this bad.
you do realize patients can just leave right? Paying 1 million dollars for patient charts is absurd
They can, but the majority don’t as they just come once a month or less, and if they leave they have to go through the entire intake process again, which can cost a lot. Furthermore, if they leave they may not find the same service for the same price. It’s all supply and demand. I’m doing a very very rough comparables analysis bud. When you do actual financial due diligence for a leveraged buy out like this, you'd survey the attrition rate and factor that in. P/E is 3x which seems reasonable to me for a low small town grocer growth industry like this. A back of the envelop DCF actually would put this practice at somewhat higher value than 1M. All this is standard stuff and plenty of consultants can do business appraisal for you--the only difference here is this doctor most of the sourcing and analysis himself, with some help, presumably, of a lawyer.
It's JUST like buying a rental building. Every year some people would leave, but then you just find replacements.
Furthermore, these contracts are often structured that if you lose a lot patients in the process your valuation changes in the pay period, vaguely resembling a convertible note. OTOH, owners mortgages are backed by income streams of the practice, so the current owners often are willing to give a low interest rate.
Of course, someone not as savvy, such as you, would be all like holyshizzzballz 1M for charts never ever ever when I already have 500g of student loans. And thusly you'll be twiddling your thumb waiting in your office for 5 years. When people think about risk adjust return, they often don't factor in opportunity cost.
It's JUST like buying a rental building. Every year some people would leave, but then you just find replacements.
Someone at my hospital messed up bigtime and cc'd me their agreement with the agency.
They make 67% on top of what I make per hour.
132% more for weekday 24 hour pager call.
388% more (wish I was making this up) for weekend 24 hour pager call.
Also their contract specifies that the agency gets paid extra for overtime hours (>8 hours a day), which is not anywhere in my contract.
Had no idea I was getting hosed this bad.
They can, but the majority don’t as they just come once a month or less, and if they leave they have to go through the entire intake process again, which can cost a lot. Furthermore, if they leave they may not find the same service for the same price. It’s all supply and demand. I’m doing a very very rough comparables analysis bud. When you do actual financial due diligence for a leveraged buy out like this, you'd survey the attrition rate and factor that in. P/E is 3x which seems reasonable to me for a low small town grocer growth industry like this. A back of the envelop DCF actually would put this practice at somewhat higher value than 1M. All this is standard stuff and plenty of consultants can do business appraisal for you--the only difference here is this doctor most of the sourcing and analysis himself, with some help, presumably, of a lawyer.
It's JUST like buying a rental building. Every year some people would leave, but then you just find replacements.
Furthermore, these contracts are often structured that if you lose a lot patients in the process your valuation changes in the pay period, vaguely resembling a convertible note. OTOH, owners mortgages are backed by income streams of the practice, so the current owners often are willing to give a low interest rate.
Of course, someone not as savvy, such as you, would be all like holyshizzzballz 1M for charts never ever ever when I already have 500g of student loans. And thusly you'll be twiddling your thumb waiting in your office for 5 years. When people think about risk adjust return, they often don't factor in opportunity cost.
It's totally different. When you buy a rental property, you still have the asset if renters leave. When the patient's are the asset and the patient leaves, you no longer have the asset.
If this guy is only buying patient lists, I guess he really hedged his risk:
- decreased valuation based on patient attrition
- collateral of loan tied to business and not to personal assets
- generous pay-back terms
Anyways, this guy took on a huge risk and got a huge reward. Kudos.
Latest numbers: 40 hours a weekday job locum full time at a NYC state hospital (MPC), capped out at 10 patients a day. No nights no weekends no call, $200+ an hour. BAM. If anyone wants the recruiter's contact PM.
Latest numbers: 40 hours a weekday job locum full time at a NYC state hospital (MPC), capped out at 10 patients a day. No nights no weekends no call, $200+ an hour. BAM. If anyone wants the recruiter's contact PM.
Latest numbers: 40 hours a weekday job locum full time at a NYC state hospital (MPC), capped out at 10 patients a day. No nights no weekends no call, $200+ an hour. BAM. If anyone wants the recruiter's contact PM.
Full-time employed psychiatrists there make 195k for comparison (public info for state employees)
Theoretically, at least, the hospital will be trying to fill the spot with an employee. Though, frequently this can take a long time, especially when the position isn’t paid well.Can you just work as locums indefinitely?
Theoretically, at least, the hospital will be trying to fill the spot with an employee. Though, frequently this can take a long time, especially when the position isn’t paid well.
Let's say I strictly want to work locums. Would it be possible to do 40 hrs a week 48 weeks a year x 20 years? In other words can I make a career of locums or will I frequently be unemployed when positions get filled?
Latest numbers: 40 hours a weekday job locum full time at a NYC state hospital (MPC), capped out at 10 patients a day. No nights no weekends no call, $200+ an hour. BAM. If anyone wants the recruiter's contact PM.
Could you PM me the contact info? It’s not letting me PM you for some reason. Thanks!
Seriously. A psychiatrist not only doing cash only but charging $600 an hour?It's full cash. Primarily psychopharm. He "lucked out" in that he purchased an existing practice through owners financing. He's an MBA so very savvy about how to valuate business. Other details I am not privy of. He generates a revenue of 1M, but I don't think he nets 1M. Roughly I think the breakdown would be $600 per hour, 35 clinical hours a week, 48 weeks a year. Typically in this biz you have at most 1-2x revenue valuation or 4x profit. So assume an owners financing package with interest of 5% (total interest of 100k), he'd have EBITA ~ 600k. If he lives frugally for 5 years he'll then have another 200k dividend once the mortgage is done.
The rough math here is the owner derives 1M total revenue from a full time clinician, with 200-300k overhead including capital investment, then take a 50% cut, pay the employee 300k, and take in an end of year dividend of 300k. Part of the overhead will also accrue through capital investment. So a comparable employed position would max out around 300k W-2.
This lifestyle compares very favorably to a mid level banker or a legal partner at a mid sized firm, which typically have similar compensation structure (~300-450k base, everything else is dividend/performance/bonus). OTOH Very little travel. Very little nights/weekends/deadlines. You need another 5ish hours a week for admin/billing, etc. a week. Minimal overhead--don't need a secretary. Assuming 80 visits a week, one visit a month you have about 300-350 patients. This level of admin work you can usually do yourself, or at most hire a remote low cost secretary for appointments, etc.
I went to one of the top 10 programs by doximity in a major metro.
Seriously. A psychiatrist not only doing cash only but charging $600 an hour?
What kind of seriously sick people can afford this?
Seriously. A psychiatrist not only doing cash only but charging $600 an hour?
What kind of seriously sick people can afford this?
So my questions to the Cash paying psychiatrists is this. Considering that the seriously ill people in psychiatry are most often not gonna have the steadiest jobs, the best insurance, do you feel at all bad for excluding these needy people from your care? Like the teacher who has a psychotic break at 30 and decompensates, takes a LOA, for a few weeks, then back to work but needs frequent close follow up for Bipolar 1. Let’s say she needs an OP psychiatrist or she moves cities. And that’s a good example of a working middle class person who can’t afford $300 a month on top of what she pays at her job for premiums.