What is working at Kaiser like for a psychiatrist?

[the5thelement]

They are actively seeking psychiatrists in my area. I know someone who has worked
with them for 15 years & is very happy to collect the regular paycheck. From what i can gather, they work the
family medicine hard but psychiatry I am not so sure. I like the fact everything
seems to be nicely integrated, you can refer for therapy easily and you have access to primary care/other specialties under the same roof. The golden handcuffs are enticing too..... But it sounds too perfect. What is the catch?

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[reca]

Are the golden handcuffs that golden? I heard they changed their retirement benefits a few years ago and that the new plans, while good, are nothing extraordinary. Before, when you factored in the retirement benefits, they’d give even cash pay practices a run for their money in terms of lifetime compensation. Now, it’s more similar to VA benefits.

Just what I heard, idk. I wouldn’t consider working for them just because of their insane “no outside work” clause. I didn’t go through all this training to have to get some rando to “approve” me if I wanted to volunteer at a free clinic.

 

[nexus73]

Benefits vary I think depending on which Kaiser area (Socal, nocal, oregon, washington etc). My friend works there and there are basically no therapists available even with contracting out to non kaiser therapists. Sounds like they try to keep simpler patients in primary care so psych sees more complexity. Patient panel never closes so it will build and build and sounds like it’s hard to send some back to PCP because they want to keep their psychiatrist. And patients message a fair amount and it’s expected you manage those messages. But it’s pretty standard 60 minute intakes and 30 min followups so it’s not an unreasonable grind.

Kaiser has the best health insurance I’ve seen anywhere and includes dental and vision all very low cost, low deductibles, etc.

For me the biggest barrier is 5 days a week of clinic. Every psychiatrist I’ve talked to tries to do less than that because it gets so draining. My friend at Kaiser said the docs he works with eventually realize 5 days is not sustainable and try to take on various admin roles or whatever they can to cut the direct patient care time but not go below full time pay/benefits.

 

[MedMan80]

From what i saw in Norcal, it was 3 weeks PTO to start, no real RVU model so you can't get more for working harder. Seemed like very manageable load of patients. Honestly the benefits did not seem as amazing as others had touted, but if one wanted a chiller gig with a stable paycheck it didn't seem bad.

 

[Stagg737]

I would just never work there d/t their inbox policy. Patients having the ability to directly message me and me having to respond to every message without support staff triaging them is something I find ridiculous if employed by a large system like Kaiser. I already dislike outpatient enough with someone filtering patient messages. If I'm going to have to answer every message I better be making PP money.

 

[annoyedpsychiatrist]

I would just never work there d/t their inbox policy. Patients having the ability to directly message me and me having to respond to every message without support staff triaging them is something I find ridiculous if employed by a large system like Kaiser. I already dislike outpatient enough with someone filtering patient messages. If I'm going to have to answer every message I better be making PP money.

that part isnt as bad. I do have a nurse who helps me (im not at kaiser but patients can directly message me) and i prefer the ability to message me than phone calls. I carry around 400 or so active patients and the messages arent bad, usually can respond fairly quickly and address it. It beats "so and so called and is wanting to speak with you" then playing phone tag. I also make sure i address the plan clearly at each visit as far as what to expect, our goals, etc to try and tie up loose ends.

Im straight salary at my job with no RVU but thats fine for me and im happy with my pay.

I agree with five day work week tbh, it is SUPER draining. One thing I did was save my PTO as much as possible and i took every monday for several months to make 4 day work weeks. More manageable now for sure..

 

[Stagg737]

that part isnt as bad. I do have a nurse who helps me (im not at kaiser but patients can directly message me) and i prefer the ability to message me than phone calls. I carry around 400 or so active patients and the messages arent bad, usually can respond fairly quickly and address it. It beats "so and so called and is wanting to speak with you" then playing phone tag. I also make sure i address the plan clearly at each visit as far as what to expect, our goals, etc to try and tie up loose ends.

Im straight salary at my job with no RVU but thats fine for me and im happy with my pay.

I agree with five day work week tbh, it is SUPER draining. One thing I did was save my PTO as much as possible and i took every monday for several months to make 4 day work weeks. More manageable now for sure..

Sure, but this depends on what patients the system accepts and tells you that you'll be seeing. I generally prefer messages too, but many of my patients message asking to be called back and sometimes it really is needed over a quick message. Plenty of those issues can be addressed by the nurse/office staff. If you've got a relatively low or even moderate acuity panel without severe PDs, I'm sure it's fine. If you're seeing demanding patients or SMI, it can turn into an absolute nightmare.

 

[annoyedpsychiatrist]

Sure, but this depends on what patients the system accepts and tells you that you'll be seeing. I generally prefer messages too, but many of my patients message asking to be called back and sometimes it really is needed over a quick message. Plenty of those issues can be addressed by the nurse/office staff. If you've got a relatively low or even moderate acuity panel without severe PDs, I'm sure it's fine. If you're seeing demanding patients or SMI, it can turn into an absolute nightmare.

all mine are moderate-high acuity. Id guess 30% high acuity, 60% moderate acuity, 10% mild patients. We accept everyone generally and have no exclusionary criteria. Which TBH is exhausting at times because i usually get people with BPD, complex neuro cases, people who have failed every med, etc.

Interestingly enough the very sick people arent always the ones that message like crazy its usually the personality disorder ones moreso than anything else. Or the drug seeking ones. Those I have a low tolerance for and although we accept pretty much everyone I still control what I prescribe and I try to weed out drug seeking very fast.

 

[smalltownpsych]

all mine are moderate-high acuity. Id guess 30% high acuity, 60% moderate acuity, 10% mild patients. We accept everyone generally and have no exclusionary criteria. Which TBH is exhausting at times because i usually get people with BPD, complex neuro cases, people who have failed every med, etc.

Interestingly enough the very sick people arent always the ones that message like crazy its usually the personality disorder ones moreso than anything else. Or the drug seeking ones. Those I have a low tolerance for and although we accept pretty much everyone I still control what I prescribe and I try to weed out drug seeking very fast.

100% with weed out the drug seekers fast. With the Borderline PD folk, they need good therapy and if you can find a couple therapists to collaborate or refer who can feed the patients need then your life will be a lot easier. I know that because I work with Borderline PD all day long and they rarely bother their psychiatrists. 😉

 

[FlowRate]

I've posted about this several times on the forum.

I work in a non-CA region.

Salary comp $300kish
Retirement benefits valued at minimum $40k per year
Excellent other benefits (group disability with pretty good terms, health/dental/vision is very low cost/basically free)
6 total weeks of time off and you're not forced to use educational days on anything educational if you don't want to

The first 9 months-18 months of working here are the hardest because your schedule is wide open and you haven't built a panel of follow-up patients.

By 18 months ("steady state"), accrual of pretty much all relevant benefits is in full swing, you've hit the long-term schedule of 2 hours of admin, 1 hour of lunch, 6 hours f2f patient care time, and you have enough of a panel that you're not slammed with a several intakes every day.

What are the downsides?

Our department functions pretty well when we're filling all of our FTE. Turnover pushes out access for intake/transfer appointments a few weeks and that makes it a little harder to see f/u patients as quickly as you might otherwise like (e.g. 8 weeks instead of 6 weeks). Partly mitigating that, we have excellent nursing staff who can do nursing assessment calls between appointments if you need someone to be checked in on + patient messaging system.

Therapy access is poor nationally. I think it's actually easier for patients to get in with a therapist here than it was in Boston. The only difference is that patients may end up actually seeing their therapist a bit less frequently than would be ideal (q2-3 weeks). That was also true of system-employed therapists when I was in residency so I don't think it's uniquely bad.

(Not a downside, but mitigating therapy access some.) We have excellent access to both in-house and contracted IOP lite/IOP/PHP options (and our in-house is super high quality and largely DBT based.) We have ECT in-house and esketamine and TMS contracted.

In my region, employers love high deductible plans. So patients have "Kaiser" insurance but with high deductible benefits so they're often surprised that they have to pay out of pocket for their care. That's the healthcare market here, not a Kaiser decision. If we could have everyone on an HMO plan, that's what we'd prefer (obviously.)

Whether this is a downside depends on your perspective. In an effort to ensure patients had open access to psychiatry, there's very little triage. So we have a double-edged sword of seeing a bit more bread-and-butter first-start SSRI's than some of us think is appropriate/necessary. But at least those appointments are easy and also often rewarding when the patients get better quickly. Then we send 'em back to PCP.

We get a lot of "ADHD" assessments in previously-undiagnosed adults, although I think that's true everywhere at the moment. There is absolutely zero organizational pressure to "give out" ADHD diagnoses or controlled substances and, actually, we're to a certain degree oriented the opposite way (want to ensure high quality assessments, appropriate use of medications, etc.)

What are some myths/misconceptions?

No one is "telling" you how to practice medicine. We have a very reasonable formulary with pretty much everything you'd normally use covered and it's easy to get prior auth for expensive 3rd line options as long as you've tried the 1st and 2nd line options already. We have a ton of autonomy, including which patients we want to engage with by message vs. scheduling them for an appointment or a phone call. The only time someone might "tell" you how to practice medicine is if you're a ****ty psychiatrist and you need coaching on how to set boundaries/assess safety/not prescribe tons of controlled substances with little rationale/etc. The vast majority of our docs do not need any of that coaching and I find my whole team to be high quality overall.

The "golden handcuffs" aren't that golden or that handcuffy in our region. Everything vests by year 3 and you get all of it when you leave. The "golden handcuffs" in other regions are the super awesome pension that you have to stay like 15ish years for to make it "worthwhile" and something like 5-10 years to qualify for anything. (Depends on exact region how that works.) The retirement benefits we get, while pretty good, are not worth as much as the insane pensions from the CA regions.

I actually can't think of others that aren't included in that one. But let me know some and I'll tell you if it's true or not.

If you want to have a psychodynamic psychotherapy practice setting patients weekly for an hour, you're not a good fit for this model and should do private practice. If you want to see ALL of your patients q2 or q4 weeks even though they're B/B MDD/GAD starting an SSRI, you're not a good fit for this model. We do have some responsibility to resource stewardship and trying to ensure all (Kaiser insured) patients can get access to care. You will not be able to practice cush/lazy outpatient PP style where you keep a tiny panel you see all the time. You can see patients who actually need to be seen urgently without issue (we have urgent slots built in to our schedule templates.)

Finally, I'm enjoying the job overall, it's hard to imagine a realistic employed option that would be better than this. I'm sure there are some niche jobs that would be better but very hard to find. This is a large org that you can simply apply to with little effort searching. I have no plans to leave at the moment. If I were to leave it would be either if something major about the job itself were changed or if I wanted to do a therapy PP. But the longer I go without being a true therapist (the rustier I get), the less likely I'll end up pursuing that.

 

[Stagg737]

100% with weed out the drug seekers fast. With the Borderline PD folk, they need good therapy and if you can find a couple therapists to collaborate or refer who can feed the patients need then your life will be a lot easier. I know that because I work with Borderline PD all day long and they rarely bother their psychiatrists. 😉

The problem borderline PD/trait patients though are the ones who refuse to work with therapists. Can't count the number of patients I've worked with who make comments like "I've done a lot of therapy, it doesn't work for me" or "I've always had problems with my therapists". They become stuck on the idea that "therapy doesn't work for me, I need meds" and they often end up trying to make their psychiatrist their safety object.

I've posted about this several times on the forum.

I work in a non-CA region.

Salary comp $300kish
Retirement benefits valued at minimum $40k per year
Excellent other benefits (group disability with pretty good terms, health/dental/vision is very low cost/basically free)
6 total weeks of time off and you're not forced to use educational days on anything educational if you don't want to

The first 9 months-18 months of working here are the hardest because your schedule is wide open and you haven't built a panel of follow-up patients.

By 18 months ("steady state"), accrual of pretty much all relevant benefits is in full swing, you've hit the long-term schedule of 2 hours of admin, 1 hour of lunch, 6 hours f2f patient care time, and you have enough of a panel that you're not slammed with a several intakes every day.

What are the downsides?

Our department functions pretty well when we're filling all of our FTE. Turnover pushes out access for intake/transfer appointments a few weeks and that makes it a little harder to see f/u patients as quickly as you might otherwise like (e.g. 8 weeks instead of 6 weeks). Partly mitigating that, we have excellent nursing staff who can do nursing assessment calls between appointments if you need someone to be checked in on + patient messaging system.

Therapy access is poor nationally. I think it's actually easier for patients to get in with a therapist here than it was in Boston. The only difference is that patients may end up actually seeing their therapist a bit less frequently than would be ideal (q2-3 weeks). That was also true of system-employed therapists when I was in residency so I don't think it's uniquely bad.

(Not a downside, but mitigating therapy access some.) We have excellent access to both in-house and contracted IOP lite/IOP/PHP options (and our in-house is super high quality and largely DBT based.) We have ECT in-house and esketamine and TMS contracted.

In my region, employers love high deductible plans. So patients have "Kaiser" insurance but with high deductible benefits so they're often surprised that they have to pay out of pocket for their care. That's the healthcare market here, not a Kaiser decision. If we could have everyone on an HMO plan, that's what we'd prefer (obviously.)

Whether this is a downside depends on your perspective. In an effort to ensure patients had open access to psychiatry, there's very little triage. So we have a double-edged sword of seeing a bit more bread-and-butter first-start SSRI's than some of us think is appropriate/necessary. But at least those appointments are easy and also often rewarding when the patients get better quickly. Then we send 'em back to PCP.

We get a lot of "ADHD" assessments in previously-undiagnosed adults, although I think that's true everywhere at the moment. There is absolutely zero organizational pressure to "give out" ADHD diagnoses or controlled substances and, actually, we're to a certain degree oriented the opposite way (want to ensure high quality assessments, appropriate use of medications, etc.)

What are some myths/misconceptions?

No one is "telling" you how to practice medicine. We have a very reasonable formulary with pretty much everything you'd normally use covered and it's easy to get prior auth for expensive 3rd line options as long as you've tried the 1st and 2nd line options already. We have a ton of autonomy, including which patients we want to engage with by message vs. scheduling them for an appointment or a phone call. The only time someone might "tell" you how to practice medicine is if you're a ****ty psychiatrist and you need coaching on how to set boundaries/assess safety/not prescribe tons of controlled substances with little rationale/etc. The vast majority of our docs do not need any of that coaching and I find my whole team to be high quality overall.

The "golden handcuffs" aren't that golden or that handcuffy in our region. Everything vests by year 3 and you get all of it when you leave. The "golden handcuffs" in other regions are the super awesome pension that you have to stay like 15ish years for to make it "worthwhile" and something like 5-10 years to qualify for anything. (Depends on exact region how that works.) The retirement benefits we get, while pretty good, are not worth as much as the insane pensions from the CA regions.

I actually can't think of others that aren't included in that one. But let me know some and I'll tell you if it's true or not.

If you want to have a psychodynamic psychotherapy practice setting patients weekly for an hour, you're not a good fit for this model and should do private practice. If you want to see ALL of your patients q2 or q4 weeks even though they're B/B MDD/GAD starting an SSRI, you're not a good fit for this model. We do have some responsibility to resource stewardship and trying to ensure all (Kaiser insured) patients can get access to care. You will not be able to practice cush/lazy outpatient PP style where you keep a tiny panel you see all the time. You can see patients who actually need to be seen urgently without issue (we have urgent slots built in to our schedule templates.)

Finally, I'm enjoying the job overall, it's hard to imagine a realistic employed option that would be better than this. I'm sure there are some niche jobs that would be better but very hard to find. This is a large org that you can simply apply to with little effort searching. I have no plans to leave at the moment. If I were to leave it would be either if something major about the job itself were changed or if I wanted to do a therapy PP. But the longer I go without being a true therapist (the rustier I get), the less likely I'll end up pursuing that.

How is your inbox? Any significant changes when the policy change to patients being able to directly message their prescriber was put in place?

 

[Merovinge]

I've posted about this several times on the forum.

I work in a non-CA region.

Salary comp $300kish
Retirement benefits valued at minimum $40k per year
Excellent other benefits (group disability with pretty good terms, health/dental/vision is very low cost/basically free)
6 total weeks of time off and you're not forced to use educational days on anything educational if you don't want to

The first 9 months-18 months of working here are the hardest because your schedule is wide open and you haven't built a panel of follow-up patients.

By 18 months ("steady state"), accrual of pretty much all relevant benefits is in full swing, you've hit the long-term schedule of 2 hours of admin, 1 hour of lunch, 6 hours f2f patient care time, and you have enough of a panel that you're not slammed with a several intakes every day.

What are the downsides?

Our department functions pretty well when we're filling all of our FTE. Turnover pushes out access for intake/transfer appointments a few weeks and that makes it a little harder to see f/u patients as quickly as you might otherwise like (e.g. 8 weeks instead of 6 weeks). Partly mitigating that, we have excellent nursing staff who can do nursing assessment calls between appointments if you need someone to be checked in on + patient messaging system.

Therapy access is poor nationally. I think it's actually easier for patients to get in with a therapist here than it was in Boston. The only difference is that patients may end up actually seeing their therapist a bit less frequently than would be ideal (q2-3 weeks). That was also true of system-employed therapists when I was in residency so I don't think it's uniquely bad.

(Not a downside, but mitigating therapy access some.) We have excellent access to both in-house and contracted IOP lite/IOP/PHP options (and our in-house is super high quality and largely DBT based.) We have ECT in-house and esketamine and TMS contracted.

In my region, employers love high deductible plans. So patients have "Kaiser" insurance but with high deductible benefits so they're often surprised that they have to pay out of pocket for their care. That's the healthcare market here, not a Kaiser decision. If we could have everyone on an HMO plan, that's what we'd prefer (obviously.)

Whether this is a downside depends on your perspective. In an effort to ensure patients had open access to psychiatry, there's very little triage. So we have a double-edged sword of seeing a bit more bread-and-butter first-start SSRI's than some of us think is appropriate/necessary. But at least those appointments are easy and also often rewarding when the patients get better quickly. Then we send 'em back to PCP.

We get a lot of "ADHD" assessments in previously-undiagnosed adults, although I think that's true everywhere at the moment. There is absolutely zero organizational pressure to "give out" ADHD diagnoses or controlled substances and, actually, we're to a certain degree oriented the opposite way (want to ensure high quality assessments, appropriate use of medications, etc.)

What are some myths/misconceptions?

No one is "telling" you how to practice medicine. We have a very reasonable formulary with pretty much everything you'd normally use covered and it's easy to get prior auth for expensive 3rd line options as long as you've tried the 1st and 2nd line options already. We have a ton of autonomy, including which patients we want to engage with by message vs. scheduling them for an appointment or a phone call. The only time someone might "tell" you how to practice medicine is if you're a ****ty psychiatrist and you need coaching on how to set boundaries/assess safety/not prescribe tons of controlled substances with little rationale/etc. The vast majority of our docs do not need any of that coaching and I find my whole team to be high quality overall.

The "golden handcuffs" aren't that golden or that handcuffy in our region. Everything vests by year 3 and you get all of it when you leave. The "golden handcuffs" in other regions are the super awesome pension that you have to stay like 15ish years for to make it "worthwhile" and something like 5-10 years to qualify for anything. (Depends on exact region how that works.) The retirement benefits we get, while pretty good, are not worth as much as the insane pensions from the CA regions.

I actually can't think of others that aren't included in that one. But let me know some and I'll tell you if it's true or not.

If you want to have a psychodynamic psychotherapy practice setting patients weekly for an hour, you're not a good fit for this model and should do private practice. If you want to see ALL of your patients q2 or q4 weeks even though they're B/B MDD/GAD starting an SSRI, you're not a good fit for this model. We do have some responsibility to resource stewardship and trying to ensure all (Kaiser insured) patients can get access to care. You will not be able to practice cush/lazy outpatient PP style where you keep a tiny panel you see all the time. You can see patients who actually need to be seen urgently without issue (we have urgent slots built in to our schedule templates.)

Finally, I'm enjoying the job overall, it's hard to imagine a realistic employed option that would be better than this. I'm sure there are some niche jobs that would be better but very hard to find. This is a large org that you can simply apply to with little effort searching. I have no plans to leave at the moment. If I were to leave it would be either if something major about the job itself were changed or if I wanted to do a therapy PP. But the longer I go without being a true therapist (the rustier I get), the less likely I'll end up pursuing that.

Great summary and compare that to working for Lifestance or whatever other PE owned practice is and its clear why folks would prefer Kaiser. It is freaking painful to have patients that need to get access to weekly therapy and get seen q3 weeks, I am not sure how I would be able to treat severe social anxiety, OCD, etc without good weekly therapy.

 

[comp1]

What is the current status of the NorCal and SoCal pensions for new physicians?

 

[FlowRate]

The problem borderline PD/trait patients though are the ones who refuse to work with therapists. Can't count the number of patients I've worked with who make comments like "I've done a lot of therapy, it doesn't work for me" or "I've always had problems with my therapists". They become stuck on the idea that "therapy doesn't work for me, I need meds" and they often end up trying to make their psychiatrist their safety object.


How is your inbox? Any significant changes when the policy change to patients being able to directly message their prescriber was put in place?

We've had patients directly messaging us the whole time I've been working here. It's completely manageable. There's a big component of practice/personality style though. I encourage patients to message me if they need something but I also corral patients who aren't appropriately messaging very quickly.

It should be telling that it's extremely unusual for any of the docs in my clinic to leave/finish work later than 5PM. I finish on time basically every day and I almost never work through lunch. We get 2 hours of admin time in part because we do direct messaging with patients so you have plenty of time for doing so.

Great summary and compare that to working for Lifestance or whatever other PE owned practice is and its clear why folks would prefer Kaiser. It is freaking painful to have patients that need to get access to weekly therapy and get seen q3 weeks, I am not sure how I would be able to treat severe social anxiety, OCD, etc without good weekly therapy.

We contract with a PHP/IOP here that does a really great job with severe anxiety disorders so if symptoms are bad I'm usually trying to get patients to do that. But I agree it's really frustrating when patients can't/won't make time for IOP/PHP and aren't able to get weekly treatment. I have seen some patients make good progress with every other week even if it's suboptimal.

What is the current status of the NorCal and SoCal pensions for new physicians?

As far as I can tell, they're still status quo. TPMG and SCPMG are super financially stable thanks to how much of CA KP covers.

 

[annoyedpsychiatrist]

We've had patients directly messaging us the whole time I've been working here. It's completely manageable. There's a big component of practice/personality style though. I encourage patients to message me if they need something but I also corral patients who aren't appropriately messaging very quickly.

It should be telling that it's extremely unusual for any of the docs in my clinic to leave/finish work later than 5PM. I finish on time basically every day and I almost never work through lunch. We get 2 hours of admin time in part because we do direct messaging with patients so you have plenty of time for doing so.

We contract with a PHP/IOP here that does a really great job with severe anxiety disorders so if symptoms are bad I'm usually trying to get patients to do that. But I agree it's really frustrating when patients can't/won't make time for IOP/PHP and aren't able to get weekly treatment. I have seen some patients make good progress with every other week even if it's suboptimal.

As far as I can tell, they're still status quo. TPMG and SCPMG are super financially stable thanks to how much of CA KP covers.

you work at kaiser? do you like it overall?

 

[FlowRate]

you work at kaiser? do you like it overall?

Yes and yes.

There are frustrations with any job, of course, but I think the majority of the frustrations with my job are going to be common to any employed setting. I do envy private practice docs and their ability to be more choosy about cases (I'm very tired of the impressionable "ASD/ADHD" pandemic.)

 

[annoyedpsychiatrist]

Yes and yes.

There are frustrations with any job, of course, but I think the majority of the frustrations with my job are going to be common to any employed setting. I do envy private practice docs and their ability to be more choosy about cases (I'm very tired of the impressionable "ASD/ADHD" pandemic.)

from what you described, our jobs sound extremely identical, as i work for a hospital systme outpatient type job, and have pretty much same type of frustrations

 

[nexus73]

We've had patients directly messaging us the whole time I've been working here. It's completely manageable. There's a big component of practice/personality style though. I encourage patients to message me if they need something but I also corral patients who aren't appropriately messaging very quickly.

It should be telling that it's extremely unusual for any of the docs in my clinic to leave/finish work later than 5PM. I finish on time basically every day and I almost never work through lunch. We get 2 hours of admin time in part because we do direct messaging with patients so you have plenty of time for doing so.

We contract with a PHP/IOP here that does a really great job with severe anxiety disorders so if symptoms are bad I'm usually trying to get patients to do that. But I agree it's really frustrating when patients can't/won't make time for IOP/PHP and aren't able to get weekly treatment. I have seen some patients make good progress with every other week even if it's suboptimal.

As far as I can tell, they're still status quo. TPMG and SCPMG are super financially stable thanks to how much of CA KP covers.

does this mean 6 hours of patient time per day, max 12 followups?

 

[FlowRate]

does this mean 6 hours of patient time per day, max 12 followups?

Yes.

 

[calvinhobbes]

What’s the salary like at TPMG if someone doesn’t mind posting of DM’ing me? Thanks

 

[MedMan80]

What’s the salary like at TPMG if someone doesn’t mind posting of DM’ing me? Thanks

Child psych for Norcal is 364k per year

 

[reca]

What’s the salary like at TPMG if someone doesn’t mind posting of DM’ing me? Thanks

350k for adult psychiatry

 

[rexlax]

Hello!
Late to the thread, but for others interested and want to DM me with questions/details feel free to reach out.

I've worked at TPMG (Kaiser Permanente Northern California's medical group) for the past 10 years, and I anticipate staying there for the entirety of my career (probably around 15 years more). While it's not perfect (no organization or system of care is really), I'm definitely happy with my choice working there.

Just some 2 cents:

Each Kaiser Medical Group (TPMG for Northern CA, SCPMG for Southern California, Mid Atlantic, Georgia, Hawaii, Colorado, Washington, and Northwest (OR and Southern Washington) all have differences, including their benefit structure.

Northern California Salary and Benefits: (350k for adult, 365k for child starting salaries). Every 7 years or so, there's also a SpA (a salary adjustment that's built in which also is a nice add on). There are end of year bonuses and extra spring bonuses for shareholders. The benefits are immense. There is a healthy and ongoing pension plan upon retirement, and retirement perks that include free healthcare for life, a permanente matching plan, and salary deferral plan. There's now public service loan forgiveness as an option (getting 75k loans forgiven which was a pleasant surprise), and all the usual dental, long term care, disability, etc. etc. which are quite generous. Definitely a massive perk.

Inbox - It was real onerous maybe the last 5 years, but things have been changing drastically. Desktop medicine is coming to Psychiatry which has regional ancillary staff reviewing messages and siphoning off messages before even coming to your local ancillary team which siphons more off before coming to you. My med center has MAs that help with scheduling and vitals, RNs that help with assessments, and risk assessments, relaying information, and pharmacists that handle refill requests, bridge appointments (between your appointments if needed), and adult ADHD cases. In addition, we have implemented a new SPMI program (severely persistent mentally ill) regional program where regional pharmacists are monitoring and caring for patients with diagnosis of schizophrenia, schizoaffective, and bipolar disorder diagnosis - everything from LAI, to Clozaril to metabolic monitoring and AIMs. The team approach is immense, and really has created a team like approach in care. You absolutely can forward messages to the right pool of ancillary staff to take care of things with some direction.

In addition, there are some agreements with Adult/Family Medicine PCPs to initiate 2 trials of antidepressants before even referral to our department, as more PCPs are needing to handle these cases more and more. There are often night float teams, and every medical center has triage teams that help with the hospitalization process so if you're doing outpatient work, your day is not upended trying to find beds, etc.

Scheduling - 5 days a week is likely more dependent on the operational needs of a clinic. Many clinics are able to flexibility work things out depending on life circumstances. Just depends. I think there's a lot more flexibility than people realize. Right now, there's a mix of in-person/wfh days.

Upper Leadership - the new CEO has given a specific shout out and prioritization for mental health. She has plans for short term bridge and long term visions for the organization. It is refreshing but I can see movement and not a reactivity but actual intentionality on future positive directions for the organization.

Yes, there is definitely openings for therapists, but there's also external referral possibilities and an infrastructure for IOP, PHP, higher levels of care that is organized and on top of things IMO. There's also ketamine, TMS, and most recently opportunities to have inpatient brexanolone treatments for postpartum depression if appropriate. There's now two Kaiser (eventually three) psych residency training programs in NorCal and lots of training programs including a KP Allied Health Sciences Program for MFTs that is about to graduate their first class of therapists.

Anyway, I think above all, I enjoy working with my colleagues and team. I really appreciate my interactions with the other departments in this integrated system of care. This is just one system of care, and of course one size doesn't fit all in terms of mental health needs. But I do think there's a lot positives working at TPMG Northern California Kaiser. Anyway, hope it explains some things!

 

[MedMan80]

What surprised me was only 15 days of PTO to start, i believe it went up after the first few years but that sullied any talk of "great benefits" at the get-go.

 

[Psych19]

There are end of year bonuses and extra spring bonuses for shareholders. The benefits are immense. There is a healthy and ongoing pension plan upon retirement, and retirement perks that include free healthcare for life, a permanente matching plan,

Are you willing/able to share any details about the
- bonuses
- pension plan
- retirement match?

 

[PikminOC]

Hello!
Late to the thread, but for others interested and want to DM me with questions/details feel free to reach out.

I've worked at TPMG (Kaiser Permanente Northern California's medical group) for the past 10 years, and I anticipate staying there for the entirety of my career (probably around 15 years more). While it's not perfect (no organization or system of care is really), I'm definitely happy with my choice working there.

Just some 2 cents:

Each Kaiser Medical Group (TPMG for Northern CA, SCPMG for Southern California, Mid Atlantic, Georgia, Hawaii, Colorado, Washington, and Northwest (OR and Southern Washington) all have differences, including their benefit structure.

Northern California Salary and Benefits: (350k for adult, 365k for child). Every 7 years or so, there's also a SpA (a salary adjustment that's built in which also is a nice add on). There are end of year bonuses and extra spring bonuses for shareholders. The benefits are immense. There is a healthy and ongoing pension plan upon retirement, and retirement perks that include free healthcare for life, a permanente matching plan, and salary deferral plan. There's now public service loan forgiveness as an option (getting 75k loans forgiven which was a pleasant surprise), and all the usual dental, long term care, disability, etc. etc. which are quite generous. Definitely a massive perk.

Inbox - It was real onerous maybe the last 5 years, but things have been changing drastically. Desktop medicine is coming to Psychiatry which has regional ancillary staff reviewing messages and siphoning off messages before even coming to your local ancillary team which siphons more off before coming to you. My med center has MAs that help with scheduling and vitals, RNs that help with assessments, and risk assessments, relaying information, and pharmacists that handle refill requests, bridge appointments (between your appointments if needed), and adult ADHD cases. In addition, we have implemented a new SPMI program (severely persistent mentally ill) regional program where regional pharmacists are monitoring and caring for patients with diagnosis of schizophrenia, schizoaffective, and bipolar disorder diagnosis - everything from LAI, to Clozaril to metabolic monitoring and AIMs. The team approach is immense, and really has created a team like approach in care. You absolutely can forward messages to the right pool of ancillary staff to take care of things with some direction.

In addition, there are some agreements with Adult/Family Medicine PCPs to initiate 2 trials of antidepressants before even referral to our department, as more PCPs are needing to handle these cases more and more. There are often night float teams, and every medical center has triage teams that help with the hospitalization process so if you're doing outpatient work, your day is not upended trying to find beds, etc.

Scheduling - 5 days a week is likely more dependent on the operational needs of a clinic. Many clinics are able to flexibility work things out depending on life circumstances. Just depends. I think there's a lot more flexibility than people realize. Right now, there's a mix of in-person/wfh days.

Upper Leadership - the new CEO has given a specific shout out and prioritization for mental health. She has plans for short term bridge and long term visions for the organization. It is refreshing but I can see movement and not a reactivity but actual intentionality on future positive directions for the organization.

Yes, there is definitely openings for therapists, but there's also external referral possibilities and an infrastructure for IOP, PHP, higher levels of care that is organized and on top of things IMO. There's also ketamine, TMS, and most recently opportunities to have inpatient brexanolone treatments for postpartum depression if appropriate. There's now two Kaiser (eventually three) psych residency training programs in NorCal and lots of training programs including a KP Allied Health Sciences Program for MFTs that is about to graduate their first class of therapists.

Anyway, I think above all, I enjoy working with my colleagues and team. I really appreciate my interactions with the other departments in this integrated system of care. This is just one system of care, and of course one size doesn't fit all in terms of mental health needs. But I do think there's a lot positives working at TPMG Northern California Kaiser. Anyway, hope it explains some things!

Everything all sorted out after the yearly strikes? Patients seem within ten days of intake etc as the California rules say?

With the outpatient referral network, they are in network with KP?

 

[calvnandhobbs68]

In addition, there are some agreements with Adult/Family Medicine PCPs to initiate 2 trials of antidepressants before even referral to our department, as more PCPs are needing to handle these cases more and more. There are often night float teams, and every medical center has triage teams that help with the hospitalization process so if you're doing outpatient work, your day is not upended trying to find beds, etc.

lol I mean stuff like this though....like how would this have even been an expectation to begin with? I'm never going to try to "find beds" as someone's outpatient psychiatrist, they can go to the ER or call crisis and thats their job once someone has confirmed they require inpatient hospitalization.

 

[comp1]

I distinctly remember in residency we had to "find a bed" for our outpatients who were suicidal or homicidal. It was every bit as horrible as you might imagine, but we were specifically ordered not to send these patients to the ED (or call 911 which would have the same effect) and instead to cancel the rest of the clinic day with the patient sitting in our offices until well in the evening until I both found a bed and arranged the ambulance. It's nice that Kaiser has a team to take that over.

 

[calvnandhobbs68]

I distinctly remember in residency we had to "find a bed" for our outpatients who were suicidal or homicidal. It was every bit as horrible as you might imagine, but we were specifically ordered not to send these patients to the ED (or call 911 which would have the same effect) and instead to cancel the rest of the clinic day with the patient sitting in our offices until well in the evening until I both found a bed and arranged the ambulance. It's nice that Kaiser has a team to take that over.

lol this does not happen in the regular outpatient world. I'll call ahead to the ER to let them know you're coming and my concerns but you're either going to the ER with a family member or I'm calling EMS to come transport you.

That's actually a rather weird setup, no PCPs are direct admitting patients from their offices to the hospital anymore these days as far as I've seen. When my infant had to be admitted, PCP sent us to the ER and called ahead. There's also no EMTALA pressure if you're trying to admit someone from an outpatient clinic.

 

[rexlax]

Trying my best to answer what I can:

Time Off: @MedMan80, you're right 3 weeks PTO to start. It becomes 4 weeks PTO at year 4, and 5 weeks at year 11. But you also get 1 week of Ed Leave year which can accrue as well, and there's still the additional holidays of New Years, MLK, Presidents, Memorial, July 4th, Labor Day, Thanksgiving and Christmas. There's ways to strategically also set your days up. Some people like the 4 10-hour days, but it often ends up being the "extra day off on a M or F" is just recuperation time from a rigorous 4 day schedule. I find it pretty workable to have the time off, and most departments are actually quite flexible in granting time off as long as basic operations are still intact.

Bonuses: Yup, there's an end of the year bonus around December, and for shareholders there's an extra bonus in March with the amount depending on how the organization does well financially. There's been a minimum amount that's been given, but on other years, it can be higher. The end of the year bonuses are also tied to some hours to do in collaboration with other departments (to meet and discuss common issues or overlapping ones), and they are actually quite nice to connect with others. There's a lot of support in ensuring that everyone gets those completed.

Pension Plan: It's one of the 3 plans that Kaiser helps with benefits (the other two are Permanente Contribution Plan (plan 2) and the Tax Deferral Plan -pretax and post). You get all 3. The Pension Plan is based on the years of service (need 5 years of service to be vested), and credited service. There are options of how you want to receive your pension (early, full early, normal at age 65, and postponed). Basically, you take the highest 3 consecutive years of salary over your career (the highest average compensation), multiplied by a pension percentage (based on years of credited service). And you get an amount that you receive as a pension every month. That was a super gross generalization. It's too complex to explain here, because there's many factors depending on how many years one does and when they want to want payments to begin or how long want payments to last. However, it's absolutely still going and strong.

Retirement Match - not sure if we have that per se, but TPMG does contribute a tax deferred contribution into plan that is a percentage of Social Security wage base plus a percentage of income with a maximum contribution of a certain amount (sorry, not putting numbers since I actually don't have the latest). This is called the Plan 2 .

Plan 3 is the Salary Deferral Plan in which you can contribute a percentage of income pretox to 401k, after-tax to Roth 401k or combo.

Other Perks - forgot to mention - but there's 5k a year for professional expenditure reimbursements (doesn't accrue, it's use it or lose it every year). There's also reimbursements for your licensure and DEA in addition to that. You can get a little time for board preparation. There's also a homebuyers interest free loan that one pays back after 10 years (it allowed me to purchase a starter home, which doubled in value - had massively good fortune and timing).

Shareholder - when you're a shareholder, you are obligated to purchase shares (which allow the fullest of the benefits). The share cost does go up, and there's both required shares to purchase and shares that you can optionally add on. I highly highly recommend saving so you can maximize the shares purchased as the share values pretty much increase a very healthy percentage a year and it's all compounding. When one retires, it's a massive amount you get when you are forced to share your shares. Many people live off that for awhile before activating other sources of retirement income streams.

Sorry, trying to answer between some things at work! Will answer other questions shortly!

 

[FlowRate]

It becomes 4 weeks PTO at year 4, and 5 weeks at year 11. But you also get 1 week of Ed Leave year which can accrue as well

Does TPMG require that ed leave be used on "approved" ed stuff or is it just an extra week of PTO functionally like in my region?

 

[rexlax]

Strikes - yes, after those strikes of 8-10/2022, I think everyone was glad to move forward. Access has actually been quite good on a whole, with initiate to seen access being in a 10 day window for therapist (and 15 days for MDs). There were concerns about return access for therapists , and that has all looked actually quite good across the board lately and in line with DHMC requirements. There are multiple levers to make that happen (including connect 2 care regional hub, IAC intake coordinators, etc etc) , and the therapist/clinician makes the assessment whether it is clinically indicated or appropriate for someone to be seen within 10 days. (Patients expecting daily psychoanalytic therapy are going to be pretty darn disappointed here). There are definitely some programs in place such as KP Accelerate Depression which allows for time limited weekly individual therapy coupled with case management from psych techs, groups, and if needed med management. From the strike, there is an agreement for a partnership between union and the management group to work through a regional model of care committee, and they are addressing many facets of things to improve upon - including different treatment tracks for more streamline and specific care (trauma, DBT, etc). I think there's definitely some movement in progress; however, the contracts seem to be every 2-3 years. I think most organizations with organized labor will often be dealing with this (check the news, there's usually a strike of some kind going on). The good news is that the relationships between the MDs and the staff are very healthy and I think people are able to separate some of that and still work towards delivering collaborative patient care needs quite well.

External Referrals: Yes, there is a utilization of outpatient referrals through an external provider network (those outside providers contracted with Kaiser to provide services). Those are utilized only if the services is not available to be provided or can't. It definitely was used a lot during the strike last year, and while still at times used, much less so. I think Kaiser Permanente still aims for trying to provide whatever services they can in-house, but sometimes we simply don't have something, and generally the clinicians are trusted in making those decisions.

Ed Leave: Many physicians use that time to do MOC articles or "self study" or some go do CME with conferences, etc. I think on a whole, people are trusted to use it responsibly but it essentially is PTO like. I think there are certain circumstances that a Chief can question it (taking 3 weeks of accrued ed leave, etc), but typically you are trusted to use it in how you see fit and you stay board certified/licensed.

 

[calvinhobbes]

Any updates to what it’s like to work at Kaiser as a psychiatrist at other Kaisers like Midwest and Georgia, etc?

 

[VarthDader]

Non-psychiatrist checking in. Looking to move states and my options appear to be Kaiser/ Concentra/ Locums. Concentra is a non-starter for obvious reasons. Would love to hear Kaiser input from those who work there/ have buddies that work there in other fields/ etc etc

 

[clozareal]

Non-psychiatrist checking in. Looking to move states and my options appear to be Kaiser/ Concentra/ Locums. Concentra is a non-starter for obvious reasons. Would love to hear Kaiser input from those who work there/ have buddies that work there in other fields/ etc etc

What's the obvious reason for those of us who haven't heard of Concentra?

 

[FlowRate]

Non-psychiatrist checking in. Looking to move states and my options appear to be Kaiser/ Concentra/ Locums. Concentra is a non-starter for obvious reasons. Would love to hear Kaiser input from those who work there/ have buddies that work there in other fields/ etc etc

Googling Concentra, are you EM-trained looking to do UC work?

 

[VarthDader]

What's the obvious reason for those of us who haven't heard of Concentra?

Corporate overlords. Crap pay. Forced to “collaborate” with a sea of nps. Dubois practices. Etc. similar to HCA, if you’ve heard of that clusterf***.

Googling Concentra, are you EM-trained looking to do UC work?

I am not EM.

 

[FlowRate]

Corporate overlords. Crap pay. Forced to “collaborate” with a sea of nps. Dubois practices. Etc. similar to HCA, if you’ve heard of that clusterf***.

I am not EM.

I don't personally know any UC docs here but honestly it seems like a pretty good gig as far as that kind of work goes. Superficially, many of the UC docs I've run into seem happy. It's a patient population who get all of their care in the system which is great for continuity. It seems a little different than just manning a standalone UC.

 

[MacDonaldTriad]

This is what I hear.