What salary would you expect from this job?

[trophyhusband]

Here are some details about a position that my wife just spoke to a recruiter (internal) about today. She decided to hear more about it but she wants to know what a realistic salary to ask for if she were to go on the interview:

Inpatient Adult and C&A:
4 other docs and 71 beds so if full 14 patients
Let's say half adult half adolescent
No weekends, no weekday call
70% Medicaid (probably mostly rural based on location)
Midwest but a decent college town we wouldn't mind living in

So SDN hivemind what would you ask for this job? Also, is seeing 14 patients between 8-5 realistic? My wife is the type that likes to go above and beyond so that could lead to issues with efficiency I'm guessing.

Any other thoughts?

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[SmallBird]

Here are some details about a position that my wife just spoke to a recruiter (internal) about today. She decided to hear more about it but she wants to know what a realistic salary to ask for if she were to go on the interview:

Inpatient Adult and C&A:
4 other docs and 71 beds so if full 14 patients
Let's say half adult half adolescent
No weekends, no weekday call
70% Medicaid (probably mostly rural based on location)
Midwest but a decent college town we wouldn't mind living in

So SDN hivemind what would you ask for this job? Also, is seeing 14 patients between 8-5 realistic? My wife is the type that likes to go above and beyond so that could lead to issues with efficiency I'm guessing.

Any other thoughts?

About $300k, based on extrapolations from my recent job search.

 

[trophyhusband]

About $300k, based on extrapolations from my recent job search.

That's what I was estimating as well. We'll see if she actually wants to interview once she talks to the next person. This place asked what her salary expectations were and then they told her what the patient load was, cute that.

 

[nexus73]

Here are some details about a position that my wife just spoke to a recruiter (internal) about today. She decided to hear more about it but she wants to know what a realistic salary to ask for if she were to go on the interview:

Inpatient Adult and C&A:
4 other docs and 71 beds so if full 14 patients
Let's say half adult half adolescent
No weekends, no weekday call
70% Medicaid (probably mostly rural based on location)
Midwest but a decent college town we wouldn't mind living in

So SDN hivemind what would you ask for this job? Also, is seeing 14 patients between 8-5 realistic? My wife is the type that likes to go above and beyond so that could lead to issues with efficiency I'm guessing.

Any other thoughts?

I've definitely seen this be an issue, particularly with women, who are excellent psychiatrists. I would say 10 patients per day is sustainable, with occasional spikes up to 14 being manageable.

I can't imagine a job like this would be straight salary. With patient load fluctuations, I would want some type of guaranteed base plus production pay.

 

[trophyhusband]

I've definitely seen this be an issue, particularly with women, who are excellent psychiatrists. I would say 10 patients per day is sustainable, with occasional spikes up to 14 being manageable.

I can't imagine a job like this would be straight salary. With patient load fluctuations, I would want some type of guaranteed base plus production pay.

Right, it's salary + production bonus. I don't think she'll be able to get them up to $300k in salary but salary + bonus = $300k seems doable. Edit: Though she'll certainly ask for $300k in salary + bonus if she does indeed want the job (never hurts to ask right?).

Unfortunately it sounds like they're running 50 beds with 4 Psychiatrists currently and they have the beds for up to 71 so we're guessing this position is going to get them up to capacity more or less. So it seems like it'll be 12-14 most of the time.

 

[nexus73]

Right, it's salary + production bonus. I don't think she'll be able to get them up to $300k in salary but salary + bonus = $300k seems doable. Edit: Though she'll certainly ask for $300k in salary + bonus if she does indeed want the job (never hurts to ask right?).

Unfortunately it sounds like they're running 50 beds with 4 Psychiatrists currently and they have the beds for up to 71 so we're guessing this position is going to get them up to capacity more or less. So it seems like it'll be 12-14 most of the time.

I also recommend she ask for student loan repayment (if she has any loans) and a retention bonus (or signing bonus) that vests after a certain amount of time or you pay back a portion or all of it if you leave early. Also clarify whether she'll have to supervise midlevels (if she'd even want to) and negotiate compensation.

 

[trophyhusband]

I also recommend she ask for student loan repayment (if she has any loans) and a retention bonus (or signing bonus) that vests after a certain amount of time or you pay back a portion or all of it if you leave early. Also clarify whether she'll have to supervise midlevels (if she'd even want to) and negotiate compensation.

Thanks, student loan repayment is available, relocation is as well, no supervision of midlevels... recruiter didn't mention signing/retention bonus but she'll definitely ask. I think she's pretty excited about the no call but wary of a patient load of 14. Still need to find out what the benefits are too as well as we both highly value vacation time (amongst other benefits).

 

[benlinus]

seems more like a 235k-250k , no weekends and no weekday call I think takes it out of the 300k conversation; now if your wife is C&A trained then that's a different story, may take it close to 300k if they are desperate for a child psychiatrist; if asking for a sign on bonus, relocation, and student loan repayment that may lower the base; and 14 patients is actually around the lower end of patient load I've been seeing during interviews, anything lower than that won't even put you close to 300k, and don't even worry about production bonus if you see less than 14 patients per day; I don't know your wife's experience level (new graduate vs old head) but that will be taken into consideration also

 

[trophyhusband]

seems more like a 235k-250k , no weekends and no weekday call I think takes it out of the 300k conversation; now if your wife is C&A trained then that's a different story, may take it close to 300k if they are desperate for a child psychiatrist; if asking for a sign on bonus, relocation, and student loan repayment that may lower the base; and 14 patients is actually around the lower end of patient load I've been seeing during interviews, anything lower than that won't even put you close to 300k, and don't even worry about production bonus if you see less than 14 patients per day; I don't know your wife's experience level (new graduate vs old head) but that will be taken into consideration also

C&A trained. She already talked them down to 10-12 patients a day. She won't be expecting $300k for that but she might ask for it anyway.

As far as the bolded, a couple of places tried that trick on her and her response is always "do the insurers pay you more based on my years of experience?" When they have to respond no that usually shuts it down pretty quick and if they still insist on going that route she walks away.

 

[Shikima]

C&A trained. She already talked them down to 10-12 patients a day. She won't be expecting $300k for that but she might ask for it anyway.

As far as the bolded, a couple of places tried that trick on her and her response is always "do the insurers pay you more based on my years of experience?" When they have to respond no that usually shuts it down pretty quick and if they still insist on going that route she walks away.

Consider taking a medical directorship with a stipend and benefits and then 1099 on a per diem basis. She can dictate how many a day and billing level for herself as she's working for herself.

 

[trophyhusband]

Consider taking a medical directorship with a stipend and benefits and then 1099 on a per diem basis. She can dictate how many a day and billing level for herself as she's working for herself.

Interesting, thanks! Might have to try that... I think they are looking for a Medical Director (and she's currently a Medical Director so I don't think it'd be out of place to inquire).

 

[J ROD]

Personally, I think 12-14 is doable given a 2-3 new patients per day. 250-300K

 

[Jules A]

As far as the bolded, a couple of places tried that trick on her and her response is always "do the insurers pay you more based on my years of experience?" When they have to respond no that usually shuts it down pretty quick and if they still insist on going that route she walks away.

Yeah I used that with one of my first jobs, was prepared to walk of course, but they met my rate with no further negotiation attempts, lol.

 

[finalpsychyear]

C&A trained. She already talked them down to 10-12 patients a day. She won't be expecting $300k for that but she might ask for it anyway.

As far as the bolded, a couple of places tried that trick on her and her response is always "do the insurers pay you more based on my years of experience?" When they have to respond no that usually shuts it down pretty quick and if they still insist on going that route she walks away.

Well always tell your wife to count her residency and fellowship because that is experience and no reason to break it down unless they really pry.

 

[trophyhusband]

Ok, new question for the board. Let's say you have 3 job offers and all are broadly acceptable but one is "the one." But of course you haven't seen the contract just the one page offer letter. What exactly do you do? Accept the one offer and hope there are no irreconcilable differences in the contract negotiations? We don't really have enough time to start again with the interview process so that's a factor as well.

It seems crappy to accept multiple offers but my wife isn't sure what's kosher in this process since her past couple go 'rounds were with academic places where the contract wasn't really negotiable.

 

[Shikima]

Ok, new question for the board. Let's say you have 3 job offers and all are broadly acceptable but one is "the one." But of course you haven't seen the contract just the one page offer letter. What exactly do you do? Accept the one offer and hope there are no irreconcilable differences in the contract negotiations? We don't really have enough time to start again with the interview process so that's a factor as well.

It seems crappy to accept multiple offers but my wife isn't sure what's kosher in this process since her past couple go 'rounds were with academic places where the contract wasn't really negotiable.

Start somewhere and move up. No noncompete clauses. 90 day no fault employment termination from either party.

 

[Psychotic]

Ok, new question for the board. Let's say you have 3 job offers and all are broadly acceptable but one is "the one." But of course you haven't seen the contract just the one page offer letter. What exactly do you do? Accept the one offer and hope there are no irreconcilable differences in the contract negotiations? We don't really have enough time to start again with the interview process so that's a factor as well.

It seems crappy to accept multiple offers but my wife isn't sure what's kosher in this process since her past couple go 'rounds were with academic places where the contract wasn't really negotiable.

Are you suggesting that these places expect you to "accept" an offer based on a one page offer letter, before they show you a contract? Are these conditional acceptances, i.e., can you accept and then graciously back out of the acceptance if you find the contract unacceptable? Is this sort of thing more common with academic gigs?

Even if a contract is more or less non-negotiable, I can't imagine verbally accepting, much less signing an offer letter, without having in hand a contract and having enough time to have it vetted by a lawyer if necessary.

 

[trophyhusband]

Are you suggesting that these places expect you to "accept" an offer based on a one page offer letter, before they show you a contract? Are these conditional acceptances, i.e., can you accept and then graciously back out of the acceptance if you find the contract unacceptable? Is this sort of thing more common with academic gigs?

Even if a contract is more or less non-negotiable, I can't imagine verbally accepting, much less signing an offer letter, without having in hand a contract and having enough time to have it vetted by a lawyer if necessary.

These are all non-academic positions and yes you receive a one page offer letter that you sign. The academic ones she's signed before were the contract.

She's only has one of the letters right now (the other two should be arriving today) and it looks like she'd need to sign this to accept the offer and then sign a "Physician Services Agreement" (i.e. the contract) at a later date. This place is an FQHC so it might be a bit different than the other two places.

 

[Psychotic]

These are all non-academic positions and yes you receive a one page offer letter that you sign. The academic ones she's signed before were the contract.

She's only has one of the letters right now (the other two should be arriving today) and it looks like she'd need to sign this to accept the offer and then sign a "Physician Services Agreement" (i.e. the contract) at a later date. This place is an FQHC so it might be a bit different than the other two places.

Do they not provide a sample physician services agreement at the time of the interview? How binding is the letter she signs? Does it say anything about being conditional until the contract is signed? Do they verbally describe the key points in the contract, particularly non-compete stuff, benefits, etc?

I am just entering this tunnel, but I appreciate you pointing this out. I had no idea...sounds absurd to me.

 

[trophyhusband]

Do they not provide a sample physician services agreement at the time of the interview? How binding is the letter she signs? Does it say anything about being conditional until the contract is signed? Do they verbally describe the key points in the contract, particularly non-compete stuff, benefits, etc?

I am just entering this tunnel, but I appreciate you pointing this out. I had no idea...sounds absurd to me.

The offer letter states the pay, bonuses, and whatnot. But nothing about the job itself. It states that this is the entirety of the agreement but will be superseded by the Physician Services Agreement which has not as of yet been made available yet.

This is not the job she's probably going to accept but it's odd to me as well that she hasn't gotten the chance to review the PSA. But then again she hasn't asked as it's probably not the one she'll be accepting. We'll see what the other ones say.

 

[trophyhusband]

Looks like the the second offer letter is roughly the same. Spells out pay, bonus, time off, etc. but states the contract will come later from the legal dept.

I guess the good thing is that option #2 is so desperate for another doc that even if she tells them no now they'd offer her again in a second if she got back in touch with them. So she still has an out if there are issues with the contract itself.

Edit: To anyone who's interested she's taking the position initially discussed in the original post. They settled somewhere between the initial amount discussed with the recruiter and $300k. She also asked for an additional week of vacation and received it. All in all she's happy.

 

[WingedOx]

Are you suggesting that these places expect you to "accept" an offer based on a one page offer letter, before they show you a contract? Are these conditional acceptances, i.e., can you accept and then graciously back out of the acceptance if you find the contract unacceptable? Is this sort of thing more common with academic gigs?

Even if a contract is more or less non-negotiable, I can't imagine verbally accepting, much less signing an offer letter, without having in hand a contract and having enough time to have it vetted by a lawyer if necessary.

If this is a VA gig, that's kind of just how they do things...

 

[splik]

Are you suggesting that these places expect you to "accept" an offer based on a one page offer letter, before they show you a contract? Are these conditional acceptances, i.e., can you accept and then graciously back out of the acceptance if you find the contract unacceptable? Is this sort of thing more common with academic gigs?

Even if a contract is more or less non-negotiable, I can't imagine verbally accepting, much less signing an offer letter, without having in hand a contract and having enough time to have it vetted by a lawyer if necessary.

no, there are quite a few places that do that. it's not conditional, if you've signed, it means you've accepted the position. there may not even be a contract at all (i never got a contract). It is important that you have got everything you need IN WRITING though. This can be from emails back and forth, but there needs to be a written agreement.

 

[Psychotic]

Question for Trophyhusband:

Looking at the timeline in this thread, from her first hearing about the gig from a recruiter (July 10) to the offer letter (today?), when did she interview? All in all, sounds like pretty fast process from the very start to offer letter - 3 weeks. When is she expected to start the job, or was she able to negotiate something on that since it sounds like you will have to move.

 

[Psychotic]

no, there are quite a few places that do that. it's not conditional, if you've signed, it means you've accepted the position. there may not even be a contract at all (i never got a contract). It is important that you have got everything you need IN WRITING though. This can be from emails back and forth, but there needs to be a written agreement.

In this particular case, though, there is going to be a contract that will be signed AFTER she signs the letter, hence my questions. And that sounds screwed up to me, notwithstanding what you are saying about letters without subsequent contracts. I would not sign the letter without first seeing at least a draft of the actual contract.

Emails, etc., do not constitute a written agreement, at least nothing enforceable, or so I would assume. Maybe our resident expert JD/MD will chime in here...

 

[Psychotic]

If this is a VA gig, that's kind of just how they do things...

Since the OP says it was the job in the original post, it doesn't sound like a VA gig. I assume that VA contracts are of the variety "when you've seen one, you've seen them all" and probably are readily shown to any applicant upon request, but someone who has gone through the VA process can comment.

 

[trophyhusband]

Question for Trophyhusband:

Looking at the timeline in this thread, from her first hearing about the gig from a recruiter (July 10) to the offer letter (today?), when did she interview? All in all, sounds like pretty fast process from the very start to offer letter - 3 weeks. When is she expected to start the job, or was she able to negotiate something on that since it sounds like you will have to move.

Interview was this weekend the initial offer letter was presented the day of the interview and she negotiated through the weekend. She had another offer that she could use for negotiation so that helped. We told all of the places where she interviewed (3 in total during this same time period) that she'd be making a quick decision and they all set up interviews and presented offers within days of those interviews.

She's going to be starting the beginning of Oct. and moving is no big deal anymore since we've moved for med school, residency, fellowship, and her second job. We're old pros at it now and we've been paring down what we own over the years so we only really move the essentials.

 

[hamstergang]

In this particular case, though, there is going to be a contract that will be signed AFTER she signs the letter, hence my questions. And that sounds screwed up to me, notwithstanding what you are saying about letters without subsequent contracts. I would not sign the letter without first seeing at least a draft of the actual contract.

Emails, etc., do not constitute a written agreement, at least nothing enforceable, or so I would assume. Maybe our resident expert JD/MD will chime in here...

I believe that signing the offer letter binds you to negotiate the contract in good faith. That is, you are agreeing that you want the job and will negotiate the details. You can back out. But you can't sign the offer letter with no intention of actually taking the job (e.g. just to hear the salary to take to another job) or then start to negotiate ridiculous things in the contract (e.g. demand that all staff call you "king").

But I don't really know.

 

[NJWxMan]

This is a $235K - $250K salaried position.

I think you are missing a key detail which can be brutal on these type of units: vacation coverage. Many organizations are granting 5-6 weeks of PTO/vacation for their employed physicians. In the end, she would likely be covering other patients 1/3 of the year. Many times, the hospital admin will describe this as "light vacation coverage." In my experience, there are usually good reasons that a recruiting service is brought into the mix. Also, the larger the unit, the greater the likelihood of large patient census swings (for example, personal census jumping from 8 patients to 14 patients overnight).

Here are some details about a position that my wife just spoke to a recruiter (internal) about today. She decided to hear more about it but she wants to know what a realistic salary to ask for if she were to go on the interview:

Inpatient Adult and C&A:
4 other docs and 71 beds so if full 14 patients
Let's say half adult half adolescent
No weekends, no weekday call
70% Medicaid (probably mostly rural based on location)
Midwest but a decent college town we wouldn't mind living in

So SDN hivemind what would you ask for this job? Also, is seeing 14 patients between 8-5 realistic? My wife is the type that likes to go above and beyond so that could lead to issues with efficiency I'm guessing.

Any other thoughts?

 

[trophyhusband]

This is a $235K - $250K salaried position.

I think you are missing a key detail which can be brutal on these type of units: vacation coverage. Many organizations are granting 5-6 weeks of PTO/vacation for their employed physicians. In the end, she would likely be covering other patients 1/3 of the year. Many times, the hospital admin will describe this as "light vacation coverage." In my experience, there are usually good reasons that a recruiting service is brought into the mix. Also, the larger the unit, the greater the likelihood of large patient census swings (for example, personal census jumping from 8 patients to 14 patients overnight).

Well she negotiated more than the top end of that range so that's good.

Good point on the coverage issue. I guess the good thing about it is that every one of the docs has been there longer term and they all seem happy with the arrangement (though vacation coverage is not something she thought to discuss). She's an addition to the staff not a replacement for someone who left.

There is no recruiter service the recruiter I'm referring to is the internal recruiter she contacted to get more info on open positions.

Edit: This is why I still come to SDN because these aren't necessarily things that she or I would think to ask. These types of potential issues are why we never buy when we move to a new area. We always rent for a couple of years to make sure the place isn't a disaster which is has been very helpful with her current job... we can just up and move after the first year.

 

[Ahamis]

In my experience, there are usually good reasons that a recruiting service is brought into the mix.

Can you explain me why?
It is kind of hard to find jobs in a different region of the country without the help of a recruiter, isn't it?

 

[trophyhusband]

Can you explain me why?
It is kind of hard to find jobs in a different region of the country without the help of a recruiter, isn't it?

From my wife's experience no, just call any place you're interested in working and you'll usually have people falling all over themselves to offer you a job. There were a few places that didn't really respond (usually smaller college towns with decently sized residency programs in them) but for the most part it was easy. Don't know how easy or hard it would be if you need a visa but overall it was simple. My wife is C&A trained but she was also looking at adult positions and both seemed available all over.

 

[NJWxMan]

Recruitment services and locums cost hospitals big money. I believe a place meant alone banks a recruitment service about $25k. Also, good jobs don't have high turnover and they usually can find someone local to jump into the position when someone leaves.

Can you explain me why?
It is kind of hard to find jobs in a different region of the country without the help of a recruiter, isn't it?

 

[Jules A]

R Also, good jobs don't have high turnover and they usually can find someone local to jump into the position when someone leaves.

I think it is a good strategy to contact a facility one is interested in but the above has been my experience for the most part. Not only do the good places to work have lower turnover but when someone does resign in most cases we have already circled the wagons and recruited a friend/colleague we know from the community.