I was saying that Kaiser used to be a nice lifestyle with good perks and people may have taken that over a high salary. It's really not that hard to gross $700k in psych anywhere if you're willing to piece together multiple jobs and be a workhorse at jobs that aren't the most desirable.
Kaiser has over 500 psychiatrists in California and covers 40% of the healthcare market.
Fair enough. Looks like psychiatry can be the land of milk and honey everywhere, including SoCal. Kudos to you guys
Thanks for looking that data up. They have 9M members in CA. So they are way off the minimum recommendation of 1 psychiatrist to 10k people and actually closer to 1 per 18k people.
I'd say it's the other way around, CA seems to have a really good job market for psych, whereas Florida or Washington, not so much, from the jobs I've seen.
Those comments were made by residents..give them a year to get hit by reality and then talk to them again
Almost all of us in medicine have the ability to make 500k+ if we are flexible with location and know how to use the system to our advantage.
I mean yeah Im a resident but I also have made 250k in moonlighting similar jobs pgy4 so I think I have a decent take on the situation.
Any time there is a major conference out there I get at least 2 or 3 emails from recruiters for Kaiser asking if I’d like to visit their booth. For APA I was getting no less than 2-3 emails per week the month before from Kaiser and I’m nowhere near Cali geographically.
calmatters.org
My opinion is that the California market pays relatively more for psychiatry because they have been relatively slower to approve independent NP practice. My prediction is that this will likely change in the coming years.
Nurse practitioner requirements are changing, allowing them to practice without physician supervision
New California nurse practitioner requirements will allow them to practice without physician supervision.
Show me any HMO/insurance network that meets "recommended" psychiatrist/pop (or therapist/pop) ratio while covering a large portion of the state...
It definitely sounds like a worse gig in the two CA regions due to state law requiring them to force all psychiatrists to do X number of intakes per week regardless of panel size/follow-up access. Not sure if that's what you felt was specifically soul crushing about the gig.
So much of this. Obviously, things are different everywhere, but when I tried to renegotiate my reimbursements after two years of practice, I was quoted less than my state's Medicaid rates. When I pushed back, I was told that rates were based on tenure with the insurer and how many patients I was moving. I was given the chance to appeal, and they came up, I think $10 on the 99214 and $4 on the 90833.
Where was this?
People keep talking about the art of insurance negototiations, but what does that actually mean? Like the above poster mentioned he was paid let’s say 110/99214, when he told them to screw off they went up to 115/99214. What else are you going to do to improve that rate? I’m genuinely curious because I feel like this is really important information I haven’t been able to figure out
It's a long long game. My strategy was to contract with as many insurances as possible. Negotiate them all as high as I can. Then...like a skilled hunter/battle commander, you wait.
There is a limit to the supply and demand graph, but sometimes companies don't pay you your 'fair' cut. .
Agreed. Regularly assessing your pay and shopping around for another job if you're employed is imo an imperative as employers will assume that you're content with your salary if you don't speak up. Should #1 rule for employed physicians. For independent physicians #1 rule is the negotiation game that @randomdoc1 is talking about up here ^. Although both of these tactics suck and require time, effort, and confrontation that few who sign up for medicine are willing to do.
More of this content please!
How many people actually stay with Kaiser though?
From my experience there and what I've read/heard, turnover rate is pretty high for outpatient facing specialties. The patient inbox message responsibilities are no joke soul crushing. Their emphasis on patient satisfaction just adds insult to injury. And all that work is uncompensated.
People really need to just... Stop working for them. It's unfortunate what people do to themselves for no good reason
I don't think the turnover is worse than any other employed position. If anything it's probably less than typical employed work. I can't speak to CA regions but the messaging stuff is somewhat compensated by having 2 hours of admin time per day. You're also not forced to endlessly accommodate patients--you can set limits/boundaries.
Gotta agree with this. So many specialities can put together normally two jobs that both flexible schedules and allow you an ability to see patients when works best for you which gives you volume but also autonomy which is the holy grail. Most can pull mid upper 6 figures with a set up like that without working 60+ hours.
IMO better to focus on efficiency which leads to volume while maximizing your billing practices and keeping your job lean and flexible
Kaiser is desperate because the turn over rate is so high , they lose people quickly because of the horrid schedule and micromanagement.
This 100% accurate. You’re a slave to their system and have zero autonomy, it’s like being in high school and your principal has all the power over you , but not really, his secretary does.
I'm in South Carolina
I was so confused because there's another calvinandhobbes on this forum who's a regular. I don't think this is an accurate take.
At least in my region none of that is accurate. It's worst in the first 18 months (particularly months 3-9) because you're slammed with intakes but then it settles as you start to hit a steady state panel/get follow ups blocking slots and as the extra admin time kicks in. There's no 4-7 year retention bonuses. Everything else vests in the first 3 years.
You must work at a unicorn Kaiser location. **Extra** admin time? Follow-ups **blocking** slots? What usually happens at Kaiser for outpatient facing specialties is the panel continues to grow and grow and grow which obviously results in more and more patient inbox messages/demands.
Yeah as I said earlier in the thread, CA is unique because the state government mandated that their psychiatrists do X number of intakes per week. Repatriation is king in those regions because otherwise you drown in excessive panel size.
Haha yeah but I think I’m the original
In regards to compensation, or job scarcity? Could you elaborate?
That’s insane. Probably not a big deal for inpatient, but I can’t imagine anyone wanting to work outpatient in a state that has a legally requires intakes per week. Absolutely absurd.
I'm assuming this is just for kaiser employees
I'm trying to find documentation to refresh my memory, I may be mixing up what CA actually requires (10 days maximum wait for psychiatry appointments) with how the CA regions have instantiated that requirement (required number of intakes per week.) I could have sworn that when I looked this up a couple of years ago it was actually a state regulation (it's a notably memorable thing to come across a state requiring intake slots...) but since then there was a newer MH bill so a lot of google hits point to that now. The regulation would have applied to all HMO's rather than just KP.
California requires insurance companies provide access to psychiatry (or any specialist) within 15 business days. So this would affect Kaiser. If they can't do so they are supposed to cover out of network care. I've used this to my advantage as an OON doc.
I mean, it's completely stupid. My state actually demands that we have new and f/u appointments available even sooner than CA does. I don't think any insurance network in any state would actually meet that criteria... There aren't enough psychiatrists in the country to meet these lofty goals universally.
