Competitive salary for this OP job?

[AnonymousPGY4]

Hi everyone,
I am in the negotiation phase and wanted to know what is a competitive salary for this particular job. They mentioned they could do 250-275K base with a sign-on bonus but they do not do student loan repayment. $4000 CME per year. Guaranteed salary first two years, then it's purely RVU-based.

-Purely OP position at a community hospital that is affiliated with a well-known academic hospital
-Chicago suburbs
-32 clinical hours/week, no call
-60 minute new evals, 30 minute f/u's
-Epic EMR
-Demographics: generally high functioning, middle-class typical American suburban pop; primarily mood disorders, anxiety disorders; they allow providers to choose which disorders they feel comfortable working with (personally, I'd like to filter out SUDs)
-Ancillary support: nurses and MAs check and do a first pass on your Inbasket messages and help with refills and prior auths
-10 mi radius 2 year noncompete
-I don't know the rest of the benefits package yet besides $4000 CME/year because they haven't sent me the LOI

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[AtlasCarraway]

Still some "depends" factors -- how long new evals / follow-ups are (ie are they going to pack you with 15-min follow-ups for all of those 32 hours?). I hate the salary floor dropping out from under you after year 2, totally depends on what their $/wRVU rate is after that though.

I'm not too in touch with Chicago COL expectations and how that scales. I'm on the job hunt myself and would expect more like $280-300k for this job in my region (Southern-central US, large metro area).

The non-compete sucks. A lot.

Seems like above-average CME allowance.

 

[robellis]

Missing lots of info like how much per wrvu will they pay? Is there a bonus above the base? How many minutes for follow up and new patients?

 

[wolfvgang22]

Is the non-compete for the first two years you work there, or two years after you leave? That can make a big difference. Other than that, if you have 30 minute follow-up and one hour new evaluations, it sounds good so far. How many new evaluations per day? How many patients per day? Any guaranteed charting time? Don't do a "walk-in" clinic unless you want to churn patients and basically be a psych ER office.

I will be interested in the benefits (health insurance, malpractice, retirement, vacation). Any advancement opportunity in the organization?

As an aside, if you want my advice:
I started practice not wanting to do SUD or buprenorphine at all out of residency, thinking it would be a lot of work. I also didn't want to see much schizophrenia. In practice, I found it is actually less work than severe anxiety patients, personality disorders, or chronic mood disorder patients that are often entitled and ask for benzos or Adderall all the time and are dissatisfied when I say "no". SUD patients ready for treatment and the patients with Schizophrenia have been more appreciative and quite lovely much of the time. Outpatients with Schizophrenia are generally much more stable than the patients I saw in crisis in residency. Suboxone is easy. Make yourself more valuable than the NP, and the docs scared of these patients due to ignorance. Get your Suboxone certification and clozapine certification. It takes like an hour to do the clozapine REM registration and 4 hours to get your DEA X waiver for Suboxone online if you are efficient. 90% of psychiatrists seem to come out of residency scared of SUD. I know attendings 10 years into practice still scared of SUD and MAT.

 

[AnonymousPGY4]

Ooops, I forgot to include that it's 60 minute new evaluations and 30 minute follow-ups. They are flexible and willing to go up to 90 min news and 45 min f/us when I start to ease me into it. The noncompete is 2 years after I leave. As I said, I don't have information on the full benefits package yet since they haven't sent a LOI.

 

[robellis]

Ooops, I forgot to include that it's 60 minute new evaluations and 30 minute follow-ups. They are flexible and willing to go up to 90 min news and 45 min f/us when I start to ease me into it. The noncompete is 2 years after I leave. As I said, I don't have information on the full benefits package yet since they haven't sent a LOI.

What’s the wrvu dollar amount

 

[calvinhobbes]

Here’s the very important part about using EPIC: can the patients message you in the system asking for refills, appointments, questions, rants, desires, frustrations, medication refills for their kids, etc?

If so, do not pass go and do not collect $200!

But seriously, if you take this job, make sure you get it into your contract that patients *cannot* message you in EPIC. You will thank me— and your sanity, family, and life will thank you as well!

 

[TexasPhysician]

Pretty average gig right now

 

[calvnandhobbs68]

Agree, pretty average offer, I'd think about in line with what you'd get in a lot of private practice settings as well with probably better benefits. You need to nail down the dollar/RVU thing though cause that's a make or break part, you don't want your salary to suddenly take a nosedive year 3 cause you're only seeing 32 hours of patients per week. 32 hours is a 1 hour lunch and 30 min afternoon break, so that's pretty solid. I'd see if they would limit your new evals a day to 4-5 a day though for the first several months so you aren't swamped with 6 evals all day/every day getting booked out for weeks with no time for followups until your schedule starts catching up...if it's part of a larger hospital system almost guarantee they have a waiting list like every other hospital system in the country right now.

10 mile noncompete might hurt if you wanted to bail after a few years but stay in the Chicago area.

 

[hamstergang]

But seriously, if you take this job, make sure you get it into your contract that patients *cannot* message you in EPIC. You will thank me— and your sanity, family, and life will thank you as well!

I like the messages so much more than phone calls. My patients don't use it much. It allows me to control how long I spend on the response and don't result in an endless conversation. Or I can respond with a phone call if needed.

 

[calvinhobbes]

I like the messages so much more than phone calls. My patients don't use it much. It allows me to control how long I spend on the response and don't result in an endless conversation. Or I can respond with a phone call if needed.

I guess haha. My inbox unfortunately is flooded daily 😂, maybe bc the job encourages it and all the patients over-use it! Lol

 

[robellis]

The wrvu part is by far the most important part of this equation, if they pay 65 per wrvu versus 45 completely changes the job and it’s viability

 

[Stagg737]

Still some "depends" factors -- how long new evals / follow-ups are (ie are they going to pack you with 15-min follow-ups for all of those 32 hours?). I hate the salary floor dropping out from under you after year 2, totally depends on what their $/wRVU rate is after that though.

I'm not too in touch with Chicago COL expectations and how that scales. I'm on the job hunt myself and would expect more like $280-300k for this job in my region (Southern-central US, large metro area).

The non-compete sucks. A lot.

Seems like above-average CME allowance.

CoL in Chicago is very high and rising with the population decline of the area. Not quite NYC or San Fran, but after living in 2-3 other cities it would take MINIMUM 350k to go back, and most of my family is there…

 

[FlowRate]

I guess haha. My inbox unfortunately is flooded daily 😂, maybe bc the job encourages it and all the patients over-use it! Lol

This is all about setting expectations and boundaries with your patients and whoever makes your schedule template. Get some urgent slots blocked in your schedule and tell patients, in more patient friendly words, that you should have an appointment to discuss their messaged issues and treatment options more thoroughly.

And I don't mind the more straightforward messages from my patients. If I trusted one of our two nurses more I might punt things to them more often but... I don't.

 

[clozareal]

Sounds pretty good to me. I would probably think hard about whether to negotiate the non-compete (decrease # of years or number of miles or less likely that they'll budge on this is redlining all together). Also, if the $/wRVU is high enough, I would consider negotiating down the time it takes to reach it so you have higher earning potential earlier on.

 

[calvinhobbes]

This is all about setting expectations and boundaries with your patients and whoever makes your schedule template. Get some urgent slots blocked in your schedule and tell patients, in more patient friendly words, that you should have an appointment to discuss their messaged issues and treatment options more thoroughly.

And I don't mind the more straightforward messages from my patients. If I trusted one of our two nurses more I might punt things to them more often but... I don't.

Thank you

 

[Trismegistus4]

As an aside, if you want my advice:
I started practice not wanting to do SUD or buprenorphine at all out of residency, thinking it would be a lot of work. I also didn't want to see much schizophrenia. In practice, I found it is actually less work than severe anxiety patients, personality disorders, or chronic mood disorder patients that are often entitled and ask for benzos or Adderall all the time and are dissatisfied when I say "no". SUD patients ready for treatment and the patients with Schizophrenia have been more appreciative and quite lovely much of the time. Outpatients with Schizophrenia are generally much more stable than the patients I saw in crisis in residency. Suboxone is easy. Make yourself more valuable than the NP, and the docs scared of these patients due to ignorance. Get your Suboxone certification and clozapine certification. It takes like an hour to do the clozapine REM registration and 4 hours to get your DEA X waiver for Suboxone online if you are efficient. 90% of psychiatrists seem to come out of residency scared of SUD. I know attendings 10 years into practice still scared of SUD and MAT.

I agree with this. I would much rather see schizophrenics and addicts who are motivated for treatment, than the upscale housewives who just need their Xanax and Adderall to shuttle their kids to soccer practice and run their Etsy shop, and military veterans with alleged PTSD from their non-direct-combat experiences who hate the VA and need you to prescribe their Klonopin and write a letter so they can drag their "service dog" with them everywhere they go even though they can never quite tell you what exactly the dog actually does for them...

 

[Merovinge]

CoL in Chicago is very high and rising with the population decline of the area. Not quite NYC or San Fran, but after living in 2-3 other cities it would take MINIMUM 350k to go back, and most of my family is there…

This is wildly untrue. There are many different COLA's you can look at but none show Chicago to be anything more than a bit above the mean and wayyyyy less than NYC and San Fran. The burbs vary widely from working class to posh but none hold a match to the burbs of San Fran (e.g. Napa, Silicon Valley). Chicago is quite on par with many other smaller metros (e.g. Denver, Portland, Nashville, Charlette, etc), there's a significant discount in COLA due to winter.

Cost of Living Calculator | Cost of Living in Chicago, Illinois | Salary.com

Compare the Cost of Living in Chicago, Illinois against another US Cities and States. Salary.com's Cost of Living Calculator lets you compare the cost of living and salary differentials State to State or over 300+ US cities. See what you'll need to earn to keep your current standard of living...

www.salary.com

https://www.bestplaces.net/cost-of-living/chicago-il/santa-monica-ca/50000

 

[Stagg737]

This is wildly untrue. There are many different COLA's you can look at but none show Chicago to be anything more than a bit above the mean and wayyyyy less than NYC and San Fran. The burbs vary widely from working class to posh but none hold a match to the burbs of San Fran (e.g. Napa, Silicon Valley). Chicago is quite on par with many other smaller metros (e.g. Denver, Portland, Nashville, Charlette, etc), there's a significant discount in COLA due to winter.

Cost of Living Calculator | Cost of Living in Chicago, Illinois | Salary.com

Compare the Cost of Living in Chicago, Illinois against another US Cities and States. Salary.com's Cost of Living Calculator lets you compare the cost of living and salary differentials State to State or over 300+ US cities. See what you'll need to earn to keep your current standard of living...

www.salary.com

https://www.bestplaces.net/cost-of-living/chicago-il/santa-monica-ca/50000

No, Chicago is quite expensive and that link is very misleading. There are some cheaper suburbs, but they're still not very good for CoL and mid-sized metros I've lived in or visited are almost uniformly cheaper. That article only gives a few areas of expense. Sales tax is one of the highest in the nation at 10.25% only behind Tacoma, and that's down from 11.5% several years ago. Utilities are fairly high and if you're in a suburb that Chicago supplies water to the city bleeds you (suburbs did a horrible job negotiating the contracts). While housing may be cheaper than other areas, IL has the second highest property tax in the US, and of small metros 5/15 most expensive are in IL and Cook County's effective rate is 1.55%. So where most other expensive metros cut their population a break, IL screws them anyway.

Plus, Chicago is not a safe area in general. Some of the suburbs are safer, but even then it's common for individuals to come from the city out to the suburbs running scams. My parents town (a safer town) had a rash of a couple dozen car break-ins/thefts a couple years ago d/t this. I'm currently not in the safest city in the US, but my CoL is legitimately about half to 2/3 (previously said 1/3, meant 1/2 to 1/3 cheaper) of what my parents and in-laws is, and according to your link where I'm at is only about 5% below the national average.

I'm not saying this to be argumentative. I'm saying all this as someone who spent 25+ years of my life in IL and whose parents have lived there 50+ years and am very familiar with the financial aspects of IL. There are things I love about Chicago, but financially they are much worse off than it appears on the surface and the trends for the future look bleak.

 

[J ROD]

Seems like a fair offer. Would verify wRVU per hr is around $60-65 per hr. Also, the messages from patients can be a major issue. It is nice if you have staff that screens them first. Cuts down on number.

 

[1edyfirel]

Here’s the very important part about using EPIC: can the patients message you in the system asking for refills, appointments, questions, rants, desires, frustrations, medication refills for their kids, etc?

If so, do not pass go and do not collect $200!

But seriously, if you take this job, make sure you get it into your contract that patients *cannot* message you in EPIC. You will thank me— and your sanity, family, and life will thank you as well!

I don’t know if this is make or break, but I just left a job for several reasons, and if I’m being honest the Epic messaging killed me. I thought it was outrageous patients had 100% direct access to me—and I was great at boundaries, had my spiel, but it was just a mental burden I personally could not handle. Admin support sucked, but had it not I could maybe have survived if there was a nurse filtering messages and only sending me what was important. I was working with a large academic group, very high fxn, relatively affluent pt population. Hospitals m.o. was that all doctors were essentially on call all the time for their patients to provide the VeRy bEsT cArE. Part of my bonus was based on responding to messages within a certain timeframe It wasn’t concierge and I wasn’t paid concierge levels, but holy **** it seems like the patients thought I was. I was amazed with the garbage patients would message me ALL THE TIME and at all hours. Literally asking me for phone numbers for pharmacies in between 5-page suicidal cries for help and so much more fun stuff. (Who the hell thinks they should message their PHYSICIAN for a phone number??) I’ll never take a job that provides that kind of direct access to me again.

 

[Bartelby]

In all the systems I have seen you check messages during normal clinic hours. You are clear with patients that you don't check after hours and that messaging is not appropriate for emergencies. Is that not typical?

 

[1edyfirel]

yeah I did check them only during business hours, also set it so that my responses went out the next day or 2 and not immediately (I answered immediately b/c I like an empty inbox, but epic does let you schedule when a message is delivered.) I still found it very annoying, tedious and burdensome. But that’s me. Looks like others like the system. I think in big systems admin/nurses need to be filtering doctors messages, taking care of what they can, and forwarding to you what you need to do. No reason a patient should be able to email me directly to reschedule or ask me for a phone number or complain because the pharmacist was rude to them. (And I didn’t answer those messages, just ended up rerouting to admin who were doing god knows what. But that gets draining and again, I’m not admin.) Another problem was other docs DID answer messages outside business hours; one PCP was responding on Sundays at midnight. That skews pt expectations.
Anyway, I hated it. Won’t do it again.

 

[Sushirolls]

I don’t know if this is make or break, but I just left a job for several reasons, and if I’m being honest the Epic messaging killed me. I thought it was outrageous patients had 100% direct access to me—and I was great at boundaries, had my spiel, but it was just a mental burden I personally could not handle. Admin support sucked, but had it not I could maybe have survived if there was a nurse filtering messages and only sending me what was important. I was working with a large academic group, very high fxn, relatively affluent pt population. Hospitals m.o. was that all doctors were essentially on call all the time for their patients to provide the VeRy bEsT cArE. Part of my bonus was based on responding to messages within a certain timeframe It wasn’t concierge and I wasn’t paid concierge levels, but holy **** it seems like the patients thought I was. I was amazed with the garbage patients would message me ALL THE TIME and at all hours. Literally asking me for phone numbers for pharmacies in between 5-page suicidal cries for help and so much more fun stuff. (Who the hell thinks they should message their PHYSICIAN for a phone number??) I’ll never take a job that provides that kind of direct access to me again.

This and other things within Big Box shops that admin views you as a mere employee cog and not a professional are part of the reason why the pros/cons of opening one's own practice are getting greater. If you are going to bust your donkey, bust your donkey for yourself.

In all the systems I have seen you check messages during normal clinic hours. You are clear with patients that you don't check after hours and that messaging is not appropriate for emergencies. Is that not typical?

You can educate patients, you can have policies, but patients still will.

 

[Trismegistus4]

I don’t know if this is make or break, but I just left a job for several reasons, and if I’m being honest the Epic messaging killed me. I thought it was outrageous patients had 100% direct access to me—and I was great at boundaries, had my spiel, but it was just a mental burden I personally could not handle. Admin support sucked, but had it not I could maybe have survived if there was a nurse filtering messages and only sending me what was important. I was working with a large academic group, very high fxn, relatively affluent pt population. Hospitals m.o. was that all doctors were essentially on call all the time for their patients to provide the VeRy bEsT cArE. Part of my bonus was based on responding to messages within a certain timeframe It wasn’t concierge and I wasn’t paid concierge levels, but holy **** it seems like the patients thought I was. I was amazed with the garbage patients would message me ALL THE TIME and at all hours. Literally asking me for phone numbers for pharmacies in between 5-page suicidal cries for help and so much more fun stuff. (Who the hell thinks they should message their PHYSICIAN for a phone number??) I’ll never take a job that provides that kind of direct access to me again.

I was just about to post that patients being allowed to message you in Epic is probably inevitable at the kinds of institutions that our favorite poster whose namesake is a favorite Japanese dish might liken to large retail chain stores, but lo and behold, he has already done so.

Huge container markets are all about patient satisfaction.

 

[calvinhobbes]

Yup, I know exactly how you feel. You become a slave to your inbox and if you don’t respond in time, the patients get mad and message someone else, or schedule a video appt with you because you didn’t reply to their message right away. It’s a nightmare! Never, ever again will I work at a place where the words “patient messaging” and “inbox/inbasket management” exist. It’s a literal disgrace that I was asked “hi doc reschedule my appt I can’t make it” or “hi please tell me if I am suicidal or not Bc my wife says so but I don’t know what to do can you call me back right away”. And if you don’t reply, you’re either yelled at by the office manager or the patient!! Yeah, no thanks, never again!

 

[calvnandhobbs68]

Yup, I know exactly how you feel. You become a slave to your inbox and if you don’t respond in time, the patients get mad and message someone else, or schedule a video appt with you because you didn’t reply to their message right away. It’s a nightmare! Never, ever again will I work at a place where the words “patient messaging” and “inbox/inbasket management” exist. It’s a literal disgrace that I was asked “hi doc reschedule my appt I can’t make it” or “hi please tell me if I am suicidal or not Bc my wife says so but I don’t know what to do can you call me back right away”. And if you don’t reply, you’re either yelled at by the office manager or the patient!! Yeah, no thanks, never again!

Yeah but at least if they schedule an appointment, you're getting paid for it. This is why I prefer a production/split model to salary. I actually have an incentive to see more patients.

That's why I have no problem saying "sounds like something we should discuss in an appointment" if it's something that seems like it'll take longer than 5 minutes. I can bill for an appointment, I can't bill for a million questions back and forth.

 

[calvinhobbes]

Yeah but at least if they schedule an appointment, you're getting paid for it. This is why I prefer a production/split model to salary. I actually have an incentive to see more patients.

That's why I have no problem saying "sounds like something we should discuss in an appointment" if it's something that seems like it'll take longer than 5 minutes. I can bill for an appointment, I can't bill for a million questions back and forth.

I see what you mean … but it’s def still an eye-sore and time consuming even going through the questions and responding, etc. but yeah you bring up a good point!

 

[hamstergang]

I feel like I'm seeing double. You two should agree to allow only one to enter each thread.
@calvinhobbes @calvnandhobbs68

 

[deleted1100659]

I think highly functional patients can be equally or more stressful sometimes. They may feel a bit more entitled, or as if they're a VIP and expect a little extra from you. I work with higher acuity patients, and one perk is there isnt as much entitlement. It is pretty easy to explain why you arent prescribing stimulants to the patients when half the UDS is positive

 

[clausewitz2]

That's why I have no problem saying "sounds like something we should discuss in an appointment" if it's something that seems like it'll take longer than 5 minutes. I can bill for an appointment, I can't bill for a million questions back and forth.

I need to get better about this. The trick of course is that you have to keep enough flex in your schedule to be able to get someone with questions like that in within a few days time; "sounds like we should discuss in an appointment" works less well when this means they wait six weeks.