Is this offer too good to be true?

[Marasmus1]

I have recently sealed the deal with my own first attending contract. As we are finalizing for my wife`s attending contract negotiations as well, she received an offer from another hospital which puzzled us and wanted to share here. This hospital is an hour away from the one I signed with so it won`t be convenient but I felt it was too good to refuse so here we go;

State Hospital with academic affiliation

Inpatient Adolescent Residential

Census : 12 follow ups. 1-2 new admissions/discharges weekly. Average length of stay 6 to 8 weeks. Have two adult residents and CAP fellows at any point so it will be mostly supervisory. Notes are done by the residents
No calls, no weekends, no overnight, can leave the hospital after rounding but needs to be available by phone until 5 pm. They have 2 NPs covering over the night 7 days on and 7 days off. It is independent practice state for NPs
Compensation: 290 k
PTO : 36 days vacation, 14 days observed holidays including federal and state, 10 days CME, 12 days sick so total of 72 days of PTO
401k with %10 match
medical insurance, dental and vision are %100 paid by employer
5k CME and 5k relocation reimbursement.
The hospital is located in a booming district of a desirable area in south east.
No Non-Compete, Private practice is allowed.

What could be the potential glitches/red flags we should be looking for ? Thanks for the inputs.

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[TexasPhysician]

Quality of insurance?
Do consults?
Teaching or research requirements?
Required to help with special projects?
When someone is out sick, do you cover their patients too?
Outpatient clinic time?
Who rounds on holidays?
What happens if the NP is sick?
Vacation days roll over?

 

[Bartelby]

I am interested in some of the above questions Texas posted as well.

From what you have presented, though, this seems like a really chill job. I presume your wife is CAP trained, so in private practice in many markets she could probably make meaningfully more than $290k. Looking at the whole package, though, if she wants a pretty relaxed job with quite good compensation for the effort involved this seems very hard to beat.

 

[SmallBird]

I'm not sure why that offer is puzzling, even if it's pretty good. I guess if you view the workload as minimal because of the presence of trainees then it might be seen as more compelling but that applies to lots of academic positions. When I was at an academic medical center I had two residents but I still had to briefly meet each patient and if you want to be a good teacher and ensure good quality care then the supervisory role can take some time. If the resident comes up with a poor formulation it can be a fair amount of work to reverse engineer it, course correct, and then provide the teaching to help the resident understand how they went wrong. So in my view having trainees is a wash and I get done quicker seeing the same number of patients in my current role without trainees. There are plenty of inpatient CAP roles that will pay substantially more for 12 patients a day albeit with higher turnover and greater acuity.

The main red flag though is that most residential programs provide absolutely egregious care. There are multiple institutions that have been investigated for various abuses ranging from physical abuse to inappropriately long lengths of stay. Residential Treatment has a very inconsistent evidence base and studies comparing it to much briefer treatment courses shows no difference in outcomes. Residential Treatment conflicts with almost every major theory of development, attachment and recovery and is mostly a resource for wealthy families who lack interest in doing the hard work of solving problems as a family

 

[calvnandhobbs68]

Yeah so as above one of my big questions here would be what’s the actual sick/vacation coverage model? If they’re giving her 36 days vacation + 10 CME + 12 days sick, I’m assuming someone will be covering her that entire time so who is she gonna have to cover when they take their 6 weeks of vacation or out for 2 weeks for sick days?

It does sound like it’ll be pretty good compensation for the supposed workload, as long as that workload doesn’t include covering someone else’s patients every day for 25%+ of the year (which is what all this time off adds up to).

Another thing is that I saw it’s a state hospital inpatient adolescent residential unit, which is possibly another reason they’re having to headhunt. I would suspect this is gonna be a pretty rough population both in terms of severity and the old “throw meds to fix mostly social/family problems and hope they seem better in 2 months” issue.

 

[PikminOC]

Doesn't matter if independent state for np. The hospital and insurances will link her name to their care for greater reimbursement. She will still be tied in the case of malpractice

 

[annoyedpsychiatrist]

given that youre not doing notes and have residents/fellows, it gives the indication you have more time to actually supervise and provide a safety net.

10% match on 401k is pretty sick though, and the PTO perk is definitely above average. Your wife can go home, apparently review remotely and be available by phone while residents do scut work seems lucrative. No non compete, also great. 100% insurance paid, another really good perk. And likely will be PSLF eligible

As long as no additional work/coverage that isnt otherwise specified in OP, this does seem very lucrative.

 

[Merovinge]

The main red flag though is that most residential programs provide absolutely egregious care. There are multiple institutions that have been investigated for various abuses ranging from physical abuse to inappropriately long lengths of stay. Residential Treatment has a very inconsistent evidence base and studies comparing it to much briefer treatment courses shows no difference in outcomes. Residential Treatment conflicts with almost every major theory of development, attachment and recovery and is mostly a resource for wealthy families who lack interest in doing the hard work of solving problems as a family

This is really not the reality of CAP RTC care. RTC is an essential lifeline for patient's struggling with SUDs, EDs, severe SIB, or illness so severe as to not be able to physically attend a PHP. The majority of RTC work is covered by insurance and absolutely not some Malibu horseback riding on the beaches (although clearly those places exist). Family involvement is heavy/significant in every reputable RTC and this absolutely does not conflict with the literature on recovery. ASAM has specific guidelines for adolescent level of care as do multiple eating disorder organizations. RTC work is tough as not only are the patients very sick but you are also expected to meaningfully improve their disease state (unlike IP where the goal is "stabilization" and almost never long-term improvement or meaningful recovery).

 

[calvnandhobbs68]

This is really not the reality of CAP RTC care. RTC is an essential lifeline for patient's struggling with SUDs, EDs, severe SIB, or illness so severe as to not be able to physically attend a PHP. The majority of RTC work is covered by insurance and absolutely not some Malibu horseback riding on the beaches (although clearly those places exist). Family involvement is heavy/significant in every reputable RTC and this absolutely does not conflict with the literature on recovery. ASAM has specific guidelines for adolescent level of care as do multiple eating disorder organizations. RTC work is tough as not only are the patients very sick but you are also expected to meaningfully improve their disease state (unlike IP where the goal is "stabilization" and almost never long-term improvement or meaningful recovery).

For sure, I suspect this is probably a tough job mentally which may be why it looks like such a good deal. You're probably getting a pretty rough population at the state hospital residential program.

I agree it's important to not throw the baby out with the bathwater here. RTFs have the same issue as many other facilities in that the face to face staff can often be variable in quality and underpaid, which contributes to the already stressful situation of taking care of a pretty severe population you're constantly having to monitor for drug use, self harming, suicide, etc. It's kind of like saying group homes aren't helpful for patients with ID/DD or SMI....the idea and overall theory can be very helpful when implemented correctly but staff are often overworked, underpaid and undertrained. This is even worse these days when people can go get a job at Aldi for $17/hr vs working as a tech/PCA at an RTF or group home.

 

[annoyedpsychiatrist]

For sure, I suspect this is probably a tough job mentally which may be why it looks like such a good deal. You're probably getting a pretty rough population at the state hospital residential program.

I agree it's important to not throw the baby out with the bathwater here. RTFs have the same issue as many other facilities in that the face to face staff can often be variable in quality and underpaid, which contributes to the already stressful situation of taking care of a pretty severe population you're constantly having to monitor for drug use, self harming, suicide, etc. It's kind of like saying group homes aren't helpful for patients with ID/DD or SMI....the idea and overall theory can be very helpful when implemented correctly but staff are often overworked, underpaid and undertrained. This is even worse these days when people can go get a job at Aldi for $17/hr vs working as a tech/PCA at an RTF or group home.

these are all fairpoints, they probably make it attractive because a lot of community/state places often have trouble recruiting. Often ancillary staff theres a high burnout, but for what they're offering it seems positive that they seem to acknowledge that and they're not leading with unrealistic expectations. I think being a CAP situation makes it further complicated as its been a while since ive done CAP inpatient work but i imagine theres more BS to deal with and parental drama, and given the setting these are probably families with many many issues.