Opinion about the job offer

[Marasmus1]

Midwest Urban Teaching Hospital inpatient child and adolescent psychiatry faculty position

190K base salary, no minimum RVU expectation, no bonus structure
Once a week, weekday pager call on average 4-5 pages from 5 pm to 8 am, very rarely getting paged between 12 am to 7 am, no weekends and federal holidays
Average patient load 5-6 a day, Max patient load is 8, half a year have a fellow or resident, research is encouraged but not expected,
No expectation of cross coverage with other departments.
Medical, dental, vision benefits, 403b with 3% match, HSA with 2k maximum employer contribution, 3k CME annually, malpractice with tail coverage
3 weeks vacation
Non compete clause with the radius of 100 miles
Multiple adult psychiatry moonlighting opportunities in the area with 4 major teaching hospital within 50 miles radius

I would like some opinions. I will probably negotiate 200k but with average patient load being 5-6 I don`t think I have too much leverage there. Please don`t tell me as a child psychiatrist I am worth minimum 250k because I know the market well. I have not yet found a job where I would get paid 250k seeing 5-6 kids on average daily.

Thanks for the input

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[MisterKitty]

Sounds ****ty

 

[calvnandhobbs68]

I mean I’ll comment on the rest later but….I hope that’s a typo. 100 mile noncompete clause? Lol I’d get that crap cut down to 10% of that if not less. Or get rid of the noncompete completely. Then you can see a few private patients in the afternoons during your free time if you want.

That 403b match sucks but you won’t be able to negotiate that.

if it’s really max 8 patients a day and you have no minimum productivity, you can probably spend half your day doing whatever depending on how frequent the turnover is.

Try to get another week of vacation, 3 weeks is definitely lower than usual.

This could be an okay setup if you can just round on patients morning/early afternoon and then maybe setup your own small cash private practice outpatient for a few patients every afternoon. Totally doable with an max 8 patient census, usually 6.

 

[Sushirolls]

I'll anticipate/expect/assume the patient load will be truly be 7-8.
But 7-8 C&A, with potential 1/2 year resident / fellow, not bad.
The lack of cross coverage is great - hopefully that is truly in writing? Don't exactly want the poor management of the adult department to lead to more work for you which in turn leads to you quitting because another department was poorly run.
2K HSA from employer is nice.
3 weeks vacation is painful. Are there other specific sick days? or CME specific days? The federal holidays, what does that add up to these days? Does it push you into 5 or 6 weeks worth of time off?
Wording on the non-compete, might preclude working any of those moonlighting jobs. Look into that. The better question is if there is internal moonlighting? Or extra pay to cover weekend rounding /call?

Would you do this job if were really 7-8 daily census? And is this a routine C&A unit, or some other specific sort of unit?
Next question is, what do you want for your career at the stage you are in?
This has the potential to be a low stress job conducive to an excellent work life balance. Is this what you want at your current stage of life? Do you have other things to occupy your time and energy? Hobbies? family? training for olympics? Or even, are you academically inclined and want to do research and publish? Could be a great pairing to have quality teaching for students and research.

 

[Marasmus1]

Non compete is not negotiable. But I do not want to work more anyway. I would rather run a kite in the afternoon. I agree with 403 b and vacation but I think no weekends and federal holidays for an inpatient job balances it out. When you have a resident or fellow, it becomes 2-3 patients of my own and 2-3 patients of trainee to supervise. I would likely be heading out by 3 pm more than not.

 

[Marasmus1]

Sounds ****ty

y

 

[Marasmus1]

I'll anticipate/expect/assume the patient load will be truly be 7-8.
But 7-8 C&A, with potential 1/2 year resident / fellow, not bad.
The lack of cross coverage is great - hopefully that is truly in writing? Don't exactly want the poor management of the adult department to lead to more work for you which in turn leads to you quitting because another department was poorly run.
2K HSA from employer is nice.
3 weeks vacation is painful. Are there other specific sick days? or CME specific days? The federal holidays, what does that add up to these days? Does it push you into 5 or 6 weeks worth of time off?
Wording on the non-compete, might preclude working any of those moonlighting jobs. Look into that. The better question is if there is internal moonlighting? Or extra pay to cover weekend rounding /call?

Would you do this job if were really 7-8 daily census? And is this a routine C&A unit, or some other specific sort of unit?
Next question is, what do you want for your career at the stage you are in?
This has the potential to be a low stress job conducive to an excellent work life balance. Is this what you want at your current stage of life? Do you have other things to occupy your time and energy? Hobbies? family? training for olympics? Or even, are you academically inclined and want to do research and publish? Could be a great pairing to have quality teaching for students and research.

Thanks for the input. This is a children`s hospital so no adult department (which allows me to moonlight at any adult facility around). 5 CME days and 10 sick days are in the contract. I will try to go up to 4 weeks vacation but sounds like 3 weeks is the standard in this hospital. The average census is really 5-6 ( a friend of mine is an attending in this facility and said he has not had 8 patients since May, have been weeks with only 2-3 patients a day mostly in the summer, numbers go up to 7-8 in winter and spring. )

This is a routine unit. I have zero debt at this point so not really motivated to see 10 more extra patients for only 60 to 70 k extra compensation a year. I have a lot of hobbies, actually working on a novel. I don`t mind teaching but probably won`t step in research realm

 

[Sushirolls]

With what you just posted, you have probably found the right fit for you, and despite the lower income on the scale of potential, you just might be more content happy than most. Roll the dice, give it a chance. You also have a friend there, so social supports is a big plus.

Give this pitch a swing, see if you hit the stands. Report back in coming months/year if you did hit that upper deck.

 

[Mass Effect]

Non compete is not negotiable. But I do not want to work more anyway. I would rather run a kite in the afternoon.

I mean, it's not just a matter of working more. What if it doesn't work out? Are you willing to move to make a living? I hope you're not buying a house. Frankly, I think as physicians we're our own worse enemy. None of us should be signing non-compete clauses, esp ones with a 100 mile radius.

 

[comp1]

If the non-compete is truly non-negotiable, I'm concerned they may not really want you OR want to trick you into remaining in a less than ideal job because you've settled in the location. What the heck is their response when you try to "negotiate" A HUNDRED MILE RADIUS? How do they even justify that? Outside of the government tied to congressional regulations, most employers are not able to be "non-negotiable" in this market. Fortunately, non-competes are not part of government jobs. That clause is the most concerning thing for me and other people apparently. Non-compete clauses hurt us all when we acquiesce and them being banned in CA is a big part of what made the innovation in Silicon Valley possible. Everything about this job seems low except the workload which is pretty average. For me, the non-compete would make it "non-negotiable."

 

[robellis]

Thanks for the input. This is a children`s hospital so no adult department (which allows me to moonlight at any adult facility around). 5 CME days and 10 sick days are in the contract. I will try to go up to 4 weeks vacation but sounds like 3 weeks is the standard in this hospital. The average census is really 5-6 ( a friend of mine is an attending in this facility and said he has not had 8 patients since May, have been weeks with only 2-3 patients a day mostly in the summer, numbers go up to 7-8 in winter and spring. )

This is a routine unit. I have zero debt at this point so not really motivated to see 10 more extra patients for only 60 to 70 k extra compensation a year. I have a lot of hobbies, actually working on a novel. I don`t mind teaching but probably won`t step in research realm

Why would seeing 10 extra patients per day equate to making 60k more when you’re being paid 190k for 6 patients per day

 

[TexasPhysician]

Being an employer (practice owner), I am a proponent of non-competes within reason. A 100 mile radius is no longer about competition. It is about punishing employees. Practices 99 miles away are not a reasonable threat. Additionally this is an inpatient job. I’d require the contract to state that it only applies to inpatient. An outpatient practice is not competition to inpatient.

 

[Marasmus1]

A side note. I am on visa which means I have to work in a federally underserved area for 3 years to qualify for permanent residency. So once I sign this contract I am in for 3 years unless they put a gun on my head. So I understand the concerns about non compete but I am legally unable to work anywhere else until I complete my service.

99% of the jobs I have found are either in bad areas, bad hospitals that pay 300k or facilities like federal prison in which you see 40 patients a day for 400k. This one is one of the few which is a nationwide recognized hospital.

Also how come 5 to 6 patients a day is average in C/A psychiatry ? I have speaken to countless of facilities and recruiters and only found one hospital in which the average is 4 and the pay is better but there are more bears than humans in 50 mile radius of this location so I said no.

 

[Marasmus1]

With what you just posted, you have probably found the right fit for you, and despite the lower income on the scale of potential, you just might be more content happy than most. Roll the dice, give it a chance. You also have a friend there, so social supports is a big plus.

Give this pitch a swing, see if you hit the stands. Report back in coming months/year if you did hit that upper deck.

Thank you for the input. Work life balance is my number one priority.

 

[Stagg737]

The federal holidays, what does that add up to these days?

If Juneteenth becomes a regular federal holiday like it was this year, the total is up to 11.

Thanks for the input. This is a children`s hospital so no adult department (which allows me to moonlight at any adult facility around). 5 CME days and 10 sick days are in the contract. I will try to go up to 4 weeks vacation but sounds like 3 weeks is the standard in this hospital. The average census is really 5-6 ( a friend of mine is an attending in this facility and said he has not had 8 patients since May, have been weeks with only 2-3 patients a day mostly in the summer, numbers go up to 7-8 in winter and spring. )

This is a routine unit. I have zero debt at this point so not really motivated to see 10 more extra patients for only 60 to 70 k extra compensation a year. I have a lot of hobbies, actually working on a novel. I don`t mind teaching but probably won`t step in research realm

The bolded makes a huge difference with the non-compete imo, and Texas makes a great point about practice setting. 100 miles may not be as unreasonable as it seems depending on the stipulations. Sounds like it's limited to CAP positions, is that all CAP positions or just inpatient? How long is it for? 6 months? A year? 2 years? That also makes a big difference imo.

So total PTO is 15 vacation days, 11 fed holidays, 10 sick days, and 5 CME? So 41 days total? If you take vacation on weeks with fed holidays you can stretch that 15 vacation days to nearly 4 weeks. Seems fairly reasonable to me.

Agree with Sushi, this actually seems like a decent position for you. If it's a low CoL area 190K may not be as terrible as it sounds, especially without any debt. I'd never take it for FTE, but doesn't seem to be an issue here. I also agree with others, the combination of salary and financial benefits in combination with the non-compete as is would be a no-go for me, but may work for you. I'd want to know details of the non-compete.

Last concern is the same as Comp1, that non-compete is a big red flag. If this is so strictly non-negotiable, what else is in the small print that may be problematic. Sounds like they know you need the Visa and are taking advantage of that. I'd definitely have a lawyer scour the contract to make sure there aren't any hidden surprises.

Also how come 5 to 6 patients a day is average in C/A psychiatry ?

Because for every kid on your census you're actually seeing 2-3 patients (kid + parents). It's a big reason I dropped CAP as a potential career path.

 

[calvinhobbes]

Just saw an opening for child psych in PA for 470k. So I really do think you can negotiate a better offer!

 

[calvinhobbes]

And tell them to get rid of that 100m radius non-compete clause, that’s nuts in my opinion. Otherwise the patient load seems okay but many child psych units now are experiencing a surge of psych admits now post-Covid compared to previous years, so you may be seeing many more patients than you realize… is this hospital in Ohio? Ultimately I would get a lawyer to also help you with the ins and outs of the contract, to better negotiate, so they don’t screw you. Good luck!

 

[dl2dp2]

It's not a great job but given the circumstances (visa requirement, federally qualified status) I think you might have to take it and sit for 3 years.

 

[erg923]

How does an employer really know if you are practicing 50 miles away or 100 miles away? How is that measured, anyway? Also, 190K for such an in-demand area of psychiatry seems ridiculous as well.

 

[Sushirolls]

Google maps has draw line distance function.
Does your NPI number have new practice address?
Do the various insurance companies have you listed on directory for practice location at XYZ?
Do you have a website listing your practice address at nearby?
Not hard to sleuth out.

 

[AtlasCarraway]

100 miles is straight up malicious. But if you can reconcile that with the rest of your wants/needs, it could work.

 

[calvinhobbes]

btw is this a children’s hospital hiring you as in a peds department? If so, that’s why the salary may be so low …

 

[deleted1100659]

When i was residency, my program paid attendings on the lower end, and even they didn't go that low. Forgive me, but 190k seems on the low side, especially since you are doing weekly pager call. Even though your daily census isnt that high, there could be other forms of stress. Plus, the number of patients seen sometimes isnt as important as the complexity.

Also dont understand why an inpatient setting would make you agree to a non compete. Theoretically wouldnt it only help them, as if you did extra outpatient work you could see discharge follow ups? I would think midwest isnt overly saturated with psychiatrists

 

[Sushirolls]

Big Box shops will have boiler plate contracts with non-competes for everyone.
These are bargaining tools.
When people do eventually want to leave, or if they scat on people that prompts a leave, these can be used to disappear in exchange for indemnifying the Big Box organization for all the transgressions...

Doc: Big Box shop, you are not fullfilling your contract with me as evidenced by X, Y, and Z. Therefore I'm quitting and please direct your questions to my lawyer.
Big Box shop: we have a deal for you, we don't admit fault, you don't sue us for X and Y, and your non-compete goes away. What do you say?
Doc: sure
Big Box shop: oh, and don't talk about fight club, first rule, in the small print.

Non-competes can be used by Big Box Shops as a buffer to the problems they create, a pseudo-'get out of jail, free card'

 

[MedMan80]

Fwiw I'm also a j1 waiver, out in the boonies. I see about 10 kids a day all outpatient and consider it cush. I get 280K, 4 weeks off..downside is the rurality, but this is manageable for me. I'd try to bring the base to 210K, anywhere on the east coast even academic 4 week vacation is standard, plus atleast 10K moving expenses.

Also technically non complete is not allowed on J1 waiver, so get them to take that out

 

[Sushirolls]

That's right, can't have non-competes for waiver jobs!

 

[J ROD]

Personally, I would not work for that amount. I like making money. Sounds like you already have your mind made up and want affirmation. So, I bless it and think it is a good fit for your situation and what you want. Good luck!

 

[NickNaylor]

I work in an academic setting so I'm used to getting scammed as far as compensation goes, but even I would say that that doesn't sound like a good gig. That non-compete is a joke (though seemingly not an issue for you) and the retirement benefits are terrible (that match percentage is worse than when I was a resident at our local county hospital). Do you get paid extra for call? I also work on an inpatient unit and we take call backing up the resident one day/week which is basically a free 5% raise for essentially no work. What about weekend coverage? How does that work and do you get paid beyond your salary?

You describe the hospital as a "teaching hospital" but are you actually working with trainees? Are you essentially supervising with no expectation of doing work on your own? If that's the case and you get paid for any additional work outside M-F, 9-5 then the salary kind of makes a bit more sense.

 

[LutGholein]

I wonder if they are screwing you over with that Visa status stuff.

 

[PikminOC]

Big Box shops will have boiler plate contracts with non-competes for everyone.
These are bargaining tools.
When people do eventually want to leave, or if they scat on people that prompts a leave, these can be used to disappear in exchange for indemnifying the Big Box organization for all the transgressions...

Doc: Big Box shop, you are not fullfilling your contract with me as evidenced by X, Y, and Z. Therefore I'm quitting and please direct your questions to my lawyer.
Big Box shop: we have a deal for you, we don't admit fault, you don't sue us for X and Y, and your non-compete goes away. What do you say?
Doc: sure
Big Box shop: oh, and don't talk about fight club, first rule, in the small print.

Non-competes can be used by Big Box Shops as a buffer to the problems they create, a pseudo-'get out of jail, free card'

Are noncompetes enforceable?

 

[PikminOC]

Just saw an opening for child psych in PA for 470k. So I really do think you can negotiate a better offer!

Which hospital?

 

[PikminOC]

Non compete is not negotiable. But I do not want to work more anyway. I would rather run a kite in the afternoon. I agree with 403 b and vacation but I think no weekends and federal holidays for an inpatient job balances it out. When you have a resident or fellow, it becomes 2-3 patients of my own and 2-3 patients of trainee to supervise. I would likely be heading out by 3 pm more than not.

Run a kite?

 

[TexasPhysician]

Are noncompetes enforceable?

This may depend on the state and it’s own rules. In my state, yes as long as they follow certain guidelines.

 

[Copper_Tracker]

OP, kind of depends how much you want to work. If money isn't a huge draw for you and you are excited about the prospect of working some extremely cush hours but for well below market compensation, then it sounds like a solid job. That said, you should be aware that the market is pretty phenomenal right now and there is a lot of negotiating power for Psychiatrists across the country due to the very significant supply shortage.

Every single job offer I've come across in the past few months has been for over 300k with standard 40 hour work week. When I evaluate these offers on paper, they just don't seem taxing at all.

 

[Mass Effect]

OP, kind of depends how much you want to work. If money isn't a huge draw for you and you are excited about the prospect of working some extremely cush hours but for well below market compensation, then it sounds like a solid job. That said, you should be aware that the market is pretty phenomenal right now and there is a lot of negotiating power for Psychiatrists across the country due to the very significant supply shortage.

Every single job offer I've come across in the past few months has been for over 300k with standard 40 hour work week. When I evaluate these offers on paper, they just don't seem taxing at all.

Is the market really that good these days? Is it post Covid? I've been at my place for a few years now, but when I was job hunting location and setting was everything. At that time, don't think you'll get 300K in academics or county health centers in Manhattan or LA for example. You likely would for Iowa or Minnesota. Private practice is a little different, but the big cities are usually inundated with private pay and eat what you kill model last I checked.

 

[SmallBird]

Midwest Urban Teaching Hospital inpatient child and adolescent psychiatry faculty position

190K base salary, no minimum RVU expectation, no bonus structure
Once a week, weekday pager call on average 4-5 pages from 5 pm to 8 am, very rarely getting paged between 12 am to 7 am, no weekends and federal holidays
Average patient load 5-6 a day, Max patient load is 8, half a year have a fellow or resident, research is encouraged but not expected,
No expectation of cross coverage with other departments.
Medical, dental, vision benefits, 403b with 3% match, HSA with 2k maximum employer contribution, 3k CME annually, malpractice with tail coverage
3 weeks vacation
Non compete clause with the radius of 100 miles
Multiple adult psychiatry moonlighting opportunities in the area with 4 major teaching hospital within 50 miles radius

I would like some opinions. I will probably negotiate 200k but with average patient load being 5-6 I don`t think I have too much leverage there. Please don`t tell me as a child psychiatrist I am worth minimum 250k because I know the market well. I have not yet found a job where I would get paid 250k seeing 5-6 kids on average daily.

Thanks for the input

I think what makes me feel this is a bad offer is the entire package - the salary is low, the vacation is low, there is no off-service time, there is a pager call, and the retirement match is very poor. The absolute lowest a child psychiatrist would make at my academic institution would be about $220k but there would be much more vacation, much better retirement match, academic time, etc. My current caseload is 5-6 patients 35 weeks per year for better benefits. My first job was also a waiver job at an academic institution in the Northeast and I was paid significantly more than that but granted I had to see 8 patients.

 

[whopper]

I'm in the midwest. I was a university professor, got out of it and went into private practice. Within 1 year I was earning 2x as much, working half as much. 4 years later I was making 3x as much.

I used to be a professor at U of Cincinnati. I was happy there despite that academia didn't pay as much. I was working with the best of the, best, had great colleagues, fantastic residents, a lot of respect, and the institution was excellent. I moved to a new area because my wife became a professor in a different institution. I later joined another university that I couldn't tolerate-the staff members were hardly doing their jobs, some residents were good but about half were mediocre or worse, I was bringing in a lot of money into the department and getting paid less than a 1/3 of what I brought in, if a computer broke it never got fixed. Literally never. Same computers that were broken on my first day were broken on my last day. Security took 30 minutes to show up to the unit if patients were violent.

Moving out to private practice was the best thing I did. I still recommend new graduates strongly consider academia because you don't learn as much as you need to know in residency, but if so go to an academic center that will encourage your own growth. Once, however, you plateaued in what they can teach you, and I recommend at least 2 years, consider the benefits of staying, but for me there wasn't much room after 3 years.

Had I stayed in Cincinnati I speculate I might've never gotten out of academia. The bonuses of it were good enough for me not to be curious enough to look elsewhere. Also Cincinnati isn't having anywhere near the shortage of psychiatrists as where I am now in Missouri cause the city retains many of it's graduates. In short had I left U of Cincinnati I would've made more money but not much more in private practice, hence staying in the university, with all it had going for it, likely would've kept me happy.

 

[calvinhobbes]

Which hospital?

I deleted the email a while back but it was a rural city in PA. It was a recruitment email with many diff positions open in diff cities, ah sry can’t remember the hospital. But there were sooooo many openings. All requesting MD/DOs only.

 

[PikminOC]

I deleted the email a while back but it was a rural city in PA. It was a recruitment email with many diff positions open in diff cities, ah sry can’t remember the hospital. But there were sooooo many openings. All requesting MD/DOs only.

Yes then they hire mid-levels for the MD to supervise.

 

[calvinhobbes]

Yes then they hire mid-levels for the MD to supervise.

Well that sucks lol

 

[Marasmus1]

Update;

After back and forth negotiations through emails + one more site visit, I was able to get slightly better offer. Base salary went up to 210k, vacation went up to 4 weeks but contingent upon me accepting 2 federal holiday pager call a year (or 3 weeks vacation with no federal holiday call), the corporate match to retirement did not change unfortunately.

After they spoke to the attorney, they removed the non compete clause but again knowing that I would not be able to work anywhere else due to H1b status ( so not sure if that would be considered a gain).

They offered Saturday outpatient option at one of their satellite clinic in the area for extra 4k compensation a month every other Saturday. However, the clinic sounds a lot of work as they said they would schedule 90 minutes new evals and 30 minutes follow ups from 8 am to 6 pm. So I am potentially looking up to 15 patients on Saturday If I take it but again I do not need to sign up for that.

 

[robellis]

This is just sad

 

[LimpSpatula]

Midwest Urban Teaching Hospital inpatient child and adolescent psychiatry faculty position

190K base salary, no minimum RVU expectation, no bonus structure
Once a week, weekday pager call on average 4-5 pages from 5 pm to 8 am, very rarely getting paged between 12 am to 7 am, no weekends and federal holidays
Average patient load 5-6 a day, Max patient load is 8, half a year have a fellow or resident, research is encouraged but not expected,
No expectation of cross coverage with other departments.
Medical, dental, vision benefits, 403b with 3% match, HSA with 2k maximum employer contribution, 3k CME annually, malpractice with tail coverage
3 weeks vacation
Non compete clause with the radius of 100 miles
Multiple adult psychiatry moonlighting opportunities in the area with 4 major teaching hospital within 50 miles radius

I would like some opinions. I will probably negotiate 200k but with average patient load being 5-6 I don`t think I have too much leverage there. Please don`t tell me as a child psychiatrist I am worth minimum 250k because I know the market well. I have not yet found a job where I would get paid 250k seeing 5-6 kids on average daily.

Thanks for the input

That sounds like something you should not even reply to.

 

[MedMan80]

At the end of the day if you get a good vibe from the people and the area is good, go for it man. My saying was that on a J1 waiver we can get 1. Good pay, 2. good job 3, good location, PICK 2 out of the 3, you can't get all 3 (unless really lucky).

 

[ridethecliche]

I'm in the midwest. I was a university professor, got out of it and went into private practice. Within 1 year I was earning 2x as much, working half as much. 4 years later I was making 3x as much.

I used to be a professor at U of Cincinnati. I was happy there despite that academia didn't pay as much. I was working with the best of the, best, had great colleagues, fantastic residents, a lot of respect, and the institution was excellent. I moved to a new area because my wife became a professor in a different institution. I later joined another university that I couldn't tolerate-the staff members were hardly doing their jobs, some residents were good but about half were mediocre or worse, I was bringing in a lot of money into the department and getting paid less than a 1/3 of what I brought in, if a computer broke it never got fixed. Literally never. Same computers that were broken on my first day were broken on my last day. Security took 30 minutes to show up to the unit if patients were violent.

Moving out to private practice was the best thing I did. I still recommend new graduates strongly consider academia because you don't learn as much as you need to know in residency, but if so go to an academic center that will encourage your own growth. Once, however, you plateaued in what they can teach you, and I recommend at least 2 years, consider the benefits of staying, but for me there wasn't much room after 3 years.

Had I stayed in Cincinnati I speculate I might've never gotten out of academia. The bonuses of it were good enough for me not to be curious enough to look elsewhere. Also Cincinnati isn't having anywhere near the shortage of psychiatrists as where I am now in Missouri cause the city retains many of it's graduates. In short had I left U of Cincinnati I would've made more money but not much more in private practice, hence staying in the university, with all it had going for it, likely would've kept me happy.

I always appreciate your posts and I'm definitely taking the bolded to heart. The fact that the timeline will work out just about perfectly with my PSLF-ish is just icing on the cake.