Seeking Input for Two Job Offer Comparison

[psychiatree]

Seeking some input since I feel conflicted between 2 job offers.
Both are in the same city (VHCOL). Lots of details in the compensation package but to put it briefly:
One is outpatient, M-F 32 hours direct pt care/wk, 30 min follow up and 60 min new eval, $290k salary with salary increases annually (estimated to be ~$385k in 4 years), many great benefits if i stay long term such as K1 from W2 after 3-4 years (would help with tax burden), 18 days PTO, and qualifies for PSLF.
The other is inpatient which is the setting I much highly prefer, M-F leave when done rounding (I would estimate 4-6 hrs/day), $350-400k salary, 12-15 pts/day (will always be W2 and be in a higher tax bracket), up to 30 days PTO but it seemed like it's contingent on being able to find coverage, but does NOT qualify for PSLF.
I currently have >$350k in medical school loans with 5 years of credit for PSLF already.
Economically, it makes more sense to do the outpatient job, but doing outpatient does not excite me.
Work, life, balance would be much better with the inpatient job but I would have to pay back my loans and pay higher taxes.
Anyone been in this situation and care to chime in?
Thanks!

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[PsyDr]

FYI: the CARES act created a tax free way for employers to pay $5k/yr for your student loans. It might be useful to ask the inpatient job if they are willing to move some of the compensation into that.

 

[calvnandhobbs68]

Seeking some input since I feel conflicted between 2 job offers.
Both are in the same city (VHCOL). Lots of details in the compensation package but to put it briefly:
One is outpatient, M-F 32 hours direct pt care/wk, 30 min follow up and 60 min new eval, $290k salary with salary increases annually (estimated to be ~$385k in 4 years), many great benefits if i stay long term such as K2 from W2 after 3-4 years (would help with tax burden), 18 days PTO, and qualifies for PSLF.

I'm not sure what you're talking about here and why you're describing it in IRS schedules. Schedule K2 is basically about international reporting requirements for a partnership or S corp. If you're talking about Schedule K-1, are you saying they're promising to make you a partner or shareholder? Because that's a big promise and you'd be wanting to get that in writing somewhere and definitely have a lawyer review it. It's also weird that it'd qualify for PSLF (so has to be non-profit?) but you'd also be able to get distributions under a partnership at some point?

 

[psychiatree]

I'm not sure what you're talking about here and why you're describing it in IRS schedules. Schedule K2 is basically about international reporting requirements for a partnership or S corp. If you're talking about Schedule K-1, are you saying they're promising to make you a partner or shareholder? Because that's a big promise and you'd be wanting to get that in writing somewhere and definitely have a lawyer review it. It's also weird that it'd qualify for PSLF (so has to be non-profit?) but you'd also be able to get distributions under a partnership at some point?

my mistake. yes i mean K1. working for this physician group did not qualify for PSLF until about half a year ago. it's a standard contract so all associates have the opportunity to become partners and take distributions

 

[nexus73]

Without running exact numbers, I'd say take the PSLF qualifying job. Loans done in 5 years is huge. Are there no inpatient non profits around?

 

[calvnandhobbs68]

my mistake. yes i mean K1. working for this physician group did not qualify for PSLF until about half a year ago. it's a standard contract so all associates have the opportunity to become partners and take distributions

Again, sounds kind of dicey especially when you say they "didn't qualify for PSLF" until 6 months ago. In what way did they suddenly become eligible for PSLF? They became a nonprofit somehow in a non-shady way? When you search their EIN on the PSLF site does it show up? You want to be 100 percent sure of this and also 100 percent sure they retain their non-profit status...this is a lot of money on the line for you.

Remember that also part of the qualifications for PSLF is that you have to "work full time" for the qualifying organization, so becoming a partner/shareholder of the organization may also be a little iffy here, I'm actually not sure how odd that is and probably something you want to pay a tax attorney to look at/talk about given the amount of money at stake.

But yes it's pretty clear if Job 1 actually qualifies for PSLF it's a way better financial option.

 

[TexasPhysician]

While one job may pay more than the other, I wouldn’t call the difference substantial. If inpatient makes a substantial difference in quality of life, I would go that route. Even if it pays a little less, we use $ to improve happiness. It seems worth the price.

 

[icysky]

Again, sounds kind of dicey especially when you say they "didn't qualify for PSLF" until 6 months ago. In what way did they suddenly become eligible for PSLF? They became a nonprofit somehow in a non-shady way? When you search their EIN on the PSLF site does it show up? You want to be 100 percent sure of this and also 100 percent sure they retain their non-profit status...this is a lot of money on the line for you.

Remember that also part of the qualifications for PSLF is that you have to "work full time" for the qualifying organization, so becoming a partner/shareholder of the organization may also be a little iffy here, I'm actually not sure how odd that is and probably something you want to pay a tax attorney to look at/talk about given the amount of money at stake.

But yes it's pretty clear if Job 1 actually qualifies for PSLF it's a way better financial option.

Job 1 sounds like Kaiser. CA and TX had laws preventing docs from owning hospitals and thus a lot of doctors are part of physician for profit groups and thus did not qualify for PSLF, even if they worked with a qualifying patient population. Department of education recently changed the rules to allow those groups to qualify for PSLF given the state laws. Kaiser submitted the necessary PSLF forms and it started counting approximately six months ago (rule was announced even before then but took some time for the DOE to process and see what that looks like). Colleagues at Kaiser said they recently submitted their forms and got their payments counted.

 

[Bartelby]

You should do the math, but I agree with TexasPhysician. If you love inpatient work and would be happier doing that, that counts for a lot. It seems likely things would work out fine financially in either scenario, and even if you plan to switch as soon as your PSLF comes through ~5 years is a long time spent doing something you don't really like.

In my career so far I have figured out what "good enough" meant for me financially. Once at that level (which is a little below average psychiatrist earnings in my mind) I shift to prioritizing work environment, the type of work, the quality of care I can provide, time off, and a lot of other factors. This has worked out really well for me so far, as I have generally been happy with work and still have no real financial worries. As a disclaimer, though, I have a high-earning spouse and I don't have very expensive tastes so your mileage may vary.

 

[hamstergang]

Economically, it makes more sense to do the outpatient job, but doing outpatient does not excite me.
Work, life, balance would be much better with the inpatient job but I would have to pay back my loans and pay higher taxes.

You're asking other people to decide how much money to value your happiness at?

 

[finalpsychyear]

Seeking some input since I feel conflicted between 2 job offers.
Both are in the same city (VHCOL). Lots of details in the compensation package but to put it briefly:
One is outpatient, M-F 32 hours direct pt care/wk, 30 min follow up and 60 min new eval, $290k salary with salary increases annually (estimated to be ~$385k in 4 years), many great benefits if i stay long term such as K1 from W2 after 3-4 years (would help with tax burden), 18 days PTO, and qualifies for PSLF.
The other is inpatient which is the setting I much highly prefer, M-F leave when done rounding (I would estimate 4-6 hrs/day), $350-400k salary, 12-15 pts/day (will always be W2 and be in a higher tax bracket), up to 30 days PTO but it seemed like it's contingent on being able to find coverage, but does NOT qualify for PSLF.
I currently have >$350k in medical school loans with 5 years of credit for PSLF already.
Economically, it makes more sense to do the outpatient job, but doing outpatient does not excite me.
Work, life, balance would be much better with the inpatient job but I would have to pay back my loans and pay higher taxes.
Anyone been in this situation and care to chime in?
Thanks!

What happens if you only get to 5 years of forgiveness. Is it all or nothing if you don't hit 10 years?

The inpt job sounds close to a 100k/year gross increase over the outpatient so maybe 60-65k net per year is what 300-325k in the next 5 years?

Could you do outpatient and do some inpt coverage to still hit that 400k number that might be the ideal to get all the benefits including loan forgiveness?

Just remember it's highly overlooked that making 100-150k extra per year can knock out your loans very quickly. Plus doing inpt would give you close to 400k plus maybe some PT hours elsewhere for outpatient since you'd have more time.

 

[comp1]

Ugh, I could never do outpatient, particularly at Kaiser! Just the voicemails and inbox messaging alone... There should be plenty of PSLF jobs all around. Corrections, county inpatient, VA, etc. Don't limit yourself to these two jobs. And don't do outpatient if you prefer inpatient. They're very different and you're going to be unhappy.

 

[calvnandhobbs68]

What happens if you only get to 5 years of forgiveness. Is it all or nothing if you don't hit 10 years?

The inpt job sounds close to a 100k/year gross increase over the outpatient so maybe 60-65k net per year is what 300-325k in the next 5 years?

Could you do outpatient and do some inpt coverage to still hit that 400k number that might be the ideal to get all the benefits including loan forgiveness?

Just remember it's highly looked over that making 100-150k extra per year can knock out your loans very quickly. Plus doing inpt would give you close to 400k plus maybe some PT hours elsewhere for outpatient since you'd have more time.

Not if what he's saying happens on the oupatient job actually happens. It sounds like a lower lead in first year with basically equivalent to the inpatient job by year 3-4, so minimal salary difference (maybe even salary benefit for the outpatient job tax-wise) with PSLF benefit with the outpatient job.

But yes I agree OP I feel like you should be able to find an inpatient job with maybe a slightly lower salary that would still qualify for PSLF...most hospital systems are technically non-profits.

 

[finalpsychyear]

Not if what he's saying happens on the oupatient job actually happens. It sounds like a lower lead in first year with basically equivalent to the inpatient job by year 3-4, so minimal salary difference (maybe even salary benefit for the outpatient job tax-wise) with PSLF benefit with the outpatient job.

But yes I agree OP I feel like you should be able to find an inpatient job with maybe a slightly lower salary that would still qualify for PSLF...most hospital systems are technically non-profits.

I would think the inpatient job would also go up over the next 4 years with options of call, moonlighting, negotiating more $ after 1-2 years.

But yes your correct if the inpatient job stays the same range for next 4 years but the outpatient is increasing 20-25k/year would be good to know vs a large bump up in year 4 of like 50-60k.

I just feel if $ is the goal you can't beat inpt esp if you can leave after rounds that's typically the model of those in my area who gross high 6 figs leave by noon and options to do 12-5pm work somewhere else or different places at premium hourly rates.

if money soley had been my goal and i could go back i would have taken the inpt role from 5-6am done by noon and do telepsych in pm while building a PP that i ultimately would feed from the inpt work and hire the NPs. However I value lifestyle, sleep and dating and moving forward in my personal life was the main priority post residency which i def made the right choice looking back. Those might also be something to think about for OP if it applies or not.

 

[clozareal]

Seeking some input since I feel conflicted between 2 job offers.
Both are in the same city (VHCOL). Lots of details in the compensation package but to put it briefly:
One is outpatient, M-F 32 hours direct pt care/wk, 30 min follow up and 60 min new eval, $290k salary with salary increases annually (estimated to be ~$385k in 4 years), many great benefits if i stay long term such as K1 from W2 after 3-4 years (would help with tax burden), 18 days PTO, and qualifies for PSLF.
The other is inpatient which is the setting I much highly prefer, M-F leave when done rounding (I would estimate 4-6 hrs/day), $350-400k salary, 12-15 pts/day (will always be W2 and be in a higher tax bracket), up to 30 days PTO but it seemed like it's contingent on being able to find coverage, but does NOT qualify for PSLF.
I currently have >$350k in medical school loans with 5 years of credit for PSLF already.
Economically, it makes more sense to do the outpatient job, but doing outpatient does not excite me.
Work, life, balance would be much better with the inpatient job but I would have to pay back my loans and pay higher taxes.
Anyone been in this situation and care to chime in?
Thanks!

Just running the numbers.

If you have $350k in student loans and over the next 5 years at 6% interest rate, it would accrue to about $400k in the next 5 years. This amount forgiven in 5 years would be a post-tax amount that you are paying from your non-PSLF job. Therefore, the pre-tax amount is ~$650-700k depending on your state taxes and tax filing status. You would divide this total and add it on to your PSLF eligible job salary to see what your "total comp" package is over 5 years. It is $130-140k extra in gross per year.

In job #1, the "total comp" package would then be $420k in year 1 up to $525k in year 4.

This beats out job #2 in numbers alone.

 

[Stagg737]

Just running the numbers.

If you have $350k in student loans and over the next 5 years at 6% interest rate, it would accrue to about $400k in the next 5 years. This amount forgiven in 5 years would be a post-tax amount that you are paying from your non-PSLF job. Therefore, the pre-tax amount is ~$650-700k depending on your state taxes and tax filing status. You would divide this total and add it on to your PSLF eligible job salary to see what your "total comp" package is over 5 years. It is $130-140k extra in gross per year.

In job #1, the "total comp" package would then be $420k in year 1 up to $525k in year 4.

This beats out job #2 in numbers alone.

True, but if the inpatient position is truly a "done by noon/2" type of position, nothing is stopping OP from taking a side-hustle a couple of days per week to pull in extra $100k per year. I guess they could do something similar with the outpatient job as well, but after 32 clinical hours of doing something they don't like do they really want to do more of it?

I agree with others though that OP should be able to find an inpatient gig that qualifies for PSLF fairly easily. OP also hasn't commented on if they're really locked into the location. Moving to an area that's not VHCOL can make a significant difference at those income levels, especially if they're looking to stay there longer term.

 

[mistafab]

If I were you I would do what I love. 5 years is a long time. If you hate your life year 3, you’re staring down the barrel of horrible life for 2 years more and feeling stuck/trapped.

The money difference between both is a wash anyway after taxes. I’d rather cut myself free of the handcuffs, do what I love, and come up with a plan to pay the debt off. Simple math. If you put 100k towards your loan while working inpatient every year, you’re debt free in 4 years anyway. It’s not like your income wont go up.

When you have two choices that are similar, pick freedom. That’s what I would do. If life were just math, things would be easy.

 

[clozareal]

If I were you I would do what I love. 5 years is a long time. If you hate your life year 3, you’re staring down the barrel of horrible life for 2 years more and feeling stuck/trapped.

The money difference between both is a wash anyway after taxes. I’d rather cut myself free of the handcuffs, do what I love, and come up with a plan to pay the debt off. Simple math. If you put 100k towards your loan while working inpatient every year, you’re debt free in 4 years anyway. It’s not like your income wont go up.

When you have two choices that are similar, pick freedom. That’s what I would do. If life were just math, things would be easy.

The two choices aren't similar financially in my opinion though. It's a difference of $100k per year. It depends on their personal financial circumstances and what they can afford.

Also, they never said they hated outpatient vs loved inpatient. If it was a split that was that extreme, then I would say do inpatient and try to pay off the loans in a different way. It's probably not financially the best choice, but it would be for the quality of life if the outpatient job was miserable.

I think if you're choosing between an okay job that makes more sense financially vs something better that makes less financial sense and that this is a temporary situation, then I would say just stick it out for a few more years and do PSLF for 5 years if the job is tolerable. Obviously don't do it if you're "staring down the barrel of a horrible life" for the outpatient job.

Just make sure you don't take the golden handcuffs and decline the sign on bonus (it actually is more like a zero interest forgivable loan) if it is Kaiser so you don't get stuck having to work a job you might not like in order to keep that bonus.

 

[Merovinge]

You didn't mention call with the IP job but that would be a huge consideration for me as well. I prefer IP to OP work as well, but took brutal call and even at q7, being woken up every 2 hours once weekly is a huge burden. If you ever have kids it becomes an even worse burden. I settled on the middle ground of PHP/IOP work without call but similar acuity to IP.

Of the two options I agree financially with 5 years left for PSLF that OP makes more sense. Nothing stopping you from jumping ship to IP if you truly want that level of intensity after the loans are gone. Money does less work in VHCOL areas so a 100k or so pretax a year will make a demonstrable difference in your life unless you have very modest goals.

 

[calvinhobbes]

Job 1 sounds like Kaiser. CA and TX had laws preventing docs from owning hospitals and thus a lot of doctors are part of physician for profit groups and thus did not qualify for PSLF, even if they worked with a qualifying patient population. Department of education recently changed the rules to allow those groups to qualify for PSLF given the state laws. Kaiser submitted the necessary PSLF forms and it started counting approximately six months ago (rule was announced even before then but took some time for the DOE to process and see what that looks like). Colleagues at Kaiser said they recently submitted their forms and got their payments counted.

Can confirm, Kaiser and their physician groups count for PSLF now. Actually, Kaiser always counted, it’s just their physician groups that didn’t count , and Kaiser can’t directly hire docs, thus they were hired by the physician group like SCPMG, etc. anyways, yes correct working for a Kaiser entity now counts for pslf which is huge (only in Cali and Texas).

 

[Trismegistus4]

True, but if the inpatient position is truly a "done by noon/2" type of position, nothing is stopping OP from taking a side-hustle a couple of days per week to pull in extra $100k per year.

This may not be universal. My hospital has an "exclusive service" clause in the contracts and technically we are "on" for 12 hour shifts, despite being able to leave when we are done; thus, you are not allowed to work anywhere else during those 12 hours. A couple of years ago, they found out some people were doing private practice in the afternoons and made them stop.

 

[Stagg737]

This may not be universal. My hospital has an "exclusive service" clause in the contracts and technically we are "on" for 12 hour shifts, despite being able to leave when we are done; thus, you are not allowed to work anywhere else during those 12 hours. A couple of years ago, they found out some people were doing private practice in the afternoons and made them stop.

True, but OP specifically said it’s a “leave when you’re done rounding” job, so should be doable if they want. Though you make a good point to make sure something like that isn’t written into the contract to prevent that.

 

[sloh]

This may not be universal. My hospital has an "exclusive service" clause in the contracts and technically we are "on" for 12 hour shifts, despite being able to leave when we are done; thus, you are not allowed to work anywhere else during those 12 hours. A couple of years ago, they found out some people were doing private practice in the afternoons and made them stop.

How did they find out? Asking for a friend

 

[finalpsychyear]

How did they find out? Asking for a friend

1.Usually they told staff and eventually it gets around esp if someone got offended by their tone, pitch, or lack of small talk.

2. Something happened on unit and the person was awol and couldn't be reached

All guesses

 

[Merovinge]

1.Usually they told staff and eventually it gets around esp if someone got offended by their tone, pitch, or lack of small talk.

2. Something happened on unit and the person was awol and couldn't be reached

All guesses

So bloody true. Probably the number 1 driver of staff irritation of both my partner and myself over the last few years. Never realized talking about the local sports team or weather was going to be so relevant.

 

[Trismegistus4]

How did they find out? Asking for a friend

Haha. Maybe "found out" was a poor choice of words. It wasn't exactly a secret; those doing it didn't think they were breaking any rules. I think it was more a classic case of a new sheriff in town: old management hadn't cared, but new management took over and decided it was important to enforce the clause.

I have to wonder, though, how does one find out that a job is a "leave when you're done rounding" job? At my place, I know the administrators don't really like this, but know there's nothing they can do about it, as if they decided to chain us all to our desks all afternoon we'd all just quit. I would think that when you're applying for a job, administration wouldn't want to advertise this, and asking about it would make a bad impression. @psychiatree, is this something they were open about?

 

[sloh]

Haha. Maybe "found out" was a poor choice of words. It wasn't exactly a secret; those doing it didn't think they were breaking any rules. I think it was more a classic case of a new sheriff in town: old management hadn't cared, but new management took over and decided it was important to enforce the clause.

I have to wonder, though, how does one find out that a job is a "leave when you're done rounding" job? At my place, I know the administrators don't really like this, but know there's nothing they can do about it, as if they decided to chain us all to our desks all afternoon we'd all just quit. I would think that when you're applying for a job, administration wouldn't want to advertise this, and asking about it would make a bad impression. @psychiatree, is this something they were open about?

“Better to ask for forgiveness than permission” —good motto to live by as a physician haha

 

[comp1]

It shouldn't be hard to ask about this. You ask "is there an expected tour of duty with this position?" If there is, you shouldn't be leaving during it. If there isn't, then you leave when you're done. Ideally there's a heck of a lot more you're doing in a salaried inpatient position than just seeing individual patients and writing prescriptions. It shouldn't just be outpatient with sicker people. You should be leading teams, running groups, developing SOPs, connecting to community resources, educating trainees, supporting nursing, etc.

 

[psychiatree]

@Trismegistus4 i ask what the day to day duties of the current psychiatrists looks like and what they do once they are done with rounding and admissions. 2 out of 3 jobs have straight up told me i can come and go as i please but just be available by phone until 5PM as a selling point and the one other job strictly said all psychiatrists must stay on site until 5PM.

 

[Merovinge]

Haha. Maybe "found out" was a poor choice of words. It wasn't exactly a secret; those doing it didn't think they were breaking any rules. I think it was more a classic case of a new sheriff in town: old management hadn't cared, but new management took over and decided it was important to enforce the clause.

I have to wonder, though, how does one find out that a job is a "leave when you're done rounding" job? At my place, I know the administrators don't really like this, but know there's nothing they can do about it, as if they decided to chain us all to our desks all afternoon we'd all just quit. I would think that when you're applying for a job, administration wouldn't want to advertise this, and asking about it would make a bad impression. @psychiatree, is this something they were open about?

Speaking to the other staff psychiatrists would be an ideal place to start.

This goes for all jobs that have staff psychiatrists. Always speak to them. Try to speak to at least 2. More is better. Anyone reading this, TALK TO THE OTHER DOCTORS before taking a new job.