thoughts and opinions on this job?

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finalpsychyear

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Ok. I currently am being offered a 32-40 hour telepsych job which the site is located about 1hr 10 minutes from me. It requires one day a week to be on site but the rest is done via home or wherever you have an internet connection. They are offering $150/135 depending on if you don't want benefits or want benefits.

I currently have a 2 day private practice but am planning to move in the next 3 months and i will still be about that 1 hr 10 min from this telepsych site and my private practice. Ultimately, I will probably build a new private practice in this newer area but this seems like a great way to kind of transition since i can be wherever 3 out of the 4 days for the telepsych. Any idea if this is reasonable hourly rate?

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I don't know much about telepsych positions, but what would the position involve? Any specific population or need, and what acuity? Did they specify number or length of your clinic visits, is it mostly NP or mostly established RV, any other expectations for you other than direct clinical care of your patients? All med management?

A big one for me would be connection with an established health system/hospital/clinic with supports in place, including clinicians near the patient who are comfortable managing difficult situations in-person while the psychiatrist is an hour+ away. Feel free to ignore any of the above questions if it's getting too specific or would give away the location/job, etc.
 
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The $135 vs $150 vs is a reasonable spread for benefits if they are decent. Don't underestimate the 2 extra hours a week you will spend in the car, even if not unpleasant. I have one long distance job and I calculate it as a 10 hour day a week which in your case will reduce your hourly to $108 or $120 and on a yearly basis a loss of $7,020 or $7,800. Bottom line for me is I require either a higher hourly rate or to be compensated for drive time which many will do depending on their need.
 
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The $135 vs $150 vs is a reasonable spread for benefits if they are decent. Don't underestimate the 2 extra hours a week you will spend in the car, even if not unpleasant. I have one long distance job and I calculate it as a 10 hour day a week which in your case will reduce your hourly to $108 or $120 and on a yearly basis a loss of $7,020 or $7,800. Bottom line for me is I require either a higher hourly rate or to be compensated for drive time which many will do depending on their need.
Working from home seems like fun, just wearing a dress shirt with some shorts on. The issue for me is that I need some sort of social interaction or I go crazy.
 
Ignoring the Telepsych aspect of this position (could be a pro or con depending on the person, and which doesn't appear at first glance to be pushing this $rate up or down much), it's interesting to note how similar many of these "typical" or "standard" employed outpatient positions (non-academic) end up being when you break things down and compare total packages, controlling for hours/call/vacation/CME/benefits, etc. This seems to be in stark contrast to the challenging task of comparing reasonable rates between a "typical" employed outpatient role and other varieties of clinical work. The wide varieties of positions and huge disparities in clinical need between even neighboring towns seems to skew the data that gets thrown around, making it hard to find accurate regional averages or expectations of what might be a "fair" offer for a certain role.

My colleagues and friends in the field (early career faculty, residents, fellows) have often mentioned getting mixed and confusing messages when going through this process, and I've definitely felt that way at times. On one hand, there seems to be this barrage of exciting, dramatic and diverse openings being advertised to recruit hard-to-fill positions all over the country. Examples you have likely seen - offers with massive sign on bonuses (sometimes with small print attached...), starting compensation "guarantees" well above the 90th percentile, escalating and almost desperate offers to recruit to remote or less "desirable" locations/settings, etc. And in reality, some have had successful experiences working in these highly recruited positions.

Certainly if your goals and career ideals line up with an underserved role or location, this recruitment barrage starts to look more interesting and more realistic. Example - you are in luck if you love inpatient work in a busy semi-rural psych hospital, and enjoy the diverse and exciting experiences when covering their ER every third weekend, and genuinely appreciate being available for your patients on regular weekday coverage calls so you can help them during the latest crisis. If that's you, great, what an opportunity - you get to take your pick from a vast array of very highly compensated roles that few seem to want.

I mention all this because it's the thought process and information-gathering process that came up for myself and for several of my close friends - the "average" or "fair" rate or salary is going to be significantly different not only between regions and cities, but also between types of positions in those areas. The details matter - break down the benefits, add it up as best you can, compare to other nearby openings that look similar. You'll see surveys out there with higher numbers than this, but this may or may not be relevant depending on where and what you want to do. Hope this helps someone. Wish this topic had been discussed a few years ago in residency...
 
Ignoring anything else, $150/hr is the going offer for telepsychiatry jobs. You could probably negotiate higher, but initial offer is not insulting.

The recruiter mentioned i could probably get 155 given the driving but that makes me think 160 probably and that does compensate a bit for the driving. To be fair though most jobs would probably average 20 min each way which is 2.5 hrs in 4 days. The big bonus I feel is the 3 days i do telepsych i could be in my "potentially new office" in the new area i am planning to move to and starting to see patients immediately after the last telepysch patient.
 
(I think?) Everyone is assuming this is hourly rate. Just wanted to make sure that was what you meant.


yes but 160 may be possble. 1099 no benefits at that



Hourly yes. I'm trying to get 155 so i asked for 160 with no benefits except i think i get malpractice which i am due to renew in july so that is a plus i guess. I asked for them to clarify how long are appts and intakes.... I'm not sure what exactly I can negotiate with a community mental health clinic in terms of intakes and follow ups although in an ideal world i would get 30 min follow ups and 60 min new evals and apart from the VA i think I won't get better than maybe 20 min follow ups and 45 min new evals?.
 
I need help in this department. I asked for 160 in hopes of getting 155... probably should have asked for 170 lol...
 
I generally recommend asking quite a bit higher. You never know how desperate they are and what the budget is.

Your 100% right and usually i'm not this bad. The recruiter called me right after the interview saying they really want me and what were my terms. He admitted his interest in getting this done asap and I am kicking myself for not saying 180 lol... guess will hear back tmrw. To be fair i asked about malpractice and intake times to be clarified. He made it sound like there was a one time negotiation that i could do but that is crap if i don't even know all the terms of malpractice and intake and appt times right? I hope I wasn't a sucker if they counter with 155 or 160.
 
I generally recommend asking quite a bit higher. You never know how desperate they are and what the budget is.

Ok, I did get my 160 per hour for 32 hrs a week but no benefits so makes me think i could have gotten more oh well. So this job is mine if i want it.

Now, I visited a private psych hospital facility... reminds me of a spa or something that only takes commercial insurances and no medicaid with average lengths of stay of 8 days. They want to use the private model where you the physician do your own billing and they would like to say the docs their make 400-500k carrying a census of 16-18 pts M-F while some also doing outpatient PP on the side in addition to this and you can round on the weekends on your folks if you want or they pay whoever signs up extra. They also give all the private docs a 75k stipend to cover daily tx team meetings and another 1 hr meeting per week. They are obviously doing well because they just opened a sister site about 20 minutes away and the only reason there is an opening is one of the docs is at the main site is running the sister site. As an incentive they know i want to do private practice and they support that and are offering to rent me space for 350-400 bucks a month plus referrals from all the other docs in the inpatient unit...... I'm so torn as the telepsych job is very tempting paying me 5k a week for 4 days of work and i have nothing to do with the billing just getting a steady check and still allows me to move to where i was planning yet this facility is literally 3 minutes from where i would live and it obviously offers a higher upside if the docs are pulling if you include the 75k stipend in the 400-500 range just from this inpatient work.... help??
 
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finalpsychyear: being able to do your own billing is a great asset- you will make more $ in the long run, and a generous stipend never hurts. IF you think you could get your own billing set up quickly, then take the position at the private psych facility. maybe you could delay taking that position while you get your billing set up, and do telepsych temporarily
 
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Ok, I did get my 160 per hour for 32 hrs a week but no benefits so makes me think i could have gotten more oh well. So this job is mine if i want it.

Now, I visited a private psych hospital facility... reminds me of a spa or something that only takes commercial insurances and no medicaid with average lengths of stay of 8 days. They want to use the private model where you the physician do your own billing and they would like to say the docs their make 400-500k carrying a census of 16-18 pts M-F while some also doing outpatient PP on the side in addition to this and you can round on the weekends on your folks if you want or they pay whoever signs up extra. They also give all the private docs a 75k stipend to cover daily tx team meetings and another 1 hr meeting per week. They are obviously doing well because they just opened a sister site about 20 minutes away and the only reason there is an opening is one of the docs is at the main site is running the sister site. As an incentive they know i want to do private practice and they support that and are offering to rent me space for 350-400 bucks a month plus referrals from all the other docs in the inpatient unit...... I'm so torn as the telepsych job is very tempting paying me 5k a week for 4 days of work and i have nothing to do with the billing just getting a steady check and still allows me to move to where i was planning yet this facility is literally 3 minutes from where i would live and it obviously offers a higher upside if the docs are pulling if you include the 75k stipend in the 400-500 range just from this inpatient work.... help??

The things that stuck out to me is 16-18 patients private insurance in a "spa" like setting is a heavy load and likely to require more hand holding and brow mopping then what we normally consider with inpatient where I count on at least several of my patients presenting with their underpants on their head and toilet paper shoved in their ears which basically concludes my brief MSE. On the flip side if the census isn't high that will reduce your gross. I would also shore up details on the weekend coverage because your description sounds vague. Consider getting in touch with a psychiatrist or two to better weigh the pros, cons and reality of what the job will entail.
 
The things that stuck out to me is 16-18 patients private insurance in a "spa" like setting is a heavy load and likely to require more hand holding and brow mopping then what we normally consider with inpatient where I count on at least several of my patients presenting with their underpants on their head and toilet paper shoved in their ears which basically concludes my brief MSE. On the flip side if the census isn't high that will reduce your gross. I would also shore up details on the weekend coverage because your description sounds vague. Consider getting in touch with a psychiatrist or two to better weigh the pros, cons and reality of what the job will entail.


Spoke to another psychiatrist in the group for 4 years. He confirmed that a census of 15 pts with occasional calls plus the stipend will put you in the 400-500k range just from the inpatient gig. He claimed he starts inpt at 7am-2pm then heads to his private practice so this guy is pulling 600-700k likely lol... then i found out that each wing of the hospital is either substance abuse, depression/anxiety, or psychosis/mania and each have a census of 24 with two attendings except the psychosis wing which has only 1 attending who is doing 24 pts a day on his own. I think they would place me in that wing which i realized is probably not what i want to do even if it were 10 pts a day to start with. Weekends are up to you as they have enough people wanting to do them but they expect you to answer your units calls from 6am-6pm M-F then one person in the group is responsible for phone coverage from 6pm-6am for the whole week every 6 weeks and they give that person a 2k stipend for that additional coverage for the week.
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The telepsych gig is offering anywhere from 32-40 hrs as long as you do 8 of those hours on site which is about 1 hr 20 min from me. This would pull 250-310 roughly with no benefits just strict 1099 and probably with some side work i'm doing about 14 hrs a week would put me 350-400.

I have no idea if 1099 work of 46-54 hrs M-F with no nights or weekends and 3 of those days I can be anywhere in the USA over 48 weeks only getting 350-400k is high, average, or low for the hours worked??
 
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