Thoughts on a contract for inpatient psych? New graduate

[Druix]

I'm graduating this summer from CA fellowship, supervisors from my program are less than helpful about market rates for contracts in non-academic settings so I'm hoping others can provide some guidance on an offer I've received.

Large (>1 million) mid-western city, Free standing psych hospital (adult and child) as part of a larger healthcare system

• Guarantee salary 310k for 3 years then productivity
• Productivity bonus past 4400 RVU @$55 per RVU (w/ opps for extra RVU)
• Avg of 9 pts/day (30 bed unit with 3 docs), 2 intakes/day
• Call is 1:6 weekends covering only my unit, and 1:6 nights
• 200k loan repayment (as a forgivable loan over 5(!) years)
• 30k sign on bonus (forgivable loan over 2 years)
• 20 days vacation (fellow docs cover vacations)
• 2k CME (3 days)
• Pays for boards, licensure, malpractice with tail, benefits seems pretty normal with what I've seen from other big hospital groups
• Non-compete for 2 years with a radius that would allow me to work in a few different places

I thought this seemed great compared to offers I heard during preliminary phone interviews in many different regions of the country but I recognize the knowledge gap I have with regard to what contracts people are ultimately negotiating/signing. Any general thoughts on an offer like this? What am I missing?

Edited to show accurate RVU payment

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[Doc1401]

I'm graduating this summer from CA fellowship, supervisors from my program are less than helpful about market rates for contracts in non-academic settings so I'm hoping others can provide some guidance on an offer I've received.

Large (>1 million) mid-western city, Free standing psych hospital (adult and child) as part of a larger healthcare system

• Guarantee salary 310k for 3 years then productivity
• Productivity bonus past 4400 RVU @$65 per RVU (w/ opps for extra RVU)
• Avg of 9 pts/day (30 bed unit with 3 docs), 2 intakes/day
• Call is 1:6 weekends covering only my unit, and 1:6 nights
• 200k loan repayment (as a forgivable loan over 5(!) years)
• 30k sign on bonus (forgivable loan over 2 years)
• 20 days vacation (fellow docs cover vacations)
• 2k CME (3 days)
• Pays for boards, licensure, malpractice with tail, benefits seems pretty normal with what I've seen from other big hospital groups
• Non-compete for 2 years with a radius that would allow me to work in a few different places

I thought this seemed great compared to offers I heard during preliminary phone interviews in many different regions of the country but I recognize the knowledge gap I have with regard to what contracts people are ultimately negotiating/signing. Any general thoughts on an offer like this? What am I missing?

So this actually looks like a really good offer on paper. I am a bit in disbelief that you will get 65 dollars per RVU after 4400, so it makes me wonder if you would receive adequate volume to take advantage of the RVU bonuses.

 

[Druix]

So this actually looks like a really good offer on paper. I am a bit in disbelief that you will get 65 dollars per RVU after 4400, so it makes me wonder if you would receive adequate volume to take advantage of the RVU bonuses.

You're right, it's actually $55 per RVU. I assume that's what the post salary-guarantee rate would be as well. There is some other salary guarantee (that is much lower) once you transition to productivity but the docs I talked to indicated they didn't see any big changes in income once they transitioned.

 

[whopper]

Looks good on paper. The reality might not match that paper but unless you have inside information you're not going to find out otherwise without actually taking the job.

 

[TexasPhysician]

I wouldn’t sign a non-compete for inpatient work. It makes no sense beyond pissing you off. It’s not like you are going to take the patients off the unit to your new job.

 

[whopper]

As long as you make the practice far enough away it's fine but it's the distance that can be a critical factor.

Also it's been debated here not to worry about the non-compete cause no one cares.

Not true. Depends on the employer. Again you won't know unless you have inside information or you actually take the job.

 

[SmallBird]

I'm graduating this summer from CA fellowship, supervisors from my program are less than helpful about market rates for contracts in non-academic settings so I'm hoping others can provide some guidance on an offer I've received.

Large (>1 million) mid-western city, Free standing psych hospital (adult and child) as part of a larger healthcare system

• Guarantee salary 310k for 3 years then productivity
• Productivity bonus past 4400 RVU @$55 per RVU (w/ opps for extra RVU)
• Avg of 9 pts/day (30 bed unit with 3 docs), 2 intakes/day
• Call is 1:6 weekends covering only my unit, and 1:6 nights
• 200k loan repayment (as a forgivable loan over 5(!) years)
• 30k sign on bonus (forgivable loan over 2 years)
• 20 days vacation (fellow docs cover vacations)
• 2k CME (3 days)
• Pays for boards, licensure, malpractice with tail, benefits seems pretty normal with what I've seen from other big hospital groups
• Non-compete for 2 years with a radius that would allow me to work in a few different places

I thought this seemed great compared to offers I heard during preliminary phone interviews in many different regions of the country but I recognize the knowledge gap I have with regard to what contracts people are ultimately negotiating/signing. Any general thoughts on an offer like this? What am I missing?

Edited to show accurate RVU payment

Looks great but there is a missing piece here. The incentive rate is great, and you say it kicks in at 4400, but does that mean that they are paying you 310k for 4400 rvus? If so, that’s a great deal. But you should confirm what happens after year 3 and make sure that it’s not something like $50 per RVU and $55 for those above 4400.

 

[trophyhusband]

I wouldn’t sign a non-compete for inpatient work. It makes no sense beyond pissing you off. It’s not like you are going to take the patients off the unit to your new job.

Depends on whether they have their own outpatient practice in the system. Might now want this doc opening up their own practice and taking all the insured patients. But even if that's the case this person should argue that a non-compete while employed and no post-employment one is more reasonable.

 

[trophyhusband]

Looks great but there is a missing piece here. The incentive rate is great, and you say it kicks in at 4400, but does that mean that they are paying you 310k for 4400 rvus? If so, that’s a great deal. But you should confirm what happens after year 3 and make sure that it’s not something like $50 per RVU and $55 for those above 4400.

In other words OP if they're paying $310k for 4,400 RVU you're getting ~$70/RVU. If that drops down to the stated $55 ($50 would be even worse) you'd need 5,600+ just to get back up to your $310k base in previous years.

 

[SmallBird]

In other words OP if they're paying $310k for 4,400 RVU you're getting ~$70/RVU. If that drops down to the stated $55 ($50 would be even worse) you'd need 5,600+ just to get back up to your $310k base in previous years.

Exactly

 

[FlowRate]

As a side-conversation, would anyone be willing to comment on how inpatient billing typically works out? I have a good handle on outpatient, but is it really feasible to hit 2.2 RVU/hr (or 2.2 RVU/pt) with only 9 patients?

 

[SmallBird]

As a side-conversation, would anyone be willing to comment on how inpatient billing typically works out? I have a good handle on outpatient, but is it really feasible to hit 2.2 RVU/hr (or 2.2 RVU/pt) with only 9 patients?

Yes.

Admit 2: 2 x 3.25 = 7.5
Discharge 2: 2 x 1.9 = 3.8
Do two family or individual therapy sessions: 2 x 1.39 + 2 x 1.5 = 5.88
One high complexity follow ups: 1 x 2
Two regular follow ups: 2 x 1.39 = 2.78

Total: 21.96 or 2.44 per patient

That’s my average day.

 

[FlowRate]

Yes.

Admit 2: 2 x 3.25 = 7.5
Discharge 2: 2 x 1.9 = 3.8
Do two family or individual therapy sessions: 2 x 1.39 + 2 x 1.5 = 5.88
One high complexity follow ups: 1 x 2
Two regular follow ups: 2 x 1.39 = 2.78

Total: 21.96 or 2.44 per patient

That’s my average day.

~5 hours of face time with patients? (If kinda leisurely/thorough.)

 

[SmallBird]

~5 hours of face time with patients? (If kinda leisurely/thorough.)

Less then that. 45-60 min for the family therapy, about 30 min for individual therapy. Follow ups can be done much more quickly with more time spent on coordination of care. So about 4 hours contact time?

 

[chajjohnson]

Less then that. 45-60 min for the family therapy, about 30 min for individual therapy. Follow ups can be done much more quickly with more time spent on coordination of care. So about 4 hours contact time?

Are you still covering the inpatient unit while you are doing clinic appointments? I can imagine a few random busy days on the unit could screw up your schedule.

 

[SmallBird]

Are you still covering the inpatient unit while you are doing clinic appointments? I can imagine a few random busy days on the unit could screw up your schedule.

I don’t do much outpatient but sometimes if it’s a busy day on the unit I’ll be doing notes or returning calls between appointments. I have excellent nursing staff with good object relations which makes all the difference in the world.

 

[Sushirolls]

As long as the non-compete exists, walk away. Non-competes are enforceable and a pain to deal with lawyers, and no guarantee you'll prevail. Non-competes serve as less of non-compete but more of a logistics shackle. Or should you ever have a potential lawsuit against the employer in the future - a bargaining chip for them to 'get out of jail free card.' Don't provide them with a free monetary settlement chip.

Life will change, and a lot can happen in 3 years. Marriage? Kids? Strong community ties? House? All things that will shift the scales from wanting to move and keep you tied to to the location. If/when the job shows its true colors, you no longer have the exit of working for a competitor in town or the ace up your sleeve of opening your own private practice. Employers known this improves their odds of increasing the tolerability of their poor admin decisions, rising wRVU targets, (insert your own negative here), etc. A former health system job I had, I lost count of how many other physicians confided in me their disdain for the system, administration, their immediate departmental management. Yet they stayed put because of those anchors - and a non-compete.