Thoughts on job offer

[Techmed07]

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[clozareal]

What's the productivity threshold? How long will it take to get there? How many intakes are they wanting you to do per day/week?

What's the target to get that $44k?

What administrative responsibilities do you have?

What $ per RVU?

Four year commitment for $40k is too long. I get that they have to have their return on investment to hire you but either increase the bonus amount or decrease the commitment time.

 

[Techmed07]

I’ll ask? What’s a good one
Mostly giving lectures and attending meetings. Will be in a primary care clinic

 

[calvnandhobbs68]

I mean it's not a great job on the face of it, how many hrs/week are they expecting for this?

So they don't give you any base after the first 2 years? Then you need to know a LOT about how the clinic operates and how the RVUs and $/RVUs are calculated. Things like being a medicaid clinic where 25% of the patients no-show a day will kill your RVU generation.
All the questions above are great questions from a financial standpoint.
Also, is the admin compensation comparable on a $/hr basis as your RVU generation would be during that same time? So, for instance, you don't end up losing money after year 2 because that admin time is cutting into your billable patient hours time and you're making less $/hr than you would seeing patients (unless you're really into lectures/meetings...).

Agree that 4 year commitment is too long. I'd ditch the 40K just to not have the commitment or tell them it's 20K for 2 years, because if you find out you aren't hitting anywhere close to RVUs at year 2 and you aren't gonna hit your targets to get the same salary the next couple years, you want negotiating room to bail out and you'll lose a lot more than 40K potentially if you're locked in for 4 years. Actually seems a little suspicious that they may be trying to keep you locked in past the guaranteed base phase.

 

[Celexa]

I’ll ask? What’s a good one
Mostly giving lectures and attending meetings. Will be in a primary care clinic

30% for giving lectures and attending meetings? That confuses me. Will you not have an administrative or educational title? Specific managerial responsibilities? Is this academic with a faculty title? Does 'Administration' also mean time to chart? 30% sounds like a lot of time they're giving you for something so vague.

You also haven't given numbers in terms of appt length and rvu targets that would let people speak to whether they're realistic.

Other things that matter--What will your admin support be like? Any midlevel supervision? Schedule flexibility? Vacation coverage?

 

[wolfvgang22]

I always prefer to negotiate a higher base salary instead of a bonus. First, because employers always use a bonus to try to lock you in for a period of time, and it is possible the position could be terrible once you're in it. Second, because if the job is good, you'll earn more money in the long term if you stick around. I'd ask for $10k or $15k bonus with one year commitment and a $220k base salary.

As others say, I'd learn the details of the wRVU targets, how many patients no show, how much admin time you'll actually have, support staff, etc. What's turnover like there? Are current staff happy?
Let's face it, there are always things in every job that you won't find out about until you are doing it, and a year is plenty of time to know if you need to bail or if you want to hang around or if you need to renegotiate.

 

[annoyedpsychiatrist]

I dont think its a great deal. Average income is around 300k now for psych. Theres many jobs out there that offer that as a base salary. Even with admin bonus its only 250K. Sign on bonus for a four year commitment sucks imo. How do you know youll like it there for four years? Im guessing you forfeit it if you dont stick it out. Im in a state with no income tax and its still not hard to find >280k a year jobs with guaranteed salary. Once you factor in income tax into the 250k that drops it even further.

maybe if it was very low patient volume and admin requirements were easy. Even then it doesnt sound appealing to me.

just my two cents.

 

[Techmed07]

Ok. How about three years? For 40k

They won’t budge on the salary ( something about fair market value)

So it’s two years guaranteed and then straight productivity. It’s a hospital system similar to Kasier

 

[sloh]

They won’t budge on the salary ( something about fair market value)

Lol these motherf*******

 

[Stagg737]

I'd ask for $10k or $15k bonus with one year commitment and a $220k base salary.

Was going to say before OP chimed in that's not going to happen. You'd be asking for an extra $80k over 2 years and giving them back $25-30k, no way they'd just hand out an extra $50k with a pay breakdown this complex, especially if they're using the "fair market value" argument. I agree with the rest of your post though, too many moving pieces that are question marks to lock into a 4 year contract.

@Techmed07 , 4 years is a long contract without knowing a lot more here. What are those admin duties and how many hours are they expected to take? What are the productivity goals to hit the bonus? After the first 2 years what's the $/wRVU? No one is going to be able to tell you if this is a fair job without that information. There's many other factors as well, but we at least need that to guage this job.

 

[calvnandhobbs68]

Ok. How about three years? For 40k

They won’t budge on the salary ( something about fair market value)

So it’s two years guaranteed and then straight productivity. It’s a hospital system similar to Kasier

lol base salary of 180k is not fair market value for psychiatry in any way shape or form but whatever....might tell you a bit about how they're operating here. I guess they'd say 250K base with the admin time but again 250K is pretty low end for outpatient full time right now.

 

[Techmed07]

They went down to three years.

 

[mistafab]

Strong pass bro.

 

[Merovinge]

Ok. How about three years? For 40k

They won’t budge on the salary ( something about fair market value)

So it’s two years guaranteed and then straight productivity. It’s a hospital system similar to Kasier

Something about getting bent over is what you mean to say. The median data for psychiatrists is widely available and obviously much higher than they are stating. I guess anyone can just make up anything and say it, seems to the be the way the world is going these days...

 

[clozareal]

As a CAP, I got offers of base salaries of $300-350k or more if I beat productivity thresholds, which came out to about 30 clinical hours a week.

I probably wouldn't take this job based on the finances alone but there are so many other factors to consider, such as what team you'll be working with, if it's with a patient population or niche you enjoy, location, perks, prestige, if they're allowing you to do something you really enjoy like TMS or addiction or if you want to do lots of psychotherapy as an example. If I did take this job, I would not take the sign on bonus and contingency in working there. I would want the flexibility to leave after a few months if it's a terrible work environment.

Kaiser gives you $100k for payback in 7 years, but you can decline it. They also have a home loan program, a retirement account and contribution, and a pension on top of that. If you can find a good Kaiser group, it can actually be a pretty sweet deal but it's location specific. Not sure if it's the same with this group you're looking at.

 

[calvinhobbes]

Don’t accept anything less than 300k. Remember you are in demand and the shortage is real and you bring a knowledge base no one else has.

 

[annoyedpsychiatrist]

They went down to three years.

i would base any initial contract off of no more than two years, because you have no idea how good/bad the job is until you start. I would even say its a red flag theyre trying to get you into a four year contract, makes me feel like theyre trying to lock you in so you feel stuck there.

Whenever someone says "fair market value" i laugh silently in my head. You know fair market value is? Supply and demand. The demand right now is high and I would guess the supply in your area does not meet the demand. Lets say they're basing fair market value off MGMA, which a lot of places do. If they are doing that, its still UNDER fair market value. So what is their basis for fair market value? What equation are they using? Hell you can look on medscape and see thats definitely not a good salary. Also if its a hospital system that adds fuel to the fire. Many of these places are not for profit, and get government grants, and all kinds of things like that. They make their money in other areas and arent soley reliant on you for profit, like a private clinic would be. If a hospital system is offering below average salaries for their doctors then that would give me major pause to wanting to work for that system. When I was interviewing for different jobs a year ago, the LOWEST hospital system job for outpatient adult i encountered was like 280k, but there were also other perks like bonuses and what not.

If you want to go the hospital system route (which is what Im in now, has its pros and cons but overall I like it), google the largest hospital systems in your area, reach out to them, and get comparisons of offers.

 

[Marasmus1]

Don’t accept anything less than 300k. Remember you are in demand and the shortage is real and you bring a knowledge base no one else has.

Even in full time Academia?

 

[forchinet121]

Even in full time Academia?

Do you have less knowledge and skills as an academic? Is the shortage less? Is the demand less? If any of those things are true your pay will change

 

[Techmed07]

What's the productivity threshold? How long will it take to get there? How many intakes are they wanting you to do per day/week?

What's the target to get that $44k?
3101
What administrative responsibilities do you have?
See below
What $ per RVU?
$58
Four year commitment for $40k is too long. I get that they have to have their return on investment to hire you but either increase the bonus amount or decrease the commitment time.

 

[calvnandhobbs68]

Why did you delete your initial post and then do this weird response post with barely any responses or fleshing out of this job?

Were you just looking for us to tell you it was a good offer? Because it wasn't. It doesn't look like you're willing to figure out the specifics so people can give you a better idea of what to ask for or what is reasonable either.

 

[Merovinge]

Why did you delete your initial post and then do this weird response post with barely any responses or fleshing out of this job?

Were you just looking for us to tell you it was a good offer? Because it wasn't. It doesn't look like you're willing to figure out the specifics so people can give you a better idea of what to ask for or what is reasonable either.

I'm pretty confused on the psychology of wanting reassurance about taking a bad job and then instead of wanting to get paid what you are worth trying to dismiss/obfuscate what is occurring.

Techmed you have worth, you have value. If you've ever been led to feel less than, it stops now. If you want to take a low paying job because it's a good lifestyle or because it's a stepping stone to get your into a geography you want/your partner needs you in, or for other reasonable reasons, that's completely fine. If you are just a young attending applying for jobs and getting bad offers, there are many many many more employers in the sea. You have extremely valuable skills and deserve to be paid market worth for all the hard work/sacrifice you made.

 

[SmallBird]

Even in full time Academia?

It may be a bit difficult to make this a rule, but I've decided to go back to academics after a few good years at the boxiest big box and I just insisted it needed to be > $300k and was ultimately successful. Individual experience may vary but things have definitely changed. When I left fellowship in 2017 I was offered $160k for full time academic and this wasn't unusual.

 

[DOswag]

Or..... is techmed secretly undercover as someone trying to hire a psychiatrist and wanted real feedback on the job offer but couldn't handle the truth?

 

[littlefred]

Or..... is techmed secretly undercover as someone trying to hire a psychiatrist and wanted real feedback on the job offer but couldn't handle the truth?

15 year member though. The long con.

 

[Celexa]

Or..... is techmed secretly undercover as someone trying to hire a psychiatrist and wanted real feedback on the job offer but couldn't handle the truth?

Haha this almost certainly isn't true but if it were I have zero problems with clueless admins coming here and getting dumped on.

 

[mistafab]

Just to summarize OG post:
All OP CAP gig
180k base 2 yr guarantee
70k for admin guarantee
Post 2 yr no base clinical, all RVU based with no actual clinic info (billings, collected, no show, payor mix, etc)
Forced 4 yr contract at first. Later “negotiated” to 3 years.

Lol

 

[Merovinge]

Just to summarize OG post:
All OP CAP gig
180k base 2 yr guarantee
70k for admin guarantee
Post 2 yr no base clinical, all RVU based with no actual clinic info (billings, collected, no show, payor mix, etc)
Forced 4 yr contract at first. Later “negotiated” to 3 years.

Lol

If I remember correctly it was 30% admin so 70k x 10/3 = 233k imputed value for full-time admin.

I'm a CAP and my fellows are all getting around 300k starting for full-time clinical OP no call jobs (employed w/ full bennies and PTO etc).

 

[wolfvgang22]

I feel like folks are being a bit harsh on OP. Let's keep things friendly.

 

[calvnandhobbs68]

I feel like folks are being a bit harsh on OP. Let's keep things friendly.

Less harsh about the original question and more harsh about what exactly this response is all about.
Nobody is looking down on OP for entertaining various job offers and asking for feedback about it, nothing to be embarrassed about, but the lack of response and then the stealth deletion of the original post is likely pretty annoying to all the people who took a little time to give honest feedback about the initial offer and suggest next steps.

 

[Merovinge]

Less harsh about the original question and more harsh about what exactly this response is all about.
Nobody is looking down on OP for entertaining various job offers and asking for feedback about it, nothing to be embarrassed about, but the lack of response and then the stealth deletion of the original post is likely pretty annoying to all the people who took a little time to give honest feedback about the initial offer and suggest next steps.

On the contrary, this sub is great to have people across the US review a job offer and give you points of comparison in a way that most docs just do not get access to.

 

[Trismegistus4]

the stealth deletion of the original post

This is my least favorite thing about SDN. For some reason it's so common: you see a thread with what looks like an interesting title and a bunch of replies, click on it, and it looks like there was an interesting discussion, but the OP is "." If I were the admins, I'd set like a 1-hour time limit on the ability to edit a post.

 

[Psychresy]

Thoughts on this job....

1900 per shift. Tele ER coverage. 12 hrs either 7a to p or vice versa. Day shift is 6-8 consults. Night is 3-4. It seems pretty slow, I could do some telepsych during the day as well. Per hour it's not great, but per unit of work it seems to be pretty good. 1099.

 

[mistafab]

For day coverage, depending on how picky you're allowed to be with your shifts, seems decent for 1099 (which I feel is fair around 150-200/hr). For night coverage, that pay is low. Should be at least time and a half compared to day coverage for either a night or weekend shift.

With these jobs though you gotta ask about what resources are at that ER besides you. You being the "doc" for psych in ED is very different in a setting with people collecting lots of busywork data (like a LCSW) and getting collateral, vs if it is just you doing it tabula rasa on each patient.

 

[forchinet121]

Thoughts on this job....

1900 per shift. Tele ER coverage. 12 hrs either 7a to p or vice versa. Day shift is 6-8 consults. Night is 3-4. It seems pretty slow, I could do some telepsych during the day as well. Per hour it's not great, but per unit of work it seems to be pretty good. 1099.

That’s 160/hr for ER work..should be like 250

 

[Stagg737]

Thoughts on this job....

1900 per shift. Tele ER coverage. 12 hrs either 7a to p or vice versa. Day shift is 6-8 consults. Night is 3-4. It seems pretty slow, I could do some telepsych during the day as well. Per hour it's not great, but per unit of work it seems to be pretty good. 1099.

Agree with Forchinet that this pay isn't worth it. My "shifts" in the ER are basically 6 hours and can be exhausting, 12 hour shifts can be absolutely monstrous and I wouldn't consider this for less than $2500 per shift.

Even then, you still need to have discussions regarding what all the responsibilities you hold would be and available assitance/resources. A large part of what I do involves knowing what local resources are available for dispo and deciding if people need inpatient psych vs crisis stabilization vs substance detox vs whatever. If you don't know where you can send patients and they don't assist you, this could be a nightmare.

 

[ksharp33]

Thoughts on this job....

1900 per shift. Tele ER coverage. 12 hrs either 7a to p or vice versa. Day shift is 6-8 consults. Night is 3-4. It seems pretty slow, I could do some telepsych during the day as well. Per hour it's not great, but per unit of work it seems to be pretty good. 1099.

Garbage.

 

[annoyedpsychiatrist]

Thoughts on this job....

1900 per shift. Tele ER coverage. 12 hrs either 7a to p or vice versa. Day shift is 6-8 consults. Night is 3-4. It seems pretty slow, I could do some telepsych during the day as well. Per hour it's not great, but per unit of work it seems to be pretty good. 1099.

you can make double that hourly rate with quite a few locums jobs. Underpaid and who knows if theyre bsing you on patient quantity. Plus, depending on acuity of the patient, can be more complicated than it initially appears. I personally wouldnt go for it.

 

[jbomba]

Anyone know of tele locums that is double this? I havent seen it. Heck, I havent seen in person ER double this..

 

[annoyedpsychiatrist]

Anyone know of tele locums that is double this? I havent seen it. Heck, I havent seen in person ER double this..

not sure specifically for ER but i get emails of much higher rates where at a minimum they are amendable to at least part time telehealth. Im sure a lot of these places are quite flexible hence why theyre going through locums and theyre willing to make concessions

 

[Yale Medicine]

That’s 160/hr for ER work..should be like 250

They're making a 100% premium on you at estimate.

 

[Mad Jack]

Just to summarize OG post:
All OP CAP gig
180k base 2 yr guarantee
70k for admin guarantee
Post 2 yr no base clinical, all RVU based with no actual clinic info (billings, collected, no show, payor mix, etc)
Forced 4 yr contract at first. Later “negotiated” to 3 years.

Lol

That's horrific