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500-750k psych job, what's the catch?

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  • cheetamorf
    replied
    Originally posted by hypercube View Post
    "The psych median conversion factor is ~$60 per wRVU"

    Hello, I have a similar question, looking to relocate to South Florida; currently working in the Midwest.

    I get paid currently on productivity, at ~ $60/RVU in an employed position, and in addition, I get benefits ( Medical insurance, CME, 401K match, etc)
    I am now negotiating a potential job in South FL, that would be an independent contractor, with no benefits. They countered at $30/RVU and I am still working back and forth on fair compensation ( while the value per RVU is lower, the number of patients is double and they have mid-levels and residents helping with notes meaning that the total amount of $ would be similar )

    Taking into consideration that there is no state tax in FL, and the location is more attractive/competitive; would you say that $30/RVU is a fair market for the area? Would I do better if I negotiate a percentage of collections instead? ( they initially offered 65% of collections)

    Are there professionals out there that could help with a market analysis of an offer in addition to a contract review?

    Thanks for any help


    I currently work in a position (non-psych, academic) where I am getting on average $30-35/wRVU with benefits included (actually paid on collections, but this is what it is averaging). I have some midlevel (half day) and resident support (2 half days). I'm considering leaving because the pay structure is what I would consider to be very poor. Everything else about the job is pretty good. You are basically going to still have to do the same amount of work that you currently do, plus supervising a resident or midlevel seeing the same number of patients as you do now just to break even. Do not take collections, but make sure you are at least in the mid $40/wRVU with benefits included.


    Originally posted by wideopenspaces View Post

    I'm in UT and our docs doing ect at the academic medical center, along with inpatient, make around 400-500k/ year working 4 weeks on, 2 weeks off, 8 inpatients per day. With excellent benefits.
    I'm also in UT in at the academic center and would love to talk to these folks. I have to see approximately 20 outpatients a day (or 15 procedures) to make substantially less than 400k. I'm not psych, but our inpatient providers would easily need to see 20+ a day to be making that salary. I would love to know how they are managing to make this system profitable and share it with our chair...

    Leave a comment:


  • Kamban
    replied
    Originally posted by Antares View Post
    At some point apparently I became a fossil. Whatever happened to building your own practice? I know nothing of RVUs. I graduated residency, built a psych private practice over four years while employed part time, and have been in full time private practice for the last 27 years. 35 patients a week, 4 days, mostly psychotherapy with or without meds, self-pay, no insurance. I like it, my patients like it, no boss, no exploitation, the work is interesting and enjoyable. Recommended.
    Reducing to 5-10 hours Spring 2023.
    Same here. I have no idea how RVU is calculated. I take insurances, but have discared some low paying ones that have onerous pre auth requirements and pay very late. I set my own hours and am happy.

    I think the OP should try and set up his own practice or move to better paying ones.

    Leave a comment:


  • Antares
    replied
    Originally posted by FIREshrink View Post

    It’s wonderful, but leaves most middle and low income Americans unserved/without access they can afford, so we need more than 1 model.
    Agreed.

    (Still, one can run one’s own practice instead of working for someone else in other models. But of course your point is well-taken)

    Leave a comment:


  • FIREshrink
    replied
    Originally posted by Antares View Post
    At some point apparently I became a fossil. Whatever happened to building your own practice? I know nothing of RVUs. I graduated residency, built a psych private practice over four years while employed part time, and have been in full time private practice for the last 27 years. 35 patients a week, 4 days, mostly psychotherapy with or without meds, self-pay, no insurance. I like it, my patients like it, no boss, no exploitation, the work is interesting and enjoyable. Recommended.
    Reducing to 5-10 hours Spring 2023.
    It’s wonderful, but leaves most middle and low income Americans unserved/without access they can afford, so we need more than 1 model.

    Leave a comment:


  • Antares
    replied
    At some point apparently I became a fossil. Whatever happened to building your own practice? I know nothing of RVUs. I graduated residency, built a psych private practice over four years while employed part time, and have been in full time private practice for the last 27 years. 35 patients a week, 4 days, mostly psychotherapy with or without meds, self-pay, no insurance. I like it, my patients like it, no boss, no exploitation, the work is interesting and enjoyable. Recommended.
    Reducing to 5-10 hours Spring 2023.

    Leave a comment:


  • Tim
    replied
    Originally posted by hypercube View Post

    It's a physician owned group practice, that contracts with a hospital to provide inpatient care. I would be doing inpatient, ECTs, and consults.

    I wonder if people getting paid $60/RVU are actually getting paid more than 100% collection?
    Regarding the above two paragraphs:
    First of all, the physicians that own the group are in business to make money. Make no mistake, RVU or collections, you are an employee. They will make money, buy wholesale and sell under contract retail. Not once have you mentioned partnership options etc. This has all the flags of an associate getting royally screwed.
    Second, no one gets paid more than total collections unless it is a feeder position. Your spot is subsidized by high paying referrals. Not what you described.

    If you search “geographic artbitrage” you will find many posts. Basically, VHCOL with low pay is losing game and some groups churn associates. What is the retention rate? You search needs to consider not only the first contract, but the future.

    Succinctly, you need to consider:
    compensation, job and location. What you describe seems like a dead end. Southeast, Southwest, Midwest , mountains etc. Force yourself to look at other opportunities and other locations. It’s not RVU vs collections.
    Last edited by Tim; 06-25-2021, 09:38 AM.

    Leave a comment:


  • childay
    replied
    Originally posted by wideopenspaces View Post

    Yes, it is literally 4am. I would never in a million years do it but my friend who does, doesn't seem to mind. She's mostly upset she doesn't get more ect shifts!
    Hard pass..

    Leave a comment:


  • wideopenspaces
    replied
    Originally posted by Lithium View Post

    Are they all still starting ECT at 4AM?
    Yes, it is literally 4am. I would never in a million years do it but my friend who does, doesn't seem to mind. She's mostly upset she doesn't get more ect shifts!

    Leave a comment:


  • Kamban
    replied
    Originally posted by hypercube View Post

    After such a strong response from the forum, I am having serious doubts If I take it, for sure will update you guys

    However, I still don't get the percentage of collections vs RVU question; if $30/RVU = 65% collections; they either:

    1. Are poorly managed and not collecting enough
    2. Insurances over there are really stingy compared with other parts of the country
    3. They are charging too much of a premium to guarantee $/RVU vs me taking that risk.

    If I am missing something, please let me know. I wonder if I should counter with a higher collection percentage instead? How much is reasonable in those types of cases? Do people ask for 100% collections ( or even higher than 100% collections)
    Never ask for % of collections when you

    1. Do not know the insurances of the patients
    2. Have no idea what each insurance pays for each code for their patients
    3. Have no clue or control on what type of patients you will get. You will be an employee. The other partners will get better paying patients and you will get the low paying insurances and Medicaid. Protest won't help since you have already moved from Midwest to FL and probably settled there. What can you do - quit and leave?
    4. You have no control how the staff will bill and collect.

    Please look for a better job.

    Leave a comment:


  • Lithium
    replied
    Originally posted by wideopenspaces View Post

    They do 2 weekends, covering another docs patients, along with their own and then get the other 2 weekends off while that doc covers theirs. The ones who don't do any ECT make a lot less, I think closer to 300k. Apparently ECT pays well.
    Are they all still starting ECT at 4AM?

    Leave a comment:


  • hypercube
    replied
    Originally posted by Zaphod View Post
    Plz update us after 6 months on this job.
    After such a strong response from the forum, I am having serious doubts If I take it, for sure will update you guys

    However, I still don't get the percentage of collections vs RVU question; if $30/RVU = 65% collections; they either:

    1. Are poorly managed and not collecting enough
    2. Insurances over there are really stingy compared with other parts of the country
    3. They are charging too much of a premium to guarantee $/RVU vs me taking that risk.

    If I am missing something, please let me know. I wonder if I should counter with a higher collection percentage instead? How much is reasonable in those types of cases? Do people ask for 100% collections ( or even higher than 100% collections)

    Leave a comment:


  • wideopenspaces
    replied
    Originally posted by sweetnpsycho View Post

    Does the weeks on include weekends? If not, this is amazing as 8 inpatients per day and ECT seems like half a day of work.
    They do 2 weekends, covering another docs patients, along with their own and then get the other 2 weekends off while that doc covers theirs. The ones who don't do any ECT make a lot less, I think closer to 300k. Apparently ECT pays well.

    Leave a comment:


  • Zaphod
    replied
    Plz update us after 6 months on this job.

    Leave a comment:


  • sweetnpsycho
    replied
    Originally posted by wideopenspaces View Post

    I'm in UT and our docs doing ect at the academic medical center, along with inpatient, make around 400-500k/ year working 4 weeks on, 2 weeks off, 8 inpatients per day. With excellent benefits.
    Does the weeks on include weekends? If not, this is amazing as 8 inpatients per day and ECT seems like half a day of work.

    Leave a comment:


  • Hank
    replied
    Originally posted by NumberWhizMD View Post
    You can certainly purchase recent MGMA data to verify for yourself, but I find it hard to believe it's that low. And if it is, you have to determine if it's worth it to live in South Beach for over 50% less of what you could make pretty much anywhere else.
    I was in Miami Beach a week and a half ago. Utterly shocked at the number of trashy people walking around. Even at the Fountainebleu, there were low class folks who made Las Vegas look sophisticated and classy. I’m hardly svelte, but there were folks entirely too hefty for the fishnets and see through clothing they were wearing.

    Slow service, weak mixed drinks, automatic 18% gratuities and a food and drink offering that seemed to suggest that southern Italian cheap pasta was haute cuisine and American macrobrews were the pinnacle of brewing excellence.

    In fairness, the wine selection was okay at the local liquor stores even if the beers were terrible. Plus the Cuban and Colombian restaurants were pretty dang good. Still, the overall experience was trashier than Vegas or Cabo, which really takes some effort.

    Leave a comment:

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