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

[FreshPaint]

Got an email from a recruiter about this job which says 500-750k which sounds hard to believe. Thought I'd see what the WCI community thinks:


-Full time, Las Vegas, Outpatient
-The Psychiatry practice is owned by a Solo Psychiatrist MD practitioner. The practice has been in business for 9 years.
-The practice is currently doing traditional office based visits combined with Telepsych.
-Each Initial Evaluation is 45 minutes to 1 hour
-Each follow up med refill visit is 15 minutes
-You also have opportunities to work in our hospitals and nursing home contracts but is optional.

The patient case load is:
Depression
Anxiety
Drug & Alcohol Addiction
Schizophrenia
Body Disorders
Bipolar Disorder

Patient Demographics:
Most of our patients are Adults and are between the ages of 30-55 years old.
Most are middle income

Insurance Mix is comprised of:
20% Self Pay
40% Medicaid & Medicare
40% Major Medical Commercial Insurance
The Schedule is M-F 9-5 p.m.
The Salary is between $500,000-$750,000 per year.
You are expected to see 20-30 follow up patients a day. You will see the same patient every month.

We have EMR called PBO MD. It takes approximately 2 minutes to complete a note and bill the insurance of the patient.
We also have TMS and Spravato for our patients.

Organizational Structure:

(3) Psychiatrist MDs

(5) Psychiatric Mental Health Nurse Practitioners

(3) LCSW Social Workers

We have RNs, Psych Techs and MAs on staff.


I'm still in residency so I'm naive to billing calculations, but I don't see how it's possible that an MD owner of a practice would want to pay another MD $500k for this volume of work, unless I'm missing something.

[wideopenspaces]

The catch:
Las Vegas
20-30 follow ups a day (+ how many intakes?)
Supervising mid-level


I wouldnt touch that job with a 10 ft pole. My friend moved to Vegas after our psych residency. The jobs were so awful there he took a locums job on the east coast just so he didn't have to work in Vegas. Psychiatry is just a giant poop show there for whatever reason. Stay away.

Look for jobs that keep intakes to 2/day and allow 30 minute med checks on the outpatient side. Unless all you are doing is prescribing adderall all day, 15 minutes just isn't enough time to see your patients and to actually know how they are doing. Good luck in the job search.

[nephron]

I suspect that a lot of the physician recruiter offers that are too good to be true are probably too good to be true and just bait and switch offers. I wouldn't recommend going through a physician recruiter, they are only interested in collecting their fees from your future employer and not interested in helping you obtain a position. It's not too hard to find a job on your own, your future employer will appreciate not having to pay some recruiter 20-30K that could have gone into your signing bonus for doing it. Never give a physician recruiter your phone number, you will get spammed for years by recruiters making cold calls telling you about job opportunities.

[Lithium]

I can only imagine that most of the self pay patients are getting the Spravato or TMS. Perhaps the rest are really wealthy and demanding. The listing says “most” are 30-55. How many of the rest are under 18?

I also found WOS’s comment amusing. I think the job market in the whole Mountain West pretty much sucks, which is why I’m doing locums on the EC. Though probably not for too much longer.

[CMartel02]

This volume of patients would easily put you above the 90th percentile in psychiatry for volume or higher. I would say 500k when your clinic is packed is doable, as you would be generating far, far more than that. That said, who wants to do 15 minute follow-ups? Is that what you went through all of that training for? You will be shoving patients out the door. All it takes is one patient not doing well, and your schedule is shot. I would argue this is a poor treatment model, as well. I prefer to do therapy, as well, in 30 to 40 minute appointments. Your patients will appreciate you more, you will come to know them better, can work on their real issues and things come out in longer appointments that wouldn't otherwise. This job sounds like a recipe for burnout. I work long hours and take a lot of call, but I know my patients, feel fulfilled, and when it comes down to dollars and cents, a 99214 and 90833 have equal RVU values.

[FIREshrink]

This is a pill mill. You want no part of it. They are possibly engaging in insurance fraud; I bet they are billing 99214 for every single 13 min face to face visit. It would be hard to justify that based on H/E/MDM but they probably prepopulate your notes so it looks like you're doing more work than you are.

If you do a good job with follow up patients, you can spend 25 minutes with each of them and legally and ethically bill 99213+90833 for each/most of them. That is 2.47 work rvus, just about five per hour. If you did that six hours per day you'd have 30 work RVUs. The psych median conversion factor is ~$60 per wRVU so that is $1800 for six hours of work. If you work 225 days per year you'd earn $400k per year. 250 days if you want to earn $450k. Do that eight hours per day if you want to earn $540k or $600k respectively.

This is the going rate in any west cost RVU based outpatient practice. You don't need to go to a pill mill or sacrifice your ethics or treat human beings like numbers to make an excellent living in psychiatry. Psychotherapy is extremely valuable and currently reimbursed very well when performed with E&M by a psychiatrist.

[hypercube]

"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

[NumberWhizMD]

"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 don't know the market at all in South Florida, but as a PCP I wouldn't even touch that conversion factor. You would be grossly underpaid.

[hypercube]

I don't know the market at all in South Florida, but as a PCP I wouldn't even touch that conversion factor. You would be grossly underpaid.

Hello NumberWhiz
Thanks for the reply. Yes, I agree with you that it looks grossly as an underpayment. However, I interviewed 4 other places and actually, the compensation is comparable ( this one is paying 20% more, but the other ones were employed positions with benefits, so it evens out). I also believe different specialties have a different $/RVU; so psychiatry RVU compensation may be different for a PCP ( family medicine, IM?)

[NumberWhizMD]

Hello NumberWhiz
Thanks for the reply. Yes, I agree with you that it looks grossly as an underpayment. However, I interviewed 4 other places and actually, the compensation is comparable ( this one is paying 20% more, but the other ones were employed positions with benefits, so it evens out). I also believe different specialties have a different $/RVU; so psychiatry RVU compensation may be different for a PCP ( family medicine, IM?)

Yes, different specialties have different RVU conversion factors. However, a simple google search with 2019 data showed MGMA median for psychiatry as $67.45/RVU. $30/RVU AND no benefits is laughable. 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. From my understanding, psychiatry pays pretty well, and I think you are selling yourself short.

[hypercube]

Yes, different specialties have different RVU conversion factors. However, a simple google search with 2019 data showed MGMA median for psychiatry as $67.45/RVU. $30/RVU AND no benefits is laughable. 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. From my understanding, psychiatry pays pretty well, and I think you are selling yourself short.

Thanks, yes you make a good point. Factoring all of that.
Do you mind sharing the link for the 2019 MGMA data? Googled it but can't find it. I have 2017 data.

[NumberWhizMD]

http://www.medpac.gov/docs/default-source/contractor-reports/jan19_medpac_disparities_physiciancompensationreport_cvr_contractor_sec.pdf

[Zaphod]

"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

Lol, so you're justifying it as same because you'll be doing double the work. What do you think will be your malpractice exposure, the same, double or more?

This isnt relatively close. The independent rate should be significantly higher than employed. Residents etc...is literally more additional work. This is beyond laughable.

[Kamban]

"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

Compared to your current $60/RVU with benefits you should get $30 extra per RVU because of lack of benefits and HCOL compared to Midwest. Not $30/RVU. I would not touch that with a ten foot pole. So you want to work twice as hard, supervise, get burnt out because it is South Florida. Even your PA would get more per RVU. Are they joking.

If you take it, you are a sucker.

[FIREshrink]

We pay $65 plus excellent benefits and no state income tax, and no Florida which is definitely a plus in my opinion.