Salary Advice? - We All Have to Make a Living

Buprenorphine Post
Posts: 1404

Postby drpasser » Tue Jul 28, 2015 10:28 am

So, I think I read something recently, a new reg perhaps?

What I saw states, pts in OBOT need urine drug testing nine times per year.

Maybe someone can track this down. But that is my understanding. Nine tests/year.


Posts: 198

Postby NoDrugs4u » Tue Jul 28, 2015 10:28 am

Thanks m_kaylor for the comprehensive information. My "on call" is only during clinic hours 9-3, and only for calls from the Nurse Practitioner to get orders. Then I see the patients one day a week in the clinic. It is a new clinic, so no patients to start. Unfortunately, my state just passed an independent practice law for nurse practitioners, so they no longer need physician supervision. But they still cannot get an X-number, thank goodness. I am not a fan of NPs and PAs doing a doctors work, but this is a good opportunity for me. For now we have agreed on $25/hr for on-call time and $150/hr for clinic work, with the option to negotiate when business picks up.

Thanks mack86, my private practice is very similar to your philosophy. But I feel like the 'bargain basement' of bup treatment, I only charge $180 per month, self-pay, no insurance hassle. But I do not offer 24hr access or counseling. I recommend counseling and give resources, but like you I do not schedule or verify. However, I still don't understand why in the middle of the heroin 'epidemic', I still only have 6 patients after a year of bup practice? That's why I took the clinic job!

Posts: 70

Postby mack86 » Tue Jul 28, 2015 10:28 am

When I see patients on my own I charge $340. That is for the month and includes UDS, plus 24/7 telephone access. Surprisingly, no patients take advantage of that; they only call me unless they have a problem. (Such as ending up in the ER for a minor injury and the doc wants to give them opiates, I want them to call me then). I handle all the paperwork. No insurance. They are required to have outside counseling but I don't arrange for it. When they decrease their dose, I prescribe them the same quantity of buprenorphine, and reward them for decreasing their dose by only charging them when I have to write a prescription. That way, many of them will decrease their dose to 2-4 mg a day, and they are only paying the $340 every 2, 3 or even 4 months.

I give a discount to military.

Patients are willing to pay these amounts. Rarely do they complain of the cost. I have been told I'm cheaper than many others in the area.

In another practice, patients pay the office about $360/month, get counseling and UDS there, and I get $100 per patient. Typically I see 2-3 patients an hour. In this practice, the patients do not get a financial break and it is tougher for them.

Posts: 22

Postby m_kaylor » Tue Jul 28, 2015 10:28 am

Your on-call rate should depend on how often you are called and when. Are you triaging all phone calls from all patients for the clinic 24 hours a day? That could get miserable very quickly. Do you have any idea how busy the in office day will be? If less busy and call is light then try to negotiate a salary/month rather than hourly to cover in office and your on call with what you think is fair. That way you aren't stressing if they don't have anyone for you to see or your schedule isn't filled and they ask you to take off early for the day. It is great if your one day in clinic is light and your on call is minimum. If they will keep you busy then I would go for an hourly rate as you will be compensated better as you are there for longer hours. I would prefer an hourly rate over the the per-patient-seen fee in that it eliminates worries about no shows which are high in our field. Clarify up front about administrative hours as some clinics will staff patients once a week or so or do chart reviews. You need to clarify with employer whether you will be paid even if you aren't seeing patients. In either situation it is ideal to also work in some sort of bonus for number of patients seen over a certain figure. Win-win for you and the clinic if you do a great job and are really busy. You should be paid more if you are taking on liability by managing mid levels that might be providing psychiatric or medical care. I started with the local hourly rate for urgent care or ER work--factored in liability coverage for midlevels and then added more to this given supply and demand as there aren't many doctors knocking on doors to do addiction in my neck of the woods and negotiated from there.

Posts: 198

Postby NoDrugs4u » Tue Jul 28, 2015 10:28 am

That's awesome, entjwb, about getting certified and teaching. Is that the grandfather clause where you qualify if you work in addiction for so many years? Or did you take a fellowship?

Re salary, yes I was asking about in-office salary and on-call salary ideas. They want to pay hourly, not per patient. $300/hr sounds great, good for you.

Posts: 180

Postby entjwb » Tue Jul 28, 2015 10:28 am

I think you need two rates one for patients seen and on for the on call time. I get $100 per patient seen. Which is $300 an hour plus malpractice membership in ASAM and CME allowance. I have been qualified to take the board exam in October and hopefully will pass and be able to do more. If successful hope to teach a session on Addiction Medicine to Medical Students and Residents in local Medical School.

Posts: 571

Postby kcairns » Tue Jul 28, 2015 10:28 am

Kevin, i'll take it, start booking me in, how do you get to mizzippi anyway?

Posts: 198

Postby NoDrugs4u » Tue Jul 28, 2015 10:28 am

edbill, not sure what you mean by "include your 100 bup patient fees"? No, I would not exceed my 100 limit, but since I have only 7 active patients in my private practice I don't think that will be an issue.

Thanks for the ballpark figures Dr. Passer, I just wanted a frame of reference without getting into credentials and other details.

Thanks tdbailey, I will get one of those g-mail anonymous emails and contact you. I like to stay private on all message boards. You never know, your boss or ex-wife might be on here waiting to get dirt on you!

They want me to be in the clinic one day per week and be on-call the other days. Daytime on-call only, phone-call only, during business hours only. Thanks everyone!

Posts: 1404

Postby drpasser » Tue Jul 28, 2015 10:28 am

You never told us about your certifications, which can make a difference.

A very ballpark standard hourly rate is $125/hr. I would ask for $175/hr and so, maybe you could meet in the middle @ $150/hr.

$150/hr times 40 hrs/wk = $6000/wk; which isn't bad, particularly if you have no overhead or operating expenses.

Good luck!

Posts: 101

Postby edibill » Tue Jul 28, 2015 10:28 am

The job doesn't include your 100 bup patient fees I hope.

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