Questions About Psych (Fellowships, Salary in Northeast)

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Hi Everyone,
A few more questions have come up for me regarding the field of psychiatry. I would appreciate it if some of you would be able to answer some of the questions.

1) Fellowships: a) Does one have to do a fellowship in the same place as one's residency, or can one do one's residency in one place and a fellowship elsewhere (also, even if this is possible, is it typical?)? b) One Psychiatrist resident on this forum, got a D.O. and then plans to do a CAP fellowship. Is that typical (I know that D.O.'s don't have a hard time getting into psych. residencies. But do they have a hard time getting into CAP fellowships?)?

2) Salary: I am a bit concerned about investing in medical school now for fear that my future salary will not be adequately high enough to make the hundreds of thousands of dollars of tuition/expenses that I will have to pay for medical school a worthwhile investment. I would hate to pick a specialty based on salary alone, and at the moment am most interest in Psychiatry although it is one of the lower paying specialties. That said: a) Do any of you know what the typical salary for a psychiatrist in the Northeast is (I would love to hear from someone who is actually in the field and knows firsthand about this, rather than those who base there answer on statistics available online [I have seen all of these statistics])? b) Also, what would the salary for a CAP psychiatrist be? c) Finally how do the salaries look for such doctors around the metropolitan area of New York (like in NYC, or northern NJ)?

I know that this is a rather long post, but I would appreciate any and all responses. Thanks!

child fellowships are not competitive - anyone with a pulse can get into a CAP fellowship. the majority of those wanting to go into child end up not pursuing it. There are some categorical adult+child 5 year programs, or you can fast-track (i.e. do 3 years of general residency +2 yrs of CAP) which can be at the same program or different one. Each program has its own rules but it is common for people to go elsewhere as some programs don't have child fellowships or don't have good ones. I know someone who went to the worst psychiatry residency program in the country and then went into one of the top child fellowships.

You are not going to be poor as a physician in any specialty whatever anyone says. It is not clear what is going to happen with the ACA now that the individual mandate (which ironically was a republican idea put forward by the Heritage Foundation) looks like it is dead. However the ACA is good for primary care specialties - there will likely be an increase in salaries for FM, IM, Peds, and psychiatry it will be procedure-based specialties where renumeration will (quite rightly) decrease.

Salaries have been discussed elsewhere (do a search), but will obviously be less in places like NYC where there are a large number of psychiatrists, but even there they are making a decent wage and many sadly have cash-only private practices.

Originally Posted by YES123

Hi Everyone,
A few more questions have come up for me regarding the field of psychiatry. I would appreciate it if some of you would be able to answer some of the questions.

1) Fellowships: a) Does one have to do a fellowship in the same place as one's residency, or can one do one's residency in one place and a fellowship elsewhere (also, even if this is possible, is it typical?)? b) One Psychiatrist resident on this forum, got a D.O. and then plans to do a CAP fellowship. Is that typical (I know that D.O.'s don't have a hard time getting into psych. residencies. But do they have a hard time getting into CAP fellowships?)?

2) Salary: I am a bit concerned about investing in medical school now for fear that my future salary will not be adequately high enough to make the hundreds of thousands of dollars of tuition/expenses that I will have to pay for medical school a worthwhile investment. I would hate to pick a specialty based on salary alone, and at the moment am most interest in Psychiatry although it is one of the lower paying specialties. That said: a) Do any of you know what the typical salary for a psychiatrist in the Northeast is (I would love to hear from someone who is actually in the field and knows firsthand about this, rather than those who base there answer on statistics available online [I have seen all of these statistics])? b) Also, what would the salary for a CAP psychiatrist be? c) Finally how do the salaries look for such doctors around the metropolitan area of New York (like in NYC, or northern NJ)?

I know that this is a rather long post, but I would appreciate any and all responses. Thanks!

1) no - you can do your residency where you want and CAP where you want. However, sometimes it's just more convenient to stay at the same place. Some "academic" types think it's better the branch out more and see different perspectives, but this is chump change compared to your quality of life. Also, CAP is not competitive at all - just the opposite!

2) Income based repayment!

Hi,
Thank you both for your responses! (Splik, I especially appreciate your thorough response) They we quite helpful. Just two more points for:
1) Boba, what do you mean by "Income based repayments".
2) My question about whether one has to do one's fellowship in one place has been answered ( so no need to waste your time responding to this anymore). I am still looking to find out whether a D.O. can get into a CAP fellowship and am also looking for more salary information for Psychiatrists in the Northeast. If you know some information about these topics please share that.
Thanks!

Originally Posted by YES123

I am still looking to find out whether a D.O. can get into a CAP fellowship and am also looking for more salary information for Psychiatrists in the Northeast. If you know some information about these topics please share that.
Thanks!

Yes.

What salary range are you looking for? Contact a recruiter and ask them.

.

child fellowships are not competitive - anyone with a pulse can get into a CAP fellowship

A guy in my residency showed up to work late pretty much everyday, didn't know WTF he was doing everyone in the program thought he was incompetent, and he'd ask patients "Do you hear any voices?" and they'd answer "I hear your voice." He took that to assume they were psychotic and put them all on Risperdal. Whenever I was on call on weekends I'd have to stop the Risperdal on many of these patients who were actually truly depressed and not psychotic.

And guess what programs offered him an interview for child fellowship? Pretty much every single one he applied, Columbia, Johns Hopkins, a bunch of Ivies.....

Originally Posted by whopper

A guy in my residency showed up to work late pretty much everyday, didn't know WTF he was doing everyone in the program thought he was incompetent, and he'd ask patients "Do you hear any voices?" and they'd answer "I hear your voice." He took that to assume they were psychotic and put them all on Risperdal. Whenever I was on call on weekends I'd have to stop the Risperdal on many of these patients who were actually truly depressed and not psychotic.

And guess what programs offered him an interview for child fellowship? Pretty much every single one he applied, Columbia, Johns Hopkins, a bunch of Ivies.....

Sometimes I hear stories about people being kicked out of residency for being incompetent and it makes me scared. Then I hear stories like this and it's all better.

Of course, this raises the question: if Child and Adolescent Psych docs make so much more money for one more year of training and don't take any call why is the fellowship noncompetitive?

The non-CAP psychiatrists know why . . . !!!

The only reason I can think of is lack of passion of people wanting to further their education in this specific field. I have no problems with anyone wanting an easy lifestyle (so many gifted residents choose Derm for that reason) so long as while they do their work as a physician they take it seriously. If they have a great life outside of work, more power to them, but unfortunately I see too many lazy doctors out there who do terrible work.

As for that resident, a theory that crossed my mind was that the program went lenient on him because it turned out that his aunt was a professor in the program, and they took strong steps to keep it a secret. I found this out as a chief, was told this by the head of the dept of one of the hospitals where the resident was located, and higher ups in the program whined about this resident being incompetent behind closed-doors. I became aware of this because as a chief, attendings start whining complaints while in front of the chief, while in front of other residents they must look professional.

No one was willing to point out the Emporer's clothes and bring up the issue to the point where action was going to be taken, partly IMHO because they didn't want to upset that professor that was his aunt. They just hurrumphed here and there.

Personally I thought it was pathetic because that guy's work was leading to bad care and that should not have been tolerated one iota.

But getting back to salary..

IMHO going into fellowship simply for the money is not worth it and I've mentioned this several times before. First if you are in debt, we're talking likely several thousands of dollars in more interest that will accumulate because during fellowship year you're barely making enough to live comfortably if that at all. While fellowship on average does make more money for the attending it's not THAT much. Per several websites it's on the order of about 10K per year. Given that you'll work on a salary for about $35-45K for what would like be about 65+ hours a week of work (if not more), while as an attending you could've realistically made about 200K for that amount of work, we're talking about 15 years before it merely breaks even! Also factor in the possibility that they'll work you 80+ hours, and on that schedule you could've made $350K+ as an attending (I'm using inexact figures. I did post the exact math based on the average salaries as reported by legit sources in a previous thread, but it's late and I feel like going to sleep soon), third, if you become an attending sooner, you could invest a bigger chunk or pay of debts sooner saving or making a heck of lot more money and in this game TIME IS A FACTOR LIKELY ON THE ORDER OF 10k+/YEAR, fourth, if someone's not psassionate about it, why subject yourself to another year of working your tail off without being an attending?

Yes, it's possible to reap in huge amounts of money thanks to fellowship, but that too can be done simply with general psychiatry as well. For example, if you're a good child psychiatrist, I can see you making a practice charging out-of-pocket for much more than usual insurance rates if you are very good. Then again, I can see the same of a general psychiatrist. Trying to go into fellowship simply for the money is like trying to bank on making more money on an algorithm where factors T,U,V,W,X, Y, Z all make a difference but you're only going to rely on factor X and ignore the other factors for one year.

Agree with people avoiding fellowships, especially research fellowships, child, forensics and addiction. Especially in top programs. Its not worth it guys. Everyone who applies is likely dumb, mute, has their own axis I (and II) disorder.

I once knew a guy who couldnt even speak (his tongue was cut out my a Hungarian opera singer) and he smelt like cheese. He did however interview at all the top programs in child and forensics including all the ones in fly over land.

We're in psych, we are not the movers and shakers of the medical world. We are more like catfish than whales and sharks. A cozy private practice in the mountains making our own DSM-6 is just fine with me.

:P

Originally Posted by BobA

Of course, this raises the question: if Child and Adolescent Psych docs make so much more money for one more year of training and don't take any call why is the fellowship noncompetitive?

The non-CAP psychiatrists know why . . . !!!

i think many are changing their minds because of the parents

I'm probably going to do a second fellowship after child fellowship. I'm probably going to stay in academics and make 30-40% less than I could taking the same job across town at a non-academic institution. I'm probably going to be really happy with my choices.

You should do fellowships because you want to do fellowships, because you want the knowledge, expertise, and experiences to be a sub-specialist, recognizing that other people who don't do the fellowship may still be able to do the job 50-90% as well as you do it most of the time. If you don't want to do a fellowship, you probably shouldn't do it. If you're doing it for more money, you probably shouldn't do it. Do it because it sounds rewarding to you personally and to be the kind of psychiatrist you want to be. Don't do it otherwise.

i'm for sure doing two fellowships: forensic and child, and likely going to do a 3rd: addiction. Why? While I am money hungry, it doesn't have much to do with that. I would probably end up making the most money overall if I just focused on 1 of those 3 fellowships and left to go into private practice immediately afterward. However, I just want to learn those three fields to the greatest depths possible, just out of pure intellectual interest and enjoyment, and because I know that learning one specialty well can translate into better performance in other specialties. I am young, single, and have the next 3-6 decades (depending on how long i live) to run a private practice and make as much money as i want, so why not.

Originally Posted by BobA

2) Income based repayment!

Is anyone here doing this???

Originally Posted by Chimed

Is anyone here doing this???

Probably. With the PSLF.

5y for residency + fellowship only leaves 5 more years to "payoff". I'm planning on doing those at a nearby state child psych hospital, if they'll have me, while I start my own cash practice slowly on the side.

Why?

#1 Can't really afford 10y repayment plan during residency. IBR payments are much more doable.

#2 I don't believe that the gov't will screw over the IBR-ers THAT much. Historically, changes (besides interest rates) have applied to those whose loans originated after the year of the change. I believe this will continue.

If not, our back up plan is to continue to live on a resident-like salary (~100k combined), and put my entire attending paycheck to loans. Also hoping for a bit of help from my employer, etc.

#2 I don't believe that the gov't will screw over the IBR-ers THAT much. Historically, changes (besides interest rates) have applied to those whose loans originated after the year of the change. I believe this will continue.

The problem with IBR, is that no one has "joined the program.". We all had to submit proof of income to our lenders to get the IBR rate, but none of us have signed anything with the government.

If the policy changes, I'm not so confident that any of us will be grandfathered in, because we signed no contracts, and submitted no paperwork to the government showing that we are in this repayment program.

Originally Posted by notdeadyet

The problem with IBR, is that no one has "joined the program.". We all had to submit proof of income to our lenders to get the IBR rate, but none of us have signed anything with the government.

If the policy changes, I'm not so confident that any of us will be grandfathered in, because we signed no contracts, and submitted no paperwork to the government showing that we are in this repayment program.

Yeah, I know, but if you look at the history of changes to student loans, almost every change, including the recent ones that Obama passed, have applied to loans originated after a certain date.

For example, I'm not eligible for certain benefits in the newest package because they only apply to loans originated after my loans (2014, I think).

I know, this is all crystal ball work. I'm definitely doing IBR for the 1st 5 years (or as long as it holds). If IBR is still in place in 5 years, we'll make a decision from there based on my attending salary (if I'm making 300k/year or something crazy at my first job, then I'd probably NOT do IBR, and just pay them off as fast as possible). If I'm making 150k, then I probably WILL continue IBR (as long as it seems like it's not going away) and risk it.

If they yank the rug out from under us at the last second, I'd be sad, but it's still doable. I've still made an excellent investment. My old job, which I left 8 years ago, paid $30k/yr. In July, I'll start making 50k/year, or almost a 100% increase. In 5 years, I'll be making 5 to 7 times what I was making in 2004. That's awesome. Even if it costs me 500k total (which is more than the worst case scenario I've dreamed up), I've still come out WAY, WAY ahead, both financially, socially, and personally.

The only issue with PSLF that you have to account for is the IRS considers the amount written off as taxable income.

Originally Posted by YES123

That said: a) Do any of you know what the typical salary for a psychiatrist in the Northeast is (I would love to hear from someone who is actually in the field and knows firsthand about this, rather than those who base there answer on statistics available online [I have seen all of these statistics])?

Are you talking academics or community practice? Judging by the responses to this post, I assume the latter.

In case you were asking about academics -- it pays a lot less. If you are on the research track you make much, much less. For example, a starting research-track attending at UCSF or MGH would make about $125K, whereas a starting research-track attending at UMich would make about $150K.

anyone know how competetive the CAP at UCSD/UCI/Cedars/UCLA or USC? i am interested in getting one of those spots eventually. any insights? thanks.