$500 an hour not bad for a psych NP

[Mad Jack]

Good for them, not a single one that I know are making that, and they are all excellent physicians from excellent residency programs.

Meanwhile I also don't know a single physician in primary care making less than 250 outside of academics... Let me help your friends...

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[Piebaldi]

Meanwhile I also don't know a single physician in primary care making less than 250 outside of academics... Let me help your friends...

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I'm not suggesting that they shouldn't get all they can - but please note that the states noted after a brief look show MT,MS, NE, Eules, Tx, AL, etc. Not exactly the most happening states in the world. Some of those are also med evals paying like 1k a day, etc.

I don't see any LA, Manhattan, NY, Chicago, etc. Again I have no problem with PCPs making money - I think they deserve a good salary without a doubt.
But in more saturated areas, 200k is the norm, even some interventionalist cardiologists are getting offers in the high 200's which are very low, (i even had an Ortho group offer me 200k! for an interventioanl pain job!!) and the places have no difficult in filling the positions.

I'm sure that my friends would have gotten higher salaries if they could have - they are bright doctors who are well trained. Not all areas pay well. there was an offer of >450k in WV for PM&R - it's great money, but then I would have had to be in WV. No thanks. I'll take my $300k for a 6 hour day in Chicagoland. Getting a crap ton of $$ to be in the end of the world is not worthwhile. At least not to mel

 

[Mad Jack]

I'm not suggesting that they shouldn't get all they can - but please note that the states noted after a brief look show MT,MS, NE, Eules, Tx, AL, etc. Not exactly the most happening states in the world. Some of those are also med evals paying like 1k a day, etc.

I don't see any LA, Manhattan, NY, Chicago, etc. Again I have no problem with PCPs making money - I think they deserve a good salary without a doubt.
But in more saturated areas, 200k is the norm, even some interventionalist cardiologists are getting offers in the high 200's which are very low, (i even had an Ortho group offer me 200k! for an interventioanl pain job!!) and the places have no difficult in filling the positions.

I'm sure that my friends would have gotten higher salaries if they could have - they are bright doctors who are well trained. Not all areas pay well. there was an offer of >450k in WV for PM&R - it's great money, but then I would have had to be in WV. No thanks. I'll take my $300k for a 6 hour day in Chicagoland. Getting a crap ton of $$ to be in the end of the world is not worthwhile. At least not to mel

If you actually looked through the listings there's positions in such rural places as Los Angeles, CA, Denver, CO, Atlanta, GA, and suburbs of Boston, MA.

 

[Piebaldi]

If you actually looked through the listings there's positions in such rural places as Los Angeles, CA, Denver, CO, Atlanta, GA, and suburbs of Boston, MA.

Granted I did not look at ALL the listings but none of the listings that I saw where in those locations. Not sure what you are arguing here? Does the average FM/IM non-hospitalist grad start at $250k nationally?Not from the people that I know. Does it happen? I'm sure it does. Am I glad if PCPs get good money? Absolutely.

Again not sure what you are arguing for here?

 

[Mad Jack]

Granted I did not look at ALL the listings but none of the listings that I saw where in those locations. Not sure what you are arguing here? Does the average FM/IM non-hospitalist grad start at $250k nationally?Not from the people that I know. Does it happen? I'm sure it does. Am I glad if PCPs get good money? Absolutely.

Again not sure what you are arguing for here?

That it's easy to make 250k if you want to. The average male physician in FP does

 

[Piebaldi]

That it's easy to make 250k if you want to. The average male physician in FP does
View attachment 293517

Well I'm happy for male FM physicians, good for them!

 

[calvnandhobbs68]

lol what is happening in this thread

Piebaldi on a crusade today

 

[birchswing]

Someone mentioned it's important that psychiatrists are doctors first and psychiatrists second. I can't comment on that.

But, I would argue that the single most important element missing from the conversation is being a good person first, whether you are a psychiatrist or a psych NP or whatever.

And that is something I don't know of there being training for, screening for, or even incentives for. In fact with our current system, the incentives are such that you practice what makes the most money with the population that can pay the most for it. I blame the AMA, the other medical school licensing organizations, and federal government for that.

I think being a good person is probably more important in psychiatry than any other medical field.

I've been a patient of MDs whom I would not feel comfortable watching my dog for ten minutes.

And I mean that's kind of a foundational basis for a relationship on top of which you provide the best help you can.

 

[VA Hopeful Dr]

Good for them, not a single one that I know are making that, and they are all excellent physicians from excellent residency programs.

You can be a great physician and be bad at business or not want to move from a saturated area.

 

[tr]

No, it’s not. It’s stupid to give large groups new prescribing rights, evaluate for years, and then determine how many patients were placed at risk. The FDA wouldn’t do this with new drugs. Skip the research big pharma, just start selling xyz. It should have been evaluated on a smaller scale over a long period of time in the real world (no VA or military influence) with consent.

(Actually the FDA does exactly this with new drugs (postmarketing surveillance), and even more so with non-drug products like flame ******ants and plasticizers, which are now ubiquitous in our environment as environmental scientists begin to conduct the research that will help us understand their effects.)

But that aside, I agree, the situations where NPs have full practice rights are mostly low acuity settings where meaningful outcomes like mortality are hard to use because they are rare, and softer outcomes like BP and glucose control are similar, as one would expect them to be, because I don't see why an NP couldn't do effective lifestyle counseling etc.

In psychiatry we haven't even figured out what kind of quantifiable outcome measure we could use among physicians. It's pretty much patient satisfaction and peer esteem. Very weak.

 

[Mad Jack]

flame ******ants

The preferred term is fire suppressants these days

These smart filters are... not so much some days

 

[Mad Jack]

lol what is happening in this thread

Piebaldi on a crusade today

"NPs Make All the Money and Physicians Make $3.50: The Thread"

 

[WisNeuro]

That it's easy to make 250k if you want to. The average male physician in FP does

How old is that data by chance? Back when my wife was looking, there was nothing under 215 that we saw, between a couple metro areas, West Coast and Midwest. Are academics just dragging the averages down? Or are people just taking terrible jobs in some places?

 

[VA Hopeful Dr]

How old is that data by chance? Back when my wife was looking, there was nothing under 215 that we saw, between a couple metro areas, West Coast and Midwest. Are academics just dragging the averages down? Or are people just taking terrible jobs in some places?

Partially that. Partially that lots of places offer less at starting but with a much much higher ceiling. For example: my starting salary at the job I'm at now when I took it in May of 2018 was 190k. The next year my productivity was such that I earned a fair bit more than that. This year I'm on track to earn more than the previous year.

You also have to factor in part-time jobs which some survey's factor in and some don't.

 

[WisNeuro]

Partially that. Partially that lots of places offer less at starting but with a much much higher ceiling. For example: my starting salary at the job I'm at now when I took it in May of 2018 was 190k. The next year my productivity was such that I earned a fair bit more than that. This year I'm on track to earn more than the previous year.

You also have to factor in part-time jobs which some survey's factor in and some don't.

Hmm, yeah, her first year was salaried, to get her up to production, and then it went to productivity. The salaried figure was 220, and once she's gone to production, she's been well above that the past two years. Especially after we tweaked some of her billing.

 

[TexasPhysician]

(Actually the FDA does exactly this with new drugs (postmarketing surveillance), and even more so with non-drug products like flame ******ants and plasticizers, which are now ubiquitous in our environment as environmental scientists begin to conduct the research that will help us understand their effects.)

But that aside, I agree, the situations where NPs have full practice rights are mostly low acuity settings where meaningful outcomes like mortality are hard to use because they are rare, and softer outcomes like BP and glucose control are similar, as one would expect them to be, because I don't see why an NP couldn't do effective lifestyle counseling etc.

In psychiatry we haven't even figured out what kind of quantifiable outcome measure we could use among physicians. It's pretty much patient satisfaction and peer esteem. Very weak.

The FDA may fast-track drugs, but name a single drug in the last 10 years that didn’t have phase 1 testing? Phase 2? Just because they have REMS and other after approval studies doesn’t mean they don’t have initial safety studies.

 

[Piebaldi]

Partially that. Partially that lots of places offer less at starting but with a much much higher ceiling. For example: my starting salary at the job I'm at now when I took it in May of 2018 was 190k. The next year my productivity was such that I earned a fair bit more than that. This year I'm on track to earn more than the previous year.

You also have to factor in part-time jobs which some survey's factor in and some don't.

Sigh. I overall like you as a poster - I really do. I think you are rational and generally speaking make reasonable arguments. But what you said above is PRECISELY what I was mentioning. You started at 190k - you didn't start at 250k. Sure most and probably ALL doctors make more the longer they work, the more into their career they are, etc. But the point is that you started much lower than that. But my point is that starting salaries are many times much lower than 250k. Yes long term most physicians including primary care will make more without a doubt.

Ok, my point is made.

 

[Piebaldi]

Hmm, yeah, her first year was salaried, to get her up to production, and then it went to productivity. The salaried figure was 220, and once she's gone to production, she's been well above that the past two years. Especially after we tweaked some of her billing.

You are "tweaking" your wife's billing? wow.

 

[WisNeuro]

You are "tweaking" your wife's billing? wow.

Shh, adults are talking.

 

[Piebaldi]

Shh, adults are talking.

You have a Psychologist PHd person "tweaking" his FP wife's billing. That doesn't scream Medicare fraud.

 

[WisNeuro]

You have a Psychologist PHd person "tweaking" his FP wife's billing. That doesn't scream Medicare fraud.

Free point of advice for you. You might get farther in life by asking clarifying questions, rather than making *****ic statements displaying your ignorance.

 

[Piebaldi]

Free point of advice for you. You might get farther in life by asking clarifying questions, rather than making *****ic statements displaying your ignorance.

Nothing *****ic - if your wife is able to get through med school and residency, i'm sure she' scapable of doing her own billing. A psychologist has no business tweaking his physician wife's billing.

 

[WisNeuro]

Nothing *****ic - if your wife is able to get through med school and residency, i'm sure she' scapable of doing her own billing. A psychologist has no business tweaking his physician wife's billing.

If you'd like to continue with your obsessional rants against me, fine by me, most of us will simply ignore you. If you'd like to have a meaningful conversation, just let us know.

 

[Piebaldi]

If you'd like to continue with your obsessional rants against me, fine by me, most of us will simply ignore you. If you'd like to have a meaningful conversation, just let us know.

Sorry to break it to you, but you are not part of the "we." No obsessional rants. Again you are not part of the "us." Remember that.

 

[MBBSMOM]

I have no clue how this thread derailed so far from the original topic.

 

[MacDonaldTriad]

HMMMMMM.

 

[VA Hopeful Dr]

Sigh. I overall like you as a poster - I really do. I think you are rational and generally speaking make reasonable arguments. But what you said above is PRECISELY what I was mentioning. You started at 190k - you didn't start at 250k. Sure most and probably ALL doctors make more the longer they work, the more into their career they are, etc. But the point is that you started much lower than that. But my point is that starting salaries are many times much lower than 250k. Yes long term most physicians including primary care will make more without a doubt.

Ok, my point is made.

It was not until one of your last posts that you mentioned starting salary. Everything before that was just salary in general. We call that moving the goal posts.

If you want to discuss starting salary, we can do so but I addressed that already to someone else:

Partially that. Partially that lots of places offer less at starting but with a much much higher ceiling. For example: my starting salary at the job I'm at now when I took it in May of 2018 was 190k. The next year my productivity was such that I earned a fair bit more than that. This year I'm on track to earn more than the previous year.

You also have to factor in part-time jobs which some survey's factor in and some don't.

I have a college friend who started with a group that offers starting pay around the same as where I started. By his 18th month with that job, he was earning over 300k. My job is similar.

But in the interest of fairness, I can amend my previous statement. If after more than 2 years at the same practice, if you're not breaking 250k you're doing something very wrong.

 

[Piebaldi]

It was not until one of your last posts that you mentioned starting salary. Everything before that was just salary in general. We call that moving the goal posts.

If you want to discuss starting salary, we can do so but I addressed that already to someone else:



I have a college friend who started with a group that offers starting pay around the same as where I started. By his 18th month with that job, he was earning over 300k. My job is similar.

But in the interest of fairness, I can amend my previous statement. If after more than 2 years at the same practice, if you're not breaking 250k you're doing something very wrong.

I thought that was clear but perhaps not. Yes I'm pretty sure most physicians including primary care docs are making more than 250k long term.

 

[Mad Jack]

How old is that data by chance? Back when my wife was looking, there was nothing under 215 that we saw, between a couple metro areas, West Coast and Midwest. Are academics just dragging the averages down? Or are people just taking terrible jobs in some places?

It's Medacape 2019. Women also worked significantly fewer hours in the survey, I'm betting that accounts for much of the discrepancy, as would regional differences and preferences for academic vs private practice

 

[VA Hopeful Dr]

I thought that was clear but perhaps not. Yes I'm pretty sure most physicians including primary care docs are making more than 250k long term.

So all of your little fit here was because PCPs make more later in their career than at the start?

I thought that this was a) common knowledge and b) not unique to primary care.

200k isn't a bad starting number, especially if it keeps going up from there.

 

[Piebaldi]

So all of your little fit here was because PCPs make more later in their career than at the start?

I thought that this was a) common knowledge and b) not unique to primary care.

200k isn't a bad starting number, especially if it keeps going up from there.

Huh? I didn't have any fit. That is the most normal thing in the world, not sure what you mean. To suggest that all PCPs start at $250k I don't agree with. That's the point that I was trying to make. As you stated you started at 190k. With NPs starting at around $100k plus it seems like a small difference in my opinion for all the work put in to become a physician.

 

[Mad Jack]

Huh? I didn't have any fit. That is the most normal thing in the world, not sure what you mean. To suggest that all PCPs start at $250k I don't agree with. That's the point that I was trying to make. As you stated you started at 190k. With NPs starting at around $100k plus it seems like a small difference in my opinion for all the work put in to become a physician.

Becoming a NP takes a few years less (on average you're looking at 7-8 years from undergrad to finish). So let's say they're starting right as a physician enters residency, they're making an average of 108k (being generous considering starting pay is lower than average pay) while you're earning an average of 58k (for simplicity) from the age of 26-30. They're 150k ahead at age 29, and probably have 140k less in debt. But then for the next 35 years, you will earn 237k on average as a generalist and 341k as a specialist, putting you at an extra 129k/year for the next 36 years as a generalist (and a later start by 1-4 years but an increased salary if 233k/year versus the average NP). You make up the difference in pay before you've ended your third year in practice.

This applies in psych as much as any other field. You make more than twice (and sometimes three times) as much as the average NP is pulling, and you also have the ability to do things nurses can't (and likely legally never will) be able to do, such as involuntary commitments, hearings, etc in many states and the knowledge that you have the best skills available to serve your patients well. If that isn't enough upside to make you happy then I don't know what to tell you.

 

[VA Hopeful Dr]

Huh? I didn't have any fit. That is the most normal thing in the world, not sure what you mean. To suggest that all PCPs start at $250k I don't agree with. That's the point that I was trying to make. As you stated you started at 190k. With NPs starting at around $100k plus it seems like a small difference in my opinion for all the work put in to become a physician.

NPs doing primary care don't start at 100k.

 

[MBBSMOM]

NPs doing primary care don't start at 100k.

If @Piebaldi is so upset that he/she thinks that NPs make more. I just wonder why didn’t he/she become an NP if they’re so upset over this.

 

[Piebaldi]

I have seen lots of ads for NPs at 100k plus. Our NPs start at 100k in private practice, and have a cush schedule. Only recently have they even started taking call given some docs left for other opportunities. One of my colleagues hired at the same time as me for example started at $200k. He takes call once or twice a month during week (whole week) and both weekend days. pretty rough.

When you take into account the much lower hours (many NPs dont take call in other settings also), they don't do weekends, etc. it's not a bad gig. And tkaing into account all the working hours we have vs what NPs have, the salary shrinks even more. Yes ultimately doctors make more but the gap is not huge is my point. And NPs can change whenever they want - some of our NPs went from ID to Rehab within a matter of years, etc. We can't do that. We'd have to re-train all over again.

Sigh I'm dropping out of this thread. Perhaps my experiences are not as others, which is ok. I'm all up for doctors and PCPs making good $$.

NPs doing primary care don't start at 100k.

 

[clausewitz2]

You... Do realize that PhDs were doctors before the MD ever existed, right? We are physicians, but if anything, they hold the real title of "doctor."

Minor point, but this is not really true. Doctor of Philosophy as a degree is a high medieval invention, clearly postdating the various doctorates of theology, law, and medicine that were well-established in Italy, France and the Low Countries by the eleventh century. PhD as a title is not attested anywhere until later and in some countries in Central Europe just did not exist until the 1600s.

Remember, the early universities were basically fancy trade schools.

So for example William of Ockham, the "Invincible Doctor" and the guy with the razor, was a theologian, not a PhD.

 

[Mad Jack]

Minor point, but this is not really true. Doctor of Philosophy as a degree is a high medieval invention, clearly postdating the various doctorates of theology, law, and medicine that were well-established in Italy, France and the Low Countries by the eleventh century. PhD as a title is not attested anywhere until later and in some countries in Central Europe just did not exist until the 1600s.

Remember, the early universities were basically fancy trade schools.

So for example William of Ockham, the "Invincible Doctor" and the guy with the razor, was a theologian, not a PhD.

Fair fair, I meant to say that the first doctorate was most likely nonmedical, as the most likely recipient of the official title would have been a theologian in Paris around the mid-12th century. Hard to say for certain, as there were three doctors at the time, but most sources I've looked into in the past seem to lean toward it having most likely been awarded to a member of the clergy (though it's really semantics since degrees as we think of then today didn't crop up for a few hundred more years)

 

[clausewitz2]

Fair fair, I meant to say that the first doctorate was most likely nonmedical, as the most likely recipient of the official title would have been a theologian in Paris around the mid-12th century. Hard to say for certain, as there were three doctors at the time, but most sources I've looked into in the past seem to lean toward it having most likely been awarded to a member of the clergy (though it's really semantics since degrees as we think of then today didn't crop up for a few hundred more years)

Well of course it probably was clerical since universities are an outgrowth of the cathedral school system. The point I was trying to make is more that your argument supports calling D.Divs "doctor" way more than your average academic psychologist.

But, uh, back on the rails, yeah?

 

[Mad Jack]

Well of course it probably was clerical since universities are an outgrowth of the cathedral school system. The point I was trying to make is more that your argument supports calling D.Divs "doctor" way more than your average academic psychologist.

But, uh, back on the rails, yeah?

This thread is very circumstantial

 

[Stagg737]

But that aside, I agree, the situations where NPs have full practice rights are mostly low acuity settings where meaningful outcomes like mortality are hard to use because they are rare, and softer outcomes like BP and glucose control are similar, as one would expect them to be, because I don't see why an NP couldn't do effective lifestyle counseling etc.

This is no longer true. There are quite a few hospitals changing their ICUs to be run by NPs with either no direct physician supervision or physicians only available via phone. The NP lobby is very strong, and I do not have the faith that some do that things will work out very well in the long-run.

This thread is very circumstantial

I think we've moved past circumstantial and well into tangential territory at this point...

 

[Mad Jack]

This is no longer true. There are quite a few hospitals changing their ICUs to be run by NPs with either no direct physician supervision or physicians only available via phone. The NP lobby is very strong, and I do not have the faith that some do that things will work out very well in the long-run.



I think we've moved past circumstantial and well into tangential territory at this point...

On a long enough timespan, everything has the chance to return to circumstantiality.

 

[tr]

This is no longer true. There are quite a few hospitals changing their ICUs to be run by NPs with either no direct physician supervision or physicians only available via phone. The NP lobby is very strong, and I do not have the faith that some do that things will work out very well in the long-run.

Wow NPs running the ICU with no physicians? That's a bit worrisome! But should make a great setting for a comparative outcomes study if true

 

[reca]

Wow NPs running the ICU with no physicians? That's a bit worrisome! But should make a great setting for a comparative outcomes study if true

There was a reddit post by an NP recently stating that she had been hired to provide ICU coverage at night. Was asking for textbook recs to help her read up on stuff she might see. No ICU experience at all prior to the job.

 

[Jules A]

There was a reddit post by an NP recently stating that she had been hired to provide ICU coverage at night. Was asking for textbook recs to help her read up on stuff she might see. No ICU experience at all prior to the job.

Scary, I thought the Acute Care NP tract was the only one that actually required prior RN experience in the ICU.

 

[calvnandhobbs68]

There was a reddit post by an NP recently stating that she had been hired to provide ICU coverage at night. Was asking for textbook recs to help her read up on stuff she might see. No ICU experience at all prior to the job.

Good god

Would literally be better off sending a 4th year medical student. At least they've been in an ICU before.

 

[tr]

Good god

Would literally be better off sending a 4th year medical student. At least they've been in an ICU before.

Oh man, if you had put me in charge of the ICU as a fourth year (or now for that matter) everyone would be dead by morning. I'm picturing setting everybody's vent settings to 'random' and handing out pressors based on sock color.

I'm sure an NP with years of supervised ICU experience would do better than an MD trainee, but the idea of hiring someone with no relevant experience to work in an ICU blows my mind

 

[calvnandhobbs68]

Oh man, if you had put me in charge of the ICU as a fourth year (or now for that matter) everyone would be dead by morning. I'm picturing setting everybody's vent settings to 'random' and handing out pressors based on sock color.

I'm sure an NP with years of supervised ICU experience would do better than an MD trainee, but the idea of hiring someone with no relevant experience to work in an ICU blows my mind

lol that's what I'm saying for sure the ICU nurses would have been better but...no ICU experience? wtf

 

[reca]

Scary, I thought the Acute Care NP tract was the only one that actually required prior RN experience in the ICU.

She was an FNP hired to the job.

 

[TexasPhysician]

She was an FNP hired to the job.

that’s how people die.

 

[finalpsychyear]

that’s how people die.

Yes people will maybe quite a bit before this circus is put to proper order.