Did the expected salary for psychiatry make you hesitate about choosing psychiatry? If yes, how did you get over your hesitation?

[Anotherwin]

Just looking to get some different opinions, as I am a current medical student who is leaning towards psych but is hesitating because of the average salary.

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[Celexa]

Not at all, because the hours and lifestyle more than compensate for not being paid like a surgeon.

Now PGY3 still with zero regrets.

 

[Bartelby]

I second Celexa. Keep in mind that the raw salary you see in surveys isn't the only thing that matters, the hours worked (which often get ignored) matter a great deal. If you want to work surgery hours in psychiatry you can do so and make significantly more than the average psychiatrist. For me earning a normal psychiatrist's salary while also enjoying some work-life balance is more than enough.

 

[phagocytosis41]

Just looking to get some different opinions, as I am a current medical student who is leaning towards psych but is hesitating because of the average salary.

Not trying to seem rude, but if the average salary is preventing you from committing to psychiatry, I wouldn't commit to it at all. There are a lot of factors that play a role in choosing a specialty. If average salary is your biggest concern, go for some sort of surgical specialty or become CEO of Bloomberg.

 

[Anotherwin]

Not trying to seem rude, but if the average salary is preventing you from committing to psychiatry, I wouldn't commit to it at all. There are a lot of factors that play a role in choosing a specialty. If average salary is your biggest concern, go for some sort of surgical specialty or become CEO of Bloomberg.

I would not say it is my biggest concern, but the advice I have gotten so far is to also consider salary. So I thought to ask.

 

[Psychresy]

Not trying to seem rude, but if the average salary is preventing you from committing to psychiatry, I wouldn't commit to it at all. There are a lot of factors that play a role in choosing a specialty. If average salary is your biggest concern, go for some sort of surgical specialty or become CEO of Bloomberg.

We all pick careers, industries, fields for a variety of reasons - putting your head in the sand and pretending earning potential isn't one of them is just naive. One should not be shamed because they want to make X dollars a year. One can be money motivated and also be a good physician - the two are not mutually exclusive. And the suggestion to just become CEO of Bloomberg.... I can't even.

 

[phagocytosis41]

We all pick careers, industries, fields for a variety of reasons - putting your head in the sand and pretending earning potential isn't one of them is just naive. One should not be shamed because they want to make X dollars a year. One can be money motivated and also be a good physician - the two are not mutually exclusive. And the suggestion to just become CEO of Bloomberg.... I can't even.

I never said picking a profession to attain an earning potential shouldn't be a reason to pick a profession, I said considering to not enter profession because of a salary should be a strong indication to think about whether to enter into that profession in the first place. I never said one should be ashamed to make a certain amount of money, that is you putting words into my mouth. I agree money is one reason to choose a profession, but it shouldn't be the tipping point to Not enter a profession. The suggestion to become CEO of Bloomberg was a joke, sorry you didn't understand that, but it was said tongue in cheek. I think your answer was a bit naive, not well put together and completely missed the point of my comment.

 

[phagocytosis41]

I would not say it is my biggest concern, but the advice I have gotten so far is to also consider salary. So I thought to ask.

That is fine, but in my opinion the fact that the salary is causing you to be hesitant to choose that profession should cause you to reconsider that profession. You should choose a specialty that you enjoy and isn't just based on salary. Salary is one factor, but there are many other factors like work/balance, the actual field, how much patient interaction you have, etc.

 

[TexasPhysician]

I’d say that psychiatry earns a reasonable MD salary. It isn’t derm or spine surgery. It isn’t peds or FM either.

There is a large spectrum of salaries in every field. I know primary care docs that earn $140k and $400k working the same hours in similar cities.

I’ve spoken to psychiatry peers that find my income low and others that find it high.

Too many people look at averages and assume we are getting paid 10% in either direction. The truth is far from it.

 

[Psychresy]

I never said picking a profession to attain an earning potential shouldn't be a reason to pick a profession, I said considering to not enter profession because of a salary should be a strong indication to think about whether to enter into that profession in the first place. I never said one should be ashamed to make a certain amount of money, that is you putting words into my mouth. I agree money is one reason to choose a profession, but it shouldn't be the tipping point to Not enter a profession. The suggestion to become CEO of Bloomberg was a joke, sorry you didn't understand that, but it was said tongue in cheek. I think your answer was a bit naive, not well put together and completely missed the point of my comment.

That's just like, you're opinion, man.

 

[jbomba]

I never said picking a profession to attain an earning potential shouldn't be a reason to pick a profession, I said considering to not enter profession because of a salary should be a strong indication to think about whether to enter into that profession in the first place. I never said one should be ashamed to make a certain amount of money, that is you putting words into my mouth. I agree money is one reason to choose a profession, but it shouldn't be the tipping point to Not enter a profession. The suggestion to become CEO of Bloomberg was a joke, sorry you didn't understand that, but it was said tongue in cheek. I think your answer was a bit naive, not well put together and completely missed the point of my comment.

Aren't you the neurotic med student? Chill brosef, chill.

 

[phagocytosis41]

That's just like, you're opinion, man.

your** Same for you too my man, your (not you're) opinion. Don't be upset you were called out buddy. And next time, a little tip, don't insult others. Thanks.

 

[phagocytosis41]

Aren't you the neurotic med student? Chill brosef, chill.

Lets not throw out insults now. Are we resorting to personal attacks now? Lol, what did I say to you? Did I offend you? I guess you're one of those people who sit on the sidelines stalking others. Do you talk to your attending that way?

 

[TexasPhysician]

Let’s get back on track folks.

 

[Mad Jack]

I would not say it is my biggest concern, but the advice I have gotten so far is to also consider salary. So I thought to ask.

If 268k isn't enough to do the job, feel free to do something else. Also keep in mind that our salaries are directly linked to mental health parity provisions in the ACA and had previously been less than half they are today, so with the striking down of the ACA salaries could suffer greatly.

I would still rather do this for less money than be any other kind of physician

 

[UTsksk]

I think in the grand scheme of things you’ll be fine money wise. One thing that turned me away from peds was that it just didn’t make much when compared to other specialities (ironically I’m in child adolescent fellowship). I guess my concerns regarding pay were alleviated by just asking some of my mentors how they felt about salary. Some gave me ballpark figures and I felt comfortable with it. In the end you’ll find that psych won’t be up there with ortho or other surgical specialties. I think psych in general is probably mid to low end of compensation but if you compare hours maybe then it bumps up to mid.

 

[jbomba]

One just need look at locums jobs (or add up the CPT codes) to see what one could make. 175-200 hour is pretty readily available in most major cities I've looked at. Extrapolate that out to surgery hours and you're making 500k+ a year.

 

[phagocytosis41]

I think in the grand scheme of things you’ll be fine money wise. One thing that turned me away from peds was that it just didn’t make much when compared to other specialities (ironically I’m in child adolescent fellowship). I guess my concerns regarding pay were alleviated by just asking some of my mentors how they felt about salary. Some gave me ballpark figures and I felt comfortable with it. In the end you’ll find that psych won’t be up there with ortho or other surgical specialties. I think psych in general is probably mid to low end of compensation but if you compare hours maybe then it bumps up to mid.

It's cool that you're in CAP, I have thoughts about doing that after residency. Is the salary that different between CAP and General Psych?

 

[Anotherwin]

If 268k isn't enough to do the job, feel free to do something else. Also keep in mind that our salaries are directly linked to mental health parity provisions in the ACA and had previously been less than half they are today, so with the striking down of the ACA salaries could suffer greatly.

I would still rather do this for less money than be any other kind of physician

What drew you to psych so much?

 

[TexasPhysician]

It's cool that you're in CAP, I have thoughts about doing that after residency. Is the salary that different between CAP and General Psych?

In the average salaried job, the difference is small. The private would appreciates the value more. In my cash outpatient clinic, I wouldn’t bring on someone that isn’t CAP.

 

[Mad Jack]

What drew you to psych so much?

The challenging and complex nature of mental illness, being in a field that is likely to see the greatest growth in treatment options in our lifetimes, and the more personal nature of the treatment provided

 

[sloh]

One just need look at locums jobs (or add up the CPT codes) to see what one could make. 175-200 hour is pretty readily available in most major cities I've looked at. Extrapolate that out to surgery hours and you're making 500k+ a year.

Compensation should always be talked about in the context of hours worked

 

[liquidshadow22]

So you might approach 400k with one of those locums full time at $200/hr but without any of the other benefits. those locum gigs are not giving you any benefits-- no PTO, no 401k, no health insurance etc. I doubt you can equate to a salaried orthopod, ENT, urologist etc.

Different story if you find locums out in Cali for $300 + an hour, but it is definitely not common.

 

[jbomba]

So you might approach 400k with one of those locums full time at $200/hr but without any of the other benefits. those locum gigs are not giving you any benefits-- no PTO, no 401k, no health insurance etc. I doubt you can equate to a salaried orthopod, ENT, urologist etc.

Different story if you find locums out in Cali for $300 + an hour, but it is definitely not common.

Yeah I think those locums jobs are great for someone with a working spouse who has benefits, etc. Though you can work 1099/LLC vs. S-Corp and with a good accountant you can find a lot of loop holes to save money whereas a W2 would be unable to do so. I have a friend who through a variety of loop holes his accountant relies on, pays roughly 25% on his 300k yearly salary. So I think if you're working 50-60 hours at 200 hour and have a skilled accountant you could be pretty close to that W2 salaried urologist for similar hours.

Regarding CA locums, I would say 200 is low and 250 appears to be the norm, with corrections routinely approaching 300-325. Not sure if you were saying not the common out in CA or just generally speaking across the States. Though I also see similar rates in NY and of course terrible hard to staff regions as well.

 

[phagocytosis41]

If 268k isn't enough to do the job, feel free to do something else. Also keep in mind that our salaries are directly linked to mental health parity provisions in the ACA and had previously been less than half they are today, so with the striking down of the ACA salaries could suffer greatly.

I would still rather do this for less money than be any other kind of physician

I agree!

 

[MisterKitty]

If 268k isn't enough to do the job, feel free to do something else. Also keep in mind that our salaries are directly linked to mental health parity provisions in the ACA and had previously been less than half they are today, so with the striking down of the ACA salaries could suffer greatly.

I would still rather do this for less money than be any other kind of physician

If the pay drops below half of what it currently is I would for sure do something else

 

[Mad Jack]

If the pay drops below half of what it currently is I would for sure do something else

More likely they would drop to around 200k, as the pre-ACA salarirs were around 186k on average. This is a doubtful worst case though

 

[Shufflin]

my salary and lifestyle is on par with Derm. just giving another perspective

 

[brazilianpsych]

my salary and lifestyle is on par with Derm. just giving another perspective

What do you do? Just curious, but is it private practice?

 

[Shufflin]

not private practice. i do inpatient, outpatient, phone call coverage of ER, some ketamine. im also exec management and get paid for that too. all one location. work half-days.

 

[Psych19]

If 268k isn't enough to do the job, feel free to do something else. Also keep in mind that our salaries are directly linked to mental health parity provisions in the ACA and had previously been less than half they are today, so with the striking down of the ACA salaries could suffer greatly.

I would still rather do this for less money than be any other kind of physician

More likely they would drop to around 200k, as the pre-ACA salarirs were around 186k on average. This is a doubtful worst case though

I have a hard time believing most insurers would immediately cut reimbursements to mental health specifically, even if parity protections were taken away by dismantling the ACA. I think the public has increasingly recognized the need for behavioral health services (especially substance use treatment). That said, I could see stagnation in incomes if other reimbursements were to climb and BH reimbursements stayed the same.

For those who take insurance (especially in community mental health or hospital settings), I would be concerned that Medicaid reimbursements will take a hit (across the board psych and non-psych) in the near future due to (1) state budget crises from Covid and (2) less Federal govt assistance to states to help fund Medicaid.

 

[Sushirolls]

I have a hard time believing most insurers would immediately cut reimbursements to mental health specifically, even if parity protections were taken away by dismantling the ACA. I think the public has increasingly recognized the need for behavioral health services (especially substance use treatment). That said, I could see stagnation in incomes if other reimbursements were to climb and BH reimbursements stayed the same.

For those who take insurance (especially in community mental health or hospital settings), I would be concerned that Medicaid reimbursements will take a hit (across the board psych and non-psych) in the near future due to (1) state budget crises from Covid and (2) less Federal govt assistance to states to help fund Medicaid.

Parity laws haven't even been followed now. With ACA gone, I could easily see insurance companies peeling back on psych coverage even further.

I have several insurance that right now I'm paneled with specifically sub-contracted out their mental health & SUDs rates to separate third party insurance that pays Scat compared to their rates for other medical services. So in essence I am getting scrap rates simply because I'm psychiatry. Parity is a joke, and even the recent hit UBH took in the courts isn't enough to make the big insurance companies change their tune.

As a CEO, why do what's right / expected when you can save $100 dollars, and IF you get caught, you only get fined $50, you still come out ahead $50. This is the decision some insurance companies are making. The slap on the wrist is worth it.

 

[PikminOC]

Just the individual mandate was pulled from aca, was there more?

 

[PikminOC]

my salary and lifestyle is on par with Derm. just giving another perspective

Is the risk on pat with derm?

 

[Sushirolls]

Just the individual mandate was pulled from aca, was there more?

Not that I'm aware of. Just speaking more to the 'what if'

 

[Shufflin]

Is the risk on pat with derm?

Good question. Not sure since I don't know the risk milieu of Derm. Hard to say. With procedures come more risk, but that's an oversimplification.

 

[thepoopologist]

Just looking to get some different opinions, as I am a current medical student who is leaning towards psych but is hesitating because of the average salary.

Anecdote:
When I was in medical school between 2009-2013, the average psychiatry salary being reported was 200k/year. Everyone was talking about Anesthesiology and Emergency Medicine. You could buy a home near the ocean in California for mid-600k at 10% down with a 5% rate. Tesla was about 25 dollars a share. Amazon was in the 100s. Bitcoin had just been released and were 1-5 cents a piece.

 

[hebel]

Anecdote:
When I was in medical school between 2009-2013, the average psychiatry salary being reported was 200k/year. Everyone was talking about Anesthesiology and Emergency Medicine. You could buy a home near the ocean in California for mid-600k at 10% down with a 5% rate. Tesla was about 25 dollars a share. Amazon was in the 100s. Bitcoin had just been released and were 1-5 cents a piece.

I agree, things change. I was in school more recently (2012-2016) when psych was still paying around that (my psych preceptors were making 180k at a community hospital) and EM was super popular. There were FSEDs, SDGs, and 500+/hr locums jobs in Texas. Check out recent threads in the EM forum, and you'll find the landscape has changed quite a bit in only about 5 years. On the other hand, in psych it's become very easy to find jobs making 300k+.

A lot of this comes down to what you're looking for. With psych, if things continue as they are you will not be paid "poorly" and will make more per hour than a large number of other doctors. On the other hand, it's undeniable that you can generally make a lot more money in other things such as ortho, retina, mohs surgery, etc...at least as long as our system appears to prioritize procedures for compensation. However, if you like psychiatry I wouldn't let pay be a reason not to do it as I think it's objectively pretty solid.

 

[Mad Jack]

Parity laws haven't even been followed now. With ACA gone, I could easily see insurance companies peeling back on psych coverage even further.

I have several insurance that right now I'm paneled with specifically sub-contracted out their mental health & SUDs rates to separate third party insurance that pays Scat compared to their rates for other medical services. So in essence I am getting scrap rates simply because I'm psychiatry. Parity is a joke, and even the recent hit UBH took in the courts isn't enough to make the big insurance companies change their tune.

As a CEO, why do what's right / expected when you can save $100 dollars, and IF you get caught, you only get fined $50, you still come out ahead $50. This is the decision some insurance companies are making. The slap on the wrist is worth it.

A major insurer just got a 10 year injunction for not following the law and it was front page on I think it was the APA Times

 

[Mad Jack]

Parity laws haven't even been followed now. With ACA gone, I could easily see insurance companies peeling back on psych coverage even further.

I have several insurance that right now I'm paneled with specifically sub-contracted out their mental health & SUDs rates to separate third party insurance that pays Scat compared to their rates for other medical services. So in essence I am getting scrap rates simply because I'm psychiatry. Parity is a joke, and even the recent hit UBH took in the courts isn't enough to make the big insurance companies change their tune.

As a CEO, why do what's right / expected when you can save $100 dollars, and IF you get caught, you only get fined $50, you still come out ahead $50. This is the decision some insurance companies are making. The slap on the wrist is worth it.

A major insurer just got a 10 year injunction for not following the law and it was front page on I think it was the APA Time

I agree, things change. I was in school more recently (2012-2016) when psych was still paying around that (my psych preceptors were making 180k at a community hospital) and EM was super popular. There were FSEDs, SDGs, and 500+/hr locums jobs in Texas. Check out recent threads in the EM forum, and you'll find the landscape has changed quite a bit in only about 5 years. On the other hand, in psych it's become very easy to find jobs making 300k+.

A lot of this comes down to what you're looking for. With psych, if things continue as they are you will not be paid "poorly" and will make more per hour than a large number of other doctors. On the other hand, it's undeniable that you can generally make a lot more money in other things such as ortho, retina, mohs surgery, etc...at least as long as our system appears to prioritize procedures for compensation. However, if you like psychiatry I wouldn't let pay be a reason not to do it as I think it's objectively pretty solid.

Psych residency spots have expanded greatly though, we could easily become the next EM. Hopefully I'm retired by the time it's a problem

 

[Mad Jack]

Good question. Not sure since I don't know the risk milieu of Derm. Hard to say. With procedures come more risk, but that's an oversimplification.

There's also the less financial risks of psychiatry. We're by far more likely to be murdered by a patient than other physicians, for instance. I'm unconcerned about it, but I know a guy that was beaten pretty badly by a patient last year and easily could have died

 

[PikminOC]

A major insurer just got a 10 year injunction for not following the law and it was front page on I think it was the APA Time

Psych residency spots have expanded greatly though, we could easily become the next EM. Hopefully I'm retired by the time it's a problem

It won't be a problem. There will still be very few psych for the population

 

[sloh]

I agree, things change. I was in school more recently (2012-2016) when psych was still paying around that (my psych preceptors were making 180k at a community hospital) and EM was super popular. There were FSEDs, SDGs, and 500+/hr locums jobs in Texas. Check out recent threads in the EM forum, and you'll find the landscape has changed quite a bit in only about 5 years. On the other hand, in psych it's become very easy to find jobs making 300k+.

A lot of this comes down to what you're looking for. With psych, if things continue as they are you will not be paid "poorly" and will make more per hour than a large number of other doctors. On the other hand, it's undeniable that you can generally make a lot more money in other things such as ortho, retina, mohs surgery, etc...at least as long as our system appears to prioritize procedures for compensation. However, if you like psychiatry I wouldn't let pay be a reason not to do it as I think it's objectively pretty solid.

This is so true for my specialty (PM&R) as well. I was in school from 2011-2015 and PM&R paying around 220-240k/yr then. Right now, within a subset of jobs (1099 SAR work) in PM&R, it's pretty easy to make 350k/year working 4 days/week, 4-6 hour days. Not sure how long this will last before saturation kicks in but things can change on the dime.

 

[Anotherwin]

not private practice. i do inpatient, outpatient, phone call coverage of ER, some ketamine. im also exec management and get paid for that too. all one location. work half-days.

Would it be alright if I sent you a direct message in order to inquire further about your career path?

 

[Sushirolls]

It won't be a problem. There will still be very few psych for the population

I question this proclamation. I'm right next to an ARNP school and thus a saturated market. I'm competing directly with ARNPs and that is more revealing than Psych Residency production numbers.

I'm even getting solicitation calls from web based training ARNPs seeking clinical rotations.

 

[Stagg737]

A major insurer just got a 10 year injunction for not following the law and it was front page on I think it was the APA Times

It was APA Times, it’s the same UHB that Sushi was referring to.

I question this proclamation. I'm right next to an ARNP school and thus a saturated market. I'm competing directly with ARNPs and that is more revealing than Psych Residency production numbers.

I'm even getting solicitation calls from web based training ARNPs seeking clinical rotations.

Agree that mid-level encroachment is a much bigger risk than parity or any of the other potential federal bills short of moving to a single-payer system. The solicitations for clinical rotations is actually very common as well. I actually had a LinkedIn message about this as a resident already. The desperation of some of those students is sad on multiple levels.

I’d also argue that telehealth may play a significant role in decreased salaries as well. Once companies go back to pre-COVID rates I think many employers will have a reason to pay less as many patients may be unwilling to come in-person after being seen by telehealth for nearly a year.

 

[PikminOC]

I question this proclamation. I'm right next to an ARNP school and thus a saturated market. I'm competing directly with ARNPs and that is more revealing than Psych Residency production numbers.

I'm even getting solicitation calls from web based training ARNPs seeking clinical rotations.

I was referring to too many Psychiatrists. That was what the post I was referring to was about. i said psych, not nurses.

I don't care about desperation of np. They are free to go to med school.

 

[AD04]

To OP, go into whichever field makes you happy. And to decide that, you have to sample as many specialties as you can. In medicine, no matter the specialty, you can't go hungry and poor as an employed physician so money isn't that big of a deal. (The story is different as a business owner.) When you like what you do, you can do it longer which not only makes you more money but enables you to contribute to society longer.

I make a lot but it doesn't make me happy. I was happier when I was a resident as life is more than earning lots of money.

 

[Stagg737]

I was referring to too many Psychiatrists. That was what the post I was referring to was about. i said psych, not nurses.

I don't care about desperation of np. They are free to go to med school.

The problem is that employers and patients often don't care about the difference between MD/DO and NP. Why see a physician when you can seen an NP faster who will give you whatever med you want? Same thing from employer side of things. Why hire a physician who may cost twice as much for a job that an NP can fill and possibly get higher patient satisfaction scores from handing out meds like candy? Physicians are competing with mid-levels for patients now. Whether we like it or not, that's the reality.

Psych is still relatively safe on this front compared to other fields d/t the significant shortage of mental health professionals compared to need. Look at areas like FM, peds, even EM and you'll see a much different picture. With the advent of mass enlistment of telehealth to see encounters, I'd be willing to bet we're going to be seeing a lot less of those high paying jobs out in BFE because access may no longer be as big of an issue in the coming years. Additionally, why hire a physician for those positions at 300k+ per year when you can hire an NP using telehealth for 1/3 of the price? I'm not immediately worried about psych, but mid-level encroachment is a very real thing which may play a significant role in salary (of all fields) going forward.

Relating this to OP's original question, the salary doesn't deter me at all and was actually a huge plus for psych. Work like a surgeon and you can pull in surgeon pay ($400k+ easily), or work a 9-5 job with no call and make ~$200k. There's still a huge shortage of mental health professionals and that likely won't be changing in the near future (next 10-15 years). It's also got a lot more flexibility in terms of job options, many of which don't require fellowship training. That means flexibility in terms of ways to make money as well, and it's definitely the field in which it is easiest to set up your own cash-only practice. In med school I was fortunate enough to rotate with some attendings who had somewhat unique positions, and this forum has actually been a great resource for learning what else is out there. As Texas said earlier, there is so much variation in psych that the average salary numbers are somewhat meaningless if you're willing to actually work to build your career.

So the tl; dr is no, the "average" salary in psych did not deter me from the field at all (and I'd argue should not be a prime reason to deter anyone).

 

[Merovinge]

work a 9-5 job with no call and make ~$200k.

Outside of very few markets, there should be no one making less than 230-250k working fulltime in psych unless you have very low case loads, research, significant other benefits (ala VA) even for full outpatient no-call jobs. This is not pediatrics.