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High-paying psychiatry residency program?

Discussion in 'Psychiatry' started by omnirom, 03.08.13.

  1. omnirom

    omnirom

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    I'm 6 figures deep in debt from school, and with an interest rate of 7%, I feel like I'm suffocating. Does anyone have recommendations for high-paying residency programs?
  2. F0nzie

    F0nzie

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  3. twright

    twright

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    Columbia probably pays the most in absolute terms, although the value probably gets eroded by the costs of housing. During your PGY3 and PGY4 years you convert to a New York State salary line and consequently get paid more ($75-80,000) than the other non-psych PGY3's & PGY4's ($56-58,000).

    The cost of living issue is not trivial. You could matriculate to the University of Iowa, for example, and make the same amount as a Columbia resident ($54-56,000 for PGY3 & 4). However, $50K in Iowa is like $109K in New York City:

    http://money.cnn.com/calculator/pf/cost-of-living/
  4. shan564

    shan564 Below the fray

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    We all have big debt with high interest rates. If you're highly concerned about the loans, you could try using a military loan repayment program.

    The salary isn't highly variable between different programs... usually ranges between $45k and $60k. If you really want to save a lot of money, the best way to do it is to go to a place with low cost of living.

    Also, moonlighting opportunities vary a lot from place to place. You can make a lot of extra money with moonlighting if you go to a program with a light call schedule. There are a lot of relatively cushy programs in psychiatry. If you want to work hard, you can clear six figures in PGY3 and PGY4.
  5. fzwarrior

    fzwarrior

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    Learn to salute.
  6. digitlnoize

    digitlnoize Rock God

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    Public Service Loan Forgiveness. Residency, then work for a non-profit (Academic, Jail, State Hospital. Or your own "non-profit" practice. Pay loans for 10 years under IBR (actually pay as you earn is even cheaper), and all remaining balances are forgiven. Poof. You're welcome.
  7. F0nzie

    F0nzie

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    I was interested in this route until I was informed that my wife's salary would be used in calculating the monthly payment. The math came out to 50k/year toward the loan. At that rate, I realized I was not going to have problems with a remaining balance after 10 years...
  8. notdeadyet

    notdeadyet Still in California Moderator

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    There is no contract for this. The possibility of this loophole being closed is high when the public gets wind of all the people earning $200K/year wiping out their entire school debt with a program designed for teachers and social workers.
    You can avoid that by filing "married filing separately." Just use turbotax or whatnot to estimate what kind of tax hit you'll take from filing separately. If it's not too bad, you can do IBR just based on your income.
  9. toothless rufus

    toothless rufus

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    Spouse salary doesn't have to be figured in. Just file taxes separately.
  10. F0nzie

    F0nzie

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    oh yea
  11. DJspreadsheet

    DJspreadsheet inside the box

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    It'd be a pretty cold shot to not grandfather all the people currently making the effort.

    There's also the argument that medicine is getting turned on its head, and this country needs physicians. The last bastion from indentured servitude is PSLF and pulling this card will make becoming a physician an even more precarious venture than it already is. Not the best PR move on the government's part.
  12. Bartelby

    Bartelby

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    Yale's salary was really high, and cost of living is low. I agree with the above about moonlighting probably mattering more in the end though (if you are willing to put that much time/effort into it).
  13. myPsychAlt

    myPsychAlt mailing bobcats

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    No one is really going to care... I ran the numbers and assuming I did a fellowship then, the eventual cost would equal somewhere between a zero% interest loan and actually making money on the deal as the total payment would be less than the disbursement of the loan. The loophole is going to close and it's going to close hard.
  14. DJspreadsheet

    DJspreadsheet inside the box

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    Well fortunately for those of us now starting residency, we'll at least get to see how they first respond prior to our job search.
  15. myPsychAlt

    myPsychAlt mailing bobcats

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    Just be safe and don't count on it. I've been talking with other residents who have debated refinancing the student debt to a home-equity loan. Lower interest rate by far, though the pros and cons are a little above my pay grade at this point.
  16. someguy321

    someguy321

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    i understand that you still pay income tax on the amount forgiven though, no? depending on one's debt and the interest accumulating, its not as sweet as it sounds.. but still will save money for most folks
  17. DJspreadsheet

    DJspreadsheet inside the box

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    No, you don't pay tax with PSLF.
  18. someguy321

    someguy321

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    dam.. thats too sweet then
  19. myPsychAlt

    myPsychAlt mailing bobcats

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    Another thing to remember is that if the loophole closes, there certainly will not be any "grandfathering." IIRC, PSLF happens when the person reaches the 10 year threshold and proves their employment, then get's forgiveness then. There's no "signing up" for the program outside of registering your employment, which isn't a binding agreement of any sort, just a way to save paperwork later.

    no guarantee. If they close this thing my money would be around 2017-2019 after the forgiveness starts to kick and and the government realizes how much money they're pissing away.
    Last edited: 03.09.13
  20. MDchouette

    MDchouette

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    I would agree with others who have said that moonlighting is where you are going to be able to make the difference, not in your salary. You can add $10-15K easily to your salary per year moonlighting. I would look for a program in a city with a low cost of living (no Boston or New York!) where you can moonlight starting in PGY3. I don't know if there are places where you can moonlight during PGY2.

    I would also check out the call schedule for PGY3. The less call you have, the more you can moonlight, and the less stressed you will feel by doing both moonlighting and call.
  21. ajndersn

    ajndersn

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    From what I understand MCW could be a great program in the midwest for good pay and good moonlighting. Salary is $54k and you could start moonlighting PGY-2. Milwaukee is very inexpensive as well.
  22. st2205

    st2205 PGY2

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    Housing is comparatively more expensive, and property taxes are outrageous. That said, it was my #2. Also, in addition to 54k they give you 1.5k on top of it.
  23. SmallBird

    SmallBird

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    At Yale you can moonlight as soon as you have done your CL rotation, which is in your pgy2 year. There is lots of internal moonlighting paying around $125 per hour (generally for a 16 hour on call shift at the 75 bed psych hospital), which added to the very high base salary (64k for pgy1 next year, plus health insurance) is certainly helpful.
  24. TexasPhysician

    TexasPhysician Moderator

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    Yes, there are programs that let you start moonlighting in PGY-2 as soon as you get your license at any place you wish. I pulled in maybe 25k before PGY-3.

    Heck Arkansas has internal moonlighting that you can start during PGY-1.....at least when I applied.
  25. Elle726

    Elle726

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    .
    Last edited: 06.18.13
  26. billypilgrim37

    billypilgrim37 Unstuck in Time

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    Since the new work hour rules were put into place, there has been no pgy1 moonlighting allowed per ACGME. I was moonlighting as a pgy1.

    Sent from my DROID RAZR using SDN Mobile
  27. Soggun

    Soggun

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    Specifics I can't get into since I don't go to these programs and don't know if anything has changed in the two years since I've been on the interview trail...

    That being said, the two programs I know about that stick out are Case Western (if I remember correctly, the reimbursement rate for moonlighting is quite high) and Cambridge Health Alliance (which I know a little more about, but has a pretty light call schedule and allows moonlighting starting in 2nd year... they also have pretty awesome benefits [stipends and such]).

    Hope that helps!

    Edit: I realized I should specify, one of the reasons you can moonlight at CHA is that the moonlighting I'm referring to is really just paid call in-house. Some programs will allow this type of arrangement since you can still be covered in the hospital under your limited license.
  28. toothless rufus

    toothless rufus

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    Is it unusual for a program contractually limit moonlighting to their institution only, preventing residents from finding their own (possibly better paying) gigs? How would they found out if you just did your own thing anyway? Kinda lame to mess with your nonresidency free personal time.
  29. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor

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    ?Free personal time? What's that? We OWN you.

    But seriously...you will need your program's reference to be credentialled to work as a physician somewhere else. And, unless you intend to lie, which would be most unprofessional of you, moonlighting applies to your duty hours reporting.
  30. notdeadyet

    notdeadyet Still in California Moderator

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    I haven't heard of programs doing this. I'm sure some do, but I wouldn't call it the norm. My place allows in-house moonlighting starting in PGY-2. The only limitations (other than hour restrictions) for doing moonlighting after that is that many places I contacted don't hire pre-PGY-3's.
  31. toothless rufus

    toothless rufus

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    Yes I understand that. But what I am saying is a program should not say, "yes you can moonlight...but only for us." Especially when there are NO in house opportunities at all. Even if there were plentiful opportunities, we should be able to moonlight wherever we want, as long as its within the 80 hr limit, no?
  32. Igor4sugry

    Igor4sugry Junior Member

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    There is a catch-22 with people who have lots of loans in IBR.

    If you moonlight and earn more, then next year your IBR payment will be higher.
  33. billypilgrim37

    billypilgrim37 Unstuck in Time

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    No. My program has internal and external opportunities, but they don't approve every external opportunity for various reasons. Internal opportunities offer significant protection and easier access to supervision. Our external opportunities are arranged so our internal malpractice covers us (they take a small cut, but it's reasonable). Moonlighting is a privilege, not a right, as long as you are bound to the acgme contract renewal you sign every year.

    Sent from my DROID RAZR using SDN Mobile
  34. Superpsych

    Superpsych

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    As others have said probably Midwest area programs with moonlighting would be the best money maker with the low cost of living plus some of them pay very well.

    Or you could sell a kidney.... just kidding :naughty:
  35. vistaril

    vistaril

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    most programs are going to approve *most* external moonlighting opportunities.....the only ones they likely wouldn't approve are shady or ethically questionable ones(such as non-physicians employing a psychiatry resident to be an adderall mill) or external moonlighting gigs that overlap with what should be time working on a rotation as part of the residency program.....

    usually most moonlighting is done on the weekends or evenings/nights when pgy-3's and 4's are not going to have any responsibilities with the residency program.

    Furthermore, duty hours for pgy 3's and 4s are never going to be an issue with moonlighting. I moonlight what is considered a bunch probably(probably make 90k or so this year doing it), but I've never even come remotely close to a work hours violation.....also keep in mind that I think you can go over 80 hrs one week, so it's the average over like 4 weeks that matters.....so if your hours(rotations + moonlighting) were 90 hrs, 60 hrs, 40 hrs, 65 hours you would be way way under the hour limits.

    but basically, unless your external moonlighting gig is really ridiculous, the program is going to ok it. If word got out that a psych program was trying to make moonlighting difficult for pgy3's and 4's, that wouldnt be good for the program in terms of its ability to attract decent people.
  36. vistaril

    vistaril

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    except for in house moonlighting(and some of it would require a medical license as well), apgy-1 in every state I know of wouldnt be eligible for a medical license and a medical license is going to be a requirement for moonlighting.
  37. toothless rufus

    toothless rufus

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    I sometimes wonder how much of a concern this is to some programs, as they know they willl fill regardless, or how concerned programs are in general about their residents, as some display their level of resident investment right at the start by having substantially lower salaries in the first place as compared to other local programs. Makes one want to pursue higher paying moonlighting gigs just to catch up to the status quo, and to deal with those programs as little as possible outside of the minimum hours required for the actual residency.
  38. vistaril

    vistaril

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    are there more than a few programs that have 'substantially lower salaries' though? I cant remember exactly what the salaries were for each program I looked into, but I dont think the highest and lowest differed by more than 7k in terms of pgy1 salaries, and *most* were within 2-3k of each other(the 7k differences were outliers)......a 2k difference you can more than make up for in just 1 weekend of moonlighting.

    I also don't think 'knowing they will fill' is or isn't that big of a deal...there are some decent programs that have had a year where they don't fill, and there are some godawful programs that always fill. A sketchy program can make sure they fill simply by inviting godawful candidates who are very unlikely to match and just ranking them somewhere on the list.....I think the reason residency programs generally allow external moonlighting to all pgy3's and 4's(as long as it doesnt seem illegal/unethical) is simply because there isn't any logical reason(from their pov) why they wouldn't. There is no advantage in any way to the program to say "you can't work that job"....they wouldn't benefit from it in any way, so even if there was no downside(residents badmouthing the program) it would still be permitted as it is now.
  39. nancysinatra

    nancysinatra

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    What do you mean it is a privilege? How on earth can it be a "privilege" to be "allowed" to work for a reasonable wage on top of working for peanuts for years in a situation that can only be described as Dickensian, whilst meanwhile your medical school loans have accumulated nearly as much in interest over the last four years as you've made in salary during that entire period? Are you applying for the job of Program Director somewhere?

    And in fact, it IS a right. Assuming you've passed Step 3, you can quit your job after intern year, get a state medical license, and "moonlight" until you hit Medicare age at some urgent care place if you so choose. That's called "working."

    I moonlight only so as to accumulate dough to pay off the capitalized interest on my loans, not so I can buy some Porsche or whatever or take off for weeks at a time to Bora Bora. Only my PD would describe this situation as a "privilege."
  40. billypilgrim37

    billypilgrim37 Unstuck in Time

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    It's a "privilege" because THEY have the "right" to revoke your ability to moonlight and maintain good standing in your program. You certainly have the right to leave a residency program and work. Just like many jobs have non-competes that don't let you work for other agencies, your residency program determines what you're allowed to do without jeopardizing your position in the program. You're simply not entitled to do whatever you want while you're a resident unless you want to have your position threatened.

    As vistaril rightly points out, most places place few or only reasonable restrictions, but work too many hours, the wrong hours, not having enough time between shifts, etc., and your program can revoke your moonlighting or put you on probation, and that sort of thing can have repercussions down the line when credentialing applications or even state license applications ask if there's ever been any disciplinary action against you (according to my state board at least, and our local managed care company, such academic--that's what it would be considered--probation counts, and not reporting it can cause you problems).

    This stuff clearly happens rarely, but it doesn't do anybody any good to go into these situations feeling entitled when you don't really hold the cards.
  41. shan564

    shan564 Below the fray

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    +1. It's perfectly reasonable for any employer to restrict you from taking other jobs. Especially if you agreed to that policy when you accepted the job. Moonlighting policy is usually out in the open at the residency interview.
  42. vistaril

    vistaril

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    i think it's important to remember a few things(which I've partly already touched on):

    1) Programs don't have any interest/anything to gain from pgy3-4 residents *not* moonlighting. Why would they care if I'm covering a unit on the weekend an hour away vs playing golf?

    2) Programs generally want happy residents. I would imagine it would be *very difficult*(in already difficult field from the programs perspective) to recruit decent candidates if all the pgy3+ residents are bitter and resentful towards the program, which a no(or unreasonably limited) moonlighting policy would generate. Applicants pick up on those vibes.

    3) Any program that prevented pgy-3 residents from moonlighting would likely justify it on the basis of the resident 'not being ready' for such clinical duties. If that were the case, you can bet the residents who want to moonlight would attack each subsequent rotation they are on for every little detail that isn't designed to maximize training/education experience. Programs don't want to have to deal with this.

    So while in theory the program does have total control over your ability to moonlight, the reality is that these things are going to practically limit it, or We did have one resident a couple of years ago have a moonlighting job rejected, but it was truly some ridiculous gig that screamed pill mill.
  43. Superpsych

    Superpsych

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    How it was explained to me was that they really only care if: it is a shady place to moonlight, you are over duty hours, or not ready clinically.
  44. LimbicResponse

    LimbicResponse Analyzing your every move

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    I know of a couple of programs that have no moonlighting pgy3 , some but little moonlighting pgy4. One of them somehow manages to get over 14 residents every year ... During the interview season, moonlighting seemed a bit of a secret thing to talk about at a lot of programs.
  45. notdeadyet

    notdeadyet Still in California Moderator

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    Exactly. And by "not ready clinically," they really mean if you're struggling in your program.
  46. nancysinatra

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    I hardly feel entitled. But you do hold the cards. You always hold the cards that determine what happens in your own life. None of us are enslaved, certainly not to this profession. But the thing is, it is NOT a "privilege" to moonlight, especially not if the moonlighter in question is at a program with less than average pay or benefits and has already paid for their education, and knows their license will be revoked if they default on their loans! That's like saying to a Russian serf that it was a "privilege" that they might get to empty the chamber pot of the highest overlord once and awhile in exchange for some extra gruel, seeing as otherwise they were close to starving. That's NOT a privilege. That's merely yet one more demeaning condition of serfdom. Perhaps you might describe it as a "perk" subject to the mercurial whims of the overlords.

    My point is, you SOUNDED like a PD in your post above what with using admin-speak. Now normally you don't sound like a PD... unless you've gotten a new job?
    Last edited: 03.12.13
  47. nancysinatra

    nancysinatra

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    That's because you're supposed to go to your interviews acting like you are eager to work for absolutely free, you are so enthusiastic about learning the essentials of psychiatry and providing care to patients that the thought of compensation hasn't even crossed your mind and to be honest you'd feel more comfortable just not discussing that part of it, and maybe not even being compensated seeing as that could corrupt the purity of your learning experience.

    There are definitely programs that will accommodate this wish.
  48. shan564

    shan564 Below the fray

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    Yeah, that was my outlook. I never asked about moonlighting or salary or cost of living... partially because I wanted to give that "eager" impression, and partially because it didn't really have that big of an impact on my decision.
  49. billypilgrim37

    billypilgrim37 Unstuck in Time

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    You know, I was chasing this white rabbit the other day, and he went in this hole, and... ;)

    Folks in non-psychiatric fields moonlight a LOT less than we do (for lots of good reasons), and even the very good program at my medical school allowed very little moonlighting (at least, there wasn't much available that didn't involve a long drive, and even then, not much). There have been people at my program who have seriously pushed the limits of what they should be able to do and almost ruined it for the rest of us by being idiots. So when I say it's a privilege, I'm talking to the people who were moonlighting 50-60 hours a week despite being given multiple warnings and violating duty hours left and right.
  50. nancysinatra

    nancysinatra

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    Thank you BP for clarifying! That makes more sense. (And I am glad you are back from your brief stint as a PD ;-) )

    Yeah I know we are lucky to get to moonlight--it's added to my salary quite nicely. Surgery folks can't moonlight at all from what I hear. And yeah, folks that push the limits should be voted off the island. They are putting us all in jeopardy. If there's people at your program doing that they are real dolts. I know my own PD has a master's degree or PhD in "officially adhering to and documenting all institutional, program, and ACGME regulations" and would love nothing more than to catch some resident in the act of moonlighting 1 nanosecond more than allowed and have them swiftly and summarily dismissed citing "total disregard for professionalism and systems based knowledge." So yeah we gotta watch out.

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