How the competitiveness of medical specialties should be...

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I don't blame med students who shun psychiatry - this week "prescribing psychologists" (some of them actually call themselves "medical psychologists") got the thumbs up in Illinois to prescribe (with heavy restrictions though). Now it's LA, NM and IL. That's the first step. Second step is they'll erroneously claim their performance is equal to BC psychiatrists. Last step? What the CRNAs now do to Anesthesiologists- demand equal scope of practice. Why go through medical hoops if your online PhD in Psychology and some crappy part-time medical training makes you equal under the law? I wouldn't be surprised if psychiatry eventually goes down to 150k again after they plug the demand.

So factor in mid-levels. For example Derm got too greedy- they restrained supply too much and I'm positive Derm NPs will be big within 10 years. Ditto Pain-
states with independent NPs have plenty of shoddy pain clinics where they'll hire a schmuck Anesthesiologist looking for a 2nd job part-time to read charts for a 2-3 hours a week while they do their dangerous quackery.
As far as I know, there is no APA accredited online degree so I would not think there are crappy online degree licensed psychologists and from what I see the additional training guidelines are rigorous. At the hospital where I work, the medical doctors, some very good ones at that, would rather have myself and the other psychologists prescribe than the mid-levels and they count us as "real" doctors even. I had a good conversation about it with the ER doc just this past weekend. What I told him was that I would need to have sufficient education, training, and supervised practice before I could even begin making medication recommendations not to mention independent practice. As a licensed healthcare professional it is my ethical obligation to ensure that I am practicing within the scope of my level of competency and I make those decisions every day. So I take a little offense at the insinuation that psychologists are going to receive "an online PhD in Psychology and some crappy part-time medical training". Sure there are bad psychologists just as there are lots of bad doctors and I won't even argue which is worse since I doubt there is hard data on it.

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As far as I know, there is no APA accredited online degree so I would not think there are crappy online degree licensed psychologists and from what I see the additional training guidelines are rigorous. At the hospital where I work, the medical doctors, some very good ones at that, would rather have myself and the other psychologists prescribe than the mid-levels and they count us as "real" doctors even. I had a good conversation about it with the ER doc just this past weekend. What I told him was that I would need to have sufficient education, training, and supervised practice before I could even begin making medication recommendations not to mention independent practice. As a licensed healthcare professional it is my ethical obligation to ensure that I am practicing within the scope of my level of competency and I make those decisions every day. So I take a little offense at the insinuation that psychologists are going to receive "an online PhD in Psychology and some crappy part-time medical training". Sure there are bad psychologists just as there are lots of bad doctors and I won't even argue which is worse since I doubt there is hard data on it.

2 minutes of googling found an APA accredited online doctoral program in psychology.

http://www.fielding.edu/generalInfo/accreditation.aspx
 
they count us as "real" doctors even. Sure there are bad psychologists just as there are lots of bad doctors and I won't even argue which is worse since I doubt there is hard data on it.
Lol (for the bolded part)... just bad psychologists, but LOTS of bad doctors.
 
I added Rad Onc to the list under Competitive due to its no call, no weekends, high pay lifestyle, but semi-saturated to very saturated market in the big desirable cities and somewhat risky procedures from a malpractice standpoint. Also, days can be long and tiring going to tumor board and servicing multiple hospital sites for many Rac Onc docs. More and more they're becoming employees of hospital systems (hospital systems bid for the cheapest groups) which means less autonomy and less mobility, just like Radiology, Anesthesiology, and Emergency Med.
 
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@greenlion ... Isn't average psych salary between 150-180k anyway?

The trend seems to be a newly-minted psychiatrist out of residency picks up a 35hr per week job making $180K, and then starts his or her solo practice in tandem, making 25K, then 75K, then 150K as the practice grows in the first 6mo to a year and then quits the 35hr job. In CA it's quite acceptable to ask for $250 to $300 per hour from clinic patients. At that rate you can make anywhere from $200K to $400K depending on how hard you wanna push it and manage your already-low overhead. Bring in another partner, skim off your 25%, and now you're talking another 50K to 75K in passive income. No surgical equipment. No examination tables.
 
Nice add there @Frazier.

Notice how Gyn, Ortho, Thoracic Surg and Gen Surg have the most claims actually paid. All seem to be very very risky specialties.
 
so consensus here is psych is the way to go?
 
2014 Medscape Physician Report.

Overall career satisfaction across specialties:

fig25.jpg


http://img.medscape.com/pi/features/slideshow-slide/compensation/2014/public/overview/fig25.jpg

...and 2012 data for a bit of added reliability:

fig16.jpg

fig17.jpg

http://img.medscape.com/pi/features/slideshow-slide/compensation/2012/public/fig17.jpg
 
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Just an aside here, but I think I know why Neurology has a morbid 39% satisfaction rate for income. I was discussing this with a Neurology attending at my hospital and he said the big money-maker for Neurologists was NCSs and EMGs, and the govt just slashed payment for EMGs (and I think NCSs too). This cut also really hurt PM&R who utilize them regularly as well.
 
so consensus here is psych is the way to go?

Yes. Why would you take a job where your pay was in the hands of government-run insurance??
 
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Inaccurate study. The author of this study himself admits he does not have sufficient information and is basically guessing on alot of these results. His analysis looks like all the rest. The studies are far-fetched because they find the average salary (from internet sites like Salary.com) and then divide by the number of hours worked for a full time job for 11 months to account for vacation. This is NOT how to calculate psychiatry's hourly rate.

My best advice is to see what current psychiatrists are being offered, and do the math yourself. ie. 280K for 40hrs/week, 260K for 40hrs/wk, 175K for 20hrs/wk, etc.
 
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(the darn slow public computer double-posted on accident)
 
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Inaccurate study. The author of this study himself admits he does not have sufficient information and is basically guessing on alot of these results. His analysis looks like all the rest. The studies are far-fetched because they find the average salary (from internet sites like Salary.com) and then divide by the number of hours worked for a full time job for 11 months to account for vacation. This is NOT how to calculate psychiatry's hourly rate.

My best advice is to see what current psychiatrists are being offered, and do the math yourself. ie. 280K for 40hrs/week, 260K for 40hrs/wk, 175K for 20hrs/wk, etc.

I didn't know psychiatrists can make up to that much. Thanks.
 
I didn't know psychiatrists can make up to that much. Thanks.

there are outliers in everything....I know plenty of internists who make 500-650k...that doesn't mean it's typical. Overall psychiatrist is one of he lowest paying fields.

the way to make money in medicine is one of two ways- lots of volume, or lots of highly reimbursed procedures. Its hard to do good work in psych and do lots of volume, and obviously we have no procedures.
 
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This is basically what I realized in medical school. There were a few departments where everyone was happy to be at work, and psychiatry was one of them. My classmates seemed oblivious though and felt those fields were too boring. I'm pretty sure when I'm 60 I'll want "boring".

Personally I wouldn't care if surgery made a million dollars a year and every third patient was a puppy that just wanted to cuddle. I still wouldn't do it.

Yep, I realized this too. Not enough medical-types with a good entrepreneurial/business spirit. My epiphany was when I took the most recent statistics from the US Labor Department and broke physician compensation down into hourly rates. The list looked much, much different than what people are used to seeing. However, a couple of surgical specialties were still in the top, but psych and a few others moved way up.

One of my greatest moments in residency was getting on the elevator with a PGY3 medicine resident. He looked at my ID Badge and said, "Oh, psych huh. Don't you miss being a real doctor?". As the doors opened and I began to walk out on the main floor, I looked at him and smiled, saying, "Hmm, good question. I will think about that while I'm driving home". It was 3:30PM.
 
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What about running a telepsych network? A, "central" office in a more populated area staffed by yourself and mid-levels or other docs with satellite locations running telepsych platforms. I'm sure someone is already doing this.
 
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Yeah, I have always been an outside-the-box thinker. I'm always looking at systems and ways of doing things and thinking, "Wow, that's really stupid. It would probably be a lot better ... " Unfortunately, most times someone beats me to it before I'm in the position to do it myself.
 
Yeah, I have always been an outside-the-box thinker. I'm always looking at systems and ways of doing things and thinking, "Wow, that's really stupid. It would probably be a lot better ... " Unfortunately, most times someone beats me to it before I'm in the position to do it myself.

my dad does that because child psych is so rare in rural areas

he could make a lot more money, but he doesn't care about that. he only does it because of need.
 
I didn't know psychiatrists can make up to that much. Thanks.

Psychiatrists on the staff at hospitals make 250K in many parts of the country working a normal 40 hr week. I can give you the names of hospitals. PM if interested.

Coming out of residency you can make 200K easily. Grow your own practice and you double that number @Baller MD. What do you think $250 per hour gets you? one of the lowest paid specialties in medicine? Bull crap.
 
there are outliers in everything....I know plenty of internists who make 500-650k...that doesn't mean it's typical. Overall psychiatrist is one of he lowest paying fields.

the way to make money in medicine is one of two ways- lots of volume, or lots of highly reimbursed procedures. Its hard to do good work in psych and do lots of volume, and obviously we have no procedures.

Always a pessimist. When will you learn that salary surveys don't factor in fewer hours worked on average in psychiatry, and all the part-timers? Surprising coming from you. What offers have you gotten there in Alabama?

I would argue psychiatry is one of the best paid non-surgical specialties on an hourly basis. Who makes $200 per hour as readily as we do? The fact that we don't have procedures and make this much supports my point.
 
Always a pessimist. When will you learn that salary surveys don't factor in fewer hours worked on average in psychiatry, and all the part-timers? Surprising coming from you. What offers have you gotten there in Alabama?

well I'm not staying in Alabama, but mostly inpatient jobs in many parts of the state probably average 220-250k or so for full time work + maybe 1 weekend a month of call coverage.

Also, Alabama is a little unique in that one huge group controls virtually all the hospital contracts in the Birmingham area(and they've even expanded to a few other cities). So if one wanted to work in the Birmingham area(which is the only area of Alabama I would be ok with), you've really got no choice but to work for them if you want to do inpatient. And it's not the sort of group where your pt numbers are moderate if you know what I mean. Or you could work in academics which isn't going to pay nearly as much.
 
my dad does that because child psych is so rare in rural areas
.

Im sure there are some good child psychs out there(well I know there are), but to be honest I'm not sure having even more people out there throwing 9 year olds on Risperdal, Zyprexa, etc would be some great thing.
 
Im sure there are some good child psychs out there(well I know there are), but to be honest I'm not sure having even more people out there throwing 9 year olds on Risperdal, Zyprexa, etc would be some great thing.

i agree, but it is gonna happen anyways

at least have a child psych do it than a NP or GP

i'm sure you're tired of having to treat patients all messed up on GP meds
 
In regards to certain specialties ability to separate themselves from government regulation via reimbursement manipulation (ie medicare), here are some quantitative differences from 2012 across specialties (most are pretty logical, given the bread and butter of the field):

Specialists most likely to accept new Medicare patients now:
• Cardiologists (96%)
• Hematologists/Oncologists (96%)
• Urologists (95%)
• General Surgeons (92%)
• Anesthesiologists (91%)
• Neurologists (91%)
• Gastroenterologists (90%)
• Radiologists (87%)
• Orthopedic Surgeons (86%)
• Ophthalmologists (85%)​

Specialists least likely to accept new Medicare patients now:
• Adult Psychiatrists (57%)
• Plastic Surgeons (68%)
• Internists, Generalists (73%)
• Family Practitioners (75%)
• Obstetricians/Gynecologists (76%)​

http://www.jacksonhealthcare.com/media/137811/physiciantrendsreport_ebook0712-final.pdf
(Page 11)
 
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i agree, but it is gonna happen anyways

at least have a child psych do it than a NP or GP

i'm sure you're tired of having to treat patients all messed up on GP meds

the vast majority of patients I see on ridiculous polypharmacy regimens are from other psychs.......

And I don't see why it matters whether a child psych or psych np is prescribing Zyprexa to 9 year olds....result is the same. The vast majority of child psychs who see all these wild out of control 8 year olds on medicaid from terrible home environments see them for brief med checks and throw meds at them. And they do that because Medicaid doesn't pay enough for them to see the kid for longer periods of time, and they are being paid good money by some agency and that agency needs to recoup their money......the idea that we need more of those providers doing that is absurd in my opinion. It's almost like saying an area needs more drug dealers because the citizens are having to drive 45 mins to another area to get their fix.....
 
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@vistaril what do u suggest be done for those out of control 8 year olds from terrible home environments? Serious question. I think it's important for students (me) to understand the pessimists pov
 
Change of environment. But if being a zyprexa zombie keeps your drunk father from beating you for annoying him then maybe its the next best alternative.
 
Psychiatrists on the staff at hospitals make 250K in many parts of the country working a normal 40 hr week. I can give you the names of hospitals. PM if interested.

Coming out of residency you can make 200K easily. Grow your own practice and you double that number @Baller MD. What do you think $250 per hour gets you? one of the lowest paid specialties in medicine? Bull crap.

So I've looked at a few VA psychiatry jobs on their website and apparently it can pay up to 250k. That + pension must be a sweet gig. But I bet there's a catch like you won't be getting 250k starting.
 
So I've looked at a few VA psychiatry jobs on their website and apparently it can pay up to 250k. That + pension must be a sweet gig. But I bet there's a catch like you won't be getting 250k starting.

the VA has a pay scale depending on specialty....at the bottom of psychiatrist and outpt primary care. Then above that you things like pm&r, neurology. Anesthesia is above this. The highest paying specialties the VA actually doesn't have a lot of people on salary for.....this is more often contract work
 
the VA has a pay scale depending on specialty....at the bottom of psychiatrist and outpt primary care. Then above that you things like pm&r, neurology. Anesthesia is above this. The highest paying specialties the VA actually doesn't have a lot of people on salary for.....this is more often contract work

I know it depends on specialty. But I recall a post from a while ago about how the VA bumped the max salary for psychiatrist from around 200k to 250k maximum. How exactly do you get them to pay you 250k? I'm not sure how VA pay works. I just know that they interview you and meet up with a bunch of other people and try to figure out how much they are going to pay you after they have accepted you for the job, instead of telling you out-front how much you will be making during interviews. Although I could be wrong about this.
 
I know it depends on specialty. But I recall a post from a while ago about how the VA bumped the max salary for psychiatrist from around 200k to 250k maximum. How exactly do you get them to pay you 250k? I'm not sure how VA pay works. I just know that they interview you and meet up with a bunch of other people and try to figure out how much they are going to pay you after they have accepted you for the job, instead of telling you out-front how much you will be making during interviews. Although I could be wrong about this.

250 would be for senior/section head type job for someone with a lot of experience and would contain a lot of admin responsibilities.

Most of the VA jobs I looked at were going to pay in the 160 range
 
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250 would be for senior/section head type job for someone with a lot of experience and would contain a lot of admin responsibilities.

Most of the VA jobs I looked at were going to pay in the 160 range

I knew it was too good to be true.
 
I know it depends on specialty. But I recall a post from a while ago about how the VA bumped the max salary for psychiatrist from around 200k to 250k maximum. How exactly do you get them to pay you 250k? I'm not sure how VA pay works. I just know that they interview you and meet up with a bunch of other people and try to figure out how much they are going to pay you after they have accepted you for the job, instead of telling you out-front how much you will be making during interviews. Although I could be wrong about this.

Location plays a large role. Couple months ago I saw a posting for Appalachian VA salary range was listed as 200k-250k... Not a bad potential floor. 830-400 m-f. 5-6 weeks Vaca+all the federal days off. Limited to no call, IIRC. Wasn't admin/director/etc. Plain old psychiatrist listing.

Like someone mentioned earlier, tack on the sweet benefits package and typical pace for VA and it is an interesting opportunity if you don't mind the bread and butter patient population.
 
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Location plays a large role. Couple months ago I saw a posting for Appalachian VA salary range was listed as 200k-250k... Not a bad potential floor. 830-400 m-f. 5-6 weeks Vaca+all the federal days off. Limited to no call, IIRC. Wasn't admin/director/etc. Plain old psychiatrist listing.

Like someone mentioned earlier, tack on the sweet benefits package and typical pace for VA and it is an interesting opportunity if you don't mind the bread and butter patient population.

https://www.usajobs.gov/GetJob/ViewDetails/357066400

Different posting. Has some on-call duties...not as sweet as the Appalachian gig --not surprised it filled fast.

But salary range shows I wasn't imagining things -- they're out there occasionally.
 
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you only need internship yr for it? whats the pt of completed all four yrs of residency then?
 
you only need internship yr for it? whats the pt of completed all four yrs of residency then?

It does sound humorous, huh.

Nevertheless, the paragraph right below it basically says that you need to complete a psych residency.
 
For easy reference: summation of various posts/links from earlier.
Overall, not too shabby of a performance.

9QrUegy.jpg

image.jpg
 
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what are the hours like during psych residency?
 
what are the hours like during psych residency?

Depends on the program and the year.

Some community/cush ones might be more towards 40 hrs/week.
Some academic powerhouses might be more towards 70 hrs/week.

I imagine there are some that moonlight and grind to average 80 hrs/week.

For what I understand first 2 years are more intense that the last 2 (as call responsibilities often diminish in later years).
 
call? I assumed there were programs without overnight call or weekends
 
but is it overnight call or just evening?
 
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