How the competitiveness of medical specialties should be...

[DD214_DOC]

Was enough wearing green, eh?

In some ways. It's not terrible, but I just want complete control over my life. Since, you know, it is mine and all.

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[SMC123]

I got two questions for you guys.
1. This post started off by saying that psych salary is about 200k, with some regions reaching (225k, midwest). Now we are talking about how that is only possible outpatient once you have an established practice, and not salaried at the hospital. What are the real chances of making that much? Comparing it to PM&R, IM, Neuro?

2. How does a psych intern year differ from ones for em, im, neuro, pm&r? Are there any differences?

 

[Leo Aquarius]

I got two questions for you guys.
1. This post started off by saying that psych salary is about 200k, with some regions reaching (225k, midwest). Now we are talking about how that is only possible outpatient once you have an established practice, and not salaried at the hospital.

Wait, who said that?

Starting salaries in psych I've seen for salaried positions (full-time) ranged from 200K to over 300K (some geriatric job in Florida). A graduate from my program last year got a government job with the state and started at 220K, and that's government. Another graduate from a while back worked for the prison system and started somewhere around 210K. Another graduate went on to work for a mental health clinic and she started above 200K. Another got a job working less than 40 hrs a week at a psych emergency center and started OVER 250K. Another found a job in Pennsylvania making around 285K. So I know for a fact you can start very well in psychiatry in a salaried spot.

Now this discussion is just looking at starting salaries, since I'm assuming you are talking about starting salaries.

When you talk private practice the pay is largely geographical dependent, but in the geography around me people charge $250 or $300 an hour typically (some more). So calculate the salary from that.

A famous investment firm once came to my residency to give a dog and pony show about how knowledgeable and capable they are at helping doctors invest. One of the things they talked about was the increase in salaries for psychiatrists over the past 5 years. They said 5 years ago starting salaries sat around 180K. Now all they see are over 200K. So there's a trend, and I hope that trend will continue as society wakes up to the need for better mental health care.

 

[Leo Aquarius]

One of the big reasons I'm pushing for finding your own balanced life is because I've talked with many hospice patients and gained some perspective on life from their stories. They all say at one point or another that they wish they hadn't worked so hard and occupied their mind and time away from family. The other big regret was becoming something others wanted them to become and not what they themselves wanted to become. This was summarized in a very nice Op Ed piece in The Guardian.

http://www.theguardian.com/lifeandstyle/2012/feb/01/top-five-regrets-of-the-dying

 

[Nasrudin]

I agree passionately with Leo above. The salary was heavy on my mind for a a while as I contemplated the sum total of my loans. But....what I decided was that I can manage that by living more spartan. Not by compromising what I want to do with my life.

I'm now looking around for what would be a stimulating and rewarding career in psych. You should do the same wherever you go.

Regarding the intern year it's typically much lighter and less grueling than a full medicine year. Which is I think what neuro, PM&R, and of course medicine do. EM you'll have some off service months and then x amount of shifts per month in the ED. You should consult those forums or colleagues for specifics.

And it varies a lot program to program. For instance I'm working like a medicine intern in a busy NYC hospital. 80 plus/week. With some more human friendly spurts of neuro.

Some psych programs have a mix of ED and outpatient medicine months.

But all of us will do 6 months of medicine and neuro and 6 months of inpatient and ED psych as interns.

If you're thinking of doing IM. Stop. And punch yourself in the nuts. Feel that pain. It's a tiny fraction of what you have in store. Contemplate. Correct. And go PM&R or psych or ED.

 

[vistaril]

I got two questions for you guys.
1. This post started off by saying that psych salary is about 200k, with some regions reaching (225k, midwest). Now we are talking about how that is only possible outpatient once you have an established practice, and not salaried at the hospital. What are the real chances of making that much? Comparing it to PM&R, IM, Neuro?

2. How does a psych intern year differ from ones for em, im, neuro, pm&r? Are there any differences?

It's fairly easy to get a starting job for around 200-225 in many places right out of residency for an employed inpatient hospital positions. Tons of national hospital corps(UHS, HCA, a few others) are offering this....now whether it is a good job or not is another story. Right now UHS recruiters are telling me that their avg salaries for inpatient employed positions are in the low 200s....same for HCA. Now their inpatient medicine/hospitalist jobs only pay slightly more than that(HCA recruiter said just 10k more on average).....but the HUGE difference is they let their inpatient hospitalists work a lot of other jobs while they are simultaneously working their work week as a hospitalist. UHS does at least, not sure about HCA but I think they have the same policies. So that's a big difference....having to be present all day vs just coming in and rounding on your patients that have already been seen by someone else and then going and seeing more inpatients at another paid contracted out job. Could eb the difference between making 450k in IM vs 225k in psych.

I've actually taken a UHS position, so I'm fairly familar with them.

But these aren't 'lifestyle' positions....for the security of a comfortable salaried check with benefits right out of residency you give up a lot....autonomy, lifestyle, patient population, etc....

 

[vanfanal]

I agree passionately with Leo above. The salary was heavy on my mind for a a while as I contemplated the sum total of my loans. But....what I decided was that I can manage that by living more spartan. Not by compromising what I want to do with my life.

I'm now looking around for what would be a stimulating and rewarding career in psych. You should do the same wherever you go.

Regarding the intern year it's typically much lighter and less grueling than a full medicine year. Which is I think what neuro, PM&R, and of course medicine do. EM you'll have some off service months and then x amount of shifts per month in the ED. You should consult those forums or colleagues for specifics.

And it varies a lot program to program. For instance I'm working like a medicine intern in a busy NYC hospital. 80 plus/week. With some more human friendly spurts of neuro.

Some psych programs have a mix of ED and outpatient medicine months.

But all of us will do 6 months of medicine and neuro and 6 months of inpatient and ED psych as interns.

If you're thinking of doing IM. Stop. And punch yourself in the nuts. Feel that pain. It's a tiny fraction of what you have in store. Contemplate. Correct. And go PM&R or psych or ED.

What's wrong with IM again? I ask because I'm on a psych elective right now and am contemplating if I want to do it. Now I'm wondering if I should do IM. I think I've largely forgotten what it was like since I did it a year ago (research this year). Care to remind me of what I may be blocking?

 

[vistaril]

What's wrong with IM again? I ask because I'm on a psych elective right now and am contemplating if I want to do it. Now I'm wondering if I should do IM. I think I've largely forgotten what it was like since I did a year ago (research this year). Care to remind me of what I may be blocking?

I think if you work it right, IM can be very very laid back and lucrative.

 

[Nasrudin]

What's wrong with IM again? I ask because I'm on a psych elective right now and am contemplating if I want to do it. Now I'm wondering if I should do IM. I think I've largely forgotten what it was like since I did it a year ago (research this year). Care to remind me of what I may be blocking?

Well. There this this effect of being a useless clerk that tends to distort the fun of solving IM academic puzzles. Which become by comparison a fun skill building exercise. You like it when you get that UWorld question about cystic fibrosis right that only 15% of people did. And so on. So it seems interesting. After you clerk for some hours where you have little responsibility and you're rarely on call or there until late. And you cut out for holidays and lectures and whatever you can make up for not being there. It seems ok in this light. And you imagine it's awesome being a Real Doctor.

Then you become an intern. And get strapped, like a beast of burden, to pull all the details of patient care along for long boring hours. Clicking your life away under the fluorescent lights. Where thinking and studying up on the stuff coming at you means the difference between getting out of there to catch the last glimpse of sunlight. Or living a completely subterranean existence. Like a mole.

You'll never know the pure ecstasy of dropping a rec and hauling @ss. Or being able to gently cut off a patient who wants to know who will take of their cat while they're in the hospital and wants to know if you can call their cousin Edna in Long Island to tell her about the cat...etc...etc....etc...by saying yeah...uh...you're going to need to follow that up with your primary team. MmmmK. Thanks. Tootles.

Well that poor f@ck in the middle of everything. Who's everyone's b!tch. Is you. If you go IM and don't compete like hell, with everyone else who discovered what a **** train you all are on, to get one of the sweet fellowships to get you off it.

Being square in the middle of the medical bureaucracy puts your dumb ass in the middle of The **** Show.

You've been warned.

 

[vanfanal]

Well. There this this effect of being a useless clerk that tends to distort the fun of solving IM academic puzzles. Which become by comparison a fun skill building exercise. You like it when you get that UWorld question about cystic fibrosis right that only 15% of people did. And so on. So it seems interesting. After you clerk for some hours where you have little responsibility and you're rarely on call or there until late. And you cut out for holidays and lectures and whatever you can make up for not being there. It seems ok in this light. And you imagine it's awesome being a Real Doctor.

Then you become an intern. And get strapped, like a beast of burden, to pull all the details of patient care along for long boring hours. Clicking your life away under the fluorescent lights. Where thinking and studying up on the stuff coming at you means the difference between getting out of there to catch the last glimpse of sunlight. Or living a completely subterranean existence. Like a mole.

You'll never know the pure ecstasy of dropping a rec and hauling @ss. Or being able to gently cut off a patient who wants to know who will take of their cat while they're in the hospital and wants to know if you can call their cousin Edna in Long Island to tell her about the cat...etc...etc....etc...by saying yeah...uh...you're going to need to follow that up with your primary team. MmmmK. Thanks. Tootles.

Well that poor f@ck in the middle of everything. Who's everyone's b!tch. Is you. If you go IM and don't compete like hell, with everyone else who discovered what a **** train you all are on, to get one of the sweet fellowships to get you off it.

Being square in the middle of the medical bureaucracy puts your dumb ass in the middle of The **** Show.

You've been warned.

Wow, that certainly jogs some memories, mainly the unhappiness I felt in IM. Although if you can stick it out, some of those fellowships are pretty sweet gigs.

Speaking of cats, I actually spent about 2 hours today trying to find a home for three cats who belonged to one of my patients on the adult inpatient psych unit I'm on. I enjoyed it though, and the team was very appreciative of my work.

 

[vanfanal]

Just wondering, on my elective the day pretty much finishes around 3:30-4:00pm. We see 6-8 patients, I finish up all the work with my attending, and he's gone by 3:30-4:00pm. I typically stay behind just to see if there's anything extra I can do, but the day is pretty much over. Just wondering if this is typical or not. It's weird having the time to exercise and actually cook food these days, though I aint complaining.

 

[SMC123]

are you in residency or med school?

 

[vistaril]

Well. There this this effect of being a useless clerk that tends to distort the fun of solving IM academic puzzles. Which become by comparison a fun skill building exercise. You like it when you get that UWorld question about cystic fibrosis right that only 15% of people did. And so on. So it seems interesting. After you clerk for some hours where you have little responsibility and you're rarely on call or there until late. And you cut out for holidays and lectures and whatever you can make up for not being there. It seems ok in this light. And you imagine it's awesome being a Real Doctor.

Then you become an intern. And get strapped, like a beast of burden, to pull all the details of patient care along for long boring hours. Clicking your life away under the fluorescent lights. Where thinking and studying up on the stuff coming at you means the difference between getting out of there to catch the last glimpse of sunlight. Or living a completely subterranean existence. Like a mole.

You'll never know the pure ecstasy of dropping a rec and hauling @ss. Or being able to gently cut off a patient who wants to know who will take of their cat while they're in the hospital and wants to know if you can call their cousin Edna in Long Island to tell her about the cat...etc...etc....etc...by saying yeah...uh...you're going to need to follow that up with your primary team. MmmmK. Thanks. Tootles.

Well that poor f@ck in the middle of everything. Who's everyone's b!tch. Is you. If you go IM and don't compete like hell, with everyone else who discovered what a **** train you all are on, to get one of the sweet fellowships to get you off it.

Being square in the middle of the medical bureaucracy puts your dumb ass in the middle of The **** Show.

You've been warned.

being an IM intern during residency has almost nothing in common(in terms of the stuff you talk about above) with working different contracted hospitalist gigs in private and community hospitals.

The hospitalists I know out in community practice come in, do their work, and then touch base with SW to see how all that stuff shakes out. The consult world is completely different as well as specialists are grateful for your consults, and are eager to make your job easier(so they can get $$)....and making your job easier means giving you plenty of time to get to that other hospital 25 minutes away to see your patients there(where you are also on salary)....

I had no interest in doing IM/hospitalist, but if you do it right and are willing to hustle the money can be very good(500 or more)

 

[bronx43]

Well. There this this effect of being a useless clerk that tends to distort the fun of solving IM academic puzzles. Which become by comparison a fun skill building exercise. You like it when you get that UWorld question about cystic fibrosis right that only 15% of people did. And so on. So it seems interesting. After you clerk for some hours where you have little responsibility and you're rarely on call or there until late. And you cut out for holidays and lectures and whatever you can make up for not being there. It seems ok in this light. And you imagine it's awesome being a Real Doctor.

Then you become an intern. And get strapped, like a beast of burden, to pull all the details of patient care along for long boring hours. Clicking your life away under the fluorescent lights. Where thinking and studying up on the stuff coming at you means the difference between getting out of there to catch the last glimpse of sunlight. Or living a completely subterranean existence. Like a mole.

You'll never know the pure ecstasy of dropping a rec and hauling @ss. Or being able to gently cut off a patient who wants to know who will take of their cat while they're in the hospital and wants to know if you can call their cousin Edna in Long Island to tell her about the cat...etc...etc....etc...by saying yeah...uh...you're going to need to follow that up with your primary team. MmmmK. Thanks. Tootles.

Well that poor f@ck in the middle of everything. Who's everyone's b!tch. Is you. If you go IM and don't compete like hell, with everyone else who discovered what a **** train you all are on, to get one of the sweet fellowships to get you off it.

Being square in the middle of the medical bureaucracy puts your dumb ass in the middle of The **** Show.

You've been warned.

"Compete like hell?" Lol, wut? If you're a decent medical student from an American school, then you'll likely match into a decent academic institution. If you're from a decent academic institution, then you should have zero issues matching into whatever specialty you pick as long as you aren't a total dumba**. Hospitalist at a private hospital can be a sweet gig, but I agree that it isn't the most glamorous thing in the world. If you go into IM, I would not think twice about doing a fellowship. GI, cardio, pulm/CC, heme/onc are all sweet gigs that I would take in a heartbeat over the likes of ED, psych, and PM&R. Even the lesser known IM subspecialties are hidden gems like allergy&immunology, and even rheumatology (about to explode with new biologics = lucrative infusion centers a la heme onc).

On the other hand, if you're a FMG and/or below average student, and you think you might not be able to land a fellowship (AND cannot stand the idea of doing hospitalist work), then yes, go for PM&R or psych.

I would avoid EM at all cost, but that's just me... I would rather gore myself with a rusty pole than do random night shifts at the age of 50.

 

[Girly X]

As someone considering Psych, but with all the "usual" concerns, this thread has been quite an interesting and informative read.

Carry on

 

[SMC123]

I just dislike the whole physical examination part all together. I dont ever know what I am listening for with hearts and lungs, what im looking for in the ear..just go through the motions

 

[Leo Aquarius]

... I would not think twice about doing a fellowship. GI, cardio, pulm/CC, heme/onc are all sweet gigs that I would take in a heartbeat over the likes of ED, psych, and PM&R. Even the lesser known IM subspecialties are hidden gems like allergy&immunology, and even rheumatology (about to explode with new biologics = lucrative infusion centers a la heme onc)...

It's great to get perspective on things around here. Very refreshing to read your post bronx.

I'm glad those specialties appeal to you. Let me quickly share my take on them:

GI is all about fitting 10 colonoscopies into a day. Yes, I worked for a GI clinic for a summer and that's the pace. That's frankly not how I want to spend my time. Too dirty.
Cardio.... I love cardiology, but it's exhausting hours. Spoke to a few cardiologists and they all said you'll spend more time in the hospital than anywhere else. They looked pale and tired.
CC, I loved it and was really good at it in med school. But hey, tweaking vent settings and having intubated patients wasn't my thing. I need patients to communicate with.
Heme/onc, another rotation I actually did in med school and loved. But it made me very sad 1) seeing doctors break terminal news to patients, and 2) seeing patients who are slowly dying.
ED, I agree with you 100%. There's no way in hell anyone is going to get me out of bed in the middle of the night away from my family. Night time is my private time. Protected. Sacred.
PM&R, nobody knows who or what they do outside of medicine. It's the new kid on the block, too new for my liking. It tries to be neuro light and ortho light without the surgery.
Surgical specialties are fascinating, but I personally hated being in the OR.

Well, that's my 2 cents. Psych is all about what I consider most important, the patient-doctor therapeutic alliance. And it's ALWAYS interesting.

 

[Nasrudin]

Different strokes I suppose.

I still maintain that IM is a set up for unsuspecting medical students.

Go for it and come back tell us how awesome it is.

 

[Armadillos]

I'm sure there are some amazing hospitalists jobs out there (just like there are amazing psych jobs), but universally the feeling I get from IM people is that hospitalists are overworked and the work is not very glamorous. Seems like there are very few hospitalists who would say being a hospitalists is their passion or calling.
On the other hand in smaller tons you have those general IM docs who still admit and care for their own patients and despite having way worse hours and making less than hospitalists they actually seem incredibly fulfilled because its very rewarding work and they have great long term relationships with their patients.

 

[bronx43]

It's great to get perspective on things around here. Very refreshing to read your post bronx.

I'm glad those specialties appeal to you. Let me quickly share my take on them:

GI is all about fitting 10 colonoscopies into a day. Yes, I worked for a GI clinic for a summer and that's the pace. That's frankly not how I want to spend my time. Too dirty.
Cardio.... I love cardiology, but it's exhausting hours. Spoke to a few cardiologists and they all said you'll spend more time in the hospital than anywhere else. They looked pale and tired.
CC, I loved it and was really good at it in med school. But hey, tweaking vent settings and having intubated patients wasn't my thing. I need patients to communicate with.
Heme/onc, another rotation I actually did in med school and loved. But it made me very sad 1) seeing doctors break terminal news to patients, and 2) seeing patients who are slowly dying.
ED, I agree with you 100%. There's no way in hell anyone is going to get me out of bed in the middle of the night away from my family. Night time is my private time. Protected. Sacred.
PM&R, nobody knows who or what they do outside of medicine. It's the new kid on the block, too new for my liking. It tries to be neuro light and ortho light without the surgery.
Surgical specialties are fascinating, but I personally hated being in the OR.

Well, that's my 2 cents. Psych is all about what I consider most important, the patient-doctor therapeutic alliance. And it's ALWAYS interesting.

Well, yeah. I mean, you do what you like - no one can tell you otherwise. What I was saying about the IM subspecialties is that many offer incredible pay and lifestyle. It's cool that you don't like colonoscopies (me neither), but you can't go wrong with making $450k with regular hours and minimal call. The thing with IM is that it's easily the most versatile field you can go into, because of the wide variety of different subspecialties you can choose from. There is the intense, almost-surgery field like interventional cardiology, or you have derm-lite with allergy & immunology. And then you have everything in between. I personally think rheumatology is one of the most fascinating fields in all of medicine, and it's set to explode. I think it's at a point where heme onc was 20 years ago. I'm expecting competitiveness of rheumatology to shoot up in about 5 years when people realize you can set up your own shop (Arthritis Center of [insert city]), do injections, DEXA scans, and own infusion centers while working 45 hours a week. You also have longitudinal care for patients with fascinating diseases like scleroderma, lupus, vasculitis, etc.
I'm assuming you are a decent student from an American school, so you should have minimal fears about not matching the fellowship of your choosing. You might not be able to do cardio at Mass General, but I don't hear of many AMGs from respectable institutions that don't match at all.

 

[SMC123]

first you have to survive the first three yrs of im residency

 

[bronx43]

first you have to survive the first three yrs of im residency

Huge misconception all medicine residencies are brutal. Sure, there are programs that are malignant that will work you 90+ a week, but those are going by the way of dinosaurs. Don't get me wrong, IM residency isn't a cake walk, but it is very very manageable, and is borderline easy if you find a supportive program. Out of all my friends that are doing IM at academic centers, only one is at a shop that is "old-school." Everyone else rarely ever breaks or even comes close to breaking hours. I average 65 hours at my institution while on service months, and around 35 hours on elective/clinic months.

 

[Over9000]

Pathology is the best field in medicine, if you can find a job.

The hours are generally regular, the pace of the work is not extreme, its mostly thinking (similar to psych) with very few procedures. Paths make a massive impact on patient care, even though the work is done behind the scenes. The income, again if one can find a job, can be quite good (around the level of derm).

In regards to the stuff that tends to deter people from path: autopsies are extinct and generally worthless, grossing is generally done by technologists, and forensics is, well, you don't have to do any if you don't want to ( why anyone would perplexes me).

It is a shame that medical students are put off of path. It probably has to do with a lot of things including the stigma of being a pathologist, the whole legendary autopsy ritual, being exposed to academic pathologists who are by and large very strange individuals, the FMG-heavy nature of the field (makes the field seem like it is less prestigious/worthy of strong domestic talent), the complete lack of exposure to the day-to-day practice of pathology in medical school, and most of all, the very bad job market.

 

[SMC123]

how bad is the job market honestly? if its really that that bad why do students keep taking the risk of going into it

 

[Over9000]

how bad is the job market honestly? if its really that that bad why do students keep taking the risk of going into it

Very bad. Everyone basically requires a fellowship to land a job. Often, two fellowships are done. Even then, finding a job is not a guarantee - the proportion of fellows who can't find a job after two fellowships is somewhere in the teen percentages. There's a study posted in the pathology forum - the ASCP job market survey - that outlines this.

Most students in path are FMGs who are looking for a way into the American system. It's an easy door to entry, and some come in with hopes of transferring once they get their GME funding. Others enter it because, frankly, they would never be able to practice clinical medicine due to intellectual or professional deficiencies. As for AMGs, many are derm/rads rejects who back up with pathology for the lifestyle or hopes to get into a dermpath fellowship. Others are path keeners, but those tend to go to the major academic programs like MGH where the pedigree is enough to land a job.

 

[vistaril]

Huge misconception all medicine residencies are brutal. Sure, there are programs that are malignant that will work you 90+ a week, but those are going by the way of dinosaurs. Don't get me wrong, IM residency isn't a cake walk, but it is very very manageable, and is borderline easy if you find a supportive program.

Agreed....and many programs let you do 8-9 elective months your third and last year. At some community and laid back academic programs with good lifestyle, the medicine residents are frequently leaving at 1-2 pm.

When I did medicine as an intern(not at a community place but a fairly large academic center), you had to get their pretty early(715-730), but I was usually checking out around 2-230 every day....

 

[vanfanal]

Wow, that certainly jogs some memories, mainly the unhappiness I felt in IM. Although if you can stick it out, some of those fellowships are pretty sweet gigs.

Speaking of cats, I actually spent about 2 hours today trying to find a home for three cats who belonged to one of my patients on the adult inpatient psych unit I'm on. I enjoyed it though, and the team was very appreciative of my work.

are you in residency or med school?

Med school.

 

[vanfanal]

I agree passionately with Leo above. The salary was heavy on my mind for a a while as I contemplated the sum total of my loans. But....what I decided was that I can manage that by living more spartan. Not by compromising what I want to do with my life.

I'm now looking around for what would be a stimulating and rewarding career in psych. You should do the same wherever you go.

Regarding the intern year it's typically much lighter and less grueling than a full medicine year. Which is I think what neuro, PM&R, and of course medicine do. EM you'll have some off service months and then x amount of shifts per month in the ED. You should consult those forums or colleagues for specifics.

And it varies a lot program to program. For instance I'm working like a medicine intern in a busy NYC hospital. 80 plus/week. With some more human friendly spurts of neuro.

Some psych programs have a mix of ED and outpatient medicine months.

But all of us will do 6 months of medicine and neuro and 6 months of inpatient and ED psych as interns.

If you're thinking of doing IM. Stop. And punch yourself in the nuts. Feel that pain. It's a tiny fraction of what you have in store. Contemplate. Correct. And go PM&R or psych or ED.

I think that's my biggest problem. Money is "heavy on my mind" as well.

 

[Nasrudin]

I think that's my biggest problem. Money is "heavy on my mind" as well.

I hear you. It's daunting. But I think I'm just comfortable with a small life style. Partly by necessity as I like the most expensive cities best. But I mean it when I say shrunken. Small apartment. No car. Short walking commute. No traveling for vacation. Just hanging out in my cool city taking fun day trips. No expensive objects that are nonfunctional. And I plan on working hard. Full time job plus a side gig.

When I combine the flexibility and demand of psych, I like my chances of chipping away at my debt in good time.

I think within 3-5 years after graduating I could easily see myself slowing up a bit and being more selective in finding a great fit for a job.

That said. I ruled out pediatrics purely based on low salary. I really like working with children. But I'm not signing up for NP money after working this hard. Ain't happenin.

 

[Leo Aquarius]

Money and lifestyle occupy opposite ends of the proverbial seesaw. The more you tip towards money, the more you tip away from lifestyle and vice-versa. One goes up as the other goes down. Where you want to fall on that seesaw will determine your happiness. For psychiatrists you give up a little on average income but gain a ton on lifestyle. The extreme would be brain surgery. Big money. No lifestyle.

In my opinion a few specialty set-ups seem to defy the seesaw analogy. Any private practice that pays a high hourly wage and requires minimal manual work AND is in high demand would do that. Psychiatry, amazingly, falls into this camp, along with a rare few others. Dermatology / Cosmetics / Plastics. Some ophtho. Infertility clinics. Health spas. Maybe a dozen or so pathology groups in the entire country.

A few specialties defy the seesaw analogy in the opposite direction. Peds is so low-paying that you put in lots of hours for moderate pay - and God forbid you try to tip in favor of lifestyle and that money side falls into the ground. For pathology, just finding a damn seesaw is a miracle (and many of those jobs are being farmed out to pod labs). Look at anesthesiology. Their pay seems to keep getting cut by 10% every few years according to a doctor I know in CA. And then there's the rest of middle class America. They struggle to make ends meet, many working two jobs because the economy laid off so many people in the last 5 years. They don't even have a nice mechanism that pays well according to effort put in. So let's be thankful psychiatry is in such demand and our salaries are rising with the lowest malpractice rates and such high satisfaction rates.

 

[MacDonaldTriad]

Nasrudin and Leo, thank you for some validation of what I have been trying to say. You put it better than I did, but I will try again. If you cannot live below your means as a psychiatrist, you have some really wicked expenses that far exceed medical school. It would take a cocaine problem, a large dysfunctional family with personal weak boundaries, or a huge medical problem to exclude psychiatry as a viable option for most medical graduates. We do make enough money for a reasonable person. If you need to be Donald Trump, you missed that boat when you got into medicine.

 

[vistaril]

I think that's my biggest problem. Money is "heavy on my mind" as well.

Hate to break up this cheerleading session, but how much money a physician makes is mostly dependent on two factors: how many patients they can see/procedures they do in a given time interval and how much they get paid for each pt encounter/procedure.

It really is that simple.

And psych scores at or near the bottom in both. We spend more time with our pts per encounter than other physicians. Far more in some cases. And we certainly don't make up for that lost volume with high reimbursements per encounter compared to other specialties.

Can an employed psych who hustles make 300k? Sure....in some areas yeah with the right gig and a little extra work. But that scenario certainly won't be a lifestyle one, or one that is likely very satisfying. And one can make 500k applying those same principles in primary care in some areas.

 

[Nasrudin]

Nasrudin and Leo, thank you for some validation of what I have been trying to say. You put it better than I did, but I will try again. If you cannot live below your means as a psychiatrist, you have some really wicked expenses that far exceed medical school. It would take a cocaine problem, a large dysfunctional family with personal weak boundaries, or a huge medical problem to exclude psychiatry as a viable option for most medical graduates. We do make enough money for a reasonable person. If you need to be Donald Trump, you missed that boat when you got into medicine.

Well. I owe you an apology. So I am sorry. When I first conceived of the debt problem it seemed acquiring cash was the only remedy. But after thinking about it enough and letting more sane notions of the quality of our time here in this life come to the forefront, I reimagined how to approach the situation.

I appreciate your impetus to dig deeper. I think what was really frustrated me about it was that I would have to compromise things I might be interested in doing just to make top dollar. And then projected my dissatisfaction of that.

I feel righted and back on proper course.

Financial health is important to not being stressed. But as you've indicated. Psych provides the means. The rest is just living sensibly. Which seems somewhat uncommon, strangely enough.

 

[MacDonaldTriad]

No apology necessary. You are smart enough to figure this out. Not so sure Vistaril will ever be content. Vistaril, if you are so unhappy with psychiatry, why do you persist? Psychiatry feeds most of us enough and we feel rewarded enough. Not so sure you will be content here if it is all about pay and hours worked.

 

[vistaril]

No apology necessary. You are smart enough to figure this out. Not so sure Vistaril will ever be content. Vistaril, if you are so unhappy with psychiatry, why do you persist? Psychiatry feeds most of us enough and we feel rewarded enough. Not so sure you will be content here if it is all about pay and hours worked.

Oh I feel I'm compensated fairly....never indicated otherwise. Me pointing out some basic economic principles comparing psych to medical fields(where either volume or procedures reign supreme) doesn't mean I'm claiming poverty.

 

[vistaril]

One more thing- this idea that it being a good thing psych has more cash pay providers than other fields is the dumbest thing. All this means is that more of us do cash pay because our third payer reimbursements per encounter are so poor. Iow, its a bad sign.

 

[Leo Aquarius]

They're not poor. See the new 2014 Medicare fee schedule for all specialties. Which specialty got the biggest boost this year in reimbursements? Was it Derm? Plastics? Immunology? GI or Cardiology?

Nope.

The greatest boost went to mental health providers including psychiatry. Now we won't get rich off these increases, but the Centers for Medicare and Medicaid Services (CMS) are putting more money in our Psych pockets, giving us more credence as a specialty. Essentially the CMS is saying mental health really matters.

 

[Shikima]

They're not poor. See the new 2014 Medicare fee schedule for all specialties. Which specialty got the biggest boost this year in reimbursements? Was it Derm? Plastics? Immunology? GI or Cardiology?

Nope.

The greatest boost went to mental health providers including psychiatry. Now we won't get rich off these increases, but the Centers for Medicare and Medicaid Services (CMS) are putting more money in our Psych pockets, giving us more credence as a specialty. Essentially the CMS is saying mental health really matters.

Do you happen to know when the new fee schedule is meant to kick in?

 

[MacDonaldTriad]

“Living well is the best revenge.”
Generally attributed to George Herbert (1593-1633)
English clergyman and poet

Someone should make a specialty in "treating the diseases of the rich", it would be very popular.

 

[slappy]

From The Pardoner's Tale that follows The Physician's Tale: "Radix malorum est cupiditas". Also featured in another famous book.

I personally see very little practical difference between the salaries of 225k and 450k even though one is twice as much as the other.

 

[bronx43]

From The Pardoner's Tale that follows The Physician's Tale: "Radix malorum est cupiditas". Also featured in another famous book.

I personally see very little practical difference between the salaries of 225k and 450k even though one is twice as much as the other.

Notsureifsrs.

Two words. Financial independence.

Another two words. Early retirement.

 

[vistaril]

From The Pardoner's Tale that follows The Physician's Tale: "Radix malorum est cupiditas". Also featured in another famous book.

I personally see very little practical difference between the salaries of 225k and 450k even though one is twice as much as the other.

insane.......225k with high tax rates, massive student loan burdens, etc is a heck of a lot less than 450k.

You have to consider that for people who owe massive student loans, 450k actually becomes much more than 2x 225k....

 

[slappy]

Totally serious.

Why do you want to retire early? Is it because you don't like/enjoy your work?

Also, all those years of toil getting educated just so you can retire early with money in hand seems a bit futile to me.

 

[Baller MD]

Totally serious.

Why do you want to retire early? Is it because you don't like/enjoy your work?

Also, all those years of toil getting educated just so you can retire early with money in hand seems a bit futile to me.

Eh, if I was born into a trust fund, I wouldn't even go to med school.

Different strokes for different folks.

 

[bronx43]

Totally serious.

Why do you want to retire early? Is it because you don't like/enjoy your work?

Also, all those years of toil getting educated just so you can retire early with money in hand seems a bit futile to me.

You seriously enjoy work more than your hobbies? Time to get new hobbies, bro. Like BallerMD said, if I was born into money, I would laugh at the thought of going to med school.

Another thing. It's not just about retiring early. It's about the OPTION of doing what you want when you want with no fear for your finances. Hell, if you really wanted, you can do pro-bono work if you liked your "job" that much.

 

[greenlion]

Well you have to do something. I think a lot of people idealize things like 'retiring early' - but then what? Most common thing is sitting on one's ass waiting to die.
Yes there's hobbies- but many people don't have true hobbies. Is painting un-noteworthy pictures or photographing birds really going to do something for you? (and if it does- maybe you should have pursued that to begin with).

I get the "options" thing- but really what would you do? There's travelling but you can travel throughout your life (and you should before you grow old and it becomes more difficult/burdensome).

 

[Baller MD]

Well you have to do something. I think a lot of people idealize things like 'retiring early' - but then what? Most common thing is sitting on one's ass waiting to die.
Yes there's hobbies- but many people don't have true hobbies. Is painting un-noteworthy pictures or photographing birds really going to do something for you? (and if it does- maybe you should have pursued that to begin with).

I get the "options" thing- but really what would you do? There's travelling but you can travel throughout your life (and you should before you grow old and it becomes more difficult/burdensome).

But it doesn't pay the bills like medicine can, does it?

 

[slappy]

A lot of jobs can pay bills.

 

[Baller MD]

A lot of jobs can pay bills.

Not if you want a Porsche...

 

[greenlion]

Not if you want a Porsche...

(edited: too much personal info)
I guess if you like Porsches that much. But then you probably wouldn't retire any earlier on 450k than 225k because there are always better/newer car(s) and bigger house(s).