is child psychiatry worth it from a financial standpoint?

[milan95]

I have enjoyed my child psych rotations quite a bit. However, so much time is spent on a single case - is it worth it financially?

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[clozareal]

It depends. If you do it, it's financially better to fast track. Let's say a CAP makes $350k vs $300k from a non-CAP. If losing out on one year of salary for a fellow's salary is $300-70k = $230k you'll be losing out on. The difference of $50k would take at least 4-5 years to recuperate.

Much of the time, a CAP salary is going to be 10-20% higher. If you do private practice, it can be more. My cash rates are about 50% higher than my adult only colleagues. Insurance might reimburse you the same. Because I have an hourly rate, I can spend that additional time with the patient without having to worry that it's costing me money.

 

[comp1]

It's really the wrong question. You're going to spend sooooo much of your life at work. You really need to be doing what makes you happiest in that work. The financial difference is absolutely minimal here compared to the literal decades of work life ahead of you.

 

[Atreides]

So BCBS sent me their fee schedule. They offer chid psychiatrists 150% of the adult psychiatrist rate. It comes out to $350 for a 99214 + 90833. That's out the door, no negotiating needed.

 

[milan95]

So BCBS sent me their fee schedule. They offer chid psychiatrists 150% of the adult psychiatrist rate. It comes out to $350 for a 99214 + 90833. That's out the door, no negotiating needed.

Thank you! This is helpful info. Looks like at least BCBS recognizes the extra work the child psychiatrists put in!

 

[clozareal]

Oh yeah. Cigna sent me their contract for CAP after I got board certified. They offered me 200% what they initially offered me for adult only.

 

[MedMan80]

*jealousy increases*

 

[comp1]

You've got at least 200% the interview to complete, so seems reasonable to be.

 

[Candidate2017]

It's really the wrong question. You're going to spend sooooo much of your life at work. You really need to be doing what makes you happiest in that work. The financial difference is absolutely minimal here compared to the literal decades of work life ahead of you.

OP, the other correct question to ask is: Why do most child psychs prefer to have a panel of at least 50% adult patients despite lower reimbursement?

*jealousy increases*

Even as an adult psychiatrist there are many ways to recreate the fulfillment that child psychs experience: speak with your adult patients' parents at every visit, gather reams of collateral, and do an autism and adult onset ADHD eval on every new patient. Also, nothing beats the feeling of prescribing Abilify or Risperdal for... reasons.

 

[milan95]

OP, the other correct question to ask is: Why do most child psychs prefer to have a panel of at least 50% adult patients despite lower reimbursement?



Even as an adult psychiatrist there are many ways to recreate the fulfillment that child psychs experience: speak with your adult patients' parents at every visit, gather reams of collateral, and do an autism and adult onset ADHD eval on every new patient. Also, nothing beats the feeling of prescribing Abilify or Risperdal for... reasons.

is it because having 100% child leads to more burnout?

 

[FlowRate]

OP, the other correct question to ask is: Why do most child psychs prefer to have a panel of at least 50% adult patients despite lower reimbursement?

Huh, if you happen to know of any profession surveys that I could use to substantiate this, it'd be really helpful to me in my current administrative role. I hadn't heard this/come across this phenomenon previously.

 

[clozareal]

OP, the other correct question to ask is: Why do most child psychs prefer to have a panel of at least 50% adult patients despite lower reimbursement?

I prefer 10-20% adults on my panel but perhaps I'm an anomaly. I get paid the same whether it's an adult or child in my private practice.

 

[calvnandhobbs68]

Huh, if you happen to know of any profession surveys that I could use to substantiate this, it'd be really helpful to me in my current administrative role. I hadn't heard this/come across this phenomenon previously.

I’d be interested in this as well. I’d also like to see if they make a distinction between preferring a percentage of adult patients and HAVING a percentage of adult patients. 18+ is a much bigger age range than 4/5-17 and I start seeing plenty when they’re 15+…they all become adults eventually. I’m not kicking the adults out of my practice just because they’re adults, so I can absolutely see a large percentage of my patient panel being adults in 10 years.

Around the reimbursement stuff, at least around here the child and adult reimbursement rates from insurance seem to be the same (and nowhere near 350 for 99214+90833)

 

[FlowRate]

I’d be interested in this as well. I’d also like to see if they make a distinction between preferring a percentage of adult patients and HAVING a percentage of adult patients. 18+ is a much bigger age range than 4/5-17 and I start seeing plenty when they’re 15+…they all become adults eventually. I’m not kicking the adults out of my practice just because they’re adults, so I can absolutely see a large percentage of my patient panel being adults in 10 years.

Around the reimbursement stuff, at least around here the child and adult reimbursement rates from insurance seem to be the same (and nowhere near 350 for 99214+90833)

Yeah in our practice the child psychs are currently saying they strongly prefer not to see any adults. About 30% of their panels are 18 and 19 years old (aged up into technically being adults.)

 

[Merovinge]

OP, the other correct question to ask is: Why do most child psychs prefer to have a panel of at least 50% adult patients despite lower reimbursement?



Even as an adult psychiatrist there are many ways to recreate the fulfillment that child psychs experience: speak with your adult patients' parents at every visit, gather reams of collateral, and do an autism and adult onset ADHD eval on every new patient. Also, nothing beats the feeling of prescribing Abilify or Risperdal for... reasons.

I gather this is at least partially tongue-in-cheek, but when asked a while back about the soft hazing that adult psychiatrists routinely did of child/adolescent psychiatrists in residency this is exactly what I was referring to.

There are plenty of people explaining why a cash child psychiatrist may have significant numbers of adult patients, the largest being that they age out and want to continue onward, but 0% of the dozens of child/adolescent psychiatrists I know choose to have a panel of >50% adults, it's essentially unheard of in my geography. The demand is just simply higher for child/adolescent than adult and everyone accepting insurance is full and stays perpetually full. Many of my patients end up seeing NPs for outpatient f/u that are not able to private pay.