A psych resident I know accepted a position out of residency starting 130k. This shocked and scared me as I am medical student interested in psych and possess a substantial loan debt. He says he accepted the offer because the job is in really nice location and he has crucial family ties there but I don't think that makes up for. Sorry for not giving many details but trying to have this person remain anonymous. Is this really uncommon in psych or does this happen more than we like to believe?
Psych Attending Getting Low balled?
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That's a lot less than any full-time psychiatrist this side of Hannibal Lecter is worth. There's a 12-page thread on psychiatrist compensation on the front page. Start there.
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That's not an unheard-of starting base salary for academic attendings in parts of the NE.
It's not reflective of the general psych job market.
It's not reflective of the general psych job market.
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Academics is the lowest paying sector.
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I would bet that it is either an academic job OR less than full-time. Remember, a lot of psychiatrists choose to work less than 40 hours a week, because we can, which is one reason why it appears psychiatrists earn less than other specialties. Making 90K if you're only working 20 hours a week isn't necessarily a bad deal.
In fact, that's a good thing to keep in mind any time you're trying to compare our income to other specialties. Yes, many other specialties make more money than I do, but they also work much longer hours and have worse lifestyles. In my opinion, once you have an upper middle class income, the value of any more money quickly reaches diminishing returns. Time off to do what I want with my family means lot more to me at this point than extra money would.
Where I live, academic medicine jobs pay around 150K, but I took a job that paid me >$225,000 my first year going up to >$280,000 after 1 year. I actually would have preferred the academic job in a lot of ways (loved the faculty at the program, loved the nature of the work), but money talks when you have student loans to pay off.
If anyone is surprised that I just told you what I make, here's why: My view is that when we keep mum about our salaries, we are just making it easy for employers to screw us over in negotiations. No need to be ashamed or secretive about it.
In fact, that's a good thing to keep in mind any time you're trying to compare our income to other specialties. Yes, many other specialties make more money than I do, but they also work much longer hours and have worse lifestyles. In my opinion, once you have an upper middle class income, the value of any more money quickly reaches diminishing returns. Time off to do what I want with my family means lot more to me at this point than extra money would.
Where I live, academic medicine jobs pay around 150K, but I took a job that paid me >$225,000 my first year going up to >$280,000 after 1 year. I actually would have preferred the academic job in a lot of ways (loved the faculty at the program, loved the nature of the work), but money talks when you have student loans to pay off.
If anyone is surprised that I just told you what I make, here's why: My view is that when we keep mum about our salaries, we are just making it easy for employers to screw us over in negotiations. No need to be ashamed or secretive about it.
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Short answer if that is a full time position: yes
There are multiple reasons why one would choose to stay at a certain facility for a given salary (professional advancement opportunities, working relationships with colleagues, quality of support staff, patient demographics, research opportunities, complacency, the list goes on). That being said, looking at things purely from a monetary lens...
That figure is low. You see this kind of scenario happening to fresh graduates who do not know their real worth in the current market. Psychiatrists are in high demand and from experience, facilities are willing to outbid other facilities' salaries to retain you if you are willing to negotiate tactfully.
(Department chairs at) academic institutions are quick to take advantage of naive attendings, who generate significant revenue for facilities for a fraction of the cost.
I have seen attendings complain about or make note of their low salaries in academic centers, but no one forces these individuals to stay. If there is a contractual obligation, the cost from a breach of contract could be easily recouped from a higher salary at a different job.
Salary surveys are helpful to illustrate one's worth in the market. It is also useful to know local averages to help in negotiating your salary to a reasonable level, and to avoid being lowballed.
There are multiple reasons why one would choose to stay at a certain facility for a given salary (professional advancement opportunities, working relationships with colleagues, quality of support staff, patient demographics, research opportunities, complacency, the list goes on). That being said, looking at things purely from a monetary lens...
That figure is low. You see this kind of scenario happening to fresh graduates who do not know their real worth in the current market. Psychiatrists are in high demand and from experience, facilities are willing to outbid other facilities' salaries to retain you if you are willing to negotiate tactfully.
(Department chairs at) academic institutions are quick to take advantage of naive attendings, who generate significant revenue for facilities for a fraction of the cost.
I have seen attendings complain about or make note of their low salaries in academic centers, but no one forces these individuals to stay. If there is a contractual obligation, the cost from a breach of contract could be easily recouped from a higher salary at a different job.
Salary surveys are helpful to illustrate one's worth in the market. It is also useful to know local averages to help in negotiating your salary to a reasonable level, and to avoid being lowballed.
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You have the answer to your puzzlement right there, right in front of your nose. Actually, 2 reasons given, and your colleague evidently sacrificed compensation for factors that matter more to him. People do this all the time.
BTW, what is this "nice" location? Location is a huge factor in compensation. When you limit yourself to location, especially highly desired locations on the east coast, you may take quite a hit in compensation.
FWIW, I have no desire to be underpaid in one of the "nice" cities (almost always code for one of the highest cost of living cities or regions in the country).
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HarryMTieboutMD
Top tier academic medical centers are well known for paying their young faculty far below their market value, especially if they are purely clinical (meaning, no chance at bringing in NIH money, getting tenure, etc). And at the creme de la creme institutions, the pay is even worse because it is an "honor" to work there. (starting salary for clinical track instructor in psychiatry is around $125k in our department... and they are way overworked... our dept is pretty open about this). People are often afraid to leave the academic milieu and become nostalgic for the intellectual culture, grand rounds, working with the experts, etc. If you are not going to do research, absent a specific skill set that is going to generate a lot of revenue for the department (ie, high profile forensic cases, cash only impaired physician evals, etc), you absolutely don't need money at all (ie, rich spouse so you can set your own work hours), or you intend to apply for a forensics/CAP fellowship eventually (equivalent to IM people doing a hospitalist year- the other psych fellowships are wortheless btw), starting off as clinical faculty in academia is a rather poor decision... unless you absolutely are incapable of practicing medicine without teaching.
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Is C&A really a worthless fellowship?
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Not if you want to do academics. Strictly from the perspective of monetary gain, though, yes, it probably is outside of going into private practice. The C&A attendings at my institution, for example, make less than their adult counterparts.
There are some who argue that many psych fellowships are completely worthless with respect to getting you more advanced clinical training apart from a couple of exceptions (e.g., C&A and forensics) depending on what you want to do. Many of the residents who have graduated from our program and go on to become faculty aren't fellowship trained even if they're doing consults, geriatrics work, etc.. That's not the institution's preference - they would prefer to have fellowship-trained physicians - but the reality is that they are hard to come by. I think the only exception to that is C&A, where all of our faculty are C&A trained.
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I believe he said all fellowships aside from C&A and forensics are worthless, which from a salary and honestly from a practice perspective, it's probably true. A C&A fellowship is necessary if you want to work with children outside of the smallest/most remote areas of the country.
About the op's friend, my understanding is that these prestigious low pay faculty jobs often offer some way to make more money (like free office space and support for your own RVU generating clinic). The pay probably still winds up being crap. I know people have individual circumstances where they don't need to care about money, but accepting a job for low pay hurts all of us.
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Ah, I missed the CAP mention in his post. Have a horrible hangover today, my thinky bits aren't quite in working order.
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I don't know what state the op's friend is in, but a rough calculation of that pay leads to take home pay of around $6700/month. Assuming the op's friend has the average amount of medical school debt ($180k per figures -- this is low because it doesn't include interest and includes all those 0s for rich people and military folk, etc), you'd be looking at around $1k in loans with income based repayment and around $2k/month, assuming you want to pay off the loans in 10 years instead. You also want to save for retirement because you lost 4 years in medical school and probably weren't able to put away a ton in residency. Maybe this job comes with a generous pension? Do you lose it if you leave after a few years? You probably still want to maximize your $18k/year contributions, so there goes another $1500/month (although pretax so the effects of this are smaller -- lets say you lose $1k/month to retirement savings). And then you've got to live -- houses in "desirable" parts of the country start close to $500k, so there goes $2500/month at least in rent or a mortgage. Kids? Daycare, private schools, college savings? Remember that you've lost essentially 8 years of income.
So op's friend is left with $4700/month assuming he has an average amount of medical school debt. Now we're down to $3700/month when we include retirement savings. I think as a resident I took home around $2600/month -- not that much of a difference.
So op's friend is left with $4700/month assuming he has an average amount of medical school debt. Now we're down to $3700/month when we include retirement savings. I think as a resident I took home around $2600/month -- not that much of a difference.
yes thats very low compared to averages but it all depends on location location location. And not location as in "that's a nice/desirable place, may have to take less"(thats only one component of it). If the contracts in your area are either not very good with various payers or all the contracts are already tied up, that plays a role too(even if it's not a coast). I anticipate making more than 130k with the job I took, but it's also going to be a hassle in a lot of ways such that I would take a 130k job that didn't come with those hassles.
Idiotic that anyone would even consider settling for 130k within any field of medicine, hassles or not.
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? How would you make that as a PGY3?
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Moonlighting. Probably program/region dependent -- doesn't discount that this is crap pay.
280k after 1 year is pretty impressive. Are you in the midwest?
Harvard is the extreme example of the inverse relationship between prestige and pay.
The Hopkins job must surely include a lot of protected time? Or it's an example of psychotic grandiosity.
1) It's not idiotic if that's the choice between working for that or not eating and one isn't location flexible
2) change 'any field of medicine' to 'any area of mental health' and it is more appropriate in this forum(this is a psychiatry forum)
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OP: This does happen, but I suspect that except in some very weird circumstances, it won't apply to you.
Your salary is always backed by what you do. The reason researchers' salary is low is because NIH funding for doing research has a very low associated capped salary, at all levels from trainee all the way to senior researchers. Institutionally, you can either take the low salary and enjoy the work, or work additionally to supplement your salary (moonlight, etc) as allowed. Or, as you get more senior, you can leverage your salary based on job search results. But this is all very advanced and not relevant to you.
Certain clinical positions also have very low associated salaries, especially at major centers. This is often due to pressure to "keep it reasonable" with the researchers in the same department, or some other arbitrary cap (i.e. government jobs). However, it is NOT true that "location" restriction is a factor. In general (vistaril exempted, that is), you can find ~$100-150 an hour moonlighting positions at ANY location in the US. Let's say you work 10 hours a week, you bump your salary up to $180-190k with a $130k base salary at 50 hours a week. People who choose these types of jobs invariably do it for a reason (i.e. don't want to move, aspiration for academic career, just general inertia, benefits etc.) Often in the situation of govt jobs, the base pay is low, but mechanisms have been created such that "overtime" pay can significantly add to your salary to make the jobs competitive to recruit at least reasonable MDs.
Based on my unscientific survey, if you go on the job market and don't care about the "prestige" factor, even in major metros, the standard clinical salary is reaching 225-250 range all-in comp. Higher in the suburbs/exurbs. As you may see in the other thread, in 2nd/3rd tier locations, salary can be quite high (>400k) if you work ~ 50hrs.
Your salary is always backed by what you do. The reason researchers' salary is low is because NIH funding for doing research has a very low associated capped salary, at all levels from trainee all the way to senior researchers. Institutionally, you can either take the low salary and enjoy the work, or work additionally to supplement your salary (moonlight, etc) as allowed. Or, as you get more senior, you can leverage your salary based on job search results. But this is all very advanced and not relevant to you.
Certain clinical positions also have very low associated salaries, especially at major centers. This is often due to pressure to "keep it reasonable" with the researchers in the same department, or some other arbitrary cap (i.e. government jobs). However, it is NOT true that "location" restriction is a factor. In general (vistaril exempted, that is), you can find ~$100-150 an hour moonlighting positions at ANY location in the US. Let's say you work 10 hours a week, you bump your salary up to $180-190k with a $130k base salary at 50 hours a week. People who choose these types of jobs invariably do it for a reason (i.e. don't want to move, aspiration for academic career, just general inertia, benefits etc.) Often in the situation of govt jobs, the base pay is low, but mechanisms have been created such that "overtime" pay can significantly add to your salary to make the jobs competitive to recruit at least reasonable MDs.
Based on my unscientific survey, if you go on the job market and don't care about the "prestige" factor, even in major metros, the standard clinical salary is reaching 225-250 range all-in comp. Higher in the suburbs/exurbs. As you may see in the other thread, in 2nd/3rd tier locations, salary can be quite high (>400k) if you work ~ 50hrs.
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Well, if it makes you feel any better, an attending told me that Pediatricians at Harvard get paid 90k....
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Such an "honor" making 1/2 of what you'd make elsewhere in a city where you're paying 4x+ for housing.
Moonlighting shifts at $1k+. One per weekend + 70k base salary and you're pretty much there.
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You do realize there is no "harvard" when it comes to physicians. Harvard doesn't have any hospitals only affiliated hospitals and they different hospital systems are widely different in terms of prestige, pay, working conditions. Partners is the most prestigious and tends to pay the least (I heard a few years ago they were paying some subspecialty internal medicine physicians like endocrinology 70k at BWH) though I am sure boston children's and Dana Farber pay poorly as well, and the Cambridge Health Alliance (which is also harvard affiliated but includes hospitals no one has ever heard of before) pays a little better. Conversely, actual Harvard faculty are among the best paid in the country. Only physicians are narcissistic enough to take air and prestige over actual compensation.
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When I was a professor at U of Cincinnati I was paid 180K plus benefits, plus extras cause they had a profit-sharing model where docs that worked hard and were profitable got more money. All in all is came out to about $225K/year. Now while this was great in academia I took a pay hit of about 50K taking the job but I wanted it cause I got to work with the best and it did make me a better psychiatrist. (I might be off a few thousand here or there. This happened about 4 years ago).
U of Cincinnati was smart when it comes to academia. They knew how to make money. Of course they weren't as efficient as a private practice office but compared to other places I've seen they were much better with efficiency and made money as a result. Every year for several years they were never in the red.
130K IMHO is the department lowballing the new doctor and possibly taking advantage of the naivete of someone who doesn't understand what they're worth or it's a department that doesn't know how to make money so they can't offer more.
Another aspect is many academic institutions don't know how to make money. (U of C is an exception). I've seen departments where there are no financial incentives for many who work in the department so like a communist collective a lot of people don't do their jobs well. While of course medicine and profits don't always coincide they do quite often. E.g. I've seen academic docs have office hours for patients and out of 5 hours only see 1-2 patients....literally and they don't give a damn cause if they saw 10 patients they wouldn't make any more money.
In defense of the department many academic institutions are not making good money and the added rules to prevent pharmaceutical company representation has only hurt it more. For example many professors used to be the first ones contacted to do a pharm dinner and got paid about $1500+ a gig. Now many professors can't do this due to new rules.
U of Cincinnati was smart when it comes to academia. They knew how to make money. Of course they weren't as efficient as a private practice office but compared to other places I've seen they were much better with efficiency and made money as a result. Every year for several years they were never in the red.
130K IMHO is the department lowballing the new doctor and possibly taking advantage of the naivete of someone who doesn't understand what they're worth or it's a department that doesn't know how to make money so they can't offer more.
Another aspect is many academic institutions don't know how to make money. (U of C is an exception). I've seen departments where there are no financial incentives for many who work in the department so like a communist collective a lot of people don't do their jobs well. While of course medicine and profits don't always coincide they do quite often. E.g. I've seen academic docs have office hours for patients and out of 5 hours only see 1-2 patients....literally and they don't give a damn cause if they saw 10 patients they wouldn't make any more money.
In defense of the department many academic institutions are not making good money and the added rules to prevent pharmaceutical company representation has only hurt it more. For example many professors used to be the first ones contacted to do a pharm dinner and got paid about $1500+ a gig. Now many professors can't do this due to new rules.
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HarryMTieboutMD
But hey, if you're an attending at McClean, you get to diagnose Brandon Marshall with Borderline Personality Disorder. Funny how clairvoyant and accurate Mount Miser was/is...
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You're right about all of that. Our program is in an expensive city and pays about 150-200/hr for moonlighting. (But the 200/hr is a 6 hr Friday night ED shift IIRC) When you factor in CoL, residents make approximately the same or more in terms of PPP in lower CoL cities. The numbers work out either way
Re: Harvard. People are usually referring to Partners/BIDMC/BCH when they talk about Harvard. I'd imagine Mt Auburn actually pays pretty well, and of course the multiple VA's pay decently, but no one thinks Mt Auburn or the VA when you say Harvard. Brigham nurses with ~10 years of experience make more than new IM attendings, but I always wonder how much of the FTE for those attendings is not RVU generating.
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If you are paid less than 250k per 40 hours of work per week you are being shafted.
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Tell that to the big new hospital in my city who insists that a lot less than that for full-time + some on call responsibility (limited but still existent) is normal. Actually though I'm now thinking I must live in a low salary city because I don't think $250k for no more than 40 hours/week is normal here. Maybe I'm missing something.
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This is almost as misleading as Vistaril's salary reports. The data tells as there is significant regional variation; 250k is very uncommon for a salaried position in the northeast.
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That's what I always think when I read posts like this. The most I was ever compensated was $215,000.
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HarryMTieboutMD
Most grads from my program who go into private practice (generally midwest) are around $220k for 50ish hrs/week +/- call. Someone who graduated last year got 240k for a consult job in ATL averaging 8-4:30 but sometimes will have hectic call schedules and at times working straight through the weekends (still a very nice setup). The opportunities (especially in our city) are there to make a lot more, but it will be RVU based, and the hours won't be as friendly.
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I work 70 hours a week in the Chicago suburbs and make over 500k, people need to negotiate harder.
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Ahh but it's academic/pseudoacademic so its actually pretty good (only unfortunate if you were working for a different system that has been gobbled up and thus having your earning depreciate). You live in a high salary city- even medicaid pays more in your state than in most other states from what i've seen...
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I guess I live in a higher income city than say cities in the NE although I don't know people who make $250k without doing call if you're not counting whatever benefits are worth (and that's always a variable and sometimes questionable calculation). At least employed people -- maybe private practice folks are doing that.
Yes, though, earning depreciation is exactly my story if I want to stick with what would be closest to my current job, which I actually like. It's not the best start to an employment relationship. Aside from the salary differential, also fewer perks than are standard for employed non-community positions here (less CME money, no student loan money, they don't pay for licensure or board certification fees). No apologies for this, either. Maybe people are knocking down their door to work there, and they don't need to improve their offer. Good retirement, though, but a chunk of that only vests after 3 years.
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Not as phallic as a the big black tower.
Factor in that in the midwest there's better pay for psychiatrists. A thing I forgot to add is the retirement packages. U of C had an incredible package. Some places pay very little for retirement. I left U of C to St. Louis U taking a pay cut of about $225 to $180K and to add insult U of C's retirement package was one of the best I've ever seen with a pension that was half your salary plus free healthcare the rest of your life. St. Louis U? No pension, no healthcare on retirement. IMHO This was more than a $45 K paycut. If I lived another 20 years past retirement this was on the order of a $100K/year paycut, and I was bringing in over $500K a year to St. Louis U so I didn't understand what the heck they were doing.
Factor in that in the midwest there's better pay for psychiatrists. A thing I forgot to add is the retirement packages. U of C had an incredible package. Some places pay very little for retirement. I left U of C to St. Louis U taking a pay cut of about $225 to $180K and to add insult U of C's retirement package was one of the best I've ever seen with a pension that was half your salary plus free healthcare the rest of your life. St. Louis U? No pension, no healthcare on retirement. IMHO This was more than a $45 K paycut. If I lived another 20 years past retirement this was on the order of a $100K/year paycut, and I was bringing in over $500K a year to St. Louis U so I didn't understand what the heck they were doing.
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I worked 10 months last year at about 36 hours a week and took home $250k.
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Not true. $200K for a VA job or county job is not unusual in many areas. It would definitely not be unusual for an academic job in many areas.
Blanket statements like this don't hold a lot of water. In many areas and in many contexts, $250K would be considered a great salary. I can believe that there might be regions in which $250K/year is "getting shafted," but I certainly wouldn't consider this universal or even the norm.
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I would consider it to be abnormal based on the simple economics of supply and demand. Couple that to the pay disparity for many decades and still is going on.
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HarryMTieboutMD
That's surprising. I thought SLU was offering really good packages to quality faculty
Independent contractor?
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Yup.
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So paying total FICA/self-employment tax and lack of benefits significantly reduces the gross as compared to W2 employee. I usually require 25% more than my base employee wage for contractual work. I'd be interested to hear how much others allow for the lack of benefits and paying extra taxes when negotiating 1099 positions.
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People are really bad at doing this accounting. ON the other hand, the 1099 position has a TON more tax sheltering opportunities in the SEP-IRA, SEP-401, and ways of deducting business expenses. So when you include that stuff, it's not as stark a difference as it seems.
When comparing W2/1099 positions, to compare apples to apples you factor in the differences in the extra taxes you are paying as a 1099 and the lack of benefits.
for instance, assuming a 250k salary - you are paying an extra $3625 in Medicare (1.45% of 250k) and $7347 in Social Security tax (6.2% of 118,500) for a total of $10,972 extra as a 1099 compared to W2
then, you have to add the extra expenses of Health insurance, malpractice, and retirement.
Those last 3 factors are variable depending on your personal health/#of people covered in your family (health insurance premiums), # of years you've been practicing (malpractice premiums), and whether the W2 position provides a match (e.g. 6% match versus no match). As a 1099, keep in mind that you can put away up to 53k as backdoor roth, which you don't pay tax on when you retire.
for instance, assuming a 250k salary - you are paying an extra $3625 in Medicare (1.45% of 250k) and $7347 in Social Security tax (6.2% of 118,500) for a total of $10,972 extra as a 1099 compared to W2
then, you have to add the extra expenses of Health insurance, malpractice, and retirement.
Those last 3 factors are variable depending on your personal health/#of people covered in your family (health insurance premiums), # of years you've been practicing (malpractice premiums), and whether the W2 position provides a match (e.g. 6% match versus no match). As a 1099, keep in mind that you can put away up to 53k as backdoor roth, which you don't pay tax on when you retire.
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Thank you for the great information. Something I consider during negotiations is that although the 1099 write-offs are a plus I don't feel that negates the need for employers to pay me a significantly increased rate when I do contractual work. A ROTH IRA for example although an excellent perk is coming out of my pocket not my employer's.
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Bingo!
