Psychiatry Jobs

[Anasazi23]

Hi everyone,

A consistently hot and/or interesting topic revisited in this forum is that of post-residency employment. As I myself come closer to graduation (looking at PGY-IV soon), I too, am interested in this.

We give a lot of anecdotal advice and stories, but I thought that I might share with you my job offers, since I'm already beginning to receive them. I'll qualify that I've seen no headhunters, but did complete a 10 minute interview with one company who actually tracked down my hospital pager number and had me paged.

This might give us an opportunity to see what's out there and for how much money and compensation. Others are certainly free to chime in.

-a

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Members don't see this ad.

 

[Anasazi23]

Alexandria Bay, NY "Heart of the 1000 islands"

J1 Visa waiver accepted
Paid malpractice + relocation
28 bed hospital, "low" call
__________________________

$165-175k

 

[OldPsychDoc]

As you post these, it might be helpful to the readers if you were to mention inpatient/outpatient, public/private, other pertinent work environment issues.

 

[Anasazi23]

Good idea. The above offer, however, said little more than this. I suppose it's a tactic to get you on the phone - asking questions.

 

[juddson]

Alexandria Bay, NY "Heart of the 1000 islands"

J1 Visa waiver accepted
Paid malpractice + relocation
28 bed hospital, "low" call
__________________________

$165-175k

That's not bad. I'm pleased to see this sort of thing. This may turn out to be the single most helpful thread in a long time.

Judd

 

[MBK2003]

Augusta, ME

Inpatient long-term state hospital and forensic
Call 1:4 (I think) but light due to long-term nature of pt pop
Paid malpractice
I'm not sure about visa waivers (doesn't hit my radar)
$180,000

 

[Solideliquid]

Augusta, ME

Inpatient long-term state hospital and forensic
Call 1:4 (I think) but light due to long-term nature of pt pop
Paid malpractice
I'm not sure about visa waivers (doesn't hit my radar)
$180,000

WHen they say call is it usually home call or do you have to spend the night at the hospital like a resident?

 

[OldPsychDoc]

WHen they say call is it usually home call or do you have to spend the night at the hospital like a resident?

This is usually home call, or some similar arrangement.
Depends on whether hospital admissions need to be staffed--for example, I work for a large organization, so call gets spread among about 30 psych docs. We have to come in to the hospital about 3 weekend days/3 months to staff admits and consults worked-up overnight by residents and moonlighters. We also have phone back-up responsibilities to those folks and the system at large during the weeks we're on. Not bad AT ALL, especially compared to residency!
We just hired, BTW--start at $165K with productivity increases.
I'm grossing $205K this year--2nd year out!

 

[juddson]

We just hired, BTW--start at $165K with productivity increases.
I'm grossing $205K this year--2nd year out!

Outstanding, my friend. Outstanding!!

Judd

 

[BrianUM]

Alexandria Bay, NY "Heart of the 1000 islands"

J1 Visa waiver accepted
Paid malpractice + relocation
28 bed hospital, "low" call
__________________________

$165-175k

Hey congrats Anasazi!

Must be very exciting.

 

[Caetano-MD]

I found a "Salary Website" that seems requisitely "overly general" BUT that also provides MEDIAL SALARIES (for psychiatrists) BY CITY.

So even though this won't tell you if you are comparing a C/L psychiatrist and a private therapy-based psychiatrist it at least gives you an idea if, say, Newark-based Jersey shrinks make more than Princeton-based shrinkage.

Give it a gander

Cheers and Let's keep this thread going!

http://swz.salary.com/salarywizard/layouthtmls/swzl_narrowbrief_HC03.html

 

[Caetano-MD]

I meant MEDIAN incomes.

Also "PSYCHIATRIST" is, oddly, NOT listed under "PHYSICIAN" but all on its own, a couple centimeters below

 

[Anasazi23]

Got this on email today:
********************************
Opportunity Description
Specialty: Psychiatry
Candidate Type: MD, DO, DO-Allopathic
J1 Acceptable: No
Certification: Board Certified, Board Eligible
Licensed:

Psychiatry Opportunity
In Newark, Ohio
(Greater Columbus, Ohio area)


30 Miles East of Columbus, Ohio
First Rate Hospital System (Rated a Top 100 Hospital for 7 Years)
Brand new, state-of-the-art Emergency and Surgery Suites (2007)
Salary: $200,000 base salary
Quarterly bonus based on productivity and quality indicators
Full benefits, 3 Retirement Options, including an outstanding pension plan
Nationally Recognized & Top Rated Public School System (Granville, Ohio)
Many other excellent benefits
Not a J1 or H1-B opportunity

 

[psychR1]

Thanks for the useful info people!

 

[Anasazi23]

I get periodic offers through a website called practicematch. They somehow found my beeper number a number of months ago and I took the time to answer a bunch of their questions regarding my desired practice location, hours, call preferences, salary, etc., and they try to match me with these types of opportunities.

Here's another one...though no mention of salary:

Canton-Potsdam Hospital
Address: 50 Leroy Street
Potsdam, NY 13676


Opportunity Criteria
Specialty: Psychiatry
Candidate Type: MD, DO
Visas Accepted: None


Canton - Potsdam Hospital


Canton-Potsdam Hospital provides the best of both worlds: we have the technology and staff expertise you’d expect to find in a big city, yet we also have the work ethic, collegiality, and dedication to service that you’d expect of a close-knit community like ours. With major educational institutions close by, our patients’ needs run the gamut from emergency care, to sports medicine, to maternity, to cardiopulmonary rehabilitation. We also see patients from outside our immediate vicinity: our chemical rehabilitation unit is the only hospital-based service in the upstate region, drawing patients from Albany, Buffalo, Binghamton, and points in-between.

Canton-Potsdam Hospital recently underwent a major construction and renovation project and customer service initiative. We now offer state-of-the-art operating suites, new maternity options like hydro-birthing, a fully automated laboratory, and an attractive, efficient ambulatory surgery unit. In addition, our links with community health organizations, and Fletcher-Allen Health Care—one of the premier teaching hospitals in the region—give you and your patients access to expanded options for professional growth and outstanding medical care.

Canton-Potsdam Hospital fosters excellence in the practice of medicine. I hope you will consider joining our medical staff and helping to improve the health and well being of our community.


About Our Opportunity


Canton-Potsdam Hospital Inpatient Rehabilitation Unit is looking for a BE/BE Psychiatrist to assume the Clinical Directorship. The qualified candidate will have Inpatient Clinical Directorship duties and see patients in an outpatient setting.

The communities of Canton and Potsdam are without psychiatry services and the primary care physicians are requesting a local psychiatrist to refer patients.


About Our Area

Experience Life in the Foothills of the Adirondacks

Canton-Potsdam Hospital is located in the beautiful St. Lawrence River Valley in the Foothills of the Adirondacks. Skiing, snowshoeing, cycling, ice-skating, rock climbing, hiking, fishing, and boating are just a few of the outdoor pleasures the region has to offer. Olympic-quality venues are just 90 minutes away in Lake Placid. Cosmopolitan dining, museums, galleries and entertainment, as well as international air travel, are 90 minutes to the north in French-speaking Montreal and Canada’s capital city, Ottawa.

The Potsdam school district is home to the State of New York’s 2003 Teacher of the Year, and the area boasts four colleges: Clarkson University, St. Lawrence University, the State University of New York (SUNY) at Potsdam, and SUNY Canton. SUNY Potsdam is home to the Crane School of Music, alma mater of world-renowned opera diva Renee Fleming. St. Lawrence University, alma mater of actor Kirk Douglas, brings internally acclaimed writers and performers to campus regularly. Clarkson offers Division I hockey, hosts an annual Odyssey of the Mind competition for local school children, and offers world-renowned research and development in pharmaceuticals, environmental health and safety, and materials science. SUNY Canton offers a four-year nursing degree.

In addition to the four colleges, major area employers include Alcoa, GM, and Corning, Inc. Housing is reasonably priced, and there are a variety of housing options, including year-round resort-style waterfront homes. St. Lawrence County boasts one of the lowest crime rates in the nation: people will tell you they feel comfortable leaving their doors unlocked at night. Potsdam offers a regional airport for personal aircraft and charter air transportation, and well-maintained roadways connect the region to major arteries, such as the New York State Thruway system and the Trans-Canada Highway. Massena airport (20 minutes) provides commuter flights. Shopping includes big-box stores and specialty boutiques, as well as a lively antiques and collectibles scene.

 

[Anasazi23]

Upstate New York:
Psychiatry Opening


Practice at a Glance



Employed Position in Psychiatry

Compensation: $165K - 175K

J1 Visa Waiver Accepted

Paid Malpractice & Relocation

28 Acute Psych Beds, 159 Bed Hospital

Adding 8M- 10M Addition with New Psych Unit

Busy In-Patient Service

BC or BE Required

Low Call



Community Located in Beautiful Upstate New York



Easy Access to Ottawa

City Located on the St. Lawrence River

Access to International Airport & Major Metro

Outdoor Paradise: Hiking, Fishing, Camping and Biking

Excellent School System

Family Oriented Community

 

[tennreb]

It seems that the Northeast has considerably lower pay than other parts of the country, which is the opposite for nearly every other profession.

 

[Dartos Vader]

It seems that the Northeast has considerably lower pay than other parts of the country, which is the opposite for nearly every other profession.

Just look at medicare reimbursment rates across the states. I did some casual research on this when I was considering where to do a peds residency (my how things have changed in two years). A well child visit in Arizona pays about 130 dollars. In New York medicare reimburses (can't remember exact figures) about one tenth that amount. Don't know why, but those were the numbers.

 

[Anasazi23]

...big reason I'm moving out of here when I'm done. Among many others.

 

[jjmack]

It seems that the Northeast has considerably lower pay than other parts of the country, which is the opposite for nearly every other profession.

while this may be true nyc is one of the few places where you can have a cash only practice in almost any speciality.

 

[prominence]

Just look at medicare reimbursment rates across the states. I did some casual research on this when I was considering where to do a peds residency (my how things have changed in two years). A well child visit in Arizona pays about 130 dollars. In New York medicare reimburses (can't remember exact figures) about one tenth that amount. Don't know why, but those were the numbers.

anyone know how texas fares (specifically houston)?

 

[prominence]

bump

 

[PsychMD2100]

Texas tends to pay better but I spoke to a resident training in Texas regarding their laws. My friend said that the Texas mental health laws are different from many of the laws on the coasts with regard to providers having had counseling/taken psych meds. Supposedly, it's harder to get licensed and credentialed if you have had ANY mental health care in the past.

This became a concern because she had seen a therapist for depression and had been on SSRIs for a while.

Although it may not be a factor for most people on this board, it may say something about the overall climate of Texas with regard to mental health care.

Anyone else hear or experience similar things?

 

[Doc Samson]

My friend said that the Texas mental health laws are different from many of the laws on the coasts with regard to providers having had counseling/taken psych meds. Supposedly, it's harder to get licensed and credentialed if you have had ANY mental health care in the past.

Well, that would eliminate ~75% of my residency class since a lot of us were in therapy - my guess is that there's some language in their about "...restrict your abilities to provide care...".

 

[Dramkinola]

Check out New Orleans.

Pre-Katrina population of 5 parishes (counties) around New Orleans - 1.45 million
Post-Katrina population - 1.2 million

Pre-Katrina census of Psychiatrists in New Orleans - 190+
Post-Katrina census of Psychiatrists in New Orleans - sub-40

 

[Therapist4Chnge]

Check out New Orleans.

Pre-Katrina population of 5 parishes (counties) around New Orleans - 1.45 million
Post-Katrina population - 1.2 million

Pre-Katrina census of Psychiatrists in New Orleans - 190+
Post-Katrina census of Psychiatrists in New Orleans - sub-40

Wow.....though not totally surprising. I've heard that the rate of psychologists is about the same (~20%).

-t

 

[Dramkinola]

reminds me of the saying, "physician heal thyself..."

it seems mental health professionals had a greater rate of exodus than other medical fields. Apparently we're more "fragile" psychologically and couldn't take the stress.

 

[Therapist4Chnge]

I considered moving there 5-6 years ago, and I am seriously considering it once I finish up school. I'm a bit concerned about the long-term viability, but it may be a nice interim stop. I heard they are offering loan repayment and bonuses because it is still considered a disaster relief area AND there is such a severe shortage (both psych and psychiatry)

-t

 

[Anasazi23]

reminds me of the saying, "physician heal thyself..."

it seems mental health professionals had a greater rate of exodus than other medical fields. Apparently we're more "fragile" psychologically and couldn't take the stress.

I don't think it's the stress so much a it's the deplorable practice conditions and general difficulty in living in such an area at this time. There is also the practical issue of money. Many patients with money moved out...likely permanently. The docs follow the money. Not to mention that many hospitals are functioning at half-staff. Many are fed up with inpatient work, and have subsequently relocated their practices accordingly.

Nobody wants to be an attending on call Q3 with no backup...

 

[Dartos Vader]

anyone know how texas fares (specifically houston)?

Don't know specifics but in GENERAL the southwest tends to pay quite well. Plus the cost of living in texas isn't too bad either. I don't remember where it was, but the stats are available for free somewhere on medicare/medicaides website.

 

[Dramkinola]

I don't think it's the stress so much a it's the deplorable practice conditions and general difficulty in living in such an area at this time. There is also the practical issue of money. Many patients with money moved out...likely permanently. The docs follow the money. Not to mention that many hospitals are functioning at half-staff. Many are fed up with inpatient work, and have subsequently relocated their practices accordingly.

Nobody wants to be an attending on call Q3 with no backup...

I'm not sure where you got that info from?
Deplorable practice conditions?

The reality is, the closes thing you can compare New Orleans currently to is if a large bomb went off and destroyed HALF of your city. That's what it looks like. East of the city, everything is pretty much gone. the other half is almost virtually untouched.

Ochsner Clinic Foundation moved in and bought three additional hospitals and is refitting them to better standards than before. If anything, practice conditions are better than before, if not the same.

Patients with money moved out? No... patients with money lived in higher areas that did not flood. The only people that have not come back (for the most part) are the poor who either could not afford to evacuate, could not afford to buy a house and rented, thus not elligible for the rebuilding loans/grants, or found that Houston/Atlanta had better public services and do not want to come back.

How many psychiatrists work inpatient? Not many. And anyway, that is the major part of psychiatry currently struggling in New Orleans. We have no inpatient beds. We have private clinics with 2-3 month waiting lists, State Mental Health Clinics overflowing, day programs with wait lists, partial hospital programs opening up and running to capacity... although group homes are lacking...

All in all, New Orleans is EXTREMELY livable, enjoyable, with lucrative possibilities all over the place. For example, there is only one physician in the whole city doing ECT currently. There is a need for any and every kind of health professional here.

I considered moving there 5-6 years ago, and I am seriously considering it once I finish up school. I'm a bit concerned about the long-term viability, but it may be a nice interim stop. I heard they are offering loan repayment and bonuses because it is still considered a disaster relief area AND there is such a severe shortage (both psych and psychiatry)

We would love to have you. They ARE offering up to $110K as loan repayment/bonuses to lure psychiatrists, OB/GYN, peds, Family med, Internists, Psychologists, Clinical Social workers, therapists, etc... (info on Louisiana Dept of Health and hospital website under Job core, i believe)

 

[Anasazi23]

I'm not sure where you got that info from?
Deplorable practice conditions?

The reality is, the closes thing you can compare New Orleans currently to is if a large bomb went off and destroyed HALF of your city. That's what it looks like. East of the city, everything is pretty much gone. the other half is almost virtually untouched.
......

...if you say so

http://www.healthleadersmedia.com/viewcontent/89470.html

http://www.usatoday.com/news/nation/2007-01-15-katrina-mental-health_x.htm

http://www.medicalnewstoday.com/medicalnews.php?newsid=42684

http://www.disasternews.net/news/article.php?articleid=3146

http://www.usatoday.com/news/nation/2006-11-08-mental-health_x.htm

http://development.mc.duke.edu/medAlum/DMANweb/Spring07/NewOrleans.htm

Don't get me wrong...I think it's admirable that you're dedicated to health care in the region. But realistically, all things being equal, it's a tough place to be a doctor right now.

 

[Therapist4Chnge]

We would love to have you. They ARE offering up to $110K as loan repayment/bonuses to lure psychiatrists, OB/GYN, peds, Family med, Internists, Psychologists, Clinical Social workers, therapists, etc... (info on Louisiana Dept of Health and hospital website under Job core, i believe)

So I've been told. I have some contacts down there (through colleagues), so I'm going to look hard at the logistics of it all. I don't think it'd be a permanent move, but it may be a nice way to take care of my loans and get some good experience.

I'll PM you with a couple questions I have...I don't want to side-track this thread.

-t

 

[Dramkinola]

...if you say so

http://www.healthleadersmedia.com/viewcontent/89470.html

http://www.usatoday.com/news/nation/2007-01-15-katrina-mental-health_x.htm

http://www.medicalnewstoday.com/medicalnews.php?newsid=42684

http://www.disasternews.net/news/article.php?articleid=3146

http://www.usatoday.com/news/nation/2006-11-08-mental-health_x.htm

http://development.mc.duke.edu/medAlum/DMANweb/Spring07/NewOrleans.htm

Don't get me wrong...I think it's admirable that you're dedicated to health care in the region. But realistically, all things being equal, it's a tough place to be a doctor right now.

I read the links... and at least four of those articles say what I have been saying.
No Inpatient beds.
Double to triple caseloads for psychiatrists. (which means more money?)
Not enough mental health professionals.
Increased "mental illness," i.e., "Katrina Funk"...

The mental health clinics that are in repopulated areas are almost all open. The ones that aren't are in the areas destroyed. The ones that are open are hiring as many psychiatrists as they can find.

The point I was making earlier was that "business" is out the roof. But this is so because the patient population has increased by leaps and bounds with a inverse reduction (instead of proportionate increase) of mental health professionals.

The first article and one other one complain about hospital renumeration. If you're running a clinic, you don't worry about that. That's hospital administrations' problem, and is being corrected with University Hospital downtown being expanded into a temporary replacement for the Old Charity. being a resident, I am benifitting from an increase in quality, quantity, and diversity of psychopathology.
I am also benefiting from the shortage in psychiatrists with an increase in moonlighting options.

My point wasn't that everything is perfect, but it's still not all doom and gloom, and as far as options in mental health jobs, there is no where else in the US with more demand.

 

[Anasazi23]

Demand is there, for sure. And I truly wish that city luck in recovering.

A largely medicaid population in the larger scheme of psychiatric practice may not be the ideal practice situation for many psychiatrists. That, plus the call schedule, and great diffuculty in obtaining ancillary services make it a less than ideal practice situation for some physicians.

In terms of less selfish psychiatric exposure, I think you're absolutely right. Lots of pathological diversity, end stage psychiatric illness, and many more types of disease states are great from an academic standpoint. That's what many of the articles were referring to, and give credence to the fact that outside practice demands vs. available services make for a potentially difficult situation for docs.

 

[Dramkinola]

Demand is there, for sure. And I truly wish that city luck in recovering.

A largely medicaid population in the larger scheme of psychiatric practice may not be the ideal practice situation for many psychiatrists. That, plus the call schedule, and great diffuculty in obtaining ancillary services make it a less than ideal practice situation for some physicians.

In terms of less selfish psychiatric exposure, I think you're absolutely right. Lots of pathological diversity, end stage psychiatric illness, and many more types of disease states are great from an academic standpoint. That's what many of the articles were referring to, and give credence to the fact that outside practice demands vs. available services make for a potentially difficult situation for docs.

All I know is what I see... and working at most of the hospitals in the area at some point or another during the past year, plus my father also being a practicing psychiatrist here, i see anything BUT a difficult situation.

 

[i61164]

On another topic...

What will you do if a job is posted for 165-175 and they offer you 165? I think I would ask for the 175. If they wont give it, either they don't want you that bad or the 175 was just false advertising. If they can't afford to give you the 10 grand, just ask for 3 extra weeks of vacation. That would be worth about the same. I bet they won't give the extra vacation. It seems like the job market is pretty good for psychiatrists so it's probably safe to "push" them a little. What do you guys think?

 

[Anasazi23]

I'm still learning this stuff, but it seems that the higher ends of offers are commensurate with experience or credentialing. I think that if you're a year or two out, and are board certified, there's no reason to get the higher number.

But I also agree with you. I know some folks that are in the market right now, and they do have significant bargaining power due to the need for psychiatrists.

 

[Anasazi23]

Anyone that can offer any advice about going through locum tenens companies? I'm hearing a lot about signing contracts vs. not, which ones are more reputable, insurance issues and later practice radius stuff, etc.

Thanks.

 

[prominence]

how long can a typical locum tenens contract last up to (i.e one year)?

 

[i61164]

I'm still learning this stuff, but it seems that the higher ends of offers are commensurate with experience or credentialing. I think that if you're a year or two out, and are board certified, there's no reason to get the higher number.

But I also agree with you. I know some folks that are in the market right now, and they do have significant bargaining power due to the need for psychiatrists.

So you mean 165 is for someone straight out of residency and 175 is for someone with a fellowship or with a few years experience? I guess that's better than a poke in the eye. I knew a guy that got a job offer from an insurance company in New York and he wanted to bargain for a higher salary. It was an entry level professional job that would usually be filled with someone straight out of undergrad. This guy had a masters degree in finance from Columbia so he mentioned that to them and they increased their offer by 500 bucks. Who would have thought that a masters in finance from Columbia is only worth 500 bucks.

Anyway, I don't know if the same is true for psychiatrists, from what I have seen in business it pays to bargain for a higher starting salary because bonuses and future pay raises tend to be calculated as a percentage of your salary.

 

[PsychMD2100]

A friend of mine in IM did locum tenens for about 6 months. Of course, IM is quite different from psychiatry, but he was able to sign month-to-month. He only had to give 2 weeks notice prior to his departure.

According to this internist, they pay you higher hourly wages, but then they don't give you health care benefits, 401k, etc since you're considered an independent contractor instead of an employee.

 

[USUHS2008]

I've been contemplating moonlighting once I get past internship year. Does anyone know what the rates per shift or hour tend to be? I'm in the D.C. area, but any info would be helpful! Thanks!

 

[Anasazi23]

Psychiatry News

"Lucrative 100% Outpatient Opportunity for Psychiatry"
Employed Opportunity, 100% Outpatient
175k Salary + Productivity Incentives
Sign On Bonus, Car Allowance, and Loan Repayment
Comprehensive Benefits Include Health and Paid Malpractice
3 Weeks Vacation
Will Assist in Training for Subutex Detox
Paid CME
No Call

"Charming Lake Charles Area"
Short Drive to the Gulf Coast
Outdoor Enthusiasts Enjoy Abundant Hunting, Fishing, Boating, Golf & Water Ski Year Round
The "Festival Capital of Louisiana": More than 75 Fairs, Festivals and Special Events Each Year
Southern Food and Comfort
Close to Houston Metro Area
Low Crime Rate
Lakeside Real Estate Available
Great Place to Raise a Family

 

[Anasazi23]

Just a reminder...I'm not posting these job opportunities to fill positions, but because I get numerous requests to give examples of practice conditions and salaries that are waiting for graduating psychiatry residents, and to allow students to see what might be in store.

I got this by email today:

SARATOGA COUNTY MENTAL HEALTH
STAFF PSYCHIATRIST
SALARY: $156,267 Plus Excellent Benefits
This position carries out medical/professional duties and assists in monitoring the quality and effectiveness of the community mental health (including mental ******ation and alcoholism) services and facilities.
Applies psychiatric expertise to the planning, coordination and operation of the mental health and mental ******ation services provided within Saratoga County.
Makes recommendations to the Director of Community Mental Health Services towards attaining an effective and comprehensive community mental health services and mental ******ation program.
The incumbent will perform all related duties as assigned. This physician has the option to cover call with the Saratoga Hospital inpatient psychiatrists.

MINIMUM QUALIFICATIONS:

License to practice medicine at the time of application
License to practice medicine in the State of New York at the time of appointment
Board eligibility to practice psychiatry

 

[prominence]

do outpatient mental health clinics or (hospital) inpatient psychiatric units offer pension plans for psych attendings upon retirement?

 

[Anasazi23]

Many do, yes.

 

[OldPsychDoc]

do outpatient mental health clinics or (hospital) inpatient psychiatric units offer pensions for psych attendings upon retirement?

This comes down to the (eternal) question of working in "corporate private practice", public sector practice, academia--e.g all to some extent "employed" positions--vs. truly "private private practice", such as the cash-only practices that some envision.

If you take a salaried or employed position, these tend to include pension, 401k's, insurance, and other benefits, thus saving you LOTS of headache. If you go it entrepeneurially--you're on your own for all of these things, though they are often available via professional networks.

Personally, that's why I chose the former, and was quite happy to do so. I do accept that others have different expectations for their careers.

 

[sga430]

just heard the wichita va pays 230k.

 

[Lucad142]

I'm pretty sure I remember reading somewhere on Forbes that, for psychiatrists, Idaho was the #1 paying state in America