Salary and midlevels moving in?

[kurite]

Hello,
i know there is plenty of data online in terms of psychiatrists salary being anywhere from 170-210k per year but I have also heard this includes a lot of older psychiatrists putting in significantly less than 40 hours a week. Does anyone have any idea about what the average psych salary is working around 40 hours a week? How much starting?

Also i know that other medical professionals such as nurse practitioners are now able to prescribe medication and essentially act as a psychiatrist, is this something that may hurt the physicians?

Thank you

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[nitemagi]

Do a search.

 

[chicagochildpsych]

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[erg923]

Also i know that other medical professionals such as nurse practitioners are now able to prescribe medication and essentially act as a psychiatrist

It is sad that this is the perception of what a psychiatrist is. Splik?

 

[kurite]

It is sad that this is the perception of what a psychiatrist is. Splik?

I know it by no means what a psychiatrist is but that being said seeing patients and simply prescribing is a part of the profession.

 

[erg923]

I know it by no means what a psychiatrist is but that being said seeing patients and simply prescribing is a part of the profession.

Yes. But that would mean that primary care doctors essentially "act as psychiatrists" then, using your logic. And I don't think anyone would argue that, even though the write more prescriptions for psychotropic than anyone else.

 

[Armadillos]

seeing patients and simply prescribing

What do you mean by this?

Would you say the same thing about an endocrinologist or an infectious disease specialist?

 

[hamstergang]

Economically, I'm sure med students and residents hate that I "act as a psychiatrist," but I definitely enjoy it.

I doubt it affects my salary much as there's just such a huge deficit of psychiatrits. The reason I care is for our patients:

Most of the training NPs get is deficient. I can't interpret a CXR (nor do I want to), but you're right I had an hour long class on the subject, lol. The best instruction I've had on it were from YouTube....
Admittedly, much of my psych training was deficient, and it is quite time consuming to both play catch up and keep current.

 

[SmallBird]

The harm people fear from midlevel encroachment appears to be vastly overstated. The significant shortage of psychiatrists makes them an indispensable part of the mental health workforce. The differences in length of training mean that psychiatrists may enjoy some priority in obtaining medical director positions at CMHC's, on inpatient units, etc. Psychiatrists may have the opportunity to develop additional skills in leadership, research, complex diagnostic issues, interventional approaches etc during residency, and these skills are valued by certain employers. Nurse practitioners may accumulate equivalent experience throughout there careers, and in instances where they are equally prepared through this experience, they will likely earn close to their physician colleagues. I think that trying to argue that something intrinsic to being a psychiatrists is the reason we should be paid more money is misguided and likely to be threatened; rather, we should attempt to develop unique competencies that allow us to provide additional value. I am quite unsympathetic to the idea that we should get more money for prescribing the same dose of methylphenidate to the same patient. On the other hand, as a second year CAP fellow, I'll be consulting to some nurse practitioners on management of complex ASD comorbidity cases, with recognition that my dedication to clinical work and research in this area adds value to this process.

 

[nancysinatra]

Are NP programs regulated by some equivalent of the ACGME? Because I have worked with and or seen the work of numerous NPs now, and they vary to a great extent. Some are as good as the most solid psychiatrists; others are horrible. But you see the same thing IN psychiatry. We as a field can hardly say we are consistent, so, to criticize NPs because they don't meet our "standard" seems ludicrous. We don't have a standard!

And about the proclaimed "shortage" of psychiatrists - why is that? Has society in the last 50 or 100 years become more mentally ill than it was before? Why does this shortage exist, at this point in time? Sometimes I think there isn't a shortage at all - just a lot of people in the community who think their problems can be solved with medications, when not all of them can.

 

[NickNaylor]

Are NP programs regulated by some equivalent of the ACGME? Because I have worked with and or seen the work of numerous NPs now, and they vary to a great extent. Some are as good as the most solid psychiatrists; others are horrible. But you see the same thing IN psychiatry. We as a field can hardly say we are consistent, so, to criticize NPs because they don't meet our "standard" seems ludicrous. We don't have a standard!

And about the proclaimed "shortage" of psychiatrists - why is that? Has society in the last 50 or 100 years become more mentally ill than it was before? Why does this shortage exist, at this point in time? Sometimes I think there isn't a shortage at all - just a lot of people in the community who think their problems can be solved with medications, when not all of them can.

Around the 1970s, psychiatry as a field became shunned by medical students, thus the number of folks entering the field declined and never really quite recovered. There is some evidence that the prevalence of some psychiatric disorders has also increased in that time. Whether that is due to changes in diagnostic criteria or a bona fide increase in the prevalence due to increased incidence is anyone's guess.

 

[Shikima]

Around the 1970s, psychiatry as a field became shunned by medical students, thus the number of folks entering the field declined and never really quite recovered. There is some evidence that the prevalence of some psychiatric disorders has also increased in that time. Whether that is due to changes in diagnostic criteria or a bona fide increase in the prevalence due to increased incidence is anyone's guess.

Increases in personality disorders magnified by immaturity?

 

[WisNeuro]

There is some evidence that the prevalence of some psychiatric disorders has also increased in that time. Whether that is due to changes in diagnostic criteria or a bona fide increase in the prevalence due to increased incidence is anyone's guess.

At best, the research I have seen would suggest that it's equivocal. That rates among subgroups may vary, slightly, but overall rates of mental illness are relatively unchanged over time.

 

[splik]

Around the 1970s, psychiatry as a field became shunned by medical students, thus the number of folks entering the field declined and never really quite recovered. There is some evidence that the prevalence of some psychiatric disorders has also increased in that time. Whether that is due to changes in diagnostic criteria or a bona fide increase in the prevalence due to increased incidence is anyone's guess.

As psychiatry became more biomedically oriented, all those students who were interested in psychiatry because they didn't like medicine, or were interested in social justice, activism, humanities and social sciences etc, abandoned psychiatry from primary care. actually it was the 1990s when recruitment into psychiatry was at its lowest with about 3% of students choosing psychiatry, and there was a significant reduction in the number of residency positions in psychiatry in the 1990s which despite the large increase in positions in recent years hs never returned to what it was at the beginning of 1990s (because there aren't enough people interested to fill the spots).

In terms of prevalence of psychiatric disorders - up until recently it appears that the incidence of psychosis has been overall stable or declining over time. There does seem to be an uptick in recent years in european studies over the past 10 years or so however. As for depression: the ECA did not find any evidence to support mental disorders like depression increasing over time. Though the age of onset is now in the 2nd and 3rd decades of life rather than in the 4th and 5th. the NCS-R did find an increase in prevalence of depression, but a slight decrease in the incidence of MDD. This suggests that depression has become more chronic, though fewer people are becoming depressed. I (and others) have argued that this is because of the widespread use of antidepressants which may be increasing the chronicity of depression or making people psychologically dependent on drugs that they are told are like "insulin for diabetes".

There does not seem to be any evidence that the most severe mental disorders - psychotic bipolar I disorder, or schizophrenia are more prevalent. In fact as the concept of bipolarity has vastly expanded, manic-depressive psychosis strictly defined still has a prevalence of 0.5%. A recent study has even suggested that the incidence of dementia is declining (which would make sense).

In some there is no evidence that problems that psychiatrists can actually be useful for are increasing, though there may be an increase in problems that psychiatrists have no hope in hell of treating (**** life syndrome, social inequality, racism, poverty, marginalization, alienation) though even this is doubtful.

 

[Shikima]

As psychiatry became more biomedically oriented, all those students who were interested in psychiatry because they didn't like medicine, or were interested in social justice, activism, humanities and social sciences etc, abandoned psychiatry from primary care. actually it was the 1990s when recruitment into psychiatry was at its lowest with about 3% of students choosing psychiatry, and there was a significant reduction in the number of residency positions in psychiatry in the 1990s which despite the large increase in positions in recent years hs never returned to what it was at the beginning of 1990s (because there aren't enough people interested to fill the spots).

In terms of prevalence of psychiatric disorders - up until recently it appears that the incidence of psychosis has been overall stable or declining over time. There does seem to be an uptick in recent years in european studies over the past 10 years or so however. As for depression: the ECA did not find any evidence to support mental disorders like depression increasing over time. Though the age of onset is now in the 2nd and 3rd decades of life rather than in the 4th and 5th. the NCS-R did find an increase in prevalence of depression, but a slight decrease in the incidence of MDD. This suggests that depression has become more chronic, though fewer people are becoming depressed. I (and others) have argued that this is because of the widespread use of antidepressants which may be increasing the chronicity of depression or making people psychologically dependent on drugs that they are told are like "insulin for diabetes".

There does not seem to be any evidence that the most severe mental disorders - psychotic bipolar I disorder, or schizophrenia are more prevalent. In fact as the concept of bipolarity has vastly expanded, manic-depressive psychosis strictly defined still has a prevalence of 0.5%. A recent study has even suggested that the incidence of dementia is declining (which would make sense).

In some there is no evidence that problems that psychiatrists can actually be useful for are increasing, though there may be an increase in problems that psychiatrists have no hope in hell of treating (**** life syndrome, social inequality, racism, poverty, marginalization, alienation) though even this is doubtful.

Yeah but this doesn't explain how everyone coming out from an Inpt unit has the diagnosis of Bipolar disorder.

 

[PistolPete]

Yeah but this doesn't explain how everyone coming out from an Inpt unit has the diagnosis of Bipolar disorder.

Ugh, vomit. I swear, if we ever come up with a blood test to confirm/discredit bipolar disorder that will be a Nobel Prize and the dawn of a golden age in psychiatry. Why are so many psychiatrists blind to borderline personality disorder? Oh wait, because there's no meds for it and they can't bill for it....

 

[splik]

[QUOTE="PistolPete, post: 17530646, member: 107651"Why are so many psychiatrists blind to borderline personality disorder? Oh wait, because there's no meds for it and they can't bill for it....[/QUOTE]
this is horsesh*t by the way - its fraud to bill for diagnoses patients dont have and you can admit patients with a diagnosis of borderline personality disorder - which is regarded a severe personality disorder. in reality it would be unlikely that your patient just has a dx of BPD though if they are requiring inpatient care - depression, bipolar disorder, anxiety disorder, substance use disorders are often highly comorbid. You do not need to have a major mental disorder to warrant inpatient hospitalization. however there does need to be some code billed to justify this. Also the APA's good psychiatric management of BPD does recommend a variety of different medications for symptom clusters (anxious/depressed/affective instability, anger/impulsivity, cognitive/perceptual) and has been shown to be comparable to DBT for reducing suicidality. There are even some programs that admit patients with BPD to inpatient unit when not in crisis to learn skills and "reward" them for not presenting in crisis, breaking down the association between the inforcement for presenting in crisis and hospitalization.

But yes it is true that for example a diagnosis of schizophrenia will get you a longer authorization for hospitalization than a diagnosis of BPD. Or a diagnosis of substance-induced depressive disorder will get you a shorter authorization than a diagnosis of bipolar I disorder, MRE depressed, severe etc. But this is partly based on the estimates of what someone might need if fiendishly tempered by managed care.

You can for example code:
1. suicidal ideation (R45.851)
2. borderline personality disorder

 

[Shikima]

Personality disorder (301.9) (F60.9)

 

[PistolPete]

.

 

[PistolPete]

Thanks. I was mostly being facetious, but I think you catch my drift. I see many patients that come in with a diagnosis of bipolar disorder, and when a careful interview is done, they talk about aggressive outbursts, or mood lability, or interpersonal difficulties, etc. however no history of hypomania or mania or sleep disturbance or anything else that could point to bipolar disorder. Family will say how they have to "walk on eggshells" around them. And yes, they almost always have a comorbid MDD, or GAD, or something like that, but almost never a true bipolar disorder.

 

[splik]

bipolar disorder was the faddish diagnosis of the 2000s because of the atypical antipsychotics. these very same patients were diagnosed with depression in the 1990s when the SSRIs were in vogue, and anxiety neurosis in 70s and 80s. but bipolar disorder is so 10 years ago now - adult ADHD is the diagnosis of the past few years thanks to Shire and aggressive marketing of Adderall...

 

[Doctor Bagel]

bipolar disorder was the faddish diagnosis of the 2000s because of the atypical antipsychotics. these very same patients were diagnosed with depression in the 1990s when the SSRIs were in vogue, and anxiety neurosis in 70s and 80s. but bipolar disorder is so 10 years ago now - adult ADHD is the diagnosis of the past few years thanks to Shire and aggressive marketing of Adderall...

People seem to really cling to their bipolar diagnoses, though, which is a curious thing. I don't think people were particularly attached to their MDD diagnoses or their "anxiety neurosis" diagnoses (well, unless you're Woody Allen or live in New York). Well, actually adult ADHD seems to do the same thing. No one ever wants to have that diagnoses go away or be removed from a problem list.

About bipolar disorder, the people who actually have it never want to admit that they have it, as opposed to all the other folks who think their bipolar diagnosis explains everything in their life.

 

[splik]

People seem to really cling to their bipolar diagnoses, though, which is a curious thing. I don't think people were particularly attached to their MDD diagnoses or their "anxiety neurosis" diagnoses (well, unless you're Woody Allen or live in New York). Well, actually adult ADHD seems to do the same thing. No one ever wants to have that diagnoses go away or be removed from a problem list.

About bipolar disorder, the people who actually have it never want to admit that they have it, as opposed to all the other folks who think their bipolar diagnosis explains everything in their life.

people cling to a bipolar disorder diagnosis because they think it provides them moral exculpation for their bad behavior in a way that a diagnosis of a neurotic disorder does not. same goes for ADHD.

 

[smalltownpsych]

About bipolar disorder, the people who actually have it never want to admit that they have it, as opposed to all the other folks who think their bipolar diagnosis explains everything in their life.

Ain't that the truth. We could probably improve our diagnostic validity by just asking patients if they have it, then diagnose the opposite. I think the use of the "my bipolar" phrase might also add to ability to detect false positives.

 

[AcronymAllergy]

Sigh, if I could do nothing else but stem the tide of "adult ADHD" diagnoses I see assigned by all sorts of providers, I'd be a very, very happy person. And the same level of patient-held "I want this diagnosis" applies in the college population for parents of students, where particularly (at least in my experience) in upper-class circles, it's almost preferred. Perhaps because ADHD doesn't have the same negative connotations as intellectual disability or autism spectrum, is sexier than a learning disorder, and is easier to swallow than bad parenting and slacker NOS as the diagnoses.

 

[WisNeuro]

Sigh, if I could do nothing else but stem the tide of "adult ADHD" diagnoses I see assigned by all sorts of providers, I'd be a very, very happy person. And the same level of patient-held "I want this diagnosis" applies in the college population for parents of students, where particularly (at least in my experience) in upper-class circles, it's almost preferred. Perhaps because ADHD doesn't have the same negative connotations as intellectual disability or autism spectrum, is sexier than a learning disorder, and is easier to swallow than bad parenting and slacker NOS as the diagnoses.

If there is no return to school question, we straight up refuse the consult.

 

[Shikima]

people cling to a bipolar disorder diagnosis because they think it provides them moral exculpation for their bad behavior in a way that a diagnosis of a neurotic disorder does not. same goes for ADHD.

It legitimizes and marginalizes at the same time. A terrible consequence.

 

[kurite]

Im sorry if I offended anybody early on in this thread. I was simply wondering if I decide to go into psychiatry if the field will always be as lucrative as it is now or if NPs and PAs may be able to lower salary potential?

 

[scudiera]

It's not particularly lucrative right now?

 

[Doctor Bagel]

Im sorry if I offended anybody early on in this thread. I was simply wondering if I decide to go into psychiatry if the field will always be as lucrative as it is now or if NPs and PAs may be able to lower salary potential?

I think the reaction initially was that this has been discussed a lot on this forum, and if you do a search, you'd probably find that. Also, IMO, it's kind of a depressing topic, so maybe people want to talk about it. I'm a pessimist, but I really do expect that NPs will lead to wage reduction in the future. I work in a state where NPs don't need supervision, so we are going to have to start to really advocate to show that we can provide some additional value. I suspect all states are going to eventually reach this point although it might be many years down the road.

 

[F0nzie]

I think the reaction initially was that this has been discussed a lot on this forum, and if you do a search, you'd probably find that. Also, IMO, it's kind of a depressing topic, so maybe people want to talk about it. I'm a pessimist, but I really do expect that NPs will lead to wage reduction in the future. I work in a state where NPs don't need supervision, so we are going to have to start to really advocate to show that we can provide some additional value. I suspect all states are going to eventually reach this point although it might be many years down the road.

Insurance companies determine the value psychiatrists provide 90% of the time. The paradigm is lose, lose, win. The patient loses, the doctor loses, and the insurance wins. NPs are the next losers in line. The more they lose, the more we lose. Everybody is a loser except the insurance company.


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[smalltownpsych]

Insurance companies determine the value psychiatrists provide 90% of the time. The paradigm is lose, lose, win. The patient loses, the doctor loses, and the insurance wins. NPs are the next losers in line. The more they lose, the more we lose. Everybody is a loser except the insurance company.


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Don't forget the federal gov, I think they are winning too. Oh and great example of Dr. Bagels point about pessimism. Dealing with the systems the cards are often stacked against us, but on a more optimistic note, in spite of it all we still help a lot people and for now make a decent living.

 

[Doctor Bagel]

Insurance companies determine the value psychiatrists provide 90% of the time. The paradigm is lose, lose, win. The patient loses, the doctor loses, and the insurance wins. NPs are the next losers in line. The more they lose, the more we lose. Everybody is a loser except the insurance company.


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I think with insurance companies (and yes, the government), anybody seeing a patient for a psychiatric assessment for x period of time (or for x complexity level) is interchangeable regardless of training, years of work, competency, etc.. Patient gets seen, box gets checked, done.

 

[MacDonaldTriad]

If you hire NPs, they pay for themselves. They can even make you money. They are not capable of everything, but they are a lot cheaper than hiring a new psychiatrist in your group. Everyone sounds like they think NPs will lower our salaries, but the opposite can be true.

 

[Shikima]

If you hire NPs, they pay for themselves. They can even make you money. They are not capable of everything, but they are a lot cheaper than hiring a new psychiatrist in your group. Everyone sounds like they think NPs will lower our salaries, but the opposite can be true.

Good for routine follow-ups... maintaining.

 

[finalpsychyear]

Good for routine follow-ups... maintaining.

This is true. Got to watch out in states where they can practice indep. They can leave your practice and open up shop nearby Im guessing a lot of their maintainence patients would flock to them. I have heard this happen in PCP offices but would imagine could happen in psych.

 

[smalltownpsych]

This is true. Got to watch out in states where they can practice indep. They can leave your practice and open up shop nearby Im guessing a lot of their maintainence patients would flock to them. I have heard this happen in PCP offices but would imagine could happen in psych.

Why would the patient choose the NP over the psychiatrist? We have arguably even more midlevel competition from LCSW, MFTs, and LCPCs, but my practice is busy and many patients choose the higher credential intentionally and others just believe that I am more competent based on my own individual abilities.

 

[erg923]

Why would the patient choose the NP over the psychiatrist? We have arguably even more midlevel competition from LCSW, MFTs, and LCPCs, but my practice is busy and many patients choose the higher credential intentionally and others just believe that I am more competent based on my own individual abilities.

In my experience, most don't know the difference. Many don't pay attention to what their "prescriber" actually is. A minority care and know the difference. This is VA, mostly.

 

[NontradCA]

In my experience, most don't know the difference. Many don't pay attention to what their "prescriber" actually is. A minority care and know the difference. This is VA, mostly.

I tend to think this is the last place a psychiatrist's salary would drop. It would make bad press considering all the PTSD, vet suicide rah rah.

 

[smalltownpsych]

In my experience, most don't know the difference. Many don't pay attention to what their "prescriber" actually is. A minority care and know the difference. This is VA, mostly.

True, I guess I shouldn't have said many. The minority that care also tend to be conscientious about other things like showing up to their appointments so that helps when you are in a more competitive environment. I also feel that the higher training gives me a competitive edge over the average midlevel just in my clinical abilities and that also helps keep my schedule full.

 

[notdeadyet]

I tend to think this is the last place a psychiatrist's salary would drop. It would make bad press considering all the PTSD, vet suicide rah rah.

The VA doesn't have to drop salaries. You do not have the annual or biannual raises you typically get at most places (other than cost of living adjustments).

The VA did a salary bump a few years ago and it caused a bit of ruffled feathers because docs who were being hired were getting salaries more than docs who had been there for 10 years.

So all the VA has to do is not offer any more salary adjustments and it has the effect of salaries dropping.

 

[Armadillos]

In my experience, most don't know the difference. Many don't pay attention to what their "prescriber" actually is. A minority care and know the difference. This is VA, mostly.

This was generally my thought and is probably true. But recently have had a couple hilarious interviews with inpatient manic patients ranting about how X agency is conspiring against them by having them see "nurses pretending to be doctors".

 

[NontradCA]

The VA doesn't have to drop salaries. You do not have the annual or biannual raises you typically get at most places (other than cost of living adjustments).

The VA did a salary bump a few years ago and it caused a bit of ruffled feathers because docs who were being hired were getting salaries more than docs who had been there for 10 years.

So all the VA has to do is not offer any more salary adjustments and it has the effect of salaries dropping.

Thank you for the info.

Wow, that's pretty crummy. Did those docs eventually get raises?

 

[URMD]

How long is NP school? Google says 1-3 years, but generally what is it? 1? 3?

 

[Dharma]

How long is NP school? Google says 1-3 years, but generally what is it? 1? 3?

Doh!

 

[notlucid]

Comparing the best nurse practitioner to worst resident is not accurate and is sad.

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[Extralong]

How long is NP school? Google says 1-3 years, but generally what is it? 1? 3?

To become a NP:
1) Graduate High school
2) Bachelors in Nursing: 3-4 years
3) Take NCLEX - one time test
4) Become RN
5) Masters in Nursing: 2 years
6) Become NP with prescribing rights
Total years: 6 years after High School

 

[Shikima]

To become a NP:
1) Graduate High school
2) Bachelors in Nursing: 3-4 years
3) Take NCLEX - one time test
4) Become RN
5) Masters in Nursing: 2 years
6) Become NP with prescribing rights
Total years: 6 years after High School

Isn't that how it is done in Euro typically for becoming a MD?

 

[Doctor Bagel]

Isn't that how it is done in Euro typically for becoming a MD?

They still have to do a residency. NPs can practice independently (in states with independent practice, which is more than half of them) without any training after they complete school. So six years, and you're done. Whereas we have to work as residents for 4 years being supervised and earning a reduced salary after 8 years of school (of 6 in Europe or at some of the fast track schools like UMKC). The NPs I work with have less experience actually doing psychiatric work even though I finished training after them.

 

[PistolPete]

They still have to do a residency. NPs can practice independently (in states with independent practice, which is more than half of them) without any training after they complete school. So six years, and you're done. Whereas we have to work as residents for 4 years being supervised and earning a reduced salary after 8 years of school (of 6 in Europe or at some of the fast track schools like UMKC). The NPs I work with have less experience actually doing psychiatric work even though I finished training after them.

And Insurance companies and many employers equate them to psychiatrists :/