So can we talk money?

[nexus73]

Can someone tell me what the catch is with this job? Some shady math?

http://www.indeed.com/viewjob?cmp=Institute-for-Personal-Development-(IPD)&t=Outpatient+Psychiatrist&jk=a76dc2e7e2593e4e&q=child+psychiatrist+$175,000

Looks like you have to pay at least some of your malpractice insurance. Also,the job is in the boonies. I wonder if advertised salary is guaranteed or just a possibility based on productivity.

---

Members don't see this ad.

 

[Psychotic]

I have recently read a lot of job ads that state something like "1 year psychiatry experience required" and in a couple of cases it is more years than that (I saw one requiring 5 years).

Begs these questions: are these jobs really out of reach for people just out of residency? Anybody gotten a job right out of residency that had that requirement in the job listing? Is it just a negotiating thing, maybe lower initial pay for a shrink right out of residency?

 

[TexasPhysician]

I have recently read a lot of job ads that state something like "1 year psychiatry experience required" and in a couple of cases it is more years than that (I saw one requiring 5 years).

Begs these questions: are these jobs really out of reach for people just out of residency? Anybody gotten a job right out of residency that had that requirement in the job listing? Is it just a negotiating thing, maybe lower initial pay for a shrink right out of residency?

Ignore it. The people creating the ads sometimes have no idea or need something as a placeholder. Some may perceive a child psych job to require 5 years experience (length of residency/fellowship).

 

[notdeadyet]

Begs these questions: are these jobs really out of reach for people just out of residency? Anybody gotten a job right out of residency that had that requirement in the job listing? Is it just a negotiating thing, maybe lower initial pay for a shrink right out of residency?

Always apply to stuff like that. There is almost zero effort in sending off a resume and quick cover letter (if needed), so there's no harm in trying.

Keep in mind that if folks have to post a job listing, it means the preferred method of getting word out locally and asking for referrals from the existing psychiatrist community has failed. What they are looking for and what they will accept may soon become two different things.

 

[OldPsychDoc]

I have recently read a lot of job ads that state something like "1 year psychiatry experience required" and in a couple of cases it is more years than that (I saw one requiring 5 years).

Begs these questions: are these jobs really out of reach for people just out of residency? Anybody gotten a job right out of residency that had that requirement in the job listing? Is it just a negotiating thing, maybe lower initial pay for a shrink right out of residency?

As I see it, if you've graduated from residency you have 3.5 years psychiatry experience.

It's up to you to demonstrate that and sell it on your job interviews.

 

[smalltownpsych]

As I see it, if you've graduated from residency you have 3.5 years psychiatry experience.

It's up to you to demonstrate that and sell it on your job interviews.

Yeah, my first job as a licensed psychologist was asking for 5 years experience which with three years of clinical rotations during school which is about 20 hours a week and one year internship and one year postdoc was easy to show on my CV. Both guys doing the hiring were impressed by my experience and didn't really think or even really know about my freshly printed license with the ink barely dry.

 

[Trismegistus4]

Looks like you have to pay at least some of your malpractice insurance. Also,the job is in the boonies. I wonder if advertised salary is guaranteed or just a possibility based on productivity.

It says "Psychiatrists schedule 1-4 encounters per hour depending on clinical preference of psychiatrist." I'm sure you only get to $300k if you schedule 4 encounters per hour.

 

[deleted310399]

physicians from minority backgrounds get paid less, but I haven't heard it harder to get into group practice. not that group practice is a big thing in psychiatry, people tend to go into solo private practice. There are fewer minority psychiatrists in academia, but that is mainly because of the pay being lower.

there are of course patients who don't want to see a doctor who is black (or of some other racial background) and I have heard some really horror stories from residency. but i dont think most people care. though it is interesting, i wonder if it is harder to have a successful cash private practice in psychiatry if you're black? but i don't think kaiser and the like care about that sort of thing and many larger employers are trying to diversify their workforce.

WTF , what is this **** ..??

 

[mikey5311]

I'm doing a bit of negotiating and am still really unclear what pay ranges are there and make sense. Can I throw out a couple of scenarios and have you tell me what you think the going rate in your city for that would be? About where I'm at -- pretty significant shortage of providers but also desirable with an ever increasing cost of living. Not SF, LA, NYC, Boston levels yet but definitely also not Kansas City either.

First scenario:
fulltime inpatient in a reasonably busy unit with say phone call once a week and once a month weekend in-house call + overnight phone call for half of that weekend

Second scenario:
full-time community MH with say 13 patients/day. No call/no weekends.

Third scenario:
fulltime non-community outpatient MH (say Kaiser types of places), again 13 patients/day. No call/no weekends. 4 days a week. Days maybe busier days because of fewer no shows?

Fourth scenario:
fulltime VA, VA level of busy, which is not super. 2 weeks of call mainly providing supervision to residents.

No, I'm not debating all these different jobs, but I am trying to get a handle on what psychiatry incomes really are.

 

[mikey5311]

Damn. I'm living outside the U.S. and trolling through this board. I've never imagined how materially focused/selfishly obsessed you American docs are. Now I understand why the US has crappy health care, but nice equipment and cars.

 

[st2205]

Damn. I'm living outside the U.S. and trolling through this board. I've never imagined how materially focused/selfishly obsessed you American docs are. Now I understand why the US has crappy health care, but nice equipment and cars.

Your outside-looking-in perspective (even if it sounds uniquely like an angsty American who is inside-looking-in) sure lends credibility to your argument. It's a shame that it took a thread like this to inform a DO/PhD student, who is apparently living abroad, why the U.S. has crappy healthcare but nice cars.

 

[Rogue Penguin]

Damn. I'm trolling.

^ I fixed your post for you.

 

[smalltownpsych]

Damn. I'm living outside the U.S. and trolling through this board. I've never imagined how materially focused/selfishly obsessed you American docs are. Now I understand why the US has crappy health care, but nice equipment and cars.

Really? Do you even have a job? Seriously. I worked in two different industries (transportation and finance) for ten years before becoming a psychologist. I fought for money back then and fight for it now. Exchange of goods and services through using representative value units is part of human society and has been ever since the first caveman gave his shiny sea shells to the shaman to cure him of his evil spirits.

 

[Shikima]

Most recently, saw a job posting 290K/yr + rvu + loan repayment. I wouldn't bother with MGMA any longer as it does trend supply & demand economics.

 

[NickNaylor]

Most recently, saw a job posting 290K/yr + rvu + loan repayment. I wouldn't bother with MGMA any longer as it does trend supply & demand economics.

What kind of geographic setting is this in? E.g., high/low COL area, urban/suburban/rural, etc. Just curious.

 

[Shikima]

What kind of geographic setting is this in? E.g., high/low COL area, urban/suburban/rural, etc. Just curious.

Recruiters never give details. Just the amounts.

 

[NickNaylor]

Recruiters never give details. Just the amounts.

Ah. Well that makes it a bit difficult to figure out whether the offer is appealing or not, then. That sounds like a great deal based on where I'm living, but in the Bay Area or some other high COL area? Maybe not so much.

 

[Shikima]

Ah. Well that makes it a bit difficult to figure out whether the offer is appealing or not, then. That sounds like a great deal based on where I'm living, but in the Bay Area or some other high COL area? Maybe not so much.

A lot of salaries are less in NY/NJ/CT, and about the same for the bay area. It seems that loan repayment is starting to come back where it wasn't available before.

 

[sunlioness]

Yeah, salaries throughout the urban northeast aren't that great


Sent from my iPad using Tapatalk

 

[medicaresucks]

Hey guys. About to graduate soon and considering starting my own practice. I hear alot of discrepancies when it comes to insurance payments. While I know you cannot talk about specific private insurance rates, I wanted to know how they generally range compared to medicare rates. In my area 99213, 99214, 90833 the therapy add on pay respectively: 70, 104, 65.

How does this compare to the private pay insurances? Some attendings i hear say its always at least medicare while others say medicare pays higher than alot of privates etc... but i have heard some insurances paying 50 dollars for a 99213. Just want to figure out some basics before going down this somewhat daunting process of PP.

 

[Shikima]

That 90833 is a good reimbursement for 15-20 mins. Better than my rates at around $35-40. But each insurance company will have different rates; for example, value options is a very poor imburser compared to BCBS.

 

[TexasPhysician]

Hey guys. About to graduate soon and considering starting my own practice. I hear alot of discrepancies when it comes to insurance payments. While I know you cannot talk about specific private insurance rates, I wanted to know how they generally range compared to medicare rates. In my area 99213, 99214, 90833 the therapy add on pay respectively: 70, 104, 65.

How does this compare to the private pay insurances? Some attendings i hear say its always at least medicare while others say medicare pays higher than alot of privates etc... but i have heard some insurances paying 50 dollars for a 99213. Just want to figure out some basics before going down this somewhat daunting process of PP.

There is no generalized comparison. Varies based on region/location and your ability to negotiate rates.

 

[sweetlenovo88]

There is no generalized comparison. Varies based on region/location and your ability to negotiate rates.

Is there a way to research the area first? Am I to assume the more remote/bigger need for psych the higher the compensation or negotiating power?

 

[medicaresucks]

That 90833 is a good reimbursement for 15-20 mins. Better than my rates at around $35-40. But each insurance company will have different rates; for example, value options is a very poor imburser compared to BCBS.

I appreciate the response. That same insurer who is paying 35-40 for a 90833 ,which is less than medicare in my area paying 65 for 90833, do they at least pay on par or more for the 99213 which in my area is around 70? Also, are your medicare rates in the region your quoting lower than the ones in mine so that may explain why the private ins is also lower?

There is no generalized comparison. Varies based on region/location and your ability to negotiate rates.

So there is no truth that private ins has to pay at least the medicare rates in the given area as many of my attendings have said. Thus, they can be above and below the medicare payments for the given area? That is news to me. Thank you for that clarification. Do you at least get to see all the rates for a given insurance panel before you sign the dotted line?


Just found this great resource outlining E/M rates via commercial insurance depending on your area in the country and based on pcp vs med specialty vs surgical rates. Basically its somewhere between 75-80 dollars for the average private ins payment for a 99213.

http://www.physicianspractice.com/f...6D-A24B-761E98D7C98B&rememberme=1&ts=03022015

 

[TexasPhysician]

Is there a way to research the area first? Am I to assume the more remote/bigger need for psych the higher the compensation or negotiating power?

The answer is likely no to your questions. When I was considering accepting insurance companies, they refused to provide rates until I provided a rented address for the practice and completed a bunch of forms.

If you choose a more rural area, it could be that you have to take insurance to survive. If the companies know this, rates could be low. You also don't want an overcrowded area as insurances won't need you as much. Some regions are significantly weighted toward 1 insurance company which can force lower rates. Being a small practice hurts to as they don't negotiate much with small practices.

I've seen physicians establish groups partly to negotiate with more power. An insurance company in an urban area can't easily afford to lose >50% of a certain specialty.

The insurance companies spend a lot of time/money analyzing the market to learn how little they can pay you. You even sign contracts that don't allow you to discuss rates with peers.

 

[sweetlenovo88]

The answer is likely no to your questions. When I was considering accepting insurance companies, they refused to provide rates until I provided a rented address for the practice and completed a bunch of forms.

If you choose a more rural area, it could be that you have to take insurance to survive. If the companies know this, rates could be low. You also don't want an overcrowded area as insurances won't need you as much. Some regions are significantly weighted toward 1 insurance company which can force lower rates. Being a small practice hurts to as they don't negotiate much with small practices.

I've seen physicians establish groups partly to negotiate with more power. An insurance company in an urban area can't easily afford to lose >50% of a certain specialty.

The insurance companies spend a lot of time/money analyzing the market to learn how little they can pay you. You even sign contracts that don't allow you to discuss rates with peers.

Thanks for the info

 

[PistolPete]

The answer is likely no to your questions. When I was considering accepting insurance companies, they refused to provide rates until I provided a rented address for the practice and completed a bunch of forms.

If you choose a more rural area, it could be that you have to take insurance to survive. If the companies know this, rates could be low. You also don't want an overcrowded area as insurances won't need you as much. Some regions are significantly weighted toward 1 insurance company which can force lower rates. Being a small practice hurts to as they don't negotiate much with small practices.

I've seen physicians establish groups partly to negotiate with more power. An insurance company in an urban area can't easily afford to lose >50% of a certain specialty.

The insurance companies spend a lot of time/money analyzing the market to learn how little they can pay you. You even sign contracts that don't allow you to discuss rates with peers.

But one can still see what their rates are and negotiate before officially signing on the dotted line and accepting insurance right? In other words, they can't force you to accept their insurance prior to revealing rates, right?

 

[TexasPhysician]

But one can still see what their rates are and negotiate before officially signing on the dotted line and accepting insurance right? In other words, they can't force you to accept their insurance prior to revealing rates, right?

Correct

 

[Extralong]

I feel strongly the necessity to post this once more:

Psychiatry numbers from MGMA 2105 for the 2014 year.

All areas Mean: 264K
Eastern Mean: 230K
Midwest Mean:271K
Southwest Mean: 267K
West mean: 285K

Psych is very valuable, and I would definitely make sure you are aware of this. Obviously for many academic centers, its much lower, but generally, you can really squeeze out pretty good income. If I were you, I would buy the MGMA book($700), and calculate if you are getting paid below a certain percentile, say below 50th, and then request an increase in your salary using that book as one of your sources. Happens all the time.

But thats likely for 30-40 hours of work at 50th percentile. The reason you see a poll with such high numbers because in real life, places are desperate for psychiatry and are willing to pay much more 300-400K with amazing benefits. IMO.

 

[Information Underload]

I feel strongly the necessity to post this once more:

Psychiatry numbers from MGMA 2105 for the 2014 year.

All areas Mean: 264K
Eastern Mean: 230K
Midwest Mean:271K
Southwest Mean: 267K
West mean: 285K

Do you have a link for these numbers, or did you buy the book? Having a link for this from a credible source would be quite timely now.

 

[W19]

Psychiatry numbers from MGMA 2105 for the 2014 year.

All areas Mean: 264K
Eastern Mean: 230K
Midwest Mean:271K
Southwest Mean: 267K
West mean: 285K
But thats likely for 30-40 hours of work at 50th percentile. The reason you see a poll with such high numbers because in real life, places are desperate for psychiatry and are willing to pay much more 300-400K with amazing benefits. IMO.

300-400k! That's a new one...

 

[notdeadyet]

All areas Mean: 264K
Eastern Mean: 230K
Midwest Mean:271K
Southwest Mean: 267K
West mean: 285K

Two things with this:

- Salary surveys are inflated by nature. This is not a criticism of any particular survey.

- Means for an industry aren't particularly helpful for a field like psychiatry. For one, our field is skewed old (and experienced and better paid), so interpreting a starting is a challenge.

Considering $300k-$400k with benefits for most jobs the norm will leave folks VERY disappointed.

Rather than surveys of mean salaries, more relevant is asking what folks are actually being offers in their area.

Out my way in California, starting salaries look like this:

academic is around $150k-$200k.
Many county and public jobs around $190-$215k.
Prison/state hospital work for $235k.
Lots of private practice jobs for $240-250k. Kaiser is starting at about $275k.
There are also some starting at $275k that is psychotherapy/medication mixed, but pretty limited to NPI, UCSF, and close connections.


Sent from my iPhone using Tapatalk

 

[Extralong]

MGMA book is pricey:

http://www.mgma.com/industry-data/survey-reports/physician-compensation-and-production-survey

 

[Extralong]

Look, I'm not here to start arguing whats the right price point, but there are so many factors, including location, sign-on bonuses, how well and what you decide to negotiate into/out of your contract, the hours your willing to work, possible moonlighting, academics, and so many other things that I cannot think off the top of my head.

Purely, in my opinion, 300K-400K is not enough for psychiatrists, and should by much higher. This number obviously scares heads of departments, financial people, and basically anyone that has to dole out the money to the physician. If I were a chair of a department(I am not), or CFO(I am not), I wouldn't like me posting these numbers.

Maybe the survey is skewed here on SDN, and I would implore you look at contracts carefully with the proper tools, and make decision for your self. Statements here are both from experience and opinion, and teasing out what is what is nearly impossible. There are long term members that have great points, but sometimes different perspectives can you give you a sense of the diversity of income that is out there.

 

[notdeadyet]

Your point is valid, Extralong. But folks who have negotiated for salary will probably tell you that there is an important difference between price and value.

I like to think I deliver outstanding, patient-centric, compassionate, evidence-based, prudent, efficient care. I may think that I'm worth $400k.

But if an employer can hire two of me for half the price, even if they can't hold a candle to my work, they will.

 

[Extralong]

Your point is valid, Extralong. But folks who have negotiated for salary will probably tell you that there is an important difference between price and value.

I like to think I deliver outstanding, patient-centric, compassionate, evidence-based, prudent, efficient care. I may think that I'm worth $400k.

But if an employer can hire two of me for half the price, even if they can't hold a candle to my work, they will.

I agree, yes all very true. I think it is difficult to find two. Though, price vs value is obviously a big discussion among other things when looking into a job. Other factors include satisfaction, and if your working enough(in hours) to make 400K, are you able to find time to spend with family friends, go on vacation, or basically use any of that money.

 

[zolof]

I agree, yes all very true. I think it is difficult to find two. Though, price vs value is obviously a big discussion among other things when looking into a job. Other factors include satisfaction, and if your working enough(in hours) to make 400K, are you able to find time to spend with family friends, go on vacation, or basically use any of that money.

I agree. When people quote these type of salaries, such as northeast, southeast, averages, etc, they are meaningless without the context and details which are too many to list, many that you pointed out. There are so many factors not taken into account, bonuses though out the year, working environment, patients per hour/day, violent patients, etc. In my experience at least in my neck of the woods, I have plenty of friends making crazy salaries above 400K, But I know them very well and see them and they are ALL every single one, doing calls all the time, and additional things, private practice etc, to get those salaries. I just have never seen the above 300K gotten without lots of additional overtime work. I managed to get more than that, but that was Locums, without any benefits and lots of commuting so in actually I was working more than 40 because of my commuting. And yes I barely had time for family, hobbies, etc, and I hated that part of it. I loved the money but hate that I can't spend any free time doing what I want, because Im too tired.

 

[michaelrack]

I agree. When people quote these type of salaries, such as northeast, southeast, averages, etc, they are meaningless without the context and details which are too many to list, many that you pointed out. There are so many factors not taken into account, bonuses though out the year, working environment, patients per hour/day, violent patients, etc. In my experience at least in my neck of the woods, I have plenty of friends making crazy salaries above 400K, But I know them very well and see them and they are ALL every single one, doing calls all the time, and additional things, private practice etc, to get those salaries. I just have never seen the above 300K gotten without lots of additional overtime work. I managed to get more than that, but that was Locums, without any benefits and lots of commuting so in actually I was working more than 40 because of my commuting. And yes I barely had time for family, hobbies, etc, and I hated that part of it. I loved the money but hate that I can't spend any free time doing what I want, because Im too tired.

That is what I have seen also

 

[Leo Aquarius]

I agree. When people quote these type of salaries, such as northeast, southeast, averages, etc, they are meaningless without the context and details which are too many to list, many that you pointed out. There are so many factors not taken into account, bonuses though out the year, working environment, patients per hour/day, violent patients, etc. In my experience at least in my neck of the woods, I have plenty of friends making crazy salaries above 400K, But I know them very well and see them and they are ALL every single one, doing calls all the time, and additional things, private practice etc, to get those salaries. I just have never seen the above 300K gotten without lots of additional overtime work. I managed to get more than that, but that was Locums, without any benefits and lots of commuting so in actually I was working more than 40 because of my commuting. And yes I barely had time for family, hobbies, etc, and I hated that part of it. I loved the money but hate that I can't spend any free time doing what I want, because Im too tired.

Ah, what I call the Neurosurgeon's Dilemma, without the neurosurgery income.

 

[mgdsh]

Making $300K+ while working <40 hours a week on average and having time for vacations is entirely possible.

 

[W19]

Making $300K+ while working <40 hours a week on average and having time for vacations is entirely possible.

What? Cash practice in Manhattan...

 

[nexus73]

What? Cash practice in Manhattan...

I think Kaiser in NorCal plus pickup an inpatient call weekend once a month would get you there. A bit more than 40 hours.

 

[mgdsh]

I think Kaiser in NorCal plus pickup an inpatient call weekend once a month would get you there. A bit more than 40 hours.

Base+Bonus alone gets you there. Also factor that $0 is paid for healthcare unlike most other places where they will deduct a significant amount every month for your premiums.

You get reimbursed time off or paid extra for your inpatient calls which are 3-4x/yr.

 

[notdeadyet]

Also factor that $0 is paid for healthcare unlike most other places

Yes, but does it have to be Kaiser?


Sent from my iPhone using Tapatalk

 

[mgdsh]

Yes, but does it have to be Kaiser?


Sent from my iPhone using Tapatalk

technically you get 2 insurance plans, the Kaiser physician plan which is the best healthcare plan I've ever seen and a back up $1mil Cigna plan.

 

[Dharma]

Making $300K+ while working <40 hours a week on average and having time for vacations is entirely possible.

possible but not typical.

 

[Leo Aquarius]

If you're going for Psych, think in the 200s, not 300s to 400s+. Any doctor can make $300K to $400K+ if they work "extra" in the "right city". What people want to know is the typical, majority income in Psych, and that, from what I've seen, sits in the $220K to $260K range for a full-time 8am to 5pm employed position these days.

The poll is a bit misleading because people are assuming it includes estimated benefits. We need a poll that asks straight salary for 8 to 5 work.

 

[medicaresucks]

If you're going for Psych, think in the 200s, not 300s to 400s+. Any doctor can make $300K to $400K+ if they work "extra" in the "right city". What people want to know is the typical, majority income in Psych, and that, from what I've seen, sits in the $220K to $260K range for a full-time 8am to 5pm employed position these days.

The poll is a bit misleading because people are assuming it includes estimated benefits. We need a poll that asks straight salary.

So your quoting a 40-45 hour work week roughly in an employed position which is pretty much spot on. However, from speaking to those in the private practice sector, those accepting insurance working those hours are clearing 300k after overheard. Of course if you add calls and weekend shifts on inpt units your looking at somewhere in the 350-400. I think what you said is spot on for employed positions but what i have said is more accurate for a 40-45 hr private practice seeing 80-100 patients a week. In fact, an attending who i just spent a few days at his "side" private practice which is 16 hrs a week says he clears 200k just from this. Of course he sees patients q10 to q15 min for med management only.

 

[dl2dp2]

Just got off phone with another recruiter. Seattle metro, academic affiliated community site, full outpatient, mostly private insurance. full time no call no weekend. 280k+ RVU + full benefits. With very slight weekend call coverage, 300k + RVU. This actually sounds like a decent job-they say 60 min initial, 20/30 min f/u, with "protected therapy block if desired".

A friend of mine reports a 300k+ job in Minneapolis with loan repayment and 50k+ sign-on

I'm seeing high 200s and low 300s more and more now. I'd say unless you are going for straight academic job the base should be 250 + RVU with in an average locale. NE/bay area scale down by about 20% (i.e. 200 +RVU to total ~ high 200s) not unreasonable. Current attendings, if wiling to relocate, can often get a 20% pay bump.

 

[splik]

Just got off phone with another recruiter. Seattle metro, academic affiliated community site, full outpatient, mostly private insurance. full time no call no weekend. 280k+ RVU + full benefits. With very slight weekend call coverage, 300k + RVU. This actually sounds like a decent job-they say 60 min initial, 20/30 min f/u, with "protected therapy block if desired".

hmmm... 280k is very very atypical for the seattle metro area. i know some people who've just signed up to a 280k job and the only way you could count it as "seattle metro" is by having a liberal definition as the only "academic affiliated" community hospital that pays that is hundreds of miles away on the other side of the state. I know of another job which again would have to liberally stretch the "seattle metro" area definition that pays 270k but it's hospitalist telepsychiatry including inpatients and ER consultation 7 on 7 off for 12 hours at a time....

Salaries have been increasing in the area quite a bit for psychiatry but we're talking getting above 200, not in the high 200s. also if a job needs a recruiter... it's because they can't find anyone to do it...