What's life like for psychiatry residents & beyond????

[roady]

Hi everyone,

I need to know how much you work as a psychiatry resident (please include the intern year). If you are beyond residency, I would love to know how consuming your work life is.

This is a quick inventory that may go a brief way to answering longer, deeper concerns I have regarding the field. Most prominently: how to avoid becoming a pill-pushing MD--and how to be a truly healing, talk-therapy-in-one-form-or-another-applying psychiatrist (and get paid for it!), while having time to myself. Crazy me, I want it all. Well, I mean "much" if not "all" is absolutely fine too...

I've had the good fortune of getting a little input earlier from a member of the community here on the life of a resident, and the numbers of about 45 hours per week of work related time during residency was mentioned. That gave me some hope. Does it reflect the experience of others here? I do intend to lead a life beyond medicine--I especially miss sports...I hope that is not held too much against me--at least not so much that you wont answer my question! I really appreciate your input. Also, I would really like to know what the life of psychiatrists is like--please feel free to range at length--I love long answers!

Thanks again~

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[PsychMD]

Psych. residency training is by far more "enjoyable" and "lifestyle protective" than life as a "real" psychiatrist after residency training. After residency, you really have to be quite proactive re. arranging your practice to suit your specifications AND be profitable too. You can have a lot of fun practicing, derive lots of professional gratification, yet not make a lot of $$$, and after a while, especially if you have family obligations, debts, etc....this may start eating at you...or NOT, depending on what priorities you have. Some people just like the security of an employed position, but then you won't have a lot of control over hours, pt. population, administrators' wishes/demands, etc. Other people will lean towards a private practice model, but then you will be quite subsumed to the "forces" of the marketplace, which is quite penetrated by managed care, which DOES NOT reimburse you well at all for psychotherapy or for the adequate time needed for good quality inpatient work or consult-liaison work. Some people will like to work in a mixture of settings and with different reimbursement models (private practice, salary, indep. contractor), but then you really have to juggle a lot of balls in the air at the same time. Of course, there is academia and research too for those who are so inclined.

All in all, you pretty much have to BUILD your style and practice, and keep working at it on your own, because more often than not you have to work your way AROUND the "system" rather than "within" it, in order to have the opportunity to continue to deliver high-quality care.

There are also some striking geographical differences/regional variations regarding the quality of services and available supports varying quite dramatically even from county to county in a specific state. It DOES make a difference, believe me.

Another obstacle I've hit my head on several times (and maybe it's just me, so take it with a grain of salt) is that I have not found much "career" mentoring (either during training or after it) available out there, in the "real world", especially for the current generation coming out of residency within the past 10 years or so. You kind of have to find your own mentors, do your own thing, etc. Most physicians are pretty independent anyway, but then there's very little sense of community, plus there are different agendas, goals, and interests, depending on which setting you are practicing in (academia, private, salaried, indep. contractors, etc.).

Good news is that: I still enjoy practicing psychiatry more than anything else. The field is fun, challenging, varied, immensely gratifying from a professional perspective at this time.
Bad news is that: I'm not good at business and I loathe politics...so no wonder my perspective may sound a bit depressing overall. Don't let it discourage you. Most colleague psychiatrists that I know are pretty happy and satisfied overall.

 

[roady]

Thank you very much for sharing your experience, PsychMD. It means a lot to me. Any other opinions/situations out there?

PsychMD, do you believe I could lead a 9-5 life 5 days a week and make over 75k? Do you think I could have a 9-5 life during Residency??

Thank you very much again for taking the time to write. I am reading with hungry eyes...

Roady

 

[purpledoc]

Thank you very much for sharing your experience, PsychMD. It means a lot to me. Any other opinions/situations out there?

PsychMD, do you believe I could lead a 9-5 life 5 days a week and make over 75k? Do you think I could have a 9-5 life during Residency??

Thank you very much again for taking the time to write. I am reading with hungry eyes...

Roady

You can check out my answer in the other thread where you posted about hours of work during residency.

After residency, absolutely you can work 9-5 on weekdays and make over 75K. You can almost certainly make 90K or more. It just means that you will be working for a salary in a community mental health center or for a big for-profit managed care company, like Kaiser. Or, you might be an attending on a psych unit. You may have some minor on-call responsibilities -- say, being available by phone on the occasional weekend -- but you can probably even find a job without that. In some areas you can work half-time, or two full days/wk, for example, and make $60K or more. You will not, however, be doing a single ounce of psychotherapy.

If you have a successful private practice in the right area, don't spend too much on rent, and don't have any staff (except perhaps someone to help occasionally with billing, if needed) you can actually see patients *less* than 40 hrs a week and still handily make $75K. Think about it -- let's say you want to make $120K gross (to include tax, some benefits, some overhead), and work five days a week for 48 wks/yr. That's $2500/wk, or $500/day. See five patients every day for $100 each and you can go home.

The initial start-up expenses of a private practice do have to be factored into account, regardless. However, once it's going well, you have the most flexibility in terms of time and what days you want to work.

Hope this helps.

 

[roady]

Purpledoc,

I found your post helpful. Thanks as well for answering on the other post about the time commitment involved. Thank you!! May I ask: how far along are you in your training? Are you happy with your hours??

You know, as a result of the input I've been able to gather so far, however, I am still uncertain as to whether I'll be able to find a residency where I can still pursue competitive team athletics in the evenings.

I'm serious. I actually want the best of both worlds. All things considered...I hope this is possible!! Can anyone else provide some feedback to add to the pool of possibilities?? If there are any particular names of residencies that are more life friendly (err..non-work life friendly), I'd love to know about them. It's a matter of life or LIFE--please help me to live mine writ large.

THANK YOU!

 

[gj smoove]

What in the hell is wrong with you people. You are an MD. Why in the hell are you only trying to make $75,000.00? I can see if you are a psychologist or something but come on. You should be asking about what you need to do to make $250,000 or $300,000. I feel like I'm in the twightlight zone. Most of the private practice psychiatrist I know make at least $250,000. Don't sell yourselves so short people. You worked your but off to get into Medical School, went through 4 hard core years, then you have residency. Make sure you get compensated. Don't worry about people judging you for making money. There is nothing wrong with being financially successful and being a great physician. You guys need to raise your standards. I know residents who moonlight and make $100,000. Don't ever let me see another email asking how to make some baby income. You wanna make $75,000.00 become a teacher.

You can check out my answer in the other thread where you posted about hours of work during residency.

After residency, absolutely you can work 9-5 on weekdays and make over 75K. You can almost certainly make 90K or more. It just means that you will be working for a salary in a community mental health center or for a big for-profit managed care company, like Kaiser. Or, you might be an attending on a psych unit. You may have some minor on-call responsibilities -- say, being available by phone on the occasional weekend -- but you can probably even find a job without that. In some areas you can work half-time, or two full days/wk, for example, and make $60K or more. You will not, however, be doing a single ounce of psychotherapy.

If you have a successful private practice in the right area, don't spend too much on rent, and don't have any staff (except perhaps someone to help occasionally with billing, if needed) you can actually see patients *less* than 40 hrs a week and still handily make $75K. Think about it -- let's say you want to make $120K gross (to include tax, some benefits, some overhead), and work five days a week for 48 wks/yr. That's $2500/wk, or $500/day. See five patients every day for $100 each and you can go home.

The initial start-up expenses of a private practice do have to be factored into account, regardless. However, once it's going well, you have the most flexibility in terms of time and what days you want to work.

Hope this helps.

 

[roady]

What in the hell is wrong with you people. You are an MD. Why in the hell are you only trying to make $75,000.00? I can see if you are a psychologist or something but come on. You should be asking about what you need to do to make $250,000 or $300,000. I feel like I'm in the twightlight zone. Most of the private practice psychiatrist I know make at least $250,000. Don't sell yourselves so short people. You worked your but off to get into Medical School, went through 4 hard core years, then you have residency. Make sure you get compensated. Don't worry about people judging you for making money. There is nothing wrong with being financially successful and being a great physician. You guys need to raise your standards. I know residents who moonlight and make $100,000. Don't ever let me see another email asking how to make some baby income. You wanna make $75,000.00 become a teacher.

gj smoove,

Believe it or not, I love your post. Thank you so much. I share your view point exactly. After all this work...you're so correct. However, there is a point in time in which I can see I will either have to make time-intensive or sellout-intensive (ie, take pill-pushing positions--when I believe in talk therapy) to get lots of money, or you find a way to work less hours and do less time-intensive work to pursue other things.

Now I know there are a lot of gaps in my knowledge. That's where I'm at--not knowing exactly what the road map is beyond MSIII. Even in MSIII...But what I've seen and heard so far points to the posibilities you've mentioned--at the cost of "paying dues" meaning long hours and hard-work into the next 4 years beyond residency and more...And at some point you get out on the other side and you've got a great position, income, and maybe the room for some free time. But it took decade(s) and lots of burning the midnight oil.

I'm not getting younger. I want to see what I can do in athletics. It means the world to me..If I could put together a 9-5 Mon-Fri life with 75K net with no more than 6 more years (MSIII & IV, then 4 years residency), I'll take it. Of course if I find a way to do the same and make $250,000K, I'd take it just as well. But I want to play my sports..today. And I can't. And I'm not even sure I'll be able to play that first intern year. Scarier yet...even PG2 makes me wonder if I'll have the time...You just don't get the prime athletic years in your life twice. I would like to know how and where to do this...

I need to learn everything I can. I am definitely listening if you can help me get where I need to go. I do NOT know it all. I am gathering information...and terrified that I wont get there. But maybe with a little help...
P.S. I have worked my ass off to get this far. I can hardly work any harder. I am not just "looking for an easy way". But working hard isn't the only thing. Working smart has to have a part--there's not much harder I could work anyway. Thanks for your insights. I am eager to hear any further insights you may have--and keep pushing in this quagmire.

 

[gj smoove]

Based off od what you are saying, I think private practice child psychiatry or PM&R would be good choices. Lifestyle and time off is good and you can make over $200,000...before taxes that is.

gj smoove,

Believe it or not, I love your post. Thank you so much. I share your view point exactly. After all this work...you're so correct. However, there is a point in time in which I can see I will either have to make time-intensive or sellout-intensive (ie, take pill-pushing positions--when I believe in talk therapy) to get lots of money, or you find a way to work less hours and do less time-intensive work to pursue other things.

Now I know there are a lot of gaps in my knowledge. That's where I'm at--not knowing exactly what the road map is beyond MSIII. Even in MSIII...But what I've seen and heard so far points to the posibilities you've mentioned--at the cost of "paying dues" meaning long hours and hard-work into the next 4 years beyond residency and more...And at some point you get out on the other side and you've got a great position, income, and maybe the room for some free time. But it took decade(s) and lots of burning the midnight oil.

I'm not getting younger. I want to see what I can do in athletics. It means the world to me..If I could put together a 9-5 Mon-Fri life with 75K net with no more than 6 more years (MSIII & IV, then 4 years residency), I'll take it. Of course if I find a way to do the same and make $250,000K, I'd take it just as well. But I want to play my sports..today. And I can't. And I'm not even sure I'll be able to play that first intern year. Scarier yet...even PG2 makes me wonder if I'll have the time...You just don't get the prime athletic years in your life twice. I would like to know how and where to do this...

I need to learn everything I can. I am definitely listening if you can help me get where I need to go. I do NOT know it all. I am gathering information...and terrified that I wont get there. But maybe with a little help...
P.S. I have worked my ass off to get this far. I can hardly work any harder. I am not just "looking for an easy way". But working hard isn't the only thing. Working smart has to have a part--there's not much harder I could work anyway. Thanks for your insights. I am eager to hear any further insights you may have--and keep pushing in this quagmire.

 

[PsychMD]

Psych. residency is definitely not as tough as most other specialties. For the 6 months of Int. Med/Neuro, the only tough part is the 2-4 mo. of Int. Med, which is comparable to any Int. Med. internship. Why do I say 2-4mo? Because in some programs, you can choose to do 2 mo. of Int. Med, and 2 mo. of ER work. If you do 2 mo. of ER, it will be shift work, and no extra call. (Not all programs have this oppt., but it doesn't hurt to ask). Also, the call for the 2 mo. of Neuro will not be as "labor-intensive" as the Int. Med. months. For the 6 months of Psych. during PGY I, some programs will restrict your call duties stricttly to the INPATIENT patient population, which will mean answering lots of phone calls, but little physical running to do admits or ER evals., or consults. Again, you have to ASK during your interviews, specifically what does being on call for Psych. during PGY I entail. (Some programs are indeed expecting you to cover all: Inpt. AND ER Psych. AND Consults; those will be tough, but NOT ALL programs are structured this way.)

For PGY II, ask about whether they have "night float". In a night float, you do the night shift and then go home in AM after checking out during early AM rounds. Typically this is for the Psych. ER rotation.

I guess that some of the more "laid back" programs in the suburban Southwest are more lifestyle protective, and also offer good oppts. for excellent clinical training: think San Antonio, TX, also maybe some New Mexico or Oklahome programs.

Most urban setting programs in major metro areas, like NYC, Philly, or other "high prestige" programs in the NE...will also work you harder.

You should definitely go look at different programs' websites...most Psych. depts. out there have user-friendly, well-set up, comprehensive sites that will address those "on call" set-up questions.

Psych. Residency is DEFINITELY conducive to a "closer to normal" lifestyle than any other residencies I am aware of, but I have also heard lots of heartache from the "top tier" programs, and especially from the NYC programs.

OTOH...you say you are an athlete and have interests in Sports/Coaching. Maybe, if you have an long-term interest in pursuing Sports Medicine, you should look into PM&R too. I don't know much about this, but I assume, again, that suburban programs are "easier" than urban ones, that you should ask during interviews about their on call requirements, that you should probably assume that you'll have longer requirements for Med/Surg.-type rotations, thus more onerous call, especially during the first 1 1/2-2 years. You should also ask in the PM&R threads.

 

[RustNeverSleeps]

Not to be stupid, but can child psychiatrists really get away with charging that much more than general psychiatrists? I know there is a shortage of child psychiatrists, but that is still a big difference. Does anyone know what a common hourly rate for a child psychiatrist is? Thanks!

 

[boston DO]

Not to be stupid, but can child psychiatrists really get away with charging that much more than general psychiatrists? I know there is a shortage of child psychiatrists, but that is still a big difference. Does anyone know what a common hourly rate for a child psychiatrist is? Thanks!

i know of child psych in boca raton, florida who charge $300 for initial evaluation and $125 for follow-ups. cash only, no insurance companies to deal with. sounds pretty good.

getting back to psychiatrist compensation, i've read that the average psych makes 150-160000/year. i believe that gj mentioned that he knows psychiatrists that make 250000, how is this possible? are they only in private practice? do insurance companies really reimburse that well for psych visits? i hear that medicaid only pays $45 for an initial psych eval. doesn't sound too promising.

 

[16846]

Would it be difficult to find a salaried position as a BC Psychiatrist (no subspecialty) that pays at least $120K and is mostly out-patient with some in-patient responsibility in a suburban area?

 

[roady]

PsychMD,

Thank you very kindly for your detailed, informative posting. Just what I was hoping to hear about. Those programs in the Southwest you mention have me excited--the weather for outdoor sports sounds like it has year-round potential in those parts. Is it the lack of large numbers of patients in these parts that tends to make them more "lifestyle protective", as you put it, or what is the reason for that do you think?

I am excited about hearing that others are exploring possibilities. It's been a mystery to me why the big buzz at my medical school has been about peds, pediatric surgery, and now lately about child psych here...what is it with all these fields cathering toward children??? I don't rightly understand if the excitement is actually on an individual basis for the specialties I mention, or if it's in fact some kind of phenomenon related to services for children being in high demand...Hmm! An idea comes to me--is it that despite their brutality, even HMOs can legitimize skimping on paying for services when they are for children, and therefore people are sniffing out the money and moving toward the above fields??

Thanks for your thoughts. I am hoping and welcoming any additional feedback along the type PsychMD has sent. Thank you very much once again, PsychMD.

Roady

p.s. I really have no desire to go so far as to give any extra training time toward any fellowship, but as far as what Boston DO says--I've heard similar numbers. So how can you reconcile these mathematical disparities gj, others??

 

[gj smoove]

One of the psychiatrist I know makes $400,000 a year. The ones that make a lot of money are only private. If you want to make money, you must be a fool to work for a hospital. If you love psych and you are comfortable in your skills to a point of being purely private you'll be the doc 90210 of psychiatry. How do I know? Because I spent last week asking private psychiatrist how much they make. The last guy met with me at his Beverly Hills home and schooled me. Most psychiatrist don't care about money so they just work for some hospital after residency and take what they can get. Then there are those that care about money like several in the private sector. Psych is what you make it.

i know of child psych in boca raton, florida who charge $300 for initial evaluation and $125 for follow-ups. cash only, no insurance companies to deal with. sounds pretty good.

getting back to psychiatrist compensation, i've read that the average psych makes 150-160000/year. i believe that gj mentioned that he knows psychiatrists that make 250000, how is this possible? are they only in private practice? do insurance companies really reimburse that well for psych visits? i hear that medicaid only pays $45 for an initial psych eval. doesn't sound too promising.

 

[Big Lebowski]

I'm currently in my PGY-2 year. My call schedule is set up so that I take about 2 calls per month. So on an average non-call week, I would say I'm working consistently 45 hours per week (that includes about an hour for lunch). I don't work at all on the weekends unless I'm on call. Presently, the majority of my time is spent on inpatient. Half of my Wednesday is in didactics. Half of my Friday morning is spent meeting with a long-term psychotherapy patient and my Friday afternoon is spent in clinic. Call is busy, but not stressful (how many real psych emergencies are there anyway) and I get to go home post-call by about 11:30AM.

Life is pretty good. I really like what I do and I have plenty of free time to pursue my other interests. I have a lot of friends in other specialties who gripe about how much they work and what they do (several are considering switching fields).

 

[kchan99]

Do you know if the $400,000 is his salary after expenses? The rent in Beverly Hills is quite high, but I don't know how it compares to areas like NYC Upper East. And one should keep in mind that a Beverly Hills psychiatrist would dress well (higher cost of clothing and necessity of dry cleaning since psychiatrists wear real clothing).

One of the psychiatrist I know makes $400,000 a year. The ones that make a lot of money are only private. If you want to make money, you must be a fool to work for a hospital. If you love psych and you are comfortable in your skills to a point of being purely private you'll be the doc 90210 of psychiatry. How do I know? Because I spent last week asking private psychiatrist how much they make. The last guy met with me at his Beverly Hills home and schooled me. Most psychiatrist don't care about money so they just work for some hospital after residency and take what they can get. Then there are those that care about money like several in the private sector. Psych is what you make it.

 

[gj smoove]

No, he makes $400,000 before taxes. I wish it was after taxes. I guess $260000 after taxes. As far as expenses, all he would have to do is pay rent on his office. It's not like he needs expensive equipement.

Do you know if the $400,000 is his salary after expenses? The rent in Beverly Hills is quite high, but I don't know how it compares to areas like NYC Upper East. And one should keep in mind that a Beverly Hills psychiatrist would dress well (higher cost of clothing and necessity of dry cleaning since psychiatrists wear real clothing).

 

[kchan99]

Clothes are expensive equipment for women. Maybe the wardrobe part is easier for guys, even in Beverly Hills...

 

[purpledoc]

Do you know if the $400,000 is his salary after expenses? The rent in Beverly Hills is quite high, but I don't know how it compares to areas like NYC Upper East. And one should keep in mind that a Beverly Hills psychiatrist would dress well (higher cost of clothing and necessity of dry cleaning since psychiatrists wear real clothing).

You're right -- expenses include not only rent and whether or not you have an office manager, but what you wear. You have to look expensive to charge high rates, and it does add up. Plus, private practice has no benefits. When you're out on your own and have no health insurance, no life insurance, no disability insurance, no pension plan, etc etc and set all that up yourself, well, you'll see how complicated and expensive it gets.

And of course, to emphasize a basic point again, a salary of $120,000 in NYC is not the same as a salary of $120,000 in a smaller city like Minneapolis. In Manhattan, you're renting a tiny apartment with no hope of buying one on that salary, and have no car. In Minneapolis, you own a house and a car. Think about that when you're trying to decide about various jobs or private practice.

The other point for folks to think about is, do you want to be a psychiatrist, or a good psychiatrist? I knew a psychiatrist who saw six patients an hour for psychopharmacology visits. He was doing quite well financially. I personally would give up my license first.

 

[kchan99]

I haven't even mentioned furniture in private practice. Psychiatrists in private practice do need equipment. After all, the patient has to sit on something. I imagine the bare minimum would be seating for two and a desk.

Psychiatrists have to wear real clothing, whereas other physicians, such as surgeons, can get away with scrubs or buttoned white coat over whatever kind of shirt in the clinic. The blazer isn't necessary.

With regard to psychopharmacology, I've heard that some dermatologists have skills in that. Some people approach dermatologists for delusional skin lesions and infestations. In dermatology, paroxetine and mirtazapine are used for itch relief.


So now I want to know where psych residents are making $100K a year and what they're doing for moonlighting.

 

[purpledoc]

So now I want to know where psych residents are making $100K a year and what they're doing for moonlighting.

New York City will get you pretty close. If your base salary is $40,000 and you moonlight once a week for a 16 hr shift (say, psych ED, or psych house doc, from Fri. 4 pm to Sat. 8 am) at $50/hr, you're already at about $80,000/yr. If you add in another 6 hr shift sometime during the week (say, 4 pm to 10 pm), you've got another $15,000/yr.

And that's at $50/hr. Depending on where you moonlight, you can make more than that.

 

[MBK2003]

I can give you the moonlighting stats for our program (in NYC), in-network moonlighting at off-campus inpatient psych floor $80/hr for 12 hour shift on Sat to Sun, and $65/hr for 5pm to 8am Mon to Fri. Weekend duties include Progress Notes for all inpatients (24-30), all new psych consults on the Med/Surg floors and the ICU, and notes for all the Med/Surg patients on 1:1 observation (works out to be almost 12 hours of non-stop work). Weeknight duties are 2-3 new patient admissions and all remaining psych consults. It's great pay, but the work load is unbelievable.

Additionally, regarding salaries, I know of one private pay Child Psychiatrist on the Upper West Side who clears $300K/yr gross treating kids 3pm to 9pm Monday to Friday and one Saturday a month. For him it all about the over-indulged children of wealthy Upper Westsiders (who pay $400 for eval and $200/hr for treatment).

 

[16846]

Would it be difficult to find a salaried position as a BC Psychiatrist (no subspecialty) that pays at least $120K and is mostly out-patient with some in-patient responsibility in a suburban area?

Anybody?

 

[PsychMD]

Infiniti: No, I don't think it would be too difficult. Try to avoid "headhunters" if at all possible (most of those are for jobs that have chronic difficulties re. getting filled, for various reasons, and more often than not those reasons are red flags).

You can think about working for Kaiser Permanente (look up their website; they have various locations in different states). Or, a community med-surg. hospital with a psych. unit may also be a different kind of option. You can look up such hospitals; many have websites. Even some county jobs are OK; some counties are really great to work for, and you can combine outpt. community clinic work with inpatient work.

Actually, for a BC psychiatrist, the salary should be somewhat higher than the 120K you mentioned. But, ultimately, especially for an employed doctor, it's not JUST the salary that matters; there are a lot of other factors to consider in order to have a good fit.

 

[16846]

But, ultimately, especially for an employed doctor, it's not JUST the salary that matters; there are a lot of other factors to consider in order to have a good fit

Can you elaborate on this, please?

 

[PsychMD]

An employed doc will generally have little or sometimes even NO control nor input over his/her patient case load, call responsibilities, scheduling, general administrative program organization (e.g. staffing, control over who gets admitted on an inpt. unit). He/she will ALWAYS however be expected to shoulder the ultimate responsibility and liability for patient outcomes. If the local system has lots of glitches and pre-existent dysfunctionalities, it is sometimes difficult to overcome them, as an employed doc.
Nowadays, some med-surg. hospitals are understaffed (both nursing-wise, tech-wise, and MD-wise), some outpt. clinics have some unrational expectations re. length of appointments or pt. case load, some administrators may somehow expect the lone or the few employed psychiatrist to just be available for wearing lots of hats at the same time, and generate as much income as possible...in an era when most inpt. units are money losers and may receive little support from the general hosp. administration. Sometimes there are pre-existent dysfunctional relationships between Med/Surg. and Psych, or Psych. and ER Depts. (typically this occurs in systems that are already under the strain of dwindling staff and an increased load of patients, or an increased load of uninsured or underinsured patients with pre-existent poor access to regular primary care, multiple co-morbidities.). Some hospitals are in transition from a former "private practice model" to a "hospitalist model". Some local communities have scarce outpt. resources, thus no support for referrals for additional services or outpt. tx.
It is different to work in a place where a couple of docs are employed and several others are in private practice, versus a place where all the docs are employed (like in county systems).
Geography does matter, since it seems that the overall quality of care and available resources in Psychiatry is extraordinarily variable from county to county, even within the same state.
Collegiality does matter. Support staff stability is important. Clear professional role definitions are important, and so are good/professional boundaries and interactions between the various teams.
Most psychiatrists enjoy pursuing a variety of tasks/duties, such as combining inpatient work with consult-liaison, and/or outpatient work. If you are an employee, in some places you may not have this opportunity, and you will be tasked to do whatever is needed at that particular moment, e.g. all inpt., or all outpt., and soon it all starts to look like an assembly line, priming one for burnout pretty soon, unless you are quite pro-active from the start re. work requirement expectations and role definition.
Primarily, I think, for an employed psychiatrist, the most difficult balance to attain would be the balance between the job expectations/requirements/resources over which you may have very little control on one hand, and the responsibility towards your patients and towards yourself, on the other hand.

 

[16846]

An employed doc will generally have little or sometimes even NO control nor input over his/her patient case load, call responsibilities, scheduling, general administrative program organization (e.g. staffing, control over who gets admitted on an inpt. unit). He/she will ALWAYS however be expected to shoulder the ultimate responsibility and liability for patient outcomes. If the local system has lots of glitches and pre-existent dysfunctionalities, it is sometimes difficult to overcome them, as an employed doc.
Nowadays, some med-surg. hospitals are understaffed (both nursing-wise, tech-wise, and MD-wise), some outpt. clinics have some unrational expectations re. length of appointments or pt. case load, some administrators may somehow expect the lone or the few employed psychiatrist to just be available for wearing lots of hats at the same time, and generate as much income as possible...in an era when most inpt. units are money losers and may receive little support from the general hosp. administration. Sometimes there are pre-existent dysfunctional relationships between Med/Surg. and Psych, or Psych. and ER Depts. (typically this occurs in systems that are already under the strain of dwindling staff and an increased load of patients, or an increased load of uninsured or underinsured patients with pre-existent poor access to regular primary care, multiple co-morbidities.). Some hospitals are in transition from a former "private practice model" to a "hospitalist model". Some local communities have scarce outpt. resources, thus no support for referrals for additional services or outpt. tx.
It is different to work in a place where a couple of docs are employed and several others are in private practice, versus a place where all the docs are employed (like in county systems).
Geography does matter, since it seems that the overall quality of care and available resources in Psychiatry is extraordinarily variable from county to county, even within the same state.
Collegiality does matter. Support staff stability is important. Clear professional role definitions are important, and so are good/professional boundaries and interactions between the various teams.
Most psychiatrists enjoy pursuing a variety of tasks/duties, such as combining inpatient work with consult-liaison, and/or outpatient work. If you are an employee, in some places you may not have this opportunity, and you will be tasked to do whatever is needed at that particular moment, e.g. all inpt., or all outpt., and soon it all starts to look like an assembly line, priming one for burnout pretty soon, unless you are quite pro-active from the start re. work requirement expectations and role definition.
Primarily, I think, for an employed psychiatrist, the most difficult balance to attain would be the balance between the job expectations/requirements/resources over which you may have very little control on one hand, and the responsibility towards your patients and towards yourself, on the other hand.

Wow, lots of food for thought. Thanks for the informative reply, I appreciate it.

 

[roady]

PsychMD,

I also appreciate it very much. Thank you once again for going the extra mile and really writing something which sounds like it is made of important, hard-learned-through-personal-experience material. I wish a few more folks would add to our discussion here. Of course, this thread in itself has been outstanding already! Still, better would be better. THANKS A LOT FOR ALL THE GREAT RESPONSES FROM EVERYBODY

In particular, I am excited by the details I am hearing about here. Since this is an anonymous forum (not that it would necessarily matter if the information was discussed in a non-anonymous manner necessarily anyhow), would anyone be willing enough to provide me with some names of programs in the South (From Florida to California--and anywhere in between--so that I could benefit from the wonderful year-round weather to play sports)?? I would like to hear about the know psychiatry programs where hours are kept to a minimum while the actual training is more psychotherapy intensive, less pharmacotherapy/behavioral in nature.

Short of great hours, I am still hungry for any information I may receive regarding psychiatry programs which have a bent toward the talk-therapy (eclectic--not just psychotherapeutic with the Freudian dominance) approaches to patients (rather than what I imagine are the much more widespread pharmacodynamic and cog/behavioral models in use).

OK...HEAVY studying ahead for a fast approaching test so I have to go...

THANKS A LOT FOR ALL THE GREAT RESPONSES FROM EVERYBODY ONCE AGAIN!!

 

[PsychMD]

Roady, although I know you are expecting and deserving answers from lots of other potential participants, I feel compelled to plug here my own "Alma Mater", UT-Health Science Center at San Antonio, TX. It's been an outstanding residency re. care for residents' wellbeing, re. excellent clinical learning opportunities in a variety of settings, and eclectic psychotherapy exposure. I hear they've continued to also beef up their research (Dr. Bowden is now Chairman there) oppts. and capabilities in the past few years. Faculty is also very good, accessible, and enthusiastic about teaching (the "older" contingent as well as the relatively newer recruits). People are generally very happy there.

 

[gilgul]

I am a MS-III who's done his psych clerkship. I've done lots of other stuff in the mental health field, too.

My attitude is that I know how I want to treat my patients, how I'm going to be a good doc for them. I know exactly what kind of training I need, and what my practice will look like when I have it set up. Now its just a matter of execution.

The point is, I know exactly where I want to go, and I just need to make it happen. I want a private practice built from referrals from PCPs, where I do all kinds of brief psychotherapy with my patients, and solve their problems in flexible and creative ways. I am in control. When the line starts forming, I will raise my rates up to what the market will bear.

The point is, in psychiatry as in all specialties, be an excellent doc, and treat your patients well, and they will come back, tell their PCPs, tell their friends. Then the many will come to you.

OTOH, if you try to fit your practice into whatever restrictions you may find in an HMO/County M.H. clinic/Outpatient ward/Consult-Liason, and you're not treating your patients how you want to because of external pressures, they will note this and not come back, not tell their friends, and you will wither.

Why give your freedom and responsibility of the patients away to managed care or beaurocracies?

 

[drmoscow]

Hi Roady. I am currently a PGY3 in a Mid Western residency program . Life is a nice balance of work and leisure. Of course, I still break into a sweat when I see my intern colleagues grappling with eighteen non-stop months of calls, but after that it's been smooth sailing. I have had no call for the past ten months and man does it feel good! I will have to agree with our colleagues, life AFTER residency is definitely far more strenuous than these relatively-carefree days when you get whole half hours to meet your clients. Of course, the big bucks start rolling in too, but then there's something to be said about quality - of - life - issues. My colleague who thinks MDs are crazy if they only want 75 K might be forgetting that people have different priorities.Nonetheless, I hope I do not sound too naive when i say psychiatrists might be able to enjoy the pleasures of 75-100 K as well as an active social life too...perhaps more easily than surgeons or internists.
In summary, right now, life is niiiiice. I leave my clinic on friday evenings without a care in the world...come to think about it, that's how I feel leaving MOST of my evenings!

 

[Seven_Years_Later]

I'm sorry to rehash the same question, but I am truly confused about psychiatry earning potential. Right now I am a 4th year Osteopathic MS, and I have known that psych was my direction since day one. I'd like to point out that reimbursement is not my top priority, but it is nice! I look at stuff like the bureau of labor and statistics, glass ceiling, and other "self-report" surveys about reimbursement and they all seem to float around 175k/yr. That being said, I have used EVERY opportunity in med school to buddy up with the psychiatrists I had access to, and that figure is well below what they claim to make. The lowest paid psychiatrist I know works at the VA hospital, and he still clears the 175k figure with a 28-34h work week. Aside from her, the next lowest paid is in his first year post residency/fellowship (psychosomatic fellowship) working at a hospital in Virginia with a starting salary of 280k + bonus. My last conversation with him had him making around 305k in his first year. I literally do not know a single psychiatrist outside of the VA making below 260k. Most closer to 300k. All of them are either in hospitals or large groups, and the majority did not complete fellowships or combined residencies. Are these doctors lying to me? Are the salary numbers on the "self-reporting" websites including PA and NP who work in psych? Is there a huge discrepancy in the payment of folks on J1 waivers that pull the numbers down? Does it include residents making 40-50k? Someone please help me figure out what is going on

Thanks very much!
Seven_Years_Later

 

[Shikima]

I wouldn't worry too much about it. Graduate and finish residency (& fellowship if you choose). I know that there are many consideration which draw your attention to the salary, but in the end, you'll do well. You'll be leaving your first job anyways as a general rule of thumb and as you gain experience and understanding what is out there, you'll become more acquainted to what is being pitched. Just continue to read the forums.

 

[Dharma]

necro 7-eleven

 

[WingedOx]

@Seven_Years_Later Was "Eleven_years_later" taken?

As for your question: I've seen academic jobs around here (somewhat saturated urban market) offer as low as 138k/year to out of residency graduates. Said places haven't recruited well given that you can do a lot better even in the VA and private systems. Keep in mind though that a lot of the private jobs work you for that money.

 

[Doctor Bagel]

I'm sorry to rehash the same question, but I am truly confused about psychiatry earning potential. Right now I am a 4th year Osteopathic MS, and I have known that psych was my direction since day one. I'd like to point out that reimbursement is not my top priority, but it is nice! I look at stuff like the bureau of labor and statistics, glass ceiling, and other "self-report" surveys about reimbursement and they all seem to float around 175k/yr. That being said, I have used EVERY opportunity in med school to buddy up with the psychiatrists I had access to, and that figure is well below what they claim to make. The lowest paid psychiatrist I know works at the VA hospital, and he still clears the 175k figure with a 28-34h work week. Aside from her, the next lowest paid is in his first year post residency/fellowship (psychosomatic fellowship) working at a hospital in Virginia with a starting salary of 280k + bonus. My last conversation with him had him making around 305k in his first year. I literally do not know a single psychiatrist outside of the VA making below 260k. Most closer to 300k. All of them are either in hospitals or large groups, and the majority did not complete fellowships or combined residencies. Are these doctors lying to me? Are the salary numbers on the "self-reporting" websites including PA and NP who work in psych? Is there a huge discrepancy in the payment of folks on J1 waivers that pull the numbers down? Does it include residents making 40-50k? Someone please help me figure out what is going on

Thanks very much!
Seven_Years_Later

So I'm new to the post training world and not great about advocating for myself with money and all, but those sound like high salaries. From talking to people here, it seems $200 to $250k (which would include call) seem to be more normal salaries for full-time employment. VA and academics are around $190k. Maybe it's regional? Another thing to remember is that a lot of psychiatrists work part-time.

 

[Doctor Bagel]

yes this is definitely regional. you are not going to see these salaries in parts of the country one could actually live in. Our VA starting salary is a little over $170K

I could probably make serious bank going to back to the part of the country I'm from, and the cost of living is much less than here, too. Virginia doesn't sound like a horrible place to live, though. Northern Virginia is a suburban Washington DC area -- really expensive, though, so I would expect a higher salary there. I got a few emails recently with pretty high salaries for places like South Dakota and Indiana (not even Indianapolis).

 

[jjmack]

$170k is a lot of money in STL, NYC and LA, no so much…

yes this is definitely regional. you are not going to see these salaries in parts of the country one could actually live in. Our VA starting salary is a little over $170K

 

[Shikima]

Over $210k with Midwest VAs and lower costs of living and taxes to boot.

 

[Achillees]

What is expected in southeast?