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romanticscience said:
Outpatient Solo PP: Quiet/comfortable office, low overhead, ~$300/hr ($450/hr forensic), 40-hr week, no call/no weekend, preference to choose who I work with doing meds and/or therapy.
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Where are you in the US and how many years away from residency are you?
 
romanticscience said:
Outpatient Solo PP: Quiet/comfortable office, low overhead, ~$300/hr ($450/hr forensic), 40-hr week, no call/no weekend, preference to choose who I work with doing meds and/or therapy.
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If you don’t mind me asking, how much of that is forensics work? How many weeks off do you typically take each year?
 
RevDO said:
I've heard of this kind of set up but it's my understanding that it is difficult to have this kind of practice if you didn't go to a "brand name" program or live outside a massive city like NYC, Boston, etc. Is this something that you believe could be reasonably achieved from somebody from a "mid/low tier" academic program in a smaller city, say 200k-500k?
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I’m in a metro with ~500k people and pretty low CoL; know an individual with a nearly identical practice (charges $250/hr adult, $300/hr child). Non-elite residency in the midwest but did do CAP fellowship at MGH. Has been practicing for 25+ years though. So yes, it's doable but not something you'll just walk into.
 
RevDO said:
I've heard of this kind of set up but it's my understanding that it is difficult to have this kind of practice if you didn't go to a "brand name" program or live outside a massive city like NYC, Boston, etc. Is this something that you believe could be reasonably achieved from somebody from a "mid/low tier" academic program in a smaller city, say 200k-500k?
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You can take insurance and clear around 250+/hr once you’re full even after overhead depending on the setup. Lower end for me is about 230/hr with a full followup panel once my group takes their cut and higher end is around 260/hr. Theoretical max is around 325/hr but that’s if I’m hitting 100% 99214s + 90833s and I’m trying not to get under insurance crosshairs just yet (although I do 30min followups so I do actually do a fair amount of CBT skills in the followup visits). Intakes pay less than followups so you’d make less until you’re seeing mostly followups. Your panel will grow much more slowly if you go cash only and most people who do that start out part time PP and part time inpatient/IOP/residential etc for extra income while their cash practice builds up but you’ll make more money in the end with less overhead if you’re cash only.

There are plenty of private practice psychiatrists even in midsized cities who are completely full.

Just remember though for people who throw these numbers around you’re never going to have 100% collections and a 100% show rate with a 100% full panel. So people will extrapolate that out and be like “WOW I could make 400k/yr!” but that’s operating under a lot of assumptions that never really happen in the real world.
 
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Stagg737 said:
If you don’t mind me asking, how much of that is forensics work? How many weeks off do you typically take each year?
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Not much forensics, really. I'll do only about 3-5 cases per year. I've noticed the headaches involved in related administration and dealing with lawyers v. clinical work make it less appealing to me. Also, the type of cases within my scope is not really a big moneymaker (~ 10hr/total).

I actually don't know how much I take off, probably 3-weeks.
 
romanticscience said:
Not much forensics, really. I'll do only about 3-5 cases per year. I've noticed the headaches involved in related administration and dealing with lawyers v. clinical work make it less appealing to me. Also, the type of cases within my scope is not really a big moneymaker (~ 10hr/total).

I actually don't know how much I take off, probably 3-weeks.
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To folks who are asking about whether this is sustainable in mid-sized cities, i am in the same city as @romanticscience and am hitting similar numbers per hour in an insurance based practice with a group taking a cut for dealing with some aspects of administration. I am a year and change out from residency and am basically full.
 
Similar to those above - PP with high rates for a niche field in a niche field. Forensic work at 450/hr IME but double that for conferences and depositions. I got to see the rate sheets for the opposing counsel's docs during discovery and found out that I am at charging at the very low end of the spectrum. It was kind of shocking, actually!
 
RevDO said:
I've heard of this kind of set up but it's my understanding that it is difficult to have this kind of practice if you didn't go to a "brand name" program or live outside a massive city like NYC, Boston, etc. Is this something that you believe could be reasonably achieved from somebody from a "mid/low tier" academic program in a smaller city, say 200k-500k?
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There is huge variability among psychiatrists. Is there a good-looking, biz-savvy, kind, affable, smart, and IVY educated PP person out there? Sure but that’s not the modal shrink. Pedigree matters but what is most important are having people want to come back for the “right” reasons (aka, not candy; that’s too easy!)

I really believe that the “quality follow up” is the most important thing to a successful PP. Getting them in the door is easy and consultations are more energy. Keeping them may be more a challenging art. It matters more than SEO, a swanky office, or a Harvard degree. Know your stuff, have empathy, and get people better. Then, you’ll have people who are motivated to see you. Get enough of those and you can have a few days of 12 patients that you have the stamina to see. Should some of them be d/c’d back to PCP? Sure. But I’m lazy and greedy j/k 😛

One last point. Being high quality doesn’t mean you have to be doing therapy ALL THE TIME. Do it when you have to—patients will appreciate that when they are stuck between Dr. 15 min med check and Dr. stuffy analyst “I make all my patients see me for weekly therapy.” I feel much better having a bunch short appointments when these people all graduated from a time-limited therapy period of longer sessions.
 
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romanticscience said:
Outpatient Solo PP: Quiet/comfortable office, low overhead, ~$300/hr ($450/hr forensic), 40-hr week, no call/no weekend, preference to choose who I work with doing meds and/or therapy.
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Very similar setup here. Solo, outpatient practice going on 13 years. 100% self-pay. I work about 47 direct-service hours/week (largely because the demand is so high) and hope to pull back in the next year. ~65 patients/week; ~$300/hour. Adults and child/adolescent. Most patients are integrated meds and psychotherapy. Very low # no-show/late cancellations and those that do still get charged. No forensics, no couples.

In a metro area of ~1 million, moderate COL. Alumnus of a state and private university - no Ivy League. As in most areas, high demand here.
 
TikiTorches said:
How much is the base? You have an MBA? How many people do you supervise? Do you still see patients?
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To clarify this is my bosses position. He is younger than I am. He has told people he is going to be [insert high achieving position] and they have laughed at him, and I’m not sure why because he’s very likable.

The boss sees 15 patients a week.

I see 15 a day with 4 day work week and reach ~650 being director of service. It helps to be friends with the boss. I don’t want his job, but I think it’s attainable if you have a business sense and people like you.

Everyone in the group is grossing >500k.
 
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robellis said:
What…
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On face value you say that,but then you look at how profitable the hospital has now become and he’s actually underpaid. We’ve reduced our avg ED LoS from 3 days to 12 hrs, added moonlighting, retreats for residents and in process of adding both an additional adult and peds unit within 3 years.
 
LimpSpatula said:
To clarify this is my bosses position. He is younger than I am. He has told people he is going to be [insert high achieving position] and they have laughed at him, and I’m not sure why because he’s very likable.

The boss sees 15 patients a week.

I see 15 a day with 4 day work week and reach ~650 being director of service (and I just graduated). It helps to be friends with the boss. I don’t want his job, but I think it’s attainable if you have a business sense and people like you.

Everyone in the group is grossing >500k.
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I’m not clear on what you do is it outpatient inpatient, a free standing psych hospital? It’s hard to judge when there aren’t many specifics but seems like a good gig. Is it in a high COL area? All important factors I think
 
robellis said:
I’m not clear on what you do is it outpatient inpatient, a free standing psych hospital? It’s hard to judge when there aren’t many specifics but seems like a good gig. Is it in a high COL area? All important factors I think
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Inpatient in moderate-high CoL area on West Coast. Avg is 350-400k for the area. In terms of QoL, I personally think inpatient is night and day compared to outpatient, with the exception of cash PP. But starting one has it’s own significant headaches.
 
LimpSpatula said:
Inpatient in moderate-high CoL area on West Coast. Avg is 350-400k for the area. In terms of QoL, I personally think inpatient is night and day compared to outpatient, with the exception of cash PP. But starting one has it’s own significant headaches.
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The real question is, can we join?

I was quoted $300k-$350k-ish for a NorCal inpatient position (not a great city) in an academic community setting. If everyone in your group is making >$500k that's awesome.
 
hallowmann said:
The real question is, can we join?

I was quoted $300k-$350k-ish for a NorCal inpatient position (not a great city) in an academic community setting. If everyone in your group is making >$500k that's awesome
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PM’d you
 
I guess this question depends on you. I'll be making $320-370k doing 8-4 inpatient with minimal call. I would rather switch careers than be bothered to do outpatient and all of the extracurriculars that come with it. Being home in time to have a great family life while still being able to leave all my work "on the unit" is - in my humble opinion - the sweetest gig in all of psychiatry.
 
LimpSpatula said:
Inpatient in moderate-high CoL area on West Coast. Avg is 350-400k for the area. In terms of QoL, I personally think inpatient is night and day compared to outpatient, with the exception of cash PP. But starting one has it’s own significant headaches.
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Is this 350-400k number accurate for new grads, or does it take time to work up to it? I've mainly been looking at outpatient West Coast in the higher COL areas, and I'm finding 250k to low 300s, without any clear path to advance income.
 
calvnandhobbs68 said:
It pays to be the boss
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Actually, it really doesn't. Lots of responsibility and minor income differential. You only climb to keep others not to be your boss, but your ability to make a difference is not always what you think. Sorry to burst your bubbles. I guess the best I can say is that just managing patients can get old, but the thrill of moving up isn't something to glorify unless you like disappointment. You still have to earn your money the old fashion way.
 
MacDonaldTriad said:
Actually, it really doesn't. Lots of responsibility and minor income differential. You only climb to keep others not to be your boss, but your ability to make a difference is not always what you think. Sorry to burst your bubbles. I guess the best I can say is that just managing patients can get old, but the thrill of moving up isn't something to glorify unless you like disappointment. You still have to earn your money the old fashion way.
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It is less about paying to be the boss and more that it pays to be the guy taking a cut of what everyone else is making. So perhaps "it pays to be the capo" or "it pays to be the king"?
 
MacDonaldTriad said:
Actually, it really doesn't. Lots of responsibility and minor income differential. You only climb to keep others not to be your boss, but your ability to make a difference is not always what you think. Sorry to burst your bubbles. I guess the best I can say is that just managing patients can get old, but the thrill of moving up isn't something to glorify unless you like disappointment. You still have to earn your money the old fashion way.
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I never said you'd make a difference. What is said is it PAYS to be the boss. And being the boss is way different in private practice vs academics for instance (where you're never really "the boss" in academics, even if you're the chair of the department).

720K isn't a "minor income differential".
 
$200k in academia... but VERY reasonable caseload w/ great ancillary support. ZERO call or weekends (told them I value work life balance and call would have been a dealbreaker). Awesome patient population (well, subjective I guess but I love working w/ teens). In a sense it's a very "coast-FIRE" job (with the exception of when half your coworkers are on vacation or sick). Accounting for commute it maybe reaches 40 hours, but if you are efficient the actual "work" bit comes nowhere close. You can work hard and provide "Cadillac" level care to each kiddo and still have plenty of leftover time...

Will probably stay at this job until I retire (in a couple of years), unless I find something that is easier and pays more $$$
 
Copper_Tracker said:
I guess this question depends on you. I'll be making $320-370k doing 8-4 inpatient with minimal call. I would rather switch careers than be bothered to do outpatient and all of the extracurriculars that come with it. Being home in time to have a great family life while still being able to leave all my work "on the unit" is - in my humble opinion - the sweetest gig in all of psychiatry.
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How many patients per day for this income? This is above salary survey medians I've seen. Is this salary or RVU or something else?
 
One of my attendings in med school had an interesting set-up. Medical director of a child-psych hospital but didn't see kids there (occasionally covered call if attendings were sick). Negotiated a contract to have 12 beds as overflow for the state hospital (adults on separate unit) which he covered 2 weeks per month. Also covered psych consults for another smaller hospital in the area, most we ever saw were 2 new consults in a day and never had a load over 4 patients. Most unique aspect was contracting with 4-5 nursing homes to see their patients once a month basically to make sure no one needed to go inpatient. Rarely made med changes on these patients and was paid $4-5k/mo per NH to be on staff. Grossed >$1m/yr in total.

Since then also helped open a geri-psych unit at the smaller hospital that residents in our program moonlight at. I believe he serves as the medical director there as well, but haven't talked to him in a while.
 
calvnandhobbs68 said:
I never said you'd make a difference. What is said is it PAYS to be the boss. And being the boss is way different in private practice vs academics for instance (where you're never really "the boss" in academics, even if you're the chair of the department).

720K isn't a "minor income differential".
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I am very aware that chairmen are often marginalized and my point is that the increase in pay is often not worth the HR headaches, the regulatory audits, and the buck stopping endpoint of profits or lack of them. Some of the most feathered beds are in middle management in academics.
 
MacDonaldTriad said:
I am very aware that chairmen are often marginalized and my point is that the increase in pay is often not worth the HR headaches, the regulatory audits, and the buck stopping endpoint of profits or lack of them. Some of the most feathered beds are in middle management in academics.
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If people want to make money they’re not in academics.
 
It is neat seeing what kinds of setups others have!

My own situation is surely not a "best" but it is very realistic and attainable and works well for my personal goals. My partner is also a high income earner so earning a very high income is not a big priority for me. I earn just over $300,000 for a little over 40 hours of work conducted at what I consider to be a pretty relaxed pace. I have minimal call. I am also likely going to start scaling back my hours to more part-time as I approach what I consider to be financial independence (reaching a point where I could survive on savings pretty much indefinitely if I needed to).

I think longer term I envision myself working something like 4 days a week, 8 hours per day. I don't plan to ever take a job that will require grinding or falling below my own personal standard of care. While some of these listed jobs such as a thriving cash practice or earning $750,000 as an administrator are pretty exceptional, I don't think my situation is, which illustrates that you made a great choice going into psychiatry (even "average" setups tend to be pretty sweet). Just get through the early years of residency, there is a light at the end of the tunnel and it isn't an oncoming train!
 
I think the true "made it" moment in psychiatry can be achievable in any job setting as long as you save enough of your salary in the first couple of years. Imagine if you have a portfolio of just 1 million dollars in an ETF like VTSAX or VFIAX in a bull market like this... you'll have made $360k in the last 12 calendar months without working a single hour. No job can be more cush than that!!
 
LimpSpatula said:
I see 15 a day with 4 day work week and reach ~650 being director of service. It helps to be friends with the boss. I don’t want his job, but I think it’s attainable if you have a business sense and people like you.
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Are you a resident?
 
AD04 said:
Are you a resident?
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LimpSpatula said:
~650 being director of service.
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OP,

Psychiatry is the best specialty in medicine. High demand. High location independence due to being able to practice telepsychiatry. Good lifestyle and / or high income. At one point, I was thinking of living on the beach in a young city doing telepsychiatry in the day and having fun / dating at night.

Enjoy the process. It sucks at the moment but it gets better each year. One of my happiest times was in residency as it was a period of high growth. It was also the last time for me to easily make friends in the same walk of life as me.

Once you progress in life and attain higher status and higher wealth, it's harder to make friends because less people will be on the same level. Those who are on the same level will be spread out.

Regarding your question about lifestyle and income, it is what you want.

One of my friends works 4 days a week, 10 hours a day and makes over $300k / year.

Another works 5 days a week, 8 hours a day and makes over $600k / year as he runs his own practice.

Another works 5 - 7 days a week, depending on call and makes over $500k / year.

I work 5 - 7 days a week, depending on call and make over those numbers, to the extent I cannot share my exact number with family or friends.

At the end of the day, if you make $200k / year or more, you have more than enough to live an upper-middle class lifestyle in perpetuity (with proper planning of finances and savings).
 
I am still trying to figure out the best fit for me in terms of hours worked and type of work I spend my time doing...but I do know that I'm so much more happier being self-employed with my own private practice than I ever was working as an employee in a health care system.

I graduated residency in 2020 and started my own practice in June 2021. My salary is much lower now but I live in the rural midwest and my family's needs are simple. I get to choose when I work and have slowly been building my practice. I'm working about 5 hours a week right now doing that. To supplement my income, my husband and I bought a condemned house and renovated it into an airbnb close to our house. I also work a couple of weekends a month doing loucm tenens work in the region. My end goal is to work PP about 15 hours per week which will be about 150k/year and possibly continue locums.

I love using my creativity in my private practice while also still honing my inpatient skillset in the hospital and helping with coverage - but not having to deal with any of the politics. I get to just focus on seeing patients.

It really just depends what your priorities are. Once I got really clear on what mattered to me and my family, the rest followed. Personally, I don't prioritize making a ton of money. I have time and bandwidth to volunteer and mentor medical students and also be more involved in my community because I no longer feel burned out. I can't second enough how much better having my own practice is than working for big box health care - especially with outpatient.
 
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Sushi, is that 120k after tax? As you continue to build up the panel that suggests you could expect 240k from 20 or fewer hours clinical contact, likely more because overhead will not scale fully with increased volume. Not bad!
 
Sushirolls said:
And on that high note...

I'll wrap up year 3 of my private practice at the end of this year, likely to net in my pocket 120K this year for ~9 clinical hours of work per week and 6 weeks vacation.

Never working for a Big Box Shop again, PRICELESS.
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Not bad for basically a day and a half of work a week 👍
 
Bartelby said:
Sushi, is that 120k after tax? As you continue to build up the panel that suggests you could expect 240k from 20 or fewer hours clinical contact, likely more because overhead will not scale fully with increased volume. Not bad!
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120k pretax.
200k gross likely.
Overhead is ~84K now but with scaling up, unlikely to surpass 110K.
 
Very, very saturated area, heavy in ARNPs, Big Box Shops, and a pinch of things on my end that limit the folks coming in the door. So not completely by choice. But I'm growing! Goal is 20-27 clinical hours as of today but that can always change in coming years.
 
Sushirolls said:
Very, very saturated area, heavy in ARNPs, Big Box Shops, and a pinch of things on my end that limit the folks coming in the door. So not completely by choice. But I'm growing! Goal is 20-27 clinical hours as of today but that can always change in coming years.
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Given what your competition is, I'm curious-- the people who come to you instead of Big Box Shops and ANRPs, what are they looking for? Is it something intrinsic to the objective fact that you are a physician, or is it something about you as a person? Are your clients seeking something through you or is it something idiosyncratic to your practice? Non biased answers only please
 
The percentages are hard to lock down and really my subjective best guess:

I've had people come to me simply because we were the first to answer a phone and return a call.
Because I'm not an ARNP.
Some people intentionally seek out doctors outside of the Big Box shops - especially the medical folks, MA, CNA, RN, PA, Docs, etc
Because something happened and they realized their years of care with an ARNP needed more expertise
Some people knew me from past places I worked, followed me, so to speak.
Some word of mouth within family units or friend circles
Lots of looking up on insurance directory and calling people down the list
Few random "we liked your website the best" usually from parents trying to get the adult kids to come in, and they did their research legwork
Some PCP referrals mostly from non Big Box shop entities, i.e. the small independent practices.
Randomly in spurts from PCPs in Big Box shops. i.e. when their psychiatrists are saying no or full, or those who've known me from past jobs of the quality I do, they specifically want this difficult patient to go to me.
Google searches and there I was
Psychology today - but that seems to have slowed down in past months.
I used to take one insurance that wasn't as widely taken with the non-Big Box Shop docs, and so people would come to me when their doc dropped their insurance. Little less so another lower paying insurance - because I actual take it. A funneling due to access, so to speak.
When other doctors retire and people are searching for a new one.
I'm also addiction medicine, so a pinch of people come to me specifically for alcohol or opioids because of that, but oddly, not that much really.
And something people usually don't ever say, but still could be a factor are demographics: age, gender, race; (some might like or not like?) My name has also been interpreted as particular religion/ethnic group, too and could bring some folks in or turn some off. Who knows?
*Forgot to add, I have a positive, helpful, assistant. Small amount of people didn't want me as their first choice, say for benzos, or whatever, try other places but then circle back because of the positive experience with my assistant on the phone.

The ones bolded above are the bigger reasons why people come to me.
In grand summary who I am, the services I offer are not special, and rarely are people truly seeking me out. I don't have a concrete well established defining niche. I'm not peddling any snake oils. I simply exist and do my job and strive to have calls returned. My few online reviews are overly bad, too. Just something about Psychiatry and the patients you got who are truly grateful and feel their life has been saved aren't exactly wanting to put their name out their online for a review, which I understand.
 
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Sushirolls said:
Very, very saturated area, heavy in ARNPs, Big Box Shops, and a pinch of things on my end that limit the folks coming in the door. So not completely by choice. But I'm growing! Goal is 20-27 clinical hours as of today but that can always change in coming years.
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Was your policy no benzos ever or no controlled substances ever? If the later, losing the adults with ADHD contingent definitely eliminates a significant outpatient population. Even more so the people who think they might have ADHD, who might accept the results of a thorough evaluation in that regard but are going to be looking elsewhere if they know there is zero chance of stimulants.
 
No benzos. But my assistant preambles that I won't, but they will be tapered if already on and receptive to this potential plan. I get a few here and there who specifically want that and its a good pairing. Granted if on benzos by Sleep Medicine say for RBD, I won't get involved with that. I've got 2-4 people who get their benzos from their PCP, one ambien from their PCP and each visit I review and offer to taper them off.

No prescribing any benzos has definitely slowed the rate of growth, and retention. But definitely has reduced the issues of my 'on call' phone. Back when I was in the Big Box Shop, I would cover for colleagues, and when I did that it was frequent benzo crisis after benzo crisis. lost script. Ran out, needs refills, etc, etc. I would prescribe more benzos in a one week coverage than I would over a 6-12 month period with my own patients.

I do stimulants, and to my surprise, a lot of ADHD, far more than alcohol/opioids. But I also urine test my stimulant patients, which some folks are grateful and see the utility for society greater good, or are ambivalent, but a few are ticked off and transfer elsewhere. But its also helped cut down on the comorbid cannabis use, and even picked up some other random elicits here and there too - confirmed with confirmation testing. Definitely a lot of stimulants.
 
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