.

[tr]

---

Members do not see this ad.

Meh I always call bull**** with this. It’s a “money loser” because academic centers are terribly inefficient. It’s a money loser because they do things like pay 3 middle managers in the finance department to calculate out if it’s a money loser or not and pay 3 secretaries to do the job of one secretary in private practice. The amount of incompetence in these big systems is hilarious and often times incompetent people just get shifted around, especially administrative staff. Big academic centers also negotiate big rates for themselves or keep their patients internal to their systems. If psychiatry was truly a money loser then I wouldn’t be able to go setup shop and make money year one anywhere.

Now inpatient psychiatry is a different story, that’s likely a money loser because a bunch of those patients are uninsured or Medicaid.

Outpatient psychiatry is a money loser if you take anything other than the handful of insurances that pay well.

Academic psychiatry departments can either severely restrict their patient population to these few insurances + cash pay patients to do well financially, *or* accept a wider variety of insurances and accept that this will require financial support from more pecunious departments.

Note that refusing to take most insurances creates much bad blood for psychiatry in its relationships with other departments, because people from other services who do take those insurances then can't refer their patients internally for mental health care.

 

[G Sheb]

Outpatient psychiatry is a money loser if you take anything other than the handful of insurances that pay well.

Academic psychiatry departments can either severely restrict their patient population to these few insurances + cash pay patients to do well financially, *or* accept a wider variety of insurances and accept that this will require financial support from more pecunious departments.

Note that refusing to take most insurances creates much bad blood for psychiatry in its relationships with other departments, because people from other services who do take those insurances then can't refer their patients internally for mental health care.

Very much this.
If you don't have enough clout and/or are stuck in the 'wrong' location, it's hard to attract well off patients and your CMHC/inpatient unit/psych ER is going to bleed.
The net positive for institutions though is to absorb the losses. Certainly don't want to be know as the program that abandoned its community.

 

[Candidate2017]

Hospitals and PE haven’t figured out how to really profit from psychiatry the way they have from every other field but if they ever did forget it they’ll sweep through so fast you’ll never know what hit you.

PE already swept through psychiatry. So fast, you missed it. They raised billions of dollars in 2020, pocketed their share, and exited shortly thereafter. They are directly responsible for Adderall shortages and creating stimulant refugees, but bear no legal obligations because they don't prescribe or manage the business. Classic PE playbook.

They've move on. Meanwhile, we're wondering what the DEA is gonna do with Ryan Haight.

 

[clausewitz2]

Outpatient psychiatry is a money loser if you take anything other than the handful of insurances that pay well.

Academic psychiatry departments can either severely restrict their patient population to these few insurances + cash pay patients to do well financially, *or* accept a wider variety of insurances and accept that this will require financial support from more pecunious departments.

Note that refusing to take most insurances creates much bad blood for psychiatry in its relationships with other departments, because people from other services who do take those insurances then can't refer their patients internally for mental health care.

Our local academic center funds its outpatient programs mostly on the back of the absolutely astounding number of IOPs that they run (16 at last count, all with different focuses). The reimbursement is apparently extremely favorable. Prior to them stumbling upon this model there were rumblings every few years of just closing up shop on all the adult outpatient stuff, although as far as I know it never went anywhere.

I also have it on good authority from the head of the inpatient service line that in their system inpatient is by far the more profitable side of things, but there are some special circumstances involved.

 

[dl2dp2]

Note that refusing to take most insurances creates much bad blood for psychiatry in its relationships with other departments, because people from other services who do take those insurances then can't refer their patients internally for mental health care.

This is prevalent in academic medical centers. I recently interviewed for a div chief position (which ultimately they did not want me, but that's a separate thread lol--and i suspect even if they made an offer I wouldn't have taken it, and my subconscious got the better of me...), and realized that most large academic medical centers psychiatry is subsidized by internal referrals and operate in a very strange way. I.e. since they lose money anyway they don't CARE how much money they lose, and therefore people have no incentive to see more patients. The fewer patients you see, the more arbitrary scarcity goes up, which then makes it impossible to take external referrals. On and on to infinity.

It's almost a microcosm of how socialism fails and causes artificial scarcity.

Unfortunately, as a byproduct, subsidies have a cost, and academic salaries, therefore, become rigid and bureaucratic ("we have an exact mathematical formula for your salary"). Eventually, they become completely out of sync with market salary. Now, as you said, if you want to do research you kinda don't have a choice (or do you? trying to figure that out...), or you'd have to rely on sketchy practices of gray zone side gigs. But the issue here is that people leave quickly and you are left with a rotating cast of new grads and women who married rich, both of whom typically endorse stories of exploitation and yet do not have the ability, ultimately, desire, to move, at least for a while...

 

[calvnandhobbs68]

Outpatient psychiatry is a money loser if you take anything other than the handful of insurances that pay well.

Academic psychiatry departments can either severely restrict their patient population to these few insurances + cash pay patients to do well financially, *or* accept a wider variety of insurances and accept that this will require financial support from more pecunious departments.

Note that refusing to take most insurances creates much bad blood for psychiatry in its relationships with other departments, because people from other services who do take those insurances then can't refer their patients internally for mental health care.

Yeah you know what I say to this? Eyeroll emoji. Show the actual numbers and how they break down. Big academic systems also have the negotiating power to obtain higher reimbursements for E+M codes and also benefit from “nonprofit” status much of the time. Again, I do just fine taking most of the commercial insurances in the area and Medicare pays as much as they do. Medicaid is obviously generally a money loser.

What also actually ends up happening is that academic places seem to suffer from worse inefficiencies as I’ve noted above. They also don’t care about things like decreasing their no show rates.

Does trying to expand the ortho or radiology or dermatology departments tend to bring in more incremental revenue than psychiatry? Sure. But that doesn’t mean that psychiatry needs to “lose money” in an absolute sense, just in an incremental sense vs departments that generate more revenue more easily. They can basically overcome the inefficiency by how much extra revenue they generate.

 

[Candidate2017]

I always thought that attendings in academic centers don't do as much work or see as many patients. The residents/fellows see the patients, do the history gathering, returns messages/calls from patients, and tells the patient the plan. Seems chill.

I like working with residents but they are not a net timesaver. They are orders of magnitude less efficient with their time than I am and they regularly leave critical information out of the H&P, which creates problems down the road and often requires me to go on fact-finding cleanup missions later in the course of treatment. All this is fine because they are learning. But from my perspective it's actually faster and more efficient for me to see patients solo.

I think you are both right because psychiatry can be as easy or as hard as you choose for it to be, depending on how you choose to practice. Minimum standards vs. going above and beyond/OCPD.

If you don't have enough clout and/or are stuck in the 'wrong' location, it's hard to attract well off patients and your CMHC/inpatient unit/psych ER is going to bleed.

Psych units and CMHCs are profitable. But the bulk of their profits don't come from our billings/procedures, unlike ortho, cardiology, etc. Their profits come from things like facility fees (inpatient) and political lobbying/grants (CMHC). When institutions complain psych is not profitable, they are just bemoaning the inability to flog more dollars from our labor.