$275 per hour

[nexus73]

I was talking to a well respected ED psychiatrist from California yesterday. I asked him if ED psych was generally compensated better than psychiatrist running the inpatient units. He went on to describe how psych salaries have escalated amazingly the last 10 years and how you can't get anyone for less than $275/hour. He said 10-15 years ago it was a lot of work to hit $300K a year, and now psychiatrists are easily getting $550K a year.

This is not my current experience. Am I missing something? Where are these jobs?

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[calvnandhobbs68]

California is a different market in general. 500K in California is also much different than 500K in Wisconsin or Alabama or Ohio.

 

[TexasPhysician]

California is a different market in general. 500K in California is also much different than 500K in Wisconsin or Alabama or Ohio.

Exactly.

 

[Psychresy]

I was talking to a well respected ED psychiatrist from California yesterday. I asked him if ED psych was generally compensated better than psychiatrist running the inpatient units. He went on to describe how psych salaries have escalated amazingly the last 10 years and how you can't get anyone for less than $275/hour. He said 10-15 years ago it was a lot of work to hit $300K a year, and now psychiatrists are easily getting $550K a year.

This is not my current experience. Am I missing something? Where are these jobs?

Are you looking in California? What city is this doc in?

 

[nexus73]

Are you looking in California? What city is this doc in?

Bay Area. I just thought psychiatrists made about the same or even less in big metro areas, and just had to deal with the insane real estate market somehow.

 

[MisterKitty]

Man **** this should have done surgery

 

[jbomba]

Bay Area. I just thought psychiatrists made about the same or even less in big metro areas, and just had to deal with the insane real estate market somehow.

Im looking in CA and it seems rates are higher. I admit I have no seen 275 for ED psychiatry however. I'm curious if this is a W2 or locums position which might account for the higher rate.

 

[nexus73]

Im looking in CA and it seems rates are higher. I admit I have no seen 275 for ED psychiatry however. I'm curious if this is a W2 or locums position which might account for the higher rate.

He said 275 was employed with benefits. 1099 was $300.

 

[thepoopologist]

What an awesome rate.

 

[robellis]

Man **** this should have done surgery

Radiologists are making 400/hr go to their forum and see their discussion…if you picked psych for money you will surely be disappointed

 

[deleted1100659]

275 an hour in california is different then a a low cost of living state with no state income tax for example. California has crappy state taxes and higher cost of living so once you factor those in, not what it seems. 300k a year may be close to 400k a year or so depending on cost of living, taxes, etc

 

[jbomba]

He said 275 was employed with benefits. 1099 was $300.

That's an insane rate. I'm going to be looking in the bay area myself when I graduate. Hoping I find something similar!

 

[jbomba]

275 an hour in california is different then a a low cost of living state with no state income tax for example. California has crappy state taxes and higher cost of living so once you factor those in, not what it seems. 300k a year may be close to 400k a year or so depending on cost of living, taxes, etc

I would encourage people to use a state tax calculator to determine what a specific salary will look like.

In CA $275/hr full-time employed is roughly $364k annually after tax...or just over 30k a month for the married physician with standard deductions. 30k a month is more than enough to live very nicely even in the bay area.

California Income Tax Calculator - SmartAsset

Find out how much you'll pay in California state income taxes given your annual income. Customize using your filing status, deductions, exemptions and more.

smartasset.com

 

[deleted1100659]

I would encourage people to use a state tax calculator to determine what a specific salary will look like.

In CA $275/hr full-time employed is roughly $364k annually after tax...or just over 30k a month for the married physician with standard deductions. 30k a month is more than enough to live very nicely even in the bay area.

California Income Tax Calculator - SmartAsset

Find out how much you'll pay in California state income taxes given your annual income. Customize using your filing status, deductions, exemptions and more.

smartasset.com

Comparing my hourly rate to that hourly rate to calculate the gross income, then a federal income tax caculator+state+fica and all that probably drops it to 315k. Plus all the other stuff that gets taken out like retirement, student loan payments, health insurance, etc. But im also doing it as being single rather than married, so being single the taxes would hit pretty hard.

my understanding is the bay area is way more expensive than the average US city, especially a southeast or midwestern city. Im sure you could still live just fine on that salary but im thinking quality of life for how much you pay, ratio.

 

[jbomba]

Comparing my hourly rate to that hourly rate to calculate the gross income, then a federal income tax caculator+state+fica and all that probably drops it to 315k. Plus all the other stuff that gets taken out like retirement, student loan payments, health insurance, etc. But im also doing it as being single rather than married, so being single the taxes would hit pretty hard.

my understanding is the bay area is way more expensive than the average US city, especially a southeast or midwestern city. Im sure you could still live just fine on that salary but im thinking quality of life for how much you pay, ratio.

Sorry just trying to understand. You used that calculator and came away with 315k using your current rate (which is different from 275/hr?)

The calculator posted has federal, state, fica, etc. Just wondering why such a large difference between figures.

edit:I think I see, you did 275/hr full time but used no deductions and single rather than married, which would in fact be 315k a year.

 

[calvnandhobbs68]

I would encourage people to use a state tax calculator to determine what a specific salary will look like.

In CA $275/hr full-time employed is roughly $364k annually after tax...or just over 30k a month for the married physician with standard deductions. 30k a month is more than enough to live very nicely even in the bay area.

California Income Tax Calculator - SmartAsset

Find out how much you'll pay in California state income taxes given your annual income. Customize using your filing status, deductions, exemptions and more.

smartasset.com

ER is usually not working 40 hours a week. Somewhere around 32-35 hours a week is more typical (broken into 8-10 hour shifts).

I'm sure 275/hour for any amount of hours per week is enough to live nicely, but you have to factor COL into account in California bay area...which is pretty astronomic compared to much of the rest of the country. The median sale price for a Bay Area house right now is $1.29 million. The median sale price for a house in Columbus, OH is $229K. The median sale price in the chicago metro area is $310K.

 

[jbomba]

ER is usually not working 40 hours a week. Somewhere around 32-35 hours a week is more typical (broken into 8-10 hour shifts).

I'm sure 275/hour for any amount of hours per week is enough to live nicely, but you have to factor COL into account in California bay area...which is pretty astronomic compared to much of the rest of the country. The median sale price for a Bay Area house right now is $1.29 million. The median sale price for a house in Columbus, OH is $229K. The median sale price in the chicago metro area is $310K.

Yeah, that's fair point. I guess it all depends on frame of reference. I grew up in the Bay Area so people spending a lot on homes was just normal to me. My feeling is if you're bringing in ~30k a month post-tax, you should be able to save 20% gross salary (9k) and live in a 2M dollar house (9k a month) and have enough for everything else to live comfortably and not be house poor (12k). But yeah I realize this view is probably totally different from someone who grew up in Kansas.

 

[deleted1100659]

Yeah, that's fair point. I guess it all depends on frame of reference. I grew up in the Bay Area so people spending a lot on homes was just normal to me. My feeling is if you're bringing in ~30k a month post-tax, you should be able to save 20% gross salary (9k) and live in a 2M dollar house (9k a month) and have enough for everything else to live comfortably and not be house poor (12k). But yeah I realize this view is probably totally different from someone who grew up in Kansas.

imagine the property tax on a 2 million dollar home though. Also if you have medical school debt thats a factor as well. It seems like a lot, but in the adult life there are so many expenses and bills. What kinda sucks too is the feeling of "rushed" when it comes to building your retirement account since we start off later.

By all means not a bad salary, just pointing out that money goes fast when you're an adult, and high income equals high taxes, unless you're elon musk or jeff bezos.

 

[Merovinge]

imagine the property tax on a 2 million dollar home though. Also if you have medical school debt thats a factor as well. It seems like a lot, but in the adult life there are so many expenses and bills. What kinda sucks too is the feeling of "rushed" when it comes to building your retirement account since we start off later.

By all means not a bad salary, just pointing out that money goes fast when you're an adult, and high income equals high taxes, unless you're elon musk or jeff bezos.

Property taxes in Cali are low relative to the cost of the house (that is the percentage is low to balance out the raw cost being so high). I lived in a house that was purchased for $255,000 that had $11,000 property tax. I have seen houses in Cali for 1.5 million that have just over $11k property tax. Don't even get me started on the delta in public education between these two areas...

 

[TexasPhysician]

Yeah, that's fair point. I guess it all depends on frame of reference. I grew up in the Bay Area so people spending a lot on homes was just normal to me. My feeling is if you're bringing in ~30k a month post-tax, you should be able to save 20% gross salary (9k) and live in a 2M dollar house (9k a month) and have enough for everything else to live comfortably and not be house poor (12k). But yeah I realize this view is probably totally different from someone who grew up in Kansas.

I own a 3600sq ft home that I built new, and the price was less than my annual income. What would the value be in the Bay Area?

It’s not that you can’t live in the Bay Area with a physician salary. You certainly can. My home (good size in my opinion) is <$2k/month including taxes. Compared to your example, I’m putting $7k toward retirement every month compared to the Bay Area instead of a home there. That’s $84k every year. Assuming everything else is the same price, the same salary needs to be $84k more in the Bay Area to even match cost of living elsewhere. Is my home average in the Bay Area or is the difference even higher?

 

[jbomba]

I own a 3600sq ft home that I built new, and the price was less than my annual income. What would the value be in the Bay Area?

It’s not that you can’t live in the Bay Area with a physician salary. You certainly can. My home (good size in my opinion) is <$2k/month including taxes. Compared to your example, I’m putting $7k toward retirement every month compared to the Bay Area instead of a home there. That’s $84k every year. Assuming everything else is the same price, the same salary needs to be $84k more in the Bay Area to even match cost of living elsewhere. Is my home average in the Bay Area or is the difference even higher?

I also view owning a home in a recession proof area like the nicer neighborhoods of the bay to be a solid retirement vehicle. That 2.5M home is going to increase significantly in value over the next 25 years. If one could manage to save 20% gross (while living in the bay, as in this example) and hold on to a piece of real estate over that same period of time, they would be sitting very very pretty when they're ready to downsize and/or slow down.

I think the primary thing is, do you make enough to save 20% gross, pay for the house, and not be house poor (I'd argue 12k after savings/house is more than enough in the example above)? If one can achieve that, I think it really doesn't matter where you are living as long as you are happy. Costs, taxes aside, California (and the bay area in particular) is one of the most beautiful and culturally rich areas in the country. It's not a bad place to call home.

 

[TexasPhysician]

I also view owning a home in a recession proof area like the nicer neighborhoods of the bay to be a solid retirement vehicle. That 2.5M home is going to increase significantly in value over the next 25 years. If one could manage to save 20% gross (while living in the bay, as in this example) and hold on to a piece of real estate over that same period of time, they would be sitting very very pretty when they're ready to downsize and/or slow down.

I think the primary thing is, do you make enough to save 20% gross, pay for the house, and not be house poor (I'd argue 12k after savings/house is more than enough in the example above)? If one can achieve that, I think it really doesn't matter where you are living as long as you are happy. Costs, taxes aside, California (and the bay area in particular) is one of the most beautiful and culturally rich areas in the country. It's not a bad place to call home.

I know too many older physicians that went broke investing in Cali real estate about 10-12 years ago. They didn’t have the disposable income to hold the vacancies and flips they were doing out there. If it is just your primary home and you can delay retirement 6-10 years in a housing bust, I wouldn’t worry that eventually Cali real estate will rebound. I doubt the returns would match investing the difference in rent/mortgage from living in the Midwest though.

 

[NickNaylor]

Yeah, don't see anything like that for ED work in the Dallas area. Even for 1099 positions the maximum rate I've heard of for ED work is around $200/hour, maybe a bit more depending on the locums firm you're working with.

$300+ an hour isn't unreasonable for outpatient work, but I haven't seen that for ED work. Anything in California is anomalous and likely not something you'll find elsewhere, except for perhaps other high COL areas.

 

[Merovinge]

I doubt the returns would match investing the difference in rent/mortgage from living in the Midwest though.

There's virtually no question that they wouldn't, you clearly pay a premium to live in the Bay area, So Cal near the Ocean, DC, NYC, Seattle, Hawaii, and other areas to a lesser extent. You also don't have the temperate weather, top universities/schools, or host of culture that those areas offer. As a fellow midwesterner, Bay area CoL is too steep for my blood but it is certainly a livable area for physicians and there are obvious reasons why people are willing to pay more to live in desirable places. The whole benefit of a higher income is to have options, some might be to own a boat, some a huge home, some to retire early, and others to live in high CoL areas.

 

[FlowRate]

We did a LOT of ED work in residency. Not sure I'd be willing to do that work again even for that sort of pay in a more typical COL area...

 

[MisterKitty]

Radiologists are making 400/hr go to their forum and see their discussion…if you picked psych for money you will surely be disappointed

Definitely didn’t pick psych for the money, but I wish I would have considered it more as a student because at this point I should have ruled it out for the money. As a pgy3 hearing the offers our recent graduates accepted, I’m kicking myself for not more seriously looking at how much less paid the field is compared to rads, anesthesia, and other comparably competitive specialties.

 

[nexus73]

Definitely didn’t pick psych for the money, but I wish I would have considered it more as a student because at this point I should have ruled it out for the money. As a pgy3 hearing the offers our recent graduates accepted, I’m kicking myself for not more seriously looking at how much less paid the field is compared to rads, anesthesia, and other comparably competitive specialties.

not to derail too much, but anesthesia lifestyle sucks, as usually tied to a hospital with weekends and getting called in all hours when on call. Rads is making good money, but churning through tons of studies go go go. Optho is usually seeing dozens of patients a day to make their money, same with derm. Psych is more like 10-16 patients per day, not 40. I can see the schedules of other docs in my system and I've got 12 outpatients a day, then have a panic attack looking at the 30-40 per day for ortho or neprhology, who must be praying for no shows.

Any surgical specialty is going to have nights/weekends in house. If a psychiatrist wants to see 40 patients per day and do mediocre work they can and make a lot of money. These other specialties are just usually much busier, like extreme sports, and psych is more like a cup of coffee with a friend. Depends on what you want and what you think is sustainable. Just thank god you didn't go into Family Medicine, or heaven forbid...pediatrics.

 

[MisterKitty]

not to derail too much, but anesthesia lifestyle sucks, as usually tied to a hospital with weekends and getting called in all hours when on call. Rads is making good money, but churning through tons of studies go go go. Optho is usually seeing dozens of patients a day to make their money, same with derm. Psych is more like 10-16 patients per day, not 40. I can see the schedules of other docs in my system and I've got 12 outpatients a day, then have a panic attack looking at the 30-40 per day for ortho or neprhology, who must be praying for no shows.

Any surgical specialty is going to have nights/weekends in house. If a psychiatrist wants to see 40 patients per day and do mediocre work they can and make a lot of money. These other specialties are just usually much busier, like extreme sports, and psych is more like a cup of coffee with a friend. Depends on what you want and what you think is sustainable. Just thank god you didn't go into Family Medicine, or heaven forbid...pediatrics.

For sure love the work and what we do; just a bit envious of compensation when talking through offers residents in other specialties are considering.

And for sure FM, peds, general IM would put me in an inpatient unit with active SI.

 

[calvnandhobbs68]

I mean just for reference, like @NickNaylor said, I can definitely hit $275 an hour with a 99214 + 99214/90833 an hour. That's not crazy, the "crazy" part is the ER part because that's probably a money losing scheme at $275 an hour when you're doing maybe 1 SMI Medicaid evaluation an hour. They're basically paying to be able to provide some kind of psych coverage at that point.

 

[jbomba]

For sure love the work and what we do; just a bit envious of compensation when talking through offers residents in other specialties are considering.

And for sure FM, peds, general IM would put me in an inpatient unit with active SI.

Couldn't you easily round on two inpatient units and get paid two full-time gigs? More than a couple attendings at my program do this. They're making 250-300k for each unit for about 40 hours of total work a week. That should put you in line with essentially all the other "high paying specialties" with a few exceptions.

 

[Psychresy]

I know too many older physicians that went broke investing in Cali real estate about 10-12 years ago. They didn’t have the disposable income to hold the vacancies and flips they were doing out there. If it is just your primary home and you can delay retirement 6-10 years in a housing bust, I wouldn’t worry that eventually Cali real estate will rebound. I doubt the returns would match investing the difference in rent/mortgage from living in the Midwest though.

Definitely an extra 80k a year in the market will produce significantly higher returns than that of home equity. That's said, if an individual can invest 20% gross at 550k salary over an entire career they would likely have over 10 million dollars at retirement. Along with that 3, 4, 5, 6+ million dollar? California property.

At the end of the day isn't that enough to live extremely well in retirement? And if you get to spend your life in a beautiful place like the Bay area as in this example, do you really need that extra $84,000 invested every year?

 

[calvnandhobbs68]

Definitely an extra 80k a year in the market will produce significantly higher returns than that of home equity. That's said, if an individual can invest 20% gross at 550k salary over an entire career they would likely have over 10 million dollars at retirement. Along with that 3, 4, 5, 6+ million dollar? California property.

At the end of the day isn't that enough to live extremely well in retirement? And if you get to spend your life in a beautiful place like the Bay area as in this example, do you really need that extra $84,000 invested every year?

Yeah the rolling blackouts and wildfires sound just gorgeous. I mean people argue back and forth all the time on here about whether it's worth it to live somewhere like the Bay Area for a real estate COL that's like 4x even other major cities in the US so this argument could go on forever. However, for an extra 84K a year, I could spend 4 weeks on vacation in Bali every year and still have money left over to invest. One year of that difference could pay for a M4. One year of that difference is almost a down payment on an average "doctor size" house most of the rest of the country.

The big issue as @TexasPhysician noted was that you can become house poor really quick in that area. For some people, that's totally fine, they're fine putting most of their money into their house.

I also wonder if that area is going to be seeing quite the same amount of real estate value growth as in the past. The overall nationwide housing shortage is driving up prices everywhere but there are several trends going against them. Remote work is a huge factor, especially given the amount of companies in that area whose work processes are amenable to remote work (e.g. all the tech companies). California overall is not doing well with climate change and fires/drought/power outages/etc are huge issues.

 

[TexasPhysician]

Definitely an extra 80k a year in the market will produce significantly higher returns than that of home equity. That's said, if an individual can invest 20% gross at 550k salary over an entire career they would likely have over 10 million dollars at retirement. Along with that 3, 4, 5, 6+ million dollar? California property.

At the end of the day isn't that enough to live extremely well in retirement? And if you get to spend your life in a beautiful place like the Bay area as in this example, do you really need that extra $84,000 invested every year?

I’m just debating for fun here.

I took a calculator from a website called Smart Asset to calculate after-tax income on $550k in Cali. It says about $26k/month. $9k is rent/mortgage based on an above post. Saving 20% gross each year is $9k/month. That leaves $8k for monthly expenses.

Reduce the gross income to $350k ($200k less) in Oklahoma. After taxes, you have about $19k. You could save the same $9k for retirement which is about 31% gross savings. $2k gets you a 3000+ sq ft home. Same $8k remaining for monthly expenses.

This very rough estimate puts a price of $200k extra needed to equalize available monthly net income. This is due to higher federal taxes on increased income, Cali state taxes, and home costs. There are plenty of people that believe $200k is worth it to live there. I’m a big fan or doing what makes you happy. I’m just arguing that the increased average psychiatrist rates in California don’t result in any more income each month after basic calculations.

 

[rjs2131]

Definitely didn’t pick psych for the money, but I wish I would have considered it more as a student because at this point I should have ruled it out for the money. As a pgy3 hearing the offers our recent graduates accepted, I’m kicking myself for not more seriously looking at how much less paid the field is compared to rads, anesthesia, and other comparably competitive specialties.

This is so location, position and workload dependent. Work as much as some of those other specialties and you’ll make plenty. Also, PP can be pretty lucrative with the right setup and you’ll generally work less hours than other specialties.

There’s also something to be said about sustainability and flexibility within psych, don’t see many people picking psych with the goal of retiring in 10-15 years. If you enjoy the work, you’ll likely last longer than many docs in other fields.

 

[TexasPhysician]

Definitely didn’t pick psych for the money, but I wish I would have considered it more as a student because at this point I should have ruled it out for the money. As a pgy3 hearing the offers our recent graduates accepted, I’m kicking myself for not more seriously looking at how much less paid the field is compared to rads, anesthesia, and other comparably competitive specialties.

Psych has high variability. I know psychiatrists working 25 clinical hours and netting $800k and those working 36 clinical hours for $180k. The set-up and location make a big difference.

 

[robellis]

Psych has high variability. I know psychiatrists working 25 clinical hours and netting $800k and those working 36 clinical hours for $180k. The set-up and location make a big difference.

Yeah but that’s not the point, we are talking the average grad from an average program with the typical salaries, on average psych is way underpaid compared to other fields, the average offers for anesthesia are 450k when you graduate for the average grad while it’s 250k for psych…big difference…now yes there are psychs that make 800k but also anesthesiologists that make 1M but those are not the typical grad

 

[TexasPhysician]

Yeah but that’s not the point, we are talking the average grad from an average program with the typical salaries, on average psych is way underpaid compared to other fields, the average offers for anesthesia are 450k when you graduate for the average grad while it’s 250k for psych…big difference…now yes there are psychs that make 800k but also anesthesiologists that make 1M but those are not the typical grad

The average grad can pull $800k in a few years in private practice taking insurance. It isn’t even that hard. You just need the follow-ups. This guy doesn’t even maximize his revenue. Downsides are that it isn’t great care, and most psychiatrists refuse to work that way. He bills about 5 99214’s per hour and has 1 extender doing similar. He won’t address more than 1 med change per patient per visit, and won’t do therapy. He isn’t in a popular city, so insurance psychiatrists are not plentiful.

Most psychiatrists look for 2 follow-ups per hour and admin time. This effects salary that a profiting entity will offer. Basic anesthesia gigs don’t have the variability in outpatient codes and volume to see huge differences.

 

[deleted456421]

I want to be clear to medical students and residents viewing this thread: employed positions in the Midwest and Northeast (trust me, I've been looking) are going to pay you ~275k. My current job is mediocre at best but I feel stuck because it pays $400k, which is way more than anyone else I know, and I attended an excellent, name brand residency.

This is a per diem position without any benefits, including time off. Even so, it’s a much better deal than anything else I've found, especially considering what the average psychiatrist is getting paid. 800k a year is absolutely not typical without significant capital investment and seriously compromising what I consider to be good psychiatric care.

Most jobs I've looked at recently require supervision of numerous "advanced practice providers" without any additional pay in addition to seeing your own panel. Locums boards are pretty much empty in the Midwest, so don't count on that to make bank. In fact, I just got a call from a desperate recruiter offering $270k for a leadership position at a community mental health program in rural Texas with one other adult psychiatrist, two C/A psychiatrists, and 6 "APPs."

Psychiatry is an amazing field, but the numbers you see casually thrown around in this forum are unrealistic. I'm not trying to be another Vistaril, but someone needs to better represent the average psychiatry job in this forum.

 

[AD04]

My current job is mediocre at best but I feel stuck because it pays $400k, which is way more than anyone else I know, and I attended an excellent, name brand residency.

I wonder if there is any correlation between high earnings and reputation of residency.

Psychiatry is an amazing field, but the numbers you see casually thrown around in this forum are unrealistic.

A salary survey can give you a ballpark what others are getting. Most offers should fall between $250k - $300k. The high numbers aren't unrealistic. It's very realistic but not many people want to make the sacrifice or have the capabilities to get them.

 

[Cath Up]

I want to be clear to medical students and residents viewing this thread: employed positions in the Midwest and Northeast (trust me, I've been looking) are going to pay you ~275k. My current job is mediocre at best but I feel stuck because it pays $400k, which is way more than anyone else I know, and I attended an excellent, name brand residency.

This is a per diem position without any benefits, including time off. Even so, it’s a much better deal than anything else I've found, especially considering what the average psychiatrist is getting paid. 800k a year is absolutely not typical without significant capital investment and seriously compromising what I consider to be good psychiatric care.

Most jobs I've looked at recently require supervision of numerous "advanced practice providers" without any additional pay in addition to seeing your own panel. Locums boards are pretty much empty in the Midwest, so don't count on that to make bank. In fact, I just got a call from a desperate recruiter offering $270k for a leadership position at a community mental health program in rural Texas with one other adult psychiatrist, two C/A psychiatrists, and 6 "APPs."

Psychiatry is an amazing field, but the numbers you see casually thrown around in this forum are unrealistic. I'm not trying to be another Vistaril, but someone needs to better represent the average psychiatry job in this forum.

Will it impact my non-academic career to not attend UPMC, in lieu of a mid-tier academic or community place?

 

[deleted456421]

I wonder if there is any correlation between high earnings and reputation of residency.

I doubt it. In fact, most of my co-residents seemed to gravitate toward fellowship and lower paying academic jobs. My peers at work come from all kinds of institutions. I only added the fact about myself to illustrate that residency reputation isn't impeding my job search.

The high numbers aren't unrealistic. It's very realistic but not many people want to make the sacrifice or have the capabilities to get them.

That's why I added the bit about capital investment. I promise you, though, that none of the many private practice psychiatrists I know are making anywhere near $800k. Many of them abandoned full self-employment to join other practices in some capacity (the VA, for instance) out of boredom, limited patient recruitment, or for additional benefits. Maybe 1 in 100 psychiatrists have the business sense and moral fortitude (or abandonment) to open a practice overseeing a dozen midlevels in order to hit that number.

 

[Candidate2017]

Optho is usually seeing dozens of patients a day to make their money, same with derm. Psych is more like 10-16 patients per day, not 40.

These other specialties are just usually much busier, like extreme sports, and psych is more like a cup of coffee with a friend.

Apples to oranges though. Ophtho and derm can quickly see 80-100 patients/day with nary an issue, with an army of scribes, techs, and MAs doing the heavy lifting. They spend 5 minutes with patients and finish notes in a few clicks. If they have to spend more time, it's because they're doing a procedure that compensates more, but takes less time, than managing a 99215 actively suicidal patient. By the time I'm done talking with the patient and 911, and documenting, ophtho or derm has finished half a dozen cataracts, lasiks or biopsies. Heck, by the time I can pull up Johnny's pharmacy records and figure out if he is filling his Adderall as prescribed, derm has probably seen 2-3 patients.

Yes, psych visits can be like "coffee with a friend", but this is very dependent on patient population, requires lots of screening and takes a bit of time to achieve. Towards end of my residency clinic, all my patients were stabilized and indeed "coffee with a friend". Now, however, I'm picking up a panel of patients from departing psychiatrists and these visits are definitely not coffee visits or ophtho/derm visits.

 

[deleted456421]

Will it impact my non-academic career to not attend UPMC, in lieu of a mid-tier academic or community place?

I don't think so. Although I don't view psychiatry's future job prospects as favorably as others (by which I mean the average psychiatrist isn't going to be making $500k anytime soon and NPs are an inevitable force to reckon with), I highly doubt you'll have any problems finding a decent job.

 

[TexasPhysician]

I wonder if there is any correlation between high earnings and reputation of residency.



A salary survey can give you a ballpark what others are getting. Most offers should fall between $250k - $300k. The high numbers aren't unrealistic. It's very realistic but not many people want to make the sacrifice or have the capabilities to get them.

There is typically a correlation between prestigious programs and lower pay. This is due to a higher percentage of grads going into academia and research.

 

[TexasPhysician]

I doubt it. In fact, most of my co-residents seemed to gravitate toward fellowship and lower paying academic jobs. My peers at work come from all kinds of institutions. I only added the fact about myself to illustrate that residency reputation isn't impeding my job search.


That's why I added the bit about capital investment. I promise you, though, that none of the many private practice psychiatrists I know are making anywhere near $800k. Many of them abandoned full self-employment to join other practices in some capacity (the VA, for instance) out of boredom, limited patient recruitment, or for additional benefits. Maybe 1 in 100 psychiatrists have the business sense and moral fortitude (or abandonment) to open a practice overseeing a dozen midlevels in order to hit that number.

Reaching $600k+ almost always requires being self-employed. Even then, most psychiatrists don’t work surgery hours so they won’t hit those numbers. The people claiming that they would be better off doing 40-50 hours in anesthesia just don’t understand the math. The money is there. Most psychiatrists just understand that money isn’t everything. You can provide good care and still be paid fairly well.

A 99214 (2 diagnoses) isn’t hard to reach. For argument sake, let’s say that is worth $100 (can be a fair bit more depending on geography). Instead of 5 like my peer, 4 per hour med management only is $400. If you do anesthesia hours (40hrs/week), that is about $800k gross. Add a counselor or single midlevel, and you are net $700k+. To get there, you’ll need a few years of plenty of new intakes which significantly reduces your revenue. You need to reach the point of mostly known follow-ups. You also need to be efficient, likely get bad reviews for speed, and not provide ideal care.

I’m not telling people to do this. I’m just saying that if you are willing to work grueling hours like a surgeon, you can make really good money.

 

[robellis]

Reaching $600k+ almost always requires being self-employed. Even then, most psychiatrists don’t work surgery hours so they won’t hit those numbers. The people claiming that they would be better off doing 40-50 hours in anesthesia just don’t understand the math. The money is there. Most psychiatrists just understand that money isn’t everything. You can provide good care and still be paid fairly well.

A 99214 (2 diagnoses) isn’t hard to reach. For argument sake, let’s say that is worth $100 (can be a fair bit more depending on geography). Instead of 5 like my peer, 4 per hour med management only is $400. If you do anesthesia hours (40hrs/week), that is about $800k gross. Add a counselor or single midlevel, and you are net $700k+. To get there, you’ll need a few years of plenty of new intakes which significantly reduces your revenue. You need to reach the point of mostly known follow-ups. You also need to be efficient, likely get bad reviews for speed, and not provide ideal care.

I’m not telling people to do this. I’m just saying that if you are willing to work grueling hours like a surgeon, you can make really good money.

It’s not worth 100 though lifestance (a very big psych employer) pays 60 per 99214

 

[calvnandhobbs68]

It’s not worth 100 though lifestance (a very big psych employer) pays 60 per 99214

That’s at a 60/40 split. So they estimate a 99214 itself pays about 100ish. Also I’m not 100 percent sure lifestance isn’t scamming with those numbers.

There are absolutely markets where a 214 pays more than that. All of my panels pay more than that for a 99214.

 

[robellis]

That’s at a 60/40 split. So they estimate a 99214 itself pays about 100ish. Also I’m not 100 percent sure lifestance isn’t scamming with those numbers.

There are absolutely markets where a 214 pays more than that. All of my panels pay more than that for a 99214.

Yeah but 60/40 is what we’re being paid, again we’re talking about an employee position for the average grad not someone who starts their own business

 

[calvnandhobbs68]

Yeah but 60/40 is what we’re being paid, again we’re talking about an employee position for the average grad not someone who starts their own business

Youre literally quoting a post which is talking about being self employed. Did you read the post?

Employed positions will very rarely lead to optimizing income. They usually offer an increased salary/stability the first couple years for a huge portion of your income on followup years. At a full panel of 35 patient contact hours per week (70 30-min followups per week) at 99214 at 100 bucks a followup, they’re now skimming 134,400/year off you at a 40% take. That’s how they make their money back.

 

[robellis]

Youre literally quoting a post which is talking about being self employed. Did you read the post?

Employed positions will very rarely lead to optimizing income. They usually offer an increased salary/stability the first couple years for a huge portion of your income on followup years. At a full panel of 35 patient contact hours per week (70 30-min followups per week) at 99214 at 100 bucks a followup, they’re now skimming 134,400/year off you at a 40% take. That’s how they make their money back.

Haha I may have missed that part but again it’s misleading to discuss being self employed, we are talking about the average psychiatrist versus the average anesthesia or surgeon etc, if they wanted to be self employed and owned surgery centers they’d make 1.5M but again that’s not the typical the typical is 450k for them vs 250k for us..I agree with you though being employed you won’t make much compared to what you could make on your own and in a good environment