$275 per hour

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As was previously mentioned, why can't you just take two inpatient jobs and work better than surgery hours for 5-600k? What other fields of medicine can you work two full time jobs for 40-50 hours a week?
 
robellis said:
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
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Exactly. There are very few (if any at all) in anesthesia or radiology making 250-275k working full time yet it is our average.
 
MisterKitty said:
Exactly. There are very few (if any at all) in anesthesia or radiology making 250-275k working full time yet it is our average.
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Those specialties are also doing much higher risk activities and are taking on much more liability than your average psychiatrist. So comparing them is a little misleading. Yes, if your only concern is to maximize income at the median then psychiatry is probably not the field for you for quite a few reasons.
 
Psychresy said:
As was previously mentioned, why can't you just take two inpatient jobs and work better than surgery hours for 5-600k? What other fields of medicine can you work two full time jobs for 40-50 hours a week?
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It's hard doing this long term on a w2 basis, employers will start messing with your schedule, increase your patient load based on the needs of the facility, etc.
 
MisterKitty said:
Exactly. There are very few (if any at all) in anesthesia or radiology making 250-275k working full time yet it is our average.
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You are correct. If someone is only willing to do the “average” job, psych will maybe always be behind anesthesia and rads. We are also comparing very different fields.

Procedures are typically a big profit item. Anesthesia is needed for these surgeries. With midlevels increasing their presence in hospitals, scans are increasing and rads is being pushed to read more for no increase in $. Add to the fact that psych has more FQHC jobs out there and inpatient centers can actually lose money (not even break even). The margins are very low. This is a constant downward push on averages.

That said, it is much easier to create a lucrative private practice in psych. Less business intelligence is needed compared to anesthesia and rads. An imaging center is very expensive and can fold without quickly building volume. Anesthesia contracts come and go. The model in anesthesia and rads is much more about being employed. Part-time positions are harder to find.

Psych has the flexibility to work very little hours or grueling hours. The range in net revenue is huge and easier to fluctuate between. I prefer the flexibility and range of revenue in psych. It’ll probably allow me to work much longer in life as well. If you just want to walk out of residency to ample $400k jobs, psych isn’t the right field.
 
The salary comparison on this forum is usually between psych and rads gas or surg sub specialties, but these aren’t really comparable fields. Might be more useful to compare salaries with IM, family med, neurology
 
michaelrack said:
It's hard doing this long term on a w2 basis, employers will start messing with your schedule, increase your patient load based on the needs of the facility, etc.
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You probably know better than I do as I'm just a resident, but the attendings I know who do this don't seem to have any issue with this set up. If the employer doesn't require to be in house for x number of hours seems like it shouldn't be a problem.
 
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Kirby said:
Locums boards are pretty much empty in the Midwest, so don't count on that to make bank.
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Not sure what boards you're looking at, but I'm getting plenty of postings from recruiters for $300k+/yr jobs in the midwest. I actually got 3 last week within 50 miles of where I'm living...

Kirby said:
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.
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Our program is the opposite. Not "brand name" outside of our city, but I know more than a handful of past co-residents who took jobs over $400k/yr that actually sounded pretty decent. One or two of them are making significantly more and I know one drops in on this forum at times.

robellis said:
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.
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As said above, it's a lot harder and higher risk to open a surgery center than a psych office. Pay a couple thousand per month to rent a small office and you're good. Heck, with telehealth gaining so much traction you don't even need an office, just work out of your house, lol. And if we want to work the typical hours of those other fields, we would be a lot closer to $450k too.
 
Stagg737 said:
Not sure what boards you're looking at, but I'm getting plenty of postings from recruiters for $300k+/yr jobs in the midwest. I actually got 3 last week within 50 miles of where I'm living...
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I guess that's the problem with the term Midwest. I've been keeping an eye out for postings in a three state area on locumtenens just in case something amazing shows up. However, I'll add that I haven't been looking tooo hard since I'm fairly content where I am right now.
 
Kirby said:
I guess that's the problem with the term Midwest. I've been keeping an eye out for postings in a three state area on locumtenens just in case something amazing shows up. However, I'll add that I haven't been looking tooo hard since I'm fairly content where I am right now.
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I mean recruiter jobs are usually crap but since the recruiters won't leave my google voice text number alone....

Midwest Region- 0.5M
Metro DC- $316,000/yr
Milwaukee and Madison areas- $450,000
Green Bay, WI- $361,000
Dauphin County, PA- $250,000
Hudson Valley, NY- $250,000
Sonoma County, CA- $340,000
Chicagoland, IL- $350,000
Asheville, NC- $300,000+
King of Prussia, PA- $300,000
Above MGMA western philly suburbs 7 on 7 off- Yr 1 guaranteed comp $340,000, $30,000 in retention bonus year after year

I no joke get **** in the mail AT MY HOME ADDRESS somehow like every week trying to entice me to come out to some "top 10 places to live in the US" for "300K+ per year"

Again I would probably not take any of these jobs because there's a reason they're desperately fishing for people.
 
calvnandhobbs68 said:
I mean recruiter jobs are usually crap but since the recruiters won't leave my google voice text number alone....

Midwest Region- 0.5M
Metro DC- $316,000/yr
Milwaukee and Madison areas- $450,000
Green Bay, WI- $361,000
Dauphin County, PA- $250,000
Hudson Valley, NY- $250,000
Sonoma County, CA- $340,000
Chicagoland, IL- $350,000
Asheville, NC- $300,000+
King of Prussia, PA- $300,000
Above MGMA western philly suburbs 7 on 7 off- Yr 1 guaranteed comp $340,000, $30,000 in retention bonus year after year

I no joke get **** in the mail AT MY HOME ADDRESS somehow like every week trying to entice me to come out to some "top 10 places to live in the US" for "300K+ per year"

Again I would probably not take any of these jobs because there's a reason they're desperately fishing for people.
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What’s the deal with the 0.5M job?
 
calvnandhobbs68 said:
idk ask comphealth
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I haven’t seen any jobs with that high of income guaranteed before either I feel we should have a thread to post these jobs in and discuss them, I think anesthesia has a similar thread where they either praise or bash different jobs could be good for a lot of the new grads and young attendings not yet established
 
robellis said:
I haven’t seen any jobs with that high of income guaranteed before either I feel we should have a thread to post these jobs in and discuss them, I think anesthesia has a similar thread where they either praise or bash different jobs could be good for a lot of the new grads and young attendings not yet established
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When they don’t list the city, I assume it is in a terrible location. I don’t love the Midwest, so I’m already thinking bad location in a bad region.
 
TexasPhysician said:
When they don’t list the city, I assume it is in a terrible location. I don’t love the Midwest, so I’m already thinking bad location in a bad region.
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When they don't even name the state, gives you a pretty good idea how undesirable the location is. There are shockingly only a handful of states in the country that don't have a single good city.
 
Not to derail but I’d be curious what your guys’ opinion of this job is, $312k. Their homepage has more information on the facilities.

Psychiatrist

Click the link provided to see the complete job description.
mtstatejobs.taleo.net

Just a med student.
 
Gonzalo de Montalvo said:
Not to derail but I’d be curious what your guys’ opinion of this job is, $312k. Their homepage has more information on the facilities.

Psychiatrist

Click the link provided to see the complete job description.
mtstatejobs.taleo.net

Just a med student.
Click to expand...

Wikipedia notes the town in question has no services beyond a single convenience store, a post office, and one solitary bar. So...it'd be quite the experience.
 
Gonzalo de Montalvo said:
Not to derail but I’d be curious what your guys’ opinion of this job is, $312k. Their homepage has more information on the facilities.

Psychiatrist

Click the link provided to see the complete job description.
mtstatejobs.taleo.net

Just a med student.
Click to expand...
I’ve heard from someone who was there as a locums it’s staffed poorly with nurses. Like one RN overseeing a whole 15 bed unit with psych techs (think someone with a high school diploma and basic mental health training) making up the difference. Patients or staff getting assaulted was not uncommon.
 
Gonzalo de Montalvo said:
Not to derail but I’d be curious what your guys’ opinion of this job is, $312k. Their homepage has more information on the facilities.

Psychiatrist

Click the link provided to see the complete job description.
mtstatejobs.taleo.net

Just a med student.
Click to expand...

I’ve heard good things about the Montana State Hospital (or at least 1 of them. Do they have 2?). Friend said the hours were good and the staff cared. He wasn’t a fan of the winters.
 
TexasPhysician said:
I’ve heard good things about the Montana State Hospital (or at least 1 of them. Do they have 2?). Friend said the hours were good and the staff cared. He wasn’t a fan of the winters.
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Yeah it’s the only one. Having lived near there the winters can be cold and long (minimal fall and spring seasons, snowfall variable but can be from Halloween to 1st of April). Nice to hear someone had a good experience other than the winters.
 
robellis said:
I haven’t seen any jobs with that high of income guaranteed before either I feel we should have a thread to post these jobs in and discuss them, I think anesthesia has a similar thread where they either praise or bash different jobs could be good for a lot of the new grads and young attendings not yet established
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Would love to see that thread. Got an e-mail from one of our attendings that a former resident's practice is hiring in NYC: Average FT doc making $500k, potential up to $800k, potential to help with procedures (TMS and ketamine) or working from home. Would be seriously considering this if I didn't have certain restrictions on where I'm looking to work.
 
I would 100% have upped and moved to a place where I could snowboard and/or mtb/road/gravel bike all year round.

I feel like it's not worth the breakup though but holy heck I had an identity crisis when I had to cancel a fellowship interview in a location like that. 😭😭😭.
 
Psychresy said:
You probably know better than I do as I'm just a resident, but the attendings I know who do this don't seem to have any issue with this set up. If the employer doesn't require to be in house for x number of hours seems like it shouldn't be a problem.
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This set up would be nice but can you find out how the attendings get around treatment team meetings (often in mornings so can't be in 2 places at once), being on-call (hard to round on second hospital when you're on call from the first place and they're constantly calling you), and when admin tries to start asking you to do things like covering the resident clinic in the afternoon, cover the PHP/IOP randomly when there's a need, etc etc? Maybe they have strategies around all this
 
clausewitz2 said:
Wikipedia notes the town in question has no services beyond a single convenience store, a post office, and one solitary bar. So...it'd be quite the experience.
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Also 15 vacation days each year
 
TerraceHouse said:
This set up would be nice but can you find out how the attendings get around treatment team meetings (often in mornings so can't be in 2 places at once), being on-call (hard to round on second hospital when you're on call from the first place and they're constantly calling you), and when admin tries to start asking you to do things like covering the resident clinic in the afternoon, cover the PHP/IOP randomly when there's a need, etc etc? Maybe they have strategies around all this
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Wouldn't a locums job alleviate most of those issues?
 
TerraceHouse said:
This set up would be nice but can you find out how the attendings get around treatment team meetings (often in mornings so can't be in 2 places at once), being on-call (hard to round on second hospital when you're on call from the first place and they're constantly calling you), and when admin tries to start asking you to do things like covering the resident clinic in the afternoon, cover the PHP/IOP randomly when there's a need, etc etc? Maybe they have strategies around all this
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The strategies are very simple:
1) don’t attend the treatment meetings
2) don’t agree to cover the php/iop
3) don’t take call too much although you’ll have to probably once a week at each place
 
robellis said:
The strategies are very simple:
1) don’t attend the treatment meetings
2) don’t agree to cover the php/iop
3) don’t take call too much although you’ll have to probably once a week at each place
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There's definitely been attendings who did these things and at least at the for-profit hospital I'm training at, they've all been let go. They also carried that reputation with them and were let go at the OTHER for profit hospital they used to do this at. They did say they hit $600k for a couple years and then were let go. Doesn't seem sustainable long-term.

EDIT: to be more accurate, not all of them were "let go" but 1 left b/c all the residents/employed attendings talked crap and I think they felt mistreated. 1 didn't get their contract renewed.
 
TerraceHouse said:
There's definitely been attendings who did these things and at least at the for-profit hospital I'm training at, they've all been let go. They also carried that reputation with them and were let go at the OTHER for profit hospital they used to do this at. They did say they hit $600k for a couple years and then were let go. Doesn't seem sustainable long-term.

EDIT: to be more accurate, not all of them were "let go" but 1 left b/c all the residents/employed attendings talked crap and I think they felt mistreated. 1 didn't get their contract renewed.
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Maybe don't work for a for-profit hospital. Their job is to squeeze out more profits and eventually get rid of money losing propositions, i.e., you.

You definitely can cover multiple units. I know psychiatrists who cover multiple units, consults, clinic in afternoons and weekends, etc. They are rumored to approach $1 mil. They also rely heavily on their trusted midlevels to triage, collect SW info, preround patients, etc. They keep the units running smoothly. I would definitely say they are saving the hospitals a bit of money.
 
nexus73 said:
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.
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Lol... IM hospitalist here. I have a few FM docs in my hospitalist group who are doing well, and it's a fairly manageable job. We see 16 patients per day plus 1 admit on average and make 330k/yr working 7 days on/off (11 hrs shift). FM/IM docs at my place can make 400k+/yr if they work 17.5 days/month.
 
Splenda88 said:
Lol... IM hospitalist here. I have a few FM docs in my hospitalist group who are doing well, and it's a fairly manageable job. We see 16 patients per day plus 1 admit on average and make 330k/yr working 7 days on/off (11 hrs shift). FM/IM docs at my place can make 400k+/yr if they work 17.5 days/month.
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inpatient medicine is different. Outpatient primary care, facing 20 minutes followups and an overflowing inbox is the problem. PCP pay should be doubled and cardiology pay slashed IMO.
 
nexus73 said:
inpatient medicine is different. Outpatient primary care, facing 20 minutes followups and an overflowing inbox is the problem. PCP pay should be doubled and cardiology pay slashed IMO.
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lol 20 minute followups? how luxurious...peds clinic was 15 minute followups, 10 min sick visits, hope you're quick with the EMR!
 
calvnandhobbs68 said:
lol 20 minute followups? how luxurious...peds clinic was 15 minute followups, 10 min sick visits, hope you're quick with the EMR!
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How are they tolerating their ****ty pay? It’s actually nuts
 
nexus73 said:
inpatient medicine is different. Outpatient primary care, facing 20 minutes followups and an overflowing inbox is the problem. PCP pay should be doubled and cardiology pay slashed IMO.
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Many FM docs are jumping into the hospitalist bandwagon right now. I guess they are starting to realize that they are getting a bad deal doing outpatient (seeing 25+ patients per day for a salary of 225k/yr). Right now, one can make 300k/yr 7 days on/off without dealing with the 15 minutes follow ups, prior authorization, replying to messages to one's inbox constantly. But the 7 days on/off is not for everyone. Some people LOVE it; others HATE it.

Heck, I am getting $2500+/day locum offers every day into my inbox.
 
You could get much higher hourly as an expert witness.
 
psyguru said:
You could get much higher hourly as an expert witness.
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Yeah but this is not something that any of us graduate residency knowing how to do so not applicable to like 90 percent of psychiatrists
 
robellis said:
Yeah but this is not something that any of us graduate residency knowing how to do so not applicable to like 90 percent of psychiatrists
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Mostly true.
 
Zendo said:
In your experience, what would be the best way for a married physician couple to maximize lifestyle/compensation in pysch? I imagine that the private practice potential of psych would be best able to take advantage of a couple who are in the same specialty, compared to taking employed positions or joining large PP groups in other specialties. Would that be a correct assumption, or is there little benefit over having a solo practice?
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There are definitely some benefits like space for 2 people costing less than 2x 1 person (same as house/apt), as well as not having to redouble effort for policy, forms, etc. Downside is that all your financial eggs are then in one basket and you may not want to work next to your significant other all day/everyday. With dual physician household you shouldn't need to maximize gain to achieve your financial goals, so I would make sure each of you does the type of practice you most want to do. If that happens to be PP, then sure you would have a leg up on most solo PP folks for cost and effort basis.
 
To piggyback off the original question, whats a ballpark rate a psychiatrist can bring in taking insurance, once their practice is up and running? I'm thinking mostly 99214 + 90833. I get it that insurance rates vary wildly, but any chance to provide a ball park? And I imagine we could do two of these per hour (3 seems possible but quality may begin to suffer I imagine)?
 
Psychresy said:
To piggyback off the original question, whats a ballpark rate a psychiatrist can bring in taking insurance, once their practice is up and running? I'm thinking mostly 99214 + 90833. I get it that insurance rates vary wildly, but any chance to provide a ball park? And I imagine we could do two of these per hour (3 seems possible but quality may begin to suffer I imagine)?
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You can use CMS reimbursement as a reference point. Median non-facility prices nationally are roughly $133 for 99214 and $72 for 90833. So 99214 + 90833 is about $205 per appointment or $410/hr. See 12 f/ups per day with no new patients (assuming 30min f/ups with some no-shows) and that's $2460/day = $12,300/week. Work 45 weeks per year and that's grossing $553,500.

However, that's assuming everyone is a 99214 + 90833 and that you're fully reimbursed for all of those services billed. You should hopefully be able to get better rates from insurance than CMS, but you're also much less likely to get reimbursed for every service you bill for and will likely have to put in significantly more effort collecting on all those charges. You're also not going to be able to bill everyone at 99214 and are very unlikely to be able to drop the 90833 that frequently. Plus, that's just your gross before all expenses and taxes. Net take-home is going to look very different.

Theoretically, one could make bank with a very reasonable work schedule if everything is able to be optimized with minimal to no hiccups. Realistically, that's never going to happen. It's a lot easier to optimize everything in a cash-only setup where you require patients have a CC on file than to try and give a reasonable ballpark for a practice taking insurance without knowing a lot more specifics.

What you should be asking isn't so much for a general ballpark that we could provide. A better question is how well could you optimize the system you'd work in? Depending on your ability to optimize billing and collections, you can have massive differences (like 6 figure differences for seeing the same # of patients) in what your ballpark income could be.
 
Stagg737 said:
You can use CMS reimbursement as a reference point. Median non-facility prices nationally are roughly $133 for 99214 and $72 for 90833. So 99214 + 90833 is about $205 per appointment or $410/hr. See 12 f/ups per day with no new patients (assuming 30min f/ups with some no-shows) and that's $2460/day = $12,300/week. Work 45 weeks per year and that's grossing $553,500.

However, that's assuming everyone is a 99214 + 90833 and that you're fully reimbursed for all of those services billed. You should hopefully be able to get better rates from insurance than CMS, but you're also much less likely to get reimbursed for every service you bill for and will likely have to put in significantly more effort collecting on all those charges. You're also not going to be able to bill everyone at 99214 and are very unlikely to be able to drop the 90833 that frequently. Plus, that's just your gross before all expenses and taxes. Net take-home is going to look very different.

Theoretically, one could make bank with a very reasonable work schedule if everything is able to be optimized with minimal to no hiccups. Realistically, that's never going to happen. It's a lot easier to optimize everything in a cash-only setup where you require patients have a CC on file than to try and give a reasonable ballpark for a practice taking insurance without knowing a lot more specifics.

What you should be asking isn't so much for a general ballpark that we could provide. A better question is how well could you optimize the system you'd work in? Depending on your ability to optimize billing and collections, you can have massive differences (like 6 figure differences for seeing the same # of patients) in what your ballpark income could be.
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Thanks for that explanation. Would using a good billing company reduce a lot of non payment and take admin time off my plate? I feel like I write good, efficient notes that covers all the bases. Maybe I'm naively thinking this will result in less hiccups.

In my residency clinic it seems 90% are a 99214. Almost everyone has a couple chronic diagnoses it seems. I was imagining the real world would be similar as well.
 
Psychresy said:
Thanks for that explanation. Would using a good billing company reduce a lot of non payment and take admin time off my plate? I feel like I write good, efficient notes that covers all the bases. Maybe I'm naively thinking this will result in less hiccups.

In my residency clinic it seems 90% are a 99214. Almost everyone has a couple chronic diagnoses it seems. I was imagining the real world would be similar as well.
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It is similar everyone is 99214 and half or more are 90833 if you do 30 minute appointments
 
Psychresy said:
Thanks for that explanation. Would using a good billing company reduce a lot of non payment and take admin time off my plate? I feel like I write good, efficient notes that covers all the bases. Maybe I'm naively thinking this will result in less hiccups.

In my residency clinic it seems 90% are a 99214. Almost everyone has a couple chronic diagnoses it seems. I was imagining the real world would be similar as well.
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Any billing company should free up significant admin time. If they're not then there's no point in using them. Imo the thing billing is best at is actually submitting the billing and then harassing insurance companies so they actually pay. The actual billing to insurance companies isn't the issue, the problem is getting them to send the check. Some insurance companies are good about reimbursement. Others will pull out all the stops to minimize what they actually pay you and some will just flat out not reimburse for certain codes (992's and 90833 won't fall into that group though). I believe there was a recent thread where someone was having problems getting reimbursed for 90833s from a particular insurance company. Figuring out which insurance companies are going to actually reimburse for what you bill without having to spam them for every other bill submitted is part of the optimization process I mentioned.

You're correct that what you bill will likely be similar. Unless you see a high volume of straightforward ADHD med-checks, the vast majority should be 99214 and you can probably tack on the 90833 to many of them as long as you're documented appropriately.
 
For general Psychiatry, there really isn't a need to use a billing company. You will hemorrhage money on them.
An integrated clearing house, like with Luminello, and other EMRs will drastically save you money.
I went from ~$600/month to ~$70/month.
My assistant follows up on the odd ball claims, which is usually the patient having different insurance than what we thought.
 
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