Any predictions as to why or when psychiatry is going to crash? Everyone is talking about a boom, bubble, and burst cycle.

[TexasPhysician]

lol I doubt it. I didn’t see many plastic surgeons or dermatologists who ran cash only operations out on the streets in 2008-2009.

Plastics, lasik groups, aesthetics, dpc practices, addiction centers, etc were all effected. More established groups cut back on overhead and road it out. A large addiction company I’ve worked at cut 1/2 of all facilities and staff. Many addiction psychiatrists lost their jobs.

Physicians are never really “out on the streets”, but they do give up on new practices that aren’t performing, supplement their income, or get terminated due to lack of demand.

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[Mad Jack]

So I'm bumping this after looking at residency position growth. I think we are good to 2035, at least, but residency positions have increased around 90% in the last decade and a half. Any thoughts on when or if things will go south? I think there is likely ample demand and that midlevels haven't had a huge impact, but that's just me

 

[finalpsychyear]

So I'm bumping this after looking at residency position growth. I think we are good to 2035, at least, but residency positions have increased around 90% in the last decade and a half. Any thoughts on when or if things will go south? I think there is likely ample demand and that midlevels haven't had a huge impact, but that's just me

The answer to this question is unknown. To err on the side of caution, I work and try and save like there's only a 5-10 year window left. At worst, Ill be very close to my FIRE numbers then at least whatever happens I am less effected. In reality I don't see any issues almost for sure in the next 5-10 year window which takes us into 2032. I also would urge you to work up into admin like positions like med director, CMO etc as no matter what happens there will always be 1 MD and then armies of mid levels so you want to secure those type of spots if you can over the next several years to protect yourself for the years after that especially if you plan on 15-20 years of practicing from today.

 

[Mad Jack]

The answer to this question is unknown. To err on the side of caution, I work and try and save like there's only a 5-10 year window left. At worst, Ill be very close to my FIRE numbers then at least whatever happens I am less effected. In reality I don't see any issues almost for sure in the next 5-10 year window which takes us into 2032. I also would urge you to work up into admin like positions like med director, CMO etc as no matter what happens there will always be 1 MD and then armies of mid levels so you want to secure those type of spots if you can over the next several years to protect yourself for the years after that especially if you plan on 15-20 years of practicing from today.

Yeah, my goal is to be able to retire in 10 years, so I'm not super worried. I'm thinking things could get rough in about 15-20, but who knows, better safe than sorry

 

[finalpsychyear]

Yeah, my goal is to be able to retire in 10 years, so I'm not super worried. I'm thinking things could get rough in about 15-20, but who knows, better safe than sorry

counting 401k plus taxable if one can put away 100k over the next 10-11 years its almost 2m so i think most can do this and be safe over the next 10 yrs.

 

[allantois]

All I was saying is that there is plenty of mental illness as a result of what’s happening in the country (shootings, wars, COVID, etc). You have to wear a tinfoil hat to say that the US doesn’t have an issue with mass shootings.

 

[Username2015]

Yeah, my goal is to be able to retire in 10 years, so I'm not super worried. I'm thinking things could get rough in about 15-20, but who knows, better safe than sorry

On the positive side:
-I feel there will always be people who want care from those with the highest level of training or who have the most complex problems.
-Demand seems good lately

On the negative side:
-NPs appear to be coming to psychiatry in huge numbers. They think psychiatry is easy to do well and is an easy way to get paid more
--It will take a while before they saturate markets
--The quality of their care seems lacking, and I've received patients who left their NPs to get higher quality care

It's hard to predict the future. I'll plan for the worst and save so I have the option of retiring very early. If I cannot find a good part of psychiatry in the future, I'll switch to a nonclinical, likely non-medical career.

 

[Mad Jack]

On the positive side:
-I feel there will always be people who want care from those with the highest level of training or who have the most complex problems.
-Demand seems good lately

On the negative side:
-NPs appear to be coming to psychiatry in huge numbers. They think psychiatry is easy to do well and is an easy way to get paid more
--It will take a while before they saturate markets
--The quality of their care seems lacking, and I've received patients who left their NPs to get higher quality care

It's hard to predict the future. I'll plan for the worst and save so I have the option of retiring very early. If I cannot find a good part of psychiatry in the future, I'll switch to a nonclinical, likely non-medical career.

Many of the NPs seem to get fired or quit rather quickly from what I've seen though, and often refuse to take complex cases, so I don't know how big of a long-term impact they'll have. Some of the better ones from good programs are great but many come out of online programs where they arranged their own lackluster rotations and they really don't know much

 

[Username2015]

Many of the NPs seem to get fired or quit rather quickly from what I've seen though, and often refuse to take complex cases, so I don't know how big of a long-term impact they'll have. Some of the better ones from good programs are great but many come out of online programs where they arranged their own lackluster rotations and they really don't know much

All good points.

One thing I will add to my prior comment is that psychiatry is a little bit more resilient to becoming terrible compared to other fields because there is so much optionality within the field. There are so many diagnostic niches, multiple employment schemes, and treatment contexts from which to choose that if one of them ever gets bad, you can switch to areas that are better.

EM & RadOnc are fields that appear to be less resilient to downturns since they have more of their eggs in one basket. Emergency medicine has tied its work to a specific setting: Emergency Departments, which are hard to set up on your own and encourage an employment model. If being an employed physician in an ER is less needed or becomes worse, there are fewer alternatives. Radiation oncology has generally tied its work to a treatment modality: radiation (also hard to set up on your own). If reimbursement or clinical need for this modality drops, there are fewer alternatives. Pediatric Hem/Onc is similarly bad since in many cities, there is only one employer who can offer all the oncology protocols. That means the employer power is excessive and peds hem/onc fellows get limited job offers that are grossly underpaying unless they are willing to move cities and apply more broadly.

Psychiatry does not pay as much as other fields, but it does have variety going for it which makes it a bit more adaptable to changing times.

 

[allantois]

Number of Psych NP certifications: in 2021, 6,109 took the test and 5,321 passed, compared to (respectively) 4,114 and 3,315 in 2020 and 1,497 and 1,328 in 2016.

 

[Mad Jack]

Number of Psych NP certifications: in 2021, 6,109 took the test and 5,321 passed, compared to (respectively) 4,114 and 3,315 in 2020 and 1,497 and 1,328 in 2016.

Thankfully there's many things they simply cannot legally do or be reimbursed for, such as ECT, TMS, commitment hearings, etc. And we can always peace out of the insurance market and work for ourselves with very little overhead. Many of the positions that had tried hiring NPs either had them quit or fired them where I was before and brought doctors back on because the NPs weren't working out for various reasons. It's very likely psych NPs will end up like many NPs in other fields- unable to find full-time practitioner work and forced to stay on doing part-time RN work due to saturation at the midlevel. Given all of that, I think we've still got at least 15 years before things really get concerning, if even then. And by concerning, I mean for people out of the gate looking for employed positions- experienced psychiatrists can easily start their own private practice and build it up before the system saturates.

 

[Ellomate]

Barrier to becoming an NP is so ridiculously low with these online programs... They should have to go to school for it. Forgo their nursing salary for 1.5-2 years to get an advance degree like CRNA.
But ofc they lobby for "shortages" in middle-of-nowhere for new grads to open up med spa and psych PP in a nice city.

 

[motuza]

Mowgli was raised by Wolfs and Tarzan was raised by great apes and they turned out OK. Honestly, aristocrats have been outsourcing the raising of their children for a very long time and there may be some examples of this not going well, but mostly it is fine and the attachment is surprisingly normal. It is only relatively recently that this is frowned upon.

Not to mention that much of the world where collectivism is the norm “crowdsources” child rearing through extended families. And the vast majority of these children do well in that system barring socioeconomic disparities. Are we going to tell every Latin American, Asian and African country that they are raising their children incorrectly? Or is it only rich European countries that raise children properly?

 

[finalpsychyear]

Number of Psych NP certifications: in 2021, 6,109 took the test and 5,321 passed, compared to (respectively) 4,114 and 3,315 in 2020 and 1,497 and 1,328 in 2016.

so likely 6k in 2022, 7k in 2023, and probably 10k in 2025. I don't like it but again this is more of an issue for those graduating in the next few years not for established PP or employed psych docs. I still stick by my 5-10 year outlook and encourage wherever you are you move towards director type rolls otherwise its a simple well we can pay 100k for a fresh psych np instead of paying 250k for a psych doc and admin will always be tempted to cut and make the most $. However if you have director,CMO roles you are likely protected indefinitely until they start letting NPs become med directors, CMO, etc but i doubt this happens in 10 years time but i urge everyone to save and invest like 10 years is what the time horizon is.

I have been fearful for this since I started 6 years ago and can attest to not a single doc being hired where I work only as some have left more NPs fitting the role.

 

[Trismegistus4]

so likely 6k in 2022, 7k in 2023, and probably 10k in 2025. I don't like it but again this is more of an issue for those graduating in the next few years not for established PP or employed psych docs. I still stick by my 5-10 year outlook and encourage wherever you are you move towards director type rolls otherwise its a simple well we can pay 100k for a fresh psych np instead of paying 250k for a psych doc and admin will always be tempted to cut and make the most $. However if you have director,CMO roles you are likely protected indefinitely until they start letting NPs become med directors, CMO, etc but i doubt this happens in 10 years time but i urge everyone to save and invest like 10 years is what the time horizon is.

I have been fearful for this since I started 6 years ago and can attest to not a single doc being hired where I work only as some have left more NPs fitting the role.

I've been assuming the raison d'être of all these medical director positions we see advertised lately is to be the rubber-stamper of all the NPs who are actually seeing the patients. Am I wrong?

 

[hallowmann]

Many of the NPs seem to get fired or quit rather quickly from what I've seen though, and often refuse to take complex cases, so I don't know how big of a long-term impact they'll have. Some of the better ones from good programs are great but many come out of online programs where they arranged their own lackluster rotations and they really don't know much

I've seen this turn over in a lot of places with NPs, mainly because they see their work as shift work, clocking in, and gigs. I can't blame them, because these clinics hire them to replace physicians and very few want to work the physician lifestyle, despite expecting to be treated like one.

Thankfully there's many things they simply cannot legally do or be reimbursed for, such as ECT, TMS, commitment hearings, etc. And we can always peace out of the insurance market and work for ourselves with very little overhead. Many of the positions that had tried hiring NPs either had them quit or fired them where I was before and brought doctors back on because the NPs weren't working out for various reasons. It's very likely psych NPs will end up like many NPs in other fields- unable to find full-time practitioner work and forced to stay on doing part-time RN work due to saturation at the midlevel. Given all of that, I think we've still got at least 15 years before things really get concerning, if even then. And by concerning, I mean for people out of the gate looking for employed positions- experienced psychiatrists can easily start their own private practice and build it up before the system saturates.

I suspect this is very regional. I've seen clinics and inpatient units be completely replaced with NPs in my area. You get the turn over still, but these places rarely care about the quality of psychiatric treatment, so continuity is meaningless. I've even watched and seen them hire 2 NPs at a greater overall expense to do the work of one psychiatrist. I genuinely have no idea why that happens. In my region though, they also open up their own clinics, run ketamine infusion clinics and "integrative" clinics where they sell supplements. Quality of care between the CMHCs vary significantly based on management, where newer psych grads will actually care and employ midlevels with supervision, whereas the older psychiatrists or non-psychiatrists never seem to care about quality or supervision.

Barrier to becoming an NP is so ridiculously low with these online programs... They should have to go to school for it. Forgo their nursing salary for 1.5-2 years to get an advance degree like CRNA.
But ofc they lobby for "shortages" in middle-of-nowhere for new grads to open up med spa and psych PP in a nice city.

It's honestly very disturbing. Some NP programs boast 100% acceptance rates and I've seen multiple NPs that work fulltime as RNs while getting their PMHNPs online. They basically spend at most a couple hours a day on the curriculum, have someone they know let them shadow, then they get their hours signed off.

I agree with @Mad Jack that I've worked with some good ones that know their limits, but sometimes even they surprise me every once and a while. Not to mention the sheer variability in quality is in insane, at best they're OK, but the majority I've seen I can't tell what they were thinking.

I'm currently getting a bunch of patients from one that was working for a couple years at this clinic. For some patients, they hadn't had metabolic labs checked the entire time despite on neuroleptics (some weren't actually taking them, despite carrying an array of diagnoses that contradicted each other - and clearly having SUD and personality disorders), others paradoxically were stuck on subtherapeutic SRI doses despite having genuine poorly controlled OCD and answering negative to being asked if they ever had tried or been offered higher doses (no evidence of it in documentation), and then others just seemed to have weird boundary expectations based on the way she did things. I genuinely think in some cases they just aren't taught how to manage psychiatric patients and make it up as they go along, rather than actually seek education/advice on it.

 

[michaelrack]

Thankfully there's many things they simply cannot legally do or be reimbursed for, such as ECT, TMS, commitment hearings, etc.

I don't think ect is a legal issue; but not aware of any NP's doing it. I know peripherally of some psych NP's looking into getting a TMS machine

 

[Mad Jack]

I don't think ect is a legal issue; but not aware of any NP's doing it. I know peripherally of some psych NP's looking into getting a TMS machine

I think it's a reimbursement issue. ECT is considered a physician-level procedure performed under anesthesia, it would be like an NP billing for a surgery. TMS they may be able to do but I haven't yet seen it.

 

[deleted456421]

Mass shootings are a false issue conjured up by left wing media and has nothing to do with guns, but merely a symptom of humanity. Look to the East and see the deaths derived by knives or riots. Its humans not shootings - but what's different is the media fervor for them and using it as a political spin.

This is hilarious. It's the right wing that created a false narrative: "It can't be the guns! It must be mental illness." Literally every gun lover I know has suggested we need more mental health resources to combat this "surprising" rise in gun violence.

All empiric evidence suggests mass shootings are unique to the U.S.A. "knives or riots" are tiny causes of homicide in comparison.

Edit: I'm starting to understand your desire to head to a deep red state.

 

[allantois]

so likely 6k in 2022, 7k in 2023, and probably 10k in 2025. I don't like it but again this is more of an issue for those graduating in the next few years not for established PP or employed psych docs. I still stick by my 5-10 year outlook and encourage wherever you are you move towards director type rolls otherwise its a simple well we can pay 100k for a fresh psych np instead of paying 250k for a psych doc and admin will always be tempted to cut and make the most $. However if you have director,CMO roles you are likely protected indefinitely until they start letting NPs become med directors, CMO, etc but i doubt this happens in 10 years time but i urge everyone to save and invest like 10 years is what the time horizon is.

I have been fearful for this since I started 6 years ago and can attest to not a single doc being hired where I work only as some have left more NPs fitting the role.

I just think it's absurd that there is more NPs graduating than physicians overall and more psych NPs graduating than psychiatrists. Med schools draw from all backgrounds, while NPs draw from nurses. There is only so many people who have the brains to do medical work and ultimately I think a lot of NPs do realize that their education poorly prepared them for their new roles.

 

[Ellomate]

One of our inpatient patient was hospitalized due to an arrhythmia from an outpatient NP giving levothyroxine after seeing low TSH level. The speculation is that the NP thought TSH was Thyroid hormone.

 

[J ROD]

I think the next ten years will be good. I recently looked around and was offered 300 plus. Most around 350. For a fairly easy work schedule. I do believe the np issue will come into play. However if you are a competent better than average psychiatrist I don’t think you will have a problem getting a job over next 20 to 25 years. I would recommend getting yourself set up where you want to be in the next decade. There is also private practice. But the retirement and insurance benefits do mean something.

 

[painballer27]

@J ROD Were these inpatient or outpatient jobs? Are you looking to change jobs? Seems like you have a great deal currently

Edit: Sorry, forgot you don't like being quoted.

 

[Ellomate]

The average seems to be in the 275k range (+/- 25k). After adjusting for inflation (3-4% each year), is there a chance that salaries can actually decrease as the market saturate or will is pretty much be stabilized by then?

 

[J ROD]

@J ROD Were these inpatient or outpatient jobs? Are you looking to change jobs? Seems like you have a great deal currently

Edit: Sorry, forgot you don't like being quoted.

Inpatient. Perhaps. Money is not the problem. Drama and being told what to clinically at times by nursing administration Only mind when I say please don’t quote me

 

[Splenda88]

I think the next ten years will be good. I recently looked around and was offered 300 plus. Most around 350. For a fairly easy work schedule. I do believe the np issue will come into play. However if you are a competent better than average psychiatrist I don’t think you will have a problem getting a job over next 20 to 25 years. I would recommend getting yourself set up where you want to be in the next decade. There is also private practice. But the retirement and insurance benefits do mean something.

Based on my observation in IM, the bean counters don't care about competence. I guess things might be different in psych.

 

[finalpsychyear]

I just think it's absurd that there is more NPs graduating than physicians overall and more psych NPs graduating than psychiatrists. Med schools draw from all backgrounds, while NPs draw from nurses. There is only so many people who have the brains to do medical work and ultimately I think a lot of NPs do realize that their education poorly prepared them for their new roles.

It is a true tragedy this has happened. It only maybe made sense for surgical specialists who out of wanting more cases had NPs to get them more cases but it has done nothing but hurt any non procedural field in the long run and if i remember they are already doing scopes and non invasive procedures in academia. I don't know future salaries but I'd rather be pessimistic and work now as if there is a 50% inflation adjusted drop that occurs step wise from now till 2032. .

We all need to save 100k MINIMUM which includes everything 401k/HSA/Roth/taxable/savings but I'd advise not counting your gains in yearly house equity even though i guess technically you could. Might be tougher for 1 income household but doable and even easier in a tax free state florida/texas. I even think 100k should be the minimum since expenses are unpredictable.

If you can do more do it. You picked up wknds and moonlighted a bit and 2022 or 2023 you invested 150-175k then do it and use that extra amount as a buffer in case the following year you only can invest 50-75k etc. Invest in the market even if you do index funds you'll maybe get close to 2m in the next 10-11 years. Even if you don't you'll get close and even if salaries drop to 50% or roughly 150k inflation adjusted 10-11 years from now you are still set with that 2m in invested assets even with that 150k inflation adjusted salary. This might sound like a doomsday scenario but your covered. In 2012 would you believe there would be this many psych NPs 10 years later? While I doubt this degree of negativity happens you'll be way more ahead than pretending its not possible.

 

[J ROD]

Based on my observation in IM, the bean counters don't care about competence. I guess things might be different in psych.

Not really probably but I like to think so in my mind. One reason I am looking for that medical director role. Got to have one MD

 

[whopper]

Psychiatry will crash and burn when someone finds a cure-all to psych disorders.

The demand has gotten even more so in the last few years. I don't see it going down either.

 

[finalpsychyear]

Psychiatry will crash and burn when someone finds a cure-all to psych disorders.

The demand has gotten even more so in the last few years. I don't see it going down either.

This is all true. Salaries wont keep up with inflation so you may make 250-300 k in 3-5 years from now but it will have the equivalent inflation adjusted to much less than that so i don't know what the math on a 250k salary in 3-5 years will be probably closer to 200k imo maybe less with the flood of NPs and more autonomy for them I do firmly believe employed psych will

 

[Merovinge]

This is all true. Salaries wont keep up with inflation so you may make 250-300 k in 3-5 years from now but it will have the equivalent inflation adjusted to much less than that.

I'd like access to your crystal ball. Past evidence certainly suggests MD salaries keep up with inflation. While I certainly don't think they will keep up with our very high rates of inflation, there are clearly other issues with the overall economy if we continue run >8% CPI.

 

[finalpsychyear]

I'd like access to your crystal ball. Past evidence certainly suggests MD salaries keep up with inflation. While I certainly don't think they will keep up with our very high rates of inflation, there are clearly other issues with the overall economy if we continue run >8% CPI.

History of medicine has been a downward slope. For example anesthesia was netting 1m in the 80s let alone surgical spec and now that equivalent is like 3-4 million for anes. alone. Medicine only trends down with time independent of inflation.

 

[FlowRate]

History of medicine has been a downward slope. For example anesthesia was netting 1m in the 80s let alone surgical spec and now that equivalent is like 3-4 million for anes. alone. Medicine only trends down with time independent of inflation.

I was trying to vet your claims and came across this book which shows real physician pay tripling since 1960. It's inflation adjusted supposedly.

https://www.mercatus.org/system/files/helland-tabarrok_why-are-the-prices-so-damn-high_v1.pdf

 

[finalpsychyear]

I was trying to vet your claims and came across this book which shows real physician pay tripling since 1960. It's inflation adjusted supposedly.

https://www.mercatus.org/system/files/helland-tabarrok_why-are-the-prices-so-damn-high_v1.pdf

I was trying to vet your claims and came across this book which shows real physician pay tripling since 1960. It's inflation adjusted supposedly.

https://www.mercatus.org/system/files/helland-tabarrok_why-are-the-prices-so-damn-high_v1.pdf

I have direct knowledge of specialists earning multi 7 figures in the late 90s it was common for cardio, ortho, rads, ent,optho to pull this in PP. 1-2 million 25 years ago is crazy but we missed the golden times. Fyi 1 million in 1997 is 3 mill today.. 2mill.then lol... its why neurosurgeons were buying small planes.

 

[painballer27]

I have direct knowledge of specialists earning multi 7 figures in the late 90s it was common for cardio, ortho, rads, ent,optho to pull this in PP. 1-2 million 25 years ago is crazy but we missed the golden times. Fyi 1 million in 1997 is 3 mill today.. 2mill.then lol... its why neurosurgeons were buying small planes.

Wow. Things sure have gone downhill...

 

[AD04]

I have direct knowledge of specialists earning multi 7 figures in the late 90s it was common for cardio, ortho, rads, ent,optho to pull this in PP. 1-2 million 25 years ago is crazy but we missed the golden times. Fyi 1 million in 1997 is 3 mill today.. 2mill.then lol... its why neurosurgeons were buying small planes.

Do you have actual survey data to show that 90th percentile income for those fields decreasing since the 90s?

 

[docksan]

Wow. Things sure have gone downhill...

No they haven't. Physicians are still in the top 5-10% earners in the world.

 

[painballer27]

No they haven't. Physicians are still in the top 5-10% earners in the world.

But are they worse off than they used to be? It seems so

 

[psyspy]

Should those of us entering into psych in the next 1-2 y be swayed away from a fellowship in light of all this?

 

[psyspy]

But are they worse off than they used to be? It seems so

Yes based on what was said above this is true

 

[Merovinge]

Should those of us entering into psych in the next 1-2 y be swayed away from a fellowship in light of all this?

If anything, I think swayed towards would make more sense. The more specialized you are the less replaceable you are. Admittedly, a lot of this specialization can come without fellowship training but several of the options make a lot of sense and are either 1 year or add 1 year (CAP w/ fast track).

 

[Merovinge]

I have direct knowledge of specialists earning multi 7 figures in the late 90s it was common for cardio, ortho, rads, ent,optho to pull this in PP. 1-2 million 25 years ago is crazy but we missed the golden times. Fyi 1 million in 1997 is 3 mill today.. 2mill.then lol... its why neurosurgeons were buying small planes.

1 million in 1997 is 1.82 million today...

You are quoting the highest earning doctors in the highest earning fields during times when reimbursement was broken (LOL at CTs billed as 500 radiographs) compared to any statistics or averages. Honestly sounds like someone coming in to say what their one patient responded to and how this should be what we base our decisions on rather than real data.

 

[PikminOC]

So I'm bumping this after looking at residency position growth. I think we are good to 2035, at least, but residency positions have increased around 90% in the last decade and a half. Any thoughts on when or if things will go south? I think there is likely ample demand and that midlevels haven't had a huge impact, but that's just me

Psych residents have increased or all residency slots?

 

[PikminOC]

I just think it's absurd that there is more NPs graduating than physicians overall and more psych NPs graduating than psychiatrists. Med schools draw from all backgrounds, while NPs draw from nurses. There is only so many people who have the brains to do medical work and ultimately I think a lot of NPs do realize that their education poorly prepared them for their new roles.

Much more difficult to become a physician than a nurse. And the nurses have supreme confidence.

 

[PikminOC]

Based on my observation in IM, the bean counters don't care about competence. I guess things might be different in psych.

No different in psych. They have the collaboration physician in case there's a malpractice case to throw under the bus.

 

[PikminOC]

I'd like access to your crystal ball. Past evidence certainly suggests MD salaries keep up with inflation. While I certainly don't think they will keep up with our very high rates of inflation, there are clearly other issues with the overall economy if we continue run >8% CPI.

Reimbursements decrease and staff and other costs increase. Where are you seeing increased reimbursement and decreased overhead?

 

[PikminOC]

Psychiatry will crash and burn when someone finds a cure-all to psych disorders.

The demand has gotten even more so in the last few years. I don't see it going down either.

And that cure all apparently is psilocybin. 🙄

 

[PikminOC]

@J ROD Were these inpatient or outpatient jobs? Are you looking to change jobs? Seems like you have a great deal currently

Edit: Sorry, forgot you don't like being quoted.

So he quotes others and doesn't like to be quoted?

 

[PikminOC]

Just for giggles: The “collapse” will happen when the next big recession comes about. 50%+ (est) of psychiatrists are cash only. What will happen when people can’t afford it? Cash practices that are not well established may fold. More psychiatrists will look for PT or FT employed work. They will supplement their practice or get out entirely. Add in the midlevels and you will see a big influx of psychiatric supply for similar demand. This will drop rates.
This isn’t a true “collapse”, but it will likely drop rates.

So soon?

 

[comp1]

I'm wondering what data or trend would actually reassure people that this isn't happening or likely to happen? I mean so many people have hard evidence that salaries are doing great and yet there's still so much anxiety. I don't get it.