As an attending, what kind of hours do you put in?

[Abider]

---

Members don't see this ad.

I was having a conversation with a physician on the Allo forum and he is resolute in his observation that junior Attendings put in more hours that residents. That contradicts with my basic assumptions.

In my happy little world. I work my butt off to train in this specialty for 4 years and then I'm considered a go-getter because I put in an extra week end shift. And I put in 60 hours for a few years and then drop down to 50 for a mid career groove. In my later years maybe 35-45.

He's saying as a junior attending worth my salt I'll be cranking at near the 80 mark. With the implication that it is a sense of duty to my relative inabilities that I would put in the time. Or that this is the reality of junior doc's who want a good career position.

Who's projections are more accurate? Have I been fooled by reading more here? Is Psych different from the other fields?

Thanks

 

[digitlnoize]

I was having a conversation with a physician on the Allo forum and he is resolute in his observation that junior Attendings put in more hours that residents. That contradicts with my basic assumptions.

In my happy little world. I work my butt off to train in this specialty for 4 years and then I'm considered a go-getter because I put in an extra week end shift. And I put in 60 hours for a few years and then drop down to 50 for a mid career groove. In my later years maybe 35-45.

He's saying as a junior attending worth my salt I'll be cranking at near the 80 mark. With the implication that it is a sense of duty to my relative inabilities that I would put in the time. Or that this is the reality of junior doc's who want a good career position.

Who's projections are more accurate? Have I been fooled by reading more here? Is Psych different from the other fields?

Thanks

Not an attending, but I did a number of rotations in non-academic settings with attendings.

Inpatient Unit #1: Attending worked inpatient 8am-noon, hour for lunch, then outpatient from 1-4. Only 4 days a week. $225k/year.

Inpatient Unit #2 (State Hospital): Attending worked 9am-3 or 4pm, 3-4 days a week (alternating week, 3 days one week, 4 days the next). Also had an outpatient practice during his days off from the state gig, cash only. Gets paid ~$185k for the ~32 state hours/week, and another $200/hour from his Private practice gig. Nice setup.

Consult Liaison Attending: basically 8-5-ish, weekdays only for the most part. Backup pager call shared with another attending on weekends, but not a busy super crazy service so light off work load. Not sure about salary.

Inpatient Child Attending: Another 8-4 person. Takes some time off here and there to do Forensics work for mad money.

Overall, I'd say most of my attendings have been putting in ~40 hours per week and bringing in between $180-220k per year. It's a nice gig.

Some people will work more early on to pay off debt and what not, but there's no need to kill yourself doing it. I don't plan on breaking 60 EVER after residency.

If someone could post the link to the recent Medscape survey that'd be really useful. I'm on my phone and it's too much trouble to look it up right now. Basically it found that a large percent of psychiatrists work < 30 hours per week, which lowers our average salary.

 

[Abider]

Not an attending, but I did a number of rotations in non-academic settings with attendings.

Inpatient Unit #1: Attending worked inpatient 8am-noon, hour for lunch, then outpatient from 1-4. Only 4 days a week. $225k/year.

Inpatient Unit #2 (State Hospital): Attending worked 9am-3 or 4pm, 3-4 days a week (alternating week, 3 days one week, 4 days the next). Also had an outpatient practice during his days off from the state gig, cash only. Gets paid ~$185k for the ~32 state hours/week, and another $200/hour from his Private practice gig. Nice setup.

Consult Liaison Attending: basically 8-5-ish, weekdays only for the most part. Backup pager call shared with another attending on weekends, but not a busy super crazy service so light off work load. Not sure about salary.

Inpatient Child Attending: Another 8-4 person. Takes some time off here and there to do Forensics work for mad money.

Overall, I'd say most of my attendings have been putting in ~40 hours per week and bringing in between $180-220k per year. It's a nice gig.

Some people will work more early on to pay off debt and what not, but there's no need to kill yourself doing it. I don't plan on breaking 60 EVER after residency.

If someone could post the link to the recent Medscape survey that'd be really useful. I'm on my phone and it's too much trouble to look it up right now. Basically it found that a large percent of psychiatrists work < 30 hours per week, which lowers our average salary.

Thanks. I've read your posts and others. And it corroborates what I've experienced working for docs in a large HMO system.

For the kind of money you referenced I wouldn't need to work 60. Really I just want one full time job with and extra shift on the weekend to make extra money to pay down debt. Or a combination of jobs that equal around 50 hours a week to the same end.

I couldn't get where this dude was coming from.

If Psych is some island of normalcy in an otherwise 70-hour work week of junior attendings then I'm no longer interested in other fields.

But if this guy is off, then I'm still entertaining outside interests in family and internal medicine. Like a few others here in their past/present career choices, Palliative Medicine is a strong draw for me. And general medicine seems to be the best preparation for it. That's another reason I'm asking.

 

[OldPsychDoc]

I'm in my 8th year and I average about 45 hours a week, with frequent breaks to check the Internet, plus 4-5 weekends a year. 60% inpatient/40% outpatient/IOP. Well over $200k since year 3.

 

[Abider]

I'm in my 8th year and I average about 45 hours a week, with frequent breaks to check the Internet, plus 4-5 weekends a year. 60% inpatient/40% outpatient/IOP. Well over $200k since year 3.

Outstanding. I would love something like that. Thanks. That's encouraging.

 

[JamesPhilly]

I'm in my 8th year and I average about 45 hours a week, with frequent breaks to check the Internet, plus 4-5 weekends a year.

Does this mean you only get off 4-5 weekends a year, or that you occasionally have to work a weekend?

I'm understanding you to mean the latter as 45 hrs a week would seem too little for covering weekends as well

 

[OldPsychDoc]

Does this mean you only get off 4-5 weekends a year, or that you occasionally have to work a weekend?

I'm understanding you to mean the latter as 45 hrs a week would seem too little for covering weekends as well

Work 4-5 weekends a year. We rotate call a week at a time. During the week it's covering infrequent phone calls, and on those weekends we actually show up on the units to staff admissions, etc.

 

[JamesPhilly]

thanks for clarifying

 

[aphenomenon]

Totally depends. At my MGH interview one of my senior interviewers told me he and most of the faculty work over 80 hours a week (everythng included). Depends where you are, what you want to be doing, and how much you want to be working.

 

[sunlioness]

I work a solid 40, no weekends or call. The latter is unusual in my department though as I made a deal to be the standing back up to our C&L guy in exchange for not having to take call. I'm contractually forbidden from sharing my salary, but it's in the range of the ones above.

I think Attendings (my autocorrect has now insisted on capitalizing that three times) in other fields can work really crazy hours. I frequently hear friends from medical school complaining how there aren't work hour restrictions or caps anymore.

 

[Abider]

I work a solid 40, no weekends or call. The latter is unusual in my department though as I made a deal to be the standing back up to our C&L guy in exchange for not having to take call. I'm contractually forbidden from sharing my salary, but it's in the range of the ones above.

I think Attendings (my autocorrect has now insisted on capitalizing that three times) in other fields can work really crazy hours. I frequently hear friends from medical school complaining how there aren't work hour restrictions or caps anymore.

Thanks, that's interesting. If that's the case, I wonder how much of it discretionary. I had a neurosurgeon that worked like a machine. But he owned 2 of the buildings he had office space in, just that I knew of, that he rented to other practices. As one of the few neurosurgeons in any town, it seems unlikely that he had no choice in his schedule.

But maybe there are things that I just don't understand yet. Like maybe to maintain the contracts to provide the neurosurgery service to the several hospitals he operated in he had to work crazy hours.

Similarly, maybe the climate of certain fields is such that this is what they have to do. Which is why I'm asking, I suppose. Which leads me to ask why Psych would be an exception.

Did all the psychiatrists get together at The Meeting and just say let's just all agree to take it easy and work a straight 40, who's in favor?

Because if psychiatry really is one of the few fields that sees fit to balance a human life with work, well than my match is made. Which is fortunate because their is at least an inherent attraction.

I don't mind pushing the extreme hours in residency training. But I really want a a 55 hour work week with plenty of time to do yoga, take long walks, watch stand up comedy, listen to my favorite radio shows, grind out some guitar fantasies etc. And I don't want to be guilty and considered a slovenly hack for this. The stuff I hear coming out of the mouths of doc's in other fields makes me feel weird for wanting these. Really? I thought a taught focused concentrated 50 hour work week was pretty damned respectable.

WTF is wrong with our colleagues. Are they zombies?

 

[whopper]

Even if an attending worked more hours than a resident there's signfiicant differences.

The pay, the treatment by staff members, and that it'd be of the person's choice.

Work 80 hrs a week at 10x the pay of a resident, where everyone pays you respect, and you're doing by choice is far different than making peanuts, people treat you like crap, and you have no choice.

Especially if you got an attending you're working under that blows (doesn't teach, doesn't know what he's doing and expects you do to all the dirty work).

 

[nitemagi]

Even if an attending worked more hours than a resident there's signfiicant differences.

The pay, the treatment by staff members, and that it'd be of the person's choice.

Work 80 hrs a week at 10x the pay of a resident, where everyone pays you respect, and you're doing by choice is far different than making peanuts, people treat you like crap, and you have no choice.

Especially if you got an attending you're working under that blows (doesn't teach, doesn't know what he's doing and expects you do to all the dirty work).

Agree wholeheartedly.

I'm a little less than a year out, and I do about 60-65hrs/week at 3 different jobs. Do a 4/40 at a county mental health urgent care, plus my private practice, plus some contract work doing outreach to the homeless and mentally ill (I serve the two ends of socioeconomic spectrum). I work a lot, and I've definitely turned the corner and am making a lot. Getting paid for your time and having it be your choice is a good thing.

 

[Abider]

Agree wholeheartedly.

I'm a little less than a year out, and I do about 60-65hrs/week at 3 different jobs. Do a 4/40 at a county mental health urgent care, plus my private practice, plus some contract work doing outreach to the homeless and mentally ill (I serve the two ends of socioeconomic spectrum). I work a lot, and I've definitely turned the corner and am making a lot. Getting paid for your time and having it be your choice is a good thing.

Cool. Getting some wind in my sails after burying myself in this debt would feel good. And if it was my own enterprise and initiative that put me on this course then it would feel right.

It's the ethos of sacrificing yourself to the alter of medicine because it's the holy necessity of our profession that makes me want to vomit.

Some of the conversations I've had have been tedious along the lines of sacrificing everything for this or you're worthless self-serving hack. And all I'm talking about is some regeneration of your daily health and vigor.

The sad portending eyes of a maternal-fetal medicine doc hit home deeply to me when after surviving a major heart attack he told us ducklings to take care of ourselves above all else. I'm nearly 40 and crawled back from a devastating work injury to be here. So I'm more sensitive to this than most.

And I don't feel the slightest compunction about my joy that psychiatry seems to offer a wide variety of flexible work schedules that will enable me a daily rigorous exercise routine (which is in my case pain therapy not vanity).

But the saps of medicine are always about their business of making you feel guilty with their superiority. At least at my stage here in the womb.

 

[whopper]

A big frustration for me while being a resident was some of the attendings, I knew more than them by my 3rd-4th year, and if they screwed up, the nurse manager would go up to me and start yelling at me asking me why did I let it happen.

The way this dysfunctional hierarchy was working, the attending could not be replaced because there was a shortage of psychiatrists and they hospital came to the conclusion that if they got rid of a bad one, they'd either get a worse one or none at all. So then the nurse manager, who is told by the dept, to make sure nothing goes wrong has to keep this mo-fo attending happy. When residents get their opportunity to critique the program, nurses were usually held immune. They could only rate their attendings.

So in short, there's no consequences with the nurse manager ripping apart a resident who didn't do anything wrong.

I brought this up to the program director. There were two in my residency program. The main one was in a different hospital, and pretty much just didn't seem to care. Okay I get that because the other was in the actual hospital where this was going on and she was the dept. chair. When I told her what was going on, she told me this had gone on for years and spelled out the politics that they couldn't replace bad doctors. I was only told this when I was a chief resident because by then I was in the inner circle with managing the clinical stuff.

Anyways, a little PTSD from residency. Here was this mo-fo attending making about 8x what I made and I knew more than him, then on top of that, the dept chair told me this same idiot was a resident in the same program and was terrible even then.

The shortage of psychiatrists guarantees us jobs but it also guarantees us to be working with idiots who will not be replaced. While I sometimes miss where I did my training, some of the friends there, and being able to have a mixed drink on the boardwalk right after work, remembering all this BS reminds me why I haven't gone back.

 

[JESSFALLING]

It also guarantees us to be working with idiots who will not be replaced.

Careful 🙂

 

[notdeadyet]

Y

 

[snarfer]

I work 40 hours per week(no call, all outpt, no overhead, 8-5pm gig) for $200K with board certification for a hospital system. But 2 weeks per month, I work an extra 20 hours for extra, hourly pay because we are constantly asked to help out. I would work 60 hours every week if I thought I can handle the mental stress. IMO, most YMDs don't work more than 40 hours to avoid mental burnout. I love my job but treating the 10-20% hostile, entitled, dual or trip diagnosis (legal/substance/MH) pts daily really take its toll by 5pm.

There are a few who can handle the 60-80+ hour work week and they easily pull in $350+ seeing adults only. Add 15% more if you can see peds pts.

 

[Chimed]

I work 40 hours per week(no call, all outpt, no overhead, 8-5pm gig) for $200K with board certification for a hospital system. But 2 weeks per month, I work an extra 20 hours for extra, hourly pay because we are constantly asked to help out. I would work 60 hours every week if I thought I can handle the mental stress. IMO, most YMDs don't work more than 40 hours to avoid mental burnout. I love my job but treating the 10-20% hostile, entitled, dual or trip diagnosis (legal/substance/MH) pts daily really take its toll by 5pm.

There are a few who can handle the 60-80+ hour work week and they easily pull in $350+ seeing adults only. Add 15% more if you can see peds pts.

How much time do you get for RV's and evals?

 

[whopper]

I was able to do about 60 hours no problem until my daughter was born. While I can still do it, I can also have a kid develop problems related to me not being home with her and the rest of the family. I also developed a gutt I didn't used to have because I don't have time to work out as much as I used to do.

I'm now working about 45 hours a week.

 

[Abider]

I work 40 hours per week(no call, all outpt, no overhead, 8-5pm gig) for $200K with board certification for a hospital system. But 2 weeks per month, I work an extra 20 hours for extra, hourly pay because we are constantly asked to help out. I would work 60 hours every week if I thought I can handle the mental stress. IMO, most YMDs don't work more than 40 hours to avoid mental burnout. I love my job but treating the 10-20% hostile, entitled, dual or trip diagnosis (legal/substance/MH) pts daily really take its toll by 5pm.

There are a few who can handle the 60-80+ hour work week and they easily pull in $350+ seeing adults only. Add 15% more if you can see peds pts.

Interesting, thanks. I wondered if the nature of the work might limit one's ability to grind out long hours.

But man. All of these figures the attendings are dropping are really great. Nice hours and nice pay. And like whopper said the ability to scale up and down at will seems to be there for the picking.

Makes the debt burden seem more reasonable.

 

[Abider]

As to the glut of idiots thing. That's too bad.

Seems like we have somewhat of a collection bin for mercenary IMG's who just want to be in the States and pitifully slackerish American grads.

As much I'm thinking about life balance I do not want to be in this latter category. Under any circumstances.

What's confusing to an about to be M3 is why some fields like to tout a zero compromise ethos in the life balance issue and if there is not some substance to the notion. Maybe 100 hour weeks is how you become a good surgeon and so on. It's also not clear to me why exactly there seems to be a different deal struck in different fields. For instance you don't hear senior derm people lamenting how the young slackers are hacks because they don't put in the 100 hour weeks like you're supposed to.

 

[digitlnoize]

If you ask me, we put far too much emphasis on TIME in physician training, and not enough emphasis on COMPETENCE.

There shouldn't even be a set length for residency. Once you're able to meet all the competencies, you should be done. Some people might be able to do that in 2 years, others might take 5.

 

[PikminOC]

No one has mentioned RVU compensation. Most hospitals I see have this model after a 1-2 year guarantee. The hospitals hold you very accountable for how many RVU's you make as they are covering your malpractice and health insurance.

 

[whopper]

Seems like we have somewhat of a collection bin for mercenary IMG's who just want to be in the States and pitifully slackerish American grads.

Funny cause the guy I was talking about fits the above description. He's from another country where doctors are treated like royalty and not expected to work hard. I one time even told the guy I was fearing his lack of care would lead to a bad outcome and he told me that would even be a good thing because then the resident on duty would learn from the experience.

While it's unfair to peg every single foreign doctor as like the above, there is a type of doctor from a 3rd world country that I've noticed wants to continue the entitlement he had in the other country. Doctors in several other countries are treated to the degree where the staff make them coffee are on the order of the local kingpin because in some ways they are. A person's life is in their hands and piss them off, they might not do as good a job. While we doctors should be treated with certain respect that comes with the position, IMHO a doctor not doing their job is not entitled to that. It's unfair to think every single foreign doctor is like this and I've seen several terrible doctors born and raised in this country.

(I'm not joking). I did bring this up to the program but they told me that unless I actually recorded it, it was his word vs. mine. At that point I pretty much lost respect for the organization, but I was on my way out of there being that it was my 4th year, I already got into fellowship, and it was just a few months from graduation. I realize I couldn't prove he did it so I get why they told me what they told me, but his record of poor work was indefensible. I actually even sympathised with the dept. chair who told me she also thought he was terrible but couldn't replace him. The thing that bugged me was there were people in the program defending him for whatever reason such as he was a former classmate in residency.

Anyways, if you work in a good dept you can avoid the idiots. Don't think every place blows. There are good departments out there and higher scale treatment institutions or practices but you have to show you are a better physician to get into these places. As for the idiots being everywhere, I've seen that in other fields of medicine as well.

 

[Indodo]

I work 40 hours a week and work for a CMH center. I make in the mid 100s and have not been able to start a private job yet becasue I really can't afford to take the time off and lower my salary even more. My student loan payment is higher than my house payment and there seems to be no hope for raises in the future. Oh and I'm not even sure if my bosses all have 4 year degrees.

This is depressing.

 

[Leo Aquarius]

I work 40 hours a week and work for a CMH center. I make in the mid 100s and have not been able to start a private job yet becasue I really can't afford to take the time off and lower my salary even more. My student loan payment is higher than my house payment and there seems to be no hope for raises in the future. Oh and I'm not even sure if my bosses all have 4 year degrees.

This is depressing.

That's very depressing. For all the years of sacrifice... I would quit. Go find a better job. With the shortage of psychiatrists you can find a better gig. If someone told me now as a 4th year med student that I would have to work 40 hrs a week for 150K after 8 years of grueling training I'd quit now and change careers.

I could have made $150K a year at the job I was at before med school. Why the heck do all this training to be used by a terrible system?

 

[whopper]

I moonlit at a CMH place and my moonlighting hours would've gotten me more than 150K a year had I done 40 hours a week there (I didn't). They offered me to work as an attending after I graduated for what would've been just under 200K, and I turned it down. Further, a buddy of mine did take up a job with them for 40 hours a week for about 225K a year.

Further, the place was setup in a very user-friendly manner for the attendings. Nurses did all the gruntwork such as prior authorizations and dealing with patient phone calls.

Not every CMH center was as good as this place.

I'd look into other job opportunities in your area. I'd also look into side gigs because that will open doors if you don't know what else is out there and it'll get your name out to other places.

 

[Indodo]

I am limited by location because all my family is in this area. I am going to start moonlighting in the ER so that eventually I can go t 3 days per week and start a private practice.

The job is just a job to me. Its 40 hours and temporary. The rest of my life is really great so it works out for now.