Attendings, what's the most you can make if you wanted to?

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There was a guy on here selling a practice that makes 500k for 41 hrs a week
 
NickNaylor said:
I just charge a going rate of $5 per alprazolam tablet prescribed. I offer a combination deal of alprazolam and amphetamines for $7.50 per tablet prescribed.

:idea:
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May want to check that math again. But, if they’re on enough benzos, the math may add up, for them.
 
If you are selling your professional services by the hour or service, your income will always be limited by constraints on your time.

If your income comes from other sources -- if you are able to leverage your own skills and expertise through the efforts of others or enterprises you own (ex. own the practice, not be the practice) then your income potential is unlimited.

But what do you want to do for a living? Practice medicine? Or run a medical business?
 
Attendings I feel like should know the answer to this, I mean by doing basic math and knowing what's reasonable. Like is it reasonable to open up your own place, accept insurance, see 5 med management patients per hour while also hiring a couple therapists and end up making 600k a year? I want the attendings to answer that question since I'm only a astudent and don't really know the answer. I feel like it might be possible also to work for a hospital and get paid based on what you bill so if you see a ton of patients in hospital you can also make 500k by cranking out patients that way. I would again like some attendings or experience people to shed light on that. I mean cardiologists that crank through patients are making 1m+ so as psychs we should be able to at least crack a half mil...
 
Throwaway01 said:
This isn't a question about "how much you make", it's "how much CAN you make, if you WANTED to."
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Which has also been discussed in several threads. Search function is your friend. To answer your question, I've had 2 attending making over 500k and one of them cleared 7 figures. If you Build the right business model and are savvy it's possible. If you want to do purely clinical work my guess would be around 500k + or - X based on geographic area and reimbursement model if you're willing to put the hours in. Just a guess though...
 
Stagg737 said:
Which has also been discussed in several threads. Search function is your friend. To answer your question, I've had 2 attending making over 500k and one of them cleared 7 figures. If you Build the right business model and are savvy it's possible. If you want to do purely clinical work my guess would be around 500k + or - X based on geographic area and reimbursement model if you're willing to put the hours in. Just a guess though...
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How old were they, what were they doing, can anyone that wants to make that kind of money do it?
 
Merely said:
How old were they, what were they doing, can anyone that wants to make that kind of money do it?
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Both were late 40's/early 50's in practice around 15 years. One worked in private practice and in a hospital (can give more details in PM if you want), the other is a medical director of a psych hospital and does some other psych stuff on the side (again can given more details in PM), the latter is the one making 7 figures. Neither of them do anything I would remotely consider shady or unethical either, so it is possible to do without selling your soul.

To your last question, let's do some basic math. From everyone I've talked to, it's completely reasonable to land a contract straight out of residency making at least 200k/year working around 40 hours/wk (assuming you're not going into academic medicine). Now consider moonlighting. It's pretty reasonable to be able to find a position paying $100/hour. If you assume a 50 week year, then at $100/hr, you're adding $50,000 to your salary for every additional 10 hours you work. Put in 70 hours a week and you're hitting $350k, and that's with conservative numbers for salary and moonlighting. The health center associated with my school is offered a $250k salary to a psychiatrist fresh out of residency with a 8-5 workday. I also recently talked to a resident who was getting almost $200/hr moonlighting. Do the math there and 70 hours per week would be $550k/year. That's not even getting into some of the smarter business models like the ones my aforementioned attendings utilized.

Are these work hours that people would want to work? No, and the guys pulling in the really big salaries both work very hard and are pretty financially savvy. That flexibility is one of the things I really like about psych. It's one of the few fields where you can really make your career what you want in terms of reimbursement. You can work minimal hours and have a comfortable lifestyle, or you can really focus on a strong reimbursement model, work hard, and have strong earning potential.

Would love to hear from some of the attendings here, as I always like hearing what options are out there and what to reasonably expect out of them.
 
Stagg737 said:
To your last question, let's do some basic math. From everyone I've talked to, it's completely reasonable to land a contract straight out of residency making at least 200k/year working around 40 hours/wk (assuming you're not going into academic medicine). Now consider moonlighting. It's pretty reasonable to be able to find a position paying $100/hour.
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Just want to point out one can find with not too much difficulty a clinician educator job in an academic setting making "at least 200k" per year right out of residency. I received multiple offers for such jobs and make "at least 200k" working at an academic medical center, with decent benefits (it should not be forgotten that academic medical centers all have good retirement plans and other things, accrue 5 weeks of vacay a year, have plentiful professional leave, and my salary would be covered for extended medical leave. If I stay with the institution for 34 yrs, I will collect 100% of my x salary that averages as the 3 highest yrs income for the remainder of my life). I don't take call and would be paid extra (and quite well) if I wanted to work weekends as well. I then make additional income doing my forensic work some of which can be done during the day. I could see additional pts for extra income if I wanted to.

I have friends working at other academic institutions making "at least 200k" with the potential to supplement their income in other ways.

BTW 100/hr for extra help is not good. As a resident I got more than double that for moonlighting and could triple that now if I wanted to (but only for limited hours).

I am kinda depressed to hear medical students talking about "cranking out" patients at such an early stage in your career. Who would want to do that? How is that providing good patient care? Psychiatry is by no means the highest paying specialty but you will make enough money in psychiatry. Don't be greedy. If you really want to bring in the big bucks, then a career in clinical medicine is not for you. Doctors are basically serfs, there's only so much money you can make seeing patients, and if you are making lots of money that way you are either doing something illegal, unethical, or both.
 
splik said:
I am kinda depressed to hear medical students talking about "cranking out" patients at such an early stage in your career. Who would want to do that? How is that providing good patient care? Psychiatry is by no means the highest paying specialty but you will make enough money in psychiatry. Don't be greedy. If you really want to bring in the big bucks, then a career in clinical medicine is not for you. Doctors are basically serfs, there's only so much money you can make seeing patients, and if you are making lots of money that way you are either doing something illegal, unethical, or both.
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👍
 
splik said:
I am kinda depressed to hear medical students talking about "cranking out" patients at such an early stage in your career. Who would want to do that? How is that providing good patient care?
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Nothing is ideal. The need is so great that we do need our share of psychiatrists who do 15-20 appointments. The attendings I meet who bash 15-20 minute appointments are always those who see 5 patients a day in clinic, most of whom are stable, with great insurance.
 
splik said:
I am kinda depressed to hear medical students talking about "cranking out" patients at such an early stage in your career. Who would want to do that? How is that providing good patient care? Psychiatry is by no means the highest paying specialty but you will make enough money in psychiatry. Don't be greedy. If you really want to bring in the big bucks, then a career in clinical medicine is not for you. Doctors are basically serfs, there's only so much money you can make seeing patients, and if you are making lots of money that way you are either doing something illegal, unethical, or both.
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You're depressed now? We start off depressed! 350k in debt, we have no choice but to think about paying that back in the beginning part of our career. I want nothing more than to enjoy treating my patients with absolutely no rush and have a humble living. Shame us youngins all you want, but this what the past generation allowed medicine to turn into.
 
Throwaway01 said:
You're depressed now? We start off depressed! 350k in debt, we have no choice but to think about paying that back in the beginning part of our career. I want nothing more than to enjoy treating my patients with absolutely no rush and have a humble living. Shame us youngins all you want, but this what the past generation allowed medicine to turn into.
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Your question makes absolutely no sense. Paying off 350k debt quickly has very little to do with how much you make and much more to do with how little you spend.

I've said in several threads, trying to generate 500k plus in clinical net profit or W2 income in a year, especially in a high tax state, is highly highly inefficient. Portions that go beyond 350k will be taxed at 50% marginal or more. The fact you are even asking this very question shows that you have not done your homework, and really are very ignorant about how the American taxation and business system work.

There are real ballers in psychiatry, but they either live on the coasts and run highly lucrative cash practices or live in the heartland and run and own large clinical operations. Neither of which is really accessible a career as a "typical attending". The fact that these types of people can make a lot of money is completely irrelevant to your present status. For example, I didn't even realize how much money I could make until I started making it. You need to figure out why you need to make X amount and why you are going into psychiatry, and take a good look at yourself to see if you have that kind of credentials. If not, then your expectation should be where MGMA is.
 
Stagg737 said:
Would love to hear from some of the attendings here, as I always like hearing what options are out there and what to reasonably expect out of them.
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I personally knew a couple of people who have worked (not at the clinician capacity) at a private practice that had a clinical arm and a research arm (industry sponsored pharm studies) in a smaller midwestern city. Owned by a psychiatrist...he signs off on research studies and has multiple APRNs and 1-2 psychiatrists underneath doing med checks. (Plus full staff of admin and research assistants...many of whom are IMGs aspiring to get into residencies....) The clinic/patient load is kept full round the clock. I was told he clears 1 million easy.

A former resident who graduated from the same program I did worked under another guy out of a larger midwestern city. He ran a practice that contracted out multiple psych docs to round on nursing homes and hospital units and was expanding to outpatient. That former resident neared 500k on pure patient volume (lots of nursing homes each day I was told)....and this is the guy working UNDER the owner of that practice. So you can imagine how much the top guy cleared.

Common theme here is that they don't rely 100% on clinical time to generate their annual income...it's more of a healthcare business owner than being a full time clinician.

splik brings up a good point in that other job settings confer much more non-tangible (and some would argue, more important) benefits than pure $$$....which I'm not surprised that younger students/residents may not appreciate until they get into the real world so to speak.
 
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Throwaway01 said:
You're depressed now? We start off depressed! 350k in debt, we have no choice but to think about paying that back in the beginning part of our career. I want nothing more than to enjoy treating my patients with absolutely no rush and have a humble living. Shame us youngins all you want, but this what the past generation allowed medicine to turn into.
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See my post in paying off debt
 
There are plenty of mental health centers or practices owned/run by psychologists and social workers who hire psychiatrists. You don’t have to have a medical degree to start a business, I think people overlook that fact pretty often.
 
calvnandhobbs68 said:
You don’t have to have a medical degree to start a business
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In some states, at least, you do need a medical degree to own a medical practice. Though that probably has nothing to do with your point overall.
 
Okay so attendings realistically if you worked 60 hours a week at jobs accessible to you (not opening up a profitable pp, just simply working more at current jobs so no skills required) would you make 400k by just working 60 hours a week?
 
splik said:
I work 60hrs/wk at the mo and I am burnt out
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Yeah but hypothetically would you be near 400k or 500k if you weren't burnt out at 60 hrs/week?
 
Merely said:
Okay so attendings realistically if you worked 60 hours a week at jobs accessible to you (not opening up a profitable pp, just simply working more at current jobs so no skills required) would you make 400k by just working 60 hours a week?
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Straight up contract work for 60 hours without trying to maximize income would put you around 350-500k based on location, hours, and willingness to drive.
 
TexasPhysician said:
Straight up contract work for 60 hours without trying to maximize income would put you around 350-500k based on location, hours, and willingness to drive.
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Thank you! You just answered the question everyone constantly asks! The answer is psych can make 300-500k if willing to work surgeon hours essentially, not including being a smart businessman, taking risks, opening up a pp, etc....so for the average graduating resident and med students that's what you can expect if willing to work hard but if you're gonna work average 40hrs with no call then expect the 200-300k you see as quoted average
 
Merely said:
Okay so attendings realistically if you worked 60 hours a week at jobs accessible to you (not opening up a profitable pp, just simply working more at current jobs so no skills required) would you make 400k by just working 60 hours a week?
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I know an attending in NYC that works 60 hours a week doing a combination of PP, CL (contract) and on-call (1 night a week). Probably makes around 430-450k/year. No wkds.

I personally have seen emails offering straight out of residency, 250k for 40 hrs/week in a decent/coastal location, and 300k for 40 hrs/week in less desirable location. And you can supplement these base incomes with weekend on calls. So possible to make 300k on the coasts, 350k otherwise if you are willing to do 50-55 hour weeks.
 
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Blitz2006 said:
I know an attending in NYC that works 60 hours a week doing a combination of PP, CL and on-call. Probably makes around 430-450k/year.

I personally have seen emails offering straight out of residency, 250k for 40 hrs/week in a decent/coastal location, and 300k for 40 hrs/week in less desirable location. And you can supplement these base incomes with weekend on calls. So possible to make 300k on the coasts, 350k otherwise if you are willing to do 50-55 hour weeks.
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Spoke with a classmate who has been out a few years and he is doing 30 hours of contract work and 8-9 hrs of PP where he sees 25 ish pts mind u. No weekends, nights or calls. Says he is getting roughly 400k for 48wks but this is with no benefits at all. One of the better deals I've heard of but since its not w2 maybe its more common idk.
 
finalpsychyear said:
Spoke with a classmate who has been out a few years and he is doing 30 hours of contract work and 8-9 hrs of PP where he sees 25 ish pts mind u. No weekends, nights or calls. Says he is getting roughly 400k for 48wks but this is with no benefits at all. One of the better deals I've heard of but since its not w2 maybe its more common idk.
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Is the PP cash or insurance? Large Urban Area?
 
Merely said:
Okay so attendings realistically if you worked 60 hours a week at jobs accessible to you (not opening up a profitable pp, just simply working more at current jobs so no skills required) would you make 400k by just working 60 hours a week?
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Yes, but like others have said, you'll burn out.
 
PistolPete said:
Yes, but like others have said, you'll burn out.
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I agree but to play Devils advocate why can all other specialties easily push 60-70 hrs a week and psych will only burn out?
 
Merely said:
I agree but to play Devils advocate why can all other specialties easily push 60-70 hrs a week and psych will only burn out?
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Because of the nature of work. Behavioral medicine is one of the most taxing of the specialties due to personality dynamics. I do believe seeing 40 HTN and Diabetics who are poorly controlled and non-treatment adherence has similar circumstances.

It really boils down to the long hours and the numbers seen by moving the meat through the assembly line. Current medical reimbursement models encourages this as reimbursement is tied to the clinical encounter only. Whether you are in PP or employed, it comes down to needing to see more to earn more, especially with current student loan debt which weighs heavily upon people.

Recently a psychiatry journal attempted to education about burnout by telling physicians to use mindfulness (which is another discussion in of itself), demonstrate more empathy (already spending too much energy through attempting to motivate change?) and demonstrate a higher level of professionalism (ie: keep your mouth shut and continue to work). These elements are all contributory towards burnout leading to poor physician outcomes.

The days about the psychiatrist opening up shop at 9am and leaving at 3pm are long gone as reimbursements are garbage.
 
Shikima said:
Because of the nature of work. Behavioral medicine is one of the most taxing of the specialties due to personality dynamics. I do believe seeing 40 HTN and Diabetics who are poorly controlled and non-treatment adherence has similar circumstances.

It really boils down to the long hours and the numbers seen by moving the meat through the assembly line. Current medical reimbursement models encourages this as reimbursement is tied to the clinical encounter only. Whether you are in PP or employed, it comes down to needing to see more to earn more, especially with current student loan debt which weighs heavily upon people.

Recently a psychiatry journal attempted to education about burnout by telling physicians to use mindfulness (which is another discussion in of itself), demonstrate more empathy (already spending too much energy through attempting to motivate change?) and demonstrate a higher level of professionalism (ie: keep your mouth shut and continue to work). These elements are all contributory towards burnout leading to poor physician outcomes.

The days about the psychiatrist opening up shop at 9am and leaving at 3pm are long gone as reimbursements are garbage.
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I really agree with your comments on the burnout literature - there is a trend of framing a capacity to tolerate an excessive workload as a physician competency, when in reality the systems need to change and strategic rebellion is indicated.

I have a different perspective on the reimbursement - it's probably too low, but the psychotherapy add on codes allow for more satisfying and well compensated clinical encounters, where you can generate more revenue by giving more to each patient rather than by seeing more patients.
 
SmallBird said:
I really agree with your comments on the burnout literature - there is a trend of framing a capacity to tolerate an excessive workload as a physician competency, when in reality the systems need to change and strategic rebellion is indicated.

I have a different perspective on the reimbursement - it's probably too low, but the psychotherapy add on codes allow for more satisfying and well compensated clinical encounters, where you can generate more revenue by giving more to each patient rather than by seeing more patients.
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Personally speaking, I wish this were the case if I were trained adequately for psychotherapy - it would be inappropriate for me to conduct it as such. As it stands, and there is a battle occurring, if psychotherapy ought to be part of psychiatry medical curriculum. I look at it this way, therapists irrespective of the credentials have undergone 1000s of hours of psychotherapy and supervision. We haven't. I honestly do not have time to go out and pay to learn it as I'm busy trying to get from under my debt burden, without debt then it would be possible.
 
Shikima said:
I look at it this way, therapists irrespective of the credentials have undergone 1000s of hours of psychotherapy and supervision. We haven't.
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That is completely untrue. Of course, individual results may vary, but much of the therapy being delivered at CMHCs, VAs and even in private practices is by people who are quite inexperienced - the barrier to entry is increasingly low, and the training requirements for licensed therapists is variable.

An average psychiatry residency should prepare you to confidently deliver the type of therapeutic intervention that is ethically billable both in the spirit and strict interpretation of the add-on codes. It would not take 1000s of hours or additional debt to develop some skills in motivational interviewing and brief supportive interventions. The principles of these and other therapies overlap with those that inform the biopsychosocial formulation which is at the center of psychiatric practice.
 
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I have supervised, worked with, and taught psychiatry residents, as well as masters level clinicians and psychologists. They do not have superior skills in managing their own emotions and the impact of work. Most definitely not.
 
I hear what you both are saying, I don't feel it is correct for me to engage in this despite the "teachings" from a few weekly classes and supervision when doing the mandatory clinic+psychotherapy in PGY 3. I am sure there are better programs out there which do a find job in teaching this.

With that said, if seeing someone for 30 mins for crisis and is established with a therapist or a med management session is extended, I know that E&M coding allows for billable minutes; I think 25-30 mins for a 99214. Is this correct in psychiatry and how is it documented?
 
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