Attention to money...

[Venko]

So as an non-psychiatrist observer, the fact that three of the first ten threads have to do with money makes me wonder if people are considering psychiatry for the lifestyle and financial rewards rather than the joy of caring for the mentally ill.

I'll be the first to admit that you must keep an eye on financial well being, but from first hand experience, the emotional burnout that the practice of psychiatry causes is insurmountable if you dont truly feel passion for the specialty.

My time as a psychiatry resident was the most emotionally taxing experience of my life even if I found it cognitively and physically acceptable.

Do other senior physicians agree that to be a psychiatrist for the money would be a difficult life?

TL

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[TheRiddler]

We're only human.

 

[Armadillos]

So as an non-psychiatrist observer, the fact that three of the first ten threads have to do with money makes me wonder if people are considering psychiatry for the lifestyle and financial rewards rather than the joy of caring for the mentally ill.

I'll be the first to admit that you must keep an eye on financial well being, but from first hand experience, the emotional burnout that the practice of psychiatry causes is insurmountable if you dont truly feel passion for the specialty.

My time as a psychiatry resident was the most emotionally taxing experience of my life even if I found it cognitively and physically acceptable.

Do other senior physicians agree that to be a psychiatrist for the money would be a difficult life?

TL

I think a lot of it has to do with the fact that to a decent amount of med students psych is very appealing except for the fact that it is a notoriously low prestige field and also is perceived to be on the lower end of the spectrum financially, when many med students are carrying 200k+ in loans I think it's perfectly reasonable for people to plan ahead to see what the financial realities may be for their family. I think most people on here talking money are genuinely interested in psych but are trying to allay some of the fears that come along with choosing a less competitive field

 

[digitlnoize]

I think a lot of it has to do with the fact that to a decent amount of med students psych is very appealing except for the fact that it is a notoriously low prestige field and also is perceived to be on the lower end of the spectrum financially, when many med students are carrying 200k+ in loans I think it's perfectly reasonable for people to plan ahead to see what the financial realities may be for their family. I think most people on here talking money are genuinely interested in psych but are trying to allay some of the fears that come along with choosing a less competitive field

This. Also agree with the above post that doing psych only for the money would be dumb. But if you happen to enjoy this field (as I do), you should not be afraid of being poor.

 

[Leo Aquarius]

Here are only some of the big factors when deciding a specialty:

Interest (in the specialty)
Salary
Geography
Competitive strength
Ego-stimulation
Work-load / Work-demand

In the mind of the most competitive med student, competitive strength and geography are already taken care of, and the priority reflects the cultural priority:

Salary & Ego-stimulation & Work-load > Interest

This is why Dermatology is so appealing, because it hits the maximum salary and ego-stimulation with a low work-load. Anyone who can walk into this situation will find the field "interesting." Decades ago when Derm wasn't competitive, the top students became surgeons. Society valued hard work, and being concerned about lifestyle was seen as weak. Now surgery is reaching to FMGs to fill their ranks. Sad? No, it's human nature following societal values. Lifestyle is the new priority.

Interest is not the main factor in how med students make decisions, but it finalizes the choice once fields are narrowed down. Med students are almost all interested in multiple fields. Why do the most competitive med students keep applying to the most competitive specialties? It's due to ego-stimulation and salary along with interest. Other times it's all about work-load and wanting that balance for a family. You rarely see the top of the class go into pediatrics, psychiatry, or family medicine. That's either because those fields aren't interesting enough, or other factors are MUCH more important, and I think it's the latter.

So pointing out salary being a major consideration is really stating the obvious, and being concerned about it, despite the honorable intent, won't change anything. Salary and work-load are some of the most compelling reasons med students decide on specialties, and psych offers a solid hourly salary with low-stress work and tons of geographic flexibility. It lacks ego-stimulation and super high salaries which turns off the competitive at heart. For less competitive students, it's one of the best deals in medicine. The best deals in town are always "interesting."

 

[OldPsychDoc]

I'll be the first to admit that you must keep an eye on financial well being, but from first hand experience, the emotional burnout that the practice of psychiatry causes is insurmountable if you dont truly feel passion for the specialty.

I have to agree with this point as well--it's why we're combing through 800 applications to find the ones who really have that passion. Even those of us who have the love for it have bad days, weeks...my last 3 days were mind numbing. If I hated it, or if I didn't feel I was getting paid decently, well, I'd be teaching chemistry or cooking meth or something else...

 

[Psychotic]

Here are only some of the big factors when deciding a specialty:

Interest (in the specialty)
Salary
Geography
Competitive strength
Ego-stimulation
Work-load / Work-demand

In the mind of the most competitive med student, competitive strength and geography are already taken care of, and the priority reflects the cultural priority:

Salary & Ego-stimulation & Work-load > Interest

This is why Dermatology is so appealing, because it hits the maximum salary and ego-stimulation with a low work-load. Anyone who can walk into this situation will find the field "interesting." Decades ago when Derm wasn't competitive, the top students became surgeons. Society valued hard work, and being concerned about lifestyle was seen as weak. Now surgery is reaching to FMGs to fill their ranks. Sad? No, it's human nature following societal values. Lifestyle is the new priority.

Interest is not the main factor in how med students make decisions, but it finalizes the choice once fields are narrowed down. Med students are almost all interested in multiple fields. Why do the most competitive med students keep applying to the most competitive specialties? It's due to ego-stimulation and salary along with interest. Other times it's all about work-load and wanting that balance for a family. You rarely see the top of the class go into pediatrics, psychiatry, or family medicine. That's either because those fields aren't interesting enough, or other factors are MUCH more important, and I think it's the latter.

So pointing out salary being a major consideration is really stating the obvious, and being concerned about it, despite the honorable intent, won't change anything. Salary and work-load are some of the most compelling reasons med students decide on specialties, and psych offers a solid hourly salary with low-stress work and tons of geographic flexibility. It lacks ego-stimulation and super high salaries which turns off the competitive at heart. For less competitive students, it's one of the best deals in medicine. The best deals in town are always "interesting."

One correction: Derm has been uber competitive since at least the 1970s - I talked to a family friend who entered the field in the late 70s, and the way it worked at his med school, the top student in the class was guaranteed the derm residency spot for the asking, and year after year that is exactly what the top graduates chose - not surgery, not rads (which is an example of a field that was non competitive in the 70s and 80s), but derm, the ultimate lifestyle / prestige residency for the last 40 years, at least.

 

[freaker]

Well, this is an anonymous forum. Many here are in training. What are the taboo subjects you don't bring up in your training program?

Many of these are going to focus on money, what goes on in a private practice, and what that lifestyle is like. Many are also assuming unrealistic call schedules, including long overnight in-house work which frankly are not a part of psychiatry in any other setting other than in a training program. In other words, many are fantasizing about a different lifestyle.

The other side to being in a training program is that many are getting ready to head into a job market (hey, it's job hunting time) coming from training programs that do quite a bit to educate on academic matters but less so towards the practical.

I think the passion for many is an assumed at this point. You don't go into psychiatry for prestige or money v. other fields, where both are more of an assured thing. You do want to balance that side of things into the equation, though.

 

[st2205]

People have done much worse for money and prestige (see most surgical fields, some IM subspecialties, OB, etc.)

 

[Shikima]

I have to agree with this point as well--it's why we're combing through 800 applications to find the ones who really have that passion. Even those of us who have the love for it have bad days, weeks...my last 3 days were mind numbing. If I hated it, or if I didn't feel I was getting paid decently, well, I'd be teaching chemistry or cooking meth or something else...

Your avatar needs changing...

 

[Shikima]

Well, this is an anonymous forum. Many here are in training. What are the taboo subjects you don't bring up in your training program?

Many of these are going to focus on money, what goes on in a private practice, and what that lifestyle is like. Many are also assuming unrealistic call schedules, including long overnight in-house work which frankly are not a part of psychiatry in any other setting other than in a training program. In other words, many are fantasizing about a different lifestyle.

The other side to being in a training program is that many are getting ready to head into a job market (hey, it's job hunting time) coming from training programs that do quite a bit to educate on academic matters but less so towards the practical.

I think the passion for many is an assumed at this point. You don't go into psychiatry for prestige or money v. other fields, where both are more of an assured thing. You do want to balance that side of things into the equation, though.

I tried to have a convo like that once during residency -- it was dissapointing when they knew so little because of institutionalization.

 

[happygilmore]

One correction: Derm has been uber competitive since at least the 1970s - I talked to a family friend who entered the field in the late 70s, and the way it worked at his med school, the top student in the class was guaranteed the derm residency spot for the asking, and year after year that is exactly what the top graduates chose - not surgery, not rads (which is an example of a field that was non competitive in the 70s and 80s), but derm, the ultimate lifestyle / prestige residency for the last 40 years, at least.

Amy data or proof? I've never heard that Derm was uber competitive before money and lifestyle factors. It's not competitive in other countries that pay derm the same as any other doc either.

 

[happygilmore]

Here are only some of the big factors when deciding a specialty:

Interest (in the specialty)
Salary
Geography
Competitive strength
Ego-stimulation
Work-load / Work-demand

In the mind of the most competitive med student, competitive strength and geography are already taken care of, and the priority reflects the cultural priority:

Salary & Ego-stimulation & Work-load > Interest

This is why Dermatology is so appealing, because it hits the maximum salary and ego-stimulation with a low work-load. Anyone who can walk into this situation will find the field "interesting." Decades ago when Derm wasn't competitive, the top students became surgeons. Society valued hard work, and being concerned about lifestyle was seen as weak. Now surgery is reaching to FMGs to fill their ranks. Sad? No, it's human nature following societal values. Lifestyle is the new priority.

Interest is not the main factor in how med students make decisions, but it finalizes the choice once fields are narrowed down. Med students are almost all interested in multiple fields. Why do the most competitive med students keep applying to the most competitive specialties? It's due to ego-stimulation and salary along with interest. Other times it's all about work-load and wanting that balance for a family. You rarely see the top of the class go into pediatrics, psychiatry, or family medicine. That's either because those fields aren't interesting enough, or other factors are MUCH more important, and I think it's the latter.

So pointing out salary being a major consideration is really stating the obvious, and being concerned about it, despite the honorable intent, won't change anything. Salary and work-load are some of the most compelling reasons med students decide on specialties, and psych offers a solid hourly salary with low-stress work and tons of geographic flexibility. It lacks ego-stimulation and super high salaries which turns off the competitive at heart. For less competitive students, it's one of the best deals in medicine. The best deals in town are always "interesting."

Good post.

 

[OldPsychDoc]

Your avatar needs changing...

I had WW up there for awhile, but changed back to the kindly old potions professor after the series finale.

Here--enjoy this.

 

[Jorje286]

This is hardly an issue exclusive to the psych forum though. In pretty much every specialty subforum money is the #1 discussion topic. Maybe for good reason, but it's no question that money and social prestige are really significant factors in attracting people to medicine in the first place. Take away the money and see how competitive med school will be. But on the other hand maybe you will get the people who are really passionate about patient care. It's sort of ironic how taboo this topic is in "real life" medical training, but true intentions come up when people can hide behind anonymity. The contrast is laughable though. I guess you can ultimately blame the capitalistic system our world is driven by.

 

[happygilmore]

This is hardly an issue exclusive to the psych forum though. In pretty much every specialty subforum money is the #1 discussion topic. Maybe for good reason, but it's no question that money and social prestige are really significant factors in attracting people to medicine in the first place. Take away the money and see how competitive med school will be. But on the other hand maybe you will get the people who are really passionate about patient care. It's sort of ironic how taboo this topic is in "real life" medical training, but true intentions come up when people can hide behind anonymity. The contrast is laughable though. I guess you can ultimately blame the capitalistic system our world is driven by.

Agreed. Ortho, for example, was not competitive 20 years ago. It was a back up for gen surg rejects. Now is #1 earner and everyone has a passion for it. Kind of a joke.

I think most people find specialties they like then start learning about things outside of patient care (which we see day to day). Leo summed it up well, after we find a handful of choices we like then you learn about pluses and minuses of each.

 

[heyjack70]

This is hardly an issue exclusive to the psych forum though. In pretty much every specialty subforum money is the #1 discussion topic. Maybe for good reason, but it's no question that money and social prestige are really significant factors in attracting people to medicine in the first place. Take away the money and see how competitive med school will be. But on the other hand maybe you will get the people who are really passionate about patient care. It's sort of ironic how taboo this topic is in "real life" medical training, but true intentions come up when people can hide behind anonymity. The contrast is laughable though. I guess you can ultimately blame the capitalistic system our world is driven by.

And then there would be concerns about the ability of those people to provide quality medical care.

Money isn't an evil. It's a measure of value. Talking about how to get paid for the value you bring as a doctor is an important discussion because as we look for work there is an adversary (insurance company, private practice MD, hospital, clinic, HR etc) that is trying to pay us the least amount possible to do a job.

 

[Jorje286]

And then there would be concerns about the ability of those people to provide quality medical care.

Money isn't an evil. It's a measure of value. Talking about how to get paid for the value you bring as a doctor is an important discussion because as we look for work there is an adversary (insurance company, private practice MD, hospital, clinic, HR etc) that is trying to pay us the least amount possible to do a job.

The idealistic in me thinks we do things at our best when we are doing them for their own sake, and that's when we are fully engaged in the task. There's no question imo that money as a motivator ends up corrupting the practice to a certain degree; but the pressures of daily life are such that most people have to be anxious about providing for a decent (not even luxurious) life so no one's right to judge whatever motivation people bring in.

 

[heyjack70]

The idealistic in me thinks we do things at our best when we are doing them for their own sake, and that's when we are fully engaged in the task. There's no question imo that money as a motivator ends up corrupting the practice to a certain degree; but the pressures of daily life are such that most people have to be anxious about providing for a decent (not even luxurious) life so no one's right to judge whatever motivation people bring in.

I don't think they're mutually exclusive. You can do a good job as a psychiatrist for the sake of being a good psychiatrist. And you can get paid well for the time you spend doing it.

 

[happygilmore]

I don't think they're mutually exclusive. You can do a good job as a psychiatrist for the sake of being a good psychiatrist. And you can get paid well for the time you spend doing it.

Yup. Biggest myth in medicine is that if you want to profit then you don't want to serve patients or do a good job.

Some of the most profitable businesses offer some of the most exceptional products and services.

 

[BobA]

Being a psychiatrist really isn't that emotionally draining for me. I thought a lot about doing Emergency Medicine instead of psychiatry as I liked that too in medical school and would have made much more money. However, working nights is just something I can't do - it takes me 5-7 days for my sleep to normalize after a night shift and I figure that will only get worse with age. So for me working in the ER would be more draining - without decent sleep I'd be a wreck physically and emotionally.

Of course, there are days when patients get to me, but that's why we work on teams and even see therapists ourselves. Over time and with training psychiatrists learn to see patient behaviors are symptoms of their condition, upbringing, etc, and that understanding makes difficult patient behaviors pack less of a punch. And the vast majority of patients are actually very nice.

A little off topic, but Neurology was the most emotionally draining rotation for me in medical school and residency. Every time someone had a stroke I felt like crying for them and their families. But some of my friends are very happy doing neurology. We all respond to different situations differently I suppose.

 

[peppy]

I agree that doing it just for the money is not enough. Psychiatry - especially psychotherapy - can be very emotionally draining.
However, I don't think there is any shame in wanting to be well compensated for doing this work.
We all went through a lot of sacrifice to reach this point. While I do enjoy the work more often than not, there's no way that I would consider it to be worth all the stress, sleep deprivation, emotional abuse (for example during my surgery rotations ), financial debt, being at the mercy of the NRMP match to decide where you will live for 4 years of your life, etc. if I did not expect to be well compensated in the end for all this.

 

[SmallBird]

Amy data or proof? I've never heard that Derm was uber competitive before money and lifestyle factors. It's not competitive in other countries that pay derm the same as any other doc either.

Well that isn't necessarily true - dermatology is definitely competitive where I trained and pretty similar to psychiatry in terms of compensation. It does offer a good lifestyle, but so does psychiatry so I am not entirely sure why it is more competitive.

 

[Nasrudin]

I'm in the camp that is weary with the indoctrination we receive that insists we blush and demur at such core competencies as finances. Particularly as the newly minted docs will be entering the field at perpetually rising high water marks for debt load.

I don't blush. I want to hustle and maximize my earning potential. And invest like whopper. Lifestyle is also important. I want to work smart.

Psychiatry is far and away the most interesting thing I could do in medicine but why that should make me an institutionalized lamb instead of a wolf financially speaking is unbeknownst to me.

 

[Nasrudin]

Furthermore what is this arbitrary and vague benchmark of passion constantly bandied about?

Truly passionate and single minded people are somewhat strange and awkward. The best athletes. The best racecar drivers. Champions are passionate. Lance Armstrong is passionate to the core. As well as single minded, unidimensional, awkward, and tend towards being @ssholes.

What is this humorless hole in the hearts of modern man that he has to fill the void with some single minded notion of passion. Sounds Christ-like in its ambition.

I'd rather just like human beings and life in general. Than compress all my varied interests and desire for a variety of experiences in this life into one thing. For the badge of being called passionate by those in a position of dispensation of approval of me.

 

[SmallBird]

Furthermore what is this arbitrary and vague benchmark of passion constantly bandied about?

Truly passionate and single minded people are somewhat strange and awkward. The best athletes. The best race drivers. Champions are passionate. As well as single minded, unidimensional, awkward, and tend towards being @ssholes.

What is this humorless hole in the hearts of modern man that he has to fill the void with some single minded notion of passion. Sounds Christ-like in its ambition.

I'd rather just like human beings and life in general. Than compress all my varied interests and desire for a variety of experiences in this life into one thing. For the badge of being called passionate by those in a position of dispensation of approval of me.

A friendly thought - your complicated writing style makes it difficult to see what your point is frequently.

 

[Nasrudin]

A friendly thought - your complicated writing style makes it difficult to see what your point is frequently.

There's 2 elements of our secondary education I find distasteful:

1. Medicine preaches that hustling skills are vulgar.
2. Passion is an exhalted but unclear notion. It's difficult to know what someone means by it. It could mean dull unreflective ambition or a weird singularity of expression. Etc

Both of these strike me as tools of manipulation rather instruments of personal empowerment and creativity.

Clear enough?

 

[happygilmore]

A post from the other thread:

A knowledge base with utility to clinical patient outcomes is the marker for the ability to succeed.

The better outcomes that are yielded because you use this ability are the meaure of a good psychiatrist. Less suicide, less addiction, improved mood, better social functioning, etc. You are pushing against the tide of the world of course.

Any physician who can't make a salary to their liking is just thinking like an indentured servant to the private healthcare business interests. You are a fool if you can't carve a slice out for yourself, with the whole pie going to all the people who know nothing of medicine and contribute nothing of utility there. As well as governments fee for being there, same difference as private businesses

There's 2 elements of our secondary education I find distasteful:

1. Medicine preaches that hustling skills are vulgar.
2. Passion is an exhaled but unclear notion. It's difficult to know what someone means by it. It could mean dull unreflective ambition or a weird singularity of expression. Etc

Both of these strike me as tools of manipulation rather instruments of personal empowerment and creativity.

Clear enough?

I wanted to comment on each of these.

The reason physician are starting to get frustrated and becoming employees is because physicians stopped hustling. There was this idea that everything will work itself out if you just do your best with your patients and focus on the medicine.

Now CEOs of hospitals and insurance companies are cleaning up. Physicians are becoming employees and having to write the proper words in notes to get properly reimbursed. Physicians have ignored the business side to their own peril. Most docs I hear complain about insurance and interference into their practice - well, this all happened because insurance companies and everyone else remembered to hustle and be wolves why physicians just focused on patients.

 

[Dharma]

There's 2 elements of our secondary education I find distasteful:

1. Medicine preaches that hustling skills are vulgar.
2. Passion is an exhaled but unclear notion. It's difficult to know what someone means by it. It could mean dull unreflective ambition or a weird singularity of expression. Etc

Both of these strike me as tools of manipulation rather instruments of personal empowerment and creativity.

Clear enough?

I like your writing style dude. Keep doing yo' thing!

 

[Nasrudin]

A post from the other thread:






I wanted to comment on each of these.

The reason physician are starting to get frustrated and becoming employees is because physicians stopped hustling. There was this idea that everything will work itself out if you just do your best with your patients and focus on the medicine.

Now CEOs of hospitals and insurance companies are cleaning up. Physicians are becoming employees and having to write the proper words in notes to get properly reimbursed. Physicians have ignored the business side to their own peril. Most docs I hear complain about insurance and interference into their practice - well, this all happened because insurance companies and everyone else remembered to hustle and be wolves why physicians just focused on patients.

Well, for me hustling is whatever it means to you. Let's say it's my secondary objective to write a science fiction novel about an android therapist who solves crimes. Hustling in that case would be paying my bills with a psychiatrist gig as quickly as possible with little impact. Then I can write. In fact, I can't remember who...but somebody said they were doing something like that to write.

My questioning the idea of passion was not to question oldpsychdoc's steadfast gentlemanly intent with his use of the word but rather the illusion that there is some objective uniform meaning of it.

To use my writer's example as typical of many of my thankfully interesting and varied future colleagues in psych, passion would be difficult to measure in a psych resume. It is my position that these things are merely mechanical symbols that could therefore be exploited by sociopaths. One of the reasons I'm seeking the psychiatry milieu is because it seems to attract human curiosity and repulse the mechanically minded.

I am currently watching documentaries on ancient military battles. I'm up to Hannibal's conquest of Rome. I was hoping some understanding of a pattern underlying the causes of human conflict would emerge to my perception. I'm also studying for CK. I like that about psych--that I am completely typical in it. So many of us do a variety of things. And try to look at things in different ways.

I could've played a passion symbol in the residency application card game by hopping onto my home program's world renowned researcher's well-funded publish or perish train. I decided to go to more yoga classes to maintain excellent fitness as a middle aged med student.

As I consider myself passionately curious about the whole of human experience and think that important to psychiatry, I find the idea that it is a quick easily gathered objective measure, somewhat alien.

 

[happygilmore]

Well, for me hustling is whatever it means to you. Let's say it's my secondary objective to write a science fiction novel about an android therapist who solves crimes. Hustling in that case would be paying my bills with a psychiatrist gig as quickly as possible with little impact. Then I can write. In fact, I can't remember who...but somebody said they were doing something like that to write.

My questioning the idea of passion was not to question oldpsychdoc's steadfast gentlemanly intent with his use of the word but rather the illusion that there is some objective uniform meaning of it.

To use my writer's example as typical of many of my thankfully interesting and varied future colleagues in psych, passion would be difficult to measure in a psych resume. It is my position that these things are merely mechanical symbols that could therefore be exploited by sociopaths. One of the reasons I'm seeking the psychiatry milieu is because it seems to attract human curiosity and repulse the mechanically minded.

I am currently watching documentaries on ancient military battles. I'm up to Hannibal's conquest of Rome. I was hoping some understanding of a pattern underlying the causes of human conflict would emerge to my perception. I'm also studying for CK. I like that about psych--that I am completely typical in it. So many of us do a variety of things. And try to look at things in different ways.

I could've played a passion symbol in the residency application card game by hopping onto my home program's world renowned researcher's well-funded publish or perish train. I decided to go to more yoga classes to maintain excellent fitness as a middle aged med student.

As I consider myself passionately curious about the whole of human experience and think that important to psychiatry, I find the idea that it is a quick easily gathered objective measure, somewhat alien.

I applaud you for that. Much more interesting to learn about world history and stay in shape than to do research in your free time and be overweight.

In the end, you'll relate better to people by being a well rounded person - much more important than being a cookie cutter applicant. Those activities pay off in the long run.

 

[gibits]

Yup. Biggest myth in medicine is that if you want to profit then you don't want to serve patients or do a good job.

Some of the most profitable businesses offer some of the most exceptional products and services.

I have been hustling in my current job and I know for a fact my my patient care isn't as sharp as I'd like it. Maybe I just suck, but I'm just the type that will dig. I dig into the charts, the labs, I ask my patients and staff a buttload of questions. I like doing that, I like playing detective and feel that is the way I can work effectively. I'm sure a smarter person can do things better in less time, but that just isn't me.

It's because of this I'm going into employee status rather than PP. I personally have always wanted to be a psychiatrist since I was in middle school, the pay was just a bonus. This doesn't mean other people are wrong just because they place a higher value on their pay check. It just means we all are individuals that have different priorities and values. It's also why I wanted to go into this field in the first place.

 

[Chimed]

I have been hustling in my current job and I know for a fact my my patient care isn't as sharp as I'd like it. Maybe I just suck, but I'm just the type that will dig. I dig into the charts, the labs, I ask my patients and staff a buttload of questions. I like doing that, I like playing detective and feel that is the way I can work effectively. I'm sure a smarter person can do things better in less time, but that just isn't me.

It's because of this I'm going into employee status rather than PP. I personally have always wanted to be a psychiatrist since I was in middle school, the pay was just a bonus. This doesn't mean other people are wrong just because they place a higher value on their pay check. It just means we all are individuals that have different priorities and values. It's also why I wanted to go into this field in the first place.

Sounds like you should go into Forensics.

 

[Chimed]

Well, this is an anonymous forum. Many here are in training. What are the taboo subjects you don't bring up in your training program?

Many of these are going to focus on money, what goes on in a private practice, and what that lifestyle is like. Many are also assuming unrealistic call schedules, including long overnight in-house work which frankly are not a part of psychiatry in any other setting other than in a training program. In other words, many are fantasizing about a different lifestyle.

The other side to being in a training program is that many are getting ready to head into a job market (hey, it's job hunting time) coming from training programs that do quite a bit to educate on academic matters but less so towards the practical.

I think the passion for many is an assumed at this point. You don't go into psychiatry for prestige or money v. other fields, where both are more of an assured thing. You do want to balance that side of things into the equation, though.

I agree with this. As good as I felt my training was, the program did little to address things like finances and issues surrounding the job market. I think the majority of us on this forum either had good training and are competent in their work, are currently in a residency getting plenty of supervision, or are medical students learning the basics of medicine. So, I'm not sure the incentive to come on this site to discuss case issues or other aspects of treatment are as needed or as potent of an issue. The thing that is not discussed in training is the financial aspects of our chosen career path. It is refreshing to have an open discussion about this issue and ask things that are not brought up with supervisors. Because of this, the perception that this is what we primary think about is skewed. Many visit this forum to fill that particular gap in our training. In truth, it's a small part of choosing psychiatry.

 

[digitlnoize]

I have been hustling in my current job and I know for a fact my my patient care isn't as sharp as I'd like it. Maybe I just suck, but I'm just the type that will dig. I dig into the charts, the labs, I ask my patients and staff a buttload of questions. I like doing that, I like playing detective and feel that is the way I can work effectively. I'm sure a smarter person can do things better in less time, but that just isn't me.

It's because of this I'm going into employee status rather than PP.

That's funny because I would say that is exactly why you should do PP. YOU get to decide how much time you spend per patient. If you want to do 2 hour appointments, so be it. No employer is going to be so lax as to let you do that much "digging". Your job is to generate revenue, and chart biopsy isn't a billable code.

I want to do PP so I can decide how things are run. I can say when a patient needs extra time, or when I need a day off. I can decide that the money is less important to me.

 

[whopper]

Hmm well since we're talking money....

Someone's a fool or already wealthy to not consider money. If you read the book Rich Dad Poor Dad, the author shows that most Americans are programmed to think that money is bad. They tend to think in terms of being good and rich are mutually exclusive.

The point he wants to make is living so that you are in control of your wealth is not a sin at all, in fact you'll be more likely to help others, add to society, and be able to sleep feeling safe and comfortable. Where's the evil in that? If you want financial control, you will have to worry about things like money. Of course, there's an evil if you think money is the end-all-be-all, but he sees most people that aren't wealthy don't have that problem.

And as a little more self-revealing, I'm losing about 50K-100K a year working for the university. I could be making a heck of a lot more money if I went completely private. Alas it would drive me nuts..so I don't do that, but if I did that I think I could realistically make $350K a year.

But I could do a mixture of private practice mixed with working for the state hospital that would lock me in for a solid pension (work 25 years for them, you get half your salary the rest of your life), and private practice. I was doing that before I worked for the university, and I found the mix very good. That would bring me in about $275-300K a year and bring me on track to make about $80K a year from pension after I retire, in addition to my own additional private retirement funds, assuming they pay were to somehow stay the same as it is today. If anything it'd likely go up.

I choose to work for the university for less money because I want to be working with some academically elite people that are teaching me things I could not otherwise learn. I spent about 45 minutes in Henry Nasrallah's office today hanging out with one of the top researchers (not Nasrallah, a guest of his) in the country one-on-one, and I was able to fire away questions. A mentor of mine that is a nationally renown forensic psychologist works with me everyday, I don't think any of my colleagues are bad doctors. I couldn't say that when I was outside of this environment. My PD from fellowship that is a nationally ranked physician and has advanced the state of the art in the field and has his office right next to mine, and he has a Guttmacher award on his wall. I got my first murder-case working for the university, and if I was offered one on my own, I don't think I would've wanted it. Being with the university, having top people supporting me, I knew I could do it and be confident I didn't make some type of greenhorn mistake.

At some point, the desire to make more money and be my own guy may make me divorce the university. For now I am enjoying what I'm learning.

Gordon Ramsay's first TV show, Boiling Point, features the then-chef, in his 30s, and leaving a highly paid job where he was wealthy, to make his own restaurant. Along the way, he encounters plenty of problems, overcomes them, and he wants to be in charge of his own destiny, and reaching his fullest potential.

The show has been an entrepreneurial inspiration for me. You don't make decisions like this simply because of the money.

http://www.youtube.com/watch?v=0lVIodG7lYY

 

[Venko]

I think people may be off topic...

My point is I expected be balance between threads on money and those that deal with the many other aspects of the practice. Certainly you should know about and consider money. In my opinion, it should come after considering your passion or joy for the specialty. All physicians will be well compensated. At the end of the day, most specialties makes between 10 and 30 times the hourly wage of their patients.

You will be well compensated.

Now, I was struck by how much talk of money there is on your boards. It seems far in excess.

I can see that the elders all the way down to the nubies are so hung on the business of medicine and defend this forum's volume of finance related content.

Cheers to you all, may you get paid as you see fit. As for me...

#1 Love of specialty
#2 stability, lifestyle, finances, etc.

I can add this to my list of reasons why I was not built to be a psychiatrist.

 

[heyjack70]

I can add this to my list of reasons why I was not built to be a psychiatrist.

What's this?

 

[deleted307836]

I think people may be off topic...

My point is I expected be balance between threads on money and those that deal with the many other aspects of the practice. Certainly you should know about and consider money. In my opinion, it should come after considering your passion or joy for the specialty. All physicians will be well compensated. At the end of the day, most specialties makes between 10 and 30 times the hourly wage of their patients.

You will be well compensated.

Now, I was struck by how much talk of money there is on your boards. It seems far in excess.

I can see that the elders all the way down to the nubies are so hung on the business of medicine and defend this forum's volume of finance related content.

Cheers to you all, may you get paid as you see fit. As for me...

#1 Love of specialty
#2 stability, lifestyle, finances, etc.

I can add this to my list of reasons why I was not built to be a psychiatrist.

This comes off as a little self-righteous. There have been plenty of threads in the EM boards about money/hours. And as stated, what is discussed on SDN is not representative of all practitioners in a specific field.

 

[happygilmore]

Hmm well since we're talking money....

Someone's a fool or already wealthy to not consider money. If you read the book Rich Dad Poor Dad, the author shows that most Americans are programmed to think that money is bad. They tend to think in terms of being good and rich are mutually exclusive.

The point he wants to make is living so that you are in control of your wealth is not a sin at all, in fact you'll be more likely to help others, add to society, and be able to sleep feeling safe and comfortable. Where's the evil in that? If you want financial control, you will have to worry about things like money. Of course, there's an evil if you think money is the end-all-be-all, but he sees most people that aren't wealthy don't have that problem.

I've read this book and the point is a good one. There is no dichotomy between being passionate, enjoying or doing an excellent job and being a business person. Look at sports, people like Michael Jordan were able to do both.

I think a lot of people in medicine believe you can be either virtuous or financial savvy. Maybe because some physicians have done bad things in the name of profit, therefore the conclusion is that anything in the name of profit must lack virtue.

They are independent factors.

This comes off as a little self-righteous. There have been plenty of threads in the EM boards about money/hours. And as stated, what is discussed on SDN is not representative of all practitioners in a specific field.

Yeah, and look at derm. They don't even try to hide that it's money/lifestyle. EM docs are no different.

Like someone said above, I think we learn about what we like medically out in the hospital and day to day activities - then come online to learn about other facets.

 

[medicaresucks]

Been doing private practice for about 3 months now and here are some thoughts.

1. ALOT of work running your own business.. your in charge of A-Z
2. Billing is a pain in the ass when you accept insurance
3. It gets socially lonely at times

Anyways, I started out with insurance paneling paperwork in january and almost all of them now are finally set.. such a pain in the ass. The area I work the psychiatrists are not taking new patients so the PCPS were sending them out almost 2 hours away. I went and spoke to some of them about a few months before i started... lunches etc... and my practice was full after about the 3rd week into it. In fact, I was getting a bit too ambitious and was doing every other saturday so im kinda feeling burned out already!


My typical day is 9-530 Monday through Friday and every other Saturday 9-5.
With no shows accoutned for we are seeing about 25 patients a day and since i dont take a lunch hour it makes it easier to book that many. This and next month are completely full and im getting new patient calls every day and am considering to work every saturday to accommodate this or get a Psychiatric NP.

Anyways, as for billings we mostly use 99213.. and some 99214 with the appropriate modifier codes for psychotherapy for almost all patients as 16 min of therapy allows you to tag on the 30 min therapy code. I have a huge load of medicare pts maybe almost 50-60%...

Im trying to work extra hard now just to pay off my loans asap and then after this 12 month period Im planning on either stopping the saturdays or hiring a NP.

Right now im projecting for the next year the following numbers based on the last 2 months and i dont see it slowing down anytime soon and the issue more is i dont have any more spots in my practice.

25pts per day x $100 ( 99213+therapy averaged for all providers) * 5 days = 12500

12500 * 46 weeks = 575,000
I actually think this is conservative as it does not account for the 99214 which is $103.00 themselves plus therapy add on nor does it account for the new patients which are being paid at almost 160.00 per medicare rates.

( im taking a week off every 8 weeks and luckily am trading coverage with the other guy in the area so it works out well and i think i'll need the break thought i haven't' had a chance to take any time yet 3 months in)

1. Granted this does not take into account the every other saturdays i am working as Im not sure how long i will keep doing that..

2. at the end of the day its satisfying as hell as im reaping all the benefits and am my own boss and that truly is priceless for me.

to be continued

Hmm well since we're talking money....

Someone's a fool or already wealthy to not consider money. If you read the book Rich Dad Poor Dad, the author shows that most Americans are programmed to think that money is bad. They tend to think in terms of being good and rich are mutually exclusive.

The point he wants to make is living so that you are in control of your wealth is not a sin at all, in fact you'll be more likely to help others, add to society, and be able to sleep feeling safe and comfortable. Where's the evil in that? If you want financial control, you will have to worry about things like money. Of course, there's an evil if you think money is the end-all-be-all, but he sees most people that aren't wealthy don't have that problem.

And as a little more self-revealing, I'm losing about 50K-100K a year working for the university. I could be making a heck of a lot more money if I went completely private. Alas it would drive me nuts..so I don't do that, but if I did that I think I could realistically make $350K a year.

But I could do a mixture of private practice mixed with working for the state hospital that would lock me in for a solid pension (work 25 years for them, you get half your salary the rest of your life), and private practice. I was doing that before I worked for the university, and I found the mix very good. That would bring me in about $275-300K a year and bring me on track to make about $80K a year from pension after I retire, in addition to my own additional private retirement funds, assuming they pay were to somehow stay the same as it is today. If anything it'd likely go up.

I choose to work for the university for less money because I want to be working with some academically elite people that are teaching me things I could not otherwise learn. I spent about 45 minutes in Henry Nasrallah's office today hanging out with one of the top researchers (not Nasrallah, a guest of his) in the country one-on-one, and I was able to fire away questions. A mentor of mine that is a nationally renown forensic psychologist works with me everyday, I don't think any of my colleagues are bad doctors. I couldn't say that when I was outside of this environment. My PD from fellowship that is a nationally ranked physician and has advanced the state of the art in the field and has his office right next to mine, and he has a Guttmacher award on his wall. I got my first murder-case working for the university, and if I was offered one on my own, I don't think I would've wanted it. Being with the university, having top people supporting me, I knew I could do it and be confident I didn't make some type of greenhorn mistake.

At some point, the desire to make more money and be my own guy may make me divorce the university. For now I am enjoying what I'm learning.

Gordon Ramsay's first TV show, Boiling Point, features the then-chef, in his 30s, and leaving a highly paid job where he was wealthy, to make his own restaurant. Along the way, he encounters plenty of problems, overcomes them, and he wants to be in charge of his own destiny, and reaching his fullest potential.

The show has been an entrepreneurial inspiration for me. You don't make decisions like this simply because of the money.

http://www.youtube.com/watch?v=0lVIodG7lYY

 

[gibits]

That's funny because I would say that is exactly why you should do PP. YOU get to decide how much time you spend per patient. If you want to do 2 hour appointments, so be it. No employer is going to be so lax as to let you do that much "digging". Your job is to generate revenue, and chart biopsy isn't a billable code.

I want to do PP so I can decide how things are run. I can say when a patient needs extra time, or when I need a day off. I can decide that the money is less important to me.

That's what I thought when I turned down a job with the state. That I was the boss. Well that is only half true. Yes, I can decide how long I spend with a patient but then I will be missing lunch and rushing to see a consult in another hospital because I need to get to the office to see my outpt patients at 1:00. I'm constantly rushing. And I don't really have that much say in my time, consults at hospitals have to be done within 24 hours, office patients have to be seen on time. If you dilly dally you will run late and can't pick up your kids on time and be charged a dollar a minute you run over, and your kids give you that "I'm the last kid to be picked up" look which makes you feel hella guilty.
Just to illustrate my point, I brought a new PS3 with Grand Theft Auto 5 and have not gotten to play it yet. I have had 4 weekends off in 4 months of work. My new job is only 4 days a week, all outpt work, with great benefits, 401k and loan forgiveness. It pays less but I would need to make almost 40% more in PP to equal it's value. Something I'm not sure I want to invest in.

 

[Venko]

This comes off as a little self-righteous. There have been plenty of threads in the EM boards about money/hours. And as stated, what is discussed on SDN is not representative of all practitioners in a specific field.

My comment may seem self-righteous. Many of these comments seem very greedy to me. As for the EM forum....finances were discussed in one thread in the first ten. Everything is a balance and in my opinion alone, the psychiatry forum is off-balance with finance heavy threads.

As for the question about what, "this," is...well, "this," is a belief that money and lifestyle is the most important decision. Certainly not all psychiatrists (nor all the psychiatrists on SDN) feel this way, but the vocal majority seem to feel this way. I do not feel this way.

Oh well, I asked the question, I need to deal with the fact that people dont think like me. Its okay, I'm the outsider in this forum, I will quietly head back to the EM forums. Again, I hope that you all get paid the way you hope to be.

Cheers to you all,
TL

 

[heyjack70]

I guess an intelligent person would know that message board threads fluctuate and it's illogical to assume a snapshot of the top threads is indicative of how much a topic is discussed over the years. Oh well.

 

[trophyhusband]

My comment may seem self-righteous. Many of these comments seem very greedy to me. As for the EM forum....finances were discussed in one thread in the first ten. Everything is a balance and in my opinion alone, the psychiatry forum is off-balance with finance heavy threads.

As for the question about what, "this," is...well, "this," is a belief that money and lifestyle is the most important decision. Certainly not all psychiatrists (nor all the psychiatrists on SDN) feel this way, but the vocal majority seem to feel this way. I do not feel this way.

Oh well, I asked the question, I need to deal with the fact that people dont think like me. Its okay, I'm the outsider in this forum, I will quietly head back to the EM forums. Again, I hope that you all get paid the way you hope to be.

Cheers to you all,
TL

So I'm not a psychiatrist (my wife is in training) but I read these forums a lot since they discuss a lot of info she'd never get in her training especially financial info (I work in healthcare finance so it's interesting to me on other levels as well).

At any rate, I'm commenting because of the highlighted comment above because you don't seem to understand arbitrary endpoints. Just because at the current time there are three (five whatever) topics at the current moment in the top ten on the Psych forum and only one in the EM forum it doesn't mean at another point in time you can't wander into the EM forum and see seven of the top ten posts be about financial matters. I don't know why arbitrary endpoint arguments irk me so much but they do and I couldn't help but comment.

Edit: *sigh* And then I read heyjack's post who basically just said this same thing. I should have figured someone would get around to it eventually.

 

[Venko]

TrophyHusband and HeyJack...okay. you're points are heard. As you read this forum answer me this...do people sound as though they have a passion for helping people with mental illness or do you feel there is a disproportionate attention to lifestyle and money?

Either way, my opinion is the passion for caring for the mentally ill is not jumping off the screen. It very well could be wrong because as HeyJack points out, this is a snapshot assessment that is not representative of those who don't post or who have posted at other times. (Maybe one day I too can be as intelligent as you

You all are the content experts as there are very energetic posts from medical students through attendings here who suggest my beliefs may be old fashioned. I cannot dispute the consensus opinions expressed.

I leave you all in peace. Thank you for your honesty and time.

Sincerely,
TL

 

[MacDonaldTriad]

Thinking about future finances is very natural for a cohort of posters who are in debt and have never had a salary that can match expenses. In psychiatry, you will still more than triple your income when you complete training. That will be more than enough if you are smart about how you live.

Just like there are hundreds of crazy diets, but the only ones that work have you burning more calories than you consume; financial security is the simple ability to live below your means. I can point to many dermatologists who are house poor with alimony, and fancy sports cars that have less disposable income than most psychiatrists.

Think about what your priorities truly are and a psychiatrist’s pay will be sufficiently rewarding. If it isn’t, you are probably in the wrong field. Everyone likes more money, but I don’t like it enough to be a surgeon or an internist. I’m sure there are some specialists who feel they couldn’t be paid enough to every be a psychiatrist, but that is what is unique about our field; you have to love it, or it is absolutely unsustainable in the long run.

 

[Jorje286]

For the idea that you can somehow be invested in both money and profession, that is probably true, but it's all about what is your primary motive. And it's the primary motive I'm questioning. You can "enjoy" being a psychiatrist (or any other medical specialty), but if you've been driven to do it primarily for the money, will you really be doing as good a job as someone who's only in it for the work itself? I don't think so. And even then, this could become especially contradictory in medicine. Medicine is built around the altruistic ideal and that's where it's at its best, and that runs completely contradictory to the profiteering "make money or die" world we live in. I do think money is fundamentally evil, as it's plainly prostituting your time and productivity to make sure you and your family survive. The question is of course if there's anything better.

 

[Nasrudin]

TrophyHusband and HeyJack...okay. you're points are heard. As you read this forum answer me this...do people sound as though they have a passion for helping people with mental illness or do you feel there is a disproportionate attention to lifestyle and money?

Either way, my opinion is the passion for caring for the mentally ill is not jumping off the screen. It very well could be wrong because as HeyJack points out, this is a snapshot assessment that is not representative of those who don't post or who have posted at other times. (Maybe one day I too can be as intelligent as you

You all are the content experts as there are very energetic posts from medical students through attendings here who suggest my beliefs may be old fashioned. I cannot dispute the consensus opinions expressed.

I leave you all in peace. Thank you for your honesty and time.

Sincerely,
TL

As the one of the energetic medical students in reference...

I don't know about old or new but definitely your views seemed fashioned, as we all are, by a certain type of background.

Most of us are caring people who work hard and care about the quality of our work or we wouldn't be physicians of any type. What I want to know is this: if I'm working diligently to complete my daily tasks as an intern or whathaveyou and maintaining a good attitude and positive regard for my work, my patients, and my colleagues, what is the significance of how I arrive at my conscientiousness? How does it differ if I take myself so seriously that I am constantly watching my barometer of passion?

Skill, attitude, and due diligence are independent of differences in our internal economies. I personally take a more eastern, zen like approach. I place equanimous importance on a wider selection of my life's possibilities so that I am resilient and firmly positive in the daily setbacks of my work. For me, it doesn't help my effectiveness to place the currency of passion and the proving of it on anything. What does help my effectiveness and my ability to care for the people who depend on me is actual cash. I haven't the luxury or inclination to have a distaste for it.

Although I appreciate that this is at odds with the Abrahamic imagination and it's emphasis on salvation.

For me Finacial skills are an expression of personal competence and creativity and effectiveness in how you move the through the world. It's a skill that I have been abysmal at that I am determined to master. Like dressing well. It has a material component but belies social understanding and skill that multiply one's effectiveness in all things.

 

[st2205]

This forum has a selection bias. It should be no surprise that money is discussed more on an anonymous forum because it's a taboo topic in general discussion with other professionals. It is likely that way in large part because the nature of medicine and the stigma against profit as opposed to altruism. This forum in no way gives an accurate representation of the thoughts and opinions because the people who post here have professional lives offline. I mean, when was the last time the treatment for schizophrenia was discussed on this forum? Would it be safe to conclude that because it's infrequent that it's because nobody is thinking about or cares about schizophrenia treatment in their day to day professional lives? Or do we assume that the only thing running through peoples' minds is money, program prestige, or the salary differential between an OB and a shrink?