Bored of making alot of money?

[F0nzie]

So I started moonlighting in my 3rd year of residency working random weeknights and weekends and thought it was the best thing since sliced bread. I saw the money in my checking account rise and I was able to completely pay off one of my student loans. I was finally able to stop complaining about feeling short-changed by my resident salary.

At the start of my 4th year of residency I landed an inpatient job that paid extremely well. There was a month where I was covering weekends, nights, and weekdays after hours and I was able to earn 20k in addition to my resident salary. Now I have all this extra money lying around that I can put towards more student loans, retirement, investments, or whatever I want. But over the last 3-4 months I have scaled back dramatically-- I am turning down more moonlighting work, and slightly dreading the one weekend a month that I am scheduled to cover.

What I have come to realize for myself is that making extra money isn't really all that exciting anymore and I am no longer interested in seeking full-time positions. I prefer the idea of finding a job working 2 days a week, not taking call and still making 6 figures. I could spending the rest of my time with family, rekindling old hobbies, or expanding my exercise regimen. The possibility of doing something else with my time outside of medicine also sounds very exciting.

My lifestyle is very conservative. I do not spend a lot of money on myself outside of basic necessities such as food, rent, insurance, and nice clothes. The most money I spend probably comes from buying expensive protein shakes for body building. I do spend a lot on holidays to buy gifts for family members, but I feel those costs are contained and anticipated.

I honestly never thought I would say this after 12 years of education, but I do not feel I need an extra 100k working full-time. So is anybody else looking for part-time work or bored with making money?

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[kindasorta]

All I can say is welcome to the beauty of psych. Everyone in medicine blabs about how much money X specialty makes vs Y, average salaries and whatnot. The reality is that research strongly supports the notion that over a certain amount (~75k), happiness is no longer attributed to increasing salaries. Having control of one's life is the foundation of happiness, and psych allows that better than any if not all specialties.

 

[st2205]

So I started moonlighting in my 3rd year of residency working random weeknights and weekends and thought it was the best thing since sliced bread. I saw the money in my checking account rise and I was able to completely pay off one of my student loans. I was finally able to stop complaining about feeling short-changed by my resident salary.

At the start of my 4th year of residency I landed an inpatient job that paid extremely well. There was a month where I was covering weekends, nights, and weekdays after hours and I was able to earn 20k in addition to my resident salary. Now I have all this extra money lying around that I can put towards more student loans, retirement, investments, or whatever I want. But over the last 3-4 months I have scaled back dramatically-- I am turning down more moonlighting work, and slightly dreading the one weekend a month that I am scheduled to cover.

What I have come to realize for myself is that making extra money isn't really all that exciting anymore and I am no longer interested in seeking full-time positions. I prefer the idea of finding a job working 2 days a week, not taking call and still making 6 figures. I could spending the rest of my time with family, rekindling old hobbies, or expanding my exercise regimen. The possibility of doing something else with my time outside of medicine also sounds very exciting.

My lifestyle is very conservative. I do not spend a lot of money on myself outside of basic necessities such as food, rent, insurance, and nice clothes. The most money I spend probably comes from buying expensive protein shakes for body building. I do spend a lot on holidays to buy gifts for family members, but I feel those costs are contained and anticipated.

I honestly never thought I would say this after 12 years of education, but I do not feel I need an extra 100k working full-time. So is anybody else looking for part-time work or bored with making money?

I've been moonlighting for the past 6 months or so (making way more than I'll ever make moonlighting in residency) and it has been great. It paid for our first real trip with our kids to Disneyland as well as a graduation trip to Hawaii with the kids. Outside of that, I'm burning out a bit. I'd like to have loans, and a mortgage, in my rear-view. I'm wanting to just enjoy the time now, which I am, but I'm also conflicted between taking advantage of the opportunity and relaxing.

 

[HirsuteAnthony]

Can you really make 6 figures working ~16 hours per week!? That would seem like the obvious choice to me. Nothing is more valuable than time.

 

[vistaril]

All I can say is welcome to the beauty of psych. Everyone in medicine blabs about how much money X specialty makes vs Y, average salaries and whatnot. The reality is that research strongly supports the notion that over a certain amount (~75k), happiness is no longer attributed to increasing salaries. Having control of one's life is the foundation of happiness, and psych allows that better than any if not all specialties.

this is true for certain things...I think it would probably be difficult to be a 2 day a week CT surgeon for example(although Im sure one exists somewhere). But that's a silly example anyways I just picked because nobody debates between being a CT surgeon and a psychiatrist. But in all of medicine there are plenty of other ways one can work from 1 to 3 days a week if they want to....pediatrics, radiology, dermatology, and bunches of other fields. Certainly EM. And it's not just health care....one can do lots of professions 1-3 days a week.

There are IM moonlighting in house/overnight jobs where you can work 1-3 days or nights a week.

 

[vistaril]

Can you really make 6 figures working ~16 hours per week!? That would seem like the obvious choice to me. Nothing is more valuable than time.

If you took a position making 120 dollars an hour and did 16 hrs per week x 50 weeks at that, that would be 96,000 dollars.....of course thats contractor rate most likely so your without benefits and paying both ends of fica, and it probably wouldnt be the most enjoyable job in the world(think grinding at a cmhc type place)...but thats about 100k.

I think 20 hrs a week would be more reasonable.....but most of us, given med school debt, need to make more than 100k a year. I dont think my wife is planning o0n paying of all my debt.

 

[PikminOC]

All I can say is welcome to the beauty of psych. Everyone in medicine blabs about how much money X specialty makes vs Y, average salaries and whatnot. The reality is that research strongly supports the notion that over a certain amount (~75k), happiness is no longer attributed to increasing salaries. Having control of one's life is the foundation of happiness, and psych allows that better than any if not all specialties.

 

[shan564]

All I can say is welcome to the beauty of psych. Everyone in medicine blabs about how much money X specialty makes vs Y, average salaries and whatnot. The reality is that research strongly supports the notion that over a certain amount (~75k), happiness is no longer attributed to increasing salaries. Having control of one's life is the foundation of happiness, and psych allows that better than any if not all specialties.

Agreed. Now If I can just find a girl who agrees with that, I'll be the happiest guy in the world.

 

[kindasorta]

this is true for certain things...I think it would probably be difficult to be a 2 day a week CT surgeon for example(although Im sure one exists somewhere). But that's a silly example anyways I just picked because nobody debates between being a CT surgeon and a psychiatrist. But in all of medicine there are plenty of other ways one can work from 1 to 3 days a week if they want to....pediatrics, radiology, dermatology, and bunches of other fields. Certainly EM. And it's not just health care....one can do lots of professions 1-3 days a week.

There are IM moonlighting in house/overnight jobs where you can work 1-3 days or nights a week.

EM ain't so lifestyle friendly though. Working 3 days a week in EM is much more emotionally and physically taxing than psych. Peds, well then you'd have to be a pediatrician. Derm, I guess so, but derm is derm. Radiology sounds like torture. Talk about whack and stack or grinding. Radiology is the epitome of that.

The advantage psych has, at least for people in psych, is that it's actually interesting / chill work. I'd much rather have a conversation with someone that smell their feet or inspect their buttholes.

 

[Bartelby]

I'm not sure if you could pull off six figures in two days (if an average salary if 180-200k working probably 40-50 hrs/week), but I get where you are coming from. I am thinking three day weekends for life with ten hour days otherwise might be a good "part time" (as far as medicine is concnerned) option for me in the future.

 

[BS81]

I'm not sure if you could pull off six figures in two days (if an average salary if 180-200k working probably 40-50 hrs/week), but I get where you are coming from. I am thinking three day weekends for life with ten hour days otherwise might be a good "part time" (as far as medicine is concnerned) option for me in the future.

I'm having trouble deciding if the three day weekend or Wednesday, Saturday, Sunday off are the better deal.

 

[vistaril]

EM ain't so lifestyle friendly though. Working 3 days a week in EM is much more emotionally and physically taxing than psych. Peds, well then you'd have to be a pediatrician. Derm, I guess so, but derm is derm. Radiology sounds like torture. Talk about whack and stack or grinding. Radiology is the epitome of that.

The advantage psych has, at least for people in psych, is that it's actually interesting / chill work. I'd much rather have a conversation with someone that smell their feet or inspect their buttholes.

oh no doubt....but em also has flexibility in it's own way that psych doesn't in that there is absolutely no overhead, office, etc....and even though they generally can do less clinical hours the hourly wage(on clinical hours) is a lot higher....230-240 dollars/hr in many cases.

Radiology is really cool for people who enjoy that type of thinking. I would hate it.

but again, most people in psych werent having some massive debate with themselves....psych vs surgery, psych vs radiology, psych vs anesthesia......that's just not common. Occasionally, peds vs psych(to do child psych) is an actual dilemna people have.

 

[kindasorta]

I'm having trouble deciding if the three day weekend or Wednesday, Saturday, Sunday off are the better deal.

I figure working for 10 hrs a day is basically the whole day anyway, so what about just calling it and working 3 13's. 4 days off a week. How you like them apples?

 

[kindasorta]

oh no doubt....but em also has flexibility in it's own way that psych doesn't in that there is absolutely no overhead, office, etc....and even though they generally can do less clinical hours the hourly wage(on clinical hours) is a lot higher....230-240 dollars/hr in many cases.

Radiology is really cool for people who enjoy that type of thinking. I would hate it.

but again, most people in psych werent having some massive debate with themselves....psych vs surgery, psych vs radiology, psych vs anesthesia......that's just not common. Occasionally, peds vs psych(to do child psych) is an actual dilemna people have.

For me comparing specialties really is a non-issue because I genuinely wouldn't want to do any of them. Work is work, and it gets old after a while. It's called work for a reason. Few of us are blessed with a true passion for anything, let alone our job. So to have the freedom to craft a palatable schedule for myself while still making enough coin to live a cool life is basically the closest most of us in the Western world will come to employment utopia.

 

[BS81]

oh no doubt....but em also has flexibility in it's own way that psych doesn't in that there is absolutely no overhead, office, etc....and even though they generally can do less clinical hours the hourly wage(on clinical hours) is a lot higher....230-240 dollars/hr in many cases.

Radiology is really cool for people who enjoy that type of thinking. I would hate it.

but again, most people in psych werent having some massive debate with themselves....psych vs surgery, psych vs radiology, psych vs anesthesia......that's just not common. Occasionally, peds vs psych(to do child psych) is an actual dilemna people have.

230-240 is not the standard by any means. But they generally get 50-80% more per hour for contract work compared to psych. If the EM docs are making 230-240 per hour in a rural area, the psychiatrists could get $150+/hr for 1099 work there. I did briefly consider EM, but those guys work hard, and I quickly found out in third year that I hate procedures. But it's probably the most intense work in all of medicine. There's a reason most semi-retire in to admin or urgent care work at around 50. And the patients in the ED are awful to deal with and you just have to sit there and take it because of Press Ganey scores. Those guys deserve what they make. The grass can be green and brown on both sides of the fence.

 

[billypilgrim37]

The grass can be green and brown on both sides of the fence.

Just like the body fluids they have to walk through all day.

 

[digitlnoize]

if an average salary if 180-200k working probably 40-50 hrs/week.

According to Medscape, 75% of psychiatrists work < 40 hours a week. 35% work < 30 hours a week. With a 180-200k salary. I'd say avg hours per week is probably 35 or so. So 100k would probably take around 18 hours a week.

 

[vistaril]

According to Medscape, 75% of psychiatrists work < 40 hours a week. 35% work < 30 hours a week. With a 180-200k salary. I'd say avg hours per week is probably 35 or so. So 100k would probably take around 18 hours a week.

there are lots of different salary surveys I see out there....the medscape one appears to be particularly generous to psych relative to others. Also, I thought 2012 medscape had psychiatry with an average of 170k, which would mean 18 hrs a week would be more like 85k. I dont trust medscape at all for procedure based specialties...it has GI at like 280 for example, and doesn't have anything much above 300. This indicates people in private practice groups just arent reporting their salaries accurately....a GI making 280k must be seeing like 3 patients a day, and doing 2-3 scopes a week. That just doesn't add up. There are people in mu fiance's new group who make 280k in 2-3months....

http://www.forbes.com/sites/jacquel...e-best-and-worst-paying-jobs-for-doctors-2/2/

this has psych at 189(tied for lowest with peds and family), but note it has neurology at 280 and medicine hospitalists at 221. It also has more realistic numbers(which I think are probably still low from reality) in fields like interventional cards and ortho.

 

[kindasorta]

there are lots of different salary surveys I see out there....the medscape one appears to be particularly generous to psych relative to others. Also, I thought 2012 medscape had psychiatry with an average of 170k, which would mean 18 hrs a week would be more like 85k. I dont trust medscape at all for procedure based specialties...it has GI at like 280 for example, and doesn't have anything much above 300. This indicates people in private practice groups just arent reporting their salaries accurately....a GI making 280k must be seeing like 3 patients a day, and doing 2-3 scopes a week. That just doesn't add up. There are people in mu fiance's new group who make 280k in 2-3months....

http://www.forbes.com/sites/jacquel...e-best-and-worst-paying-jobs-for-doctors-2/2/

this has psych at 189(tied for lowest with peds and family), but note it has neurology at 280 and medicine hospitalists at 221. It also has more realistic numbers(which I think are probably still low from reality) in fields like interventional cards and ortho.

What makes you think a PP psych would accurately report income? I'd love for any fathomable argument why any specialty isn't underreporting their income on a salary survey. I mean come on vistaril, your constant diminishment of the field and always contrarian / negativistic attitude toward psych waters down your perceived truth to reality ratio quite a bit. And yes I realize a truth to reality ratio makes absolutely no sense, but I can't think of any other way to put it.

Why have you never argued that psych PP income is volitionally underreported?

 

[BS81]

there are lots of different salary surveys I see out there....the medscape one appears to be particularly generous to psych relative to others. Also, I thought 2012 medscape had psychiatry with an average of 170k, which would mean 18 hrs a week would be more like 85k. I dont trust medscape at all for procedure based specialties...it has GI at like 280 for example, and doesn't have anything much above 300. This indicates people in private practice groups just arent reporting their salaries accurately....a GI making 280k must be seeing like 3 patients a day, and doing 2-3 scopes a week. That just doesn't add up. There are people in mu fiance's new group who make 280k in 2-3months....

http://www.forbes.com/sites/jacquel...e-best-and-worst-paying-jobs-for-doctors-2/2/

this has psych at 189(tied for lowest with peds and family), but note it has neurology at 280 and medicine hospitalists at 221. It also has more realistic numbers(which I think are probably still low from reality) in fields like interventional cards and ortho.

The medscape survey also lists that about 15% of GIs make more than 500k, which I'm sure is true. Merritt Hawkins surveys private practice groups. A lot of those people are partners in those groups and skew those numbers. Not every GI is a partner in a private group or even employed by those groups... the trend is towards being an employee, such as hospital employment, multi specialty groups, part of ACOs and most of those peeps make the 300-350k range.
You are applying your anecdotal evidence and extrapolating it to everyone which just isn't the case.

Look at the survey in depth:

http://www.medscape.com/features/slideshow/compensation/2012/gastroenterology

 

[vistaril]

What makes you think a PP psych would accurately report income? I'd love for any fathomable argument why any specialty isn't underreporting their income on a salary survey. I mean come on vistaril, your constant diminishment of the field and always contrarian / negativistic attitude toward psych waters down your perceived truth to reality ratio quite a bit. And yes I realize a truth to reality ratio makes absolutely no sense, but I can't think of any other way to put it.

Why have you never argued that psych PP income is volitionally underreported?

it is much easier to underreport if there are multiple revenue streams....facility fees, professional fees, ancillary services fees, etc.....psych does not have these.

From a financial standpoint I think psychs actually come out better a lot of the time working for organizations on a salaried basis. In some cases you may take a hit to work for yourself, but a lot of psychs who do really love the autonomy.

 

[F0nzie]

According to Medscape, 75% of psychiatrists work < 40 hours a week. 35% work < 30 hours a week. With a 180-200k salary. I'd say avg hours per week is probably 35 or so. So 100k would probably take around 18 hours a week.

Your salary estimate for 18 hours is spot on with the offers I have seen. The fact that over 1/3 of practicing psychiatrists work less than 30 hours is really interesting. Just never thought I would feel this way fresh out of residency.

 

[kindasorta]

it is much easier to underreport if there are multiple revenue streams....facility fees, professional fees, ancillary services fees, etc.....psych does not have these.

From a financial standpoint I think psychs actually come out better a lot of the time working for organizations on a salaried basis. In some cases you may take a hit to work for yourself, but a lot of psychs who do really love the autonomy.

Uh, this isn't reporting to the IRS. These are salary surveys. They say what they want to say.

 

[Bartelby]

According to Medscape, 75% of psychiatrists work < 40 hours a week. 35% work < 30 hours a week. With a 180-200k salary. I'd say avg hours per week is probably 35 or so. So 100k would probably take around 18 hours a week.

Wow, nice

 

[Bartelby]

Just never thought I would feel this way fresh out of residency.

I wonder if you burned out a bit on the excessive moonlighting? 20k of moonlighting in a month (as a resident) seems like a lot. You may find later that you want to work more than two days a week especially if your spouse and kids are at work and school.

Then again, there is no shortage of fulfilling things to do outside of medicine!

 

[HirsuteAnthony]

I've been moonlighting for the past 6 months or so (making way more than I'll ever make moonlighting in residency) and it has been great. It paid for our first real trip with our kids to Disneyland as well as a graduation trip to Hawaii with the kids. Outside of that, I'm burning out a bit. I'd like to have loans, and a mortgage, in my rear-view. I'm wanting to just enjoy the time now, which I am, but I'm also conflicted between taking advantage of the opportunity and relaxing.

Can you make significantly more per hour moonlighting than you can doing more conventional per diem work?

 

[st2205]

Can you make significantly more per hour moonlighting than you can doing more conventional per diem work?

What do you mean? I'm working as an independent contractor at a hospital (not providing care, obviously).

 

[michaelrack]

Can you make significantly more per hour moonlighting than you can doing more conventional per diem work?

It depends. If you do locums coverage on weekends/holiday, you may potentially be able to get holiday/weekned bonuses...

 

[michaelrack]

I figure working for 10 hrs a day is basically the whole day anyway, so what about just calling it and working 3 13's. 4 days off a week. How you like them apples?

It's hard to be productive for a full 13 hours. However, this may not matter much if you are working a gov job. There are some state psych facilities that are desperate for docs, and you may be able to arrange a schedule like this (maybe M,W,F 13 hrs each) for a salary of about 150-170k plus full benefits.

 

[F0nzie]

I wonder if you burned out a bit on the excessive moonlighting? 20k of moonlighting in a month (as a resident) seems like a lot. You may find later that you want to work more than two days a week especially if your spouse and kids are at work and school.

Then again, there is no shortage of fulfilling things to do outside of medicine!

Yea it is possible I may have burned out. That busy month actually felt easier than medicine though. What's happening to me? I know. I am turning into a sissy.

 

[TexasPhysician]

If you took a position making 120 dollars an hour and did 16 hrs per week x 50 weeks at that, that would be 96,000 dollars.....of course thats contractor rate most likely so your without benefits and paying both ends of fica, and it probably wouldnt be the most enjoyable job in the world(think grinding at a cmhc type place)...but thats about 100k.

I think 20 hrs a week would be more reasonable.....but most of us, given med school debt, need to make more than 100k a year. I dont think my wife is planning o0n paying of all my debt.

A previous resident in my program who is C&A boarded has her own private practice. She works roughly 18 hours/week and after overhead earns about $175k/year.

It is certainly doable, but she initially put in many extra hours to set up the practice herself.

 

[JourneyAgent]

A previous resident in my program who is C&A boarded has her own private practice. She works roughly 18 hours/week and after overhead earns about $175k/year.

It is certainly doable, but she initially put in many extra hours to set up the practice herself.

Holy crap!

18 hours a week and all my bills paid.

I had have to up something serious. Like bullfighting or something....

 

[Chrismander]

Are there any psych ER's near you? Here there's one that a lot of docs (esp those who want reduced schedules or who want to double it with another part time or even full time gig) will do 24 hour shifts at. It also gives loan repayment (federal) once you hit 20 or 40 hours (for half or full amount of loan repayment) since it's an underserved area.

 

[vistaril]

Are there any psych ER's near you? Here there's one that a lot of docs (esp those who want reduced schedules or who want to double it with another part time or even full time gig) will do 24 hour shifts at. It also gives loan repayment (federal) once you hit 20 or 40 hours (for half or full amount of loan repayment) since it's an underserved area.

outside of academic centers(which would also come with an academic appt), these are not common at all. There are now some state facilities where you may see people for triage and in acute situations, but I wouldnt call this a psych er.

'psych er' work in the real world just isn't that common or practical because there is nobody to pay you for it. In most community hospitals the er doc or whatever just calls the crisis team sw(or however it works in your state....laws vary greatly) to get the ball rolling when someone needs to be assessed for a bed. The real world is different than residency where we hang out in the er at 10pm waiting for 'consults' to come through the medical ER where we can see the pt in the ER....

 

[OldPsychDoc]

outside of academic centers(which would also come with an academic appt), these are not common at all. There are now some state facilities where you may see people for triage and in acute situations, but I wouldnt call this a psych er.

'psych er' work in the real world just isn't that common or practical because there is nobody to pay you for it. In most community hospitals the er doc or whatever just calls the crisis team sw(or however it works in your state....laws vary greatly) to get the ball rolling when someone needs to be assessed for a bed. The real world is different than residency where we hang out in the er at 10pm waiting for 'consults' to come through the medical ER where we can see the pt in the ER....

You know, Vist, the main problem I have with your responses around here is that you have such a remarkable gift for generalization of your own situation to how everything else in the "real world" must be. There are myriad variations on psychiatric emergency services, and in many places they are quite different from the model you describe.

 

[vistaril]

You know, Vist, the main problem I have with your responses around here is that you have such a remarkable gift for generalization of your own situation to how everything else in the "real world" must be. There are myriad variations on psychiatric emergency services, and in many places they are quite different from the model you describe.

oh no that has little to do with my own situation.....I'd be curious to know where all these non-academic non-state mental health affiliated(where you are basically triaging admissions...call it a psych ER if you want I guess) emergency room jobs are for psychiatrists.....I've probably gotten 100 mass mailing type job offers in the last 50 days, and I can't recall one that was for a psychiatrist working out of the emergency room. but if you do know of such a job opening feel free to provide a link for the op.

 

[shan564]

You know, Vist, the main problem I have with your responses around here is that you have such a remarkable gift for generalization of your own situation to how everything else in the "real world" must be. There are myriad variations on psychiatric emergency services, and in many places they are quite different from the model you describe.

OPD is my hero.

 

[PikminOC]

oh no that has little to do with my own situation.....I'd be curious to know where all these non-academic non-state mental health affiliated(where you are basically triaging admissions...call it a psych ER if you want I guess) emergency room jobs are for psychiatrists.....I've probably gotten 100 mass mailing type job offers in the last 50 days, and I can't recall one that was for a psychiatrist working out of the emergency room. but if you do know of such a job opening feel free to provide a link for the op.

You're right, you're always right, you're never wrong.
Why do you share your extensive knowledge with us peons?

 

[shan564]

You're right, you're always right, you're never wrong.
Why do you share your extensive knowledge with us peons?

He is on a quest to enlighten us.

 

[PikminOC]

He is on a quest to enlighten us.

Vistaril,
Why spend your time educating us?
You could make an extra 100G during that time grinding.

 

[notdeadyet]

I've probably gotten 100 mass mailing type job offers in the last 50 days, and I can't recall one that was for a psychiatrist working out of the emergency room. but if you do know of such a job opening feel free to provide a link for the op.

So your logic is: because I haven't been told about a job (which I get from the mass mailings that are done to staff hard-to-fill/undesirable jobs, hence the mass mailing), it must not exist.

Your corner of the world, wherever it is, is not necessarily representative of psychiatry. The reason so many people on this board disagree with your characterization a of the field, the practices, the opportunities, the level of skill, and the possibilities is that wherever you are practicing is NOT the norm for most of us.

We all have a tendency to generalize,nut most people hear other folks' different experiences and think, "wow, it sounds different there" as opposed to your reaction of "it's not true because its not what I've seen at Acme University or moonlighting here in Acme County." The fact that you don't seem to get that is why many of us don't buy your claims of "top NE program." Most folks at top programs or even middle-of-the-road urban NE programs haven't seen such a small slice.

 

[PikminOC]

So your logic is: because I haven't been told about a job (which I get from the mass mailings that are done to staff hard-to-fill/undesirable jobs, hence the mass mailing), it must not exist.

Your corner of the world, wherever it is, is not necessarily representative of psychiatry. The reason so many people on this board disagree with your characterization a of the field, the practices, the opportunities, the level of skill, and the possibilities is that wherever you are practicing is NOT the norm for most of us.

We all have a tendency to generalize,nut most people hear other folks' different experiences and think, "wow, it sounds different there" as opposed to your reaction of "it's not true because its not what I've seen at Acme University or moonlighting here in Acme County." The fact that you don't seem to get that is why many of us don't buy your claims of "top NE program." Most folks at top programs or even middle-of-the-road urban NE programs haven't seen such a small slice.

Do you really want to go there? Do you think you are getting thru at all?

 

[vistaril]

So your logic is: because I haven't been told about a job (which I get from the mass mailings that are done to staff hard-to-fill/undesirable jobs, hence the mass mailing), it must not exist.
.

I have worked more diversity of jobs(one outpt med mgt and one weekend inpt + consults and that's just currently) than most people here, and that probably includes a few attendings(not saying I have more experience overall than many attendings, just that some attendings have only really worked in one setting).....I think I know what's out there. Your constant complaints of "but it must just be like that in your part of the country....stop generalizing!" is ridiculous- What do you imagine Blue cross psych coverage is like in arizona compared to texas compared to vermont compared to wherever? Are you under the impression that the plans are going to be that vastly different from one state to another That VA's in Texas are that different than VAs in wisconsin? Yes, some areas have more of an urban population and some more of a rural population....some have a little better stated funded community programs....some have a little more stringent committment rules. You get the point. But the basic dynamics are generally the same. Now your point about residency experiences being very different is true to a greater extent Im sure, but academic psychiatry isn't the real world. For those of us not pursuing an academic career(ie most people), we are more concerned with what is out there in the community in different areas(public, private, inpt, outpt) vs some utopian vision of what psychiatry should be.


And I didn't say there were absolutely no psychiatry emergency positions in the whole country outside of academia and affiliated state hosp/govt funded positions(where the term really isnt applicable). Im sure there is one somewhere. But it's obviously not common, and the reason it isn't common is obvious.

 

[vistaril]

You're right, you're always right, you're never wrong.
Why do you share your extensive knowledge with us peons?

Not sure where you got the idea you believe I think you and others are 'peons'; we're just having a discussion where there is sometimes disagreement.

If I can manage to provide a little balance to the constant cheerleading in here I am content......between med students coming on and pointing out how they are diagnosing brain tumors on consult services weekly, to med students and residents believing they can open up cash pay med mgt private practices that rake in money hand over fist without prostituting themselves, to the constant mischaracterizations of how competitive the average psych applicant is, to either being very naive about how other med students and specialties view us to outright lying about....someone has to provide that balance.

 

[billypilgrim37]

Your constant complaints of "but it must just be like that in your part of the country....stop generalizing!" is ridiculous

It may be ridiculous, but when so many of us point out that our friends are taking jobs that don't sound anything like what you describe, we're not making it up. I have no doubt that you're describing a sizable chunk of the psychiatric practice environment, but the idea that there isn't room for creativity when there are stake holders other than just private insurance doesn't fit with some of our experiences. Come visit a blue state sometime! It might do you some good.

 

[michaelrack]

What do you imagine Blue cross psych coverage is like in arizona compared to texas compared to vermont compared to wherever? .

BCBS reimbursement varies a lot from state to state. It is low in Alabama, where they control 80% of the private market. It is a lot better in neighboring Mississippi. Agree with most of your other points.

 

[DOC PENGUIN]

Not sure where you got the idea you believe I think you and others are 'peons'; we're just having a discussion where there is sometimes disagreement.

If I can manage to provide a little balance to the constant cheerleading in here I am content......between med students coming on and pointing out how they are diagnosing brain tumors on consult services weekly, to med students and residents believing they can open up cash pay med mgt private practices that rake in money hand over fist without prostituting themselves, to the constant mischaracterizations of how competitive the average psych applicant is, to either being very naive about how other med students and specialties view us to outright lying about....someone has to provide that balance.

Not to be a jackass, but don't sell yourself long. Just by reading you, I ASSUME you have this air of "I'm right." As if your experience trumps theirs. Your stories aren;t very straight and your "Balance" isn;t constructive nor is it enlightening. Your'e not the only one who has qualms about his field. I'm sure Digitalnoize and Splik have constructively outlined the flaws. And please please please, prove to us that your notions are correct, start something in the IM or Surg board, and link it to us. If you can;t take that chance, you are losing credibility.

 

[DOC PENGUIN]

It may be ridiculous, but when so many of us point out that our friends are taking jobs that don't sound anything like what you describe, we're not making it up. I have no doubt that you're describing a sizable chunk of the psychiatric practice environment, but the idea that there isn't room for creativity when there are stake holders other than just private insurance doesn't fit with some of our experiences. Come visit a blue state sometime! It might do you some good.

He says he's in a top northeast program. He is in a blue state by default. THere are only 2 places that are not exclusively blue, New Hampshire and Litchfield County, CT

 

[vistaril]

BCBS reimbursement varies a lot from state to state. It is low in Alabama, where they control 80% of the private market. It is a lot better in neighboring Mississippi. Agree with most of your other points.

well of course the reimbursement varies, and this matters some in terms of how practices are set up.....but just because one insurer pays 15-20% more(or whatever) in one state vs another doesn't neccessarily mean that the general practice of psychiatry is going to be a lot different. Maybe there is some marginal difference in the percentage of psychs doing 90805s vs 98062(going by old codes, not caught up with new codes yet) to reflect this difference.....but these aren't things that are going to make the practice of psychiatry totally different from one area to another generally.

Also, this is true in other specialties as well....and while salaries do in fact differ by region in many cases, you don't see endocrinologists in texas saying "you guys in Ohio are practicing a completely different type of endo than us here".....

 

[DOC PENGUIN]

well of course the reimbursement varies, and this matters some in terms of how practices are set up.....but just because one insurer pays 15-20% more(or whatever) in one state vs another doesn't neccessarily mean that the general practice of psychiatry is going to be a lot different. Maybe there is some marginal difference in the percentage of psychs doing 90805s vs 98062(going by old codes, not caught up with new codes yet) to reflect this difference.....but these aren't things that are going to make the practice of psychiatry totally different from one area to another generally.

Also, this is true in other specialties as well....and while salaries do in fact differ by region in many cases, you don't see endocrinologists in texas saying "you guys in Ohio are practicing a completely different type of endo than us here".....

True, but some studies suggest the quality of care is best in the Northeast and Midwest while the south suffers. I believe this was done by the Commonwealth fund.

Politics, aside, your statement is correct.