Child Psychiatry is Miserable

[Regnvejr]

I'm confused. What is the truth here. If Child Psych only adds 20,000 more than the opportunity cost of 1 or 2 years of fellow pay is DEFINITELY not worth it.

Let's lay it out on the table. Based on personal or hearsay anecdotes, what are some of the opening salaries offered to child fellows?

Since it doesn't matter if anybody knows:

Out of residency & fellowship (5 year), private psychiatric hospital where I did 40% kids, 60% adult and 4 hr/day outpt clinic mix I was offered 195K + 15K/year for 1 weekend call/mth. Generous bonuses, but hard to reach.

When I couldn't stand private medicine anymore, non-profit community health center nearly all outpt + 1-2/mth competency evals at local hospital, incl. a bit extra training of FP residents and answering their calls regarding quagmires offers about 175K, about 1/4 are kids or geriatrics. Minor bonuses, but easier to reach. I could probably make a lot more if I started my own clinic (others in the community have), but then that is not my interest.

Lots of work, acute and chronic shortage of mental health prescribers and therapists (Thank God for CNP-P's). Anybody want to come to dry fly-over land, your schedule could be full in a couple of weeks.

---

Members don't see this ad.

 

[whopper]

I wouldn't go into the field if it were just for the money. If you really enjoy child psychiatry, then go into the field. Money is a factor, but it shouldn't be the motivating factor.

If you really are after the money, just do regular psychiatry, and spend your time reading on investing instead of 2 years where you are very likely to work your tail off while earning a resident's salary.

 

[MDPhDgrrrl]

Hi guys,
I just read this thread and almost peed my pants laughing.
I've spent the last ten years of my life trying to get to a point where I would be studying Psychiatry. I'm about to start my residency this summer. Along the way, I've had all manner of crappy jobs to pay bills - waiting tables, pouring pints, shuffling papers, making coffees for a-holes, typing up letters. Ten years ago I put up with the crappy jobs because I was hellbent on becoming a C&A psychiatrist, so I hope I don't get too disillusioned when I finally get there, as some of the above comments would suggest....

Ya know, I think jobs in general just suck. My husband has an awesome job as a prof, he's head of a department - and he makes about 30 'phone calls a day, writes about 100 emails a day, and has an offensive amount of paperwork to deal with. Paperwork that would make your balls shrink.
I just sort of think the 'phone calls and paperwork come with these kinds of jobs - where you have a lot of responsibility and a big paycheck.

Maybe we can hire an assistant when we're done with our fellowships, and he/she can do the phone calling and paperwork for us? $175K/year is still a ridiculously large income considering we're in a depression. I would be happy to sit around twiddling my thumbs while my kids are in class if I get paid for it...more time to enjoy my starbucks....and still better than the administrative **** jobs I was doing in my early twenties.....

 

[stn2006]

175k is not much. I am not quiet sure about the work hours, and workload. PCP such as family practice average salary now is 185k now. that is only after 3 yrs of training while general psychiatry is 4 yrs.

 

[notdeadyet]

175k is not much. I am not quiet sure about the work hours, and workload.

I think MDPhDgrrrl was referring to $175K being a very large salary in general. It's top 3-4% of incomes in the country. And you can count on one hand the number of jobs that will pay that fresh out of the gate.

There used to be a chart that showed a list of the total salaries of the different specialties and then a list of the salaries broken down by hours worked. Psych jumped up considerably on the second list.

 

[whopper]

It's not child psychiatry, but I see several claim that forensic psychiatry is the road to riches.

Not from what I've seen, and several of those raking in the money are hired guns, or they worked extremely hard to get there. Don't even think about being a hired gun. If you are-well then you are a scumbag.

One of the top forensic psychiatrists, that I will not name, he has over 100 publications, is currently working at any time on at least 3 research projects. Lawyers from all over the country call him up and ask him to testify on a case.

The amount of hours he had to do learning a field outside the realm of general psychiatry, write those publications, etc, IMHO if you're in it for the money, you'd be better off opening a private clinic.

If I didn't pursue forensic fellowship this year, considering the hours I'm working this year, I'd be making much more, probably 2x what the average psychiatrist earns. I've found a very good money making opportunity after fellowship, and it's not in forensic psychiatry, it's in general clinical psychiatry...though for several reasons, I will still work in forensic psychiatry because I love it---30 hrs forensic, 16-20 hrs clinical. The clinical is paying much more than the forensic!

As for my forensic colleagues who are doing the hard-core cases that are called by lawyers all over the country, each case brings on a heck of a lot of work. This is not the type of field where you just do a case and the money falls into your lap. It can be hard work. You'll have to do a lot of research on strange cases that are outside the realm of what usually happens in our experience (e.g. read up dozens of articles on vehicular suicides). Flying to another state, living in a hotel for a few days, and then interviewing someone who refuses to cooperate, well it's very stressful.

The bottom line is you have to love what you're doing. If you're going into child psychiatry just because the money 1) you probably won't get the money you think is in the field 2) you probably won't like your job and 3) you probably won't be a good child psychiatrist.

 

[Indryd]

175k is not much. I am not quiet sure about the work hours, and workload. PCP such as family practice average salary now is 185k now. that is only after 3 yrs of training while general psychiatry is 4 yrs.

Good lord...somebody needs a little dose of perspective.

 

[psychfun]

I've found a very good money making opportunity after fellowship, and it's not in forensic psychiatry, it's in general clinical psychiatry.

pray, share?

PF

 

[whopper]

A private practice that is only made of psychologists and counselors wants a psychiatrist to join them. Why? Most people who seek a mental health professional seek a psychiatrist first. Several of their patients need a psychotropic medication and they don't have a medical doctor that works for them. They feel a psychiatrist will greatly add to their practice. It's headed by a psychologist who is also a professor and is published on the topic of anxiety disorders.

There are only 2 other psychiatric practices in the county, and one of those practices is run by a psychiatrist with a very bad reputation.

They are willing to pay very very well, as if I was actually running the private practice myself, yet I'm only working there about 15-20 hours a week. The pay is actually twice what the state will offer me for forensic work, and the state's already told me they'll put me on the highest pay grade possible for someone with my level of training (fellowship with likely board certification by the end of the summer).

I get to do forensics, clinical work, and work privately (high pay), work with my PD who's greatly advanced the field, no calls, teach residents and medstudents, have access to possible research projects, while still being able to earn the benefits of a state job (pension, health insurance, etc). 30 hrs is the bare minimum I have to work with the state while earning state benefits at 20% the cost of a full time employee. I'm really loving this mix.

The practice has psychotherapists who specialize in all the forms I can think of that I want my patients on including DBT. I am loving that. I am very frustrated when I get borderline PD patients and there's no one that can handle their DBT.

The downside is the current office does not have much of a medical setup. No sharps containers, no nurses, no balances (to check weight), no lockable drawers for meds, etc. They are only used to seeing mildly depressed and anxious patients. I did inform the practice that with a psychiatrist, if we were to see patients outside that spectrum, we're going to likely need some medical equipment, a nurse, hypodermic needles, panic buttons, etc. We're planning on working it out as it comes along. At first we'll continue to see the same types of patients, and then see if we can gradually expand to include more medically-intensive cases.

 

[Sneezing]

Hi guys,
I just read this thread and almost peed my pants laughing.
I've spent the last ten years of my life trying to get to a point where I would be studying Psychiatry. I'm about to start my residency this summer. Along the way, I've had all manner of crappy jobs to pay bills - waiting tables, pouring pints, shuffling papers, making coffees for a-holes, typing up letters. Ten years ago I put up with the crappy jobs because I was hellbent on becoming a C&A psychiatrist, so I hope I don't get too disillusioned when I finally get there, as some of the above comments would suggest....

Ya know, I think jobs in general just suck. My husband has an awesome job as a prof, he's head of a department - and he makes about 30 'phone calls a day, writes about 100 emails a day, and has an offensive amount of paperwork to deal with. Paperwork that would make your balls shrink.
I just sort of think the 'phone calls and paperwork come with these kinds of jobs - where you have a lot of responsibility and a big paycheck.

Maybe we can hire an assistant when we're done with our fellowships, and he/she can do the phone calling and paperwork for us? $175K/year is still a ridiculously large income considering we're in a depression. I would be happy to sit around twiddling my thumbs while my kids are in class if I get paid for it...more time to enjoy my starbucks....and still better than the administrative **** jobs I was doing in my early twenties.....

No it is not. Your husband can call and email and profess all day long but being a physician and being greatful for just having a 6 digit salary is rediculous. If your husband screws his job up what happens? Some college student doesn't get a grade? One research project doesn't come to completion? Some pliable minds get plied away from mediocrity or they don't learn the material they're supposed to?

If a child psychiatrist doesn't do their job they can kill a kid, or ruin them for the rest of their life. 175K isn't enough if you ask me.

Medical folks need to stop being so complacent with their work environment, regulations, and wages. You are worth a lot ($1.3 million). Fight for it! If you don't, some CEO will be more than happy to take your money.

 

[whopper]

Getting OT, but IMHO, you need to factor this in on something more than just the salary per year.

E.g. if being a doctor required 20 years of training, IMHO it better pay over 1 million a year.

Doctors spend several years, as a profession, working incredibly hard, requiring top academic achievement, while earning nothing or meager salaries for about 12 years. Very few people can be doctors. That merits higher pay.

While we do earn 6 figure salaries after we finish that process, several other fields, well you could've fattened up your 401k which could've accumulated a lot of money. E.g. a friend of mine who is an engineer, that only required 4 years of college, a cardiologist buddy of mine and he compared how much money they would both make for the rest of their lives. The engineer turned out to make as much money, per hour.

WTF? How could that be? Well think about it. The engineer that does not earn a 6 figure salary did not work the equivalent of 2 full time jobs while earning a resident's salary for 4 years, did not go to medical school where he acquired over $200K in debt, and started earning at 21. He was able to put money into his 401k.

All the while, lifestyle-wise, my engineer friend was able to buy a nice home at age 25, (certainly as good as several doctors I know) and actually had a life in his 20s.

I don't know why anyone would be a doctor for the money. Yeah, we make comfortable salaries, but only after working like slaves, in a spartan environment, while having to maintain top scores that most people could not attain for > 10 years.

The only real financial advantage of being a doctor is we have job-security. Had my engineer friend chose to work as hard as me or my cardiologist friend, he could've made possibly even more as an engineer because anyone working that hard often siginifcantly gets bumped up in the company.

And as mentioned above, if you want to be complacent about your salary, well your happy little corporation will gladly take it away from you. Does the CEO of that hospital deserve to earn more money than you? What are their hours like? Their education?

 

[Suedehead]

love this thread. worth resurrecting.

what about child/adol fellowship for getting a 'better' perspective on the developmental aspects of adult psych presentations? I mean, how many cases of 'MDD' are not 'diseased' per se but rather despairing or demoralized or poorly coping pts with 'developmental' issues.

Do you practicing C&A psych docs feel your work with kids has helped you understand your adult pts better?

 

[Manicsleep]

I don't know if you need a fellowship to learn that.
First you should study molluscs and then observe children. Or you could read piaget.

On a serious note. It probably would help your understanding in the short term however without practice you would forget it. You can and should get that training in adult psychiatry through electives and extra reading. Its good stuff.

 

[BobA]

Wouldn't it be great if some of these parents could fast track into a "good parenting" fellowship?

 

[Manicsleep]

Wouldn't it be great if some of these parents could fast track into a "good parenting" fellowship?

 

[Regnvejr]

Wouldn't it be great if some of these parents could fast track into a "good parenting" fellowship?

 

[maranatha]

I don't know if you need a fellowship to learn that.
First you should study molluscs and then observe children. Or you could read piaget.

On a serious note. It probably would help your understanding in the short term however without practice you would forget it. You can and should get that training in adult psychiatry through electives and extra reading. Its good stuff.

Agree. I think it is very helpful to have a developmental background and perspective, but not sure you really need to do a fellowship to get that if you plan on just working with adults. With that said, I know 2 attendings who completed a C/A fellowship and no longer see kids. They have both said that they would still have done the fellowship and feel it makes them a better adult psychiatrist. I've heard that several times. (Of course, they could just be saying that to make them feel better about potentially wasting 2 years with something they didn't use. )

 

[snarfer]

Agree. I think it is very helpful to have a developmental background and perspective, but not sure you really need to do a fellowship to get that if you plan on just working with adults. With that said, I know 2 attendings who completed a C/A fellowship and no longer see kids. They have both said that they would still have done the fellowship and feel it makes them a better adult psychiatrist. I've heard that several times. (Of course, they could just be saying that to make them feel better about potentially wasting 2 years with something they didn't use. )

This is true. A bit of disclosure is required here as I am child trained. I believe one needs to be trained in CAP in order to be a complete psychiatrist.

 

[Chimed]

This is true. A bit of disclosure is required here as I am child trained. I believe one needs to be trained in CAP in order to be a complete psychiatrist.

Being in a child fellowship, I'm a bit biased toward this as well. However, do you really think a pediatric fellowship is necessary or rather just more exposure to development and, perhaps, seeing kids during the adult training would be more useful?

 

[billypilgrim37]

Children are not just small adults, but adults really are just big children.

Doing adult training alone is a lot like watching Evil Dead 2. Plenty of people only see Evil Dead 2, and it's probably enough to get the early Sam Raimi/Bruce Campbell experience. But for those of us who also watch the original Evil Dead, our understanding of the legend of the Necronomicon and how it relates to plants attacking humans enhances our experience of Evil Dead 2 and makes us much better developed horror movie viewers.

The best part of this analogy is that a Geri Fellowship would relate well to Army of Darkness, an enjoyable and valuable but generally superfluous addition to training.

 

[OldPsychDoc]

Children are not just small adults, but adults really are just big children.

Doing adult training alone is a lot like watching Evil Dead 2. Plenty of people only see Evil Dead 2, and it's probably enough to get the early Sam Raimi/Bruce Campbell experience. But for those of us who also watch the original Evil Dead, our understanding of the legend of the Necronomicon and how it relates to plants attacking humans enhances our experience of Evil Dead 2 and makes us much better developed horror movie viewers.

The best part of this analogy is that a Geri Fellowship would relate well to Army of Darkness, an enjoyable and valuable but generally superfluous addition to training.

Wow.

Perhaps we also need a follow-up poster discussing the correlation between thread length and occurence of loose associations to obscure movie references as well...

(BTW--congratulations on your upcoming 1000th posting!)

 

[toothless rufus]

Children are not just small adults, but adults really are just big children.

Doing adult training alone is a lot like watching Evil Dead 2. Plenty of people only see Evil Dead 2, and it's probably enough to get the early Sam Raimi/Bruce Campbell experience. But for those of us who also watch the original Evil Dead, our understanding of the legend of the Necronomicon and how it relates to plants attacking humans enhances our experience of Evil Dead 2 and makes us much better developed horror movie viewers.

The best part of this analogy is that a Geri Fellowship would relate well to Army of Darkness, an enjoyable and valuable but generally superfluous addition to training.

Haha! That's great! All I have to say about this is "work shed."

 

[Suedehead]

Children are not just small adults, but adults really are just big children.

Doing adult training alone is a lot like watching Evil Dead 2. Plenty of people only see Evil Dead 2, and it's probably enough to get the early Sam Raimi/Bruce Campbell experience. But for those of us who also watch the original Evil Dead, our understanding of the legend of the Necronomicon and how it relates to plants attacking humans enhances our experience of Evil Dead 2 and makes us much better developed horror movie viewers.

The best part of this analogy is that a Geri Fellowship would relate well to Army of Darkness, an enjoyable and valuable but generally superfluous addition to training.

best. analogy. ever.

 

[Regnvejr]

Children are not just small adults, but adults really are just big children.

Doing adult training alone is a lot like watching Evil Dead 2. Plenty of people only see Evil Dead 2, and it's probably enough to get the early Sam Raimi/Bruce Campbell experience. But for those of us who also watch the original Evil Dead, our understanding of the legend of the Necronomicon and how it relates to plants attacking humans enhances our experience of Evil Dead 2 and makes us much better developed horror movie viewers.

The best part of this analogy is that a Geri Fellowship would relate well to Army of Darkness, an enjoyable and valuable but generally superfluous addition to training.

LOL. Clearly, not the type-A, study 25 hrs/day, no life student. Good for you.

 

[digitlnoize]

Children are not just small adults, but adults really are just big children.

Doing adult training alone is a lot like watching Evil Dead 2. Plenty of people only see Evil Dead 2, and it's probably enough to get the early Sam Raimi/Bruce Campbell experience. But for those of us who also watch the original Evil Dead, our understanding of the legend of the Necronomicon and how it relates to plants attacking humans enhances our experience of Evil Dead 2 and makes us much better developed horror movie viewers.

The best part of this analogy is that a Geri Fellowship would relate well to Army of Darkness, an enjoyable and valuable but generally superfluous addition to training.

Awesome. My only addition would be to note that Army of Darkness could also relate fairly well to Addiction...

My hope was that Joss Whedon's forthcoming, raved about movie, "Cabin in the Woods" was going to be the fully realized version of what Evil Dead could have been (the movie's posters certainly seem to suggest so, if you google them)...but now it's in movie studio financial limbo...wish I had a boomstick.

 

[whopper]

Didn't know how many Raimi fans we have here. We certainly are geeks. I mean that in a good way.

 

[carlosc1dbz]

Since it doesn't matter if anybody knows:

Out of residency & fellowship (5 year), private psychiatric hospital where I did 40% kids, 60% adult and 4 hr/day outpt clinic mix I was offered 195K + 15K/year for 1 weekend call/mth. Generous bonuses, but hard to reach.

When I couldn't stand private medicine anymore, non-profit community health center nearly all outpt + 1-2/mth competency evals at local hospital, incl. a bit extra training of FP residents and answering their calls regarding quagmires offers about 175K, about 1/4 are kids or geriatrics. Minor bonuses, but easier to reach. I could probably make a lot more if I started my own clinic (others in the community have), but then that is not my interest.

Lots of work, acute and chronic shortage of mental health prescribers and therapists (Thank God for CNP-P's). Anybody want to come to dry fly-over land, your schedule could be full in a couple of weeks.

Just wanted to say thank you for throwing out some numbers. It really helps put things into perspective. Many times people just say things like good money, or comfortable salary, and your just left wondering what they think good money is.

 

[psychdoc9]

I am a Child Psychiatrist and do 100% outpatient, 90% child. I find it highly enjoyable and satisfying. When I look back at my training, I learned real Psychiatry in last 2 years of my training as compared to first 3. I think C&A Psych illnesses are more biological and more treatable. Consider ADHD with medication effect size of 90% (100% in real practice), autistic disorder who no one knows how to diagnose (Adult psych docs have no clue about it, majority of Child Psychiatrists specially who were trained more than 10 years ago have theoretical knowledge of it but miss it all the time clinically). I have a belief that they will get better because most of them do. My patients thank me more than ever when kids get better. Yes, lower functioning, inpatient material kids are hard, not because of the illness but psychosocial choas, and I don't feel like I can do anything to help the kid. For the same reason I dislike inpatient child psychiatry to the core. Thats why I do not do inpatient but I love my outpatient practice.

Do not judge the field just by your experience in residency training. That's not true picture in real world.

 

[thepoopologist]

[rant]

Ok, I'm being provocative....but I'm also serious.

I'm working (including call) 70-80 hours/week on the inpatient unit, and I'm feeling like this will never end. Granted, I didn't really have an interest in child psych prior to this rotation, but now I must say that if there was one iota of interest left in me from a profession-choosing standpoint....it's been thoroughly squashed.

You can't scratch your butt without getting consent from a parent who hasn't had contact with their kid for 5 years, since you never have a court paper stating that their parental rights were terminated. As a result of this, kids go 4-5 days without medication change due to the social work and legal snags.

The kids are in school all day, and the teachers get pissed if you take them out. When I get there at 8, they're in class, if you get there before 8, you can't bother them because they're in "transition," or they're sleeping. Every admission requires a family meeting, and every discharge requires another...usually with 3-10 people present, including the parent (if they are allowed to have contact with the kid), the social worker, their social worker at the foster agency, the school principal, the teacher, the ACS worker, the foster agency representative, possibly a grandmother, and sometimes more.

The kids themselves are fine. Too bad I barely get to see them.

Another thing I hate is spending all day on the phone....in child psych, you better learn to love it, because you'll be making dozens of phone calls a day to get endless collateral on every admission...sometimes being required to call the same outside source multiple times to get medication histories, etc.

Add to this required case presentations, consents for everything you can imagine, unending seclusion paperwork, and evaluations for "tummyaches and headaches," and you want to just get up and walk out.

On top of all this, nobody is ever quite sure what the diagnosis is (bipolar vs. ADHD, anyone?) (Does childhood Bipolar even exist?), and use almost prozac and risperdal exclusively, thanks to legal-induced defensive medicine.

The interesting part of the work is that you can see these patients and know how your current adult patients 'got the way they are now.'

I acutally look forward to call nowadays, so that I can enjoy the post-call day mostly off. I've considered volunteering for more call for this purpose. That should tell you something.

I feel like anyone who voluntarily wants to do this on an inpatient basis is insane.

[/rant]

I'm bumping this. I read this today and laughed and laughed. This sums up my experience.