Compensation Report 2014

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Thanks for the link

Right, but like Medscape, I presume the low number of hours is what drags psych down...30 hours/week avg. Although the 90th percentile in MGMA data for psych is surprisingly quite low.....

I'm not sure what to believe. Do ortho spine really pull in 1.6m? damn
 
yeah fair enough

just trying to figure out which survey ti believe. ..mgma or medscape
 
Blitz2006 said:
yeah fair enough

just trying to figure out which survey ti believe. ..mgma or medscape
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Believe that both provide accurate results with respect to their methodologies. And also salary.com. I believe all three surveys, but I find the Medscape data more useful because they also report a lot of meaningful confounders like the number of hours worked.
 
right

mgma numbers just seem a bit inflated to me...
 
That data is from 2012. How has it changed?
 
Blitz2006 said:
right

mgma numbers just seem a bit inflated to me...
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Their methodologies reflect people who are in a particular type of practice setting that tends to be more lucrative.
 
Looking at the job offers that have been posted on this forum, I thought that 250-300k was more typical. This would certainly put psych on par with other fields of medicine.
 
vanfanal said:
Looking at the job offers that have been posted on this forum, I thought that 250-300k was more typical. This would certainly put psych on par with other fields of medicine.
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apples to oranges. Can you make 300k in psych depending on your practice style, number of hours worked, setting, etc? Yeah, most people could. But in then making a comparison to other fields you have to apply the same specifiers with setting, practice style, location, etc......and not use some 'average' salary listed, by mgma or medscape of whatever.

I know a psychiatrist right now just out of residency who make almost as much money as one spine surgeon just out of fellowship. The spine surgeon, of course, has an academic position that is 60% research. he makes about 330k. The psychiatrist who makes that much money is not in academia, has a high volume inpatient salaried job, then *another* part time high volume contracted by the hour outpt job. Those are two extremes of pay. The reverse of that extreme would be to imagine a junior psych attending in academia who does 60/40 research/clinical(and thus takes some pay cut because they arent funded yet as a researcher) and makes 125k(instead of 155k) vs the private practice high volume spine guy who makes 1.4 million. 3330k vs 330k on one extreme.....125k vs 1.4 million on another.

You're not going to make a lot of money in psychiatry compared to other fields. And if that's not important to you, that's fine. That doesn't mean you shouldn't do it. But if you tell yourself it pays just about as much as other fields, you're fooling yourself.
 
You shouldn't be comparing psychiatrists to spine surgeons, either--let's look at psych inpatient vs. general IM hospitalists, and general adult outpatient vs. outpatient primary care. I think we come out pretty well in those comparisons, especially factoring in workload.
 
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OldPsychDoc said:
You shouldn't be comparing psychiatrists to spine surgeons, either--let's look at psych inpatient vs. general IM hospitalists, and general adult outpatient vs. outpatient primary care. I think we come out pretty well in those comparisons, especially factoring in workload.
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of course those are fair points. I was mainly thinking of those in here who believe certain specialties max out at much less than they do.

As for inpatient psych vs hospitalist medicine, a lot of places are now going 7/7 with hiring inpatient psych. So the workload then is similar, but the pay trails a bit(~10-15%) The upside is you could work a bit on the off week(just like hospitalists). I think the biggest advantage from the medicine hospitalist POV though is the flexibility to be more creative in setting up the schedules. I know medicine hospitalists that accept a contract and work those duties into their other duties...I think someone on salary as an inpatient psych hospitalist model would have a hard time pulling that off(although you never know)....
 
vanfanal said:
Looking at the job offers that have been posted on this forum, I thought that 250-300k was more typical. This would certainly put psych on par with other fields of medicine.
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The new grads I know have been getting offers consistently in the 200-250k range. I'd say the average has been around $225k + Benefits. This is mostly for outpatient group work.
 
vistaril said:
of course those are fair points. I was mainly thinking of those in here who believe certain specialties max out at much less than they do.

As for inpatient psych vs hospitalist medicine, a lot of places are now going 7/7 with hiring inpatient psych. So the workload then is similar, but the pay trails a bit(~10-15%) The upside is you could work a bit on the off week(just like hospitalists). I think the biggest advantage from the medicine hospitalist POV though is the flexibility to be more creative in setting up the schedules. I know medicine hospitalists that accept a contract and work those duties into their other duties...I think someone on salary as an inpatient psych hospitalist model would have a hard time pulling that off(although you never know)....
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I think that the 7/7 model would be much more benign for a psychiatrist than for an IM hospitalist, since the patients on inpt psych usually aren't as sick. On inpatient IM, you're constantly running around putting out urgent fires...
 
vanfanal said:
Looking at the job offers that have been posted on this forum, I thought that 250-300k was more typical. This would certainly put psych on par with other fields of medicine.
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I thought it was more like 170k-220k... 250k-300k seems to be quite high for psych.
 
BestDoctorEver said:
I thought it was more like 170k-220k... 250k-300k seems to be quite high for psych.
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My understanding is that 250-300k may be based on more hours (i.e.. 40-50hrs/week), rather than the 30-35hrs that most people say psychiatrists work.
 
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vanfanal said:
Maybe the difference is dependent on practice environment. My understanding is that 250-300k may be based on more hours (i.e.. 40hrs/week), rather than the 30-35hs that most people say psychiatrists work.
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$250-300k is definitely out there, but it's not typical. That's the kind of job you might have to move for and work more hours at.
 
Yeah what's with the craigslist type ads?
 
Haha that 500k to 700k is insane. I read the posting and it looks like the total compensation package with benefits will somehow exceed a net worth of 500k. It sounds too good to be true. But who knows. Someone better check it out. I would but I'm still a resident.
 
I'm happy with the salary ranges I'm seeing on there. Everything from 150k to 700k. The job for 300k - 350k is legit. Man, that's how much surgeons in specialties get paid.
 
If a psychiatrist can make as much as medical specialist by working the same number of hours, that's fair. Just as a medical specialist would make what an average psych makes working the fewer hours. I think that people want more equity rather than just higher salaries.
 
so can we extrapolate from these figures that if you work 55 to 60 hours you can potentially hit 450 to 500k in certain parts of the country?
 
And if you're using compensation to decide between fields as different as psychiatry and rads, take a step back and rethink things.
 
SteinUmStein said:
And if you're using compensation to decide between fields as different as psychiatry and rads, take a step back and rethink things.
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True. But for someone deciding between psych and similar fields such as neuro, FP or IM, compensation is likely the second biggest factor after knowing that you enjoy the line of work; and many people can see themselves doing more than one thing.

It's disheartening to see that psych psych maxes out at a lower amount compared to other relatively similar specialties. Like I mentioned in my previous post, I think it's about equity rather than the actual number. Of course, let me admit that I have no idea what 220k vs 300k means in terms of real-world difference and the kind of lifestyle you can live. But even with tax (lets's say 50%), 40k seems like it can make a big difference whether you choose to spend it or save for retirement or invest.
 
disheartening? im confused.

those merritt hawkins numbers makes psych look like jackpot (considering how competitive psych is compared to ROAD)

and people keep forgetting, you can work more or less where you want for psych...which for me is a huge plus.

sure the guys in rads and optho may make a bit more, but in what setting?
 
Jester25 said:
What's the purpose of comparing it to other fields, unless you are trying to decide between the two fields?
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just using it as a benchmark. illustrating that psych is a rewarding field, thats all.
 
mgdsh said:
Why's that so hard to believe? $350k from a 40 hour week means $175 an hour...
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Is that the going rate for psych? I get confused around here with Vistaril saying we're all going to be homeless and others saying psych has one of the highest hourly wages in medicine. The data we have helps somewhat but it's still pretty poor quality, surveys are not a great way to get compensation data and that's most of what we have.
 
Well if you search a few other threads, Leo Aquarius makes some very informative posts and states that in Cali there are Psychiatrists pulling in 300-400/hr.....

But if this was the case then 50 hour week guys should be clearing 500k no problem...
 
Blitz2006 said:
Well if you search a few other threads, Leo Aquarius makes some very informative posts and states that in Cali there are Psychiatrists pulling in 300-400/hr.....

But if this was the case then 50 hour week guys should be clearing 500k no problem...
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Those kinds of anecdotes are very interesting and encouraging but are still not the kind of data many students are looking for on a country-wide and specialty-wide basis. It's a curiosity from my perspective as I've already matched, but I know there are others out there looking for this information and it's surprisingly hard to find in a reliable or consistent form.
 
mgdsh said:
Why's that so hard to believe? $350k from a 40 hour week means $175 an hour...
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I don't know, but the two psych docs I had a chance to talk to in south FL told me they make over 300k working 40 hours/week. However, they both have their own practice for more than 15 years...
 
Bartelby said:
Nice analysis, and good point re: salary vs. total charges.
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I spent a few years golfing with a bunch of hospital executives and administrators, and I quickly realized their metrics are $'s, RVUs, and performance compared against rival/similar hospital systems.

If you are employed at a hospital…you'll want to know your total "cost" to the hospital (salary, health insurance premiums, malpractice insurance, pension, etc), as *that* is the number that the number crunches will care the most about. Ask any administrator and they can tell you price per head (both FT and PT) of benefits, and then add on salary, malpractice, and fringe costs like conference travel. Salary can often be 75%+ of the total cost, so you need to have good data to overcome objections to any sig. raise.

Now you need to figure out your total billed RVUs. There is a formula, often it is tweaked by each hospital system to fit their metrics. Be aware there are different types of RVUs, so know which one they are quoting you. If you can't get the RVU numbers, you can get your total billing numbers and use them. Gross (all billing), Net Adjustments (discounted rates per provider contracts, written off bad debt, etc), and then your total receivables (what was actually collected after adjustments, etc). Someone in billing has this information, if not…then usually your dept administrator has it or can get it. Depending on your payor mix, you'll probably want to stick with gross numbers, but it is helpful to know the other numbers.

The tricky part of using straight dollars is that you have little to no control over the collection side of things, and % collections can be really funky at some/most/all hospitals because you are reliant on the billing dept to fight for your dollars. Knowing your billed RVU #'s helps account for this, though sometimes how RVUs are calculated are not an accurate representation for your speciality; it cuts both ways. Oh…and in-pt work usually runs in the Red, so be careful what you ask for if you do mostly in-pt because your argument is lost on $'s. Your negotiating point will not be salary, it'd probably be headache of trying to find another provider.

Now you just need to know the going rate around town for compensation (or at least the regional averages, like above), and then you can be in a much better position to negotiate. Some want to skip just to this section, but then you are negotiating blindly, as the administrator should know everything I just mentioned.
 
SteinUmStein said:
Those kinds of anecdotes are very interesting and encouraging but are still not the kind of data many students are looking for on a country-wide and specialty-wide basis. It's a curiosity from my perspective as I've already matched, but I know there are others out there looking for this information and it's surprisingly hard to find in a reliable or consistent form.
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I think it is safe to say our hourly wage after expenses is about $120/hr, based on an 8 hour day and 48 week year, which puts us close to the average for most specialties.

Just do the math: seeing 3 outpatients per hour billing $100/visit and assuming 60% collections gives us $60/visit or $180 in revenue/hr, of which we will keep roughly 67% after overhead. This would be the typical job advertised on indeed.com, taking into account joining an already established practice booked out weeks ahead with fixed overhead and room to grow.

My own estimation which comes from cold calling psych recruiters last year is that a fresh out of residency graduate could expect roughly $220,000 for a 40 hour week, seeing 16 to 24 outpatients or rounding on 8 to 12 inpatients each day.

Some places start at < $200,000 if they are in very desirable places or have academic responsibilities that take time away from billing. Hospitals typically have some sort of RVU bonus that rewards you with a percentage of revenue from billing over your minimum expected billing. These bonuses can increase salary by about 25% but have a lot of hoops and require very efficient medicine.

90% of the offers fell into the $220,000 - $260,000 range. The median was $240,000. Most offered more for weekends/consults/ED coverage.

The places that advertise anything over $275,000 to start require you to generate well over $400,000 in billing and will come with some sort of catch which usually entails a combination of unfavorable hours/weekday call/covering a sister facility many miles away, but those jobs are also out there.
 
Sporadicus said:
I think it is safe to say our hourly wage after expenses is about $120/hr, based on an 8 hour day and 48 week year, which puts us close to the average for most specialties.

Just do the math: seeing 3 outpatients per hour billing $100/visit and assuming 60% collections gives us $60/visit or $180 in revenue/hr, of which we will keep roughly 67% after overhead. This would be the typical job advertised on indeed.com, taking into account joining an already established practice booked out weeks ahead with fixed overhead and room to grow.

My own estimation which comes from cold calling psych recruiters last year is that a fresh out of residency graduate could expect roughly $220,000 for a 40 hour week, seeing 16 to 24 outpatients or rounding on 8 to 12 inpatients each day.

Some places start at < $200,000 if they are in very desirable places or have academic responsibilities that take time away from billing. Hospitals typically have some sort of RVU bonus that rewards you with a percentage of revenue from billing over your minimum expected billing. These bonuses can increase salary by about 25% but have a lot of hoops and require very efficient medicine.

90% of the offers fell into the $220,000 - $260,000 range. The median was $240,000. Most offered more for weekends/consults/ED coverage.

The places that advertise anything over $275,000 to start require you to generate well over $400,000 in billing and will come with some sort of catch which usually entails a combination of unfavorable hours/weekday call/covering a sister facility many miles away, but those jobs are also out there.
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Very informative, thanks.

220 to 260k as you mentionned, is for a 40 hour week.

my question, as I have been banging on this thread, is what is average for a dude that works 50 to 60 hours a week.

I'm basically trying to see where psych compares with the other workaholic specialists (gen surg, cards)
 
BestDoctorEver said:
I don't know, but the two psych docs I had a chance to talk to in south FL told me they make over 300k working 40 hours/week. However, they both have their own practice for more than 15 years...
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Solid. Is this Miami metro area?
 
Blitz2006 said:
Very informative, thanks.

220 to 260k as you mentionned, is for a 40 hour week.

my question, as I have been banging on this thread, is what is average for a dude that works 50 to 60 hours a week.

I'm basically trying to see where psych compares with the other workaholic specialists (gen surg, cards)
Click to expand...

This is easy to calculate if you use Sporadicus' excellent post to start. Using a starting value of $120/hour and working 48 weeks per year, you can easily do the math:

40 hour work week - $230k
50 hours -$288k
60 hours - $345k
and so on...

It's obviously up to the individual to either find positions that offer these hours, to cobble together multiple positions, or to just start their own practice and book more patients/cover more facilities/etc, but that should be very possible in most places given current and future high demand for services.
 
Blitz2006 said:
Very informative, thanks.

220 to 260k as you mentionned, is for a 40 hour week.

my question, as I have been banging on this thread, is what is average for a dude that works 50 to 60 hours a week.

I'm basically trying to see where psych compares with the other workaholic specialists (gen surg, cards)
Click to expand...


I think the reason no one knows is because hardly anyone works that many hours in psych.

Example: earlier this year my current hospital was advertising openings to work part time in the psych ED, 8 hour shifts paying $140/hr. I asked an attending about said rate, the reality was that you could get a flat rate of $100/hr regardless of how busy it gets, or you can get $75/hr + $65 for every H&P you generate. Assuming there are beds available and it is busy enough that you can generate one admission per hour, that's theoretically $140/hr. It is a lot more likely that you will never hit that number, and will opt for the flat rate. Some days you will work every single minute and stay an hour afterwards to return phone calls and wrap things up for the new shift. This will not be compensated time.

Do a shift every Tuesday afternoon and again Saturday morning and you will have hit an extra 16 hours per week for an extra $1600 in income.

Do that every single week, 52 weeks per year, and you will have added $83,200 to your salary. At a base of 220, that is $303,200 for 56 compensated hours of work. After progressive federal and state taxes remove $0.40 per dollar earned over $186,000 you will actually pocket an additional $957 per week- that's $136 more per day, working 6 days a week, missing Saturday afternoon and getting home every Tuesday night at about 2 AM - you will likely be burned out and very unhappy all the time. You will be a surgeon.
 
3pts/hr
60% collections
33% overhead

I think these all are pretty generous numbers and more indicative of a large organization. Try this webpage (https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do?submitbutton=accept) to figure out reimbursements (if they block it just search for AMA CPT coding as it is an AMA sponsored webpage). The numbers don't lie. Rather than seeing 3 pts per hour you can see 2 and code an E/M (I typically do 99212 or 213) and an add-on therapy (usually 90833 as I always do a bit of CBT if not supportive during our sessions). My outpatient residency program is being reimbursed for therapy as are physicians in my area. The new coding is boosting incomes but practices are still learning to integrate the codes to their system and transition the 15/20min pts to 30min.

I'm still a resident and don't have hard numbers yet for a practice so take this all with a big grain of salt. All I know is that from speaking to physicians in my community, who are not cash practices BTW, there is money to be had by running your own show or teaming up with others. As residents we typically jump at the first crummy job that is thrown at us, are underpaid while we pay enormous over head because we have these gargantuan student loans that don't wait for us to find that perfect job. Don't for a second forget that others know that and are taking advantage of that fact. A well run private practice will allow you to provide good patient care while making a great income. It just takes time to build up the courage and financial resources to start such an endeavor.
 
It's sort of the ultimate grass-is-greener scenario when you have psychiatrists grasping at extra hours to get to that surgeon salary. Chat with a surgery resident or go on the surgical subspecialty boards and you will find crowds of unhappy surgeons who would gladly trade their extra salary for another 20-30 hours of family time every week but who have difficulty finding jobs that don't require coverage/weekends/a certain number of OR slots per week.

Once your salary is in the six figures your extra time that you want to use to improve your financial house is better spent reading about financial independence, smart and diversified investments, and working on streamlining/simplifying your family's budget than just churning out more gross salary.
 
SteinUmStein said:
It's sort of the ultimate grass-is-greener scenario when you have psychiatrists grasping at extra hours to get to that surgeon salary. Chat with a surgery resident or go on the surgical subspecialty boards and you will find crowds of unhappy surgeons who would gladly trade their extra salary for another 20-30 hours of family time every week but who have difficulty finding jobs that don't require coverage/weekends/a certain number of OR slots per week.

Once your salary is in the six figures your extra time that you want to use to improve your financial house is better spent reading about financial independence, smart and diversified investments, and working on streamlining/simplifying your family's budget than just churning out more gross salary.
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This is true.... Other than the tremendous weight of loan debt I have hanging over me. I would like the option of working tons of hours for a few years to pay off my debt, then relax later.

I'm sure this is true for many of us.
 
SteinUmStein said:
It's sort of the ultimate grass-is-greener scenario when you have psychiatrists grasping at extra hours to get to that surgeon salary. Chat with a surgery resident or go on the surgical subspecialty boards and you will find crowds of unhappy surgeons who would gladly trade their extra salary for another 20-30 hours of family time every week but who have difficulty finding jobs that don't require coverage/weekends/a certain number of OR slots per week.

Once your salary is in the six figures your extra time that you want to use to improve your financial house is better spent reading about financial independence, smart and diversified investments, and working on streamlining/simplifying your family's budget than just churning out more gross salary.
Click to expand...
But when you just finished residency and you look at that big loan that you have to pay back, I guess some people might want to work more hours so they can pay off that loan. I would not mind working an extra 10 hours/wk so I can pay back my loan in a faster time.... I am looking to be 250k in the red after med school...Boy! I think I should start crying now! I wonder if psych has these 30k/year in loan repayment jobs like FM/Peds/OBGYN if one works in an underserved area and/or for a CHC... I would not mind taking a 140k-150k salary if I can find a deal like that....
 
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