Could what happened to EM happen to psychiatry?

[Techmed07]

Just wondered to the EM forum it’s pretty frightening. The Derm page also is frightening.

I can’t imagine graduating from residency and not finding a job. Could this happen to psych— and if so how do we stop it?

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[PikminOC]

Just wondered to the EM forum it’s pretty frightening. The Derm page also is frightening.

I can’t imagine graduating from residency and not finding a job. Could this happen to psych— and if so how do we stop it?

Too late

 

[psychacad]

lol. No one can predict the future, but for now you can get a job anywhere you want (literally, anywhere), work how many hours in whatever setting you want. Can't get better than that.

 

[nexus73]

Big difference is there is no private practice emergency medicine. Emergency medicine is in an emergency room. Period. Sure you can work urgent care but that’s not really the same, and pays a lot less. So fill up the emergency rooms with fresh residency grads and mid levels and you’ve got issues for employed ED docs and downward pressure on salaries.

And really psych has so many practice locations (private practice, employed outpatient, inpatient, c/L, emergency psych, addiction psych, community mental health, FQHC, primary care consults, prison psych, etc.) and is so underserved it’s unlikely the same thing could happen. You know all the smaller town hospitals with EDs staffed with family doctors? And they have no psychiatrists at all. These small towns of 30-100,000 people could probably support 5 or more psychiatrists. And they have zero. And it’s like this everywhere you go because there are nowhere near enough psychiatrists. And coming changes with Medicare/Medicaid requirements will push health systems to expand there mental health services because they need to provide quality, which means keeping people with mental health struggles stable and reducing use of high cost inpatient beds.

Even in most big metro areas there is a shortage, though not as bad as smaller places. IMO, current trajectory indicates minimal concerns about job security or pay cuts. (...knock on wood)

 

[PikminOC]

Big difference is there is no private practice emergency medicine. Emergency medicine is in an emergency room. Period. Sure you can work urgent care but that’s not really the same, and pays a lot less. So fill up the emergency rooms with fresh residency grads and mid levels and you’ve got issues for employed ED docs and downward pressure on salaries.

And really psych has so many practice locations (private practice, employed outpatient, inpatient, c/L, emergency psych, addiction psych, community mental health, FQHC, primary care consults, prison psych, etc.) and is so underserved it’s unlikely the same thing could happen. You know all the smaller town hospitals with EDs staffed with family doctors? And they have no psychiatrists at all. These small towns of 30-100,000 people could probably support 5 or more psychiatrists. And they have zero. And it’s like this everywhere you go because there are nowhere near enough psychiatrists. And coming changes with Medicare/Medicaid requirements will push health systems to expand there mental health services because they need to provide quality, which means keeping people with mental health struggles stable and reducing use of high cost inpatient beds.

Even in most big metro areas there is a shortage, though not as bad as smaller places. IMO, current trajectory indicates minimal concerns about job security or pay cuts. (...knock on wood)

Midlevels are already starting to take over...in all settings

 

[Techmed07]

What about the fact that we keep increasing residency spots?

 

[robellis]

If we keep increasing residency spots, this will happen to every field including psychiatry. The immune fields are not increasing residency spots and have leadership that cares about their future, other leaders like EM and rad onc are willing to sell out their younger docs for immediate returns.

 

[Techmed07]

Have we been increasing residency spots? How is our leadership concerning this?

 

[dl2dp2]

I agree that a dramatic increase in residency spots will be a bigger issue. This has not been too dramatic an issue for psych.

As I said before, job market for lower-tier MD/DO/FMG etc has already worsened as they are competing against NPs for less desirable jobs. Top residency programs have not expanded their slots all that much, and the most desirable jobs in psychiatry are going to the top grads in general, and regionally to top regional program graduates. Most profitable PPs are easier to sustain in the best grads for many reasons.

If you go into psych you should be prepared to work hard in medical school and match as well as you can. This will protect somewhat against the onslaught that might happen in 10 years. If you are a top national/regional program grad you should be expecting a relatively nice lifestyle specialty (i.e. ~ 300k total comp working 40 hours a week at a facility) with a high ceiling (500k-1M all in for full time in profitable PP). If you are in a regular community program or below (i.e. state hospital program, etc), the expectation is an average job, which is typically ~250k total comp working ~ 50 hours a week at a facility with some call, or an insurance-driven PP that max out at 300k with a relatively low ceiling.

I actually think that top psych jobs have ALWAYS been quite good but the average job in this field substantially improved, which is why comeptition overall increased. Top jobs won't change much w.r.t. increased NP/ residency slots, etc.

 

[psychacad]

I agree that a dramatic increase in residency spots will be a bigger issue. This has not been too dramatic an issue for psych.

As I said before, job market for lower-tier MD/DO/FMG etc has already worsened as they are competing against NPs for less desirable jobs. Top residency programs have not expanded their slots all that much, and the most desirable jobs in psychiatry are going to the top grads in general, and regionally to top regional program graduates. Most profitable PPs are easier to sustain in the best grads for many reasons.

If you go into psych you should be prepared to work hard in medical school and match as well as you can. This will protect somewhat against the onslaught that might happen in 10 years. If you are a top national/regional program grad you should be expecting a relatively nice lifestyle specialty (i.e. ~ 300k total comp working 40 hours a week at a facility) with a high ceiling (500k-1M all in for full time in profitable PP). If you are in a regular community program or below (i.e. state hospital program, etc), the expectation is an average job, which is typically ~250k total comp working ~ 50 hours a week at a facility with some call, or an insurance-driven PP that max out at 300k with a relatively low ceiling. Jobs in low

What's your evidence for that claim?

I have quite a few IMG friends from "low tier programs" and they have had no issue whatsoever finding decent jobs in whatever geographical area they like.

As an IMG myself, I received two offers in PP in midtown San Diego with full flexibility time-wise and with a potential making 300k+ working less than 40 hours a week. AND I needed at the time H1b sponsorship.

Currently I work clinically per diem in another supposedly "super-saturated" market and on average make more than $300 an hour for on-call coverage if one counts actual work time. It's probably a better deal than PP $-wise and employers definitely aren't weeding out "low tier IMG/DOs".

This hasn't been my experience at all, and the experience of people I know as well.

 

[dl2dp2]

What's your evidence for that claim?

I have quite a few IMG friends from "low tier programs" and they have had no issue whatsoever finding decent jobs in whatever geographical area they like.

As an IMG myself, I received two offers in PP in midtown San Diego with full flexibility time-wise and with a potential making 300k+ working less than 40 hours a week. AND I needed at the time H1b sponsorship.

Currently I work clinically per diem in another supposedly "super-saturated" market and on average make more than $300 an hour for on-call coverage if one counts actual work time. It's probably a better deal than PP $-wise and employers definitely aren't weeding out "low tier IMG/DOs".

This hasn't been my experience at all, and the experience of people I know as well.

I would say the jobs you quote are average jobs. Yes, IMGs will still find jobs, but the market was better prior to the NP infusion. I am probably much older than you and I know a number of older IMGs who built very profitable PPs. Impression for them now is that this is much less accessible for younger IMGs, as insurance PPs are more willing to take on an NP. WIthin the universe of options for average IMGs, I would say the average psych job is still quite good (i.e. better than average job experience in path, neurology, general IM, peds, etc) and possibly better than mid tier (i.e. EM, anesthesia, etc).

I don't see what I say and what you say being fundamentally contradictory. Things are pretty good for now, but if you are a med student you should try your best to match as well as you can.

 

[hebel]

I agree that a dramatic increase in residency spots will be a bigger issue. This has not been too dramatic an issue for psych.

As I said before, job market for lower-tier MD/DO/FMG etc has already worsened as they are competing against NPs for less desirable jobs. Top residency programs have not expanded their slots all that much, and the most desirable jobs in psychiatry are going to the top grads in general, and regionally to top regional program graduates. Most profitable PPs are easier to sustain in the best grads for many reasons.

If you go into psych you should be prepared to work hard in medical school and match as well as you can. This will protect somewhat against the onslaught that might happen in 10 years. If you are a top national/regional program grad you should be expecting a relatively nice lifestyle specialty (i.e. ~ 300k total comp working 40 hours a week at a facility) with a high ceiling (500k-1M all in for full time in profitable PP). If you are in a regular community program or below (i.e. state hospital program, etc), the expectation is an average job, which is typically ~250k total comp working ~ 50 hours a week at a facility with some call, or an insurance-driven PP that max out at 300k with a relatively low ceiling.

I actually think that top psych jobs have ALWAYS been quite good but the average job in this field substantially improved, which is why comeptition overall increased. Top jobs won't change much w.r.t. increased NP/ residency slots, etc.

I think the reputation or 'tier' of your program has little to do with this, apart from there perhaps being a correlation between high achieving medical students ending up as high achieving attendings.

Even then, I think personability and business acumen are more important than where you trained for success in the community.

 

[psychacad]

I would say the jobs you quote are average jobs. Yes, IMGs will still find jobs, but the market was better prior to the NP infusion. I am probably much older than you and I know a number of older IMGs who built very profitable PPs. Impression for them now is that this is much less accessible for younger IMGs, as insurance PPs are more willing to take on an NP. WIthin the universe of options for average IMGs, I would say the average psych job is still quite good (i.e. better than average job experience in path, neurology, general IM, peds, etc) and possibly better than mid tier (i.e. EM, anesthesia, etc).

I don't see what I say and what you say being fundamentally contradictory. Things are pretty good for now, but if you are a med student you should try your best to match as well as you can.

Is 300k+ for something like a 30 hour work week an average job in a highly desirable location? If so, that actually makes the point even more.

 

[dl2dp2]

Is 300k+ for something like a 30 hour work week an average job in a highly desirable location? If so, that actually makes the point even more.

This is an average PP job yes. A top job would have a net per partner profit in the 500k+ range for 30 clinical hours. Remember if you work 30 clinical hours in IM you can probably make 300k these days. This type of job does not show a strong competitive advantage for psych vs. IM.

I think the reputation or 'tier' of your program has little to do with this, apart from there perhaps being a correlation between high achieving medical students ending up as high achieving attendings.

Even then, I think personability and business acumen are more important than where you trained for success in the community.

Reputation is a marker of high achievement, which makes a difference throughout your career. Interpersonal aptitude and business acumen are always more important than where you trained, but these things are not communicated through a CV when recruiters put CVs in front of people eyes. They certainly do not draw eyeballs from patients directly. Of course, once you developed a track record post-residency, that matters much more than residency itself--but then there's still reputational factors for the jobs you might draw from--it's just less clear. For example, the best sell for a PP job is an existing book of business for a PP.

 

[PikminOC]

Have we been increasing residency spots? How is our leadership concerning this?

Leadership? They are backing mid-levels and not fighting that. Better to have more Psychiatrists than more mid-level

 

[PikminOC]

What's your evidence for that claim?

I have quite a few IMG friends from "low tier programs" and they have had no issue whatsoever finding decent jobs in whatever geographical area they like.

As an IMG myself, I received two offers in PP in midtown San Diego with full flexibility time-wise and with a potential making 300k+ working less than 40 hours a week. AND I needed at the time H1b sponsorship.

Currently I work clinically per diem in another supposedly "super-saturated" market and on average make more than $300 an hour for on-call coverage if one counts actual work time. It's probably a better deal than PP $-wise and employers definitely aren't weeding out "low tier IMG/DOs".

This hasn't been my experience at all, and the experience of people I know as well.

300 k in san Diego is nothing given the cost of living there

 

[psychacad]

This is an average PP job yes. A top job would have a net per partner profit in the 500k+ range for 30 clinical hours. Remember if you work 30 clinical hours in IM you can probably make 300k these days. This type of job does not show a strong competitive advantage for psych vs. IM.

That's my point. If this is what currently an average job looks like found with minimal effort and no time, then what's behind the doomsday-predictions for anyone not graduating from a "top tier residency"? The $500+/hour cash PP have never been a standard for the field and are impossible outside a very few select markets. It's also probably double more work when you count all the extraneous "non-clinical" work needed.

300 k in san Diego is nothing given the cost of living there

OK? This is where a bit of perspective is needed.

 

[VA Hopeful Dr]

If we keep increasing residency spots, this will happen to every field including psychiatry. The immune fields are not increasing residency spots and have leadership that cares about their future, other leaders like EM and rad onc are willing to sell out their younger docs for immediate returns.

Do keep in mind that a) the US population is actively increasing - on average 10% every census and b) baby boomer docs are in the process of retiring. In Texas (only source I could really easily find) 1/4 of all psychiatrists in the state were over age 65 at the end of 2019. Might not generalize to the whole country, and admittedly psychiatrists can usually practice longer than say orthopedic surgeons, but that's still a huge number that should all be retired in the next 10-15 years at most.

 

[AD04]

Every specialty have been frightened across the ages as change is inevitable. Let's say you can accurately predict the future and that psychiatry's outlook is dimmer. How will it affect your actions? Or is this just a mental exercise? Let's say you're right and psychiatry's outlook will get worse. Will psychiatry decline slower or faster or at the same rate compared to other specialties?

Do psychiatry because you enjoy it. And if you do a good enough job and are able to negotiate well, you'll get paid well. Once you get paid well, diversify. Position yourself in a way that the future won't affect you much.

I am 99% sure I will not get replaced by NPs because they cannot and will not do what I do. But in the 1% chance that administration decides to shakes things up and pretty much torpedo the psychiatric program to the ground, I can get another job with a phone call to my network. If the worst case happens and I can't get a job again in psychiatry, my passive income already covers my living expenses and the passive income will only grow larger and larger.

Position yourself so you cannot lose so you don't have to worry about the future.

 

[jbomba]

300k for 30 hrs a week is a standard outpatient job these days?

 

[calvnandhobbs68]

Just wondered to the EM forum it’s pretty frightening. The Derm page also is frightening.

I can’t imagine graduating from residency and not finding a job. Could this happen to psych— and if so how do we stop it?

Nobody's graduating from derm and can't find a job

Is it probably more difficult in derm now to set yourself up to make 500K in LA doing cosmetics all day? Sure. That's way different than "not finding a job".

EM, as noted above, has been killing itself with its expansion of residency slots, the midlevel model in many ERs (similar to anesthesia where 1 ED doc supervises multiple midlevels) and is purely hospital based. Can't go set up an EM private practice.

 

[dl2dp2]

300k for 30 hrs a week is a standard outpatient job these days?

For outpatient, IMO the standard is 230-250k guaranteed base with total comp ~ 300k for a reasonable RVU target. Inpatient ~ 275k for 1 FTE salaried no call no weekend. This off the cuff estimate for me also conforms with MGMA/Medscape numbers.

 

[Sushirolls]

There should definitely be concerns. People are losing their jobs at Big Box shops and replaced by midlevels.

Many of the expanding telehealth Big Box shops expect volume, and pay low, stiffing you with risk.

Some docs who have started PP are hiring midlevels, one in my general metro area who opened the same time as me, has already hired an ARNP to join.

I am in a saturated market overall, and have slow, but solid growth. Being next to ARNP factory doesn't help, but just this week I picked up another disgruntled patient wanting physician level care so there is still some pocket of understanding in routine community patients the quality difference, but this is often after they spin their wheels for awhile with ARNPs and not up front when they first start seeking care.

Anticipate greater saturation into all markets and all practice settings by midlevels and with that impact on pay - not directly but indirectly - that everyone is taking the same 'good' insurance in the area. And if you start taking lower paying insurance your relative per hour gross income will be relatively less. Practice growth will be slower and can possibly be a barrier to entry into private practice. I.e. you can survive X months of limited income, but your area requires Y months of limited income and you can't survive that timeline. Midlevels in my area are teaming up with Natropaths for snake oil cash practices. Society has shifted from wanting the classic NYC archetype high rise Psychiatrist to now those who want snake oil experiences - which Psychiatrists in general are less likely to venture into these clinics.

As Big Box shops preference the cheaper ARNP - for both IP and OP - this will force more Psychiatrists into private practice OP so you now you are competing not with just ARNPs but also a handful more Psychiatrists.

Things will be tougher out there with each progressive year.

A blip will happen once the 70yo psychiatrists retire, and in my area there are a handful. But this is still 5-10 years out because they just don't ever retire. One simply moved to another area and has outreach with telemedicine to original locale...

Psychiatrists who wish to do cash only will need to be proficient and offer therapy with their management.

Med check focused docs like my self will have tougher competition with all the above.

 

[Sushirolls]

In grand summary, for Psychiatry, don't fret too much about any of this, but do as others noted above, try to strive for better brand training if able to - but not training we recognize but what people in the community will recognize. For instance UPMC we know as program with strengths. A patient in the community doesn't know or care about UPMC but if you train at Mayo or Cleveland Clinic they will recognize that name.

Secondly, pay attention to the private practice side of things, create a google drive folder and stash things away that would help you in the future as this can be your fall back. Be knowledgeable and prepared to open your own private practice.

 

[Sushirolls]

300k for 30 hrs a week is a standard outpatient job these days?

Nope.

 

[90833]

EM is going through what pharmacy and pathology have already gone through.

Take a look at the pharmacy and pathology forums. These fields have been saturated for 8+ years. New pharmacists may have some trouble finding jobs, but currently employed still have good job security. New pathologists usually have to do 1-2 fellowships, but they eventually find full time secure employment. If you are worried about losing your job, work government jobs in corrections, CMHC, and at the VA. Your administrators can’t easily swap you out for someone cheaper.

Live substantially below your means and achieve financial independence.

 

[Stagg737]

Midlevels are already starting to take over...in all settings

Yes, but their generally poor care combined with general lack of efficiency often means some job security for decent psychiatrists who can function efficiently.

Every specialty have been frightened across the ages as change is inevitable. Let's say you can accurately predict the future and that psychiatry's outlook is dimmer. How will it affect your actions? Or is this just a mental exercise? Let's say you're right and psychiatry's outlook will get worse. Will psychiatry decline slower or faster or at the same rate compared to other specialties?

I agree with your well-articulated post, but I think there is a valid answer to the bolded question. If we knew that the field would tank in 10 years and that our salaries would be slashed/job security gone, I'd be working my but off early to build up that nest egg and earn income that I can put into passive investments earlier with the hopes of successfully FIREing. Without knowing that will happen, I'm more likely to take a bit of a pay cut to do something I really enjoy and have more time off for hobbies and other activities.


@Techmed07 , as others have said there's a big difference between psych and EM and even psych and Derm. EM docs are limited to ER settings and urgent care. One could argue that they could try opening their own UC clinic or a free-standing ER, but that seems nearly impossible given the opening investment and overhead. Psych is far more flexible than any of the above fields with outpatient, inpatient, residential, PHP/IOP, long-term care facilities, state hospitals, etc as practice settings. It's relatively cheap to have your own PP in terms of overhead compared to almost every other field. There's also a far wider variety in terms of subspecialties including subspecialties which don't involve any clinical work (forensics). You can do therapy only, meds only, procedures only, etc. The flexibility and diversity of practice settings and modalities lends itself to greater security.

If you ultimately are looking for job and pay security find a niche and do something that no one else can or will do, or find a subspecialty that is so desperate for specialists that you hold all the cards (eating disorders, autism/neurodevelopmental evals, etc). Even so, I agree that there is likely solid job security in psych for generalists for at least the next 10-15 years even with mid-level encroachment and other factors.

 

[ArdorAyurveda]

What if you went to a Ivy league undergrad, top 10 med school, and then scored 20th% on Step 1 and Step 2? Not expecting to go to Havard or Yale for residency, but would this student still be competitive for residency at, say, Tulane, MCW, or Northwestern? Aiming for a residency program in a major city not on the coasts

 

[reca]

What if you went to a Ivy league undergrad, top 10 med school, and then scored 20th% on Step 1 and Step 2? Not expecting to go to Havard or Yale for residency, but would this student still be competitive for residency at, say, Tulane, MCW, or Northwestern? Aiming for a residency program in a major city not on the coasts

A 10th percentile and a 99th percentile on Step 1 are equivalent now.

 

[psychacad]

What if you went to a Ivy league undergrad, top 10 med school, and then scored 20th% on Step 1 and Step 2? Not expecting to go to Havard or Yale for residency, but would this student still be competitive for residency at, say, Tulane, MCW, or Northwestern? Aiming for a residency program in a major city not on the coasts

lol, you can get in those residency programs from literally anywhere. If you did well in med school you can also potentially get in into any program, including Yale and Harvard.

The biggest advantage of getting into a "big name" is if you're planning to stay in academia. Still, it's doable to break in those places since pay tends to be on the lower side. Many "top" programs will take IMG faculty who need visa sponsorship as well.

Otherwise it's a fairly level playing field. When push comes to shove, employers care about competency and efficiency, not a name on your CV.
Pick somewhere you see yourself practicing in the future and where you will be happy and thrive.

 

[Techmed07]

I think you just need a brand name somewhere on your CV --- Its like a marketing thing. It does appear that when a market is saturated the top places are not as affected ( eg. See law school and MBAs). I am guessing some of the posters are applying the same logic to psychiatry.

 

[nowaysanjose]

EM is going through what pharmacy and pathology have already gone through.

Take a look at the pharmacy and pathology forums. These fields have been saturated for 8+ years. New pharmacists may have some trouble finding jobs, but currently employed still have good job security. New pathologists usually have to do 1-2 fellowships, but they eventually find full time secure employment. If you are worried about losing your job, work government jobs in corrections, CMHC, and at the VA. Your administrators can’t easily swap you out for someone cheaper.

Live substantially below your means and achieve financial independence.

EM nor any physician specialty will ever be near pharmacy. Let’s not kid ourselves. Covid volumes have drastically affected EM job prospects which may or may not be temporary

edit: typo

 

[Techmed07]

Never say never.

 

[Candidate2017]

As I said before, job market for lower-tier MD/DO/FMG etc has already worsened as they are competing against NPs for less desirable jobs. Top residency programs have not expanded their slots all that much, and the most desirable jobs in psychiatry are going to the top grads in general, and regionally to top regional program graduates. Most profitable PPs are easier to sustain in the best grads for many reasons.

What is a desirable PP psychiatry job? It's sort of all the same, see patients every 20-30 minutes, all day, for a fee. +/- therapy, different patient populations, and different compensation structures but still the same.

It's always been said the better your residency, the lower your income. The richest psychiatrists I've seen are the IMGs who work their butts off, 6-7 days a week, heavy call, multiple clinics and psych wards. Sure, there are some Stephen Stahl types raking in millions, but relatively few.

 

[Candidate2017]

There should definitely be concerns. People are losing their jobs at Big Box shops and replaced by midlevels.

Many of the expanding telehealth Big Box shops expect volume, and pay low, stiffing you with risk.

Some docs who have started PP are hiring midlevels, one in my general metro area who opened the same time as me, has already hired an ARNP to join.

Midlevels may not be bright, but they are easier to work with. Physicians, especially psychiatrists, have a reputation for being very independent-minded, as opposed to team players. I'd prefer teaming up with a midlevel than my friends in a PP, unfortunately.

 

[Techmed07]

HRSA estimated that child psychiatry would be at a surplus by 2030

The recently published Health Resources and Services Administration (HRSA) “Behavioral Health Workforce Projections, 2016–2030” made the unsubstantiated determination that at most, the demand for child psychiatric services in 2016 exceeded the supply by 20%.8 Using this evaluation of current shortage, the HRSA projected an oversupply of 3720 child psychiatrists in 2030. This flawed analysis illustrates the importance of the McBain et al1 data. The HRSA estimated an annual rate of increase in child psychiatrists that was double (4.28% vs 2.17%) what was found by McBain et al.1 There is no reason to expect such a rapid increase.

 

[Sushirolls]

Midlevels may not be bright, but they are easier to work with. Physicians, especially psychiatrists, have a reputation for being very independent-minded, as opposed to team players. I'd prefer teaming up with a midlevel than my friends in a PP, unfortunately.

I've tried on numerous occasions to get my resident colleagues to join me. Geography, timing, stud loans, etc have all been barriers. I'll still take the independent minded psychiatrist over ARNP every time.

 

[ArdorAyurveda]

A 10th percentile and a 99th percentile on Step 1 are equivalent now.

not quite yet, i'm taking step 1 in july so still scored

 

[Stagg737]

HRSA estimated that child psychiatry would be at a surplus by 2030

The recently published Health Resources and Services Administration (HRSA) “Behavioral Health Workforce Projections, 2016–2030” made the unsubstantiated determination that at most, the demand for child psychiatric services in 2016 exceeded the supply by 20%.8 Using this evaluation of current shortage, the HRSA projected an oversupply of 3720 child psychiatrists in 2030. This flawed analysis illustrates the importance of the McBain et al1 data. The HRSA estimated an annual rate of increase in child psychiatrists that was double (4.28% vs 2.17%) what was found by McBain et al.1 There is no reason to expect such a rapid increase.

I don't buy this. The kids who really need the psychiatric help, aka the ones "in the system", don't get nearly the help they actually need in most places and many sub-specialty areas like the ones I listed above (eating disorders, autism evals) are in woefully short supply. I'm in a metro of ~2mil and I've been told there are 2 docs that do autism evals and very limited options for eating d/o treatments. Last I was told (about a year ago) it was at least a full year wait to get an autism eval from a child-psych specialist here. This was from a pediatrician who has numerous kids they want to refer for these evals.

Also, your quote is saying that the HRSA is significantly overestimated the saturation. Regardless, I highly doubt it will be an issue in the near future.

 

[ArdorAyurveda]

What is the market like for eating disorders? Is a "fellowship" in eating disorder necessary? I imagine it'd be pretty easy to go cash pay in a wealthy suburb/urban area

 

[Mad Jack]

Do keep in mind that a) the US population is actively increasing - on average 10% every census and b) baby boomer docs are in the process of retiring. In Texas (only source I could really easily find) 1/4 of all psychiatrists in the state were over age 65 at the end of 2019. Might not generalize to the whole country, and admittedly psychiatrists can usually practice longer than say orthopedic surgeons, but that's still a huge number that should all be retired in the next 10-15 years at most.

Trouble is, psych docs are uniquely positioned to practice into very old age. Larger cohorts that practice longer could ultimately result in a glut in the market. I would encourage anyone to work hard, save hard, and get enough cash to be able to walk away regardless of their field. Be it a glut or massive changes in the way medicine is structured in the country, any number of factors could make you obsolete or miserable. Hope for a long, happy, successful career, but plan for what happened to path to happen to you

 

[Mad Jack]

What is the market like for eating disorders? Is a "fellowship" in eating disorder necessary? I imagine it'd be pretty easy to go cash pay in a wealthy suburb/urban area

Eating disorder market is good, but the liability and stress of the job are quite high

 

[dl2dp2]

What is a desirable PP psychiatry job? It's sort of all the same, see patients every 20-30 minutes, all day, for a fee. +/- therapy, different patient populations, and different compensation structures but still the same.

It's always been said the better your residency, the lower your income. The richest psychiatrists I've seen are the IMGs who work their butts off, 6-7 days a week, heavy call, multiple clinics and psych wards. Sure, there are some Stephen Stahl types raking in millions, but relatively few.

Eh. Don't study and match poorly. Hang your hope on people don't care about residency reputation. Be my guest.

It's not sort of all the same. One job pays $800 an hour, one job pays $200 an hour.

 

[jbomba]

Eating disorder market is good, but the liability and stress of the job are quite high

In reality what is the psychiatrists role in this type of practice? My understanding is the heavy lifting is done by therapists with medicine docs managing the medical issues if on an inpatient unit.

 

[robellis]

Eh. Don't study and match poorly. Hang your hope on people don't care about residency reputation. Be my guest.

It's not sort of all the same. One job pays $800 an hour, one job pays $200 an hour.

What job that you can apply for pays 800 per hour?

 

[dl2dp2]

What job that you can apply for pays 800 per hour?

Why would you think you'd "apply" for a job? I think this is where being an IMG very seriously disadvantage you. IMGs by and large have NO clue how starting a business in the US works. You get invited for such a job. I've never applied for a job that pays $800 an hour. In fact, I've never applied (seriously) for a job. LOL. People find me and they ask me how much I charge, and then they either agree to it or not. They offer me jobs and I make a counteroffer. If you go to a university program with a regional reputation you generally don't need to apply for jobs in psych.

 

[IsWhat]

Us American grads learn SO much about the business side of medicine in medical school. /s

 

[psychacad]

I graduated from a top 5 residency program. 90% ended in "regular" jobs in normal hospitals or stayed in academia as faculty, research or fellowship. All of them had to "apply" for a job. A few started PP while taking insurance and most certainly aren't getting paid $800 an hour. Those are rare PP opportunities that need years to build in very select marketplaces. Having a big name definitely makes your name jump on an application but it doesn't get you an $800/hr job. lol. And even if it did, is catering to the hyperrich the minimal standard for a decent job? Theres a point where elitism becomes a joke on itself.

 

[Mad Jack]

In reality what is the psychiatrists role in this type of practice? My understanding is the heavy lifting is done by therapists with medicine docs managing the medical issues if on an inpatient unit.

Only ED people I know had a heavy inpatient component, but basically they handled everything from meds to phosphate levels to diets, worked with nutritionists and therapists, but if things went wrong the finger is being pointed at the doc. Given that eating disorders are second only to gender dysphoria in mortality, and given that the patients tend to be younger and with higher SES families, you're in a pretty ugly spot when one dies

 

[Techmed07]

Why would you think you'd "apply" for a job? I think this is where being an IMG very seriously disadvantage you. IMGs by and large have NO clue how starting a business in the US works. You get invited for such a job. I've never applied for a job that pays $800 an hour. In fact, I've never applied (seriously) for a job. LOL. People find me and they ask me how much I charge, and then they either agree to it or not. They offer me jobs and I make a counteroffer. If you go to a university program with a regional reputation you generally don't need to apply for jobs in psyc

I know people with Harvard - Yale pedigree that are working for high end residential pulling in $700/eval/hr. The guy contractor is definitely a med school/residency/fellowship snob. Law school and business school brands have a similar effect. Their networks just opens them up for different types of employment and opportunities. I don’t see why psychiatry would be different.

Edit—typo