Curious, How much do psychiatrists generally make...??? NYC, East coast..?

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If you think about it, $1 million per year is certainly doable.

Let's break down the numbers:

You can find locum tenens job for $200 / hr.

That means the facility (i.e. CMHC) is paying the locum tenens company at least $260 / hr.

Let's assume the facility is making 20% profit off of the physician, so it is making $312 / hr (after overhead, but before paying the locum tenens company). And that is for serving patients with a wide range of insurances (low-paying to high-paying).

You think about all the people making money off of you and and say, "I'll cut out the middlemen and start my own practice."

You're willing to take insurance. And since there is a severe shortage of psychiatrists, you pick and choose the highest paying ones. Since you're willing to take insurance, your practice fills without any problems. You're also more efficient than the average psychiatrist and able to see several patients per hour. You make $400 / hr in profit. (It helps that the overhead is low.)

At 40 hours a week and for 50 weeks, $400 / hr is $800,000 a year.

If you decide to expand (i.e. hire NP / PA / psychiatrist) or include value-added services (therapy, TMS, alternative treatments), you can increase your profit without spending more time.

The type of psychiatrist who can do this -- create and grow businesses -- is different and scarcer than the run-of-the-mill employed psychiatrist. Many won't feel comfortable doing this, but a few will. It is certainly doable.

In a sense, there are a few things you can do to increase your income:

- go to somewhere underserved
- negotiate your worth
- start your own business (and find ways to maximize profit)

Most physicians have families and are rooted, so their ability to walk away during negotiations or take on business risk is severely reduced.

I agree that if you're making 3x or 4x what the average physician makes, you're not going to brag about it. Why be the target of people's envy and jealousy? Or why motivate competition to spring up?

 

[DetectiveAlonzo]

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[F0nzie]

I really feel like y'all should stop throwing these numbers out there.

Seriously.

Pretend math is more fun than actually doing it and counting how much money is left over


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[DetectiveAlonzo]

Pretend math is more fun than actually doing it and counting how much money is left over


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haha yah cause we all know the real king is that EM hourly pay tho.

😉

 

[Merely]

no point

Why did you delete your comments? You are an extremely interesting poster considering your perspective as a very successful physician/business operator and a lot of us really enjoy your insights. I really hope you don't decide to leave/stop commenting because that would certainly be a loss for the community as a whole.

 

[dl2dp2]

You can make the more by not doing therapy, not talking to patients, cutting appointment sessions down progressively shorter... That is not gonna be great care.

There also seems to be this bizarre idea that you will make bank with a cash only private practice. You can do quite well potentially with a cash practice, but I don't know of anyone who set up a psychotherapy-based cash practice for the money.

Although overall I agree with your post, the situation in the high end psychotherapy/subspecialty market is quite a bit better than you might think. There is a non-trivial number of people who make somewhere between 500k-750k doing mostly psychotherapy/combined therapy med mgmt in major markets--this is something like $600 an hour, about 25-30 clinical hours a week. There are a small number, but a non-zero number of people who can clear a mil a year doing subspecialty practice. They charge between $800-$1000 an hour.

People generally don't work that much more beyond that, since all earned income get reduced dramatically via ordinary income taxes. Usually you work for a few years and your investment income would more than replace a large portion of your hourly clinical revenue, and these high end practices tend to drop their caseload to 10-15 hours a week, plus other work such as academia or systems of care (or, if they really want $, business oriented activities, as you describe). But I would say senior clinicians in this field in a major market, especially if they have a certain reputation in the community, are quite well to do, and compare favorably to other high end professionals (i.e. corporate law, consulting, etc.) This is based on things I know, like knowing where they live, where they send their kids to school, where they vacation, etc. But if you want to play this game, the entire CV has to be shiny.

This shortening of time spent per patient thing is a U-shaped curve. At some point you end up spending more time again with a patient, since they pay you so much per minute of your time. Now, I don't know if in your mind only treating people who can pay you high fee is "ethical"...but it's certainly feasible.

Academic is a different beast. While there are wealthy academics--they tend to come from money, there are also fairly "poor" (i.e. living more of a modest middle class lifestyle) academics who are not very good with managing money. Furthermore, I know a lot of academics, and have never ever heard of an academic clearing 500k a year, even senior endowed professors...that's chairman's salary for a major department. Nevertheless, someone who can sustain a long academic career tend to do much better than their peers (i.e. PhDs).

Rank and file facility driven clinicians get average salaries as you say, but that's not what we are talking about here. I'm just pointing out exceptions do exist even for people who do only clinical work.

In average communities, some business savvy psychiatrists end up running fairly large operations, and a high proportion of their net worth is in their practice, but again that's not what we are talking about and as you described above, this isn't really clinical work.

 

[justfolks]

Just a patient, but this is spot on re the high-end market in my major East Coast city - especially the part about needing a shiny CV.


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[On Walden Pond]

Irate? How about healthy skepticism? If psych is such a lucrative field why is it relatively non-competitive to match in? 2016 AMGA survey had psych at 226K and ortho at 443K, so something is not adding up...would you believe me if I told you that I know several orthopods that work 70-80 hrs per week and make 2 million+? I hope you wouldn't bc I know none that make this amount but its analogous to what you're claiming

Residents who are graduating are getting offers around 220K for a 40 hour week. They aren't entrepreneurial, as are most psych residents coming out of residency. Hope this helps.

 

[vm26]

Residents who are graduating are getting offers around 220K for a 40 hour week. They aren't entrepreneurial, as are most psych residents coming out of residency. Hope this helps.

That sounds reasonable/accurate

 

[FranzLO]

Residents who are graduating are getting offers around 220K for a 40 hour week. They aren't entrepreneurial, as are most psych residents coming out of residency. Hope this helps.

I have heard about how flexible psychiatry is and it definitely depends on a variety of factors but I was wondering how much easier it would be to work more or find a job working like 50 hours a week or so for some extra money? Paying off my loans I know is doable but I feel that I would be comfortable working a little bit more if not a lot more than the average psychiatrist. I wouldn't intend to sacrifice patient care or anything but I am just curious how this field works, and how this would fit into outpatient vs. inpatient, moonlighting/additional jobs etc. In my head I could imagine seeing more patients in the outpatient setting to do this per day, or have an additional job if I handle an inpatient unit (I am not even sure how this works), but other than that I am not sure how it works. I just know that a lot of advice on here has said psychiatry is flexible, but I am wondering how much.