Current Practice Environment

[George Anderson]

I wanted to share my observations regarding the current practice environment in my area. As many of you may know I have been out of residency for almost a year. I have a part-time community mh job and a private practice in one of the 10 largest cities in the US.

First observation: Psychiatric nurse practitioners out number Psychiatrists 4:1 in several of the community agencies. In a state that offers independent practice without differentiation of roles except in certain legal situations such as inpatient psychiatry this significantly reduces the number of job openings.

Second observation: 2 fresh grads from my program were laid off from a large multispecialty clinic after the outpatient psychiatry department was axed. They are back at home.

Third observation: One of the major community mh providers laid off a large number of their child psychiatrists and replaced them with psychiatric nurse practitioners.

Fourth observation: Several large multispecialty practices in pediatrics, developmental pediatrics are hiring psychiatric nurse practitioners to perform the role of a child psychiatrist and self referring.

Fifth observation: Nurse practitioners are taking an entrepreneurial role and hiring large numbers of therapists and generating internal referrals for their private practices.

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[George Anderson]

This is useful information for all providers. It now seems clear that Psychiatric nurse practitioners and Physician Assistants will be the real winners under the Affordable Care Act. Psychiatrists and psychologists along with counselors will be toast. Social workers will be used for home visits and discharge planning.

 

[SteinUmStein]

This is useful information for all providers. It now seems clear that Psychiatric nurse practitioners and Physician Assistants will be the real winners under the Affordable Care Act. Psychiatrists and psychologists along with counselors will be toast. Social workers will be used for home visits and discharge planning.

Define what you mean by "toast." Unemployed? Underpaid? Overworked? Underworked?

 

[@JackShephard]

This is useful information for all providers. It now seems clear that Psychiatric nurse practitioners and Physician Assistants will be the real winners under the Affordable Care Act. Psychiatrists and psychologists along with counselors will be toast. Social workers will be used for home visits and discharge planning.

I agree that midlevels win in the ACA, in almost every field but surgery.

Define what you mean by "toast." Unemployed? Underpaid? Overworked? Underworked?

By toast he means paid less. There's still enough need to go around to employ nearly everyone.

 

[SteinUmStein]

That makes more sense. Toast to me means gone, not decreased in pay, so I was confused since I have yet to hear that the ACA would put psychiatrists out of work. If anything we've got a lot more patients with coverage who are now seeking care.

 

[F0nzie]

This is useful information for all providers. It now seems clear that Psychiatric nurse practitioners and Physician Assistants will be the real winners under the Affordable Care Act. Psychiatrists and psychologists along with counselors will be toast. Social workers will be used for home visits and discharge planning.

The way healthcare is being delivered is changing. Combined with the shortage of psychiatrists and certain state legislations, a masters in nursing is the new minimum standard to practice psychiatry.

Psych NPs in my state make 150k working 4 days a week-- masters level nursing, no residency, no MCAT, no USMLE, no CME, no board certification, no MOC, lower malpractice (apparently). Since this is an ultra low barrier to entry and is a super lean financial/physical/emotional investment, it is an attractive package for anybody with average intelligence and decent work ethic that wants to make a good living.

I already know how the current environment affects me. As an MD I still have a competitive edge with employers that strive for high standards (with their non-compete clauses and board certification requirements... which I am not interested in for personal reasons) and my own private practice where I only accept cash. In places with limited funding I am not necessarily the best option.

The part that concerns me is the large private insurance outpatient groups that are folding and the clinical positions that are quickly being occupied by nps. They may not replace our knowledge or experience but sheer numbers of nps in the future may result in less available positions if the creation of these positions continue to be limited by the availability of state/federal funding or employer subsidies. It's pretty clear to me that when it comes to Psychiatry, need does not equal demand and playing the shortage card does not mean we will be practicing psychiatry the way we envision.

 

[George Anderson]

I agree that midlevels win in the ACA, in almost every field but surgery.



By toast he means paid less. There's still enough need to go around to employ nearly everyone.

Jack,
This was clearly a poor choice of words. Paid less is more likely.

 

[@JackShephard]

Psych NPs in my state make 150k working 4 days a week-- masters level nursing, no residency, no MCAT, no USMLE, no CME, no board certification, no MOC, lower malpractice (apparently). Since this is an ultra low barrier to entry and is a super lean financial/physical/emotional investment, it is an attractive package for anybody with average intelligence and decent work ethic that wants to make a good living.

And that is the problem. I can't imagine what life would be like without having to meet all these requirements.

The fact that a nurse can skate through rather benign training and earn 150k is mind blowing. At least the nurse anesthetists can argue they have high quality skills for their niche - I'm not quite sure if the Psych NP can say the same.

NPs will follow the $ and the path of least resistance. I'm sure it's much better to be a psych NP than an internal medicine NP. If psych pays more than derm, emergency, surgery or IM subspecialties, then they will fill that role - and not in rural areas, they will go to the desirable places to live.

Jack,
This was clearly a poor choice of words. Paid less is more likely.

I'm not doing psychiatry but I did enjoy the rotation and found it interesting.

Edit: I hate to say this guys, but who in their right mind could recommend getting an MD to practice psychiatry when you could get an NP and get paid 150k. No weed out pre-med classes, no MCAT, no pre-clinical sciences, no surgery/IM, no Step 1, 2, 3, little malpractice. It's almost not fair that the government would let these 2 VERY different paths do similar work (excluding complex patients and in patient).

 

[SteinUmStein]

I don't think many people outside of psychiatry have been recommending students to get an MD for this purpose in recent years. Every attending I had outside of psychiatry was pretty much saying saying it was a waste of time, either directly or indirectly. I got a lot of eye rolls when they found out I was interested in psych, and not just from surgeons. Even our esteemed medicine and neurology colleagues with whom we frequently rotate hold a good bit of contempt that they more or less hide when we're around. This is not a specialty for those with thin skin.

I do wonder what it will take for NP privileges to get dialed back a bit, maybe a high-profile botched case or a broader published evaluation of their outcomes vs. MD's/DO's.

Quick edit: And when has the government had any interest in "fair"? The public holds no pity for "rich doctors."

 

[Mistuda]

Considering I was deciding b/w 2 specialties, had very competitive board scores, and went with my gut and applied to psychiatry (I'm a 4th year) b/c I enjoyed my rotation and the field the most..this thread is disheartening to say the least. Psych can't be nearly this doom and gloom...right???

 

[SteinUmStein]

Considering I was deciding b/w 2 specialties, had very competitive board scores, and went with my gut and applied to psychiatry (I'm a 4th year) b/c I enjoyed my rotation and the field the most..this thread is disheartening to say the least. Psych can't be nearly this doom and gloom...right???

I'm in a similar spot, almost all specialty options were on the table (which is frustrating when people assume you're doing psych because you didn't work M3 year or bombed the boards), and I decided against a somewhat more competitive specialty and picked psych because I loved it. I guess it comes down to what you want to do every day. No amount of money or prestige will make up for what you do 40++ hours/week for the rest of your career. If we end up making NP salaries down the road, most of us will be fine. Those who have massive debt loads just won't have the luxury of choosing specialties like family medicine, psych, or gen med/gen peds. And it will probably be a luxury in 10 or 15 years to pick those specialties if things continue on their current trajectory. It's not practical to spend this much time, money, and effort on a career to end up in the same spot as a nurse with a master's degree.

However, I'd do it all again in a heartbeat. In the marathon of life the only person you're racing is yourself.

Edit: To go beyond cheesy platitudes, some practical advice I've heard - Find a niche that you enjoy that you are good at. Things like CL, forensics, but not just fellowships - get experience in quality improvement, administration, teaching, research. With skills in a niche area or multiple areas you will find a great position somewhere.

 

[Psychotic]

Considering I was deciding b/w 2 specialties, had very competitive board scores, and went with my gut and applied to psychiatry (I'm a 4th year) b/c I enjoyed my rotation and the field the most..this thread is disheartening to say the least. Psych can't be nearly this doom and gloom...right???

This thread is being carpet bombed with gloom, doom, and negativity by a couple of posters I have never heard of before - Jack Shepherd and George Anderson (and both with just a handful of posts, and one joined SDN yesterday, the other less than a month go), posting alongside the most negative of psych posters with a long track record of vitriol, Vistaril.

Keep that in mind before deciding you are being fed truth from on high from the most insightful of psychiatry masters. I don't know who these guys are, and I don't really care what any of them have to say about these or any other matters.

 

[moonshined]

.

 

[@JackShephard]

This thread is being carpet bombed with gloom, doom, and negativity by a couple of posters I have never heard of before - Jack Shepherd and George Anderson (and both with just a handful of posts, and one joined SDN yesterday, the other less than a month go), posting alongside the most negative of psych posters with a long track record of vitriol, Vistaril.

Keep that in mind before deciding you are being fed truth from on high from the most insightful of psychiatry masters. I don't know who these guys are, and I don't really care what any of them have to say about these or any other matters.

Hey, I wish you guys the best. I was just projecting based on my knowledge of government and business/economics. I hope my guesses were wrong.

I've used sdn for around 5 years, I lost my log in info.

 

[Nasrudin]

I'm certainly paying close attention to Fonzie's reports. And wondering to myself if state policies are going to factor into where I set up for work. Let's not be too certain about dismissing this and calling it gloomy or elevating it to a pervasive inevitablility just yet.

I'm watching all of it closely. It won't be horrible wherever we end up compensation wise. But I see nothing that would indicate we couldn't quite easily be in for some huge hits--only one of which is competition from NP's.

 

[@JackShephard]

Are you implying that they may all be in the same residency program and have similar experience/views?

I don't know what he's implying. My argument was summed up by the poster on the other page who mentioned medical training is to blame.

Ask yourself this, can we train *insert medical specialty* faster? If yes, then the midlevels will move in during the next decade (it's already happening, it's not even conjecture).

This happened in anesthesia, you can train basic anesthesia faster than 4 yr UG, 4 yr med school, 4 years residency. 12 years is too long to train - midlevels will step in. Same with psych, 12 years is too long. Surgery is an example of the opposite, it really does take 12 or more years to train them. No midlevels will be encroaching.

I don't think this is new information, I think the new information has come from the practicing psychiatrists saying that it is already happening today.

If I'm 100% wrong then great! I hope I am. If not, then I'm happy to raise the discussion for those considering this field. Either way, it doesn't affect me - so I hope the best for everyone here. I know our training is 10x harder.

 

[@JackShephard]

I'm certainly paying close attention to Fonzie's reports. And wondering to myself if state policies are going to factor into where I set up for work. Let's not be too certain about dismissing this and calling it gloomy or elevating it to a pervasive inevitablility just yet.

I'm watching all of it closely. It won't be horrible wherever we end up compensation wise. But I see nothing that would indicate we couldn't quite easily be in for some huge hits--only one of which is competition from NP's.

Exactly, I'm done with this discussion. Good luck everyone.

I don't think you ignore this nor do I think it's gloom and doom. Physicians in general need to get more involved politically and think about how other groups are working against them for their own greed and self interest at the expense of physicians.

 

[Psychotic]

Are you implying that they may all be in the same residency program and have similar experience/views?

No. Just that this is an anonymous internet forum, and I have no idea who these people are or what axe they have to grind.

 

[vistaril]

NPs will follow the $ and the path of least resistance. I'm sure it's much better to be a psych NP than an internal medicine NP. If psych pays more than derm, emergency, surgery or IM subspecialties, then they will fill that role - and not in rural areas, they will go to the desirable places to live.

I'm not doing psychiatry but I did enjoy the rotation and found it interesting.

Edit: I hate to say this guys, but who in their right mind could recommend getting an MD to practice psychiatry when you could get an NP and get paid 150k. ).

I don't think 150k for a 40(or less) hour week is typical for psych nps in most areas. VAs are paying outpt psych nps 95-100k in my area for full time work, and starting outpt psychs(M-F, no inpatient so no call) at around 150-155k.

I do know some psych nps making 150kish, but they are doing so by hustling....combining 2 2/3rdish time jobs to get above 50-55 hrs/week for example.

What I see happening is psych np salaries eventually coming down some in psych as supply catches up with how sweet a deal it is now. And internal med PA/NP salaries probably bumping up a bit more. What I actually see in the future(and already know of some examples) is medicine pas/nps doing most of the day to day hospitalist duties which allow the im hospitalist groups to cover multiple services. This makes sense economically for everyone....the hospitals and the hospitalists(who can easily top 500k in many areas with such setups if they work hard)

 

[Psychotic]

I'm certainly paying close attention to Fonzie's reports. And wondering to myself if state policies are going to factor into where I set up for work. Let's not be too certain about dismissing this and calling it gloomy or elevating it to a pervasive inevitablility just yet.

I'm watching all of it closely. It won't be horrible wherever we end up compensation wise. But I see nothing that would indicate we couldn't quite easily be in for some huge hits--only one of which is competition from NP's.

I am not dismissing any of it, just looking for more balanced perspective than focusing solely on what a couple of interlopers on a psych thread are spreading. Medicine is undergoing big changes, a process that started 10+ years ago with declining reimbursements, and now the fallout from Obamacare is still just being sorted out. My point is that this thread got too one-sided, that's all. The one dude isn't even going into psych, but he just came over here to help us out, I guess.

 

[vistaril]

I don't know what he's implying. My argument was summed up by the poster on the other page who mentioned medical training is to blame.

Ask yourself this, can we train *insert medical specialty* faster? If yes, then the midlevels will move in during the next decade (it's already happening, it's not even conjecture).

This happened in anesthesia, you can train basic anesthesia faster than 4 yr UG, 4 yr med school, 4 years residency. 12 years is too long to train - midlevels will step in. Same with psych, 12 years is too long. Surgery is an example of the opposite, it really does take 12 or more years to train them. No midlevels will be encroaching.

I don't think this is new information, I think the new information has come from the practicing psychiatrists saying that it is already happening today.

If I'm 100% wrong then great! I hope I am. If not, then I'm happy to raise the discussion for those considering this field. Either way, it doesn't affect me - so I hope the best for everyone here. I know our training is 10x harder.

well and no midlevels will ever encroach on surgery because the 'key step' requires a sh*tton of actual hands on OR time....something that a PA or np would simply never get access to in their training.

also the procedure based medicine specialties will be safe as well. Midlevels will continue to grow in those fields but always in a way that completely protects the role of the physician.

the fields that are obviously most protected by midlevels are all surgical fields. Then the IM subspecialties are pretty safe as well....and yes this even includes the more cognitive based IM subspecialties.

Inpatient medicine has some more decent years imo...but will eventually go downhill. I think what you are going to see in the next decade is PAs doing more of the grunt work on hospitalist services and increasing physician productivity and thus salaries. But eventually, the hospitals and payers will win this battle and hospitalist salaries will stagnate.

Outpt family medicine will be hurt. And psych. Probably outpt psych(for all but the boutique cash practices) more than inpatient(but this will be hit too)

 

[George Anderson]

I'm in a similar spot, almost all specialty options were on the table (which is frustrating when people assume you're doing psych because you didn't work M3 year or bombed the boards), and I decided against a somewhat more competitive specialty and picked psych because I loved it. I guess it comes down to what you want to do every day. No amount of money or prestige will make up for what you do 40++ hours/week for the rest of your career. If we end up making NP salaries down the road, most of us will be fine. Those who have massive debt loads just won't have the luxury of choosing specialties like family medicine, psych, or gen med/gen peds. And it will probably be a luxury in 10 or 15 years to pick those specialties if things continue on their current trajectory. It's not practical to spend this much time, money, and effort on a career to end up in the same spot as a nurse with a master's degree.

However, I'd do it all again in a heartbeat. In the marathon of life the only person you're racing is yourself.

Edit: To go beyond cheesy platitudes, some practical advice I've heard - Find a niche that you enjoy that you are good at. Things like CL, forensics, but not just fellowships - get experience in quality improvement, administration, teaching, research. With skills in a niche area or multiple areas you will find a great position somewhere.

I am all for optimism along with developing competence in a niche that is needed and wanted by persons able to pay. I am an LCSW with Post Graduate Trainng in Child Psychotherapy. I am from the good old days. I graduated from Smith College School of Social Work in 1971 and completed my Post Graduate Fellowship from Harvard in 1974. During the 80s and part of the 90s, my wife and I owned a Psychiatric Clinic that operated in 12 states. We had psychiatrists, psychologists and clinical social workers on a contractual basis.Our income was quite substantial for 12 years.

When Managed Health Care was established, we lost all of our contracts. I re-invented myself by writing a simple curriculum for use with male batterers'. This curriculum was published in 8 languages. I quickly became a major provider in this niche. Several years later, I wrote a curriculum in Anger Management. The Anger Management niche proved to be more lucrative and having a wider range of use than DV.

Five years ago, I was asked by a major hospital chain to write a curriculum for use with "disruptive physicians". This model is based on Emotional Intelligence. I am now the largest provider in the nation providing coaching for "disruptive physicians" and selling licensing agreements to physicians who wish to use my model

I have multiple streams of income from the sell of my training material, live and on-line training as well as coaching. For every client seen, I am paid in advance a substantial amount.

I am telling this story because if a non-physician can suceed in a niche that is needed and wanted by persons (physicians) with the ability to pay, so can anyone reading this post.

 

[Nasrudin]

I am all for optimism along with developing competence in a niche that is needed and wanted by persons able to pay. I am an LCSW with Post Graduate Trainng in Child Psychotherapy. I am from the good old days. I graduated from Smith College School of Social Work in 1971 and completed my Post Graduate Fellowship from Harvard in 1974. During the 80s and part of the 90s, my wife and I owned a Psychiatric Clinic that operated in 12 states. We had psychiatrists, psychologists and clinical social workers on a contractual basis.Our income was quite substantial for 12 years.

When Managed Health Care was established, we lost all of our contracts. I re-invented myself by writing a simple curriculum for use with male batterers'. This curriculum was published in 8 languages. I quickly became a major provider in this niche. Several years later, I wrote a curriculum in Anger Management. The Anger Management niche proved to be more lucrative and having a wider range of use than DV.

Five years ago, I was asked by a major hospital chain to write a curriculum for use with "disruptive physicians". This model is based on Emotional Intelligence. I am now the largest provider in the nation providing coaching for "disruptive physicians" and selling licensing agreements to physicians who wish to use my model

I have multiple streams of income from the sell of my training material, live and on-line training as well as coaching. For every client seen, I am paid in advance a substantial amount.

I am telling this story because if a non-physician can suceed in a niche that is needed and wanted by persons (physicians) with the ability to pay, so can anyone reading this post.

Fascinating background! Thanks for stopping by to comment. I hope to hear more of your thoughts.

 

[Tyrone Slothrop]

I am all for optimism along with developing competence in a niche that is needed and wanted by persons able to pay. I am an LCSW with Post Graduate Trainng in Child Psychotherapy. I am from the good old days. I graduated from Smith College School of Social Work in 1971 and completed my Post Graduate Fellowship from Harvard in 1974. During the 80s and part of the 90s, my wife and I owned a Psychiatric Clinic that operated in 12 states. We had psychiatrists, psychologists and clinical social workers on a contractual basis.Our income was quite substantial for 12 years.

When Managed Health Care was established, we lost all of our contracts. I re-invented myself by writing a simple curriculum for use with male batterers'. This curriculum was published in 8 languages. I quickly became a major provider in this niche. Several years later, I wrote a curriculum in Anger Management. The Anger Management niche proved to be more lucrative and having a wider range of use than DV.

Five years ago, I was asked by a major hospital chain to write a curriculum for use with "disruptive physicians". This model is based on Emotional Intelligence. I am now the largest provider in the nation providing coaching for "disruptive physicians" and selling licensing agreements to physicians who wish to use my model

I have multiple streams of income from the sell of my training material, live and on-line training as well as coaching. For every client seen, I am paid in advance a substantial amount.

I am telling this story because if a non-physician can suceed in a niche that is needed and wanted by persons (physicians) with the ability to pay, so can anyone reading this post.

How do you break into this sort of work or initially start selling your materials?

 

[@JackShephard]

I am all for optimism along with developing competence in a niche that is needed and wanted by persons able to pay. I am an LCSW with Post Graduate Trainng in Child Psychotherapy. I am from the good old days. I graduated from Smith College School of Social Work in 1971 and completed my Post Graduate Fellowship from Harvard in 1974. During the 80s and part of the 90s, my wife and I owned a Psychiatric Clinic that operated in 12 states. We had psychiatrists, psychologists and clinical social workers on a contractual basis.Our income was quite substantial for 12 years.

When Managed Health Care was established, we lost all of our contracts. I re-invented myself by writing a simple curriculum for use with male batterers'. This curriculum was published in 8 languages. I quickly became a major provider in this niche. Several years later, I wrote a curriculum in Anger Management. The Anger Management niche proved to be more lucrative and having a wider range of use than DV.

Five years ago, I was asked by a major hospital chain to write a curriculum for use with "disruptive physicians". This model is based on Emotional Intelligence. I am now the largest provider in the nation providing coaching for "disruptive physicians" and selling licensing agreements to physicians who wish to use my model

I have multiple streams of income from the sell of my training material, live and on-line training as well as coaching. For every client seen, I am paid in advance a substantial amount.

I am telling this story because if a non-physician can suceed in a niche that is needed and wanted by persons (physicians) with the ability to pay, so can anyone reading this post.

Very impressive and definitely an opinion that I would value more than my own.

 

[F0nzie]

Thanks for sharing George.

This doesn't need to be a doom and gloom thread... everyone thought a 2nd recession was going to hit several years ago and yet the stock market was on fire.

 

[George Anderson]

How do you break into this sort of work or initially start selling your materials?

I am new to this forum. I would be happy to share once I am more seasoned.

 

[Tyrone Slothrop]

I am new to this forum. I would be happy to share once I am more seasoned.

Well considering you've been practicing a fair bit longer than I've been alive, I'm almost certain you're seasoned enough.

Whenever you're up for it, I'm looking forward to hearing what you have to say. Thank you for sharing your experience with us.

 

[George Anderson]

I am actually honored to have an opportunity to share my experiences with a new generation of clinicians. Given the length of time that I have been in practice, it may be worth suggesting that anyone interested in my work may also visit my website at www.andersonservices.com or googling me: George Anderson anger management.

Here are some of my suggestions:

• If patient care is your goal, stay with this and begin planning early for the steps needed to be successful.
  
  
• Select the best program available and invest in mastering whatever interest you.
  
  
• Rather than focusing on the present, consider potential needs of those you wish to serve. i.e. When I decided to focus on anger management, I read Goleman’s book on Emotional Intelligence. I quickly determined that a focus on “impulse control” may offer more potential benefits than just techniques for managing anger.
  
  
• When writing my workbooks for anger management, batterers’ intervention and coaching for disruptive physicians, I purposely decided to self-publish so as to avoid having to share the profits with any source. This proven to be a good decision as my profit margins are very high. i.[GA1].
  

[GA1]

 

[George Anderson]

How do you break into this sort of work or initially start selling your materials?

Tyrone,
I suggest that you select a niche that is needed and wanted by persons able to pay and demonstrate your competence by writing articles, blogs and presentations at conference and workshops.
Social media is an incredible opportunity for all of us to establish a presence on the Internet.
In my opinion, Emotional Intelligence offers the greatest new niche for psychologists who wish to do good and well.

 

[George Anderson]

Thanks for sharing George.

This doesn't need to be a doom and gloom thread... everyone thought a 2nd recession was going to hit several years ago and yet the stock market was on fire.

FOnzie,
I agree with you. I suggest that the current situation be considered an opportunity for those interested in expanding their practice options.
In my opinion, Emotional Intelligence skill enhancement is too often overlooked by clinicians. This is a very popular intervention for
well educated persons who often will pay for coaching or training as well as businesses interested in increasing their bottom line.

I am impressed with your posts.

 

[George Anderson]

The following may be a bit skewed because it's based on one region of the country. I was recently looking for a new job and interviewed at places in the big city (3 million + in the metro area) all the way out to a 30,000 person town with a lonely inpatient unit. My experience echoes what others have posted on these forums. Big cities do not have a psychiatrist shortage for good jobs (child psych excluded in this statement).

The employers I met with in the big city had been interviewing several candidates over the previous month and the pay and benefits were much lower. I was clearly one of several applicants they were considering for about 180K salary job. In the smaller cities/towns, they had been advertising positions for more than 1 year, filling with locums, and couldn't get anyone to sign on despite paying significantly more (230-260K per year, base +RVU, with better reimbursement for moving, sign on, CME etc). A friend interviewed at a community mental health center in the bigger city and said he was offered 130K for full time work (30 minute follow up, 60 minute intake, with 60 minutes of charting time a day). So it's not surprising to me that Fonzie applied to 10 places and only got 2 interviews, there is much more competition in metropolitan areas.

I've also seen a lot of part-time psychiatrist mom's or dad's who are married to a spouse with a corporate job that is basically paying for everything. The psychiatrist spouse seems content to work 2 days a week and looks at their occupation less like a job and more like a hobby. Not really concerned about the paycheck. I think they may be driving the market rate for psychiatrists down in the larger markets.

One of the most underserved populations in the nation are hiding in full view. Physicians are prone to a wide variety of work related issues that lead to depression, burnout, anxiety, suicide, poor impulse control and divorce. My greatest source of income is from providing Emotional Intelligence Coaching for "disruptive physicians". I have expanded my reach to include civility training for attorneys and coaching for executives.
If this can be done by an LCSW, why not a physician, psychologist or psychiatrist.

I am routinely paid $4,900 - $5,900 in advance for the coaching I offer. I am paid $5000 for a 45 minute presentation. Why spend all of your time and energy on fighting a losing battle? Last year, I received $15,00 for a four hour presentation for 50 physicians.

 

[Psychotic]

Ummm...we been spammed.

 

[Tyrone Slothrop]

Ummm...we been spammed.

Hardly, we've been given insight from a successful working professional in an avenue that is new to me at least. It beats most of the discussion we see here.

 

[Psychotic]

Hardly, we've been given insight from a successful working professional in an avenue that is new to me at least. It beats most of the discussion we see here.

Even if it is "insightful" (meaning something you hadn't thought of?), it is still spam-ish.

There is a lesson here: the pessimistic gloom and doomers spend all of their time telling us the end is nigh. The optimists look for entrepreneurial ways to turn their hard earned professional standing and expertise into cash flow. I plan to be in the latter group myself, but I was already in that camp before reading this thread. If this "spam" served as your wake-up call, welcome aboard!

 

[touchpause13]

Sorry if this is a n00b question, but a lot of the NP encroachment seems to be very state dependent. I'm curious if some states or parts of the country are more psychiatrist friendly than others?

 

[George Anderson]

Ummm...we been spammed.

Please accept my apology. I did not think of my post being spam.

 

[George Anderson]

Ummm...we been spammed.

Please accept my apology. I did not think of my post as spam.

 

[George Anderson]

Ummm...we been spammed.

I am doing my best to apologize to you. I did not consider my post spam.

 

[notdeadyet]

I am doing my best to apologize to you. I did not consider my post spam.

I'm not saying you're spamming or not spamming, but when you post on a forum designed for physicians, mention services you provide to physicians, quote prices, and provide a link to your web-page that advertises how to contract with you, it comes across as spamming.

 

[Psychotic]

I am doing my best to apologize to you. I did not consider my post spam.

Doesn't really matter what I think, or what you think. If it is spam, a moderator will do something about it. No apology to me is necessary.

I am just a cynical dude, and I get sick of reading the "sky is falling" from a bunch of negative nancy's without any countering discussion. You must admit it is odd that you showed up on this thread out of the blue, chiming in on the shrinking money pie for psychiatrists, and lo and behold, you soon reveal that you sell anger management therapy to doctors! Some of the people on this site could probably benefit from your services, btw...hello, Vistaril?

 

[George Anderson]

I'm not saying you're spamming or not spamming, but when you post on a forum designed for physicians, mention services you provide to physicians, quote prices, and provide a link to your web-page that advertises how to contract with you, it comes across as spamming.

I'm not saying you're spamming or not spamming, but when you post on a forum designed for physicians, mention services you provide to physicians, quote prices, and provide a link to your web-page that advertises how to contract with you, it comes across as spamming.

You failed to notice is that Tyrone and FOunzie asked that I share my experience.

 

[notdeadyet]

You failed to notice is that Tyrone and FOunzie asked that I share my experience.

You listed the services you provide to physicians, the prices you charge, and a link to your company website. I'm just trying to highlight why some might interpret this as spam.

I've got no skin in this game, just trying to highlight why your post might come across a commercial in nature.


Sent from my iPhone using Tapatalk

 

[beezley]

Attending, midwest, employed full time OP. Rural areas are screaming for psychiatrists. Very few NPs that are interested in/do psychiatry in this area. If you go rural at all, tons of opportunities for an MD/DO psychiatrist. 40 hours, starting close to 200k. Feel respected (almost alarmingly so) for my training. Get out of the city rat race if that is what you want.

 

[SteinUmStein]

Seriously, the need is great, and not just in the Midwest. Any rural area in the US is begging for psychiatrists. Get out of metropolitan areas and you will find an entire world of opportunities. Source: Lived my entire life in rural areas and know many docs who fell in love with rural medicine and will never go back. Get outside your comfort zone and check it out.

 

[xlithiumx]

Echoing Beezley and Stein, I'll chime in that the opportunities are plentiful and lucrative in the upper Midwest, including in major metro areas. Currently in an employed position, doing hospital work in the AM and clinic in PM (60 minute evals and 30 min f/u). Call 1 weekend in 6. Should clear 300k this year with bonus. It is not all doom and gloom.

 

[F0nzie]

Attending, midwest, employed full time OP. Rural areas are screaming for psychiatrists. Very few NPs that are interested in/do psychiatry in this area. If you go rural at all, tons of opportunities for an MD/DO psychiatrist. 40 hours, starting close to 200k. Feel respected (almost alarmingly so) for my training. Get out of the city rat race if that is what you want.

I was raised in a rural environment and I've thought a lot about how much better it might be to raise my children in a small town instead of a big city.

Congrats btw!

 

[touchpause13]

Just curious. I've always wanted to return to the twin cities.

(But obviously I realize how far in the future that is)

 

[vistaril]

Echoing Beezley and Stein, I'll chime in that the opportunities are plentiful and lucrative in the upper Midwest, including in major metro areas. Currently in an employed position, doing hospital work in the AM and clinic in PM (60 minute evals and 30 min f/u). Call 1 weekend in 6. Should clear 300k this year with bonus. It is not all doom and gloom.

how many inpatients do you have to see per day?

 

[PistolPete]

Thanks to all the current practicioners for posting your experiences. It's so hard to accurately judge work conditions/salary in psych.