Do child psychiatrists actually make up for the “lost” attending year from fellowship?

[milan95]

For those of you already in practice:

• Did you feel that the higher pay in child psych eventually made up for the lost year?
• How long did it take to “break even,” financially speaking?
• Did the job opportunities (private practice, consulting, etc.) feel broader or more lucrative than general psych?

Would love to hear from anyone who’s been down this road! The reason this is important is because I took a number of years before medical school, so every year spent in training, not mkaing attending money, is impactful.

---

Members don't see this ad.

 

[shoomer]

If you're going to be working for 10+ years as a physician, the income disparity with one lost year of attending earnings is honestly negligible. Go to a program with moonlighting and the gap will be even smaller.

You will have a broader array of opportunities from child psych for sure. They're not necessarily much more lucrative when it comes to salaried positions. Private practice cash pay is where you can charge higher rates more easily.

 

[TexasPhysician]

This is hard to quantify because I’ve never applied to the VA or generic practice in which there was an adult psych and CAP jobs with salaries sitting there for me to do the math straight up. I take the jobs I enjoy that are lucrative regardless of population.

My situation may be different than others too. I did my extra year where they allowed moonlighting. I could leave my academic training at 4pm to do 2 more hours of private practice elsewhere. Then I could take home call for a facility overnight. Then I’d round on the weekend. I earned as much or more than most of my academic faculty. That resulted in nothing to “make-up”.

 

[comp1]

I mean if you're going to be working 10 years as a physician, the income difference between child psych and general psych is also pretty small, possibly the same as a year of general attending salary. If you enjoy working with kids, do it. Fellowship should pretty much never be about money. You will not find any VA CAP jobs. 🙂 But even if you could, the pay at the VA would be the same. There is a slight pay bump for initial board certification, but not for anything beyond that. VA pay is based on longevity and which group your primary specialty falls into. There's also a tiny bump for management, but it's miniscule for physicians relative to other sort of clinicians. Ultimately, again, you do a fellowship because you enjoy the patient subpopulation, not for money.

 

[Bartelby]

The trouble with any analysis like this is how broad the range of annual incomes is, and how aggressively you moonlight during fellowship.

In general I think about a $200,000 opportunity cost is a fair estimate for each year of fellowship presuming no moonlighting in fellowship and that you take a relatively average 40-hour per week job. If you can earn $20,000 more per year I think that would cover one year of fellowship over the next decade. This ignores investment returns and tax bracket considerations, which I think would not make a massive difference over the course of one year.

I think it is very realistic to make up that lost income with the additional CAP qualification if you want to, but far more important is which type of work you enjoy more. I don't think you will have a massive financial advantage either way, with the possible exception of a cash-based child practice in some areas, so I would let interest in the job you will eventually hold guide you much more than any financial consideration.

 

[Bartelby]

And a disclaimer, I am not a child psychiatrist. I think it is a wonderful path for people who like the work, but I always found adult psychiatry much more engaging.

 

[Merovinge]

I made $150k my PGY 5 year of fellowship, my attendings were making around 175-180k (obviously academic salaries), and the median was around 250k, so I lost around $100-150k. My career would not look remotely the same without CAP training, but I also think anyone posting on SDN and reddit asking about how the money is going to be in CAP is not someone I would necessarily be jumping to promote into CAP fellowship. It becomes apparent in a hurry those who enjoy working with kids versus those who don't. I have seen folks from less prestigious residencies do CAP fellowship and then just practice adult psychiatry as an effort to whitewash their CV's, so that's certainly an option for people, although again is very easily seen through by those who actually practice in the field.

 

[calvnandhobbs68]

I do think it would be good to consider that we all come from different financial/personal situations, and how much a loss of attending salary can impact someone. Trust me, if it was really about the money, I would just do gen psych and do brain stim. The fact that I enjoy child psych is precisely why I am still considering it and frankly, I am spending a lot of cognitive load on this despite all my financial/personal issues..even when I am supposed to have made up my mind by now..

Yeah I mean you just actually need to want to do child psych. Child psych ends up being a lot more like pediatrics than psych at times, especially in terms of family dynamics and multiple decision makers. You've almost always got more than 1 "patient", even with up to teenagers.

I think it's more about if you're well trained enough to see younger kids if that's what you want to do. If you don't do a fellowship, you almost absolutely have minimal experience with patients <13-14yo besides a couple required rotations in general psych residency.

I think the salary difference isn't that big of a difference unless you're doing private practice in like LA or NYC or something. Insurance doesn't pay me any more as far as I'm aware. There are some states where insurance does pay a differential but that isn't common. Salaried positions maybe pay slightly more. You'll have some more opportunities but also some fewer ones (ex. there's really not a lot of opportunity to do ketamine or TMS unless you're seeing a lot of adults or working in a research setting). I mean, child psych is kind of the exception with kids in general where you at least don't get paid LESS to see kids lol.

 

[Merovinge]

I do think it would be good to consider that we all come from different financial/personal situations, and how much a loss of attending salary can impact someone. Trust me, if it was really about the money, I would just do gen psych and do brain stim. The fact that I enjoy child psych is precisely why I am still considering it and frankly, I am spending a lot of cognitive load on this despite all my financial/personal issues..even when I am supposed to have made up my mind by now..

I admit to not being your financial advisor and do want to keep space for those who have had life happen that caused deviations in their financial plan. Even in those situations it's either A) catastrophic, so obviously don't do fellowship and support your family or B) tough but will be limitedly impacted by a CAP fellowship you moonlight during such that the actual change financially is a rounding error of maybe a few vacations and a few meals out over a handful of years. Really feels like this is an overthink to me, do what you actually enjoy doing and just ensure you can moonlight during fellowship (which is basically every fellowship I know of).

 

[clozareal]

CAP jobs pay about 10-20% more in my experience with the job offers except in out of network private practices where it's much more. I probably make 50% more than my adult colleagues on an hourly rate although I'm in an area that can command those rates.

Based on the job offers I was getting, I've broken even after about 2 years (as measured by making $200k more than the max job offer I received before deciding on PP).

If you like treating kids and families, then doing CAP won't confer any long-term financial downside.

Lots of job opportunities all over the country for CAP. I was just sent a job offer in the midwest LCOL area for mid-300s outpatient M-F gig without any call and a $60k sign on bonus. I don't think it's necessarily more options than adults (nor does it matter because you just need one job) but the supply for CAPs is definitely less so the opportunities aren't as competitive.