Does rural pay better?

[Mozibox]

Data source: Mozibox

Key Insights:
Southeast Region:
Rural positions show total compensation of about $372K.
Metro roles average around $338K.

Lower Cost-of-Living West Region (LCOL West):
Rural roles average roughly $320K.
Metro positions come in at about $300K.

Overall, our data suggests that rural psych roles may offer a modest compensation advantage compared to metro roles in these regions.

A Few Caveats:
Our analysis is based on a limited number of data points, so these findings are preliminary.
Variations in compensation structures and local market conditions might also influence the numbers.

A bit about myself: I am a physician and my husband is in tech. Salary transparency in tech is 10x that in medicine. My goal is to bring more salary transparency to medicine and to empower more physicians with the tools and transparency needed to navigate their careers with confidence through real-time salary insights tailored to each specialty.

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[TexasPhysician]

The problem is that you don’t have a good data source. This leads all subsequent stats to be inaccurate.

 

[Mozibox]

Thank you for your feedback. The data source will get more accurate as the dataset grows. As a former statistician, we incorporate statistical analysis into our analysis and flag outliers. For any given specialty (most medium size specialties), if you are able to get ~5-10% of the doctors to contribute data, it will give us numbers that are quite close to the ground truth. We saw that with occupational medicine. At this point, about 20% of the occupational medicine physicians have contributed their data. For occ med, there were some fluctuations in the numbers on the dashboards in the beginning. Since hitting 10%, the numbers have been very stable, meaning additional data have not moved the numbers up or down too much. We are now at 20% (not much different from when it was at 10%). For psych, we are not there yet, but with time and with additional data points, we will be closer to the ground truth. Happy to discuss more. 🙂

 

[Sushirolls]

The other issue with psychiatry is it isn't just one job. It's not like say, GI, where you have academic GI versus private practice GI, but the job duties are essentially the same, with minimal impact from doctors who have Admin hours, or teaching hours, or research hours.

Psychiatry has Community Mental health.... all inpatient. Or blend inpatient/outpatient. Private equity owned hospital inpatient. Community non-profit inpatient. Academic inpatient. Some Psychiatry ED full time jobs. Community mental health crisis units functioning like a pseudo Psych ED. Hospital based Consultation Liasion jobs. Some times that even folded in with an IP or OP or even both job! Then you have the Child/adolesecent docs blended into the adult clinics/units/jobs etc. State hospitals. Private cash practices. Private insurance / cash practices. Private insurance only practices. IOP/PHP jobs. Residential addiction jobs. Residential eating disorder jobs. ECT? TMS? Ketamine infusions? The list goes on that makes it very difficult to extrapolate and collect a data set that will be even close to meaningful.

And rural means so many things... One community I was working in years ago was more than 100K but on some metrics was considered rural. I'm now in a true rural area that includes a catchment that has Open Range laws (cows can run free, you can't say anything, and if you hit one, you pay the rancher. Don't want cows on your land, you have to fence your land, to keep them out).

Just from that screen shot, what is Pension? I'm not aware of any jobs these days in psych that offer true pensions. They might have 401k or similar. Actually, only pension I can think of are the military officers putting in 20 years+ and their retirement is essentially a pension. But some jobs don't just have a 401K or 403b, they have an additional 457f.

So unless this data truly defines what the work of the psychiatrist is doing or has a restrictive inclusion list, its unlikely to be meaningful for Psychiatry.

A place like SDN where you can get a handful of anecdote reports, will likely still reign supreme.

But I do hope you get an abundance of reports to be something that is value... and can compete against entities like MGMA, etc.

 

[comp1]

All federal jobs continue to offer pensions in addition to 401k like vehicles and Social Security. In terms of the OP's topic, rural jobs are harder to fill and thus would be more likely to have locums in them. And indeed, what does rural even mean? You can live in the middle of nowhere and be seeing inpatients hundreds of miles away in an urban core in the morning and a community outpatient clinic surrounded by cornfields in the afternoon.

 

[Mozibox]

This is how we ask this question: which best describes the setting of your primary practice? 1) large metro (>1 million); 2) metro medium; 3) metro small; r) rural (<50,000)

Yes, pensions are not uncommon. TPMG (Kaiser Northern CA), academia, and some private sectors still offer pensions.

 

[Stagg737]

This is how we ask this question: which best describe the setting of your primary practice? 1) large metro (>1 million); 2) metro medium; 3) metro small; r) rural (<50,000)

Yes, pensions are not uncommon. TPMG (Kaiser Northern CA), academia, and some private sectors still offer pensions.

So how do you capture job cobblers and individuals with smaller but not insignificant side gigs? I’m academic in mid-size metro for your criteria, but I also do telehealth to half a state where some towns are <100 people and the nearest Walmart is over an hour away.

 

[Mozibox]

For this version, the goal is to be able to capture 90% of the scenarios. The rest 10% may need some additional customization (will be included in future versions). For those, one thought is to allow more free texting and display those as individual entries instead of being part of the aggregate data. Side sigs will be a survey of its own and are not meant to be captured by this salary survey. The hourly rate for side gigs varies a lot depending on the setting (startup consulting vs med-legal expert opinions, etc.) Thanks for your input. I greatly appreciate it.

 

[Stagg737]

For this version, the goal is to be able to capture 90% of the scenarios. The rest 10% may need some additional customization (will be included in future versions). For those, one thought is to allow more free texting and display those as individual entries instead of being part of the aggregate data. Side sigs will be a survey of its own and are not meant to be captured by this salary survey. The hourly rate for side gigs varies a lot depending on the setting (startup consulting vs med-legal expert opinions, etc.) Thanks for your input. I greatly appreciate it.

So as an aside, I think it would benefit your project to ask people what percentage of their income/work is through their primary practice. Other than the VA and my academic center, I think most of the psychiatrists I know have hybrid work settings. This is especially true for private inpatient docs of which I think I only know 1 or 2 in the private world who don't do some significant side hustle that accounts for a fair percentage of their income. Even at my academic center all of the inpatient psychiatrists have their own smaller outpatient panels other than 1.

Idk how familiar you are with psychiatry, but I am very doubtful you'll capture 90% of scenarios or come even close to that (probably closer to 50-60% honestly) if you're not considering this.

 

[TexasPhysician]

For this version, the goal is to be able to capture 90% of the scenarios. The rest 10% may need some additional customization (will be included in future versions). For those, one thought is to allow more free texting and display those as individual entries instead of being part of the aggregate data. Side sigs will be a survey of its own and are not meant to be captured by this salary survey. The hourly rate for side gigs varies a lot depending on the setting (startup consulting vs med-legal expert opinions, etc.) Thanks for your input. I greatly appreciate it.

That’s the problem with psychiatry. Over 10% have weird scenarios, well over. Of the residents in my class, only 1 has a singular job. There is a scenario where a 2nd could be figured out through a primary job with optional call that is paid. The rest of us have multiple PT jobs and/or ownership interests, not a primary with a side gig. I’m currently at 5. Ive never completed a salary poll, because there isn’t a survey that matches what I do, and if it did, it would take too long to bother.

Many do locums work that is not a salary but periodic weeks here and there that varies based on travel preferences. One of my better psych friends can’t tell you what he will earn in 6 months because that is too far out. He keeps expenses low and works when/how he wants. I’m shocked at how common this is. If he does 3 months in rural Montana with lower hours and 3 months in NYC with high hours for $200K total, do you 2x the number for a full year? Is it rural or urban? Do you average in $200K FT or PT as he works hard hours in NYC? If you 2x the number and averaged the hours, you would get a pretty statistic for a FT job he would never accept, but you can’t average Montana/NYC either.

Then you’ve got a couple psychiatrists near me that work about 10 clinical hours per week with 20 “admin” hours to qualify for health insurance benefits. They earn about $60K/year + benefits for “FT”.

Another friend is living in 1 state and doing telepsych only about 24 hours/week in another state with different size cities. Pay is low but all telepsych on hours he wants.

Salary numbers sound cool to sit around and look at, but they just don’t work well in psych. Sticking with just people I hang with, 75%+ have odd situations. That’s probably high, but I’ve never done a nationwide poll. I’ll be surprised if over 60% truly had a typical 8-4 job +/- 1 PT side gig.

Surveys probably work well to determine psychiatry pay in academia, military, and the VA. After that, it gets quite murky. I don’t think I can name a single psychiatrist I know that works FT 1 job that isn’t considered one of those 3 categories.

 

[Merovinge]

Salary numbers sound cool to sit around and look at, but they just don’t work well in psych. Sticking with just people I hang with, 75%+ have odd situations. That’s probably high, but I’ve never done a nationwide poll. I’ll be surprised if over 60% truly had a typical 8-4 job +/- 1 PT side gig.

Surveys probably work well to determine psychiatry pay in academia, military, and the VA. After that, it gets quite murky. I don’t think I can name a single psychiatrist I know that works FT 1 job that isn’t considered one of those 3 categories.

This might be geographic or age based variation, but I train CAP fellows and a very significant portion are choosing employed jobs with pretty straightforward salary structures (either RVU or collection based models) that are not academic, military, or VA. There are still the more entrepreneurial types cobling together jobs but I do think the data, even in psychiatry, is showing that to be slowing down from the Glory Days.

That said I do agree with the point that capturing this data in a meaningful way in psychiatry is going to be much harder than other fields of medicine and should include some consulting with psychiatrists to have any chance to be helpful.

 

[Mozibox]

So as an aside, I think it would benefit your project to ask people what percentage of their income/work is through their primary practice. Other than the VA and my academic center, I think most of the psychiatrists I know have hybrid work settings. This is especially true for private inpatient docs of which I think I only know 1 or 2 in the private world who don't do some significant side hustle that accounts for a fair percentage of their income. Even at my academic center all of the inpatient psychiatrists have their own smaller outpatient panels other than 1.

Idk how familiar you are with psychiatry, but I am very doubtful you'll capture 90% of scenarios or come even close to that (probably closer to 50-60% honestly) if you're not considering this.

This is very helpful! May I DM you?

 

[Mozibox]

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That’s the problem with psychiatry. Over 10% have weird scenarios, well over. Of the residents in my class, only 1 has a singular job. There is a scenario where a 2nd could be figured out through a primary job with optional call that is paid. The rest of us have multiple PT jobs and/or ownership interests, not a primary with a side gig. I’m currently at 5. Ive never completed a salary poll, because there isn’t a survey that matches what I do, and if it did, it would take too long to bother.

Many do locums work that is not a salary but periodic weeks here and there that varies based on travel preferences. One of my better psych friends can’t tell you what he will earn in 6 months because that is too far out. He keeps expenses low and works when/how he wants. I’m shocked at how common this is. If he does 3 months in rural Montana with lower hours and 3 months in NYC with high hours for $200K total, do you 2x the number for a full year? Is it rural or urban? Do you average in $200K FT or PT as he works hard hours in NYC? If you 2x the number and averaged the hours, you would get a pretty statistic for a FT job he would never accept, but you can’t average Montana/NYC either.

Then you’ve got a couple psychiatrists near me that work about 10 clinical hours per week with 20 “admin” hours to qualify for health insurance benefits. They earn about $60K/year + benefits for “FT”.

Another friend is living in 1 state and doing telepsych only about 24 hours/week in another state with different size cities. Pay is low but all telepsych on hours he wants.

Salary numbers sound cool to sit around and look at, but they just don’t work well in psych. Sticking with just people I hang with, 75%+ have odd situations. That’s probably high, but I’ve never done a nationwide poll. I’ll be surprised if over 60% truly had a typical 8-4 job +/- 1 PT side gig.

Surveys probably work well to determine psychiatry pay in academia, military, and the VA. After that, it gets quite murky. I don’t think I can name a single psychiatrist I know that works FT 1 job that isn’t considered one of those 3 categories.

Thank you! May I DM you? I would like to make this as useful as possible for psych and refine our questions. Unlike all the generic physician salary surveys out there, ours is customized to each specialty, so we can easily add/modify our questions. I developed our original questions with the help of two psychiatrists, but to your point, psych is complicated. The more input I get the better. Let me know if it’s okay to DM you. Thanks again!

 

[clozareal]

Why are we getting this influx of salary transparency companies on this forum lately? It seems like every day someone is referencing (i.e., advertising) a new company that all say the same thing but only slightly different visualizations. Accounts like these spam the different specialty forums with the same links/considerations as solicitation.

 

[comp1]

I think they're desperate for even low quality (eg self reported) data. Medicine is so opaque compared to a lot of other industries and psychiatry orders of magnitude more.

 

[clozareal]

I think they're desperate for even low quality (eg self reported) data. Medicine is so opaque compared to a lot of other industries and psychiatry orders of magnitude more.

That's because medicine isn't dominated by a handful of companies that offer similar compensation structures (base + bonus + RSU) and have similar level progressions for similar roles and movement between companies that require that comparison.

 

[Stagg737]

This is very helpful! May I DM you?

Yep, feel free.

 

[Candidate2017]

The data is out there and seems accurate for fulltime W-2 jobs (such as inpatient, outpatient, academic, VA, Kaiser, CMHC) and locums rates. For everyone else (part timers, semi-retired, job cobblers, PP, and other entrepreneurial types), the data won't be accurate because there isn't an apples to apples comparison. We have psychiatrists doing therapy out there home(!) once a week to psychiatrists working 7 days a week with no days off, and everything in between.

 

[Mozibox]

@Candidate2017: Glad to hear! This survey is meant to capture people's main practice. I've been thinking about how to best incorporate side gig income (as many physicians do consulting, etc.). One thought is to have a separate survey for side gigs, where we ask doctors about their specialty/subspecialty, type of side gigs (start-up consulting, med-legal, expert witness, chart reviews, telemedicine, etc.), the hourly rate as well as the number of hours. If you have any suggestions, let me know.

 

[clausewitz2]

@Candidate2017: Glad to hear! This survey is meant to capture people's main practice. I've been thinking about how to best incorporate side gig income (as many physicians do consulting, etc.). One thought is to have a separate survey for side gigs, where we ask doctors about their specialty/subspecialty, type of side gigs (start-up consulting, med-legal, expert witness, chart reviews, telemedicine, etc.), the hourly rate as well as the number of hours. If you have any suggestions, let me know.

Maybe what is not being conveyed is that for an much higher percentage of psychiatrists than for other specialties, the side gigs collectively -are- the main gig.

 

[Mozibox]

Maybe what is not being conveyed is that for an much higher percentage of psychiatrists than for other specialties, the side gigs collectively -are- the main gig.

Got it! For future versions, we will try to best incorporate those scenarios. Bear with us as we continue to improve. 🙂