Fancy Markets vs Smaller Metros

[Aracari]

Hello,

With regards to the cash pay private practice market/earnings, is it really that much better to be in a HCOL area like NYC/LA vs being in one of the top 10 metros by population?

If you are a graduate from a mid-tier university program does this also make a difference with respect to potential earnings in private practice in terms of determining a good location? How does one balance where to consider starting a private practice (assuming the individual is unattached and can move anywhere) for highest likelihood of higher earnings vs the cost of living in these places?

Thanks!

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[Sushirolls]

Go live where you want to live, then make the best of it.

 

[WisNeuro]

Go live where you want to live, then make the best of it.

Yeah, first step should always be, "in what cities would I like to live in the first place." I mean, I could go live in East TN with no income tax and low COL, but then I'd have to live in East TN. If it's more expensive to live where I want, I'm more than willing to pay the "happiness tax."

As to the OP, I can't imagine what program you graduated from does much to affect your earning potential in many places. In terms of several of the people I refer to, I have no idea where they went. I just go by reputation.

 

[comp1]

This is a difficult question to answer because this mercenary perspective to both a career and geographic location is...rare. What exactly is the goal? To retire early? To start another career?

 

[Aracari]

This is a difficult question to answer because this mercenary perspective to both a career and geographic location is...rare. What exactly is the goal? To retire early? To start another career?

Hi,

Sorry for being so blunt with my posting. I was in a hurry between clinics while writing it. I'm really not all that mercenary. It's more because I'm trying to decide between 2 different metro areas which have similar appeals but have different pros and cons. It's hard to decide to "go where I want to live" because of these different pros and cons.

 

[LadyHalcyon]

Go closest to where you have family

 

[wolfvgang22]

Go closest to where you have family

Assuming you like your family, or have family.
I kid, I know you mean supports.

 

[Aracari]

Go closest to where you have family

I appreciate the input but can someone please answer my original questions?

Just want to have a sense as to whether the top 1-2 cities/metro areas in population have better average/median/high non-insurance private practice earnings potential compared to the other top 8 metro areas.

 

[wolfvgang22]

Sorry, I don't know the answer.

 

[dl2dp2]

I appreciate the input but can someone please answer my original questions?

Just want to have a sense as to whether the top 1-2 cities/metro areas in population have better average/median/high non-insurance private practice earnings potential compared to the other top 8 metro areas.

Yes.

Is this answer helpful?

 

[Aracari]

Yes.

Is this answer helpful?

Can you still do fairly well in the other 8 metros? What would be the average income for 30-40 hours a week in private practice?

 

[calvnandhobbs68]

Can you still do fairly well in the other 8 metros? What would be the average income for 30-40 hours a week in private practice?

Dude nobody is gonna go do market research for you for the top 10 metro areas in the country. Go figure it out, poke around with the local APA chapters and other private practice people in the area, call practices and see how long their wait times are for new patients, see what people are charging, etc.

 

[romanticscience]

Hello,

With regards to the cash pay private practice market/earnings, is it really that much better to be in a HCOL area like NYC/LA vs being in one of the top 10 metros by population?

If you are a graduate from a mid-tier university program does this also make a difference with respect to potential earnings in private practice in terms of determining a good location? How does one balance where to consider starting a private practice (assuming the individual is unattached and can move anywhere) for highest likelihood of higher earnings vs the cost of living in these places?

Thanks!

I aimed at residencies in fancy markets (NYC/SF) with private practice hopes. Didn't match in a fancy market but made the best of it. The ceiling is higher for cash in the top-10. I hustle in a mostly insurance-based full time solo private practice; not charging $600 dollars/hr but given the COL/hourly rate/lifestyle in my city, I think I'm doing OK. PM for details.

 

[TexasPhysician]

It is easy to see how HCOL areas would generally have higher cash rates. Everything is more expensive there.

Any reasonably good sized town can probably support a cash psychiatrist. Higher cost of living, higher family income areas, and average traffic levels likely play a big role. Local competition also comes into play. That may change yearly.

The ideal location isn’t simple. There is a lot to consider.

 

[dl2dp2]

Can you still do fairly well in the other 8 metros? What would be the average income for 30-40 hours a week in private practice?

Yes.
Average income for 30-40 hours in PP would likely be average income that's MGMA, given a pleurality of psychiatrists are in PP.

LOL. Is this helpful?

 

[rjs2131]

I appreciate the input but can someone please answer my original questions?

Just want to have a sense as to whether the top 1-2 cities/metro areas in population have better average/median/high non-insurance private practice earnings potential compared to the other top 8 metro areas.

This question becomes irrelevant fairly quickly when you take into account all of the other things that come along with a higher COL city/area (i.e. more expenses + surrounded by people who spend more money at baseline)...is your end goal just to make as much money as possible?

If you're just starting out as an attending it's also unlikely you'll be making significantly more than the median your first year out (if you're going into PP, chances are it'll be less because you'll be building a patient panel). If you're planning to start your own practice, you'll probably be cash negative for a while. If you're planning to join a practice, how much you make will ultimately come down to the percentage you take home and that varies by practice (even in the same location).

Lots of variables to consider but before you go through the hassle of calculating all of these things - figure out what it is you actually want in the long run.

 

[Merovinge]

Outside of rare circumstances and after adjusting for CoL the answer is no. There are plenty of successful PP psychiatrists in all of the large cities in this country, although their distribution will clearly be shifted towards downtown and high SES suburbs in general. NYC and LA are both great and terrible cities for different reasons but there is not some magical thing that happens there that is different than Seattle, Chicago, Houston, SF, Atlanta, DC, Phoenix etc.

 

[Splenda88]

Any of these top 10 metro should have a few upper middle class zip codes that can support a well run cash based psych practice. You just have to do your market analysis.

Rank	Metropolitan statistical area	2019 estimate	2010 Census	% change	Encompassing combined statistical area
1​	New York City-Newark-Jersey City, NY-NJ-PA MSA	19,216,182	18,897,109	+1.69%	New York-Newark, NY-NJ-CT-PA CSA
2​	Los Angeles-Long Beach-Anaheim, CA MSA	13,214,799	12,828,837	+3.01%	Los Angeles-Long Beach, CA CSA
3​	Chicago-Naperville-Elgin, IL-IN-WI MSA	9,458,539	9,461,105	−0.03%	Chicago-Naperville, IL-IN-WI CSA
4​	Dallas-Fort Worth-Arlington, TX MSA	7,573,136	6,366,542	+18.95%	Dallas-Fort Worth, TX-OK CSA
5​	Houston-The Woodlands-Sugar Land, TX MSA	7,066,141	5,920,416	+19.35%	Houston-The Woodlands, TX CSA
6​	Washington-Arlington-Alexandria, DC-VA-MD-WV MSA	6,280,487	5,649,540	+11.17%	Washington-Baltimore-Arlington, DC-MD-VA-WV-PA CSA
7​	Miami-Fort Lauderdale-West Palm Beach, FL MSA	6,166,488	5,564,635	+10.82%	Miami-Port St. Lucie-Fort Lauderdale, FL CSA
8​	Philadelphia-Camden-Wilmington, PA-NJ-DE-MD MSA	6,102,434	5,965,343	+2.30%	Philadelphia-Reading-Camden, PA-NJ-DE-MD CSA
9​	Atlanta-Sandy Springs-Alpharetta, GA MSA	6,020,364	5,286,728	+13.88%	Atlanta–Athens-Clarke County–Sandy Springs, GA-AL CSA
10​	Phoenix-Mesa-Chandler, AZ MSA	4,948,203	4,192,887	+18.01%	Phoenix-Mesa, AZ CSA

 

[cleareyedguy]

Hi,

Sorry for being so blunt with my posting. I was in a hurry between clinics while writing it. I'm really not all that mercenary. It's more because I'm trying to decide between 2 different metro areas which have similar appeals but have different pros and cons. It's hard to decide to "go where I want to live" because of these different pros and cons.

You seem to be asking strangers to work harder on their answers than you are in formulating a question. To be blunt, there is no answer to your question that would be generally applicable. Having said that, if you are eliminating all variables aside from your market viability, you'd need to assess what niche you intend to fill, what referral sources you might have or might be able to develop, the quality of your medical care, etc. Those are questions that relate to you, not everybody.