Financial independence through psychiatry

[Merovinge]

I've seen a number of posts about salary by medical students/residents as well as recent interest in the FIRE movement (Financial Independence Retire Early for those unaware) and just hit a big milestone for myself so I wanted go give anyone interest a real example of a "traditional" medical student without any family support.

Background: Grew up upper-middle class as a young child but then due to life circumstances spent formative years lower middle class. College financing was clearly something that I would need to procure on my own. Began working mowing lawns by high-school, held part-time jobs from 16-18 and saved >50% of this. Obtained significant scholarships and worked my freshman and sophomore year in a research lab to cover all undergraduate expenses (left without any loans). Took out are $175k for medical school (state school, 6.8% interest) to cover 4 years + living expenses. No paying jobs from 21-26.

Residency: Was very overwhelmed by my student loan payments and tried to pretend they didn't exist. Eventually after a few months of not paying, formally put into forbearance. Don't try this at home folks, but I think it's important to understand that other people make big money mistakes too. Got onto IBR a little before PGY-3 year, did not have the re-pay options to subsidize loan rates when I was in training. Looked into moonlighting options as a PGY-3 but options in my city were not good. Mid PGY-5 year I began to moonlight as an adult psychiatry attending working to cover weekends and some evening hours, Initially offered $110/hour, negotiated up to $150 an hour (had already passed adult boards) working about 15 hours/week.

Finances at end of fellowship: Loans had grown to about $240k with my lowly IBR contributions for a life-time loan of around $250k. Living with significant other for much of fellowship but anything I saved on rent went into a diamond and wedding costs.

Attending job hunting: Spoke with a variety of hospital chains in the area, was looking for predominantly inpatient CAP work so even in a big city the list is pretty narrow of applicable places. Most colleagues making around 250K for similar work in my area. Was able to land a position with administrative responsibilities out of the gate for 300k, fully employed with benefits, gave up moonlighting job. Worked about 36-40 hours a week with q8 home call (averaged 3-4 calls/night between 10pm-7am). Wife was completing residency this year (recently married), making about 60k. Lived like a resident except for a few changes: needed a car for work, took my wife's Honda and bought her a new BMW in cash (about 40k). Rest of the income went into student loans. Note 2, definitely should have maxed my 401k, I did not fund it at all; should have maxed a backdoor roth, failed to do so. Did fund HSA. Final loan status - $120,000 remaining when I left this job after 1 year.

Year 2: I had to move due to wife landing attending job elsewhere. New position's contract offered a student loan repayment option covering about $75,000 in 3 installments at the end of each year total annual salary (including this loan repayment) is nearly identical to last positions. Recently completed first year and had first installment arrived. I used a calculator to figure out how much the loan would move to over the next 2 years while awaiting the next 2 payments from employer and cleared the rest out about 4 months ago. Now turning off monthly payments and essentially debt free if continuing on with this job for 2 more years.

Other financials to catch up on: Fully funded 401k for last and this caldender year for wife & self, fully funded backdoor roth IRA for last year/this year for wife & myself. Large disability insurance taken out on wife (her risk of disability is much higher than mine as a male psychiatrist). Savings rate is close to 50% due to being DINKs presently, with the rest of our funds having fully paid off our house (low CoL area) and now working on growing taxable investment account. All assets in low cost index funds.

I have no plans to retire early and hope to work as long as I can provide effective care for my patients, but I do want students and residents to know that you can make a great salary while still working 40 hours or less a week and thoroughly enjoy your work in psychiatry.

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[OldPsychDoc]

Enviable. Congratulations. As you acknowledge, your circumstances are fairly ideal for this path--DINK, low COL area, etc.
An older student with a child (or 4!) and spouse working a lower income career (or SAH) will have different challenges, and they shouldn't feel shamed that they can't keep up with the "Merovinge Plan" . Moonlighting may not be possible due to family time needs, child care and educational expenses will need to be factored in. (And after a call from GrandmaPsychDoc just now, elder care, for many of us here in the Sandwich Generation caring for parents!)
Readers should be aware that YMMV.

 

[Merovinge]

I absolutely agree, my main message is that even if you do have high loans or other needed fixed expenses,, psychiatry as a field definitely can let you have a strong revenue stream. One does not need to do derm/rad onc/spine surgery to reach financial independence. I've heard from medical students that score very highly on Step 1 that they get heavily pressured by advisers, attendings, peers, and family to go into (currently) high paying specialties and I find that notion absurd.

 

[Merely]

Thanks for your insight and story, very appreciated

 

[Mass Effect]

I've seen a number of posts about salary by medical students/residents as well as recent interest in the FIRE movement (Financial Independence Retire Early for those unaware) and just hit a big milestone for myself so I wanted go give anyone interest a real example of a "traditional" medical student without any family support.

Background: Grew up upper-middle class as a young child but then due to life circumstances spent formative years lower middle class. College financing was clearly something that I would need to procure on my own. Began working mowing lawns by high-school, held part-time jobs from 16-18 and saved >50% of this. Obtained significant scholarships and worked my freshman and sophomore year in a research lab to cover all undergraduate expenses (left without any loans). Took out are $175k for medical school (state school, 6.8% interest) to cover 4 years + living expenses. No paying jobs from 21-26.

Residency: Was very overwhelmed by my student loan payments and tried to pretend they didn't exist. Eventually after a few months of not paying, formally put into forbearance. Don't try this at home folks, but I think it's important to understand that other people make big money mistakes too. Got onto IBR a little before PGY-3 year, did not have the re-pay options to subsidize loan rates when I was in training. Looked into moonlighting options as a PGY-3 but options in my city were not good. Mid PGY-5 year I began to moonlight as an adult psychiatry attending working to cover weekends and some evening hours, Initially offered $110/hour, negotiated up to $150 an hour (had already passed adult boards) working about 15 hours/week.

Finances at end of fellowship: Loans had grown to about $240k with my lowly IBR contributions for a life-time loan of around $250k. Living with significant other for much of fellowship but anything I saved on rent went into a diamond and wedding costs.

Attending job hunting: Spoke with a variety of hospital chains in the area, was looking for predominantly inpatient CAP work so even in a big city the list is pretty narrow of applicable places. Most colleagues making around 250K for similar work in my area. Was able to land a position with administrative responsibilities out of the gate for 300k, fully employed with benefits, gave up moonlighting job. Worked about 36-40 hours a week with q8 home call (averaged 3-4 calls/night between 10pm-7am). Wife was completing residency this year (recently married), making about 60k. Lived like a resident except for a few changes: needed a car for work, took my wife's Honda and bought her a new BMW in cash (about 40k). Rest of the income went into student loans. Note 2, definitely should have maxed my 401k, I did not fund it at all; should have maxed a backdoor roth, failed to do so. Did fund HSA. Final loan status - $120,000 remaining when I left this job after 1 year.

Year 2: I had to move due to wife landing attending job elsewhere. New position's contract offered a student loan repayment option covering about $75,000 in 3 installments at the end of each year total annual salary (including this loan repayment) is nearly identical to last positions. Recently completed first year and had first installment arrived. I used a calculator to figure out how much the loan would move to over the next 2 years while awaiting the next 2 payments from employer and cleared the rest out about 4 months ago. Now turning off monthly payments and essentially debt free if continuing on with this job for 2 more years.

Other financials to catch up on: Fully funded 401k for last and this caldender year for wife & self, fully funded backdoor roth IRA for last year/this year for wife & myself. Large disability insurance taken out on wife (her risk of disability is much higher than mine as a male psychiatrist). Savings rate is close to 50% due to being DINKs presently, with the rest of our funds having fully paid off our house (low CoL area) and now working on growing taxable investment account. All assets in low cost index funds.

I have no plans to retire early and hope to work as long as I can provide effective care for my patients, but I do want students and residents to know that you can make a great salary while still working 40 hours or less a week and thoroughly enjoy your work in psychiatry.

Congratulations. I agree with your point regarding psychiatry. I do think your situation is a bit unique, given that your wife is also a physician. I mean, if someone can't make a decent living and pay off debt in a two-physician family, that sounds like a finance 101 fail to me. Most people won't have your circumstances.

 

[TexasPhysician]

I think it can be done in any medical field. IM hospitalists are averaging $300k+ for 15 days/month.

Don’t get me wrong. I love psych, but the revenue is there in all fields except maybe ged peds.

 

[WisNeuro]

I think it can be done in any medical field. IM hospitalists are averaging $300k+ for 15 days/month.

Don’t get me wrong. I love psych, but the revenue is there in all fields except maybe ged peds.

Pretty much. Spouse is family med w/OB who had ~300k loans from undergrad/med school, I had no debt. She finished residency Summer of 17, started new job in fall 17, and currently owes high 5 figures. This is with both of us buying new cars in the meantime, living in a nice area, and having a child. Both of us have maxed out our 403bs and personal IRAs each year as well. Even having a rough budget and not going crazy with spending is enough for most people, depending on location (i.e., not San Francisco).

 

[Shufflin]

I hesitated chiming in, wondering if convincing folks you can make it big is the right way to go. Will we attract more gunners, or perhaps more higher IQ folks with higher Step scores? Will we improve how Psych is practiced by getting higher-scoring residents? What are we selecting for?

My sense is that Psych pays well, a lot of jobs out there land you in the $250K range ~ typical full-time employee job.

 

[MedMan80]

.

 

[TexasPhysician]

I hesitated chiming in, wondering if convincing folks you can make it big is the right way to go. Will we attract more gunners, or perhaps more higher IQ folks with higher Step scores? Will we improve how Psych is practiced by getting higher-scoring residents? What are we selecting for?

My sense is that Psych pays very well, but a lot of jobs out there land you in the $250K range ~ typical full-time employee job.

The magic happens in those special jobs you don't find online, the jobs you hear about through others, and in the solo practice arena. You can hit huge numbers. I wrap up by noon, hit the gym, then pick up my child from school by 1:45. Write notes for an hour at home. Done.

I’ve done some inpatient work that had me out by noon. Didn’t pay that though. What is the catch?

 

[FlowRate]

I’ve done some inpatient work that had me out by noon. Didn’t pay that though. What is the catch?

I'm imagining starting at 6 and charging $400/hr. No way anyone in psych works 3 hours a day to make that much money.

Well I guess there is a way. I met a CAP fellowship director who worked a few hours every evening doing family therapy for anorexia at $1000/session.

 

[Shufflin]

I’ve done some inpatient work that had me out by noon. Didn’t pay that though. What is the catch?

Reasonable question. The catch is that I'm doing multiple things ~ inpatient, outpatient, detox, and covering an urgent care by telepsych after I leave (low volume but paid per hour), plus stipend money. Also doing some ketamine. It all adds up fast.

 

[Merely]

If you see 25-30 pts a day for about 6 hours you can generate a lot of money, not unreasonable although must be extremely “efficient”..shufflin is seeing 30pts per day which is very impressive that’s how he gets that high

 

[Attending1985]

If you see 25-30 pts a day for about 6 hours you can generate 700k+, not unreasonable although must be extremely “efficient”..shufflin is seeing 30pts per day which is very impressive that’s how he gets that high

If you are seeing 25 patients per day you are not practicing psychiatry you are are being paid to generate scripts and sign notes. What a joke.

 

[Merely]

If you are seeing 25 patients per day you are not practicing psychiatry you are are being paid to generate scripts and sign notes. What a joke.

That’s your opinion..others would obviously disagree

 

[Attending1985]

That’s your opinion..others would obviously disagree

Yes if you can delude yourself into thinking anything if you are motivated by money. This kind of care is why people don’t trust psychiatrists and why we have such poor outcomes.

 

[AD04]

I certainly admire @Shufflin ability to hustle. How many hours do you work in a week? Do you work weekends?

Sadly to say, some of my peers have done questionable things for money. Not only did they practice bad medicine (think pill mill and controlled substances), they didn’t even negotiate well for the risk they put on their medical license. Deep debt causes deep desperation.

 

[Armadillos]

I generally bite my tongue on these threads, but feel like it’s getting out of hand at times and is potentially damaging to Medstudents reading this. This is not in reference to any particular poster but just the general theme.

Aside from cash only docs setting high cash hourly rates, if you hear of someone making 1.5x-3x what is typical for a full time psychiatrist it is because they are actually working what should be multiple full time jobs and are cramming them into one day by “being efficient” (cutting corners) at each.

As someone who works with a bunch of really, really sick patients in outpatient public psychiatry I see how negative this type of practice is for my patients when they are hospitalized at the places where these “efficient” docs round before going to their second and third jobs. My patients get horrible care and frankly its a massive waste of society’s money to pay for these hospitalizations where there is minimal medical decision making, minimal collection and review of past/outpatient records, minimal collateral gathering, essentially no coordination of care with primary outpatient psychiatrist (me), completely useless checkbox progress notes and to top it off a generic lawyer written discharge summary template with 1 sentence and some med names dropped into it.

I understand this model is great for psychiatrist income and people have loans to pay, but it sucks for my patients and is not why most of us got into medicine.

 

[Attending1985]

I generally bite my tongue on these threads, but feel like it’s getting out of hand at times and is potentially damaging to Medstudents reading this. This is not in reference to any particular poster but just the general theme.

Aside from cash only docs setting high cash hourly rates, if you hear of someone making 1.5x-3x what is typical for a full time psychiatrist it is because they are actually working what should be multiple full time jobs and are cramming them into one day by “being efficient” (cutting corners) at each.

As someone who works with a bunch of really, really sick patients in outpatient public psychiatry I see how negative this type of practice is for my patients when they are hospitalized at the places where these “efficient” docs round before going to their second and third jobs. My patients get horrible care and frankly its a massive waste of society’s money to pay for these hospitalizations where there is minimal medical decision making, minimal collection and review of past/outpatient records, minimal collateral gathering, essentially no coordination of care with primary outpatient psychiatrist (me), completely useless checkbox progress notes and to top it off a generic lawyer written discharge summary template with 1 sentence and some med names dropped into it.

I understand this model is great for psychiatrist income and people have loans to pay, but it sucks for my patients and is not why most of us got into medicine.

Well said.

 

[Shufflin]

There's a real danger of moving too quickly at the cost of care, very important to raise this point. It's unacceptable and dangerous. 25 patients in an office setting over 3 hours is crazy. That's dangerous medicine.

My situation is that around a third of my patients are stable, awaiting placement. So that leaves around 15 acute folks over 3 or 4 hours allows me to spend a lot of time with each.

 

[finalpsychyear]

I generally bite my tongue on these threads, but feel like it’s getting out of hand at times and is potentially damaging to Medstudents reading this. This is not in reference to any particular poster but just the general theme.

Aside from cash only docs setting high cash hourly rates, if you hear of someone making 1.5x-3x what is typical for a full time psychiatrist it is because they are actually working what should be multiple full time jobs and are cramming them into one day by “being efficient” (cutting corners) at each.

As someone who works with a bunch of really, really sick patients in outpatient public psychiatry I see how negative this type of practice is for my patients when they are hospitalized at the places where these “efficient” docs round before going to their second and third jobs. My patients get horrible care and frankly its a massive waste of society’s money to pay for these hospitalizations where there is minimal medical decision making, minimal collection and review of past/outpatient records, minimal collateral gathering, essentially no coordination of care with primary outpatient psychiatrist (me), completely useless checkbox progress notes and to top it off a generic lawyer written discharge summary template with 1 sentence and some med names dropped into it.

I understand this model is great for psychiatrist income and people have loans to pay, but it sucks for my patients and is not why most of us got into medicine.

250-300 is a lot of money for someone used to making 50k and for most trying to make significantly more will come with its own cost that cannot be quantified. 18k a month after tax (300k married salary in a state with income tax) if you were not able to have any deductions or roughly that with bennies as an employeed model. If you lived off 5k a month almost double your lifestyle in residency that leaves you with 156k you could put towards loans in 1 year.

I paid off my loans through moonlighting in residency. I don't understand why others don't do that even if its a portion and knock the remaining out in the first 3 years of attending life.

 

[NickNaylor]

There's a real danger of moving too quickly at the cost of care, very important to raise this point. It's unacceptable and dangerous. 25 patients in an office setting over 3 hours is crazy. That's dangerous medicine.

My situation is that around a third of my patients are stable, awaiting placement. So that leaves around 15 acute folks over 3 or 4 hours allows me to spend a lot of time with each.

15 patients over 4 hours is still only ~15 minutes each. Is that "a lot of time?" I dunno, I guess. It's not all that dissimilar from a typical outpatient visit. But there are certainly some patients who will require more time than that (and also some that may require less).

 

[Merely]

15 patients over 4 hours is still only ~15 minutes each. Is that "a lot of time?" I dunno, I guess. It's not all that dissimilar from a typical outpatient visit. But there are certainly some patients who will require more time than that (and also some that may require less).

Everyone has their own style that’s the beauty of medicine

 

[NickNaylor]

Everyone has their own style that’s the beauty of medicine

Yes, but at some point "style" and "substandard care" become the same. Sure, I can do an assessment in 15 minutes and a follow-up in 5. The question is whether or not that's quality care. I would say no in nearly all situations.

 

[clausewitz2]

Yes, but at some point "style" and "substandard care" become the same. Sure, I can do an assessment in 15 minutes and a follow-up in 5. The question is whether or not that's quality care. I would say no in nearly all situations.

Even more prosaically, if we make 15 minute assessments and 5 minute follow-ups a standard, normal thing, there ceases to be any reason why anyone should employ a psychiatrist instead of an ARNP except where required by law.

 

[MedMan80]

In the end is a need being met?, would the unit shut down if the shufflin was not meeting some sort of need. These docs doing 3-4 gigs is coming out of necessity much of the time and shortage of psychiatrists is not helping that anytime soon..

 

[dl2dp2]

Even more prosaically, if we make 15 minute assessments and 5 minute follow-ups a standard, normal thing, there ceases to be any reason why anyone should employ a psychiatrist instead of an ARNP except where required by law.

This is why I think it's much better ethically to actually practice good medicine to only people who can afford your fees than capitulate to a sweatshop system. This, of course, worsens the shortage. But in my mind the duty of a physician first and foremost is to his/her patient, not to "social justice" (broadly defined). In outpatient practice, often people need long evals, lots of family meetings, etc. With unannounced cancellations, you'd need multiple visits to complete an eval if you are insurance reimbursed. This clearly worsens shortage.

Plus, govt jobs actually typically don't involve sweatshops. People who are sweatshopping in psychiatry are doing it wrong IMO--not just necessarily clinically.

 

[Attending1985]

Even more prosaically, if we make 15 minute assessments and 5 minute follow-ups a standard, normal thing, there ceases to be any reason why anyone should employ a psychiatrist instead of an ARNP except where required by law.

Is there any reason why the public or other physicians should respect us if this is our standard of care? No.

 

[Armadillos]

In the end is a need being met?, would the unit shut down if the shufflin was not meeting some sort of need. These docs doing 3-4 gigs is coming out of necessity much of the time and shortage of psychiatrists is not helping that anytime soon..

Or if docs didn’t normalize this mentality then the massively profitable hospital chains would eventually have to offer higher salaries to stay in business and the glut of psychiatrists charging rich folks $400/hr to fiddle with their benzos would move to areas of greater need.

 

[Merely]

Even more prosaically, if we make 15 minute assessments and 5 minute follow-ups a standard, normal thing, there ceases to be any reason why anyone should employ a psychiatrist instead of an ARNP except where required by law.

I don’t see how that logically follows..psychiatrists are superior to NP in every aspect of medicine so it would follow that a psychiatrist would be much safer than an NP to conduct short visits, an NP would need much more time with a pt

 

[Mass Effect]

Reasonable question. The catch is that I'm doing multiple things ~ inpatient, outpatient, detox, and covering an urgent care by telepsych after I leave (low volume but paid per hour), plus stipend money. Also doing some ketamine. It all adds up fast.

So then you're not really done at noon. You're being paid for being on-call at an urgent care place, even if it's from home. Also, if you're seeing that many patients, I'd argue that you shouldn't be done by noon.

If you are seeing 25 patients per day you are not practicing psychiatry you are are being paid to generate scripts and sign notes. What a joke

Exactly.

There's a real danger of moving too quickly at the cost of care, very important to raise this point. It's unacceptable and dangerous. 25 patients in an office setting over 3 hours is crazy. That's dangerous medicine.

My situation is that around a third of my patients are stable, awaiting placement. So that leaves around 15 acute folks over 3 or 4 hours allows me to spend a lot of time with each.

Seeing 15 acute patients in 3 hours is less than 15 minutes per patient.

One of the problems in this field is the lure of the money and docs doing multiple jobs at once. If you spread yourself too thin, you run the risk of offering substandard care that the rest of us have to clean up. Seeing 25 patients in 4 hours, acute or not, is not good medicine under any model, imo.

 

[clausewitz2]

I don’t see how that logically follows..psychiatrists are superior to NP in every aspect of medicine so it would follow that a psychiatrist would be much safer than an NP to conduct short visits, an NP would need much more time with a pt

Please explain the mystical qualities that allow psychiatrists to outperform NPs when their follow-up appointments are the length of a TV commercial break.

Our advantages are a greater breadth of experience, longer training, and (hopefully) a better knowledge base. You cannot meaningfully apply any of those if you are barely talking to the patient. Yes there are those collaborative care models where you never see them but you are sure as hell talking about most of those patients for more than 5 minutes each.

 

[Mass Effect]

I don’t see how that logically follows..psychiatrists are superior to NP in every aspect of medicine so it would follow that a psychiatrist would be much safer than an NP to conduct short visits, an NP would need much more time with a pt

The point is that the psychiatrist who sees 25 patients in 4 hours is providing the same level of care that an NP would seeing those 25 patients in a day. And the NP would be a lot less expensive.

 

[Trismegistus4]

If you are seeing 25 patients per day you are not practicing psychiatry you are are being paid to generate scripts and sign notes. What a joke.

Remember @phorensic? He hasn't posted here since December but he once said one of his gigs was covering a hospital on the weekend where he'd see 50 to 70 patients a day. And he was pretty dismissive of those who thought there was something wrong with that.

 

[Attending1985]

The point is that the psychiatrist who sees 25 patients in 4 hours is providing the same level of care that an NP would seeing those 25 patients in a day. And the NP would be a lot less expensive.

Completely agree and just wanted to add that, in general, psychiatric care sufffers as well.

 

[Attending1985]

Remember @phorensic? He hasn't posted here since December but he once said one of his gigs was covering a hospital on the weekend where he'd see 50 to 70 patients a day. And he was pretty dismissive of those who thought there was something wrong with that.

Yeah because he doesn’t care about anything but making money.

 

[Mass Effect]

Remember @phorensic? He hasn't posted here since December but he once said one of his gigs was covering a hospital on the weekend where he'd see 50 to 70 patients a day. And he was pretty dismissive of those who thought there was something wrong with that.

These jobs are insanely lucrative. I interviewed for a weekend gig like this. It paid close to 10K per weekend, which included 50 patients a day and call for the whole weekend. I can see why some would be attracted to it, but it's just not good care for those 50 patients. As soon as I heard the work load, I turned it down.

 

[Attending1985]

I don’t see how that logically follows..psychiatrists are superior to NP in every aspect of medicine so it would follow that a psychiatrist would be much safer than an NP to conduct short visits, an NP would need much more time with a pt

Explain how a psychiatrist is superior. How can you excercise your knowledge base when you only have 15 minutes worth of information. Everyone on here laments the encroachment of psychiatric nurse practitioners in our field. At the same time we are advocating that we don’t learn psychotherapy, practice strictly biological model, and see patients in 15 minutes. We essentially want to be a nurse practitioners and get paid more. We are digging our own grave. It doesn’t take four years to learn how to use a psychiatric medication. It’s time to raise the standard of care. Make sure psychiatrists have a vast knowledge of medicine and psychotherapy. That’s what sets us apart. If you don’t want to take the time and energy to learn it and practice it then why do you deserve the money.

 

[dl2dp2]

These jobs are insanely lucrative. I interviewed for a weekend gig like this. It paid close to 10K per weekend, which included 50 patients a day and call for the whole weekend. I can see why some would be attracted to it, but it's just not good care for those 50 patients. As soon as I heard the work load, I turned it down.

I wouldn't call this "insanely lucrative..." A weekend gig of 8PM Friday to 8AM on Monday would be 60 hours at 10000, which yields $166 per hour. There are telepsych jobs that pay better than that. Frankly it's a ****ty job that provides ****ty care, but it can be a good fit for some people who can't get a better gig. It's not rare to generate 10k revenue working two longish half days a week in some markets during business hours in cash private practice.

 

[Mass Effect]

I wouldn't call this "insanely lucrative..." A weekend gig of 8PM Friday to 8AM on Monday would be 60 hours at 10000, which yields $166 per hour. There are telepsych jobs that pay better than that. Frankly it's a ****ty job that provides ****ty care, but it can be a good fit for some people who can't get a better gig.

But it's home call. I don't know, to me it sounded like a lot of money, but I can see how it isn't when you break it down to hourly rates. I completely agree though that you're providing ****ty care.

 

[thepoopologist]

 

[Monocles]

The naive part of me thinks that there has to be a way that you can work less, provide standard of care to your patients, and still maintain your lifestyle. Nothing against the posters above but I personally wouldn't feel comfortable seeing pts for less than 15 minutes.

I think one of the parts of FIRE that doesn't get talked about a lot is preventing lifestyle creep. I had classmates who are half a million dollars in debt and yet when we go out they would spend $100 on drinks whereas I get my $5 slice of jumbo pizza and hang out with them. They really seem to embrace the "physician lifestyle" even though we're still trainees. To each their own.

Disclaimer I don't think to FIRE or not FIRE is wrong either way... as long as you are happy make your own decision.

 

[Merovinge]

The naive part of me thinks that there has to be a way that you can work less, provide standard of care to your patients, and still maintain your lifestyle. Nothing against the posters above but I personally wouldn't feel comfortable seeing pts for less than 15 minutes.

I think one of the parts of FIRE that doesn't get talked about a lot is preventing lifestyle creep. I had classmates who are half a million dollars in debt and yet when we go out they would spend $100 on drinks whereas I get my $5 slice of jumbo pizza and hang out with them. They really seem to embrace the "physician lifestyle" even though we're still trainees. To each their own.

Disclaimer I don't think to FIRE or not FIRE is wrong either way... as long as you are happy make your own decision.

Actually most of the FIRE movement for lower incoming generators is heavily slanted towards lowering expenses (in ways that seem absurd if you are a top 1-3% income earner). Most MDs however have not had the classic introduction to FIRE and lifesteal creep will come at you from all angles and is a virtual inevitability unless one puts up active transport to stop it - completely agree with you.

I'm glad people are talking about the topic, I will say that all my jobs to date have allowed 30 minute followup and 1hour long evals or seeing about 14 inpatients over a 6-8 hour long day. No entrepreneurship (to date, I hope to at some point), no cutting corners on care. I think the slide down that path is a dark road where you end up justifying your actions and forget what great patient care actually looks like.

 

[dl2dp2]

The naive part of me thinks that there has to be a way that you can work less, provide standard of care to your patients, and still maintain your lifestyle. Nothing against the posters above but I personally wouldn't feel comfortable seeing pts for less than 15 minutes.

Yeah no. In my opinion, the best way to make more money in this field *by far* is to provide FABULOUS care that's BETTER than standard of care to your patients, and charge a lot MORE. I see people for 90 min+ evaluations often over multiple visits. My child colleagues see people for 4 hours 360 degree evaluations--and charge for every minute. I don't compete with NPs. I actually deliver evidence-based care. I actually do real DSM5 diagnoses. I actually do manual driven (and insight-oriented) psychotherapy. I actually discuss risks and benefits thoroughly. I actually have subspecialty knowledge. People I see know that their mental health is worth every penny they pay me, and many of them are not wealthy at all (several are on ACA or Medicaid and still pay full cash!). Families and patients actually trust me. AND I make way more money per hour (and I suspect, altogether) than people who see 25 patients in 60 minutes or whatever... You need to stop thinking of yourself as garbage and stop treating everyone else like garbage, and then you'll realize that people will stop treating you like garbage. This is how it works.

 

[calvnandhobbs68]

I absolutely agree, my main message is that even if you do have high loans or other needed fixed expenses,, psychiatry as a field definitely can let you have a strong revenue stream. One does not need to do derm/rad onc/spine surgery to reach financial independence. I've heard from medical students that score very highly on Step 1 that they get heavily pressured by advisers, attendings, peers, and family to go into (currently) high paying specialties and I find that notion absurd.

Well.....except you have a spouse who’s a doctor. How much did she have in loans and what speciality is she in? Even if she’s doing peds (except sounds like she’s doing something procedural with the disability insurance comment) you boost your gross income by at least 180K (on the way low end).

Your example doesn’t actually support the point you’re trying to make at all. The second doctor income absolutely makes a huge difference.

 

[Merely]

Well.....except you have a spouse who’s a doctor. How much did she have in loans and what speciality is she in? Even if she’s doing peds (except sounds like she’s doing something procedural with the disability insurance comment) you boost your gross income by at least 180K (on the way low end).

Your example doesn’t actually support the point you’re trying to make at all. The second doctor income absolutely makes a huge difference.

Lol

 

[calvnandhobbs68]

There's a real danger of moving too quickly at the cost of care, very important to raise this point. It's unacceptable and dangerous. 25 patients in an office setting over 3 hours is crazy. That's dangerous medicine.

My situation is that around a third of my patients are stable, awaiting placement. So that leaves around 15 acute folks over 3 or 4 hours allows me to spend a lot of time with each.

“A lot of time”

Dude 15/4 is 3.75 patients per hour. Of “acute patients”. So 15 minutes a patient.

Primary care follow ups are 15 minutes a patient.

I would hardly call this “a lot of time”.

I agree with the poster above that what will set people apart in this field is taking time to make meaningful and thoughtful diagnoses and decisions. As someone who had experience in another field, I really do agree with the idea that psych is an easy field to do passably in. The art is in the mastery of the field. The vast majority of decisions you make are not going to cause immediate harm to a patient and it really does not take a physician to adjust someone’s Zoloft or up their haldol. The more people subscribe to this 15 minute med check thinking the more people will wonder what exactly is different from psychiatrists vs NPs.

 

[Sushirolls]

The naive part of me thinks that there has to be a way that you can work less, provide standard of care to your patients, and still maintain your lifestyle. Nothing against the posters above but I personally wouldn't feel comfortable seeing pts for less than 15 minutes.

I think one of the parts of FIRE that doesn't get talked about a lot is preventing lifestyle creep. I had classmates who are half a million dollars in debt and yet when we go out they would spend $100 on drinks whereas I get my $5 slice of jumbo pizza and hang out with them. They really seem to embrace the "physician lifestyle" even though we're still trainees. To each their own.

Disclaimer I don't think to FIRE or not FIRE is wrong either way... as long as you are happy make your own decision.

Follow along the thread I started about my start of a private practice. I do 90min evals, and have gone as low as 60min or as high as 120min. Follow ups are 30min. I'm also selectively taking on therapy patients with some integrated hypnotherapy. My goal is 30 hours clinical time per week, but 40 hours total office time.

 

[Shufflin]

Just to clarify, on days I have a new intake I'm spending a good 45 min with that intake and expanding my day. The 15, and sometimes it's 10 or 11, acute patients I'm seeing are follow-ups, I'm averaging around 15 min to 20 min on follow-ups, not 5 min as some folks are saying. I understand some of you think I'm giving substandard care, but that's not the case. This thread is getting a bit, how do you say, icy?

 

[Merovinge]

Well.....except you have a spouse who’s a doctor. How much did she have in loans and what speciality is she in? Even if she’s doing peds (except sounds like she’s doing something procedural with the disability insurance comment) you boost your gross income by at least 180K (on the way low end).

Your example doesn’t actually support the point you’re trying to make at all. The second doctor income absolutely makes a huge difference.

I specifically avoiding any discussion of this because it was not relevant to my loan repayment or status to date. She contributed 60k as a fellow and has this year as well to loans/household expense, a contribution that many/majority of individuals with a bachelor's degree can earn. It's true that now we are going to significantly outstrip a single earning psychiatrist but her income has not been at all related to my ability to clear 240k of loans in 2 years (+2 more years of contracted payments).

Not everyone is a traditional student, doesn't have kids, and has an earning spouse, but my point is this falls well within the normal/achievable range for many people reading this.