Have felt the same way, although my motivations for not sharing my income situation are not so altruistic. Am quite happy for medical students and other doctors to consider psychiatry “low paying” and avoid it on that basis as it maintains the current situation of low supply. Of course, due to the nature of our patient interactions typically being of longer duration, and with relationships tending to be ongoing there is already a natural limit to the availability of psychiatric appointments. Should probably add that due to regional differences I’m also not competing with prescribing psychologists or nurse practitioners and this is unlikely to change anytime soon.
As a bit of a personal side project, I have been collecting data on my private practice income since I started in 2015.
All dollar amounts are in AUD, and our Financial year runs from July 1 to June 30.
Income drops are typically explained due to taking annual leave – usually around December and June, and there was one overseas trip in March-April 2017. Slowdowns are generally expected through December and January due to the Christmas/NY period, and the rooms also close during this time.
Large increases on the graph are to some extent due to receiving inpatient payouts which I only bill once the patient is discharged which leads to an element of lag. Sometimes these balance out – eg. May and June 2019 are similar, despite taking 2 weeks off in June, as I received a few large payments from admissions done in the preceding months.
I started at 2 sessions (1 day) a week, increasing to 3 sessions around October/November of 2015. Somewhat reluctantly added another session in September 2018. This was because they had someone else interested in using the room for a half day and I didn’t want to feel rushed out and a few patients were complaining they couldn’t get into see me. Not sure when I will increase sessions next. Adding a third clinic day might get me over 450k pa, but I question if I really need that? If I earn more, I suppose I could retire faster – but how does one really conceptualise the state of working 2 days a week and having 4 day weekends?
My usual office hours are 8.30 to 5.30pm, and will see inpatients after those times. For new patients I will type up my notes in the same evening, and aim to finalise and send letters within the next 2-3 days. If I could cut back on the letter writing time, I would save a lot of time. However, while taking shortcuts is tempting I know that a constant complaint from GP referrers is that many psychiatrists don’t write back at all. Having reasonably detailed letters is a good summary and reminder for myself, and can often provide a good starting point to lead things off in review appointments. It’s also helpful for formal third party, insurance or legal requests which I can bill for. Getting paid for these has been quite an interesting experience. Some psychiatrists will accept the meagre “Recommended rate” on offer which may be less than a $80 and write a half assed report, but I prefer to do something of quality (as these reports reflect on myself) and demand that they actually pay me for my time which could end up being in the thousands. To date, this has ended up being a bonus source of income which I wouldn’t have otherwise known about during my training.
When I started I was seeing up to 6 new assessments in a day, and could be finishing around 2-3am which was also very draining. At the time it was manageable at only 1 day a week, but can remember thinking to myself that this wasn’t going to be sustainable in the long term, and definitely not as a full time gig. Over time I started to have more review appointment and less new patients. Developed some mild RSI which led to investing in a microphone and voice recognition software which also cut down on the admin time quite a bit.
If I admit any inpatients, I try to see them at least 5-6x a week which would roughly work out to an additional day per week. In total I’d estimate that I’d have around 17-25 hours of clinical face to face time per week, with about 5 hours of unbillable admin which is mainly letter writing back to referrers. I haven’t included practice running costs in those numbers, but the main expense is room rental which is a fixed sessional fee. Over time, this has become a smaller proportion of total income, hovering around the 10-15% mark.
Regarding fees, I have only raised my fee once in early 2019 and have not noticed much in terms of cancellations etc. After going to the dentist for a check-up I realised that I couldn’t actually remember how much I had been charged the previous appointment and figured most patients would probably be the same so long as the rise wasn’t extremely drastic. As well as having sunk costs, I also figured that psychiatric patients would wear the cost as opposed to starting out with someone new, which would have a higher initial cost for the first consultation. I had considered similar principles in designing my fee structure, which is slightly discounted for the initial consult fee relative to review appoints. Later on I was out on a GP visit and discussing this with my hospital marketing manager who told me that when she worked in sales you could pretty much get away with a 5-7% increase each year without too much issue. Try and push 10-15% and people will start to complain. I had increased reviews by 4% and new appointments by about 7.5% as I figured new patients would have no existing basis to compare against.
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