hourly rate

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gopens67 said:
Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
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actual numbers aside, it's important to realize that a psychiatrist(or psychologist) listed cash rate is often very different from their average effective rate, which is also different from there actual collected rate.

For example, I know one analyst whose rate is listed at 200/hr, but with discounts to certain pts and such her effective charges come out to about 160-165/hr. And what she actually ends up collecting is more like 140-145/hr gross.
 
vistaril said:
actual numbers aside, it's important to realize that a psychiatrist(or psychologist) listed cash rate is often very different from their average effective rate, which is also different from there actual collected rate.

For example, I know one analyst whose rate is listed at 200/hr, but with discounts to certain pts and such her effective charges come out to about 160-165/hr. And what she actually ends up collecting is more like 140-145/hr gross.
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how does she determine who does and doesn't get a discount? their financial status?
 
gopens67 said:
Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
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I haven't seen that high yet in a clinical practice. I have seen higher than $500/hr for forensic work. Clinically I've been seeing $350ish/hr and they collect that. You need a business mindset, flexible hours, and do quality work in the right location.
 
The highest rates I've ever heard of were $2k for a 1.5 hr evaluation, and $350 for a 30 minute follow up. Not sure what percentage of that psychiatrist's patients were full fee. You can probably guess the location.
 
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I know someone who charged $700/hr for forensics. Gets about a case every month or two. Like, flown out of state for 4 days, expenses paid, to work on a case. Not steady work though. Day gig is child inpatient.

The averages I've seen are closer to the $250-350 range, with $300 being about average. Fill rates and no-show rates are VERY variable though, so hard to gauge.
 
Who actually pays this? Seriously? If you have insurance, wouldn't you just find someone on the insurance plan?
 
Silent Cool said:
Who actually pays this? Seriously? If you have insurance, wouldn't you just find someone on the insurance plan?
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Around me that's REALLY hard. There are only a couple places that take insurance in town. The resident clinic, and maybe 1-2 private psychiatrists who are all full. For child, there's only 1 guy that takes any insurance, and even he only takes a couple high paying ones...and is VERY full. So, there's not much choice. People drive for 30-60 minutes, just to find a CASH person who isn't full.

The shortage is pretty bad. Granted, I don't exactly live in a "big city", but it's a fairly desirable small one, and we're fairly short handed here. If you leave my town and go to some of the more rural, but still decent sized ones, it's WAY worse. I have a bunch of inpatients that live 2-4 hours away (we're the closest inpatient unit) whose only option is a pill mill (like, 5 min visits, lots of benzos) or their PCP.
 
Silent Cool said:
Who actually pays this? Seriously? If you have insurance, wouldn't you just find someone on the insurance plan?
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Even if there are psychiatrists on a particular plan, many have 3-4 month waits for first appointments. Patients with means will often go to a cash only psychiatrist and then stay there.
 
digitlnoize said:
Around me that's REALLY hard. There are only a couple places that take insurance in town. The resident clinic, and maybe 1-2 private psychiatrists who are all full. For child, there's only 1 guy that takes any insurance, and even he only takes a couple high paying ones...and is VERY full. So, there's not much choice. People drive for 30-60 minutes, just to find a CASH person who isn't full.

The shortage is pretty bad. Granted, I don't exactly live in a "big city", but it's a fairly desirable small one, and we're fairly short handed here. If you leave my town and go to some of the more rural, but still decent sized ones, it's WAY worse. I have a bunch of inpatients that live 2-4 hours away (we're the closest inpatient unit) whose only option is a pill mill (like, 5 min visits, lots of benzos) or their PCP.
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Are there substantial differences in salary between cash- vs. insurance-based practices? I imagine you get less with the latter, but is it a huge difference? If there really is so much demand for the service, I imagine schedules can be booked solid unless reimbursement rates are pitiful.
 
No.
NickNaylor said:
Are there substantial differences in salary between cash- vs. insurance-based practices? I imagine you get less with the latter, but is it a huge difference? If there really is so much demand for the service, I imagine schedules can be booked solid unless reimbursement rates are pitiful.
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I think the main difference is in autonomy. You'll hear plenty of sentiment on this board that folks want to be their own boss, have freedom to practice according to their own parameters, perhaps have designs on developing a practice entrepenurially... But for many of us, we're perfectly happy with the security of large hospitals or multi-specialty practices, and make darn near as much now--minus the headaches of building a practice, etc. Yeah, perhaps we won't build the $HalfMillion/year practice in 20 years, but we can build that in 10-12 years of employer-matched 401K anyway.
 
NickNaylor said:
Are there substantial differences in salary between cash- vs. insurance-based practices? I imagine you get less with the latter, but is it a huge difference? If there really is so much demand for the service, I imagine schedules can be booked solid unless reimbursement rates are pitiful.
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I'm not sure about "salary", but if you own your own place cash has some advantages: Higher Fee per hour worked, more time to spend with patients, lower overhead (less staff required). It does have a major disadvantage: namely that you fill slower and have a smaller referral pool than you would otherwise have.

I used to be a big proponent of cash only, but I do think it limits the growth of your practice, especially in terms of mid-levels, add-on docs, additional locations, etc. Any given area can only support so many cash-only patients because you have to have money to pay for it, and many of our patients don't.

Assuming a single physician owned practice (i.e. it's your place and you're the only doc), salary is probably close to equal in each setting, if you practice like most psychiatrists. Insurance-based docs tend to see patients quicker (i.e. 15-20 min med checks). Cash docs tend to take more time, but charge more. It really ends up balancing out, as the big referral pool means your insurance based practice will be full much more quickly and probably stay more full, thus you'll bill more visits but at a lower rate, with higher overhead (which if you're smart doesn't have to be TOO much higher). Cash will fill more slowly and likely bill fewer visits at a higher rate with lower overhead. Obviously exceptions exist as there are plenty of cash practices that stay really full, but this is very location dependent, also child or adult matters a bit in this. There's more cash in the child world, but it's not clear that actual take home pay is significantly higher, maybe slightly. Overall, I'd give cash a slight income edge, but with more uncertainty and longer startup time and more limited growth potential. Just depends on what you want.
 
OldPsychDoc said:
Yeah, perhaps we won't build the $HalfMillion/year practice in 20 years, but we can build that in 10-12 years of employer-matched 401K anyway.
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You can build a $500k/year salary in 10-12 years of 401k?!? Really?!? I'd love to see some numbers. I'm sure you could build a $500k 401k (too many k's!!!), but a 500k/year 401k would be...almost $9 million assuming an 6% annual rate of return. I just don't see how to get there that fast...am I missing something?
 
digitlnoize said:
You can build a $500k/year salary in 10-12 years of 401k?!? Really?!? I'd love to see some numbers. I'm sure you could build a $500k 401k (too many k's
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a 500k 401k over 10 years would be tough as well....assuming a salary of 175k and a 6% contribution rate and a 6% match,
OldPsychDoc said:
No.


I think the main difference is in autonomy. You'll hear plenty of sentiment on this board that folks want to be their own boss, have freedom to practice according to their own parameters, perhaps have designs on developing a practice entrepenurially... But for many of us, we're perfectly happy with the security of large hospitals or multi-specialty practices, and make darn near as much now--minus the headaches of building a practice, etc. Yeah, perhaps we won't build the $HalfMillion/year practice in 20 years, but we can build that in 10-12 years of employer-matched 401K anyway.
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in some ways(depending on your investment goals) it is actually not much worse to be self employed for 401k purposes.....cap is 57k i think instead of 17.5k.

So you get 40 extra thousand you can stuff in tax free. typical 401k matching is 5-6%. On a 200k salary that is 10-12k in 'extra' money. But if your total tax rate is 25% and you can put in 40k less to defer, well...do the math.

if someone makes 200k and has a 5-6% matching plan and only puts in the 5-6%, they aren't likely to get to 500k socked away unless. That would only represent a total deposit(include match) of 100-110k. I don't feel like doing the math right now but to get to 500k based on that initial deposit over a 10 year period would be a truly wicked interest rate, even with compounding interest. Now if one maxed out there 401k, that changes things somewhat....on the other hand if a self employed person maxed out that 401k, that would change the numbers even more.
 
digitlnoize said:
You can build a $500k/year salary in 10-12 years of 401k?!? Really?!? I'd love to see some numbers. I'm sure you could build a $500k 401k (too many k's!!!), but a 500k/year 401k would be...almost $9 million assuming an 6% annual rate of return. I just don't see how to get there that fast...am I missing something?
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Nope--sorry for the misunderstanding. I did mean building the 401k to a balance over $500,000.

(And I do max out the annual contribution, fwiw.)
 
Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
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I've seen it, but this is for doctors that are truly exceptional, were known to be one of the best in the area and had clients with money that knew enough to know the doctor was that good.

But for many of us, we're perfectly happy with the security of large hospitals or multi-specialty practices, and make darn near as much now--minus the headaches of building a practice, etc. Yeah, perhaps we won't build the $HalfMillion/year practice in 20 years, but we can build that in 10-12 years of employer-matched 401K anyway.
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For me, most psychiatrists, not all, but most I've seen in the community are terrible. I'm talking psychiatrists that give their patient Xanax and Adderall-no matter what is going on with the patient, to ones that give attractive woman breast exams (but only the attractive ones), to ones that are treating panic disorder with Abilify.

While working in the community, I got sick of seeing patients being completely screwed over by other docs.

In a university setting, at least the one I'm in now, most of my colleages rate from good to best in the country, I can call up someone considered one of the top people in the world for input, undergo geek-psychiatry-talk with someone that actually knows something vs some idiot psychiatrist telling me that "Latuda is my favorite medication because...." (real reason pharm company kickback).

Please do not interpret my statements as a criticism of all doctors working in the community. I know some that are exceptional. Who knows? I may do that in the future myself being that it could pay better than the university if you play your cards right.
 
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Whopper are you saying most psychiatrists you've seen are terrible? I mean I need to digest that for a minute. If true, then something's seriously wrong with this field of medicine. And if true, that fact alone would make me want to switch fields. PM&R perhaps.
 
Leo Aquarius said:
Whopper are you saying most psychiatrists you've seen are terrible? I mean I need to digest that for a minute. If true, then something's seriously wrong with this field of medicine. And if true, that fact alone would make me want to switch fields. PM&R perhaps.
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When you start practicing you will inherit patients on weird med combinations. Some of that may not be prescriber incompetence but rather last ditch efforts at providing stability for the patient in a less than ideal practice environment. Don't let it get to you. Start from scratch if you have to but also weigh the risks of decompensation especially if there is a history of severe suicide attempts or extreme violence.
 
Whopper are you saying most psychiatrists you've seen are terrible? I mean I need to digest that for a minute. If true, then something's seriously wrong with this field of medicine. And if true, that fact alone would make me want to switch fields. PM&R perhaps.
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Yes to question 1.

Is there something seriously wrong with this field? I can't answer that because I see this problem in all fields of medicine. That answers your last issue.

Most is not 99% or close to it. It's more on the order of > 50% to 2/3ds. This is not something unique to where I am. I've seen this problem all across the country and in several states. Residents may be oblivious to this because of the blinders one has in that level of training and the belief that someone above you is likely better. Another blinder is if you're in a good program with good attendings, well that's to be expected, but work in a state asylum, start taking patients from attendings in an outpatient setting, you start seeing what I'm talking about.

How many times have you seen a PCP make their own patient addicted to an opioid? Run a pill-mill? See a diabetic patient in the ER with an infection, given an antibiotic and not check the blood sugars despite that it's basic knowledge to know that an infection could easily raise blood sugar? I see this all the time. All fields of medicine have doctors that dont' care. Don't let that hurt your view of psychiatry. If you give a damn, that's even more reason to stay in this field. or any field you're passionate about. So long as you have the passion you likely will not be that bad.

When you start practicing you will inherit patients on weird med combinations. Some of that may not be prescriber incompetence but rather last ditch efforts at providing stability for the patient in a less than ideal practice environment
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And yes, I've had that. I have patients now on weird med combinations that were 5th line or more and all the meds that would have usually and should've worked didn't work. In those situations the attendings need to document why they did what they did.

But no, I've seen some doctors give Xanax and Adderall to everybody, start a patient on 5 meds the first visit (antipsychotic, antidepressant, sleep med, mood stabilizer, benzo) all in the first visit.

There are bad doctors in this field. There's bad doctors in every field.
 
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Just to let you guys know of a weird med combo, one of my patients is on Tramadol, Mirtazapine, Lunesta, and Gabapentin to treat his OCD and PTSD. Nothing else worked. None of the SSRIs, SNRIs, several TCAs, and several psychotropics where I tried them out of desperation on the least amount of evidenced-based data they could work such as Namenda for OCD, SAM-E, etc. The guy's a candidate for cingulotomy. I did document everything quite extensively.

The problem with him is I suspect several of the meds that were tried would've worked had he not had POTS and an atonic bladder. Genetic testing was conducted that showed he was likely a good candidate for some of the meds for his psychiatric disorders. Several meds that were tried skyrocketed his BP out of control due to his POTS or caused him to have to self-catheterize due to his atonic bladder. The slightest anticholinergic effect of any meds seemed to cause this problem.

I ended up making a chart on his file so that any future attending would see that pretty much almost everything was tried. The Mirtazapine actually didn't do anything other than help him sleep, but without it he does not sleep at all. That's why we haven't done an MAO-I, because if he stops the Mirtazapine, and he'll have to be off of it for weeks, he won't sleep--AT ALL.

In his current state, he's better than not with these meds, but not good enough to be going back to school. We're currently discussing cingulotomy because he's scared to do it. He's had about 5 other psychiatrists and several psychologists evaluate him, one of them being a high-end OCD researcher. He told me he's the best he's been for years on this regimen despite him still having a GAF of only about 35-45.
 
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whopper said:
Just to let you guys know of a weird med combo, one of my patients is on Tramadol, Mirtazapine, Lunesta, and Gabapentin to treat his OCD and PTSD. Nothing else worked. None of the SSRIs, SNRIs, several TCAs, and several psychotropics where I tried them out of desperation on the least amount of evidenced-based data they could work such as Namenda for OCD, SAM-E, etc. The guy's a candidate for cingulotomy. I did document everything quite extensively.

The problem with him is I suspect several of the meds that were tried would've worked had he not had POTS and an atonic bladder. Genetic testing was conducted that showed he was likely a good candidate for some of the meds for his psychiatric disorders. Several meds that were tried skyrocketed his BP out of control due to his POTS or caused him to have to self-catheterize due to his atonic bladder. The slightest anticholinergic effect of any meds seemed to cause this problem.

I ended up making a chart on his file so that any future attending would see that pretty much almost everything was tried. The Mirtazapine actually didn't do anything other than help him sleep, but without it he does not sleep at all. That's why we haven't done an MAO-I, because if he stops the Mirtazapine, and he'll have to be off of it for weeks, he won't sleep--AT ALL.

In his current state, he's better than not with these meds, but not good enough to be going back to school. We're currently discussing cingulotomy because he's scared to do it. He's had about 5 other psychiatrists and several psychologists evaluate him, one of them being a high-end OCD researcher. He told me he's the best he's been for years on this regimen despite him still having a GAF of only about 35-45.
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I would suggest participation in one of the clinical trials for IV ketamine before sending a patient for cingulotomy.


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just recently heard of a few psychiatrists in a big city near me that charge over $600 for an initial visit and $400 for follow-up visits. They are associated with a big academic center. Do they really receive most of this fee or is some of it going to the academic center? Are most psychiatrists at academic centers paid by salary or by production? BTW, i just want to state for the record that I doubt any psychiatrist is actually worth this ludicrous rate. And I imagine all of their pts have to be loaded to even consider being seen by these docs.
 
gopens67 said:
Are most psychiatrists at academic centers paid by salary or by production? .
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both- base salary, % of collections or based on rvu's (sometimes at different rates for teaching clinic vs attending clinic), various supplements for being a chief of service or running a ward, portion of research grants. Often there are multiple sources of income- department, medical school, hospital,
 
At many academic centers, faculty can see private patients in their offices and use their university for billing, malpractice, etc. the psychiatrist keeps the money but pays a vig in overhead (which I've heard vary from 18-25%).
 
gopens67 said:
just recently heard of a few psychiatrists in a big city near me that charge over $600 for an initial visit and $400 for follow-up visits. They are associated with a big academic center. Do they really receive most of this fee or is some of it going to the academic center? Are most psychiatrists at academic centers paid by salary or by production? BTW, i just want to state for the record that I doubt any psychiatrist is actually worth this ludicrous rate. And I imagine all of their pts have to be loaded to even consider being seen by these docs.
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I don't see how this is outrageous at all. Medicare currently reimburses around $150 for an initial eval and maybe $130 for a 45 min followup. The $600 initial evals are almost always 90 min. So, medicare gives you $300 and this guy wants to charge $300 more for an initial eval. It's not THAT expensive if this is a second opinion consultation for some kind of subspecialty concerns. Given the fact that people pay $150 for a mud bath and $300 for a haircut and $1000 an hour for a good lawyer... An initial psychiatric consultation is a very serious, potentially life altering service.

And no, you don't have to be "loaded" to be seen by these docs, as my calculation shows above. This is a common but unfortunate misconception. Many many exhausted middle income patients get consultations or even routine treatment by private pay doctors if they can get some partial reimbursement from their insurance. You see a psychiatrist once every one or two months, and $400 once a month is about $5000 a year. If you make 80k a year and the medications changes are very helpful, you bet your ass he will pay that out of pocket---to keep a job, or stay in school, for example.

For most parts of the country $300 haircuts are uncommon, however. But in these parts, as I showed above, even Medicare provides a solid $200 per hour revenue stream for psychiatrists.
 
sluox said:
I don't see how this is outrageous at all. Medicare currently reimburses around $150 for an initial eval and maybe $130 for a 45 min followup. The $600 initial evals are almost always 90 min. So, medicare gives you $300 and this guy wants to charge $300 more for an initial eval. It's not THAT expensive if this is a second opinion consultation for some kind of subspecialty concerns. Given the fact that people pay $150 for a mud bath and $300 for a haircut and $1000 an hour for a good lawyer... An initial psychiatric consultation is a very serious, potentially life altering service.

And no, you don't have to be "loaded" to be seen by these docs, as my calculation shows above. This is a common but unfortunate misconception. Many many exhausted middle income patients get consultations or even routine treatment by private pay doctors if they can get some partial reimbursement from their insurance. You see a psychiatrist once every one or two months, and $400 once a month is about $5000 a year. If you make 80k a year and the medications changes are very helpful, you bet your ass he will pay that out of pocket---to keep a job, or stay in school, for example.

For most parts of the country $300 haircuts are uncommon, however. But in these parts, as I showed above, even Medicare provides a solid $200 per hour revenue stream for psychiatrists.
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theoretically perhaps......you can do the same theoretical exercise for high volume outpt IM through medicare and get some figure like 1100/hr......but they don't actually
see anything close to that.

And some middle income patient, let's say an 80k salary, isn't going to pay 5k a year of their disposable income to see someone for an hour ONCE A MONTH. That's probablyu 20-30% of their disposable income on med checks.......I've yet to meet anyone who will shell out that much of their disposable income for med checks.

Most psychiatrists here don't take medicare.....and this is most definitely not an area where 300 dollar haircuts are common. Medicare is a giant cluster**** in private practice. I'd avoid it and go with only the largest commercial insurances in the area.
 
gopens67 said:
just recently heard of a few psychiatrists in a big city near me that charge over $600 for an initial visit and $400 for follow-up visits. They are associated with a big academic center. Do they really receive most of this fee or is some of it going to the academic center? Are most psychiatrists at academic centers paid by salary or by production? BTW, i just want to state for the record that I doubt any psychiatrist is actually worth this ludicrous rate. And I imagine all of their pts have to be loaded to even consider being seen by these docs.
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yes, someone paying that much is almost certainly very loaded. Not many of those patients exist.
 
notdeadyet said:
At many academic centers, faculty can see private patients in their offices and use their university for billing, malpractice, etc. the psychiatrist keeps the money but pays a vig in overhead (which I've heard vary from 18-25%).
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My last academic center, the going rate was ~50%.
 
vistaril said:
And some middle income patient, let's say an 80k salary, isn't going to pay 5k a year of their disposable income to see someone for an hour ONCE A MONTH. That's probablyu 20-30% of their disposable income on med checks.......I've yet to meet anyone who will shell out that much of their disposable income for med checks.
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Your calculation is incorrect. Someone who makes 80k a year who pays $400 a month on mental health is paying about 10% of the disposable income. And if you need medications to stay functioning you BET the patient is going to pay for quality service.

I don't really care to debate you. Everyone I see is doing very well as psychiatrists around where I live (a wealthy suburb close to a major city). It sounds like your area really lacks opportunity and I think you should move.
 
FWIW I have patients who make as little as $30-40k a year (in one of the countries most expensive regions). They find it worth while to come see me out of network.

I'm not saying that's every patient, but there are those who will make their mental health a priority.
 
vistaril said:
And some middle income patient, let's say an 80k salary, isn't going to pay 5k a year of their disposable income to see someone for an hour ONCE A MONTH. That's probablyu 20-30% of their disposable income on med checks.......I've yet to meet anyone who will shell out that much of their disposable income for med checks.
.
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If the med check involves prescriptions for large quantities of xanax, adderall, and suboxone; I can imagine patients paying that amount
 
sluox said:
Your calculation is incorrect. Someone who makes 80k a year who pays $400 a month on mental health is paying about 10% of the disposable income. And if you need medications to stay functioning you BET the patient is going to pay for quality service.

I don't really care to debate you. Everyone I see is doing very well as psychiatrists around where I live (a wealthy suburb close to a major city). It sounds like your area really lacks opportunity and I think you should move.
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if someone who makes 80k does have that much disposable, they live an extremely simple/bare bones life...especially if they live in the sort of area where this sort of practice is common. People who live like that sort of existence don't drop that sort of money on mental health care. It just doesn't add up.

The medications a cash pay psychiatrists prescribes aren't special. They don't have a special license to write for certain psychotropics that work better than the rest of the meds we all use. Patients who 'need medications' can get them from a number of providers.
 
michaelrack said:
If the med check involves prescriptions for large quantities of xanax, adderall, and suboxone; I can imagine patients paying that amount
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well perhaps....although many cash pay practitioners will do this for less than that
 
vistaril said:
The medications a cash pay psychiatrists prescribes aren't special. They don't have a special license to write for certain psychotropics that work better than the rest of the meds we all use. Patients who 'need medications' can get them from a number of providers.
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Your point is meaningless. We all know that there are huge geographical variations in the practice of medicine. Cash pay may be not viable for you where you are, but it is viable where I am.

What's special about cash pay psychiatrists is the amount of time and attention paid to the patients and often the brand name (both in terms of CV and in terms of reputation in the community) to ensure a certain degree of quality. There's nothing special about a pair of jeans from True Religion, and yet it's sold for $200 instead of $30 at Walmart. Cash pay psychiatry is exactly that, a low supply high demand luxury service for the mass affluent.

What's unique about psychiatry, as a specialty, is that an average AMG often has a good shot at a top program (unlike say, derm), and as a graduate of a top program one could potentially make a lot more money than his/her peers in a large city/wealthy suburb. Also, there are very few emergencies and the call schedules are often very humane. This is different from Medicare driven cognitive specialties such as neurology and IM, because no matter how good you are most of your patients will be on Medicare, and you have no choice but to take them.

IMHO, psychiatry is one of the best "lifestyle" specialties. The money's not quite there, at least for your average insurance taking Walmart psychiatrist for the middle class (200k for 40 hours of work), but the controllable hours and flexibility of practice style, autonomy, the interesting cases and the possibility to help patients in major major ways makes the specialty extremely appealing. The catch is, if you are really gun-ho about making 300k+, developing a good CV and a reputation in community and a quality referral base, I think, is far more important in psychiatry than in many other specialties--in another word, there is less guarantee and a written down pathway. And if that's the point you are trying to make in an admittedly clumsy way, I agree with you.
 
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sluox said:
There's nothing special about a pair of jeans from True Religion, and yet it's sold for $200 instead of $30 at Walmart. Cash pay psychiatry is exactly that, a low supply high demand luxury service for the mass affluent.
.
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well no, the true religion jeans are better. No doubt nowhere close to 7 times better, but they are better. better stitching, better cotton, etc....

Abilify prescribed by a cash pay psychiatrist for med mgt is exactly the same as prescribed by any psychiatrist.
 
vistaril said:
Abilify prescribed by a cash pay psychiatrist for med mgt is exactly the same as prescribed by any psychiatrist.
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This point is so ridiculous it's bordering on absurd. Your logic is completely out of wack. Psychiatrists are not wholesalers of Abilify. We sell services, not goods. Cash psychiatrists' service of evaluating for the appropriateness of using Abilify and the judgement of correctly using it alone or in combination at the right dosage, etc. is, judged by the market, superior than 10 min med checks dictated by insurance.
 
sluox said:
This point is so ridiculous it's bordering on absurd. Your logic is completely out of wack. Psychiatrists are not wholesalers of Abilify. We sell services, not goods. Cash psychiatrists' service of evaluating for the appropriateness of using Abilify and the judgement of correctly using it alone or in combination at the right dosage, etc. is, judged by the market, superior than 10 min med checks dictated by insurance.
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and my earlier point is that the use of psychotropics isn't rocket science.....there aren't 3000 different drugs, and the way pharmacology is tied to dx in our field often means diagnostic mistakes, to the extent they are made, sometimes are covered up for anyways by one drug having multiple indications.....
 
vistaril said:
and my earleir point is that the use of psychotropics isn't rocket sceince.....there aren't 3000 different drugs, and the way pharmacology is teid to dx in our feild often means diagnostic mistakes, to the extent they are made, sometimes are covered up for anyways by one drug having multiple indications.....
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I strongly disagree. There is huge variability in quality within and between all types of mental health practitioners.
 
TexasPhysician said:
me strongly disagree. There is huge variability in quality within and between all types of mental health practitioners.
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yes, but going back to the original discussion it isn't clear how they are often distributed in terms of practice settings and rates. For example I know of several cash pay psychiatrists who don't practice anything near a decent standard of care.
 
OT: but thar be something seriously wrong and awesome with the site. Apparently t'programmers at SDN have run the whole site through Ye Olde Google Translate and set it to "Pirate."

This is so epic.

You may now resume your regularly scheduled arguing about how much (or little) we make. Spoiler: We have a very nice lifestyle and are generally compensated very well for how much we work (or don't work, as the case may be).
 
I paid about that much per month for weekly massage therapy when my SCI stuff was at its worst. With a LOT lower disposable income than 80k. Resident salary while paying about 1k per month on student loans. I can see people doing that for mental health even if only monthly.
 
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