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Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
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.
Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
Who actually pays this? Seriously? If you have insurance, wouldn't you just find someone on the insurance plan?
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.Who actually pays this? Seriously? If you have insurance, wouldn't you just find someone on the insurance plan?
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.
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.
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.
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.
Who actually pays this? Seriously? If you have insurance, wouldn't you just find someone on the insurance plan?
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
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.
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?
Are there really prominent psychiatrists that can charge $500 an hour for visits and maintain full schedules?
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.
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.
Big Fish, Small Pond.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.
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.
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
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.
Are most psychiatrists at academic centers paid by salary or by production? .
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.
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.
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.
My last academic center, the going rate was ~50%.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%).
That's far and away the worst I've heard. Ouch....My last academic center, the going rate was ~50%.
Yeah... can be pretty ugly.That's far and away the worst I've heard. Ouch....
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.
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.
If the med check involves prescriptions for large quantities of xanax, adderall, and suboxone; I can imagine patients paying that amount
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.
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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Abilify prescribed by a cash pay psychiatrist for med mgt is exactly the same as prescribed by any psychiatrist.
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.
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.....
me strongly disagree. There is huge variability in quality within and between all types of mental health practitioners.
Abilify prescribed by a cash pay psychiatrist for med mgt is exactly the same as prescribed by any psychiatrist.