How do you know there is a demand for psychiatrists?

[medimedimedi]

I always hear that there is a huge need for more psychiatrists, but I did some preliminary searches for jobs that didn't strongly support this claim (compared to other specialties). There doesn't seem to be that many jobs posted, so what are the observations that make everyone say there's such a gap in supply and demand? For example, there is a supply and demand gap in dermatology because most dermatologists with clinics are booked many months in advance. Is there a similar situation in psychiatry?

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[smalltownpsych]

In rural areas, the demand is huge. Our hospital has been trying to hire a psychiatrist for over a year and is using an PMHNP to fill the gap. We have about 30k or so people in our service area and the nearest psychiatrist is two hours away and have 2 (adult) to 6 (child) months to get a new appointment. Just looking at the rough prevalence stats, would mean we have about 300 people with schizophrenia and another 300-600 with Bipolar Disorder, not to mention how many people have serious depression, complex personality disorders, anxiety disorders, co-occurring disorders, etc. Our PMHNP has about 1200 patients that she has seen in the last year and is begging for help. As a psychologist, I can provide a substantial amount of treatment, but as anyone on this board can tell you, for many of the more serious disorders, a psychiatrist should be prescribing their medications. The PCPs sure as heck don't want to do it some of them even ask me what they should prescribe. Also, I have never heard of a psychiatrist who had a lack of work to do even when I was doing my clinical rotations in a major city.

 

[sunlioness]

It takes 4-6 months for a new patient to be seen in our department. We are actively recruiting for 4-5 positions.

 

[vistaril]

I think there is often blurring between 'shortage', 'demand', and job opportunities that are good. Just because there is a shortage in an area doesn't mean that will translate to good high paying jobs that are easy to get and provide good job satisfaction. And just because there is a saturation doesn't mean the opposite. It's a lot more complicated than that.

Then you have regions/cities where certain types of jobs are available, but they aren't good jobs. meaning they are unlikely to provide both decent to good salary that is guaranteed(ie around 200k) and good hours and/or patient loads/volume. Don't get me wrong there are people here who are in those situations now, but that situation is not possible with any job I know of here for new grads. Now this area is bit saturated though.

Basically it's very area dependent. If I went an hour or more from here I can find such jobs for new grads(200k jobs with reasonable patient loads and good working conditions)

 

[mgdsh]

I liked something I saw @Indodo post. Parapharsing: "When cities like SF and NYC have psychiatrist shortages you know theres a ton of need for us out there."

 

[hamstergang]

The need for more psychiatrist is based on the patients, how many there are and how long it takes for them to get appointments. That doesn't mean that there are jobs available for psychiatrists to fill this need.

Also, I believe that psychiatry is a relatively small field. So, completely making these numbers up, pretend that there are five IM docs for every one psychiatrist. Then, if you see two job postings for IM to every one for psychiatry, that does not mean that there is more demand for IM but in fact the opposite.

 

[wolfvgang22]

Is OP trolling? I've been recruited since PGY1...

 

[heyjack70]

It seems like the high demand rural areas would probably have to start paying $300,000 for a 40 hour week, and they would have little problem finding a good psychiatrist. That salary number may be too high or too low, but the reality seems to be there is not enough money to just keep upping the salary until they attract a psychiatrist. And the outcome is the community goes without and it falls on primary care, the ED, and more frequently, the jail/prison system, to pick up the slack for mental health care. That would be an interesting study; how much money does the community save by having a psychiatrist, in regards to preventing admissions, ED visits, and incarcerations.

 

[Shikima]

It seems like the high demand rural areas would probably have to start paying $300,000 for a 40 hour week, and they would have little problem finding a good psychiatrist. That salary number may be too high or too low, but the reality seems to be there is not enough money to just keep upping the salary until they attract a psychiatrist. And the outcome is the community goes without and it falls on primary care, the ED, and more frequently, the jail/prison system, to pick up the slack for mental health care. That would be an interesting study; how much money does the community save by having a psychiatrist, in regards to preventing admissions, ED visits, and incarcerations.

Likely the green journal would kick it back saying they don't like any variation of a multi-modal study being published.

 

[dl2dp2]

I think there is often blurring between 'shortage', 'demand', and job opportunities that are good. Just because there is a shortage in an area doesn't mean that will translate to good high paying jobs that are easy to get and provide good job satisfaction. And just because there is a saturation doesn't mean the opposite. It's a lot more complicated than that.

This is true. However, nationwide >50% of psychiatrists don't take insurance. That in itself tells me that there is a very high demand.

 

[vistaril]

This is true. However, nationwide >50% of psychiatrists don't take insurance. That in itself tells me that there is a very high demand.

well it also tells you about reimbursement as well though. If GIs were suddenly reimbursed 75 bucks(or pick your own number) for colonoscopies we'd see a big cash pay colonoscopy industry too.

But yeah, I do think there is a demand for good patient centered outpt care. Which with what reimbursements what they are for outpt non-procedural services, so many practitioners just have to see lots of patients to make good money. Hence the tradeoff of decreasing volume and increasing reimbursement per patient while perhaps decreasing overhead too.

But I just never looked at the large number of cash pay psychiatrists(unless you are in a market like san Francisco where there are tons of wealthy people....most of us aren't) as a good thing for us. It points to low reimbursement more than anything for insured services.

 

[vistaril]

It seems like the high demand rural areas would probably have to start paying $300,000 for a 40 hour week, and they would have little problem finding a good psychiatrist.

but again this(although it seems logical in one way) really isn't accurate- it's an oversimplification of a supply/demand curve. The reality is that even in areas of EXTREME SHORTAGE, the codes(if you are taking insurance) still pay what they pay. You can't create money out of thin air. Now for inpatient work in some communities the county or state may throw in a stipend or some grant money to make up for it and keep a unit open. But that typically doesn't exist for outpt pp(it may for some funded cmhcs).

Too often on salary we pay too much attention to the supply/demand curve and not enough to what revenue is actually generated for the work. Just because radiology may be saturated in some areas, if someone is reading a lot of mris really fast that is still generating a heck of a lot more revenue/profit than an outpt psychiatrist who works in an extreme shortage area....and the salaries will reflect that(even though the higher paying field may be 'saturated').

 

[Promethean]

My girlfriend had a psychotic episode recently. She was discharged from the psych hospital with instructions to follow up as an outpatient. The wait for a psychiatrist at the clinic they referred us to was 4 months. The shortest time frame we found in the area was 2 months, with a doc who is cash only. Our GP was willing to help with prescribing during the gap. That was the best care available to someone who was fresh from a 2 week inpatient stay and who has the resources to access that care.

There are people really hurting right now who really need psychiatric care and can't get it for any amount of money.

Just because jobs are not posted does not mean that opportunities don't exist. Psych is one of the few specialties where you really don't need to be anyone's employee, and where setting up in practice yourself doesn't have to have unattainable start up costs, even as a new attending. I'm committed to primary care, but looking hard at the family med/psych residencies.

 

[vistaril]

but again it really doesn't matter if there is a 4 month wait for intakes for insured patients vs a 2 week wait. The revenue generated, as long as you are full, is still going to be the same. When you are taking insurance, you don't get paid more because there is an insane wait. If anything, it's a BAD thing because a lot of patients don't wait 4 months. They will make the appt, but then by the time 4 months rolls around the circumstances are of course much different and they are more likely to not show up. That's not good.

 

[Promethean]

but again it really doesn't matter if there is a 4 month wait for intakes for insured patients vs a 2 week wait. The revenue generated, as long as you are full, is still going to be the same. When you are taking insurance, you don't get paid more because there is an insane wait. If anything, it's a BAD thing because a lot of patients don't wait 4 months. They will make the appt, but then by the time 4 months rolls around the circumstances are of course much different and they are more likely to not show up. That's not good.

Ah... but if there is a 4 month wait, and you are a new entrant into the market, you can set your own terms. Some of the people who are offered a 4 month wait can afford to pay cash and will be willing to do so in order to be seen. If that bothers your conscience, offer a sliding scale to fill the rest of your slots.

We aren't really talking about whether someone who is in practice and unhappy with their reimbursements can raise their salary. The question is whether there is really a demand... and plainly there is.

 

[dl2dp2]

Ah... but if there is a 4 month wait, and you are a new entrant into the market, you can set your own terms. Some of the people who are offered a 4 month wait can afford to pay cash and will be willing to do so in order to be seen. If that bothers your conscience, offer a sliding scale to fill the rest of your slots.

We aren't really talking about whether someone who is in practice and unhappy with their reimbursements can raise their salary. The question is whether there is really a demand... and plainly there is.

This is not as simple as it seems--and vistaril is partly right. Here is what I imagine happens: in smaller markets, there are just not enough money to go around for people to not use insurance, and out of network benefits are insufficient to support a large number of patients because in the end they still have to pay >$100 a visit, which means that they literally cannot find anyone who would see them. Meanwhile, private psychiatrists who have a lot of open hours don't see anyone because they'd rather get paid somewhat less (and work less) than enrolling into a network. So you have this very inefficient, two tailed system that completely lacks transparency, mostly because of poor reimbursement on the contract by managed care.

This intuition isn't completely correct--even in smaller markets (i.e. a mid-sized city in a very small state), I've been trying to find referrals, and everyone who advertises on the web are "full" and "cash-only". I have no idea what they charge, but I think probably not more than the R&C (perhaps even slightly less?). This probably explains why 60% of psychiatrists are cash only, but the median salary is still only slightly over 200k.

Vistaril wants to make 500k working 30-40 hours a week. The only answer is to move to a large market: still a shortage, and I feel it. But a lot of money flowing around, and *some* private practice psychiatrists make as much per hour as top consultants in any other field (>$600, i.e. approximately what a lawyer in a mid/small sized firm charges per billable hour). Quite a few are making >500k a year. It's not uncommon to see junior full time PP attendings make 300k. As a savvy PP psychiatrist, your total income does not compare favorably to, say, an entrepreneur in the tech industry, or a hospital administrator, or an executive in the entertainment industry--these people (and their wealthy hipster offsprings) will be your patients. But your income can compare very favorably to PP in other medical (hospital-based) specialties. Psychiatry (along with dermatology, REI, and a couple others) is an unusual medical specialty where the non-executive salaries at the top are not located in rural areas, and generally not publicized in employed positions.

 

[vistaril]

Ah... but if there is a 4 month wait, and you are a new entrant into the market, you can set your own terms. Some of the people who are offered a 4 month wait can afford to pay cash and will be willing to do so in order to be seen. If that bothers your conscience, offer a sliding scale to fill the rest of your slots.
QUOTE]

it's not that simple. The problem in here is people conflate the issue of rates and cash pay psychiatry. Are there psychiatrists who accept cash only and charge 350(or whatever) an hour? Sure. Are there a good number of cash pay psychiatrists? Sure. (but I think you'll find in most areas it is nowhere close to this 50-60% number. I think I read recently where almost half of psychiatrists take medicare as outpts, so if a full half take medicare and I know there are tons who have their own contracts but not taking medicare there is a discrepancy somewhere). but 1 + 1 in this case doesn't equal 2.

I think it's important to separate out LA/SF/Manhattan from the mix. The reality is most psychiatrists don't practice in these cities. In fact over 90% of the country doesn't. So what sluox is talking about in his san fran cash practice, or what nitemagi describes in his LA practice- that doesn't apply to you if you are practicing in Santa Fe or a suburb of Dallas or whatever. Does cash pay and out of network still exist? Sure, to some degree. But to a much lesser extent, and more importantly the rates are generally much less. I'm in a medium sized metro area(1.1 million or so) in the deep south, and although it's a poor state we have a few communities with some money. Nothing like SF/LA of course, but one of the communities frequently makes lists of 'wealthiest' in the nation based on income, housing prices, etc. And there is not a booming cash pay industry here. There are psychs who do cash pay, but my guess is(and I've talked to a few) they do about as well as the insurance based outpt psychs. They probably end u[ making a touch more per hour in some cases but get fewer hours(some by choice, some not). And I can speak to Nashville, Orlando, and Columbia(sc) as well- it's pretty similar in these smaller to bigger cities. Some cash pay, but insurance is still the standard and where cash pay does exist it's much different than in LA/San Fran/Manhattan.

again, this isn't a poke at cash pay psychiatrists. Heck Im jealous of people who make 400 dollars an hour with that pt population and limited overhead. Good for them. But it's just not the standard for most people.

 

[Promethean]

So, my girlfriend is paying $125 in cash per month for a 5 minute medication check. That is all psychiatrists do around here. Like, you literally cannot find any that do longer than 15 minute appointments, and these are strictly to discuss medications. Any other modality of treatment is handled by a nonphysician, for additional charges of course. And for this, she had to wait 2 months for an opening, as her guy is booked solid.

Let's be generous and say that his average appointment time runs a little longer than hers, in the 10 minute range. Let's assume that he can only fill 4 slots per hour, and that he uses remaining time for making notes, etc. Also, let's say that only 75% of his appointments show up over the course of the 4o hours he is available M-F, and that he takes 4 weeks a year of vacation. $500 x .75 x 40hrs x 48wks = 720k He operates a solo office (no secretary salary to be paid), out of a modest building. Even if you play with my numbers a fair bit, there is plenty of potential for substantial take-home in private practice. Maybe only 2 patients come in per hour for 5 minute med checks... that still yields $360k plus a lot of free time. Even if he filled more slots with lower-reimbursing insurance clients and paid a staff member to help him manage the billing, he'd still come out way ahead.

$125 per month isn't an impossible expense if the care is genuinely needed. I know working class families who are paying more than that for cable alone (not including internet.) I saw a psychiatrist in 2000/2001 when I was working as a barista making minimum wage plus tips. I was paying cash then, at over $90 per session. I was being seen weekly, so it was more expensive than my rent, but it had to be done or I was absolutely going to kill myself. With her life on the line, if we had to pay $500 per month out of pocket, we would find a way.

 

[Promethean]

...it's not the standard for most people.

You are absolutely correct. No argument there. I'm just saying that it is possible, and that there are people doing it, even in a small market like mine. And that the need is so great that those people are still overbooked.

There are a lot of reasons not to go that route, and everyone who isn't earning like that has at least one good reason why not. I'm not disparaging those reasons, or saying that everyone should do that. I'm just saying that here, in my small rust belt city, if someone wanted to open up a new private practice charging $600, they could fill 40 hours per week with cash customers no problem because there are just not enough appointments available to patients who really need care.

If someone fresh from inpatient for florid psychosis can't be seen in less than 2 months at any price, then there are so many people on waiting lists that some of them will be able and grateful to pay for access to care.

 

[vistaril]

So, my girlfriend is paying $125 in cash per month for a 5 minute medication check. That is all psychiatrists do around here. Like, you literally cannot find any that do longer than 15 minute appointments, and these are strictly to discuss medications. Any other modality of treatment is handled by a nonphysician, for additional charges of course. And for this, she had to wait 2 months for an opening, as her guy is booked solid.

Let's be generous and say that his average appointment time runs a little longer than hers, in the 10 minute range. Let's assume that he can only fill 4 slots per hour, and that he uses remaining time for making notes, etc. Also, let's say that only 75% of his appointments show up over the course of the 4o hours he is available M-F, and that he takes 4 weeks a year of vacation. $500 x .75 x 40hrs x 48wks = 720k He operates a solo office (no secretary salary to be paid), out of a modest building. Even if you play with my numbers a fair bit, there is plenty of potential for substantial take-home in private practice. Maybe only 2 patients come in per hour for 5 minute med checks... that still yields $360k plus a lot of free time. Even if he filled more slots with lower-reimbursing insurance clients and paid a staff member to help him manage the billing, he'd still come out way ahead.

$125 per month isn't an impossible expense if the care is genuinely needed. I know working class families who are paying more than that for cable alone (not including internet.) I saw a psychiatrist in 2000/2001 when I was working as a barista making minimum wage plus tips. I was paying cash then, at over $90 per session. I was being seen weekly, so it was more expensive than my rent, but it had to be done or I was absolutely going to kill myself. With her life on the line, if we had to pay $500 per month out of pocket, we would find a way.

well I don't know what to tell you- if you can get a job as an outpatient psychiatrist seeing patients for 5 minutes each every month, that sounds like a great deal and I'd go for it. That would mean you need to find a thousand or so patients per month willing to pay that for such little time.

Now have I(and others) seen cash pay patients that are ok with requiring such little time? Sure...they are usually ADHD patients without insurance who are just happy to pop in and pop out. But it's very unlikely that you are going to be able to build an entire practice like that. Also, it's not very likely that you are going to see them every month if they are so simple. If they are so simple that you only need to spend 5 minutes with them, why would they see you every month? generally you're going to do 3 month appts after they are stable(and just give them the hard copies of the schedule 2 stim the other 2 months).

I know that's not the reality here, or anywhere I'm familiar with. I don't think any of the practitioners here spend 5 minutes with patients and are reimbursed 125 dollars cash for those 5 minutes. There are practitioners who do accept cash and do get more than that per pt visit, but they aren't moving anywhere near that sort of volume.

The reality is that most 5 minute encounters with a med mgt psychiatrist aren't going to be all that productive or life-changing. It's silly to compare such a 5 minute encounter with a service that someone uses continuously an entire month(like a cell phone bill or cable or rent or whatever). If a patient is so sick that they require a high level of care and 'need' to see mental health so frequently, I'd argue that any practitioner who only sees them for 5 minutes isn't practicing up to the standard of care.(unless it's in a cmhc setting and there is tons of support staff, counselors, sw, etc......but then this cash pay angle goes out the window anyways of course)

 

[vistaril]

another quick point- your girlfriend is a VERY atypical patient in a number of ways. The number of patients with florid psychosis who go to outpt psychiatry and pay cash is very very small. I think it would be a mistake to extrapolate to overall numbers of this practice based on a patient type that really doesn't exist in significant numbers.

The majority of recent hospital discharges with psychosis are going to be seen in community mental health centers of some sort. They are called different things in each community but every community has something of that nature just about. The care may not be the best depending on the location(but then again I don't see how it could be any worse than 5 minutes for an intake and probably little to no ancillary support, which in some cases is really what the patient needs more than a psychiatrist)

 

[dl2dp2]

another quick point- your girlfriend is a VERY atypical patient in a number of ways. The number of patients with florid psychosis who go to outpt psychiatry and pay cash is very very small. I think it would be a mistake to extrapolate to overall numbers of this practice based on a patient type that really doesn't exist in significant numbers.

The majority of recent hospital discharges with psychosis are going to be seen in community mental health centers of some sort. They are called different things in each community but every community has something of that nature just about. The care may not be the best depending on the location(but then again I don't see how it could be any worse than 5 minutes for an intake and probably little to no ancillary support, which in some cases is really what the patient needs more than a psychiatrist)

I'm surprised by how much I agree with you on the things you wrote in this thread.

I think the demand in smaller cities is still there, but I agree that likely you won't make that much more running a cash pay practice. But the control (and hour) is better IMHO than in other specialties that make similar salaries, and the cost of living is quite a bit lower in smaller markets. So it's that kind of trade off. I think the difference between you and I are one of expectation--I went into the field thinking it'll be like primary care and I'll make 200k doing 9-5. I came out of training seeing big market psychiatrists making a LOT of money. Whereas, you went into it thinking maybe you can spin it into a gastroenterology-like gig, but find yourself unable to do so in a smaller market.

The 200k 40 hours a week gig is extremely easy to find in psychiatry, independent of type of practice, hours, location, etc.. That's what I call "high demand" perhaps. Supposedly the same cannot be said about things like rads and cards...

 

[vistaril]

I don't disagree and I have a 210ish 40hr a week outpt gig now(in addition to a bunch of contracts on the side)...but it's not what I would consider tremendously pleasant or satisfying work. It's a pretty busy outpt clinic that treats insured patients and we are kept moving throughout the day. It's not an unreasonable volume for such a practice, but it's also far from 'cush'. If I could make the same thing with less volume and less stress and just an easier day overall I'd jump at it, but I don't know any new practitioners here(save for maybe at the VA) who have those jobs.

I don't know what you mean by the market in rads and cards. I have a family member who is actually in one of those fields and he makes more than I do in a year in 3-4 months.

I'll defer to you guys on big markets. Never worked in one before. But again, this doesn't represent practice reality for most because most of us don't live in LA/SF/Manhattan. I'm not in a 'big market' now(quite far from it), but if you plotted where every single psychiatrist in the country works on a population density graph, I'd be over the median by those metrics- there are more working psychiatrists in less urban areas than me than more urban areas.

 

[F0nzie]

Psych reimbursements are a joke. They are a underestimation of the time and energy needed by Psychiatrists to treat mental illness.

I took my son to the pediatric cardiologist to get an echo. Spent less than 5 minutes with the cardiologist and paid 2k for the visit. $125 is nothing.

 

[digitlnoize]

Well, there's this map. I can't find a similar one for adults, but this is pretty bad. The dark blue areas are the counties with 0 child psychiatrists. That would be most of the country. I'm in a county in the 2 (teal) range (which is accurate, we have exactly 2 child psychs) and their wait lists are >6 months. One takes cash only the other takes 1 insurance. And this is a fairly desirable college town with a pop between 50-100k...not the boonies.

There's a really bad shortage. I think the reasons you don't see as many job ads as you'd expect (although there's a lot) is that most of there aren't THAT many "jobs". There's tons of opportunity to set up shop and soak up these patients, not tons of employers looking to hire, outside of state entities, VA's, jails, and academics.

Edit: Best I could do for adults. From 2006, and for "mental health professionals", but still...you get the idea.

 

[DD214_DOC]

For child psych, 300k+bonuses in Missouri. 500k in Alaska.

 

[vistaril]

Psych reimbursements are a joke. They are a underestimation of the time and energy needed by Psychiatrists to treat mental illness.

I took my son to the pediatric cardiologist to get an echo. Spent less than 5 minutes with the cardiologist and paid 2k for the visit. $125 is nothing.

Yep and that's all that matters- what the visits reimburse. It doesn't matter to bcbs that there is a 3 or more month wait. I don't get paid any more than if I fill up my schedule the week before(I actually probably get paid less because no show rate is going to be much higher)

And other fields with less 'demand' only have it affect their bottom line if they actually have significant numbers of open slots and they are sitting around reading magazines at 11am. Which they generally don't.

High reimbursement and low demand beats low reimbursement and shortage everytime in insurance based games.

 

[chicagochildpsych]

I had no problem finding a well paying job in a major metro

 

[F0nzie]

For child psych, 300k+bonuses in Missouri. 500k in Alaska.

*puts on his snowshoes*

 

[DD214_DOC]

*puts on his snowshoes*

Yeah, my colleague here was not happy about the Alaska thing. He got orders after fellowship for Alaska and discovered a civilian here was offered 500k for the exact same job he's going to be filling ... for a lot less money.

 

[Shikima]

If your friend who is over near Fairbanks can build a reputation and connections and manage to stay there for the next couple of years while moonlighting, he'll walk into the same paying job.

 

[Cinclus]

For child psych, 300k+bonuses in Missouri. 500k in Alaska.

But where in Alaska?

 

[DD214_DOC]

But where in Alaska?

Fairbanks area

 

[PistolPete]

Nice to see this. Sometimes those of us in training lose sight of what's out there. Can't wait to be done with residency/fellowship and finally get out there and do my own things, and may the real $$$. I recently put my e-mail down on a jobs board and now get offers several times per week... it feels good.

 

[Mad Jack]

I always hear that there is a huge need for more psychiatrists, but I did some preliminary searches for jobs that didn't strongly support this claim (compared to other specialties). There doesn't seem to be that many jobs posted, so what are the observations that make everyone say there's such a gap in supply and demand? For example, there is a supply and demand gap in dermatology because most dermatologists with clinics are booked many months in advance. Is there a similar situation in psychiatry?

http://www.indeed.com/q-psychiatrist-$110,000-jobs.html (1,117 jobs that state they pay >110k)
http://www.indeed.com/q-dermatologist-$110,000-jobs.html (424 jobs stating they pay >110k)
http://www.indeed.com/q-cardiologist-$120,000-jobs.html (410 jobs stating they pay >120k)
http://www.indeed.com/q-general-surgeon-$130,000-jobs.html (975 jobs stating they pay >130k)

Psychiatrists are in demand enough to go basically wherever they please. You won't be hurting for employment or money.

 

[PikminOC]

Psych reimbursements are a joke. They are a underestimation of the time and energy needed by Psychiatrists to treat mental illness.

I took my son to the pediatric cardiologist to get an echo. Spent less than 5 minutes with the cardiologist and paid 2k for the visit. $125 is nothing.

Exactly right. There is a lot of work beyond writing notes. Patients don't know that.

For the echo the 2k included the echo and interpretation right?

 

[Shikima]

Exactly right. There is a lot of work beyond writing notes. Patients don't know that.

For the echo the 2k included the echo and interpretation right?

Same thing for my son's pediatrics office visit. Billed $240, Ins gave her $170. 4 shots @ $73 each.
I spend 45 mins for an intake and I get $150.

 

[Armadillos]

Same thing for my son's pediatrics office visit. Billed $240, Ins gave her $170. 4 shots @ $73 each.
I spend 45 mins for an intake and I get $150.

I think currently many PCPs lose money or at best break even on childhood immunizations

 

[Shikima]

I think currently many PCPs lose money or at best break even on childhood immunizations

That was only one part of the visit.... I doubt she spent 45 mins.
My illustration is to point out the disparity in reimbursements despite 'parity laws'.

 

[PikminOC]

I think currently many PCPs lose money or at best break even on childhood immunizations

Correct.
Overhead is much higher than in psychiatry.

 

[DD214_DOC]

Start working in a manner that is commensurate with reimbursement

 

[F0nzie]

Exactly right. There is a lot of work beyond writing notes. Patients don't know that.

For the echo the 2k included the echo and interpretation right?

Actually I was wrong. I just got the bill in the mail $5475 for the doctor visit, echo, and EKG.

 

[PikminOC]

Actually I was wrong. I just got the bill in the mail $5475 for the doctor visit, echo, and EKG.

That's what I thought. I hope your kid is ok.

 

[PikminOC]

Start working in a manner that is commensurate with reimbursement

Please explain.

 

[TexasPhysician]

Yeah, my colleague here was not happy about the Alaska thing. He got orders after fellowship for Alaska and discovered a civilian here was offered 500k for the exact same job he's going to be filling ... for a lot less money.

Guaranteed salary? What's the catch other than location?

 

[heyjack70]

Guaranteed salary? What's the catch other than location?

Working in Fairbanks has got to be challenging from a social standpoint. You can trade the uber liberal, "what natural antipsychotic can you give me", metropolitan/hippie, for the 'I ain't got no mental illness...I just got my bootstraps and this here rifle" patients. Plus probably tons of addiction.

 

[AlbinoHawk DO]

Well, there's this map. I can't find a similar one for adults, but this is pretty bad. The dark blue areas are the counties with 0 child psychiatrists. That would be most of the country. I'm in a county in the 2 (teal) range (which is accurate, we have exactly 2 child psychs) and their wait lists are >6 months. One takes cash only the other takes 1 insurance. And this is a fairly desirable college town with a pop between 50-100k...not the boonies.

There's a really bad shortage. I think the reasons you don't see as many job ads as you'd expect (although there's a lot) is that most of there aren't THAT many "jobs". There's tons of opportunity to set up shop and soak up these patients, not tons of employers looking to hire, outside of state entities, VA's, jails, and academics.

With this kind of shortage, what stops someone from charging $500 cash for every 15 or 30 minutes? 6 month waiting list means that there would be many takers.

 

[Frazier]

With this kind of shortage, what stops someone from charging $500 cash for every 15 or 30 minutes? 6 month waiting list means that there would be many takers.

Nothing stops anyone from setting their own prices. You could charge 1M for a med check if you want. I don't think there would be many takers, let alone at $500 a pop.

Many reasons stemming from 3 main ones...

1) Patients couldn't afford it.
1a) Looking at the whole patient-population-pie, there is already a relatively small number of pts willing to pay cash at current standards. I can't even come up with an estimate of how few pts would be willing to routinely pay $500 for a 15-min med check (15mmc).

2) Patients would refuse to pay it.
2a) Bill: $500 for <15 min of time... Patient more likely to say 'to hell' with getting psychiatric treatment period or seek treatment from someone other than a psychiatrist charging $500 per 15mmc...which brings us to:

3) Encroachment.
3a) If we could wave a magic wand and tomorrow it became common for psychiatrists to fill their schedule with $500 cash per 15mmc --- it is the day that psych becomes the most competitive field in healthcare. Not only in medicine, but exponentially harder push from NP's & RxP's.

The patient that has no means (ie transportation) to escape the immediate region of exorbitant prices is most likely not going to be a cash pay psych patient to begin with.

In other words, it would be worth most patients' time to drive an hour or whatever to the healthcare provider that can offer the cheaper price.

For high prices, you need to be offering a unique skill of expertise warranting the cost in the consumer's mind. In today's economy, I do not see the unique skill that could be leveraged in a standard humdrum 15mmc to warrant $500 in any patient's mind.