Are you currently doing this? The reason you don’t understand is because you’ve never actually tried to do it, go make 650k a year then report back on how easy it is, the only people making these comments seem to be residents who haven’t done it yet, is it possible? Of course but it definitely requires more than 40 hours a week and is a grind that generally is not worth it for the majority of people.
Honestly this sounds like a nightmare. Time is the most precious commodity and the choice to monitize every waking hour baffles me. Most animals spend most of their lives idling pleasantly.
I mean theres other people in this thread who are further along than me (pgy4) who are also reporting on this. But FWIW, I'm making >200k moonlighting this year (residency salary not included) so I feel somewhat qualified to speak on this.
If you're trying to say that 16 hours a week, 52 weeks a year (who on earth would work more than 46 weeks in a year, honestly), you could consistently be making $300 per hour "easily" (16 x 52 = 832 hours, 832 x 300 = 250k) you're neglecting a lot of the undercompensated hours. Sure, at 832 clinical hours of cash-based private practice you could generate $250k/year if you're billing $300 per hour and collecting at the time of service, but it takes a while to build up to that and then continue to maintain it when you're also working another job, especially since you won't be quite as available.
I generate far more than 300 per hour for the small clinic I moonlight at now. Their negotiated rates are in line with solo practice docs in the area so it's not like they've got a special contract.
Leads me to believe you are either in NYC or Singapore?
What's going on in Singapore?
Being somewhat facetious. But yes in a one to one comparison, there is no comparison. The most direct comparison would be a PP owner with multiple therapists and potentially other psychiatrists working there.
It is not standard for people to generate 300k in 16 hours of private practice and it doesn't matter what you pencil out because the data on income shows that's not how it bears out.
That's averaging 400/hr at 16 hours for 47 weeks a year. I'm not disagreeing with you, but in a hcol city is it really that unreasonable to achieve as a solo practitioner? Most of the cash practices I look at around here have follow up rates that would allow for this.
Both NYC and Singapore were named the most expensive cities to live in (as per an article I read the other day
).
Agree with 5th element, this sounds absolutely miserable. Even if you're getting your notes done, I better be making a ton to be commuting 4 hours per day then going to outpatient clinic. Even then, sounds like this person has no life outside of work, which is why I'd guess he said he wouldn't do it for long. But yes, you can make 7 figures if you decide to work the equivalent of 3 FT positions.
You've got to do more than "work a little", you have to be a workhorse or at least do so initially to build the practice up and continue your efficiency permanently. Having a good system with reliable people is also easier said than done. The more you expand and do, the more policies you need with reliable people to follow through. One poor employee can sink the ship. A lot of physicians also just don't have the business sense to do this. If everyone did, there wouldn't be any of us employed in outpatient positions outside of academic centers.
This is assuming everyone is being given a 90833 add-on which isn't realistic (and sometimes fraud) as well as neglecting no-show rates and assuming insurance is actually going to reimburse you for all of that. I don't think a lot of people realize how much of a battle it can be just to get insurance to pay you.
I've got a highly recommended medical biller who claims he gets reimbursed 96%. Seems like a good biller could alleviate the time and frustration of that battle, no?
All helpful info, thank you.
Sorry, I should specify when I say work a little I am being a little facetious. I mean you are gonna have to work hard (which many psych docs sorry don't have that mentality and see even seeing a handful of patients a day as hard) and you will have to be efficient IE all the time you are "working" in the day is actual money generating work. You can't be "working" for 8 hrs but if you truly look at how much time is spent on an income-driving activity and see that it is truly 4 hours. That is why inpatient work is so efficient you can truly create an efficient day. No sitting around waiting for patients or having people throwing off your schedule. Notes can be efficiently managed with smart phrases/templates to do most of the heavy lifting so you are not wasting an hour plus on notes each day. Plus if you have good nursing and good SW much of the extra busy work will be managed. PP is a whole different ball game when it comes to trying to generate above 500k while not working some grueling days.
Yes this is something they will do so not only does your biller need to be on top of it but so does your documentation. And they can drag you through audits and make you fight hard to get the money and waste a lot of your precious time. So just billing out all 99214+90833 or 99213+90833 you better make sure you and your biller are both on top if it. Because the audit process is not a fun one and its time consuming and they will do what ever they can to take back money from you
I don't believe that only doing income generating activities is the same as being efficient. Good patient care will require tasks like attending rounds, working collaboratively with social workers on psychosocial aspects of care, providing expert perspective to milieu staff on strategies for dealing with particularly difficult patients, talking to families, engaging with hospital structures such as pharmacy, compliance, legal, the ED, nursing leadership around ongoing strategies for quality improvement, reviewing recent literature to make sure you remain up to date on best practices, understanding local policy changes, completing commitment paperwork, responding to patient experience people, completing prior authorizations, and documenting in a way where your note carries the necessary information to support billing, inform the practice of subsequent providers and fully capture your formulation and work done versus just using a bunch of dot phrases. I am very efficient but also do a good job and I make good money but it is not 4 hours for 15 patients its more like 5 - 6 hours for 10 - 12 patients. I have no doubt that there are providers who see more patients in less time but if you were to achieve that by refusing to be comprehensive in the way described I wouldn't hire you on my team, and I would likely have no difficulty finding someone who was willing to do a more thorough job as income data supports that most people are ok making $350k for a full time (6 - 8 hours) inpatient job versus wanting to make more for a half day which is what you are proposing as a reasonable standard.
I guess I will just mostly fully disagree. The things you describe are part of why I said you need a good team. 90+% of engaging with "hospital structures" should be done by others, dunno why legal is in there how often are you talking to legal? Prior auth can be done by office staff. Talking to families should primarily be sw or nursing unless it is only something you can do (you should be doing what you are the expert at). Why are you talking to the ED? (I work at both a stand-alone and integrated psych hospital and neither requires interaction with an ED im genuinely curious why you talk to the ED unless you are doing consults. I also worked at a VA and still had no contact with the ED.) Nursing leadership should self-manage and if you are constantly needing to talk to them that describes that there are issues. QI is admin work I dont want to do that work and that would not be daily that is normally a monthly meeting. I could keep addressing the other very small things you bring up which are all hopefully not things you do that add to your daily time. Collaborative work with good nurses and good social workers that are competent will involve texts during the day and maybe a phone call if you don't have your staff trained well. 10-15 min to work on talking to specific people about the few priority cases (if you are only caring 12 patients you might have 1 that is a high-needs family you cant try to tell me even 4+ will be) Staffing done twice a week in between the contact throughout the week takes 40min total and this would encompass UM/SW/Nursing supervisors. It sounds to me like there are some massive holes in the team approach you describe if you are finding the need to be in contact with all the people you mentioned on a daily basis for such a small caseload.
Oh I completely realize you don't agree. I'm explaining why reality is the way it is, which is where only a very small proportion of psychiatrists make the kind of money you believe should be easy to achieve. Please practice in a way that feels good to you and in a few years you can post about how mad you are that NPs are replacing your narrow, profit-driven, rote, strictly biomedical functions.
I think it’s good that people can understand there are multiple ways to work and to know there actually are ways to structure your work, work ethic, and your team. I’ve seen both ends where the hospital is set up to make sure the doctors work is central and highly efficient and functional or in other set ups where you do social work jobs, nursing jobs etc. I didn’t become a psychiatrist to do Sw. I love them and respect them but I don’t envy nor want to do their job same with nursing. I love the team environment and really like the people that I work with we get along quite well. So my work is set up seemingly dichotomously different than your job and people should know that it exists and not to settle if they don’t want to.
I guess that's fair. To clarify, I don't 'do' the SW or nurses job, but I leverage the knowledge and experience that comes from a long and broad training experience (residency) to guide their decisions (such as offering input on appropriate behavioral strategies for managing problematic behavior, or encouraging specific guidance being shared with the outpatient provider that is derived from information learned about the patient in the course of their hospitalization). The unit I work on now is very well set up but the physicians involve themselves in other aspects of care to the benefit of the patients and other providers. This drives good, measurable outcomes and a good work experience. Yes, you are correct, one could insist on not being involved in the overall vitality of the unit and restrict yourself to biomedical functions - I would say I also didn't become a psychiatrist to 'do SW' but I certainly didn't become one just to start antipsychotics and I try and apply my experience to the care of the patient across more than one dimension. I still make a lot of money but no, I could not make $1 million with my approach. My primary reason for engagement around this was the suggestion that making $1 million in psychiatry was somehow not exceptional and I contest that it is because it requires a very narrow style of clinical practice that may impact patient care or not be tolerated by systems that expect more. I am glad that you have found a way to find it to be both possible and meaningful.
