How likely is it to make $375-400k in Psych?

[MusicDOc124]

---

Members do not see this ad.

At that total income... you ever question whether it's worth it to work those weekends, given I'm guessing your total marginal tax rate has to be North of 50% on the extra $40k/year? Or are the weekends mandatory for this gig?

I negotiated $6k for CME, all other required expenses paid for (aside from CME), and a barely existing non-compete (5 miles) with a few built-in exemptions even though it barely exists - only two locations within the 5 miles, and one is part of the exemption. Since call is paid extra, and I going to cover my own unit, not a big deal since I get paid. Long term, I won’t take call, but for short term I don’t mind. My other half is currently a resident in a busy field and most weekends I’m on call, she’s on call as well. The very few I cover when she’s off, she gets some time to herself and sees family.

TLDR, mandatory, and because I negotiated other things, I left this as is.

 

[Ellomate]

Physicians traditionally round at hospitals then leave, but remain available by pager. Unfortunately, a number of psychiatrists believe taking up the yoke of employed status is nice. But as an employee, you may need to punch the clock. However, I guarantee your CMO and CEO enjoy long lunches outside the hospital as well as afternoons golfing. Heck, go ahead and invite them out on your dime. While they're out lunching and golfing with you, none of them will ask why you aren't still at the hospital.

How do doc's manage new admissions if they leave at 1pm?

 

[jbomba]

How do doc's manage new admissions if they leave at 1pm?

Admits after noon are seen the next day at my hospital.

 

[Taddy Mason]

How do doc's manage new admissions if they leave at 1pm?

Admits after noon are seen the next day at my hospital.

In residency, our inpatient attendings were usually gone by 12pm or 2 at the very latest and residents did the admissions. Some systems will have an on call attending or mid-level do “late” admissions that are then seen by the primary attending the following morning as per @jbomba

 

[mistafab]

Most places let you do admissions within 24 hours. I typically do them while I'm there, but will put off afternoon admits to the morning. Often times there's so much non-MD stuff that admissions need that it's easier for everyone else anyway for me to see them the next day. The only urgent things really are setting up a CIWA, most other things are easier to get done after a period of observation.

 

[FatherPsychiatry]

Attached is LA county psychiatry employee data for 2024.

Average is >$400k for base pay. Including benefits etc, average is $545k.

So to answer OPs question, very high likelihood

(I took out employee names but if you really want to dig in, this information is publicly available on transparentcalifornia.com )

 

[Stumpyman]

Attached is LA county psychiatry employee data for 2024.

Average is >$400k for base pay. Including benefits etc, average is $545k.

So to answer OPs question, very high likelihood

(I took out employee names but if you really want to dig in, this information is publicly available on transparentcalifornia.com )

Where are folks finding these gigs? As a graduating resident, I certainly can't find anything close to these numbers in California (aside from corrections).

 

[FlowRate]

Attached is LA county psychiatry employee data for 2024.

Average is >$400k for base pay. Including benefits etc, average is $545k.

So to answer OPs question, very high likelihood

(I took out employee names but if you really want to dig in, this information is publicly available on transparentcalifornia.com )

The data on that website is a little confusing. I searched several of the highest salary people and there's nothing on their linkedin about california for several of them. I also wonder if it somehow tallies pension disbursements or something.

 

[2025DandW]

The data on that website is a little confusing. I searched several of the highest salary people and there's nothing on their linkedin about california for several of them. I also wonder if it somehow tallies pension disbursements or something.

My understanding is pensions are included.

 

[Bartelby]

I am very curious about the salaries posted on that website too. I used that website to check some other counties in high cost of living areas and it looks like the typical county psychiatrist earns 500k+ per year total compensation, some well over that.

Does anyone know what that looks like in real life? I wonder whether items like pension mentioned above add a huge amount to the total such that actual pay is a lot lower than it looks from that website. Because those salaries look far better than anything I have seen even in high cost of living areas.

 

[Taddy Mason]

I am very curious about the salaries posted on that website too. I used that website to check some other counties in high cost of living areas and it looks like the typical county psychiatrist earns 500k+ per year total compensation, some well over that.

Does anyone know what that looks like in real life? I wonder whether items like pension mentioned above add a huge amount to the total such that actual pay is a lot lower than it looks from that website. Because those salaries look far better than anything I have seen even in high cost of living areas.

I know for a fact that in ND state employed psychiatrists make $350-$700k+, which doesn’t include pensions or other benefits; and the jobs are pretty cushy in terms of duties and call - you just have to put up with living in ND which also has extremely limited mental health resources. Where as community employed psychiatrists make $200-$300k. So, with ND being both very low COL and desirability, those numbers seem roughly accurate by comparison. I’m too lazy to post a link to the ND salary data but it’s very easy to find on Google.

 

[comp1]

Oh goodness, no to North Dakota. Cannot handle snow. Remember the LA county jobs DO include corrections, a heck of a lot of them and yes, they would include all benefits in any description. That's how you compare it to private practice.

 

[Taddy Mason]

Oh goodness, no to North Dakota. Cannot handle snow. Remember the LA county jobs DO include corrections, a lot of them and yes, they would include all benefits in any description. That's how you compare it to private practice.

The snow is tolerable imo, it’s everything else that isn’t. I entertained returning there and taking a job at the state hospital after training given the high pay + low COL, but just can’t justify it.

 

[MedMan80]

The snow is tolerable imo, it’s everything else that isn’t. I entertained returning there and taking a job at the state hospital after training given the high pay + low COL, but just can’t justify it.

Purely subjective on the snow part mate.

 

[mistafab]

I mean... working in LA county you have to make half a million or you can't even eat. That's an outlier for run of the mill practice but it is also an outlier for having people poop on your driveway - or having millionaires still need to find street parking where they live.

Couldn't pay me enough to work there.

 

[TexasPhysician]

I know for a fact that in ND state employed psychiatrists make $350-$700k+, which doesn’t include pensions or other benefits; and the jobs are pretty cushy in terms of duties and call - you just have to put up with living in ND which also has extremely limited mental health resources. Where as community employed psychiatrists make $200-$300k. So, with ND being both very low COL and desirability, those numbers seem roughly accurate by comparison. I’m too lazy to post a link to the ND salary data but it’s very easy to find on Google.

If there are cushy jobs in ND making $700K, please send them to me. I’d want to consider that.

 

[Taddy Mason]

If there are cushy jobs in ND making $700K, please send them to me. I’d want to consider that.

The $700k+ position (which also comes with a pension…) is the medical director of the state hospital which is currently filled. I did my sub-I there, still stay in touch with him, and was heavily recruited to come back. General staff psychiatrist positions are all north of $350k + pension, a reasonable case load, and pretty generous call. Downsides are extremely limited resources, living in the middle of nowhere even by ND standards, and the weather (for some…).

 

[FlowRate]

I mean... working in LA county you have to make half a million or you can't even eat. That's an outlier for run of the mill practice but it is also an outlier for having people poop on your driveway - or having millionaires still need to find street parking where they live.

Couldn't pay me enough to work there.

IDK man, if you wanted to pay me transportation by helicopter from home money, I'd consider it.

 

[TexasPhysician]

The $700k+ position (which also comes with a pension…) is the medical director of the state hospital which is currently filled. I did my sub-I there, still stay in touch with him, and was heavily recruited to come back. General staff psychiatrist positions are all north of $350k + pension, a reasonable case load, and pretty generous call. Downsides are extremely limited resources, living in the middle of nowhere even by ND standards, and the weather (for some…).

$350K for a job involving call doesn’t seem very special. At $700K with a pension, I’m willing to consider most LCOL areas.

 

[Taddy Mason]

$350K for a job involving call doesn’t seem very special. At $700K with a pension, I’m willing to consider most LCOL areas.

Call averages out to ~10-12 nights/year, is from home, and rarely involves actually being called for anything. Also, $350ish is for newer grads. You can clear above $400k with experience or after working there for only a few years and that doesn’t include pension in one of the lowest COL places in the country. Plus your day is done before 3pm.

 

[MedMan80]

Call averages out to ~10-12 nights/year, is from home, and rarely involves actually being called for anything. Also, $350ish is for newer grads. You can clear above $400k with experience or after working there for only a few years and that doesn’t include pension in one of the lowest COL places in the country. Plus your day is done before 3pm.

How much is it worth to have the nearest walmart 40 minutes away, nothing but endless cornfields in all directions...it is peaceful and serene to some..but to others who were raised in civilization is not easy to bear..

 

[Taddy Mason]

How much is it worth to have the nearest walmart 40 minutes away, nothing but endless cornfields in all directions...it is peaceful and serene to some..but to others who were raised in civilization is not easy to bear..

Technically wheat and flax fields and there’s a Walmart 5min away from the state hospital…but yeah… I was raised in one of the urban areas of ND and have no desire to return…

 

[Splenda88]

Technically wheat and flax fields and there’s a Walmart 5min away from the state hospital…but yeah… I was raised in one of the urban areas of ND and have no desire to return…

Not even for 700k/yr.

 

[esob]

Admits after noon are seen the next day at my hospital.

This is generally how it works at my hospital as well.

 

[Taddy Mason]

Not even for 700k/yr.

The lack of resources is probably the nail in the coffin for me. Also, while you do have med students and residents it’s not really an otherwise academic environment which I much prefer.

 

[Stagg737]

How much is it worth to have the nearest walmart 40 minutes away, nothing but endless cornfields in all directions...it is peaceful and serene to some..but to others who were raised in civilization is not easy to bear..

I mean, sounds like Sushirolls wet dream…

Not even for 700k/yr.

$700k/yr for what sounds like almost a PT position sounds pretty great. If I didn’t have a family I’d tolerate that for 3-4 years to FIRE and then move wherever I wanted and do PT work for another 5-10 years to let that 7 figure egg grow.

 

[FlowRate]

I mean, sounds like Sushirolls wet dream…



$700k/yr for what sounds like almost a PT position sounds pretty great. If I didn’t have a family I’d tolerate that for 3-4 years to FIRE and then move wherever I wanted and do PT work for another 5-10 years to let that 7 figure egg grow.

Funny enough, it's the sort of thing I'd only do if I DID have a family. Trying to date in that sort of situation sounds awful.

 

[clausewitz2]

Funny enough, it's the sort of thing I'd only do if I DID have a family. Trying to date in that sort of situation sounds awful.

What are you talking about, ND is a state of great ethnic and cultural diversity. In some parts of the state, people's ancestors come from Norway. Whereas in other parts of ND, people's ancestors come from other parts of Norway.

 

[Taddy Mason]

What are you talking about, ND is a state of great ethnic and cultural diversity. In some parts of the state, people's ancestors come from Norway. Whereas in other parts of ND, people's ancestors come from other parts of Norway.

And Germany (hence the name of the capital), but that’s pretty much it.

 

[vanfanal]

There's a new app called Marit health which is supposed to be real physician renumeration data and a free alternative-like to MGMA - by physicians for physicians kind of thing. It's free if you contribute. Not a bad gander....

 

[MedMan80]

Funny enough, it's the sort of thing I'd only do if I DID have a family. Trying to date in that sort of situation sounds awful.

Not just dating, as someone who worked 3-4 years in such a setting, finding restaurants, stuff for the kid to do, commuting to nearest airports, finding DIVERSITY was difficult to say the least.

 

[Merovinge]

Not just dating, as someone who worked 3-4 years in such a setting, finding restaurants, stuff for the kid to do, commuting to nearest airports, finding DIVERSITY was difficult to say the least.

OMG driving 6 hours to the nearest large airport or driving 2 hours then flying an hour then waiting to go on an international flight is so infuriating, I can hardly put into words. How people do it with children boggles my mind (I haven't lived rural since having a kid).

 

[MedMan80]

OMG driving 6 hours to the nearest large airport or driving 2 hours then flying an hour then waiting to go on an international flight is so infuriating, I can hardly put into words. How people do it with children boggles my mind (I haven't lived rural since having a kid).

My most memorable moment was the only restaurant in town acting like it was doing you a favor for making you take out for dinner (subpar food). It was simply supply and demand economics. All in all the people and patients were sweet, for the most part. Working in rural america also means working with the most psychiatrically vulnerable poplulations, ridden with childhood trauma, sexual abuse and substance abuse. Very challenging but in someways rewarding.

My hospital system treated physicians really well until COVID tightened their budget, we had no pay rise after COVID and this led to a steady departure of docs out of the system and influx of NP's and PA's..

 

[Merovinge]

My most memorable moment was the only restaurant in town acting like it was doing you a favor for making you take out for dinner (subpar food). It was simply supply and demand economics. All in all the people and patients were sweet, for the most part. Working in rural america also means working with the most psychiatrically vulnerable poplulations, ridden with childhood trauma, sexual abuse and substance abuse. Very challenging but in someways rewarding.

My hospital system treated physicians really well until COVID tightened their budget, we had no pay rise after COVID and this led to a steady departure of docs out of the system and influx of NP's and PA's..

I got the glory day split of rural medicine. My med school had a rural med rotation where you spent a month with 1 PCP. This guy was an icon in the (tiny) town. I even tried going to a towny bar on a weekend and someone recognized me as being the student with this PCP and bought me a beer. I can absolutely see the appeal of that type of work when it existed.

Later, when I went to work rural (which was right before and then during COVID), the c-suite of the local hospital chain (which has 100% monopoly) was continuing to mismanage things (although they were dealt a very hard hand). One of the highest ranking executive's who made 2x my salary had a hard time stringing together a coherent sentence and could have been mistaken for late Biden/Trump in his coherence rating. I did not appreciate how different the environment is when your top employs went to low tier schools and your other employees got their degrees from the University of Phoenix or similar online diploma mills. Admin meetings were like a scene out of the Office at times.

 

[lobstar]

As another data point, everyone I know at 400k is either private practice, straight churning a hospital clinic, chair of a department, or inpatient with call/weekends.

 

[FlowRate]

As another data point, everyone I know at 400k is either private practice, straight churning a hospital clinic, chair of a department, or inpatient with call/weekends.

Worth also pointing out that a lot of PP people cite their gross income minus practice expenses, but don't always subtract stuff that's usually covered by benefits when employed (health insurance is the biggest one, but some employers can have retirement and other benefits that are worth an additional $50k+ on top of the health insurance.)

 

[Stagg737]

Funny enough, it's the sort of thing I'd only do if I DID have a family. Trying to date in that sort of situation sounds awful.

No way. I want my kids to have exposure and plenty of opportunities to grow and experience as much as they can. Maybe if I was an infertile DINK and shared a favorite pastime with rabbits or didn’t have kids and had plenty of vacation time to travel being married in one of those locations would be fine. Kids makes a community that rural a strict no-go for me though. Ironically, it also makes living in a city proper a no-go as well, but for very different reasons.

 

[calvnandhobbs68]

No way. I want my kids to have exposure and plenty of opportunities to grow and experience as much as they can. Maybe if I was an infertile DINK and shared a favorite pastime with rabbits or didn’t have kids and had plenty of vacation time to travel being married in one of those locations would be fine. Kids makes a community that rural a strict no-go for me though. Ironically, it also makes living in a city proper a no-go as well, but for very different reasons.

haha in other words....not a lot of people want to live in these areas any way you slice it. Which is why they are the way they are.

 

[Cath Up]

I've talked with several internal recruiters recently. 2 outpatient clinic jobs with 36 pt hours that get to 350-425k. One has a signing bonus with no vesting/clawback, the other cites 350k 50%ile, 425k 75ile% earning. Both with box shops in nice payer mix areas in the PNW. A nearby inpt unit has a 1 in 4 weekend rounding, you see 15-17 pts/day for 350-375k, round and go, everyone has other gigs.

 

[MedMan80]

I've talked with several internal recruiters recently. 2 outpatient clinic jobs with 36 pt hours that get to 350-425k. One has a signing bonus with no vesting/clawback, the other cites 350k 50%ile, 425k 75ile% earning. Both with box shops in nice payer mix areas in the PNW. A nearby inpt unit has a 1 in 4 weekend rounding, you see 15-17 pts/day for 350-375k, round and go, everyone has other gigs.

These are dream jobs in probably unpopular areas

 

[Cath Up]

These are dream jobs in probably unpopular areas

They’re box shops and the inpt is private, so I’m sure there are issues with all of them I’m unaware of, and at least for me probably some moral injury involved. But they’re all commutable in a desirable area (HCOL) with less than 3 hours weekly total commute time if you don’t want to live near them (though theyre in good areas with good payor mix).

 

[Stagg737]

These are dream jobs in probably unpopular areas

Nah, one of my former co-residents had a job like that in PP in the Seattle area. She talked to us on a guest panel during PGY4 didactics about career options after residency. Was very blunt that she needed that extra income (was making a little over $400k) over what was typical expected income (~300k) just to justify living in an apartment out there as CoL where we did residency was so much lower (mid/large city with large metro area I. The Midwest).

 

[calvnandhobbs68]

These are dream jobs in probably unpopular areas

36 patient contact hours outpatient for that salary range is nowhere near "dream job".

With a full panel, even down to 250/hr gets you 250x36x48 weeks/year= 432K.
Bigger organizations like that may have negotiated insurance rates where that's only like 60% of what you're billing.

 

[Cath Up]

36 patient contact hours outpatient for that salary range is nowhere near "dream job".

With a full panel, even down to 250/hr gets you 250x36x48 weeks/year= 432K.
Bigger organizations like that may have negotiated insurance rates where that's only like 60% of what you're billing.

This is a great point and something I’m trying to contend with. Certainly could make more and feel less taken advantage of/more freedom etc with my own setup but with loans there is desire to have guaranteed income… and 400k guaranteed is tempting at least in year 1.

 

[MedMan80]

36 patient contact hours outpatient for that salary range is nowhere near "dream job".

With a full panel, even down to 250/hr gets you 250x36x48 weeks/year= 432K.
Bigger organizations like that may have negotiated insurance rates where that's only like 60% of what you're billing.

In my metro area such gigs are not easy to find