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

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How does someone make 400 in academics?
Well this was some years ago. I left because they changed the compensation model in a way that disfavored me. You need to work somewhere that either has a production model (e.g. RVU or EWYK), or allows faculty practice or else have lucrative contracts/professional services agreements. Alternatively, you have to put in more hours doing weekend rounding etc (which I never did).

just bear in mind if you are making 400+ in academics as junior faculty, you could probably be making way more for the same work elsewhere since they heavily "tax" your earnings. I work half as much and make more in pp than I did in academics. Of course, it took me several years to get to that point.
 
I'm guessing you could get to $400k running an academic forensics fellowship where you got a large cut of earnings. This is not something you plan or expect, however. You do academics for academics, not the pay.
 
I have a colleague in an undesirable part of CA who shared he is making $500k doing academics 7 on 7 off (26 weeks off per year) in academics with 350k base + 150k RVU bonus (residents see 100% of patients which are 20-25 per day). If he was willing to do 7 days on every week he'd be pulling 7 figures as a W2 academic attending who barely spends 2-3 hours per day in the morning staffing/rounding with residents then goes home

I did the math and his hourly rate is higher than the average CT/neuro-surgeon based on actual time spent at work.
 
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I have a colleague in an undesirable part of CA who shared he is making $500k doing academics 7 on 7 off (26 weeks off per year) in academics with 350k base + 150k RVU bonus (residents see 100% of patients which are 20-25 per day). If he was willing to do 7 days on every week he'd be pulling 7 figures as a W2 academic attending who barely spends 2-3 hours per day in the morning staffing/rounding with residents then goes home

I did the math and his hourly rate is higher than the average CT/neuro-surgeon based on actual time spent at work.
He's also almost certainly doing those residents a huge disservice by not providing adequate supervision. I sometimes have to staff that many patients with residents (usually on call weekends when we get slammed) and it is definitely a much weaker educational experience for them. 2-3 hours to staff 20-25 patients isn't educational other than just "supervising" reps. Someone could do the same and even make much more while working less by "supervising" an army of NPs.

This is the same churn-and-burn practice that inevitably leads to low quality care and mistakes being missed. I've seen more than a couple of docs get burned by this, including one whose patient made national news because they weren't supervising their residents properly and the patient killed a bunch of people when they should have never been discharged.
 
He's also almost certainly doing those residents a huge disservice by not providing adequate supervision. I sometimes have to staff that many patients with residents (usually on call weekends when we get slammed) and it is definitely a much weaker educational experience for them. 2-3 hours to staff 20-25 patients isn't educational other than just "supervising" reps. Someone could do the same and even make much more while working less by "supervising" an army of NPs.

This is the same churn-and-burn practice that inevitably leads to low quality care and mistakes being missed. I've seen more than a couple of docs get burned by this, including one whose patient made national news because they weren't supervising their residents properly and the patient killed a bunch of people when they should have never been discharged.
Fair points although much of this is presumptuous. I'm currently making over 700k per year doing a very easy job in CA but I wouldn't bother sharing any details on this forum with anyone because of this kind of judgmental attitude I commonly see on here. People on here are free to continue to believe that 300k is a great psych salary for 40 hours per week and practice the way they want
 
Applies to many specialties haha. Hard to gauge what the real world practice of an attending is like until you're actually out. And for many, especially those with families, money soon becomes the #1 priority, with work-life balance being second to that. And many physicians are okay with a job that is tolerable as opposed to 10/10 enjoyable if it means they make a lot of money with good work-life balance.

Yup, just searched Cards and Derm for Kaiser in California.
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Kaiser also pays rather well for psych, within striking distance of derm at the high end
 
Fair points although much of this is presumptuous. I'm currently making over 700k per year doing a very easy job in CA but I wouldn't bother sharing any details on this forum with anyone because of this kind of judgmental attitude I commonly see on here. People on here are free to continue to believe that 300k is a great psych salary for 40 hours per week and practice the way they want
There is a huge different between having thoughts on what is a fair or great salary and what is standard or substandard care (or supervision). We take care of human beings, we aren't producing widgets, in many instances creation of additional income with less time is done at the cost of providing adequate care. The fact that you believe a bunch of anonymous peers would have a judgemental attitude about how you make your income taking care of human beings already speaks to everything about your situation.

I have spent plenty of time with attendings that "see" 50-80 patients/day in psychiatry and yes they make 700-1000k/year. It's nothing new under the sun.
 
Fair points although much of this is presumptuous. I'm currently making over 700k per year doing a very easy job in CA but I wouldn't bother sharing any details on this forum with anyone because of this kind of judgmental attitude I commonly see on here. People on here are free to continue to believe that 300k is a great psych salary for 40 hours per week and practice the way they want
I’m not saying we shouldn’t be advocating for fair or better compensation. I know plenty of psychiatrists who provide good care making well over $400k. I work with some of them in academia. I’m also not saying that one can’t make good money like you or your acquaintance does unless they provide bad care. I also don’t think anyone one here thinks $300k is a “great” salary for a physician working 40 hours a week. Pretty much everyone says that should be the bare minimum with the possible exception being academia.

What I am saying is that seeing 25 patients in 3 hours and going home when you’re supervising residents is not conducive with providing good care AND educating residents. That set up is almost certainly a failure in at least one if not both of those duties.
 
Fair points although much of this is presumptuous. I'm currently making over 700k per year doing a very easy job in CA but I wouldn't bother sharing any details on this forum with anyone because of this kind of judgmental attitude I commonly see on here. People on here are free to continue to believe that 300k is a great psych salary for 40 hours per week and practice the way they want

I don't think anyone here judges salaries in CA, they seem higher than anywhere else. Making 700k in the South seems to be significantly harder, I heard about a guy making 500k doing locums travelling all over, including different states.
 
Fair points although much of this is presumptuous. I'm currently making over 700k per year doing a very easy job in CA but I wouldn't bother sharing any details on this forum with anyone because of this kind of judgmental attitude I commonly see on here. People on here are free to continue to believe that 300k is a great psych salary for 40 hours per week and practice the way they want

you def need to be making that out there to survive. Its like equivalent to 450-500 when you factor in taxes, housing, etc. vs the midwest unless you in the boony areas. In sure you could push it even more if you wanted.
 
Fair points although much of this is presumptuous. I'm currently making over 700k per year doing a very easy job in CA but I wouldn't bother sharing any details on this forum with anyone because of this kind of judgmental attitude I commonly see on here. People on here are free to continue to believe that 300k is a great psych salary for 40 hours per week and practice the way they want
No judgement here brother. You gotta make 600k+ just to breathe on the California coast. 700k there in SF/LA/SD is like 400-500k down here in Texas. Completely understandable.

I'm currently job cobbling and heading towards north of 400. Not breaking a sweat and just around 45-50 hours per week.
 
you def need to be making that out there to survive. Its like equivalent to 450-500 when you factor in taxes, housing, etc. vs the midwest unless you in the boony areas. In sure you could push it even more if you wanted.
Maybe even more than that if you want an equivalent house. Where I'm at the median for an "average" house (3 bedroom, 2 bathroom) is just over $400k. Multiple CoL calculator sites (Nerdwallet, Bankrate, etc) say the median for the same house in LA or San Fran would be over $1.35 mil (almost a million more), in San Diego it would be $1.15 mil, even San Jose is over $1 mil. Unless someone wants to live in Bakersfield or Fresno housing is likely going to be at least double (maybe even triple) compared to many other other places.

For a more irl comparison, the previous place I rented was 4 bedroom, 3 bathroom and 2500 sq ft in a nice neighborhood near great trails and 15 minutes from downton and we paid $1,600/mo and current Zestimate is under $400k. We moved to the "wealthiest" zip code in our state on the opposite side of the metro and paid a little over $550k for a 4k sq ft house 3 years ago. Similar houses to mine in LA and San Diego are mostly in the $2.5-3.5 mil range (or much more in high end areas). My mortgage with escrow is around $4k/mo, in CA it would be 5x that and more than my take home after taxes is. We could never have what we have here in many of the nice areas in CA and even the "cheaper" areas we would still not be able to live the way we can here.
 
Wow that is a high income. A bit more call than people I know in academics but they make $100k+ less.
24-26 days of call in total (all paired, 2 days at a time as mentioned). So yea, a little more in general, but I cover my own unit where I know the patients already + consults for the weekend.

wow that's amazing. Is this middle of nowhere? I always thought people take a hit on their comp doing academic. I thought it was soley for people who are "passionate" about teaching. What does cross coverage look like in addition to your full time day job? What is the total bonus on top of your base? Are you generating 150k from weekend call & cross coverage alone? That still seems high. Is this fairly achievable in the academic world or did you get really lucky? Thank you!
Generating 50k from call. Bonus is 25k. About 10k from cross coverage throughout the year. Rest is base. Cross coverage in general has been I see a couple consults when we're short on the consult team, or I cover the other inpatient unit or the PHP/IOP program for a day or period. Each of these instances pays extra. And negotiated a lot with a little luck. Not in the middle of nowhere. In a good area and very close to major metro in northeast.
 
300k ain't anything anymore guys these days. Nobody should be impressed with a 300K salary at this point. 400K is the new 300K.

Punch it into the CPI calculator, it's shocking. 300K Sept 2025 has the equivalent buying power to $238,500 in Jan 2020.
Wow, yeah, by CPI my base specialty salary has gone down since 2020 (~320 now is equivalent to ~250 in 2020 and our salary was ~280 in 2020).
 
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so technically, our real wages are declining. this is sad.

That was part of the reason my motto almost 10 years ago that work now is worth more so milk it sooner to get a double boost meaning your wage means more 5 years ago plus if your investing heavy your going to compound that higher wage and more time in the market. It doesn't help that competition from NPs has sprung up way more not that psychiatrists aren't getting jobs easily now but theres def a change exactly as i was hoping would not be.

My advice for the next 5 years work extra hard now if possible and again dumping more if not all that extra in the market you will be thanking your younger self in 2030. Its also shocking how much less motivation you will have to work more the older you get. Its not always fun doing close to 2 FTE but find ways to stack jobs, not work nights/wknds/holidays you can still make it life style friendly. By 2030 if i keep my schedule as is, I could be essentially roughly where an average psychiatrist working full time at 65 yo would be execept i'd be early 40s.

Good luck.
 
so technically, our real wages are declining. this is sad.
I think this has been happening to most specialties for like 20-30 years now. Golden age of medicine peeps had it made.

Actually, I asked chatGPT and this is what it said after some researching:

4. Putting it together for “the last 30 years”​


If we take “last 30 years” roughly as 1995 → 2025 and ask, “Has average physician real income just been declining the whole time?” the best summary is:
  • 1995–early 2000s: Real earnings fell (≈7% down).
  • mid-2000s–late 2010s: Real earnings rose modestly; several data sources show compensation keeping up with or slightly beating inflation.
  • late 2010s–early 2020s: High inflation + relatively slow nominal pay growth → real earnings fall again.
Across the full span, big national datasets (e.g., CPS-based work by Mahoney et al.) suggest small positive long-run growth (≈0.7%/yr since 1980 for physicians), but with that growth concentrated before ~2010 and a slight decline since.
 
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I think this has been happening to most specialties for like 20-30 years now. Golden age of medicine peeps had it made.

Actually, I asked chatGPT and this is what it said after some researching:

4. Putting it together for “the last 30 years”​


If we take “last 30 years” roughly as 1995 → 2025 and ask, “Has average physician real income just been declining the whole time?” the best summary is:
  • 1995–early 2000s: Real earnings fell (≈7% down).
  • mid-2000s–late 2010s: Real earnings rose modestly; several data sources show compensation keeping up with or slightly beating inflation.
  • late 2010s–early 2020s: High inflation + relatively slow nominal pay growth → real earnings fall again.
Across the full span, big national datasets (e.g., CPS-based work by Mahoney et al.) suggest small positive long-run growth (≈0.7%/yr since 1980 for physicians), but with that growth concentrated before ~2010 and a slight decline since.
The last 5 years have been brutal for physicians with slow raises and high inflation. It has absolutely shown how critical it is to have money in the markets to make up for this. Graduating as an attending now is clearly worse than 10 years ago when I did, but the same can be said for almost every field...
 
The last 5 years have been brutal for physicians with slow raises and high inflation. It has absolutely shown how critical it is to have money in the markets to make up for this. Graduating as an attending now is clearly worse than 10 years ago when I did, but the same can be said for almost every field...

Yeah the last 5 years have been ridiculous....guess thats what happens when you turn on the money printer and jack up the national debt by $10 trillion. Other issue of course is that there hasn't been a real sustained market correction in some time.

I really hadn't looked at it much before but it's shocking when you go back and look at other periods over the same time before 2020 to see how much inflation over the last 5 years wiped out buying power relative to even 10 year periods before then.
 
The last 5 years have been brutal for physicians with slow raises and high inflation. It has absolutely shown how critical it is to have money in the markets to make up for this. Graduating as an attending now is clearly worse than 10 years ago when I did, but the same can be said for almost every field...

Another reason to make more TODAY and invest it asap because its the only way to come out of this system. If you do a deeper dive into the global money system which increases 10% yearly you need to be getting that just to stay even. Not worth talking about here that will be even more depressing.
 
Yeah the last 5 years have been ridiculous....guess thats what happens when you turn on the money printer and jack up the national debt by $10 trillion. Other issue of course is that there hasn't been a real sustained market correction in some time.

I really hadn't looked at it much before but it's shocking when you go back and look at other periods over the same time before 2020 to see how much inflation over the last 5 years wiped out buying power relative to even 10 year periods before then.
Those of us who are older remember the 70s and early 80s. It was much worse, but we made it out in one piece.
 
Invest 20-30% of gross base salary maxing out BD Roths, 401k or 403b, HSA, governmental 457s, then put the rest in taxable mutual funds. Any bonuses or side gig $ go to other investments (primarily real estate) for further diversification. Use 100% bonus depreciation of your properties in year 1 of owning if you go that route. Keep buying and doing 1031 exchanges until you die.

This is my roadmap, albeit a lot of a work on the RE side. I doubt I’ll ever be out of medicine completely, but this hopefully gets me to a place where I don’t ever have to work again if I so choose within 10-15 years.
 
Those of us who are older remember the 70s and early 80s. It was much worse, but we made it out in one piece.

Yea, people forget the days of the early 80’s when a mortgage rate under 15% was a steal and inflation rates were over 10%. Different times in terms of affordability, but rates aren’t even close to what they were.

Nah, I disagree. If 1980s was hard mode, we're playing in insane mode in 2025. And it will only get worse. I feel very bad for those who are not established in their careers as the upward mobility ladder will only get pulled up higher and higher. In 1980's, sure inflation and interest rates were high but you could be a saver (CD, money market) and still come out ahead with real yield. These days, real yield for savers is negative. Now you have to go out further on risk curve to real returns (S&P 500). Money also went further in the 1980s.

@finalpsychyear is correct that this is a race against time, especially for those that want to be upper-middle or upper class.

---

Per AI:

question: compare median wage to price of S&P 500, price of median hous, price of big mac, price of gas of early 1980s and 2025

answer:
Median U.S. household income has roughly quadrupled nominally from ~$21,000 in 1980 to ~$83,600 in 2025, but purchasing power against these assets has diverged sharply—housing and S&P affordability worsened, while Big Mac/gas improved.

Key Metrics Comparison (Nominal Dollars)​


Median Household Income$21,020$83,5924.0x-
S&P 500 (Year-End Close)~136 (1980)~6,000 (est.)44x11x (less affordable)
Median House Price$64,000$410,0006.4x1.6x (less affordable)
Big Mac Price$1.00$5.705.7x1.4x (less affordable)
Gas (per Gallon)$1.19$3.052.6x0.65x (more affordable)


Housing: Went from 3x median income (affordable) to 5x (strained), driven by rates/supply.
S&P 500: Explosive gains outpaced wages ~11x, boosting wealth for investors but not median buyers.
Big Mac/Gas: Kept closer to wage growth; gas even cheaper relatively due to efficiency/tech. Real terms show inflation eroded wage power overall since 1980.


question: overall, was cost of living relatively cheaper for median wage earner early 1980s or 2025

answer:
Overall, the cost of living was relatively cheaper for the median wage earner in the early 1980s than in 2025.

Median household income rose nominally from ~$21,000 (1980) to ~$83,600 (2025)—a 4x increase—but key expenses outpaced it:

  • Housing: 3x income ($64,000 home) vs. 5x ($410,000) today; affordability eroded despite lower rates.
  • Cars: ~1/3 income ($7,600) vs. >1/2 ($47,000+).
  • Essentials (bread/gas): Similar multiples, but healthcare/education exploded (college tuition 24x).
One 1980 income supported a home, car, vacation; 2025 often needs dual incomes for basics. Inflation-adjusted, real purchasing power stagnated or declined for housing/milestones.
 
What is a pgy2 to do?
Expect to live a less lavish lifestyle, live in MCoL areas, cobble together multiple jobs to make bank, or marry someone with a similar or higher income. There's actually still a lot of roads that can lead to FIRE or working a full career and retiring very well while living good along the way. Again, almost everyone else has it worse than we do, even if we do still have it worse.
 
What is a pgy2 to do?

I could be wrong in 5 years, but investing money has been very easy as an attending. I recently graduated and my savings have already reached around 5-6mo of living expenses, now I started putting more money in stocks. Ofc that is besides max 401k. Of note I have an average job and haven't even started making real money yet, on the other hand I haven't bought a house yet.

My recs for now: get a job that pays median or more, but most importantly, don't do dumb financial decisions. I think most doctors will become rich in America if they don't do make very dumb financial decisions. And yes, not flying first class or buying a Porsche out of residency shouldn't even be recommended, as it is obvious. That is what I am referring as very dumb financial decisions. Sometimes I watch Dave Ramsay podcast cuts and doctors do call with questions like that. "I am finishing residency next month, can I buy a Lambo??"
 
300k ain't anything anymore guys these days. Nobody should be impressed with a 300K salary at this point. 400K is the new 300K.
Very true.
I think most doctors will become rich in America if they don't do make very dumb financial decisions.
Definitely. In addition to buying high end cars or very expensive houses straight out of training, there's a whole industry of financial salesmen that specifically target "dumb doctors" (apparently they actually call them that!) with whole life insurance or other bad financial products.
 
Nah, I disagree. If 1980s was hard mode, we're playing in insane mode in 2025. And it will only get worse. I feel very bad for those who are not established in their careers as the upward mobility ladder will only get pulled up higher and higher. In 1980's, sure inflation and interest rates were high but you could be a saver (CD, money market) and still come out ahead with real yield. These days, real yield for savers is negative. Now you have to go out further on risk curve to real returns (S&P 500). Money also went further in the 1980s.

@finalpsychyear is correct that this is a race against time, especially for those that want to be upper-middle or upper class.

---

Per AI:

question: compare median wage to price of S&P 500, price of median hous, price of big mac, price of gas of early 1980s and 2025

answer:
Median U.S. household income has roughly quadrupled nominally from ~$21,000 in 1980 to ~$83,600 in 2025, but purchasing power against these assets has diverged sharply—housing and S&P affordability worsened, while Big Mac/gas improved.

Key Metrics Comparison (Nominal Dollars)​


Median Household Income$21,020$83,5924.0x-
S&P 500 (Year-End Close)~136 (1980)~6,000 (est.)44x11x (less affordable)
Median House Price$64,000$410,0006.4x1.6x (less affordable)
Big Mac Price$1.00$5.705.7x1.4x (less affordable)
Gas (per Gallon)$1.19$3.052.6x0.65x (more affordable)


Housing: Went from 3x median income (affordable) to 5x (strained), driven by rates/supply.
S&P 500: Explosive gains outpaced wages ~11x, boosting wealth for investors but not median buyers.
Big Mac/Gas: Kept closer to wage growth; gas even cheaper relatively due to efficiency/tech. Real terms show inflation eroded wage power overall since 1980.


question: overall, was cost of living relatively cheaper for median wage earner early 1980s or 2025

answer:
Overall, the cost of living was relatively cheaper for the median wage earner in the early 1980s than in 2025.

Median household income rose nominally from ~$21,000 (1980) to ~$83,600 (2025)—a 4x increase—but key expenses outpaced it:

  • Housing: 3x income ($64,000 home) vs. 5x ($410,000) today; affordability eroded despite lower rates.
  • Cars: ~1/3 income ($7,600) vs. >1/2 ($47,000+).
  • Essentials (bread/gas): Similar multiples, but healthcare/education exploded (college tuition 24x).
One 1980 income supported a home, car, vacation; 2025 often needs dual incomes for basics. Inflation-adjusted, real purchasing power stagnated or declined for housing/milestones.
I agree and disagree. I was referring to inflation, which was worst during the 70s into the 80s. In terms of being middle-class, the middle class has been disappearing since the 80s, so I agree it sucks not to be in the portion of people that are upper class or rich. Some would argue the tax policies of the 80s, which have continued full force into 2025, led to the demise of the middle class with some growth in those considered upper class, but unfortunately, those who are struggling has also grown. There is more divergence between the haves and have nots.
 
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Nah, I disagree. If 1980s was hard mode, we're playing in insane mode in 2025. And it will only get worse. I feel very bad for those who are not established in their careers as the upward mobility ladder will only get pulled up higher and higher. In 1980's, sure inflation and interest rates were high but you could be a saver (CD, money market) and still come out ahead with real yield. These days, real yield for savers is negative. Now you have to go out further on risk curve to real returns (S&P 500). Money also went further in the 1980s.

@finalpsychyear is correct that this is a race against time, especially for those that want to be upper-middle or upper class.

---

Per AI:

question: compare median wage to price of S&P 500, price of median hous, price of big mac, price of gas of early 1980s and 2025

answer:
Median U.S. household income has roughly quadrupled nominally from ~$21,000 in 1980 to ~$83,600 in 2025, but purchasing power against these assets has diverged sharply—housing and S&P affordability worsened, while Big Mac/gas improved.

Key Metrics Comparison (Nominal Dollars)​


Median Household Income$21,020$83,5924.0x-
S&P 500 (Year-End Close)~136 (1980)~6,000 (est.)44x11x (less affordable)
Median House Price$64,000$410,0006.4x1.6x (less affordable)
Big Mac Price$1.00$5.705.7x1.4x (less affordable)
Gas (per Gallon)$1.19$3.052.6x0.65x (more affordable)


Housing: Went from 3x median income (affordable) to 5x (strained), driven by rates/supply.
S&P 500: Explosive gains outpaced wages ~11x, boosting wealth for investors but not median buyers.
Big Mac/Gas: Kept closer to wage growth; gas even cheaper relatively due to efficiency/tech. Real terms show inflation eroded wage power overall since 1980.


question: overall, was cost of living relatively cheaper for median wage earner early 1980s or 2025

answer:
Overall, the cost of living was relatively cheaper for the median wage earner in the early 1980s than in 2025.

Median household income rose nominally from ~$21,000 (1980) to ~$83,600 (2025)—a 4x increase—but key expenses outpaced it:

  • Housing: 3x income ($64,000 home) vs. 5x ($410,000) today; affordability eroded despite lower rates.
  • Cars: ~1/3 income ($7,600) vs. >1/2 ($47,000+).
  • Essentials (bread/gas): Similar multiples, but healthcare/education exploded (college tuition 24x).
One 1980 income supported a home, car, vacation; 2025 often needs dual incomes for basics. Inflation-adjusted, real purchasing power stagnated or declined for housing/milestones.
You are ignoring a major portion of the period I mentioned, the 1970s. This was what got Carter voted out of office. I remember 17 cent gas and waiting in block long lines when gas jumped in price during the 70s.
eta: Between 1976 and 1980 the cost of the average house increased by ~50%. In contrast, the cost of the average house increased by ~23% between 2020 and 2024.
 
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