in 5 years do you see psych salaries same, higher, or lower?

[finalpsychyear]

Inflation should not be considered in this assessment. Will contractors still get somewhere in the 150-200/hr range for inpt or outpt work or do you see this changing much if i'm asking you all to look at your crystal balls?

I vote no way and if anything slight increases in payment if we are basing it on medicare payments for EM and therapy which have all been increasing 50 cents to 1 dollar the last few years.

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[MacDonaldTriad]

Demand is an all time high and will not be changing soon. Pay will not go down and even if it did a little, no one is going to starve and no one feels sorry for us.

 

[Doc1401]

It is a good question. Employers often use the negotiation argument that salaries are going to be decreasing, which is not true

 

[DisorderedDoc417]

Salaries are strong in the midwest. Most recent comp reports I've reviewed note up 15% in the past 2 years. It is an excellent time to be in psychiatry with no downs in the immediate future. Need will not be decreasing.

 

[finalpsychyear]

I guess alot of other people in other fields always talk about doom and gloom. Lots of people around me are saying bro you should be working like mad because you don't know how long those salaries are going to stay this high and work hard for the next 10 years since im a new attending and basically invest as much as possible so then even if after 10 years things got bad you'd be kinda already fine if you invested and saved carefully those first 10 years. Maybe I needlessly worry but yeah in 10 years from now when I am much more financially independent and invested in various things I will truly not feel the pressure like I do in some ways now even though im single.

 

[TexasPhysician]

I love this field, but I expect salaries to drop a bit.

We have had a pretty significant run-up on salaries lately. Local academic jobs that historically pay poorly have increased starting salaries about 20% (that’s huge). Few medical fields have a continued drift north with salaries. There is increasing competition from midlevels and even psychologists trying to invade the field. Younger populations vote for more access than quality care politically. I’ve seen companies replace all psychiatrists in the mental health department with NP’s.

I don’t believe that we are doomed by any means. Midlevels are invading all fields. The stigma of mental illness is decreasing and more people are seeking help.

I’m personally big on joining or creating a physician only practice that will look out for each other. It decreases the odds of being replaced or cutting your salary. Bonus points if the group works together to build other profitable businesses.

 

[finalpsychyear]

I could see the salary dropping with regards to inflation adjusted. I just dont see a psych doc doing inpt/out at less than 160 an hour 5 or even 10 years from now. For one cpt payments typically do rise very small but over 10 years from now the will rise further. Of course if you staff with all midlevels that is a different story but at least in my state you need an MD for supervision.

I think for the next 5 years minimum things will stay EXACTLY the same or even a slight increase. 5-10 years from now slight decrease probable, then 10 years + most likely 20-30% cut at worst with doom and gloom in full effect under the most probable worst case scenario.

Going to be working my ass off till 2024 pushing 60 hours with PP and a side job but no nights or wknds and maybe 2-3 wks of vaca a year. If i can't hit 450+ at some point in the next 5 yrs i guess i'll have to do some wknds.

 

[AD04]

It is a good question. Employers often use the negotiation argument that salaries are going to be decreasing, which is not true

Does anyone take a pay cut today for because salaries may drop in the future? LOL.

I would counter and say I want pay raise today because salaries may go up the the future.

I don’t think salaries will drop because we have too much leverage. Increase may slow, or it may not slow. Huge demand, limited supply. Few patients will choose to see NP / psychologist over physician. This field is not dependent upon insurance companies or hospitals. This is the best specialty to have a cash-based micropractice.

There is a fundamental shift in society that is much different than even a decade ago. The way American society is set up and how intertwined the field is with law and the government, demand will only increase. Government will only increase as well as no governmental entity will self-regulate. The rise of technology and promotion of individualism results in social isolation. Broken marriages and broken families, suicide and drugs. Being alone and unloved. Even if a person has everything, there is an emptiness he will feel. Part of the culture is to avoid discomfort at all cost. The allure of a pill to take away life’s problems is too great.

That’s not to mention the schizophrenics and the classically “crazy” people no one wants to deal with. They’re not going anywhere.

Overall, the other parties need us far more than we need them. This will be the case for a very very long time.

 

[WisNeuro]

Few patients will choose to see NP / psychologist over physician.

Assuming they have a choice. We've had no drop in patients as we've had more NPs hired in our clinic this past year and patients transferred to them.

 

[DisorderedDoc417]

I could see the salary dropping with regards to inflation adjusted. I just dont see a psych doc doing inpt/out at less than 160 an hour 5 or even 10 years from now. For one cpt payments typically do rise very small but over 10 years from now the will rise further. Of course if you staff with all midlevels that is a different story but at least in my state you need an MD for supervision.

I think for the next 5 years minimum things will stay EXACTLY the same or even a slight increase. 5-10 years from now slight decrease probable, then 10 years + most likely 20-30% cut at worst with doom and gloom in full effect under the most probable worst case scenario.

Going to be working my ass off till 2024 pushing 60 hours with PP and a side job but no nights or wknds and maybe 2-3 wks of vaca a year. If i can't hit 450+ at some point in the next 5 yrs i guess i'll have to do some wknds.

You’re expecting salaries to drop by 50k a year? Or to be less with respective to inflation? That’s not going to happen.

 

[finalpsychyear]

You’re expecting salaries to drop by 50k a year? Or to be less with respective to inflation? That’s not going to happen.

After sifting through the last 10 years of compensation salary for all specialties, it seems aside from a few procedural specialties EVERYONE is making more in 2018 than say 2013 or 2008 even if adjusted for inflation yet i understand some are doing more procedures relative to the past.

I am no longer worried about the field for the next 5 years but will not take it for granted.

 

[clozareal]

It's hard to predict the future, but we can look at past trends to inform us about what can happen. Just one data point which is fraught with its own problems, but Medscape reports that the past trend has been great for psychiatry. Psychiatrist reported largest gains in the past year out of any specialty.

Medscape: Medscape Access

Another data point that looks promising is that Merritt Hawkins reports that psychiatry is the second most sought after specialty for their physician recruitment (with first being Family Medicine). Demand obviously doesn't directly translate into salary since that's not how our reimbursement rates are set up, but it can help with negotiations. Salary has increased by about 20% over the past 5 years according to this report.
https://www.merritthawkins.com/uplo...hysician_Incentive_Review_Merritt_Hawkins.pdf

 

[ziggyhope]

I get at least one call from a headhunter every other day, emails daily. When I started getting those as a PGY-1, they were on average ~250K, now I mostly see ~300-350K. Provided I do not pay attention to the details, and the jobs that post pay upfront maybe the less desirable ones, but still, I noticed the increased in just the past two years.

 

[finalpsychyear]

I get at least one call from a headhunter every other day, emails daily. When I started getting those as a PGY-1, they were on average ~250K, now I mostly see ~300-350K. Provided I do not pay attention to the details, and the jobs that post pay upfront maybe the less desirable ones, but still, I noticed the increased in just the past two years.

for clarification the salary increases are for employed positions. i dont think there has been any change in cpt payments in the last 2 years at least in the area I am for PP.

 

[SeniorWrangler]

Wages are "sticky downwards", as they say, so they're unlikely to go down, it's much more likely that psychiatrists will be increasingly replaced by midleves and that working conditions will deteriorate.

 

[Shikima]

Wages are "sticky downwards", as they say, so they're unlikely to go down, it's much more likely that psychiatrists will be increasingly replaced by midleves and that working conditions will deteriorate.

Agree with this. More large corporations will take advantage of physicians or replace them with NPs if they can because of the profit margins. Insurers unlikely will increase reimbursements, if not go down which means you have to see more if going this route. MH is already heavy and seeing more per day will only add to the burden towards burnout.

 

[MedMan80]

Agree with above, the hospital where I am, large private entity with attached academic center is already incentivizing RN to become psychiatric NP and recently opened their own psych NP program. These mid-levels will continue to flood the market, reducing opportunities for us. That being said I don't think it's all doom and gloom, as we still will have opportunities open to use that only attending's can fill..

 

[MacDonaldTriad]

I disagree with all of you. So there are 6 or 7 thousand NP's writing psychotropics. If this were to double, it wouldn't even come close to denting the fact that 50K primary care doctors are already writing psychotropics poorly. The consumers of our widgets want to buy from us, we just are in short supply so market forces make them seek alternatives. Don't be a chicken little, the sky isn't falling, this is a predictable consequence of our being in a very fortunate market. Just ask a drug rep who is writing their pills, they will say, "family medicine of course, but we wish you would."

 

[WisNeuro]

I disagree with all of you. So there are 6 or 7 thousand NP's writing psychotropics. If this were to double, it wouldn't even come close to denting the fact that 50K primary care doctors are already writing psychotropics poorly. The consumers of our widgets want to buy from us, we just are in short supply so market forces make them seek alternatives. Don't be a chicken little, the sky isn't falling, this is a predictable consequence of our being in a very fortunate market. Just ask a drug rep who is writing their pills, they will say, "family medicine of course, but we wish you would."

While I agree that there will always be a segment of the population that will want to see doctoral level providers for services, I think an even larger segment of the population either doesn't know the real difference, or just wants whatever is quicker and easier. Another segment of the population may wish to see doctoral level providers, but simply doesn't have the choice due to a variety of constraints (availability of providers in the geo area, availability of providers due to their lack of choice in insurance, etc). I wouldn't call it a sky is falling thing, rather a slow, protracted turnover to midlevels for a variety of services in healthcare.

 

[TexasPhysician]

I disagree with all of you. So there are 6 or 7 thousand NP's writing psychotropics. If this were to double, it wouldn't even come close to denting the fact that 50K primary care doctors are already writing psychotropics poorly. The consumers of our widgets want to buy from us, we just are in short supply so market forces make them seek alternatives. Don't be a chicken little, the sky isn't falling, this is a predictable consequence of our being in a very fortunate market. Just ask a drug rep who is writing their pills, they will say, "family medicine of course, but we wish you would."

While I may be wrong, the last statistic I saw has psychiatric specific NP’s at 1:3 compared to psychiatrists. Rate of growth will have them at 1:2 in a few years.

 

[MacDonaldTriad]

Even if you believe that our primary function is to write meds, 2/3rds of psychotropics are written by non-psychiatrists already. If NPs go from 1:3 to 1:2, this wouldn't even bring it to 3/4ths. I still have confidence in our value added function. Even if you are a check list diagnostician who just writes meds, there is still a huge market for this abomination of our specialty. If all we do is write SSRIs, we deserve to be replaced.

 

[WisNeuro]

Even if you believe that our primary function is to write meds, 2/3rds of psychotropics are written by non-psychiatrists already. If NPs go from 1:3 to 1:2, this wouldn't even bring it to 3/4ths. I still have confidence in our value added function. Even if you are a check list diagnostician who just writes meds, there is still a huge market for this abomination of our specialty. If all we do is write SSRIs, we deserve to be replaced.

Don't forget the benzos.

 

[MacDonaldTriad]

Oh yah, those do more good than harm

 

[WisNeuro]

Oh yah, those do more good than harm

🙂 Yeah, we're still cleaning up after a long-time psychiatrist left here a few months ago. That dude loved to hand out stims and benzos.

 

[splik]

While I may be wrong, the last statistic I saw has psychiatric specific NP’s at 1:3 compared to psychiatrists. Rate of growth will have them at 1:2 in a few years.

there are over 10x as many psychiatrists as there are actual psych NPs. remember most NPs in psych are FNPs not Psych NPs. if you add in those FNPs doing psych the ratio of psychiatrists to psych NPs is about 1:4.75

 

[calvnandhobbs68]

I mean people have been saying the same thing about family medicine and anesthesia since I was in undergrad. They were the first specialities to get exposure to the NP (CRNA) flood. Psych NPs weren’t even really on the radar 10 years ago, I feel like there’s recently been a bum rush because of all the “lack of mental health resources” exposure in the media.

People are still steadily making 300+ starting salaries in anesthesia and opening concierge cash based family practices. If anything the recruiting for family med has gotten more intense. There’s a significant shortage of most specialities (save some like pathology).

 

[SeniorWrangler]

Don't forget the benzos.

Benzos without stimulants is like eggs without bacon.

 

[Stagg737]

While I agree that there will always be a segment of the population that will want to see doctoral level providers for services, I think an even larger segment of the population either doesn't know the real difference, or just wants whatever is quicker and easier. Another segment of the population may wish to see doctoral level providers, but simply doesn't have the choice due to a variety of constraints (availability of providers in the geo area, availability of providers due to their lack of choice in insurance, etc). I wouldn't call it a sky is falling thing, rather a slow, protracted turnover to midlevels for a variety of services in healthcare.

The problem there is that the quick and easy solution they get often times won't actually help them and will frequently actually make the patients' conditions worse. If I have any confidence in how midlevels work in the psych field, it's that they create more messes for actual physicians to clean up (at least in my limited experience). Same can be said for most FM docs treating psychiatric conditions. Given the shortage you mention and the inadequate care too many patients receive, I'm not worried about the career prospects for psychiatrists anytime soon. At least not as a threat from non-psychiatrist providers.

 

[WisNeuro]

The problem there is that the quick and easy solution they get often times won't actually help them and will frequently actually make the patients' conditions worse. If I have any confidence in how midlevels work in the psych field, it's that they create more messes for actual physicians to clean up (at least in my limited experience). Same can be said for most FM docs treating psychiatric conditions. Given the shortage you mention and the inadequate care too many patients receive, I'm not worried about the career prospects for psychiatrists anytime soon. At least not as a threat from non-psychiatrist providers.

The mess to clean up situation is definitely anecdotal, and I imagine is highly variable depending on region and system. I'd love to see some good actual outcome research. I'm not sure I see a difference in the "mess makers" as there are plenty who make those messes at both the doctoral and midlevels. Regardless, the only thing that matters in most healthcare systems and insurances is that the right checkboxes have been checked off so some administrator who has never delivered healthcare can be happy with their spreadsheets.

 

[Stagg737]

The mess to clean up situation is definitely anecdotal, and I imagine is highly variable depending on region and system. I'd love to see some good actual outcome research. I'm not sure I see a difference in the "mess makers" as there are plenty who make those messes at both the doctoral and midlevels. Regardless, the only thing that matters in most healthcare systems and insurances is that the right checkboxes have been checked off so some administrator who has never delivered healthcare can be happy with their spreadsheets.

That's fair, I've seen plenty of treatment plans made by physicians that were obviously inadequate even to a medical student. However, this has been far more common when the plans were developed by midlevels or non-psychiatrist physicians as opposed to those actually trained to prescribe psychotropic medications. It may be anecdotal, but I've seen far more simple mistakes and mismanagement of complex cases by non-psychiatrists of any kind than by psychiatrists (though I have seen a few of those as well which made me wonder how those individuals haven't lost their license for malpractice).

 

[WisNeuro]

That's fair, I've seen plenty of treatment plans made by physicians that were obviously inadequate even to a medical student. However, this has been far more common when the plans were developed by midlevels or non-psychiatrist physicians as opposed to those actually trained to prescribe psychotropic medications. It may be anecdotal, but I've seen far more simple mistakes and mismanagement of complex cases by non-psychiatrists of any kind than by psychiatrists (though I have seen a few of those as well which made me wonder how those individuals haven't lost their license for malpractice).

That's fair, and I don't doubt that is the case in some areas. I just haven't seen it in several that I have worked in. The VA had been doing a great job at tapering down and not starting benzos where I worked, less so with opiates. But, the system I'm in now hands benzos out like candy, and it's mostly from psychiatrists embedded in our larger community clinics. I'd love to see some actual data that delineates prescribing habits by different providers (PCP, psychiatrists, NP, etc) to see what it looks like, but to my knowledge, a good study that would actually be interpretable, does not exist. Until then, we're just relying on anecdotes from both sides, which are subject to biases.

 

[TexasPhysician]

That's fair, and I don't doubt that is the case in some areas. I just haven't seen it in several that I have worked in. The VA had been doing a great job at tapering down and not starting benzos where I worked, less so with opiates. But, the system I'm in now hands benzos out like candy, and it's mostly from psychiatrists embedded in our larger community clinics. I'd love to see some actual data that delineates prescribing habits by different providers (PCP, psychiatrists, NP, etc) to see what it looks like, but to my knowledge, a good study that would actually be interpretable, does not exist. Until then, we're just relying on anecdotes from both sides, which are subject to biases.

I think that if anyone did a large enough study that took in enough information (highly unlikely), the results would be staggering. Below is my findings:

I live in a large city (top 10 US) and see a lot of treatment plans/records. There are 2 psychiatrists that I have identified as failures. I never understand their thought process. You can rule out a diagnosis by reading theirs. Both are older and hopefully retire soon. There is a 3rd that I don’t agree with, but her thought process is just $$. She is good when she takes her time which is rare, but she believes that some care is better than none. Other psychiatrists may have different opinions than mine or different prescribing preferences, but I can understand exactly what they are doing.

Peds does a fair job as well. Most of my peds referrals do a good job of initiating a treatment that follows their diagnosis. It is conservative and appropriate. Sometimes I just refer back and give them virtual phone high fives (not really).

FM is a total crapshoot. 1 FM will give everyone stims but absolutely 0 benzos ever. Another FM thinks ADHD doesn’t exist so 0 stims, but he believes that Clonazepam 2mg BID is a good starting point for anxiety. The others rarely make a decision that makes sense with documentation. Few make decisions that I agree with.

Midlevels are by far the most confusing. While some seem intelligent when I speak to them, documentation proves me wrong. Some document in detail and actually write “facts” that are just incorrect. This boggles my mind. If I were called to testify, I could say that the diagnosis is wrong (could be seen as subjective in psych), and actually state that their documentation is false based on current knowledge with sound books to back me up. Some justify their clinical decisions on blood levels and ignore patient improvement and side effects. They actually document that the patient is stable but the blood level isn’t perfect, so compounding pharmacies or unique dosing is needed to get VPA to 115-125 and similar nonsense. Many ignore FDA approvals. My favorite is 1 that uses Vraylar for anxiety over SSRI’s, and midlevels are here to decrease healthcare costs? While most seem conservative with controlled substances, I can rarely make sense of what they are doing.

No field is perfect by any means. Sometimes psychiatrists are to blame for not better educating their midlevels. Their education was never meant to be a terminal degree, but even their supervisors fall short of understanding this.

 

[medicool]

With the number of International medical graduates in Psychiatry decreasing, I predict that the not so desirable Community mental health centers, Correctional settings, and State hospitals will likely have to pay more(already happening). A lot of IMGs fill these positions due to visa needs. Also, Psychiatry is one of the few branches that you can set up a solo practice with little overhead so if employed salaries move significantly downwards, you may likely see a shift of many people moving to a hybrid model of contracting /billing for inpatient services/local agencies and maybe adding a private practice on the side. Telepsychiatry will continue to expand and I bet that the majority of people who use Insurance would prefer to see an MD/DO provider.

 

[psychm]

Psych will be in a good place for the next 10-20 years, if I had to guess. Even if it rapidly changes and becomes more competitive for trainees, I still think decades of reality have led to where we are now, so in particular US MDs at any respectable program are going to have great jobs available to them for quite a while.