Interviewing a Psychiatrist

[jumpbean2]

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I wanted to share an experience I had the other day, when I had the opportunity to visit a privately practicing psychiatrist through a program at my University.

I got 30 minutes to ask him basically anything pertaining to his practice and profession and I wanted to share the findings.

He operates a sole private practice full time. His expenses include malpractice, part-time secretary, and rent.

He explained that he use to do psychotherapy and med management but has switched almost exclusively to med management because there's more money and it's less taxing mentally.

For 90 minute evaluations he charges 500 dollars. For 15-20 Minute med management appointments he charges 100 dollars.

He said he sees about 25-30 patients a day, 5x a week!! This really surprised me, that seems like a lot!

In generals hes seeing patients about 7-8 hours of his day but is in the office about 10 hours a day.

As you can imagine, given the figures he definitely makes a lot of money. I was hesitant to ask but he was open about it. He told me that working the hours he does he makes about 550,000-600,000 a year.

I should note, though, that he is in his early 50s at the height of his career and is quite a respected psychiatrist in a lucrative area.


He also said he plans to scale back his hours in within a few years.

His favorite thing about his job was being in charge and the money.

His advice for new psychiatrists was to start in a salaried position as an employee, establish a reputation and get some experience, then branch into private practice.

Just thought I'd share this experience, was definitely surprising and enlightening.

 

[vistaril]

this is definately not typical...the number of psychiatrists getting 500 dollars from self pay patients for doing MED MANAGEMENT intakes is very very low.

 

[kindasorta]

^Is a resident in an academic program really that well-versed in private practice gigs and how lucrative they may or may not be? Seems like a lot of the opinions on the matter are just dogma that gets perpetrated. All your faculty mentors, presumably, aren't private practice off-the-grid psychiatrists. All your job hunts are as an employee. Why would you have your finger on the pulse of private practice psychiatry?

The few true PP people I've run into all speak of making >400k, without exception.

 

[vistaril]

^Is a resident in an academic program really that well-versed in private practice gigs and how lucrative they may or may not be? Seems like a lot of the opinions on the matter are just dogma that gets perpetrated. All your faculty mentors, presumably, aren't private practice off-the-grid psychiatrists. All your job hunts are as an employee. Why would you have your finger on the pulse of private practice psychiatry?

The few true PP people I've run into all speak of making >400k, without exception.

well most practicing psychiatrists in the US are in private practice, and salary surveys indicate that they make on average about 200k...or ~15k or so more than their salaried(govt and academia) counterparts.....

dont doubt that there are some >400k pp psychiatrists in practice....just as there are some 135k types in private practice. there are going to be outliers on both ends.

 

[kindasorta]

well most practicing psychiatrists in the US are in private practice, and salary surveys indicate that they make on average about 200k...or ~15k or so more than their salaried(govt and academia) counterparts.....

dont doubt that there are some >400k pp psychiatrists in practice....just as there are some 135k types in private practice. there are going to be outliers on both ends.

We've already pointed out that those numbers are greatly skewed by part-timers. Also, many psychiatrists are hunting a relaxed lifestyle and fart around and don't maximize their income potential. If your goal is to maximize income, it seems fairly easy. Especially if you're an American with even a hint of affability.

I think the burden is on you to show me how a psychiatrist working 50 hrs/week, taking good insurance, working for him/herself, is NOT making >300k.

 

[jumpbean2]

We've already pointed out that those numbers are greatly skewed by part-timers. Also, many psychiatrists are hunting a relaxed lifestyle and fart around and don't maximize their income potential. If your goal is to maximize income, it seems fairly easy. Especially if you're an American with even a hint of affability.

I think the burden is on you to show me how a psychiatrist working 50 hrs/week, taking good insurance, working for him/herself, is NOT making >300k.

I definitely think under the circumstances you've listed making >300K would be pretty easy.

I think the psychiatrist I interviewed is a fairly extreme example of this.


Since it seems most people are interested in the finances I'll elaborate on this...

I also asked him how his earnings are so much higher than the averages and he said..
a. many psychiatrists in salaried positions or in academia bring the averages down.
b most psychiatrists in private practice only work part-time because of the flexible hours.
c. He has geared his own practice towards making money, ie more med management, long hours, limited part-time staff.

He also stressed that while it is more money, he feels he earns it. He said working 50+ hours a week is tiring and there are a lot of responsibilities this PP entails.


He said all the full time privately practicing psychiatrists he knows make around 400K, if not more, with only a few exceptions.

This might be a trend unique to the region though, but it is something to consider.

On another note I think it's important to realize it's probably not as simple as setting up shop in private practice and automatically making half a million dollars a year. The first year or two are probably slower. But I do believe that if one established a respected private practice and is full time for several years, they'd hit the big bucks.

Ultimately I think it boils down to what you want. Many PP psychiatrists chose that arena not for money but for flexibility. They can dictate their hours, focus on whatever types of treatment they want, and really have no one to answer to. That being said, I think some psychiatrists do choose PP for big money though and there is definitely an opportunity for that.

I'd love to hear more of what people think.

 

[PikminOC]

Thanks for this thread OP. Very helpful.
You get paid what the market will bear.

 

[vistaril]

We've already pointed out that those numbers are greatly skewed by part-timers. Also, many psychiatrists are hunting a relaxed lifestyle and fart around and don't maximize their income potential. If your goal is to maximize income, it seems fairly easy. Especially if you're an American with even a hint of affability.

I think the burden is on you to show me how a psychiatrist working 50 hrs/week, taking good insurance, working for him/herself, is NOT making >300k.

you can believe whatever you want....believe that people are going to be lining up to pay you 500 dollars cash money and give you their first born daughter for all I care.... There are multiple different salary surveys out there, some that sample > 40 hrs/week for people in all fields.

 

[shan564]

I definitely think under the circumstances you've listed making >300K would be pretty easy.

I think the psychiatrist I interviewed is a fairly extreme example of this.


Since it seems most people are interested in the finances I'll elaborate on this...

I also asked him how his earnings are so much higher than the averages and he said..
a. many psychiatrists in salaried positions or in academia bring the averages down.
b most psychiatrists in private practice only work part-time because of the flexible hours.
c. He has geared his own practice towards making money, ie more med management, long hours, limited part-time staff.

He also stressed that while it is more money, he feels he earns it. He said working 50+ hours a week is tiring and there are a lot of responsibilities this PP entails.


He said all the full time privately practicing psychiatrists he knows make around 400K, if not more, with only a few exceptions.

This might be a trend unique to the region though, but it is something to consider.

On another note I think it's important to realize it's probably not as simple as setting up shop in private practice and automatically making half a million dollars a year. The first year or two are probably slower. But I do believe that if one established a respected private practice and is full time for several years, they'd hit the big bucks.

Ultimately I think it boils down to what you want. Many PP psychiatrists chose that arena not for money but for flexibility. They can dictate their hours, focus on whatever types of treatment they want, and really have no one to answer to. That being said, I think some psychiatrists do choose PP for big money though and there is definitely an opportunity for that.

I'd love to hear more of what people think.

I think everything you said is correct. You can make a lot of money if you want to. Med management pays big bucks, but a lot of psychiatrists choose not to do it because they'd rather treat the patient with whatever the patient needs. Some psychiatrists will only see therapy patients, and some will only see med management patients. Some people call themselves "psychopharmacologists" and don't see any other patients.

 

[kindasorta]

you can believe whatever you want....believe that people are going to be lining up to pay you 500 dollars cash money and give you their first born daughter for all I care.... There are multiple different salary surveys out there, some that sample > 40 hrs/week for people in all fields.

I'm not talking about cash only. As I said, I'd simply love an explanation for how someone working 50 hrs/wk, taking insurance, with the goal of maximizing income with respect to how many patients they're seeing, is not making >300k.

In reality I should ask how they're not making >400k, but you seem to believe they are making 200k. Thirty seconds with a calculator will show this assertion to be absurd.

 

[vistaril]

I'm not talking about cash only. As I said, I'd simply love an explanation for how someone working 50 hrs/wk, taking insurance, with the goal of maximizing income with respect to how many patients they're seeing, is not making >300k.

In reality I should ask how they're not making >400k, but you seem to believe they are making 200k. Thirty seconds with a calculator will show this assertion to be absurd.

And I don't think you have a lot of understanding for how the real world works.....salaries aren't determined by calculators. There are about 20 different salary surveys out there for psychiatrists in private practice and by taking the mean of all of them you will see that just shy of or right at 200k is about the average.......I'll believe that a lot more than anecdotal stories or you punching projections into your calculator.

 

[shan564]

And I don't think you have a lot of understanding for how the real world works.....salaries aren't determined by calculators. There are about 20 different salary surveys out there for psychiatrists in private practice and by taking the mean of all of them you will see that just shy of or right at 200k is about the average.......I'll believe that a lot more than anecdotal stories or you punching projections into your calculator.

I think he meant to say "why don't my calculations agree with the salary surveys?"... not "the salary surveys are wrong because the math says so."

 

[kindasorta]

And I don't think you have a lot of understanding for how the real world works.....salaries aren't determined by calculators. There are about 20 different salary surveys out there for psychiatrists in private practice and by taking the mean of all of them you will see that just shy of or right at 200k is about the average.......I'll believe that a lot more than anecdotal stories or you punching projections into your calculator.

Unless you can show me a survey that accounts for hours worked, they really have no relevance to realistic income potential. Especially in a field like psychiatry. Psych has already been shown to have the largest (or near) % of people working under 40hrs/wk. That clearly muddies the waters of average income for full-timers. And when you fold into that academics and salaried workers - they dilute the reality even further.

As you've mentioned many times, a CPT code is a CPT code. Well punch those CPT code reimbursements into a calculator, and when you see 4 patients an hour, for 8 hrs a day, with 30% overhead - you're making far more than 200k. Even allotting for many no-shows.

So I'm telling you that what you're saying just sounds like parroted negativistic dogma. I'm not even sure you really believe it. But if you do, and since I know you like to expose the TRUTH, I once again would love to hear how you'd be making <300k as a full-time, PP, outpatient psychiatrist, focusing on med management.

 

[vistaril]

Unless you can show me a survey that accounts for hours worked, they really have no relevance to realistic income potential. Especially in a field like psychiatry. Psych has already been shown to have the largest (or near) % of people working under 40hrs/wk. That clearly muddies the waters of average income for full-timers. And when you fold into that - private practice people - who make even more than full-timers in academia or that are salaried...well, I think it's clear the real numbers are in the 300-400k range.

As you've mentioned many times, a CPT code is a CPT code. Well punch those CPT code reimbursements into a calculator, and when you see 4 patients an hour, for 8 hrs a day, with 30% overhead - you're making far more than 200k. Even allotting for many no-shows.

So I'm telling you that what you're saying just sounds like parroted negativistic dogma. I'm not even sure you really believe it. But if you do, and since I know you like to expose the TRUTH, I once again would love to hear how you'd be making <300k as a full-time, PP, outpatient psychiatrist, focusing on med management.

Hell ask sunlionness....a member of this forum. She was doing outpt medmgt private practice(taking insurance) awhile back and while she didn't state her specific salary, she implied that she wasn't making even near 200k, much less 300 or 400k. Because the money wasn't coming in she actually went back to salaried work.

You can do the same type of 'calculator crunching' based on cpt codes for any specialty and come up with much higher numbers than private practice salary ranges(25-50-75) show.....

 

[kindasorta]

Hell ask sunlionness....a member of this forum. She was doing outpt medmgt private practice(taking insurance) awhile back and while she didn't state her specific salary, she implied that she wasn't making even near 200k, much less 300 or 400k. Because the money wasn't coming in she actually went back to salaried work.

You can do the same type of 'calculator crunching' based on cpt codes for any specialty and come up with much higher numbers than private practice salary ranges(25-50-75) show.....

It just doesn't make any sense to me. I'm not saying I'm correct, I'm just asking for anyone to show me why I'm incorrect. It's not like you'd have trouble getting patients, which is the only bottleneck to filling your practice.

 

[vistaril]

It just doesn't make any sense to me. I'm not saying I'm correct, I'm just asking for anyone to show me why I'm incorrect. It's not like you'd have trouble getting patients, which is the only bottleneck to filling your practice.

from what I hear it is a combination of things....patients not showing up, patients not paying their copays, insurance companies rejecting/denying claims(a big one), overhead not really running at 28-30%(if you're doing that sort of volume), the fact that you are paying for licensing and cme's out of your own pocket(as opposed to having them often paid for you in many salaried positions)

I've told this story before, but if my fiance was doing the same kind of projections(based on what screening and dx colonoscopies reimburse and how many they can do a day and just typing those numbers in a calculator), her salary would be 1.6-1.9 million a year *after* overhead.....but of course it isn't.

 

[michaelrack]

My best guess, with nothing to back it up, is that a solo- outpt psychiatrist taking mostly private insurance, with routine office hours, can expect to net in the low $300,000's if he is reasonably productive and does mostly med managment.

 

[jumpbean2]

My best guess, with nothing to back it up, is that a solo- outpt psychiatrist taking mostly private insurance, with routine office hours, can expect to net in the low $300,000's if he is reasonably productive and does mostly med managment.

I think this is probably fairly accurate. I think people saying their averages would only be a bit more than 200K are estimating quite conservatively.

If a private psychiatrist opts to operate with finances chiefly in mind and takes ethical measures to maximize profits...

I think 300-350K is reasonable, 400-500K is optimistic but not unheard of, and 500K+ is rare.

 

[vistaril]

I think this is probably fairly accurate. I think people saying their averages would only be a bit more than 200K are estimating quite conservatively.

If a private psychiatrist opts to operate with finances chiefly in mind and takes ethical measures to maximize profits...

I think 300-350K is reasonable, 400-500K is optimistic but not unheard of, and 500K+ is rare.

lmfao....you guys are going to be in for a rude awakening if you are expecting to do a psych residency and then come out and make 300-350k+ working m-f doing outpt med mgt.

These averages of ~200k are the *high* averages. There are many other averages(just google 'psychiatrist average salary') and you will see that other averages range from 150s to 180s. Anyway, the point of this isn't to talk about averages, but rather point out that in this whole forum there isn't a single private practice outpt med mgt practitioner making that kind of money. none. zero. zip. You'd think that would tell you something. Now there may be people in this forum making that, and there may even be some people in this forum who do a little bit of private outpt work(in addition to lots of other salaried and contract work) to get close to that range, but not a single person here is making 300k+ doing outpt private practice psychiatry.

In contrast, when you browse other forums and people are throwing around numbers there are actually people working in that capacity making the numbers they talk about in the forum.

There are other reasonable people on this forum on the matter. Fonzie, someone who has actually been pursuing such jobs, has made several insightful posts on the matter. Sunlionness actually has done something that all you med students and interns ramble on about(being an outpt med mgt pp psych), and she made insightful comments as well on the matter. But you guys, some of you still in med school(and pre psychology? what?), act as if all you have to do is hang up a shingle and there are tons of pleasant patients with great insurance just beating down your door begging you to push the dose on their ssri. Sorry, but that's not reality.

To make even close to the numbers you guys are throwing around(350k?) in outpt med mgt, you have to grind like you wouldnt believe. You have to be 90801ing in your sleep. And when you have to generate that sort of volume, you're going to have to take on a ton of drug seeking stimulant patients and a ton of axis 2 patients who aren't being helped by the massive polypharmacy you are throwing at them....and you know that, but because you need to keep banging out 90801's you have no choice but to add that third mood stabilizer to their regimen...after all, she isn't going to keep seeing you if you aren't adding meds to 'help fix her'.

All the salary surveys out there basically indicate that the 90th percentile psychiatrist out there makes about 265k. That's the 90th percentile. So arguments about part time nonsense or whatever are invalid(obviously 90th percentile earners arent generally part time). You guys who think you are going to make *well* above the 90th percentile doing something easy(outpt med mgt m-f) with no extra work(as many 90th percentiles probably do) are delusional.

 

[billypilgrim37]

This is the one thread where I entirely agree with V. It's almost confusing. I feel a little dirty.

Sent from my DROID RAZR using SDN Mobile

 

[JohnMD34]

lmfao....you guys are going to be in for a rude awakening if you are expecting to do a psych residency and then come out and make 300-350k+ working m-f doing outpt med mgt.

These averages of ~200k are the *high* averages. There are many other averages(just google 'psychiatrist average salary') and you will see that other averages range from 150s to 180s. Anyway, the point of this isn't to talk about averages, but rather point out that in this whole forum there isn't a single private practice outpt med mgt practitioner making that kind of money. none. zero. zip. You'd think that would tell you something. Now there may be people in this forum making that, and there may even be some people in this forum who do a little bit of private outpt work(in addition to lots of other salaried and contract work) to get close to that range, but not a single person here is making 300k+ doing outpt private practice psychiatry.

In contrast, when you browse other forums and people are throwing around numbers there are actually people working in that capacity making the numbers they talk about in the forum.

There are other reasonable people on this forum on the matter. Fonzie, someone who has actually been pursuing such jobs, has made several insightful posts on the matter. Sunlionness actually has done something that all you med students and interns ramble on about(being an outpt med mgt pp psych), and she made insightful comments as well on the matter. But you guys, some of you still in med school(and pre psychology? what?), act as if all you have to do is hang up a shingle and there are tons of pleasant patients with great insurance just beating down your door begging you to push the dose on their ssri. Sorry, but that's not reality.

To make even close to the numbers you guys are throwing around(350k?) in outpt med mgt, you have to grind like you wouldnt believe. You have to be 90801ing in your sleep. And when you have to generate that sort of volume, you're going to have to take on a ton of drug seeking stimulant patients and a ton of axis 2 patients who aren't being helped by the massive polypharmacy you are throwing at them....and you know that, but because you need to keep banging out 90801's you have no choice but to add that third mood stabilizer to their regimen...after all, she isn't going to keep seeing you if you aren't adding meds to 'help fix her'.

All the salary surveys out there basically indicate that the 90th percentile psychiatrist out there makes about 265k. That's the 90th percentile. So arguments about part time nonsense or whatever are invalid(obviously 90th percentile earners arent generally part time). You guys who think you are going to make *well* above the 90th percentile doing something easy(outpt med mgt m-f) with no extra work(as many 90th percentiles probably do) are delusional.

I definitely disagree.

I worked in an outpatient program for many years but switched to my own private practice to earn more.

I was earning about 200K a year in my salaried position, and in my private practice position I now earn 325-345K a year. I do it full time, but I've gotten to a point where I don't have to work aggressively to make that kind of salary. If I wanted to increase my hours a bit and do more med management I'm confident I could near 400K.

There are few (if any) accurate surveys that focus solely on the earnings of full time private practice psychiatrists.

Additionally few PP psychiatrists are in it to make top dollar. In my opinion it is, for the most part, older psychiatrists (50-75) who do it because it affords them flexibility and freedom that a salaried position doesn't.

I am lucky because the program I worked for now often refers patients to my practice and
I don't deny that my earnings are probably above average for private practice psycs, but to say they are flagrantly high is an exaggeration.


The majority of PP psycs I know who strive to make a lot of money make about 250-400K a year.

Obviously there are a lot of factors that go into this. Location, fees, insurance or lack thereof, office overhead, services offered, ect.

I do know one or two that are earning around the 500K mark, but in my opinion they do so at the expense of patient care. They do almost exclusive med management and cram in 35-40 appointments a day.

What you have to realize is PP is a BUSINESS. There are a lot of expenses associated with it as such, but the flip side is there is no cap as to what you take home. All profits are yours.

 

[vistaril]

I definitely disagree.

I worked in an outpatient program for many years but switched to my own private practice to earn more.

I was earning about 200K a year in my salaried position, and in my private practice position I now earn 325-345K a year. I do it full time, but I've gotten to a point where I don't have to work aggressively to make that kind of salary. If I wanted to increase my hours a bit and do more med management I'm confident I could near 400K.

There are few (if any) accurate surveys that focus solely on the earnings of full time private practice psychiatrists. .

this is not true....a *lot* of psychiatrists are still employed in full time private practice(mostly in small groups).....perhaps even a majority of psychiatrists.

 

[vistaril]

It's also somewhat unusual and suspicious that 'JohnMD34' has absolutely no posting history before that post, and writes in the exact same manner(even to the point of the way his sentences are divided) as the OP of this thread.....just saying.

 

[BobA]

lmfao....you guys are going to be in for a rude awakening if you are expecting to do a psych residency and then come out and make 300-350k+ working m-f doing outpt med mgt.

👍👍

Every week or so I get a flier from one undisclosed mid-sized southeastern city advertising a 300K position. . . it usually reads like this "only 2hrs from the Ozarks. . . lots of lakes for enjoyment . . . local symphony and art museum . . . etc" Not exactly some place I want to settle for the rest of my life, or the kind of work where I feel like I'm making a difference in people's lives that I got into this business for.

 

[vistaril]

👍👍

Every week or so I get a flier from one undisclosed mid-sized southeastern city advertising a 300K position. . . it usually reads like this "only 2hrs from the Ozarks. . . lots of lakes for enjoyment . . . local symphony and art museum . . . etc" Not exactly some place I want to settle for the rest of my life, or the kind of work where I feel like I'm making a difference in people's lives that I got into this business for.

well I actually wouldnt mind settling in such a mid-sized city, and I get a lot of the same offers, and when I call they are *never* a guaranteed 300k+ salary.....it's always the possibility of such a thing depending on a lot of factors that aren't likely to be met.

 

[Doctor Bagel]

Maybe I have a skewed perspective, but the private practice psychiatrists around here seem to have full practices and are doing OK as far as income. Now, OK, might not mean making $300k+ a year, though. Most of ones I know take insurance but also do a lot of psychotherapy, which might be why they're in private practice.

 

[jumpbean2]

It's also somewhat unusual and suspicious that 'JohnMD34' has absolutely no posting history before that post, and writes in the exact same manner(even to the point of the way his sentences are divided) as the OP of this thread.....just saying.

Haha well on this accusatory note, I think this thread has run its course.


My opinion is still one of optimism. That making 300K is very possible with the right mindset and resources. Yes, I have only just begun medical school, so I do conceive that many of you probably have more experience in this arena. I am simply basing my opinion off the real-word experiences and interactions I have had with privately practicing psychiatrists in my area.

To each his own.

 

[vistaril]

Haha well on this accusatory note, I think this thread has run its course.


My opinion is still one of optimism. That making 300K is very possible with the right mindset and resources. Yes, I have only just begun medical school, so I do conceive that many of you probably have more experience in this arena. I am simply basing my opinion off the real-word experiences and interactions I have had with privately practicing psychiatrists in my area.

To each his own.

well i mean I'm not sherlock holmes, but it was pretty obvious. A supposed attending with no posting history, suddenly joins *that day* to join that particular thread....

And there is nothing wrong with optimism. I think some residents are overly optimistic about what pp med mgt is going to be like because of their outpt resident med mgt experience. Sometimes part of it is at the VA, and this is *not* representative of the real world. Most importantly, as was pointed out earlier, if you magically converted every single one of their 90801's and 90805's into reimbursements by (insert popular insurer), you wouldn't come close to paying their salary....heck Im not even sure you could pay overhead. Second, all those patients aren't investing anything in their care either. heck in many cases they even get paid to show in the form of a travel voucher. So it's not representative at all, and I think some residents who rotate through outpt VA's see that and try to extrapolate it to pp and that's ridiculous. Many residents also rotate as an outpt through a faculty clinic of some sort, and this is also not the real world. Again, the salaried positions aren't be supported by that level of clinical work, and furthermore the support system is generally far in excess of what a lean pp would have.


One is to do things that maybe aren't so ethical or appropriate care(for example some outpt practices have >35% of their adult pts on a stimulant and > 60% of their patients on a stimulant, a scheduled benzo, or both). That will bring the people in. The other thing is to be *really good* at different therapies(usually requires extra formal training) and to provide a service in this area that people actually want and that separates you from the majority of providers. And when I say that I don't mean you sprinkle in some supportive and cbt work in a 25 minute med check. But the idea that someone is just going to go out and run through basic pharm algorithms in a med mgt clinic and make serious dollars without a lot of hassle or without being a candyman is just absurd.

 

[vistaril]

Maybe I have a skewed perspective, but the private practice psychiatrists around here seem to have full practices and are doing OK as far as income. Now, OK, might not mean making $300k+ a year, though. Most of ones I know take insurance but also do a lot of psychotherapy, which might be why they're in private practice.

yeah, this is true....I've met a lot of psychiatrists who work outpt and take insurance and book in 1 hr sessions. and obviously with 1 hr there is real therapy going on. but keep in mind when they are taking reimbursement for this the reimbursement generally averages about 125-130 dollars total for that hour, and they can probably only be seen 16-20 times a year.

Now you can make a living that way, and you will likely have happy patients who fill your clinic. but in doesn't a take a brain surgeon to figure out that if you are getting reimbursed 125-130 per hour of work and that is your gross, you aren't going to do all that well financially....even if you are running super lean in terms of overhead.