Is it possible (or realistic) to pull $400k in psych?

[Doctoscope]

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There was a whole conversation in my class group chat about procedures and their importance in the US healthcare system for compensation. That got me thinking, what's the most procedure-less specialty I can think of, and it was psych. So in the absence of procedures, Is it possible to make $400k in psych without working unreasonable hours? The number is honestly arbitrary, it just seemed like a physician salary that's on the higher end.

 

[voxveritatisetlucis]

Not unless you either work a ton or own a successful practice. Keep in mind that most people who share salaries here and Reddit tend to be high earners

 

[lacrossegirl420]

Not realistic, don’t go into psych if you care about money

 

[mrbreakfast]

You can make >$400K in a specialty with zero procedures. For the average physician, compensation can be defined mathematically as (patients seen) * (complexity/acuity of cases), with a modifier for specialty knowledge required. So the more patients you see, and the higher acuity/complexity of cases, the more you will make.

The problem is that, unless you're a hospitalist or something, the average complexity of your cases is going to be capped at a low-moderate level, so the only way to get that compensation formula up is by increasing your patients seen. Then it becomes a question of how many patients you can feasibly, or want to, see in a day.

The people who are making big incomes in prescription-based fields, like psych or pain management, are people who are seeing a patient every 5-10 minutes, prescribing controlled substances to everyone, and typically charging cash - this practice model works great until you get yourself in trouble, which inevitably happens.

You will make plenty of money as a doctor. Pick a specialty in which you earn "enough" money while still being happy.

 

[RangerBob]

I’ve heard of plenty of psychiatrists making around $400k without having to work surgeon hours.

I’ve heard plenty of PCPs pull that income also without working surgeon hours.

All depends on your business model/contract/payor mix and your efficiency.

 

[Splenda88]

I’ve heard of plenty of psychiatrists making around $400k without having to work surgeon hours.

I’ve heard plenty of PCPs pull that income also without working surgeon hours.

All depends on your business model/contract/payor mix and your efficiency.

Not hard to make 400k+ in most specialties in medicine if you are ok to work outside of US major metros.

I am on track to make ~450k this year working on average 18 days/month as an IM hospitalist

 

[DO2015CA]

Not hard to make 400k+ in most specialties in medicine if you are ok to work outside of US major metros.

I am on track to make ~450k this year working on average 18 days/month as an IM hospitalist

18 days per month seems like it could be rough. How is it? Most hospitalists I know work 14 (obviously don’t make 450) and they complain that it’s a lot. They spend their 7 days off recovering/dreading their next 7 days on

 

[Splenda88]

18 days per month seems like it could be rough. How is it? Most hospitalists I know work 14 (obviously don’t make 450) and they complain that it’s a lot. They spend their 7 days off recovering/dreading their next 7 days on

It's 14 days every 28 days, but it's actually 15 days/month.

18 days have not been rough for me thus far.

Well, I dont know many who dread that 7 days. It they were, they all would be doing outpatient Monday thru Friday.

More FM docs are doing inpatient these days as opposed to IM doing outpatient.

 

[DO2015CA]

It's 14 days every 28 days, but it's actually 15 days/month.

18 days have not been rough for me thus far.

Well, I dont know many who dread that 7 days. It they were, they all would be doing outpatient Monday thru Friday.

More FM docs are doing inpatient these days as opposed to IM doing outpatient.

Nice to hear it from someone that’s in it with a different perspective

 

[Splenda88]

Nice to hear it from someone that’s in it with a different perspective

If you want to hear other perspective, become a member of the hospitalist FB group.

Most of these people like their job, especially the ones who have jobs that are round and go. These people work 50 hrs every other week to make 300k. One of my former co-residents have a job like that in Missouri and he is making 375k/yr (Just got a 50k raise ~3 months ago)

 

[Candidate2017]

There was a whole conversation in my class group chat about procedures and their importance in the US healthcare system for compensation. That got me thinking, what's the most procedure-less specialty I can think of, and it was psych. So in the absence of procedures, Is it possible to make $400k in psych without working unreasonable hours? The number is honestly arbitrary, it just seemed like a physician salary that's on the higher end.

Yes, you can make $400k without working unreasonable hours in psychiatry. But psych is generally not an efficient specialty that benefits from economies of scale, unless you see 4 patients an hour and toss them their stimulant or benzo of choice a.k.a. Dr. Feelgood.

High compensation specialties tend to be efficient specialties: repetitive and lacking in patient input (i.e., Ortho: "bone broke, me fix," Derm: "rash, you put cream," Rads: "get out, me read," GI: "you sleep, me scope your butt"). For example, if they decide to work an extra 30 minutes, derm can see an extra 6 patients, GI can do 2 extra scopes, all of which pay massively more than me seeing an extra psych patient, who will invariably rant at me with some version of "You don't understand, I have ADHD, my aunt who's a nurse on TikTok diagnosed me!" or "I'm Jesus, I don't need no meds, see you in court!" So yeah, I am gonna work an extra 30 minutes to generate 1/6th the pay of derm?

And psych patients can create a lot of unpaid or low paid work. We are the only specialty upon which every state imposes volumes of medicolegal laws.

In sum, procedural specialties result in higher pay because of two factors: procedures reimburse more, and you can efficiently do more paying work when there's minimal input from patients, families, other providers, or society to slow you down.

 

[mistafab]

The more your day looks like a suit’s, and less like a doctor - the more you will make.

Psychiatry included.

 

[DOswag]

Psychiatrist here, graduated residency in 2019. First year post military (separated last year after HPSP commitment to Air Force, made about 190K my last year active duty) live in a top 10 city in US in regards to population. I work 40 hrs per week on the dot. Four days mon-thur 10 hr days get every Friday off and a 3 day weekend. No nights, no call, no weekends, straight outpatient seeing 15-20 patients per day. Work for a clinic that does a lot of TMS (generates a lot of rvu’s and is very effective), also does a lot of ketamine treatments. Great staff support (indescribable how this has been coming from the military) good benefits. The first 3-6 months pretty much made the base salary but once I started getting a lot of patients in TMS started hitting bonuses based on rvu production. On pace for this calendar year to make about 400K. There’s other psychiatrists in the practice that are making 5-600K. The average for psychiatry is closer to 300K if you’re looking at practice comparisons and location across the country. It is definitely possible to make 400K in psych without working yourself like a surgeon but I do admit my job isn’t the standard or norm for psych though there are these types of jobs out there. Or you can work 50-60+ hrs per week and make a lot of money in psych with a mix of inpatient/outpatient or other practice setups, locums etc. But you can also work 30 hrs in a super Cush job and pull 200-250K. Big demand for psychiatrist currently.