Is it possible to do $14,000 monthly productivity as outpatient psychiatrist?

[Techmed07]

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[clausewitz2]

Are you asking if you can generate 14k of revenue monthly as an outpatient psychiatrist? Yes. That is 3500 per week. That's 168k per year. I could probably limit myself to 10-12 clinical encounters per week and do that kind of business. I do look forward to hopefully still being able to generate significant revenue even working one day a week well into "retirement" age.

 

[Sushirolls]

Yes, 14K of net income is possible.

 

[dl2dp2]

I'm more interested in knowing if it's possible to 14k weekly productivity. Or maybe 140k monthly productivity.

 

[clausewitz2]

I'm more interested in knowing if it's possible to 14k weekly productivity. Or maybe 140k monthly productivity.

I have had days where I hit a number that if sustained over five days would get to 14k weekly. It is not a pace that I care to keep up with in even the medium-term, but not impossible.

 

[Sushirolls]

Snap shot, back calculated my current hourly rate as of todays most recent numbers, could possibly Gross - but not net - 14K per week with 41 hours of clinical time. Concur with clausewitz, no thank you. Not worth it.

When resident with moonlighting I was pushing 80-100+ hours a week. Don't know how I did it then. Even the thought of approaching 30 clinical hours per week seems like staring at the task of summiting Mt McKinley.

 

[jbomba]

I have had days where I hit a number that if sustained over five days would get to 14k weekly. It is not a pace that I care to keep up with in even the medium-term, but not impossible.

So say I want to open a practice after residency. Is it just a matter of getting on with a few of the better paying providers in my area +/- medicare and opening shop? If I work 40-45 clinical hours a week should I pretty consistently and easily hit that goal?

 

[Sushirolls]

Depends on insurance rates in your local area. Depends on the percentage or people in your local area who have which insurance. Depends on your overhead. Depends on saturation of your local area of other Psychiatrists and ARNPs. Depends on national trends destined to destroy the health system year after year if they get pushed thru state or national legislative bodies.

Depends on your future older self, will you actually want to work 40-45 clinical hours per week? Odds are against that. Toss a spouse, or kid(s), or health, or another family members health, or hobby into the mix and quickly that's just not the goal anymore.

Entropy is real, and a heck of a force.

 

[FlowRate]

You could brand yourself as being an "integrative and holistic medicine" psychiatrist and charge $600/hr. (local person does that, states on her website that she's full and not taking new pts -- $850 for an intake.)

Or be a residency classmate of mine who charges that much because of the combination high demand in her location and a smaller city with a lot of wealth. Also helps that she's working in the same offices as someone who's already built a full practice charging that much and sends her all their excess referrals.

 

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[NickNaylor]

$14k/week gross with 50 clinical hours/week would be <$300/hr. There are plenty of psychiatrists that charge far more than that in my area and psychiatrists are very much in demand here.

Of course, that doesn't include other expenses and whether or not you would want to work 50 hours/week is questionable, but if you can master the "customer service" part of private practice and are an attentive clinician, $14k/week seems entirely reasonable to me in my area if you're willing to put in the hustle.

 

[clausewitz2]

$14k/week gross with 50 clinical hours/week would be <$300/hr. There are plenty of psychiatrists that charge far more than that in my area and psychiatrists are very much in demand here.

Of course, that doesn't include other expenses and whether or not you would want to work 50 hours/week is questionable, but if you can master the "customer service" part of private practice and are an attentive clinician, $14k/week seems entirely reasonable to me in my area if you're willing to put in the hustle.

Bear in mind 50 clinical contact hours per week (assuming no gaps) means 65 hours per week easily.

 

[Psychresy]

Bear in mind 50 clinical contact hours per week (assuming no gaps) means 65 hours per week easily.

Just out of curiosity how do you figure? During our outpatient year in residency we had 32 clinical hours a week and it translated to about 34 hours, and we were responsible for prior auths, phone calls, etc. I type fast and had notes done in the visit so nothing left to do after work. Maybe the real world is different though, which is why I ask.

 

[TexasPhysician]

Just out of curiosity how do you figure? During our outpatient year in residency we had 32 clinical hours a week and it translated to about 34 hours, and we were responsible for prior auths, phone calls, etc. I type fast and had notes done in the visit so nothing left to do after work. Maybe the real world is different though, which is why I ask.

That is very dependent on how much staff assistance you have. My staff do all PA’s. I on average return <1 phone call per week. I complete most notes during appointments. I have been lucky with low staff turnover lately. My non clinical hours are minimal.

There have been weeks where I’m interviewing new staff, appealing unemployment claims, and getting out of a subpoena. Terrible weeks do exist in which I do 25 clinical hours and 20 non-clinical hours, but thankfully this is quite rare. Knock on cyber-wood.

 

[NickNaylor]

Bear in mind 50 clinical contact hours per week (assuming no gaps) means 65 hours per week easily.

Sure, there's going to be additional time required that's not reimbursed. But for the OP's question, I think the answer is "yes" depending on the circumstances, one of which is how much you're willing to work.

 

[Techmed07]

what about $60,000 monthly productivity?

 

[hamstergang]

what about $60,000 monthly productivity?

Where do you see this thread going? Are you going to keep throwing out numbers until you hit one that gets a 50/50 mix of yes and no? Are you just looking for the most you can expect to make without any details about the set up you have available?

 

[calvnandhobbs68]

what about $60,000 monthly productivity?

What about

 

[clozareal]

You could brand yourself as being an "integrative and holistic medicine" psychiatrist and charge $600/hr. (local person does that, states on her website that she's full and not taking new pts -- $850 for an intake.)

Or be a residency classmate of mine who charges that much because of the combination high demand in her location and a smaller city with a lot of wealth. Also helps that she's working in the same offices as someone who's already built a full practice charging that much and sends her all their excess referrals.

Is this because "integrative and holistic medicine" docs tend to treat higher SES that are willing to pay cash? Or is there something special or more effective about this type of medicine bringing these people in.

 

[NPDude362]

What about $50,000 monthly revenue for a Psych NP working 50 hours a week as an independent practice owner. Is that possible?

 

[FlowRate]

Is this because "integrative and holistic medicine" docs tend to treat higher SES that are willing to pay cash? Or is there something special or more effective about this type of medicine bringing these people in.

It's the (higher SES) people who would see a naturopath at the same time as seeing the rest of their medical team. So belief that there are "natural treatments western medicine doesn't want you to know." Easily wooed by heavily marketed science of marginal utility (genetic testing, urine neurotransmitter metabolite testing), also marketed as being "natural supplement strategies pharma doesn't want you to know." I'm sure the placebo effect is huge when you're paying big money for treatments you're convinced are better/exclusive/going to work supported by "scientific testing" that targets their "unique" needs.

 

[sloh]

It's the (higher SES) people who would see a naturopath at the same time as seeing the rest of their medical team. So belief that there are "natural treatments western medicine doesn't want you to know." Easily wooed by heavily marketed science of marginal utility (genetic testing, urine neurotransmitter metabolite testing), also marketed as being "natural supplement strategies pharma doesn't want you to know." I'm sure the placebo effect is huge when you're paying big money for treatments you're convinced are better/exclusive/going to work supported by "scientific testing" that targets their "unique" needs.

Too smart for their own good

 

[FlowRate]

Too smart for their own good

Some of the naturopaths in the area put on their websites that they "specialize" in treating executives, professionals, athletes, etc.

I think it's an appeal to those who want to feel very clever for seeking out those services.

 

[jbomba]

What about $50,000 monthly revenue for a Psych NP working 50 hours a week as an independent practice owner. Is that possible?

How about 50,000 monthly revenue to your bottom line for each psych NP you employ? is this possible?

 

[Techmed07]

It is in a contract I have... Where 14k is monthly minimum and 60k is the goal.

 

[clausewitz2]

It is in a contract I have... Where 14k is monthly minimum and 60k is the goal.

In that they are guaranteeing you at least 14 monthly? What do you have to do to hit the goal?

If this is how it is specified in your contract then surely the contract will tell you the circumstances under which you will make these amounts of money.

 

[clausewitz2]

It's the (higher SES) people who would see a naturopath at the same time as seeing the rest of their medical team. So belief that there are "natural treatments western medicine doesn't want you to know." Easily wooed by heavily marketed science of marginal utility (genetic testing, urine neurotransmitter metabolite testing), also marketed as being "natural supplement strategies pharma doesn't want you to know." I'm sure the placebo effect is huge when you're paying big money for treatments you're convinced are better/exclusive/going to work supported by "scientific testing" that targets their "unique" needs.

I've seen it argued that we won't know pharmacogenetic testing is actually useful without a properly blinded randomized trial, i.e. treating half of subjects based on their pharmacogenetic test results and half of them based on randomly assigned pharmacogenetic results from someone else. Otherwise, you are demonstrating placebo, not personalization.

 

[calvnandhobbs68]

I've seen it argued that we won't know pharmacogenetic testing is actually useful without a properly blinded randomized trial, i.e. treating half of subjects based on their pharmacogenetic test results and half of them based on randomly assigned pharmacogenetic results from someone else. Otherwise, you are demonstrating placebo, not personalization.

There’s lots of details in the ways you could design this…I like that one. I’d even go one step further and say half would get randomly assigned results from someone else that were compared to their OWN results (that the patient was blinded to of course) to ensure that they aren’t similar. Otherwise if genetic testing is beneficial, you could pick up enough people with similar enough genetic profiles in the “placebo” group to get a treatment effect.

Or you could make it more simple and just say half the people get fake genetic results they’re shown and treatment is based off of (so their genetic testing isn’t actually performed but they’re shown a profile that they believe is theirs but is totally made up or you could run it and generate the opposite of their true genetic profile). Actually I think that way might separate out placebo effect the best since you’re literally doing the opposite of what their real genetic profile generates.

 

[clausewitz2]

Or you could make it more simple and just say half the people get fake genetic results they’re shown and treatment is based off of (so their genetic testing isn’t actually performed but they’re shown a profile that they believe is theirs but is totally made up or you could run it and generate the opposite of their true genetic profile). Actually I think that way might separate out placebo effect the best since you’re literally doing the opposite of what their real genetic profile generates.

I do like the idea of randomly generated profiles, but it's possible that you might end up with biologically implausible profiles, and then the manufacturers could claim that obviously there was no efficacy because you made up impossible results that could never be true for anyone, etc. etc. I'm agnostic as to where the profiles should come from but I think it ought to be derived from someone's results. Agree on making sure they don't match too closely; you could use an algorithm of some kind to automate the sorting profess based on some minimum disagreement value.

 

[Candidate2017]

Is this because "integrative and holistic medicine" docs tend to treat higher SES that are willing to pay cash? Or is there something special or more effective about this type of medicine bringing these people in.

Higher SES people in their daily life have experienced that they get a superior product or service when they pay more for something that is personalized, rare, different, and not widely offered to the masses.

However, evidence based medicine is actually medicine for the masses because the gold standard of treatment usually does not change based upon SES. So the wackier and more "holistic" treatments you are willing the shill, the more the higher SES people perceive they are getting something better.

 

[clausewitz2]

Higher SES people in their daily life have experienced that they get a superior product or service when they pay more for something that is personalized, rare, different, and not widely offered to the masses.

However, evidence based medicine is actually medicine for the masses because the gold standard of treatment usually does not change based upon SES. So the wackier and more "holistic" treatments you are willing the shill, the more the higher SES people perceive they are getting something better.

Totally independent of quality, don't forget that consuming rare, personalized, and different services enhances one's status way more than discount prices affordable to all. Imagine how superior you can feel to those prole sheeple who still go to conventional doctors. Naturopaths also see much lower volumes than, like, any PCP, so they can take lots of time to build rapport. If you're not medical, it's easy to mistake "I feel good emotionally when I leave that office" with "I am in better health."

 

[clozareal]

I've seen it argued that we won't know pharmacogenetic testing is actually useful without a properly blinded randomized trial, i.e. treating half of subjects based on their pharmacogenetic test results and half of them based on randomly assigned pharmacogenetic results from someone else. Otherwise, you are demonstrating placebo, not personalization.

This one is probably the best randomized trial and even then, the treatment choices weren't made for the patient based on the genetic results, but rather the genetic results were given to the psychiatrist who would have to interpret it themselves and choose. Almost all of the studies I've seen are industry sponsored.

Impact of pharmacogenomics on clinical outcomes in major depressive disorder in the GUIDED trial: A large, patient- and rater-blinded, randomized, controlled study - PubMed

Current prescribing practices for major depressive disorder (MDD) produce limited treatment success. Although pharmacogenomics may improve outcomes by identifying genetically inappropriate medications, studies to date were limited in scope. Outpatients (N = 1167) diagnosed with MDD and with a...

pubmed.ncbi.nlm.nih.gov

 

[splik]

Is this because "integrative and holistic medicine" docs tend to treat higher SES that are willing to pay cash? Or is there something special or more effective about this type of medicine bringing these people in.

I see a lot of patients who come to me as their "last resort" after seeing naturopaths, functional medicine doctors and other practitioners peddling quack treatments. In my experience, most of these people are not particularly rich and these healers wouldn't be able to earn a living if they were mainly dependent on wealthier clientele. They specialize in desperation. many patients and families rack up significant debts paying for this care. often they aren't just seeing the worried well either, they see some pretty sick patients. but it might be easier to accept that you have chronic lyme disease, heavy metal poisoning, autoimmune encephalitis, PANDAS, SIBO, disseminated candidemia, subclinical hypothyroidism, MSIDS, or whatever the diagnosis du jour is that doesn't sound like a psychiatric disorder.

Another issue is the stigma of mental illness lead some people to search for other explanations and treatments. psychiatry itself has been so mired in pseudoscience and is prone to fads, that it isn't a huge leap to some of this stuff. the lack of certainty in psychiatry also leads people to look elsewhere. I have pts who have seen psychics, shamans, spirit release therapists etc in addition to the integrative and functional medicine docs etc.

 

[clozareal]

I see a lot of patients who come to me as their "last resort" after seeing naturopaths, functional medicine doctors and other practitioners peddling quack treatments. In my experience, most of these people are not particularly rich and these healers wouldn't be able to earn a living if they were mainly dependent on wealthier clientele. They specialize in desperation. many patients and families rack up significant debts paying for this care. often they aren't just seeing the worried well either, they see some pretty sick patients. but it might be easier to accept that you have chronic lyme disease, heavy metal poisoning, autoimmune encephalitis, PANDAS, SIBO, disseminated candidemia, subclinical hypothyroidism, MSIDS, or whatever the diagnosis du jour is that doesn't sound like a psychiatric disorder.

Another issue is the stigma of mental illness lead some people to search for other explanations and treatments. psychiatry itself has been so mired in pseudoscience and is prone to fads, that it isn't a huge leap to some of this stuff. the lack of certainty in psychiatry also leads people to look elsewhere. I have pts who have seen psychics, shamans, spirit release therapists etc in addition to the integrative and functional medicine docs etc.

One of the first patients I saw in medical school came into the psych ER with their exorcist. I went to his website and he claimed a board certification in it.

I find it interesting the stigma against diagnoses in certain chapters in the DSM (somatic symptom and related disorders, schizophrenia spectrum disorders, and personality disorders in particular) but strong desire to have diagnoses in other chapters (neurodevelopmental disorders like ADHD and autism, trauma- and stressor-related disorders, and dissociative identity disorders).

 

[Mad Jack]

You could brand yourself as being an "integrative and holistic medicine" psychiatrist and charge $600/hr. (local person does that, states on her website that she's full and not taking new pts -- $850 for an intake.)

Or be a residency classmate of mine who charges that much because of the combination high demand in her location and a smaller city with a lot of wealth. Also helps that she's working in the same offices as someone who's already built a full practice charging that much and sends her all their excess referrals.

Oh yeah, there's a "nutritional psychiatrist" I know of that charges $700/intake and has a full practice

 

[Mad Jack]

How about 50,000 monthly revenue to your bottom line for each psych NP you employ? is this possible?

Possible? Yes. Would you find one willing to work under the conditions required? Not a chance

 

[Candidate2017]

One of the first patients I saw in medical school came into the psych ER with their exorcist. I went to his website and he claimed a board certification in it.

I've alway wanted to be like the psychiatrists in "The Exorcist" and say this to a patient:

Clinic Director: There is one outside chance for a cure. I think of it as shock treatment as I said, it's a very outside chance. Have you ever heard of exorcism? Well, it's a stylized ritual in which the rabbi or the priest try to drive out the so-called invading spirit. It's been pretty much discarded these days except by the Catholics who keep it in the closet as a sort of an embarrassment, but uh, it has worked. In fact, although not for the reasons they think, of course. It's purely a force of suggestion. The victim's belief in possession is what helped cause it, so in that same way, a belief in the power of exorcism can make it disappear.

Chris MacNeil: You're telling me that I should take my daughter to a witch doctor? Is that it?

 

[Therapist4Chnge]

It's mostly about being a good business person and at least a sub-par to mediocre clinician. Figure out how to justify fees on the higher-end of fees in your community, use mid-levels to generate passive income, and make sure to have great staff to handle scheduling and billing. A lot of clinicians try to do everything solo and that is almost always a bad use of their time.

 

[Psychresy]

It's mostly about being a good business person and at least a sub-par to mediocre clinician. Figure out how to justify fees on the higher-end of fees in your community, use mid-levels to generate passive income, and make sure to have great staff to handle scheduling and billing. A lot of clinicians try to do everything solo and that is almost always a bad use of their time.

Out of curiosity how much will a single mid level add to your revenue, generally speaking?

 

[PsyDr]

I've seen it argued that we won't know pharmacogenetic testing is actually useful without a properly blinded randomized trial, i.e. treating half of subjects based on their pharmacogenetic test results and half of them based on randomly assigned pharmacogenetic results from someone else. Otherwise, you are demonstrating placebo, not personalization.

“FDA is alerting patients and health care providers that claims for many genetic tests to predict a patient's response to specific medications have not been reviewed by the FDA, and may not have the scientific or clinical evidence to support this use for most medications.”

 

[DownJonesIndustrial]

What about $50,000 monthly revenue for a Psych NP working 50 hours a week as an independent practice owner. Is that possible?

Sounds like I used to. Now, I don't really like talking to people anymore. I've made over $30,000 in a month seeing only Medicaid people so you could get close if you are able to control a lot of variables. Incidentally, that's not really a pleasant panel.

Keep in mind you'd need at least two efficient people for support staff. Write no letters, don't do PAs, finish your note before the patient leaves the room, etc.