For people going into medicine for the money, here's the deal. Government keeps cutting reimbursements across specialties, each year a different victim is targeted. Spending 8 years in training to make $200K is pathetic. If you're smart enough to be a doctor, you're smart enough to join, say, an investment firm or consulting agency like McKinsey, work just as hard for 2 years, come out making more than $200K, then pivot into business school, and leverage that to start as an executive somewhere making much much more. After 8 years of this $200K would be the tip you left for the waitress.
I know you're just given McKinsey as an example but an associate at McKinsey is not making >200k during their first 2 years, more like low mid 100s with potential for bonuses. McKinsey likes people with brand name educations. If you went to HMS or Stanford or Yale you'll basically automatically get a case interview, they may even interview you at your school if you're a student. if you go to east virginia or east carolina or some other backwater you'd be lucky to even get an interview at all. And while the case interview is not exactly rocket science I know a fair few physicians who did not even make it through that. If you do happen to get a job with them, they will work you to the bone, much harder than your average psych resident works (but the same as a resident doing "real" medicine), and they spit people out quite a bit so there's no guarantee you won't get fired within those 2 years. You wouldn't need to even do an MBA, they have their "mini MBA", people use it as a platform to get into VC etc. Given alot of people who apply for psychiatry are the dregs, I think a sizeable proportion would never make it. Also lots of physicians have no business acumen at all and would be completely unsuited to this kind of work. It's not just about being smart, and quite frankly I have met plenty of doctors who weren't terribly bright.
Physicians are basically serfs albeit highly respected and well-paid ones. You can't expect to bring in the big bucks by seeing patients alone, especially in a non-procedural specialty. But there are too many fields that offer you stable employment commanding what most people would regard as a high salary. If you want to make lots of money it's more risky as there are no guarantees at all. some ways psychiatrists have increased they revenue:
1) having a business employing multiple psychiatrists or nurse practitioners,
2) having a disability company doing independent medical examinations/disability evaluations (and independently contracting a good number of physicians to do these evaluations), 3) 3) providing consultation/medication to fortune 1000 (organizational psychiatrists and psychoanalysts in particular do this),
4) launching a start up (mental health has entered the tech market place as evidenced by Tom Insel's recent departure of the NIMH for Google/Alphabet),
5) becoming a shill for the pharmaceutical companies (of course it's all public now but one can triple or quadruple their basic income by whoring oneself out to the drug companies -- the golden era is over as psychopharmaceutical research is dying but there's still money to be made),
6) having a psychopharmacogenomic testing lab
7) having a lab for autoimmune panels etc,
8) forensic work (only a few rise to the top but senior forensic psychiatrists in NYC charge $900/hr for forensic consultation)
9) having your own line of neutraceuticals or other nutritional products
10) writing self-help books (which are amongst the biggest selling particularly in related to weight loss, smoking, fitness, and sleep),
11) having your own locum tenens company,
12) having a pseudoscience practice that has some sort of gimmick (like Dr. Amen's SPECT practice, or having a chain of ketamine clinics --- TMS is not a good bet for earning money as the overhead costs are quite high and few people are going to cough up $15k upfront for treatment)
13) developing a new form of psychotherapy
14) developing a new psychometric tool or psychiatric rating scale
15) having an educational business focusing on psychiatric CME products
the practice of medicine is largely protected from the whims and fancies of the free market, thus guaranteeing a fair salary for all. but these other potential revenue streams are at the whim of the free market with its attendant risks - you could potentially clean up or fall flat on your face...
I currently make more than four times my highest wage ever in various businesses and it is because of the combination of business experience and professional abilities. Psychiatrist make much more than that. Sure some can hit the business jackpot, but it's much more of a gamble than psychiatry, that's for sure.
