Job advice

[painballer27]

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Plenty of inpatient jobs that let you round and leave.

I thought most of these jobs were in the 250-300 range...

 

[forchinet121]

Are you a psychiatric resident or are you a psychiatric attending or are you neither? And if you are in the psychiatric field, why not make the most of it? For some reason, you're playing the surgical specialist skin flute really hard. If you can answer my question, I'll give you few more details of the people I have in mind.

I’m a fourth year psychiatric resident, I don’t know what it means to “make the most of it” as I’m certainly planning on doing that but that has a different meaning for different people. I am currently looking for a job for when I graduate and am very familiar with the job market for psychiatrists and surgical specialists. I’m not playing any flute, I am giving you the realities of the financial prospects of different fields based on my experience of knowing 20+ surgical specialists and psychiatrists. If you have a different experience I’d love to hear it.

 

[forchinet121]

But when you can clear 4-450 working 3 hours a day, why do you need to make a million dollars in a clinic?

Do your 24 hours of clinic a week and you're approaching that elusive seven figures.

Good luck with that, try it and report back when you’re making 7 figures working 24 hours a week as a psychiatrist

 

[painballer27]

Good luck with that, try it and report back when you’re making 7 figures working 24 hours a week as a psychiatrist

Okay. So you don't think it's possible. It seems we have a disagreement between several members on this thread regarding incomes in the field of psychiatry.

I am not a moderator of this forum, but I am going to serve as one. First, let's establish a fact: the average income in psychiatry is lower than that of most, if not all, surgical specialty. Do we all agree on this, @jbomba @forchinet121 @AD04 ?

It seems that @AD04 is asserting that incomes in psychiatry can far exceed what most people believe. He (or she, I'll keep using he though to make my life easier) claims that he knows many people who make extraordinary incomes in psychiatry in excess of 700k. He has also stated in several posts in the past that he makes quite a bit himself, from what I can gather, more than 600k per annum.

@jbomba is still in training, but is optomistic about the field, claiming a practicing psychiatrist can make over 400k for 3 hours of work per day, or approach 7 figures by working 24 hours a week. If this statement is indeed true, then I think we can all agree psychiatry is among the most lucrative fields in medicine.

@forchinet121 is a skeptic. He does not believe these claims. He has implied multiple times in this thread and on others that psychiatry is a low paying field, and that it is nowhere near as lucrative as fields such as orthopedics, dermatology, ophthalmology, urology, ent, cardiology, GI, etc.

Let's continue this discussion in a a productive manner. No more playing each other's skin flutes. Other readers, chime in. Let's hear your opinion in this debate.

 

[jbomba]

Okay. So you don't think it's possible. It seems we have a disagreement between several members on this thread regarding incomes in the field of psychiatry.

I am not a moderator of this forum, but I am going to serve as one. First, let's establish a fact: the average income in psychiatry is lower than that of most, if not all, surgical specialty. Do we all agree on this, @jbomba @forchinet121 @AD04 ?

It seems that @AD04 is asserting that incomes in psychiatry can far exceed what most people believe. He (or she, I'll keep using he though to make my life easier) claims that he knows many people who make extraordinary incomes in psychiatry in excess of 700k. He has also stated in several posts in the past that he makes quite a bit himself, from what I can gather, more than 600k per annum.

@jbomba is still in training, but is optomistic about the field, claiming a practicing psychiatrist can make over 400k for 3 hours of work per day, or approach 7 figures by working 24 hours a week. If this statement is indeed true, then I think we can all agree psychiatry is among the most lucrative fields in medicine.

@forchinet121 is a skeptic. He does not believe these claims. He has implied multiple times in this thread and on others that psychiatry is a low paying field, and that it is nowhere near as lucrative as fields such as orthopedics, dermatology, ophthalmology, urology, ent, cardiology, GI, etc.

Let's continue this discussion in a a productive manner. No more playing each other's skin flutes. Other readers, chime in. Let's hear your opinion in this debate.

To be clear, I'm asserting one can find a 400k inpatient job where an efficient doc could finish rounding on 15 patients in 3-4 hours per day. I get these emailed to me regularly by recruiters. I also believe one could go into private practice and work 24 hours per week (in the right locale with the right payor mix) and gross another 500k. I guess that's not 1M, but with a weekend of extra weekend coverage at the inpatient job (or another unit), 1M is highly attainable. This would be done in just under 40 clinical hours a week.

On one hand I do agree psychiatry has average pay. On the other hand, I believe that on an hourly basis a psychiatrist is nowhere near the average in pay rate. If you take a psychiatrist with a surgeon's work mentality, there is almost no way he isn't making 7 figures if he's got enough wits to network a little and negotiate. Hell even without this he can probably pass the 7 figure mark.

I guess I don't get the debate. Check out these recruiters begging us to come work at their hospitals (I only look in decent cities in coastal states btw). 400k inpatient jobs are not the norm, but they are certainly not uncommon whatsoever. And just look at pp reimbursement rates. Do the math, it's all right there.

 

[liquidshadow22]

private practice and work 24 hours per week (in the right locale with the right payor mix) and gross another 500k

Not happening as a solo psych. This would be 99% income for part time work. Only could happen if you are running high tier cash practice in a few select areas of the country and you happen to fill it consistently. Highly unlikely a psychiatrist taking insurances is going to make this unless you are upcoding on a regular basis. Maybe in the west coast but this is definitely not a common occurrence.

 

[dl2dp2]

@jbomba is still in training, but is optomistic about the field, claiming a practicing psychiatrist can make over 400k for 3 hours of work per day, or approach 7 figures by working 24 hours a week. If this statement is indeed true, then I think we can all agree psychiatry is among the most lucrative fields in medicine.

@forchinet121 is a skeptic. He does not believe these claims. He has implied multiple times in this thread and on others that psychiatry is a low paying field, and that it is nowhere near as lucrative as fields such as orthopedics, dermatology, ophthalmology, urology, ent, cardiology, GI, etc.

Let's continue this discussion in a a productive manner. No more playing each other's skin flutes. Other readers, chime in. Let's hear your opinion in this debate.

Not happening as a solo psych. This would be 99% income for part time work. Only could happen if you are running high tier cash practice in a few select areas of the country and you happen to fill it consistently. Highly unlikely a psychiatrist taking insurances is going to make this unless you are upcoding on a regular basis. Maybe in the west coast but this is definitely not a common occurrence.

It might be feasible on insurance — this assumes an average billing of around 400 an hour. But gross 500k might net you much less if you take insurance. 24 hour gross clinical hours will also take a lot more work on admin etc. This ends up being in and of itself a full time job. So you take two full time jobs to make 1M a year. Feasible, maybe. Advisable? No.

Ideally you want to have solopreneur EBITA of 1M working 40 clinical hours a week. Is that feasible for an average resident without owning equity in a business? The answer is maybe. Not likely but possible.

Recently a large telepsych company offered me $300 an hour doing pure online NP supervision. I said no… I think it might be feasible to cobble together 2-4 gigs where each pays $400 an hour via pure telepsych and this would end you around 800k pure 1099 profit at the peak level doing around 40 hours clinical work without any coverage/biz activity etc. But one of the gigs might have a night/weekend component. Some of the gigs might take a lot of hard core negotiation and are undesirable (correctional) and or unstable (temp coverage). This might be your best bet for a >500k total comp in this field with a good lifestyle and without advanced techniques (high end cash, run a large business, blah blah).

High end cash and large business are non trivial endeavors. I recently did a informal check on how many residents achieved either from a top residency i’m familiar with and it’s around 5-10ish percent (if that). That said, top programs might be academic feeders, but the rate of independent academic career is around that number as well. It’s possible in either of these pathways to get to a point where you work a lot less and make a lot more, but I would count on it as a usual achievable

 

[nexus73]

15 patients in 4 hours is garbage care

 

[forchinet121]

It might be feasible on insurance — this assumes an average billing of around 400 an hour. But gross 500k might net you much less if you take insurance. 24 hour gross clinical hours will also take a lot more work on admin etc. This ends up being in and of itself a full time job. So you take two full time jobs to make 1M a year. Feasible, maybe. Advisable? No.

Ideally you want to have solopreneur EBITA of 1M working 40 clinical hours a week. Is that feasible for an average resident without owning equity in a business? The answer is maybe. Not likely but possible.

Recently a large telepsych company offered me $300 an hour doing pure online NP supervision. I said no… I think it might be feasible to cobble together 2-4 gigs where each pays $400 an hour via pure telepsych and this would end you around 800k pure 1099 profit at the peak level doing around 40 hours clinical work without any coverage/biz activity etc. But one of the gigs might have a night/weekend component. Some of the gigs might take a lot of hard core negotiation and are undesirable (correctional) and or unstable (temp coverage). This might be your best bet for a >500k total comp in this field with a good lifestyle and without advanced techniques (high end cash, run a large business, blah blah).

High end cash and large business are non trivial endeavors. I recently did a informal check on how many residents achieved either from a top residency i’m familiar with and it’s around 5-10ish percent (if that). That said, top programs might be academic feeders, but the rate of independent academic career is around that number as well. It’s possible in either of these pathways to get to a point where you work a lot less and make a lot more, but I would count on it as a usual achievable

So talking with many recruiters I’m seeing the rates for telepsych at 160-190/hr for 2/pph. Can you share which company is offering 300/hr for supervision and how you would go about procuring a 400/hr position?

 

[TexasPhysician]

I think we are getting off-track from the OP’s question. If the OP wants academia and teaching, offers in the $200-300k range for FT are the norm. Expect the lower side of that.

 

[Jules A]

15 patients in 4 hours is garbage care

And doesn't include the hour required for treatment team that now includes everyone from OT, PharmD, EVS to pastoral care. Its been a while since I've seen the 1/2 day inpatient rounding jobs especially without call or weekend rotations. Hospitals are now more likely to require CL and ED work in addition to working the units. The locums recruiters speak their own language sometimes.

 

[Candidate2017]

Do you happen to know many psychiatrists making well over 700k or 1M? Because I certainly don’t but those are common numbers in other fields (not salary surveys which are a joke but actual numbers when talking with docs)..I’m definetly open to hearing your experience if you know many high income psychiatrists though…

I know some, but not many, psychiatrists (and psychologists who employ psychiatrists) who make upper 6 figures to 7 figures. They accomplish this by either covering multiple psych wards and doing clinic, or owning large practices. They are atypical. I agree those earnings are more routinely possible via procedural specialties rather than psychiatry.

So talking with many recruiters I’m seeing the rates for telepsych at 160-190/hr for 2/pph. Can you share which company is offering 300/hr for supervision and how you would go about procuring a 400/hr position?

To get good rates, reach out directly to places that need you and negotiate. Some will play ball and some won't.

 

[Candidate2017]

And doesn't include the hour required for treatment team that now includes everyone from OT, PharmD, EVS to pastoral care.

Most "required" things aren't really required. Nothing stops you from humoring a treatment team meeting for more than 5 minutes and leaving to see another patient. Especially when it takes 5 minutes each to run the list with the charge nurse or ask the SW whether anything is urgent right now, today.

 

[calvnandhobbs68]

Most "required" things aren't really required. Nothing stops you from humoring a treatment team meeting for more than 5 minutes and leaving to see another patient. Especially when it takes 5 minutes each to run the list with the charge nurse or ask the SW whether anything is urgent right now, today.

Sure and then you get known as the “difficult” doctor who the nurses tell all the patients families to contact you about the patients care or page you every time someone has a headache or constipated or agitated to “double check” PRN orders. Or say all the nurses are too busy to fetch their patients to come to you for interview and you have to find everyone yourself. Staff can make your life quite difficult if you don’t make at least some effort to be nice and go along with reasonable unit rules.

I don’t mean have hours long treatment team meetings where everyone just bitches about their least favorite patients but there are ways to have decent coordinated meetings where you’re clearly in charge of the flow that aren’t 5 minutes long.

 

[Jules A]

Most "required" things aren't really required. Nothing stops you from humoring a treatment team meeting for more than 5 minutes and leaving to see another patient. Especially when it takes 5 minutes each to run the list with the charge nurse or ask the SW whether anything is urgent right now, today.

Yeah those were the days. At one the 9am treatment team is 7 days a week. They go down the list by room number so all three attendings are present and every discipline weighs in on each patient which takes over an hour. While I value the information the nurses share this team approach pendulum thing has swung too far. The nurses are perfectly capable of telling me if patients attended groups. I don't need OT's blow by blow of the previous day's art project.

 

[BiscoDisco]

Treatment teams aside, is meeting with an inpatient for 15 minutes then moving on really that bad of care? Certainly you're going to have the floridly psychotic patients where the meeting is 3-4 minutes which allows additional time for those who need it. I'm not buying that getting through 15 patients in 4 hours is bad care. Particularly if you're a biologically oriented psychiatrist who isn't doing all that much therapy. Certainly the pharmacologic decisions you're making in two minutes is better than the 20-30 minutes some NP is spending being a friend to the depressed borderline...then proceeding to put a couple antipsychotics, Xanax, and Adderall into the MAR.

 

[AD04]

I’m a fourth year psychiatric resident, I don’t know what it means to “make the most of it” as I’m certainly planning on doing that but that has a different meaning for different people. I am currently looking for a job for when I graduate and am very familiar with the job market for psychiatrists and surgical specialists. I’m not playing any flute, I am giving you the realities of the financial prospects of different fields based on my experience of knowing 20+ surgical specialists and psychiatrists. If you have a different experience I’d love to hear it.

That clears things up. You're just relaying to us what others told you but it isn't from your own experience. Maybe be a bit more open minded when an attending has a different view point. I'll fulfill my end of the bargain about providing more details:

Person #1: Owns multiple psychiatric clinics in a desirable place to live for physicians. Servicing Medicaid population. Provides really crappy care but the patients have no other options so clinics are full with patients every day. I was invited to his yacht because he wanted to recruit me.

Person #2: Rounds in 2 different hospitals and gets stipend for medical directorship. Bills insurances for service provided. Used to do private practice but sees it is higher $ / hr working in hospitals. Relies a lot on residents to do the bulk of the work (including call).

Person #3: C-level executive for regional institution and gets good reimbursement per patient as institution has a monopoly on healthcare. Puts in a lot of clinical hours and is very productive.

There are other people but you get the idea.

I am not a moderator of this forum, but I am going to serve as one. First, let's establish a fact: the average income in psychiatry is lower than that of most, if not all, surgical specialty. Do we all agree on this, @jbomba @forchinet121 @AD04 ?

It seems that @AD04 is asserting that incomes in psychiatry can far exceed what most people believe. He (or she, I'll keep using he though to make my life easier) claims that he knows many people who make extraordinary incomes in psychiatry in excess of 700k. He has also stated in several posts in the past that he makes quite a bit himself, from what I can gather, more than 600k per annum.

Average in psychiatry is lower than that in surgical specialty. I said that upthread. But average isn't destiny. Psychiatry can pass $700k, even $1 million per year.

 

[painballer27]

I was invited to his yacht because he wanted to recruit me.

Did you go on his yacht? Did you you join him?

 

[TexasPhysician]

Treatment teams aside, is meeting with an inpatient for 15 minutes then moving on really that bad of care? Certainly you're going to have the floridly psychotic patients where the meeting is 3-4 minutes which allows additional time for those who need it. I'm not buying that getting through 15 patients in 4 hours is bad care. Particularly if you're a biologically oriented psychiatrist who isn't doing all that much therapy. Certainly the pharmacologic decisions you're making in two minutes is better than the 20-30 minutes some NP is spending being a friend to the depressed borderline...then proceeding to put a couple antipsychotics, Xanax, and Adderall into the MAR.

Some patients are easy, but some take real time. As a resident moonlighting, I came across an inpatient that had been admitted for days involuntarily. Police brought him in for disrupting a fast food establishment and acting “psychotic”. Clinic notes said delusional and making up words. I doubt the psychiatrist spent more than a few minutes on the notes and adjusting neuroleptics. Now I’m calling translation services and trying to find someone that recognizes these “made up” words on the weekend. Turns out that not knowing English can be mistaken for psychotic.

If you are really doing your job, getting collateral, establishing baseline, calling outpatient psych, etc takes time.

I can’t emphasize enough how calling me (outpatient psych) could have improved and shortened the inpatient stay while preventing readmission had I gotten a call.

 

[forchinet121]

That clears things up. You're just relaying to us what others told you but it isn't from your own experience. Maybe be a bit more open minded when an attending has a different view point. I'll fulfill my end of the bargain about providing more details:

Person #1: Owns multiple psychiatric clinics in a desirable place to live for physicians. Servicing Medicaid population. Provides really crappy care but the patients have no other options so clinics are full with patients every day. I was invited to his yacht because he wanted to recruit me.

Person #2: Rounds in 2 different hospitals and gets stipend for medical directorship. Bills insurances for service provided. Used to do private practice but sees it is higher $ / hr working in hospitals. Relies a lot on residents to do the bulk of the work (including call).

Person #3: C-level executive for regional institution and gets good reimbursement per patient as institution has a monopoly on healthcare. Puts in a lot of clinical hours and is very productive.

There are other people but you get the idea.



Average in psychiatry is lower than that in surgical specialty. I said that upthread. But average isn't destiny. Psychiatry can pass $700k, even $1 million per year.

This proves my point, you seem to be excited about people working 60+ hours per week to make 700k+. The people I’m talking about are working 40-50 hours per week and making 1.5M without being extremely entrepreneurial and owning multiple clinics. At the end of the day, you can believe whatever helps you sleep at night but you’re just wrong if you think psychiatry’s earning potential is even close to that of the top surgical specialties. To learn a bit more why don’t you go over to the optho forum on this very website, you’ll be shocked at the numbers they’re throwing around. Also make friends with the surgeons in your own institution and they’ll start telling you some numbers

 

[BiscoDisco]

Some patients are easy, but some take real time. As a resident moonlighting, I came across an inpatient that had been admitted for days involuntarily. Police brought him in for disrupting a fast food establishment and acting “psychotic”. Clinic notes said delusional and making up words. I doubt the psychiatrist spent more than a few minutes on the notes and adjusting neuroleptics. Now I’m calling translation services and trying to find someone that recognizes these “made up” words on the weekend. Turns out that not knowing English can be mistaken for psychotic.

If you are really doing your job, getting collateral, establishing baseline, calling outpatient psych, etc takes time.

I can’t emphasize enough how calling me (outpatient psych) could have improved and shortened the inpatient stay while preventing readmission had I gotten a call.

All fair points. Maybe I'm spoiled where I am, but SW will be the ones to call collateral, so I guess I was hoping/assuming I could find a place like this to work. Or I imagine I could simply hire an eager pre-med to scribe and call collateral. Though if I were the one who had to actually do it, I would imagine I could do this from the car driving home from work, etc. Or maybe while I'm finishing notes, etc.

 

[BiscoDisco]

This proves my point, you seem to be excited about people working 60+ hours per week to make 700k+. The people I’m talking about are working 40-50 hours per week and making 1.5M without being extremely entrepreneurial and owning multiple clinics. At the end of the day, you can believe whatever helps you sleep at night but you’re just wrong if you think psychiatry’s earning potential is even close to that of the top surgical specialties. To learn a bit more why don’t you go over to the optho forum on this very website, you’ll be shocked at the numbers they’re throwing around. Also make friends with the surgeons in your own institution and they’ll start telling you some numbers

I think you're off as well. I've given my moonlighting numbers on here.

I'm getting $250 from an outpatient clinic per hour. I could easily ramp up to 24 hours a week if I had the time but I cannot with residency requirements.
I've gotten at least a couple offers from private psych hospitals offering ~400k to round and have been told it's doable to finish and leave in 3-4 hours. Lets call it 4. I still hold you can provide good care in that amount of time when the cap is <15.
I have regular weekend gigs which pay 5k, but I also have another weekend gig which pays 8400 (admittedly its a long weekend so I don't do it as frequently).

Add it up.

250*24 = 288k + 400k + 8400*12 = ~800k for 44 hours a week + one weekend a month.

Like you, I'm also a pgy4. I didn't look long or hard for these offers/jobs. I'm not special or attending a top tier program that gets me some kind of preference. I agree with you, the path to 1M is easier in derm or some other surgical sub-specialty. But it's not all that hard in psych to make big bucks. If you disagree with anything here, I'd be happy to know what it is.

 

[painballer27]

250*24 = 288k + 400k + 8400*12 = ~800k for 44 hours a week + one weekend a month.

Wow!

 

[Jules A]

I've gotten at least a couple offers from private psych hospitals offering ~400k to round and have been told it's doable to finish and leave in 3-4 hours. Lets call it 4.

If this is coming from someone other than a physician recruiter namely another psychiatrist actually working the job I would jump on it.

 

[AD04]

This proves my point, you seem to be excited about people working 60+ hours per week to make 700k+. The people I’m talking about are working 40-50 hours per week and making 1.5M without being extremely entrepreneurial and owning multiple clinics. At the end of the day, you can believe whatever helps you sleep at night but you’re just wrong if you think psychiatry’s earning potential is even close to that of the top surgical specialties. To learn a bit more why don’t you go over to the optho forum on this very website, you’ll be shocked at the numbers they’re throwing around. Also make friends with the surgeons in your own institution and they’ll start telling you some numbers

LOL. You got to be a troll. Is this the same person behind @Merely and @robellis ? I thought you started your attending job last year and now you're a 4th year resident again?

 

[AD04]

Did you go on his yacht? Did you you join him?

No.

 

[forchinet121]

LOL. You got to be a troll. Is this the same person behind @Merely and @robellis ? I thought you started your attending job last year and now you're a 4th year resident again?

You’re arguing psychiatrists can make as much as orthopedic surgeons and i’m the troll? Dunning Kruger at its finest

 

[TexasPhysician]

I think you're off as well. I've given my moonlighting numbers on here.

I'm getting $250 from an outpatient clinic per hour. I could easily ramp up to 24 hours a week if I had the time but I cannot with residency requirements.
I've gotten at least a couple offers from private psych hospitals offering ~400k to round and have been told it's doable to finish and leave in 3-4 hours. Lets call it 4. I still hold you can provide good care in that amount of time when the cap is <15.
I have regular weekend gigs which pay 5k, but I also have another weekend gig which pays 8400 (admittedly its a long weekend so I don't do it as frequently).

Add it up.

250*24 = 288k + 400k + 8400*12 = ~800k for 44 hours a week + one weekend a month.

Like you, I'm also a pgy4. I didn't look long or hard for these offers/jobs. I'm not special or attending a top tier program that gets me some kind of preference. I agree with you, the path to 1M is easier in derm or some other surgical sub-specialty. But it's not all that hard in psych to make big bucks. If you disagree with anything here, I'd be happy to know what it is.

15 inpatients with average LOS of 5 days is 3 new per day. 45 min each per eval plus documentation = 2.25 hours. 3 collateral phone calls at 10 min each = 30 min. 1 treatment team meeting including additional info from other collaterals = 30 min. 12 follow-ups with visit plus documentation plus review labs and nursing notes at only 10 min each average = 2 hours. In my mind, the primary psychiatrist has over 5 hours of work per day plus call for admissions assuming no delays for decent care. This is why 15 inpatients is considered a FT job in many places.

12 long weekends includes what? 48 hours of call, admissions, and rounding?That’s essentially adding 12 hours/week of additional work that kills a weekend.

Your outpatient numbers assume 48 full weeks per year. The clinic will likely be closed holidays which will cut contractor hours. Unless you make them up elsewhere with even more hours/week or take under 1-2 weeks of vacation/year, you are over-estimating your hours.

The “44 hours each week” just became an average of 60+ every working week. I know very few psychiatrists wanting anything to do with this schedule and juggling multiple jobs that will be upset if you are late or miss something important.

The more relaxed academia jobs with associated pay offered to the OP are pretty typical. You can certainly make more by working much harder or with many more hours.

 

[nexus73]

A nearby psych unit the docs see about 20 patients a day. Two major differences from our hospital. They see almost all psychotic or manic people, so not a lot of chit chat, and patients are committed and waiting for state hospital for weeks, so they have less patient turnover than average which makes it easy as it's mostly same patients for weeks at a time. And even if person is depressed and can have a normal conversation, they just don't do it, and the patients hate it. I've had my clinic patients admitted there who don't even know if they saw a doctor during the hospital stay, let alone remember his name. I think this speaks to the fact that even if it can be done, it's not good care. The 20 patients per day works because the patient population is ideal for rapid visits and the docs really aren't engaged outside of cranking RVUs. Typical psych units with broader mix of patients will be hard to do this.

15 patients in 4 hours, maybe weekend cross coverage, not great, but at least more believable...patients don't know you and you're just checking in to see if they need anything to keep things going until Monday. 15 patients in 4 hours 5 days a week...this sucks all around, except for the doctors paycheck.

 

[jbomba]

15 inpatients with average LOS of 5 days is 3 new per day. 45 min each per eval plus documentation = 2.25 hours. 3 collateral phone calls at 10 min each = 30 min. 1 treatment team meeting including additional info from other collaterals = 30 min. 12 follow-ups with visit plus documentation plus review labs and nursing notes at only 10 min each average = 2 hours. In my mind, the primary psychiatrist has over 5 hours of work per day plus call for admissions assuming no delays for decent care. This is why 15 inpatients is considered a FT job in many places.

12 long weekends includes what? 48 hours of call, admissions, and rounding?That’s essentially adding 12 hours/week of additional work that kills a weekend.

Your outpatient numbers assume 48 full weeks per year. The clinic will likely be closed holidays which will cut contractor hours. Unless you make them up elsewhere with even more hours/week or take under 1-2 weeks of vacation/year, you are over-estimating your hours.

The “44 hours each week” just became an average of 60+ every working week. I know very few psychiatrists wanting anything to do with this schedule and juggling multiple jobs that will be upset if you are late or miss something important.

The more relaxed academia jobs with associated pay offered to the OP are pretty typical. You can certainly make more by working much harder or with many more hours.

Not sure what OP was implying for his set up, but for me, I have a gig that involves covering 20 ish patients. As the weekend doctor, I don't feel obligated to sit down and spend 15-20 minutes with each patient. My mentality is, I'm there to keep things afloat, recognize problems, make med changes when clearly indicated or if a patient has a reasonable request. Covering 20 patients in 3 hours does not feel difficult or wrong to be perfectly honest. If this were a M-F gig, I would feel differently. I can do my own billings and it ends up somewhere around 140 per patient, so normally 6k a weekend. I go in early and am out by 930/10. I'll answer calls throughout the day, but truthfully it barely feels like working. I could envision myself doing something like this 20 or so times a year when I finish residency next summer. So another 120k to whatever base job + pp I end up doing.

Also, the OP noted he gets $250/hr for pp. He also noted he works for another clinic who takes a part of his billings (60/40).

Based on my calculations, if OP were doing his own pp combo of cash/insurance, using a billing company (lets assume 7%), had a part-time staff member ($25/hr x 16hr), and other standard overhead items in a tele/in person hybrid practice, he'd be looking at roughly grossing 453k (at his current weekly hours and full rate before the clinic takes their deductions) less above mentioned deductions 32k (billing), 18k (staff), 20k (other overhead) he'd be making $355/hr. He'd be able to work less and make same money doing things himself. Finding a better weekend gig like the one I described above and that 750-800k scenario is doable for a lot less than 60+ hours a week.

 

[Stagg737]

Lots of quotes, sorry : P

Can you be specific? For example, many surgical specialist can graduate residency, join a private practice group that has ownership of a surgery center, become a partner, and be automatically guaranteed an income >1MM for a typical 40-50 hour work week. Straightforward idea, how are you seeing that happen in psychiatry? There are a million psych clinics and the majority are not even grossing 1M let alone netting that. We had a thread on here of a guy who is considering closing down his clinic because it’s not profitable. Where are you seeing these million dollar psychiatrists and what are they doing?

If it's a solo practice, sure. If it's a group and they're not grossing 1M+ per year they're doing something very, very wrong. In med school I saw the books for a group practice of 3 psychiatrists, 1 NP, and 5 therapists and they were grossing over 1M per month. This was not a typical clinic and I wouldn't want to work there, but one of the docs laughed when I suggested he was making around $600k per year.

extraordinary incomes in psychiatry in excess of 700k.

Idk that I'd call 700K "extraordinary" as most could probably do it, but it's certainly on the high end and requires a lot of work in one way or another.

Its been a while since I've seen the 1/2 day inpatient rounding jobs especially without call or weekend rotations.

I've received plenty of postings for positions like these and I honestly don't know any inpatient docs with a decent workload (<12) who go home after 1pm regularly. Most of those required call and weekend coverage though.

Most "required" things aren't really required. Nothing stops you from humoring a treatment team meeting for more than 5 minutes and leaving to see another patient. Especially when it takes 5 minutes each to run the list with the charge nurse or ask the SW whether anything is urgent right now, today.

Sure and then you get known as the “difficult” doctor who the nurses tell all the patients families to contact you about the patients care or page you every time someone has a headache or constipated or agitated to “double check” PRN orders.

Agree with Candidate, the way to fix this is to run the team yourself. When the physician is running the treatment team, you can legitimately run through 20 patients in 15 minutes. When nursing or someone else runs it then you end up hearing about everyone's art projects and whether they liked their eggs this morning. If staff documents well and comes to the meeting prepared, there's no reason for these meetings to take as long as they often do.


There are certainly ways to solidly clear $1M per year in psych, and I know a few psychiatrists who did this. Most of those methods include some form of supervision or ownership/administrative duties in medium to large practices. It's possible with clinical work, but you'd have to be hypomanic at baseline to be able to manage that for any prolonged period of time and almost certainly involves providing terrible patient care. There's also the geographical consideration. There was a locums position floating around at one point that was $450k for 6 months of inpatient coverage in Alaska. That + telehealth could easily gross <1M, but outside of the most desirable jobs good luck finding those needles in the hay field.

 

[rjs2131]

Hi All,

I am 3 years out of training(child fellowship) and currently living in the South. I have a few job offers(a mix of adult and child) and would appreciate your thoughts.

1) MGH outpatient with 200 K salary and RVU expectation of 3200(CMS 2019 guidelines) plus resident/student teaching. No sign-on bonus. The job will require relocation to Boston and MA license.

2) Outpatient telepsychiatry job with an academic psych department in my state with a 264 K salary with a 23 k bonus at the end of the year, Also, a 10 K sign-on bonus with equipment for home office. Does not require relocation or licensure as the job is in the same state but will require 6 in-person visits a year for departmental meetings with a 100-mile commute one way. The RVU expectation is 3747(CMS 2019 guidelines).

3) UPMC outpatient telepsychiatry with 212 K salary with a bonus of 15 K. PA state license needed. No relocation or RVU requirement but no designated admin time.

Thanks in advance!

Back to the original question - I agree with others who have said that unless your goal is academic psychiatry (which it sounds like it isn’t), you’re accepting less than your worth with any of these jobs. This is especially true if you’re a child psychiatrist - demand is higher than adult psych and you shouldn’t accept <300k if you’re working 30+ patient hours (assuming 30 min follow-ups, 60-90 min news - if less than this time per patient you should be making more).

I would look into joining a PP that’s close to an academic center and offering some teaching if you want to stay involved in academia. Honestly, you’d make more money and have much more control (and probably little to no call) if you did PP full-time and some “volunteer” teaching. Not sure if all academic institutions allow this but worth looking into.

Also - I’d start the PP path sooner rather than later if that’s the end goal. Takes time to build a panel, figure out your own preferences (there are many) and what you want your practice to look like.

 

[Candidate2017]

Sure and then you get known as the “difficult” doctor who the nurses tell all the patients families to contact you about the patients care or page you every time someone has a headache or constipated or agitated to “double check” PRN orders.

Or, you could be known as the doctor who brings coffee, donuts, pizza, and other sundry foodstuffs. Nurses love things that increase their lipids and glucose, as well as doctors who take care of floor issues quickly. Not sure why you think floor nurses would get vindictive over lengthy, inane treatment team meetings for which they have no love. They aren't admin nurses looking to be part of C-suite... those types, they do get bum hurt.