Just curious....what are your plans in terms of career goals for psychiatry?

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futureherooftime622

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I'm really interested to hear about your thoughts!!!
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Short term - inpatient psychiatry work out of residency. I’d like to hone my skills and hopefully have some mentors out of residency so I can keep learning/growing. Maybe some research on the side as well, including seeing patients in my specific field of research interest.

Long term - full time private practice. Hopefully, expanding on the research I did early career into a successful business. Not sure how it will turn out but hey - ideas have to start somewhere.
 
After residency and CAP fellowship, working in an FQHC/community health center type of setting. I spent years working in that kind of setting before medical school and I'd like to return to it. I have a service commitment to work in underserved settings, and the setting I described would fit that commitment.
Maybe a small private practice on the side depending on how motivated I am.
In any case, large city - probably Boston or Chicago.
I wouldn't mind to slowly wade into more academic waters, maybe be involved in clinical research. I have a close friend in Chicago who does a lot of work with transgender youth, NIH funded studies, etc, and holds an academic appointment. I think I'd have an "in" there if I wanted it. And I do think I'd enjoy teaching.

I feel like I have a lot of options and no particular pressure to nail anything down just yet. My husband and I don't have kids (and won't), he's a successful professional, we both had careers before medical school, we're "ahead" on our retirement plans; so I don't feel a lot of pressure to make money. That helps me feel more relaxed about career goals.
 
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Ideally- largely clinical/translational research, would like to see patients within the context of my specific research interests.

The reality though is that this is a tough path, so we’ll see what life brings
 
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Consult and/or inpatient in a more med-psych style place. Preferably with a C&A population.
 
Well the plan is to work with the criminally insane...so inpatient psych at a correctional facility. This would be my main gig.

I'd also like to have a private practice, probably part-time that focuses on forensic cases and psychotherapy. In an ideal world, I would also do research on psychedelic-assisted psychotherapy.

I don't know how exactly I will make all that happen, and it probably won't happen all at the same time...but those are my goals, currently.
 
Ideally I’d like to be seeing 3-4 inpatients followed by 3-4 outpatients, 4 days per week, no call, no weekends, and be paid handsomely.

Alas, I don’t have that but do work outpatient four days per week and enjoy my flexibility. I’m going to stay with this job for the foreseeable future. Has great benefits. At least stay 4 more years to get all pension and vesting from 401k. It’s a non-profit so hopefully PSLF, if that ever transpires. After that, I have no idea. Ideally I’d like to go to part time, but that would be after being out of debt and a good amount of retirement set up. I’d prefer more schizophrenia and bipolar and less depression/anxiety and personality disorders. Wouldn’t mind a state hospital gig but wouldn’t want the state hospital. Maybe fade off into telepsych, not that that’s my preferred way to see patients.
 
Career in government healthcare (VA, DOD, State). I like the patients and mission-driven aspects. These systems are usually well resourced and have a reasonable pace. Also, my prior military time counts toward federal pension and I love all those holidays.
 
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I've moved to telepsychiatry after tiring of the unbelievable amount of violence I saw in the state hospital setting. Same pay, same benefits, similar workload and far more safe. I'm hoping it works out for the foreseeable future.
 
thepoopologist said:
I've moved to telepsychiatry after tiring of the unbelievable amount of violence I saw in the state hospital setting. Same pay, same benefits, similar workload and far more safe. I'm hoping it works out for the foreseeable future.
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How does one start out in telepsychiatry? Do you need to purchase all the equipment yourself? Do you sign up with a firm who sets you up?

Marasmus1 said:
Find a 4 days on 3 days off job that pays 300k+ and have some life.
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Point me in the right direction and I will.
 
Cash private practice Child psych, hand picked stable as hell patients, motivated to get better.
 
Ideally academic community mental health, seeing more chronically ill patients in a coordinated specialty care model, with some health policy work during my non-clinical time.
 
Mass Effect said:
How does one start out in telepsychiatry? Do you need to purchase all the equipment yourself? Do you sign up with a firm who sets you up?



Point me in the right direction and I will.
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Check merritt hawkins if location does not bother you too much.
 
My fantasy would be about 20-30 hours a week as director of a UHR/early psychosis service and then a small cash-only private practice where I can do what I think is best rather than what an insurance company decides they will pay for. I recognize this is a fantasy.

Being a part-time captive psychiatrist of a big group psychology practice (seems like a common model around these parts) wouldn't be so bad depending on how intent the owners are on trying to get me to grind.
 
MedMan80 said:
Cash private practice Child psych, hand picked stable as hell patients, motivated to get better.
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Honestly I want that too, minus the C&A part.

But I find it hard to sleep at night knowing that the people who need us most are the people who can't pay $400 for a session with any kind of regularity (with very few exceptions, such as people with trust funds, wealthy families, or significant reserves before mental illness struck). In its most severe forms, mental illness F--cks with people's lives, and that often includes loss of employment, income, and other resources.

I may still be a youthful idealist, but I believe our healthcare system truly has its incentives wrong.

That said, I do also have my soft spot for the high-functioning sorts, especially with extreme anxiety, cluster B/C traits, and trauma. I also think that the term "worried well" is categorically invalidating, and I have a soft spot for that group of people, too. The above groups would comprise my ideal outpatient practice. The best pay scheme to give me enough money to achieve FIRE and still make me feel like a good person remains to be determined.
 
Question: Would it be possible to do a combined Internal Medicine/Psych residency, followed by a Forensics fellowship and an Infectious Disease fellowship?

I ask because Infectious Disease sounds pretty fascinating, but I don't want to give up psych.

Everyone says that you ultimately have to just pick one, so I'd pick psych...but Infectious Disease just sounds SO interesting.

As for a final job, I imagine you could specialize in psychiatric comorbidities of HIV-infections or other infectious diseases in criminal-justice related patients (people on parole, people in jail, etc.) And you can always have a private practice of forensic psych cases on the side because apparently Infectious Disease does not pay much.

Just thinking out loud here...Emory, Tulane, UC-Davis, University of Texas-Southwestern, and Medical University of South Carolina all offer Psych/IM residencies, as well as Forensic Psych + Infectious Disease Fellowships. Could be interesting.
 
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Boola Boy said:
Question: Would it be possible to do a combined Internal Medicine/Psych residency, followed by a Forensics fellowship and an Infectious Disease fellowship?

I ask because Infectious Disease sounds pretty fascinating, but I don't want to give up psych.

Everyone says that you ultimately have to just pick one, so I'd pick psych...but Infectious Disease just sounds SO interesting.

As for a final job, I imagine you could specialize in psychiatric comorbidities of HIV-infections or other infectious diseases in criminal-justice related patients (people on parole, people in jail, etc.) And you can always have a private practice of forensic psych cases on the side because apparently Infectious Disease does not pay much.

Just thinking out loud here...Emory, Tulane, UC-Davis, University of Texas-Southwestern, and Medical University of South Carolina all offer Psych/IM residencies, as well as Forensic Psych + Infectious Disease Fellowships. Could be interesting.
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Our main HIV psychiatrist is an addictions guy.

You don't need a forensic fellowship to treat prisoners.

You are dramatically overestimating how tight the coupling is between formal fellowship training and the kinds of work you can do in this field.
 
^Thanks for clarifying! I admit that I don't know a lot, just asking questions to get a better idea of the field of psychiatry.
 
Boola Boy said:
^Thanks for clarifying! I admit that I don't know a lot, just asking questions to get a better idea of the field of psychiatry.
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I considered going many of those roads, as I found them all fascinating. Even applied to IM/Psych programs but ultimately ranked them lower than my match.

Consider the difference between things that are interesting or even fascinating to you, and things that are fulfilling and ultimately worth devoting your life to.
 
Private outpatient with a functional/integrated component and featuring custom surveys and analytics (I did genomics in a previous life and want to give my patients visualized data as part of their care). As much psychotherapy as I can possibly do, augmented with ketamine or evidence based psychedelics.
 
I know I've kind of mentioned it before but I'd like to use psychiatry as a platform for activism/advocacy. I don't know how I'm going to do it. The path is very unclear. Hopefully I'll receive some guidance along the way.
 
I really like this thread! I think about my future career a lot.

After reading through other threads on SDN, it seems like private practice is the way to go for me because it seems like that way you retain the most autonomy. I also want to travel a lot.

I see myself having two options:

1) Become a academic psychiatrist that publishes so much that I basically get invited to conferences all the time.
2) Save up money and use my vacation time to travel when I feel like it.

The first option does not appeal to me because I'm not really interested in teaching. I also have a diverse set of interests, and I don't really know how I could pursue research in both psychedelic-assisted psychotherapy AND in forensic psychiatry. Furthermore, the places I would travel to would be limited to where the conferences are...and I have a very specific set of places that I want to visit.

Basically, I think being in private practice would give me the most control over where and how often I travel. And perhaps give me more time for hobbies that I would like to cultivate like writing poetry, skiing, hiking, and camping.

So now I'm thinking outpatient private practice (definitely don't want to take call), taking forensic cases and integrative psychiatry with an emphasis on psychedelic assisted therapy. Will probably do a child/adolescent fellowship because I have a soft spot for kids.

Given the lack of overlap between forensics and integrative psych, I think I'll have two separate private practices or something. Probably 3 days of forensics, 1-2 days of integrative psych.

I've been an employee long enough to know that I'll struggle to find fulfillment if I don't have control over my schedule and which patients I see.

Really great thread. I love reading what other people are planning on doing because it gives me ideas that I've never thought about.
 
Boola Boy said:
I also want to travel a lot.

I see myself having two options:

1) Become a academic psychiatrist that publishes so much that I basically get invited to conferences all the time.
2) Save up money and use my vacation time to travel when I feel like it.

The first option does not appeal to me because I'm not really interested in teaching. I also have a diverse set of interests, and I don't really know how I could pursue research in both psychedelic-assisted psychotherapy AND in forensic psychiatry. Furthermore, the places I would travel to would be limited to where the conferences are...and I have a very specific set of places that I want to visit.

Basically, I think being in private practice would give me the most control over where and how often I travel.
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Just something to think about. Private practice is probably the most difficult set-up for traveling. Patients don’t understand us being unavailable for 1-2 weeks. You’ll need to arrange coverage (not easy), have a partner, or work during travel. A friend of mine in pp thus hasn’t taken more than 1 week of vacation at a time since residency. Come to think of it, neither have I. Academic friends take 2-4 weeks off at a time yearly plus conferences. A friend doing inpatient 7 on 7 off takes weekly trips all of the time.

I really enjoy pp, but vacation problems are probably the #1 drawback.
 
TexasPhysician said:
Just something to think about. Private practice is probably the most difficult set-up for traveling. Patients don’t understand us being unavailable for 1-2 weeks. You’ll need to arrange coverage (not easy), have a partner, or work during travel. A friend of mine in pp thus hasn’t taken more than 1 week of vacation at a time since residency. Come to think of it, neither have I. Academic friends take 2-4 weeks off at a time yearly plus conferences. A friend doing inpatient 7 on 7 off takes weekly trips all of the time.

I really enjoy pp, but vacation problems are probably the #1 drawback.
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Thank you for the insight. Is it possible to write up forensic psych evaluations while travelling? What kind of work can you do during travel besides telepsych? I understand that if telepsych is really my only option, it would limit my travel plans somewhat.

Update: To give some background on my hesitation to pursue a career in academic psychiatry, I will refer to splik's post on clinician educators. The general vibe that I get from the post is that academics pays significantly less in exchange for being affiliated with the department.

Not that $$$ is my sole reason for going into medicine, but I would like to be compensated fairly for what I do...and also, I'm not big on teaching. If I have some misconceptions, please feel free to correct me...I welcome the experience of people who have already walked the path...

But alas. If vacation time will be limited in private practice, I suppose I'll just have to practice in a city that I like!
 
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I have no idea. Just looking for the sweet, sweet overlap of my interest/curiosity & temperament. Seems to have worked so far.

The ongoing equation: inpatient work + addictions? + policy? + social justice + writing + teaching - children (bah!) - outpatient (too slow) = ???

I've also been surprised by how much I've enjoyed working at our residency's VA. I like the vets. CPRS is my jam. The buildings are constantly breaking down but the social services are robust and make a difference. I like the 80s decor and the fact that I know half the staff's names.
 
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Boola Boy said:
Thank you for the insight. Is it possible to write up forensic psych evaluations while travelling? What kind of work can you do during travel besides telepsych? I understand that if telepsych is really my only option, it would limit my travel plans somewhat.

Update: To give some background on my hesitation to pursue a career in academic psychiatry, I will refer to splik's post on clinician educators. The general vibe that I get from the post is that academics pays significantly less in exchange for being affiliated with the department.

Not that $$$ is my sole reason for going into medicine, but I would like to be compensated fairly for what I do...and also, I'm not big on teaching. If I have some misconceptions, please feel free to correct me...I welcome the experience of people who have already walked the path...

But alas. If vacation time will be limited in private practice, I suppose I'll just have to practice in a city that I like!
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Private practice often has limited coverage for vacations, and patients don’t like switching psychiatrists, especially cash practices. You’ll need to be available for refills, problems, and maybe telepsych to established patients. In academics, every insurance is usually accepted, so patients have no choice.

Rough numbers: private practice total compensation may be $400k+ to academia $260k. That’s a big difference, but most people can live really well on $260k.

In academia you can cover residents which can be enjoyable, but there is a lot of beuracracy.

There are positives and negatives to every gig.
 
TexasPhysician said:
Private practice often has limited coverage for vacations, and patients don’t like switching psychiatrists, especially cash practices. You’ll need to be available for refills, problems, and maybe telepsych to established patients. In academics, every insurance is usually accepted, so patients have no choice.

Rough numbers: private practice total compensation may be $400k+ to academia $260k. That’s a big difference, but most people can live really well on $260k.

In academia you can cover residents which can be enjoyable, but there is a lot of beuracracy.

There are positives and negatives to every gig.
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Is it possible to do academia + 2-3 times a week cash PP in big cities like NY, Boston, LA, SF and make over 400k?
 
Boola Boy said:
Thank you for the insight. Is it possible to write up forensic psych evaluations while travelling? What kind of work can you do during travel besides telepsych? I understand that if telepsych is really my only option, it would limit my travel plans somewhat.

Update: To give some background on my hesitation to pursue a career in academic psychiatry, I will refer to splik's post on clinician educators. The general vibe that I get from the post is that academics pays significantly less in exchange for being affiliated with the department.

Not that $$$ is my sole reason for going into medicine, but I would like to be compensated fairly for what I do...and also, I'm not big on teaching. If I have some misconceptions, please feel free to correct me...I welcome the experience of people who have already walked the path...

But alas. If vacation time will be limited in private practice, I suppose I'll just have to practice in a city that I like!
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You are obviously quite naive because you are very early on in your pathway. If you are not into teaching then you cannot be a forensic psychiatrist.

Forensic psychiatrists educate attorneys, judges, juries, law enforcement, organizations, HR etc about mental health issues as they interface with legal ones. Forensic psychiatrists are excellent, enthusiastic teachers. Forensic psychiatrists might provide MCLE for attorneys, be invited to talk to judges, testify in front of congress (either state or federal), teach law school classes, in addition or instead of teaching medical students, residents, fellows, psychiatrists, and psychologists. Being an enthusiastic educator who can explain complex concepts to learners including lay audiences, is probably the second most important skill for a forensic psychiatrist. The first is being an outstanding clinical psychiatrist.

In addition, teaching others on psychiatric topics is often an important piece of evidence that establishes your credibility as an expert witness. You will usually be asked when being qualified as an expert whether you teach (often specifically on whatever topic is at issue, e.g. addiction, PTSD, violence risk assessment, suicide etc).

One does not need to work at a medical school to be a forensic psychiatrist (more are in private practice), but (almost) every successful forensic psychiatrist has an academic appointment/affiliation and donate their time to teaching students/residents.

Forensic psychiatrists also need to be detail oriented, and be able to read through thousands and thousands of pages of records, watch or listen to many (sometimes hundreds+) hours of video or audio recordings which can be tedious, and write reports which can sometimes be quite long. You need to be able write clearly, explain complex ideas simply and free from psychiatric jargon, and be as objective as you can. In some areas (e.g. if you want to do violence risk assessment of sex offender evaluations) a solid understanding of statistics and psychometrics is also important.

I will also add that while academic institutions do pay much less, depending on the institution you might get very good benefits (like a really good pension), large amounts of sick leave, may be eligible for a paid sabbatical etc. I get about 5 weeks vacation a year, lots of public holidays, 90 days of paid sick leave, unlimited leave to attend and speak at conferences, and a lot of time for particular professional activities such as consulting and expert witness work. The environment can be intellectually stimulating, and you may not be expected to churn as much. On the flip side, no one will love or respect you unless you are bringing in huge grants, incompetent people are overpromoted, the bureaucracy can be stifling, and you will have to take on increasing amounts of uncompensated work in order to advance academically.

Marasmus1 said:
Is it possible to do academia + 2-3 times a week cash PP in big cities like NY, Boston, LA, SF and make over 400k?
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On the east coast it is typically encouraged of faculty to have private practices in order to compensate for their desultory salaries and they often use their harvard/columbia etc affiliation to market said private practice. On the west coast, if you are working in academics, you cannot have your own cash pp. The institutions own you and will not allow you to do clinical work outside the institution. depending on the institution, you may be permitted to have a (typically insurance based) practice through the university to supplement your income. some faculty flout these rules, but when discovered usually face severe disciplinary action.
 
splik said:
On the east coast it is typically encouraged of faculty to have private practices in order to compensate for their desultory salaries and they often use their harvard/columbia etc affiliation to market said private practice. On the west coast, if you are working in academics, you cannot have your own cash pp.
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I've been wondering about this so as follow-up--in this case, is "west coast" anything south/west of Maryland or is there some opportunity for academic/private mix in the south and mid/mountain-west (if not as much as in the NE)?
 
Not sure where you guys are seeing 260K for academic, still 190-220 most places i looked..
 
MedMan80 said:
Not sure where you guys are seeing 260K for academic, still 190-220 most places i looked..
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From recent discussions, sounds like Yale is mostly > 200k now, Harvard affiliates still < 200k, Brown is signnificantly more for most positions, not sure about the New York programs.
 
I am almost done with 2nd year residency and not sure what I want to do! I am not even sure if I want to go to academics or not. One thing I knew until recently is doing CAP fellowship but I am having sencond thoughts now. :smack:

I enjoyed my CL rotation alot, so maybe that would be a career option. One thing I know for sure is not wanting to end up working in an acure inpatinet unit.

Is it normal not knwoing what I want to do at this point? :shrug:
 
I trained at a pretty decent place and was always a top performer on prite/boards. At one point, I had ambitions to continue on this trajectory, work in academics or maybe somewhere ritzy, and make a name for myself perhaps. But throughout training, I encountered a lot of really uptight people with strong personality traits, and by the time I finished, I'd had a sufficient number of negative experiences in academia that I didn't want to go back. While academic bureaucracy is not for me, I understand it is an environment from which some psychiatrist have a lot to gain. At the end of the day, what matters most to me I think is being in a chill, low-stress work environment. That and money. The narcissistic supply I lose from high-prestige work has to be made up somehow.
 
TexasPhysician said:
Total comp. Academia can pay $200k + good health plan + dental + retirement matching + disability, etc.
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For anyone who might be confused by that it's worth noting that this is a reminder that "cash PP income" does not include any of the items you mentioned, nor does it include the additional FICA tax from being your own employer.
 
Thank you all for getting back to me. I was just accepted into medical school this year, so please forgive my ignorance.

I wasn't really looking for exact salary numbers because my goal is not really a number, but more of an understanding of the work-life balance between PP and academic medicine. Like I said earlier, though, if you can only take a few days off per year in private practice, that just underscores the importance of practicing in a location that you truly love.

@splik, I gotta admit, your benefits package sounds very nice! But that last bit about the expectation to take on more and more uncompensated work to advance in academics...just don't tickle my fancy. I feel like I'd just rather do clinical/forensic work and get compensated for it.

But who knows, that could change as I progress through my career.
 
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SmallBird said:
From recent discussions, sounds like Yale is mostly > 200k now, Harvard affiliates still < 200k, Brown is signnificantly more for most positions, not sure about the New York programs.
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Is that for instructor level clinician educator positions?
 
billybb said:
Is that for instructor level clinician educator positions?
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Assistant Professor. Clinician Educators at Yale and Brown don't typically do instructor level, you can usually get Assistant Professor right off the bat. I don't think instructor vs assistant professor clinician educator necessarily has a big impact on salary at most places, although it clearly does for clinician-scholars.
 
Gotcha. Thanks!!

SmallBird said:
Assistant Professor. Clinician Educators at Yale and Brown don't typically do instructor level, you can usually get Assistant Professor right off the bat. I don't think instructor vs assistant professor clinician educator necessarily has a big impact on salary at most places, although it clearly does for clinician-scholars.
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splik said:
I am talking about actual west coast (CA, OR, WA) as I am familiar with the institutions in those states. There are almost no medical schools in the mountain west, but Colorado does not allow any outside professional activities such as private practice or even forensic/expert witness work. The midwest is much less conductive to private practice as most people expect to use their insurance for psychiatric services, and it's where psychotherapy went to die. I have not heard of people at the major institutions in the midwest having their own private practices. Some years ago at least, I know that Pittsburgh used to let faculty see pts after hours and use their office space but I'm not sure if that's allowed for new faculty nowadays (these arrangements are unfortunately dying off at most places).


Per AAMC, in FY2016-17 (I don't have the FY17-18 yet but it is available), the median total compensation for an assistant professor in general psychiatry was 207k, the 25%ile was 181k, the 75%ile was 243k, and the 90%ile was 290k. This is total compensation so includes additional compensation for additional administrative/leadership roles, incentive bonus, RVU-based productivity, supplemental income etc, but does NOT include benefits (i.e. retirement, health insurance, disability etc) which depending on the institution may be generous in themselves.
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A good number of faculty at Pittsburgh have their own private practices and get to use their office space, provided they kick in 30% to the group that technically employs all UPMC physicians (that is separate from the medical school or hospital system as such). Our total compensation (minus benefits) is below that quoted median for outpatient people and a bit above it for the inpatient people.
 
Here on the east coast most faculty practices range from accepting insurances to cash only, but all of them seem to take a piece of the pie. Most attending's have offices within the institution itself.
 
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