Locum Rates in California for Psychiatrist Common or no?

[twospadz]

I went through locum job postings for psychiatrists in California and I see some that are 200-235/hr. How common are these or are these just anomalies?

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[needadvicebadly]

I went through locum job postings for psychiatrists in California and I see some that are 200-235/hr. How common are these or are these just anomalies?

Any idea where in California these are? Short term or long term jobs?

 

[Orgone]

Unless it is a particularly cushy job, I would recommend not taking a locum position in california for less than 200/hr. For the very high paying ones, they wont pay your travel or housing. the ones on the lower end (e.g. low 200s) should cover all of that.

Also my experience in NY (outside of NYC).

 

[BiscoDisco]

if you are willing to work in the middle of nowhere or in state hospitals/corrections you can get 250-280/hr. Unless it is a particularly cushy job, I would recommend not taking a locum position in california for less than 200/hr. For the very high paying ones, they wont pay your travel or housing. the ones on the lower end (e.g. low 200s) should cover all of that. So bear those costs in mind in your calculations.

Are these higher paying jobs within a couple hours of a major metro; i.e. you can do 2-4 days at a time and come home?

Can you pack in like 4 15 hour days or are you kind of limited to your hours?

 

[Mass Effect]

Are these higher paying jobs within a couple hours of a major metro; i.e. you can do 2-4 days at a time and come home?

Can you pack in like 4 15 hour days or are you kind of limited to your hours?

Every locums job is different, even in the same city. It's lucrative. Burnout rate is high, from what I hear. I've also heard from colleagues that in less desirable places and/or during busy travel times, such as over Christmas, you can make 30 - 40 grand in two weeks. I have a friend who traveled the country doing locums jobs. She'd work for two weeks, take several weeks off. Rinse and repeat.

 

[Merely]

Every locums job is different, even in the same city. It's lucrative. Burnout rate is high, from what I hear. I've also heard from colleagues that in less desirable places and/or during busy travel times, such as over Christmas, you can make 30 - 40 grand in two weeks. I have a friend who traveled the country doing locums jobs. She'd work for two weeks, take several weeks off. Rinse and repeat.

You could make that In inpatient seeing 30ish patients a day at any job, doesn’t need to be locums and isn’t too impressive..

 

[needadvicebadly]

You could make that In inpatient seeing 30ish patients a day at any job, doesn’t need to be locums and isn’t too impressive..

What type of jobs are out there paying per encounter? Or are you referring to 1099 employment?

 

[Mass Effect]

You could make that In inpatient seeing 30ish patients a day at any job, doesn’t need to be locums and isn’t too impressive..

What inpatient gig pays $720,000 a year (30 grand every 2 weeks)?

 

[Merely]

What inpatient gig pays $720,000 a year (30 grand every 2 weeks)?

I just told u lol

 

[Mass Effect]

I just told u lol

No, you didn't. Name a specific inpatient gig paying $720,000 a year. City and hospital please.

 

[Merely]

No, you didn't. Name a specific inpatient gig paying $720,000 a year. City and hospital please.

I don’t think you understand..any inpatient gig with the volume to allow you to see 30 patients a day when you’re paid on productivity would be around what you’re saying..whether or not you wanna spend the effort/time to see that many is a different story

 

[Mass Effect]

I don’t think you understand..any inpatient gig with the volume to allow you to see 30 patients a day when you’re paid on productivity would be around what you’re saying..whether or not you wanna spend the effort/time to see that many is a different story

Again, name one. That isn't supposed to be a hard question since you seem to know. Name an inpatient gig with a base salary and RVUs that allows for 720 - 960K a year. I have yet to come across a standard full-time position paying that. And who is talking about 30 patients/day? The locums gig I did right after graduation I capped at 15 patients a day and still made just over 20K for 10 days (M-F).

 

[BiscoDisco]

Again, name one. That isn't supposed to be a hard question since you seem to know. Name an inpatient gig with a base salary and RVUs that allows for 720 - 960K a year. I have yet to come across a standard full-time position paying that. And who is talking about 30 patients/day? The locums gig I did right after graduation I capped at 15 patients a day and still made just over 20K for 10 days (M-F).

Did you have the option of doing more than 15 patients when you were there?

 

[splik]

Are these higher paying jobs within a couple hours of a major metro; i.e. you can do 2-4 days at a time and come home?

Can you pack in like 4 15 hour days or are you kind of limited to your hours?

you could do 4 10s. i suppose you could try to negotiate other schedules but 2 days is not going to work and I doubt 15 hour days are going to work for these jobs either

No, you didn't. Name a specific inpatient gig paying $720,000 a year. City and hospital please.

he doesn't understand how RVU models work. remember the house always wins. so the more pts you see, the less you make per RVU so seeing 30 pts is typically going to be diminishing returns. (even MGMA advocates physicians should not be paid in the 90th %ile if they are in the 90th %ile productivity). I did inpt once where we got paid $3500 to see up to 28 pts (including doing about 5 admits and 4 discharges/day) and no EMR. so technically if you were working 5 days a week every week (which no one did) you could make over 700k as an IC but its unsustainable, would require working long hours and you would have no defense in a lawsuit working that many hours and seeing that many pts.

nowadays i get paid a little over $1000 a day for seeing 2-3 pts on average.

 

[Mass Effect]

Did you have the option of doing more than 15 patients when you were there?

I mean, yeah, you can, but you shouldn't. My particular contract, you wouldn't get paid more and seeing more than that in a day when you're not just doing weekend eyes-on-the-patient work is not cool.

you could do 4 10s. i suppose you could try to negotiate other schedules but 2 days is not going to work and I doubt 15 hour days are going to work for these jobs either


he doesn't understand how RVU models work. remember the house always wins. so the more pts you see, the less you make per RVU so seeing 30 pts is typically going to be diminishing returns. (even MGMA advocates physicians should not be paid in the 90th %ile if they are in the 90th %ile productivity). I did inpt once where we got paid $3500 to see up to 28 pts (including doing about 5 admits and 4 discharges/day) and no EMR. so technically if you were working 5 days a week every week (which no one did) you could make over 700k as an IC but its unsustainable, would require working long hours and you would have no defense in a lawsuit working that many hours and seeing that many pts.

nowadays i get paid a little over $1000 a day for seeing 2-3 pts on average.

This. I'd much rather have your gig than anything above.

 

[finalpsychyear]

There was a hospital in my area that wasn't taking medicaid for a while and the docs were making over alot for inpt for like the first 1-2 years then quickly stopped once they started taking medicaid and are always having a hard time finding docs to stay on. Seriously even in the private hospitals if your a 1099 separately billing your getting 60-70 for a follow up and that is assuming you collect 100% and then have to pay for billing.

If you rounded on 20 and got perfect billing and collection that nets you 1500 + or - a few hundred for admits/discharges. Using 1500 x 5 days/48 wks gets you 360 but you'll never have perfect collections but you will have ALWAYS have a solid 7-8% billing company fee so subtract another 30k from that roughly.

330k for 20 inpt psych 48 wks a year no bennies... if you started rounding at 5am till 1pm then worked job number 2 and needed to pay/save massively for 1-2 years i guess you could but not sustainable like other posters said. Who the hell likes to be at work at 5-7am anyways? The massive research I have done in sleep shows there is an ideal sleep time somewhere in the 930-11p sleep window and getting up roughly 7-7.5 hrs for maximum health and lowest mortality. So like i said doing those kind of hours or work will COST you something more than dollars and cents.

99% of posters and med students need to get through their head. YOU are not going to make more than the average/median salary in psych long term (240-285k). Sure work your extra weekends and extra calls but that is not sustainable in the long term. Doctors in general lack business acumen and skills. I know posters on here make it sound like its easy to set up a business and all but that is relative to other fields in medicine and those posters are highly skilled due to some history of business training/ family business/. These posters are more of the anomalies and sure for us because how we think and operate we wonder why others don't do this.

Another poster on here started a PP full blast but he was already well into his career and still its not as easy when you just hear you'll fill in 3-6 months.... sure if you take medicaid and all insurances and realize over 30-40% of your claims you'll figure out something in the insurance credentialing was wrong and they won't pay and then its too late to file them properly due to some time limit nonsense insurance put in its contract as another way not to pay you.

Anecdotally, in my class over the past 4 years of graduating 30 residents I am still the only one doing PP. A few tried and decided to do cash only/insurance but didn't have patience and proper set ups to continue it very long. You don't hear the bad outcomes. Getting a 280+ offer right outside of training with benefits is a great set up. I think my first year I barely made over my residency salary. My thinking was it was an investment but still was tempted for the 250-280 offers..

To finish the story even the few that initially tinkered with PP in my class, they have all ended up employed, moved, switched multiple jobs, with a few doing some extra weekends here and there.

Lastly, my own thoughts are even with current PP its probably got a 10 year lifeline aside from the cash only set ups and even then if i am a stable cash patient paying you 150 for a 3 month supply of some SSRI/SNRI how long before i just go to my pcp and figure out i can get a 1 year supply for a 20 dollar copay.

 

[AD04]

Lastly, my own thoughts are even with current PP its probably got a 10 year lifeline aside from the cash only set ups and even then if i am a stable cash patient paying you 150 for a 3 month supply of some SSRI/SNRI how long before i just go to my pcp and figure out i can get a 1 year supply for a 20 dollar copay.

Do the top 10% earners think about pinching pennies (possibly waiting 1 hour in an overcrowded waiting room for 5 minutes face-to-face time with a hurried physician) or about maximizing the experience (minimal wait time for 30 minutes face-to-face time with a personable physician)?

 

[needadvicebadly]

There was a hospital in my area that wasn't taking medicaid for a while and the docs were making over alot for inpt for like the first 1-2 years then quickly stopped once they started taking medicaid and are always having a hard time finding docs to stay on. Seriously even in the private hospitals if your a 1099 separately billing your getting 60-70 for a follow up and that is assuming you collect 100% and then have to pay for billing.

If you rounded on 20 and got perfect billing and collection that nets you 1500 + or - a few hundred for admits/discharges. Using 1500 x 5 days/48 wks gets you 360 but you'll never have perfect collections but you will have ALWAYS have a solid 7-8% billing company fee so subtract another 30k from that roughly.

330k for 20 inpt psych 48 wks a year no bennies... if you started rounding at 5am till 1pm then worked job number 2 and needed to pay/save massively for 1-2 years i guess you could but not sustainable like other posters said. Who the hell likes to be at work at 5-7am anyways? The massive research I have done in sleep shows there is an ideal sleep time somewhere in the 930-11p sleep window and getting up roughly 7-7.5 hrs for maximum health and lowest mortality. So like i said doing those kind of hours or work will COST you something more than dollars and cents.

99% of posters and med students need to get through their head. YOU are not going to make more than the average/median salary in psych long term (240-285k). Sure work your extra weekends and extra calls but that is not sustainable in the long term. Doctors in general lack business acumen and skills. I know posters on here make it sound like its easy to set up a business and all but that is relative to other fields in medicine and those posters are highly skilled due to some history of business training/ family business/. These posters are more of the anomalies and sure for us because how we think and operate we wonder why others don't do this.

Another poster on here started a PP full blast but he was already well into his career and still its not as easy when you just hear you'll fill in 3-6 months.... sure if you take medicaid and all insurances and realize over 30-40% of your claims you'll figure out something in the insurance credentialing was wrong and they won't pay and then its too late to file them properly due to some time limit nonsense insurance put in its contract as another way not to pay you.

Anecdotally, in my class over the past 4 years of graduating 30 residents I am still the only one doing PP. A few tried and decided to do cash only/insurance but didn't have patience and proper set ups to continue it very long. You don't hear the bad outcomes. Getting a 280+ offer right outside of training with benefits is a great set up. I think my first year I barely made over my residency salary. My thinking was it was an investment but still was tempted for the 250-280 offers..

To finish the story even the few that initially tinkered with PP in my class, they have all ended up employed, moved, switched multiple jobs, with a few doing some extra weekends here and there.

Lastly, my own thoughts are even with current PP its probably got a 10 year lifeline aside from the cash only set ups and even then if i am a stable cash patient paying you 150 for a 3 month supply of some SSRI/SNRI how long before i just go to my pcp and figure out i can get a 1 year supply for a 20 dollar copay.

But there are plenty of telepsych jobs offering 150-160/hr. 50 hours a week and you're hitting 400. Then there are the locums jobs paying in the 200s. Why wouldn't either of these be sustainable?

 

[finalpsychyear]

But there are plenty of telepsych jobs offering 150-160/hr. 50 hours a week and you're hitting 400. Then there are the locums jobs paying in the 200s. Why wouldn't either of these be sustainable?

You won't sustain doing 50 hours of telepsych long term without some burnout but go for it. Even if you do you better get a standing desk for the health implications alone. At most 40 hrs and that would net you just barely 300k. Also,because while they may pay you that rate now in a few years you'll be always at the mercy of being replaced by 2 NPs each seeing the same number of patients and making double the profit for the organization.

I'm seeing this happen in front of me. I have friends who are contractors at these kinda places and the "directors" trying to figure out why a certain doc has a high no show rate and this is a CMHC with 90% medicaid we are talking about... and it leaves those docs feeling like they are doing something wrong or responsible for the situation which is ridiculous. Thats why i advocate getting into a leadership role. Become the Med director at minimum. Otherwise you're investing years into a company concerned only about the bottom line and the second the law is tweaked by their powerful lobbyists you'll be out the door or will have to accept less money with nothing to show for it.

I still advocate multiple jobs and to work hard for the next 10 years especially if your just coming out. Worst case scenario you hit your FI and only work purely for pleasure after that. When it comes to the fact that we spent 12+ years post high school investing in getting to where we are at. No way am i rolling the dice. I remain cautiously optimistic even about that 10 year span and who knows what exactly the landscape or politicians will come up after 2030 and frankly I won't allow myself to be in a position to be affected by it then by doing something about it now and so should all new grads imo.

 

[BiscoDisco]

You won't sustain doing 50 hours of telepsych long term without some burnout but go for it. Even if you do you better get a standing desk for the health implications alone. At most 40 hrs and that would net you just barely 300k. Also,because while they may pay you that rate now in a few years you'll be always at the mercy of being replaced by 2 NPs each seeing the same number of patients and making double the profit for the organization.

I'm seeing this happen in front of me. I have friends who are contractors at these kinda places and the "directors" trying to figure out why a certain doc has a high no show rate and this is a CMHC with 90% medicaid we are talking about... and it leaves those docs feeling like they are doing something wrong or responsible for the situation which is ridiculous. Thats why i advocate getting into a leadership role. Become the Med director at minimum. Otherwise you're investing years into a company concerned only about the bottom line and the second the law is tweaked by their powerful lobbyists you'll be out the door or will have to accept less money with nothing to show for it.

I still advocate multiple jobs and to work hard for the next 10 years especially if your just coming out. Worst case scenario you hit your FI and only work purely for pleasure after that. When it comes to the fact that we spent 12+ years post high school investing in getting to where we are at. No way am i rolling the dice. I remain cautiously optimistic even about that 10 year span and who knows what exactly the landscape or politicians will come up after 2030 and frankly I won't allow myself to be in a position to be affected by it then by doing something about it now and so should all new grads imo.

Based on your observations noted above, is it fair to say you expect salaries in psych to be going down in the coming years?

 

[finalpsychyear]

Based on your observations noted above, is it fair to say you expect salaries in psych to be going down in the coming years?

probably but i highly doubt much change in the next 5 years. It gets a bit murky 5-10 years out but if i had to randomly guess i would say 10-15% raw drop not accounting for inflation which would make it worse, 10-15 years around the time I can see major changes like E/M codes being eliminated or single payer systems etc.

Suffice to see your always going to be in the 200-250K for the next decade regardless where your employed full time. Its still A LOT. You can always make more with wknds or multiple gigs.

 

[dl2dp2]

I largely agree with finalpsychyear in that the average psychiatrist in an average location should expect an average salary at an average facility.

However, if you are a top 10% kind of psychiatrist it’s feasible to set up a practice that would make a lot more and enjoy a much better income and lifestyle. Furthermore, psychiatry is one of the few specialties where moving to a high cost of living area would potentially increase your max income potential. Setting up a cash practice is not trivial and not everyone can do it. It’s best to shoot for the best training program from day 1 whenever possible. That said, it is still possible to set up a lucrative cash or semi cash practice in most locations without sterling credential, but it can be quite challenging.

 

[LADoc00]

Preface: I am NOT a psychiatrist, but I worked with a TON in an infamous location in CA for a dark chapter in my life..

They make mad money. This rate is common. Perhaps even higher for supervisory position.

It is without a doubt the best bang for buck right now among all medical specialties given future trajectories of all the surgical subs.

Enjoy it while it lasts at least! I never got invited to crazy parties they threw because I was a lab geek, but I think that wouldve been quite fun....

True story: the psych doc in the office next to mine made 727ish, some angry colleague tacked a newspaper article about her on door when this became public. So clearly psych has player haters.

 

[downwithDTB]

Can you explain your "how rvu models work" comment? I was under the impression this was generally a flat $/rvu thing... I can't understand why an employer would disincentivize added work beyond the tax hit, especially since it costs them less if they need fewer total docs... I also can't imagine anyone signing that contract. Other the opposite would make any sense.

 

[Mass Effect]

Can you explain your "how rvu models work" comment? I was under the impression this was generally a flat $/rvu thing... I can't understand why an employer would disincentivize added work beyond the tax hit, especially since it costs them less if they need fewer total docs... I also can't imagine anyone signing that contract. Other the opposite would make any sense.

I'll leave the explaining of RVUs to @splik , but the bottom line is, I'm not aware of any inpatient model where someone is hired to see 30 patients a day in an RVU model. Outpatient, maybe. Inpatient is a different beast because every patient has to be seen everyday and if your RVU employee decides it's not worth the money to see that many patients on a random Tuesday, you're screwed. Also, asking someone to see 30 inpatients a day is a great way to open yourself up to a fantastic lawsuit the second something goes wrong (and it will).

 

[Merely]

I'll leave the explaining of RVUs to @splik , but the bottom line is, I'm not aware of any inpatient model where someone is hired to see 30 patients a day in an RVU model. Outpatient, maybe. Inpatient is a different beast because every patient has to be seen everyday and if your RVU employee decides it's not worth the money to see that many patients on a random Tuesday, you're screwed. Also, asking someone to see 30 inpatients a day is a great way to open yourself up to a fantastic lawsuit the second something goes wrong (and it will).

I don’t think you know what you’re talking about tbh but I could be wrong as I’m not an expert

 

[downwithDTB]

I've worked in multiple psych hospitals where not every patient was seen every day, always in facilities that were not funded via insurance. Daily MD visits may be as much about billing as anything else... with that said, there is no reason that a contract can't be structured to require an MD to see every patient in a hospital and reimburse them per patient seen.

Regarding liability... neurosurgeons and hospitalists are covering 40-50 inpatients/day at some places... (Not saying it's great care).

 

[mymembernames]

How does locum rates in psych compare to other specialties?

 

[Mass Effect]

I don’t think you know what you’re talking about tbh but I could be wrong as I’m not an expert

No worries. The feeling is mutual.

I've worked in multiple psych hospitals where not every patient was seen every day, always in facilities that were not funded via insurance. Daily MD visits may be as much about billing as anything else... with that said, there is no reason that a contract can't be structured to require an MD to see every patient in a hospital and reimburse them per patient seen.

Regarding liability... neurosurgeons and hospitalists are covering 40-50 inpatients/day at some places... (Not saying it's great care).

I don't know where you've been working, but that is definitely not my experience. I've worked in both insurance and private pay facilities (and non-profit versus profit) and patients are seen everyday.

Regarding neurosurgeons covering 40 - 50 inpatients a day as a regular full time job, I find that incredibly hard to believe, considering they'd never have time to hit the OR. Where is that happening?

 

[needadvicebadly]

This forum is quite confusing when it comes to what one can make in our field. There's one group who essentially says sky's the limit (I'm exaggerating)...then another that essentially says don't expect more than the average.

What's a poor resident to think?

 

[clausewitz2]

No worries. The feeling is mutual.



I don't know where you've been working, but that is definitely not my experience. I've worked in both insurance and private pay facilities (and non-profit versus profit) and patients are seen everyday.

Regarding neurosurgeons covering 40 - 50 inpatients a day as a regular full time job, I find that incredibly hard to believe, considering they'd never have time to hit the OR. Where is that happening?

Neurosurgery residents cover 40-50 patients a day on the floor. They are not also operating when they do this typically and let us not forget that their specialty also thinks q3 24 hr call is a reasonable way to structure seven years of your life.

 

[Mass Effect]

Neurosurgery residents cover 40-50 patients a day on the floor. They are not also operating when they do this typically and let us not forget that their specialty also thinks q3 24 hr call is a reasonable way to structure seven years of your life.

I think residency is structured that way though. What neurosurgeon attending is taking a job where they cover 40-50 inpatients daily?

 

[Trismegistus4]

Can you explain your "how rvu models work" comment? I was under the impression this was generally a flat $/rvu thing... I can't understand why an employer would disincentivize added work beyond the tax hit, especially since it costs them less if they need fewer total docs... I also can't imagine anyone signing that contract. Other the opposite would make any sense.

Good luck getting splik to explain anything. His entire MO consists of making intentionally provocative, puzzling statements, often involving name-dropping or nonstandard/uncommon terms, usually in a haughty, know-it-all tone, then never returning to explain them even when explicitly asked to do so. Then, for some reason, receiving 50 likes and fawning praise and thanks for being such an incredibly knowledgeable and insightful poster.

This forum is quite confusing when it comes to what one can make in our field. There's one group who essentially says sky's the limit (I'm exaggerating)...then another that essentially says don't expect more than the average.

What's a poor resident to think?

@Armadillos answered this in a recent thread:

Aside from cash only docs setting high cash hourly rates, if you hear of someone making 1.5x-3x what is typical for a full time psychiatrist it is because they are actually working what should be multiple full time jobs and are cramming them into one day by “being efficient” (cutting corners) at each.

 

[needadvicebadly]

Good luck getting splik to explain anything. His entire MO consists of making intentionally provocative, puzzling statements, often involving name-dropping or nonstandard/uncommon terms, usually in a haughty, know-it-all tone, then never returning to explain them even when explicitly asked to do so. Then, for some reason, receiving 50 likes and fawning praise and thanks for being such an incredibly knowledgeable and insightful poster.


@Armadillos answered this in a recent thread:

I just want to make upper 300s. Oddly specific perhaps but that's what I think I need in my high col area. Is this going to be doable or am I going to have to cut corners or work like a dog to achieve this?

 

[clausewitz2]

I think residency is structured that way though. What neurosurgeon attending is taking a job where they cover 40-50 inpatients daily?

Precisely, once they have any ability to choose their work conditions they stop doing this. It is just not sustainable.

 

[Merely]

Good luck getting splik to explain anything. His entire MO consists of making intentionally provocative, puzzling statements, often involving name-dropping or nonstandard/uncommon terms, usually in a haughty, know-it-all tone, then never returning to explain them even when explicitly asked to do so. Then, for some reason, receiving 50 likes and fawning praise and thanks for being such an incredibly knowledgeable and insightful poster.


@Armadillos answered this in a recent thread:

LOL

 

[Mass Effect]

I just want to make upper 300s. Oddly specific perhaps but that's what I think I need in my high col area. Is this going to be doable or am I going to have to cut corners or work like a dog to achieve this?

The post you quoted literally answered this. Beyond that answer, it's going to depend entirely on where you're living. I also challenge the belief that you need upper 300s for anywhere. You want it to keep up the lifestyle you want, sure, but need?

 

[needadvicebadly]

The post you quoted literally answered this. Beyond that answer, it's going to depend entirely on where you're living. I also challenge the belief that you need upper 300s for anywhere. You want it to keep up the lifestyle you want, sure, but need?

True, but I was hoping to get a few other opinions. Especially since they seem so vsried around here. I only here about the posters making the average and those in the 500+ range. What about those in the middle ground?

And no I don't need it. Truth be told most of us probably don't need anything past 75k. Loans or not.

 

[MBBSMOM]

True, but I was hoping to get a few other opinions. Especially since they seem so vsried around here. I only here about the posters making the average and those in the 500+ range. What about those in the middle ground?

And no I don't need it. Truth be told most of us probably don't need anything past 75k. Loans or not.

The starting salary at my current job is 240k you are salaried until you meet a certain RVU. I know a doc in my practice making 500k but that's because he works 80 hours a week and thinks 3 minutes with a patient is enough. I make around 240-300k it depends on the year and how much RVUs I earn. I usually round on 6-7 inpatients a day unless I'm covering for someone on vacation. But sometimes I'll only have around 2-3 inpatients because I cover a very small inpatient eating disorder unit. Also, my hospital has a PHP so I'll have around 4-12 PHP patients it just depends. But PHP patients only need to be seen once a week. I'm usually at work from 9-4 it just depends. But my hospital also has me do mandatory clinic duties twice a week. So I only do a clinic for 3 hours 2 days and my appointments are 30 minutes in length. I usually spend a lot of time also with my inpatients and PHP patients. I've done family sessions that have lasted 2 hours. I could earn more but I don't want to provide sub-par care.

 

[Sushirolls]

-There are 100% wRVU jobs out there. As Splik pointed out, wRVUs are in favor of the 'house' and you won't win if trying to maximize work effort to reward ratio.
-Some jobs have wRVU conversion factors that increase with more productivity or even decrease with less productivity.
-In general the culture with most inpatient units will be favorable to some one wanting to see more patients. However, med directors may be wary for quality concerns as others above pointed out, or that the person really doesn't grasp what they are asking for and the med dir will limit in a paternalistic fashion because they don't want the doc to burn out. Or they already have a pretty good set up with work life balance and don't want to upset the rest of the group because one person wants to do more. Should that person ever leave, the rest of the group then has to adjust everything again to accommodate for such a large deficit. Or the med dir needs to explain to their higher ups why everyone else isn't seeing as many patients - is everyone else lazy, or is one doc just being excessive - which is easier to explain to higher up people (answer: the problem that doesn't exist in the first place).
-If people want to see 20+ inpatients a day, they need to seek out the myriad of for profit free standing psych hospitals. I believe they are UHS?, HCA?, and Springstone?, and I might be missing 2 other smaller companies. You are more likely to find a complete 1099 set up with a per patient structure. But understand, the pay at these places may be great if you truly just want to do volume. But if you are a little slower (be it for over charting, doing uncompensated things like talking with family, or quality as loosely defined here on SDN) you may make less money at these gigs then other jobs.
-Non-profit hospitals and health systems are likely to have MGMA based 'Fair Market Value' upper limit thresholds at 75th and 90th percentiles you won't be allowed to exceed.
-Locums in general can pay more than routine jobs. But for routine jobs and locums, the devil is in the details. There are bad jobs, and bad locums gigs. What's in the contract. The high dollar pay doesn't mean you should take the job. There can be so many other land mines in the contract, or the work culture, or the patient population, or state laws, etc. The more experience you garner (sadly that means bad jobs, bad contracts) the more astute you will be at analyzing for the good. A surrogate is reading on SDN, talking with your attendings who have worked outside of academia, talking with co-residents, etc.
-Can a fresh residency grad, set themselves up in a way to make 500K+? I believe its possible, but it will likely require devoting all waking, and many sleeping hours to work with virtually no free time for self care, family, friends, exercise, medical appointments, grocery shopping, laundry, and essentially living. As people have noticed, the sentiments on SDN are not encouraging to this life decision. But for those who want to chose to do this, we still live in America, Land of the Free and how much money you want/need is no one's business but your own. But be aware there are plenty of your colleagues with integrity and professionalism, and when they see people dropping the ball they will call you on it and likely move towards having you let go if nothing serious that warrants a stronger intervention.

-Neurosurgeons round on so many patients for two reasons, there are so few neurosurgeons so they are it, and they will see them all. Secondly, they are quick follow ups, in part because they don't need to talk to most of their patients, is the patient alive, no fever, no infection, off the vent?, shunt stable?, labs stable? etc, all things that take less than 5 minutes to assess. What takes the longest for them is if family is around wanting to talk at those early hours when rounding, or the actual documentation. Some times they may need to do an urgent bed side procedure. Granted this all ancient recall from med student rotation days. We in psych need to talk with patients, and well, that takes time.

 

[Sushirolls]

I just want to make upper 300s. Oddly specific perhaps but that's what I think I need in my high col area. Is this going to be doable or am I going to have to cut corners or work like a dog to achieve this?

Preserve your integrity, preserve your professionalism, don't cut the corners. Not worth it.
Prepare yourself mentally to work like a dog.
Keep your eyes/ears open for opportunities to improve the effort to compensation ratio if you find that you are working like a dog.

As others have posted on SDN, there is a reason why median is median and most jobs are set up the way they are. With every step of our medical education, to be an outlier at each new phase is harder and harder. Do well in high school to be 2 standard deviations above the mean, easy. Do well in college, little harder, do well in med school, even harder. Residency, tricky to really evaluate (PRITE is garbage and not real metric...) but chances are we weren't the brightest in our batch. Post residency, same thing, odds are against you for clinically being, academically achieving, or making money that propels you into the upper bell curve.

In summary, if people really want to chase money, pick one of the other fields in medicine that has a more favorable bell curve distribution. Can you achieve heights in psychiatry? Yeah, but it likely won't be you (you is more of a y'all).

 

[Trismegistus4]

I just want to make upper 300s. Oddly specific perhaps but that's what I think I need in my high col area. Is this going to be doable or am I going to have to cut corners or work like a dog to achieve this?

I'm hardly an expert on how much a person can make, since post-residency, I've only worked 1) locums and 2) in an RVU model for a large hospital system, so I don't know what insurance actually reimburses for our commonly used codes. But in my organization, a few of the inpatient psychiatrists, who work 7 on/7 off, have their own private practices on the side. Based on what I know they make just at the inpatient gig, I'd imagine they are easily hitting upper 300's. Not sure whether you would consider that cutting corners or working like a dog, since they are working every other weekend, and I've heard (though not from themselves) when on inpatient they are leaving around 1pm to get to their private practices. They can see up to 16 patients on a bad day, though I think it's usually more like 12-13, and I don't know whether they're leaving notes to finish from home/their PP office later. Another option would be to do a 7 on/7 off inpatient job then find a 2nd gig you can do intermittently during your weeks off, like ER, consults, or telepsych. Though depending on your standards, you might still consider that working like a dog since you're still working every other weekend.

 

[Mass Effect]

A lot of this also depends on what you want out of life. I tend to cling to the idea that you're never guaranteed tomorrow. Do you really want to spend your youth working like a dog and not actually get to enjoy your family just to have that extra cash? To me, the saddest stories I hear are those that end with so and so working hard for a glorious retirement and then dying (or significant other dying) before getting there. That's a wasted life, imo.

You will never go hungry as a psychiatrist. There are a ton of ways to make more money. But the only way to make above and beyond (such as the 700K debated earlier) is to sacrifice your real life for your work life or cut extreme corners in patient care. Neither of those sound suitable to me, so give me the 200 - 300 K salary and a good life with my family to enjoy it.

 

[Merely]

A lot of this also depends on what you want out of life. I tend to cling to the idea that you're never guaranteed tomorrow. Do you really want to spend your youth working like a dog and not actually get to enjoy your family just to have that extra cash? To me, the saddest stories I hear are those that end with so and so working hard for a glorious retirement and then dying (or significant other dying) before getting there. That's a wasted life, imo.

You will never go hungry as a psychiatrist. There are a ton of ways to make more money. But the only way to make above and beyond (such as the 700K debated earlier) is to sacrifice your real life for your work life or cut extreme corners in patient care. Neither of those sound suitable to me, so give me the 200 - 300 K salary and a good life with my family to enjoy it.

I agree with this, although there was a poster here I think it was @phorensic that once said he was providing good care yet (and he said this) making 1m+ so maybe there’s something to learn from these people

 

[Mass Effect]

I agree with this, although there was a poster here I think it was @phorensic that once said he was providing good care yet (and he said this) making 1m+ so maybe there’s something to learn from these people

Yeah, it's called how to spot BS.

 

[deleted736562]

A lot of this also depends on what you want out of life. I tend to cling to the idea that you're never guaranteed tomorrow. Do you really want to spend your youth working like a dog and not actually get to enjoy your family just to have that extra cash? To me, the saddest stories I hear are those that end with so and so working hard for a glorious retirement and then dying (or significant other dying) before getting there. That's a wasted life, imo.

You will never go hungry as a psychiatrist. There are a ton of ways to make more money. But the only way to make above and beyond (such as the 700K debated earlier) is to sacrifice your real life for your work life or cut extreme corners in patient care. Neither of those sound suitable to me, so give me the 200 - 300 K salary and a good life with my family to enjoy it.

I don't disagree with this, but a lot of the anxiety about money reflect our overall economic situation. Factor in student loans, a good retirement, money for healthcare/health insurance, obscene rents/house prices in desirable areas, setting aside money for kids to attend college...etc and suddenly 250k may cut it and maybe just. In a lot of European countries with guaranteed healthcare, education, good vacation and benefits, pple have a higher qol, are less anxious and less worried about the $$ they're taking. Their take home is maybe less but I believe they are getting a better deal. I think doctors like to think they are not concerned with these issues.

I'm going on a tangent here maybe but I think the anxiety/obsession? about the numbers reflect the economic reality we're in.

 

[Mass Effect]

I don't disagree with this, but a lot of the anxiety about money reflect our overall economic situation. Factor in student loans, a good retirement, money for healthcare/health insurance, obscene rents/house prices in desirable areas, setting aside money for kids to attend college...etc and suddenly 250k may cut it and maybe just. In a lot of European countries with guaranteed healthcare, education, good vacation and benefits, pple have a higher qol, are less anxious and less worried about the $$ they're taking. Their take home is maybe less but I believe they are getting a better deal. I think doctors like to think they are not concerned with these issues.

I'm going on a tangent here maybe but I think the anxiety/obsession? about the numbers reflect the economic reality we're in.

The thing is, with the exception of the obscene student loans, all of America is dealing with everything you mentioned and almost all of them are surviving on a lot less than 250K. That's my point. It's not bad to want money. We all do. But the world will not end if you don't earn 500K a year. As a psychiatrist, you will do just fine, you will save for retirement, have money for healthcare, be able to buy a house in a desirable area, and be able to set aside money for kids to attend college. To suggest this is undoable on an average psychiatry salary is inaccurate.

 

[budda10000]

For all of you asking these salaries are offered at the various locums gigs offered in the Fresno and Bakersfield area, the UCSF fresno residents had some of the best paying moonlighting gigs(3600 for a weekend) I have seen. I signed up for locum gig job recruiters just to see what is out there. Low end appears to be $185/hr in Colorodo, one alaska(Nome alaska) offered 750k a year for regular full time work. Locums of around 200-210 an hour are pretty common within 1-2 hours of desirable metro areas in rocky mountain states. Surprisingly the best pay isn't always in the crappiest areas, it is very random.

 

[BiscoDisco]

For all of you asking these salaries are offered at the various locums gigs offered in the Fresno and Bakersfield area, the UCSF fresno residents had some of the best paying moonlighting gigs(3600 for a weekend) I have seen. I signed up for locum gig job recruiters just to see what is out there. Low end appears to be $185/hr in Colorodo, one alaska(Nome alaska) offered 750k a year for regular full time work. Locums of around 200-210 an hour are pretty common within 1-2 hours of desirable metro areas in rocky mountain states. Surprisingly the best pay isn't always in the crappiest areas, it is very random.

Any ballpark rates in Calif near the major cities?

 

[budda10000]

I don't disagree with this, but a lot of the anxiety about money reflect our overall economic situation. Factor in student loans, a good retirement, money for healthcare/health insurance, obscene rents/house prices in desirable areas, setting aside money for kids to attend college...etc and suddenly 250k may cut it and maybe just. In a lot of European countries with guaranteed healthcare, education, good vacation and benefits, pple have a higher qol, are less anxious and less worried about the $$ they're taking. Their take home is maybe less but I believe they are getting a better deal. I think doctors like to think they are not concerned with these issues.

I'm going on a tangent here maybe but I think the anxiety/obsession? about the numbers reflect the economic reality we're in.

I don't think it does because as a doc you are in probably one of the strongest positions to grow personal wealth short of investment banking/inheriting money. You have a high salaried job that never goes away and you can work wherever your want. Ways to save money include... Take a job with health benefits covered. Live in a cheaper area. Don't buy new cars. Cook your food. Take care of your health to cut down on healthcare costs/increase productivity. Live in a state with low taxes. Most importantly take what you save and invest every penny of it. With 2 decades of disciplined saving/investing your investment income can easily eclipse your physician income. More importantly you will see your tax burden decrease substantially. Even as a resident I am saving 60% of my income and investing in a mixture of stocks and rentals(profitable and cheap where I am). My effective tax rate last year was ~14% after deductions. My housing is free because I purchased the house and rent the rooms generating income over my mortgage by several hundred dollars a month. Things like this compound greatly with time. My only regret is not doing it sooner.