Pay Delusions

[Faebinder]

So what's the deal... how come so many attendings think that Psychiatrists dont make okay money? In the last year (and incidently yesterday again) I must have heard it at least five times.. from Psychiatry attendings.

My favorite is when they site different specialties as making more than them..

One sited "surgery". Inside I started laughing... I know better.. i did a year surgery fellowship. Double the work hours for half as much pay. You're better off moonlighting in some cases than taking call. I corrected that one by saying maybe they ment "spine orthopedics" and "neurosurgeons".

One sited "dermatologists". I couldn't argue with that one... I mean shave biopsies and botox scream money.

One sited that he knew a "gastroenterologist" that made over a million a year. (Yeah that is possible for a gastroenterologist, the scope anything that has an exit or entrance hole).

In their defense, all of em were either university attendings or university affiliated.

I dont count $175k particularly low compared to other specialties (ok ok ok CRNAs can make more than that.. fine).

Comments from the veterans here? Are they stuck in the past when other specialties made way more?

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[whopper]

Lots of doctors stop learning anything about the other fields once they start working in their own field. Some base their decisions on half baked notions & things that were going on in the other fields when they were medstudents.

Surgery? My dad's a surgeon--& at 70 years old still working crazy hours. In fact he worked more than me as an attending day by day than I ever did as a psyche resident. My mom-a psychiatrist was making more money than he did hour per hour. Its just that my dad worked crazy hours so his total gross was more than hers. She of course could've worked crazy hours, but who the heck wants to do that? Besides, since he worked so hard, he had bad management of his finances & probably would've ended up saving more money had he just not worked as hard.

One of my last rotations as a medstudent, some IM doc was telling me how psychiatry would be dead as a profession within a few months.

Yeah right. What planet was he on? Seems to me this guy was delusional.

If some surgeon wants to live life thinking he makes more money than I do, let him. While he's up at 2am, and I'm at home sleeping, let that false notion comfort him.

There are of course some surgeons that make more than psychiatrists, but whatever. There's plenty of specialties that make more than psychiatry, there's some that don't. Its not about the money anyways, but if you enjoy your profession & are giving your patients quality treatment.

I'm planning on making more money outside of psychiatry anyways by putting a portion of my income into investments.

 

[sunlioness]

I dont count $175k particularly low compared to other specialties (ok ok ok CRNAs can make more than that.. fine).

Comments from the veterans here? Are they stuck in the past when other specialties made way more?

I'm not making $175K. Though what I am making is low compared to what I could be making just because of what I choose to do. So no complaints here. Not right now anyway. And way too tired to do much complaining anyway,

 

[Faebinder]

I'm not making $175K. Though what I am making is low compared to what I could be making just because of what I choose to do. So no complaints here. Not right now anyway. And way too tired to do much complaining anyway,

Your in Pennsylvania... the state that produces the most psychiatrists in the world. You're lucky they are paying you.

 

[Doc Samson]

If you're willing to move (e.g. my "not Boston anymore" location), pay is excellent even if you're still in academics.

My last job is currently being advertised (so I'm not talking out of turn) for $175k, and that's in an academic university setting working 9-5 most days (consult can be a little bit unpredictable). Throw in reimbursement for voluntary call, and clearing $220k is easily doable.

 

[kumar28]

yeah..its true. My dad's a psychiatrist too and there is a lot of moolah to be made..i guess people just don't know about it

 

[OldPsychDoc]

yeah..its true. My dad's a psychiatrist too and there is a lot of moolah to be made..i guess people just don't know about it

Maybe we don't want people to know about it!

 

[michaelrack]

Some psychiatrists gross $600 per hour, probably only $500/hour after expenses:
http://www.nytimes.com/2008/07/07/nyregion/07therapists.html?_r=1&oref=slogin

 

[radslooking]

how does psych pay that well with relatively few hours?

 

[Doc Samson]

The basic market forces at work... supply (low), demand (high).

 

[Dr McSteamy]

are there really that many people that are coocoo?

on average, how much time do you spend with each pt?

what is the most common disorder?

are they mostly superworried moms bringing in their kids with anorexia and depression?

i've always known psych is pretty laid back, but i didn't know that many people see psychdocs.

 

[Effervescent]

are they mostly superworried moms bringing in their kids with anorexia and depression?

Not to start anything but if someone's kid has anorexia & depression I hardly think it's over-reacting to think the kid needs psych help!

(But I think you were probably trying to ask if a lot of the patients are the "worried well" type - ?)

 

[Faebinder]

are there really that many people that are coocoo?

The chronic mental diseases (Schizo, bipolar, major depression) are all at the same rate in all people (~1%). This 1% piles up.... so if you take those three diseases.. that's 3% right there. That's a lot of people.

on average, how much time do you spend with each pt?

what is the most common disorder?

Depends, inpatient is way different than outpatient. Most common disorders are those three mentioned above.

are they mostly superworried moms bringing in their kids with anorexia and depression?

Anorexia can kill and results in SEVERE consequences on a child. The child can end up damaging their bones and getting osteoperosis (common step 3 question) and even a cardiomyopathy resulting in life-threatening arrhythmias. They are also in danger every time they aggressively refeed. For women (related to the osteoperosis) they damage their menstral cycles.

Depression is lethal.... and there is no way to predict who will get it even if their relatives have it.

 

[Doc Samson]

are there really that many people that are coocoo?

on average, how much time do you spend with each pt?

what is the most common disorder?

are they mostly superworried moms bringing in their kids with anorexia and depression?

i've always known psych is pretty laid back, but i didn't know that many people see psychdocs.

I'm guessing that you're making some well-intentioned queries here, but you'll probably find that referring to mentally ill as "coocoo" won't find you many friends here or on your rotations.

 

[GATORANALYST]

are there really that many people that are coocoo?

on average, how much time do you spend with each pt?

what is the most common disorder?

are they mostly superworried moms bringing in their kids with anorexia and depression?

i've always known psych is pretty laid back, but i didn't know that many people see psychdocs.

Take a look around the ED. There are tons of people with mental illness(not coocoo) that need help.

 

[freaker]

So what's the deal... how come so many attendings think that Psychiatrists dont make okay money? In the last year (and incidently yesterday again) I must have heard it at least five times.. from Psychiatry attendings.

I actually had an attending tell me the other day that salaries tended to ceiling out at about 150k. I didn't want to tell him that I knew several residents from his own program that signed for more than that starting out.

From my limited viewpoint, it seems pretty region-dependent.

 

[ronin12]

I actually had an attending tell me the other day that salaries tended to ceiling out at about 150k. I didn't want to tell him that I knew several residents from his own program that signed for more than that starting out.

From my limited viewpoint, it seems pretty region-dependent.

I agree. midwest states like IA, NE, SD, ND, KS, MO etc are in shortage of psychiatrists so private hosp pay around 200K, also some VA's are also offering around 200K for starters in WI. so it all depends upon supply and demand.Acdemics and big cities are cheap shots. they usually dont have much difficulty recruiting so they pay less.

 

[toothless rufus]

Psychiatry in Ohio pays what?

 

[kumar28]

about 200k which remember is usually for a 9-5 job no call, no weekends. Weekend call is paid extra and there are plenty of opportunities for moonlighting after work.

 

[TheWowEffect]

about 200k which remember is usually for a 9-5 job no call, no weekends. Weekend call is paid extra and there are plenty of opportunities for moonlighting after work.

This may be true for places in midwest somewhat far from the main cities. Most institutional, employed jobs have call but it is mostly beeper call, except on weekends when you are required to come in to round. Also depends, if you want to do inpatient or not, and how many other doctors share the call.

Places closer to main cities range anywhere from 160K-180K. This is again for a 40-hour work week. With potential moonlighting or second jobs, you can make much more. Some semi-rural places in midwest also have sign-on bonuses.

 

[gman33]

This may be true for places in midwest somewhat far from the main cities. Most institutional, employed jobs have call but it is mostly beeper call, except on weekends when you are required to come in to round. Also depends, if you want to do inpatient or not, and how many other doctors share the call.

Places closer to main cities range anywhere from 160K-180K. This is again for a 40-hour work week. With potential moonlighting or second jobs, you can make much more. Some semi-rural places in midwest also have sign-on bonuses.

Can you provide any more specifics about a "typical" practicing psychiatrist?

Would someone have a 9-5 salaried gig and then see private patients at night? Just wondering about some of the typical setups and $.

I won't be practicing until my forties, and $ unfortunately will play a role in my decisions. Those loans won't pay themselves back.

 

[TheWowEffect]

Can you provide any more specifics about a "typical" practicing psychiatrist?

Would someone have a 9-5 salaried gig and then see private patients at night? Just wondering about some of the typical setups and $.

I won't be practicing until my forties, and $ unfortunately will play a role in my decisions. Those loans won't pay themselves back.

Yes, this is actually what a lot of psychiatrists in private sector do. They have a 32-40 hour regular job to get benefits, 401K etc. and either have their own practise on weekends and evenings or moonlight at a clinic or hospital. It is a little different if you are in academia.

I don't have a documented source but one of attendings said that 80% of psychiatry work is outpatient. Some prefer to do mainy inpatient work but have outpt gigs on the side. There is also a lot of substance abuse, nursing home, and consultation work available if you are interested in that. Bottomline is that you can easily make 200K with a 50 hour work week in most regions.

 

[gman33]

Thanks for the info.
That's what I suspected.
There is a lot of physician salary info available, but they are not always comparing the same thing. If a significant portion of one's income comes from additional sources, you need to compare that as well.

 

[TX_Longhorn]

Aspiring Radiologist here,

but here in podunkville (west texas) there are child psychiatrists making over 500k. one general psychiatrist makes 800k - he has 2 PAs that work for him as well - he works crazy hours though.

 

[TheWowEffect]

Aspiring Radiologist here,

but here in podunkville (west texas) there are child psychiatrists making over 500k. one general psychiatrist makes 800k - he has 2 PAs that work for him as well - he works crazy hours though.

Well, we are talking starting salaries here. No psychiatrists will make that much in a starting job. There is, of course, potential to make much more once you get into the thick of things. 300K is is a pretty common figure into about 3 years of general adult work/practice for people who are willing to go the distance.

 

[Effervescent]

Yes, this is actually what a lot of psychiatrists in private sector do. They have a 32-40 hour regular job to get benefits, 401K etc. and either have their own practise on weekends and evenings or moonlight at a clinic or hospital. It is a little different if you are in academia.

Can anyone comment on what typical work hours / work duties and pay schedule are in academia? What percentage of academic psychiatrists are focused on research? Is it possible to incorporate "research" into one career without being totally focused on that? (ie - still have time for patient care, not be locked away in a room somewhere writing grants nonstop for the rest of one's natural years...) Do you get a base salary from the university and earn addt'l money on top of that based on patient care, teaching duties, research money you pull in, etc.? Or does the pay still come down to the # of patients you see? What are typical responsibilites one has toward the academic institution itself? (a certain amount of time required to be spend teaching or maybe on research?) are there a lot of additional "academic" obligations? (serving on committee, etc.?) how much will the internal "politics" of your institution (and staying "in good graces") impact on your career / autonomy?

Thanks in advance for anyone who has any input on this.

 

[whopper]

but here in podunkville (west texas) there are child psychiatrists making over 500k. one general psychiatrist makes 800k - he has 2 PAs that work for him as well - he works crazy hours though.

I don't know what the situation is like in TX, but in some of the underserved areas in the country--the pay for psychiatrists is much more.

I've mentioned this before. I know several of the other fields pay more (surgery, Ob-Gyn) but I've also noticed psychiatrists do not work as much as the practitioners in those other fields per hour. As for other fields like IM, in general psychiatrists tend to earn more per year & work even less hours.

As has been mentioned in other threads, there currently is a nationwide shortage of psychiatrists, but in some areas, the shortage has created much more hurt. In Iowa for example, average pay of a psychiatrist is $180,000 and if you move into an underserved county, the state gov will pay you an extra $40,000. From what I understand that extra 40,000 is per year, not a one time bonus.

Iowa is ranked the 47th state in terms of services given for psychiatry. The direct reason is lack of psychiatrists.

The shortage while good for us in terms of pay & job oppurtunities does also create problems for us as a profession. Psychologists are gaining ground in getting the ability to prescribe meds because of the shortage. Also, I've seen several hospitals employ bottom of the barrel psychiatrists & hold onto them because they can't get anyone else. The psychiatrist knows the hospital can't get anyone else & for that reason slack off & feel they can get away with it. That screws not only the patients but also the staff & psychiatrists that also have to work this with loser psychiatrist. I know, trust me. I've worked at places and read the chart and the psychiatrist has forgotten to order the appropriate labs, didn't screen the patients for the right things etc. Now that you're on duty, and your name is on the chart, now you got to pick up the slack or else you can be held responsible. I've even been told by upper management that they can't get rid of that psychiatrist because of the shortgage, and that we all had to just deal with the problem even though it was ticking all of us (minus that bad psychiatrist) off.

I'm currently practicing in a forensic unit in Cincnnati and I'm quite happy with the area. My wife is smitten with the area because there are so many more performing arts here than where we were before. I don't know where I'll be in 2 years but I am actively looking into the psychiatric shortage situation in this immediate area. I don't know what its like here, but the shortage factor will be strongly considered. It will affect my pay, but also the quality of the other psychiatrists in the area that I will have to deal with.

Can anyone comment on what typical work hours / work duties and pay schedule are in academia?

I can't give you a good picture since I'm not too sure about this one myself, but I hear academia does not pay anywhere near as much as the private sectors & community hospitals, even in the most reputable psychiatric academic institutions. The advantages of working in an academic institution is it can boost your reputation, give extensive links (nationwide if you're connected to the right places), you're exposed to others who have excellent knowledge & stay on top of it, & if you like teaching & less hands on, you can guide your residents to do much of the work.

Is it possible to incorporate "research" into one career without being totally focused on that?

Of course. I know several psychiatrists that do research, teaching & have a private practice. It depends on how much you're willing to put into each area & what you can work with the institution you are at.

 

[Doc Samson]

Can anyone comment on what typical work hours / work duties and pay schedule are in academia? What percentage of academic psychiatrists are focused on research? Is it possible to incorporate "research" into one career without being totally focused on that? (ie - still have time for patient care, not be locked away in a room somewhere writing grants nonstop for the rest of one's natural years...) Do you get a base salary from the university and earn addt'l money on top of that based on patient care, teaching duties, research money you pull in, etc.? Or does the pay still come down to the # of patients you see? What are typical responsibilites one has toward the academic institution itself? (a certain amount of time required to be spend teaching or maybe on research?) are there a lot of additional "academic" obligations? (serving on committee, etc.?) how much will the internal "politics" of your institution (and staying "in good graces") impact on your career / autonomy?

Thanks in advance for anyone who has any input on this.

There's no one answer to this, since practices vary widely by institution. In general, salaried pay is lower at more prestigious places BUT they'll let you do all the private practice you want and you pretty much get to "eat what you kill" in terms of research grants. At less prestigious (read: less financially secure) departments, the salary might be a little higher, but if you do private practice and/or research, they're going to want a significant piece of the pie.

You can incorporate research into your career and still practice clinically. Very few psychiatrists in my experience are "all research all the time".

 

[Iquitos]

Does anyone think this blog holds any water?

http://thelastpsychiatrist.com/2006/10/shortage_of_psychiatrists.html

I thought that psychiatry was a little more protected from the midlevel provider crunch than other specialties. Anyone dare to speculate if midlevel providers are going to bring down the current attractive psychiatrist salary?

 

[MBK2003]

Does anyone think this blog holds any water?

http://thelastpsychiatrist.com/2006/10/shortage_of_psychiatrists.html

I thought that psychiatry was a little more protected from the midlevel provider crunch than other specialties. Anyone dare to speculate if midlevel providers are going to bring down the current attractive psychiatrist salary?

The threat towards child psychiatrists by midlevel practitioners varies by region - here in Northern New England, most agencies and even inpatient units prefer to hire midlevels and then some part-time signature machine, i.e. child psychiatrist, to sign off on everything as the supervising psychiatrist of record. The quality of care compared with the average child psychiatrist in some of these outfits is outrageously bad and I'm still quite shocked by the lack of diagnostic rigorousness or acumen.
This has been entirely created by the child psychiatrists who are willing to sign off on these practices and don't stand up to the agency and say they want to have direct supervision and set parameters for care quality. We only have ourselves to blame for failing to take a stand on quality and supervision. I understand that there's a lack of child psychiatrists to cover rural regions of the area, but this has become the standard of care in the urban areas with plenty of available child psychiatrists, because midlevels are cheaper. Frankly, I'm not optimistic about the future job opportunities for child psychiatrists in our state, despite the appalling level of unmet need for child and adolescent mental health care.

 

[Iquitos]

The threat towards child psychiatrists by midlevel practitioners varies by region - here in Northern New England, most agencies and even inpatient units prefer to hire midlevels and then some part-time signature machine, i.e. child psychiatrist, to sign off on everything as the supervising psychiatrist of record. The quality of care compared with the average child psychiatrist in some of these outfits is outrageously bad and I'm still quite shocked by the lack of diagnostic rigorousness or acumen.
This has been entirely created by the child psychiatrists who are willing to sign off on these practices and don't stand up to the agency and say they want to have direct supervision and set parameters for care quality. We only have ourselves to blame for failing to take a stand on quality and supervision. I understand that there's a lack of child psychiatrists to cover rural regions of the area, but this has become the standard of care in the urban areas with plenty of available child psychiatrists, because midlevels are cheaper. Frankly, I'm not optimistic about the future job opportunities for child psychiatrists in our state, despite the appalling level of unmet need for child and adolescent mental health care.

This is not a good trend, and it seems to be echoing throughout medicine. I have read that midlevel's malpractice rates are starting to shoot through the roof because of these problems, so hopefully people might realize that lower cost does not equal better in the long run.