pill-pushing for more money

[aggiecrew]

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[purpledoc]

Roady mentioned something about this in a previous post so I wanted to ask it openly to the forum...

I'm wondering if being a pill-pusher is a necessary requirement for making a lot of money in psych.

No.

Argument being that you would have 2 options: be a pill-pusher running through patients as fast as possible; prescribing meds and then going on to the next patient, throw that patient a script and then go on...etc. OR do a lot of time consuming psychotherapy that does not pay very efficiently but allows you to really connect with the patient.

Depends what you mean by "lot of money," and you don't have to necessarily "run through patients as fast as possible." There are analysts in NYC that get paid $300 for a 45 minute psychotherapy session. They're making plenty of money. Nonetheless, $150 at 3 patients/hr trumps that, while still giving you 20 minutes per patient. On the other hand, a psychopharm practice means that you have to have hundreds more patients, since the psychopharm cases don't come in weekly. You also get a lot more phone calls and refill requests. So, that apparent extra money per hour may not really be all it's cracked up to be.

Now, I understand that if a private practice doc is struggling for business and he/she is trying to get his patients off of meds, then even if he/she succeeds and the patient can get off the meds, he/she will no longer have that patient to do med checks on and make money off of. he/she would be eliminating his chances for repeat business.

However, if the doc is not private practice and is not responsible for aquiring and keeping business for himself (or in general not having to worry about getting as many patients as he/she wants) , then he/she can take all his/her patients off of meds and still do a rapid-fire, see as many patients as possible for as short of a time as possible approach because he/she doesn't have to rely on repeat business. right?

I think you're looking at the wrong variables. Getting patients off of medications is actually harder and riskier than it sounds. You will have some patients relapsing and probably ending up in the hospital. You will also end up needing to see patients more frequently while tapering them off of medications than you would need to if they were stable on medications. Even if you dischage them, some of them will relapse later and return to you. On the other hand, if you have patients that you find a good medication regimen for and they are completely stable -- especially if there is a shortage of psychiatrists in your community, so you want to have space to see new patients who desperately need help -- you may discharge them from your practice, and have them continue treatment with their primary care doc.

In other words, keeping or losing patients is not simply dependent on your philosophy about medication use.

it would still be med checks because they are visiting for consults on meds, right?

I have to admit that I hate the term "med checks." It demeans what psychiatrists do.

I don't really know much about how this all goes down so anyone out there with experience in this who can enlighten us with how it works out there in the real world would be much appreciated!

You can basically do whatever you want to do, depending on the community you practice in. You can do initial consultations only and send patients back to their primary care docs. You can do only psychotherapy. You can do only psychopharmacology. You can do only forensic evaluations. You can do any combination thereof. Whether you are going to make money depends on a lot more than just those things -- and whether you are going to make a lot of money is not the most important thing in life!

Figure out what you want to do. Then figure out how to make a living doing it. Don't do the reverse.

Peace,
Purpledoc