Psych Competitiveness and Salary

[Psych747]

I was recently reading last year's match statististics and it seems in general psych is more competitive than IM, Neuro, FM, Peds

Atleast the match data should psych is in interim competitive range compared to specialties above.

In terms of salaries, keeping some IM specialities out (cards, GI, hem/onc); are psychiatrists making same/more than internists, general neurologists, and endorsed/nephro?

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[Merovinge]

Endo and nephro have notoriously bad salaries for IM, so those might not be the greatest comparison points. Hospitalists in IM generally make about the same per hour as in psych and there are a lot of openings for both. Non-ICU or interventional neuro tends to be pretty similar to psych as well. Salary should not be a deciding factor when deciding between IM, neuro, psych - all of them can pay decently or you can grind hard and make a lot of money in any of the fields

 

[bronx43]

Endo and nephro have notoriously bad salaries for IM, so those might not be the greatest comparison points. Hospitalists in IM generally make about the same per hour as in psych and there are a lot of openings for both. Non-ICU or interventional neuro tends to be pretty similar to psych as well. Salary should not be a deciding factor when deciding between IM, neuro, psych - all of them can pay decently or you can grind hard and make a lot of money in any of the fields

Endo is not notoriously bad for the amount you work. The fellows at my institution are getting 220-240k for 40-45 hours a week of outpatient a week and no call. It's not lucrative, but it's not into neph territory.

 

[Psych747]

I personally love psychiatry. I did a couple of IM prelim interviews and my only logic at that time was maybe getting a strong medicine foundation, doing a year so I can manage my geriatric and co/morbid psych patients myself.

Though it might have been a bad idea, would do a few extra electives in IM as PG-4.


Basically salaries are about the same in Psyc, internist role, few IM si specialties, and non- intervention Neuro?

I am hoping psych salaries will be above ones listed above in a few years. From research I have done psych is becoming conparatively more competitive than before and it is in HUGE demand!

 

[clausewitz2]

I personally love psychiatry. I did a couple of IM prelim interviews and my only logic at that time was maybe getting a strong medicine foundation, doing a year so I can manage my geriatric and co/morbid psych patients myself.

Though it might have been a bad idea, would do a few extra electives in IM as PG-4.


Basically salaries are about the same in Psyc, internist role, few IM si specialties, and non- intervention Neuro?

I am hoping psych salaries will be above ones listed above in a few years. From research I have done psych is becoming conparatively more competitive than before and it is in HUGE demand!

At the end of the day pay is determined more by the choices made by CMS than any traditional notion of supply and demand. American healthcare is not a functioning market in any sense your Econ 101 textbook would recognize.

 

[Psych747]

At the end of the day pay is determined more by the choices made by CMS than any traditional notion of supply and demand. American healthcare is not a functioning market in any sense your Econ 101 textbook would recognize.

I studied public health and it seems it will become supply and demand, areas with huge shortage will have lucrative benefits to attract us to serve their communities.

 

[clausewitz2]

I studied public health and it seems it will become supply and demand, areas with huge shortage will have lucrative benefits to attract us to serve their communities.

Except that the revenue these institutions can generate from their psychiatric services is determined by what payors will fork over. Sure, psych can be and frequently is a legally mandated loss leader, but there is only so much money you can hemorrhage at the end of the day.

Obviously private cash pay is a different story.

 

[MacDonaldTriad]

Here is psychiatry’s supply and demand dynamic.

The DOJ (feds) snoop around prisons and jails and then demands that states and county governments staff more psychiatrists.

The local government agencies supply the budgets to give psychiatrists a lot more money to work in these places, largely by stripping the more community oriented or academic but government supported resources.

And that my friend is about the only supply and demand dynamic, unless you are cash only of course.

 

[BackToday]

Here is psychiatry’s supply and demand dynamic.

The DOJ (feds) snoop around prisons and jails and then demands that states and county governments staff more psychiatrists.

The local government agencies supply the budgets to give psychiatrists a lot more money to work in these places, largely by stripping the more community oriented or academic but government supported resources.

And that my friend is about the only supply and demand dynamic, unless you are cash only of course.

I've heard that 40 or 45% of Psychs are cash only or accept very limited insurance. This can't be true, right?

 

[J ROD]

Psychiatry is gonna be the "new" derm.... lol

 

[Psych747]

Except that the revenue these institutions can generate from their psychiatric services is determined by what payors will fork over. Sure, psych can be and frequently is a legally mandated loss leader, but there is only so much money you can hemorrhage at the end of the day.

Obviously private cash pay is a different story.

So the census is psych salary is at the same level as e do

Psychiatry is gonna be the "new" derm.... lol

I hear the same thing from so many people. Probably it will not become competitive as derm but will be overtaking radiology very very soon as reimbursements go down for radio.

I hope this means that salaries will increase to 300K+

 

[PistolPete]

I've heard that 40 or 45% of Psychs are cash only or accept very limited insurance. This can't be true, right?

It is true.

 

[notdeadyet]

I've heard that 40 or 45% of Psychs are cash only or accept very limited insurance. This can't be true, right?

We don't so much have a psychiatrist shortage. We have a shortage of psychiatrists willing to treat the underserved (uninsured, underinsured, and geographically remote).

If you're willing to pay cash in a big city, you will find your psychiatrist. If not, be prepared to wait.

 

[Blitz2006]

So the census is psych salary is at the same level as e do


I hear the same thing from so many people. Probably it will not become competitive as derm but will be overtaking radiology very very soon as reimbursements go down for radio.

I hope this means that salaries will increase to 300K+

Already can:

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

20% of psychiatrists earn >300k. And 70% of psychiatrists work <40 hours/week. So statistically, if you work 50 hour weeks you should be able to clear 300k easily. If you work in cash only areas (LA/SF/NYC) you can probably hit 400k-450k if you hustle.

Likewise, you can clear 350k in the midwest in an inpatient setting. But most likely you will be working in poor conditions/middle of nowhere.

And salaries are only going up in mental health, with a booming job market. But like notdeadyet said, the booming job market is lopsided and occurring more so in areas of underserved population.

Regardless, exciting time to go into psych.

I know a PGY2 resident in Radiology (NYC area) that wants to switch into Psych because of the terrible rads job market.

 

[Psych747]

Already can:

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

20% of psychiatrists earn >300k. And 70% of psychiatrists work <40 hours/week. So statistically, if you work 50 hour weeks you should be able to clear 300k easily. If you work in cash only areas (LA/SF/NYC) you can probably hit 400k-450k if you hustle.

Likewise, you can clear 350k in the midwest in an inpatient setting. But most likely you will be working in poor conditions/middle of nowhere.

And salaries are only going up in mental health, with a booming job market. But like notdeadyet said, the booming job market is lopsided and occurring more so in areas of underserved population.

Regardless, exciting time to go into psych.

I know a PGY2 resident in Radiology (NYC area) that wants to switch into Psych because of the terrible rads job market.

Agree just reassuring myself. Job prospect is good, and most importantly it's our interest in mental health.

Yes, radiology job prospects are going down. I have been witnessing radiology falling down. Also, quite a few programs went unmatched last year.

 

[Blitz2006]

Agree just reassuring myself. Job prospect is good, and most importantly it's our interest in mental health.

Yes, radiology job prospects are going down. I have been witnessing radiology falling down. Also, quite a few programs went unmatched last year.

and if you want to check out specialty competitiveness, just check out this Excel file:

https://www.aamc.org/services/eras/stats/

This year is the first time in 15 years IM Categorical has seen a DECREASE in US MD applications....very interesting. I'm curious to see the charting outcomes when they are released in 2018.

 

[splik]

I've heard that 40 or 45% of Psychs are cash only or accept very limited insurance. This can't be true, right?

Not it's not exactly true. This figure is for exclusively office based private practice psychiatrists, which make up fewer than 10% of all psychiatrists in the US. Most psychiatrists who do private practice have another job either as their primary or secondary to diversity their practice, get benefits (e.g. pension, health insurance), or as another revenue stream (most psychiatrists in most parts of the country could not expect to fill up a cash practice). This represents about 1/3 of psychiatrists (who do pp and another job as well). Psychiatrists work in many different settings including psychiatric hospitals, general hospitals, prisons and jails, VAs, academic medical centers and medical schools, nursing homes, schools, colleges, community mental health centers, and HMOs like Kaiser.

Psychiatrists who choose to go into office based private practice don't tend do it for the money (you could in many circumstances make more money taking insurance) but for autonomy, because they wish to have a psychotherapy practice, want to choose their own hours, don't want to deal with the hassles of billing or insurance companies setting limits on treatment etc. Most patients outside of specific major metropolitan areas expect to be able to use their insurance for their mental health care. Also in some parts of the country pays much better than others (for example Oregon) so you see more people taking insurance, though yes it will typically be limited to certain insurances that are less hassle and offer decent renumeration.

The average high volume med management practice that takes insurance would make more money than the average psychotherapy based cash practice.

So it's about 5% of psychiatrists who do only office based pp and take only cash (though there is another 15% who do some pp and don't take cash). The bigger issue is that most pp psychiatrists don't take medicaid or medicare, and there are many insurances that also wont be accepted because they are so terrible. Most of the Obama care plans are pretty bad when it comes to mental health but will get you into a CMHC - which in my areas have become inundated with referrals and can't cope.

 

[Psychotic]

Not it's not exactly true. This figure is for exclusively office based private practice psychiatrists, which make up fewer than 10% of all psychiatrists in the US. Most psychiatrists who do private practice have another job either as their primary or secondary to diversity their practice, get benefits (e.g. pension, health insurance), or as another revenue stream (most psychiatrists in most parts of the country could not expect to fill up a cash practice). This represents about 1/3 of psychiatrists (who do pp and another job as well). Psychiatrists work in many different settings including psychiatric hospitals, general hospitals, prisons and jails, VAs, academic medical centers and medical schools, nursing homes, schools, colleges, community mental health centers, and HMOs like Kaiser.

Psychiatrists who choose to go into office based private practice don't tend do it for the money (you could in many circumstances make more money taking insurance) but for autonomy, because they wish to have a psychotherapy practice, want to choose their own hours, don't want to deal with the hassles of billing or insurance companies setting limits on treatment etc. Most patients outside of specific major metropolitan areas expect to be able to use their insurance for their mental health care. Also in some parts of the country pays much better than others (for example Oregon) so you see more people taking insurance, though yes it will typically be limited to certain insurances that are less hassle and offer decent renumeration.

The average high volume med management practice that takes insurance would make more money than the average psychotherapy based cash practice.

So it's about 5% of psychiatrists who do only office based pp and take only cash (though there is another 15% who do some pp and don't take cash). The bigger issue is that most pp psychiatrists don't take medicaid or medicare, and there are many insurances that also wont be accepted because they are so terrible. Most of the Obama care plans are pretty bad when it comes to mental health but will get you into a CMHC - which in my areas have become inundated with referrals and can't cope.

Where are you getting those PP/cash numbers? I have never read them before (the 5 percent, etc). If your numbers are right, then what is reported is extremely misleading if not just wrong...

 

[yanks26dmb]

If someone was dead set on living in a specific geographic area, socal for instance, would it be possible to find a job after residency?

I'm assuming salary would be lower in a nicer city, but ideally I'd like to find something in LA/SD/OC and perhaps supplement that by doing locums in a more rural locale a couple of weekends a month.

 

[SoulinNeed]

http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.151.1.89?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed

It's probably fewer now as office based private practice went into decline for quite a while and has only seen a resurgence recently

it's not really misleading - half of all psychiatrists in private don't take insurance. but the overwhelming majority psychiatrists aren't office based pp psychiatrists, or don't do that exclusively so they do take insurance in some capacity, just not in their pp. I don't think anyone suggested that most psychiatrists could be found in pp - that is clearly not the case. Most psychiatrists do not have the business savvy to sustain a full time cash private practice. And given that only a few programs emphasize psychotherapy as part of the training of their residents, it's not a massive number of psychiatrists who are going into psychotherapy based practice, and all these psychiatrists are coming from the same places.

That data is 30 years ago? How accurate is it? If it's not PP, then where do Psychiatrists practice?

 

[splik]

That data is 30 years ago? How accurate is it? If it's not PP, then where do Psychiatrists practice?

well the number of solo office-based pp psychiatrists has significantly declined over the past 40 years, so one might expect the figure to be less (though there has been some resurgence in private practice in recent years). I already listed many of the settings in which psychiatrists work in.

 

[notdeadyet]

I think the disconnect here is using private practice synonymously with solo practice.

Most folks use private practice to mean a solo or group practice (vs working for city, county, state, Feds, or non-prof).

 

[Mad Jack]

I was recently reading last year's match statististics and it seems in general psych is more competitive than IM, Neuro, FM, Peds

Atleast the match data should psych is in interim competitive range compared to specialties above.

In terms of salaries, keeping some IM specialities out (cards, GI, hem/onc); are psychiatrists making same/more than internists, general neurologists, and endorsed/nephro?

Psych earns less than neurology and nephrology by a bit, more than rheum, IM, and endocrine.

Psychiatry is far less competitive than IM by a wide margin, and less competitive than neurology by a decent amount as well. The only specialty that has consistently been less competitive than psychiatry is FM.

 

[Mad Jack]

If someone was dead set on living in a specific geographic area, socal for instance, would it be possible to find a job after residency?

I'm assuming salary would be lower in a nicer city, but ideally I'd like to find something in LA/SD/OC and perhaps supplement that by doing locums in a more rural locale a couple of weekends a month.

http://www.indeed.com/q-psychiatrist-$150,000-l-los-angeles,-ca-jobs.html

 

[SoulinNeed]

I think the disconnect here is using private practice synonymously with solo practice.

Most folks use private practice to mean a solo or group practice (vs working for city, county, state, Feds, or non-prof).

Maybe that's where I'm confused. Most of the job openings I see online are from groups looking to hire and I view groups as PP.

 

[Blitz2006]

View attachment 200661
Psych earns less than neurology and nephrology by a bit, more than rheum, IM, and endocrine.

View attachment 200662
Psychiatry is far less competitive than IM by a wide margin, and less competitive than neurology by a decent amount as well. The only specialty that has consistently been less competitive than psychiatry is FM.

Refer to my above post, post #14.

These Medscape averages are skewed by number of hours Psychiatrists work (heavily on <40). I'm just a resident and I'm already receiving job offers on APA Job Central and finding jobs on Merritt Hawkins averaging 275-300k without even doing any proper "job hunting", just browsing for fun. Granted I'm sure many of these jobs are undesirable in underserviced areas, but it should be dragging the average up if people who working full time hours (40-50).

Even the other specialities are off. OBGYN looks low, the average around here is 350-400k. But also OBGYN pays on average 100-140k in malpractice. Even Optho is higher lower in real life (Retina guys clear 400-500 easy), but again, they have one of the highest overhead fees in the business (roughly 40%). I suspect its the academic guys dragging them down to $292k.



You're right about the competitiveness, but that chart is taken from 2014 charting outcomes. Lets see what it shows in 2018 charting outcomes. I suspect psych will be on par IM/Neuro, and overtaken peds/PMR. But just my prediction.

 

[Mad Jack]

Refer to my above post, post #14.

These Medscape averages are skewed by number of hours Psychiatrists work (heavily on <40). Even the other specialities are off. OBGYN looks low, the average around here is 350-400k. But also OBGYN pays on average 100-140k in malpractice.

You're right about the competitiveness, but that chart is taken from 2014 charting outcomes. Lets see what it shows in 2018 charting outcomes. I suspect it will be much closer on park with IM/Neuro

I agree with you in all respects. But in respect to working more for more money, anyone can- a hospitalist picking up an extra shift can out-earn the average psychiatrist, for instance. Nothing is cut and dry. In regard to psych competitiveness- I doubt it will approach IM by 2018, but it will get there eventually.

 

[J ROD]

Yeah, I think it will get closer but Psychiatry itself is so much a self selector that I think it will always be somewhat contained. But, I think it will move more to the middle.

 

[Blitz2006]

I agree with you in all respects. But in respect to working more for more money, anyone can- a hospitalist picking up an extra shift can out-earn the average psychiatrist, for instance. Nothing is cut and dry. In regard to psych competitiveness- I doubt it will approach IM by 2018, but it will get there eventually.

I kind of disagree with you. Because the cardiologists and orthopods that I have spoke to at my hospital, earn around 350-400k. But they are working already around 60 hrs/week and are pretty much maxed out (I don't think it is realistically physically possible to be working 70-80 hours/week as an attending and to be sustainable)

Whereas in Psychiatry the average of 216k is spearheaded by people working 30 hr weeks, part time parents, etc. Again, I'm only familiar with the NYC area, but most of the psychiatrists here who crack 45-50 hours is averaging around 300k (Brooklyn/Queen's/Long Island). And if you crank it up to 55-60 hours/week (cardiology/general surgery hours), you can approach 350k...But yes, that is pretty taxing mentally, so I dont know how sustainable it is. But there are people here who do it. and the cash only guys in Manhattan, some area killng it, but I'm not including them in the conversation because they are outliers and definitly not representative of "mainstream psychiatry".

and I know the rebuttal is that there are cardiologists and orthopods making 600-750k. And I'm sure there are a few. But I don't that is the norm anymore. And below is a thread, where I cross-examined other forums and posted the links. Post #311.

http://forums.studentdoctor.net/threads/so-can-we-talk-money.1162751/page-7#post-17253681

According to those threads, very few derm/ENT actually clear above 500k.

Anecdotally, I was talking to an Anesthesiologist. He was saying that the average pain doctor in this area earns around 450k-500k (and this is one of the highest reimbursed subspecialities) to put it in perspective.

 

[yanks26dmb]

http://www.indeed.com/q-psychiatrist-$150,000-l-los-angeles,-ca-jobs.html

I'm guessing when these jobs specify "MD" degree, a DO will suffice as well....?

 

[J ROD]

I'm guessing when these jobs specify "MD" degree, a DO will suffice as well....?

more than likely yes. However, I would think some places may only want MD.

But they are degree equivalent.

 

[Dharma]

I'm guessing when these jobs specify "MD" degree, a DO will suffice as well....?

Yes. I doubt it will make a difference.

 

[Mad Jack]

I'm guessing when these jobs specify "MD" degree, a DO will suffice as well....?

Rare is the place that cares in psych.

 

[kirkirkir]

I'm guessing when these jobs specify "MD" degree, a DO will suffice as well....?

Has anyone encountered this?

 

[smalltownpsych]

Requiring MD degree in the ad usually means no midlevels and the HR person just didn't put both degrees down. I see it all of the time with psychologist positions. Some say PhD others say PhD/PsyD, typically they won't care or even know so long as you are qualified. Although for academic research intensive positions very few PsyDs would qualify and in a few places there could be bias against the degree itself, but I have never seen it personally. I would be amazed that anyplace looking for a board certified psychiatrist would be picky about whether they were MD or DO. Our hospital would probably take a board certified psychiatrist who had the initials DOA. I see a whole Weekend at Bernie's sequel in the making.