Psych is the new derm

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Psychdoc4755

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I know this topic has been discussed to death, but I'd like to briefly resurrect it for good reason. I am noticing a few key trends in this specialty which make me very optimistic about its long term future. I'll keep it brief, structured, and to the point.

There is strongly increasing 'Mental Health' awareness in society. What was once a stigmatized, fringe sector within healthcare is now being brought to the forefront of all medicine. Fauci himself was even at APA last month because it simply cannot be ignored. Mental health these days is being touted as the most important factor within one's overall health especially for GenZ/Millennials. In these more conscientious groups, physical ailments are often not nearly as common as mental due to the abundance of advancements in preventative medicine (vaccines, healthier lifestyles, cheap/effective treatments), thus their complaints will become over time for mental in nature as opposed to physical. Similar to how patients in third-world counties with psych issues present with 'pain' as CC, patients in first-world countries will primarily present will mental health complaints as time progresses over the next several years/decades.

What this will ultimately result in is a drastic increase in competitiveness of this specialty within the next 5-10+ years as psychiatrists become more and more in demand, thus their reimbursements will increase. I've already noticed over the last 1.5 years a significant increase in the offers I get from recruiters for the same types of jobs.

Within the years to come, compensation will likely rival/surpass specialties like derm, anesthesia, ortho as psych enters the 'bougie' category or 'ROAD' specialties or whatever they call them these days lol
 
No..just no…psych will never become the new derm..ever..they do a million procedures as the core of their specialty which is where the money comes from..we do 0 procedures..in psych you can expect to make 250k for 40 hours of work..they make about 450k for 40 hours of work…so again..no..
 
No, psych is not the new derm. I have been looking for a new job for over a year. There were 50 mid-level positions for every one psychiatrist position. Some patients will cash pay psychiatrists, many won't. I and many others cash pay a dermatologist for cosmetic procedures. There is no way on earth I would cash pay a mid-level for botox of fillers. I am also having a fairly rare skin cancer removed by a different dermatologist this week because the surgery requires wide excision biopsy and MOHS. I can't see a mid-level ever being able to perform such a surgery. There is definitely a need for more psychiatrists, but that need is being taken by mid-levels. I am currently working as a locums and they are keeping me until "we can find a new psychiatrist , PA, or NP". I am not seeing an increase in compensation for positions in psychiatry. I am seeing a decrease in psychiatry positions . I don't think mid-levels provide the same quality, but the average patient has no idea if they are seeing a physician, NP or PA. People seeking out cosmetic procedures tend to be extremely particular. I'm in psychoanalysis with a psychiatrist who takes insurance 5x a week. I couldn't possibly afford to see him if he didn't take my insurance. If he opted to do a cash only practice, I wouldn't see anyone for therapy.
 
What are starting salaries for dermatologists? Anesthesia? Ortho? Optho right out of residency?

I'm seeing regular 400K+ offers with expectations of standard 40-45 hour work week in desirable areas. I'm sure there's much more to be made in other locations, settings above even those initial figures
 
Psychdoc4755 said:
I know this topic has been discussed to death, but I'd like to briefly resurrect it for good reason. I am noticing a few key trends in this specialty which make me very optimistic about its long term future. I'll keep it brief, structured, and to the point.

There is strongly increasing 'Mental Health' awareness in society. What was once a stigmatized, fringe sector within healthcare is now being brought to the forefront of all medicine. Fauci himself was even at APA last month because it simply cannot be ignored. Mental health these days is being touted as the most important factor within one's overall health especially for GenZ/Millennials. In these more conscientious groups, physical ailments are often not nearly as common as mental due to the abundance of advancements in preventative medicine (vaccines, healthier lifestyles, cheap/effective treatments), thus their complaints will become over time for mental in nature as opposed to physical. Similar to how patients in third-world counties with psych issues present with 'pain' as CC, patients in first-world countries will primarily present will mental health complaints as time progresses over the next several years/decades.

What this will ultimately result in is a drastic increase in competitiveness of this specialty within the next 5-10+ years as psychiatrists become more and more in demand, thus their reimbursements will increase. I've already noticed over the last 1.5 years a significant increase in the offers I get from recruiters for the same types of jobs.

Within the years to come, compensation will likely rival/surpass specialties like derm, anesthesia, ortho as psych enters the 'bougie' category or 'ROAD' specialties or whatever they call them these days lol
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I like your thinking but this is unlikely to play out in this fashion.

I'm currently in a saturated area with an ARNP school next door, and I keep finding new brick/motor and new tele ARNP practices popping up. I'm experiencing very slow growth rate. Some percentage is definitely my fault how I've structured my intakes, but the majority peercent is due to saturation. I have 3 major insurance companies locally that make up my payer mix. One which is a national, publicly traded company, that pays out dividends is united in its resistance to pay Psychiatrists higher contracted rates. The rumors of those who have seem to get it, is 10% if that. My attempt recently failed and as such I'm dropping this company. Paying below medicare rates simply isn't sustainable. I'm waiting on the rate review with the another large publicly traded company to see if their rates will increase like the growth of a young new tree. However, this company also pays lower than medicare locally. That means much of my practice viability is centered around one insurance company - that pays well - but in other geographic areas pays so low that Psychiatrists go blue in the face and bodily sign the cross as they curse this company. My current insurance taking status is essentially at the whims of one company and the flick of a pen from them, trouble could ensue.

With dropping the one insurance currently, its looking like 15-20% conversion rate of those patients willing to cash pay.

My small social circle I've heard of too many Psychiatrists losing their jobs to ARNPs. Market forces at play by Big Box shops favor them as the real benefactors - not the rank and file Psychiatrists - but the Big Box shops. They can get the better paying contracts. I've posted elsewhere how a 99214 for the dermatologist I saw at a Big Box shop was paid out at ~$305. Insurance companies, don't won't shan't give favorable rates to small independent Psychiatrists. With the ever increasing numbers of ARNPs and lack of knowledge by the layman of them versus us, cash markets will also be a tough road ahead and now is the time to lay a claim to this before the flood ensues by every one else.

One thing has been in a constant in the usual paradigm of change. Psychiatry is neglected, and we as a whole get scat on. Do not expect Psychiatry to be an undeniable, inducted member of ROAD.

Psychiatry has many positives, and the ability to open a practice and the flexibility to transition form multiple practice settings; but the local hospital CEOs won't ever come knocking on my door offering to facilitate a lease in the next door medical building and communications non-verbally to others that we are the new ortho/GI/Cards/CT Surgeons, etc.
 
Psychdoc4755 said:
What are starting salaries for dermatologists? Anesthesia? Ortho? Optho right out of residency?

I'm seeing regular 400K+ offers with expectations of standard 40-45 hour work week in desirable areas. I'm sure there's much more to be made in other locations, settings above even those initial figures
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I’ve never seen 400k for 40 hours advertised for psych in desirable areas..send over some proof…
 
robellis said:
I’ve never seen 400k for 40 hours advertised for psych in desirable areas..send over some proof…
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Locums. I am getting 200 an hour. It's pretty close. I don't work holidays and take days off and vacations which aren't paid for, but if I didn't take any days off it would be 400k, Looking at slightly over that for a position in which I consider a desirable area. (MetroDetroit, Mich). I think desirable area I think is person dependent. I wouldn't want to work in NYC it's so overcrowded, but some people like it.
But psychiatry isn't now and never will be the new dermatology.
 
futuredo32 said:
Locums. I am getting 200 an hour. It's pretty close. I don't work holidays and take days off and vacations which aren't paid for, but if I didn't take any days off it would be 400k, Looking at slightly over that for a position in which I consider a desirable area. (MetroDetroit, Mich). I think desirable area I think is person dependent. I wouldn't want to work in NYC it's so overcrowded, but some people like it.
But psychiatry isn't now and never will be the new dermatology.
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Thinking of doing straight locums after residency. How easy is it to get time off? I'd ideally take 8-12 weeks off a year.
 
Sushirolls said:
I like your thinking but this is unlikely to play out in this fashion.

I'm currently in a saturated area with an ARNP school next door, and I keep finding new brick/motor and new tele ARNP practices popping up. I'm experiencing very slow growth rate. Some percentage is definitely my fault how I've structured my intakes, but the majority peercent is due to saturation. I have 3 major insurance companies locally that make up my payer mix. One which is a national, publicly traded company, that pays out dividends is united in its resistance to pay Psychiatrists higher contracted rates. The rumors of those who have seem to get it, is 10% if that. My attempt recently failed and as such I'm dropping this company. Paying below medicare rates simply isn't sustainable. I'm waiting on the rate review with the another large publicly traded company to see if their rates will increase like the growth of a young new tree. However, this company also pays lower than medicare locally. That means much of my practice viability is centered around one insurance company - that pays well - but in other geographic areas pays so low that Psychiatrists go blue in the face and bodily sign the cross as they curse this company. My current insurance taking status is essentially at the whims of one company and the flick of a pen from them, trouble could ensue.

With dropping the one insurance currently, its looking like 15-20% conversion rate of those patients willing to cash pay.

My small social circle I've heard of too many Psychiatrists losing their jobs to ARNPs. Market forces at play by Big Box shops favor them as the real benefactors - not the rank and file Psychiatrists - but the Big Box shops. They can get the better paying contracts. I've posted elsewhere how a 99214 for the dermatologist I saw at a Big Box shop was paid out at ~$305. Insurance companies, don't won't shan't give favorable rates to small independent Psychiatrists. With the ever increasing numbers of ARNPs and lack of knowledge by the layman of them versus us, cash markets will also be a tough road ahead and now is the time to lay a claim to this before the flood ensues by every one else.

One thing has been in a constant in the usual paradigm of change. Psychiatry is neglected, and we as a whole get scat on. Do not expect Psychiatry to be an undeniable, inducted member of ROAD.

Psychiatry has many positives, and the ability to open a practice and the flexibility to transition form multiple practice settings; but the local hospital CEOs won't ever come knocking on my door offering to facilitate a lease in the next door medical building and communications non-verbally to others that we are the new ortho/GI/Cards/CT Surgeons, etc.
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Damn. So psych is the new EM. Bummer.
 
In all seriousness with the whole PA/ARNP thing, I'm pretty sure every subspecialty board is worried about this and I swear I can go back 15 years on these boards,etc and find posts of people fear mongering about this. Worse case scenarios even if it is true, we just transition to a more supervisory role with appropriate compensation. Do you guys seriously think that people will just stop seeing doctors and there will no longer be physicians in society soon because of some PAs/ARNPs that took our jobs? Lol
 
Psychdoc4755 said:
In all seriousness with the whole PA/ARNP thing, I'm pretty sure every subspecialty board is worried about this and I swear I can go back 15 years on these boards,etc and find posts of people fear mongering about this. Worse case scenarios even if it is true, we just transition to a more supervisory role with appropriate compensation. Do you guys seriously think that people will just stop seeing doctors and there will no longer be physicians in society soon because of some PAs/ARNPs that took our jobs? Lol
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The scope creep is increasing. PA's are now called something else. They are gaining more autonomy. As mentioned,during the past year I have been looking for a new job. 50 midlevel psych positions for one psychiatrist position.
 
The one exception may be if you compared derm to forensic psychiatry (expert witness work). Expert witness work is cash paid and there is no real mid-level encroachment.
 
Psych is good or bad depending on region and setting.

As mentioned previously I don't see much encroachment in settings where one has to regularly interact with lawyers, however I've been surprised before.
 
Psychiatry compensation already went up significantly a few years ago, and we will likely see a correction (i.e. reduction) in the coming years. I have already seen that many jobs are paying roughly the same as they were 5 yrs ago (i.e. less, adjusting for inflation). My salary is essentially the same as it was when I started 4 yrs ago. Some people even took a pay cut because of the pandemic. In academic departments, they did increase salaries to try to recruit people, but those efforts haven't helped much and what I've seen in my own department and elsewhere is that departing psychiatrists are being replaced with NPs. Which is to say, rather than pay competitively for psychiatrists these departments are now diluting their brand by hiring NPs instead. Psychiatry has also created hundreds of new residency positions whereas derm positions have stayed stagnant and NPs are not used interchangeably with dermatologists.

There has been a lot of attention to mental health in the commercial sphere but none of these will have a positive impact on the revenue psychiatrists are making. It's a race to the bottom out there with all these mental health apps flooding the marketplace with care delivered by masters levels therapists and NPs mostly. And now we have the likes of CVS and other pharmacies trying to deliver mental health care on the cheap.

Let's not even get into the parity issues. the MHPAE Act and ACA were supposed to bring us mental health parity but it is still possible for patients to have insurance with NO mental health benefits, and frequently these benefits are tossed to garbage "behavioral health carve outs" and denials are common. Dermatologists typically get reimbursed way more for E&M codes than psychiatrists (which doesn't even account for the fact that they make way more by doing procedures which we don't do).

I do not want to sound all doom and gloom as I love what I do and am very well compensated (but have multiple revenue streams including consulting and forensic work) and even with the above issues psychiatry is a fantastic field for the right people but these periodic "psych is the new derm" posts are a defense and seem to prove the point that psychiatry is still the ugly step child in medicine.

The one exception may be if you compared derm to forensic psychiatry (expert witness work). Expert witness work is cash paid and there is no real mid-level encroachment.
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Except that dermatology expert witnesses charge over $1000/hr. How many forensic psychiatrists can charge that much?
 
Another way to look at Psychiatry is, as the Titantic of the Healthcare ship sinks we will be on better part of the boat that had more life rafts available to reach compared to most other specialties. But even within Psychiatry not all will reach a life raft.

Aim for FIRE as best as possible. Have a plan B in the back of your mind.
 
Here's an interesting link about dermatologists discussing their compensation:

forums.studentdoctor.net

3 day work week with 500k salary

500k for three days per week will be difficult. However, you may realize you would rather work 3 days a week and make "less" money than work 4-5 days a week to hit 500k. Yeah... Even making 300k/yr working 3 days/wk (24-27 hrs) is quite remarkable.
forums.studentdoctor.net forums.studentdoctor.net

A good rule of thumb to use in dermatology private practice is 1 full day = $100k / year (1099).

On average dermatology pay is still higher than psychiatry pay, but it isn't astronomically higher.

Pick the specialty that is best suited for you. You are more likely to make high income in a specialty you love than a specialty you don't love. I suspect the higher earner psychiatrists have more in common with high earners in other specialties than with lower earner psychiatrists. Once you get past 90th percentile income in the specialty, making money is less about working in medicine but more about ancillary income from ownership and investments.
 
"psych is the new derm" is a meme. People like to sound as if they know what they're talking about...just because plenty of people say something, a truth does not it make. Psych has too many residency spots compared to derm
 
futuredo32 said:
The scope creep is increasing. PA's are now called something else. They are gaining more autonomy. As mentioned,during the past year I have been looking for a new job. 50 midlevel psych positions for one psychiatrist position.
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A brief search on my favorite job aggregator generated 3,621 psychiatric NP and 3,474 psychiatrist positions. Hardly 50:1 nationally
 
Sushirolls said:
Another way to look at Psychiatry is, as the Titantic of the Healthcare ship sinks we will be on better part of the boat that had more life rafts available to reach compared to most other specialties. But even within Psychiatry not all will reach a life raft.

Aim for FIRE as best as possible. Have a plan B in the back of your mind.
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That's the goal- work hard and put away as much money as possible to ensure a comfortable retirement within 10 years of practice. Build a cash-only private practice on the side so you've got a job where the only person that can fire you is your patient. The ship isn't sinking fast enough to make that an impossibility.
 
splik said:
Psychiatry compensation already went up significantly a few years ago, and we will likely see a correction (i.e. reduction) in the coming years. I have already seen that many jobs are paying roughly the same as they were 5 yrs ago (i.e. less, adjusting for inflation). My salary is essentially the same as it was when I started 4 yrs ago. Some people even took a pay cut because of the pandemic. In academic departments, they did increase salaries to try to recruit people, but those efforts haven't helped much and what I've seen in my own department and elsewhere is that departing psychiatrists are being replaced with NPs. Which is to say, rather than pay competitively for psychiatrists these departments are now diluting their brand by hiring NPs instead. Psychiatry has also created hundreds of new residency positions whereas derm positions have stayed stagnant and NPs are not used interchangeably with dermatologists.

There has been a lot of attention to mental health in the commercial sphere but none of these will have a positive impact on the revenue psychiatrists are making. It's a race to the bottom out there with all these mental health apps flooding the marketplace with care delivered by masters levels therapists and NPs mostly. And now we have the likes of CVS and other pharmacies trying to deliver mental health care on the cheap.

Let's not even get into the parity issues. the MHPAE Act and ACA were supposed to bring us mental health parity but it is still possible for patients to have insurance with NO mental health benefits, and frequently these benefits are tossed to garbage "behavioral health carve outs" and denials are common. Dermatologists typically get reimbursed way more for E&M codes than psychiatrists (which doesn't even account for the fact that they make way more by doing procedures which we don't do).

I do not want to sound all doom and gloom as I love what I do and am very well compensated (but have multiple revenue streams including consulting and forensic work) and even with the above issues psychiatry is a fantastic field for the right people but these periodic "psych is the new derm" posts are a defense and seem to prove the point that psychiatry is still the ugly step child in medicine.


Except that dermatology expert witnesses charge over $1000/hr. How many forensic psychiatrists can charge that much?
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The point I was making was there was an option as a psychiatric expert witness who can bill $600/hr and that should be close to what dermatologists can make as a clinician. It is not an apples-to-apples type comparison but I just wanted to throw that out as an option. I am not sure if there are dermatology expert witnesses able to do expert witness work part-time like forensic psychiatrists. I even know of forensic psychiatrists who do only forensic expert witness work and zero clinical work (rare and not something I recommend). I would imagine there are med-mal cases for maybe cosmetic damages but how often will you have a disability or wrongful death in a derm case (undiagnosed skin cancer??). I could be wrong and if there so few derm experts out there, they could be filling up their expert practices.
 
Didn't forensic folks make a society declaration that IME folks need to have at leas 25-50% clinical practices, in effort to dissuade / shut down the roving 100$ 100% testimony docs?
 
To some extent, certain kinds of psych jobs are *superior* to certain kinds of derm jobs.

I know several dermatologists. They typically work harder and make less money than I do. However, I make more than the average psychiatrist, especially on a per-hour basis. I would also claim that the value-add of my service vis-a-vis the service by a typical cosmetic dermatological procedure, my service wins hands down. So in that sense, I'm underpaid.

Psych is also a much larger specialty than derm. If you take the top 10% of psychiatrists and the average dermatologists, the lifestyles are perhaps comparable. However, if you drop a notch below that, the statement starts to fall apart. So I think this "psych is the new derm" thing is not accurate.
 
psyguru said:
The point I was making was there was an option as a psychiatric expert witness who can bill $600/hr and that should be close to what dermatologists can make as a clinician. It is not an apples-to-apples type comparison but I just wanted to throw that out as an option. I am not sure if there are dermatology expert witnesses able to do expert witness work part-time like forensic psychiatrists. I even know of forensic psychiatrists who do only forensic expert witness work and zero clinical work (rare and not something I recommend). I would imagine there are med-mal cases for maybe cosmetic damages but how often will you have a disability or wrongful death in a derm case (undiagnosed skin cancer??). I could be wrong and if there so few derm experts out there, they could be filling up their expert practices.
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If the field should crash and burn one of my potential plans is to get a law degree and start a practice that engages in medmal lawsuits against bad NPs. With the deterioration of quality of care it should be easy to find plenty of cases of negligence, and I'd be doing a public service by taking out bad NPs
 
Mad Jack said:
If the field should crash and burn one of my potential plans is to get a law degree and start a practice that engages in medmal lawsuits against bad NPs. With the deterioration of quality of care it should be easy to find plenty of cases of negligence, and I'd be doing a public service by taking out bad NPs
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Would love to go into practice with you on this one!
 
Mad Jack said:
If the field should crash and burn one of my potential plans is to get a law degree and start a practice that engages in medmal lawsuits against bad NPs. With the deterioration of quality of care it should be easy to find plenty of cases of negligence, and I'd be doing a public service by taking out bad NPs
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Don't they get the luxury of having another ARNP be their expert witness, i.e. a physician can't testify against them?
 
Sushirolls said:
Don't they get the luxury of having another ARNP be their expert witness, i.e. a physician can't testify against them?
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I believe that is the case currently, but like many things in the law, it is a squishy issue. I think it would take a lawyer trying to use a physician as an expert against an np and then a judge allowing it, and then various appeals, and it could establish case law on the matter.
 
Regarding the OP,
I saw a dermatologist for something growing on my skin. H&P plus biopsy probably took 25 minutes, maybe less. I have no idea what insurance paid, but it was probably a 99203 plus $$$ for biopsy, versus a psychiatrist spending 60-90 minutes on a new patient and I assume getting less reimbursement for 99205 than derm gets for their 99203+biopsy, and they can do 3 of those in 90 minutes.
 
Sushirolls said:
Don't they get the luxury of having another ARNP be their expert witness, i.e. a physician can't testify against them?
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Nope, that is not the case. It depends whether it is an independent practice state or not. In independent practice states they are supposed to be held to the standard of a physician for malpractice. Also in states with supervision, physicians who supervise NPs can be expert witnesses. I have been asked to review malpractice cases for the defense where the NP was the defendent (i.e. review in defense of the NP and supervising psychiatrist). In nursing board hearings, the expert has to be an NP and not a physician however.
 
robellis said:
I’ve never seen 400k for 40 hours advertised for psych in desirable areas..send over some proof…
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I can tell you they're out there. They're usually at for-profit hospitals, but they do advertise 40 hours a week for 400K. Not locums. I've seen these too, but I'm not looking for a job so never responded.
 
Mad Jack said:
A brief search on my favorite job aggregator generated 3,621 psychiatric NP and 3,474 psychiatrist positions. Hardly 50:1 nationally
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In my area over the past year that's what I found and for a week I counted and it was 50:1
 
Psychdoc4755 said:
Within the years to come, compensation will likely rival/surpass specialties like derm, anesthesia, ortho as psych enters the 'bougie' category or 'ROAD' specialties or whatever they call them these days lol
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Reasonable psych positions will never surpass the higher paying procedural fields unless there is a complete overhaul of the US's reimbursement system. Even if that happened, it would be procedural fields losing money and not psych making that much more. Sushirolls' analogy with the Titanic is apt. Plus psych will never beat derm simply d/t differences in volume. In psych, seeing more than 4 outpatients in an hour consistently is difficult, and arguably may be sub-standard care. I've met dermatologists who see 15-20 patients/hr. Even with cash pay, the high end of psych is competing with pretty average derm until you're in the upper percentiles.


Psychdoc4755 said:
Fauci himself was even at APA last month because it simply cannot be ignored.
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Eh, imo it was a waste of a keynote speaker. He did more reading off of statistics of COVID than meaningful commentary on current MH or MH in relation to COVID. I was very disappointed with his presentation.


robellis said:
I’ve never seen 400k for 40 hours advertised for psych in desirable areas..send over some proof…
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I've gotten a couple. That being said it depends on what you consider a "desirable" metro (San Jose, Nashville area are the two I remember)and they either had high workloads or had admin/supervising responsibilities. So not the typical, straightforward clinical position with minimal responsibility. Keep in mind, this is a handful of positions out of probably ~150+ sent to me. I've had other jobs that were $400k or could easily meet $400k with production, but these are either in BFE with some extra duties or jobs that seem like a fast road to burnout.
 
splik said:
NPs are not used interchangeably with dermatologists.
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Agree with your post except this part. They are definitely use interchangeably in our city. The derms doing MOHS or other procedures obviously aren't interchangeable, but some straight clinicians here are being replaced by NPs or just moved to "supervisory" roles. Most of the NPs I've talked to who aren't moving back to a rural area talk about going into MH, derm, or "aesthetics" and both psych and derm NPs seem to have the same clinical roles as physicians.


splik said:
Nope, that is not the case. It depends whether it is an independent practice state or not. In independent practice states they are supposed to be held to the standard of a physician for malpractice. Also in states with supervision, physicians who supervise NPs can be expert witnesses. I have been asked to review malpractice cases for the defense where the NP was the defendent (i.e. review in defense of the NP and supervising psychiatrist). In nursing board hearings, the expert has to be an NP and not a physician however.
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Interesting. From what I've been told from those involved in such cases, physicians may be able to testify, but since NPs "aren't practicing medicine" the argument is the physician can't testify on NP standards (unless they were previously an NP). I've also been told by insurance experts (in didactics) that NPs and physicians have different standards of care, but I'm also not in an independent practice state.
 
nexus73 said:
Regarding the OP,
I saw a dermatologist for something growing on my skin. H&P plus biopsy probably took 25 minutes, maybe less. I have no idea what insurance paid, but it was probably a 99203 plus $$$ for biopsy, versus a psychiatrist spending 60-90 minutes on a new patient and I assume getting less reimbursement for 99205 than derm gets for their 99203+biopsy, and they can do 3 of those in 90 minutes.
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My dermatologist said that everyone assumes that derm makes a lot,but he said that the cost of botox and fillers is far more than people think. I can say my dermatologist has saved my life now 6 times from six different skin cancers. Peds, they get paid the least and they are taking care of people's kids. I think it should be more equal. 60-90 minutes for an eval? Maybe in C&A, but in adult, I get 45 minutes.
 
Stagg737 said:
I get messages for positions offering 60 and even 90 minute evals regularly, though obviously less frequently for 90 minutes. This is not uncommon at all.
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For adult? I am clearly working in the wrong state. One job offered 30 minutes for new evals and 10 minute med appointments, I said no thank you.
 
Is psych the new derm? Kinda.

You can find jobs in psych that are like general derm, yes. Definitely out there. Is your average psych dig like derm? No.

Few ancillary points. Many NP/PA extenders add revenue streams to both derm and psych practices. The smart docs use them well. CPT changes have seen derm rates dip a bit, and psych rates go up in past 5 years. The cush derm lifestyle can be had in psych. You have to be creative and learn from those doing it, not in residency.
 
futuredo32 said:
For adult? I am clearly working in the wrong state. One job offered 30 minutes for new evals and 10 minute med appointments, I said no thank you.
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Yes, like stated above 60 minute is pretty standard where I’m at and almost everywhere I’ve seen advertised positions. I’ve seen plenty of places offer 90 minute evals though. I’ve seen 30 minute evals but I’d never take those positions. I had 1 attending who did the equivalent of 10 minute f/ups, but nearly his entire panel was stable patients there for refills or small tweaks. All jobs sent to me with time of encounters advertised at least 20 minute f/ups and most advertised 30 minute f/ups. My experience is largely from recruiters spamming me with job postings, but what you’re mentioning is pretty anomalous. At least among those positions advertising their encounter times as pros.
 
Where the heck are all of you people that you're so stressed about job prospects? Not only do I personally have lots of chill jobs available starting at $250k right out of residency, but I also get contacted by recruiters looking to hire for less desirable jobs starting at $350k. The job market is great! Most employers are so desperate that they will take NPs or MDs and happy to pay for whatever they can get. There are just not enough psychiatrists or MH NPs to meet the need.
 
comp1 said:
Where the heck are all of you people that you're so stressed about job prospects? Not only do I personally have lots of chill jobs available starting at $250k right out of residency, but I also get contacted by recruiters looking to hire for less desirable jobs starting at $350k. The job market is great! Most employers are so desperate that they will take NPs or MDs and happy to pay for whatever they can get. There are just not enough psychiatrists or MH NPs to meet the need.
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This is correct..still not even close to derm where under 400k there is laughable/insulting
 
comp1 said:
Where the heck are all of you people that you're so stressed about job prospects? Not only do I personally have lots of chill jobs available starting at $250k right out of residency, but I also get contacted by recruiters looking to hire for less desirable jobs starting at $350k. The job market is great! Most employers are so desperate that they will take NPs or MDs and happy to pay for whatever they can get. There are just not enough psychiatrists or MH NPs to meet the need.
Click to expand...

250k is the standard new grad package for a facility job. I don't think it's especially "good". That said, the expectation of a typical facilities psychiatrist is kinda low...typically it's a minimal call no weekend 40 hour thing, so if u work another 10 hours a week you can bump it up to over 300k.
 
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