Psych money

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there are virtually no single employed jobs available that will get you 400k or more. To make the big money, you either need to be in private practice (and build it up over a few years) or have a flexible hours inpatient position with some side jobs/weekend coverage ( and this also takes a few years to develop).
Well that isn’t true because I have a single employed job that pays me more than 400k. I have a flexible schedule and don’t work weekends or holidays unless I want to and will be paid for it
 
The truth about psychiatry like many specialties you’ll have massive variation. And most of that variation comes down to how efficient are you and are you rewarded for it IE you’re 1099 or a w2 with good productivity rewards. If you aren’t efficient or don’t have a job that rewards it then you will make closer to market rate.
 
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In private practice there are no friends

What dystopian world do you inhabit? In my area, the specialties with long wait lists, my area and psychiatry included, commonly refer patients out to other PP individuals whose work we trust and if we know they have a shorter wait list. There are plenty of friends in PP.
 
In private practice there are no friends
This comment sort of resonates with me. When you are in full-time solo practice, any networking/case-consultation/referral/case management/collaboration/supervision/educational activity is non-reimbursed time and not readily available.
 
I suppose in a saturated market with no wait-lists that friends might interfere. Generally though I agree that friends or at least friendly professional relationships would increase your referral base. Even if it's just referrals from a psychiatrist who fired this patient, being friendly can help. Being friends with PCPs and NPs and SW also leads to more referrals, even if they are less-desirable. If people are really seeing me as a curmudgeon or mean-spirited I imagine it would interfere with the networking.
 
How difficult is it to find a job that rewards efficiency?
I will be quite truthful I am not sure. My residency moonlighting gig turned into a full time gig so I didnt look at all for that. I found another job through my biller helping me network. So on the surface, it seemed easy but I am in a large city so there are a lot of hospitals and a much larger number of small to large private OP practices. I would guess it depends on area, density of population/opportunities and desirability. In my area most hospitals have a set up with either a w2 with a decent production (read efficiency) bonus, or more commonly they are 1099.