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Discussion in 'Psychiatry' started by kumar28, Feb 14, 2012.
This tends to be the trend currently. Anyone else noticing this.
Evidence? Where? When?
I got solicited for many many jobs (still get mailings). Never got any listings less than 200k, but never much higher than 230 either. I think the floor has increased, but the ceiling hasn't gone up too much in salaried positions.
Never got a listing under $200k? That seems promising. From previous hearsay, I was under the impression the floor was $170-180ish.
Depends on location. I wouldn't want to live in any of those places.
You mean more than the rate of natural inflation? Everything is rising at a slow rate, from costs to incomes, as inflation takes its natural course. Has it jumped more than predicted? That would be interesting.
Can anyone comment on job/salary offers in the tristate area?
Investigate on your own, such as here:
And the "tristate area" to me is Kentucky-Ohio-West Virginia, and for my wife is Kentucky-Tennessee-Missouri. You might want to specify which.
I'm guessing since you're totally oblivious to the fact that other people live other places that you mean New York-New Jersey-Connecticut.
Make sure and wave next time you fly over my home!
No, no. The tri-state area is PA - NJ - DE.
(I'd guess the OP means the NY one too)
In NJ, the going rate for a psychiatrist with the state is about 200K/year. That said the state psychiatric hospitals that pay this are known to have poor safety conditions (e.g. poor lighting, security is not reliable, etc).
In Ohio, the state pays psychiatrists 150K a year, but will pay student loans at a rate of 15K/year, and they let you do almost anything you want outside the hospital, allowing you to start a private practice and build it up, and pay your malpractice insurance.
Pay highly varies per region. Someone posted me telling me she was offered a faculty position for $130K a year in the NYC area. I currently just started a faculty position in Ohio that's almost twice that with opportunities for extra pay for doing extra things such as private forensic cases, working about 40 hours a week, pays for my malpractice, and gets my wife free tuition to work on her doctorate.
Not sure how things have changed since 2008, but its not always a given that physician salaries keep up with inflation.
Talking about wanting someone's life!
So you took the job! I remember you agonizing over the decision for quite some time...
Congrats! It seems like a nice gig, and I thought you'd wind up taking it
In other news (sorry it's a bit OT, but we'll bring it back around): While I was in Ohio for an interview at THE OSU, my car was broken into overnight at my hotel and about 10 days of my clothes, and 4 days of my wife and daughter's clothes were stolen. I was on the 2nd stop of a 4 city tour, which was to conclude with my family flying out and meeting me for a 2nd look at one of our top choices. So, I brought their stuff with me so they wouldn't have to check bags.
It was weird...I was at a nice (but not too nice) hotel, in Dublin, OH, a nice-ish suburb-y shopping area. Parked in a well lit area of the hotel. My car is a 2002 Honda Accord. ZERO Flashiness. Nothing was visible that they would want to steal. Everything they took was in the trunk.
The major loss was my wife's brand new Nikon DSLR camera (which I can't afford to replace), pretty much all of my clothes, some of the girls' clothes (but nothing too crazy or irreplaceable), a set of sapphire jewelry my wife's parents gave her for her 21st Bday, and my daughter's charm bracelet she's had her whole life, with the charms from associated major life events...
Punks. Grrr. Police are involved and looking for the camera. We are also scouring Craigslist and EBay for our stuff. What awesome about the camera, is that it embeds it's own serial number onto each picture it takes, and if that picture is ever posted online, it will generate a result in a "camera serial number search engine". So, I have hope that it will one day turn up.
I left Columbus as quickly as possible and drove home (10h or so) to regroup and deal with insurance stuff (and get some new clothes). We managed to replace a lot of stuff by hitting an AWESOME Goodwill in a ritzy suburb during our 2nd look trip. So, it all worked out fine, except the camera (sigh) and the charm bracelet (which is the thing that pisses me off the most
Needless to say, I cancelled my interview at tOSU. I'm sure it's a fine program, and what happened to me was not representative of the city (although they have more than 15,000 of these incidents per year...suck)...but after being violated like that, I couldn't have ranked it very high. Program was WONDERFULLY understanding about it all.
Anyways, to get back on topic: I hope salaries are increasing. I could use the money to replace my stuff.
Yeah, and I'm getting my butt kicked right now because I don't understand how the computer system works here yet. Everyday it's not as bad as the day before. I figure in a month I'll have everything down.
Sorry to hear about your woes with the car and camera! If you were in Ohio we might've been able to have dinner.
Aw man that blows. Did you get to do the rest of the interviews?
The pay here is very good for an academic gig. I was told I might be teaching the forensic fellows once a week in a few months. They're still figuring this out. I will likely be giving some lectures here and there to the medstudents and residents but mostly I will be doing clinical work.
I get to work directly with two of the best doctors in the country. I often say disregard those "lists" stating which places are the most competitive, but these guys IMHO deserve the honors. They advanced the field in several areas, are good teachers, and I'm glad to be working with them. One doctor, who I highly respect, was going over a case with me and taught me something I didn't know about in a very friendly and non-condescending manner, all the while having a few minutes a day on the side to check my stocks from time to time.
A trend I've noticed is the longer I stay in psychiatry residency the less I care about money other than the amount I get for buying food and paying for rent. 4 years of extinction training + fellowship. No I am not clinically depressed.
I did. Theft happened on Friday am. I came home by late Fri. night, spent the weekend here and recovered/regrouped. It's incredible how violated you feel when something like this happened, even though it's really not THAT big a deal in the grand scheme of things...
Had my next interview dinner 8h from home on Tuesday. Almost cancelled, glad I didn't, because I really liked the program. Wife and kid still few out and met me for our 2nd look after that.
1. "Bring Only What You Need To Sur-vive." - Don't pack anything that's not from Target. We could all learn a lot from Spaceballs.
2. Lock your trunk popper, so the trunk can't be popped open.
3. Don't leave ANYTHING in your car. Ever.
4. Park in clear view of a security camera...which I did.
Question for recent grads. I've noticed several job listings include tuition assistance for 15-20k a year. What is the limit typically for this? I'm assuming I couldn't get that much each year for 10 yrs.
"It's my industrial strength hair drier and I can't live without it!"
I don't know of anything that would cause a limitation. I do know that some of the loan repayment offers are tax-free. E.g. a place will pay 150K in salary + 15K of your loans, that 15K might not be taxed. In effect, it's really the equivalent of more than 15K, because you end up with more money than a place that would've paid 165K a year.
I'm sure there's some type of tax laws written on this that determine how much can be paid for loan repayment but I don't know what they are. I do know that when I did my loan repayment thing with my former employer---the state of Ohio, I had to show evidence of my loan, and the HR dept had to fill out paperwork. When I got my tax forms, the loan repayment wasn't on it and I was told it wasn't taxed, as is the case with loan repayment offers I've seen from some other institutions, unless I'm being told wrong.
While I don't doubt this figure at all, it's much easier to set up a private pay practice charging $250+ per hour in NYC than in Ohio. It's not uncommon for faculty private practices to make another $100k+ a year doing 10 hours per week. The end result is not a huge differential in pay. Though the cost of living obviously differs greatly.
The one factor I think is important to consider is that the salary ceiling in select markets (i.e. NYC, Boston, SF, LA, Miami, etc.) are vastly higher than the rest of the country, especially if you are subspecialty trained. I would say that it's not uncommon, with a certain pedigree and clever marketing, to make 500k+ if you build a niche practice catering to the wealthy. There are also other advantages of practicing in these markets, such as the possibility of building psychoanalytic-only practice, which is completely impossible anywhere outside of these markets. These boutique practice models allow you a lot more flexibility and time with individual patients. Of course, these wealthy patients can be a huge headache to deal with. The other thing about the culture (and I'm grossly overgeneralizing) on the coasts is that even upper middle class professionals on the coasts are more willing to spend $150 per session and $150 out of network benefits for a single treater, whereas people in the heartlands simply don't want to pay that much for psychotherapy.
But your main point is totally valid. An employee position in Ohio is likely much better paid in the heartlands than on the coasts, and as shown by data, the average psychiatrist likely gets paid quite substantially less on the coasts. Nevertheless, that woman who got a low-paying (likely high prestige) faculty position probably makes more money on the side than you think.
I do not live in NYC or LA, so I can't say I know anything about a culture that is willing to pay $250+ out of pocket per session. A medication management check where I live is valued at approximately $100 per 30 min session (what the clinic charges). Most private practitioners in my area charge $125-$150 for a 20-30min session. Medicare and Insurance companies say "no it's not worth $100+, it's only worth $50-$60 and contracted patients will pay a $15-25$ copay. We'll send you the remaining $35-$45 dollars several months down the road after your billing service puts up a reasonable fight for it." You're making around $100 per hour if you minimize overhead + losses and you'll be making the average psychiatrist's annual salary of 176k working 40 hours per week with 1 month vacation. Big deal, tell me something I didn't already know, right? I'm sure everybody on these forums including myself wouldn't mind doubling that figure, but is it worth it? If you do the math, it's evident you can potentially double your earning power by doing cash only, commanding a fair market rate, and eliminating the administrative costs associated with contracting with insurance companies. OR you can stick with insurance companies and use their rates to your advantage by not offering psychotherapy and doing q15 min med checks seeing 30+ patients per day. Doing it the cash practice or "I spend more time with you" way will work assuming you can fill it with cash paying clients (willing to pay 4-5X their copay) and maintain a steady flow that matches your turnover (patients dropping out, completing treatment, moving out of the area, etc). Now you need to look at the opportunity costs and how much time you lose marketing your niche private practice to maintain your cash flow as you opt out of referrals from major insurance companies. Start an an hourly rate of $250 and subtract from your hourly rate the time and money you spend marketing your niche practice to the wealthy. (FYI putting 1 ad in the yellow pages and calling it a day is NOT going to get you a steady flow of cash patients). Then subtract all unfilled time slots and use it in calculating your hourly rate.
Don't think that the midwest is all people wearing overalls with a pitchfork, though I do think your statements have some validity in many parts. A few weeks ago I had a name-brand financial guy that once in awhile appears on financial cable channels as a patient. (I made a joke that I would love to have lunch with him and discuss stock futures, he invited me to house, and I had to refuse telling him it was a boundary violation). I had another patient part of a family of near billionaire status. There's a suburb of Cincinnati called Indian Hill filled with high ranking officers for Proctor and Gamble, NFL and MLB players, etc, and yes they need psychiatric care too. Several areas in the midwest have metropolitan areas such as Indianapolis, a state capitol, what have you. The niche you mention can be attained in any area with money in the country.
Paul Keck heads the Lindner Center located outside of Cincinnati that is built on a directive to give top-quality care to the niche you described, staffed with some of the best doctors in the country.
Another differential that favors making money in the midwest is the shortage of psychiatrists is much more extreme, while in NYC there's plenty more. Of course one could make mega-money in NYC, though one could easily do so where I'm at as well.
Hmm, don't know if the position was high prestige, may have been, but this person was just starting out with no other plans or work at the time.
I think you are looking at it a bit too pessimistically. Whooper is right--move your practice to a rich suburb, market to the right clients. Have a mix of med/private therapy. Instead of seeing 30 insurance patients a day, see 15, then 3-5 private pay therapy patients. I don't think it's rare for a midwestern full time private practice psychiatrist to get paid $250k+ working decent hours a few years into practice. But my point is if you want to make $500k+ in psychiatry you probably should move to the coasts.
Additionally, as you said, money and career are two things. Perhaps you aspire for more of a life in public service. Perhaps you like research. Perhaps you like teaching. Perhaps you like administration. These things can easily trump making that additional $50k in private practice. Especially with the ridiculously high marginal tax rate for upper middle class working salary. And, money and happiness are definitely not the same thing, although they are somewhat correlated up to a point. I use non money related methods such as yoga and zen meditation (and the occasional bolus of psychodynamic psychotherapy) to keep my ying-yan in balance.
Maybe I am pessimistic but the economics of it do not make any sense in my head at this point. It seems to me if you're trying to sell a service at 4-5X the average cost, your service better be pretty damn good or special. I live in a fairly well off suburb in the southwest with an average median family income of 80k. And yes, we do have multi-million dollar mental health and detox facilities that cater to the wealthy. Only a small fraction of the patients that go to these facilities actually live in our state so even if you worked there as a staff psychiatrist earning 180k, you would not necessarily get the referrals you would need to funnel them to your cash practice. Almost every psychiatrist here in private practice accepts insurance, even those with training from prestigious programs or those with subspecialty training. The ones that have tried transitioning to cash are either transitioning back to insurance based practice or going back to institutions. I could be wrong though because this is just information I have collected over the past several years from word of mouth and my own inquiries from various attendings in the community.
Miscommunication I guess. You're talking about working less than 1 day a week.
If you're talking about having a total of 15 med management patients that you see every 1-3 months and a total of 3-5 weekly therapy patients, you would have around 20 patients on your caseload willing to pay you in cash. You'll be working less than 1 full day per week and probably making under 50k in profit.
On the otherhand, if you're talking about seeing 15 med management patients and 3-5 therapy patients 5 days a week... you would need approximately 20-25 weekly therapy patients and 300-900 1-3 month med management patients. All of course, willing to pay you in cash.
The med management patients are insurance patients. The therapy patients are cash patients. I'll assume wealthy cash paying therapy patients are more likely to stick with you for a very long time. So while it may take a few years to build up the base, once that base is established, it's pretty stable. Of course some will drop out, but the referral base from those cash patients, recommending all their jacked up friends to you, should provide enough of a mechanism to fill the lapses with new cash patients. This is assuming, of course, that people like you.
One strategic advantage to building a lucrative psych practice is that it's probably easier to be the cream rising to the crop. When you exclude all the psychiatrists that are your typical ******* doctors, those that are completely phoning it in, those that are social retards, and the large cohort that can barely understand English and are conducting interviews in a mashup of Spanglish and Tagalog, you're left with a much smaller pool of competition.
Also, make sure you have a sweet waiting room with coffee, soda, bottled water, and snacks. It's the little things.
You are probably right. This is why I say while the average is higher for an employed psychiatrist outside of the coastal markets, the ceiling is likely substantial lower. If you genuinely want to make 350k+ doing mostly therapy, you probably need to relocate. But I'm assuming even if u just do 90801 all day long, you'll get more than 200k. And staff psychiatrist salary is higher.
Plus, the cost of living is way low.
All i'm saying is resist the temptation of taking that inpatient job right out of residency.
Don't forget academics almost always pays significantly lower. If I worked for my psych hospital post grad I'd make ~ 120k-140k to start. I could make more than that going to my local VA and get a great pension and benefits. If I hit any of my private hospitals or large state psych hospitals in the area after passing boards, I'd make much closer to 180k starting off. Also most of those long terms psych hospital jobs are 8-4 jobs and leave plenty of time for private practice or occasional moonlighting.
Nicely played sir, nice indeed, congrats!
I also am doing Suboxone treatment in the university and could get a percentage of the money I bring in from those patients because they normally bring in a heck of a lot more vs. other psychiatric patients. The university has a pay structure where you're eligible for bonuses for bringing in more money in. I don't have to pay insurance while I'm here and there's plenty of perks like they pay for my cell phone internet usage, cell phone bills, etc.
I'm not sure why U. of Cincinnati seems to pay a heck of a lot more vs. institutions. It could be they just decided to pay me more than the other attendings (I highly doubt that). It could also be because the university doesn't want it's doctors working anywhere else and puts a lot of controls over them, and maybe the higher pay is a type of kickback to keep doctors happy and seeking from working elsewhere.
Whatever, I don't know. I figure after shmoozing with some of the doctors over a lunch or dinner, I'll figure these things out.
Here's a question: since loan repayment is pretax (I think), will employers be amenable to pushing any amount of agrees upon salary into "loan repayment" perks?
Now that's something to negotiate. The places I've seen that offered loan repayment were usually state or other government jobs and the tuition payment was a fixed thing that was usually not negotiable. I think a tax lawyer could better answer this question. At the place I used to work at where the tuition repayment existed, the administrative doctors merely told me to go to HR to talk to them, and when I did, the was no room for negotiation, 15K per year.
Just curious whopper how do suboxone pts bring on more than general psych pts.
Insurance pays about $75 per 20-30 minute visit. Suboxone patients where I'm at get charged about $135 for the same amount of time. Do the math.
I know plenty of doctors that charge about $150 or more for a few minutes with Suboxone though IMHO this is unethical because they're not doing a heck of a lot of things the patient needs that the manufacturer recommends.
In some areas you could charge a lot more if you're the only doctor, though IMHO once you're making a certain amount of money, it's not simply about the money anymore, you should focus more on the quality of the care. If you're really about the money, get a good financial planner--a good one with a proven track record and put the money in that, focus more on being a good doctor. Yeah I know here and there I talk about the money, but always do a good job. When you got a good rep, it gives you political/business capital to look into higher paying jobs.
as Whopper mentioned, pts are willing to pay cash for suboxone visits. In addition, you can charge $300-$400 for urine drug screens (often insurance will reimburse this amount)
Simple question here, but isn't a urine drug screen a commercial lab expense? So while you might be seeing $300 - $400 from the insurance company, the commercial lab is going to charge you to run that lab test. So do you make any money on that?
Just FYI--we went around this methadone/Suboxone track a few months ago...
a doc can do simple dip stick urine drug screenin his office. The test strip costs less than $20.