Psychiatrist salary question?

[jumpbean2]

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I think this has been brought up before, but I had a question about the earning potential of psychiatrists. The average is about 180K a year these days, probably more for private practice. But if you're in private practice what stops you from making 300-400K or maybe even more? I mean, if you crunch the number it seems feasible.

Using realistic numbers...

$275 for 50-60 minute session. Lets say you do 8 sessions a day, 5 days a week. 40 sessions at 275 a piece amounts to 11,000 multiply that x 4 for a monthly salary=44,000 x12 for annual salary=528,000 (before deducting expenses)

I know some of your sessions might be 15 minute med management but these shorter visits tend to have an even higher per minute paycheck than the hourly ones.

Even if you think these numbers are a bit optimistic, you can see my point. It seems to me that ambitious psychiatrists looking to make big bucks have the potential to do so, don't they? Do some psychiatrists do this? Does it simply boil down to wanting more free time and willing to make less? Does it have to do with simply not retaining or having enough patients to supplement this?

All thoughts appreciated.

 

[dl2dp2]

All thoughts appreciated.

This question has been raised ad nauseum.

I would say maybe 5% of psychiatrists in the country make >350k, maybe 0.5% make > 1 mil a year and this is substantiated by the salary bell curve. How is this information at all relevant to you though? Do you really care that maybe 5% of cardiologists make > 1 mil a year? Does this information now make you want to go to medical school? LOL

 

[jumpbean2]

This question has been raised ad nauseum.

I would say maybe 5% of psychiatrists in the country make >350k, maybe 0.5% make > 1 mil a year and this is substantiated by the salary bell curve. How is this information at all relevant to you though? Do you really care that maybe 5% of cardiologists make > 1 mil a year? Does this information now make you want to go to medical school? LOL

So do you think the top earning 10% earn as much as they do because they put in more hours and simply work harder and are more motivated by money? Or is it more to do with their qualifications and reputation, enabling them to charge more per session?

I would presume it's probably a bit of both, but at the same time I feel like even a psychiatrist charging average fees could make a lot more if they wanted to. I guess the reality is most psychiatrists make around 200K because they probably value their free time and have little desire to be working 10+ hours a day, especially as they get older...

I've done some observational shadowing of private psychiatrists and many of them have waiting lists, where there is months before they have an opening. This, to me, seems like a shortage of patients is hardly an issue. Theoretically it seems like they could put in a few more hours in each day and start putting a dent into their waiting list now, thus making more money. OK, im rambling now.... But it makes sense in my head.

 

[digitlnoize]

Just go look at the Medscape physician compensation survey by specialty for 2012.

If you're willing to work full time as a psychiatrist you can likely expect to make 180-250k depending on location, practice, etc. you can make more or less depending on how much you want to work.

Do it because you love it. Because its not easy.

 

[shan564]

Just go look at the Medscape physician compensation survey by specialty for 2012.

If you're willing to work full time as a psychiatrist you can likely expect to make 180-250k depending on location, practice, etc. you can make more or less depending on how much you want to work.

Do it because you love it. Because its not easy.

I think the OP's point is more along the lines of "if this is the amount that psychiatrists can charge, then why don't they earn more?"

I think if you have your own practice and all of your patients show up and pay for all of your time, then you can earn something in that ballpark. I know somebody who gotten close to those numbers without really doing anything too special.

From your 528,000, subtract about $50k for office rent/expenses and $50k for your assistant's salary. You might also need to hire somebody part-time for billing, so let's bump up the salaries to a total of about $70k. So your take-home income at this point is about $400k.

The salary surveys usually say closer to $200k. I think this is just due to hitches in the system. Some patients won't pay. Some insurance companies won't pay. Some patients won't pay their copay. Some patients won't even show up.

Also, psychiatry has a higher percentage of part-time doctors than any other specialty. That certainly deflates the income in the salary surveys somewhat.

 

[vistaril]

This question has been raised ad nauseum.

I would say maybe 5% of psychiatrists in the country make >350k, maybe 0.5% make > 1 mil a year and this is substantiated by the salary bell curve. How is this information at all relevant to you though? Do you really care that maybe 5% of cardiologists make > 1 mil a year? Does this information now make you want to go to medical school? LOL

don't know what % of cardiologists make > 1 million dollars, but those in interventional who set up a certain type of practice make that if they want to......1 million dollars)net income) in cardiology is equivalent to about 275k in psychiatry in terms of how 'hard' it is to do.

As to the original question....everyone does the numbers this way. But that, for a lot of reasons, isn't the real world. For starters most psychiatrists do not collect 275 dollars per 'session'. Some do, but that is not the norm. It's like with my fiance(a GI fellow).....if you theoretically add up what they could get for scopes and assume they do so many and then just multiply all the numbers, you can get 2-3 million per year....but most GI's dont make anywhere near that. The answer is that the real world is why.....

 

[kumar28]

gotta love vistaril's negative spin on everything psych...u know how they say if someone really bugs the &*^% out of you..that they must have a personality disorder. Well I would have to say this is definitely the case

 

[shan564]

gotta love vistaril's negative spin on everything psych...u know how they say if someone really bugs the &*^% out of you..that they must have a personality disorder. Well I would have to say this is definitely the case

Yeah, he displays classic features of splitting, but it's probably be better not to diagnose people on the Internet...

 

[nancysinatra]

gotta love vistaril's negative spin on everything psych...u know how they say if someone really bugs the &*^% out of you..that they must have a personality disorder. Well I would have to say this is definitely the case

There's nothing negative about Vistaril's post on this topic. It makes sense. He makes statements about GI too.

By the way, if someone bugs the $%^& of you it could be that the joke's on you.

And you know what else? Go visit the pathology forum. One day I checked that forum out, and I was astonished--there were actually some people saying bluntly critical things about their specialty. Some were, gasp, "negative" in their outlook about the job market. Does saying something "negative" mean someone has a personality disorder? What if their complaints are valid?

If I had a dime for every time a psychiatry resident or med student or pre-med headed for psych touted its superiority over all the other fields with a holier than thou attitude on the internet that they'd probably tone down in person, I'd never need to read another "psychiatrist salary" thread.

 

[nancysinatra]

it's probably be better not to diagnose people on the Internet...

Med students can't diagnose.

 

[michaelrack]

Yeah, he displays classic features of splitting, but it's probably be better not to diagnose people on the Internet...

I haven't noticed features of this in Vistaril's posts.

Being cynical doesn't mean that a person has a personality disorder.

 

[shan564]

By the way, if someone bugs the $%^& of you it could be that the joke's on you. In any case, your post really bugs me so I think you must have a PD.

Ha, good point.

 

[kumar28]

jokes on me..haha..good one nancy sinatra 🙄

its not just this post its every post of vistaril's...every post has a negative spin some way towards his field of choice..its odd

 

[vistaril]

jokes on me..haha..good one nancy sinatra 🙄

its not just this post its every post of vistaril's...every post has a negative spin some way towards his field of choice..its odd

well part of this is because it makes more sense to comment on things that I don't like about something(or concerns I have going to the future) than issues where the outlook is better and I don't have the same concerns.

For example, if I order a quarter pounder and they put mayonnaise on it when I said no mayo, I'm not likely to mention the cheese, ketchup, and onions which they put on correctly....but rather just the mayo.

Psychiatry the way it is organized today does have things I like. But I think it's silly to not point out some of the issues our profession faces now and going forward....in fact I think not acknowledging issues at all is denial.

 

[AleisterCrowley]

For what it's worth, I have wanted to be a psychiatrist nearly my entire life, and some of Vistaril's posts certainly tend to bring me down.

 

[shan564]

well part of this is because it makes more sense to comment on things that I don't like about something(or concerns I have going to the future) than issues where the outlook is better and I don't have the same concerns.

For example, if I order a quarter pounder and they put mayonnaise on it when I said no mayo, I'm not likely to mention the cheese, ketchup, and onions which they put on correctly....but rather just the mayo.

Psychiatry the way it is organized today does have things I like. But I think it's silly to not point out some of the issues our profession faces now and going forward....in fact I think not acknowledging issues at all is denial.

You know, that's a good response. I apologize for assuming something different. You may portray a negative spin on things, but I guess it's useful to have multiple perspectives.

 

[BS81]

If you look at some of the other boards on SDN you will notice that every specialty has it's faction that thinks that the sky is falling down. Vistaril is pretty benign compared to what you see in Anesthesiology, Radiology, Cardiology, Emergency Medicine, etc. There is a large vocal minority on those boards that talks about major reimbursement cuts, poor job market, or poor practice conditions.

 

[BS81]

don't know what % of cardiologists make > 1 million dollars, but those in interventional who set up a certain type of practice make that if they want to......1 million dollars)net income) in cardiology is equivalent to about 275k in psychiatry in terms of how 'hard' it is to do.

As to the original question....everyone does the numbers this way. But that, for a lot of reasons, isn't the real world. For starters most psychiatrists do not collect 275 dollars per 'session'. Some do, but that is not the norm. It's like with my fiance(a GI fellow).....if you theoretically add up what they could get for scopes and assume they do so many and then just multiply all the numbers, you can get 2-3 million per year....but most GI's dont make anywhere near that. The answer is that the real world is why.....

People making that kind of money is a thing of the past. Psych is becoming a pretty good deal not because the salaries are rising, but because all the other specialties' starting salaries are falling. The days of cardiologists, GI's etc. making twice or three times as much as other medical specialties are coming to an end. Pretty much everyone will be in the 200-300k (current day dollars) range soon.

 

[Columnar]

don't know what % of cardiologists make > 1 million dollars, but those in interventional who set up a certain type of practice make that if they want to......1 million dollars)net income) in cardiology is equivalent to about 275k in psychiatry in terms of how 'hard' it is to do.

As to the original question....everyone does the numbers this way. But that, for a lot of reasons, isn't the real world. For starters most psychiatrists do not collect 275 dollars per 'session'. Some do, but that is not the norm. It's like with my fiance(a GI fellow).....if you theoretically add up what they could get for scopes and assume they do so many and then just multiply all the numbers, you can get 2-3 million per year....but most GI's dont make anywhere near that. The answer is that the real world is why.....

Cardiologists hardly make 1 million or anywhere near that these days. Go to the cards forum and see how they are talking about cards fellows being offered 200-220k to start with call like every 2 days. Those days are gone. But I think what OP is saying is that it's possible for psychs to make more than 200-250k as they do now. The fact that a lot of them work less hours or part time obviously makes the income lower, but I think he/she is right in that many psychs could make more if they were willing to work more. No judgment either way on whether they should work more or less just speaking financially here.

 

[Columnar]

People making that kind of money is a thing of the past. Psych is becoming a pretty good deal not because the salaries are rising, but because all the other specialties' starting salaries are falling. The days of cardiologists, GI's etc. making twice or three times as much as other medical specialties are coming to an end. Pretty much everyone will be in the 200-300k (current day dollars) range soon.

I think you are suggesting salaries that most people will not bother to go into med school for realistically. No one will train 14 years or so for 200k, especially given how much salaries have risen in other professions with less than half the training. Momentarily the field will go that way but it's not sustainable. Why become a doctor and spend 10-14 years training when you can go into other professions and make about the same with no debt and liability? Not to mention that maybe you should look at salaries in countries like Canada where they have socialized medicine. If you think that doctors just make 200-300k, then you need more info. Many of those doctors are getting paid more than we do here.

 

[BS81]

I think you are suggesting salaries that most people will not bother to go into med school for realistically. No one will train 14 years or so for 200k, especially given how much salaries have risen in other professions with less than half the training. Momentarily the field will go that way but it's not sustainable. Why become a doctor and spend 10-14 years training when you can go into other professions and make about the same with no debt and liability? Not to mention that maybe you should look at salaries in countries like Canada where they have socialized medicine. If you think that doctors just make 200-300k, then you need more info. Many of those doctors are getting paid more than we do here.

People already train for 14 years or so for 200k (most medical subspecialties, pediatric specialists). And it's not about "socialized medicine". It's about ACO's and bundled payments. Once health care systems get money up front and every procedure they perform gets taken out of that money, the amount of scopes, imaging, and unnecessary procedures and surgeries will go down dramatically.

People have been griping for a long time in medical education that med schools attract people that have an MBA mentality rather than an MSW or MPH mentality

 

[notdeadyet]

I think you are suggesting salaries that most people will not bother to go into med school for realistically. No one will train 14 years or so for 200k, especially given how much salaries have risen in other professions with less than half the training.

Name another profession where even the bottom quartile of folks training in it are guaranteed a pay of $150K after graduation.

I'm not disagreeing that medicine is not the money train it once was, but pretending that there are many other industries that you have security of earning in the $150K range is laughable. Your average JD and MBA sure isn't.

 

[vistaril]

Cardiologists hardly make 1 million or anywhere near that these days. Go to the cards forum and see how they are talking about cards fellows being offered 200-220k to start with call like every 2 days..

lmfao...I know a few interventional cards people in private practice. They do make about that....in 6 weeks.

Also, don't buy into the nonsense hype that 'pretty much every specialty is going to be in the 200-250 range' eventually. This isn't the least bit true, and I'll believe it when I see it. people say a lot of things and have been saying a lot of things for awhile.....doesn't mean any of it has come true.

 

[BS81]

lmfao...I know a few interventional cards people in private practice. They do make about that....in 6 weeks.

Also, don't buy into the nonsense hype that 'pretty much every specialty is going to be in the 200-250 range' eventually. This isn't the least bit true, and I'll believe it when I see it. people say a lot of things and have been saying a lot of things for awhile.....doesn't mean any of it has come true.

No one makes that much even in interventional anymore (unless you are in BFE somewhere, maybe). You are extremely misinformed. You are probably cherry picking numbers of practice owners from 5-10 years ago, and most of them have sold out to hospital systems at this point. The new ACOs are going to run everything and everyone will be salaried.

 

[shan564]

No one will train 14 years or so for 200k

I did. And I'm sure a lot of others did too. I know everybody has different perspectives, but $200k is a lot of money to me. And I'm planning to go into an academic position, which means that I'll consider going through further training and put in extra hours so that I can get a lower-paying job (after I pay off my student loans, of course).

Also... ever heard of a PhD/postdoc? I know a LOT of people who do 4 years of undergrad, 5-6 years of PhD, and 4-6 years of postdoc just so that they can be in the running to fight for an academic position that starts at $90-100k and peaks at $180-200k if they're the best of the best. I have one good friend who graduated with a 3.9 GPA and had a 29 on the MCAT several years ago, so he probably could have gotten into med school somewhere, but he only applied for MD/PhD programs... and he ended up going to Hopkins to do a PhD in biomedical engineering. Not everybody makes these decisions based purely on money.

Why become a doctor and spend 10-14 years training when you can go into other professions and make about the same with no debt and liability?

I constantly tell high school and pre-med kids something along the lines of "if you're doing it purely for the money, don't go into medicine. It's a long road, and if you have the wrong motivations, you probably won't make it. If you're good enough to get into med school, then you're good enough to make more money doing something else with less training."

That said, med school is the only training course I can think of in which you're almost certain to earn $120k+. Lawyers have to fight for clients/jobs and an MBA has been substantially devalued in recent years. As somebody already pointed out, while the top JDs and MBAs may earn a lot more than most of us ever will, their degree doesn't provide the same sort of stability that you get from your MD/DO/MBBS degree. And as you probably know, stability occupies a much more critical role in Maslow's hierarchy of needs:

 

[Columnar]

People already train for 14 years or so for 200k (most medical subspecialties, pediatric specialists). And it's not about "socialized medicine". It's about ACO's and bundled payments. Once health care systems get money up front and every procedure they perform gets taken out of that money, the amount of scopes, imaging, and unnecessary procedures and surgeries will go down dramatically.

People have been griping for a long time in medical education that med schools attract people that have an MBA mentality rather than an MSW or MPH mentality

They can try whatever they want, but you will see that won't work. Most people will not go into long, arduous training to make 200k. Heck, people have been barely going into primary care now with a 3 year residency for that now. You see all the tons of FMGS in IM/FM/peds? You think that's a coincidence? No, it's not. Even now that there is this whole hospitalist movement people are barely deciding to go into IM vs specialties.

It's very different to be in something like primary care and train for 3 years vs. 6+ for other specialties (rads, rad onc, gi, neurosurg, etc) and still make 200k. No one will go into those. Are you joking?

And everyone will make the case-why waste 14 years of one's life and 300k to only make 200k? Please. And they will look to Canada and say hey Canadians make much more, have little liability, work less, and have free medical education.

So if you think that people will continue to go into medicine with the worst of all worlds, I think you are in for a rude awakening.

 

[Columnar]

lmfao...I know a few interventional cards people in private practice. They do make about that....in 6 weeks.

Also, don't buy into the nonsense hype that 'pretty much every specialty is going to be in the 200-250 range' eventually. This isn't the least bit true, and I'll believe it when I see it. people say a lot of things and have been saying a lot of things for awhile.....doesn't mean any of it has come true.

That's not common these days. Maybe you are talking about practices and partners who went into the field many many years ago. Cards salaries have gone down tremendously in the past 5+ years, same as with rads, rad onc and other procedural specialties. And to make 1 mill in 6 weeks -well that tells me something fishy is happening if that is the case.

 

[vistaril]

No one makes that much even in interventional anymore (unless you are in BFE somewhere, maybe). You are extremely misinformed. You are probably cherry picking numbers of practice owners from 5-10 years ago, and most of them have sold out to hospital systems at this point. The new ACOs are going to run everything and everyone will be salaried.

lmfao....you can keep dreaming. The vast majority of practices still work for themselves and still bill per procedure for themselves, including oftentimes lucrative facility fees(for those groups that own the facilities).....you are making a bunch of predictions you have absolutely no proof are going to happen except in your fantasy.

 

[Columnar]

Name another profession where even the bottom quartile of folks training in it are guaranteed a pay of $150K after graduation.

I'm not disagreeing that medicine is not the money train it once was, but pretending that there are many other industries that you have security of earning in the $150K range is laughable. Your average JD and MBA sure isn't.

Well there are a ton of professions out there these days where you can make in the 150k range with some years of experience, no legal liability, and most weekends/nights off. Nurses, CRNAs, lawyers, marketing managers, numerous consultants of various types, finance people (most of whom have a BA +/- MBA), engineers, cops, etc. My husband, who is an engineer, makes about 110k. Weekends off, no nights, etc. Numerous of his classmates in his current MBA in their 30's are making in the 150k-200k range at various banking/finance type jobs.

List goes on and on.

 

[Columnar]

I did. And I'm sure a lot of others did too. I know everybody has different perspectives, but $200k is a lot of money to me. And I'm planning to go into an academic position, which means that I'll consider going through further training and put in extra hours so that I can get a lower-paying job (after I pay off my student loans, of course).

Also... ever heard of a PhD/postdoc? I know a LOT of people who do 4 years of undergrad, 5-6 years of PhD, and 4-6 years of postdoc just so that they can be in the running to fight for an academic position that starts at $90-100k and peaks at $180-200k if they're the best of the best. I have one good friend who graduated with a 3.9 GPA and had a 29 on the MCAT several years ago, so he probably could have gotten into med school somewhere, but he only applied for MD/PhD programs... and he ended up going to Hopkins to do a PhD in biomedical engineering. Not everybody makes these decisions based purely on money.


I constantly tell high school and pre-med kids something along the lines of "if you're doing it purely for the money, don't go into medicine. It's a long road, and if you have the wrong motivations, you probably won't make it. If you're good enough to get into med school, then you're good enough to make more money doing something else with less training."

That said, med school is the only training course I can think of in which you're almost certain to earn $120k+. Lawyers have to fight for clients/jobs and an MBA has been substantially devalued in recent years. As somebody already pointed out, while the top JDs and MBAs may earn a lot more than most of us ever will, their degree doesn't provide the same sort of stability that you get from your MD/DO/MBBS degree. And as you probably know, stability occupies a much more critical role in Maslow's hierarchy of needs:

dude, are you really in Australia? Why even get into this conversation if you are? Your schooling is mostly free and you don't get sued all the time. Apples and oranges if you are comparing with the US.

 

[BS81]

lmfao....you can keep dreaming. The vast majority of practices still work for themselves and still bill per procedure for themselves, including oftentimes lucrative facility fees(for those groups that own the facilities).....you are making a bunch of predictions you have absolutely no proof are going to happen except in your fantasy.

In Wisconsin, the number of heart doctors in private practice has declined to 11 percent from 62 percent of cardiologists in 2007, according to the American College of Cardiology, whose main offices are in Washington. The trend is similar nationwide. The number of heart doctors working for U.S. hospitals has more than tripled, while the number in private practice has fallen 23 percent over five years, the ACC said.

http://www.bloomberg.com/news/2012-11-19/hospital-medicare-cash-lures-doctors-as-costs-increase.html

Thanks for playing. As usual your opinions are just that, opinions. And unfortunately they don't mesh with reality.

 

[vistaril]

In Wisconsin, the number of heart doctors in private practice has declined to 11 percent from 62 percent of cardiologists in 2007, according to the American College of Cardiology, whose main offices are in Washington. The trend is similar nationwide. The number of heart doctors working for U.S. hospitals has more than tripled, while the number in private practice has fallen 23 percent over five years, the ACC said.

http://www.bloomberg.com/news/2012-11-19/hospital-medicare-cash-lures-doctors-as-costs-increase.html

Thanks for playing. As usual your opinions are just that, opinions. And unfortunately they don't mesh with reality.

in situations where the hospitals are the 'employers', it is more a situation where the cardiologist(or GI) has a performance(ie volume) based guarantees through the hospital. The cardiologist is still operating under a pay for procedure model. A cardiologist is still essentially making x per stent....from an accounting purpose, it just looks different. A lot of it is just setting up the arrangement such to maximize income. If medicare pays thospital more per procedure to do it there, it makes me sense for the cardiologist to effectively function much like a contractor(this is different than a salaried employee) and work in that capacity. I know this because my fiance finishes her fellowship in 6 months, and she has a number of offers(small groups, large groups, some positions with hospital employment with affiliations with loose salary guarantees). The arrangements are often not simple, but starting salaries for many of the positions are in the mid to high 4's...and that is with a very favorable schedule. 600 would be easily attainable by year 2. And cardiology pays a good bit more than GI. Many cards procedures reimburse well into the 4 figures and can be stacked up *several* a day....in fields like IR, same concept but some of the procedures can be stacked up several per hour. IR gets reimbursed on average 280 dollars or so per CVCP, and there are busy IR's who do 20-25 of these before lunch in a day....do the math.


with the way technology is going in some of the procedure driven specialties(especially IntCards and IR), salaries will only continue to increase.

 

[deleted307836]

I constantly tell high school and pre-med kids something along the lines of "if you're doing it purely for the money, don't go into medicine. It's a long road, and if you have the wrong motivations, you probably won't make it. If you're good enough to get into med school, then you're good enough to make more money doing something else with less training."

As a pre-med, I agree with the sentiment of this post except for the part I bolded. I have good stats (so far), and I think that a medical school acceptance is very likely for me. I'm not pursuing medicine for primarily financial reasons -- it truly is the field that I see myself fit best with regardless of pay. However, I highly doubt that medicine is not my most lucrative career option. Business, engineering, and law are of no interest to me, and are not where my talents lie. So medicine is the best fit for me career-wise, and is almost certain to be the most financially rewarding path that is realistic for me to pursue despite the field's uncertain future.

 

[digitlnoize]

I'd like to point out that med school is not 14+ years of training. It's 4 extra years...maybe 7-10 if you count residency (which you shouldn't, since you're getting paid).

Choice A: get bio degree. Get job as lab tech making 50k. Live life.

Choice B: get bio degree. Spend 4 years in med school. Spend 3 years at same 50k salary. Then get big raise to 150-200k.

I know what choice I'd make.

Perhaps you can make more in corporate America. Maybe, if youre good and lucky. But that's apples and oranges. We're assuming someone who wants to go to medical school has some interest in biological processes and wouldn't be happy pushing papers all day. And you have much worse job security.

This is a silly argument IMO. Doctors of all types make good money. Do what you enjoy and the rest will take care of itself. Some of the happiest docs I know are the poorest.

 

[Columnar]

I'd like to point out that med school is not 14+ years of training. It's 4 extra years...maybe 7-10 if you count residency (which you shouldn't, since you're getting paid).

Choice A: get bio degree. Get job as lab tech making 50k. Live life.

Choice B: get bio degree. Spend 4 years in med school. Spend 3 years at same 50k salary. Then get big raise to 150-200k.

I know what choice I'd make.

Perhaps you can make more in corporate America. Maybe, if youre good and lucky. But that's apples and oranges. We're assuming someone who wants to go to medical school has some interest in biological processes and wouldn't be happy pushing papers all day. And you have much worse job security.

This is a silly argument IMO. Doctors of all types make good money. Do what you enjoy and the rest will take care of itself. Some of the happiest docs I know are the poorest.

Well, residencies that take 6 years are 14 years of training. So 4 years of undergrad, which I guess we can discount if you assume that most people who make any kind of money have a BA/BS degree, then 4 years of med school for those who get into med school straight with no post-bacs, masters, etc, plus 4-7 years of residency/fellowship. Technically sure you do get paid something for training, but making 50k or so for working like an animal I'm not sure is much pay.

Further, if you consider that these days being in fields like engineering, IT, computer science, consulting, finance, etc make in the 60k+ to start, and you can easily make mid 100's by early 30's, if salaries continue to drop I can guarantee you that the physician "shortage" will get horrific. No one wants to put in that much time and energy to be told that we don't deserve any financial reward.

 

[kindasorta]

As a doctor you also graduate and are instantly crowned "top of the food chain". To nickel and dime the decision is to ignore a pretty sizable elephant in the room: a physician is permanently employable and guaranteed a six figure income for the duration of their chosen working years. Not to mention the social benefits of being a "doctor".

All other jobs can't lay claim to such security and stability. Most others suffer from peaks and troughs, or a lifetime of possibly waking up to a slip in the lovely shade of pink.

And perhaps the biggest beauty of all, which is why psych is so brilliant.....wait for it......



NO BOSS

 

[Columnar]

As a doctor you also graduate and are instantly crowned "top of the food chain". To nickel and dime the decision is to ignore a pretty sizable elephant in the room: a physician is permanently employable and guaranteed a six figure income for the duration of their chosen working years. Not to mention the social benefits of being a "doctor".

All other jobs can't lay claim to such security and stability. Most others suffer from peaks and troughs, or a lifetime of possibly waking up to a slip in the lovely shade of pink.

And perhaps the biggest beauty of all, which is why psych is so brilliant.....wait for it......



NO BOSS

If you think you have no boss, you are mistaken. Maybe in private practice but otherwise, you start as a jr attending, and have partners who are above you. then you become partner, but you are not a super-partner.

You also have to cater/make happy the countless administrators, nurses, etc. that are at hospitals.

 

[kindasorta]

If you think you have no boss, you are mistaken. Maybe in private practice but otherwise, you start as a jr attending, and have partners who are above you. then you become partner, but you are not a super-partner.

You also have to cater/make happy the countless administrators, nurses, etc. that are at hospitals.

I'm talking about private practice - which there is nothing stopping you from doing aside from personal decisions. If working for yourself is a priority, and not staring down the barrel of a loud-sipping coffee-mug wielding boss, then you can easily do it.

Not the same for our finance and engineering and business friends.

And please spare me stories of CEO 5k/day.

 

[vistaril]

Technically sure you do get paid something for training, but making 50k or so for working like an animal I'm not sure is much pay.

Where are all these psychiatry residents 'working like an animal'?

I'd say my first year I worked a little harder than the average professional. The second year I worked about average for a professional. The third year I worked somewhat less than average(not counting moonlighting), and then this year I've worked much less than average(again not counting extensive moonlighting).....

The typical 4th year psychiatry resident has no call(ever), is 'scheduled' for a 40 hr week but we all know with excessive supervision time built into that, a free afternoon a week for scheduling/paperwork/phone calls/study built into it(which can usually be done between other things), another afternoon of frequently cancelled or optional lectures built into it, and another afternoon or morning of sparsely scheduled resident therapy clinics, it comes out to more like 20-25 'real' hrs a week. And I know for a fact at many smaller and community programs the schedule is even more lax.

There are residents and fellows in certain fields of medicine who do work really hard. Surgery, neurosurgery, obgyn to name a few. Medicine and medicine specialties is hit or miss depending on where you train and what you are training in. But psychiatry is not a taxing schedule from a time committment standpoint.

 

[shan564]

dude, are you really in Australia? Why even get into this conversation if you are? Your schooling is mostly free and you don't get sued all the time. Apples and oranges if you are comparing with the US.

Sorry, I haven't updated my "location" because I'm on the interview trail and I don't have a permanent location. I'm American and went to med school in the US, and paid about the same as a student at a private American med school. Also, lawsuits and malpractice insurance are a perfectly common event there, and they inform medical practice in the same way that they do in the US.

Well there are a ton of professions out there these days where you can make in the 150k range with some years of experience, no legal liability, and most weekends/nights off.

There's a big difference between "can" and "will." I know people who are making $150k without a medical degree, but they're in the minority. There's no other field that guarantees that income, which was my point with the Maslow pyramid... the medical salary is attractive because of the security, not because of the sheer income.

Nurses, CRNAs, lawyers, marketing managers, numerous consultants of various types, finance people (most of whom have a BA +/- MBA), engineers, cops, etc.

Are you seriously under the impression that nurses and cops make $150k? That's insane. Go talk to a random nurse or cop and ask them how many nurses/cops they know who make $150k.
Salary.com: average cop makes $50k, 90th percentile makes $68k
average nurse makes $66k, 90th percentile makes $78k

CRNAs, sure - maybe close to that. But that's their peak. And who wants to be a CRNA?

Lawyers, yes... but they don't have the security. They have to depend on finding clients, jobs etc. For us, patients and jobs are in abundance. But they're probably #2 after doctors in terms of income/security.
Salary.com: average lawyer is at $85k, 90th percentile is at $115k: http://www1.salary.com/Attorney-I-Salary.html

Consulting is as unstable of a job as you can find. Also, you have to be an expert in something already first. My dad is a corporate consultant, and he's never come close to $150k... but he's had many years at $0. If I told him I wanted to be a consultant, he'd assume that I'm being facetious.

Marketing managers is the same issue. First, most marketing people won't become managers. Second, very few of them will make that much money.

Engineers - there might be some that make $150k, but only the exceptional ones. To be making $110k, your husband must be a very successful engineer. Of course, it also depends on the type of engineer. But it's ridiculous to say that he is the norm.

My husband, who is an engineer, makes about 110k. Weekends off, no nights, etc. Numerous of his classmates in his current MBA in their 30's are making in the 150k-200k range at various banking/finance type jobs.

Ever heard of sampling bias?

 

[dl2dp2]

Where are all these psychiatry residents 'working like an animal'?

I'd say my first year I worked a little harder than the average professional. The second year I worked about average for a professional. The third year I worked somewhat less than average(not counting moonlighting), and then this year I've worked much less than average(again not counting extensive moonlighting).....

This. Being a private practice clinical shrinky-dink MD is one of the most lifestyle friendly jobs in the US. Period. 200k easily cleared with 35 hours of talking to patients, prescribing some meds, having them giving you nice gifts for the holidays, and having them tell you how much you helped them. Bliss.

Even for a government mental health clinic, you have lots of SW, easy visits, yes people get sick and sent to the ER, but you'll rarely get sued, no call or weekends, excellent retirement and benefits. Inpatients is a bit busier, but you'll see it's all junior people and they just take off after a few years of setting up the practice. And when I say busy, I'm not talking about busy like a corporate lawyer or an associate at an ibank. NOT EVEN CLOSE.

This is why in numerous physician satisfaction surveys, psychiatry is often top of the pile, trending very closely behind dermatology. You can google Medscape survey this year to see. And this is with the field vastly bigger than derm.

The main issues of the field are: (1) if you want MILLIONS, no way jose. (at least, not very easily.) (2) the stigma, not a real doc, poor prestige etc., though this is getting better (3) some people don't like talking (4) working in a more gender balanced workplace--though obv. this is a personal taste (5) no procedures. (6) the material is a bit wishy washy--this hopefully will also get better

 

[Columnar]

Sorry, I haven't updated my "location" because I'm on the interview trail and I don't have a permanent location. I'm American and went to med school in the US, and paid about the same as a student at a private American med school. Also, lawsuits and malpractice insurance are a perfectly common event there, and they inform medical practice in the same way that they do in the US.



There's a big difference between "can" and "will." I know people who are making $150k without a medical degree, but they're in the minority. There's no other field that guarantees that income, which was my point with the Maslow pyramid... the medical salary is attractive because of the security, not because of the sheer income.



Are you seriously under the impression that nurses and cops make $150k? That's insane. Go talk to a random nurse or cop and ask them how many nurses/cops they know who make $150k.
Salary.com: average cop makes $50k, 90th percentile makes $68k
average nurse makes $66k, 90th percentile makes $78k

CRNAs, sure - maybe close to that. But that's their peak. And who wants to be a CRNA?

Lawyers, yes... but they don't have the security. They have to depend on finding clients, jobs etc. For us, patients and jobs are in abundance. But they're probably #2 after doctors in terms of income/security.
Salary.com: average lawyer is at $85k, 90th percentile is at $115k: http://www1.salary.com/Attorney-I-Salary.html

Consulting is as unstable of a job as you can find. Also, you have to be an expert in something already first. My dad is a corporate consultant, and he's never come close to $150k... but he's had many years at $0. If I told him I wanted to be a consultant, he'd assume that I'm being facetious.

Marketing managers is the same issue. First, most marketing people won't become managers. Second, very few of them will make that much money.

Engineers - there might be some that make $150k, but only the exceptional ones. To be making $110k, your husband must be a very successful engineer. Of course, it also depends on the type of engineer. But it's ridiculous to say that he is the norm.





Ever heard of sampling bias?

I think you just want to believe what you want to believe, which is fine, but not realistic. You really think that nurses are not making 100k shortly after graduation with minimal effort? Many places are paying nurses 50hr or more, and they only work 12 3 hour shifts or 10 4 hour shifts. Working 1-2 days extra and they are making much much more, not to mention overtime. Same with CRNAS.

Consultants make a crapload as I've said and you are incorrect about the fact that their jobs are unstable. I have people who work as such in my family, and only with BA degrees and they have not lost their jobs yet. Cops regularly make over 100k in any major city. Look at some salary postings and you'll see.

My husband is not particularly successful, he's decent at what he does, but 110k is not that much for an engineer. There are a number of places that are paying well above that.
No weekends for the most part, no liability, no nights.

I'm not even mentioning things like finance which can be quite cushy (portfolio management, pension management, etc) where you are starting at 100k base + bonus after an MBA. Sure you may never make 300k or so but you are looking at 150k easily after a few years.

I'm not saying that being a psych for 200-250k talking to patients and prescribing meds is not cushy or the worst job in the world, of course not, but i'm saying that it's not as great given the investment.

 

[vistaril]

This. Being a private practice clinical shrinky-dink MD is one of the most lifestyle friendly jobs in the US. Period. 200k easily cleared with 35 hours of talking to patients, prescribing some meds, having them giving you nice gifts for the holidays, and having them tell you how much you helped them. Bliss.

Even for a government mental health clinic, you have lots of SW, easy visits, yes people get sick and sent to the ER, but you'll rarely get sued, no call or weekends, excellent retirement and benefits. Inpatients is a bit busier, but you'll see it's all junior people and they just take off after a few years of setting up the practice. And when I say busy, I'm not talking about busy like a corporate lawyer or an associate at an ibank. NOT EVEN CLOSE.

This is why in numerous physician satisfaction surveys, psychiatry is often top of the pile, trending very closely behind dermatology. You can google Medscape survey this year to see. And this is with the field vastly bigger than derm.

The main issues of the field are: (1) if you want MILLIONS, no way jose. (at least, not very easily.) (2) the stigma, not a real doc, poor prestige etc., though this is getting better (3) some people don't like talking (4) working in a more gender balanced workplace--though obv. this is a personal taste (5) no procedures. (6) the material is a bit wishy washy--this hopefully will also get better

well the world of outpatient med mgt private practiced(what you described initially) also involves a good bit of grinding, and many patients see that reality and aren't going to be giving you nice gifts and telling them how much you helped them. What some are going to say is "this damn lamictal you are giving me is useless. I want the xanax the other guy gave me. And you only spend 5 minutes with me".

Also, not all govt outpt jobs provide great retirement benefits. The VA yes. But not most community mental health clinics(and most people dont work there indefinetely anyways) and other govt funded outpt clinics.

Im puzzled by the reference to corporate law or ibanking types....these are alpha male types. The average year end bonus(not salary) of a goldman ibanker is what a psychiatrist makes in a few years. Of course it's a much different atmosphere in terms of stress and hours, but those two things arent apples to orange comparisons but rather apples to non-food comparisons.

Additionally, I don't think the stigma is getting better. I think this was the case awhile back in the mid to late 90s as we were still in the earlier days of the second 'psychopharm revolution' and there was more optimism for psychopharm and it's efficacy. Now that tide has turned.

As for 'wishy-washy' material....not really sure what you mean here. If you are referring to the idea that some of it seems less biological in nature...well yeah, but again, I don't see that getting better(and some people would see that as a bad thing anyways).

The biggest challenges facing psychiatry going forward(the way it is currently set up) is simply the relative lack of efficacy for the drugs we use for most of our patients.

 

[dl2dp2]

The biggest challenges facing psychiatry going forward(the way it is currently set up) is simply the relative lack of efficacy for the drugs we use for most of our patients.

Don't really get why this is the biggest challenge. Most medications period are not that efficacious. And STAR*D showed that 50% of people achieve remission by the end of level 3. 85-90% achieve remission after ECT. Some psych meds have the most dramatic effects in all of medicine (clozapine).

Perhaps what you mean is the PERCEIVED lack of efficacy of psych meds.

Also, you are implicitly agreeing with me that psych is good lifestyle, good money, high satisfaction, overall a good job. You are just being argumentative for no clear reason.

 

[vistaril]

Don't really get why this is the biggest challenge. Most medications period are not that efficacious. And STAR*D showed that 50% of people achieve remission by the end of level 3. 85-90% achieve remission after ECT. Some psych meds have the most dramatic effects in all of medicine (clozapine).

Perhaps what you mean is the PERCEIVED lack of efficacy of psych meds.

Also, you are implicitly agreeing with me that psych is good lifestyle, good money, high satisfaction, overall a good job. You are just being argumentative for no clear reason.

I'm partly agreeing with you....the picture you described is overly favorable imo and not completely realistic.

As for clozaril, Im pretty sure that isn't what you had in mind in your 35 hr a week outpatient private practice where patients bring you christmas presents and tell you how great you are.

And no, most medications are more effective than antidepressants(to name one psych class). Antibiotics work a lot better than this. Blood pressure meds work a lot better than this. There are a lot of medications that have questionable efficacy, but they generally aren't the bread and butter of a specialty's practice. Most importantly, other specialties treat through other modalities as much or more than with medications. Surgeons operate, obgyns deliver babies and operate, dermatologists excise things, etc..... Unless you are doing mostly therapy, medications are your treatment in psychiatry. The same can't be said for most specialties.

 

[notdeadyet]

Vistaril- when you constantly compare efficacy of treatment in psychiatry to delivering babies in OB-GYN and procedures in surgery, you're sort of salting the mine.

Psych outcomes don't tend to compare as favorably because unlike your examples there, psychiatry is typically about managing
CHRONIC disease. Its hard. Try telling a primary ca doc how easy it is to manage a patients diabetes or back pain and he will laugh at you.

If you want to compare psych to surgery or OB-GYN, lets talk about bringing someone down from a manic episode or an acute bout of hallucinations. Our acute management successes are pretty comparable to other acute fields of medicine.

 

[vistaril]

Vistaril- when you constantly compare efficacy of treatment in psychiatry to delivering babies in OB-GYN and procedures in surgery, you're sort of salting the mine.

Psych outcomes don't tend to compare as favorably because unlike your examples there, psychiatry is typically about managing
CHRONIC disease. Its hard. Try telling a primary ca doc how easy it is to manage a patients diabetes or back pain and he will laugh at you.

If you want to compare psych to surgery or OB-GYN, lets talk about bringing someone down from a manic episode or an acute bout of hallucinations. Our acute management successes are pretty comparable to other acute fields of medicine.

Last I checked, insulin works pretty darn well. Sometimes DM isn't managed well because of patient noncompliance, and our patients have this issue as well of course. But when variables like compliance are the same, there is no question that hypoglycemic agents, hypertensive agents, etc work better than antidepressants.

Also, 'bringing someone down from an acute bout of hallucinations' isn't hard and doesn't compare to things like surgical interventions. I'm pretty sure the medical student currently on my service(who has no interest in psych) would administer a similar treatment acutely in those situations to what the head of psychiatry at UCSF would.

 

[shan564]

Last I checked, insulin works pretty darn well. Sometimes DM isn't managed well because of patient noncompliance, and our patients have this issue as well of course. But when variables like compliance are the same, there is no question that hypoglycemic agents, hypertensive agents, etc work better than antidepressants.

I'll have to disagree. Even if a patient is compliant with treatment, diabetics still commonly continue to develop symptoms and complications. Antidepressants may not always work, but a large number of patients become asymptomatic after a while. Of course, we don't usually see those people too often (they can be managed with occasional visits or be treated by their PCP), so our perspective is slightly distorted.

Also, 'bringing someone down from an acute bout of hallucinations' isn't hard and doesn't compare to things like surgical interventions. I'm pretty sure the medical student currently on my service(who has no interest in psych) would administer a similar treatment acutely in those situations to what the head of psychiatry at UCSF would.

Yeah, that's probably true. I think surgeons certainly earn their big paychecks.

 

[vistaril]

I'll have to disagree. Even if a patient is compliant with treatment, diabetics still commonly continue to develop symptoms and complications. .

only if you are measuring the wrong endpoint. The job of an hypoglycemic is to decrease blood sugar. By any measure, they accomplish this is used correctly.

 

[shan564]

only if you are measuring the wrong endpoint. The job of an hypoglycemic is to decrease blood sugar. By any measure, they accomplish this is used correctly.

No, the job of a hypoglycemic is to improve outcomes by decreasing blood sugar. That's why the "best" RCTs in IM (i.e. the ones that get into NEJM and JAMA) are are the ones that measure long-term outcomes. Nobody cares about improving numbers on a blood panel if it doesn't translate to mortality benefit... that's why ezetimibe has fallen out of favor.