Psychiatry Earning Potential

[berkaderk]

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Hi everyone, so I've recently decided orthopedics is not for me after thinking it was for most my life, and I have been trying to figure out what to pivot to. Psychiatry is honestly at the top of my list so far. I am passionate about the subject and patients, it was a rotation I really enjoyed, ofc the lifestyle is good. My only question is what is the true earning potential? I see most positions pay around 300-350k, but I was curious if there are ways to scale up salary, such as private practice, Telehealth, and side gigs such as medical director roles or starting and owning interventional clinics such as TMS. I definitely have a desire to engage in the business side of medicine. I was curious if this is feasible, what salaries you have seen for higher earners and what they do to achieve it?

If there is a realistic path to 500k income 5-10 years into a career, I think I would have found the ideal trifecta of passion lifestyle and income, at least for me

 

[nexus73]

For most psychiatrists hitting 500K nixes the lifestyle benefit

 

[Bartelby]

For a business-minded person $500k is doable, but requires either straying from the beaten path or a lot of hard work (or both). For example, running a clinic with employees, doing high-end cash practice, locums, or working 1.5-2 full time equivalent worth of hours via moonlighting or multiple jobs.

I think 300-350k with a very good lifestyle is common. At higher incomes you may have more tradeoffs, but it's still rare to see any psychiatrist working like a surgeon.

 

[mistafab]

I think 500k is hard to get without at least short term sacrifice in terms of time investment, risk, etc. You can definitely do this in private practice, but it will take you time to set something up that can do this long term without you working your tail off. Psychiatry can easily make 500k working a surgeon's hours in a quicker time frame, but that's not usually the goal in psychiatry.

350-400K without working too hard is certainly doable even within a year or two of residency. With some business savviness and willingness to work 45-50 hours a week -- it can happen tomorrow and get you closer to low 400s. You can even do this without having to take call. Just need to think outside the box a little bit and not just sign on the dotted line with a random big box employer.

Keep in mind that the median in psych is still around 305-330 or so total comp when all is said and done. This is usually a 35-40 hour outpatient gig without any bells and whistles, pretty low pressure, and no call at a big box employed position. Regional and local variance plays a factor. Anything you do to deviate from this can potentially earn you more money - but may come with more stress or require more ingenuity (or chutzpah).

 

[TexasPhysician]

In ortho, one of the primary ways to reach a high income was to get a salaried position (with bonuses) with a group that had established referrals and staff set-up to maximize your procedures. Doing this yourself would likely result in much reduced income for quite some time and maybe forever if not very successful. Business skills are less relevant as pumping out procedures.

In psychiatry, most salaried jobs are $250-350K with limited upside. If you want to earn more, building it yourself is important. $500K 10 years into your career is not going to just happen.

I’m roughly 10 years out. About half of my graduating class is earning the national average with no desire to make changes. Half is earning over $500K by combining multiple PT jobs together or building a practice that works for them.

 

[FN9]

In ortho, one of the primary ways to reach a high income was to get a salaried position (with bonuses) with a group that had established referrals and staff set-up to maximize your procedures. Doing this yourself would likely result in much reduced income for quite some time and maybe forever if not very successful. Business skills are less relevant as pumping out procedures.

In psychiatry, most salaried jobs are $250-350K with limited upside. If you want to earn more, building it yourself is important. $500K 10 years into your career is not going to just happen.

I’m roughly 10 years out. About half of my graduating class is earning the national average with no desire to make changes. Half is earning over $500K by combining multiple PT jobs together or building a practice that works for them.

Work like Ortho and you can easily pass 1000k easy.

 

[FatherPsychiatry]

s

I definitely have a desire to engage in the business side of medicine. I was curious if this is feasible, what salaries you have seen for higher earners and what they do to achieve it?

If there is a realistic path to 500k income 5-10 years into a career, I think I would have found the ideal trifecta of passion lifestyle and income, at least for me

This would mostly lockout engaging in the business side of medicine as a primary role, but if you are OK with working in a prison in CA, you can make close to that with a good lifestyle straight out of residency (probably even higher after unlisted bonuses). So in your trifecta that covers lifestyle and income, so passion is up to you, and yes corrections work is definitely not for everyone.

Psychiatry Careers

Psychiatrist Opportunities with California Correctional Health Care Services, Apply With Us

cchcs.ca.gov

Staff Psychiatrist – Onsite Inpatient Unit
$485,712 (Board Certified)
$471,924 (Board Eligible)

Most jobs are 4 days a week. A lot of people do private practice on the off day so you can still fill that business itch.

 

[finalpsychyear]

s

This would mostly lockout engaging in the business side of medicine as a primary role, but if you are OK with working in a prison in CA, you can make close to that with a good lifestyle straight out of residency (probably even higher after unlisted bonuses). So in your trifecta that covers lifestyle and income, so passion is up to you, and yes corrections work is definitely not for everyone.

Psychiatry Careers

Psychiatrist Opportunities with California Correctional Health Care Services, Apply With Us

cchcs.ca.gov

Staff Psychiatrist – Onsite Inpatient Unit
$485,712 (Board Certified)
$471,924 (Board Eligible)

Most jobs are 4 days a week. A lot of people do private practice on the off day so you can still fill that business itch.

Not sure but 350k in the midwest is probably better when u consider housing and tax.

 

[comp1]

Yeah, it's going to need to be prison (on-site, no telehealth) in CA to get to $500k salaried to keep anything resembling a lifestyle. Fortunately, most prisons aren't near a high COLA for CA. A couple are, but most are in the very lowest COLA and least desirable areas of the state.

 

[finalpsychyear]

Yeah, it's going to need to be prison (on-site, no telehealth) in CA to get to $500k salaried to keep anything resembling a lifestyle. Fortunately, most prisons aren't near a high COLA for CA. A couple are, but most are in the very lowest COLA and least desirable areas of the state.

I love these threads talking about how much i love psych but only if i can make 500k. looking at salaries outside of the median/mean is not a wise choice imo for any field.

 

[Sushirolls]

Do ortho, and hip fellowship.
Rising Geriatric population...

 

[adiradirim]

Do ortho, and hip fellowship.
Rising Geriatric population...

Isn’t them falling more the problem?

 

[psydocc]

If there is a realistic path to 500k income 5-10 years into a career, I think I would have found the ideal trifecta of passion lifestyle and income, at least for me

Here's a realistic path to 500k income right after residency

Step 1: get a full time job, 35 hours per week, $350k per year
Step 2: get a part time job, 15 hours per week, $150k per year

This is not rocket science.

But if your real question is whether you can work <10 hours per week and make $500k+ then psychiatry is probably not a good fit for you. We don't need more David Brody-types.

 

[clozareal]

Here's a realistic path to 500k income right after residency

Step 1: get a full time job, 35 hours per week, $350k per year
Step 2: get a part time job, 15 hours per week, $150k per year

This is not rocket science.

But if your real question is whether you can work <10 hours per week and make $500k+ then psychiatry is probably not a good fit for you. We don't need more David Brody-types.

Another realistic path is in private practice.

Insurance reimburses about $200-250 for a 99214+90833. Let's say half are 99214 alone and half are 90833.

[$125/half hour (99214 alone) * 2 visits an hour * 4 hours a day + $250/half hour (99214+90833) * 2 visits an hour * 4 hours a day] * 5 days a week * 48 weeks a year (4 weeks of unpaid vacation) = $720,000 gross revenue annually for 40 hours of clinical work. If you do 30 hours then that breaks $500k already.

This doesn't account for admin time though which there is a steep learning curve for private practice. However, if you were able to get through medical school, you can learn the ins and outs of private practice which is considered business-lite.

In my area, some insurances pay more than that per half hour. Also, $250/half hour med visit seems well within the range of the going rate for a psychiatrist. My rates are much higher than that but I'm also living and providing services in a VHCOL area.

 

[finalpsychyear]

Another realistic path is in private practice.

Insurance reimburses about $200-250 for a 99214+90833. Let's say half are 99214 alone and half are 90833.

[$125/half hour (99214 alone) * 2 visits an hour * 4 hours a day + $250/half hour (99214+90833) * 2 visits an hour * 4 hours a day] * 5 days a week * 48 weeks a year (4 weeks of unpaid vacation) = $720,000 gross revenue annually for 40 hours of clinical work. If you do 30 hours then that breaks $500k already.

This doesn't account for admin time though which there is a steep learning curve for private practice. However, if you were able to get through medical school, you can learn the ins and outs of private practice which is considered business-lite.

In my area, some insurances pay more than that per half hour. Also, $250/half hour med visit seems well within the range of the going rate for a psychiatrist. My rates are much higher than that but I'm also living and providing services in a VHCOL area.

My friends In medium and low cost are on the lower end 150-200. They did the fantasy math like above and found that in the end there gross numbers were at least 15-20% less esp when you combine holidays, no shows, denials, non payment and sometimes slower months as you won't be 100% filled always. Even with slim margins lets just say you have 30% overhead thats pretty optimistic when you account for billing, rent, utilities, staff etc.

Reality is if one did work 48 weeks and got the rates you said cut 15% off that 720k then another 30% off that number and your at 430k pre tax which still needs to be taxed by uncle sam/state/local/medicare/ss/ etc.

Also as you get older you probably want more than 4 weeks of vaca. I took double that last year and keeping that now.

 

[Dopamemes]

Another realistic path is in private practice.

Insurance reimburses about $200-250 for a 99214+90833. Let's say half are 99214 alone and half are 90833.

[$125/half hour (99214 alone) * 2 visits an hour * 4 hours a day + $250/half hour (99214+90833) * 2 visits an hour * 4 hours a day] * 5 days a week * 48 weeks a year (4 weeks of unpaid vacation) = $720,000 gross revenue annually for 40 hours of clinical work. If you do 30 hours then that breaks $500k already.

This doesn't account for admin time though which there is a steep learning curve for private practice. However, if you were able to get through medical school, you can learn the ins and outs of private practice which is considered business-lite.

In my area, some insurances pay more than that per half hour. Also, $250/half hour med visit seems well within the range of the going rate for a psychiatrist. My rates are much higher than that but I'm also living and providing services in a VHCOL area.

200-250 for that combination is on the high range for most of the US. Alma/Headway can get you around the lower end of that. A solo practitioner directly contracting with insurance in most parts of the country would be thrilled to get 150-200 for a 99214+90833. Also, therapy add on codes are never that close to E/M codes. My rates were about 110 for a 99214 and 40 for a 90833. Insurance heavily incentivizes the 15 minute follow up visit model.

 

[Bartelby]

I think running those fantasy numbers is a worthwhile exercise too, but you have to take them with a huge grain of salt.

Those numbers assume that you see 100% follow-ups, that 100% of them appear as scheduled, and that you are able to fill every schedule gap without fail when setting up your schedule. Even with insurance those are far from reality.

I also think to genuinely do 40 hours of clinical care each week you would probably need to work at least 60 hours per week. You are going to do administrative work, you will have gaps in your schedule, and you will have no shows and late cancellations. You will also have to do intake assessments which typically reimburse less.

You also have to factor in dealing with people who have more pressing needs. If you have somehow filled your schedule to 100% full, are you going to be able to offer adequate follow-up to someone who is decompensating? I think having some schedule gaps is important for preserving quality of care and your own sanity.

I think starting with that fantasy number and then making various downward assumptions is a good way to go, though reality will be dictated by your local market and your skills running a practice including finding an adequate patient base. For example, maybe you make 90% of your total schedule available for clinical care, you fill 80% of available time slots, and you have a show rate of 80% (all fairly optimistic numbers). That might give you an estimate that is closer to the likely reality.

 

[Bartelby]

I also have not taken insurance in private practice. If you do, you have to factor in whether you will need a billing specialist or other office staff. If you do, that comes off your gross revenue as well.

 

[Bartelby]

One other thought though, I do like that clozareal estimated a psychotherapy add-on for only 50% of cases. My visits qualify for an add-on code probably closer to 80% of the time. Depending on reimbursement rates, that could tweak the numbers a bit higher.

And if you do find that you have some really stable people who do not need longer visits but who need to continue following with you, you could consider scheduling three per hour and increasing reimbursement that way. I would wait until you see how your workflow is going before seriously considering that route though.

 

[clozareal]

My friends In medium and low cost are on the lower end 150-200. They did the fantasy math like above and found that in the end there gross numbers were at least 15-20% less esp when you combine holidays, no shows, denials, non payment and sometimes slower months as you won't be 100% filled always. Even with slim margins lets just say you have 30% overhead thats pretty optimistic when you account for billing, rent, utilities, staff etc.

Reality is if one did work 48 weeks and got the rates you said cut 15% off that 720k then another 30% off that number and your at 430k pre tax which still needs to be taxed by uncle sam/state/local/medicare/ss/ etc.

Also as you get older you probably want more than 4 weeks of vaca. I took double that last year and keeping that now.

Regardless of private practice or any setting, you're going to be taxed. The more appropriate contrasting cost to private practice is going to be practice expenses and benefits. My overhead is about 15% but I know some who have even less.

You also have to consider benefits if you are taking a salaried job as health insurance can be an additional $10k-50k per year for a family depending on the plan. It would cost my family of 4 about $4000/month for an equivalent health insurance to what my spouse has.

200-250 for that combination is on the high range for most of the US. Alma/Headway can get you around the lower end of that. A solo practitioner directly contracting with insurance in most parts of the country would be thrilled to get 150-200 for a 99214+90833. Also, therapy add on codes are never that close to E/M codes. My rates were about 110 for a 99214 and 40 for a 90833. Insurance heavily incentivizes the 15 minute follow up visit model.

Insurance rates are hyper-local. Alma/Headway aren't insurance companies, they're intermediaries that give the provider a rate after they factor in overhead themselves. How much do you think they take as a cut? Get paneled independently if you want to see what you'll get. I found that some group practices were getting around the same as me as a solo provider so I'm not sure how much leverage a group practice has even though everyone told me they have more.

The range of 99214 that I directly received from the big insurance companies ranges from $106 to $259 with an average of $185, with Medicare non-facility price being around $150. Mind you, this was 5 years ago when I first started my practice prior to post-pandemic demand increasing for psychiatrists. Also where I chose my office also changed the rates. I could have chosen an office two miles down the road in another county/zip code and that would have given me slightly but not insignificantly lower rates of about 2-5%.

The range of 90833 that I received is $70 to $151 with an average of $104 with medicare being $80.

That being said, my average for 99214+90833 from insurance contracts is closer to $300, which could be an outlier and why I underestimated but it is my experience. One outlier insurance company offered $400 for that combo.

Yes, obviously you would have to fill up that time and also 90792/99205 for intakes are probably not going to give you as much as follow-ups. You'll have to do many more intakes at the start of practice as well before scaling up but once you're settled into private practice, it's about margin efficiency.

After going through the insurance negotiation process and taking cash patients during that process, I decided not take insurance and only take cash as I was able to have an adequate stream of patients. I bill at a higher half hourly rate than $250. OP was asking about whether there is a realistic path and I wanted to give my two cents in on another path outside salaried jobs. My income has been >$500k since I've graduated with my cash only CAP practice in a VHCOL area but I'm also living in a VHCOL area so it feels less like it. My benefits are from my spouse but otherwise, I do put in max pre-tax 401k from employer and employee portion which is much more than what the employee max is and if I wanted to put in even more pretax money, I would do a cash balance plan.

 

[FlowRate]

I haven't updated this for newer medicare rates, but this sheet can help if someone is wanting to do estimates for their specific situation, just make a copy for yourself so you can edit the numbers.

Direct Link

 

[clozareal]

I haven't updated this for newer medicare rates, but this sheet can help if someone is wanting to do estimates for their specific situation, just make a copy for yourself so you can edit the numbers.

Direct Link

This is fantastic. Thanks for creating this!

The path to >$500k with only Medicare seems to be working 7 clinical hours a day, 5 days a week, 48 weeks a year.

 

[FlowRate]

FYI, not sure how individual subspecialties shook out, but if you blend general and specialties, then between 2023 and 2024, the average of two large industry-standards salary surveys was basically zero change in psych comp. The year prior was a small % increase. I wonder if we are actually seeing the impact of proliferation of NP's depressing psych's ability to keep up w/ other specialties' pay increases over time.

 

[ObsequiousAplomb]

So in private practice this is an acheivable goal 5-10 years out for sure.
I'm 2.5 years out and I've made huge leaps in my outpatient private practice component of my business in that time.
I started seeing patients September 2023, but I wasn't in-network with any insurers until January 2024.

2024 I brought in a hair under $70k after expenses.
2025 I brought in ~$170k after expenses, with my collections amounting to roughly $350/hour and my net being ~$335/hour. I worked less than 500 hours 2025.
In 2026 I am already on pace to continue a similar growth trajectory. I've worked 30% more hours so far in 2026 than I did this time in 2025, and I know that my collections rate per hour has had a marked increase over that time (started offering some shorter appointment types, etc).

As I've said before, I don't advertise. All my business is either insurance company directing them as I'm in network or word-of-mouth growth.
My private pay rates average out to around $375/hour, but even there I could be doing much better. I frequently take over care from a provider who was charging $1000+ per hour.

The problem is that you not only have to be a psychiatrist, but you also have to market yourself well enough / have a reputation worthy of charging that rate. You also have to practice somewhere that people with that much money are looking for you to care for them.

 

[FlowRate]

FYI, not sure how individual subspecialties shook out, but if you blend general and specialties, then between 2023 and 2024, the average of two large industry-standards salary surveys was basically zero change in psych comp. The year prior was a small % increase. I wonder if we are actually seeing the impact of proliferation of NP's depressing psych's ability to keep up w/ other specialties' pay increases over time.

Fascinating update/note, I was shown the detailed numbers for the salary surveys we have and MGMA has C&A as only $10k above gen psych. The other salary survey had a notably wider spread (lower pay for gen psych and higher pay for C&A). Inpatient was paid way higher than outpt gen psych, according to the one survey that had sufficient data to report (higher than outpatient C&A.)

 

[Merovinge]

Fascinating update/note, I was shown the detailed numbers for the salary surveys we have and MGMA has C&A as only $10k above gen psych. The other salary survey had a notably wider spread (lower pay for gen psych and higher pay for C&A). Inpatient was paid way higher than outpt gen psych, according to the one survey that had sufficient data to report (higher than outpatient C&A.)

Could you provide those numbers even as Survery A, Survey B etc to avoid copyright or whatever the heck they do to gate the information?

 

[FlowRate]

Could you provide those numbers even as Survery A, Survey B etc to avoid copyright or whatever the heck they do to gate the information?

Well, I guess you can piece together one of them from what I said about the two but I'll round to the nearest 5k: Survey A: Gen Psych 315, C&A 360; Survey B: GP 325, C&A 330 (IIRC, might have been 335, I didn't take a screenshot.). Inpatient 370 (one survey). Geri, Addiction, and C&L all clustered around 315 in survey A (Addiction survey B was 300). These are the 2024 numbers, as our company has a long process for implementing pay updates and is effectively always one year behind the most recent releases.

 

[calvnandhobbs68]

Yeah the higher salary in C+A was always a function of being able to charge more in cash only or trying to just retain people due to shortage.

It's not like insurance is paying me anymore for the same E+M codes. They did expedite my credentialing back in 2021 because child was considered "critical access" or something back then but I'm not getting paid more for my visits.

 

[splik]

Yeah the higher salary in C+A was always a function of being able to charge more in cash only or trying to just retain people due to shortage.

It's not like insurance is paying me anymore for the same E+M codes. They did expedite my credentialing back in 2021 because child was considered "critical access" or something back then but I'm not getting paid more for my visits.

you may be missing out! It's is fairly common for insurance companies to pay more for CAP than for adult psychiatry. While some companies promote it, others you have to ask but they usually do have a higher fee schedule for CAP. Less often, but addiction too can also get higher rates.

 

[calvnandhobbs68]

you may be missing out! It's is fairly common for insurance companies to pay more for CAP than for adult psychiatry. While some companies promote it, others you have to ask but they usually do have a higher fee schedule for CAP. Less often, but addiction too can also get higher rates.

Yeah I've definitely heard that but it hasn't seemed common for this area....maybe I should try to poke the insurance companies again. Cigna and Aetna especially pay worse in this area.

 

[splik]

Yeah I've definitely heard that but it hasn't seemed common for this area....maybe I should try to poke the insurance companies again. Cigna and Aetna especially pay worse in this area.

There may be some geographic variance, but I can tell you cigna definitely has a higher fee schedule for CAP in my area. I don't think Aetna does but they historically paid well but seem to have gone downhill.

 

[ObsequiousAplomb]

Let's say half are 99214 alone and half are 90833.

So in private practice this is an acheivable goal 5-10 years out for sure.
I'm 2.5 years out and I've made huge leaps in my outpatient private practice component of my business in that time.
I started seeing patients September 2023, but I wasn't in-network with any insurers until January 2024.

2024 I brought in a hair under $70k after expenses.
2025 I brought in ~$170k after expenses, with my collections amounting to roughly $350/hour and my net being ~$335/hour. I worked less than 500 hours 2025.
In 2026 I am already on pace to continue a similar growth trajectory. I've worked 30% more hours so far in 2026 than I did this time in 2025, and I know that my collections rate per hour has had a marked increase over that time (started offering some shorter appointment types, etc).

As I've said before, I don't advertise. All my business is either insurance company directing them as I'm in network or work-of-mouth growth.
My private pay rates average out to around $375/hour, but even there I could be doing much better. I frequently take over care from a provider who was charging $1000+ per hour.

The problem is that you not only have to be a psychiatrist, but you also have to market yourself well enough / have a reputation worthy of charging that rate. You also have to practice somewhere that people with that much money are looking for you to care for them.

After completing four months of 2026, I can say that my hours are 62% higher than in 2025, but my collection rate has stagnated just a hare as I've had an influx of patients requesting 45 minute appointments for therapy. I only collect ~$325/hour with insurance when I'm billing 90836 add-ons. I also have at least one medicaid patient. Even with medicaid I can make ~$325/hourly average on 4x99214s in my area, it's just that I only have the one patient and don't want any more.

Based on the last four months (which included a long holiday), projected income after expenses for the year near ~$275k averaging 15 clinical hours per week.

Worth noting again that I don't have any billing specialists or a billing service. I just submit the claims via Claim.MD for 60 cents each for the first 100 per month and 50 cents each after 100 per month. Only time insurance has ever denied a claim for an office visit is when I mis-keyed the insurance ID number, easily corrected by submitting the right one. If I had bothered credentialing with more than just one insurance, I'd undoubtedly be at $500k per year working part time by now. No secretaries, no front desk staff, nobody but me to have the patients split on in my office, nobody to pay but me.

 

[DanielWestcott]

I think running those fantasy numbers is a worthwhile exercise too, but you have to take them with a huge grain of salt.

Those numbers assume that you see 100% follow-ups, that 100% of them appear as scheduled, and that you are able to fill every schedule gap without fail when setting up your schedule. Even with insurance those are far from reality.

I also think to genuinely do 40 hours of clinical care each week you would probably need to work at least 60 hours per week. You are going to do administrative work, you will have gaps in your schedule, and you will have no shows and late cancellations. You will also have to do intake assessments which typically reimburse less.

You also have to factor in dealing with people who have more pressing needs. If you have somehow filled your schedule to 100% full, are you going to be able to offer adequate follow-up to someone who is decompensating? I think having some schedule gaps is important for preserving quality of care and your own sanity.

Buffalo King Megaways​

I think starting with that fantasy number and then making various downward assumptions is a good way to go, though reality will be dictated by your local market and your skills running a practice including finding an adequate patient base. For example, maybe you make 90% of your total schedule available for clinical care, you fill 80% of available time slots, and you have a show rate of 80% (all fairly optimistic numbers). That might give you an estimate that is closer to the likely reality.

I think this is one of the more realistic takes in the thread. It's easy to calculate revenue assuming every slot is full, but real practice is rarely that predictable.

 

[ObsequiousAplomb]

I think this is one of the more realistic takes in the thread. It's easy to calculate revenue assuming every slot is full, but real practice is rarely that predictable.

One of the other major factors in calculating income people don't consider is that once you are in private practice your relationship with work hours changes significantly. No longer being married to the 40-hour or 32-clinical-hour work week means that you end up working whatever you want to work / can work.

For example, if I randomly get twice as many consultation requests one week, I'll jump to see them that week instead of spreading them out because it means I directly make that much more money than I would have otherwise. So going from 16 one week to 24 another may seem like a 50% increase in hours, but it's also a commensurate increase in pay. It also means that people keep thinking I'm available, which leads to more word-of-mouth referrals, etc.

It also means that if I schedule 20 hours and 18 hours are billed, that it was a 10% reduction in income that week, yes, but 18 hours billed and collected after expenses at $400/hour is still more than 40 hours of W2 at $180/hour. Sure, one could be frustrated with having not milked more money from the stone by not billing 40 hours, but imo not much beats that flexibility of not having to work 40 hours or being expected to work 40 hours.

This week I worked 20.33 hours, but I had initially scheduled 21.67 hours. I could choose to get very obsessed over the missed 1.67 hours / ~$555 I'm missing out on by being reliant on collections for pay, or I could recoup some from no-show fees, or I could be happy to have made a boatload of money not working that many hours and not being stressed out at all. Employed you make the same whether patients show up or not; when you're in charge you have a much more vested interest in decreasing no-shows.


It's surprisingly challenging to try to work this few hours in any other specialty and still make this much money after overhead. The margins are so incredibly much more favorable in psychiatry it's ridiculous.

Despite working less than half-time I net 90% of my collections, which are 97% of my billings, or 95% of what I schedule.

 

[comp1]

I find that W2 work keeps me from under and overworking. Just reading the above post makes me anxious.

 

[Stagg737]

This week I worked 20.33 hours, but I had initially scheduled 21.67 hours. I could choose to get very obsessed over the missed 1.67 hours / ~$555 I'm missing out on by being reliant on collections for pay, or I could recoup some from no-show fees, or I could be happy to have made a boatload of money not working that many hours and not being stressed out at all. Employed you make the same whether patients show up or not; when you're in charge you have a much more vested interest in decreasing no-shows.

Unless you work somewhere that pays an RVU-based or fee for service type model and compensates you reasonably. I make around $70/wRVU and am 100% RVU based. I'm also (mostly) not outpatient though, so no-shows aren't really something I worry about.

 

[ObsequiousAplomb]

Unless you work somewhere that pays an RVU-based or fee for service type model and compensates you reasonably. I make around $70/wRVU and am 100% RVU based. I'm also (mostly) not outpatient though, so no-shows aren't really something I worry about.

That sucks. Then again, you probably see a lot of consults that if you hadn't been paid RVUs you'd be annoyed to be seeing, and you probably follow people more closely than you would otherwise. So there's that perverse incentive for the hospital, I guess.

 

[Stagg737]

That sucks. Then again, you probably see a lot of consults that if you hadn't been paid RVUs you'd be annoyed to be seeing, and you probably follow people more closely than you would otherwise. So there's that perverse incentive for the hospital, I guess.

I actually prefer this model to being salaried. It makes the busy days a lot more tolerable and if the hospital expects me to work more I get paid for it.

A former colleague worked at another hospital in town that was paying $275k straight salary for consults. He loved it at first because he was only seeing 4-5 patients a day. Then they upped the expectation to 7-9 per day without a pay increase. He left when they said they wanted him seeing at least 10 patients per day and either didn’t bump the salary or barely increased it.

I don’t think I could ever work for straight salary unless there was a production bonus involved. I’m not willing to risk increased expectations in volume without compensation.

 

[comp1]

Salaried work should be hours based, whether inpatient or outpatient, as in I will be available for consults or admissions or follow-ups during these 40 hours per week. Tying a number of consults to that (beyond an upper limit) is not appropriate. 7 is probably an appropriate upper limit for an 8 hour day assuming mostly new patients. I find that sometimes administrators confuse outpatient and inpatient flow, which is why we need more inpatient people in administration and management

 

[ObsequiousAplomb]

I actually prefer this model to being salaried. It makes the busy days a lot more tolerable and if the hospital expects me to work more I get paid for it.

A former colleague worked at another hospital in town that was paying $275k straight salary for consults. He loved it at first because he was only seeing 4-5 patients a day. Then they upped the expectation to 7-9 per day without a pay increase. He left when they said they wanted him seeing at least 10 patients per day and either didn’t bump the salary or barely increased it.

I don’t think I could ever work for straight salary unless there was a production bonus involved. I’m not willing to risk increased expectations in volume without compensation.

Mandating a minimum amount of consults sounds like a very weird policy for a hospital to have. What if there are only 3 consults a day? Does an adminstrator start texting the internists encouraging they consult more?

could you imagine a "minimum consult" requirement for other specialists to get paid?

Actually, saying it out loud, I have trained in environments where they were doing that in a vain attempt to prevent the hospital from going under.

 

[comp1]

A psych consult service is a money loser. It is obviously required for a hospital, but it will always lose money. I have never bought into the idea that a CL service gets people out faster or saves money in some indirect way. Thus it will always frustrate financially oriented executives. It is just a requirement of getting the profitable business. And, yes, of course the concept of a minimum number of consults is very silly and only comes from people who ever only managed (or reviewed financials for) outpatient clinics.

 

[Taddy Mason]

A psych consult service is a money loser. It is obviously required for a hospital, but it will always lose money. I have never bought into the idea that a CL service gets people out faster or saves money in some indirect way. Thus it will always frustrate financially oriented executives. It is just a requirement of getting the profitable business. And, yes, of course the concept of a minimum number of consults is very silly and only comes from people who ever only managed (or reviewed financials for) outpatient clinics.

Where I trained our C/L service and addiction C/L service were the two busiest services in the hospital. They also generated the most money for our psych department - much more than outpatient. Inpatient was consistently a money loser.

 

[Stagg737]

Salaried work should be hours based, whether inpatient or outpatient, as in I will be available for consults or admissions or follow-ups during these 40 hours per week. Tying a number of consults to that (beyond an upper limit) is not appropriate. 7 is probably an appropriate upper limit for an 8 hour day assuming mostly new patients. I find that sometimes administrators confuse outpatient and inpatient flow, which is why we need more inpatient people in administration and management

Mandating a minimum amount of consults sounds like a very weird policy for a hospital to have. What if there are only 3 consults a day?

I agree. My understanding was that there were plenty of consults and they were increasing so instead of hiring more staff they expected those already working to just keep seeing more and more patients without pay increase. My former colleague left when admin said they needed to hurry up the patients they were already seeing to try and squeeze in more consults.

Does an adminstrator start texting the internists encouraging they consult more?

Actually, saying it out loud, I have trained in environments where they were doing that in a vain attempt to prevent the hospital from going under.

Sounds like exactly what admins would do to try and drum up more money. Especially if they don’t have to pay the consultant more.

A psych consult service is a money loser. It is obviously required for a hospital, but it will always lose money. I have never bought into the idea that a CL service gets people out faster or saves money in some indirect way. Thus it will always frustrate financially oriented executives. It is just a requirement of getting the profitable business. And, yes, of course the concept of a minimum number of consults is very silly and only comes from people who ever only managed (or reviewed financials for) outpatient clinics.

Not always. Where I’m at we are also the busiest consult service in the hospital by volume and also basically gatekeepers to get patients to psych hospitals once medically stabilized. We also often help discharge patients that would be sitting on medical floors for days waiting to be sent to inpatient psych when they don’t actually need it.