- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
Salary doesn't have much to do with the quality/rank of one's residency.
psychiatry salary
- Thread starter artsydoc
- Start date
Salary doesn't have much to do with the quality/rank of one's residency.
- Joined
- Feb 8, 2004
- Messages
- 8,026
- Reaction score
- 4,154
Salary could be highly variable. I know for example some doctors that are excellent that are doing community care, not making much, but they want to be in the front-lines and helping people.
One of the top 100 doctors in the country doesn't make much more money than I. He's not in it for the money.
One of the worst doctors I know makes about 1 million a year because he's in reality a drug dealer giving as much opioids as anyone wants.
Don't correlate quality with money. It's much more complicated than that. I wouldn't compare it with how much you're willing to sell out either. I know some doctors that make more money because they are good and do high quality work. A different top doctor I know makes a heck of a lot of money but IMHO it's because he's so good, and I don't think he's doing anything unethical either despite working for the pharmaceutical companies because he will outright tell other doctors to consider generics first in several cases.
It's more about how savvy you are with business, how much you're willing to think about business vs simply see yourself as a doctor, and what you're willing to do to make more money.
And for many doctors, this is foreign thinking. Many doctors are savants, knowing hyper amounts with medicine but little in other areas. As a buddy of mine that worked in a car dealership told me, whenever he saw a doctor walk through the door, he upped the prices at least 10%, often times 20-30% for docs. Why? Most docs have the money, some are stupid enough to equate spending more money as feeling better about themselves, and they don't have the time or interest to research the car. Many docs I know don't put much business acumen into their professional decisions on where to work, what to do about retirement, etc.
One of the top 100 doctors in the country doesn't make much more money than I. He's not in it for the money.
One of the worst doctors I know makes about 1 million a year because he's in reality a drug dealer giving as much opioids as anyone wants.
Don't correlate quality with money. It's much more complicated than that. I wouldn't compare it with how much you're willing to sell out either. I know some doctors that make more money because they are good and do high quality work. A different top doctor I know makes a heck of a lot of money but IMHO it's because he's so good, and I don't think he's doing anything unethical either despite working for the pharmaceutical companies because he will outright tell other doctors to consider generics first in several cases.
It's more about how savvy you are with business, how much you're willing to think about business vs simply see yourself as a doctor, and what you're willing to do to make more money.
And for many doctors, this is foreign thinking. Many doctors are savants, knowing hyper amounts with medicine but little in other areas. As a buddy of mine that worked in a car dealership told me, whenever he saw a doctor walk through the door, he upped the prices at least 10%, often times 20-30% for docs. Why? Most docs have the money, some are stupid enough to equate spending more money as feeling better about themselves, and they don't have the time or interest to research the car. Many docs I know don't put much business acumen into their professional decisions on where to work, what to do about retirement, etc.
- Joined
- Feb 21, 2007
- Messages
- 3,205
- Reaction score
- 253
Yeah, all these were grads of my program. We're not an uber top program, but a strong, well respected university program.
I don't think it had any impact on their jobs.
A public sector job will get you about 200k with full benefits and a nice pension. A privite sector job will get you about 150k-250k at the least but my current co-workers are getting 400k-600k. It's just how much you want to work, my boss works 7 days a week and sees about 40 patients a day. I have no such ambitions but it's nice to know I could if I wanted to.
Another thing to consider is the lack of overhead. A psychiatrist has no need for a nurse, low malpractice (the lowest IIRC), no need for fancy equipment. All you need is a nice office, a good administrator, a comfy couch, and your soothing demeanor to make a living.
Another thing to consider is the lack of overhead. A psychiatrist has no need for a nurse, low malpractice (the lowest IIRC), no need for fancy equipment. All you need is a nice office, a good administrator, a comfy couch, and your soothing demeanor to make a living.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
Most government psych jobs (VA/state hosp/etc) pay in the range of 150-195k (more is available for chiefs of service). Pension plans are sometimes available, but more states are moving to 403b type plans.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
Above 400k is a pretty rare income for a psychiatrist
They work like slaves to get that income. Start at 6:00 and see about 40 patients in the hospital and then outpatient until 6. Any free time, like after work or weekends or lunch is devoted to consults. Fridays are skilled nursing in group homes and nursing home. Monday's also have the addition of partial care which is another 15-20 patients on top of inpatient and clinic.
It kind of a killer, but it really is just about volume.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
killer schedule. are these docs relatively young?
I'm the youngest, most are in their 50s. I think a few dropped out of the practised since it was too busy since I'm Inheriting a bunch of their patients.
- Joined
- Jan 5, 2002
- Messages
- 2,909
- Reaction score
- 2,940
Kind of interesting because hospital based cardiologists often have similar schedules as being "normal" and yet at that level the salary difference is actually not huge. I guess their ceilings are a lot higher (i.e. possible to make 1 mil+ in cards, but not in psych), but for non-interventional there's not a huge advantage. V is gonna kill me for saying this. 300k doing private practice working 60 hours a week seems fairly easy to me. Still that's a lot of inflexible work...
- Joined
- Jun 8, 2013
- Messages
- 101
- Reaction score
- 6
Hmm... I'm reading conflicting things in this thread. Another post stated a starting salary of 200k for a VA job- with others concurring that 200k is a typical starting salary for psychiatrists. Now, you're stating 150k is a typical government starting salary. I do not know who I'm supposed to believe...
The job I was offered in the state hospital was 220k to start. I believe the prison system is even higher. County Behavioral health is about 190k, according to my senior who is working there now. I have no idea how much the VA pays, but I believe it has the best benefits being a federal pension.
- Joined
- Jul 23, 2004
- Messages
- 11,775
- Reaction score
- 2,027
It's hard. There's a LOT of regional variation.
It's further complicated by the fact that googling job adverts here and there can be misleading without a careful read. The most aggressively recruited positions (the ones responsible for the most advertising) are for the hardest to fill positions. So some may read great, but the reason they're offering so much money is that they're a miserable experience.
You need to look at broad ranges, make sure you're comfortable with it, then use word of mouth once you're in residency. Anything other than that basically amounts to tea leaves.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
as Notdeadyet has noted, there is some regional variation. Also, some of the prison jobs are not true gov jobs- you are working for a private contractor.
My county job pays about 175 if I worked full time. But it is really kick back and I get good benefits.
My private job pays 400-500 if I worked full time (net). But it is much more hectic and there are no benefits.
At the county, full time is less than full time. I take hour long lunches, coffee breaks, talk to my coworkers etc. At the private office, it is more than 40 hours and I know that if someone doesn't show up, I still have to pay the staff, pay for the lights, the rent etc. I often do call backs in the evenings at lunch and on the weekends.
My private job pays 400-500 if I worked full time (net). But it is much more hectic and there are no benefits.
At the county, full time is less than full time. I take hour long lunches, coffee breaks, talk to my coworkers etc. At the private office, it is more than 40 hours and I know that if someone doesn't show up, I still have to pay the staff, pay for the lights, the rent etc. I often do call backs in the evenings at lunch and on the weekends.
Depends on the region of the country. There's a big book with all that data, with ranges of RVU payment amounts for every specialty. I bet michael rack knows what it's called.
I've heard (no practical experience, just rumors), that often RVU is tiered with production, so if you see 2000 RVUs for example you might get paid $55 (again I have no idea what the actual amount might be), and that beyond this each RVU would be paid at $65(example again). So you would make more by doing more work in any given year. From the hospital's perspective, having one doctor doing the work of 1.5 doctors saves a lot in benefit dollars they would be paying to the other doc, so they want to pay you more.
- Joined
- Apr 17, 2004
- Messages
- 853
- Reaction score
- 22
$55.97 is the national average per RVU according to the 2012 MGMA survey report.
http://www.merritthawkins.com/candidates/BlogPostDetail.aspx?PostId=39443
- Joined
- Apr 11, 2007
- Messages
- 593
- Reaction score
- 21
Would you guys say that psychiatry could give a physician the most opportunity to have free time and manage a small business on the side?
Don't forget the plush nature of psychiatry residency as well. Lots of free time to dream your dreams. Just to give an example, my friend goes surfing in the mornings before his day starts, and I'm in a rock band that makes my life ever so sweet. Psychiatry gives you the time to be a complete person, oh what bliss. Nobody can take my stage away from me.
It boggles the mind a little bit then why the specialty isn't a lot more competitive. Is the stigma so bad? Do most doctors want to make 400k and scorn the 200 even though their lives will be defined in the hospital? Are medical students scared away by mental illness? But I imagine surgical specialties can be equally challenging in their own ways. Psych is one of the very few specialties in medicine that give you a handle on your time. That is a very precious thing to have (more so than money, imo).
- Joined
- Dec 2, 2004
- Messages
- 6,366
- Reaction score
- 4,298
- Joined
- Nov 20, 2002
- Messages
- 1,678
- Reaction score
- 69
Yes, the stigma is a big factor IMO - both the stigma on the mentally ill and the stigma against those of us who treat them. A lot of people out there who like psych choose not to do it because they're worried about what their parents will think if they don't become a surgeon or whatever. A lot of people have an overly simplistic view of psych and don't respect that the field can be intellectually challenging if you want it to be.
- Joined
- Nov 10, 2010
- Messages
- 1,175
- Reaction score
- 811
Anesthesiologists can make crazy money on a fixed schedule of 1-2 weeks a month with no follow up. But that's a procedural field and your patients are asleep most of the time.
I am actually baffled by how many people who, when I tell them I'm going into Psychiatry, respond with "Oh..." and then change the subject. I know I shouldn't care about what people think, because I will forge my own path, but I can't help but wonder, what's SO HORRIBLE about it that 99% of people out there think I have something wrong with me for wanting to be in the mental health field? Is it because they won't find me resourceful in the future like they would if I was a GI/cards guy? Is it because I seem like a pill-pusher?
- Joined
- Apr 14, 2003
- Messages
- 1,516
- Reaction score
- 20
Same here. The responses vary from "that's too bad you went through all of med school before you realized you wanted to do psychiatry" (people who don't think psychiatrists are doctors) to "uh oh! I better watch what I say around you!" (people who crack a lame joke because they're uncomfortable) to "why would you ever want to be around crazies all day?" (people who majorly discriminate against people with mental illness) to "oh..." (people who think psych is a bad decision or that I must be crazy). Or my mom, who constantly calls me a psychologist. The stigma is my least favorite part of the field, and seriously bothers me - especially the type A overachiever part of me. But the intellectual challenge, ability to really get to know my patients, great likeminded coworkers, and fascinating stuff I hear every day totally makes it worth it. The salary and ability to have a life and hobbies on the side aren't bad either.
- Joined
- May 30, 2007
- Messages
- 2,559
- Reaction score
- 464
I don't think it's entirely about stigma - it's also largely due to people's poor understanding of mental health. When people say something like "oh, I can't believe you can deal with those crazies all day," I just respond with something like "yeah, I used to find it intimidating too, but it becomes a lot easier when you're trained to do it... and it's really rewarding when you fix them." Or when they say "too bad about med school...", I'll say something like "ha... my med school experience is what led me toward psychiatry (and then explain in an appropriate way)." With the "I better watch what I say," I'll just make a joke like "I promise not to commit you to a mental institution."
As far as why psych isn't more competitive, I don't think it's entirely about the stigma. I think it's less competitive for the same reason that pathology is less competitive - psychiatry is very different from other fields of medicine, and med school tends to attract people who plan to go into medical/surgical fields. Dermatology and radiology are exceptions because they make so much money. No doctors hold a stigma against pathologists, but if you want to spend all of your time in the lab, you're more likely to become a basic science researcher than a medical doctor. If you're interested in mental health as an undergrad, you might be more likely to become a psychologist than a psychiatrist.
Another complaint I have is the 4-week med school psych rotation with like 10 hours of total teaching and the rest of the time on an inpatient psych ward. That's not enough exposure to give students a fair shot of making an informed decision regarding whether or not they find it interesting. I was lucky enough to enjoy my inpatient psych rotation, but for those people who might have had a great career in outpatient adult psych or C/L or CAP or forensics or drug/alcohol, they probably never had a chance to learn about that potential while they were in med school.
As far as why psych isn't more competitive, I don't think it's entirely about the stigma. I think it's less competitive for the same reason that pathology is less competitive - psychiatry is very different from other fields of medicine, and med school tends to attract people who plan to go into medical/surgical fields. Dermatology and radiology are exceptions because they make so much money. No doctors hold a stigma against pathologists, but if you want to spend all of your time in the lab, you're more likely to become a basic science researcher than a medical doctor. If you're interested in mental health as an undergrad, you might be more likely to become a psychologist than a psychiatrist.
Another complaint I have is the 4-week med school psych rotation with like 10 hours of total teaching and the rest of the time on an inpatient psych ward. That's not enough exposure to give students a fair shot of making an informed decision regarding whether or not they find it interesting. I was lucky enough to enjoy my inpatient psych rotation, but for those people who might have had a great career in outpatient adult psych or C/L or CAP or forensics or drug/alcohol, they probably never had a chance to learn about that potential while they were in med school.
- Joined
- Aug 1, 2005
- Messages
- 60,895
- Reaction score
- 13,699
Do Consult/Liason make more money? Just wondering if that is something worth considering the extra training.
- Joined
- Dec 2, 2004
- Messages
- 6,366
- Reaction score
- 4,298
Shhh. Not so loud...we're trying to keep this off the radar.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
no
- Joined
- Aug 1, 2005
- Messages
- 60,895
- Reaction score
- 13,699
noted. thanks.
- Joined
- Aug 1, 2005
- Messages
- 60,895
- Reaction score
- 13,699
With Obama calling out the stigma and opening it up for discussion, I don't expect our specialty to be off the radar for very long. I can already see a change in medical student's attitudes down here at the bottom. For many of us, its a very smart choice.
With obama calling out the stigma and opening it up for discussion, i don't expect our specialty to be off the radar for very long. I can already see a change in medical student's attitudes down here at the bottom. For many of us, its a very smart choice.
all hail hussein obama
- Joined
- Apr 22, 2007
- Messages
- 2,387
- Reaction score
- 128
I usually just say, "You're right, you do." in a very matter-of-fact tone. The awkward pause after that is worth hours of arguing.
- Joined
- Mar 31, 2009
- Messages
- 1,948
- Reaction score
- 143
With Obama calling out the stigma and opening it up for discussion, I don't expect our specialty to be off the radar for very long. I can already see a change in medical student's attitudes down here at the bottom. For many of us, its a very smart choice.
I think you're right, but for a more cynical reason - Obamacare has and will continue to bring procedural specialty pay down to earth, creating a more level playing field between fields with very different hours and lifestyles. I think you'll see fewer people chomping at the bit to do urology and plastic surgery when those fields stop paying two or three times the average salary of fields like FM, peds, and psych. Those specialties will probably always make more annually, but their per hour average wage may not be much more, and may even be less.
Starting salaries for ophthalmologists non-retina in Los Angeles is shockingly low, around $190,000 according to ophtho residents at my program. Starting salaries for psychiatrists in LA is around $200,000. Just word-of-mouth.
And see that's the thing. I do believe that specialties should be reimbursed on level of intensity with regards to patient care needs and time needed to train for that particular specialty. Most surgical specialties probably deserve higher than average pay. They work longer hours and they put in more years to see a return.
The problem is that our pay is more based on how they do it (techy things and procedures) instead of what they do (delivering healthcare).
My Point? Some specialties are probably overvalued/overinflated and should be adjusted accordingly (ahem, anesthesia/radiology/radonc...).And I'm very sure that other fields are GREATLY undervalued based on their inability to produce a modern and lucrative product ( IM Peds, FM).
Dealing with patients with poor mental health is worth every bit of its 200k average. However, I'd rather argue that a teacher deserves way way WAYYYY more than 40k.
Mr. Economy-Slap your hand.
- Joined
- Mar 31, 2009
- Messages
- 1,948
- Reaction score
- 143
Interesting. It always baffles me when people go into medicine and move straight to the highest cost of living area possible with the most saturated market, shooting themselves in the foot in two different ways at once. It's like they are looking for ways to feel poor as a physician. No better way to do that than to live in LA or NYC.
- Joined
- Dec 2, 2004
- Messages
- 6,366
- Reaction score
- 4,298
I just would like to point out that attempts to level the playing field between "procedural" and "cognitive" specialties have been going on since well before the Affordable Care Act came into play. CMS (Center for Medicare Services) rules over us all...
Well doctors are human. Humans are herdy. The high cost of livings are for a reason. Its a very desirable location. Doctors like walking sunny beaches and having access to the best sushi just as much as the average wage paid man.
Some people like to convince themselves that they are rich by living along cornfield-separated homes. I am not one of them.
yes but in 10+ years the optho has a partnership stake, is collecting % of facility fees for gobs of patients at the outpt surgery suite they own, has a stake in the refraction/glasses/contacts area, and 2-3 other revenue streams besides his direct billings to pts. Maybe he does start at 190, but if he works hard he has a real chance to be at 4 times that in a decade.
It's a totally different pay structure and ridiculous to compare starting salaries between the two.
- Joined
- Sep 8, 2005
- Messages
- 219
- Reaction score
- 11
Especially since all psychiatrists know how to do is roll up cash into a ball and bat it around like catnip.
- Joined
- Feb 21, 2007
- Messages
- 3,205
- Reaction score
- 253
A like minded psychiatrist could do something similar using extra clinics, mid levels, and/or suboxone...
Vistril isn't saying that psych docs can't increase their revenue. He is just pointing out that the earning max is probably higher for a surgical specialty like ophthalmologists then it is for psychiatry. I don't see why that should be controversial.
huh? That's not 'something similar'....essentially seeing more patients/more volume(which is what midlevels and suboxone is) is much much different than extra revenue sources like facility fees from owning an outpt surg suite and a lens center share.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
- Joined
- Feb 21, 2007
- Messages
- 3,205
- Reaction score
- 253
From my point of view both lead to more money, which makes them similar. I don't really care how you get there. If you grow your business you get more money. Anyone can do that, not just GI, Ophtho, and Derm.
My point is that a business-minded psychiatrist can do quite well, despite not having access to "facility fees". I know a guy who clears a million using an NP, therapists, and owning his building and charging rent.
- Joined
- Dec 22, 2007
- Messages
- 4,339
- Reaction score
- 1,602
"I don't really care how you get there. If you grow your business you get more money".
It matters how you get there. There are only so many hours in a day. A business based on a doc working 100 hrs a week isn't sustainable.
" I know a guy who clears a million using an NP, therapists, and owning his building and charging rent"
These are all smart business strategies. However, owning a building is something anyone could do and shouldn't really be compared to the revenue streams available to ophthalmology.
