psychiatry salary

[whopper]

I do know there's a law saying if the institution is big enough it has to have an EMR.

Some EMRs blow. e.g. Avatar.

Some are good such as EPIC, though EPIC could blow if the specific hospital doesn't implement it well.

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[Slikateer]

I do know there's a law saying if the institution is big enough it has to have an EMR.

Some EMRs blow. e.g. Avatar.

Some are good such as EPIC, though EPIC could blow if the specific hospital doesn't implement it well.

Avatar was the reason why I didn't choose to work at my residency program as an attending. The redundancy is ridiculous with no auto-fill function. It basically doubled my administrative time in doing progress notes, discharges, etc. It's also difficult to add on new assessment forms, taking months to get it set up. And the patches need to fix the problem could be used to pay for a better EMR, IMO.

I found the Cerner EMR system to be quite flexible, especially in setting up specific assessment and progress note formats, transferring data with seamless auto-fill apps, etc. The state system here use MHARS does a good job with that too, though the links are not as intuitive.

I will have to look out for EPIC as the state system is thinking of upgrading to that system.

 

[wolfvgang22]

Avatar was the reason why I didn't choose to work at my residency program as an attending. The redundancy is ridiculous with no auto-fill function. It basically doubled my administrative time in doing progress notes, discharges, etc. It's also difficult to add on new assessment forms, taking months to get it set up. And the patches need to fix the problem could be used to pay for a better EMR, IMO.

I found the Cerner EMR system to be quite flexible, especially in setting up specific assessment and progress note formats, transferring data with seamless auto-fill apps, etc. The state system here use MHARS does a good job with that too, though the links are not as intuitive.

I will have to look out for EPIC as the state system is thinking of upgrading to that system.

The experience you've had with Avatar is exactly the experience I've had with EPIC. EPIC has potential to be more intuitive, but I've only seen it implemented in a user friendly way that reduces redundant button hunting and typing at 1 out of 3 hospitals.

 

[notdeadyet]

EPIC has potential to be more intuitive, but I've only seen it implemented in a user friendly way that reduces redundant button hunting and typing at 1 out of 3 hospitals.

Yeah, the big strength of EPIC is customizability, but that's a double-edged sword. The reason people have such a varied impression of EPIC is that there is such a wide variance in the quality of implementation. And almost to a one, every bad implementation of EPIC seems to hinge on turf wars and doctors over-riding tech folks to have their voices heard, resulting in a less intuitive, more cumbersome workflow.

 

[Igor4sugry]

Some EMRs blow. e.g. Avatar.

Avatar is the biggest piece of *** out there. It is basically like opening up your word processor and typing. There are no efficiency benefits to it.
When using it I would save my previous progress notes into e-mail and then copy-paste.

EPIC is an awesome EMR and you can get very efficient with it.

 

[tobi44]

heard through the grape vine (from a resident) at Kaiser that they offer psychiatrists 75k signing bonus on top of 200k salary, I think its a 2 or 3 year contract. I'm having trouble believing it.

 

[gibits]

heard through the grape vine (from a resident) at Kaiser that they offer psychiatrists 75k signing bonus on top of 200k salary, I think its a 2 or 3 year contract. I'm having trouble believing it.

It's true. But they work you to the ground I heard. It's only after you become vested that things get easier. My senior has been working there for 3 years and is constantly complaining about how busy she is. Apparently it's the seniors that have it easy.
Also, once you enter Kaiser, they own you. Forget about moonlighting anywhere else or opening a privite practice on the side. Even moonlight in Kaiser is largely unavailable since the vested docs get priority.

They also require you to be broad certified within 3 years. That might not be a big deal if you did it at the end of residency, but it is hard if you have no down time.

 

[Leo Aquarius]

In West LA (Westwood, Beverly Hills) the hourly rate is around $400 per hour in private practice, in San Diego and in between its closer to $300/hr. I'm not jumping on the Kaiser train and instead will start my own practice when I get out. We do have a family friend who has his own cash practice in LA so that's my information source.

 

[notdeadyet]

heard through the grape vine (from a resident) at Kaiser that they offer psychiatrists 75k signing bonus on top of 200k salary, I think its a 2 or 3 year contract. I'm having trouble believing it.

It's true. As are gibits points.

Kaiser's starting salary where I am at pays $80k/year more than the starting academic salary. But you're working for Kaiser.

 

[gibits]

It's true. As are gibits points.

Kaiser's starting salary where I am at pays $80k/year more than the starting academic salary. But you're working for Kaiser.

Yeah but once you're vested it should be awesome right? Just survive the hazing process.

 

[notdeadyet]

Yeah but once you're vested it should be awesome right? Just survive the hazing process.

Still Kaiser. A wet dream for some folks, a nightmare for others.

It's not my environment, but I will give them this: I've heard from a few folks that went that route that if you're into the private practice vibe, it makes a nice transition post-residency. Lots of resources, training, mentoring, etc.

 

[Silent Cool]

Still Kaiser. A wet dream for some folks, a nightmare for others.

It's not my environment, but I will give them this: I've heard from a few folks that went that route that if you're into the private practice vibe, it makes a nice transition post-residency. Lots of resources, training, mentoring, etc.

Other problem with Kaiser is a pension--you have to stay 20 years to get the pension.

 

[Leo Aquarius]

Other probme with Kaiser is a pension--you have to stay 20 years to get the pension.

Life is short. Why stay anywhere for 20 years? The world is so large... work one place for a several years then try a different state, region, or country. Live life to the fullest!

 

[Silent Cool]

Life is short. Why stay anywhere for 20 years? The world is so large... work one place for a several years then try a different state, region, or country. Live life to the fullest!

+1.

Yup.

Not to mention that you may not get your pension anyway. I'll take a 401K, thanks

 

[Leo Aquarius]

I like some of what you say, but some of it is difficult to follow due to strange word / grammar choice.

I don't think anyone expects pensions after 5 years. I sure don't. Having come from the business world I know pensions come at a fairly high price of 20 to 30+ years of dedicated work. But here's what happened to a friend of mine. A year before he was to retire at age 65, and retire with pensions and benefits, the company fired him. How cold you say. But that's business for you. So why the hell wait for that?

As psychiatrists we can take our destinies into our own hands and avoid getting shafted by greed. We can set up our own boutique practice and call the shots. Forget hiring employees, it's all about inviting independent contractors to work with you. You don't need to hire anyone.

 

[DJspreadsheet]

ferning are you using dictation software to write your posts? jesus.

 

[notdeadyet]

Having come from the business world I know pensions come at a fairly high price of 20 to 30+ years of dedicated work. But here's what happened to a friend of mine. A year before he was to retire at age 65, and retire with pensions and benefits, the company fired him. How cold you say. But that's business for you. So why the hell wait for that?.

I wouldn't limit it to business either. Pensions just aren't what they used to be. Lots of folks who put in 20 or 30 years counting on a pension aren't getting it. Businesses "renegotiate" them when they run into financial problems (airline pilots from some companies pull in 60% of what they are owed) and the safest-of-the-safe, municipal and state pensions, are now even questionable. How secure is your pension when your city or state declares bankruptcy.

Pensions are a nice to have, but I wouldn't make huge personal or professional sacrifices for one.

 

[Yoyomama88]

I keep hearing anecdotal stories of many psychiatrists making over 500k- 700k in rural areas. I guess they see like 50 pts a day... Does this seem plausible to you?

 

[OldPsychDoc]

I keep hearing anecdotal stories of many psychiatrists making over 500k- 700k in rural areas. I guess they see like 50 pts a day... Does this seem plausible to you?

Maybe if you're sub-therapeutic on your lithium...

 

[wolfvgang22]

I keep hearing anecdotal stories of many psychiatrists making over 500k- 700k in rural areas. I guess they see like 50 pts a day... Does this seem plausible to you?

Good lord, no. 50 scheduled patients a day - that would be one version of hell.
$500k wouldn't be close to enough money. You'd be burned out and lose all respect for yourself as a psychiatrist pretty quick. Show me a psychiatrist that sees 50 patients a day and you'll have shown me a bad psychiatrist.

Maybe you could see 25 patients in 8 hours, and that would probably be 15 minute med checks. Most likely you'd be running some kind of stimulant or pain pill mill, or just providing bad care. Why? Because psychiatry is a specialization and not primary care for a reason - the patients can often be complex. I believe if all the patient ever needs is an Adderall XR refill for stable ADHD with no other problems (a "No side effects? Meds working? Great, here's your script, see ya later" type deal) then everyone is probably better off with such a patient going to a primary care physician. Anything more complex than that in a 15 minute psychiatry visit results in probably both unsafe and insufficient treatment.

To actually see 25 psychiatric patients (who often don't have it together well enough to always make their appointments, much less a job) you would probably be double booked, so maybe that's where the number 50 comes from. You'd be doing zero psychotherapy. Don't believe anybody that says bull**** like "I do Brief Supportive Therapy" in a 15 minute visit. Yes, I've had other psychiatrists say that to me.

An aside: If you aren't at least a tiny bit interested in doing some minimal psychotherapy then you shouldn't be a psychiatrist, in my opinion. Broadly speaking, being a physician able to prescribe is one thing that makes us different than psychologists. Being able to do therapy makes us different than neurologists, PCPS, and mid-level providers. Giving up being able to do both could conceivably one day make psychiatrists obsolete. So called "neuropsychiatrists" are asking for it.

 

[digitlnoize]

I keep hearing anecdotal stories of many psychiatrists making over 500k- 700k in rural areas. I guess they see like 50 pts a day... Does this seem plausible to you?

If people are doing this, it's only by utilizing mid-levels or other psychiatrists to see more patients than you could see alone.

Your practice could easily see 50 pts per day if you had 2 psychiatrists and 2 mid levels working for you, in addition to yourself. That's 5 providers, 10 patients each per day. But you'd increase your overhead. This would still be profitable in your favor though.

Of course, this is likely not in rural areas. You'd need a decent metro population to support this size of a practice. Not NYC big, but a medium sized city at least I'd wager.

Now, there are likely some VERY bad, unscrupulous doctors working in rural areas, who are seeing that many patients and basically just running opiate or benzo mills. Not a good idea and there is hopefully a special hell reserved for these people, one they share with child molesters and people who talk loudly during a movie.

 

[Yoyomama88]

hahahaha

 

[michaelrack]

Maybe you could see 25 patients in 8 hours, and that would probably be 15 minute med checks. Most likely you'd be running some kind of stimulant or pain pill mill, or just providing bad care. Why? Because psychiatry is a specialization and not primary care for a reason - the patients can often be complex. .

Primary care vs specialty care has nothing to do with overall complexity of the patient (although the psychiatry illness may be more complex in psychiatric practice patients).
I have done both primary care and psychiatry. IN my opinion, it is either to see 25 psych patients in a day than 25 primary care patients.

 

[michaelrack]

I believe if all the patient ever needs is an Adderall XR refill for stable ADHD with no other problems (a "No side effects? Meds working? Great, here's your script, see ya later" type deal) then everyone is probably better off with such a patient going to a primary care physician.

A lot of primary care docs aren't willing to prescribe a schedule 2 substance. These patients need to be seen at least every 3 months. Screening for diversion is part of the care of these patients.

I see most of my stable insomnia pts on even schedule 4 controlled substances (ambien, other hypnotics) every 3-4 months. The pcp's prefer that I handle it.

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Getting off the issue of controlled substances, a successful private practice of any type needs some simple patients along with the complex.