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Psychiatry vs Family Medicine

Discussion in 'Psychiatry' started by deedubs, Jun 9, 2012.

  1. deedubs

    deedubs 5+ Year Member

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    Starting 4th year. Gotta pick one for match soon. Both have my interest and I keep oscillating between the two.

    Thoughts?
     
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  3. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net 5+ Year Member

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    I'll start. First of all, you can apply to both in the match. Just a matter of ranking.

    The fields are quite different as you know. Ask yourself if you'd rather be the front entrance of medical complaints and referring out? and hearing all kinds of general medical issues and possibly treating some?

    Or, would you rather give therapy for things like anxiety, depression, etc and medically manage people with schizophrenia, biopolar disorder, etc?

    Treating diabetes and hypertension gets old for me personally. What makes us different are our personalities and minds, and that's what I look forward to every day.

    Haven't even touched on the life styles, work hours, benefits, and expectations of each field.

    From your previous posts it sounds like you really enjoy procedures. That might tip you towards family medicine. You can have very long therapeutic relationships with patients in both fields.
     
  4. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    You need a decision tree. But...I'll try:

    Procedures or No Procedures?

    Babies or No (or very few) babies?

    Own your own practice or be an employee/eventual partner at someone else's?
    (it is easier to own your own place in psych due to much lower overhead and startup costs.)

    These are just to get you started. List the differences, then question yourself.

    I think both fields are in for a VERY bright future. Much brighter than in the past.

    The other exercise I really like is to imagine yourself with 2 (or more) exam rooms waiting for you. Would you rather see the hypertensive diabetic, or the depressed patient whose SSRI has stopped working for them.
     
  5. splik

    splik Professional Cat at Large Physician Faculty 7+ Year Member

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    Actually the difference is the hypertensive diabetic depressed patient whose SSRI stopped working who you need to deal with all of their problems, or the hypertensive diabetic depressed patient whose SSRI stopped working who you just focus on the depression. Although depression worsens cardiovascular disease outcomes there is no convincing evidence that our current treatments make any difference to these outcomes...
     
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  6. splik

    splik Professional Cat at Large Physician Faculty 7+ Year Member

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    You can apply to both, but it means twice as many interviews, half as much commitment, and the likelihood of being discovered along the line. Applying to both FM and Psych means reduced likelihood of matching at all (although a rare outcome). Whilst this is mostly confounding by indication (the weakest students are likely to apply to both), there is the possibility that you get discovered through cross-talk, seeming uncommitted to either specialty and thus being less likely to match overall.
     
  7. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net 5+ Year Member

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    So the diabetic hypertensive depressed patient comes to your psych clinic what do you do? Do you treat the depression and the HTN and DM even though the latter are not your domain? Refer them to their PCP? What do psychiatrists do?
     
  8. splik

    splik Professional Cat at Large Physician Faculty 7+ Year Member

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    this appears to depend on individual competence, institutional policy, and what insurance companies will reimburse. my experience is largely confined to outside the US so I cannot say I am accurate here, but from what I gather, insurance companies will not necessarily reimburse for a psychiatrist to deal with issues such as glycemic control or a bit of hypertension. I suspect in o/p you might refer hypertensive urgency/emergency to the ER something I would pretty much never do in the UK. If this is the case, it seems to be driven by 'defensive medicine'. I'm not sure how I will feel about having to likely refer on poorly controlled diabetes considering the last time i was in a clinical setting i would be dealing with the poorly controlled diabetes that other physicians referred on!
     
  9. deedubs

    deedubs 5+ Year Member

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    Thank you all for replies.

    Two patients waiting, the depressed one sounds more interesting.

    What are everyone's thoughts on the differences in lifestyle between the two specialties?
     
  10. michaelrack

    michaelrack All In at the wrong time Physician SDN Advisor 10+ Year Member

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    Is the prospect of doing a few surgery rotations during your intern year appealing?
     
  11. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    I think a lot of that depends on your practice setting, but overall, I think your chances of having a balanced life with a good income are better in psych. It is easier to set up your own practice (lower startup costs, lower overhead) and there is a HUGE shortage that is not likely to improve in our lifetimes, especially in Child psych.

    Also, the current average salary is higher in psych if you account for the fact that most psychiatrists work < 40 hours per week. It's also easier in psych to do a cash practice and ignore insurance.

    The only real negative to psych, to me, is that you have to enjoy the work. If you don't enjoy working with psych patients, it could be very, very draining. The other big drawbacks are the lack of access and the impossible social situations that can be a headache, but you get those in FM too.

    I will say that you'll do a LOT of psych in FM too. The real question to ask yourself is: Do you want to do the other stuff (HTN, DM, joint pains, babies, OB, surgery, Derm) too?
     
  12. notdeadyet

    notdeadyet Still in California Moderator 10+ Year Member

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    Put yourself in the PCPs shoes. How would you react to having your patient come in and finding all the htn and dm meds you had put them on (possibly after trailing others or chosen based on part of a larger health plan) were all changed by someone who has had little exposure to the patient and, let's face it, a few months of experience on medicine rotations as an intern in terms of experience in this.

    The only case I could see being made realistically for this is the patient with no primary care. And then any meds you give should be a bridge until they can get to a clinic referral for appropriate care.
     
  13. Leukocyte

    Leukocyte Senior Member 10+ Year Member

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    I personaly do not see much relationship between the two specialties. It is pretty clear cut, and there is a very clear difference between the two.

    Family Medicine:

    -You are the PCP, meaning you WANT to and ENJOY to take responsibility and control over the ENTIRE patient's health.

    -You ENJOY managing MANY medical conditions spanning different feilds.

    -You ENJOY doing minor PROCEDURES.

    -You are CONFORTABLE with knowing little about too many things - NOTE: This can be a very uncomfortable feeling, as I came to find out. You might always feel like you do not know much about anything, but you do know about a lot of many different things.

    -As a PCP, patients EXPECT a more "personalized" care from you, since you are the only doc who is untimately responsible for their entire health.

    To me, practicing FM is like being in (and enjoying) a state of "mania", were one rapidly shifts from one thought process to another. It can drive some crazy!

    Psychiatry

    -You are FOCUSED on ONE thing: Mental Health

    -You are responsible for ONE aspect of the patient's health: Mental Health

    -You know one thing very well: Mental Health

    -You do not want to bother with (and do not like) managing any other medical condition that is not related to mental health.

    -You need to have a "tough skin", because some patient encounters can be very stressfull.

    Good Luck.
     
  14. sjtlgs

    sjtlgs

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    I graduated from a FP/psych combined residency, and can tell you that I love both specialities, and really for a lot of the same reasons. My interest has always been underserved medicine, and both FP and psych are well designed to work with marginalized populations and make a real difference.

    I found the majority of the FP part of my training miserable, except for outpatient clinic. Much of your 3 years is spent in the hospital, doing things you are likely to never do again (how often do FPs do central lines? run codes? etc in usual practice). The hours are generally much harder than psych and the responsibility is MUCH MUCH higher (eg - being the senior resident on call for a hospital of 250 including a 20 bed ICU).
    That being said, the training was very valuable, and the time in the outpatient clinic (what most FPs eventually end up doing) is fantastic - the clinic I spent all 5 years in was in a very poor neighborhood where the resident clinic was pretty much the only medical clinic. Driving up to the clinic I knew pretty much everyone I passed, I knew their families, their friends, had delivered a bunch of the babies I saw, and always had someone waving or saying hi. In a lot of ways I thought I made a bigger difference in that clinic than I did in the psych clinic because there are so many opportunities to do psychosocial interventions during all sorts of visits, and because you see the whole family, so you can really see when things are going downhill (or when things are really working out well).
    I also love psychiatry, for a lot of the same reasons that have already been listed - it is so nice to have a circumscribed area of responsibility (slightly different in my case because of the dual training), and to feel like you can really BE an expert eventually. At the same time, I really had a hard time with ONLY taking care of someones mental health - I think by nature I like knowing that I'm able to take care of a whole person. I also very much enjoy seeing people with psychotic disorders, and it is unlikley that you will manage medications for someone with a psychotic disorder independently (and feel comfortable doing so) as a family doctor.
    Interestingly, I think I have known many of my FP patients far better than my psych patients, largely because of the "family" in FP. I think most people who are drawn to either FP or psych are drawn towards the "people" aspect of medicine, and in that sense I don' t think you can go wrong. They are both fantastic specialities, and I am extremely lucky to practice both.
     
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  15. F0nzie

    F0nzie Physician 5+ Year Member

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    Psychiatry. Hands down.
     
  16. markglt

    markglt 10+ Year Member

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    psychiatry all day, no 2 ways about it.
     
  17. Slingshot

    Slingshot

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    Maybe the most simple way to look at it is:

    FP- Jack of all trades, experts at none (so to speak)

    Psych- Expert at one small niche

    Personally I prefer knowing everything about something rather than something about everything. Its hard enough to know everything well in psychiatry. I can't imagine FP because you need to know all of medicine, peds and psychiatry to boot since you will be seeing 75 percent of psychiatric patients anyway.
     
  18. markglt

    markglt 10+ Year Member

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    leukocyte ur spot on. i like the way u think
     
  19. Slingshot

    Slingshot

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    I am not an FP but interact with many over the years and I have to disagree with the statement an FP "controls" what goes on with the patient. That is how things USED to be or maybe how it is in smaller rural areas. However in the cities, FP has largely become someone to refer patients out to others to really take care and they really have little "control" over much of anything. Most FP's do not like to stop other specialists medications and the end up simply being an adminstrator to some degree.

    Unless you go concierge approach or something where you sit and spend a ton of time with your patients, a basic FP setup is largely just following other docs rec's for medicolegal purposes if nothing else.
     
  20. sunlioness

    sunlioness Fierce. Proud. Strong Physician 10+ Year Member

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    And even then, it's too much to know. I'm primarily outpatient, but have to cover our C&L guy from time to time. I don't enjoy it because I don't feel like I know enough or am familiar enough to do it well.
     
  21. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net 5+ Year Member

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    Since you asked about lifestyles, based on my experience it seems family medicine is more or less marathon medicine in a big city clinic. But there's so many forms of practice settings, a family medicine doc has real flexibility in working conditions across the country.

    Hours & Pace:

    The Washington University School of Medicine website indicates that family medicine doctors work on average 58 hrs per week. The Medscape survey indicates family medicine doctors spend 30 - 40 hrs seeing patients and another 10+ hrs per week doing paperwork. The family doctors on my fam med clerkship were booked solid seeing patients in clinic every day and then running to the hospital for some in-house work. They started very early, and finished around 7pm or so with paperwork. Add to that a salary that seems to be one of the lowest. I don't consider family medicine a lifestyle friendly specialty. It was very stressful. The doctor told me "it's a war, and we're fighting a battle. I'll give you 10 minutes per patient before I come in."

    Pay:
    Family Medicine
    - $158,000 - $167,000 per year mean income (Medscape and WUSTL sites)
    - You bill Medicare $100 and you only get paid $60, so insurance companies don't even cover your expenses.

    Psychiatry
    - You bill $300 per hour to your patient and he pays you directly in cash. You can chose to accept insurance if you like, but psych is one of the last specialties where you can have a cash-only practice.
    - Psychiatry has a higher average salary for fewer working hours than fam med.


    Taking income and working hours data from the WUSTL, Medscape, and ACEP sites and coming up with a dollars per hour value for each specialty, I ranked the non-surgical specialties from highest earners to lowest at bottom:

    Non-Surgical Specialties, Income Per Hour Rank

    Radiology
    Dermatology
    Anesthesiology
    Psychiatry - when combining employee and private practice rates
    Emergency Medicine
    Neurology
    Internal Medicine
    Pediatrics
    Family Practice

    sources*: http://residency.wustl.edu/medadmin/resweb.nsf/, http://www.acep.org/content.aspx?id=45806, http://www.medscape.com/sites/public/physician-comp/2011

    Keep in mind that the average income in psychiatry is not astronomical because it has one of the highest percentage of doctors working less than 30 hrs per week. So if you wanted to bring in lots of money in this specialty you could, just work 40 or more hrs.
     
    Last edited: Jun 13, 2012
  22. BS81

    BS81 5+ Year Member

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    psych sucks, do FM :thumbup:
     
    Last edited: Jun 13, 2012
  23. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net 5+ Year Member

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    I have no problem keeping our numbers small :)

    Actually, all we try to do in these forums is inform based on the resources available to us. Ultimately do what makes you happy.

    This is my 100th post !
     
  24. BS81

    BS81 5+ Year Member

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    I'm not ready to start informing and recruiting until I've matched first ;)
     
  25. vistaril

    vistaril 5+ Year Member

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    I think you're painting a very unrealistic pro-psychiatry picture of things in terms of lifestyle/pay....I'd like to know the % of psychiatrists out there working who recieve $300/hr compensation in cash money from patients. I bet it's less than 5%.

    And emergency medicine docs make more than psychiatrists per hour.....if you went over to the em boards and posted this they would laugh. Keep in mind that emergency medicine docs typically work a clinical hrs year of less than 1800 hrs in many cases.....Salaried EM positions typically pay 150-175+ per hour. Inpatient or outpt psychiatry positions do not end up paying that much.

    Psychiatry is one of the lower paying specialties in medicine. Yes, there are exceptions, but those exceptions exist in every field. If you're a family med doc and you work in a high volume doc in a box walk in clinic you can see 70 pts a day in cold season.....
     
  26. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Physician Moderator Emeritus SDN Advisor 10+ Year Member

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    The $300/hr cash is indeed a minority of psychiatry, and not representative of how most psychiatrists practice. Nevertheless, I can promise you that the average 40-50 hr week starting salaries in psych are well above the $158-167K mentioned for FP above.
     
  27. vistaril

    vistaril 5+ Year Member

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    a more honest comparison is this: what is the average STARTING salary in psych for a full time outpt position(at like a CMHC) vs the same(outpt m-f 830-5) in family med? I would bet a higher % of starting psychiatrists take positions that require either occasional weekend coverage or some inpatient responsibilities. A higher % of outpt beginning FM slots would be 100% outpt with absolutely no weekends ever. Some family med physicians work in more of a hospitalist capacity(with a little higher salaries) and some work as er physicians(with higher salaries)......furthermore, I think a certain% of family people commit financial suicide intentionally by spending inordinate amouts of time for certain office visits. They know they are doing this, and they know it is financially disastrous. If a family medicine physician wanted to set up a practice that was based on very high volume, they would be able to do this.

    I don't doubt that psych is higher, but it wouldn't be that impressive. And going by salary surveys, psych is still near the bottom. Even if psych does make more on average than family and peds, they are still a low paying specialty and still MUCH closer to these than the high $ specialties(anesthesia, rads, procedure based IM subspecialties, etc).......saying psych pay is between family medicine pay and interventional radiology pay is sorta like saying Vermon't size is between that of Rhode Island and Montana.

    most of the people graduating from our program the last several years took positions that paid between 175 and 210.

    Another issue with average reported salaries are that a higher% of psychiatrists work in non-self employed type positions......either through fixed contracts(where they are technically self employed) or just on salary. What that means is the internist who is self-employed and "makes" 220k may have actually made a good bit more than that for obvious reasons, whereas the psychiatrist who makes 200k working as a inpt psych at a state hospital really made 200k......
     
  28. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    Not sure about CMHC's (those places are usually horribly underfunded), but I've got a few full-time examples for you:

    4th year child fellow: Left early after finished 4th year to take an private practice, group, adult, outpatient job within 30 minutes of a MAJOR metro area. Full-time, outpatient med management mostly, ~40h weeks, occasional but very light home call. ~$250k/year.

    5th year child fellow grad: Iowa. $300k/year. Child outpatient med mgt. Minimal home call.

    Adult inpatient state hospital: new grad. $225k/year.

    That's just a few of the people I know who've gotten starting job offers recently.

    Not everyone does cash only, and $300 is on the higher end for that. Most places seem to pay ~$70 for a med mgt visit, it seems. You can easily do 2-3 of these an hour (4+ if you're crazy), which makes the hourly salary for a psychiatrist taking insurance $140-210/hour. $280 if you see 4 patients per hour.

    Amongst the psychiatrists who are cash only, a google search of their fees will reveal most of them charge between $225-300/hour. I'd say $250/hour is a healthy mean for this population. Your ability to do cash only will depend highly on location and/or subspecialty (child, etc).
     
  29. I know you won't get as much money and people might dispute your MD, but why does it suck?
     
  30. Bartelby

    Bartelby 10+ Year Member

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    I faced a similar dilemma. What helped me was imagining what I would rather come in the next day to do--- work in a psych clinic or work in a family medicine clinic. For me the decision leaned to working in a psychiatry clinic. Combining that with how much I enjoy learning about psychiatry had me convinced.

    It is hard to break it down into "what would I like to do for the next 45 years." It's much easier to decide, hypothetically, "what would I like to do tomorrow (if I had the choice)."
     
  31. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    Actually, the average psych salary is higher than the average FM salary in most salary surveys. When you then take into account the various factors pulling down our average (low # of hours worked per week, high percent of >55yo docs working part time, etc), it's substantially higher, especially in some subspecialties like C&A, and if calculated per hour.
     
  32. vistaril

    vistaril 5+ Year Member

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    as I said before, this is skewed by provider ideals......

    people dont go into psych with a certain ideal wrt how they are going to practice. people DO go into family with this concept.

    If a family med doc wante to maximize their income in the same way psychs do, they could. But fam docs go into family because they fundamentally(at least in many cases) are interested far more in practicing medicine a certain way and serving a certain population than with money.

    Thus, if one is looking at things from a purely financial perspective and removing core ideals related to financial practice from the mix, I bet family could on average outperform psych. Think about it- work some shifts as an er doc in a rural area, and then supplement this with high high high volume outpt urgent care clinic. That would pay more than psych....because even if you are pushing high volume outpt med mgt in psych the pts are still going to want to talk to you a bit because...well....isnt that what psychs do? If all you cared about is volume(and again most fm's dont...thats why they chose that field) you could get away with finding the right urgent care clinic and just having preprinted steroid packs and inhections printed out and run it like a factory.......

    both, along with pediatrics, are right there as the lowest paying specialties....but there are ways fm's can increase their pay if they really wanted to. Most psychs are pretty much tapped out already in terms of those possibilities....
     
  33. BS81

    BS81 5+ Year Member

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    Really? People go into psych with the ideals of maximizing income? Going in to psych for the money... that's new. If you have business acumen and go for the money you can easily clear 300k. Or if you're not interested in that you can just work for someone else for 125 an hour. UCs only pay about 80 bucks around here, and starting pay is in the 120-140k range for fm. FM has such high overhead most solo practices run like mills just to keep afloat. This negative campaigning by you against psych is getting pretty ridiculous at this point.

    At this point I think you're just trolling

    Sent from my DROID RAZR using SDN Mobile
     
    Last edited: Jul 6, 2012
  34. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    Yes, they do. At least, I did. As did many of the people who frequent this forum...according to many of the posts I've read over the years.

    I don't believe you. FM docs DO want to maximize their income the way everyone else does. There's nothing magical about FM that suddenly makes people stop caring about money. FM docs are not as altruistic as you seem to think. FM docs are struggling DESPITE running mill-type practices. The best way to make money in FM is, as you say, to not do FM and break into EM or Urgent Care (not FM).

    Face it, psychiatrists make good money per hour worked, plus we can enjoy a fantastic lifestyle while doing it. Most cash practices are charging $200-300 per hour. Most med management places doing 3 patients per hour (a healthy 20m each, which is NOT a mill by any stretch of the imagination), will be clearing at least $210/hour. This is a good paying field. Is it the highest? No. But it's far from the lowest, and much more insulated from the ongoing and future cuts than, say, radiology or ortho.
     
  35. markglt

    markglt 10+ Year Member

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    not to knock fm, because im an fm pgy2, but........i hate it.
    it was my backup and i plan to do a psych residency after i finish. However, if i do just my fm residency...and want to practice psych...can't i open up a psych practice for med. managment and only do c.o.d if reimbursiment is an issue b/c i wont be a trained psychiatrist but an fp doing just psych??
     
  36. michaelrack

    michaelrack All In at the wrong time Physician SDN Advisor 10+ Year Member

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  37. GOINGDUMB

    GOINGDUMB

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    Can anyone elaborate on this?

    Except in my case: Do IM then do a year or two of additional training (my interests is with chronic pain and addiction stuff), kinda play that Dr. Drew Pinsky style medicine?

    I don't want flames. I just have to ask about this route?
     
  38. vistaril

    vistaril 5+ Year Member

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    if you want to do addiction medicine then doing an IM residency and then a 12 month addiction fellowship would be perfect.

    Im a psychiatrist and am not complaining and as a pgy-4 have job offers I am sorting out, but it is one of the lowest paying specialties out there. The idea that it's not is silly. Someone earlier(a freaking med student?) posted that psych makes more than emergency med per hour....that is not remotely true. The em board would laugh at that concept to no end.....

    average clinical per hour salaries for emergency medicine physicians on staff(not in a group that bills separately to patients) are ~200/hr. For psych the equivalent is maybe 120/hr.
     
  39. BS81

    BS81 5+ Year Member

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    Yes if you want to work with that population. Still realize that addiction medicine and addiction psych are two similar but different things. The patients usually have their own psychiatrist if they have a possible primary psych disorder. But you aren't suddenly going to be hired to run groups or do therapy or even do psych evals. Also chronic pain from an addiction medicine stand point usually involves switching people from opiates to suboxone... and that's it. Can be lucrative though since there are no limits on suboxone patients when you are treating them for pain. But then your patients will be pissed off when they figure out how hard it is to get off the suboxone, but that's another story.

    Also, "addiction medicine" is not a true specialty yet. So you can just work for a year or two in an addiction setting and get the certification. Also it doesn't matter what residency you are coming from, people get the addiction medicine certification coming from IM, FM, ob/gyn, even rads, you just need to complete the residency.
     
  40. BS81

    BS81 5+ Year Member

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    Yes you can get ~$200/hr in a small rural ER working single coverage. But the big groups that employ EM physicians around civilization start at $125 (at least around my midwest metro). They do get benefits though on top of it, which most psychiatrists don't get with an hourly rate. But of course the ceiling is higher, and they can make $200+/hr if they find an honest group that won't exploit them and won't fire them right before they're eligible for partner status.
     
    Last edited: Sep 24, 2012
  41. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    If you want to be an employee, then yes, EM pays more than psych. That being said, it's very difficult (if not impossible) to do own your own EM practice and make the big money...you might one day make partner, but often that's just a dangling carrot.

    However, in psych private practice, if you own your own place, the ceiling is MUCH higher than in EM. You can fairly easily clear $200/hour after expenses in most psych practices...MUCH more if you're frugal, in the right area, in child, and/or unethical.

    Plus, our hours are so much better. And, no rectals, pelvics, infectious diseases, or blood and guts. Psych FTW...at least for me. Everyone is entitled to their own opinion!
     
  42. vistaril

    vistaril 5+ Year Member

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    people do their own EM practices all the time....most EM practices in suburban ER's are just groups of EM physicians coming together. The pt's insurance company gets billed for services by the EM group. The EM physicians in the group divide the pot up based on billings/collections. Most people in such practices get to be partner fairly easily since there isn't a large investment in real estate or equipment required.

    Most psychiatrists make between 170k and 220k a year. Thats where most of them fall outside academia. Most EM physicians fall a good bit above that. An EM physician in the 30th salary percentile for EM makes about as much as a psychiatrist in the 75th percent for psych.

    that's just what the data says. EM physicians also tend to work fewer clinical hours than psychiatrists.

    There is always a lot of stuff about what a psychiatrist "can" make under conditions x.y,z if things are done this way or that. Well if those games can be played, I know a family medicine physician who makes >450k.....it's best to just look at what the numbers actually say, and the numbers say psychiatry is one of the lower paying specialties.
     
  43. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    I've spent a lot of time working in ED's prior to med school, so you don't have to tell me how it works. Good luck doing that in today's market. Pretty much every hospital is already staffed by a group practice, so good luck forming your own group and finding new work.

    More and more hospitals are going with the BIG EM groups and cutting contracts with the little guys. We're seeing the consolidation of EM play out in front of us right now. So, if you want to work for a mega-group and forever be an employee, that's great. If you want to work for a smaller group, you'll STILL be an employee, but you'll likely make even less because the small group has to offer competitive prices to the hospital that's paying them for fear of losing their contract to a Big Box Group.

    Either way, the likelihood that a new EM graduate could start their own EM group and run their own ED is quite slim. Not impossible, but slim. Unless you want to start an Urgent Care...but that's high start up, not really EM, and a terrible gig IMO.

    It's not impossible to make partner, but it takes time and it's not a guaranteed thing. Many people wind up burning out and transitioning to a new environment before partnership occurs. Others burn bridges. In other cases, it's the groups playing dirty. In any case, making partner does not occur nearly as often as you are making it seem.

    Not disputing your averages, those are fairly correct numbers. I would argue that they work less hours. Most surveys I've seen (and from my own experience) puts ED docs at around a 35-40 hour work week, which is about the same (or maybe a little more) than the Medscape psych survey said a few months ago.

    Either way, the total hours in both cases are awesome, but we don't have to do the nights or weekends. I'd GLADLY take a 50k pay cut to have a 9-5 gig. Personally. Plus, the added bonuses I mentioned above of no rectals, pelvics, or blood and guts make a psych salary a clear winner for me.

    It's also one of the best lifestyle specialties, and has a MUCH lower startup and overhead (and thus, profit margin potential) than pretty much ANY other medical field, which makes it ideal for someone who DOES want to open their own practice.

    If you're looking for a salaried gig, and money is all that matters, psych may not be your best bet. If you enjoy psychiatry and don't care about money, and don't want the headaches of running a practice, psych is probably a good choice. But if you want your own practice, with low/easy startup, and you enjoy psychiatry...there's no other option.
     
  44. kumar28

    kumar28 Senior Member 10+ Year Member

    343
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    Jul 11, 2002
    Boston
    wow vistaril,
    You're a downer bro! I just graduated residency and making well over your high end of range >220, with benefits, work about 6 hours per day and with way less stress than an ER physician. dont have to work nights. I love my job, its interesting, in a private psych hospital. Also doing alot of addictions. I am also a medical director of one CD program. On call every 4th weekend. Im about 20 min away from a major city. this is also to start, my salary will go way up if I elect to stay here.

    There are so many jobs like this. We can go anywhere we want as well.

    My ER buddies are making about the same as me however they are fluctuating with days and nights. I would hate that lifestyle. Screws up family life, cant see your kids daily etc...Not to mention by fluctuating your circadian cycle you pose a higher risk for cancer...this just came out recently

    I am super happy with my decision with psych. Vistaril....are you depressed. Maybe you should get some therapy, an antidepressant maybe?? You're a pgy4...go out and make stuff happen rather than just complain. The opportunities with psych are endless
     
  45. vistaril

    vistaril 5+ Year Member

    3,752
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    Jun 10, 2012
    Like I said, individual reports are not particularly useful. I know a guy in family medicine who makes 500k a year and I also know of a guy in urology who only makes about 230k. What do you make of that? Nothing....except hopefully that there are people in every field well above and sometimes below salary norms.....

    The averages and the 25th-75th numbers make it clear that psychiatry is one of the lower paying specialties. That doesnt mean you can't do better(or worse) than these averages.
     
  46. digitlnoize

    digitlnoize Rock God 10+ Year Member

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    Feb 21, 2007
    I actually (surprise) completely disagree. Although individual reports lack the statistical power, they are very important, at least in situations like this, for letting you know what is POSSIBLE.

    The fact that it's possible to have kumar28's gig in psychiatry makes it destroy every other specialty, at least for me. Others may feel differently.

    Regardless, I do think it's important to not only look at the pure statistical data, but to look at individual stories so you can learn what others are doing and what is possible. Also, keep in mind that the stats data is a couple of years old at best, and may not always accurately reflect real numbers, for various reasons.

    I love crunching the numbers as much as the next OCPD med-student-doctor-person, but every "individual data point" that I have collected personally has FAR surpassed what's being reported in these surveys.

    My final report, and I've said it a hundred times on here, is that the averages are being lowered by the fact that >55% of our field is retiring and cutting back hours, so the numbers for someone 30-50yo in the prime of their career may be completely different from the averages.
     
  47. vistaril

    vistaril 5+ Year Member

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    Jun 10, 2012
    there are bunches of "individual stories" of physicians/residents in all these forums....go over to anesthesia and you'll learn it's very doable to make 7 figures if you hustle. go over to cardiology and you'll hear stories about how if your not doing 7 figures by your third year out of an interventional fellowship you're office manager is probably stealing from you. go over to neurology and there are stories of the many salaried inpatient gheneral neuro/stroke positions being offered at 400k+.

    There is always going to be a bunch of individual stories in every specialty that seem more appealing than what the norms are.
     
  48. BS81

    BS81 5+ Year Member

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    Mar 18, 2011
    Yes, I do go over there, especially since I was looking at neuro and anesthesia. No such claims. But a lot more people like you that are constant downers about their specialty. Maybe it was time for the Psych board to get their own token malcontent?
     
  49. Doctors don't get rich. Unless you go to Ortho and are from Hopkins, Perelman (sorry UPENN) or Harvard. Or you could charge exorbant fees untl 2014 where the ACA with just **** things up. Free market healthcare is possible people.
     
  50. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net 5+ Year Member

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    Dec 16, 2011
    Sorry, but Harvard and Hopkins have the most name brand recognition in all of medicine. Don't pretend like UPenn is on that same name recognition level. If you invoke UPenn, then you have to invoke Stanford, UCLA, UCSF and probably Yale. That's just domestically. On an international level UPenn is nothing compared to name recognition of, say, UCLA. People overseas know UCLA. You say UPenn or Perelman and they won't hear what you are saying.
     
  51. BS81

    BS81 5+ Year Member

    207
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    Mar 18, 2011
    :confused: That argument came out of nowhere. Maybe it's a west coast east coast thing, but people would probably hold UPenn over UCLA around here.
     

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