Question about psychiatry salary

[waterbottle10]

I'm not going into psychiatry but year about year psychiatry has been ranked below average in terms of salary. The thing is, I am in a major city and even here, there is a huge shortage of psychiatrists, it's hard for me to book appointments for my patients, and the MAJORITY, are cash only charging 100+ per visit. So I'm thinking if they are so booked, and they are doing cash only, the must be making a lot, assuming 150$ for a 30 min visit, that's 300$ a hr and ~3000$ a day... and since it is cash only, there is no insurance not paying 30% of the time, and there is no need to hire a biller. So why is it that psychiatrists' median salary consistently is <200k? Are these people just not joining the survey?

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[MacDonaldTriad]

Psychiatrist probably average a little north of 200K now, and can do much better if they work like a surgeon.

 

[Trismegistus4]

I'm not going into psychiatry but year about year psychiatry has been ranked below average in terms of salary. The thing is, I am in a major city and even here, there is a huge shortage of psychiatrists, it's hard for me to book appointments for my patients, and the MAJORITY, are cash only charging 100+ per visit. So I'm thinking if they are so booked, and they are doing cash only, the must be making a lot, assuming 150$ for a 30 min visit, that's 300$ a hr and ~3000$ a day... and since it is cash only, there is no insurance not paying 30% of the time, and there is no need to hire a biller. So why is it that psychiatrists' median salary consistently is <200k? Are these people just not joining the survey?

Probably. Also, the averages are dragged down by academic psychiatrists, soccer-mom psychiatrists working 8-4:30 three days a week at the VA, etc.

 

[J ROD]

a little secret....most folks don't look at the numbers. Just take the salary for what they say. You can easily make 250K+

 

[chicagochildpsych]

That's just salaried positions, me and many of my colleagues make north of 500k in direct billing models (working 70+ hours a week)

 

[J ROD]

I think we need to keep these numbers a little more quiet........Psy might become a more exciting version of derm.

Derm rashes can't attack you! Folks will be applying like crazies!! lol

 

[hamstergang]

assuming 150$ for a 30 min visit, that's 300$ a hr and ~3000$ a day

There's a few things wrong with this:
1) Who's working 10 hour days each day?
2) You don't see patients 100% of your time as you need some other work time (writing notes, making phone calls, reading charts, urinating) and some patients no-show.
3) You won't collect 100% of what you bill.

 

[waterbottle10]

There's a few things wrong with this:
1) Who's working 10 hour days each day?
2) You don't see patients 100% of your time as you need some other work time (writing notes, making phone calls, reading charts, urinating) and some patients no-show.
3) You won't collect 100% of what you bill.

1) I just assumed psychiatrists work on average a bit less so i went with 10 hours instead of 12+. I'm in a different field so IDK psych daily work #s
2) True
3) True, but like i said above, cash or CC only makes billing a lot easier, and payment rates higher than w/ insurance

That's just salaried positions, me and many of my colleagues make north of 500k in direct billing models (working 70+ hours a week)

That is pretty amazing for 70+ hours a week!

 

[Leo Aquarius]

Surveys seem to indicate a 35hr work week is your average for psych. Thats for 200K in PP, so I can see how 70hrs can bring in over 400K.

 

[SoulinNeed]

It might depends on location, as well. I don't know how many are making $300K here in Chicago.

 

[calvnandhobbs68]

There's a few things wrong with this:
1) Who's working 10 hour days each day?
2) You don't see patients 100% of your time as you need some other work time (writing notes, making phone calls, reading charts, urinating) and some patients no-show.
3) You won't collect 100% of what you bill.

You'll collect near 100% of what you bill if you're having people pre-pay or swipe their card/take their check at the visit in a cash practice. Keep a credit card on file and charge for no shows without more than 24 hours advance notice. No different than cash procedures in other specialities. People just have to get comfortable with asking for their money up front.

 

[Leo Aquarius]

You'll collect near 100% of what you bill if you're having people pre-pay or swipe their card/take their check at the visit in a cash practice. Keep a credit card on file and charge for no shows without more than 24 hours advance notice. No different than cash procedures in other specialities. People just have to get comfortable with asking for their money up front.

This is very true, and something they're trying to teach us in residency. Asking for payment is not something doctors are naturally good at.

 

[chicagochildpsych]

It might depends on location, as well. I don't know how many are making $300K here in Chicago.

I am in the Chicago suburbs.

 

[FlowRate]

I'm not going into psychiatry but year about year psychiatry has been ranked below average in terms of salary. The thing is, I am in a major city and even here, there is a huge shortage of psychiatrists, it's hard for me to book appointments for my patients, and the MAJORITY, are cash only charging 100+ per visit. So I'm thinking if they are so booked, and they are doing cash only, the must be making a lot, assuming 150$ for a 30 min visit, that's 300$ a hr and ~3000$ a day... and since it is cash only, there is no insurance not paying 30% of the time, and there is no need to hire a biller. So why is it that psychiatrists' median salary consistently is <200k? Are these people just not joining the survey?

Now this is also tempered by capture %, but 99214 pays $115 (medicare), so it's not like $100 a visit is mindblowing, it's just not cost shifted through their insurance, although they can apply for reimbursement.

 

[PikminOC]

There's a few things wrong with this:
1) Who's working 10 hour days each day?
2) You don't see patients 100% of your time as you need some other work time (writing notes, making phone calls, reading charts, urinating) and some patients no-show.
3) You won't collect 100% of what you bill.

You don't use a catheter?

 

[splik]

Now this is also tempered by capture %, but 99214 pays $115 (medicare), so it's not like $100 a visit is mindblowing, it's just not cost shifted through their insurance, although they can apply for reimbursement.

ha well if you think medicare pays out anywhere near what is billed for you're in for a rude awakening. and it is fraud to bill 99214s for each visit. a stable ADHD visit where you refill a prescription is not a 99214 visit nor would a recurrent MDD in remission with medication refill. for straightforward follow ups the pt has to have 3+ conditions (for example PTSD, MDD, and borderline personality disorder) to bill 99214 correctly. also medicare pays $103 for 99214 in private practice not $115.

 

[prominence]

a stable ADHD visit where you refill a prescription is not a 99214 visit nor would a recurrent MDD in remission with medication refill. for straightforward follow ups the pt has to have 3+ conditions (for example PTSD, MDD, and borderline personality disorder) to bill 99214 correctly.

It is possible to bill based on face to face time spent with the pt and bill for a 99214 provided that you spent 25 minutes with the other and spent half the time coordinating care for the pt.

 

[splik]

It is possible to bill based on face to face time spent with the pt and bill for a 99214 provided that you spent 25 minutes with the other and spent half the time coordinating care for the pt.

that's of course true and I think most payers would accept that most of the time, but these codes are supposed to be based on "medically necessary" services. Is it medically necessary to spend 25 minutes with >50% time on counseling and coordination and care for a patient who has been on the same stimulant for years and just has ADHD - or is in remission of depression with no comorbidities? I think many people would argue not. Depending on the setting, it seems that 99213 + 90833 may be more pragmatic than 99214 for more straightforward cases if you are spending 25-30mins with the patient. OTOH if you are making a medication change, i think 99214 would be fine. my point was it is probably fraudulent to be billing all or majority of visits as 99214s for the average private practice. I know CMS and various insurance companies scrutinize those who will bill lots of 99215s and I think in practice it may not go challenged to do a majority of 99214s for private insurance, but it is arguably upcoding and fraud.

 

[FlowRate]

ha well if you think medicare pays out anywhere near what is billed for you're in for a rude awakening. and it is fraud to bill 99214s for each visit. a stable ADHD visit where you refill a prescription is not a 99214 visit nor would a recurrent MDD in remission with medication refill. for straightforward follow ups the pt has to have 3+ conditions (for example PTSD, MDD, and borderline personality disorder) to bill 99214 correctly. also medicare pays $103 for 99214 in private practice not $115.

Huh, I was using this for my specific area. Looks like most codes pay about $10 more in my metro area.

Right, I already mentioned capture rate, OK sure 99213 in my area is $85 ($75), but I selected -14 because of comparable face to face time, and private insurance and cash should both pay more than medicare. It was just a quick comparison to show that $100 is not a ridiculous amount for a visit.

 

[splik]

not a great comparison but I would agree $100 a visit would seem reasonable - even the psychologists round here bill $200/hr

 

[Shikima]

So, medicare isn't the same across the board. I have much better rates than what you guys are saying with a 213/214.

 

[TexasPhysician]

Huh, I was using this for my specific area. Looks like most codes pay about $10 more in my metro area.

Right, I already mentioned capture rate, OK sure 99213 in my area is $85 ($75), but I selected -14 because of comparable face to face time, and private insurance and cash should both pay more than medicare. It was just a quick comparison to show that $100 is not a ridiculous amount for a visit.

If billed based on time then you can't bill for therapy add on code. 2 Medicare appts at roughly $100 each is about a 33% pay cut from cash at $150 each. Plus you need to hire a biller and follow Medicare guidelines. The money adds up quick.

 

[Shikima]

Value Options and BCN pay worse than Medicare.

 

[Blitz2006]

Probably. Also, the averages are dragged down by academic psychiatrists, soccer-mom psychiatrists working 8-4:30 three days a week at the VA, etc.

yep, i'll keep posting these medscape surveys:

http://www.medscape.com/features/slideshow/compensation/2014/psychiatry#16

"68% of psychaitrists worked less than 40 hours a week in 2014"

So 2/3 of psych are barely even touching 9-5 hours x 5 days/week. So thats why the average is usually around 210k. If you give a psychiatrist cardiology/surgery hours (55ish), I'm sure the average will be around 270-300k.

And remember, people don't go into Psych to work 60 hours/week, so there is automatically a selection bias. A lot of med students go into psych for "lifestyle". But there are psychiatrists here in NYC hustling 6-7 day weeks, doing ECT at 6:30am-8:30am, working 12 hours a day (8 hours inpatient/CL then 4-5 hours PP in the evening). Cash Only Practice going rate is $300/hr, but I know guys in the city charging 400-500/hr. So you can do some quick math and see how "lucrative" it can be. Not sure if these psychiatrists provide good treatment, but thats a separate argument.

I know a 60 year old psychiatrist that works in patient, and then picks up 16 hour on-call shifts, about 6-7/month. He says he clears 400k no problem.

Not bad for NYC psych.

and for argument sake, lets not forget about malpractice. OBGYN here averages $120-140k/year. Psych averages $10-12k (around 20K for ECT).

 

[NontradCA]

Do you guys think it will go down in the future?

 

[splik]

I know a 60 year old psychiatrist that works in patient, and then picks up 16 hour on-call shifts, about 6-7/month. He says he clears 400k no problem.

Not bad for NYC psych.

thats 70 hrs a week!

 

[Blitz2006]

Do you guys think it will go down in the future?

If anything its only gonna go up (as it has been for the past few years).

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[Blitz2006]

thats 70 hrs a week!

Not really. Post call leaves around lunch. Joys of having residents

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[SomeDoc]

Do you guys think it will go down in the future?

Unlikely with ACA provisions for parity. However, we should be careful discussing salaries on a public forum. If one googles "psychiatrist salary," an SDN thread is fourth in the result list. Uninformed policy makers frequent public forums like this where numbers are posted without meaningful context (ie. specialty certification/years to train, etc.), and decisions to cut physician reimbursement is made on an arbitrary basis. In reality, physician payments account to only around 5-10% of the total cost of care.

 

[waterbottle10]

Unlikely with ACA provisions for parity. However, we should be careful discussing salaries on a public forum. If one googles "psychiatrist salary," an SDN thread is fourth in the result list. Uninformed policy makers frequent public forums like this where numbers are posted without meaningful context (ie. specialty certification/years to train, etc.), and decisions to cut physician reimbursement is made on an arbitrary basis. In reality, physician payments account to only around 5-10% of the total cost of care.

cash only for everybody!

 

[FlowRate]

not a great comparison but I would agree $100 a visit would seem reasonable - even the psychologists round here bill $200/hr

What would be a good comparison?

 

[Doctor Bagel]

Just an observation and maybe false, but it seems like the people here who are super positive about salaries and unlimited income potential in psych and whatnot are all not actually done with training. It seems like all the folks out there making lots of money (and by that I mean more than average for psych and probably still less than average for other physicians aside from primary care) are working a lot.

Psych income isn't horrible, but I could work the same amount or maybe even less and probably make $100k more a year if I were doing say emergency medicine. Hospitalists make on average probably at least $50k more than us, maybe more. I like my job more but still, we're not in the super high pay range, and we're still pretty far down when you look at medical specialties even accounting for part-time workers and whatnot.

 

[TexasPhysician]

Psych income isn't horrible, but I could work the same amount or maybe even less and probably make $100k more a year if I were doing say emergency medicine. Hospitalists make on average probably at least $50k more than us, maybe more. I like my job more but still, we're not in the super high pay range, and we're still pretty far down when you look at medical specialties even accounting for part-time workers and whatnot.

I think the problem is variability. There is just too much of it. All medical specialties are the same way.

There are EM openings in rural cities doing nights with $400k+ salary (40 hr weeks) that I've seen go unfilled for quite awhile. I've seen popular urban areas where the same job during day hours pays $200k and it's filled almost instantly.

My friend is a hospitalist making $360k. He works about 90-95 hours over 7 days and then off for 7 days.

If you are willing to work nights at a busy psych ER triage facility, I've seen child psych people earning $220/hr. I think the shift was 11pm-7am. I also know child psych in academia at $150k working 45hrs/week.

It is certainly possible to make a lot of money in psych, but it isn't done working 8-5 without call or weekends. Like almost all medical fields, you can earn more with more hours, call, or working where/when no one else wants.

 

[F0nzie]

If I had to work 70-80 hours, I think psych would probably be one of the worst specialities to choose. Needing an empathic ear while being sleep deprived??? That is like a death sentence. I would take Cardiology or GI over psych any day if I had to work that much. I am not sure how working that many hours in psych is even sustainable. I can't be the only one who feels wiped out after an 8 hour day...

 

[Doctor Bagel]

If I had to work 70-80 hours, I think psych would probably be one of the worst specialities to choose. Needing an empathic ear while being sleep deprived??? That is like a death sentence. I would take Cardiology or GI over psych any day if I had to work that much. I am not sure how working that many hours in psych is even sustainable. I can't be the only one who feels wiped out after an 8 hour day...

And all the sitting inherent in outpatient psychiatry, which is the new smoking, right? I'd think 40 hours of actual patient care would be really hard.

 

[sunlioness]

And all the sitting inherent in outpatient psychiatry, which is the new smoking, right? I'd think 40 hours of actual patient care would be really hard.

It is.


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[Trousseau]

Just an observation and maybe false, but it seems like the people here who are super positive about salaries and unlimited income potential in psych and whatnot are all not actually done with training. It seems like all the folks out there making lots of money (and by that I mean more than average for psych and probably still less than average for other physicians aside from primary care) are working a lot.

Psych income isn't horrible, but I could work the same amount or maybe even less and probably make $100k more a year if I were doing say emergency medicine. Hospitalists make on average probably at least $50k more than us, maybe more. I like my job more but still, we're not in the super high pay range, and we're still pretty far down when you look at medical specialties even accounting for part-time workers and whatnot.

EM is the new Derm, though. Of course Psych can't hope to compete with that.

n = 1, but I talked to a Psych attending who told me that Psychiatrist and Hospitalist salaries are comparable when corrected for hours.

 

[st2205]

EM is the new Derm, though. Of course Psych can't hope to compete with that.

The reason derm is derm is in large pet to do with lifestyle. Dermatology makes large salaries for short (daytime) hours that, while busy, aren't as relatively stressful or taxing and they don't have to worry as much about whether they'll kill someone. Not much of that is true about EM.

 

[Doctor Bagel]

The reason derm is derm is in large pet to do with lifestyle. Dermatology makes large salaries for short (daytime) hours that, while busy, aren't as relatively stressful or taxing and they don't have to worry as much about whether they'll kill someone. Not much of that is true about EM.

True this. EM is still a bit burnout specialty. They work nights for their whole career, and they see all the horrible in medicine (angry people, malingerers, etc). Plus, consultants are probably all mean to them and endlessly annoyed when they get admissions. Their hourly rate is still pretty high, though.

 

[swisschard]

Part of the challenge of working 40+ hours/wk of direct patient care would be the burnout. I definitely spend a lot more time per patient than what I can bill for, with writing notes, liasing with other staff, phone calls, paperwork, insurance companies, coordination of care, and more. It's eye popping to say a psychiatrist charges say $300/hour cash, but when you realize all the other things required, it's effectively much less than that per hour worked. Add in the difficulty of scheduling 8 hours of cash only patients back to back on one day, let alone for 5 straight, and it's not realistic to extrapolate 40 hours/wk like this. I imagine it's more doable after the practice has been open for years, once adequate support staff is hired, in an area with high need.

 

[LPpostbacc]

It might depends on location, as well. I don't know how many are making $300K here in Chicago.

According to the BLS, Illinois is one of the LOWEST paying states for psychiatry: http://www.bls.gov/oes/current/oes291066.htm

Their numbers showed an avg salary in IL <$180K. Not that it's necessarily accurate, but a lot lower than other stats I've seen.

 

[LPpostbacc]

yep, i'll keep posting these medscape surveys:

http://www.medscape.com/features/slideshow/compensation/2014/psychiatry#16

"68% of psychaitrists worked less than 40 hours a week in 2014"

So 2/3 of psych are barely even touching 9-5 hours x 5 days/week. So thats why the average is usually around 210k. If you give a psychiatrist cardiology/surgery hours (55ish), I'm sure the average will be around 270-300k.

And remember, people don't go into Psych to work 60 hours/week, so there is automatically a selection bias. A lot of med students go into psych for "lifestyle". But there are psychiatrists here in NYC hustling 6-7 day weeks, doing ECT at 6:30am-8:30am, working 12 hours a day (8 hours inpatient/CL then 4-5 hours PP in the evening). Cash Only Practice going rate is $300/hr, but I know guys in the city charging 400-500/hr. So you can do some quick math and see how "lucrative" it can be. Not sure if these psychiatrists provide good treatment, but thats a separate argument.

I know a 60 year old psychiatrist that works in patient, and then picks up 16 hour on-call shifts, about 6-7/month. He says he clears 400k no problem.

Not bad for NYC psych.

and for argument sake, lets not forget about malpractice. OBGYN here averages $120-140k/year. Psych averages $10-12k (around 20K for ECT).

An important thing to tease out is if they are only working ~40hrs or less by choice, or b/c they can't fill their time slots. I can't imagine many new docs <30-35yo who are not willing to work more than 40-45hrs per week (50?).

 

[prominence]

My friend is a hospitalist making $360k. He works about 90-95 hours over 7 days and then off for 7 days.

Is this friend a psychiatry hospitalist?

 

[Devpsi]

An important thing to tease out is if they are only working ~40hrs or less by choice, or b/c they can't fill their time slots. I can't imagine many new docs <30-35yo who are not willing to work more than 40-45hrs per week (50?).

Granted, my knowledge is based on practices in metropolitan areas with populations <1 million, but given the shortage (or perhaps geographically imbalanced distribution) of psychiatrists, I would be surprised if anyone starting out had much trouble finding patients

 

[Merovinge]

According to the BLS, Illinois is one of the LOWEST paying states for psychiatry: http://www.bls.gov/oes/current/oes291066.htm

Their numbers showed an avg salary in IL <$180K. Not that it's necessarily accurate, but a lot lower than other stats I've seen.

This is due to the Chicago effect. Most psychiatrists in the state are in Chicago and it's a pretty popular place to want to live. Graduating PGY's getting offers around 180-200k for salaried positions in non academics. There are a lot of academic psychiatrists and those starting salaries are pretty rough ($150k ish).

 

[SoulinNeed]

This is due to the Chicago effect. Most psychiatrists in the state are in Chicago and it's a pretty popular place to want to live. Graduating PGY's getting offers around 180-200k for salaried positions in non academics. There are a lot of academic psychiatrists and those starting salaries are pretty rough ($150k ish).

What about the surrounding Chicago suburbs? And does that include PP in downtown and higher income neighborhoods?

 

[Extralong]

I'm not going into psychiatry but year about year psychiatry has been ranked below average in terms of salary. The thing is, I am in a major city and even here, there is a huge shortage of psychiatrists, it's hard for me to book appointments for my patients, and the MAJORITY, are cash only charging 100+ per visit. So I'm thinking if they are so booked, and they are doing cash only, the must be making a lot, assuming 150$ for a 30 min visit, that's 300$ a hr and ~3000$ a day... and since it is cash only, there is no insurance not paying 30% of the time, and there is no need to hire a biller. So why is it that psychiatrists' median salary consistently is <200k? Are these people just not joining the survey?

Just look at the hundred posts in the other threads. You don't even have to search it, it'll still be on the first page.

 

[Merovinge]

What about the surrounding Chicago suburbs? And does that include PP in downtown and higher income neighborhoods?

Suburbs can be a bit higher for sure. This is also for folks in my cohort, that is fresh out of training. Some friends of mine who are experienced attendings with 5+ years are certainly getting higher offers in the city.

 

[LPpostbacc]

I'm not sure what to make of it all. I have spoken to some who have been practicing a while who can't fill their schedules with enough patients, and others who are salaried and just make less per year.

I think the problem with finding referrals is that most pts don't want to pay in cash, or at all. They want insurance to pay, so that limits the available pool of docs down to a smaller number (those who take insurance).

I'm really confused as to what the average doc can expect to make.

 

[TexasPhysician]

I'm really confused as to what the average doc can expect to make.

There is a lot of diversity in psychiatry related to type of job, hours worked, and call which can also significantly skew the data. There is no accurate average.