Questions about Psychiatry. Lifestyle, stress, pay, competitveness.

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phagocytosis41

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Hey all, current DO student here.
Thinking a little about Psychiatry.
How is the life as a psychiatrist? Does it feel as if psychiatrists are under a ton of stress since they have to little to lots of mental health problems on a daily basis?
Also, I know this is super general, but how is the pay? Especially working nonacademic in a big city like NYC or Chicago.
Is it hard to work 50-70 hrs as a psychiatry (surgeon like hours) and make 350-450k+ even? Just wondering.
I hear people charging direct out of pocket for payment 200$, seeing 6 pts a day and making 300k+. Not sure if thats possible though.

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Being a Psychiatrist is dangerous super ninja work.



To get to some of your questions, I don't have too much stress but things do get stressful. I'm trained quite well and can compartmentalize work and put it behind me. Pay is very high, hours are great. I'm not the typical case. I looked hard for the two positions I'm in which took effort and time, one is leadership the other is partnership.

Ask another psychiatrist, you may hear hours are terrible and pay is mediocre and stress is high. If your question is asking what is possible, well my friend, anything is possible.
 
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The great thing about psychiatry as with medicine in general is that there are lots of different ways and settings in which you can strike out. It's hard to answer your question in a generalizable way because so much of it depends on what you're interested in, where you're planning on practicing geographically, and what kind of system you want to work in.

In my area at least, making $300k+ is not unheard of. One of the private hospitals nearby (Dallas) starts newly graduated residents at $300k for an inpatient position. Our academic center starts in the low-to-mid $200s for a similar position. Some faculty also work in the psychiatric ED for additional income. In the private practice setting, some faculty also have a part-time private practice to see their own patients, do therapy, etc.. These opportunities will obviously increase your income.

If you're willing to work a lot of hours, then being a psychiatrist can be quite lucrative.
 
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The great thing about psychiatry as with medicine in general is that there are lots of different ways and settings in which you can strike out. It's hard to answer your question in a generalizable way because so much of it depends on what you're interested in, where you're planning on practicing geographically, and what kind of system you want to work in.

In my area at least, making $300k+ is not unheard of. One of the private hospitals nearby (Dallas) starts newly graduated residents at $300k for an inpatient position. Our academic center starts in the low-to-mid $200s for a similar position. Some faculty also work in the psychiatric ED for additional income. In the private practice setting, some faculty also have a part-time private practice to see their own patients, do therapy, etc.. These opportunities will obviously increase your income.

If you're willing to work a lot of hours, then being a psychiatrist can be quite lucrative.
so if one were to work 60-70 hrs in nyc, is it fair to say 300k+ or more is possible?
 
so if one were to work 60-70 hrs in nyc, is it fair to say 300k+ or more is possible?

Yes, absolutely. Find a 40hr/week job for 250k and do some moonlighting weekends and you are above 300k.
 
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Pay is very high, hours are great. I'm not the typical case. I looked hard for the two positions I'm in which took effort and time, one is leadership the other is partnership.

Would you mind sharing your hourly pay? I'm considering locums vs partnership and wonder which one pays more per hour.
 
Hey all, current DO student here.
Thinking a little about Psychiatry.
How is the life as a psychiatrist? Does it feel as if psychiatrists are under a ton of stress since they have to little to lots of mental health problems on a daily basis?
Also, I know this is super general, but how is the pay? Especially working nonacademic in a big city like NYC or Chicago.
Is it hard to work 50-70 hrs as a psychiatry (surgeon like hours) and make 350-450k+ even? Just wondering.
I hear people charging direct out of pocket for payment 200$, seeing 6 pts a day and making 300k+. Not sure if thats possible though.

As others have pointed out, the answers will vary from person to person. For myself:

1 - Life is quite nice! My day job is 40 hours a week. I don't tend to feel that stressed most days at work; I work with a team of talented psychologists, nurses, and social workers, which makes for a lively work environment where everything does not have to fall on me. While I hear about many, many distressing things in my day-to-day work, I don't find that it creates a great deal of personal stress for me. Handling such issues is part of what you learn during training. With that said, like many (pretty much all?) other fields in medicine you will see some things that you take home with you. That's part of being human. I find, though, that helping people through devastating times in their lives gives me a sense of meaning and purpose; it's not just observing a senseless parade of trauma for me.

2 - Nonacademic pay I would expect to start over $200k for most positions, and many will be closer to $250k. In some areas, $300k is not unusual (and I'm not talking about cash private practices).

3 - If you want to work 50-70 hours per week, I am confident you can break 350k. You need to *really* think about whether you want this, because the upper end of that range sounds absolutely miserable to me in psychiatry. You might break 450k, but you will have to either be very clever with your approach (finding just the right niche) or face burnout. I would not count on 450k levels.

4 - It is possible to run a cash-only private practice, and a large number of psychiatrists are successfully doing just that. Depending on the area, $200 per hour is very attainable (in some areas the going rate is often well above that). You will have to run a business, find patients, deal with gaps in your schedule / no-shows, nonpayment, etc., so it is not for everyone. It could be a pretty sweet way to practice for the right person though.

You might not be surprised to hear this but I'm very glad I went into psychiatry! It felt like the right fit from early on, and it certainly has turned out to be for me.
 
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Would you mind sharing your hourly pay? I'm considering locums vs partnership and wonder which one pays more per hour.

In my region the locums jobs pay anywhere from $100 to $190 per hour. Partnership should translate to a better situation but it depends on what is being offered.

I do not get paid by the hour nor am I on a salary. But back of the napkin calculation here, and I'm including commute time to and from work, hospital time on the wards, and note writing time at home, I'm probably in the vicinity of $400 a hour.
 
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In my region the locums jobs pay anywhere from $100 to $190 per hour. Partnership should translate to a better situation but it depends on what is being offered.

I do not get paid by the hour nor am I on a salary. But back of the napkin calculation here, and I'm including commute time to and from work, hospital time on the wards, and note writing time at home, I'm probably in the vicinity of $400 a hour.

That's amazing. How did you find that position? What should I do to find a similar position?
 
That's amazing. How did you find that position? What should I do to find a similar position?

When I set out looking for a job I met doctors who knew doctors who knew doctors who knew about special opportunities. I got lucky I was in the right place at the right time. That was a lot of it. I wanted to avoid boxing myself in too early in my career so I avoided preset jobs like your Kaisers and what not. It's amazing how myopic we are as residents without a clue about the true bandwidth of the career landscape.
 
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another idea is find a low volume job or part-time job and do expert witness work. You can bill 400-500 an hour with expert witness work. If interested, I would recommend getting board-certified in forensics. It would take a while to get enough referrals.
 
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another idea is find a low volume job or part-time job and do expert witness work. You can bill 400-500 an hour with expert witness work. If interested, I would recommend getting board-certified in forensics. It would take a while to get enough referrals.

... and I hear that as you progress and establish a name for yourself in expert witness work you can charge more gradually over time. Some exceed the $500 an hour mark.
 
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... and I hear that as you progress and establish a name for yourself in expert witness work you can charge more gradually over time. Some exceed the $500 an hour mark.

It goes up to $700 an hour for the most experienced forensic psychiatrists. I intend on giving myself a raise after I am board certified in BIM. Another small raise after I testify 5 to 10 times in federal cases. It will then plateau for a decade or so until I get some more gray hairs or if there is a shortage of forensic psychiatrists or with inflation. About 3% of psychiatrists are forensic psychiatrists and many do not do any expert witness work. There are some non-forensic psychiatrists that do expert work as well.
 
It goes up to $700 an hour for the most experienced forensic psychiatrists. I intend on giving myself a raise after I am board certified in BIM. Another small raise after I testify 5 to 10 times in federal cases. It will then plateau for a decade or so until I get some more gray hairs or if there is a shortage of forensic psychiatrists or with inflation. About 3% of psychiatrists are forensic psychiatrists and many do not do any expert witness work. There are some non-forensic psychiatrists that do expert work as well.

Do you think a fellowship is absolutely necessary to do this line of work?

What is the best way for someone to get started from scratch?
 
Do you think a fellowship is absolutely necessary to do this line of work?

What is the best way for someone to get started from scratch?

My experience is that it isn’t necessary. Starting at a low fee and networking with attorneys is quite helpful. Almost no one spends the time doing this though because you need to build your rep from nothing. Networking pays nothing and starting at a low rate means you are leaving plenty of money on the table by not just working clinically.

After undergrad, med school, and residency +/- fellowship, most of us aren’t looking to sacrifice the time/money needed to eventually bill $500-$700/hr.
 
You dont want to start too low either....attorneys will think they get what they paid for and maybe wary. You dont want to bill less than a forensic psychologist who is starting out. One way to start out without a fellowship is to get a QME certificate and do IMEs or if you are addiction boarded an MRO and do addictions cases. Cchp can maybe help with correctional med mal but most attorneys may not know what that is. I still think I made the right decision with getting boarded in forensics.

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