Residents/Attendings, are you happy in Psychiatry?

[doodleman]

---

Members don't see this ad.

For those in psychiatry residency or an attending, can you speak upon how residency has been for you? Pros/Cons? Work-life balance
Undecided MS3 but heavily considering Psychiatry. Really looking for a good work life balance as I want to be involved in my family.
Am interested in inpatient, which I understand will perhaps need to change due to my desire for free time.
I want to go into pediatrics. Can people speak about job availability and salary particularly with that? My family is trying to persuade me against Psychiatry.
(Also potentially interested in a FM/Psych residency?)

 

[comp1]

Psychiatry is amazing. I've never regretted going into it and the only parts of psych residency that I strongly disliked were the neurology and IM rotations at the beginning. That said...I mostly initially went into psychiatry because I hated everything else. I did like psychopharm a good deal, but REALLY hated everything else. Psychiatry has always seemed a lot less stressful than other specialties. Inpatient can absolutely leave a great deal of time for family and other interests. I'm not entirely sure inpatient is really all that harder to get coverage for than outpatient.

 

[DOswag]

For those in psychiatry residency or an attending, can you speak upon how residency has been for you? Pros/Cons? Work-life balance
Undecided MS3 but heavily considering Psychiatry. Really looking for a good work life balance as I want to be involved in my family.
Am interested in inpatient, which I understand will perhaps need to change due to my desire for free time.
I want to go into pediatrics. Can people speak about job availability and salary particularly with that? My family is trying to persuade me against Psychiatry.
(Also potentially interested in a FM/Psych residency?)

Welcome to the psych forum! Things are far less bleak here than they are in the EM forum 😎. Most here are generally pretty happy with life. I know you read my post in the EM forum about where I am in my career. Loving my life so far (definitely now that I'm out of the military on the civ side). Residency in general kind of sucks because well, it's longer hours, reading/studying, and you still rotations in things not psych related during your intern year generally. But compared to just about every other residency, psych residency is pretty chill. The only months I came close the 80 hour limit were intern year when I had to do back to back months of inpatient medicine. In general most psych rotations are not going to be anywhere near that including your inpatient rotations. 3rd year gets better because you're pretty much all outpatient at most programs and then 4th year in general tends to have a lot more elective time. Call is dependent on your program as some do night float systems, some do home call, some do in house call. Typically intern and 2nd year are your heaviest call with each year getting less. All in all you'd find it difficult to find a different specialty have a better work/life balance than psych in residency.

After residency it gets even sweeter. Many different settings you can work in with psych. Inpatient, outpatient, tele work from home, a mixed bag, work less than 40 hours and still make good pay, lots of loan repayment opportunities because psych is in such need currently. Child and forensic psych are often popular fellowships for people to do but I did not do fellowship so can't speak about them directly with experience. Most psych jobs are in the 250K+ range starting out and that even goes for VA jobs. Some markets in big cities/coastal areas may be a little more saturated though with some lower pay but there are jobs out there that can be very lucrative. Also inpatient jobs can be very friendly for you with work/life balance. Plenty that pay in the 250-300+ range that will allow you to leave as soon as you finish you work. I'm sure some on here can give more about there experiences with that but I've heard of some that will allow you to leave but be available by phone until a certain time. Hopefully others will share their experiences more with you on here. It's a great field and very highly in need.

 

[TexasPhysician]

Ignore family. You need to wake up and want to go to work for the next 25+ years. Only you can determine what field does it for you.

If I had to choose a medical field all over again, it would 100% be psych.

 

[dl2dp2]

Psych is pretty awesome. ESPECIALLY if you are into WLB. The money is still not quite there for most people, nor is prestige, but both are improving. -- currently in the mid-tier (i.e. def better than peds/IM/some IM specialties, but not quite as desirable/lucrative as rads/derm/cards/GI/surgical subspecialties etc., but you usually work far FAR less). Some subspecialties within psych has higher prestige/pay due to more technical nature thereof (child, addiction, forensics, etc), so if you are thinking about pediatrics, I can tell you being a pediatric psychopharmacologist is in general more prestigious and pays way more than being a general pediatrician. Some docs, especially within those subspecialties and/or run lucrative practices can achieve extraordinarily good lifestyle/pay. It is likely that if you are a child psychiatrist you would get paid more than the best-paid subspecialties in pediatrics and work far far less. I know several pediatricians personally. They have endless calls and can't bill much. The only pediatricians who get paid well are outpatient practice owners.

My family also tried to convince me to not go into psych, which in hindsight thank GOD I didn't listen/care. It would've been a huge mistake (my differential was neurology and heme/onc, and I have personal friends in both fields. They work like MAD DOGS. Endless calls. overnights. What have yous, AND still make less). Now when I talk to my friends who are doctors, GENERALLY I work less than they do and make more money. People who make more than I do (i.e. interventionalists in private practice) generally work a *lot* and I barely ever see them. I have 2 young children and spend far too many hours at the gym 5 days a week. Your miles may vary, obviously but that's my N=1.

 

[Wheatbread]

4 years into attendinghood and I like/love-ish it. Work is very interesting, lifestyle is great, but I’ll tell you, some days are just brutal. I do both inpatient/outpatient and right now I’ve got some really tough inpatients mixed with difficult malingeringers, throw in some outpatients struggling and I’m very low on emotional reserve right now. My suggestion to students considering Psych is that you really have to like it, the amount of “stuff” you’re subjected to hearing on a daily basis can and will impact you in some way.

 

[Bartelby]

Attending here. I have been very happy with psychiatry! It is an inherently fascinating topic, and as others have mentioned the work/life balance is quite good. Inpatient psychiatry can also offer good work/life balance, especially if you don't try to pack in a private practice after your inpatient day.

I very much agree with TexasPhysician. You, and not anyone who might want you to go into a more prestigious specialty, will need to actually get up and do the work each day for the next few decades. Figure out what you want that work to look like. The money in psychiatry is pretty good when broken down by hours worked, and my sense is that it's significantly better than pediatrics.

 

[Sushirolls]

Sometimes I raise an eyebrow and chin stroke over prospects of doing GS/Colorectal/NSx or rural IM as DPC practice if had to choose again, but probably 4 out of 5 opportunities to choose again probably would have picked Psych.

These days I dream of farming, tractors, manure, cattle, goats, combines, etc. The debut of my career I was planning on practicing until my license was yanked from me. Fast forward a few years, now I'm practicing until financially things pan out that I can be a farmer. Sadly, it takes a lot of money to become a farmer, especially if starting from scratch on raw land. I've got 2.5 miles plus of fencing I need to do as a preliminary project. The funny thing is, I'm more excited about getting exhausted from driving in posts repetitiously than I am about reading ABPN articles for MOC. Or boiling down animal fats and which recipes to use for home made soap.

 

[doodleman]

Psych is pretty awesome. ESPECIALLY if you are into WLB. The money is still not quite there for most people, nor is prestige, but both are improving. -- currently in the mid-tier (i.e. def better than peds/IM/some IM specialties, but not quite as desirable/lucrative as rads/derm/cards/GI/surgical subspecialties etc., but you usually work far FAR less). Some subspecialties within psych has higher prestige/pay due to more technical nature thereof (child, addiction, forensics, etc), so if you are thinking about pediatrics, I can tell you being a pediatric psychopharmacologist is in general more prestigious and pays way more than being a general pediatrician. Some docs, especially within those subspecialties and/or run lucrative practices can achieve extraordinarily good lifestyle/pay. It is likely that if you are a child psychiatrist you would get paid more than the best-paid subspecialties in pediatrics and work far far less. I know several pediatricians personally. They have endless calls and can't bill much. The only pediatricians who get paid well are outpatient practice owners.

My family also tried to convince me to not go into psych, which in hindsight thank GOD I didn't listen/care. It would've been a huge mistake (my differential was neurology and heme/onc, and I have personal friends in both fields. They work like MAD DOGS. Endless calls. overnights. What have yous, AND still make less). Now when I talk to my friends who are doctors, GENERALLY I work less than they do and make more money. People who make more than I do (i.e. interventionalists in private practice) generally work a *lot* and I barely ever see them. I have 2 young children and spend far too many hours at the gym 5 days a week. Your miles may vary, obviously but that's my N=1.

Yes I truly don't quite care about prestige nor do I feel like I need to make a million bucks. I care more about working enough so that I do not struggle financially and can have a yearly vacation as well as having time for my family. I don't need a crazy expensive car or huge house etc. I find psychiatry TREMENDOUSLY interesting and would want to do pediatric psychiatry, so that is good to know. Family is fearful that I will not find a job and one that will pay the bills (and loans).

 

[comp1]

The family thing is a little complicated, but it's also fairly universal unless your family is heavily populated already with psychiatrists. It's likely to not go away even after you've been practicing for a long time, but it will get less! There's a bit of a grieving process for family members because well, they imagined you basically being their on call PCP even if they aren't quite consciously aware of that fantasy. It also doesn't make for as impressive sharing at the country club in comparison to vascular surgery. Your family is also ignorant, flat out. If they aren't in medicine, they likely imagine that you'll function like a psychologist with a psychologist salary. You...won't. That you can fight with flat out salary data and more specifically pay per hour worked data which is straight amazing for psychiatry. And if they are in medicine, they associate psychiatrists with some of their most frustrating patients...

 

[doodleman]

The family thing is a little complicated, but it's also fairly universal unless your family is heavily populated already with psychiatrists. It's likely to not go away even after you've been practicing for a long time, but it will get less! There's a bit of a grieving process for family members because well, they imagined you basically being their on call PCP even if they aren't quite consciously aware of that fantasy. It also doesn't make for as impressive sharing at the country club. They're also ignorant, flat out. If they aren't in medicine, they likely imagine that you'll function like a psychologist with a psychologist salary. You...won't. That you can fight with flat out salary data and more specifically pay per hour worked data which is straight amazing for psychiatry.

Yes that is exactly what I'm struggling with. Have a family member who says they feel like it would be a "Waste" after all my medical training and concern that I won't have a sustaining job lmfao..

 

[ObsequiousAplomb]

Yes that is exactly what I'm struggling with. Have a family member who says they feel like it would be a "Waste" after all my medical training and concern that I won't have a sustaining job lmfao..

As other people have said, work-life balance in psychiatry is super easy.

Base: 8 am - 12 pm inpatient job, round on a unit and leave

Option 1: spend the rest of your day playing with your children and enjoying your hobbies. Full balance attained.

Option 2: add on small private practice, where you earn $200-500 per hour (and that's with insurance!) With overhead that is at most 20% of your collections, any number of hours you want, from 0-30 per week. You are still working less than 40-50 hours per week but netting $500-800k.

Option 3: add on literally any other setting: another inpatient job, partial hospital, ECT, residential, etc. Still make $500k while working less than any surgeons.

Option 4: instead of an every-day morning rounding gig, take an ER psych or 6-month locums or 14 on 14 off inpatient job and travel 50% of the year

Option 5: work fewer than 10 hours per week, but in a small-panel therapy-based practice. Take the entire month of August off.
Charge $300 to $1100 per hour. Still end up making $140k to $500k before overhead. At 10 hours, this could theoretically be the take home for an analysis practice where you only have 2-3 patients. Never mix up your patients again, and drop your kids off and pick them up from school every day.

Granted, all of the cobbling options I mentioned aren't exactly rates you can walk into. It takes time and gumption to build these things.

As for how I enjoy psychiatry? I love it. I genuinely love every day of being an attending psychiatrist. In my solo private practice, I have never dreaded an appointment. I'm so happy that I get to talk to people I otherwise never would talk to, and get to learn their way of navigating their own life path. I get to see the ups and downs and twists and turns.

If you care more about what your extended family (or literally anyone) thinks of your career than what you think of your career, then I suggest you consider why that might be.

 

[dl2dp2]

Yes I truly don't quite care about prestige nor do I feel like I need to make a million bucks. I care more about working enough so that I do not struggle financially and can have a yearly vacation as well as having time for my family. I don't need a crazy expensive car or huge house etc. I find psychiatry TREMENDOUSLY interesting and would want to do pediatric psychiatry, so that is good to know. Family is fearful that I will not find a job and one that will pay the bills (and loans).

There's no point in setting a standard that's too low. It's also a consistent theme that I see in exploitation. It's a good idea to strive to avoid that. Here's a good video for you: this is a female psychiatrist of color who became a multimillionaire 7 years after training. And this is someone living in a very high cost-of-living area. If she can do it you can do it.



Your family doesn't really know what they are talking about. Their opinions are meaningless especially if they are in error. That being said, it's always important to build a strong professional identity, and have reasonable expectations when you are interacting with your family/friends. For example, saying that you want to be a pediatric psychopharmacologist who treats very ill children and adolescents with severe mental illness would carry a gravitas and produce a more "prestige" vibe, which you would then internalize as a presence.

People generally make these comments because they feel insecure and want to diminish you. Often times parents and other relatives "worry" about your "career" not because they truly worry about you as much as they have insecurities about THEIR OWN career and failures. When people make judgments about you, they are usually talking about themselves: how could they not be? They barely KNOW you! These are sort of insights that come out of psychoanalysis but are broadly applicable. Now you don't have to psychoanalyze every interaction of that sort, and you aren't quite trained to do that yet anyway, but these are important things to know about. It's important to not believe in your own bull**** and have consistency in your internal identity, but knowing the rules of the game (of how people's psychology works) is very helpful in my experience in designing the reactions that you want and be able to have the role that you deserve.

 

[Celexa]

For those in psychiatry residency or an attending, can you speak upon how residency has been for you? Pros/Cons? Work-life balance
Undecided MS3 but heavily considering Psychiatry. Really looking for a good work life balance as I want to be involved in my family.
Am interested in inpatient, which I understand will perhaps need to change due to my desire for free time.
I want to go into pediatrics. Can people speak about job availability and salary particularly with that? My family is trying to persuade me against Psychiatry.
(Also potentially interested in a FM/Psych residency?)

We need more child psychiatrists desperately, the job market is phenomenal, lifestyle great, and you make way more money than peds...

I'm a CL psychiatrist. I love my job. Zero regrets on choosing psychiatry. My mother initially wasn't sure what to think about me picking psych but then she asked a bunch of doctors and they all raved about what a good choice I was making and she changed her mind real quick. Was very funny.

 

[Merovinge]

Rates of depression in adolescents have increased approximately 100% in the last 20 years in the US. You really don't need much other data to imagine the demand for peds psych. It's everything I imagined it being and more. It's pretty difficult to make less than 300k/year in the US if you are full time in CAP, where full time is 32 clinical hours (or less). Make sure you get into your peds psych elective next year and hopefully that cements your decision.

 

[whopper]

I love psychiatry, but thing things I hated about the job rarely were the fault of the field.

E.g. if you work in a badly run department you're going to likely not enjoy working in that department. I didn't like working in a state hospital because I got paid just as much as the doctors that were terrible (they'd give a schizophrenia Risperidone 0.25 mg daily, the patient wouldn't get better and keep them on only that dose for literally years). When I did outstanding work they didn't pay me anymore then lopped on the harder patients onto me, but didn't make the poor performing doctors work any better. One of my bosses told me the blunt truth-due to the shortage of psychiatrists they couldn't fire the bad ones. The good ones they didn't pay more money due to pay being controlled by a state pay-grade system.

One university I was happy in, but had to move cause of my wife's work. The next university I hated. It was poorly run. I made my own private practice.

One of those things where I had to learn where my niche was in the field, and this wasn't something I was going to learn in residency training.

 

[TheRightMedication]

I've been a psychiatrist for about ten years. No regrets.

Edit and addendum: I do have regrets about not making this additional statement - I had considered primary care and I am 100% certain psychiatry was the best choice for me. I'd go so far as to say it's objectively the right choice, judging by control of schedule and hourly pay.

 

[clozareal]

Residency was great. I became close with many of them and consider some of them my best friends. I went to a difficult program that wasn't malignant by any means but did work us hard and made us see a lot of volume. It was difficult and I complained at the time but now I'm seeing the value in it where my stamina and willingness to see complex cases makes me more versatile in my work. I also wanted to go into pediatrics but then chose CAP instead. I love working with parents although it's the #1 reason why people avoid CAP.

I work about 15 clinical hours a week on average in private practice (some weeks 5 hours other weeks 20 hours and many weeks 0 hours). I mostly do 4 days a week of work but do 3 days sometimes so I can have a 4 day weekend. I take off plenty of time, probably 8-10 weeks a year. I travel during that time with my family. I get to spend time with my spouse and young children. Having the autonomy and flexibility to do so is why I did private practice so I can be there for my family. I see interesting cases and do lots of psychotherapy. I teach at the local academic institutions intermittently. I gross about twice as much as the academic jobs around here. I got plenty of job offers, all of which wanted me to work 30-40 clinical hours with call on the weekdays or weekends, which I said no to.

Inpatient is great for free time. You see locums docs working 7 on 7 off. I know inpatient docs that work 32 weeks a year and that's considered full time. I know those who do inpatient in the morning then outpatient private practice in the afternoon. There's a lot of variation and flexibility when it comes to jobs in psychiatry which is great. The demand >> supply so you won't be struggling for a job, but finding one that checks off all the things you want might be tough. The main drawback to private practice is loneliness since you aren't working on a team daily.

Why does your family not want you to go into psychiatry? They're not the ones who have to do it 40-60 hours a week in training.

 

[doodleman]

Residency was great. I became close with many of them and consider some of them my best friends. I went to a difficult program that wasn't malignant by any means but did work us hard and made us see a lot of volume. It was difficult and I complained at the time but now I'm seeing the value in it where my stamina and willingness to see complex cases makes me more versatile in my work. I also wanted to go into pediatrics but then chose CAP instead. I love working with parents although it's the #1 reason why people avoid CAP.

I work about 15 clinical hours a week on average in private practice (some weeks 5 hours other weeks 20 hours and many weeks 0 hours). I mostly do 4 days a week of work but do 3 days sometimes so I can have a 4 day weekend. I take off plenty of time, probably 8-10 weeks a year. I travel during that time with my family. I get to spend time with my spouse and young children. Having the autonomy and flexibility to do so is why I did private practice so I can be there for my family. I see interesting cases and do lots of psychotherapy. I teach at the local academic institutions intermittently. I gross about twice as much as the academic jobs around here. I got plenty of job offers, all of which wanted me to work 30-40 clinical hours with call on the weekdays or weekends, which I said no to.

Inpatient is great for free time. You see locums docs working 7 on 7 off. I know inpatient docs that work 32 weeks a year and that's considered full time. I know those who do inpatient in the morning then outpatient private practice in the afternoon. There's a lot of variation and flexibility when it comes to jobs in psychiatry which is great. The demand >> supply so you won't be struggling for a job, but finding one that checks off all the things you want might be tough. The main drawback to private practice is loneliness since you aren't working on a team daily.

Why does your family not want you to go into psychiatry? They're not the ones who have to do it 40-60 hours a week in training.

I think my parents feel like it will be a "Waste of my medical training" and I will be a pill pusher who doesn't make a difference. There are some grimy psychiatrists who have worked with them in their work who they feel just do it for money. They also are worried I won't make enough money as they say I will be responsible for finding all of my own patients and will struggle.

 

[Stagg737]

I am happy. I've been a little burnt out lately d/t my job being primarily in the ER, but that will be shifting next year and where I'm at has been quite supportive. I also take comfort in knowing that if I wanted to I could quit tomorrow and start working again almost immediately and probably make quite a bit more in pretty much any setting because I'm currently in academia. Work life balance is fantastic, job security and pay are outstanding, and I really do enjoy the majority of what I do.

Yes that is exactly what I'm struggling with. Have a family member who says they feel like it would be a "Waste" after all my medical training and concern that I won't have a sustaining job lmfao..

Yea, that's not going to be a problem, especially if you go CAP. Psychiatry is one of the most versatile and in demand medical specialties there is. I've had more than one patient in the ER tell me they probably make more than me and then the number they tell me isn't close. I'll echo what others have said that your family doesn't know what they're talking about. Show them this thread and forum if they have doubts.

I think my parents feel like it will be a "Waste of my medical training" and I will be a pill pusher who doesn't make a difference. There are some grimy psychiatrists who have worked with them in their work who they feel just do it for money. They also are worried I won't make enough money as they say I will be responsible for finding all of my own patients and will struggle.

If that's the case I can say the same thing about literally every field of medicine. Any idea how many unnecessary lap chole's surgeons do? FMs push benzos far more than psychiatrists where I'm at. Want to talk about the most underpaid/underappreciated docs? Pursue general peds. I work C/L and I utilize my "medical" training every day. You can be an excellent clinician who only works 25-30 hours a week and still clear $200k easily. No one has asked but what does your family consider "enough" money? Unless it's 7 figures you can do it in psych, but if that's their expectation medicine as a whole isn't going to meet their expectations.

 

[ObsequiousAplomb]

I am happy. I've been a little burnt out lately d/t my job being primarily in the ER, but that will be shifting next year and where I'm at has been quite supportive. I also take comfort in knowing that if I wanted to I could quit tomorrow and start working again almost immediately and probably make quite a bit more in pretty much any setting because I'm currently in academia. Work life balance is fantastic, job security and pay are outstanding, and I really do enjoy the majority of what I do.


Yea, that's not going to be a problem, especially if you go CAP. Psychiatry is one of the most versatile and in demand medical specialties there is. I've had more than one patient in the ER tell me they probably make more than me and then the number they tell me isn't close. I'll echo what others have said that your family doesn't know what they're talking about. Show them this thread and forum if they have doubts.


If that's the case I can say the same thing about literally every field of medicine. Any idea how many unnecessary lap chole's surgeons do? FMs push benzos far more than psychiatrists where I'm at. Want to talk about the most underpaid/underappreciated docs? Pursue general peds. I workC/L and I utilize my "medical" training every day. You can be an excellent clinician who only works 25-30 hours a week and still clear $200k easily. No one has asked but what does your family consider "enough" money? Unless it's 7 figures you can do it in psych, but if that's their expectation medicine as a whole isn't going to meet their expectations.

Exactly. I remember being told something like "if one out of every three of your choles / appys are normal, then you're leaving too many normal ones in."

To the OP:
Psychiatry is the only specialty where I think you actually have enough time in an encounter to go over the risks, benefits, and alternatives in extensive detail. You go get surgery and the doctor is like "there's a small chance of a little bit of temporary pain, but not if I'm a good surgeon, which I am" whereas you see psychiatrists CONSTANTLY warning patients about the dangers of their medications. Bear in mind, the risks of our medications are also FAR, FAR less than every specialty (other than maybe ophtho). The effect sizes of our treatments are comparable to that of other specialties. We at least have the hubris to acknowledge that mental illness is multifactorial, unlike the PCPs who will make up some bull**** excuse like "the reason you had this second heart attack is that you weren't taking your Lipitor" and they'll believe that lie even more than the patient doesn't.

I've met a lot of pill mill providers in every specialty. The psychiatrists, while bad, are still generally less bad. After all, we're the only specialty that thinks we shouldn't ever have sex with our patients. How can anyone willingly go into a specialty without that rule when there are ones that have that rule? Gives me the heebie-jeebies just thinking about all the other docs I have heard have had sex or married former patients. Heck, look at plastic surgeons. Looks like a large proportion of them operate on their own wives.

 

[clozareal]

I think my parents feel like it will be a "Waste of my medical training" and I will be a pill pusher who doesn't make a difference. There are some grimy psychiatrists who have worked with them in their work who they feel just do it for money. They also are worried I won't make enough money as they say I will be responsible for finding all of my own patients and will struggle.

Sounds like your parents are just uninformed/unaware of what goes into specializing in psychiatry. Psychiatrists use medical training daily unless they only do psychotherapy. Our medications have physiological effects and side effects on many organ systems in the body. They have drug-drug interactions. There are medical mimics of psychiatric illness which sometimes require imaging or lab tests. Prescribing medications means practicing medicine, which includes all of your medical training.

So there are some psychiatrists who do it for the money (although they could have many other jobs that don't require as much school and delayed gratification to make money), but are they trying to say that you'll be one of them? That would be a false attribution and a bit insulting for your parents to think of you in that way.

Doctors are not poor people. Learning personal finances and managing your money can do you more good than earning more money. So what if you have to find your own patients? Your parents think that psychiatrists are sitting in their empty offices? You may struggle finding them but there's nothing bad about that. It's part of the process to struggle and learn how to market and obtain/retain patients. If you work for inpatient or a group practice, this point is moot.

You're definitely closing many doors when you choose a specialty. It allows you to commit and really hone your skills. Most neurosurgeons will never have to know how to prescribe an SSRI. Radiologists will probably never diagnose or treat schizophrenia or bipolar disorder in their lives once they specialize.

 

[Roxas]

1st year CAP fellow here. I absolutely love both adult and CAP, and wouldn't trade this job for anything else. The only times it feels anything less than wonderful is due to factors that are not psychiatry or are out of my control as a pleb trainee, such as practice setting or frustration with bureaucratic nonsense. However most of that you'll be able to better screen for as an attending.

Yes that is exactly what I'm struggling with. Have a family member who says they feel like it would be a "Waste" after all my medical training and concern that I won't have a sustaining job lmfao..

I don't want to put this indelicately, but believe me when I say this. **** those family members. It's not their decision. They're not going to be the ones logging 30 years in a profession, taking call, waking up at all hours of the night for these patients, etc. If they think EM, or CCM, or surgery, or whatever is so damn sexy they should have put the time in and earned that clout for themselves. Then they can come back and tell you how awesome it is.

That said, the lifestyle can be good but if you don't actually like psychiatry you might be miserable during the hours you are working. It can be extremely mentally/emotionally draining, so don't pick it just for lifestyle.

 

[Tangerine123]

There's no point in setting a standard that's too low. It's also a consistent theme that I see in exploitation. It's a good idea to strive to avoid that. Here's a good video for you: this is a female psychiatrist of color who became a multimillionaire 7 years after training. And this is someone living in a very high cost-of-living area. If she can do it you can do it.

I wouldn't consider that being a low standard. We all want different things in life, and many times it's not a monetary goal. Living in a high cost-of-living area and making millions isn't everybody's default aspiration.

PGY2 here. After residency, we are planing with my partner to move to a rural area. Hopefully open a private practice as a general Psych. We want to buy a piece of land, have some cows/sheep/chickens, and grow some crops to try and be a little self sufficient to a certain degree.

As to the OP: I'm extremely happy in Psych and would chose it again. I would however, not have studied medicine if given the choice now. But within medicine, psych has been my refuge.

 

[brosa]

I'm will partially go in the opposite direction.

Psych is a medium field. Pay is not great. Hours are fine but we get paid half of what other specialties get paid to work 70% of the hours, kind of. Sometimes it annoys me how "poor" the field is lol. I think that if you are competitive enough and can go into a high paying field like optho, derms or something like that, then I think that's better. Between peds and psych tho, psych is much better and it's not even a fair match.

Some days I regret doing psych, some days I don't, but I do have hopes the field will improve in the future.

 

[Merovinge]

I'm will partially go in the opposite direction.

Psych is a medium field. Pay is not great. Hours are fine but we get paid half of what other specialties get paid to work 70% of the hours, kind of. Sometimes it annoys me how "poor" the field is lol. I think that if you are competitive enough and can go into a high paying field like optho, derms or something like that, then I think that's better. Between peds and psych tho, psych is much better and it's not even a fair match.

Some days I regret doing psych, some days I don't, but I do have hopes the field will improve in the future.

It's good to have this counterpoint. If working 4 days a week for $300k +benefits is not good enough for the amount of money you feel like you need to earn, you are in the top 5-10% of your class, then it might make more sense to do derm/optho. There are certainly a subsection of med students I've spent time around who feel it is their birthright to be in the top 1% rather than top 2-3%, if that's you, psychiatry is probably not the best field (although certainly there are psychiatrists who make 1mill/year, I know one personally and another that's close).

 

[Sushirolls]

I'm will partially go in the opposite direction.

Psych is a medium field. Pay is not great. Hours are fine but we get paid half of what other specialties get paid to work 70% of the hours, kind of. Sometimes it annoys me how "poor" the field is lol. I think that if you are competitive enough and can go into a high paying field like optho, derms or something like that, then I think that's better. Between peds and psych tho, psych is much better and it's not even a fair match.

Some days I regret doing psych, some days I don't, but I do have hopes the field will improve in the future.

And to echo this, I had a Sleep Medicine doc sub lease from me... one insurance company was paying me less than medicare rates, and that same company was paying this doc close 2x medicare. Wasn't the only company doing that.

Psych is different. Gets treated different too. You see IP units getting closed down. Psych get put in the worst building or worst floors of the hospital or health system.

 

[DOswag]

I think my parents feel like it will be a "Waste of my medical training" and I will be a pill pusher who doesn't make a difference. There are some grimy psychiatrists who have worked with them in their work who they feel just do it for money. They also are worried I won't make enough money as they say I will be responsible for finding all of my own patients and will struggle.

Your parents don’t have much understanding of psychiatric training or the pay level. Depends on what setting you work in but you will not have trouble getting patients to come to you. Also you’ll make good money. You can work less than 40 hours per week and make 250+. I haven’t been at my gig long enough to say exactly how much I’ll make because it’s largely based on an RVU/bonus structure that gets tacked on to our regular salary on a quarterly basis. But it appears I’ll be able to make 3-400 pretty consistently. Talked to others in the group that have averaged 360-440. I work Mon-Thur 10 hr days, 3 day weekend every weekend, straight outpatient, no nights, weekends, or call, solid benefits and I’m in a large city in the south.

 

[comp1]

I can't really argue that some psych units are getting closed down, but I can definitely say in California...the law is going to really require a lot more beds be built as the bar for involuntary treatment is about to get a heck of a lot lower.

 

[Cath Up]

Current resident at a community program. I decided on psychiatry during medical school. I was non-traditional and beforehand was pretty set on another non-surgical specialty.

Absolutely love psychiatry. It is fascinating, actively progressing, and feels like it addresses the true needs of people to enjoy life. I am not sure you get that as reliably in other specialties or professions (clearly people feel that way, but it feels really significant in psychiatry). It is uncommon to find a career that one can find reliable meaning in, is intellectually stimulating, and allows a comfortable lifestyle.

The more common issue I see medical students overlook is autonomy in one's career, which is where psychiatry shines relative to most of your other specialty options. Peruse the specialty related threads here and on reddit, talk to your attendings and other residents. Super super common to experience dysphoria related to loss of control/moral injury/having MBAs or nurses determining your work schedule, compensation, quality of care, team structure- huge factors in how you enjoy work and what you can accomplish for patients. Psychiatry has uncommon protections from this. Highly mobile, highly in demand (for the foreseeable future, though subject to change at some point during the next 30 years) and able to practice independently or in private groups. This is easy to overlook, but is likely hugely protective regarding career fulfillment and enjoyment.

Psychiatry is also well positioned with the mid-level onslaught. High quality psychiatric treatment makes a notable difference- it is the rule rather the exception to see patients that were poorly managed by people with inadequate training. I am sure they encroach somewhat on a portion of the patient population (which I think is ethically questionable but out of my control) but overall our quality and length of training makes a difference that is protective in nature. In some other specialties with midlevel onslaught, preventative treatment or oversight arrangements can make it difficult to notice a difference even across many years. In anesthesia for example, you effectively cannot request an anesthesiologist actually oversee your case and even if you do, you can't advocate for yourself while you're asleep if they have to step out of the room or something.

Psychiatrist compensation is not the highest hourly in medicine, but psychiatrists can titrate their work hours as they desire and make basically as much or as little as they want. Given the self-selected nature of psychiatrists, it generally seems like people enjoy earning a low to low-moderate amount for physicians as a whole, in exchange for living fulfilling private lives. But you can also make a killing in psychiatry working surgeon hours (seems like you can approach some surgeon compensation doing this).

Obviously I am extremely biased but psychiatry feels like a hack into a great life and career. You have to be able to feel empathy for the extremely vulnerable patient population, and not everyone is built to be able to take detailed social histories and have meaningful conversations with people day in and day out. But I'd put forth that we are innately social creatures and for the right person, this doesn't grow old- it isn't algorithmic to hear a person's unique story. Perhaps this is why you hear of many psychiatrists practicing until old age.

 

[doodleman]

It's good to have this counterpoint. If working 4 days a week for $300k +benefits is not good enough for the amount of money you feel like you need to earn, you are in the top 5-10% of your class, then it might make more sense to do derm/optho. There are certainly a subsection of med students I've spent time around who feel it is their birthright to be in the top 1% rather than top 2-3%, if that's you, psychiatry is probably not the best field (although certainly there are psychiatrists who make 1mill/year, I know one personally and another that's close).

Oh no that would be PLENTY for me ahah I do not need to be a millionaire.

 

[brosa]

It's good to have this counterpoint. If working 4 days a week for $300k +benefits is not good enough for the amount of money you feel like you need to earn, you are in the top 5-10% of your class, then it might make more sense to do derm/optho. There are certainly a subsection of med students I've spent time around who feel it is their birthright to be in the top 1% rather than top 2-3%, if that's you, psychiatry is probably not the best field (although certainly there are psychiatrists who make 1mill/year, I know one personally and another that's close).

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

 

[clausewitz2]

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

Based on what is reported on this board and my personal experience in the last 3.5 years as an attending, yes, yes you are. Perhaps you are where He Who Must Not Be Named used to practice, since he was routinely able to demonstrate why it was mathematically impossible for a psychiatrist to be paid more than 200k per year.

 

[Bartelby]

Agreed. I live in a high cost of living area, but low-300k full-time psychiatry jobs are not special or difficult to find where I am. It is rare to see jobs going much higher than that range, and if you do academics or VA you are typically looking more at the mid to high 200s.

I have not looked around in low cost of living areas, I imagine rates may be lower (but low $200k might still go farther than low $300k in an HCOL area).

 

[TexasPhysician]

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

In Texas and surrounding states, I am seeing roughly $220k + bonus salary for academia FT and $275 for the VA FT. These are about 40 hour gigs with good benefits. That level of income is not attracting many applicants at all. I’m talking openings for years now. A friend of mine in academia that finished the year around $260k after bonuses is the lowest paying psychiatrist FTE that I know.

 

[DOswag]

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

For sure in a bad or overly saturated metro area.

 

[DOswag]

In Texas and surrounding states, I am seeing roughly $220k + bonus salary for academia FT and $275 for the VA FT. These are about 40 hour gigs with good benefits. That level of income is not attracting many applicants at all. I’m talking openings for years now. A friend of mine in academia that finished the year around $260k after bonuses is the lowest paying psychiatrist FTE that I know.

Yep im in south Texas, see my post above regarding my gig. When I was ending my military payback I was looking for VA or other gigs mostly outpatient in Kansas, OK, or south TX. Didn’t see anything below 250 and most were 275-300 with a few 3-400 which is one I’m in currently.

 

[Stagg737]

Oh no that would be PLENTY for me ahah I do not need to be a millionaire.

$300k/yr is not difficult at all to find in psych. There are many places that will pay at least that for a very reasonable work schedule.

I'm will partially go in the opposite direction.

Psych is a medium field. Pay is not great. Hours are fine but we get paid half of what other specialties get paid to work 70% of the hours, kind of. Sometimes it annoys me how "poor" the field is lol. I think that if you are competitive enough and can go into a high paying field like optho, derms or something like that, then I think that's better. Between peds and psych tho, psych is much better and it's not even a fair match.

Some days I regret doing psych, some days I don't, but I do have hopes the field will improve in the future.

We should add more context to this. Derm gets paid so much because they are literally seeing 40-60 outpatients per day compared to a typical psychiatrist seeing 15-20. Pretty obvious why they'd make more. Ophthalmologists will see 20-30 patients per day and often do procedures. Also easy to see why they make more if one knows basics about surgical/procedural billing. I knew a psychiatrist who averaged around 40 patients per day when I was in med school, he was making upper 6 figures. Cash only varies based on locality but can charge a ton. $400/hr is not unreasonable in a lot of places and at 32hrs/wk for 45 weeks a year, that's a gross of $576k/yr.

Yes, psych often makes less than other fields, but that's partially because we see much fewer patients per hour and use the same billing codes along with working hours that many other specialties would consider part-time.

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

This is extremely atypical. Either the market where you're at is awful (if in the US) or you and your colleagues are getting seriously low-balled. Here's 3 postings I've gotten just in the past 2 weeks all of which are equivalent to at least $350k for typical FT work:

Spoiler: Midwest college town

• Hybrid inpatient and outpatient practice setting
• Monday - Friday 9-5 pm schedule
• Option for employed or 1099/Independent contractor
• $350K+ earning potential plus retention bonus
• Open to J1 and H1B candidates
• Comprehensive benefits- medical/dental/vision, short-term disability/severe illness/cancer insurance, 401k with safe harbor, 20 days PTO, 8 paid holidays, relocation assistance, CME days and allowance, full-service licensing and credentialing, and liability insurance reimbursement

Spoiler: Job in beautiful Chicago suburb

• Outpatient practice with 14+ psychiatrists & 30+ psychologists/master prepared therapists
• Flexible in-office hours with experienced office staff
• Shared weekend telephonic call of 1 in 15
• Most physicians are Independent Contractors (1099), but there is potential for employment
• Excellent earning potential; take home around $300K (24-25 patient hours weekly)

Spoiler: Slightly rural but near major metros

• 41 beds comprised of 10 adult behavioral medicine, 16 adult psychiatric services, and 15 child and adolescent beds
• Join a team of 7 Psychiatrists
• Choose from outpatient, inpatient, or a mixture of inpatient and outpatient
• $350K base salary plus $50K sign-on bonus
• $150-300K student loan repayment
• Benefits include health, dental, vision, $5K & 1 week of time off for CME, generous PTO
• Sub-specialty interests can be accommodated

 

[DOswag]

$300k/yr is not difficult at all to find in psych. There are many places that will pay at least that for a very reasonable work schedule.


We should add more context to this. Derm gets paid so much because they are literally seeing 40-60 outpatients per day compared to a typical psychiatrist seeing 15-20. Pretty obvious why they'd make more. Ophthalmologists will see 20-30 patients per day and often do procedures. Also easy to see why they make more if one knows basics about surgical/procedural billing. I knew a psychiatrist who averaged around 40 patients per day when I was in med school, he was making upper 6 figures. Cash only varies based on locality but can charge a ton. $400/hr is not unreasonable in a lot of places and at 32hrs/wk for 45 weeks a year, that's a gross of $576k/yr.

Yes, psych often makes less than other fields, but that's partially because we see much fewer patients per hour and use the same billing codes along with working hours that many other specialties would consider part-time.


This is extremely atypical. Either the market where you're at is awful (if in the US) or you and your colleagues are getting seriously low-balled. Here's 3 postings I've gotten just in the past 2 weeks all of which are equivalent to at least $350k for typical FT work:

Spoiler: Midwest college town

• Hybrid inpatient and outpatient practice setting
• Monday - Friday 9-5 pm schedule
• Option for employed or 1099/Independent contractor
• $350K+ earning potential plus retention bonus
• Open to J1 and H1B candidates
• Comprehensive benefits- medical/dental/vision, short-term disability/severe illness/cancer insurance, 401k with safe harbor, 20 days PTO, 8 paid holidays, relocation assistance, CME days and allowance, full-service licensing and credentialing, and liability insurance reimbursement

Spoiler: Job in beautiful Chicago suburb

• Outpatient practice with 14+ psychiatrists & 30+ psychologists/master prepared therapists
• Flexible in-office hours with experienced office staff
• Shared weekend telephonic call of 1 in 15
• Most physicians are Independent Contractors (1099), but there is potential for employment
• Excellent earning potential; take home around $300K (24-25 patient hours weekly)

Spoiler: Slightly rural but near major metros

• 41 beds comprised of 10 adult behavioral medicine, 16 adult psychiatric services, and 15 child and adolescent beds
• Join a team of 7 Psychiatrists
• Choose from outpatient, inpatient, or a mixture of inpatient and outpatient
• $350K base salary plus $50K sign-on bonus
• $150-300K student loan repayment
• Benefits include health, dental, vision, $5K & 1 week of time off for CME, generous PTO
• Sub-specialty interests can be accommodated

Yeah most days for me are 15-20 pts, 1hr for new patients and 20 min follow ups.

 

[calvnandhobbs68]

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

I'm with everyone else, low-mid 200s is academics salary or part time basically.

 

[Merovinge]

Also to be fair I haven't seen any peer being offered that. What I've seen is more 200-250k here, and that's got 5 days a week. Only place I've heard paying close to 300k had home call Q4 (yes, every 4 days).

Maybe I'm just in a bad metro for psych, could be that.

I do really appreciate you posting your perspective and then seeing the responses so that trainees and med students can see what is out there. I have never heard of any non-academic position paying in the 200-250k range, even that VA is higher than that around me (plus the amazing benefits). I could imagine some metro that was heavily oversaturated where demand was so low that this could be the case, but all I have ever known is demand >>> supply for psychiatry.

 

[The kitchen sink]

Curious, for locums gigs, what is the general per hour rate given for psych coverage?

 

[Candidate2017]

not everyone is built to be able to take detailed social histories

Yes, we call these specially built physicians psych residents.

 

[clausewitz2]

Yes, we call these specially built physicians psych residents/ID fellows.

FTFY

 

[Sushirolls]

I can't really argue that some psych units are getting closed down, but I can definitely say in California...the law is going to really require a lot more beds be built as the bar for involuntary treatment is about to get a heck of a lot lower.

LOL.
No, they won't. It's like every other virtue signaled mandate law... They won't fund it, and these patients with spin wheels in the ED and EM or C/L if the hospital has one, get to be the hot potato to click D/C.

One example is WA state and how they do their commitments, not enough volume in their state hospitals or turn over to facilitate new admissions, so patients get to chill in the ED. Great when judges pass fines on the state hospitals. LOL. One hand of the guberment biting the other, for problems they created in the first place.

 

[ObsequiousAplomb]

Curious, for locums gigs, what is the general per hour rate given for psych coverage?

$200 for locums seems to be standard in the mid-Atlantic for inpatient coverage. More important is to negotiate the daily rate. My locums role is $1650 per day (so I guess I'm getting paid $206.25 per hour with a guaranteed 8 hours).
Doesn't really matter how long I'm there, that's what I get paid.
It's for a very reasonable volume (unit max is 14, but right now the census is much lower) that I can finish before noon (I go in before 7). Then I can see my outpatients in the afternoon without really working all too late or missing family time.

 

[TexasPhysician]

Curious, for locums gigs, what is the general per hour rate given for psych coverage?

There isn’t a “general” or “average” rate in most medical fields. I’ve seen $125 on the low end. It goes up from there. The rate can vary significantly based on demands, locations, hours, intensity, etc.

I take PT gigs that I enjoy for as low as $150/hour. The less I enjoy the job, the more I will demand.

 

[FlowRate]

One thing to think about, more in regards to eventual practice setting as an attending, is how much patient populations can vary by region, solo/small group PP/large group/big box/CMHC, insurance/cash, etc.

There are weeks (like the last one or two) where I wish I was in a setting where I could do some screening the way solo/small group PP often do. The upside of taking all patients seeking care with X insurance or at X facility is providing care often to people who need it and can't get it elsewhere. The downside being the ones who can't get it elsewhere because they are very challenging humans to interact with and in notably unpleasant ways. Mostly too much interaction with the depressive PD's and the more vindictive/help rejecting BPD's lately.