Salary? Does this place have a running Salary thread?

[psychMDhopefully]

Residents who graduated this year, what type of offers were you getting? Im expecting 250-26ok to be the norm now.

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[splik]

you will be disappointed if you think that is the norm. there are jobs that pay that, there are jobs that pay more than that but many jobs will pay much less. This is really the wrong question to be asking- location makes a big difference, setting and population, outpatient vs inpatient, fringe benefits, call, hours worked, public vs private etc, volume of patients, whether there are administrative duties etc, child vs adult, all make a difference as does employed v independent contractor

and obviously many academic jobs will pay about half that, same is true for community jobs in some parts of the country

 

[psychMDhopefully]

you will be disappointed if you think that is the norm. there are jobs that pay that, there are jobs that pay more than that but many jobs will pay much less. This is really the wrong question to be asking- location makes a big difference, setting and population, outpatient vs inpatient, fringe benefits, call, hours worked, public vs private etc, volume of patients, whether there are administrative duties etc, child vs adult, all make a difference as does employed v independent contractor

and obviously many academic jobs will pay about half that, same is true for community jobs in some parts of the country

Yeah I know there are a lot of variables that go into pay, I'm mainly talking about outpatient, non academic, and not in a big city or a saturated market. I'm from the southeast and tend to prefer smaller to mid sized cities.

 

[splik]

I am not familiar with the SE but I would imagine that 260 would be on the high end for a salaried gig. OTOT this is the region of the country with the highest cash only practice so you could probably make more than that with your own pp or joining a group practice and taking only one or two of the better paying insurances. doing high volume med management in particular you could make bank of that is your goal

 

[wolfvgang22]

Yeah I know there are a lot of variables that go into pay, I'm mainly talking about outpatient, non academic, and not in a big city or a saturated market. I'm from the southeast and tend to prefer smaller to mid sized cities.

I earn $235,000 in a job that meets your criteria, but not in the southeast. Does not count my bonus. I started at $220k. I'm two years out of fellowship. In fact, we are hiring. It is a VA job, outpatient, some inpatient consults. I like it for the most part, if that helps, and I plan to be here a long time. Collegial environment. Opportunity to teach if you want, but not required.
Let me know by PM if you'd like to know more and are graduating residency in the next year.

 

[Blitz2006]

I earn $235,000 in a job that meets your criteria, but not in the southeast. I started at $220k. I'm two years out of fellowship. In fact, we are hiring. It is a VA job, outpatient, some inpatient consults. I like it for the most part, if that helps, and I plan to be here a long time. Collegial environment. Opportunity to teach if you want, but not required.
Let me know by PM if you'd like to know more and are graduating residency in the next year.

If you don't mind me askin', what region of the country is this and how big is the city?

 

[wolfvgang22]

If you don't mind me askin', what region of the country is this and how big is the city?

Answering publicly here would remove any anonymity I have and show up in google. I sent you a PM.

 

[psychMDhopefully]

I earn $235,000 in a job that meets your criteria, but not in the southeast. Does not count my bonus. I started at $220k. I'm two years out of fellowship. In fact, we are hiring. It is a VA job, outpatient, some inpatient consults. I like it for the most part, if that helps, and I plan to be here a long time. Collegial environment. Opportunity to teach if you want, but not required.
Let me know by PM if you'd like to know more and are graduating residency in the next year.

In your opinion, does doing a fellowship in child/adolescent or addiction increase opportunity, marketability, and income potential? I'm a 3rd year med student so still far out, do you think NPs and PAs getting into psych will make a difference in job opportunities?

 

[wolfvgang22]

In your opinion, does doing a fellowship in child/adolescent or addiction increase opportunity, marketability, and income potential? I'm a 3rd year med student so still far out, do you think NPs and PAs getting into psych will make a difference in job opportunities?

I think fellowship increases opportunity and marketability slightly. You may never get back the one or two years of attending level earnings you lose by doing a fellowship. You won't earn much more by having done a fellowship. Doing child psych opens up lots of child psych jobs to you, but this is not necessary as there are so many jobs in psychiatry available. I would only do a fellowship if you are truly interested in it, or want to work in academic psychiatry within that fellowship field. I do think doing a child fellowship made me a much better psychiatrist than I would have been otherwise.

There is an enormous shortage of psychiatrists in most of the U.S. NPs and PAs will eventually lessen job opportunities some, but they still need to be supervised by a psychiatrist and just aren't equipped to handle many patients with severe mental illness. So many older psychiatrists are retiring, and the number of residency positions are not increasing. Barring any major mental health care reforms granting mid level providers greater prescribing abilities and less supervision requirements, or adding a lot of residency training positions, there are going to be plenty of jobs for psychiatrists. In a couple of states psychologists have some prescribing ability, but like NPs, they also cannot handle complex cases regarding medication and will quickly get over their head due to a lack of training in medicine.

 

[dl2dp2]

$250k is not an unreasonable starting point IMHO. People who are already in jobs will get paid less, and if they are willing to snoop around they'll find better offers from a purely monetary perspective. Jobs that require "a lot" of call (i.e. once or every other week -- I have friends in OB lol) and mixture of inpatient/outpatient coverage, especially if in less desirable areas, I would put the starting point at 300k or 280k + very generous RVU. Keep also in mind you are really looking at first year base pay. Once you get a better sense of the billing, in insurance coverage models, it's probably better to negotiate a better RVU instead of a higher base pay because patient supply/referral is rarely the issue. From what some of the recruiters are intimating, I suspect that small groups contracting for hospitals outside of major cities but in growing metros (think Phoenix AZ, Charlotte NC) are doing "very well", so if you want to max out your pay in an insurance model, that's the type of facilities you want to look at. They also often still retain the true "partnership" track profit sharing, so that's also something to ask for. For all job hunts, usual salary negotiation rules apply and your individual milage varies greatly depending on your perceived desirability. I'm talking about a typical midrange American grad.

For locum/public models, I just got off the phone with a recruiter: 100% outpatient public job ("academic affiliated", ha) in one of the most desirable markets in the Northeast, the new hourly rate is ~ $160, no call, no weekends (if you do math, for full work week of 40 hours, this ends up being $300k for 1099, $270 for W-2). This is apparently an "ongoing need".

For busier facilities and emergency coverage at bad hours (i.e. overnight), the rate is now hovering around $200 per hour.

VA and State jobs remain lower (~ 200k). The reason being that they have hard budget line items that tend to move up very very slowly, and you can't really negotiate--but you know the cool things about this type of jobs is that often there's a high no show rate, so the intensity is not nearly as high, and once you are in nobody can/will ever fire you, so feel free to "enjoy life" and never work a lick more than your stipulated hours. But city hospitals and private non-profits (and some academic hospitals) can and do pay more as the demand is crazy and supply is non-existent. Academic jobs are a huge mix, and absolutely false that because a site is "academic" affiliated the salary is lower. One recruiter told me that they have ">30 jobs up and down the [Hudson] river, any type, anywhere and any time you want" (sounds like a used car salesman). Of course most of these jobs are "not desirable" as per the usual SDN smell test, but I bet a typical job off that list is a heck of a lot better than most other jobs in medicine.

The shortage will continue for a period of time, and let's not kid ourselves this is not ortho or even derm (thanks visaril for reminding us constantly of that), but the state of mental health care in our country is such that there is definitely money to be made, even if you don't want to work very hard.

you will be disappointed if you think that is the norm. there are jobs that pay that, there are jobs that pay more than that but many jobs will pay much less.

Splik--I'll BET you if you called a recruiter *TODAY* and asked, you'd get a job that pays this that's perhaps on par with the current desirability of your current job for a new grad. The issue is once you are in a job you don't want to move around, and facilities are counting on you to do that and therefore won't pay you more. So, yes, there are jobs that pay less, but jobs on the market generally pay more (weird effect for jobs, because usually buyers market, but not unusual for a market where there's a shortage i.e. real estate). If you get used to the VA/State lifestyle, it's hard to give that up for a pithy 30k more a year, but you know you can get it if you want...

 

[wolfvgang22]

I get decent raises and bonuses and limit gradual increase in hours and responsibility in part by making it very clear I'm desired by my old training programs and have some contacts in large metro areas, in a tactful manner. Never let an employer think you don't have options or aren't willing to move if disrespected. At the same time I show respect and commitment to my employer. It's a lot like a marriage. One has to maintain mutual respect and set appropriate limits on behavior. We are fortunate as psychiatrists in demand enough to be able to demand a modicum of fairness and respect from employers.

 

[F0nzie]

I get decent raises and bonuses and limit gradual increase in hours and responsibility in part by making it very clear I'm desired by my old training programs and have some contacts in large metro areas, in a tactful manner. Never let an employer think you don't have options or aren't willing to move if disrespected. At the same time I show respect and commitment to my employer. It's a lot like a marriage. One has to maintain mutual respect and set appropriate limits on behavior. We are fortunate as psychiatrists in demand enough to be able to demand a modicum of fairness and respect from employers.

This is a very important skill to have.


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[sweetlenovo88]

Excellent thread. I am a bit over a year out of residency and have stuck with locums. I am around 490k a year. That includes two weeks of vacation a year and maybe 4-5 holidays where I choose not to work. However, it is locums, and the difficulty lies in making temporary gigs permanent so you don't have downtime. I optimize taxes as well through my S-corp. I work five 10 hours days, M-F and then two weekends (sometimes 3) a month. I end on Friday at 9pm and have to drive four hours to my weekend job. I used to fly 3/4 weekends. Given when I have experienced so far, I cannot see myself taking a w-2 job. I have little use for their benefits and would rather optimize it on my own. I have used my income to pay off my large student loan burden, become debt free and fully fund retirement for the last two years.

 

[wolfvgang22]

Excellent thread. I am a bit over a year out of residency and have stuck with locums. I am around 490k a year. That includes two weeks of vacation a year and maybe 4-5 holidays where I choose not to work. However, it is locums, and the difficulty lies in making temporary gigs permanent so you don't have downtime. I optimize taxes as well through my S-corp. I work five 10 hours days, M-F and then two weekends (sometimes 3) a month. I end on Friday at 9pm and have to drive four hours to my weekend job. I used to fly 3/4 weekends. Given when I have experienced so far, I cannot see myself taking a w-2 job. I have little use for their benefits and would rather optimize it on my own. I have used my income to pay off my large student loan burden, become debt free and fully fund retirement for the last two years.

Thanks for your post.
Can you share a little about how you fund your retirement, health insurance costs, and malpractice coverage? Are you planning to retire early?

 

[sweetlenovo88]

b

Thanks for your post.
Can you share a little about how you fund your retirement, health insurance costs, and malpractice coverage? Are you planning to retire early?

Having self employment income, whether it is a 1099 or s-corp, allows you to put upto 53k in a individual 401 (tax deductible). You can then do a 5.5k in a backdoor roth IRA, and 3.350k in an HSA (tax deductible). I buy health insurance privately through the exchange which comes to $300 a month which is tax deductible as a business expense. Malpractice is covered by locums. I have no need for life insurance and decided not to buy disability. I have 1M liability auto insurance and will be buying umbrella insurance to 5m in the future. My goal is to fully fund retirement every year and then collect money towards a business venture. Staying away from debt except for a possible low interest rate mortgage in the future.

 

[PistolPete]

b

Having self employment income, whether it is a 1099 or s-corp, allows you to put upto 53k in a individual 401 (tax deductible). You can then do a 5.5k in a backdoor roth IRA, and 3.350k in an HSA (tax deductible). I buy health insurance privately through the exchange which comes to $300 a month which is tax deductible as a business expense. Malpractice is covered by locums. I have no need for life insurance and decided not to buy disability. I have 1M liability auto insurance and will be buying umbrella insurance to 5m in the future. My goal is to fully fund retirement every year and then collect money towards a business venture. Staying away from debt except for a possible low interest rate mortgage in the future.

Is all of your locums work inpatient? Adult only, or also child? Doing any telepsychiatry?

 

[sweetlenovo88]

Combination of telepsych and inpatient.

 

[dl2dp2]

Combination of telepsych and inpatient.

This is very helpful info. Could you quote a median hourly rate for telepsych locum? Also, could you suggest in terms of how to find locum telepsych gigs or good agencies? Thanks.

 

[wolfvgang22]

Combination of telepsych and inpatient.

Thanks for replying!
I do not think I personally could work more than 50 hours a week for very long and maintain my mental and physical health, and my family life would probably disintegrate with more hours. Do you think about $200,000 net take home after retirement and health insurance is attainable with locums at 40 hours a week?

 

[sweetlenovo88]

Thanks for replying!
I do not think I personally could work more than 50 hours a week for very long and maintain my mental and physical health, and my family life would probably disintegrate with more hours. Do you think about $200,000 net take home after retirement and health insurance is attainable with locums at 40 hours a week?

It is definetely attainable and more dependent on how much you put into retirement and your living expenses. Most locums gigs fall in the general range of 140-180 an hour with a premium for weekend work. Telepsych pays on the lower range of the scale above.

 

[PistolPete]

It is definetely attainable and more dependent on how much you put into retirement and your living expenses. Most locums gigs fall in the general range of 140-180 an hour with a premium for weekend work. Telepsych pays on the lower range of the scale above.

Got any experience with American Telepsychiatry? Do any telepsych companies allow you to set your own rate? I'd be looking to regularly supplement one workday a week and maybe an occasional weekend day as well.

I'm currently in negotiations with a potential employer and once I get details hammered out I'll post on here as well.

 

[surfguy84]

It is definetely attainable and more dependent on how much you put into retirement and your living expenses. Most locums gigs fall in the general range of 140-180 an hour with a premium for weekend work. Telepsych pays on the lower range of the scale above.

I'll apologize in advance for all the questions in this post, please feel free to answer any or all...

Is it reasonably easy to find enough locums work to fill 40-50 hours/week AND stay within 2 hours of a major metro area? Same question for tele psych as well.

Is it possible to use locums to find 24 hour assignments and simply put in your two days a week and that's it; i.e. just working weekends perhaps.

Are there assignments (locations, working certain hours) that are substantially higher than the 140-180/hr range? Will working a weekend in the middle of nowhere net substantially higher rates? Anything else you can think of for someone who will be able and willing to travel for assignments a few days a week.

Thanks so much for your insight

 

[DD214_DOC]

$147k + the cumulative value of the tears of my laments.

Child doesn't really add much to income potential in general, but could depending on location, practice structure, and what you negotiate.

The supply/demand for child psych is even greater than general psych, so I guess it's good if you're into being treated like a precious gem. From what I've seen, you could probably sacrifice every tenth patient to Cthulhu and still have your every whim catered to, as long as you stay to keep taking all the referrals.


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[nolapsych]

The amount of salary threads in this forum is really aggravating.


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[hamstergang]

The amount of salary threads in this forum is really aggravating.

I'm not necessarily disagreeing, but I'm curious as to why you feel that way?

 

[nolapsych]

It's repetitive. It's neurotic. As far as I can tell the Psych forum has way more of these type threads than any other specialty and fewer clinical discussions


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[PistolPete]

It's repetitive. It's neurotic. As far as I can tell the Psych forum has way more of these type threads than any other specialty and fewer clinical discussions


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Perhaps you can start more threads on clinical topics? I agree that our forum doesn't have as much clinical discussion as some of the other forums.

 

[michaelrack]

Pain and pathology have a lot of salary threads, also

 

[Mad Jack]

It's repetitive. It's neurotic. As far as I can tell the Psych forum has way more of these type threads than any other specialty and fewer clinical discussions


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There's a whole two salary threads out of the first 50 threads in the forum, and they're not particularly active threads. They also focus on different topics- one is specifically about how much you should ask for while moonlighting, while this is more of a general thread. People tend to worry about how much they'll make, because as much as you'd like to do what you love, that's not very realistic for some of the people out there that are 400-500k in debt. They want to make sure they can do what they love and eventually hopefully pay off their loans.

 

[Mad Jack]

Pain and pathology have a lot of salary threads, also

Anesthesia has them on and off, but most are more about "will I even have a job" these days.

 

[wolfvgang22]

I like to think we are more sensitive to the practical concerns of students and residents on this forum than some of the other specialty forums. Some of us are very open about financial and career topics, and that tends to invite more questions. I agree it can get repetitive.

That said, I welcome more clinical discussions! Maybe I'll start one soon, as I have many challenging patients.

 

[DetectiveAlonzo]

I like to think we are more sensitive to the practical concerns of students and residents on this forum than some of the other specialty forums. Some of us are very open about financial and career topics, and that tends to invite more questions. I agree it can get repetitive.

That said, I welcome more clinical discussions! Maybe I'll start one soon, as I have many challenging patients.

I agree. Maybe a thread on "violent" or "aggravated" patients... or... maybe cases that have creeped you out or maybe left you a little frazzled emotionally.

 

[wolfvgang22]

 

[DetectiveAlonzo]

lol noo I'm actually being serious for once.

 

[calvnandhobbs68]

All of the more active forums tend to have more salary questions (along with more active threads in general). I think it's more a function of forum activity. This forum is more active than even the general internal medicine forum or pediatrics forums, both of which have more actual practicing physicians and residents than this forum.

 

[SteinUmStein]

When comparing offers, does anyone have a rough guide for how to control for call? It seems like comparing apples and oranges when comparing two different jobs with two very different levels of intensity of call.

 

[nexus73]

When comparing offers, does anyone have a rough guide for how to control for call? It seems like comparing apples and oranges when comparing two different jobs with two very different levels of intensity of call.

RVUs can help compare/contrast this to some extent.

 

[OldPsychDoc]

When comparing offers, does anyone have a rough guide for how to control for call? It seems like comparing apples and oranges when comparing two different jobs with two very different levels of intensity of call.

I think that it varies too widely--the best you can do is decide whether you prefer apples or oranges, and look for the job that most closely approximates your preference.
How would you compare a 7 on/7 off inpatient job with no call to a M-F outpatient gig with 1:4 weekend coverage? Just too different...

 

[Brenn]

Why?
Should be people not be concerned about their future, only the patients?

The amount of salary threads in this forum is really aggravating.


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[digitlnoize]

The amount of salary threads in this forum is really aggravating.


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There are a fair number, but I think we can expect more than average. Why? Because the salary in our field is rather misleading. It's not as simple as glancing at the salary stats and seeing that we make $225k and that's that. The real story is that it's really variable and complex and dependent on a ton of factors (location, hours/week, cash vs insurance, RVU's, bonuses, call, mixing 2-3 jobs, half our field being semi-retired, half our field being women (who work less hours on average), etc.). It's really complex.

So, prospective psychiatrists get a mixed message. They hear from anecdotal stories that psych is a lifestyle specialty with great hours, important work, and good pay. Then they see the salary surveys and get disappointed and start wondering if maybe those anecdotes are outliers. Then they come here for a survey.

Hence all the threads.

Whether we want them or not depends on our field's philosophy towards the psychiatrist shortage. Do we treat it like Derm, and keep the supply of psychiatrists restricted and keep our salaries inflated? Or do we treat it like ED, expand residency slots, promote the hell out of the positive aspects of our field, increase recruitment, and resolve the shortage for the good of our patients and the detriment of our salaries?

What do you guys wanna do?

Me? I tend to take a middle ground and talk about the positives and the negatives and leave the residency expansion up to governmental fate.

 

[Blitz2006]

There are a fair number, but I think we can expect more than average. Why? Because the salary in our field is rather misleading. It's not as simple as glancing at the salary stats and seeing that we make $225k and that's that. The real story is that it's really variable and complex and dependent on a ton of factors (location, hours/week, cash vs insurance, RVU's, bonuses, call, mixing 2-3 jobs, half our field being semi-retired, half our field being women (who work less hours on average), etc.). It's really complex.

So, prospective psychiatrists get a mixed message. They hear from anecdotal stories that psych is a lifestyle specialty with great hours, important work, and good pay. Then they see the salary surveys and get disappointed and start wondering if maybe those anecdotes are outliers. Then they come here for a survey.

Hence all the threads.

Whether we want them or not depends on our field's philosophy towards the psychiatrist shortage. Do we treat it like Derm, and keep the supply of psychiatrists restricted and keep our salaries inflated? Or do we treat it like ED, expand residency slots, promote the hell out of the positive aspects of our field, increase recruitment, and resolve the shortage for the good of our patients and the detriment of our salaries?

What do you guys wanna do?

Me? I tend to take a middle ground and talk about the positives and the negatives and leave the residency expansion up to governmental fate.

Exactly, 2017 Medscape compensation reports just came out:

http://www.medscape.com/slideshow/compensation-2017-overview-6008547#4

And of course Psych is 6th from bottom. Again, not telling the entire story of how many of psychiatrists work less than 40 hrs/week (over 70%). I know Psychiatrists that work General Surgery hours and hit 400k, whereas GSurg average is 352k.

The shortage of psychiatrists is so great that I personally think expanding would be good, and I dont think it will lower our salary that much, especially since so many psychiatrists are over the age of 50, the shortage is only going to worsen in the next decade...

 

[splik]

Exactly, 2017 Medscape compensation reports just came out:

http://www.medscape.com/slideshow/compensation-2017-overview-6008547#4

And of course Psych is 6th from bottom.

I think that's fairly accurate when you put in in context. More interesting is psychiatrists were #3 in terms of feeling fairly compensated, which is a signifcant bump up (only EM docs and dermatologists felt more fairly compensated). This speaks the significant bump in psychiatrist remuneration in recent years. Also psychiatrists were #2 in answering "I would choose medicine again". Also psychiatrists were least likely to expect to participate in MACRA. This basically means most psychiatrists surveyed do not take medicare (only 19% expected to do MACRA). not necessarily a good thing, but MACRA is a nuisance if you are in private practice.

 

[F0nzie]

Psychiatrists probably have a higher suicide rate among physicians because nobody can answer the salary question...


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[Shikima]

I don't feel we are fairly compensated. Far too much documentation and other misc duties for the work we do which is often uncompensated.

 

[masterofmonkeys]

My offers have been consistently 190-210k for academic child psychiatry on a clinician-educator track. This is in 3 out of 4 geographical quadrants in the country.

Edit: this is about 30-50k more than I was expecting lol. Not complaining.

 

[masterofmonkeys]

Quick note on MGMA, AMGA, Medscape, etc. NONE of them control for hours worked and psych has the largest proportion (except maybe peds) of part time docs. In at least one place I interviewed, NO ONE except the boss worked 40h lol

 

[splik]

My offers have been consistently 190-210k for academic child psychiatry on a clinician-educator track. This is in 3 out of 4 geographical quadrants in the country.

Edit: this is about 30-50k more than I was expecting lol. Not complaining.

depends on where you - round these parts that is a little low for academic child but I know a friend of mine was offered 130k for a child clinician-educator track position at one of the "prestigious" programs that could not understand why they turned it down lol

 

[masterofmonkeys]

depends on where you - round these parts that is a little low for academic child but I know a friend of mine was offered 130k for a child clinician-educator track position at one of the "prestigious" programs that could not understand why they turned it down lol

True. This is also pre-bonus, and in some of the environments bonuses were consistently upwards of 30k

 

[st2205]

True. This is also pre-bonus, and in some of the environments bonuses were consistently upwards of 30k

Sign-on bonus or are you referring to a yearly bonus?

 

[masterofmonkeys]

yearly bonus