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Merely

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Can someone enter psych and make upwards of 500k if they were business minded and started their own practice? Just a hypothetical. Also, can one specialize in only like treating depression and suicidal patients and avoid other stuff?
 

wolfvgang22

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Possible but unlikely in practice. If you do, you would probably be working non stop, serving wealthy patients, and maybe doing some unethical work. Now if you own a clinic and employ others or do something non clinical, you probably can. You'll still be working all the time. Lower your expectations by $200k and you can do it.
Why would you want to treat only depression and avoid other stuff? That would get terribly boring.
 
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PistolPete

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Of course! But you'd have to own your own practice and either do cash-only, or a very high volume insurance-based practice. And yes, you could specialize in a certain field of psych if you wanted.
 

Merely

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So if one were to work as much as a neurosurgeon would they get paid as much or no because neurosurgeons make more per hour since they do procedures? I'm pretty naive about this stuff so bare with me.
 

Blitz2006

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So if one were to work as much as a neurosurgeon would they get paid as much or no because neurosurgeons make more per hour since they do procedures? I'm pretty naive about this stuff so bare with me.

Of course. Please refer to slide 14:

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

As you can see, 70% of psychiatrists work less than 40 hours/week. This is why psych is usually at the lower end of salary polls.

But if you give a psychiatrist GSurg/Cards hours (60ish/week), I'm fairly certain psych would be at the middle of the pack.

On an hourly basis, I think psych is pretty well compensated actually. And remember in psych, malpractice/overhead is very low compared to most specialties.

For example here in NYC area, OBGYN earn around 400k on average and clock 55-60 hr weeks. But they also pay around 120k in malpractice....whereas psych here can make around 350k with the same hours, but pay perhaps 8-12k in malpractice.
 
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Pathman1000

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Of course. Please refer to slide 14:

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

As you can see, 70% of psychiatrists work less than 40 hours/week. This is why psych is usually at the lower end of salary polls.

But if you give a psychiatrist GSurg/Cards hours (60ish/week), I'm fairly certain psych would be at the middle of the pack.

On an hourly basis, I think psych is pretty well compensated actually. And remember in psych, malpractice/overhead is very low compared to most specialties.

For example here in NYC area, OBGYN earn around 400k on average and clock 55-60 hr weeks. But they also pay around 120k in malpractice....whereas psych here can make around 350k with the same hours, but pay perhaps 8-12k in malpractice.

Lol. Not this again. 70% of psychiatrists see patients for less than 40 hours per week. You still have to work once the patient goes home (charting, prior authorizations, admin time).

The other posters are right OP. 500k is relatively unrealistic for psychiatry or for all but the most highly compensated surgical fields. DO NOT enter psych for money, contrary from what you may hear from delusional med students like Blitz.
 
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Blitz2006

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Lol. Not this again. 70% of psychiatrists see patients for less than 40 hours per week. You still have to work once the patient goes home (charting, prior authorizations, admin time).

The other posters are right OP. 500k is relatively unrealistic for psychiatry or for all but the most highly compensated surgical fields. DO NOT enter psych for money, contrary from what you may hear from delusional med students like Blitz.


I agree I think 500k is probably out of reach (but not impossible), but I think 350-400k is definitely doable if you work cards hours. I said psych is middle of pack, I never said we are at the Derm/Ortho/Plastics/Urology level. But I also don't think psych is at the bottom of the pack, which is what most salary surveys show us at.

One of my attendings told me his family friend, 1 son is ophtho, 1 son is child psych. Both just started working as attendings in the midwest, kansas I believe. Child psych starting salary: 300k. Ophtho: 225k. Now I now the ceiling for Ophtho might be higher, but its not all gravy in the almighty "ROAD" specialties.

So the grass isn't always greener either.
 
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PistolPete

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I know it's probably uncommon, but I know a PP psychiatrist who does mostly therapy and little med management and is cash pay (with a sliding scale) and makes about 500k per year, so it can be done in the right market.
 

northernpsy

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I am a pretty new attending psychiatrist and my salary is in the high 200s with a typical work week of around 45-50 hours. No, I'm not part of the 1% but I think it's enough that I won't starve. My job isnt perfect but I absolutely feel I am fairly compensated for the work I do.

The thing is though ...I think if you don't honestly have an interest in psych issues and some compassion even for the difficult patients, psych will feel like a terrible grind even if you aren't working intense hours. Any job in medicine is a pretty good gig compared to how most people live so just do something you sincerely like - and try to work with patients you sincerely care about helping.
 
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bamitssam

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Psychiatrists.. just like all other specialties will get less and less compensated as the years go. This will continue as insurance companies catch on to the trends, pharma companies start getting dinged by gov agencies, and as more drugs get legalized... so don't count on going into it for the money.
 

hamstergang

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Psychiatrists.. just like all other specialties will get less and less compensated as the years go. This will continue as insurance companies catch on to the trends, pharma companies start getting dinged by gov agencies, and as more drugs get legalized... so don't count on going into it for the money.
Is this trend actually something that is happening now?
 

Merely

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I pull in over 500k a year and I'm not even done with residency/fellowship yet. And, it is untrue that psychiatry has gotten worse compensation over time. The changes with the CPT coding in 2013 has been a goldmine for psychiatry.

Wow
 

Blitz2006

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Yeah correct me if I'm wrong, but psych compensation has been going up every year the past few years.

And I don't see the shortage of psychiatrists being fixed anytime soon...so our demand will only lead to greater compensation.
 
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Blitz2006

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Is this trend actually something that is happening now?

Again, medscape surveys aren't the bible, but if you look at the compensation, psych has been increasing each year by 5-10%.
 

clausewitz2

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I am a pretty new attending psychiatrist and my salary is in the high 200s with a typical work week of around 45-50 hours. No, I'm not part of the 1% but I think it's enough that I won't starve. My job isnt perfect but I absolutely feel I am fairly compensated for the work I do.

The thing is though ...I think if you don't honestly have an interest in psych issues and some compassion even for the difficult patients, psych will feel like a terrible grind even if you aren't working intense hours. Any job in medicine is a pretty good gig compared to how most people live so just do something you sincerely like - and try to work with patients you sincerely care about helping.

For what it is worth, if your household income is above 250k annually, you are at least in the top 1.5% of all US households. So maybe not as far from the 1% as you think...
 
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deleted547631

Yes (with residency/fellowship training plus moonlighting). However, I do not moonlight 365 days a year. Every holiday, vacation day, etc is spent moonlighting though. I haven't had a day off in over a year.

This is pretty awesome. I admire your work ethic! At what point in residency were you able to start moonlighting intensely?

Also, I imagine you pretty much vanquished your student loans and then some.
 

northernpsy

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For what it is worth, if your household income is above 250k annually, you are at least in the top 1.5% of all US households. So maybe not as far from the 1% as you think...
Huh. I thought I had seen somewhere that I was more like "the 3%" but I see that you are in fact correct. Well, that just reinforces my opinion that you can make enough to be doing really well in Psych, but that most other specialties are also doing well enough that it's not worth trying to do something you don't like just to chase money.

When I looked around for info on this, I found this part on Wiki's article about "Affluence in the United States" interesting in that it really shows how "everything is relative" really applies to wealth:
The income disparities within the top 1.5% are quite drastic. While households in the top 1.5% of households had incomes exceeding $250,000, 443% above the national median, their incomes were still 2200% lower than those of the top 0.1% of households. One can therefore conclude that almost any household, even those with incomes of $250,000 annually, are poor when compared to the top 0.01%, who in turn are poor compared to the top 0.000267%, the top 400 taxpaying households.
 
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masterofmonkeys

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Of course. Please refer to slide 14:

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

As you can see, 70% of psychiatrists work less than 40 hours/week. This is why psych is usually at the lower end of salary polls.

But if you give a psychiatrist GSurg/Cards hours (60ish/week), I'm fairly certain psych would be at the middle of the pack.

On an hourly basis, I think psych is pretty well compensated actually. And remember in psych, malpractice/overhead is very low compared to most specialties.

For example here in NYC area, OBGYN earn around 400k on average and clock 55-60 hr weeks. But they also pay around 120k in malpractice....whereas psych here can make around 350k with the same hours, but pay perhaps 8-12k in malpractice.

This is also why we get hosed in negotiations that use Merrit-Hawkins and other databases for comparisons. NONE offer an hours correction for salary. That's one of the battles I'm having right now.
 
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F0nzie

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The difference in expected pay for hours worked and total salary is probably due to the admin time necessary for any psychiatric practice to remain viable. Every individual you take on as a patient adds an administrative burden to the business that needs to be converted into a currency value. You also need to subtract the currency value of your uncompensated admin time. Many 8-5 jobs will include 10 hours of admin, lunch hour, PTO, conference, etc so in many cases you won't be seeing 40 hours of patients in a full time position. You may be seeing 30 hours of patients or less. So no, in most cases you will not get paid 200k to work 3 days a week or 300k+ to work 5 days a week.

The best way to appreciate the real cost burden is to run your own business, track the expenses, and see how much risk you are willing to take to hire someone to fill your shoes. Overestimating income and underestimating expenses is an easy trap to fall into when you are not the responsible party for making payments towards expenses.

Unless you have a business model that disrupts the status quo, a reliable way to make 300k+ in Psychiatry is a combination of inpatient and outpatient (200k inpatient and 100k outpatient). Inpatient in the morning allows for fast follow ups and you have all of your patients under 1 roof-- this significantly minimizes financial losses from no-shows that can be crushing in an outpatient practice. Outpatient in the afternoon will add a normal part-time salary and offer some stability if you decide to quit your inpatient job. You can probably make more than 300k if you do inpatient + ER but your hours may be less predictable.


Sent from my iPhone using SDN mobile app
 

oldanddone

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Huh. I thought I had seen somewhere that I was more like "the 3%" but I see that you are in fact correct. Well, that just reinforces my opinion that you can make enough to be doing really well in Psych, but that most other specialties are also doing well enough that it's not worth trying to do something you don't like just to chase money.

When I looked around for info on this, I found this part on Wiki's article about "Affluence in the United States" interesting in that it really shows how "everything is relative" really applies to wealth:
To add to this I'm not sure where the data cam from but a recent documentary with russel brand suggested thst if all incomes were redistributed equally the amount per person would be 150k or so....in other words it burns me when well meaning mds start acting like it is their income thst should ethically be redistributed....not lower than 150k if the numbers are correct! And the 0.1 percent can cough up! Because to get everyone to 150k it won't be from well meaning mds! Never mind that that kind of talk usually supports higher income for the 0.1 percent not for those who need it. Ie it cheapens md labour in markets and thst goes more into profit than any broader social benefit. I come from poverty. I'm socially minded. I don't trust our systems to redistribute. I'll do it myself thank you very much. Like bell hooks.
 

thoffen

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This is pretty awesome. I admire your work ethic! At what point in residency were you able to start moonlighting intensely?

Also, I imagine you pretty much vanquished your student loans and then some.

Sounds like a duty hour violation. I know I couldn't do that and take care of patients to my standard, but there are certainly some who can.
 

zolof

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I agree this doesn't sound right. Many attendings who can moonlight/overtime, as much as they want, bc no restrictions, already have a higher base salary and higher moonlighting rate, and many still don't hit 500K so as a resident, seems impossible even if one was allowed.
 

hamstergang

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I agree this doesn't sound right. Many attendings who can moonlight/overtime, as much as they want, bc no restrictions, already have a higher base salary and higher moonlighting rate, and many still don't hit 500K so as a resident, seems impossible even if one was allowed.
In another thread he said he made $8k- $10k per weekend moonlighting. If you do that every weekend of the year along with a residency salary for thr other 5 days per week, you'd hit basically $500k. But you'd also have next to 0 days off the entire year, which isn't something almost anyone is willing to endure.
 

surfguy84

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In another thread he said he made $8k- $10k per weekend moonlighting. If you do that every weekend of the year along with a residency salary for thr other 5 days per week, you'd hit basically $500k. But you'd also have next to 0 days off the entire year, which isn't something almost anyone is willing to endure.

Even if one was willing to travel anywhere on the weekends, how common are these 8-10k weekend jobs really? Seems like so much more than I've ever read about/seen mentioned around here. Anyone know?
 

Asklepian

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I pull in over 500k a year and I'm not even done with residency/fellowship yet. And, it is untrue that psychiatry has gotten worse compensation over time. The changes with the CPT coding in 2013 has been a goldmine for psychiatry.

I would take this with a grain of salt. Without proof, anyone could claim as such.
 

Merely

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Wait so can someone explain why a psychiatrist who works nsurg hours cant make nsurg income? Also, some PP physicians in other specialties (GI, cards, etc) open up their own practices and make 1M+. Is that heard of in psych or should one going into psych expect to make <400k?
 

Shikima

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Wait so can someone explain why a psychiatrist who works nsurg hours cant make nsurg income? Also, some PP physicians in other specialties (GI, cards, etc) open up their own practices and make 1M+. Is that heard of in psych or should one going into psych expect to make <400k?

You can. And it all depends on your business acumen.
 
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Mad Jack

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For what it is worth, if your household income is above 250k annually, you are at least in the top 1.5% of all US households. So maybe not as far from the 1% as you think...
The real 1% is measured in wealth, not yearly income. For that you need to crack eight figures net assets.
 
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michaelrack

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Wait so can someone explain why a psychiatrist who works nsurg hours cant make nsurg income? Also, some PP physicians in other specialties (GI, cards, etc) open up their own practices and make 1M+. Is that heard of in psych or should one going into psych expect to make <400k?

those making more than 500k per year usually have alot of procedural income, and to get near a million you need to be getting some of the facility fee for the procedures
 
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clausewitz2

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The real 1% is measured in wealth, not yearly income. For that you need to crack eight figures net assets.

Given how many American households have negative net assets (literally about 25%), I am not sure it is as hard to be in the top 1% of wealth as you think. Unless of course you mean "much smaller proportion than 1% and that nice integer is mainly for rhetorical purposes ," which is fair enough.
 

Mad Jack

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Given how many American households have negative net assets (literally about 25%), I am not sure it is as hard to be in the top 1% of wealth as you think. Unless of course you mean "much smaller proportion than 1% and that nice integer is mainly for rhetorical purposes ," which is fair enough.
http://mobile.nytimes.com/blogs/eco...ring-the-top-1-by-wealth-not-income/?referer=

It took $8.4 million in 2012 to be in the top 1%, though I read a more recent report that showed assets in excess of $10 million were required in 2015. Income keeps you floating, wealth sets you free. That's why only people that have a middle class or poor mindset think that income=wealth: they don't understand that it is not what you make, but what you actually own that makes you weathy. Once you reach a certain tipping point of wealth, it becomes pretty self-sustaining, which is not the case with income unless it is diverted to boosting wealth.
 
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zolof

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In another thread he said he made $8k- $10k per weekend moonlighting. If you do that every weekend of the year along with a residency salary for thr other 5 days per week, you'd hit basically $500k. But you'd also have next to 0 days off the entire year, which isn't something almost anyone is willing to endure.

This is unlikely given that someone would pay a resident the same or even more than an experienced attending that much on a weekend moonlighting gig. Even the highest rate I have ever seen, (250 and hour and up weekend/overtime rates) Why would they pay the same rate to a resident/fellow? Especially when they need to take care of legal issues, etc. Just seems unlikely to me. And in the places I did work with the extremely high moonlighting rates there are attendings in line for those weekends, and many have priority over others, now why would they give every single weekend of the year to a resident/fellow still in training? Now of course I do agree that as an attending, not a resident, the income potential can crazy if you are willing to work. Two of my colleagues at my former job pull in 6 to 700k, working excessive hours, including working vacation hours, but these are very experienced, who are on call and have priority over which days they want to work, and they have to sign off on residents/fellows work. But keep in mind, although the income potential is there, clinical care will suffer and your personal health will suffer.
 

splik

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This is unlikely given that someone would pay a resident the same or even more than an experienced attending that much on a weekend moonlighting gig. Even the highest rate I have ever seen, (250 and hour and up weekend/overtime rates) Why would they pay the same rate to a resident/fellow? Especially when they need to take care of legal issues, etc. Just seems unlikely to me. And in the places I did work with the extremely high moonlighting rates there are attendings in line for those weekends, and many have priority over others, now why would they give every single weekend of the year to a resident/fellow still in training?
I have no idea whether this guy is legit however the moonlighting gigs I am familiar with pay the same rate for residents as for attendings (as you working as an attending and not a resident when you do external moonlighting). also if someone is saying they will sign up for everything - then yes, anyone looking to fill their call/weekend shifts, will give priority to the person who says they will do them all - much simpler than having to find multiple people. again most of the moonlighting gigs I am familiar with, those who express interest in working the most shifts get priority. that said, if he is legit, I wouldn't recommend him post all this stuff here as sdn is not really anonymous and personally if were a training director I would fire any resident who was doing this much moonlighting.
 
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michaelrack

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Insurance (BCBS, Medicaid, etc) does not reimburse a resident any different than an attending. .

private insurance (and often medicaid) often won't credential a resident at a private hospital. The hospital can bill for your services using the locum tenens modifier for 6 months, but after that there are potential problems for a resident doing external moonlighting
 

Merely

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Moonlighting doesn't count toward duty hours. Even if it did, I'd still be within limits.



"Many attendings", "higher moonlighting rate", "Many still don't hit 500k so as a resident, seems impossible". Where are you getting this information from? You need to talk to more psychiatrists in private practice. I personally know a few making 700k-1 million plus, but they work very hard for it. Majority I know in private practice make at least 400-500k, and that's working a pretty reasonable schedule.



It's not a single job that is paying me this much. I have more than one gig. I make that much in total; the range exists due to variation in the census.

When you say very hard for the 1M, does that mean about as hard as the neurosurgeon making the 1M? So really no difference in earning potential between the two fields if one wants to put in similar amount of work?
 

Mad Jack

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When you say very hard for the 1M, does that mean about as hard as the neurosurgeon making the 1M? So really no difference in earning potential between the two fields if one wants to put in similar amount of work?
The only way to make 1M in psychiatry is if you're running several practices and skimming off of people you hire. You're not going to make that much doing garden-variety psych no matter how many hours you put in. Without breaking the law, anyway.
 

zolof

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Im not talking about private practice,. I don't know in what capacity you are talking about working but I am talking about inpatient work which tends to pay the most due to the most heavy clinical load. Im talking about hospitals with residency programs attached to them. I have worked in 4 different ones in two different states. All of them require attendings to be on call even when the residents or fellows were there moonlighting. This is common and it is the standard of care around here
 

splik

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Moonlighting doesn't count toward duty hours. Even if it did, I'd still be within limits.
you said you worked 365 days a year essentially. moonlighting does count towards duty hours (seems somewhat silly to me, but it is what it is), and includes having 1 day off every 7 (averaged out over 4 wks)...
 
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