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Does anyone know what is a reasonable to ask a prospective employer to pay per hour for a psychiatrist who has completed a child/adolescent fellowship?
 

atsai3

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Does anyone know what is a reasonable to ask a prospective employer to pay per hour for a psychiatrist who has completed a child/adolescent fellowship?
This really depends on the setting and your effort. If you are research-track academia at a place like UCSF or MGH, $110-140K or less might be the norm, probably a little more at a place like UMich. In a straight clinical role at Kaiser in NorCal/SoCal, $180-220K or more. In a straight clinical role in Ohio or Minnesota or New Mexico? People say the streets are paved with gold.

Definitely ask around to try to increase your sample size, because people rarely discuss salary openly. As a result you may get wildly divergent numbers depending on who you ask.
 

whopper

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Ohio, I'd say at the very least $125-150. Remember that's the bottom range.
 

BS81

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Ohio, I'd say at the very least $125-150. Remember that's the bottom range.
125-150$ per hour? Is that pretty standard in the midwest? That would make for a 250-300k paycheck if you actually work the 40 hour week. Do most psychiatrists just insist on not working full-time?
 

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125-150$ per hour? Is that pretty standard in the midwest? That would make for a 250-300k paycheck if you actually work the 40 hour week. Do most psychiatrists just insist on not working full-time?
Subtract 30k or so for benefits.
 

whopper

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One could certainly charge much more. I just gave the bottom range price.
 

atsai3

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I'm going to be disappointed in private practice then. That is my hourly rate while moonlighting as a gen psych resident.
Wow. We generally got $60-100/hour for moonlighting depending on the setting.
 

F0nzie

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Wow. We generally got $60-100/hour for moonlighting depending on the setting.
$60 is super low but I've seen figures like this. It's usually an undercut because you're still a resident and they feel they can reimburse you like a nurse practitioner.
 

whopper

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Anthem pays $60 per visit and has a rep, at least where I'm at of being the lowest compensation for an outpatient private practice visit. Workman's comp pays $100. Now that's for a typical visit with a little psychotherapy plus some medication adjustments or refills. You could do up to 3 per hour without breaking the rules.

Most insurance companies pay somewhere in between.

I didn't feel the rates were unfair when most patients in PP tend to get better within 1-2 visits then just want a refill. Several of those patients would be set aside 20 minutes of time and literally just wanted the script and walked out. Some patients, however, are very high maintenance and end up calling the office daily. While I didn't mind it if it was for something important, many of them called for frivolous reasons. That's where, IMHO, it became very low compensation. Where I did PP, we developed a policy that no one was allowed to talk to me unless the specified why and most of the time they had questions, I just called the receptionist and told them to call back the person themselves and give the patient the answer instead of me doing it because it saved me time. I would only do this for patients that called for frivolous reasons, but that was most of them.

At a community mental health center I worked at, we had a nurse that saw the patients before I did so she knew the patients as well as I, and whenever they called the nurse always handled it, would even order scripts for me, but would just okay it with me before she did it.
 
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Jorje286

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I'm going to be disappointed in private practice then. That is my hourly rate while moonlighting as a gen psych resident.
I don't intend to be an ahole here, but honestly I could never understand how $130 is ever "too little" or something to be disappointed about. Most people would kill for a six figure salary, never mind one near 300 k.
 

TexasPhysician

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I don't intend to be an ahole here, but honestly I could never understand how $130 is ever "too little" or something to be disappointed about. Most people would kill for a six figure salary, never mind one near 300 k.
Most people don't spend 11+ years achieving a higher education and incur hundreds of thousands of dollars of debt. Some would metaphorically kill themselves before doing that.

An engineer friend of mine with only a college degree (low gpa even) began making 100k+ after 2 years in the field and during the recession. Now he is well above that.

For 9 more years of education and tons more in loans, I do expect to earn more than my friend does. I like giving to charity, and the more I make the more I can help others. If that makes me a horrible person, then I am guilty as charged.
 

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I don't intend to be an ahole here, but honestly I could never understand how $130 is ever "too little" or something to be disappointed about. Most people would kill for a six figure salary, never mind one near 300 k.
As physicians we work long hard hours and it just so happens that some of us have families and we want to maximize our earning potential and free time. My impression was that the OP was referring to the notion of potentially making the same hourly rate working as a contracted employee compared to a private practitioner (perhaps seeing 30 minute followups and accepting insurance).

Take this simple scenario: Would you work $7/hour operating a cash register at Target 8a-5p then clock out and be done for the day, or would you setup a small business and still work the same hours at the cash register for $7/hour. Add to that additional uncompensated time with accounting, advertising, supplies,insurance, rent, electric, internet, fax, insurance panels, hiring billing and secretary, taxes... I'm probably missing more. And to top things off you can be on call for your customers 24/7. Some folks really like their autonomy and will prefer to make less, others simply do not want to work that hard to try to maximize their profits.
 

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Most people don't spend 11+ years achieving a higher education and incur hundreds of thousands of dollars of debt. Some would metaphorically kill themselves before doing that.

An engineer friend of mine with only a college degree (low gpa even) began making 100k+ after 2 years in the field and during the recession. Now he is well above that.

For 9 more years of education and tons more in loans, I do expect to earn more than my friend does. I like giving to charity, and the more I make the more I can help others. If that makes me a horrible person, then I am guilty as charged.
Agree. It is unfortunate how the media portrays physicians who "complain" about lowering salaries in medicine as if we're just greedy and selfish. First, I feel it is an honor and privilege to do what I do--help families and patients and get paid well to do it (eventually at least). However, I don't think people understand who grueling it is to get where we are. As we all have, I've sacrificed years of my life from undergrad to medical school to residency with untold hours of study and hard work--over 13 years of this! I also owe close to 200K in debt between undergrad and medical school. Again, I love what I do (on most days ;)) and feel privileged to be able to do this. But the fact is, is that we have very stressful jobs and are legally and ethically responsible for very sick patients. So, do I think we should get compensated for this? Hell ya!!!
 

billypilgrim37

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I don't intend to be an ahole here, but honestly I could never understand how $130 is ever "too little" or something to be disappointed about. Most people would kill for a six figure salary, never mind one near 300 k.
They wouldn't need to kill for it. They could just go to medical school. It's not really that hard to get in. And once you're there, it's pretty much like running a marathon on a treadmill with snipers locked on you if you step off before the 26th mile. It sucks, and you'd rather be doing about anything else, but you're probably not going to stop.
 

whopper

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Most people I knew in medschool told me if they knew it'd be as tough as it were they wouldn't have done it but by the time they figured it out it was too late. They were too much in debt, they had to stick it out.

As for reimbursement, well I'd only be repeating the above. A problem in psychiatry is despite the shortage, insurance companies aren't paying more, forcing doctors that are in extreme demand to not be able to make more, thus not correcting this market force.
 

Jorje286

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Most people I knew in medschool told me if they knew it'd be as tough as it were they wouldn't have done it but by the time they figured it out it was too late. They were too much in debt, they had to stick it out.

As for reimbursement, well I'd only be repeating the above. A problem in psychiatry is despite the shortage, insurance companies aren't paying more, forcing doctors that are in extreme demand to not be able to make more, thus not correcting this market force.
Which is sort of my point. If you're not happy and disappointed with 300k then it's not a money issue per se, and I don't think 400, 500 or even 600 will make you much happier. Anyway, I guess you can take my perspective with a grain of salt cause I'm still a student. Although I definitely didn't think it would be as tough as it turned out, I have come to appreciate the challenge in itself, so for now I'm not minding having to work really long hours with loads of stress, but maybe I will burn out at some point and I will come to hate it.

It's not really that hard to get in.
Well I beg to differ. The MCAT and the application process in itself is a serious test for stamina, putting in long hours studying and handling pressure. I can't think of any other profession that is harder to get into than medicine.
 

Leo Aquarius

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Much harder than even that. Getting As in college Calculus, Physics, Organic Chem, Biochemistry is enough to knock tons of hopefuls out of the running. Then you have to get As in the rest of your classes in college. You have to land a high score on the MCAT, arguably the hardest entry exam to a professional school. Many different people who write letters of rec hopefully love you. On top of all this, you have to volunteer and demonstrate genuine interest in helping others. On top of this, you have to demonstrate some extra special talent / activity / achievement to attract the attention of top medical schools. On top of this, there's the competition. You have to emerge as a favorite among thousands of other qualified applicants.

I'm a 4th yr med student, heading off to residency. It's long and grueling. Everything else in your life is put on hold.

In terms of money, I'm not motivated by it. I would be more than extremely pleased with 300K. One time I had a job that paid 75K and it was more money than I knew what to do with. Every month I had an extra $2000 sitting around so I just saved it. I felt rich earning over $6000 a month. Live simply. Keep life level on the ground.

Personally, I do feel somewhat burned out. My plan is to take a part-time psychiatry job after residency and be happy earning $100 - $140K a year and investing the rest of my free time into family, travel, and the hobby I love doing which could become a second career.
 
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splik

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I do not think that it is inherently wrong to make money or make lots of it (up to a point). The question is how are you making that money and at what expense? In almost all areas people making the big bucks are doing so through ethically troubling behavior. The problem with clinical practice in the US is that it incentivizes poor practice - overinvestigation, overdiagnosis, over treatment, and seeing more patients for less time are rewarded. If the profit motive incentivized good medical care there would be little argument over physician salaries. The reason the media and the public like stories about greedy physicians is because often these docs are the ones who provide the worst care, and exorbitant physician fees inflate the cost of healthcare limiting its affordability (although it is actually one of the costs that plays little role in the overall costs of healthcare) and access.

The problem is I know of lots of pay-for-performance systems or payment by results systems, or even one place where salaries are determined by patient satisfaction (which I think is problematic in psychiatry as often the best thing for the patient is not what he wants). All of these seem unsatisfactory and ultimately have some negative unforseen consequences. I just think its terrible current practice encourages short visits, multiple drugs, multiple diagnoses, little psychotherapy and doing a shoddy job overall.
 

whopper

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I think the comment that it's not hard to get in was sarcasm-meant to accentuate that psychiatrists should make at least a decent salary because the training is very exclusive and difficult.

Which is sort of my point. If you're not happy and disappointed with 300k then it's not a money issue per se, and I don't think 400, 500 or even 600 will make you much happier.
Personally, IMHO, I'm fine with how much I make and wouldn't find my quality of life significantly improving unless I made a heck of a lot more money--I'm talking 4-5x as much. I don't see myself buying a more expensive car or house if I made 2x as much. I'm fine with my Prius and even if I had a billion dollars I wouldn't see myself getting a different car (well maybe there I'd HAVE to drive something differently because maybe I'd need a bodyguard). The only thing I'd be doing significantly differently if I was swimming in money is you'd see me vacation in Paris, ski in the Swiss Alps, fly over to Japan, and the French Riviera often. If I were single I'd be likely oodling high society women (but I'm happily married).

I'm a bit different I think. I've hit a plateau where I know more money is really not going to make me happier.

But if one is still in 6 figures of debt I think the story is different. You have to make a lot of money to get yourself out of this funk within an amount of time where this debt is no longer seen as a monkey on your back for the rest of your life. It will also hurt one's ability to buy a new home and the quality of it.

I also see myself as making more money through investments and using my usual job as a means to produce capital for investments. Others see it differently, plus I'm completely out of student debt now and had a very small amount by the time I graduated residency because I spent a few years working a business before and during medical school and residency.

I also find no trouble with anyone charging a lot of money so long as they do quality work that doesn't cut corners. Well I think that should always happen no matter what you make.
 
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300k is a lot of money. How realistic is it to expect that sort of pay in psych? I've always seen avg. figures <200k--is that because most psychiatrists are only working a 40 hr week?
 

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Well I beg to differ. The MCAT and the application process in itself is a serious test for stamina, putting in long hours studying and handling pressure. I can't think of any other profession that is harder to get into than medicine.
Often the best and brightest go into other fields because there is more freedom and challenge. For a mainstream job, being a physician is competitive, but far from the hardest or requiring the most stamina, effort, etc. The fact that training is scripted makes it much easier to navigate and plan for. It is still a challenge, but let's not go overboard. Being an investment banker, running a start-up company, and similar high-failure rate jobs are far more difficult and grueling. I came from the start-up world (specializing in biotech & healthcare), and a number of the C-levels i consultd with were M.D./Ph.Ds, and they all started their ventures while still in training or just afterwards.
 

Leo Aquarius

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I worked for a $3 Billion company before med school and here's my take. Top managers intimated to me that their success did not depend on intelligence, but on brute determination, strong negotiating skills, and a 6th sense for business. Many struggled in school. One dropped out. A whole different skill set is required to excel in business and banking, or to make a business succeed. Let's not forget that 9 out of 10 new businesses fail 5 years out.

But what we're talking about is within the domain of professional schools. Medicine is the toughest. Law school is very hard in year 1, with the tremendous reading demands, memorizing cases, learning to construct arguments, etc. MBA school is, well, not as hard as law school.

Running a business vs. surviving medical training are so vastly different that I don't think you can call one harder than another. Most investment banking friends of mine couldn't handle pre-med courses in college among those who tried, and I know doctors who struggle running their own private practice. But IMO, among professional training, medicine is the hardest to enter, and survive.
 

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Most people I knew in medschool told me if they knew it'd be as tough as it were they wouldn't have done it but by the time they figured it out it was too late. They were too much in debt, they had to stick it out.

As for reimbursement, well I'd only be repeating the above. A problem in psychiatry is despite the shortage, insurance companies aren't paying more, forcing doctors that are in extreme demand to not be able to make more, thus not correcting this market force.

Ugh. This is a very sore spot with me.

How did insurance companies ever get in this position in the first place?! I don't understand how or why some outside business got control and dictates what physicians charge. WE should be the ones who set the rates and they just pay them, without hassle, and without question (except in the case of fraud of course.)

It is absolutely astoundingly ridiculous.Why do we LET anyone do this?!

Physicians alone should be able to determine what our time is worth. Of course I am talking about within reason. And I disagree on how they are talking about restructuring healthcare from fee-for-service to whatever bs they are talking about.

In addition to my interest in medicine, and psychiatry specifically, and providing a quality service, I also got into this to make a reasonably comfortable amount of money and I expect to do so considering the arduous path to get there.

Salaries for physicians should match inflation and never ever decrease. Not Cool.

I didn't get into this to make 60K a year.

I guess there is always cash only.
 

whopper

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It appears 300k is possible, but certainly not the norm for the majority of psych.
IMHO 300K is very realistic if you do private practice. The problem with private practice is it's not for everyone.

Why don't more people do it? IMHO it's because most doctors are hyper-specialized and don't know a lick about things like paying rent, managing employees, sitting down with the accountant, and worrying about someone shoveling the snow to prevent a lawsuit if someone slips on the sidewalk in front of the office.

Medical doctors enter a type of comfort-zone mixed with being a pseudo autistic-savant (indoctrinated by medical school after years of putting in inhuman amounts of data for years) where once they make something comfortable they really don't feel the need to do the job for the most amount of money. Things like being able to go home and not worry about work do matter.

I've done private practice and there are things about it that are annoying. If you work in someone else's private practice they may want you do to things you don't want, and if you own it, you got to worry about things most people don't in a institution such as the above. If you have employees that blow it can make life hell. I remember a buddy of my dad had a private practice, fired a secretary and she sued him for racial discrimination because he hired his daughter to fill in while he found another one. All the secretary could tell was this "new secretary" was of the same race as the employer and went racism-ballistic. Yes, the case was thrown out but the guy had to spend hours of wasted time and legal fees. Another buddy of mine was sued, not for malpractice but for violating someone's civil rights. The case from what I understand already incurred over 6 figures of legal fees and thankfully he didn't have to pay a dime because he's in an institution and they're covering it. Had this been private practice, he would've been SCREWED.

The benefits I get out of my faculty position are that I have colleagues that are literally some of the best doctors in the country. The atmosphere plus the ability to consult with them for emotional and professional support helps out. Further being in an institution allows one to exploit it's benefit and retirement packages. E.g. the institution will match what I put into my retirement package (right there that's about 20K a year), pay benefits, pay my malpractice, and when I'm off of work, I'm off of work. The place I'm at makes more money than most academic institutions I know of but they also force me to not be allowed to work elsewhere.
 
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