justordinary
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How did you know that this area have been bursting with psych need? How do you research that?
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seeking advice for future job prospects...
Started by justordinary
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One easy way is to randomly call offices and see how long it would take for them to get a new patient in. Longer wait times= more demand.
Scheduled a meeting with a PCP in that local area, asked questions. Learned who they refer to, population they see, and essentially the snap shot of a local community from the perspective of a PCP. Combined with the knowledge of everything I could gather from Google of private practices and all names that popped up in the area for Psychiatrists to ARNPs to NDs etc. Map out geography and presumed travel distance to bigger metros and reflected if people would drive that far or not, then discussed that with the PCP.
In summary, googling can yield a lot. Talking with locals yields more.
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My goal is to specialize in a niche area based on my interests (very interested in TRD, personality disorders, and bipolar do). Goal would be to meet with all the PCPs/therapists in my area and market myself as the TRD guy. Have a friend who essentially did the same but with OBGYNs and peripartum psych and is drowning in referrals from CASH paying patients.
It feels like creating a niche and aligning your "brand" within that niche to others you meet with is a fast way to get a lot of referrals of the patient base you want. Thoughts?
justordinary
Full Member
that is great! interestingly your interests are also my interest 🙂
I'm thinking about joining medical societies for better networking - I never paid attention to their existence before but maybe they would be useful for me in the future (why else would I pay membership fees?)
I've never really "hustled" in my life so I'd feel really awkward just going to different therapist and PCP office and introducing myself, I'd feel like a salesperson but I guess when you open your PP you kind of are a salesperson.
Lots to think about and plan for!
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I don't have any practical experience in running/marketing a private practice but even within our HMO it's common for patients to ask their therapist, PCP, or our call center for a psychiatrist who specializes in whatever their specific issue is. I'm sure that folks willing to pay cash want "the best."
I completed a forensic psychiatry fellowship with the goal in mind. I set up a website and other strategies to get referrals. FYI, I did not learn much in fellowship either how to set up a forensic practice. FYI other physicians also do expert witness work.
People want to put a face to a name. Its not so much selling yourself as much as having a real human interaction with people who might refer to you. No guarantees they will. They might even toss in some hypothetical curbside consults during the meeting too. Knowing that you like population XYZ you are more likely to get those referrals so its a win win. You also learn who to refer to for patients who need a PCP or a therapist. I routinely push to get people to have a PCP even if only for an annual visit.
I've definitely seen patients who will see an np out of necessity but will prefer a physician. I've also seen some patients (or parents of patients) actively seek out np's or pa's. On some occasions this is because they've had horrible experiences with egotistical physicians. Other times there's almost a self righteousness against the healthcare system as a whole and seeing a midlevel feels like a protest...or they're a nurse and only want an np for some reason.
Spend some time putting together a 40 min presentation on your niche specialization. Do a dog and pony show with it at all the larger psych groups. All the work is done up front, you can use it over and over, and you will gain an indelible reputation as being "the one who does" X, Y, Z.
If you are bold, you can even ask groups to pay you for the presentation (those that, say, pay grand rounds presenters).
When you have time, you should read the book, So Good They Can't Ignore You. Once you understand the message and can implement it, you will be treated with more respect and compensated more. Heck, I don't even have a restrictive covenant in my contract.
Again, that goes back to my question: Why should anyone hire you over one of the many psychiatrists or NPs in the area?
People don't just give money / autonomy / respect out of the goodness of their heart. They give them because they are compelled to.
Get private practice experience mainly to learn about the business aspect. Open your own or join someone else. Even if you join a poorly-run private practice, you'll learn a lot (basically what to NOT do). Minimize risk by doing it part-time and add more hours if it is worthwhile. The ability to be independent from your employer (by walking away) is a good bargaining chip. Business knowledge will help you negotiate better deals.
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This is very insightful. I would take it one-step further and say a quality psychiatrist should be well-versed in psychology and should be adept at power plays / negotiations. The Prince and The 48 Laws of Power should be required reading for all psychiatry residents.
Rather than making a new thread I'll just add on here... how does one actually go about finding a recruiter to help with a job search. I'm a resident and want to start moonlighting. I don't have anything internally available so need to hustle a little bit to find something externally. Any suggestions?
You probably already thought of this but:
1- ask other residents in your program where they moonlight and the pros/cons
2- ask faculty/mentors for potential moonlighting contacts
3- cold call nearby facilities to see what they offer.
I think networking is typically a better route than a recruiter, but have never worked with a recruiter before.
1- ask other residents in your program where they moonlight and the pros/cons
2- ask faculty/mentors for potential moonlighting contacts
3- cold call nearby facilities to see what they offer.
I think networking is typically a better route than a recruiter, but have never worked with a recruiter before.
Yeah have definitely done #1/2. So far nothing has panned out..
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How long does it take to become a partner at Kaiser and how much does one make as a partner?
Talk about catastrophizing. Every field of medicine is getting hit with administrative and midlevel pressure. Psychiatry is one of the few fields where you can walk away and hang your own shingle if you are sick of it
I dont think this is a fair question and a good admin should not ask that. If the definition of mental healthcare services at this institution is limited to prescribing risperidone for every psychotic patient and zoloft for every depressed one , then yeah there is not much I can bring to that tiny table. In addition to that, they cant pay me enough to work for such an institution.
I’m not saying that admins should be directly asking the question. But if a physician can’t explain why they bring more to the table and are worth more than anyone else, there’s no real justification to pay them more.
justordinary
Full Member
I think this question boils down to: why should anyone go to medical school and go through residency in order to practice psychiatry? (Or any other field in medicine)
I advise anyone that asks me about going to med school to not waste their time unless they are 99% sure they want to do a surgical specialty. NP route is much better ROI especially in states with full independent practice
justordinary
Full Member
This is bad advice in every respect except finances. Some of us would still go to med school because we take pride in our knowledge base and the fact that we don't fall to pieces and have the slightest clue what to do when our holy grail algorithm goes all wrong.
As the great Lil Wayne once said “Money talks, bull**** walks, on a mother****ing tight rope”
justordinary
Full Member
I originally posted this thread because I felt lost in academia. Now, I feel lost in being a physician and wonder why I even got the MD degree....
Meh, I earn a little over $300k for a little over 40 hours of work doing a job I find engaging and rewarding. I will be financially independent within the next five years most likely, 10 max. The sky has always been falling. I still think psychiatry is still a great option these days.
I would also feel uncomfortable being in over my head at work day after day (starting practice after inadequate training). The MD route has involved lots of sacrifice but has been worth it.
I would also feel uncomfortable being in over my head at work day after day (starting practice after inadequate training). The MD route has involved lots of sacrifice but has been worth it.
Yes, currently.
Now look at the trends at play and the trajectory of things. EM is the first real victim and a massive hammer strike to the enormous warning gong, that scat is coming to the front gates. Pathology has been the first victim we all ignored. Rad Onc is on its way to being EM. These are the things that are different when people reference "meh, doom gloom has been around for decades but things are still okay, Chive On." These 3 specialties weren't being hammered decades ago, this is what's different, and are the trends worth extrapolating.
justordinary
Full Member
Where i work, NPs make about 70% of MD salary... If they work PP, im sure they can make as much as some MDs. I really think the "doom and gloom" are not exaggerated, they are real.
Went to practicelink website.
Looked at my state for Psychiatry.
Of those positions listed, 25% clearly state ARNP in the posting. I didn't review every number to ascertain if in reading the job description they are actually wanting an ARNP or not, which could mean a higher ARNP number.
Just 5 years ago my N of 1 subjective recall, there was less than 5% specifically posted for ARNPs in my state of interest.
Reviewing the locations and entities posting these jobs in my state, They are either connected to PE large for profit medical groups that span the whole country and are giving EM docs a hard time. Are part of large Big Box shop health systems. Are the newly opened up Lifestance PE postings. Corrections. State hospital. Connected to the free standing for profit psychiatry/addiction hospitals. Community mental health centers or VA in 'middle of nowhere' per most peoples standards [I'd love to live in middle of nowhere].
Essentially, I wouldn't apply to any of these from the experienced I've accumulated in the first years of my career. Could be the selection bias of these large job boards and that they just simply won't ever have the quality word of mouth postings that other posters on here allude to. Or it could be that these are simply the entities that have shown themselves to not value The Human Resource and have high turn over for a reason.
One trend has been the increase of for profit entities and there postings; lifestance the new one, the addiction/psychiatry free standing hospitals and their slow expansion. This starts to raise parallels to dermatology; go take a walk thru their forums.
Looked at my state for Psychiatry.
Of those positions listed, 25% clearly state ARNP in the posting. I didn't review every number to ascertain if in reading the job description they are actually wanting an ARNP or not, which could mean a higher ARNP number.
Just 5 years ago my N of 1 subjective recall, there was less than 5% specifically posted for ARNPs in my state of interest.
Reviewing the locations and entities posting these jobs in my state, They are either connected to PE large for profit medical groups that span the whole country and are giving EM docs a hard time. Are part of large Big Box shop health systems. Are the newly opened up Lifestance PE postings. Corrections. State hospital. Connected to the free standing for profit psychiatry/addiction hospitals. Community mental health centers or VA in 'middle of nowhere' per most peoples standards [I'd love to live in middle of nowhere].
Essentially, I wouldn't apply to any of these from the experienced I've accumulated in the first years of my career. Could be the selection bias of these large job boards and that they just simply won't ever have the quality word of mouth postings that other posters on here allude to. Or it could be that these are simply the entities that have shown themselves to not value The Human Resource and have high turn over for a reason.
One trend has been the increase of for profit entities and there postings; lifestance the new one, the addiction/psychiatry free standing hospitals and their slow expansion. This starts to raise parallels to dermatology; go take a walk thru their forums.
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EM and pathology and rad onc don't own their patients and are most susceptible to the whims of the institutions they work for.
I wouldn't lump dermatology with them.
Why not quit your academic gig and work somewhere else? You need a bigger sample size when you talk about the landscape of psychiatry. I assure you no NPs around me make 70% of what I make.
Instead of wallowing in the doom and gloom, why not learn from those who are successful in the field and see if you can emulate their success?
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justordinary
Full Member
Can you reveal your rough geographical area? I feel that i need to move and find the right location that is most protected for physicians. I just found out my hospital offered $175k to hire a new NP when MDs get $200k salary. Is this typical??
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How long have you been practicing?
I somewhat agree with you because I don't know that many other jobs as a new IM grad that would put me on the top 3% income-wise. Let's hope things don't get worse in the near future.
So psych NP are making ~200k/yr where you work?
I have never been envy of what people make, but I would feel uneasy if my place pay NP 70% (231k/yr) of what I will make as a hospitalist. I guess I will have to find out.
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About four years as an attending.
That is great. If you have 1mil + a paid off home, you are financially independent (FI) in my book.
justordinary
Full Member
Well, i first thought they make 70% of MD but i found out it's more like 80-85% of what MDs make. I am employed, i make 200k. My institution offered NP 175k to hire this person. In private practice world, im sure NPs easily make more than me. And let's be honest about money - it's how organizations measure value for each individual's skillset. It reflects that this institution values MDs at 200k when they value NPs at 175k. Oh, and is it just me complaining about my 200k salary? No, that is what all MDs get for 40 hour work week unless they pick up extra shifts. I thought hospital admins love NPs because they are much cheaper, but it appears that they are not even that much cheaper. At this point, i question what is going on because money doesnt seem to be the only factor. Is it the lobbying? Do admins have some hidden agenda that would benefit them if they push out doctors? I have no idea
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If you’re making 200k as a full time attending psychiatrist, you have no one to blame but yourself for accepting such insulting pay
justordinary
Full Member
Thanks for such encouraging advice. I am here at sdn to gain insight and knowledge, and which a lot of people have given me here.l which i do appreciate. I am asking questions here and am transparent about the numbers i make in order to learn more about the market. Your attitude of putting down someone who comes here with pure intentions of learning is not helpful to generating conversations among members here.
justordinary
Full Member
It is academic facility in Northeast. I've heard of lower salary for "big name" facilities. Of course, if you go to more rural-ish places or midwest or south, you will make more money so don't worry too much (unless you absolutely have to work in a big name place in NYC or something, then you will have to compromise...) Also, ive heard that big telepsych firms also don't pay that much but i dont know what the numbers are.
In my searches there's always locums which pays anywhere from high 100s to low 200s. Seemingly available in any big city too. Do the math but this should be about 400k a year full time. I'm sure you could do the random weekend somewhere too in order to make up for taking more than two weeks off a year.
$175,000 for a NP isn't the problem. That any psychiatrist would accept $200,000 is the real issue. It often seems those expressing angst about pay, competition and stifling admin lack the game to negotiate a reasonable offer or stones to walk when they see the writing on the wall. OP took what they felt was a safe bet and there are positive and negative implications with that choice. I would imagine any change whether inpatient at community hospital, outpatient private practice or opening their own business would be a better move although unlikely anything will check all the boxes listed a few replies back.
justordinary
Full Member
Yea i realize more and more that im leaning towards PP. Im gathering all the information i can find about opening one. I realized there is no true safety by belonging to an institution. I thought the positives would outweigh the negatives, however over time, it appears that negatives outweigh the positives.
Academia is a strange beast and I'm not a fan, mostly due to the finances. My best advice is to constantly network with your friends from residency and current colleagues. If everyone was willing to discuss salary, terms etc. like you are the insight and opportunities are invaluable. Keeping silent only benefits the employer.
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justordinary
Full Member
Ive been only in academia so I do not have first hand experience what other places are like, but based on all i've heard it seems like it is very strange (hard to explain.....) I had high respect for many faculty members and wanted to continue to learn from them which is one of the main reasons why I stayed, despite the low salary. I thought it was worth the trade off. As of now, it's time for me to see something new....
These two things are totally ridiculous, especially the latter one...
Yes this is the same at my academic institution. the pay is lower because if your academic position whereas the NP is not academic. academic NPs make less.
If they are working you too hard clinically than it won’t be worth it. The trade off for the lower pay should be that you aren’t having to see as many pts, residents writing notes, seeing more complicated/interesting pts, having mentorship, working in an intellectually stimulating environment, and having opportunities that you won’t get elsewhere (eg educational leadership, research etc) if you don’t get these things or they don’t matter to you then you should leave. also you should have opportunities to supplement your income (that doesn’t include weekend or overnight work) such as faculty practice, chart reviews, productions educational content, item writing, consulting, expert witness work etc.
You always need to have one foot out the door. Things are going well for me currently. I don’t have to see more than 1 pt per half day typically but the obsession with productivity that has been infecting academic medical centers without a commensurate rise in pay I think means that many academic departments will struggle to recruit and retain psychiatrists. Even the NPs are leaving now!!
Look more closely at those jobs.
EM still has jobs posted but they are in the pit of Scat.
Similar profile is shaping up in Psychiatry. The same jobs post over and over. I.E. They keep turning over and are a revolving door at same Big Box shops.
One of the Big Box places I had worked at in past has since had 2-3 ARNPs 'replace' me and they all left. They've had at least 2 locums Psychiatrists there, too.
In summary there is an element of quality, and that is one of the first things to go when looking over the spiral of EM. Next will be a greater percentage shift for ARNPs / PAs. Lastly will be decline in actual number of jobs.
