So are more people going into psychiatry for money and lifestyle?`

[nevadabear123]

I've been meeting a lot of MS4's who are in the current app cycle from various schools at different conferences and a lot of them are stating that they want to do psychiatry for money and lifestyle. What are your thoughts? Will PD's know how to sift through this? Will we become the new derm? Can a step 260 without any significant activity history trump a step 240 with significant activity history?

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[TexasPhysician]

We will never be derm or plastics. I wouldn’t worry about this.

 

[Bartelby]

I don't see us becoming the new derm any time soon. The lifestyle in psychiatry is great if you enjoy the work, but this work is not for everyone. I do think this generation places more emphasis on work/life balance than did past generations of physicians, which may help nudge more competitive applicants our way.

As to your other question, I would favor a 240 step applicant with many other resume positives over a 260 applicant with an otherwise bland application any day.

 

[Mass Effect]

I've been meeting a lot of MS4's who are in the current app cycle from various schools at different conferences and a lot of them are stating that they want to do psychiatry for money and lifestyle. What are your thoughts? Will PD's know how to sift through this?

Sift through what exactly? What's wrong with people choosing their specialty based on money and lifestyle?

 

[AD04]

Sift through what exactly? What's wrong with people choosing their specialty based on money and lifestyle?

Only people who are selfless and love medicine and know everything about medicine even before they start medical school should be doctors.

How dare you think about your own happiness! Shame on you!

 

[Shufflin]

I may be in the minority here but I do predict Psych will be the new Derm

 

[finalpsychyear]

I may be in the minority here but I do predict Psych will be the new Derm

There are no procedures without a large investment in psych. Derm attracts TONS of cosemetic cash only FOREVER pts because people will always be vain. For Psych, most people graduating will get between 180-230k and that will be it if they are working full time as tons of people in psych 40% do part time make less. You will always have those that make more but i look at my class of 10 residents and they almost all fall in that salary range and the same for the class the year after. The ones that are business minded would make money in any field of medicine. I predict in 5 years a large decline not just in psych but all fields of medicine. This motivates me to work like mad with amazon/walmart getting into healthcare. That phorensic guy had the right idea..

 

[finalpsychyear]

I've been meeting a lot of MS4's who are in the current app cycle from various schools at different conferences and a lot of them are stating that they want to do psychiatry for money and lifestyle. What are your thoughts? Will PD's know how to sift through this? Will we become the new derm? Can a step 260 without any significant activity history trump a step 240 with significant activity history?

They will almost all make 180-230k in the end. Few will have the business sense to make much more and those would have been making money in any field. Business and medicine often do not mix for most. Also, i believe in 5 years drastic changes may occur. 10 year Bubbles in any specialty usually reach peak and dip and psych has already hit its 5 year high point imo and i predict a large change in 4-5 years. Don't pick a field based on money unless its derm/plastics as cosmetics will always be $$.

 

[MacDonaldTriad]

I have been hearing predictions about medicine pay going down for my whole life. Doctor's buying power has not gone down significantly within anyone's current career unless you have been practicing since the early 50s. Safe bet that psychiatry will not become the new derm and it will not tank either

 

[splik]

They will almost all make 180-230k in the end.

INn 2018, it would be considered on the low side for people to be making 180k working full time in psychiatry, even in academic jobs which are known to be lower paying. I would say that 230-280k would be considered the interquartile range for psychiatry at this point.

 

[yanks26dmb]

I may be in the minority here but I do predict Psych will be the new Derm

In what way? Board scores? When?

 

[Shufflin]

Plastics and cosmetics are in a world of their own I agree, but general derm is not the gravy train it once was.

 

[finalpsychyear]

INn 2018, it would be considered on the low side for people to be making 180k working full time in psychiatry, even in academic jobs which are known to be lower paying. I would say that 230-280k would be considered the interquartile range for psychiatry at this point.

In mid 2016 academics in upstate NY at my home program were still 180k. I have heard only minor adjustments since but nothing confirmed. n =1 so i am sure you have more data than me.

 

[finalpsychyear]

I have been hearing predictions about medicine pay going down for my whole life. Doctor's buying power has not gone down significantly within anyone's current career unless you have been practicing since the early 50s. Safe bet that psychiatry will not become the new derm and it will not tank either

But if you adjust for inflation a 180k pay in 2000 (which may have been the normal for psych then maybe i have no clue) would amt to 270 ish today which is what the surveys say via medscape but i feel that is way too high from what i hear from class mates. But raw salary means nothing if the buying power is really not what it once was.

 

[TexasPhysician]

I predict in 5 years a large decline not just in psych but all fields of medicine. This motivates me to work like mad with amazon/walmart getting into healthcare. That phorensic guy had the right idea..

I could see some aspects of medicine becoming more automated like radiology and pathology, but even that is likely decades away.

 

[finalpsychyear]

I could see some aspects of medicine becoming more automated like radiology and pathology, but even that is likely decades away.

Your right. You also have the luxury to not worry in the same manner as you have a set up that is very rare and likely minimally affected. However, I need to light a fire under myself so i can push myself a bit and while it is unlikely any changes in 5 years would actually occur besides maybe slight decreases in cpt codes that is about as secure as I will allow myself to feel.

 

[ridethecliche]

I may be in the minority here but I do predict Psych will be the new Derm

General derm is likely still profitable though. How many psych wards are being turned into ortho wings again?

 

[Shufflin]

General derm is likely still profitable though. How many psych wards are being turned into ortho wings again?

It's just a hunch I have based on what I'm hearing and seeing. I know it's far-fetched.

 

[thepoopologist]

It's just a hunch I have based on what I'm hearing and seeing. I know it's far-fetched.

If I had whatever your gig is I'd be thinking the same thing

 

[Shufflin]

If I had whatever your gig is I'd be thinking the same thing

Good point. Perhaps I'm not the best person to opine about this. (I do hope great gigs will become more the norm and not so much the exception in psych.) I will politely recuse myself from this conversation now.

 

[deleted736562]

They will almost all make 180-230k in the end. Few will have the business sense to make much more and those would have been making money in any field. Business and medicine often do not mix for most. Also, i believe in 5 years drastic changes may occur. 10 year Bubbles in any specialty usually reach peak and dip and psych has already hit its 5 year high point imo and i predict a large change in 4-5 years. Don't pick a field based on money unless its derm/plastics as cosmetics will always be $$.

The average medscape salary for psych is $270k. For young physicians (under 40), it's $260k. So I don't think your numbers are representative.

 

[finalpsychyear]

The average medscape salary for psych is $270k. For young physicians (under 40), it's $260k. So I don't think your numbers are representative.

I think they are swayed by higher salaries in california and west coast. Im on the east coast and i can def tell you that is the range. If your not doing academics then 200-230 is what i am hearing from classmates and jobs in east coast. Could be these are new grad salaries but that is what I hear aside from some very high numbers in middle of nowwhere locals.

 

[whopper]

I can tell you this. I am making way more than the sometimes reported average salary of around $180K and I work about 45 hrs a week, accept insurance (but also out of pocket), and I spend about 30 minutes per patient. I'm not doing the 5-10 minute medcheck thing that makes even more money cause it leads to bad care (unless the patient is already stabilized and just needs refills). I'm also not cutting corners. I pay my administrative assistant more than the standard, I have someone do my billing that I pay, and we don't go cheap on the office I rent.

Given that I accept insurance and am making way more than $180K, I got to say that any place paying something like this making you work much more than 40 hrs a week is robbing you or they don't know how to manage their own business. Last place I worked I was generating more than $600K a year for them and they were paying me crap for what I was bringing in (yet another reason why I left!) and I was working there about 60+ hrs a week. About once a week they'd give me some idiot gift I didn't want like a pen or headphones with the university logo on it as if that's going to make up literally for more than $150K of revenue I could've been making elsewhere on top of their measly salary. They're taking a huge chunk of what you make and putting it in their own pocket or they don't know know how to manage their own doctors.

 

[TexasPhysician]

I can tell you this. I am making way more than the sometimes reported average salary of around $180K and I work about 45 hrs a week, accept insurance (but also out of pocket), and I spend about 30 minutes per patient.

I think they were all referring to academia with $180k. In academia, that number is an accurate representation.

 

[WingedOx]

INn 2018, it would be considered on the low side for people to be making 180k working full time in psychiatry, even in academic jobs which are known to be lower paying. I would say that 230-280k would be considered the interquartile range for psychiatry at this point.

Depends on your market, really. For better or worse I've been happy to put down roots here, but when friends from residency tell me what they're making with similar RVU outputs in slightly smaller cities with significantly lower CoL, I get a little envious.

 

[AD04]

I think they are swayed by higher salaries in california and west coast. Im on the east coast and i can def tell you that is the range. If your not doing academics then 200-230 is what i am hearing from classmates and jobs in east coast. Could be these are new grad salaries but that is what I hear aside from some very high numbers in middle of nowwhere locals.

I think your class took a vow of poverty or something like that.

I'm on the east coast. The numbers my class and I have been getting range from 200k to 380k. I know the people who accepted 200k did no negotiating at all and on top of that, they're seeing more than 30 patients a day. (I just shake my head when I hear that because I know they are not the only ones. The doctors who are absolutely clueless about the real world will be taken advantage of ... hard.) Numbers around 250k - 290k is very common and can be found without much difficulty -- 40 hours a week, no call.

 

[finalpsychyear]

I think your class took a vow of poverty or something like that.

I'm on the east coast. The numbers my class and I have been getting range from 200k to 380k. I know the people who accepted 200k did no negotiating at all and on top of that, they're seeing more than 30 patients a day. (I just shake my head when I hear that because I know they are not the only ones. The doctors who are absolutely clueless about the real world will be taken advantage of ... hard.) Numbers around 250k - 290k is very common and can be found without much difficulty -- 40 hours a week, no call.

They were more than half woman so some also may have wanted less hours, knew nothing about negotiation, or were confined to a certain location. One guy went to florida and was getting 170k and getting worked hard that was in 2016 though.

 

[Blitz2006]

I think geography is the major factor.

I know here on the east coast, academics pay around 160-180k. You can hit 200k if you get out into suburbia academics and the highest I've seen is around 230k (non-academics).

Once you head more inland, the average is around 200-220k (academic) and 250-275k (non-academic), and if you are happy to go to middle of nowhere, I've seen for 300k-320k

Is Psych the next Derm? Unlikely. But its definitely not bottom tier anymore as it was 10 year ago. People keep forgetting that 70% of psychiatrists work <40 hours/week. So when you see those Medscape avearage salaries of 250k or whatever, keep in mind that it mainly represents people working 30, 35 hours/week, etc.

So $/hr, I would say psych is safely middle of the pack.

Sure, Neurosurg average salary is 500-600k or whatever, but are they working 30 hours/week?

 

[SmallBird]

I think geography is the major factor.

I know here on the east coast, academics pay around 160-180k. You can hit 200k if you get out into suburbia academics and the highest I've seen is around 230k (non-academics).

The range is broader for that in Academics. That might be accurate for Boston, but there are absolutely academic jobs on the East Coast in a higher range than that.

As for non academic on East Coast, there are options that pay considerably more than 230k! You just need to look, and cannot at all rely on what’s posted online or emailed by recruiters. When I interviewed two years ago none of the community jobs on the east coast I considered were below 230k, except for one which was $210k but only four days a week with no call.

Source: I’m on the east coast in academics.

 

[finalpsychyear]

I think geography is the major factor.

I know here on the east coast, academics pay around 160-180k. You can hit 200k if you get out into suburbia academics and the highest I've seen is around 230k (non-academics).

Once you head more inland, the average is around 200-220k (academic) and 250-275k (non-academic), and if you are happy to go to middle of nowhere, I've seen for 300k-320k

Is Psych the next Derm? Unlikely. But its definitely not bottom tier anymore as it was 10 year ago. People keep forgetting that 70% of psychiatrists work <40 hours/week. So when you see those Medscape avearage salaries of 250k or whatever, keep in mind that it mainly represents people working 30, 35 hours/week, etc.

So $/hr, I would say psych is safely middle of the pack.

Sure, Neurosurg average salary is 500-600k or whatever, but are they working 30 hours/week?

Does any field of medicine make 500-600 for 30 hrs with 4wks vacation per year? maybe cosmetic derm cash only but no one is making that dough in 30 hours with 4 wks vaca or rather maybe .01 %

 

[yanks26dmb]

Does any field of medicine make 500-600 for 30 hrs with 4wks vacation per year? maybe cosmetic derm cash only but no one is making that dough in 30 hours with 4 wks vaca or rather maybe .01 %

Private practice psych can probably pull that, no? Either cash or running through lots of med checks..?

 

[Stagg737]

Private practice psych can probably pull that, no? Either cash or running through lots of med checks..?

I had one attending who was grossing ~450k/yr. Cash only, 25-50 minute appointments, only had one office staff member who collected cash/ran credit cards and put the paper charts in the file cabinet and was paid 30k/yr. sounds low but I think it was fair considering she was working ~25 hrs a week and spent 80% of her time on FB. He worked 5 days but two days ended at 1 and the other days ended around 3:30 or 4. Was netting around 325 after paying staff, utilities, and taxes.

Not the norm, but doable.

 

[finalpsychyear]

I had one attending who was grossing ~450k/yr. Cash only, 25-50 minute appointments, only had one office staff member who collected cash/ran credit cards and put the paper charts in the file cabinet and was paid 30k/yr. sounds low but I think it was fair considering she was working ~25 hrs a week and spent 80% of her time on FB. He worked 5 days but two days ended at 1 and the other days ended around 3:30 or 4. Was netting around 325 after paying staff, utilities, and taxes.

Not the norm, but doable.

Yeah those are the rare cases. Still just so everyone who reads that is clear 325 was the amount he then had to pay roughly 50% of towards fed,state, local, fica,ss tax on and was left with roughly half that amount when all was said and done. 450 gross--> 325 after overhead -->160-175 post all taxes when all was said and done. Taxes suck!!

 

[uhmocksuhsillen]

Yeah those are the rare cases. Still just so everyone who reads that is clear 325 was the amount he then had to pay roughly 50% of towards fed,state, local, fica,ss tax on and was left with roughly half that amount when all was said and done. 450 gross--> 325 after overhead -->160-175 post all taxes when all was said and done. Taxes suck!!

That's just not true. He pays 41% tax on that amount ASSUMING he/she is single and lives in California (a very high income tax state). Live elsewhere and this number is closer to 30 than 40%.

Source: paycheckcity.com

 

[Stagg737]

Yeah those are the rare cases. Still just so everyone who reads that is clear 325 was the amount he then had to pay roughly 50% of towards fed,state, local, fica,ss tax on and was left with roughly half that amount when all was said and done. 450 gross--> 325 after overhead -->160-175 post all taxes when all was said and done. Taxes suck!!

No, 325k was the amount I thought he had, although at the time I think I just calculated state and fed taxes, wasn't including SS, fica, local, etc. He was still clearing $400k before taxes (~$410k after overhead). Just re-did the calculations in a state calculator which included FICA and all the others. He's still taking home ~260k post-tax (yes, this is in a state with income tax) even after paying overhead and his one employee. Which is still ridiculous but that's how it works.

 

[yanks26dmb]

I had one attending who was grossing ~450k/yr. Cash only, 25-50 minute appointments, only had one office staff member who collected cash/ran credit cards and put the paper charts in the file cabinet and was paid 30k/yr. sounds low but I think it was fair considering she was working ~25 hrs a week and spent 80% of her time on FB. He worked 5 days but two days ended at 1 and the other days ended around 3:30 or 4. Was netting around 325 after paying staff, utilities, and taxes.

Not the norm, but doable.

Not disagreeing with you at all..but how is this not the norm if one is taking insurance?

Using 99114 reimbursement codes (among a few other common codes), it becomes clear you can average 2-2.5 patients an hour over an 8 hour day. That ends up like 290 an hour give or take. Every doc I've worked with has said if you're taking insurance/medicare you'll fill up in no time flat.

40*290/hr *48 weeks = 556k/yr before expenses. I used 2 patients an hour not 2.5 to account for no show.

What am I missing here?

 

[finalpsychyear]

No, 325k was the amount I thought he had, although at the time I think I just calculated state and fed taxes, wasn't including SS, fica, local, etc. He was still clearing $400k before taxes (~$410k after overhead). Just re-did the calculations in a state calculator which included FICA and all the others. He's still taking home ~260k post-tax (yes, this is in a state with income tax) even after paying overhead and his one employee. Which is still ridiculous but that's how it works.

I was just giving a ball park. Yes, if your single and in a state with income tax and your post overhead amount is 325 at least in my state , which is not a high tax state , you will have roughly 200 ish in the bank assuming you did no type of self funded retirement which you almost certainly would have and been about 30-40k below that.

 

[Extralong]

I may be in the minority here but I do predict Psych will be the new Derm

This is a psych doc near my town that is doing Botox. So, we are on our way. Lol

 

[TexasPhysician]

Using 99114 reimbursement codes (among a few other common codes), it becomes clear you can average 2-2.5 patients an hour over an 8 hour day. That ends up like 290 an hour give or take. Every doc I've worked with has said if you're taking insurance/medicare you'll fill up in no time flat.

40*290/hr *48 weeks = 556k/yr before expenses. I used 2 patients an hour not 2.5 to account for no show.

What am I missing here?

Code reimbursement varies by a dozen+ factors. 1 clinic that I previously worked was reimbursed about $90 for 99214 on average. Even if you assume 3/hour = $270. I worked about 12 hours/week there with the owner psychiatrist at FT and 1 PT counselor. Owner was full. To support us, he had 2 FT billers fighting for reimbursement, 2 front office staff answering calls/scheduling/check-ins, and 1 staff verifying insurances, doing PA’s, checking deductibles, etc for the next day. He also had a PT manager to do payroll, etc. The practice could have been more efficient and could have managed with less sq ft, but he wanted to eventually expand. Overhead was over 25%. No-show fee was $20-60.

So assuming 3 99214’s/hour with 0 no-shows, he would clear about $200/hr. 1 no-show/hr could drop hourly pay to $150.

Medicine is now a business. You need to maximize efficiency, minimize all costs, etc. It isn’t easy.

 

[splik]

What am I missing here?

you are missing that if that were true, then psychiatrists would take insurance, and most do not. there is wide variation between what insurances pay in different geographical locales (even within the same city), what they pay individual docs (those in group practices can negotiate higher rates than those in solo private practice, and big hospitals can negotiate the highest rates), there is different reimbursement for CPT codes based on specialty such that psych is reimbursed lower than many other medical specialties for the same codes, there are differences in reimbursement rates between different plans of the same insurance companies, there are differences in what you bill and what is actually collected etc etc. Also working 40 clinical hours a week is a lot in psychiatry and is more than full time (would be 50 hours with other things added in), and it would be fraud to bill every single follow up as a 99214. your straightforward ADHD refills etc would be 99213 etc.

 

[finalpsychyear]

Code reimbursement varies by a dozen+ factors. 1 clinic that I previously worked was reimbursed about $90 for 99214 on average. Even if you assume 3/hour = $270. I worked about 12 hours/week there with the owner psychiatrist at FT and 1 PT counselor. Owner was full. To support us, he had 2 FT billers fighting for reimbursement, 2 front office staff answering calls/scheduling/check-ins, and 1 staff verifying insurances, doing PA’s, checking deductibles, etc for the next day. He also had a PT manager to do payroll, etc. The practice could have been more efficient and could have managed with less sq ft, but he wanted to eventually expand. Overhead was over 25%. No-show fee was $20-60.

So assuming 3 99214’s/hour with 0 no-shows, he would clear about $200/hr. 1 no-show/hr could drop hourly pay to $150.

Medicine is now a business. You need to maximize efficiency, minimize all costs, etc. It isn’t easy.

you are missing that if that were true, then psychiatrists would take insurance, and most do not. there is wide variation between what insurances pay in different geographical locales (even within the same city), what they pay individual docs (those in group practices can negotiate higher rates than those in solo private practice, and big hospitals can negotiate the highest rates), there is different reimbursement for CPT codes based on specialty such that psych is reimbursed lower than many other medical specialties for the same codes, there are differences in reimbursement rates between different plans of the same insurance companies, there are differences in what you bill and what is actually collected etc etc. Also working 40 clinical hours a week is a lot in psychiatry and is more than full time (would be 50 hours with other things added in), and it would be fraud to bill every single follow up as a 99214. your straightforward ADHD refills etc would be 99213 etc.

The sad truth is that in my area the highest paying insurance is medicare which gives roughly 100 dollars for a 99214 and 70 dollars for a 99213. But wait, they only actually will pay 80% of that allowable amount and the patient must pay 20% unless they have medicare/medicaid which then you must write off if you accept those insurances. If your going to do add on codes pts will have a hard time paying co-insurance for both codes and also some privates will only give the pts a few sessions and you need pre auths every time which is a huge time suck.

Then in my area 99214 gets paid at 93, 83, 79, and 60 (united health which is worse than medicaid in my area lol) by the 4 biggest private insurers. People have copays, coinsurances, and deductibles and in an insurance based practice people aren't going to want to just come every month unless they are really struggling or your giving controlled subs. Every day if you book 20 pts its normal to have 3-4 not show due to a variety of reasons.

So being conservative as I don't have many medicare pts because if you do that then you have MIPS and other quality programs that require more staff and headaches. Lets say in a typical day you book 20 and 16 pts show up at 78 per encounter. Provided you make all collections and everyone pays all copays and insurances in a day you just coded level 4s (which you woulnd't) which $78 x 16 pts = 1250. Yes, I know about add on codes but this year more and more insurers in my area are limiting them and wanting pre-auths which was not really happening last year and i even got a few audits and they just took the add on code money back by deducting it from another members payment even though I had the documentation. We would appeal and after lots of paperwork and back and forth were able to get it back somestimes but staff would grow frustrated and i don't have time to monitor how much effort they are putting. Its actually genius by insurance to play this game bc they know more appeals, pre-auths, denials is less money in our pockets due to people just giving up trying to get it esp if its a staff who is on salary. It is sick and ridiculous what insurances do.

I am moving to another area with a higher median income but a cash business is king at the end of the day. I too like naive med student would just think x amt of dollars plus this add on code x 20-25 pts = WOW lots of money. You can make a good living and be autonomous doing what I hope you really enjoy but my best advice is if you think like this your going to be in for an awakening when you actually crunch the numbers in the real world unless you go to a posh area which can have cash only practice and even then chances are someone is already doing it so it will take years to build that up unless you are extremely lucky.

my 2 cents.

 

[Stagg737]

@yanks26dmb , the above comments explain it pretty well.

I'll also add that the individual I'm talking about was cash only and charged full price for a no-show unless you gave 24 hours notice that you'd be missing. He could justify it as a deterrent for not communicating with his office since it was a 6-8 month wait to see him for new patients.

 

[Ahamis]

rovided you make all collections and everyone pays all copays and insurances in a day you just coded level 4s (which you woulnd't) which $78 x 16 pts = 1250.

$1250/day before overhead???
That sounds low.

 

[TexasPhysician]

$1250/day before overhead???
That sounds low.

Insurance companies and their requirements make it increasingly difficult to start a new practice. Highly recommend starting cash only or going with a more established group..

 

[LABrondo]

Insurance companies and their requirements make it increasingly difficult to start a new practice. Highly recommend starting cash only or going with a more established group..

how do you learn how to manage a cash only practice and find patients to come to see you for it?

 

[TexasPhysician]

how do you learn how to manage a cash only practice and find patients to come to see you for it?

Cash pp is leaner, so you can earn more with less volume. Be more strategic. With less over-head (0-1 staff), you could work another job 2-4 days/week while the practice builds.

 

[Salpingo]

I've been meeting a lot of MS4's who are in the current app cycle from various schools at different conferences and a lot of them are stating that they want to do psychiatry for money and lifestyle. What are your thoughts? Will PD's know how to sift through this? Will we become the new derm? Can a step 260 without any significant activity history trump a step 240 with significant activity history?

Treating people for mental health issues is never going to be a desirable lifestyle, unless you're legitimately interested in mental health issues.

 

[thepoopologist]

I've been meeting a lot of MS4's who are in the current app cycle from various schools at different conferences and a lot of them are stating that they want to do psychiatry for money and lifestyle. What are your thoughts? Will PD's know how to sift through this? Will we become the new derm? Can a step 260 without any significant activity history trump a step 240 with significant activity history?

The money and lifestyle are absolute bonuses as long as you actually like the work.

 

[finalpsychyear]

$1250/day before overhead???
That sounds low.

I also have another job FT job which helps cover the expenses. Cash only is the best but you may attract some demanding patients or pathology more than others. Insurance based PP when no EMR was required was ideal with paper charting. Also, saw a new insurance panel that mandates you have EHR. At some point insurance companies are going to be integrated into your EMR and pull your charts anytime looking for how to cut your payments, if your overusing cpt codes, etc. That is of course the probably the "secret" goal of insurance companies to eventually mandate everyone on EMR then mandate that they have access at all times.

Just be happy you can hang a shingle and be busy in psych and the overhead is less than other fields. Your never going to just start PP and boom and everything will run smooth. It will take a few years to get it the way you want. Yes, ideally have a FT job and start a cash PP 1 to half day a week and go from there.

It is not hard to get tons of medicaid/managed care pts you will have your pick of those. There is a guy in my area who see's 50/managed care medicaid in a day but the payment is 30 dollars. I would never do that due to liability and burnout and poor care.

 

[AD04]

The sad truth is that in my area the highest paying insurance is medicare which gives roughly 100 dollars for a 99214 and 70 dollars for a 99213. But wait, they only actually will pay 80% of that allowable amount and the patient must pay 20% unless they have medicare/medicaid which then you must write off if you accept those insurances. If your going to do add on codes pts will have a hard time paying co-insurance for both codes and also some privates will only give the pts a few sessions and you need pre auths every time which is a huge time suck.

Then in my area 99214 gets paid at 93, 83, 79, and 60 (united health which is worse than medicaid in my area lol) by the 4 biggest private insurers. People have copays, coinsurances, and deductibles and in an insurance based practice people aren't going to want to just come every month unless they are really struggling or your giving controlled subs. Every day if you book 20 pts its normal to have 3-4 not show due to a variety of reasons.

...

Provided you make all collections and everyone pays all copays and insurances in a day you just coded level 4s (which you woulnd't) which $78 x 16 pts = 1250.

No wonder you're all gloomy and doomy.

This is when you close up shop, move to the beach, and do telepsychiatry: 8 hours at average rate of $150 / hr = roughly the same revenue except you don't have the headache and expense of running your own practice.

The demand for psychiatry is high. The different ways to practice psychiatry is much broader than other specialties (inpatient, outpatient, anything in between, cash, insurance, locums, employment, etc). You can do well. Don't give up.