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

[uhmocksuhsillen]

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.

This is what I would love to do once I'm out of residency...telepsych while starting up a cash practice doing general and addiction, with maybe a day of inpatient.

---

Members don't see this ad.

 

[finalpsychyear]

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.

My friend was doing telepysch on a indep contract basis. The place recently found someone willing to see patients face to face and my friend lost his job just like that and it turns out the new provider is a NP. The value of running your own business and being your own boss is priceless to me.

Yes, I am gloomy about medicine in general. I feel 5 more years is the window for psych so I plan on working 60+ hours/wk starting in 2019 but no nights or call and maybe 1 wknd a month.

 

[Techmed07]

Psych is not a lifestyle speciality. We are too easy to replace, pay too low and work too hard. The traditional lifestyle specialities remain unchanged— Radiolgy, Anesthesia, Optho, Dermatology. Psychiatry isn’t even in the conversation.

 

[yanks26dmb]

Psych is not a lifestyle speciality. We are too easy to replace, pay too low and work too hard. The traditional lifestyle specialities remain unchanged— Radiolgy, Anesthesia, Optho, Dermatology. Psychiatry isn’t even in the conversation.

Most anesthesiologists around here would not agree with that.

 

[Techmed07]

It still remain that psychiatry is NOT in the conversation.

 

[uhmocksuhsillen]

It still remain that psychiatry is NOT in the conversation.

Why do so many psychiatrists on here consider it as such?

It certainly seems like it is from what I've seen ok rotations.

 

[Stagg737]

We are too easy to replace, pay too low and work too hard.

What planet do you live on? Psychiatrists are about as replaceable as any non-surgical field (plenty of derm NPs out there now, and let's not get started on anesthesiology being replaceable). And paid too low for working too hard? Most psychiatrists I know work well under 50 hours a week and easily clear 200k. Sounds like a pretty sweet gig to me...

 

[deleted736562]

Psychiatry is definitely a "lifestyle" specialty if you're fine with a mid-200s salary. I'd say it's even more lifestyle than some of the others mentioned because you're pretty much free to devise whatever schedule you would like. Flexibility counts a lot. Someone mentioned telepsychiatry as an option; you could even take that overseas where the lifestyle is at a fraction of major US cities. If you want to earn more than that, it's no longer "lifestyle".

 

[DisorderedDoc417]

What planet do you live on? Psychiatrists are about as replaceable as any non-surgical field (plenty of derm NPs out there now, and let's not get started on anesthesiology being replaceable). And paid too low for working too hard? Most psychiatrists I know work well under 50 hours a week and easily clear 200k. Sounds like a pretty sweet gig to me...

He must live in a different country because in the US we face major shortages in the Coming years with an old (and aging) average psychiatrist population in the US. I personally find the inpatient setting to be the most interesting. So much freedom in how you use your day as well. Sprinkle in some ECT. Perhaps a little moonlighting 6 weekends a year or telepsych here or there and 300-350k is easily within range — at least where I’m at. Unlike the FPs slaving away with 30 patients a day to clear 200. Alas, perspective is everything I suppose.

 

[Shufflin]

Psych is not a lifestyle speciality. We are too easy to replace, pay too low and work too hard. The traditional lifestyle specialities remain unchanged— Radiolgy, Anesthesia, Optho, Dermatology. Psychiatry isn’t even in the conversation.

If med students want to keep believing this, please by all means.

(I know I know, I said I would bow out but just had to chime in)

 

[TexasPhysician]

Why do so many psychiatrists on here consider it as such?

It certainly seems like it is from what I've seen ok rotations.

Everything is relative. I really enjoy psychiatry, and I am happy with the lifestyle.

Compared to some other fields, the lifestyle is poor.

Let’s talk Derm. Derm can easily clear $500k for under 40 hrs. 1 Derm I know semi-retired and scaled back to 5 patients/hr for $375/hr. Derm can use scribes to document, diagnose quickly with fast exams, and they do procedures that are quick/lucrative. A typical visit can easily be 5 min that includes scribe documentation. Even with a procedure, 10 patients with reimbursement per hour is possible. Hours and high income.

Other fields can do this too. A sports medicine guy I know can quickly determine the injury by a directed physical exam and use a scribe to see good volume. Insurance total payment is about $175/visit plus he has his own x-ray machine. He easily sees 6 patients per hour = >$1000/hr before overhead and imaging reimbursement. He works 9-5 with no call in his private practice.

The volume seems high, but these fields do very focused exams with easy documentation.

While psychiatry is more flexible with the ability to be low overhead, multiple other fields exist that can work 30-40 hours while earning double what psych would in the same time frame.

This keeps psychiatry from being a top lifestyle field.

 

[calvnandhobbs68]

Everything is relative. I really enjoy psychiatry, and I am happy with the lifestyle.

Compared to some other fields, the lifestyle is poor.

Let’s talk Derm. Derm can easily clear $500k for under 40 hrs. 1 Derm I know semi-retired and scaled back to 5 patients/hr for $375/hr. Derm can use scribes to document, diagnose quickly with fast exams, and they do procedures that are quick/lucrative. A typical visit can easily be 5 min that includes scribe documentation. Even with a procedure, 10 patients with reimbursement per hour is possible. Hours and high income.

Other fields can do this too. A sports medicine guy I know can quickly determine the injury by a directed physical exam and use a scribe to see good volume. Insurance total payment is about $175/visit plus he has his own x-ray machine. He easily sees 6 patients per hour = >$1000/hr before overhead and imaging reimbursement. He works 9-5 with no call in his private practice.

The volume seems high, but these fields do very focused exams with easy documentation.

While psychiatry is more flexible with the ability to be low overhead, multiple other fields exist that can work 30-40 hours while earning double what psych would in the same time frame.

This keeps psychiatry from being a top lifestyle field.

This is true. Psych exams will never be 15 minute visits unless they’re easy med follow ups. Also generally limits the number of patients per hour unless you’re willing to cut on quality of care.

 

[finalpsychyear]

Psych is not a lifestyle speciality. We are too easy to replace, pay too low and work too hard. The traditional lifestyle specialities remain unchanged— Radiolgy, Anesthesia, Optho, Dermatology. Psychiatry isn’t even in the conversation.

Had a group chat with residents from last 2 years in my class and the year before. We r pretty open about salaries and not secretive as to help each other. The range was 195-240 with the lowest being academics and the highest having some call involved and this was for 40 hours per week. 2 outliers in my group work 60+ hours a week with 1 doing 7 days a week at 3 diff jobs so not really applicable to most. Also, primary care is very in demand right now A colleague just got a 270k job as a family med working 9-4 M-F with 1 saturday a month no call, no nights, no wknds, 18 pts max per day.

Lifestyle specialty to me usually means no call, nights, or weekends PLUS high pay. So the pain med guy who works 40 clinic hour a week with no nights, wknds, or call making 500+ qualifies. To me lifestyle specialties have that 30-40 hr range with no nights, wknds, call and pull 500+ due to procedures. This is usually only pain, derm, cosmetics, or a procedure based specialty like sports that can do high volume in office.

Please don't go into psych thinking your going to make 300+ being sub 40 hrs a week. A few jobs are advertising that to attract you but pay goes down the following year. Yes, you can always make money in medicine working more but since we are primarily EM coding in the insurance model your going to make just as much as a PCP seeing 20 pts as you would in psych and i would argue that you have more medicaid/medicare in psych so lower payments and more no shows. Also as a pcp you have labs imaging galore that you can make lots of ancillary passive income if you keep it in house.

 

[Techmed07]

Had a group chat with residents from last 2 years in my class and the year before. We r pretty open about salaries and not secretive as to help each other. The range was 195-240 with the lowest being academics and the highest having some call involved and this was for 40 hours per week. 2 outliers in my group work 60+ hours a week with 1 doing 7 days a week at 3 diff jobs so not really applicable to most. Also, primary care is very in demand right now A colleague just got a 270k job as a family med working 9-4 M-F with 1 saturday a month no call, no nights, no wknds, 18 pts max per day.

Lifestyle specialty to me usually means no call, nights, or weekends PLUS high pay. So the pain med guy who works 40 clinic hour a week with no nights, wknds, or call making 500+ qualifies. To me lifestyle specialties have that 30-40 hr range with no nights, wknds, call and pull 500+ due to procedures. This is usually only pain, derm, cosmetics, or a procedure based specialty like sports that can do high volume in office.

Please don't go into psych thinking your going to make 300+ being sub 40 hrs a week. A few jobs are advertising that to attract you but pay goes down the following year. Yes, you can always make money in medicine working more but since we are primarily EM coding in the insurance model your going to make just as much as a PCP seeing 20 pts as you would in psych and i would argue that you have more medicaid/medicare in psych so lower payments and more no shows. Also as a pcp you have labs imaging galore that you can make lots of ancillary passive income if you keep it in house.

Thank you! Psychiatry is not a lifestyle speciality. I do not know why this fallacy keeps being perpetuated.

 

[deleted736562]

Please don't go into psych thinking your going to make 300+ being sub 40 hrs a week. .

It's really not that far away. The medscape median is $273k with an impressive 16% yearly increase. 300+ is very much within reach if you just add a bit of call here and there. Geographical factors are obviously very important. Both extremes of the "debate" are wrong imo.

And frankly seeing tons of pts/hour whatever the specialty is borders on poor care. You need to sit and talk to the patients and answer their questions and concerns. I've been to the 3-4 minute dermatologist. It doesn't leave a good impression.

 

[dl2dp2]

Two words why psych cannot have top $:
facility fee

It's not possible to charge for capital expenditures and derive profit from it. Low overhead has a flip side. Radiology is a great example where the main partner dividends derive from owning equipment. Rad onc is another example. This is not available to psych. As I said in other threads, passive income is how you get really wealthy.

That said, on a per hour basis for pure clinical revenue, psych is doing fine, especially if you are among the half in PP that takes only cash.

 

[VA Hopeful Dr]

He must live in a different country because in the US we face major shortages in the Coming years with an old (and aging) average psychiatrist population in the US. I personally find the inpatient setting to be the most interesting. So much freedom in how you use your day as well. Sprinkle in some ECT. Perhaps a little moonlighting 6 weekends a year or telepsych here or there and 300-350k is easily within range — at least where I’m at. Unlike the FPs slaving away with 30 patients a day to clear 200. Alas, perspective is everything I suppose.

If you're an FP seeing 30 patients/day and just barely clearing 200k you are absolutely doing it wrong.

At my current job, if I saw that volume and only worked 42 weeks/year (so 10 weeks off including holidays) billing at a low level I'd make 250k.

Those same numbers billing at the national median level brings that up to 315k.

 

[DisorderedDoc417]

If you're an FP seeing 30 patients/day and just barely clearing 200k you are absolutely doing it wrong.

At my current job, if I saw that volume and only worked 42 weeks/year (so 10 weeks off including holidays) billing at a low level I'd make 250k.

Those same numbers billing at the national median level brings that up to 315k.

Okay that wasn’t a very charitable post. 30 a day is hustling. Lets reduce that number to what... 24 a day? because most FP aren’t making 315k. Not saying they can’t. I’ve heard everything between 180k and 500k depending on if they do procedures, ob, er shifts, etc.

 

[DisorderedDoc417]

It's really not that far away. The medscape median is $273k with an impressive 16% yearly increase. 300+ is very much within reach if you just add a bit of call here and there. Geographical factors are obviously very important. Both extremes of the "debate" are wrong imo.

And frankly seeing tons of pts/hour whatever the specialty is borders on poor care. You need to sit and talk to the patients and answer their questions and concerns. I've been to the 3-4 minute dermatologist. It doesn't leave a good impression.

I used to set my sites on 250k until I realized it was low ball and typical jobs will help you produce above this with 45-50 hours a week on average no problem. Heck moonlighting even as a resident can yield 6k in a weekend.

 

[SmallBird]

Two words why psych cannot have top $:
facility fee

It's not possible to charge for capital expenditures and derive profit from it. Low overhead has a flip side. Radiology is a great example where the main partner dividends derive from owning equipment. Rad onc is another example. This is not available to psych. As I said in other threads, passive income is how you get really wealthy.

That said, on a per hour basis for pure clinical revenue, psych is doing fine, especially if you are among the half in PP that takes only cash.

Many hospital jobs will supplement psychiatrist compensation by drawing from the facility fee; this can range considerably, I would guess at my current job about 40% of what I’m paid per RVU is above what’s collected from insurance. I’ve heard of places where physician billing is so disorganized that an even greater proportion comes from the facility fee. Many hospitals and systems have prioritized negotiating for good facility fees to the neglect of physician services rate. Partial hospital reimbursement can be as high as $750 a day, resulting in a large margin which can (and frequently will) contribute to physician margin. This is often left out of the back of the envelope discussions about how much people should expect to make.

As to a lifestyle specialty overall - so many factors including personality style, clinical style, etc., go into this. I work about 40 hours per week, and 15 weekends (rounding) a year but that gets me to a little over > $400k. I’m fine with that. I could probably get there with fewer weekends as a dermatologist!

 

[Mad Jack]

Everything is relative. I really enjoy psychiatry, and I am happy with the lifestyle.

Compared to some other fields, the lifestyle is poor.

Let’s talk Derm. Derm can easily clear $500k for under 40 hrs. 1 Derm I know semi-retired and scaled back to 5 patients/hr for $375/hr. Derm can use scribes to document, diagnose quickly with fast exams, and they do procedures that are quick/lucrative. A typical visit can easily be 5 min that includes scribe documentation. Even with a procedure, 10 patients with reimbursement per hour is possible. Hours and high income.

Other fields can do this too. A sports medicine guy I know can quickly determine the injury by a directed physical exam and use a scribe to see good volume. Insurance total payment is about $175/visit plus he has his own x-ray machine. He easily sees 6 patients per hour = >$1000/hr before overhead and imaging reimbursement. He works 9-5 with no call in his private practice.

The volume seems high, but these fields do very focused exams with easy documentation.

While psychiatry is more flexible with the ability to be low overhead, multiple other fields exist that can work 30-40 hours while earning double what psych would in the same time frame.

This keeps psychiatry from being a top lifestyle field.

I mean, I have met a few psychiatrists that make $450/follow-up or $600/initial visit, cash only in PP. sure the income cap is lower, but the work is nore patient focused and comfortable. The moat well-compensated psych docs I know have cracked 7 figs employing midlevels and counselors- it's more about your business aptitude than your specialty at that point

 

[Ahamis]

Someone mentioned telepsychiatry as an option; you could even take that overseas where the lifestyle is at a fraction of major US cities. If you want to earn more than that, it's no longer "lifestyle".

Everybody keeps hypothesizing that you can do telepsych from overseas, but how many psychiatrists do you know that are actually doing that???
I have seen none despite the fact that we have many foreigners in the field.
I don't think it is that simple...

 

[deleted736562]

Everybody keeps hypothesizing that you can do telepsych from overseas, but how many psychiatrists do you know that are actually doing that???
I have seen none despite the fact that we have many foreigners in the field.
I don't think it is that simple...

I know a couple. It's not simple but it is doable.

 

[AD04]

Many hospital jobs will supplement psychiatrist compensation by drawing from the facility fee; this can range considerably, I would guess at my current job about 40% of what I’m paid per RVU is above what’s collected from insurance. I’ve heard of places where physician billing is so disorganized that an even greater proportion comes from the facility fee. Many hospitals and systems have prioritized negotiating for good facility fees to the neglect of physician services rate. Partial hospital reimbursement can be as high as $750 a day, resulting in a large margin which can (and frequently will) contribute to physician margin. This is often left out of the back of the envelope discussions about how much people should expect to make.

As to a lifestyle specialty overall - so many factors including personality style, clinical style, etc., go into this. I work about 40 hours per week, and 15 weekends (rounding) a year but that gets me to a little over > $400k. I’m fine with that. I could probably get there with fewer weekends as a dermatologist!

How do you find these types of positions? How do you get them to pay you from facility fees? Are these for-profit hospitals? A lot of the hospital recruiters I talk to said the hospitals won't even pay median RVU (low-ball me with $50 / RVU or $60 / pt above the daily limit) and they still want me to take a bunch of call -- all unpaid.

That's when I lose interest.

 

[VA Hopeful Dr]

Okay that wasn’t a very charitable post. 30 a day is hustling. Lets reduce that number to what... 24 a day? because most FP aren’t making 315k. Not saying they can’t. I’ve heard everything between 180k and 500k depending on if they do procedures, ob, er shifts, etc.

So I'll show my work on this one so you can see where I'm coming from with all of this.

For FM the vast vast majority of our works boils down to 2 codes: 99213 and 99214. Low complexity and moderate complexity established patient visits, respectively. The former is worth 1 wRVU and the latter 1.5. Nationwide, the average wRVU per encounter is around 1.3.

The median reimbursement per wRVU for family medicine is about $41/wRVU.

So 24 patients per day at let's say 4.5 days/week is 108 patient encounters/week. At 1.3 wRVU per patient that's 140 wRVU/week. If we assume 46 working weeks (that gives us 6 weeks of vacation/holidays), that's 6440 wRVU per year. At $41 per wRVU that's 264k/year.

 

[DisorderedDoc417]

So I'll show my work on this one so you can see where I'm coming from with all of this.

For FM the vast vast majority of our works boils down to 2 codes: 99213 and 99214. Low complexity and moderate complexity established patient visits, respectively. The former is worth 1 wRVU and the latter 1.5. Nationwide, the average wRVU per encounter is around 1.3.

The median reimbursement per wRVU for family medicine is about $41/wRVU.

So 24 patients per day at let's say 4.5 days/week is 108 patient encounters/week. At 1.3 wRVU per patient that's 140 wRVU/week. If we assume 46 working weeks (that gives us 6 weeks of vacation/holidays), that's 6440 wRVU per year. At $41 per wRVU that's 264k/year.

Not questioning your math. Just know the docs aren’t all making 264k a year and that’s obviously for a variety of reasons.

 

[dl2dp2]

Many hospital jobs will supplement psychiatrist compensation by drawing from the facility fee; this can range considerably, I would guess at my current job about 40% of what I’m paid per RVU is above what’s collected from insurance. I’ve heard of places where physician billing is so disorganized that an even greater proportion comes from the facility fee. Many hospitals and systems have prioritized negotiating for good facility fees to the neglect of physician services rate. Partial hospital reimbursement can be as high as $750 a day, resulting in a large margin which can (and frequently will) contribute to physician margin. This is often left out of the back of the envelope discussions about how much people should expect to make.

As to a lifestyle specialty overall - so many factors including personality style, clinical style, etc., go into this. I work about 40 hours per week, and 15 weekends (rounding) a year but that gets me to a little over > $400k. I’m fine with that. I could probably get there with fewer weekends as a dermatologist!

Yup, this happens ALL THE TIME. Don't you hate it though when people leave this out and pretend that you are a "cost center".

The only way to know what your numbers should be is to test what the market will bear. Do not put up with exploitation. You will get exploited if you do.

 

[TexasPhysician]

How do you find these types of positions? How do you get them to pay you from facility fees? Are these for-profit hospitals? A lot of the hospital recruiters I talk to said the hospitals won't even pay median RVU (low-ball me with $50 / RVU or $60 / pt above the daily limit) and they still want me to take a bunch of call -- all unpaid.

That's when I lose interest.

A lot of looking and negotiating.

I know a company that has been fairly easily getting psychiatrists at $125/hr because we generally negotiate poorly. When other companies can do this, many others try to follow. You need to find the companies with high need and desperate enough to pay well.

 

[NontradCA]

I did it for the chicks

 

[Shufflin]

A lot of looking and negotiating.

I know a company that has been fairly easily getting psychiatrists at $125/hr because we generally negotiate poorly. When other companies can do this, many others try to follow. You need to find the companies with high need and desperate enough to pay well.

This is what it all comes down to. The great divide between those crying psych is not a lifestyle specialty, and those insisting it most certainly is. The amazing opportunities are out there, but they are hidden in the fog.

Notice, too, that the pessimists on here tend to be the med students and residents. Residents just graduating residency don't have the network and history to find the great opportunities, so of course residents won't hear about the great opptys. And the med students are clueless, as we all once were.

 

[AD04]

What type of places receive facility fees? I guess hospitals. What about residential detox / substance use centers? PHP? IOP?

What type of places would be easiest to start and collect facility fees?

 

[Thruster]

I know several psychiatrists who make over 400K working 30 clinical hours per week(private out of network practices, including one recent grad). I also know 2 psychiatrists one who works for several hospital systems and clears 1.1m working about 80 hrs per week, and another who owns his own practice and clears about 1.3m about 60 hrs/week (several NPs and therapists working under him).
Kaiser in Cali pays 275 to low 300s for a 40hr work week (you will work), and there are numerous locums gigs paying between 150-200ish per hour plus housing/travel/licensure covered.
There are definitely some good gigs out there but an equal amount of predatory employers. Not playing their game and owning your own practice seems to be the key to having a lifestyle friendly high paying position.

 

[Walter Raleigh]

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.

Fresh out of medical school?

 

[Shufflin]

Fresh out of medical school?

No, he means in general.

Besides, you can't work as a psychiatrist right out of medical school.

 

[dl2dp2]

What type of places receive facility fees? I guess hospitals. What about residential detox / substance use centers? PHP? IOP?

What type of places would be easiest to start and collect facility fees?

You are thinking too hard. Technically you can find this information on the CMS website, but in order to receive facility status you will need a degree of licensure that you typically can't easily get, which would involve things like the Joint Commission. It also depends on insurance--classically "facility fee" is a Medicare concept, but lots of private/state insurance contracts also have facility fee, and those are negotiated directly with the facility. Unless you want to deal with the ins and outs of hospital admin this is typically above your pay grade.

Also, just FYI, this kind of work (i.e. dealing with facility fees and JACHO) does NOT typically pay particularly well in your typical rinky dink community hospital settings, and often are outsourced to RNs (i.e. nurse managers). Sure, you CAN get paid well if you are CEO/CFO of a very large system, but let's be honest that kind of job is kinda not something you just "apply" for.

As for substance use treatment facilities--just FYI since I'm very familiar with that space, this landscape is hella competitive right now. Major private equity is often very involved, which is a sign that it takes a lot of money/risk tolerance to make things work well. I wouldn't touch that can of worms with a five foot pole. I know examples of very wealthy and supposedly smart people lose 10M in a couple of years with this kind of thing.