So can we talk money?

[Doctor Bagel]

I'm doing a bit of negotiating and am still really unclear what pay ranges are there and make sense. Can I throw out a couple of scenarios and have you tell me what you think the going rate in your city for that would be? About where I'm at -- pretty significant shortage of providers but also desirable with an ever increasing cost of living. Not SF, LA, NYC, Boston levels yet but definitely also not Kansas City either.

First scenario:
fulltime inpatient in a reasonably busy unit with say phone call once a week and once a month weekend in-house call + overnight phone call for half of that weekend

Second scenario:
full-time community MH with say 13 patients/day. No call/no weekends.

Third scenario:
fulltime non-community outpatient MH (say Kaiser types of places), again 13 patients/day. No call/no weekends. 4 days a week. Days maybe busier days because of fewer no shows?

Fourth scenario:
fulltime VA, VA level of busy, which is not super. 2 weeks of call mainly providing supervision to residents.

No, I'm not debating all these different jobs, but I am trying to get a handle on what psychiatry incomes really are.

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[Shikima]

A bit difficult to advise on pay - do you have any starting numbers from these places?

 

[Doctor Bagel]

A bit difficult to advise on pay - do you have any starting numbers from these places?

Here are word of mouth ranges I've heard -- they're pretty broad, and it doesn't seem like more money is tied with more experiences/skills.

Fulltime inpatient with call -- $220/year to $260/year
VA gig -- this one is easier -- $190 to $220/year
Fulltime community -- $200 to $220/year
Fulltime outpatient Kaiser type of job -- $190 to $220/year

This numbers seem to fit with job offer emails I get. Average posted salaries for psychiatrists look a lot lower than what average pay actually is. I always wonder if I'm missing something.

 

[Doctor Bagel]

OK, also added a low quality poll. I'm not trying to be crass, but I've stumbled on these negotiations around money. I've also come across a few situations recently where people were making more money just because they asked for more. I'm still used to being in the beggar position and am just appreciating that I've got some skills that have economic value.

 

[doctorpilgrim]

Which region are you looking at. Inpatient should be 260k. Va sounds approx correct. Outpatient is better production based after first year. Median wrvu is 4200 to 4400 and median salary is 240 to 250k. 20 to 22 wrvu means 14 to 15 patients a day. Good luck in your search.

 

[Fermata]

Which region are you looking at. Inpatient should be 260k. Va sounds approx correct. Outpatient is better production based after first year. Median wrvu is 4200 to 4400 and median salary is 240 to 250k. 20 to 22 wrvu means 14 to 15 patients a day. Good luck in your search.

I've seen inpatient jobs near here (SE) with base of 200k with production bonus past RVU of 3300. I've seen other inpatient jobs more in the neighborhood of what you are quoting. It seems quite variable.

Those that I know who make the most have successful private practices or are hustling hard inpatient. State jobs here pay between 150k to 200k. VA jobs here start at 200k (if you are BC).

Moonlighting seems to range $95-$160/hr depending on the coverage needs.

I have friends in areas with less density of providers that make significantly more.

 

[Doctor Bagel]

Wow, one response is the $400+ and one in the $300+. When I started training, one of the graduates took a busier job that would include call, and the pay was like $240k. I remember hearing that as surprisingly high pay.

 

[Fermata]

Wow, one response is the $400+ and one in the $300+. When I started training, one of the graduates took a busier job that would include call, and the pay was like $240k. I remember hearing that as surprisingly high pay.

To make $400k as a psychiatrist you are probably going to have to work like a surgeon or are looking for a job in a fairly undesirable place to live.

 

[WingedOx]

At least no one is sub-150. Of course I do know academic jobs offering that little around here (yay major city).

 

[Fermata]

At least no one is sub-150. Of course I do know academic jobs offering that little around here (yay major city).

Starting academic jobs at my residency program start at around 150k (though don't quite shoot much higher past that).

 

[Doctor Bagel]

At least no one is sub-150. Of course I do know academic jobs offering that little around here (yay major city).

Seriously? Around here, I think they're more like $180/maybe $190. Definitely lower but not that low. I didn't look into academic jobs so am not sure of the deal, but you might maybe work less, right? Unless you have a bunch of research responsibilities.

 

[Doctor Bagel]

To make $400k as a psychiatrist you are probably going to have to work like a surgeon or are looking for a job in a fairly undesirable place to live.

That's what I would guess. And maybe have extra desired credentials like child training. Or you could be business savvy and employ a bunch of NPs and therapists.

 

[Fermata]

That's what I would guess. And maybe have extra desired credentials like child training. Or you could be business savvy and employ a bunch of NPs and therapists.

Again, you start to function more like a business owner rather than a clinician to reach that kind of income (not saying this is inherently a bad thing).

 

[PikminOC]

Benefits really should count in as money too...

 

[Doctor Bagel]

Benefits really should count in as money too...

Yeah, and how to quantify those is a question. Kaiser, VA and academic jobs I'm all guessing have really good retirement. I think Kaiser pays something like 20% of your salary into retirement savings. Community jobs on the other hand seem to have not so great benefits. Retirement matching for my community gig is like 1%, and their 403b is with a non well-regarded company that's known for having high fees and taking advantage of nonprofit employees who are supposed to be economically clueless.

Other potential pay consideration is qualification for student loan forgiveness. Depending on how I run my numbers that could be worth about $2k of take home pay a month.

I figured if I included all these factors in the poll above, there would be so many choices that it would be useless.

 

[Fermata]

Benefits really should count in as money too...

I agree. It is nice to earn a good living in this

Yeah, and how to quantify those is a question. Kaiser, VA and academic jobs I'm all guessing have really good retirement. I think Kaiser pays something like 20% of your salary into retirement savings. Community jobs on the other hand seem to have not so great benefits. Retirement matching for my community gig is like 1%, and their 403b is with a non well-regarded company that's known for having high fees and taking advantage of nonprofit employees who are supposed to be economically clueless.

Other potential pay consideration is qualification for student loan forgiveness. Depending on how I run my numbers that could be worth about $2k of take home pay a month.

I figured if I included all these factors in the poll above, there would be so many choices that it would be useless.

Some things are harder still to quantify: collegiality with peers, enjoyment of working with other staff/the patient population, etc.

I think there is inherently more heterogeneity within the field: community inpatient, state mental health, VA inpatient, VA outpatient, CMHC, private practice, academic, psychoanalytic, forensics, ACTT, etc.

http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Surveys/mha2014incensurvey.pdf

According to the numbers from last year the average base salary for psychiatry was about 217k.

I do think your tact is the correct one: gathering information from other providers in your area so you can better formulate what compensation runs in your neck of the woods.

 

[michaelrack]

The poll doesn't specify that it is only for 1 position.

 

[WingedOx]

Seriously? Around here, I think they're more like $180/maybe $190. Definitely lower but not that low. I didn't look into academic jobs so am not sure of the deal, but you might maybe work less, right? Unless you have a bunch of research responsibilities.

The particular one I know of hasn't kept one of their own graduates since 2012 for good reason. Sad too, because if not for the salaries, it's one of the better institutions and programs.

 

[Doctor Bagel]

The poll doesn't specify that it is only for 1 position.

Good point. I was hoping people would answer for their full-time pay so what you would get for a 1 FTE type of position. If you're self employed, pay for 40 hours of patient care.

 

[Doctor Bagel]

Some things are harder still to quantify: collegiality with peers, enjoyment of working with other staff/the patient population, etc.

I think there is inherently more heterogeneity within the field: community inpatient, state mental health, VA inpatient, VA outpatient, CMHC, private practice, academic, psychoanalytic, forensics, ACTT, etc.

Totally. Another factor -- mentorship and room for growth in your job. I think it's possible to fall into a lot of bad habits in some jobs.

So 2 people in the $300k range. That's exciting. I'm hoping those in the $150 to $199 range are in one of those jobs with those other updates like good benefits and good working conditions.

 

[scudiera]

To make $400k as a psychiatrist you are probably going to have to work like a surgeon or are looking for a job in a fairly undesirable place to live.

As long as it's possible if I work that hard, I'm fine with it. Thanks to whoever posted that Merritt Hawkins survey by the way, really good read. Dismaying to read their prediction of a plateau in Psych salaries due to limits in state funding, however.

 

[Mad Jack]

To make $400k as a psychiatrist you are probably going to have to work like a surgeon or are looking for a job in a fairly undesirable place to live.

I love all the places people hate and hate all the places people like, so that sounds perfect to me.

 

[Blitz2006]

So I've posted this before on this forum:

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

According to 2013 survey, 70% of Psychiatrists work <40 hours, 90% <50 hours/week. So the average salary of 217k or whatever is severely dragged down by part timers clearly.

And almost 20% earn >300k.

So by extrapolation, if you work >45 hours a week (so like 8-5, weekends off), you should be able to easily earn 300k. pretty awesome. So hourly rate then is probably along the lines of general surgery/anesthesiology/non-interventional cards (if this is in fact true).

I do scan other boards, and it looks like starting salary for cards is around 280-300k, with a ceiling of around 350-400k. But I suspect cards guy making 400k works damn hard, probably same as a psych making 400k?

http://forums.studentdoctor.net/threads/cardiology-job-market.1019969/page-4

Post #162 and post #165


I'm a lowly resident, so I don't know much about this stuff, but I do glance at APA Job central emails. I remember few months ago there was a job posting in inpatient setting in Modesto CA. $360k base, with calls -> 482k. Granted I'm sure the job was 'undesirable', but I mean 450-500k to live near the Bay Area....could be worse.

So Psych isn't actually "low paying", quite the contrary based on my reading, if it is relatively comparable to the 'all mighty cardiology'.

And I'm sure cash only guys in NYC/LA easily pull in 400k? I mean I know a child psychiatrist that charges $600/hr. Obviously does not have the volume to pump that rate for 40 hour weeks, but I'm sure he does ok

 

[Doctor Bagel]

As long as it's possible if I work that hard, I'm fine with it. Thanks to whoever posted that Merritt Hawkins survey by the way, really good read. Dismaying to read their prediction of a plateau in Psych salaries due to limits in state funding, however.

That seems not particularly surprising. I'm also wondering if all the community jobs are eventually going to be filled by psych NPs.

 

[Doctor Bagel]

So I've posted this before on this forum:

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

According to 2013 survey, 70% of Psychiatrists work <40 hours, 90% <50 hours/week. So the average salary of 217k or whatever is severely dragged down by part timers clearly.

And almost 20% earn >300k.

So by extrapolation, if you work >45 hours a week (so like 8-5, weekends off), you should be able to easily earn 300k. pretty awesome. So hourly rate then is probably along the lines of general surgery/anesthesiology/non-interventional cards (if this is in fact true).

I do scan other boards, and it looks like starting salary for cards is around 280-300k, with a ceiling of around 350-400k. But I suspect cards guy making 400k works damn hard, probably same as a psych making 400k?

http://forums.studentdoctor.net/threads/cardiology-job-market.1019969/page-4

Post #162 and post #165


I'm a lowly resident, so I don't know much about this stuff, but I do glance at APA Job central emails. I remember few months ago there was a job posting in inpatient setting in Modesto CA. $360k base, with calls -> 482k. Granted I'm sure the job was 'undesirable', but I mean 450-500k to live near the Bay Area....could be worse.

So Psych isn't actually "low paying", quite the contrary based on my reading, if it is relatively comparable to the 'all mighty cardiology'.

And I'm sure cash only guys in NYC/LA easily pull in 400k? I mean I know a child psychiatrist that charges $600/hr. Obviously does not have the volume to pump that rate for 40 hour weeks, but I'm sure he does ok

You're right, psychiatry salaries are pretty good these days and actually seem to stack up nicely against other specialties. That Modesto job might pay so much just because it's in Modesto. Or it might be horrible. Who knows?

 

[Doctor Bagel]

Other factor that's not captured by salary -- the freaking commute. I did a rotation last year at a location that would regularly turn into a 1.5 hour drive home for me. If that were a daily thing, I think that might be worth $50k/year to me.

 

[Shikima]

I'd take the job with the least amount of stress. Which is that for you, in your opinion?
I'm thinking VA?

 

[Doctor Bagel]

I'd take the job with the least amount of stress. Which is that for you, in your opinion?
I'm thinking VA?

Actually VA is not on the table at all. Just threw it out there because I kind of know what their deal is and what the pay is. There are many upsides to the VA, but I'm enjoying having a break from them for now. Just finished a VA heavy residency followed by a VA based fellowship.

But yes, I appreciate the thought about lower stress.

 

[Shikima]

Find the least complicated job with the lowest amount of hours. You'll be able to catch your breath and figure out the lay of the land.

 

[Doctor Bagel]

Find the least complicated job with the lowest amount of hours. You'll be able to catch your breath and figure out the lay of the land.

Sounds like good advice and not what I was doing, hence the changes.

So now we've got two $400k plus people and two $300k plus people.

 

[Shikima]

I guess, to help you better, what are you looking for? Better pay, yes, absolutely! Anything else?

 

[Doctor Bagel]

I guess, to help you better, what are you looking for? Better pay, yes, absolutely! Anything else?

Hell yeah for more money for less work! Actually, what I've been doing is too many jobs with uncertain work assignments in the thoughts that I would get this private practice going. I'm thinking now though that I'd like a little more stability and am backing off from the private practice thing for now (yes, totally wimping out). I've found when I'm doing on call type of stuff, though, that I overschedule myself. So, yep, stability. And the ability to feel like I'm doing some good with my work.

 

[rkaz]

Does anyone know if the VA offers part time psychiatrist positions? However if you took a part time position, would you still be privy to PSLF and other benefits (while employed and retired/pension)?

 

[Doctor Bagel]

Does anyone know if the VA offers part time psychiatrist positions? However if you took a part time position, would you still be privy to PSLF and other benefits (while employed and retired/pension)?

They do sometimes, although mine hasn't had any recently. Due to bureaucratic stuff, it seems like the VA is less flexible in just throwing something together to suit a candidate.

With PSLF, you need to employed 30 hours/week at a qualifying place -- you can combine jobs to get this. I know the VA has their own loan repayment benefits, and I'm not sure what that looks like parttime (or even fulltime).

 

[peppy]

I've also come across a few situations recently where people were making more money just because they asked for more. I'm still used to being in the beggar position and am just appreciating that I've got some skills that have economic value.

The advice I was given in residency, and which in my experience has turned out to be true, is that most places EXPECT you to negotiate with them, so don't take the first offer they put on the table. Always, always ask for more than what they offer you right off the bat. That's their lowball offer. Taking the first offer that a hospital gives you for a psychiatry salary would be like paying the sticker price on a new car.
The worst that will happen is they might say no to what you ask for, but they're not going to rescind the offer. The majority of places are desperate for psychiatrists, and you have all the power.

For my area (mid-sized urban area in midwest) this is the ballpark salary that I or someone I know ended up being quoted (I have no experience with Kaiser since we don't have that here) :
Fulltime inpatient with high census and frequent call -- $250/year to $280/year. Maybe more like 230-40K for a lighter schedule.
VA gig with light call -- around $190 to $200/year
Academic, regardless of how demanding the job is - around 180K for a new grad (this is when I realized just how much academic medicine is a labor of love and realized how amazing it is that my excellent faculty had chosen to make less money for more effort by choosing to teach us)
Fulltime community outpatient -- $200 to $230/year

I know a few people who went to small towns off the beaten path that ended up getting over $300K.

Benefits definitely seem variable. Some of the private hospitals around me offer some pretty nice retirement matching and such.

 

[Doctor Bagel]

Wow I'm really surprised that we do now have some less than $150k responses. I'm hoping they ignored the parentheses in the question and didn't adjust their income up if they're only working part time. Otherwise, wow -- academics?

 

[Trismegistus4]

I'll have had 3 locum tenens gigs this year into next, paying $140/hr, $130/hr, and $160/hr respectively. In terms of permanent positions, I've interviewed for a community outpatient job in a medium-sized Southern city, an inpatient job in a different medium-sized Southern city, and an inpatient job in the Mountain States; all offered starting salaries in the low 200's. The Southern inpatient job also had an RVU-based productivity bonus, but they were evasive about exactly how much additional money that would typically amount to.

 

[Blitz2006]

True.

But on the flip side, while understandly only a n=21, I'm still impressed that over 40% clear 300k.

Wow I'm really surprised that we do now have some less than $150k responses. I'm hoping they ignored the parentheses in the question and didn't adjust their income up if they're only working part time. Otherwise, wow -- academics?

 

[MrWonderful]

I'm interested in outpatient PP -- can anybody here describe a typical days schedule in such an environment?

 

[TexasPhysician]

Psychiatry is one of those fields where there is so much diversity. Even within outpatient, there is a huge range in patients seen and insurances accepted.

An easy low would be 180k. If you are making less than this for 40hrs work then it's because you just don't care to earn more.

 

[peppy]

Wow I'm really surprised that we do now have some less than $150k responses. I'm hoping they ignored the parentheses in the question and didn't adjust their income up if they're only working part time. Otherwise, wow -- academics?

Either a prestigious academic job or maybe someone who is just starting out in their own practice and hustling for work still? Word on the street at my residency was that prestigious academic places pay exceptionally low salaries because they can get away with doing that and still get plenty of interested candidates.
That was one of the factors that helped me come to the conclusion that striving for prestige in the academic world is just not worth it for me. :-D

 

[TexasPhysician]

Either a prestigious academic job or maybe someone who is just starting out in their own practice and hustling for work still? Word on the street at my residency was that prestigious academic places pay exceptionally low salaries because they can get away with doing that and still get plenty of interested candidates.
That was one of the factors that helped me come to the conclusion that striving for prestige in the academic world is just not worth it for me. :-D

Academics is often very cushy. Some may get grant money or be given options to moonlight or build a lucrative part-time practice. The retirement plan can also be quite good. One academic gig provides retirement at 8+% salary. Even academics in certain areas starts at 180+k.

 

[splik]

Wow I'm really surprised that we do now have some less than $150k responses. I'm hoping they ignored the parentheses in the question and didn't adjust their income up if they're only working part time. Otherwise, wow -- academics?

some of the cmhcs around here pay <150k

 

[OldPsychDoc]

Academics is often very cushy. Some may get grant money or be given options to moonlight or build a lucrative part-time practice. The retirement plan can also be quite good. One academic gig provides retirement at 8+% salary. Even academics in certain areas starts at 180+k.

No academic I know would put "get grant money" and "cushy" in the same sentence.

 

[TexasPhysician]

No academic I know would put "get grant money" and "cushy" in the same sentence.

For the record, I didn't place them in the same sentence. I was just trying to point out that even academic jobs can vary significantly.

 

[TexasPhysician]

some of the cmhcs around here pay <150k

Is that what they initially offer or what is being accepted? Does yours come with nice perks?

The cmhcs I've seen come with decent perks and have to raise their salary to attract anyone. This is likely very location dependent though.

 

[Doctor Bagel]

some of the cmhcs around here pay <150k

Really? And they are able to fill those positions? Working fulltime in community mental health here would put you in the low 200s.

As for academic jobs, maybe I'm still feeling a little cynical from training, but benefits in exchange for that lower pay include a pretty big ego boost (professor in your title, nifty write ups on the university website, working at the most prestigious place in town) and getting to push some of the work to others (residents). It would be nice to never have to write progress notes, H&Ps or discharge summaries. Again, I'm sure there are other stressors, but from the outside, it doesn't look like too bad of deal. Even for the outpatient providers, their schedules are less intense than what you see in outpatient anywhere else in the world. And yeah, generally great benefits.

 

[scudiera]

Curious about how many of the big earners are CAP boarded. Hoping some gen psych are 300+.

 

[Blitz2006]

Agreed.

Also curious as to how many 300k plus are on the coasts...

Curious about how many of the big earners are CAP boarded. Hoping some gen psych are 300+.

 

[Doctor Bagel]

Salary information from an anonymous psychiatrist --

"I make in the mid 300's per year by combining a mediocre-paying but very flexible full time inpt psych position with a lucrative weekend coverage locums assignment. That's one way to make more than 300k; the other main way is to combine a salaried job with a private practice. It's hard to make above 275k at a single position."