So can we talk money?

[thepoopologist]

I have to add, it took minimal effort to obtain these interviews. I sent my CV into whatever contact info was provided with a short message, and I was on the phone or on email talking about interview dates before I had the rest of the application done. All except one reimbursed my travel and lodging. I have to admit, my first 2.5 years of medical schools my thoughts were Gas or IM and I am so glad it didn't work out that way because it turns out I ended up being rather good (not perfect) at psychiatry and the job search has been really enjoyable. I remember looking for jobs after college where it was like a victory to get 20-30/hr and I didn't have travel and lodging paid for and I wasn't taken out to a nice meal and addressed as "Doctor". No complaints here, I'm working 35 hours a week as chief resident of my program and my life in 6 months to a year will be looking pretty good. Anyways, end of my stream of consciousness.

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[vistaril]

overall over the last 6 months I think the salary situation has gotten worse....more encroachment by psych nps may be part of the reason.

Im currently making about 9500 a month and working my ass off, spending 3 hours in the car every day, etc....

 

[finalpsychyear]

overall over the last 6 months I think the salary situation has gotten worse....more encroachment by psych nps may be part of the reason.

Im currently making about 9500 a month and working my ass off, spending 3 hours in the car every day, etc....

Im in the midwest. Are there any RTA or nursing home facilities or are those gigs taken in your area? Either of those alone could add close to half of what your making in a month.Also, in my area the local hospital offers psych 3k for a 48 hour coverage which is a 15 bed inpatient plus ed/consults.

 

[vistaril]

Im in the midwest. Are there any RTA or nursing home facilities or are those gigs taken in your area? Either of those alone could add close to half of what your making in a month.Also, in my area the local hospital offers psych 3k for a 48 hour coverage which is a 15 bed inpatient plus ed/consults.

these gigs are just done by local psychiatrists already(and they just bill independently)...all the local hospitals are already taken by a group whose own psychiatrists see their patients on the weekend(and they bill independently too).....

 

[SteinUmStein]

So, after my 1st month of interviewing, I was offered jobs from all the places I interviewed, for positions ranging from $240,000 to $310,000 for the inpatient/prison/state hospital settings. Only 1 of these offers had call (the highest offer). The others offered a 40 hours work week with no call, reasonable to light workload, with the option of 4/10 hour days. Vacation was about 5 weeks, CME was about 1 week with 1k on average. I am not sure what I will be doing with all the time and money I'll have, because after 6 more years of IBR/PSLF my loans may actually be forgiven. If they aren't, well I guess I'll moonlight with the three days a week I'll have available.

Congrats! If you don't mind, what area of the country are you in? Did you look outpatient as well? Best of luck to you, looks like you'll have lots of great options.

 

[yanks26dmb]

I have to add, it took minimal effort to obtain these interviews. I sent my CV into whatever contact info was provided with a short message, and I was on the phone or on email talking about interview dates before I had the rest of the application done. All except one reimbursed my travel and lodging. I have to admit, my first 2.5 years of medical schools my thoughts were Gas or IM and I am so glad it didn't work out that way because it turns out I ended up being rather good (not perfect) at psychiatry and the job search has been really enjoyable. I remember looking for jobs after college where it was like a victory to get 20-30/hr and I didn't have travel and lodging paid for and I wasn't taken out to a nice meal and addressed as "Doctor". No complaints here, I'm working 35 hours a week as chief resident of my program and my life in 6 months to a year will be looking pretty good. Anyways, end of my stream of consciousness.

Congratulations to on your recent offers and above situation - I'm sure you've worked hard for it.

Quick question since you mentioned moonlighting... how difficult do you think it would be for a psychiatrist to pick up shifts on his off days to bump his salary even further? Like on the off day during a 4/10 schedule as you mentioned...

 

[michaelrack]

Congratulations to on your recent offers and above situation - I'm sure you've worked hard for it.

Quick question since you mentioned moonlighting... how difficult do you think it would be for a psychiatrist to pick up shifts on his off days to bump his salary even further? Like on the off day during a 4/10 schedule as you mentioned...

It is hard to just pick up a random "shift". But let's say you had a 4/10 schedule in which you were off Wednesday. It wouldn't be that hard to find something profitable to do during that day on a regular basis- perhaps work at the local outpatient mental health center every Wed or maybe the same 2 wednesdays every month.

 

[yanks26dmb]

It is hard to just pick up a random "shift". But let's say you had a 4/10 schedule in which you were off Wednesday. It wouldn't be that hard to find something profitable to do during that day on a regular basis- perhaps work at the local outpatient mental health center every Wed or maybe the same 2 wednesdays every month.

Gotcha. Good to know. I imagine there are probably tele-psych companies out there who would be willing to let you work as few as 10-15 hours a week too?

I really like psychiatry, but I'm worried about my debt, returning to live in my high cost area after residency, etc. I don't need obscene amounts of money, but I feel like if I was able to pull in 3-350k in psych I'd be a lot less nervous about the decision.

 

[st2205]

Gotcha. Good to know. I imagine there are probably tele-psych companies out there who would be willing to let you work as few as 10-15 hours a week too?

There are but, at least the ones I'm familiar with, they want some kind of a commitment from you for a certain amount of hours per week (usually at least 8 or so). There are also numerous different setups for telepsych from seeing regular clinic patients to more variable things such as ER/hospital consults/admissions or nursing homes.

I really like psychiatry, but I'm worried about my debt, returning to live in my high cost area after residency, etc. I don't need obscene amounts of money, but I feel like if I was able to pull in 3-350k in psych I'd be a lot less nervous about the decision.

Also worth looking at is actually being being able to return to your high COL area. Over the past few years the vast majority of my friends across all specialties have had to make some compromises about their practice location. Where I'm originally from (and returning to) the market is pretty tough for many specialties and they end up out of state. I'm not sure what to tell them when they respond to me going back as if I've broken in to a tough market because psychiatry is wide open and there were many jobs. Just something to consider.

 

[yanks26dmb]

Also worth looking at is actually being being able to return to your high COL area. Over the past few years the vast majority of my friends across all specialties have had to make some compromises about their practice location. Where I'm originally from (and returning to) the market is pretty tough for many specialties and they end up out of state. I'm not sure what to tell them when they respond to me going back as if I've broken in to a tough market because psychiatry is wide open and there were many jobs. Just something to consider.

Absolutely, this is such a big part of my decision, and is one of the big things that makes psychiatry even more attractive. I really want to be able to get back to SoCal after school and residency.

In your experience, do you feel the number I quoted above is attainable in psych?

 

[prominence]

My job offers were scattered across California and I talked to a variety of psychiatrists from my interview sites about work/moonlighting and such. 300-350k was a common income range, particularly surprising to me given the reasonable amount of hours worked for this income.

I would imagine that putting in 50-60 hours per week working in a salaried position plus a moonlighting facility should translate to an annual income range of $300-350k in Southern California. Is this fair to assume?

 

[st2205]

View attachment 212143

My buddy took a job similar to this. 200k for 5 bed unit. About 1 admission per week and they don't run at full census.

 

[PistolPete]

I wonder what's wrong with that Helena Hospital job in Napa... they've been running that ad for months!

 

[prominence]

I would imagine that putting in 50-60 hours per week working in a salaried position plus a moonlighting facility should translate to an annual income range of $300-350k in Southern California. Is this fair to assume?

Would this similar setup translate to an equivalent salary in NYC, specifically in Manhattan?

 

[Armadillos]

Let's say your excluding Boston/NYC/SF

1 What would would be a typical entry level academic clinician-educator sort of salary?

2 What about typical total salary for an attending with a K-award once you factor in a typical amount of "extra" clinical work to supplement?

 

[dl2dp2]

Let's say your excluding Boston/NYC/SF

1 What would would be a typical entry level academic clinician-educator sort of salary?

2 What about typical total salary for an attending with a K-award once you factor in a typical amount of "extra" clinical work to supplement?

1. Not good. About and usually less than 200k. 150k not uncommon for some types of jobs. Some places pay more than others.

2. Again if you want to go down the K award route the totally salary tends to be awful. I'd say nationwide about 175-180k at the assistant professor level, 150k or less not uncommon at popular places. The math goes something like this: K award pays 100k for 75% FTE then 50k for another 25% FTE adds up to be about 150k. Anything above that the department would have to subsidize you.

There are some interesting tricks and your ability to execute them varies, but that's the ballpark for a 100% FTE at a major academic medical center--which is to say about 30% lower than a typical private facility salary.

 

[dl2dp2]

Would this similar setup translate to an equivalent salary in NYC, specifically in Manhattan?

Manhattan and the rest of NYC are basically two different markets. I posted in a different thread that jobs in Queens are basically paying about the same as jobs in South Dakota. If you want to make a lot of money in Manhattan your best bet is private practice. Facility based jobs are almost always terrible.

 

[prominence]

Manhattan and the rest of NYC are basically two different markets. I posted in a different thread that jobs in Queens are basically paying about the same as jobs in South Dakota. If you want to make a lot of money in Manhattan your best bet is private practice. Facility based jobs are almost always terrible.

Do you mean Queens pays well or doesn't? I have no idea if SD psychiatrist jobs pays well.

 

[dl2dp2]

Do you mean Queens pays well or doesn't? I have no idea if SD psychiatrist jobs pays well.

It's a figure of speech--Queens psychiatrists are paid very well. It's not uncommon to have a 40 hours a week job for around 300k and these jobs are not especially competitive. General rule is avoid state job if you can (almost always fixed salary). City jobs are a mixed bag. Community hospitals affiliated with large centers are your best bet. Large managed care systems (i.e. Northwell) have a salary structure very similar to Kaiser (not surprisingly). These types of jobs tend to have a commute from Manhattan of about 40-90 minutes.

 

[PistolPete]

So, after my 1st month of interviewing, I was offered jobs from all the places I interviewed, for positions ranging from $240,000 to $310,000 for the inpatient/prison/state hospital settings. Only 1 of these offers had call (the highest offer). The others offered a 40 hours work week with no call, reasonable to light workload, with the option of 4/10 hour days. Vacation was about 5 weeks, CME was about 1 week with 1k on average. I am not sure what I will be doing with all the time and money I'll have, because after 6 more years of IBR/PSLF my loans may actually be forgiven. If they aren't, well I guess I'll moonlight with the three days a week I'll have available.

Have you looked into CDCR at all? Any idea what their starting salary is like?

 

[Shikima]

Do not believe MGMA guys.

 

[SteinUmStein]

Do not believe MGMA guys.

What makes you say that? Too high, too low, not reliable? One thing I'm starting to learn is how much salaries/benefits and arrangements can vary not only by region (southeast, northeast etc) but city vs city in the same area.

 

[Jules A]

One thing I'm starting to learn is how much salaries/benefits and arrangements can vary not only by region (southeast, northeast etc) but city vs city in the same area.

And who has done their homework by networking with colleagues to have an idea what a geographic area will support. In many cases it seems to come down to those who are self-assured, business oriented and willing to negotiate for a superior salary. Ask not and receive not.

 

[PistolPete]

Yes, it is a range and can be high (a tad under 300) but you have to come back to them with a competing offer so they can submit to the higher ups for the max starting salary.

I ask because DSH says the exact same thing, so I'm stuck in this weird catch 22 where both only give ranges and both want to see competing offers...

 

[JustAGuy]

I'm wondering if these quoted salaries are total packages (bonuses, benefits, etc) or just base salaries. It's impossible to compare numbers without knowing what each includes. For example, there's a local hospital here where you can make at least 300k, but you have to hustle, it includes no benefits, and you do your own billing. Then you have the VA that only pays maybe $220k, but it's likely the better deal because it's fairly chill and the benefits are awesome.

 

[Shikima]

When you're starting off, there is little room for negotiation. Give service, get payment - in general. There are many nuances to this depending on the need and work environment.

As time goes on, you'll be able to negotiate further and stronger knowing that you're happy but you'll only go to a new environment where you'll be more happy, less work and more pay.

Do not forget your macroeconomics - supply vs demand.

 

[PistolPete]

But isn't the supply of psychiatrists way lower than the current demand?

 

[michaelrack]

But isn't the supply of psychiatrists way lower than the current demand?

In many but not all areas

 

[Chianti]

I'm wondering if these quoted salaries are total packages (bonuses, benefits, etc) or just base salaries. It's impossible to compare numbers without knowing what each includes. For example, there's a local hospital here where you can make at least 300k, but you have to hustle, it includes no benefits, and you do your own billing. Then you have the VA that only pays maybe $220k, but it's likely the better deal because it's fairly chill and the benefits are awesome.

What are standard VA benefits?

 

[Shikima]

PTO, Sick Time, usual benefits (life, health, dental), and maybe the EDRP (if they're not being cheap).

If you work 20 years, most likely end up with a 60k/yr pension, access to the insurance benefits and the TSP (401K).

 

[JustAGuy]

What are standard VA benefits?

Yeah, loan repayment, steady 40 hour weeks (actually less considering admin time), 27 days paid vacation, 15 sick days, 10 paid holidays, pension (rough estimate I've been told 1-1.1% x number of years x average of 3 highest year earnings), TSP savings matching. I think you could retire in mid 50's and get maybe ~$50-60k annual pension pay + income from your TSP (and other savings) + free medical for life.

 

[scootad.]

I have kind of a stupid question. At jobs like the VA, do most people take all or most of their sick days (even when not sick), so the 15 sick days are considered extra vacation days? Or do they require a doctor's note or proof that you are legimately sick?

 

[Jules A]

+ free medical for life.

It was my understanding your health benefits are later portable which is huge but not the same as free medical for life? I also didn't think they were doing a pension any longer although the TSP is better than 401 whatevers I've had at other places.

 

[perox124]

I have kind of a stupid question. At jobs like the VA, do most people take all or most of their sick days (even when not sick), so the 15 sick days are considered extra vacation days? Or do they require a doctor's note or proof that you are legimately sick?

As you would think people abuse the system and call out sick pretty easy. You don't need to bring a proof that you were sick at least when you take sick days sporadically. If you don't use sick days you lose them and they are not considered extra vacation.

 

[JustAGuy]

It was my understanding your health benefits are later portable which is huge but not the same as free medical for life? I also didn't think they were doing a pension any longer although the TSP is better than 401 whatevers I've had at other places.

Maybe the insurance is a shared cost. Not sure of the pension thing. That's just what I was told. I haven't seen a contract yet.

 

[erg923]

I have kind of a stupid question. At jobs like the VA, do most people take all or most of their sick days (even when not sick), so the 15 sick days are considered extra vacation days? Or do they require a doctor's note or proof that you are legimately sick?

In the VA, "sick leave" is to be used when you are sick/don't feel you can work due to your current health status, have doc/medical appt, or when you have to care for others in your family who are sick (sick child, spouse, parent). I don't drain my sick leave bank because that would be stupid, because then if I break my leg or get the Ebola, I'm screwed. But of course I don't not hesitate to use them...that's why they are they are there.

Most of my sick leave ends up being used so I can go to Dr's appt or when one of kids is sick so my wife can go to work.

 

[dl2dp2]

From a strictly financial perspective, 60k a year of pension in your mid 50s is not great. Present value of such whole life annuity at that level is only 1 million. Annuity also has terrible fee structures. The pay shortfall between VA and equity holding private facility compounded over a 20 year span is likely greater than 1 million. Yield of your own 1 million is likely higher than buying an annuity, plus no early death risk and capacity for intergenerational transfer. You do save the hassle of having to manage your own funds, which is the big plus of working for a government agency.

The supply of psychiatrists is low in almost all markets if you take insurance, which is why about 50% of self-employed psychiatrists are cash only. You can be an extremely ****ty psychiatrist and run an insurance based practice and fill within 6 months in most of the country. The corollary of this is that insurance taking private practices now have very variable quality. If you want a quality insurance taking practice, you should probably work for a large academic or integrated care system. Salaries are lower, but your patient load is usually reasonable. Such jobs are very easy to find no matter where you live.

 

[keifernny2]

At the VA Your unused sick leave can be cashed in toward your pension upon retirement. Any sick days left get added on to your service time ("time you've worked at the job") to make it seem like you've worked there longer, and thereby increase your pension checks.

So, if you had a year worth of sick days when retiring after 20 years, your pension would pay you like you'd worked 21 years.

I did the very rough math once and it seemed like, over 20 years worth of pension benefits, a sick day is worth about 30% of its value when used this way.

 

[st2205]

At the VA Your unused sick leave can be cashed in toward your pension upon retirement. Any sick days left get added on to your service time ("time you've worked at the job") to make it seem like you've worked there longer, and thereby increase your pension checks.

So, if you had a year worth of sick days when retiring after 20 years, your pension would pay you like you'd worked 21 years.

I did the very rough math once and it seemed like, over 20 years worth of pension benefits, a sick day is worth about 30% of its value when used this way.

Isn't there a certain cap on it, though, like 6 months worth?

 

[keifernny2]

Isn't there a certain cap on it, though, like 6 months worth?

No cap on sick days. The cap is on vacation days, which are counted separately.


Sent from my iPad using Tapatalk

 

[surfguy84]

Any idea what a private practice doc taking insurance can expect to make putting in 50ish hours a week? Are there any avenues to pursue as a psychiatrist that will allow supplementation of this income?

 

[Shikima]

Any idea what a private practice doc taking insurance can expect to make putting in 50ish hours a week? Are there any avenues to pursue as a psychiatrist that will allow supplementation of this income?

It'll be good.

 

[surfguy84]

It'll be good.

Maybe a better question would have been; how long would it take to fill 50hrs/week as a doc in a desirable socal city?

 

[Shikima]

Maybe a better question would have been; how long would it take to fill 50hrs/week as a doc in a desirable socal city?

Worry about graduation, licensing exams, and managing through residency first. Then job hunting will be next on the chopping block.

I also recommend you read more of the forum as this has been answered in multiple ways.

However, if you're needing instant gratification for self-indulgence, go on indeed and look up psychiatry jobs.

 

[surfguy84]

Worry about graduation, licensing exams, and managing through residency first. Then job hunting will be next on the chopping block.

I also recommend you read more of the forum as this has been answered in multiple ways.

However, if you're needing instant gratification for self-indulgence, go on indeed and look up psychiatry jobs.

Fair enough. I just feel like I should really start working towards a specific path; i.e. bolstering my residency application. Just trying to get a feel for job markets, earning potential in a couple of fields I have interest in. But I appreciate your time and will heed your advice.

 

[TexasPhysician]

Maybe a better question would have been; how long would it take to fill 50hrs/week as a doc in a desirable socal city?

Desirable is a big variable. There are also a big difference in reimbursements. If you see children and take Medicaid, you can fill in a week anywhere. No one wants to do that though.

 

[splik]

I am shocked at how much psychiatrist salaries have gone up in the past year or so. In comparison, academics sucks and affords none of the benefits you used to get (seems more work that is unrenumerated, no gurantee of time for teaching/curriculum development, no time for research without grants, no sabbatical unless tenure track which is only for hard core researchers etc. I would not regard it as cush these days either)

Here is what I've seen where i am (overpriced highly desirable locale with lots of psychiatrists):
- jail 323k/yr w/ 8 weeks vacation. $100k benefits. call is extra ($183/hr)
- prison 240-200k (call extra $141/hr)
-state hospital 240-290k (call extra $141/hr)
- group private practice w/ psychotherapy $290k
- PES in county hospital 300k for 40/hr week (450k for 60/hr)
- PES in different county hospital 270k
- academic-affiliated VA 210k
- academic-affiliated VA 240k
- group private practice w/ psychotherapy$265k
- o/p private academic center $150k
- i/p or c/l public academic center 180k
- c/l academic affiliated county 200k

i am told reasons for increasing salaries in this area is a) to compete with kaiser and b) to offer comparable compensation to unionized employees vs. an company that contracts with various counties

moonlighting/extra help opportunities can pay v. well and in some cases oversubscribed (one is paying $175/hr, one is paying $205/hr, another company is paying $246/hr - this is for overnight PES call, weekend/evening call pays a little less (130-218/hr depending on the county/agency)

There is a heavy cash only market with a new eval being $250-600/hr, median something like $325, mean $425 (i'm sort of making up these averages but they're about right)

If what the incoming administration want happens, we are going to see a precipitous decline in public sector physician salaries in the coming years due to changes in hour grants will be disbursed to states, insurance based renumeration will likely go up based on Tom Price wanting physicians to have more stake in negotiating with insurance companies, access to care for the most vulnerable will decrease, fewer physicians will work in the public sector, care for veterans will be slowly be privatized (voucher based system), and medicare will also be privatized (voucher based system), we may see less cash based practice if insurance renumeration increases, and healthcare costs will increase. add in tax cuts, and overall physician compensation is likely to increase but with worse access, quality and outcomes in healthcare.

 

[F0nzie]

I have noticed a similar trend. In my area salaries have gone up by $40-50 an hour over the last 1-2 years. It's time to ask for a raise or hop to another job!


Sent from my iPhone using SDN mobile app

 

[st2205]

The position I took pays you a flat amount per RVU generated. It has some nice benefits and such but with bonus it equates to $63/RVU, so you can do the math.

If I stayed here where I'm finishing residency you've got:

- $230k inpatient / outpatient mix, 30k sign on, something like up to $120k loan repayment (unclear on details), then about $48/RVU above 4,900. Call weekends are 3k (in addition to keeping RVUs) ~20 beds (average census 15-24). Kicker is overnight weeknight home call is $600 and is easy.

- $250k inpatient M-F no weekends. Crappy facility -- would never work here.

- $235k VA. Essentially no call. Also would never work here (it was my original plan until I actually worked in the clinic/VA).

- Something like $290 for a pretty easy military gig but it's all 1099.

- Where residency is at is like $210. Overall not bad job but as people have stuck around who trained here I don't think many people realize how much more you can get compensated outside the system.

Other places in the location I'm headed to were about $275 for inpatient stuff. My buddy took a $200k gig for 5 beds.

 

[Blitz2006]

I am shocked at how much psychiatrist salaries have gone up in the past year or so. In comparison, academics sucks and affords none of the benefits you used to get (seems more work that is unrenumerated, no gurantee of time for teaching/curriculum development, no time for research without grants, no sabbatical unless tenure track which is only for hard core researchers etc. I would not regard it as cush these days either)

Here is what I've seen where i am (overpriced highly desirable locale with lots of psychiatrists):
- jail 323k/yr w/ 8 weeks vacation. $100k benefits. call is extra ($183/hr)
- prison 240-200k (call extra $141/hr)
-state hospital 240-290k (call extra $141/hr)
- group private practice w/ psychotherapy $290k
- PES in county hospital 300k for 40/hr week (450k for 60/hr)
- PES in different county hospital 270k
- academic-affiliated VA 210k
- academic-affiliated VA 240k
- group private practice w/ psychotherapy$265k
- o/p private academic center $150k
- i/p or c/l public academic center 180k
- c/l academic affiliated county 200k

i am told reasons for increasing salaries in this area is a) to compete with kaiser and b) to offer comparable compensation to unionized employees vs. an company that contracts with various counties

moonlighting/extra help opportunities can pay v. well and in some cases oversubscribed (one is paying $175/hr, one is paying $205/hr, another company is paying $246/hr - this is for overnight PES call, weekend/evening call pays a little less (130-218/hr depending on the county/agency)

There is a heavy cash only market with a new eval being $250-600/hr, median something like $325, mean $425 (i'm sort of making up these averages but they're about right)

If what the incoming administration want happens, we are going to see a precipitous decline in public sector physician salaries in the coming years due to changes in hour grants will be disbursed to states, insurance based renumeration will likely go up based on Tom Price wanting physicians to have more stake in negotiating with insurance companies, access to care for the most vulnerable will decrease, fewer physicians will work in the public sector, care for veterans will be slowly be privatized (voucher based system), and medicare will also be privatized (voucher based system), we may see less cash based practice if insurance renumeration increases, and healthcare costs will increase. add in tax cuts, and overall physician compensation is likely to increase but with worse access, quality and outcomes in healthcare.

As always, informative post.

For interest sake, do you know roughly what $ Kaiser in your area is offering?

Also, those group private practice gigs look solid. Whats the downside?