So can we talk money?

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How much money are you making (or would make assuming you worked full-time)

  • $400k/year or more

    Votes: 26 16.3%

  • $300,000 to $399,000

    Votes: 28 17.5%

  • $250,000 to $299,000

    Votes: 27 16.9%

  • $200,000 to $249,000

    Votes: 44 27.5%

  • $150,000 to $199,000

    Votes: 20 12.5%

  • Less than $150k/year

    Votes: 15 9.4%
  • Total voters
    160
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sluox said:
This happens, and IMHO is very exploitative. They end up getting candidates who are primarily women who cannot move or negotiate very much due to family and other outside circumstances. Usually these positions also have very high turnover.
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Women are also socialized not to negotiate and take what's given to us. Shame on these employers.
 
Doctor Bagel said:
With the second one, so there was no way to make additional money? Like could you see your own private pay patients in clinic or were you stuck with medicaid types of patients for clinic, too? If not, wow, that salary sucks. Did anybody take the job?
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Unless you did an evening clinic, on your own, in your own place, own infrastructure, no there was not a way to make more money.

michaelrack said:
Unless call on weekends was minimal, I would take the 190k with no call and then make much more than an extra 20 k doing call 1-3 weekends per month somewhere else
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See Below

Doctor Bagel said:
Yeah, what is the twice a month call? Weeknights from home with no expectation of going in? Weekends in house?
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Weeknights from home, no going in. Weekends in house for 2-3 hours each morning. Residents see everyone.

sluox said:
This happens, and IMHO is very exploitative. They end up getting candidates who are primarily women who cannot move or negotiate very much due to family and other outside circumstances. Usually these positions also have very high turnover.
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Yeah, it's been a problem at this institution for a while. The School of Medicine takes a TON off the top. They do well-ish because a lot of people want to stay in the area.
 
Doctor Bagel said:
Women are also socialized not to negotiate and take what's given to us. Shame on these employers.
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TexasPhysician said:
They do this to everyone. It's on us to negotiate hard.
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Yeah, pay disparities btwn men and women for equal work make no sense in medicine since we make our money based directly off of productivity and codes. Also, from what I can tell, while the problem is slightly worse for women, ALL psychiatrists seem to suck at negotiating, and ALL of us have no idea what we bill for and/or bring in. There is a giant discrepancy there, whereas the difference between salary and billing/revenue is far smaller in other fields.
 
masterofmonkeys said:
Yeah, pay disparities btwn men and women for equal work make no sense in medicine since we make our money based directly off of productivity and codes. Also, from what I can tell, while the problem is slightly worse for women, ALL psychiatrists seem to suck at negotiating, and ALL of us have no idea what we bill for and/or bring in. There is a giant discrepancy there, whereas the difference between salary and billing/revenue is far smaller in other fields.
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Yeah, I think we feel bad about negotiating and especially about talking about money. We're also maybe a group of people who are worse at details than other physicians.

About university pay sucking, that's making me a little worried in my town because they're putting together a big, combined inpatient unit between the university and two of the bigger private hospitals. All the employees of this new system will be university employees, meaning if you do inpatient/emergency work, your options of not working for the academic center are much smaller. I'm hoping that doesn't drive down wages. I'm also hoping the whole monopoly aspect of it doesn't also drive down wages. The quote I heard from a friend regarding pay was maybe $30k below base inpatient pay. I'm hoping we psychiatrists band together and ask for our worth.
 
splik said:
Erm what is your point? Is there any profession that pay disparities make sense?!
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Don't want to set off a firestorm here, but INSIDE of any given field, within any given job description, pay disparities between men and women do tend to actually mirror productivity relatively closely. So here's what I'm trying to say: In medicine, working the same job, at the same facility, earning the same number of RVUs, everything is so cut and dried as far as pay that there should be NO pay discrepancy at all.
 
Doctor Bagel said:
Yeah, I think we feel bad about negotiating and especially about talking about money. We're also maybe a group of people who are worse at details than other physicians.

About university pay sucking, that's making me a little worried in my town because they're putting together a big, combined inpatient unit between the university and two of the bigger private hospitals. All the employees of this new system will be university employees, meaning if you do inpatient/emergency work, your options of not working for the academic center are much smaller. I'm hoping that doesn't drive down wages. I'm also hoping the whole monopoly aspect of it doesn't also drive down wages. The quote I heard from a friend regarding pay was maybe $30k below base inpatient pay. I'm hoping we psychiatrists band together and ask for our worth.
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What really concerns me about what's happening in academic medicine is that the lower pay isn't justified in terms of lower revenue/productivity/etc. It's just Big Machine Academic Bureaucracy parasitizing the pie. This is what I told the one facility that offered that hilarious compensation package. I wouldn't mind earning dirt if it's because the hospital made dirt, losing revenue to the education mission, and because we were treating mostly low income/low insurance folks. But I did mind earning dirt while basically generating the same revenue as a private doc earning 80% more. I'm idealistic, but I'm nobody's fool. Except, you know, maybe I own.
 
masterofmonkeys said:
What really concerns me about what's happening in academic medicine is that the lower pay isn't justified in terms of lower revenue/productivity/etc. It's just Big Machine Academic Bureaucracy parasitizing the pie. This is what I told the one facility that offered that hilarious compensation package. I wouldn't mind earning dirt if it's because the hospital made dirt, losing revenue to the education mission, and because we were treating mostly low income/low insurance folks. But I did mind earning dirt while basically generating the same revenue as a private doc earning 80% more. I'm idealistic, but I'm nobody's fool. Except, you know, maybe I own.
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Our university outpatient clinic only sees private insurance people -- no Medicaid and no Medicare unless you're grandfathered in. So yeah, they should be getting the same payments as any other private clinic in town. I think they are less busy, though so that could explain the lower salaries. Community and Kaiser types of places are 13+ patient a day things, which I don't think is the norm for attendings in the outpatient clinic where I trained.
 
There is limited negotiating power in my area and the salaries are lame. The scene is also overflowing with NPs. I can't even remember the last time I did a doc to doc with an actual doctor for my admitted patients.

It will just be a matter of time before the market is saturated which will keep MD salaries stagnant. NPs however, may see their salaries take a nose dive at the rate they're being pumped out.

How many patients are we going to keep cramming in an hour to keep deluding ourselves of our fate? Every now and then I convince myself I need to find a hustling job then talk myself out of it.

Our society is devolving at such a rapid rate with our need for instant gratification and shortcuts, it won't be long before the vine and snapchat of Psychiatry is here. At least the younger generation probably won't care.
 
F0nzie said:
There is limited negotiating power in my area and the salaries are lame. The scene is also overflowing with NPs. I can't even remember the last time I did a doc to doc with an actual doctor for my admitted patients.

It will just be a matter of time before the market is saturated which will keep MD salaries stagnant. NPs however, may see their salaries take a nose dive at the rate they're being pumped out.

How many patients are we going to keep cramming in an hour to keep deluding ourselves of our fate? Every now and then I convince myself I need to find a hustling job then talk myself out of it.

Our society is devolving at such a rapid rate with our need for instant gratification and shortcuts, it won't be long before the vine and snapchat of Psychiatry is here. At least the younger generation probably won't care.
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Your post has officially made me sad. 🙁 Good things don't last, though -- see the radiology thread. I do wonder about the NP issue -- I can see employers wanting us to be equal and hence driving down wages for everyone. You'd think inpatient psychiatry would be the last place to be taken over by NPs.
 
So when that time comes, do psychiatry part-time and an entrepreneurial business pursuit part-time. You'll always have ways to make $400K with a psychiatry background if you're creative and motivated.
 
To recap/update, n=38 and we still have >40% earning >300k (20% >400k). Solid. 1 in 5 psychiatrists making over 400, yeah I'll take that.
 
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Shikima said:
To put it in appropriate perspective, how many hours per week is that?
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I agree, we need more details. Also location would be nice to know, as well as how many are non child psych.

But as I keep quoting the 2013 Medscape stat, "70% of psychiatrists work <40 hrs, 90% work less than 50 hours".

Frightening.

I dunno, the numbers are still pretty damn impressive regardless, and even more so for a "non-competitive" speciality.
 
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No call. I don't believe in call any longer unless it's the sleep lab needing help with a PSG. I have my patient's trained to call during business hours or else go to the ER and become admitted - but with the help of the excellent therapists, this isn't a problem.
 
Blitz2006 said:
Sounds just as good, if not better, than a typical ER salary. 230-250ish on the east coast for 3 12s, 36 hrs/week.
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In all honesty, I wouldn't mind finding a job like that as long as there isn't call. It's basically just doing a brief, focused interview with a H&P and have SW collect collateral. And then you dispo either for a medical or psychiatric admission. People would come by and curbside you. Now, I would make it clear that I'm not doing C&L and that the work environment is strictly in the ER.
 
Shikima said:
In all honesty, I wouldn't mind finding a job like that as long as there isn't call. It's basically just doing a brief, focused interview with a H&P and have SW collect collateral. And then you dispo either for a medical or psychiatric admission. People would come by and curbside you. Now, I would make it clear that I'm not doing C&L and that the work environment is strictly in the ER.
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Doesn't sound too bad. My city doesn't have much in the way of dedicated psych ED types of jobs. I think they're coming, but they don't exist yet.

Call still sucks. I am call right now and just placed a very lame hospitalist consult for a probably dramatic patient, but I'm not in house and not driving back in, so there you go.
 
Are you skilled in ECT? You can obtain more money if you are willing to do this at a hospital that is already set up for this. I knew one psychiatrist that did ECT with inpatient and had an outpatient practice. In fact, as a PA-C, I have the opportunity to be trained in ECT. But, adding to much to your plate can obviously contribute to burnout. For this reason, I may not consider it.
 
Interesting seeing these. I am curious how my current primarily outpatient gig will turn out financially. I get a base of $200k with some student loan payments and pretty good benefits. For anything that I collect from billing above $200k, I get 55% for the first 50k, 65% for the next 50k, and then 75% for everything beyond this. I also round on the inpatient unit every 6th weekend and typically carry a few inpatients during the week, as well, which is included in these figures. I am definitely not seeing patients for volume, with 30-minute follow-ups and 1.5 hour initial evals.
 
Outpatient show rate might be an issue to make productivity.
What is the opinion on Nursing home psychiatry consults? Why Psychiatrists don't do those as you could easily have your own biller, no show rate and plenty of patients?
 
psych2009 said:
Outpatient show rate might be an issue to make productivity.
What is the opinion on Nursing home psychiatry consults? Why Psychiatrists don't do those as you could easily have your own biller, no show rate and plenty of patients?
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Easy money if you can find a job like it.
 
Shikima said:
Easy money if you can find a job like it.
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I know some geriatrics people in the community who had jobs like this. What about liability, though -- antipsychotics with geriatric patients with dementia is a hot button issue. One of those things where you read occasional articles in the paper about. One big career goal of mine is to never be mentioned in the paper for an article about patient mistreatment (unless I'm offering some sort of generic expertise or something). 🙂
 
Doctor Bagel said:
I know some geriatrics people in the community who had jobs like this. What about liability, though -- antipsychotics with geriatric patients with dementia is a hot button issue. One of those things where you read occasional articles in the paper about. One big career goal of mine is to never be mentioned in the paper for an article about patient mistreatment (unless I'm offering some sort of generic expertise or something). 🙂
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Practice good medicine. They're in a protected environment. More than likely you'd need your own malpractice unless you're apart of a health system.
 
Shikima said:
Practice good medicine. They're in a protected environment. More than likely you'd need your own malpractice unless you're apart of a health system.
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Of course I also hate geriatrics, so no nursing home work for me.

Speaking of higher liability and more possibility of bad press writeups, what about prison work? Definitely lucrative.
 
Doctor Bagel said:
Of course I also hate geriatrics, so no nursing home work for me.

Speaking of higher liability and more possibility of bad press writeups, what about prison work? Definitely lucrative.
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I've wondered about this and the protections you have against their antisocial behaviors. They can always launch a lawsuit against you or any number of complaints just because they can.
 
Just saw this in my E-mail....


The Department of Psychiatry at a well-respected hospital in Milwaukee is seeking a full-time Psychiatrist to join its practice. All candidates must be BC/BE trained in Psychiatry. The Department offers an integrated approach to the diagnosis and treatment of mental health problems, including psychiatric treatment of patients admitted to the hospital, inpatient Behavioral Health units, consultations to medical and surgical patients as well as prescribing and monitoring medications. Primary responsibilities include .25 FTE inpatient treatment and consult and liaison to other hospital units, .75 FTE outpatient clinical practice at one of the integrated primary care clinics and one-in-six week after hours/weekend call rotation for the hospital inpatient units. Additional experience in the treatment of clinical addiction is welcome but not a requirement of this opportunity.



Salary is competitive with the top Psychiatrists in this practice earning just under $400,000 annually.


lol
 
I'll be a cheesehead AND join the brew crew for 400k 😀
 
Sounds like compensation is based on production which might mean you have to work your tail off to get that 400k. I am at a gig like that and there is a limit on how much you can do and still remain effective. Also, even if you think that you wouldn't push it so hard and just settle for around 300k, you will probably get tons of pressure from admin to do more. I tend to do well in this environment myself because I am pretty efficient and have always had more RVUs than the average even when I wasn't getting paid for it cause I was on salary.

In other words, if you can't get paperwork done quickly, get patients out the door on time, and find yourself spending over an hour trying to get psychosocial info from a chatty drunk when on call, a salary job might be better for you.
 
smalltownpsych said:
Sounds like compensation is based on production which might mean you have to work your tail off to get that 400k. I am at a gig like that and there is a limit on how much you can do and still remain effective. Also, even if you think that you wouldn't push it so hard and just settle for around 300k, you will probably get tons of pressure from admin to do more. I tend to do well in this environment myself because I am pretty efficient and have always had more RVUs than the average even when I wasn't getting paid for it cause I was on salary.

In other words, if you can't get paperwork done quickly, get patients out the door on time, and find yourself spending over an hour trying to get psychosocial info from a chatty drunk when on call, a salary job might be better for you.
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This is true and I suspect that there's a catch somewhere with that job... (i.e. probably close to 60hrs/week on average than 40, +call). But let's not delude ourselves. This is not cards. Or even rads. The point being though that the cards or GIs at a similar facility might make > 500k, but the difference here is not that big, and they work a LOT harder and generally way more headaches with their ridiculous staffing needs and overhead. And this shows that it's possible these days for an efficient facility based GENERAL (non-child, non-addiction, non-forensic) psychiatrist to out-earn an intensivist or non-fellowship trained general surgeon...which to me is unthinkable a few years back. I think what happened is: 1) therapy add-on codes 2) supply and demand mismatch in the past few years actually INCREASED in our favor. I think the average non-academic job around the country that I've looked at from all the ads I'm getting in the mail this year are now closer to 250-270k (I'm guessing total comp) than 200k.
 
Good point by Sluox. Reimbursement codes are higher. We can bill $300-500 an hour with 99214s and add ons. Insurance practices may start picking up more speed again. Cash may be less relevant but still have its place in the market. I have noticed a good number of new insurance practices getting off the ground and expanding quickly. The growth potential is insane.
 
sluox said:
Just saw this in my E-mail....


The Department of Psychiatry at a well-respected hospital in Milwaukee is seeking a full-time Psychiatrist to join its practice. All candidates must be BC/BE trained in Psychiatry. The Department offers an integrated approach to the diagnosis and treatment of mental health problems, including psychiatric treatment of patients admitted to the hospital, inpatient Behavioral Health units, consultations to medical and surgical patients as well as prescribing and monitoring medications. Primary responsibilities include .25 FTE inpatient treatment and consult and liaison to other hospital units, .75 FTE outpatient clinical practice at one of the integrated primary care clinics and one-in-six week after hours/weekend call rotation for the hospital inpatient units. Additional experience in the treatment of clinical addiction is welcome but not a requirement of this opportunity.



Salary is competitive with the top Psychiatrists in this practice earning just under $400,000 annually.


lol
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hmmm, I wonder if it's the same place in Milwaukee where a friend of mine went up to work at. Said psychiatrist recently told the hospital "decrease my call burden or I'm quitting."
 
I graduated from residency this July and am making approximately 400k doing contract work through my s-corp. I get to maximize my tax deductions and contribute more to retirement. Keep in mind though I have zero paid time off or holidays. So far I have not taken any time off and worked extra to make up a holiday when needed. I am doing this for now because of my high student loan burden which is coming along quite nicely if you check my thread in the finance forum. Also in my local area, the pay here for employed physicians is terrible because it is desirable major metro area. Malpractice is covered at all jobs except one where I pay 2k a year.

This is what I do:

3 weekdays outpatient telepsych from home at $150/hr, 8 hours a day, one hour new eval, 30 min f/u. average to around 12-15 patients a day
2 weekdays at a outpatient local clinic at 150/hr, 8 hours a day, around 15 patients a day, lots of new evals scheduled at 45min
2 weekends a month inpatient at a major hospital at 4200 a weekend. high volume inpatient rounding with no call or new inpatients.

That is 40 hours a week and then two full weekends a month where I have to travel to a different city with expenses covered.

If you multiple that out over 52 weeks you get right around 400k without any vacation.

I started that 2 day a week clinic job two months ago and I am beginning to despise it. I want to try a private practice those 2 days a week. I think I shall be resigning soon but am waiting for them to get me on all the insurance panels saving me the trouble.
My questions for F0nzie, is it really possible to make $300+ per hour billing the new EM codes 99213/99214? I guess I won't know until I try it for myself. However, I heard the reimbursement in this city is not good due to the high concentration of docs and insurance companies setting the terms.
 
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Do a CPT code search in your area. The Medicare rates in my area are $108 for 99214. Insurance typically pays 20% higher. 3 follow ups an hour and you're breaking $300.
 
Maybe Fonzie or others can answer this, but what I'm wondering is, will insurances and/or MediCare pay for a 99213+90833 or 99214+90833 for a patient you see monthly for med management and do some CBT or supportive therapy? How do they determine "medically necessary"? Because in my book therapy is the starting point for all patients, and meds may or may not be needed.
 
PistolPete said:
Maybe Fonzie or others can answer this, but what I'm wondering is, will insurances and/or MediCare pay for a 99213+90833 or 99214+90833 for a patient you see monthly for med management and do some CBT or supportive therapy? How do they determine "medically necessary"? Because in my book therapy is the starting point for all patients, and meds may or may not be needed.
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I'm VA with a somewhat insanely low RVU requirement and no real productivity bonus but I document and code as a 99213+90833 as my default for half hour appointments (my documentation could probably justify level 4 if I wanted to), but I was wondering the same thing. I have a couple patients I check in with a few times a year who have an established therapist and don't want or particularly need meds from me. I do a little therapy, motivational interviewing, whatever the situations needs, and do an overview of their biopsychosocial existence.

It's hard to say I wouldn't deserve my usual level 3 plus add on just because I'm not tossing some sertraline their way, but I was wondering what type of oversight that would get in the private world.
 
F0nzie said:
Do a CPT code search in your area. The Medicare rates in my area are $108 for 99214. Insurance typically pays 20% higher. 3 follow ups an hour and you're breaking $300.
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Thanks for the update, Medicare is about the same here as well. A lot of the docs here take Medicaid HMOs which don't tend to pay very well. There is one that dominates the market, psychcare/beacon. Do you just completely avoid them? I wonder if I can have a practice here without them or if some of them actually pay adequately.
 
sweetlenovo88 said:
Thanks for the update, Medicare is about the same here as well. A lot of the docs here take Medicaid HMOs which don't tend to pay very well. There is one that dominates the market, psychcare/beacon. Do you just completely avoid them? I wonder if I can have a practice here without them or if some of them actually pay adequately.
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A bunch of the multispecialty physicians groups that I looked at around here were flat out "no public aid" for outpatient psychiatry. So assumedly it can be done.
 
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