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
Short comment from me:

MediCare actually reimburses quite well on 99213/99214/99215 because when MediCare calculates its reimburesment schedule for the procedural codes, it takes overhead/manpower, etc. into calculation. That's why traditionally, when psychiatrists were using 90801 (the equivalent of 90792 nowadays, after the change in CPT code in Jan 2013) and using 90862 (the equivalent of 99213), MediCare did not reimburse those codes that well. Now that MediCare scrapped those codes and psychiatrists can use 99203/99204/99205 and 99213/99214/99215, these E/M codes actually reimburse quite well, because, guess what, neurosurgeon's and other docs also use those codes. And they have a lot higher overhead than psychiatrists.

As a result, commercial insurances (like Anthem and United HealthCare/Optum) actually do not reimburse 20% better than MediCare anymore (yes, they used to reimburse 20% better on 90801 and 90862 compared to MediCare's reimbursement on 90801 and 90862). Now, when the commercial insurances sign a contract with you, they know you are a psychiatrist and have low overhead. Don't be surprised that their 99213/99214/99215 is even 10% lower than what MediCare reimburses.........
 
Thewonderer said:
Short comment from me:

MediCare actually reimburses quite well on 99213/99214/99215 because when MediCare calculates its reimburesment schedule for the procedural codes, it takes overhead/manpower, etc. into calculation. That's why traditionally, when psychiatrists were using 90801 (the equivalent of 90792 nowadays, after the change in CPT code in Jan 2013) and using 90862 (the equivalent of 99213), MediCare did not reimburse those codes that well. Now that MediCare scrapped those codes and psychiatrists can use 99203/99204/99205 and 99213/99214/99215, these E/M codes actually reimburse quite well, because, guess what, neurosurgeon's and other docs also use those codes. And they have a lot higher overhead than psychiatrists.

As a result, commercial insurances (like Anthem and United HealthCare/Optum) actually do not reimburse 20% better than MediCare anymore (yes, they used to reimburse 20% better on 90801 and 90862 compared to MediCare's reimbursement on 90801 and 90862). Now, when the commercial insurances sign a contract with you, they know you are a psychiatrist and have low overhead. Don't be surprised that their 99213/99214/99215 is even 10% lower than what MediCare reimburses.........
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Ugh that blows. 10% lower than MediCare? What if you're one of the few child psychiatrists in town, can you use that as leverage when you're negotiating with insurances for rates?
 
PistolPete said:
Ugh that blows. 10% lower than MediCare? What if you're one of the few child psychiatrists in town, can you use that as leverage when you're negotiating with insurances for rates?
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You are free to use whatever leverage you have. You are not an employee of the insurance company. For all intents and purposes, you are an independent contractor. So you are free to do whatever you want. If you like the rates, sign them. If you don't like the rates, don't sign them.
 
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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Show rate in my clinic has consistently been above 90%. I haven't had a cancellation or a no-show now for 2 straight weeks. I do see a lot of Medicaid, but I don't see how my collections are going to be less than 350k or so, which translates into a salary of around 300k for me plus a lot of perks.
 
W19 said:
Anyone here has a Monday-thru-Thursday job!
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No, but I know people who do. Definitely doable in psychiatry, especially in outpatient. Here, Kaiser outpatient jobs generally have one day off a week, and it's easy to get a community outpatient schedule with one day off a week. In private practice, you can do whatever you want.
 
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I could have a four day week if I worked 10 hour days. I'm sure they'd be fine with that and I consider it from time to time. Still working on getting into the flow of things first.


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Information Underload said:
Show rate in my clinic has consistently been above 90%. I haven't had a cancellation or a no-show now for 2 straight weeks. I do see a lot of Medicaid, but I don't see how my collections are going to be less than 350k or so, which translates into a salary of around 300k for me plus a lot of perks.
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Why is the show rate so high? I would love a 90% show rate. Please tell me the secret.
 
smalltownpsych said:
Why is the show rate so high? I would love a 90% show rate. Please tell me the secret.
Click to expand...

There is no secret. There are a few commonly used methods. In private practice, the standard practice is charge full fee for no show. In medicaid clinic, you either charge a no show fee ($50), or have a limited number of no shows and you no longer accept the patient. Unfortunately usually Medicaid clinics even with a no show fee has a high no show rate i.e. 15-20%, and while you can take a credit card at intake for incidentals, often these charges can't be pursued, and missed time slots are not covered by the no show fees.

Make sure patients sign a contract with these stipulations.
 
sluox said:
There is no secret. There are a few commonly used methods. In private practice, the standard practice is charge full fee for no show. In medicaid clinic, you either charge a no show fee ($50), or have a limited number of no shows and you no longer accept the patient. Unfortunately usually Medicaid clinics even with a no show fee has a high no show rate i.e. 15-20%, and while you can take a credit card at intake for incidentals, often these charges can't be pursued, and missed time slots are not covered by the no show fees.

Make sure patients sign a contract with these stipulations.
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Thanks. Some of these we already do and unfortunately we haven't been able to institute a no show charge. We actually get resistance from other medical providers at our hospital when we terminate patients. Not so much wth psychotherapy patients but more so the medication only patients who tend to.prefer the controlled substances. These patients get scheduled for intakes with me periodically and I am lucky if they make that appointment. We usually don't schedule another. We have an extremely high substance abuse problem in our community and no treatment program for it. So that affects our numbers significantly.
 
smalltownpsych said:
We actually get resistance from other medical providers at our hospital when we terminate patients. Not so much wth psychotherapy patients but more so the medication only patients who tend to.prefer the controlled substances. These patients get scheduled for intakes with me periodically and I am lucky if they make that appointment. We usually don't schedule another.
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Are the providers on salary without much incentive to eliminate no-shows?

It makes no sense to not charge a no-show fee in a private practice. Even with insurance, medication only stimulant patients are generally lower billing codes. If they pay less, it makes sense to terminate or bill for lost time.

If salaried though, I'd prefer no-shows for a more relaxing day.
 
TexasPhysician said:
Are the providers on salary without much incentive to eliminate no-shows?

It makes no sense to not charge a no-show fee in a private practice. Even with insurance, medication only stimulant patients are generally lower billing codes. If they pay less, it makes sense to terminate or bill for lost time.

If salaried though, I'd prefer no-shows for a more relaxing day.
Click to expand...

Exactly. If the hospital loses $ every time a no-show happens, you bet someone up there will push for a fee/termination. On the other hand, if you are salaried, who cares? Let 'em (the dept chairs) play amongst themselves.

I actually think clinically it's also a much better practice, especially for substance use disorders. Given the lack of providers at large, it's much better for the community to fill the treatment slots with people who actually want treatment and can't get it than schedule no-shows that take up time that's not appropriately used.
 
TexasPhysician said:
Are the providers on salary without much incentive to eliminate no-shows?

It makes no sense to not charge a no-show fee in a private practice. Even with insurance, medication only stimulant patients are generally lower billing codes. If they pay less, it makes sense to terminate or bill for lost time.

If salaried though, I'd prefer no-shows for a more relaxing day.
Click to expand...
We can either work on a productivity basis or a salary basis and I don't know who is on which other than in our department. I know that our ortho guy has not gone on productivity since we are personal friends, but I have no idea about the family practice docs who tend to be our biggest referrers and also the ones who don't want us to cut off the patients for not showing. I actually think their main objection is they don't know how to deal with patients showing up in their office talking about how they were treated unfairly. Since the only person who can prescribe here is a NP without much expertise, that magnifies the problem. I personally have never received any negative feedback for terminating a patient probably because I don't provide any drugs. These types of patients tend to self-select away from my caseload pretty quickly. Also, I am pretty good at helping my patients not be such a pain in the neck for everyone. It's often my number one target for intervention. "I am depressed because no one likes me". "Hmmm. Maybe no one likes you because you act like a jerk." This is the shorthand version, obviously. 😛
 
Slightly relevant question: any recommended resources for self-study on the financial aspects of practicing psychiatry of medicine in general. I've heard a number of folk mention White Coat Investor. Any others books, web sites, forums, etc?
 
If their main objection is not knowing what to do with these patients when they bitch, perhaps the simplest solution would be to offer to come in and do an in service on just that. A well spelled out policy in advance that you have patients sign off on and then can refer them to later is also helpful.


Sent from my iPhone using Tapatalk
 
smalltownpsych said:
Why is the show rate so high? I would love a 90% show rate. Please tell me the secret.
Click to expand...

I see strictly a child & adolescent population in an area with a shortage of psychiatrists in a primarily rural/small town population. That may help. There is no no-show fee in the clinic. They do send out messages the day before their appointments.
 
Information Underload said:
I see strictly a child & adolescent population in an area with a shortage of psychiatrists in a primarily rural/small town population. That may help. There is no no-show fee in the clinic. They do send out messages the day before their appointments.
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Ah. The kids do have a higher rate of showing up since the parents want them there. If I could get other people to bring the adults in, that would get it done. Often family or friends or other community agencies are more motivated for the patient to get treatment than the patient is, that's for sure. I had to clarify with our receptionist the other day that the patient has to make the appointment after I got two no-shows from two different agencies who made the appointment for the patients. 🙄
 
I work in an inpatient unit in a southern smaller town (about 45,000) adjacent to a larger town (total metro about 450,000). I get paid approx $60/RVU, which I believe is the MGMA 75th%. Hospital pays me the money whether it is collected or not, which seems appropriate because I am doing the work. I carry between 9-12 inpatients, call day once a week and one weekend a month, with variable consults to medical floors. Hospital is currently paying for therapy codes which adds to the RVU count. I generate about 550 RVUs/month. Social work mostly does discharge planning so everything else is pretty much on me regarding collateral, family meetings, and safety plans at discharge. Bill mostly 99232, rarely 99231. For extended encounters 99356 is also paid. Though most notes are billed on complexity, not on time, which on my inpatient unit is almost always a level 99232 followup or level 99223 admission. It is a busy job, always interesting, often stressful. We do good work and I can't imagine seeing 20 psych inpatients in 6 hours (or less) like some have mentioned other psychiatrists do. This type of job is the best employed way to maximize income IMO. There are zero no shows in the hospital. If I wanted to take more call weekends I could easily do it because the other doctors want to work less, not more. This applies to admits as well, if I wanted all the day's admits I could take them and stay until 8PM because the other docs want to minimize their work. If I wanted to add outpatient the hospital would let me work in the clinic as well and maintain the same RVU pay structure, but inpatient is busy enough right now.
 
nexus73 said:
I work in an inpatient unit in a southern smaller town (about 45,000) adjacent to a larger town (total metro about 450,000). I get paid approx $60/RVU, which I believe is the MGMA 75th%. Hospital pays me the money whether it is collected or not, which seems appropriate because I am doing the work. I carry between 9-12 inpatients, call day once a week and one weekend a month, with variable consults to medical floors. Hospital is currently paying for therapy codes which adds to the RVU count. I generate about 550 RVUs/month. Social work mostly does discharge planning so everything else is pretty much on me regarding collateral, family meetings, and safety plans at discharge. Bill mostly 99232, rarely 99231. For extended encounters 99356 is also paid. Though most notes are billed on complexity, not on time, which on my inpatient unit is almost always a level 99232 followup or level 99223 admission. It is a busy job, always interesting, often stressful. We do good work and I can't imagine seeing 20 psych inpatients in 6 hours (or less) like some have mentioned other psychiatrists do. This type of job is the best employed way to maximize income IMO. There are zero no shows in the hospital. If I wanted to take more call weekends I could easily do it because the other doctors want to work less, not more. This applies to admits as well, if I wanted all the day's admits I could take them and stay until 8PM because the other docs want to minimize their work. If I wanted to add outpatient the hospital would let me work in the clinic as well and maintain the same RVU pay structure, but inpatient is busy enough right now.
Click to expand...

Never had a position with RVUs, you're saying $60 per RVU and 550 RVU a month equal= $33k a month? Is it a pure production model with these RVUs with no other salary/benefits?
 
sweetlenovo88 said:
Never had a position with RVUs, you're saying $60 per RVU and 550 RVU a month equal= $33k a month? Is it a pure production model with these RVUs with no other salary/benefits?
Click to expand...
It is RVU production for take home, but also an employed position with benefits. It is not an independent contractor situation. It was one of the better offers during my job search, but similar jobs are available across the country in smaller places that are hurting for psychiatrists. For example, regarding how much they were hurting for docs, this place was looking for a year before I was hired, and it took another year to hire an additional psychiatrist for expanded demand. For some reason they struggle to recruit psychiatrists.

I believe chicagochildpsych has as similar work setup in metro Chicago, though he/she is working 12 hour days and making a lot more than me. And it could be that as a child psychiatrist, these opportunities are available in big cities. My experience as a general adult psychiatrist was no place in a big city will pay you this way because they don't have to; the hospital will employ the doc for somewhere between $225K-$260K, or less, because the supply of adult psychiatrists in large metropolitan areas is plentiful.
 
Anyone here with nursing home and/or assisted living staff privilege(s)? How does that work? I know a 2 psych MD who do that... and I am curious if it makes sense financially since the majority of these patients have medicaid...
 
nexus73 said:
It is RVU production for take home, but also an employed position with benefits. It is not an independent contractor situation. It was one of the better offers during my job search, but similar jobs are available across the country in smaller places that are hurting for psychiatrists. For example, regarding how much they were hurting for docs, this place was looking for a year before I was hired, and it took another year to hire an additional psychiatrist for expanded demand. For some reason they struggle to recruit psychiatrists.

I believe chicagochildpsych has as similar work setup in metro Chicago, though he/she is working 12 hour days and making a lot more than me. And it could be that as a child psychiatrist, these opportunities are available in big cities. My experience as a general adult psychiatrist was no place in a big city will pay you this way because they don't have to; the hospital will employ the doc for somewhere between $225K-$260K, or less, because the supply of adult psychiatrists in large metropolitan areas is plentiful.
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Not so easy even in big cities to get Psychitarists anymore. I had a similar offer , only the offered rvu was $50, they seemed like ready to negotiate and this is a big city. I let it go just cos I have been on call so much in my current job that I am looking to go private outpatient. I think money in private outpatient with good insurance patients should be comparable. Correct me if I am wrong.
 
Dharma said:
Slightly relevant question: any recommended resources for self-study on the financial aspects of practicing psychiatry of medicine in general. I've heard a number of folk mention White Coat Investor. Any others books, web sites, forums, etc?
Click to expand...

Bask in the joy of setting your own hourly rate. See as many or as few patients you like. Provide a superbill. Subtract office and insurance expenses. Boom. Now you're an expert.

Strong residency programs offer a private practice seminar in PGY4, which is what I took.
 
lol, more info on my program. Faculty are paid right around the 25% mark. Nurses are paid at the 90% mark. Clearly it's a money issue.
 
Final Update.

n=53.
40% earn > 300k.
17% earn >400k.

Impressive. Should send this data to medscape, lol.
 
Information Underload said:
I just can't see this as anywhere close to a representative sample.
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I think the problem is people work fewer than 40 hours but are extrapolating to 40 hrs in these calculations. The calculations aren't taking into account traveling to an additional site, assuming equal pay, etc. Home call is not being included in hours.

Too many assumptions based on a single question.

The only take-away point I see is that 400k is certainly feasible if you really hustle in the right combination of jobs.
 
Information Underload said:
I just can't see this as anywhere close to a representative sample.
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I think working hospital inpatient for RVUs (with call weekends) or being in private practice can hit these numbers with 50+ hours a week (maybe fewer?). Any salaried position isn't going to come close because the employer is going to pay the median per MGMA or AMGA salary reporting, which is far less than what the psychiatrist actually generates. A community mental health center is certainly not paying $300K for a psychiatrist to see 8 patients a day with 5 no shows.
 
I think working hospital inpatient for RVUs (with call weekends) or being in private practice can hit these numbers with 50+ hours a week (maybe fewer?).
Click to expand...

I see how that can be the case, and I guess I'll see when my first productivity bonus comes around. I just look at revenue generated from my own inpatient weekend work (Q5 weekends rounding on about 30 patients per day on the unit with about 4-7 new patients for Saturday and Sunday), and that generates only about 4.5k per weekend using Medicare rates (level 3 admits x 6 ($200 each) = $1200, level 2 progress notes at $70 each x24 Saturday and 27 Sunday = $3570) , so around 45k of reimbursement for my work. Even if the hospital lets you keep 80% of that, you're looking at only 35k extra salary or so, which is nice, but add that to the MGMA, and you're not at 400k.

Am I wrong in that thinking?
 
Information Underload said:
I see how that can be the case, and I guess I'll see when my first productivity bonus comes around. I just look at revenue generated from my own inpatient weekend work (Q5 weekends rounding on about 30 patients per day on the unit with about 4-7 new patients for Saturday and Sunday), and that generates only about 4.5k per weekend using Medicare rates (level 3 admits x 6 ($200 each) = $1200, level 2 progress notes at $70 each x24 Saturday and 27 Sunday = $3570) , so around 45k of reimbursement for my work. Even if the hospital lets you keep 80% of that, you're looking at only 35k extra salary or so, which is nice, but add that to the MGMA, and you're not at 400k.

Am I wrong in that thinking?
Click to expand...


Why are you billing level 3 evals for inpatient work? This may be a lack of inpatient billing knowledge on my part. My outpatient billing is all level 4/5.

Level 2 outpatient notes are not even trying. Again, i could be way off as I don't do inpatient.
 
So this is pretty amazing.
17.5 % of psychiatrists are making more than $400K a year.
36.6% are making more than $300 K a year.

I assume some of you are in academics or work at the VA or are just out of residency, so if you eliminate those, the amount making greater than $300K and $400K a year must be even higher.
 
TexasPhysician said:
Why are you billing level 3 evals for inpatient work? This may be a lack of inpatient billing knowledge on my part. My outpatient billing is all level 4/5.

Level 2 outpatient notes are not even trying. Again, i could be way off as I don't do inpatient.
Click to expand...
Inpatient levels go from 1 to 3, with 3 being the highest. There is no 4 or 5.
 
Information Underload said:
I see how that can be the case, and I guess I'll see when my first productivity bonus comes around. I just look at revenue generated from my own inpatient weekend work (Q5 weekends rounding on about 30 patients per day on the unit with about 4-7 new patients for Saturday and Sunday), and that generates only about 4.5k per weekend using Medicare rates (level 3 admits x 6 ($200 each) = $1200, level 2 progress notes at $70 each x24 Saturday and 27 Sunday = $3570) , so around 45k of reimbursement for my work. Even if the hospital lets you keep 80% of that, you're looking at only 35k extra salary or so, which is nice, but add that to the MGMA, and you're not at 400k.

Am I wrong in that thinking?
Click to expand...
Are you being paid based on the RVUs generated multiplied by a dollar amount, or are you paid based on actual revenue generated/collected? It's simple to work out if it's the former.
 
nexus73 said:
Are you being paid based on the RVUs generated multiplied by a dollar amount, or are you paid based on actual revenue generated/collected? It's simple to work out if it's the former.
Click to expand...

I am paid based on revenue. In some ways, less ideal than RVUs--or, like you said, harder to calculate. Thus, I get nothing for productivity for self-pay patients. The two (RVU and revenue) are related, of course. I do think it is helpful for negotiating to understand how much revenue one generates.
 
Is psych the new derm or radiology? Making bank with a great lifestyle.

Amazing how psych has been a cash cow for so many making $400K plus a year.
 
Dermatologists work hard long days seeing a boat load of patients. A psychiatrist can only get there after they build up a practice, and live in a region where they can charge good money, like $250 and up per hour.

Work up to that volume and geography then yes psych is the new derm. For the rest of psychiatrists they are probably looking at $200 - $250K for something steady, then augmenting with a second psych job if they so choose.
 
LoudBark said:
So this is pretty amazing.
17.5 % of psychiatrists are making more than $400K a year.
36.6% are making more than $300 K a year.

I assume some of you are in academics or work at the VA or are just out of residency, so if you eliminate those, the amount making greater than $300K and $400K a year must be even higher.
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Your logic is faulty. The survey was worded in a way that grossly inflators salaries.

I work a couple horrible pes shifts that no one wants so they pay bank. They are graveyard and its contract work (no benefits, etc). If I extrapolated that for the sake of the survey, I would say I WOULD be earning $400k/year.

A more accurate survey would ask how many people ARE earning $300 or $400k per year. It is nowhere near the 50% the survey suggests.

Psych is a very goo gig and it pays well, but I want to caution folks so that they don't misinterpret surveys written like this.
 
LoudBark said:
Is psych the new derm or radiology? Making bank with a great lifestyle.

Amazing how psych has been a cash cow for so many making $400K plus a year.
Click to expand...
Nope. Certainly not the case. The last thing we need is such misunderstandings becoming a lure towards this field.
 
Sorry guys if I was misleading. Psych can never match the volume, procedural abilities, and income potential that Derm has. With the right payor mix and volume, Derm can make over $1 Mill per year. I think what I was referring to was that the special group of higher Psych earners - those who can see a full day of patients and earn handsome rates in cities like New York City, Palo Alto, Boston, and Los Angeles - can match the average salary of a non-Mohs, general dermatologist. We're talking $350 - $400K. That's how I was comparing it, but should have explained a bit more. At the same token, Derm is not what it once was either.
 
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TexasPhysician said:
Still disagree.

Academic derms at my med school earned over 400k for 40 hrs gig. Private practice can be much more at 40hrs.
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The concern a lot of people in derm have is that the way they sometimes maintain those volumes is by biopsying 90% of what walks into their clinic and sending it off to a pathologist. It turns out that a nurse practitioner is just as qualified to do this as someone with an MD. Obviously you will not see NPs doing Mohs any time soon but punch/shave mills are just one CMC meeting away from getting ophtho'd
 
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