Switching specialties

[emergentmd]

Who is saying there is no risk? Of course there's risk...as with any business.

Aren't you an owner of a freestanding ED? Would you undo your investment if given the chance or was the risk worth it?

The reality is that a solo psych practice can be opened for minimal $. A surgical subspecialist can start out on the cheap as well by renting a room at a pcp practice a few days a week and operating on the others (and it costs them nothing to do their cases at a hospital or surgicenter who will welcome them with open arms).

Nobody is saying every practice will be a slam dunk let alone be successful...but if you look around you'll see enough creative ways to start small and scale up as you go.

Even if somebody in an outpatient field doesn't choose to hang their own shingle, just having the option to do so gives them a little bit more negotiating power with hospitals...especially when it's time to renegotiate.

The reality is that a solo psych practice can be opened for minimal $. A surgical subspecialist can start out on the cheap as well by renting a room at a pcp practice a few days a week and operating on the others (and it costs them nothing to do their cases at a hospital or surgicenter who will welcome them with open arms).

This statement tells me you do not understand the practice of medicine.

You do not understand how difficult and high risk it is to open up a single doctor practice. If it was much more simple, you would see offices popping up everywhere. There is a reason single doctor practices and small groups are merging/bought out. Doing HR is difficult. Getting the EMR up is difficult/expensive. Getting on Carriers are difficult/expensive. What are you going to do when BCBS (80% market in the area) tells you to take a 80% haircut or not have access to their patients. What happens the next year when they tell you to take a 90% haircut b/c other docs are taking 85%.

What are you going to tell your family that you are working 40 hrs in clinic and another 40 hours at home managing all of the paperwork. What are you going to tell your family when you have to take out a 200K bridge loan b/c BCBS payments are 6 months behind.

Docs are consolidating b/c the time and $$$ it takes to get HR/EMR/billing in order is extremely difficult.

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[TheComebacKid]

How to Increase Your Family Medicine Physician Salary | White Coat Investor

Here's how top physician earners in typically lower-income specialties are killing it and commanding over 2X+ the average for their specialty.

www.whitecoatinvestor.com

“Our first volunteer is Mike, a pediatrician who made $430,000 (>2X the average above) in 2018. He averages eight to nine hours a day, four days a week, 50 weeks a year.”

“Our second volunteer wishes to remain anonymous, but is also a primary care pediatrician who makes $450,000 working 32 hours per week over 4 days and 47 weeks a year. He also takes call 4-5 times a month.”

“This anonymous family practitioner came out of residency in 2016 owing $375K in student loans. He is an employee of a 501(c)3 hospital and made $343K in 2018 and expects to make $415K in 2019 working 42 hours per week over 4 days and refuses to sign into his EMR on his weekday off.”

“Dr. Solo” is a med-peds doc who made $500,000 in 2018 working 35-40 hours/week, 45 weeks/year. He is “always on call” with the solo practice he owns but never goes to the hospital. Call is about 3 after-hours calls per month.

There are unicorn jobs everywhere. There are EM docs pulling in 800k a year. If your advice to an EM trained person is to switch out of the specialty to secure one of these unicorn jobs in primary care, I personally think it's bad advice, but to each their own.

By and large, the average pediatrician will fare far worse financially than the average EM physician.

 

[Brigade4Radiant]

Any specialty that doesn't need a hospital or ASC to practice in, can open their open practice.

When you open your own practice you can capture more money in your pocket by having a smaller overhead than the Big Box shops, and in grand summary the difference of your Gross billings and net income/benefits paid out in employment will be higher because you now control the difference between Gross earnings and Net income.

So yes, I'm providing excellent advice for any specialty that can be office based. Woe are those tied to hospitals.

Actually you’re not because the thing is insurance controls your practice. I have friends who are in private practice let’s say insured Blue Cross just want to lawyer your reimbursement for diabetes checks by half.

Now your practice is at risk for going under. This is why practices are bought out in mass by hospital systems because they can negotiate insurance.

Also you had to pay for dealing with insurance and also the EMR that you have which is very costly.

Which is why it’s wrong to tell people that they can open up a psych practice with minimal money

 

[sloh]

If your practice/business can’t thrive off Medicare rates by VOLUME (yes there are niches out there that fulfill this but they aren’t glamorous jobs), opening up your own practice is a significant gamble. YMMV. No one can predict the future

 

[goodoldalky]

Bottom line, IMO, is you should not pick a specialty solely based on the income/economic dynamics of it. Reason being is it’s probably going to be blown up or changed within a few years anyway, so that specialty you picked for being a lucrative cash based practice now isn’t one... (There are a few exceptions... i.e.: plastics always has been and always will be lucrative due to cosmetics demand and cash based nature..)

Fact is the economic prospects of being a physician in general in the future aren’t great compared to how it has been. But given the rate of change and instability in healthcare, the only choice really is to try and pick the specialty you find most enjoyable/tolerable, pay off your loans ASAP, and sock away as much cash as you can.

 

[turkeyjerky]

I disagree. EPs will be continued to be compensated more than hospitalists. More procedures, fast-paced complexity, and a broader scope of knowledge including trauma, ortho, OB and pediatrics. If salaries become equivalent, far less will pursue EM driving demand up.

It’s on you (generally speaking) if you choose to work for a CMG and deal with their absurdity. I chose to work for a SDG following residency in the not too distant past. It wasn’t hard to find a good SDG. I used my residency alumni network and did my research. I chose a non-malignant SDG to work for in a fairly competitive area, but maybe not the most desirable area to everyone. I ended up with a great job. I have a lot of control over my practice environment. Our contract is incredibly stable with the hospital, and the local community values our group. I never wanted to work for a CMG and never do. I would leave medicine all together before I would. CMGs are just a middle man leach that take away from your compensation without adding significant value. I’m a physician. More than that, I spent years developing my knowledge base, skill set and value, which is worth more than some CMG arbitrarily trying to dictate what I do. When folks are crashing or need something emergently done, they come to me. I don’t consult it out to others. If folks want to believe CMGs aren’t so bad, or that they couldn’t possibly move, or that it’s too hard to find a SDG, then that’s their choice, but not mine. You control what you can control. If you choose to be controlled by a CMG, that’s your call. Meanwhile the sky isn’t always falling for some of us.

Definitely. There'll be even more of a two-tier marketplace coming. In the past it may have been debatable whether the time-cost of a partnership tract job was favorable. This will quickly (already has?) become a moot point as CMG rates approach pre-partner rates. The days of soaking CMGs for above or near-reimbursement rates are over.

Very curious about the people saying how the downfall of EM is only cyclical and will recover without expanding on that notion. The oversupply of EM physicians started long before COVID. There is no way on earth that any of the current residencies open are going to close. It doesn't even appear that expansion is slowing down. Looking through jobs over the past couple weeks, I'm still seeing recruitment for "Residency Program Director" in some bum **** essentially rural places across the board.

Yeah, it's a long-term unfavorable trend w/ a superimposed massive downturn due to covid. I don't see it bouncing back to quite where we were last year for a few reasons, and the long-term trend remains awful.

Look back to some classifieds in the Annals from the mid-2000s, the difference is pretty striking.

 

[Hercules]

Definitely. There'll be even more of a two-tier marketplace coming. In the past it may have been debatable whether the time-cost of a partnership tract job was favorable. This will quickly (already has?) become a moot point as CMG rates approach pre-partner rates. The days of soaking CMGs for above or near-reimbursement rates are over.
.

I’m part of a non-predatory SDG and our compensation formula has kept the pre-partner rate above the local CMG rates for a long time. Now that the CMGs are lowering the hammer it makes our pre-partner offer look even better.

 

[DeadCactus]

How to Increase Your Family Medicine Physician Salary | White Coat Investor

Here's how top physician earners in typically lower-income specialties are killing it and commanding over 2X+ the average for their specialty.

www.whitecoatinvestor.com

“Our first volunteer is Mike, a pediatrician who made $430,000 (>2X the average above) in 2018. He averages eight to nine hours a day, four days a week, 50 weeks a year.”

“Our second volunteer wishes to remain anonymous, but is also a primary care pediatrician who makes $450,000 working 32 hours per week over 4 days and 47 weeks a year. He also takes call 4-5 times a month.”

“This anonymous family practitioner came out of residency in 2016 owing $375K in student loans. He is an employee of a 501(c)3 hospital and made $343K in 2018 and expects to make $415K in 2019 working 42 hours per week over 4 days and refuses to sign into his EMR on his weekday off.”

“Dr. Solo” is a med-peds doc who made $500,000 in 2018 working 35-40 hours/week, 45 weeks/year. He is “always on call” with the solo practice he owns but never goes to the hospital. Call is about 3 after-hours calls per month.

The EM equivalents of these people are making closer to a million a year and I doubt these three are doing well in the era of COVID. If someone is not entrepreneurial enough to make money as an emergency physician, their future in pediatrics is not going to be any brighter.

The reality is that many people in medicine got there by being really good at following directions and flounder in settings that don't have clear goals and directions. I'll go so far as to argue that if the only solution someone can come up with to fix their career problems is to go back into a formalized training program, they probably don't have the personality to start an entrepreneurial business.

 

[namethatsmell]

The reality is that a solo psych practice can be opened for minimal $. A surgical subspecialist can start out on the cheap as well by renting a room at a pcp practice a few days a week and operating on the others (and it costs them nothing to do their cases at a hospital or surgicenter who will welcome them with open arms).

This statement tells me you do not understand the practice of medicine.

You do not understand how difficult and high risk it is to open up a single doctor practice. If it was much more simple, you would see offices popping up everywhere. There is a reason single doctor practices and small groups are merging/bought out. Doing HR is difficult. Getting the EMR up is difficult/expensive. Getting on Carriers are difficult/expensive. What are you going to do when BCBS (80% market in the area) tells you to take a 80% haircut or not have access to their patients. What happens the next year when they tell you to take a 90% haircut b/c other docs are taking 85%.

What are you going to tell your family that you are working 40 hrs in clinic and another 40 hours at home managing all of the paperwork. What are you going to tell your family when you have to take out a 200K bridge loan b/c BCBS payments are 6 months behind.

Docs are consolidating b/c the time and $$$ it takes to get HR/EMR/billing in order is extremely difficult.

Stop being so equivocal, it’s tough to tell how you feel. Who said there wasn’t risk in starting a business? Whoever said it was easy? Again, you can start out cheaper than one would think. Yup, it’d probably be unwise to start from scratch with 0 patients and buy a building, hire a ton of staff, and purchase EPIC. But it’s pretty bold of you to infer that starting a practice is so difficult that nobody should consider going for it. Or do you regret being a practice owner?

3 extended family members have a solo or 2 doc psych practice. Their overhead is tiny and/or went down this year. Another has been a solo peds doc for decades. Med school friend who did family medicine has a solo DPC practice. Several other friends have their own 1-4 doc practices. One has outgrown his space this year and is in the process of doubling his footprint. Despite covid they are all still keeping the lights on and some have been crushing it.

Should EM docs not try to band together and create SDGs and take back contracts from CMGs? Or should they just say “mannnn, eff it. It’s too much risk and work.” ?

 

[emergentmd]

I am not trying to be argumentative or obtuse. But for anyone to say that it takes minimal $ or effort to open up your own practice is plain false and the carriers/government is making is harder every day. Just google doctors around your area, if you live in a reasonable big city, there are very little single doc shops left.

 

[wamcp]

This right here. There’s no mechanism for EM to have a cyclical recovery. We have a systemic oversupply problem. Ask pharmacists when their recovery is coming after the boom days of the 2000s.

Hey how come there is no physician advocacy group that helps protect us? Like a medical association group? /s

it’s sad because in South Korea, doctors (who already have it far worse than we do, true) were on strike couple months ago to stop the government from flooding the market with increased numbers of medical students. Docs there don’t want their job market further destroyed. I could never see anything like that occurring here. Maybe we just have to suffer enough to finally do something, like in other countries

Coronavirus update: As COVID-19 cases jump in South Korea, doctors go on strike

Doctors across South Korea go on strike as coronavirus cases continue to rise, prompting the country's Health Minister to threaten to jail or revoke the licences of those who do not return to work.

www.abc.net.au

Striking South Korean doctors threatened with jail
Health officials in South Korea have ordered thousands of striking doctors to return to work as the country counted its 13th straight day of triple-digit jumps in coronavirus cases.

Health Minister Park Neung-hoo said those who refuse could have their licenses suspended or revoked, or even face a prison term of less than three years.

Doctors in the greater Seoul area joined physicians in other parts of the country in a three-day strike, starting on Wednesday, against Government plans to boost the number of medical students.

The walkouts have forced major hospitals in Seoul to reduce working hours or delay some surgeries, while more than 2,000 medical facilities nationwide reported their intention to close during the strike.

The Government wants to increase the number of medical students by 4,000 over the next decade, saying it's critical for dealing with crises like COVID-19 and reducing healthcare gaps between the highly developed Seoul area and the rest of the country.

But doctors' groups say the country already has enough physicians competing in a cutthroat market.

They instead want the Government to pay trainees more to encourage them to move to areas outside Seoul where health professionals are more needed.

South Korean doctors to end strike over reforms as virus surges

Agreement reached to end two weeks of action after overnight talks with government on its plans for reform.

www.aljazeera.com

Some 16,000 intern and resident doctors, the backbone of South Korea’s coronavirus response in emergency rooms and intensive care units, and temporary testing stations, walked out on August 21.

The doctors oppose the reform proposals, which include increasing the number of doctors, building more public medical schools, allowing state insurance to cover more traditional medicine, and expanding telemedicine.

Under the agreement to end the strike, the Health Ministry has agreed to scrub plans to open new medical schools and train more students, according to Yonhap. It will discuss the other issues once the coronavirus has been brought under control.

 

[Vandalia]

A few general thoughts, not in response to any specific post:

The First Lesson: Healthcare is an imperfect market; but it is still a market subject to supply and demand.

Corollary to the First Lesson: Arbitrage does not work in medicine.

Definition to the Corollary: Arbitrage is used in the simple and generic sense of "make a lot of money with little work." "Medicine" refers only to those who provide actual healthcare.

If there is a specialty that is doing well, forces both inside and outside of medicine will work to limit reimbursement. It is still possible to make a lot of money in neurosurgery or orthopedic spine, but you will spend a lot of time in training and work horrendous hours for that money. Next, as soon as medical students realize there is a golden specialty, demand for those spots will increase, and if there is a demand residencies will be created to meet that demand.

Now, you may say that all a specialty needs to do is to keep a tight grip on training programs and limit/prohibit residency expansion. There are two problems with this: First, patients need to be seen. The U.S. does effectively ration care in some areas; so that, for example, you may not be able to get a TKA immediately. But, for most things, patients need to be seen quickly. This means that either primary care docs pick up some of the slack for that specialty; or mid-levels will start seeing the simple patients. Dermatology may be fine with this arrangement; however, remember that whoever controls the patients has the power As I discussed previously, there are limited options: to increasing the physician supply, to allow non-residency trained (in that specialty) physicians to do some of the work, or to turn it over to mid-levels. Patients need to be seen, and patients today expect immediate care. We are not going back 50 years to when patients thought themselves incredibly lucky to get a Monday morning appointment.

Second, if the demand is not met, politicians and/or different parts of the government become involved. This is where the proverbial sausage is made. Imagine, if you remember, the scene in Casino where the county commissioner was meeting with Lefty talking about his nephew being fired. Imagine the leaders of the ABEM, ACEP, etc., etc. meeting with a few Washington guys: "Well, well, so you are going to effectively prohibit new EM residency programs, and increase the requirements so that some of the poorer programs will have to close. I can surely understand that, I surely can. But I see here that you can bill for the E/M codes, and maybe critical care time, and procedure codes. We may have to take a look at that; I mean maybe the amount a physician can bill should be capped at a 99285."

Now, that is an example; things like that on both sides are far more subtle, but that type of direct threat to a specialty would never happen in real life? Would it? If you see the leaders of a specialty make a dumb move, then 90% of the time it is simply a dumb move. But there are also those times when there is a gun pointed at their back.

Let me throw out this one point that applied equally to my military assignment as a staff officer who was able to sit in on the ultra secret intelligence briefings and was read-in to some other programs:

You only see the very tip of the iceberg. There is more going on behind the scenes than you can even imagine.

Critical access hospitals and their EDs are the equivalent to military basses. Politicians do not let either of those things go without a fight. You are incredibly naïve if you don't think they would hesitate to put a knife to the specialty's throat if we do anything that would put that care in danger.

This does not mean that there are no options; it does, however, mean that the decision space is constrained, and is highly non-linear.

 

[Leonthemedico]

I am a young resident that was undecided between anesth and emergency medicine and ended up choosing FM.
I think choosing the right field is a form of a compromise. Are the positives a field brings enough to compensate for its minuses? Does the lifestyle suit your needs and wishes?
If you think that the current field doesn's give you the satisfaction and you are at the beginning of your careers it is not unwise to change. What are 2 or 3 years of earning compared to a lifetime of misery?

So bellow I describe my thinking. How I chose my specialty and what I see as good or bad in each specialty.

At first I thought I was going to become an anesthesiologist. Anesthesia is a really fun field. The physiology is fun, you can learn the theory fast. Since you are not dealing with every single disease on the planet I find anesthesiology to be cognitively easier to master than EM and FM. The procedures are fun you get paid well, also you get the occasional adrenaline rush. And most of all you don't deal with patients directly.
Well why did I decide not to go to anesthesia? In my country we have this system that allows young physicians to work just as a resident would do before he decides to choose the field. That way we test the field and the higher ups test us. My god, in anesthesia it was the easiest money I earned in my entire life. The problem I saw was the looming saturation of the market. My attending would come, he'd give me the instructions and then he'd leave to drink his coffee while I was doing the case. Which was not difficult at all. Which is fine while you're a resident. But one day one needs to become an attending. And this guy that drinks his coffee is also an attending. So who's gonna do the case? Who's going to give instructions to young doctors? Well given that the market will be saturated the guy that drinks his coffee will do anything in his power to keep me as a subordinate who does the cases for peanuts and keep his position. Until they replace me with a CRNA and the guy with the coffee doesn't get replaced cause he finished his phd and become a higher up.There is no mercy. And being a subordinate worker as a doctor is very demeaning. I can't imagine having a boss all my life. I'd rather have my freedom, my patients and some job security even if it means I'd need to work harder.

So Why did I not choose EM? I also worked at the EM department for a few months. Well that was the most difficult job I ever had. You see patients when they are at their most difficult, most anxious situation in their lives. But it is the the non urgent patients that present at the EM that can really burn you out and are the most difficult. Also the schedule is bad. You want to be a good father that is involved with his kids? Forget about it. You are home in the morning when they are at school and you go to work when they are at home on Sundays and Saturdays. That was a big trade off that I was not willing to commit to. I earned a lot but I felt like it was not worth it. I spend a lot of money on fast food cause I would not cook for instance. On the other hand I really liked reading the EM textbooks, I really liked the adrenaline, the codes, the procedures, the chaos,

Now I am in FM. The field is kind of boring, but I like it. I gives me the freedom to be the master of my own schedule, the possibility to be my own boss, to work directly for my patient, to choose where I live and work, to be there for my spouse and kids when they need me and spend time with them. The field is not saturated so management gives me enough autonomy and freedom for now but in the long run I'll have to open my private practice to keep my freedom. Which is fine I am ok with risking a little money and trying private practice. I only work with two nurses of my choice that work for me and respect me so I don't need to deal with 20 nurses at the EM or in the OR trying their best to make me frustrated because they hate doctors and think they can do my job.
On the downside there are some minuses. There are no codes, no adrenaline, no blood, which is a little boring. I need to know everything about all the asthma phenotypes and all about the collagen disorders and fibromyagia and somatomorph disorders. And treat those conditions. It is cognitively one of the most difficult fields in medicine, the facts are not easy to remember and there is a lot to learn. There's also some administrative work. And of course being the lowest paid doctor while working and learning as hard as many other doctors is a big minus. I know of nurses that earn more than me in the big hospital nearby. But I am at peace about it cause what matters to me is my job security, my freedom and the time I spend with my family.

 

[WilcoWorld]

The future pay for EM can easily spiral downwards to match those of other less demanding specialties at the whim of politicians and eager voting masses chomping at the bit for “free” everything.

It's interesting that you tie future pay cuts to politicians and voters.
It's interesting because the decline in reimbursement I've witnessed in my career is totally unrelated to politicians/voters and intimately related to the actions of corporations and physicians' willingness to work for them.

 

[Candidate2017]

I just had dinner with a neurosurgeon who claimed he had "no paycheck for three months" due to COVID. I didn't press him on details, or how hard that hit him, but that's what he claimed. I mean, it's not like he was forced to order the chicken, or anything. He still got the steak. Just sayin'.

But what wine did he get?

 

[Candidate2017]

I admire psychiatrists very much, and although there are a lot of days I do not enjoy in the ER, I do not think I would enjoy practicing psychiatry very much.

I don't understand why EM docs say they don't like practicing psychiatry when in fact they deal with all the train wrecks that present to the ED floridly psychotic/manic, high, drunk, verbally abusive, violent, in handcuffs, cursing and spitting. Every. Single. Shift.

Whereas, my psych clinic panel is composed of lot of "regular" people and professionals like physicians and med students who are quite nice to work with.

 

[namethatsmell]

I don't understand why EM docs say they don't like practicing psychiatry when in fact they deal with all the train wrecks that present to the ED floridly psychotic/manic, high, drunk, verbally abusive, violent, in handcuffs, cursing and spitting. Every. Single. Shift.

Whereas, my psych clinic panel is composed of lot of "regular" people and professionals like physicians and med students who are quite nice to work with.

Could you have just answered your own question?

Here's the two-step process through which we interact with mental illness in the ED:

1) We receive many psych "train wrecks" as you say who have a remarkable ability to: disrupt the care of other ED patients, assault our staff, siphon off a significant proportion of ED resources (and our time) while sometimes also posing a meaningful threat to our well-being. Aside from ruling out some organic etiologies and addressing some hyperacute psych issues with meds we have no tools to solve these patients' issues. We titrate meds to achieve patient/staff safety.

2) If the patient needs admission, this fun can continue for days or longer as we're expected to serve as a long-term holding pen for these patients, often with minimal support, while we have to try to navigate our glacially slow and anemic inpatient psych system and (insurance authorizations, hooray!) to try to find these patients a home.

What aspect of the above would motivate an EM doc to want to do psych?

I don't doubt you have patients who are quite nice to work with. We'll probably never encounter the majority of them in the ED since your patients are by nature functioning highly enough to see you regularly in psych clinic. Those patients of yours we will see will likely present to us with something like an asthma exacerbation...and as we scan through their history we'll gloss over their dx of MDD or anxiety since it won't impact our treatment of them.

That said, I think I get the gist of what you're saying and I tend to agree -- a lot of EM docs would probably be pretty content seeing your calm and controlled patients in the comfort of a psych clinic where you have some dedicated time/resources/tools to try to help them. Whenever a med student asks me about picking a specialty I tell them to at least consider psych as I think it gets an unfairly bad rap.

 

[HemorrhagicShock]

Psych no longer has a "bad rap" - it's clearly one of the lifestyle specialties and is getting competitive. Especially when you hear stories of psychiatrists being offered half a million per year type jobs because of dire need in more suburban and rural areas. Even an hour or two outside of big cities psychiatrists are commanding incredible wages. The days of psychiatry being a specialty for foreigners and medical school pariahs are over.

 

[HemorrhagicShock]

To add to my thoughts above:

I think EM will start welcoming foreign grads once all these new programs realize that they'll need to fill their classes somehow. I don't think this change will happen soon, but I think it's an inevitability. I'll give a 3-5 year time frame before the advice to foreign grads is "try applying to an EM residency as a back-up or at least as a way to get a license and board certification."

 

[dadaddadaBATMAN]

I don't understand why EM docs say they don't like practicing psychiatry when in fact they deal with all the train wrecks that present to the ED floridly psychotic/manic, high, drunk, verbally abusive, violent, in handcuffs, cursing and spitting. Every. Single. Shift.

Whereas, my psych clinic panel is composed of lot of "regular" people and professionals like physicians and med students who are quite nice to work with.

The answer to your question is the borderlines, bdz seekers and general cluster b stuff.

I keep a good game face dealing with them in the ed, but if I had to spend an hour with some of the folks on a regular basis you’d find my brains on the office windows.

Also my management of the acutely psychotic is pretty straight forward: do they need chemical restraints or not, is there an organic illness or not. If I can answer those two questions I can basically leave the room.

 

[Angry Birds]

To add to my thoughts above:

I think EM will start welcoming foreign grads once all these new programs realize that they'll need to fill their classes somehow. I don't think this change will happen soon, but I think it's an inevitability. I'll give a 3-5 year time frame before the advice to foreign grads is "try applying to an EM residency as a back-up or at least as a way to get a license and board certification."

I think we are being a bit reactionary right now -- last I checked, EM was much more competitive than psych, especially given a significant pay disparity. Yes, if you take the lowest EM pays and compare them to the unicorn Pysch jobs, you can say otherwise... But, really, I doubt that this delta has really closed or even come close to that.

Let's not go to extreme gloom and doom here. Everyone is hurting during COVID.

 

[Candidate2017]

Psych no longer has a "bad rap" - it's clearly one of the lifestyle specialties and is getting competitive. Especially when you hear stories of psychiatrists being offered half a million per year type jobs because of dire need in more suburban and rural areas. Even an hour or two outside of big cities psychiatrists are commanding incredible wages. The days of psychiatry being a specialty for foreigners and medical school pariahs are over.

No need for rural when psych is the specialty where income increases with population density. These rural gigs are bad. You merely enrich The Man by grinding through 2-4 meth users/Addy/BZD-seekers per hour, whom you can't even fire without risk of abandonment because there is no other psychiatrist to whom you can refer. Plus death threats. The real money is from PP/owning a psych clinic. The social workers (yes, social workers) and psychologists in my area who own psych clinics make $500,000 to a million simply by taking a cut from business averse psychiatrists. The hardest part seems to be finding psychiatrists who want to work fulltime.

 

[HemorrhagicShock]

No need for rural when psych is the specialty where income increases with population density. These rural gigs are bad. You merely enrich The Man by grinding through 2-4 meth users/Addy/BZD-seekers per hour, whom you can't even fire without risk of abandonment because there is no other psychiatrist to whom you can refer. Plus death threats. The real money is from PP/owning a psych clinic. The social workers (yes, social workers) and psychologists in my area who own psych clinics make $500,000 to a million simply by taking a cut from business averse psychiatrists. The hardest part seems to be finding psychiatrists who want to work fulltime.

Sure

The overarching point is clear though and we could spend days discussing all the millions of ways in which psychiatrists can practice with satisfaction, independence, and insane reimbursement.

I just hope the real message of AVOID EMERGENCY MEDICINE is loud and clear for anybody who can still choose something else.

 

[wamcp]

Psych no longer has a "bad rap" - it's clearly one of the lifestyle specialties and is getting competitive. Especially when you hear stories of psychiatrists being offered half a million per year type jobs because of dire need in more suburban and rural areas. Even an hour or two outside of big cities psychiatrists are commanding incredible wages. The days of psychiatry being a specialty for foreigners and medical school pariahs are over.

Psychiatry Physician job in

Psychiatry Physician job in

www.practicelink.com

Outpatient Psychiatrist - $300,000 + $160,000 student loan repayment for 4 year contract + $30,000 sign on bonus; 4 day work week/3 day weekends; and additional benefits. No call, No holidays.

Seems attractive, but the location is middle of nowhere, right?

Math comes down to 'base' compensation of $347500 a year plus benefits, with 4 weekdays per week, no call, no holidays...no weekends.. damn

 

[TheComebacKid]

Wow, lots of love for psych here. Grass is always greener. I'll at least play along with psych, unlike primary care/pediatrics as discussed above, which is absolutely ludicrous.

Psychiatry is open to all of the same market forces as every other specialty in medicine, including EM. Given psychiatry has zero procedural components (maybe ECT, TMS, other weird things that I don't know about), it is ripe for midlevel encroachment. In fact, psychiatric NPs are in very high demand at this time. Many of the EDs I work at, there is no physician who assesses psychiatric patients after hours, it's all done via nurse/social worker etc.

The Beverly Hills Child Psychiatrist is not the majority of people who practice psychiatry. How many of these patients are uninsured or on medicaid? You take care of these patients in the ED and likely appreciate what a poor payer mix makes up this population. A significant percentage of them don't have a pot to piss in, let alone private insurance or a way to compensate the healthcare system for the care they receive. The fact that psychiatry has been looped in with Derm, Plastics etc is a bit excessive.

Also, I think quite frankly some of the postings in this thread for other specialties is pretty disingenuous. A unicorn psychiatry job in Geneva, NY is not in any shape or form evidence that the specialty as a whole is booming. Those jobs exist in EM as well.

I'm not saying psychiatry is a dumpster fire of a specialty (like straight up primary care or outpatient pediatrics), I don't get the sense that it is, and in terms of compensation/hour it is likely the best there is in medicine. But I do believe EM can hold its own against psychiatry.

 

[Angry Birds]

Wow, lots of love for psych here. Grass is always greener. I'll at least play along with psych, unlike primary care/pediatrics as discussed above, which is absolutely ludicrous.

Psychiatry is open to all of the same market forces as every other specialty in medicine, including EM. Given psychiatry has zero procedural components (maybe ECT, TMS, other weird things that I don't know about), it is ripe for midlevel encroachment. In fact, psychiatric NPs are in very high demand at this time. Many of the EDs I work at, there is no physician who assesses psychiatric patients after hours, it's all done via nurse/social worker etc.

The Beverly Hills Child Psychiatrist is not the majority of people who practice psychiatry. How many of these patients are uninsured or on medicaid? You take care of these patients in the ED and likely appreciate what a poor payer mix makes up this population. A significant percentage of them don't have a pot to piss in, let alone private insurance or a way to compensate the healthcare system for the care they receive. The fact that psychiatry has been looped in with Derm, Plastics etc is a bit excessive.

Also, I think quite frankly some of the postings in this thread for other specialties is pretty disingenuous. A unicorn psychiatry job in Geneva, NY is not in any shape or form evidence that the specialty as a whole is booming. Those jobs exist in EM as well.

I'm not saying psychiatry is a dumpster fire of a specialty (like straight up primary care or outpatient pediatrics), I don't get the sense that it is, and in terms of compensation/hour it is likely the best there is in medicine. But I do believe EM can hold its own against psychiatry.

Yeah seriously... Some of these posters seem to be psych folks trying to feel better about their specialty choice.
I could make half a million dollars in EM by working half a month at my current job. I choose not to do it because I'd rather have more days off.

 

[blue.jay]

Wow, lots of love for psych here. Grass is always greener. I'll at least play along with psych, unlike primary care/pediatrics as discussed above, which is absolutely ludicrous.

Psychiatry is open to all of the same market forces as every other specialty in medicine, including EM. Given psychiatry has zero procedural components (maybe ECT, TMS, other weird things that I don't know about), it is ripe for midlevel encroachment. In fact, psychiatric NPs are in very high demand at this time. Many of the EDs I work at, there is no physician who assesses psychiatric patients after hours, it's all done via nurse/social worker etc.

The Beverly Hills Child Psychiatrist is not the majority of people who practice psychiatry. How many of these patients are uninsured or on medicaid? You take care of these patients in the ED and likely appreciate what a poor payer mix makes up this population. A significant percentage of them don't have a pot to piss in, let alone private insurance or a way to compensate the healthcare system for the care they receive. The fact that psychiatry has been looped in with Derm, Plastics etc is a bit excessive.

Also, I think quite frankly some of the postings in this thread for other specialties is pretty disingenuous. A unicorn psychiatry job in Geneva, NY is not in any shape or form evidence that the specialty as a whole is booming. Those jobs exist in EM as well.

I'm not saying psychiatry is a dumpster fire of a specialty (like straight up primary care or outpatient pediatrics), I don't get the sense that it is, and in terms of compensation/hour it is likely the best there is in medicine. But I do believe EM can hold its own against psychiatry.

Psych is betting on the possibilities of low investment private practice and fee for service among wealthy areas, which is not feasible for all psych graduates. Psych NPs are getting paid high $ next to CRNA, so many of these nurses are getting into psych program to make big bucks and soon they might saturate the field. I also don't know how much psychiatrists get paid as an employee (which includes medicaid).

 

[TheComebacKid]

Psych is betting on the possibilities of low investment private practice and fee for service among wealthy areas, which is not feasible for all psych graduates. Psych NPs are getting paid high $ next to CRNA, so many of these nurses are getting into psych program to make big bucks and soon they might saturate the field. I also don't know how much psychiatrists get paid as an employee (which includes medicaid).

Agreed. For those that work as part of larger hospital systems/inpatient services etc... I don't get the sense that they are raking it in. Maybe there are some, I can't say for sure.

If you look across America, the state of mental health access is dismal, with many states having zero open psychiatric beds at any given time with ED boarding times for psych patients lasting several days. The reason for this is simple, there is no incentive for hospitals to expand access because these patients don't pay.

There is a good work/life balance likely associated with the specialty with minimal call, etc. There's a lot to like. But I wouldn't counsel a medical student to pursue psychiatry as the "golden ticket" in medicine if they didn't love the work.