To Psychiatrists- What is the financial future for the field?

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Psycho Bunny

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I have heard that Psych residencies are becoming more and more competitive to get into (which is strange to me since I've been reading that there will be even more of a shortage of psychiatrists in the coming future). Where do you see the field going in the next 10-15 years? Do you believe the expansion of NPs/other practitioners prescribing psychotropic meds will start to take its toll and lower reimbursement? What about outpatient/private practice in particular? Do you think it'll be harder to start your own?

Im an undergrad gaining research experience to be competitive for clinical PHD program but I'm wrestling with a possible change of heart...and yes I have enormous interests in both psychotherapy and psychopharmacology. And yes I know to get through medical school id need to want to be a Dr first.

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Where do you see the field going in the next 10-15 years? Do you believe the expansion of NPs/other practitioners prescribing psychotropic meds will start to take its toll and lower reimbursement? What about outpatient/private practice in particular? Do you think it'll be harder to start your own?
There are threads on SDN dating back to at least 2012 which predict the end of medicine due to NPs and PAs. Yet, salaries have increased since then. Eventually, those who predict the end of the field may be correct, but I don't know how you are supposed to figure out in advance who those lucky guessers will be.
 
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Psychiatry's future has been brighter than ever. Way more treatment options than ever. Many new mechanisms in the pipeline. Interventional exploding. Explosion of science. Explosion of patient difficulty. Greater and greater need for experts. More and more psych insurance coverage. All states prioritizing mental health. Parity laws putting places on blast.

Salary keeps going up.

NP's keep sucking horribly (not all of them).

Departments desperate for leaders, supervisors, clinical heads... etc. etc.

Psych lookin' good! We sittin pretty
 
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Minimal to no change during the course of your career. The "future" of either field shouldn't play any role in your decision making. The training involved and the actual clinical work of a psychologist and psychiatrist are massively different. Those differences should be your sole focus at this point in your education and decision making.
 
I agree with @comp1. All those questions are distractions when it comes to picking the next step in your career path which is: what is the best fit for you and your personal circumstances and personality?
 
Same thing I'm telling my family. Stay away from both PhD, and MD/DO.

Go into a trade. Welding, plumber, electrician. Even work towards being a general contractor. Look into a path that leads to owning your own business.
Not sure if I would go that far as to dissuade people from going into any sort of academia. If I were to restart undergraduate today, I would look into either econ/finance or some sort of tech field like CS.

I personally probably don't have the intellectual aptitude - but for those who can, quantitative analysis with a large national firm is probably the golden ticket.
 
Look, I'm definitely an outlier around here, though there have been others like me that post or have posted moreso in the past. I'm passing 7 figures this year and I don't run a pill mill, employ a single np (or other employee), or work myself to death.

The money is there for the initiated and creative. Don't listen to those who tell you medicine is dead.
 
Not sure if I would go that far as to dissuade people from going into any sort of academia. If I were to restart undergraduate today, I would look into either econ/finance or some sort of tech field like CS.

I personally probably don't have the intellectual aptitude - but for those who can, quantitative analysis with a large national firm is probably the golden ticket.

If you talk to anyone on tech they will tell you the job market is a bloodbath at the moment. They are not any more immune to negative structural changes than we are.

EDIT: And if we want to talk about fields that are going to struggle with the rise of AIs . . . whoo-boy entry level programmers are high on that list.
 
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Minimal to no change during the course of your career. The "future" of either field shouldn't play any role in your decision making. The training involved and the actual clinical work of a psychologist and psychiatrist are massively different. Those differences should be your sole focus at this point in your education and decision making.
Well if I embarked on this path, I'd be focused on my long term goal, which would want to be having my own private practice prescribing and also doing significant psychotherapy. I wanted to make sure that would still be feasible/marketable in the future.
 
Look, I'm definitely an outlier around here, though there have been others like me that post or have posted moreso in the past. I'm passing 7 figures this year and I don't run a pill mill, employ a single np (or other employee), or work myself to death.

The money is there for the initiated and creative. Don't listen to those who tell you medicine is dead.
That's absolutely astounding!! Could you give some insight as to how you managed that without running a "pill mill"? Are you in a large city?
 
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I feel like choosing tech or finance over medicine would, on average, have historically been a very bad idea for the recent past.
Tech is not for people with difficulty controlling worrying. My sister is a senior software engineer at Google which is one of the biggest and most stable tech companies and the stress level is immense. Her daily stress/hours several years deep into that career are easily twice what I experienced in my residency.

She has this ex who worked as an software engineer for Meta. He would work 10 hours a day, 7 days a week with zero PTO just to survive because that company has a 10-15% annual firing quota where they cull the bottom performers regularly and bring in new Stanford/Berkeley grads who are ready to give their lives up. Imagine being carefully tracked and ranked every quarter against all your coworkers and knowing that 10% of you will be gone by the end of each year...
 
I think if social media continues to exist, mental health will continue to decline. I only foresee psychiatrists being even more needed in the future.
 
That's absolutely astounding!! Could you give some insight as to how you managed that without running a "pill mill"? Are you in a large city?
I work several jobs at once. I consult to er via tele, staff an inpatient correction unit, and will pick up er shifts and some outpatient here and there. I also see patients at a high end substance abuse treatment facility. Seems like a lot on paper but effort/hours wise it's better than those big box outpatient jobs which want you seeing 2 patients per hr for 40 hrs a week. I'm in a VHCOL locale.
 
There are too many factors to predict the future.

My cash practice is still going fairly well, but patient acquisition is harder. The number of “mental health” practices in my area is up 4x due to NP’s. They aren’t great, so I do get referrals from treatment not going well there. Eventually this could be a bigger concern.

Politics and change is hard for Americans, so I don’t anticipate anxiety becoming less of a problem.

My insurance practice is picking up, but the new telehealth codes are reimbursed less. When those hit Texas, I may require in-person only. This could significantly reduce telepsych job reimbursement.

In-person psych demand is still pretty good. Technology gets better and better to reduce practice expenses.

The DEA appears more likely to return Ryan Haight laws. This may kill much of telepsych only jobs, but it’ll help in-person practices thrive.
 
My cash practice is still going fairly well, but patient acquisition is harder. The number of “mental health” practices in my area is up 4x due to NP’s. They aren’t great, so I do get referrals from treatment not going well there. Eventually this could be a bigger concern.
Idk how big this concern will get in terms of actual patient load unless an area becomes totally saturated which is certainly possible. The biggest thing I wonder with this is what type of patients will be coming to psychiatrists vs NPs?

For my telehealth clinic, the most common NP failures I see are the patients with BPD or active moderate/severe PTSD where NPs just threw them on all sorts of meds (usually antipsychotics and other mood stabilizers along with benzos) and the patient either doesn't get better or hates the side effects. I'm confident that I could easily fill a full-time OP clinic with this type of patient in 3-6 months if I wanted to. However, I don't thinks this is the pathology that most psychiatrists want to completely fill their clinics with and oftentimes these patients are either Medicaid/care or don't have great insurance. Imo the work will always be there, it's just a matter of who we're willing to accept as patients.

I think for OP if they're wanting a practice where they mostly do therapy and are also the prescribing physician, it's a great way to set themselves apart and provide an attractive service that will both be in high demand and will also hopefully attract solid patients that aren't just looking for a candy shop or quick fix.
 
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Idk how big this concern will get in terms of actual patient load unless an area becomes totally saturated which is certainly possible. The biggest thing I wonder with this is what type of patients will be coming to psychiatrists vs NPs?

For my telehealth clinic, the most common NP failures I see are the patients with BPD or active moderate/severe PTSD where NPs just threw them on all sorts of meds (usually antipsychotics and other mood stabilizers along with benzos) and the patient either doesn't get better or hates the side effects. I'm confident that I could easily fill a full-time OP clinic with this type of patient in 3-6 months if I wanted to. However, I don't thinks this is the pathology that most psychiatrists want to completely fill their clinics with and oftentimes these patients are either Medicaid/care or don't have great insurance. Imo the work will always be there, it's just a matter of who we're willing to accept as patients.

I think for OP if they're wanting a practice where they mostly do therapy and are also the prescribing physician, it's a great way to set themselves apart and provide an attractive service that will both be in high demand and will also hopefully attract solid patients that aren't just looking for a candy shop or quick fix.

I’m not seeing this. The majority of the general public is under-educated on the matter right now. Many think they saw a “psychiatrist”.
 
I’m not seeing this. The majority of the general public is under-educated on the matter right now. Many think they saw a “psychiatrist”.

when a new patient tells me they saw a "Dr X" I have never heard of, there is a 75% chance when I google their name that they are a CRNP.
 
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when a new patient tells me they saw a "Dr X" I have never heard of, there is a 75% change when I google their name that they are a CRNP.

I have at least several new patients a year tell me they were referred to me from their therapist "Dr. X" who is an....LPC or LCSW lol

The general public has no idea who's who in healthcare settings, in the hospital they'd think the secretary was a doctor or something because they wore a white coat
 
I’m not seeing this. The majority of the general public is under-educated on the matter right now. Many think they saw a “psychiatrist”.
I'm not saying they're seeking me out because I'm a psychiatrist vs an NP, it's that their previous prescriber (usually an NP) was bad and they're now being referred to me because their issues weren't appropriately diagnosed or treated.

Imo, with increased numbers of mid-levels prescribing the types of easier patients a lot of PP psychiatrists would want (relatively stable or lower acuity issues like anxiety or mild to moderate depression) will do just fine with NPs and the more difficult cases who take more time and energy and often won't have great coverage will be those constantly searching for a good doc. In my clinic, these are typically BPD or PTSD patients on the above mentioned meds, sometimes who can't/won't do therapy or just never referred. ETA: this is just what I'm seeing in my pretty limited clinic. I'd be curious what types of patients those in PP or larger outpatient clinics see the most as potential new patients.

Maybe I'm off there, but seems like it makes sense that when there's a larger volume of people prescribing with a similar patient demographic the straightforward/easy patients will be more evenly distributed and any single prescriber will see a lower percentage of them in their clinic while the problem patients that are constantly searching for a prescriber will start to make up a higher volume of patients. No?
 
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I’m not seeing this. The majority of the general public is under-educated on the matter right now. Many think they saw a “psychiatrist”.
My experience so far is that it's the rare exception that a patient is aware their former "psychiatrist" "Dr. X" was an NP. I'm convinced the NP's, at the very least, don't correct patients and suspect many actively mislead. Why else would you name your practice "Psychiatry CityName" despite 100% of your staff being NP's?
 
I've never seen a 100% NP private group practice, much less one called "Psychiatry." Where is this?
 
I've never seen a 100% NP private group practice, much less one called "Psychiatry." Where is this?
Just a humble psychologist who refers patients, but from my own experience, the following places: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts... pretty much anywhere psychiatric nurse practitioners can practice independently.
 
I have heard that Psych residencies are becoming more and more competitive to get into (which is strange to me since I've been reading that there will be even more of a shortage of psychiatrists in the coming future). Where do you see the field going in the next 10-15 years? Do you believe the expansion of NPs/other practitioners prescribing psychotropic meds will start to take its toll and lower reimbursement? What about outpatient/private practice in particular? Do you think it'll be harder to start your own?

Im an undergrad gaining research experience to be competitive for clinical PHD program but I'm wrestling with a possible change of heart...and yes I have enormous interests in both psychotherapy and psychopharmacology. And yes I know to get through medical school id need to want to be a Dr first.
I used to fear NPs taking over the field, then I actually started practicing and realized 9 out of 10 of them truly have absolutely no idea what they are doing and often are far less productive and far more averse to challenging patients than physicians. There's some good ones out there, but my god, the things I've seen prescribed and the absolute deluge of misdiagnoses of challenging patients by the ones that are subpar leaves me quite concerned. There's also a decent number of physicians that are checked out or that were never checked in to begin with. This leaves plenty of room in the field to make a difference and excel just by following evidence-based guidelines and listening to your patients.

I think the field will be fine for at least the next 10 years, but who knows in the wild world of 2025
 
I used to fear NPs taking over the field, then I actually started practicing and realized 9 out of 10 of them truly have absolutely no idea what they are doing and often are far less productive and far more averse to challenging patients than physicians. There's some good ones out there, but my god, the things I've seen prescribed and the absolute deluge of misdiagnoses of challenging patients by the ones that are subpar leaves me quite concerned. There's also a decent number of physicians that are checked out or that were never checked in to begin with. This leaves plenty of room in the field to make a difference and excel just by following evidence-based guidelines and listening to your patients.

I think the field will be fine for at least the next 10 years, but who knows in the wild world of 2025
If AI takes some chunk of our pie, it'll be the midlevels and lowest-effort MD's first. I would not doubt that ChatGPT could do a better job today than a lot of NP's. (I don't think a lot of the 'AI model does better than doctors' benchmarks are good representations of real practice, though, so I'm skeptical of claims that LLM's are already better than most doctors.)
 
Psychiatry is projected to be one of the most protected careers that exists. Sure, encroachment from midlevels and AI are real considerations. My own perspective, midlevels are so awful at the job that you have protection in that regard. With the most pessimistic view possible you know that their salary is your floor so it's not like you won't have a decent living even if things get ****tier than they are now. Our expertise is still valued, just look at the waitlists for a DO/MD vs a midlevel and you'll see. As far as AI goes... I think they will always want a liability sponge to pair with the technology. I believe AI will continue to be a tool we use and not a replacement, in part because mental health benefits from a human interaction (imagine gathering history and making a decision on a severely mentally ill patient). Furthermore, the liability for making medical decisions by some sort of AI with no oversight will inevitably result in some astronomic malpractice case... companies know this, and are not going to take that risk on. I'd love to hear if people have different opinions on this though.
 
Psychiatry is projected to be one of the most protected careers that exists. Sure, encroachment from midlevels and AI are real considerations. My own perspective, midlevels are so awful at the job that you have protection in that regard. With the most pessimistic view possible you know that their salary is your floor so it's not like you won't have a decent living even if things get ****tier than they are now. Our expertise is still valued, just look at the waitlists for a DO/MD vs a midlevel and you'll see. As far as AI goes... I think they will always want a liability sponge to pair with the technology. I believe AI will continue to be a tool we use and not a replacement, in part because mental health benefits from a human interaction (imagine gathering history and making a decision on a severely mentally ill patient). Furthermore, the liability for making medical decisions by some sort of AI with no oversight will inevitably result in some astronomic malpractice case... companies know this, and are not going to take that risk on. I'd love to hear if people have different opinions on this though.
I overall agree.

I'm somewhat hopeful that a lot of the AI stuff matures into useful tools for clinicians rather than attempts to replace them. Same with many other fields that are facing the potential outcomes of AI models.
 
I used to fear NPs taking over the field, then I actually started practicing and realized 9 out of 10 of them truly have absolutely no idea what they are doing and often are far less productive and far more averse to challenging patients than physicians. There's some good ones out there, but my god, the things I've seen prescribed and the absolute deluge of misdiagnoses of challenging patients by the ones that are subpar leaves me quite concerned.
I think this is exactly what others in the thread fear is going to happen or already is happening. Having a panel filled with an increasing proportion of patients with really sick pathology further confounded by terrible regimens attempted by NPs sounds like a nightmare.

NP's might not "take over the field", but what is left over after they're done saturating the field might be extremely demanding work and more likely to be under-compensated given that sicker patients tend to be on medicaid.
 
*Patients don't know they are seeing an ARNP often.
**They don't know their Dx or Tx is amiss.
***Some patients get conditioned by the 'yes' attitude of ARNPs, poor focus, here's your adderall! Low energy, provigil! And having a Psychiatrist who says, um, no, leads to reversion back to seeing an ARNP who says, "Yes."
 
I think this is exactly what others in the thread fear is going to happen or already is happening. Having a panel filled with an increasing proportion of patients with really sick pathology further confounded by terrible regimens attempted by NPs sounds like a nightmare.

NP's might not "take over the field", but what is left over after they're done saturating the field might be extremely demanding work and more likely to be under-compensated given that sicker patients tend to be on medicaid.
The kinds of patients that can afford good care don't want an NP, and the kinds that are so sick they can't afford good care are too complicated for an NP
 
*Patients don't know they are seeing an ARNP often.
**They don't know their Dx or Tx is amiss.
***Some patients get conditioned by the 'yes' attitude of ARNPs, poor focus, here's your adderall! Low energy, provigil! And having a Psychiatrist who says, um, no, leads to reversion back to seeing an ARNP who says, "Yes."
Eh, plenty of bad psychiatrists who do this out there too. Just a higher proportion of NPs doing this or just not knowing what they're doing at all imo. When the care is bad, won't matter what the letters are or if the patient knows them, they'll seek care elsewhere. If solid boundaries are kept and we don't act like pill mills the problem patients will typically leave of their own accord.

I think this is exactly what others in the thread fear is going to happen or already is happening. Having a panel filled with an increasing proportion of patients with really sick pathology further confounded by terrible regimens attempted by NPs sounds like a nightmare.

NP's might not "take over the field", but what is left over after they're done saturating the field might be extremely demanding work and more likely to be under-compensated given that sicker patients tend to be on medicaid.
The CMS reimbursement and adequate payment is a legit concern. The desire to not have difficult patients isn't really valid though. If we weren't prepared for complex cases, then psych (and medicine in general) was a poor career choice from the start. I'm not saying we should all expect a panel of train wrecks, but the desire to just have a cush panel of wealthy, worried-well patients who are easy to deal with is just not realistic for most.
 
The future is bright, but it's more due to the overall extreme need than anything about encroachment, good or bad.
 
I think it's fair to expect that physician salaries in general in the US will regress to the mean of the physician salaries in other peer nations, especially as the US does relatively less well economically compared to them. But I don't see why psychiatry would be affected by that faster than other specialties.
 
I think it's fair to expect that physician salaries in general in the US will regress to the mean of the physician salaries in other peer nations, especially as the US does relatively less well economically compared to them. But I don't see why psychiatry would be affected by that faster than other specialties.
I haven't been able to find this paper since I initially found it back in med school but physicians generally earn around the 95th percentile of income for their country in most countries. I wouldn't expect a huge change in our position relative to other countries unless there was a significant economic downturn here that somehow didn't affect the rest of the world (which is not impossible with the way Trump is going, but also the word is so interconnected that usually there are mutual effects, esp with the rest of the developed West.)
 
I
I haven't been able to find this paper since I initially found it back in med school but physicians generally earn around the 95th percentile of income for their country in most countries. I wouldn't expect a huge change in our position relative to other countries unless there was a significant economic downturn here that somehow didn't affect the rest of the world (which is not impossible with the way Trump is going, but also the word is so interconnected that usually there are mutual effects, esp with the rest of the developed West.)

Claude Sonnet 3.7 with extended thinking and web search enabled came up with this breakdown based on a request to evaluate this statement across OECD countries:

United States​


In the US, the 95th percentile threshold for household income in 2024 was $315,504 DQYDJ. With US physicians earning approximately $353,000 on average Statista, they typically fall above the 95th percentile of household income. Specialists tend to earn significantly more, with many placing well into the top 1-2% of household incomes.


Canada​


Canadian physicians earn the second-highest incomes among OECD countries at around $273,000 Statista. This places them near or above the 95th percentile of Canadian household incomes, though slightly lower on the income distribution than their American counterparts relative to their national distribution.


United Kingdom​


Physician incomes in the UK are substantially lower than in North America. The differential between physician salaries and other professional salaries in the UK appears to be much smaller than in the US Whitecoatinvestor, with physicians falling closer to the 80-90th percentile range of household incomes.


Germany, France, and Other European Countries​


In most OECD countries, GPs generally earned between two and five times the average wage Oecd-ilibrary. In countries like Germany, France, and other European nations, physicians typically fall between the 85th and 95th percentiles of household income, with significant variation by specialty and employment setting.


Australia​


In Australia, physicians, particularly specialists, are well-compensated relative to the general population. In Australia, the income of self-employed specialists was at least double that of self-employed GPs Oecd-ilibrary. Australian specialists likely fall in the 92-98th percentile range of household incomes.


Nordic Countries​


In Nordic countries with more compressed income distributions, physicians still earn substantially more than average workers but may not reach the extreme percentiles seen in the US. They typically fall in the 90-95th percentile range.


Key Patterns Across OECD:​


  1. Specialists vs. General Practitioners: In most countries, specialists earned more than GPs, with particularly large differentials in Australia, Belgium, and Korea Oecd-ilibrary.
  2. Public vs. Private Practice: Physicians working in the private sector tend to earn more than those in the public sector Oecd-ilibrary, affecting their percentile ranking.
  3. Income Distribution Compression: In countries with more compressed income distributions (like Nordic countries), physicians still rank high but the absolute income gap compared to median earners is smaller than in countries with wider income distributions.
  4. Healthcare System Structure: The structure of healthcare systems significantly impacts where physicians fall in the income distribution. It seems that the system of funding health care, rather than a particular method of remuneration, is the most potent factor in conditioning physician income Nih.

Overall, while physicians consistently rank among the highest income earners in all OECD countries, their exact percentile position varies significantly by country. In most OECD countries, physicians typically fall somewhere between the 85th and 99th percentiles of household income, with the highest relative positions observed in the United States, followed by Canada and Australia. The original statement that physicians generally earn around the 95th percentile holds fairly true across many OECD countries, though with notable variation.

EDIT: So no rich country has starving medical specialists who are actually practicing medicine, is the point.
 
I think it's fair to expect that physician salaries in general in the US will regress to the mean of the physician salaries in other peer nations, especially as the US does relatively less well economically compared to them. But I don't see why psychiatry would be affected by that faster than other specialties.
I'm not sure that's a great use of regression to the mean. Why would they regress to the mean of other peer nations as opposed to stay in a similar percentile place in the actual economy they are in? I certainly think there are scenarios in which physician incomes could drop some, but societies across the developed world have clearly noted a preference for doctors to be A) book smart and B) paid at least somewhat accordingly so that people who fit criterion A continue to go into medicine (see the great posts above for data and references).
 
EDIT: So no rich country has starving medical specialists who are actually practicing medicine, is the point.
Nice, I had tried to get chatGPT deepresearch to find the actual paper for me and it wasn't able to do so. Smart to just have it "write the paper" for you haha. The one I had found gave breakdown of GP vs Specialist in each country, with GP's typically being 85-95 and specialists 90-98, depending on country. IIRC the US was 92 or 93 and 97 for GP and specialist, respectively (the paper was pretty old, probably 20+ years old at this point.)
 
Nice, I had tried to get chatGPT deepresearch to find the actual paper for me and it wasn't able to do so. Smart to just have it "write the paper" for you haha. The one I had found gave breakdown of GP vs Specialist in each country, with GP's typically being 85-95 and specialists 90-98, depending on country. IIRC the US was 92 or 93 and 97 for GP and specialist, respectively (the paper was pretty old, probably 20+ years old at this point.)
UK is one notable example to this where GPs often own their own (small) practices and contract out to the NHS. This can lead to significantly higher levels of income than many specialists, even when they specialists work for the private hospitals (they all work for public hospitals but often split time between the two). Quite a well designed system although specialist pay is a bit anemic. Interestingly high prestige fields were often still competitive despite the terrible pay (e.g. neurosurgery). I would love to see some hard data on the competitiveness of specialties in the UK because they seem to somewhat buck the trend of higher pay=higher prestige that we have in the US.
 
I didn't read anything past the first post. I'm not worried. Tbh I think all of medicine is a rat race, which means everybody is just trying to "milk the cow" for as much as they can. Once you learn to be happy with what you have and not compare yourself to what others have, you will be financially more free than anyone else.
 
Where do you see the field going in the next 10-15 years? Do you believe the expansion of NPs/other practitioners prescribing psychotropic meds will start to take its toll and lower reimbursement? What about outpatient/private practice in particular? Do you think it'll be harder to start your own?

No, NPs will not reduce reimbursement. Big Box shops are adding more NPs because reimbursement is trending up.
Yes, it will take a toll as more Big Box shops demand psychiatrists be personally liable for them (supervision). All profit, no risk for The Man as employed psychiatrists become the equivalent of psychiatric anesthesiologists supervising 4 NPs a day.

Yes, PP will be harder to start. Self-employment has been trending down due to Big Box shops lobbying for EMR, increased regs, facility fees, etc., as well as younger attendings preferring employment due to perceived "quick and easy" money to pay off higher med school debt. Doctors in general are now less entrepreneurial, and increased employment leads to less negotiating power, hence more Big Box shops demanding psychiatrists supervise NPs, etc.

I've never seen a 100% NP private group practice, much less one called "Psychiatry." Where is this?

You can see their listings on Psychology Today. Lots of listings like, "Feelgood Psychiatric Clinic, About Me: My approach to psychiatry is holistic..." I'm not sure why this isn't considered practicing medicine without a medicine license.

BTW, Happy Doctors' Day, I suppose.
 
I work several jobs at once. I consult to er via tele, staff an inpatient correction unit, and will pick up er shifts and some outpatient here and there. I also see patients at a high end substance abuse treatment facility. Seems like a lot on paper but effort/hours wise it's better than those big box outpatient jobs which want you seeing 2 patients per hr for 40 hrs a week. I'm in a VHCOL locale.
Man you are juggling like 4 jobs, it doesnt SEEM like a lot IT IS a lot
 
Man you are juggling like 4 jobs, it doesnt SEEM like a lot IT IS a lot
Eh, depends on the hours spent on each. In med school I rotated with a guy who staffed nursing homes, a Geri psych unit, a child psych unit (also med director), did consults at a local 300 bed hospital, AND did outpatient telehealth. Sounds like a ton but was only actually doing around 25 clinical hours per week and was done by around 3pm at the latest every day. Super chill schedule in reality and very cool to see so many different opportunities out there.
 
Eh, depends on the hours spent on each. In med school I rotated with a guy who staffed nursing homes, a Geri psych unit, a child psych unit (also med director), did consults at a local 300 bed hospital, AND did outpatient telehealth. Sounds like a ton but was only actually doing around 25 clinical hours per week and was done by around 3pm at the latest every day. Super chill schedule in reality and very cool to see so many different opportunities out there.

25 clinical hours seems to be an underestimation?

Let's remove nursing home, as rounding is likely just once a week or month. We're left with geri unit, child unit, consults, and outpatient. That's an average of 1.25 clinical hours per setting. Sure, some geri or child are long term boarders. But there's also meetings, collateral, admissions, pages, walking to consults. Perhaps the doc works part time at each setting? What about PM call, weekends, outpatient questions, notes, etc.? Perceived hours from med school attendings can be skewed, and attendings with multiple jobs often dismiss students early so they don't get in the way of efficiency.

This seems different from Jbomba who appears to have 2 main jobs (chill prison job with downtime to do another telepsych gig) + occasional per diem gigs (ED consults, outpatient), which is not all that unusual.
 
25 clinical hours seems to be an underestimation?

Let's remove nursing home, as rounding is likely just once a week or month. We're left with geri unit, child unit, consults, and outpatient. That's an average of 1.25 clinical hours per setting. Sure, some geri or child are long term boarders. But there's also meetings, collateral, admissions, pages, walking to consults. Perhaps the doc works part time at each setting? What about PM call, weekends, outpatient questions, notes, etc.? Perceived hours from med school attendings can be skewed, and attendings with multiple jobs often dismiss students early so they don't get in the way of efficiency.

This seems different from Jbomba who appears to have 2 main jobs (chill prison job with downtime to do another telepsych gig) + occasional per diem gigs (ED consults, outpatient), which is not all that unusual.
It was multiple PT roles. Contracted with 4-5 nursing homes to see patients on a monthly basis for $2-4k/ NH/mo (this was around 2015, so before laws around psychotropics and geri patients in NH/ALFs got ridiculous), so basically did a week of this. Did geri unit and consults at the same hospital and averaged about 2-3 consults a day with geri unit only having 10 beds total, did this 2 weeks per month. Had a contract with the hospital but contracted with residents and fellows to act as moonlighters and would pay them $X per patient for them to cover consults or the geri unit some days. Staffed the child psych hospital 1 week per month (7 days) and was the busiest week for sure, closer to FT for that week. Did the telehealth on days when he wasn't doing other jobs or between other patients on slower weeks (consult/geri week).

Response to outpatient questions was basically "Can you talk at X time" and would squeeze them in as quick appointments unless it was just a refill request for non-controlled meds. Didn't take call other than the weekend he was on for child psych but was always available by phone for his med director role. He had a close friend who designed a personal EMR for him to document the NH and telehealth encounters and submitted billing through this himself for telehealth. Was clearing 7 figures back then.

Med students can have a skewed perspective, but mine is not for this situation. I indirectly work with him now (he's contracted with an affiliate hospital) and he's still doing a lot of the same stuff. I also discussed working for him a year or two ago, so also have discussed this stuff through an attending's lens. Guy is still making bank, but has expanded since I rotated with him as a student and probably works closer to actual FT hours now.
 
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