G Sheb
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Must be a joke, no?
450K after a tax means you're probably earning around 1 million in France.
Now public salary information for psychiatrists there is more like 90K.
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- Thread starter whopper
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Must be a joke, no?
450K after a tax means you're probably earning around 1 million in France.
Now public salary information for psychiatrists there is more like 90K.
I m earning 900-850k a year yes - there are some financial twists which im not well versed into and for which I have very low interest that make it so i dont have to pay that much taxes on money i dont need for a living
90k is the average in public hospital psychiatry, I m in private practice
One can potentially earn 7 figures before tax in Australia as a psychiatrist, but it usually involves a lot of medicolegal work (high $$$$ per assessment), high numbers of private admissions (high volume/turnover) or both. Then again, I'm hearing more and more about people charging a grand or more for adult ADHD assessments...
The dilemma for high income earners here (as I suspect is probably the case in France) is the progressive tax system where the highest rate (47%) kicks in at 180k.
While our taxes aren't as high as they are in France, they are still quite high.
However, the answer to this and what I don't see many talk about on here, is setting up a defined benefits plan. And if you're fortunate enough to loop a spouse into it as an employee, you can tax save hundreds of thousands of dollars every year.
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You get paid that much for directly seeing patients, or are there other components to that income?
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He’s seeing like a zillion patients a day if I remember from another thread.
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U.S. patients, if they have some sort of third party payor, don't know how good they have it in terms of quick access and choice.
In most of the world, medical access is strictly controlled, including the physician pipeline. As I understand it and maybe someone can expound, in France, one's high school national test scores determine entry into a limited number of spots into college/med school. Then, one's college/med school national test scores determine one's pick of specialty training. For example, the #1 scoring person gets first dibs on the specialty of their choice, then it proceeds down the line. I assume psychiatry in most countries is of lower popularity than the U.S., so the wait to see a psychiatrist is very long.
In the U.S., we could also see a zillion patients a day if we are freed of EMR requirements, multiple third party payors, malpractice, customer service culture, quality metrics, shared decision making, social work, civil rights, etc. The most important mandate in most countries is to see as many patients as possible given the government's finite budget and formulary, and unwillingness to go into debt to finance healthcare.
Seeing patients in private practice (with a medical assistant) and in a mental health clinic
Stopped seeing new patients at 1200ish
45% kicks in at 162k
I ve spent a few hours/days with "finance gurus" and theres so many way to cheat out taxes etc, apparently no one pays that much taxes and you re supposed to invest and all that jazz, I really dont care for it but finding someone trustworthy to handle this is turning out to be quite a challenge
G Sheb
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Out of curiosity, how does the system work in France?
I imagine you're getting paid cash.
Do you just see a ton of patients an hour or do you charge a lot for each encounter? is it just for medication management?
Why would people chose private when there's universal health care system for a fraction of the cost? Is it just wait times?
I think the average salaries even for private practice is much lower than what you're reporting here. So you're probably a very rare case.
I see a lot of patients
I do whatever i feel like doing with them, sometimes i do some quick CBT and theyre thankfull because im the only mental health specialist around that does something else than supportive therapy, sometimes they just want medication management - which usually is just reducing the obscene dosage previous providers used
Patients dont pay a dime be it in private or public sector, in the "private" sector about 20% of patients have to "pay" but they get refunded of the whole amount about 3 days later
The only real cost they have is around 30 euros a months for a health mutual
For the other 80% of the patients im getting paid by the social health care system, they dont even advance the money, it costs them nothing
The public sector has over 1 year of waiting time and isnt even accepting new patients at this time
For psychiatrists the average salaries you see in private are doctor who either do psychanalysis which takes up a lot of time or are part time
Given the amount of taxes the psychiatrists i know prefer to have free time than working
G Sheb
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That’s a bit insane to me but it makes sense.
Lots of patients in line waiting so whoever sees them reaps the “benefits”.
I’m still curious though, what kind of psychiatrist would still chose to go in the public sector and earn 90k max a year?
It seems like in both cases you’re getting paid by the government but in the “public sector” you’re a government employee and in “private” you’re not?
I am not sure I understand the difference and why there’s so much disparity in pay when the government is paying you anyways.
Here working in public may have other benefits, such as retirement fund contributions, annual leave, sick leave, study leave etc. Because the income stream is more stable, more junior psychiatrists might opt for some public work as it gives them advantage in applying for home loans. While the pay disparity isn’t as great here, it’s still substantial.
Sometimes personality issues are a factor too. One of my first public bosses was very arrogant and dismissive, so it wasn’t surprising to hear that he’d had a few goes of running his own private practice and failed at this. He didn’t seem too friendly or collegial with nurses or admin staff, so I did wonder how we went with his own reception staff. My experience was that he was very rigid, more driven by KPI targets as opposed to individual care, and lacked the flexibility and interpersonal awareness to adapt.
Can think of another boss in a director position who had an interesting quirk where if you asked him a question, it would get thrown back at you in a roundabout way and you end up having more questions – this was reported by everyone from allied health, trainees and other qualified psychiatrists. So while he dabbled in private for a while, he seemed to have trouble building up the numbers and returned to the public service after about a year. I don’t remember him being a terrible director of services, and while he didn’t have any of the negative personality attributes of the first boss, my guess is that private patients didn’t like his approach, or referring doctors didn’t feel they were getting their needs met. Here they refer with a clinical question, so the expectation is that you will deal with it.
To summarise this was probably someone who just doesn’t make decisions, or at least it’s not his automatic mode of operation. At an administrative level sometimes we can operate by consensus and working in public provides more protection. However, when dealing with patients one on one at times they will rely on our expertise and while we obviously want patients to make informed decisions, sometimes they defer to us. Can’t be sure if this is anxiety or extreme risk avoidance, but it’s certainly not uncommon. Was just thinking about a story relayed to me by colleague on his medical rotation where the senior doctor would round and make vague comments like “maybe order a CT or maybe order an MRI” leaving the junior staff confused.
Finally, there is the aspect of laziness. I’ll say most of my colleagues in public psychiatry are extremely hard working, but there are some that relish getting paid for not doing much. If patients cancel you still get an hourly wage as opposed to the fee for service private environment, and some are very good at dumping their work on the junior trainees. The most extreme example I can think of is someone who was employed across two public services, and would frequently “disappear” by telling both locations that he was working at the other – someone eventually caught on to this.
Due to the way our tax office has defined income, the only option we have to reduce taxable income is to invest in investment properties (already bubble territory) and deduct the loan interest. One can eek out a very comfortable existence working part time, and obviously the mental toll of the work contributes to this too.
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I can share some experience since there's always a lot of comparison between the Canadian and American health systems.
In Canada, everything is fee for service. The pros are that psychiatry can be quite lucrative here, though I think a lot of those practices churn and see high volumes. I see a lot of pts who complain that they've had 20 minute intakes done. Many psych docs are pulling in more than 500k CDN; and the sentiment is that if you make less than half a mil, you did something wrong that year. Very tempting, but personally that kind of practice is not for me. Malpractice is great, like $2500 and the government reimburses 75% of that. No benefits like retirement matching, and we don't need health insurance. Another plus is that everyone is a contractor and incorporated, so you can deduct expenses and defer taxes in a corporation which becomes you de facto retirement savings account. Being a contractor is great too, you get to dictate your own terms, and can literally set up a shingle and start billing government insurance.
Cons are that with fee service, you don't get paid for no shows or any work that is not direct patient care with the patient sitting in front of you like med refills, coordinating care etc. Any time of you take is also unpaid. Also, the provision of therapy is dismal. I heavily promote CBT and DBT but there's no access to it in the public system. One also cannot private bill pts for anything, you have to take the rates the government sets; one can make $240 seeing 3 med refills in an hour but only $175 for an hour of therapy whereas local psychologists are charging $220.
For my input, I accepted a position a midwest metro VA. 255k - not great compared to my colleagues, but not the worst either.
In Canada, everything is fee for service. The pros are that psychiatry can be quite lucrative here, though I think a lot of those practices churn and see high volumes. I see a lot of pts who complain that they've had 20 minute intakes done. Many psych docs are pulling in more than 500k CDN; and the sentiment is that if you make less than half a mil, you did something wrong that year. Very tempting, but personally that kind of practice is not for me. Malpractice is great, like $2500 and the government reimburses 75% of that. No benefits like retirement matching, and we don't need health insurance. Another plus is that everyone is a contractor and incorporated, so you can deduct expenses and defer taxes in a corporation which becomes you de facto retirement savings account. Being a contractor is great too, you get to dictate your own terms, and can literally set up a shingle and start billing government insurance.
Cons are that with fee service, you don't get paid for no shows or any work that is not direct patient care with the patient sitting in front of you like med refills, coordinating care etc. Any time of you take is also unpaid. Also, the provision of therapy is dismal. I heavily promote CBT and DBT but there's no access to it in the public system. One also cannot private bill pts for anything, you have to take the rates the government sets; one can make $240 seeing 3 med refills in an hour but only $175 for an hour of therapy whereas local psychologists are charging $220.
For my input, I accepted a position a midwest metro VA. 255k - not great compared to my colleagues, but not the worst either.
