Wanting to make 1M+ per year on first year out of residency

[TexasPhysician]

Well TexasPhysician,

That's partially them to blame as you mentioned, they didn't negotiate well. There is always a way to get the rates you want if you are willing to make the sacrifices. You said it yourself. They are pleased to work at home. They don't feel the need to negotiate further. Sounds like well-fed sheep, not hungry wolves.

Anyways, I've personally heard of higher rates, but that's just me. Also, the COVID situation is temporary and in the end of the day, I think we can all acknowledge that of all the specialties out there, psychiatry is being hit the least hard compared to others..

Except administrators lose their jobs when others are getting higher profits by paying less in overhead. This results in many companies dropping rates - admin has to prove their worth. The lower rates are accepted and continue to drop or we hold our ground and they rise again. We aren’t holding ground right now.

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[BiscoDisco]

To clausewitz2,

Yea man. I was actually going to practice in Northern Alaska. Come meet me there. There's this city called Barrow, Alaska with locums rates of $1500++/hr man its sick and 24/7 call pays same rate so that's 5M++ per year!

There is no way a town with a population of 4k people is paying 36k a day. Where did you see this?

You could work 365 days, make 13M, and retire with 8 or so in the bank. Does this seem like it makes sense?

 

[myPsychAlt]

You gonna round on 56 patients a day and expect to have your notes and everything else completely wrapped up after 14 hours? Anyway, I'm not aware of any pre-specified amount of time people are required to have face to face time with patients on the inpatient side. On the weekends, a lot of those encounters are less than 15 minutes given that you're just making sure the existing patients stay stable.

I worked a moonlighting inpatient rounding gig years ago in residency that would have us tack on a time-based code to our encounters. I only did it for a year then just didn't feel comfortable with it anymore once I looked closer at how they were having us code it. They got in trouble with CMS a number of years later but I'm not sure for what or if it was related.

 

[Psychdoc4755]

To TexasPhysician,

Yes, I see what you are saying that rates are decreasing now in light of COVID, but that is happening across the board and I feel like as psychiatrists with tele-psychiatry at our disposal, we are being hit the least or one of the least hard out of any other specialties. Interventionalists, elective surgery, even primary care visits are down across the board.

Regarding your idea of slowly building a business instead of rapidly trying to expand as I suggested. I do like the idea of investing extensively in real estate to reduce tax burden and increase passive income. It's certainly something I would look into once I finish my residency. You went on the suggest the idea of opening up some sort of PT focused psychiatric/counseling clinic. I'm not knocking you, if that's what you would like to do or have considered doing, I'm sure it would work well. I guess we all have different ideas of what would be a successful business and what would scale the fastest and the highest in the short and long term. Things could go wrong with my idea certainly and they could also go wrong with yours. There's always risk inherent in entrepreneurial endeavors or any sort.


To BiscoDisco,

I was actually being completely sarcastic. But it's funny, I did hear of ridiculous rates in Alaska. I'm not sure if anyone can testify to this?

 

[Splenda88]

The fact is ~400k/yr in most specialties in medicine is very doable without killing yourself... That is the sweet spot I want to be in.

 

[myPsychAlt]

Let’s compare to a small business minded psychiatrist. 30 clinical hours/week can net $375k and year 1 you could bring on a counselor. Yearly add on a counselor as they fill. Add on sports counseling and build your own clinic with green space next door. Add sports training in the green space and a PT center. Add another psychiatrist as you fill. Once you get to the point where you buy your own place, it’ll be cheaper than renting. PT centers can be started relatively cheaply with gradual expansion. Counselors have little overhead. Instead of high taxes, have your spouse qualify for real estate professional status. Yearly expand your real estate portfolio while minimizing taxes. A few years down the road, I can net more than the $1 million psychiatrist in half the hours or less. The minimal expenses don’t leave me hurting along the way. The 30 clinical hours remain enjoyable and I can do it forever. It may never be huge, but it’s easily manageable.

Back when he had his own PP, my father owned the building/land he practiced on, and it ended up being a MASSIVE time suck despite the monetary advantages. Rando stuff like permitting and having to go to city hall for exemptions for landscaping requirements, etc. YMMV, but it was on his list of "things I wouldn't do again".

 

[theduderino]

This thread reads like the psychiatry spinoff of better call saul

 

[Stagg737]

I would imagine filling 60 hours a week of cash paying patients wouldn't happen overnight, even at a low cash rate of 200/hr. That would also be 600k a year if working 50 weeks a year.

Even if it's not overnight, could easily be done in well under 2 years with the right marketing in the right geographic area. Or you can buy out a retiring doc's cash only practice (something I've actually been informally offered) and just jump right in. Has it's own separate set of problems, but is certainly a possibility.

Well TexasPhysician,

That's partially them to blame as you mentioned, they didn't negotiate well. There is always a way to get the rates you want if you are willing to make the sacrifices. You said it yourself. They are pleased to work at home. They don't feel the need to negotiate further. Sounds like well-fed sheep, not hungry wolves.

Anyways, I've personally heard of higher rates, but that's just me. Also, the COVID situation is temporary and in the end of the day, I think we can all acknowledge that of all the specialties out there, psychiatry is being hit the least hard compared to others..

Even if they are to blame, if enough docs do it en masse then the market value will decline and make it harder for you to negotiate those $225+/hr telepsych jobs. I'm guessing the market rate is going to stay at a lower rate than it was after COVID, especially if NPs are able to start seeing patients autonomously via telehealth.

 

[finalpsychyear]

Even if it's not overnight, could easily be done in well under 2 years with the right marketing in the right geographic area. Or you can buy out a retiring doc's cash only practice (something I've actually been informally offered) and just jump right in. Has it's own separate set of problems, but is certainly a possibility.



Even if they are to blame, if enough docs do it en masse then the market value will decline and make it harder for you to negotiate those $225+/hr telepsych jobs. I'm guessing the market rate is going to stay at a lower rate than it was after COVID, especially if NPs are able to start seeing patients autonomously via telehealth.

2 years lol for some it may never happen.

 

[NITRAS]

Why y’all feeding the troll?

Let him go make his million bucks a year. This whole thread is silly.

As far as I’m aware, the only physician I know who is pulling in more than $1M Is an orthopod who has a patent with Striker where he gets pretty close to a million dollars a year. He probably makes pretty close to $2M, but I really have no idea.

 

[JSizzles]

Patient- “I want to make 1 millions dollars the first year out of residency, work 90 hours a week, and move to Alaska”

me: “dammit I knew I forgot to adjust your zyprexa last visit”

 

[oldiebutgoodie1211]

Even if it's not overnight, could easily be done in well under 2 years with the right marketing in the right geographic area. Or you can buy out a retiring doc's cash only practice (something I've actually been informally offered) and just jump right in. Has it's own separate set of problems, but is certainly a possibility.



Even if they are to blame, if enough docs do it en masse then the market value will decline and make it harder for you to negotiate those $225+/hr telepsych jobs. I'm guessing the market rate is going to stay at a lower rate than it was after COVID, especially if NPs are able to start seeing patients autonomously via telehealth.

go read sushi rolls thread about starting a practice..I think he’s about 1 year in and making like 100k per year..its a big investment with little upside starting off

 

[myPsychAlt]

Why y’all feeding the troll?

Let him go make his million bucks a year. This whole thread is silly.

As far as I’m aware, the only physician I know who is pulling in more than $1M Is an orthopod who has a patent with Striker where he gets pretty close to a million dollars a year. He probably makes pretty close to $2M, but I really have no idea.

I know at least a couple. Both Ophtho. Lots of high volume operations with all office visits farmed out to ODs. plus surgicenter ownership with a number of ophtho and derm guys under their umbrella. Took 20+ years to get there and build up their practice though, and one of them gives half of it to his wife in alimony.

 

[Psychdoc4755]

Lol. Here's something for you guys.

Kenneth L. Davis - Wikipedia

en.wikipedia.org

Psychiatrist with salary of 12 million per year. Didn't the guy a few posts above me say something about highest paid doc was close to 1M and he was an orthopedist? Lol.

I guess this guy needs to adjust his Zyprexa dosing. Haha


*EDIT - Also to note, he is working in the public sector and his salary MUST be posted for all to see for legal reasons. Imagine how many more psychiatrists/docs in general making this kind of money if not likely more in private sector and are totally unknown..

 

[JSizzles]

Lol. Here's something for you guys.

Kenneth L. Davis - Wikipedia

en.wikipedia.org

Psychiatrist with salary of 12 million per year. Didn't the guy a few posts above me say something about highest paid doc was close to 1M and he was an orthopedist? Lol.

I guess this guy needs to adjust his Zyprexa dosing. Haha

If you get a hold of him can you ask him if he made that his first year out of resIdency?

 

[Stagg737]

2 years lol for some it may never happen.

go read sushi rolls thread about starting a practice..I think he’s about 1 year in and making like 100k per year..its a big investment with little upside starting off

I'm well aware of his thread and that it can be a significant struggle. I also know an individual who started a cash only practice straight out of residency and filled in 1 year. It's highly geographically dependent as well as depending on connections an individual may have (this individual got quite a few referrals from docs he worked with as a resident).

Why y’all feeding the troll?

Let him go make his million bucks a year. This whole thread is silly.

As far as I’m aware, the only physician I know who is pulling in more than $1M Is an orthopod who has a patent with Striker where he gets pretty close to a million dollars a year. He probably makes pretty close to $2M, but I really have no idea.

I know a psychiatrist making 7 figures and another who is very close. Neither of them do so through clinical work though, so if we're talking about making a million plus via clinical work then I'd agree with you.

 

[BiscoDisco]

go read sushi rolls thread about starting a practice..I think he’s about 1 year in and making like 100k per year..its a big investment with little upside starting off

I would imagine if one took insurance they'd fill much faster. I'd also imagine they could bring in 2-250/hr with insurance as well.

 

[oldiebutgoodie1211]

I would imagine if one took insurance they'd fill much faster. I'd also imagine they could bring in 2-250/hr with insurance as well.

he does take insurance lol..go read his thread

 

[Mass Effect]

If you're working with residents you legally don't have any amount of time you have to spend with a patient, you literally just have to lay eyes on them and note that case was discussed with resident.

If you're working with residents, the time you would have spent with the patient should be spent actually, you know, teaching.

 

[Mass Effect]

Mass Effect,

You said most tele-psychiatry does not pay more than 200/hr? I believe that to be a false claim. I've heard of higher rates and I'm beginning to think that $200/hr is the new minimum in psychiatry

Where? I find it interesting that you're telling those of us in the workforce that we're wrong, but you're quite evasive about where you're getting your information from.

 

[Mass Effect]

Why y’all feeding the troll?

Because some day, some doe eyed med student or premed is going to find this thread and enter into the profession based on an ill-conceived fantasy.

 

[Mass Effect]

Lol. Here's something for you guys.

Kenneth L. Davis - Wikipedia

en.wikipedia.org

Psychiatrist with salary of 12 million per year. Didn't the guy a few posts above me say something about highest paid doc was close to 1M and he was an orthopedist? Lol.

I guess this guy needs to adjust his Zyprexa dosing. Haha


*EDIT - Also to note, he is working in the public sector and his salary MUST be posted for all to see for legal reasons. Imagine how many more psychiatrists/docs in general making this kind of money if not likely more in private sector and are totally unknown..

Ah yes, the CEO and President of Mt Sinai. Why didn't you say those were the jobs you're applying for as a PGY 4? The entire tone and content of this thread would have changed had we known that. And I mean that literally.

 

[VA Hopeful Dr]

Because some day, some doe eyed med student or premed is going to find this thread and enter into the profession based on an ill-conceived fantasy.

I've seen Pre-allo, that is already happening in spades.

 

[Psychdoc4755]

I think it's ironic that people don't go into psych more often for the money. I think it's one of the best specialties for physicians who are interested in making a buck.

Nevertheless, the sentiment on this forum seems to be that no struggle in life is worth undertaking and outliers like Dr. Davis, the psychiatrist who has a salary of 12 million a year got there not through hard work and determination, but through luck and connections, so any efforts are futile and you might as well accept that you as an individual won't make more than 300-400k per year. Ha.

And to answer the question of the previous poster, I don't think I can get to Dr. Davis' position during my first year out of residency. Are you crazy? Lol. But it is something to admire yourself that you can possibly go above and beyond one day and that is what I wish to do with my life. You gotta start somewhere to get to the position of Dr. Davis or this guy:

David Cotton - Wikipedia

en.wikipedia.org

 

[Psychdoc4755]

And one last thing MassEffect,

HOME

genoatelepsychiatry.com

Look up telepsychiatry rates in Alaska: Starting offers at $510/hr. LOL

EDIT - Everything I say is evidence-based.

 

[clausewitz2]

To clausewitz2,

Yea man. I was actually going to practice in Northern Alaska. Come meet me there. There's this city called Barrow, Alaska with locums rates of $1500++/hr man its sick and 24/7 call pays same rate so that's 5M++ per year!

You know there's a reason that rate is so high, right? Do you know any thing about Barrow? From November to late January the sun never rises.

 

[futureapppsy2]

And one last thing MassEffect,

HOME

genoatelepsychiatry.com

Look up telepsychiatry rates in Alaska: Starting offers at $510/hr. LOL

EDIT - Everything I say is evidence-based.

I think you’re making a repeated logical error in thinking that you’ll make that rate for an unlimited number of hours.

 

[BiscoDisco]

I think it's ironic that people don't go into psych more often for the money.

David Cotton - Wikipedia

en.wikipedia.org

What's ironic about this? Or do you mean ironic in like, the Alanis Morisette way?

 

[clausewitz2]

I think you’re making a repeated logical error in thinking that you’ll make that rate for an unlimited number of hours.

It's Alaska - at some point you will simply run out of people.

 

[BiscoDisco]

You know there's a reason that rate is so high, right? Do you know any thing about Barrow? From November to late January the sun never rises.

In fairness, for 1500/hr, 24/7 I'd do correctional psych in an ISIS prison camp.

 

[calvnandhobbs68]

Average is <$150/hr. I know a TON of telepsych docs making $100-140/hr. The rates are dropping fast lately. Psychiatrists are being terminated with Covid or getting salaries greatly reduced. They are all turning to telepsych. Instead of negotiating well, they are accepting the lower offers and are generally pleased to work at home. Other companies hear and lower their offers.

Yep. Part of the telepsych group on Facebook. People are talking about recruiters approaching them with sub 100/hr rates at this point. They mostly get laughed at but point is that the market is starting to get so saturated in telepsych that recruiters feel comfortable even offering $85 for a new eval. And the recruiters didn’t come back with a higher offer when they got rejected per these posts, they just set off to find someone else.

so yes telepsych would negate the geographical location problem but at this point it looks like it’s gonna be pretty difficult to hit 200/hr in telepsych unless you set up your own business which means you’d have to establish a patient base somehow.

 

[myPsychAlt]

I've seen Pre-allo, that is already happening in spades.

yeah, psychdoc isn't spending enough time comparing his ideal compensation with law and i-banking, the only two other careers.

 

[CalmAndCollected]

If you're working with residents, the time you would have spent with the patient should be spent actually, you know, teaching.

Or if you’re in a for-profit hospital, that time can be spent having another full time job while you just sign resident’s notes without checking them.

 

[calvnandhobbs68]

Ah yes, the CEO and President of Mt Sinai. Why didn't you say those were the jobs you're applying for as a PGY 4? The entire tone and content of this thread would have changed had we known that. And I mean that literally.

New thread title: "Wanting to be CEO of Mount Sinai 1st year out of residency"

 

[Psychdoc4755]

Bro Mass Effect,

Without even back referring on the claim you just made, I just need to point out that your math is totally wrong on what you just posted. Lol

 

[Mass Effect]

And one last thing MassEffect,

HOME

genoatelepsychiatry.com

Look up telepsychiatry rates in Alaska: Starting offers at $510/hr. LOL

EDIT - Everything I say is evidence-based.

Oh good lord. From the link you shared:

90792 -- $230.12
90833 -- $76.68
99204 -- $274.58
99212 -- $70.32
99213 -- $119.96
99214 -- $177.55


You don't get to bill for all of them at once. That isn't how billing works. A 99212 is not the same as a 99213 is not the same as a 90792 is not the same as a 99214. You cannot bill all of these for the same patient and you cannot complete all of these for 5 different patients in one hour. There is no possible way since there are time constraints written right there in the code.

That wasn't an "offer." It was telling you about reimbursement rates.

Now I'm convinced we're being trolled.

 

[Stagg737]

If you're working with residents, the time you would have spent with the patient should be spent actually, you know, teaching.

Obviously. I was just pointing out the legal aspect of it. I'm also a resident, so I spend that time, you know, learning.

 

[michaelrack]

The reimbursement for the first 2 codes are a little high, the rest are widely inflated ( double)

 

[psyguru]

Lol. Here's something for you guys.

Kenneth L. Davis - Wikipedia

en.wikipedia.org

Psychiatrist with salary of 12 million per year. Didn't the guy a few posts above me say something about highest paid doc was close to 1M and he was an orthopedist? Lol.

I guess this guy needs to adjust his Zyprexa dosing. Haha


*EDIT - Also to note, he is working in the public sector and his salary MUST be posted for all to see for legal reasons. Imagine how many more psychiatrists/docs in general making this kind of money if not likely more in private sector and are totally unknown..

Orthopedics expert witnesses charge close to 1k an hour and 2k an hour testifying. Of course they may not get 40 hours of expert work a week. But even if they average 1 testimony a month, that is 16000 x 12 equals about 200k (excluding prep time and exam time...just for 12 days testifying).

 

[Mad Jack]

Some people are very efficient... My closest friend in residency can take care the same # of patients in 1/2 of time that I can see these same patients while not missing a thing.

I once worked on the same team with her and when she was finishing at 12 noon and go home; I was leaving the hospital at 3-4 pm. We both started ~ 7am.

You can only be so fast though. If you're billing nothing but private pay level 3s for, say, $90/each, you'd need to see around 43 patients a day with a 100% collections rate and the lowest overhead possible (around 20% top to bottom). You'd have to actually book about 60 patients a day to account for no shows, and you'd have a hellish schedule of 15 minutes per patient start to finish with no breaks for 12 hours a day 6 days per week. Basically, this is impossible right out of the gate, and would be impossible for anyone to do for any prolonged period of time, plus your patients would likely hate you because you'd be double booking and your no shows might not line up as planned, so you'd have people waiting a long time to see you which would hurt retention.

Tl;dr it is insanely unrealistic to bill enough to justify a million dollars a year

 

[Mad Jack]

The reimbursement for the first 2 codes are a little high, the rest are widely inflated ( double)

They're double our local Medicaid rate but only around 33% higher than local private insurance

 

[myPsychAlt]

myPsychAlt,

Regarding a physician's incentive to work for me over the hospital? Throughout history, there have been very smart, savvy people who have creative incentive out of nothing. What's my incentive to buy a personal computer when my typewriter writes just as fine? The answer is you create a need through brilliant marketing, strong leadership, and a vision with constant persistence and drive

So no offense, but there's nothing here that isn't a bunch of bull**** buzzwords, and not any evidence that you have any understanding of the business side of things, much less the psychiatry aspects. If I'm going to generate revenue for you, something has to be in it for me, otherwise I'd just do the high volume stuff you'd want to do for myself. The ophtho guys upthread have been able to swallow up other practices because they've been able to provide management of overhead doesn't exist in psych. You haven't managed to convince a single resident or above in this thread that you know what you're talking about, so how do you think you'd be able to do it in the real world?

Now I'm convinced we're being trolled.

I'm thinking we have a possibly sincere but naïve premed on our hands. Med student at best. Pretty obvious that he's not an MD with psych experience from his posts.

 

[oldiebutgoodie1211]

So no offense, but there's nothing here that isn't a bunch of bull**** buzzwords, and not any evidence that you have any understanding of the business side of things, much less the psychiatry aspects. If I'm going to generate revenue for you, something has to be in it for me, otherwise I'd just do the high volume stuff you'd want to do for myself. The ophtho guys upthread have been able to swallow up other practices because they've been able to provide management of overhead doesn't exist in psych. You haven't managed to convince a single resident or above in this thread that you know what you're talking about, so how do you think you'd be able to do it in the real world?



I'm thinking we have a possibly sincere but naïve premed on our hands. Med student at best. Pretty obvious that he's not an MD with psych experience from his posts.

I mean I don’t think a psych resident would have that much insight into the business side of things so it could very well be a resident

 

[myPsychAlt]

I mean I don’t think a psych resident would have that much insight into the business side of things so it could very well be a resident

His evasive answers regarding his rotation experience and management of clinical workflow are pretty glaring. He doesn't seem to know a lot about the practice of psychiatry itself.

That said, I do cringe at the lack of billing and coding understanding that residents graduate with from some programs.

 

[GoSpursGo]

I think this thread has reached its natural conclusion. If you're convinced you can make this much money go for it and report back. To others reading this thread, consider the input of literally every other person in this thread.