Ways to increase income as a Psychiatrist?

[iqureshi7]

I think it is evident that all of us are quite passionate about psychiatry. However, I haven't really seen any discussion on the business aspects of Psychiatry. What are some ways one can increase their income as psychiatrists while still doing justice to your patients?

Would appreciate your input!

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[MBK2003]

Two things my graduating colleagues are doing:
1) Cash only, full fee private practice ($300-400 for an eval, $150-200 for 30 min med visit, $200-250 for 45 min weekly psychotherapy)
2) Forensic evals $400/hr for all your time

MBK2003

 

[Anasazi23]

Perform Folstein's on your patients and bill for it.

 

[Ulquiorra]

Shucks, might as well throw in a DRE while you're at it.

 

[LHCF]

You can wear multiple hats. One of my psychiatry attendings was on staff at my medical school, did psych consultations at a jail, and did home visits for geriatric patients. I think she may have even had a private practice.

 

[musm2008]

Perform Folstein's on your patients and bill for it.

Do you really get paid more for that?

 

[maranatha]

How'bout ECT?

 

[Anasazi23]

Do you really get paid more for that?

Both neuropsychiatrists I worked closely with did it to have a baseline measure, and performed period ones to have trend data and for billing. I believe it's billed under a neurology testing code.

 

[Caetano-MD]

Both neuropsychiatrists I worked closely with did it to have a baseline measure, and performed period ones to have trend data and for billing. I believe it's billed under a neurology testing code.

So, since you pretty much do a Folstein every time you meet a patient--either explicitly or quietly in your own head--can you bill for a Mini Mental Exam with every patient visit--if you just know the code??

 

[BrianUM]

Both neuropsychiatrists I worked closely with did it to have a baseline measure, and performed period ones to have trend data and for billing. I believe it's billed under a neurology testing code.

Hey Anasazi,

I was wondering if its possible for a Neurology trained Neuropsychiatrist (a Neurologist w/ a Neuropsych fellowship) to bill both for neurological services and for a psychiatric exam. Theoretically couldnt you have your own Neurological practice and also see pts w/ primary depression, anxiety disorders, etc?

 

[atsai3]

Theoretically couldnt you have your own Neurological practice and also see pts w/ primary depression, anxiety disorders, etc?

I don't know the technical/policy specifics, but I don't think that is possible. When I was interviewing for med/psych residencies, one of my faculty interviewers was telling me that one reason why few of their trainees do a dual practice after graduation is because of some billing code thing. Had something to do with only being able to code an office visit as either medicine or psych but not both.

-AT.

 

[BrianUM]

I don't know the technical/policy specifics, but I don't think that is possible. When I was interviewing for med/psych residencies, one of my faculty interviewers was telling me that one reason why few of their trainees do a dual practice after graduation is because of some billing code thing. Had something to do with only being able to code an office visit as either medicine or psych but not both.

-AT.

Hey thanks for the heads up

What I meant, however, was whether or not it is possible as a Neurologist with neuropsych fellowship only (no Psych residency) to bill for neuro services OR psych services...i am sure a double boarded neuro/psych can but im not sure if a neurologist with fellowship can.

 

[sga430]

i remember someone on sdn charging a few docs 20 grand a year for a retainter for 24 hours phone consult. And he might get called once a month.

 

[Anasazi23]

Hey Anasazi,

I was wondering if its possible for a Neurology trained Neuropsychiatrist (a Neurologist w/ a Neuropsych fellowship) to bill both for neurological services and for a psychiatric exam. Theoretically couldnt you have your own Neurological practice and also see pts w/ primary depression, anxiety disorders, etc?

I think the details are in the specifics here. You mention neurological services and psychiatric exam. There are rules, for example from medicaid, that prohibit a patient from visiting two disciplines (and having the doctors get paid) from these visits. Since we're talking about increasing our income, however, we can pretty much put medicaid out of the picture.

Some of billing comes from diagnostic codes. So in that sense, if you bill for a procedure code or exam (Folstein) and a neurological exam, I think there is a way to also bill for a psychiatric exam as well...or at least for the treatment of the assigned diagnosis.

I'll try to look into this in more detail.

 

[BrianUM]

Thanks for the input, Anasazi.

I would imagine that another profitable way to make a lot of $ in psychiatry is through sleep medicine or clinical neurophysiology.

These are two fellowship opportunities for psychiatrists that allow for more procedures (and more $) yet they dont nearly get enough attention as child psych..am i missing something here?

 

[Anasazi23]

Thanks for the input, Anasazi.

I would imagine that another profitable way to make a lot of $ in psychiatry is through sleep medicine or clinical neurophysiology.

These are two fellowship opportunities for psychiatrists that allow for more procedures (and more $) yet they dont nearly get enough attention as child psych..am i missing something here?

One reason is that they're not board certified specialties. In other words, they won't automatically increase your income in a bread and butter psychiatry setting. A child fellowship generally will.

Another one by the way:
Independent medical exams. You can make $700 on a Saturday by doing these without much stress or treatment obligation.

 

[prominence]

Independent medical exams. You can make $700 on a Saturday by doing these without much stress or treatment obligation.

sazi, what exactly is an independent medical exam? is it the same as a disability evaluation?

 

[Anasazi23]

Basically, yes. But for psychiatry, there is much less liability, and the setting can be expanded to such things as police candidate evaluations, disability (PTSD) claims from large events (Katrina, 911), and more.

Here's a little wikipedia article.:
http://en.wikipedia.org/wiki/Independent_medical_examinations

 

[BrianUM]

I dont know if this is old news but the 1st sleep medicine exam administered by the ABPN will be this year.

Big $- run own sleep center private practice. maybe even have time left over to have a faculty position at a hospital in psychiatry

 

[jjmack]

I dont know if this is old news but the 1st sleep medicine exam administered by the ABPN will be this year.

Big $- run own sleep center private practice. maybe even have time left over to have a faculty position at a hospital in psychiatry

I heard there can be big issues with universities taking money off the top of peoples private practices so if you are in it for money I wouldn't take a faculty position.

 

[Anasazi23]

I think physicians, like attorneys in some ways, rarely hold purely academic university full time positions like a psychologist would. There is a reason for this. Much more guaranteed money is made in other venues.

University based Hospital "Faculty practice" positions can be a very good deal if you get the right one. You pay the hospital a percentage fee per patient or per total gross income, and you have the hospital base salary (about 110k-200+k), no office fee, no reception fee, no insurance cost, no phone bill, no rent, no equipment fee, free referral base, and you take in (depending how busy you choose to be), another 50-200k in private practice fees. A % goes to the hospital, and you take the rest, effectively increasing your 9am-5pm income to well over 200k without working off hours, or working some evenings in the office.

This is basically how my hospital works.

 

[robberbaron]

I have heard that the majority of what you make apart from your base goes right back to the hospital, especially at more prestigious institutions.

 

[Anasazi23]

Not the majority. If it is, then it's a bad deal. Anything over 40% is considered too much and must be negotiated down.

Keep in mind, though, that you're reataining about 30k in benefits, retirement, 401k, pension, and have virtually no overhead costs. After the hospital cut, it goes directly to you.

 

[Dramkinola]

if you're at a hospital that covers your malpractice, and has anaesthesiology, then your profit from each ECT session is about a 1000 dollars... (what i heard about our service...)
if you do an average of 15 a week (3 a day), then that's 60,000 per month... which doesn't sound right... anyone have better figures?

 

[Anasazi23]

I heard that it's more like $100 reimbursement. That extra zero might make a difference. I'll ask my attending that does it when I see him, but I thought I remembered him making that quote some time ago.