What are some different models of a psychiatrists' lifestyle after residency?

[PS2summerdays]

I think residency is similar everywhere. I am more curious about life afterwards, however. Some models I've heard of are M-F 8-5 or so with weekends off or on-call. Actually, this seems to be the only model I've heard of, save for the addition of some half-days between M-F to do outpatient. But there has to be more versatility than this, right?

I know for IM there are some 7-ON/7-OFF models. Does the same hold true for psychiatry? Does/can anyone do telepsych full time?

I am asking because I am trying to decide between hospitalist IM and psych with lifestyle/stress being the major determining factor at this point.

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[Mad Jack]

I've seen 7 on/7 off inpatient psych gigs, though they aren't as common. Full time telepsych is doable. Full time outpatient 8-5 is the most common model of practice. Many of the attendings in my area do inpatient half days followed by outpatient private practice, with a great deal of call. They work harder than most doctors I've met. Most psychiatrists where I came from work far more relaxed schedules.

 

[PS2summerdays]

I've seen 7 on/7 off inpatient psych gigs, though they aren't as common. Full time telepsych is doable. Full time outpatient 8-5 is the most common model of practice. Many of the attendings in my area do inpatient half days followed by outpatient private practice, with a great deal of call. They work harder than most doctors I've met. Most psychiatrists where I came from work far more relaxed schedules.

Mind my asking which location, geography-wise, the relaxed vs. non-relaxed schedules are?

 

[Mad Jack]

Mind my asking which location, geography-wise, the relaxed vs. non-relaxed schedules are?

It's not location-based, it is preference-based. They could easily work more relaxed schedules, but they make more than a lot of surgeons by working hard because they choose to do so. That's just the local culture- psychiatrists tend to work in less popular areas to maximize income since the demand is so high. You can make what you want of your schedule and life in psych, there is enough demand that you have a strong bargaining position when setting your terms of practice (or even working on your own, if you so choose).

 

[PS2summerdays]

It's not location-based, it is preference-based. They could easily work more relaxed schedules, but they make more than a lot of surgeons by working hard because they choose to do so. That's just the local culture- psychiatrists tend to work in less popular areas to maximize income since the demand is so high. You can make what you want of your schedule and life in psych, there is enough demand that you have a strong bargaining position when setting your terms of practice (or even working on your own, if you so choose).

Thanks so much for your answer. Sorry if I did come off as disrespectful. I do understand psychiatrists work very hard. But the nature of the work is less physically demanding/meticulous as opposed to some IM stuff. And that is why it is less stressful to me in that sense.

I honestly had no idea about the versatility of psychiatry job options. Is there any place I can look that shows job offers or different set ups? Everyone told me to go with IM because of the versatility.

 

[wolfvgang22]

For me, its student loan based, lol

 

[PS2summerdays]

For me, its student loan based, lol

Can you explain?

 

[TexasPhysician]

Hours can literally be anything you want in psych.

 

[PS2summerdays]

Hours can literally be anything you want in psych.

Is this true only for outpatient/private practice? Or also for hospital psychiatry like a C/L service?

 

[TexasPhysician]

Is this true only for outpatient/private practice? Or also for hospital psychiatry like a C/L service?

The C&L gig I considered was basically getting a % of collections. I could come and go whenever I wanted M-F to see the consults.

I’ve also worked in addictions in which someone is on the schedule every day. Psych is paid a daily rate to round on everyone. Days are split up and you round whenever on your days.

 

[wolfvgang22]

Can you explain?

Absolutely. If I didn't have student loan debt I'd probably go part time and net the same income. On bad days I want to leave practice entirely for my own health. Being a doctor sucks more than each passing year with bloated EMR documentation, worries about malpractice, entitled patients, and the erosion of independent decision as a profession. Last week, a patient hugged me and thanked me for saving his life. It was still a crap week overall because of this other stuff. That's how bad it has gotten. I'm pleased to be of service, but it's coming at a cost. I have some chronic burnout. I'm probably just a wuss because I'm one of the 8 to 5 guys that does a week of light call monthly. But it is what it is.

 

[PS2summerdays]

Absolutely. If I didn't have student loan debt I'd probably go part time and net the same income. On bad days I want to leave practice entirely for my own health. Being a doctor sucks more than each passing year with bloated EMR documentation, worries about malpractice, entitled patients, and the erosion of independent decision as a profession. Last week, a patient hugged me and thanked me for saving his life. It was still a crap week overall because of this other stuff. That's how bad it has gotten. I'm pleased to be of service, but it's coming at a cost. I have some chronic burnout. I'm probably just a wuss because I'm one of the 8 to 5 guys that does a week of light call monthly. But it is what it is.

I can't imagine how draining it is. I haven't even started residency and it scares me a lot. Hope you get to go part time soon.

 

[Mad Jack]

Thanks so much for your answer. Sorry if I did come off as disrespectful. I do understand psychiatrists work very hard. But the nature of the work is less physically demanding/meticulous as opposed to some IM stuff. And that is why it is less stressful to me in that sense.

I honestly had no idea about the versatility of psychiatry job options. Is there any place I can look that shows job offers or different set ups? Everyone told me to go with IM because of the versatility.

You didn't come off as disrespectful. And there isn't really a place to look it up, you kind of have to ask around. Indeed.com has a pretty good mix of listings for psych jobs to give you some idea though

 

[Bartelby]

I used to think 7 on 7 off sounded great. Now I have two kids and a working spouse and it doesn't sound so hot anymore. I work 730-4 and can thus do half of the daycare pickup and spend every evening and weekend with my family. I also love my work (wolvgang, I hope this is just a passing rough spot for you! Burnout is real and I think we all get there from time to time). My job does require 5-day coverage; if it did not I would do a four-day week. Overall though I am very happy with the lifestyle in psych. I look at some of my colleagues (like in OB) and just feel more and more thankful I picked psych every day!

 

[Bartelby]

Also you could probably do telepsych full time, but try it out first. I find it very boring compared to in-person meetings. I would only want to do it part time if at all.

 

[Armadillos]

Psych has some downsides, but personally being an IM hospitalist would be way more stressful.

A somewhat common practice model for outpatient jobs would be to be full time, but work 9-10hrs four days a week. Then you could either have 3 day weekends or if you really wanted the money could do a day of telepsych/etc a week.

 

[PS2summerdays]

Also you could probably do telepsych full time, but try it out first. I find it very boring compared to in-person meetings. I would only want to do it part time if at all.

Thanks for the insight. I honestly have no experience with it. But I do not think I would be offput by the boredom since I kind of grew up on Skype/video chat. Do you feel psychiatry to be particularly stressful? What stresses me out about IM is the breadth of the knowledge base and technique required. I know as a psych there is an entire DSM you need to memorize, but at least it is single-system as opposed to multi-system, which does not stress me out as much.

Psych has some downsides, but personally being an IM hospitalist would be way more stressful.

A somewhat common practice model for outpatient jobs would be to be full time, but work 9-10hrs four days a week. Then you could either have 3 day weekends or if you really wanted the money could do a day of telepsych/etc a week.

4-day weeks sound pretty neat. Is this model available for working in someone's outpatient practice? Or do people tend to set this up themselves?

 

[Mass Effect]

Psychiatry is extremely versatile. Most jobs allow you to choose if you want to work part time or full time. Full time in some places is 32 hours a week. Depends on the set up though. This is common in general outpatient but even that varies depending on locale.

CL may be variable depending on where you are. At a community hospital, they likely have an expectation of everyday coverage, though hours vary. At academic centers with one or two CL docs, you likely will work M-F 8-5. At academic centers with multiple CL attendings, you can likely when you want to be on service.

You can also do private practice cash only. Or you can do PP and do consults at nursing homes, rehab centers, etc.

You can do telepsych and never leave your home.

You can do only locums work and make a good living, working only when you choose. I had a friend do this all over the U.S. Gave him a chance to travel -- one week in CA, one week in Montana, one week in Kansas (not all in a row). They pay travel and lodging is my understanding.

You can do a moonlighting-only type gig and depending on the gig, do well. There are places that offer $5000 - $7000 (probably more some places) for weekend coverage (all day Saturday, Saturday night, and all day Sunday). I know someone who does this two weekends a month and takes M- F off while still making a decent amount to supplement her husband's income. She's a mom so she wanted to be home during the week and some weekends.

 

[PS2summerdays]

Psychiatry is extremely versatile. Most jobs allow you to choose if you want to work part time or full time. Full time in some places is 32 hours a week. Depends on the set up though. This is common in general outpatient but even that varies depending on locale.

CL may be variable depending on where you are. At a community hospital, they likely have an expectation of everyday coverage, though hours vary. At academic centers with one or two CL docs, you likely will work M-F 8-5. At academic centers with multiple CL attendings, you can likely when you want to be on service.

You can also do private practice cash only. Or you can do PP and do consults at nursing homes, rehab centers, etc.

You can do telepsych and never leave your home.

You can do only locums work and make a good living, working only when you choose. I had a friend do this all over the U.S. Gave him a chance to travel -- one week in CA, one week in Montana, one week in Kansas (not all in a row). They pay travel and lodging is my understanding.

You can do a moonlighting-only type gig and depending on the gig, do well. There are places that offer $5000 - $7000 (probably more some places) for weekend coverage (all day Saturday, Saturday night, and all day Sunday). I know someone who does this two weekends a month and takes M- F off while still making a decent amount to supplement her husband's income. She's a mom so she wanted to be home during the week and some weekends.

Thanks so much. This is an extremely comprehensive answer. I was leaning towards IM because of the short residency + versatility as an attending, but I had little idea about the versatility of psych before making this thread.

If you don't mind answering one more question (and it's fine if you don't answer, you helped a lot already)...are there any barriers to employ-ability/versatility? As in where you do residency? Where you went to medical school? Stuff like that?

 

[Shufflin]

Thanks so much. This is an extremely comprehensive answer. I was leaning towards IM because of the short residency + versatility as an attending, but I had little idea about the versatility of psych before making this thread.

If you don't mind answering one more question (and it's fine if you don't answer, you helped a lot already)...are there any barriers to employ-ability/versatility? As in where you do residency? Where you went to medical school? Stuff like that?

No barriers. We're in such short supply that being board certified will be enough, and even that's not required at some places which points to the shortage issue.

 

[Armadillos]

4-day weeks sound pretty neat. Is this model available for working in someone's outpatient practice? Or do people tend to set this up themselves?

I think lots of options for doing 4 day week, could be private, hospital system or government/VA based outpatient. May be something you have to ask for specifically.

 

[TexasPhysician]

4-day weeks sound pretty neat. Is this model available for working in someone's outpatient practice? Or do people tend to set this up themselves?

I have a contractor psychiatrist that usually chooses to work 3 eleven hour shifts/week. 4 days off weekly.

 

[Merely]

I have a contractor psychiatrist that usually chooses to work 3 eleven hour shifts/week. 4 days off weekly.

How much he make/you make off him

 

[splik]

I have friends working 4x 10s (more and more jobs are offering this), 4 8s, 4 7s, 3 10s, 4 9s, 9-5 M-F, 8-4 M-F etc - there are all ranges of schedules. It's common for people to work part time or to work their schedules around their kids/families. I know some people who only work 5-10 hours week with v small therapy only cash practices to keep their hand it while primarily raising their kids etc. There are lots of opportunities to work part-time. Some people work 16hr or even 24hr shifts less frequently to have more time off. I've tried this and it can be quite brutal when you are working. Some people just work weekends for a premium. Obviously, the less you work, the less you will make, but most of my friends are making >200k (and often times more than me as full time in academics lol).

There are also opportunity to do locum jobs - some people will do bursts of this and then take large chunks of time off between assignments not working. Locum positions include full time jobs ranging from 150-250/hr and pay for travel and accommodation expenses.

There are many opportunities to diversify your practice by switching jobs (or settings you work within the same institution), or doing a range of things. I do consults, outpatient, telepsych (it's incorporated into my practice as many pts live far away and also for hospital consults), forensics, consulting, and very occasionally do inpatient. I never take call. In academics so I am underpaid for much of what I do, or not paid at all (for editing, reviewing, writing papers, applying for grants, presenting, mentoring, committee service etc) but I get paid very well for some of the work I do and more importantly I enjoy most of the stuff I do and find it very intellectually stimulating.

 

[TexasPhysician]

How much he make/you make off him

About $330k last year. Hard to say exactly what is only profit from this contractor as overhead is certainly higher but shared.

 

[BiscoDisco]

Psych has some downsides, but personally being an IM hospitalist would be way more stressful.

A somewhat common practice model for outpatient jobs would be to be full time, but work 9-10hrs four days a week. Then you could either have 3 day weekends or if you really wanted the money could do a day of telepsych/etc a week.

What can a doc expect to make doing outpatient on a hourly basis taking insurance. I think I saw if you want to see 2.5 patients an hour you could generate something like 220-250 an hour. Thoughts?

 

[BiscoDisco]

Psychiatry is extremely versatile. Most jobs allow you to choose if you want to work part time or full time. Full time in some places is 32 hours a week. Depends on the set up though. This is common in general outpatient but even that varies depending on locale.

CL may be variable depending on where you are. At a community hospital, they likely have an expectation of everyday coverage, though hours vary. At academic centers with one or two CL docs, you likely will work M-F 8-5. At academic centers with multiple CL attendings, you can likely when you want to be on service.

You can also do private practice cash only. Or you can do PP and do consults at nursing homes, rehab centers, etc.

You can do telepsych and never leave your home.

You can do only locums work and make a good living, working only when you choose. I had a friend do this all over the U.S. Gave him a chance to travel -- one week in CA, one week in Montana, one week in Kansas (not all in a row). They pay travel and lodging is my understanding.

You can do a moonlighting-only type gig and depending on the gig, do well. There are places that offer $5000 - $7000 (probably more some places) for weekend coverage (all day Saturday, Saturday night, and all day Sunday). I know someone who does this two weekends a month and takes M- F off while still making a decent amount to supplement her husband's income. She's a mom so she wanted to be home during the week and some weekends.

How does one find these 5-7k weekend gigs? Alternatively, how does one do pp consults for nursing homes? Just a pgy1 here but trying to learn what I can about practice types early.

 

[FlowRate]

I never take call.

How did you manage this? I'd get it if you were only outpatient academic but all of the consult and inpatient folks in our departments take call. (Including people who moonlight on said services.)

 

[Sushirolls]

I've had a job in the past that was 4 day work week. 2 or 3 of those days would be inpatient in the AM with the corresponding C/L consults. Dart to outpatient clinic 3-5PM in the afternoon. The non-inpatient days were all outpatient. 1 weekend a month was inpatient coverage. Phone call on weeknights was once per week. The documentation burden and EMR and slough of other things made the 8-5 days more like 8-7. Switching back an forth from inpatient to outpatient service on 2-3 day basis allowed for the 4 day work week amongst the group; however, it was a poor model with so many sign outs that were neglected in quality. Patients and their families also hated the lack of consistency in psychiatrists.

I've seen 100% C/L jobs M-F 8-5, with no weekends and no calls in a hospital.

I've seen some doctors add Methadone clinic work in the early AM to their existing job what ever it might be.

I've seen a VA doc negotiate into a 4 day work week (genius doc - this person is on SDN, too - you know who you are!) and add in an additional telepsych day for 5th day of work.

I've seen another doc have a thriving outpatient practice with 3 ARNPs, and then barely work there while undertaking the role of Medical Director at a for profit psychiatric hospital.

I've also seen a C&A walk away from psych and become a Yoga instructor.

I've also seen a psych walk away by doing a sleep medicine fellowship and do that 100%.

Another psych walked away, did a Neurology Headache fellowship, and does that 100%.

 

[splik]

How did you manage this? I'd get it if you were only outpatient academic but all of the consult and inpatient folks in our departments take call. (Including people who moonlight on said services.)

we have a very enlightened model where they pay for weekend coverage. It is optional for extra pay. The money is quite good. However, you couldn't pay me to get out bed on a caturday morning.

 

[ArdorAyurveda]

Is 75% pp forensics and 25% pp psychoanalysis/psychotherapy viable? Or perhaps 50:50 split between the two?

 

[FlowRate]

we have a very enlightened model where they pay for weekend coverage. It is optional for extra pay. The money is quite good. However, you couldn't pay me to get out bed on a caturday morning.

Do you also not take home call/phone coverage?

 

[dl2dp2]

Is 75% pp forensics and 25% pp psychoanalysis/psychotherapy viable? Or perhaps 50:50 split between the two?

Forensics requires a lot of marketing. Fill a 75% practice takes a number of years. As do a pure psychoanalytic practice. The latter is almost not particularly viable now, and is a money losing proposition. A number of (sometimes well known) MD analysts I know in the largest market for such services are reverting back to psychopharm. There's just much much more demand for psychopharm. It's very hard to crack 500k doing psychoanalysis now compared to what was comparable (say 350k) say 15 years ago.

Do you also not take home call/phone coverage?

Facilities job this is not unusual frankly.

 

[dl2dp2]

Thanks so much. This is an extremely comprehensive answer. I was leaning towards IM because of the short residency + versatility as an attending, but I had little idea about the versatility of psych before making this thread.

If you don't mind answering one more question (and it's fine if you don't answer, you helped a lot already)...are there any barriers to employ-ability/versatility? As in where you do residency? Where you went to medical school? Stuff like that?

There are decent number of crappy jobs in psychiatry, but they are typically not as crappy or at worst equally crappy as the crappiest jobs in IM.

The best jobs in psych are still pretty competitive. I would gun for the best residency program if you want to say end up making 500k in psych working 35 hours a week or less or make 500k-750k+ working ~ 40-60 hours a week. This type of jobs exist (typically an equity owning partner at either a solo or small cash practice in certain markets, but also in leadership/ownership roles in larger organizations) in psych, but these types of jobs are extremely rare in IM. However, they are typically not accessible through a 3rd tier residency program.

This is reflected in fellowship patterns. Typically the best candidates in IM go into subspecialties where you *can* get such a job (GI etc). General IM per se don't get grads into the best jobs.

Also keep in mind the technical nature of the two fields are converging. Hospitals typically want to hire people these days who are comfortable with injections, various QA stuff, managing a team etc. IM hospitalists/outpatient rarely do procedures.

 

[PS2summerdays]

There are decent number of crappy jobs in psychiatry, but they are typically not as crappy or at worst equally crappy as the crappiest jobs in IM.

The best jobs in psych are still pretty competitive. I would gun for the best residency program if you want to say end up making 500k in psych working 35 hours a week or less or make 500k-750k+ working ~ 40-60 hours a week. This type of jobs exist (typically an equity owning partner at either a solo or small cash practice in certain markets, but also in leadership/ownership roles in larger organizations) in psych, but these types of jobs are extremely rare in IM. However, they are typically not accessible through a 3rd tier residency program.

This is reflected in fellowship patterns. Typically the best candidates in IM go into subspecialties where you *can* get such a job (GI etc). General IM per se don't get grads into the best jobs.

Also keep in mind the technical nature of the two fields are converging. Hospitals typically want to hire people these days who are comfortable with injections, various QA stuff, managing a team etc. IM hospitalists/outpatient rarely do procedures.

Wow, who the heck makes 500k working 35 hours a week! That's amazing. My application is pretty average so I'm probably not going to get into the best residency. Can you explain what you mean by "crappy?" By crappy, do you mean low pay? If I could earn 150k a year, working at low stress for <30 hours or so, I'd take that job in a heartbeat.

 

[dl2dp2]

Wow, who the heck makes 500k working 35 hours a week! That's amazing. My application is pretty average so I'm probably not going to get into the best residency. Can you explain what you mean by "crappy?" By crappy, do you mean low pay? If I could earn 150k a year, working at low stress for <30 hours or so, I'd take that job in a heartbeat.

It's not as hard as you think. if you work 35 solid clinical hours, at $300 an hour (that's $150 per med check, which is about insurance rate), 48 weeks that's 500k gross. Subtract 10-20% overhead yields about 400k.

$150 per med check is considered (sometimes very) low in some markets. This is within the range of insurance/Medicare rates. As you can see, the trick here is psych has low overhead. IM overhead, esp for hospital based is in the high 30-40% range, with similar billing. The parity law really helped, because psych uses the same E&M codes but with lower overhead.


Pay is typically not the issue for a crappy job in psych. Crappy jobs in psych are associated with facilities/public budgeting where you have little control over your patient base/hours. Pay is still higher because market forces, but you are forced to see X patients in X hours, and the patients don't cooperate or have factors outside of your control (i.e. bad social work support, etc). Similar issues exist in IM, but it's harder to escape. If you like psych you should apply broadly because the top programs are not as competitive yet as in other fields, especially if you are not in the top markets. As an example, Northwestern is often considered a "top" program, and grads of that program can often design a reasonable full time job that makes 500k if they play their cards right, but their residency program is not that competitive and accessible to an "average" AMG. Similarly, other affluent 2nd tier cities (Atlanta, Miami) have mid tier academic programs that are not that competitive (yet), but grads can often have excellent jobs.

 

[PS2summerdays]

It's not as hard as you think. if you work 35 solid clinical hours, at $300 an hour (that's $150 per med check, which is about insurance rate), 48 weeks that's 500k gross. Subtract 10-20% overhead yields about 400k.

$150 per med check is considered (sometimes very) low in some markets. This is within the range of insurance/Medicare rates. As you can see, the trick here is psych has low overhead. IM overhead, esp for hospital based is in the high 30-40% range, with similar billing. The parity law really helped, because psych uses the same E&M codes but with lower overhead.


Pay is typically not the issue for a crappy job in psych. Crappy jobs in psych are associated with facilities/public budgeting where you have little control over your patient base/hours. Pay is still higher because market forces, but you are forced to see X patients in X hours, and the patients don't cooperate or have factors outside of your control (i.e. bad social work support, etc). Similar issues exist in IM, but it's harder to escape. If you like psych you should apply broadly because the top programs are not as competitive yet as in other fields, especially if you are not in the top markets. As an example, Northwestern is often considered a "top" program, and grads of that program can often design a reasonable full time job that makes 500k if they play their cards right, but their residency program is not that competitive and accessible to an "average" AMG. Similarly, other affluent 2nd tier cities (Atlanta, Miami) have mid tier academic programs that are not that competitive (yet), but grads can often have excellent jobs.

Two more quick questions and I swear I'll leave you alone. I hate to be this annoying, but it's difficult to commit to something in life without knowing all the ins and outs.

1. This $150 a hour med-check outpatient type of job. Is that hard to get? As in, would I need an Ivy League or reputable residency to be considered for those jobs as an attending?

2. Do you foresee a shortage in the demand for psychiatry. My parents (who are not in the medical field mind you) are terrified that I will have no job prospects in psychiatry. I keep hearing there is a psychiatry shortage but what this means, I don't know. Does this mean that I can easily get employed as a psychiatrist ANYWHERE? Does it mean that only certain locations are in need of psychiatrists? Can I just access these locations through telepsych?

 

[MacDonaldTriad]

1. No
2. No

Jobs are everywhere and not going away anytime soon.

 

[Armadillos]

Yeah it can’t be overstated how flexible things are geographically for us. For many professionals, depending on the industry there may literally be 1-4 cities in the world they can live in to make a 6 figure salary. We may complain about some areas being relatively underpaid, but we literally can live anywhere we want and make a good living.

 

[Merely]

Wait if Med checks are 150 a patient, can’t you do 4 in one hour for 600...lol

 

[Sushirolls]

My area I have two payers with less than medicare rates. Only one that I'm actually getting patients for that pays in $240-270/hr range.

 

[ArdorAyurveda]

Forensics requires a lot of marketing. Fill a 75% practice takes a number of years. As do a pure psychoanalytic practice. The latter is almost not particularly viable now, and is a money losing proposition. A number of (sometimes well known) MD analysts I know in the largest market for such services are reverting back to psychopharm. There's just much much more demand for psychopharm. It's very hard to crack 500k doing psychoanalysis now compared to what was comparable (say 350k) say 15 years ago.

Thank you for responding to my question.

I wonder how profitable psychopharm will remain given that there is bipartisan support to lower drug prices?

CREATES Act

 

[Bartelby]

Thanks for the insight. I honestly have no experience with it. But I do not think I would be offput by the boredom since I kind of grew up on Skype/video chat. Do you feel psychiatry to be particularly stressful? What stresses me out about IM is the breadth of the knowledge base and technique required. I know as a psych there is an entire DSM you need to memorize, but at least it is single-system as opposed to multi-system, which does not stress me out as much.


4-day weeks sound pretty neat. Is this model available for working in someone's outpatient practice? Or do people tend to set this up themselves?

I think parts of psychiatry are stressful, though you get good at it with practice and the stress becomes manageable. For example, discharging antisocial people from the ER or inpatient units against their will tends to be an unpleasant experience. In general, most days are pretty low stress for me. Two years into attendinghood I'd say I really stress about something work related every 1-2 months.

 

[romanticscience]

Wow, who the heck makes 500k working 35 hours a week! That's amazing. My application is pretty average so I'm probably not going to get into the best residency. Can you explain what you mean by "crappy?" By crappy, do you mean low pay? If I could earn 150k a year, working at low stress for <30 hours or so, I'd take that job in a heartbeat.

I work about 40-hours/week in solo private practice and on pace to gross this amount. For 2019, I'm averaging 6-hours of 30-minute appointments + 33 hours of 45/60 minute appointments per week (~40hr/week). Some weeks, I do 5-8 hours of forensic work. I'm hitting a happy balance between therapy and medication management. Yes, I could make more per hour doing more 30-minute med-focused appointments but then the overhead would overwhelm me. I do everything myself from billing to scheduling. I'd prefer to make 300-400k with an overhead of 5%, maintaining all control versus 500k+ with a larger overhead (employees, patient panels in the 100s, 16ish patients per day who only want meds decrease a therapeutic alliance).

 

[hamstergang]

I wonder how profitable psychopharm will remain given that there is bipartisan support to lower drug prices?

What do drug prices have to do with office visits with the doctor? We're not the ones selling the drugs.

 

[AD04]

The best jobs in psych are still pretty competitive. I would gun for the best residency program if you want to say end up making 500k in psych working 35 hours a week or less or make 500k-750k+ working ~ 40-60 hours a week. This type of jobs exist (typically an equity owning partner at either a solo or small cash practice in certain markets, but also in leadership/ownership roles in larger organizations) in psych, but these types of jobs are extremely rare in IM.

I agree with your numbers for equity owners of fine-tuned, self-running practice. But is there a benefit to being owner / partner of a cash practice? How does an equity owning partner at a solo / small cash practice generate additional income beyond what he generates? Correct me if I'm wrong, but generally cash practices charge a lot per hour, but are also slower paced. So on average, cash practices make the same amount as insurance-based practices. The main attractions to cash practices are the lower overhead and less hassle from not dealing with insurance companies.

A prestigious residency program helps get your foot into the door. But an understanding of business and the willingness to take calculate risk go much further. An ivy-league trained psychiatrist plugged into the academic system will only make so much.

I would suggest that if you want go this route, it will be riskier as the path isn't so straight forward. Get a mentor so you don't repeat other people's mistakes.

 

[dl2dp2]

I agree with your numbers for equity owners of fine-tuned, self-running practice. But is there a benefit to being owner / partner of a cash practice? How does an equity owning partner at a solo / small cash practice generate additional income beyond what he generates? Correct me if I'm wrong, but generally cash practices charge a lot per hour, but are also slower paced. So on average, cash practices make the same amount as insurance-based practices. The main attractions to cash practices are the lower overhead and less hassle from not dealing with insurance companies.

A prestigious residency program helps get your foot into the door. But an understanding of business and the willingness to take calculate risk go much further. An ivy-league trained psychiatrist plugged into the academic system will only make so much.

I would suggest that if you want go this route, it will be riskier as the path isn't so straight forward. Get a mentor so you don't repeat other people's mistakes.

Yes agree on all above. I think I was being unclear--in Solo practice, unless there was another original investor (uncommon), you own 100% of the equity. Small group practices often have employees (therapists, NPs etc) that generates additional revenue. This can be substantial.

Credentialing is still helpful, but business acumen is critical.

 

[dl2dp2]

Two more quick questions and I swear I'll leave you alone. I hate to be this annoying, but it's difficult to commit to something in life without knowing all the ins and outs.

1. This $150 a hour med-check outpatient type of job. Is that hard to get? As in, would I need an Ivy League or reputable residency to be considered for those jobs as an attending?

2. Do you foresee a shortage in the demand for psychiatry. My parents (who are not in the medical field mind you) are terrified that I will have no job prospects in psychiatry. I keep hearing there is a psychiatry shortage but what this means, I don't know. Does this mean that I can easily get employed as a psychiatrist ANYWHERE? Does it mean that only certain locations are in need of psychiatrists? Can I just access these locations through telepsych?

Let me guess: Asian parents? They have no clue what they are talking about. They also don't know what a typical psych practice look like.

American medical systems are very different from in Asia or Europe, and mental health care here is very different. Your thinking on this is not clear. Employed jobs don't pay $150 per med check. $150 is gross REVENUE per billing. There's a big difference between getting a job and starting a practice. The main advantage of psych which you haven't appreciated though several above posters repeated try to drill is that it's very very easy to start a practice with psych. In that way psych is very similar to derm. And all the advantages of derm are also similar. Unlike derm, however, there's also a robust demand for psych in the public (non-cosmetic) sector. Trying reading a few books on starting a business, etc. The best jobs in psych are not "jobs"--they require owning equity. See if you can figure out what that means. This is after all America. The best jobs period are not jobs.

Think of psych as a more selective IM mainly outpatient subspecialty with better hours (i.e. allergy, etc), and much better job market (prolly one of the best in all of medicine right now). Job market can change though so that's not such a great metric for picking a job.

 

[Merely]

I work about 40-hours/week in solo private practice and on pace to gross this amount. For 2019, I'm averaging 6-hours of 30-minute appointments + 33 hours of 45/60 minute appointments per week (~40hr/week). Some weeks, I do 5-8 hours of forensic work. I'm hitting a happy balance between therapy and medication management. Yes, I could make more per hour doing more 30-minute med-focused appointments but then the overhead would overwhelm me. I do everything myself from billing to scheduling. I'd prefer to make 300-400k with an overhead of 5%, maintaining all control versus 500k+ with a larger overhead (employees, patient panels in the 100s, 16ish patients per day who only want meds decrease a therapeutic alliance).

R u cash only or insurance

 

[romanticscience]

R u cash only or insurance

Insurance