What are some ways to max out income?

[FreudsDaddy]

When its all said and done i'd like to not only say ive done all i could in psychiatry but also made as much money as I could. So im wondering what are some ways to max out my income. Also why do some doctors make 600k a year and others 150k? im talking about those in the same field. And what would I have to do to make sure im making the 600k.

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[prominence]

bump

 

[BabyPsychDoc]

And what would I have to do to make sure im making the 600k.

Make sure you do not go into psychiatry.

PS. sorry, could not resist another smiley... three more nights to go...

 

[whopper]

I'm planning on making more money outside of psychiatry than in it.

My stock portfolio this year is up about 60%. I got an Ebay business that makes me about $100 per week with only about 20 minutes of work needed for it. After I'm an attending I plan on downgrading the Ebay business and putting more into long term investments and stocks.

I'd read up on investing. Psychiatry is a field where you'll have time to track investments. The field itself is a great source of capital, but that will only get you so far. Real wealth is not about working for money. Its about money working for you.

 

[maranatha]

When its all said and done i'd like to not only say ive done all i could in psychiatry but also made as much money as I could. So im wondering what are some ways to max out my income. Also why do some doctors make 600k a year and others 150k? im talking about those in the same field. And what would I have to do to make sure im making the 600k.

What ever you do, please don't be one of those psychiatrist pushing 15 min med checks to increase your salary. That is the last thing our patients or our profession needs. If money is that important, you might want to pick a different field like one of the surgical subspecialities or something like interventional cardiology.

 

[billypilgrim37]

I got an Ebay business that makes me about $100 per week with only about 20 minutes of work needed for it.

My buddy who just started his pediatrics residency seriously had to consider dropping out of medicine due to his successful Ebaying.

The kid has an absurd knack for guessing which "toys" will become collector's items. He called me one Saturday night at like 10pm from three states away begging me to go to Meijer and buy up all of one particular weird Star Trek toy that he'd discovered was on clearance there. Being married and having nowhere better to be on a Saturday night, I performed his bidding, and found 9 of these weird items at something like ten bucks each. A year later, I get a text message saying he'd just sold the lot of them for several hundred bucks a pop. And he assures me that experience was generally par for the course for his "investments," and I'm a sucker to believe him. His condo has a spare bedroom stocked with such toy fare waiting to "ripen."

So whopper, take that 60% RoR on your stock portfolio, and behold the master of a pediatrician with a Star Trek fetish

 

[whopper]

The kid has an absurd knack for guessing which "toys" will become collector's items. He called me one Saturday night at like 10pm from three states away begging me to go to Meijer and buy up all of one particular weird Star Trek toy that he'd discovered was on clearance there

That's the same exact thing I'm doing. I knew another guy in medschool doing the same thing. So if this buddy of yours is doing the same--that's 4 people I've met in medschool or residency doing it.

I'm selling 2 toys now on Ebay which make me the $100 per week. I'd actually expand the business much more and it could land me over $1000 a week with very little input--perhaps 20 hrs a week of work but I don't want it to ever cut into my hrs as a resident...and I'm already stretching myself out a bit thin with plenty of other things. Right now I'm selling some Pirates of the Carribean toys & an interactive R2D2.

Anyways, my plan is to make a lot of money outside of psychiatry, and in doing so, hopefully it'll allow me to keep track of patients for the right reasons.

 

[Anasazi23]

Can we get an SDN discount on the R2-D2?

 

[whopper]

Anasazi, you want one, I can get you one for cheap. (The interactive R2-D2 that retails for about $150)...but only becuase you're the big cheese around here.

PM me if you're interested.

 

[OldPsychDoc]

Anasazi, you want one, I can get you one for cheap. (The interactive R2-D2 that retails for about $150)...but only becuase you're the big cheese around here.

PM me if you're interested.

Is this a violation of some SDN charter or something?



If so, I'm willing to look the other way for a break on a radio-controlled Dalek...<nudge><nudge>

 

[mgdsh]

When its all said and done I'd like to not only say ive done all i could in psychiatry but also made as much money as I could. So im wondering what are some ways to max out my income. Also why do some doctors make 600k a year and others 150k? im talking about those in the same field. And what would I have to do to make sure im making the 600k.

1) some people just have a knack for making money
2) over time you can be more selective once you start practicing: which insurances you'll accept, where you practice, how many hours you are willing to work, moonlighting on the side... are all factors
3) another difference is also academic vs non-academic
4) things like efficiency play apart in any profession : how long your commute is round trip, how much down time you have in between patients (& what percentage of your work hours are booked), how easily your billing system is setup, & how quickly you get accustomed to private practice (if you go into it)

I'm planning on making more money outside of psychiatry than in it.

My stock portfolio this year is up about 60%. I got an Ebay business that makes me about $100 per week with only about 20 minutes of work needed for it. After I'm an attending I plan on downgrading the Ebay business and putting more into long term investments and stocks.

I'd read up on investing. Psychiatry is a field where you'll have time to track investments. The field itself is a great source of capital, but that will only get you so far. Real wealth is not about working for money. Its about money working for you.

I'm surprised more psychiatrists don't know this. I'm totally with you on the investing thing. Most people also think that investing is only in stock / market related issues.

Let me also say, that as psychiatrists we have a leg up on investing than most other people (in addition to the reasons you described above: 1/3 of investing is basically psychology (keeping your emotions out of investments and reading other peoples emotions), the other 2 parts are :
- 1/3 money management (don't put more than a certain % of your money into any one position, 10% is generally a good number for when you have a larger portfolio)
- 1/3 is reading the market and understanding how to read the market

One of the best known traders is actually a psychiatrist , and yes he still practices on the side

Dr. Alexander Elder has written a few books and although I don't recommend them for beginners, when you do get to the point where you can read his books, they will also help you with other aspects in your life:

One of his better known books: Trading for a Living

Other ways to make money (aside from just seeing more patients): consulting on the side (like for a pharm company), running some type of business, real estate. There are honestly far more ways for you to make $$ outside of psychiatry than inside it. That's just the way this country is (esp. as far as opportunities go).

 

[psychfriend]

Collections, collections, collections....that is the key. You need a great office manager or billing manager that can collect on your charges. It's really an art these days. You really have to watch your collections and make sure you aren't getting ripped off by the insurance company or customers. The physician has to stay on top of it. If you expect to just see patients and leave the collections up to your staff or outsourced company, you will lose a lot of money. I have seen some offices who charge 1.5 million but can only collect 500K due to gross mismanagement by the office/billing staff. On the other hand, I've seen physicians who charge 800K and collect 650K. The challenge isn't so much in acquiing patients as it is in keeping your expenses low and collecting on what you bill. If you have a lazy or incompetent office manager, you can lose significant income by his or her failure to collect on what you bill.

Also, you have to be smart in how you run your practice so you can keep your expenses down. Are you hiring too much staff? Do you own or lease building? Do you outsource your billing or have it in-house? Sometimes, it's better to lease and outsource billing; there is not one easy answer for every situation. Poorly managed practices will have overhead that exceed 65% while superbly run practices will have expenses in the 40%-45% range(rare but it does on happen on occassion). If you are between 50-60%, that's average.

It's these basic things that people don't consider when running a practice. They are always thinking of ways to bring in additional revenue without taking the time to make their practice more efficient.

 

[psychfriend]

What ever you do, please don't be one of those psychiatrist pushing 15 min med checks to increase your salary. That is the last thing our patients or our profession needs. If money is that important, you might want to pick a different field like one of the surgical subspecialities or something like interventional cardiology.

"Pushing" 15 minute med checks? Hello, every psychiatrist does this let alone every other primary care physician. I think it's also in the patient's best interest to see how they are doing on their medication because a change may need to be made. I don't see this as being unethical. I personally think the amount of time spent on each patient varies depending on the patient's situation. I don't think we need to set an arbitrary time limit one way or the other. Some patients genuinely may need 5 minutes while others may require 45 minutes on a revisit. And psychiatrists don't make that much money on a revisit anyway. It's much more profitable to schedule as many 1st time evals than to use that time to schedule revisits.

 

[maranatha]

"Pushing" 15 minute med checks? Hello, every psychiatrist does this let alone every other primary care physician. I think it's also in the patient's best interest to see how they are doing on their medication because a change may need to be made. I don't see this as being unethical. I personally think the amount of time spent on each patient varies depending on the patient's situation. I don't think we need to set an arbitrary time limit one way or the other. Some patients genuinely may need 5 minutes while others may require 45 minutes on a revisit. And psychiatrists don't make that much money on a revisit anyway. It's much more profitable to schedule as many 1st time evals than to use that time to schedule revisits.

Actually, not "every psychiatrist" does 15 minute med checks. I've rotated througth two different outpatient clinics that scheduled 30 min appointments with every patient. Yes, there are times when one patient needed less time, and others needed more. There is also a huge difference between the occasional 15 minute check and "pushing" the appointments by scheduling your follow-ups for 15 minutes.

5 minute appointments? As a resident maybe I'm slower then you, but I have a hard time agreeing that is enough time for anyone to properly assess a patient for medication management, let alone speak with them about their quality of life and those less important issues such as SI....

 

[psychfriend]

Actually, not "every psychiatrist" does 15 minute med checks. I've rotated througth two different outpatient clinics that scheduled 30 min appointments with every patient. Yes, there are times when one patient needed less time, and others needed more. There is also a huge difference between the occasional 15 minute check and "pushing" the appointments by scheduling your follow-ups for 15 minutes.

5 minute appointments? As a resident maybe I'm slower then you, but I have a hard time agreeing that is enough time for anyone to properly assess a patient for medication management, let alone speak with them about their quality of life and those less important issues such as SI....

Sigh

That makes sense if your physician schedules 30 minutes apart with EVERY PATIENT because that would include FIRST TIME EVALUATIONS. Most psychiatrists spend 45 min-1 hour doing evaluations with first time patients. The "15 minute med check pushers" are also the ones who schedule 1 hour appointments with new patients. So essentially your doctor was "pushing" 15 minute med-checks and you didn't know it. And I doubt your doctor spent only 30 minutes with a first time patient so it's likely he was averaging around 15-20 minutes per med check. He may have scheduled patients 30 minutes apart but I'm sure he spent about 45 minutes with evals and then another 15 minutes with a med check.

Furthermore, it's not feasible to schedule followups strictly 30 minutes apart. The average reimbursement for a followup visit is $50 under most insurance plans. If your doctor spent 1 hour for an evaluation (average reimbursement is $200) and 30 minutes per followup, he would see an average of 12 patients per day in an 8 hour day. Let's assume he divides his day seeing new patients and followups. If he worked 40 hours per week for 50 weeks a year, his practice would gross 300K which isn't a lot of money when you subtract overhead. This is also assuming collections are at 100% and that every patient appears at their scheduled appointment. Sorry but the numbers let alone logic doesn't add up. I have a difficult time believing your doctor spends at least 30 minutes per followup. Either your doctor is entirely incompetent as a practice manager or you misjudged how he ran his practice. I tend to believe the latter

 

[maranatha]

Sigh

That makes sense if your physician schedules 30 minutes apart with EVERY PATIENT because that would include FIRST TIME EVALUATIONS. Most psychiatrists spend 45 min-1 hour doing evaluations with first time patients. The "15 minute med check pushers" are also the ones who schedule 1 hour appointments with new patients.

30 minutes for follow-up and an hour for new patients.

 

[psm1776]

psychfriend, you are a medical student correct?

Do you have any expperience doing an intake in an OP setting (or a med check) or any other setting in psych?

Just wondering.

Most psychs from the ones I have spoken to in private practice do an 1.5 hr eval and subsequent follow-ups range from 30 minutes to one hour. It depends.

I don't think there is only one right way. It depends on the practice, the patient & the doctor.

Feel free to continue to argue.

 

[psychfriend]

30 minutes for follow-up and an hour for new patients.

That means he is seeing an average of 12 patients per day assuming he spends half his day seeing new patients and the other half seeing followups on a 40 hour work week. The avg reimbursements for evals and followups are $200 and $50 respectively so that amounts to less than 300K gross before expenses assuming he works 48 weeks per year(2 weeks vacation and holidays). I don't know what type of patients he is accepting or where he is practicing but most psychiatrists wouldn't be able to survive under these conditions in any metropolitan area.

 

[psychfriend]

psychfriend, you are a medical student correct?

Do you have any expperience doing an intake in an OP setting (or a med check) or any other setting in psych?

Just wondering.

Most psychs from the ones I have spoken to in private practice do an 1.5 hr eval and subsequent follow-ups range from 30 minutes to one hour. It depends.

I don't think there is only one right way. It depends on the practice, the patient & the doctor.

Feel free to continue to argue.

I live in a major metropolitan market (top 10) and I've done two outpatient rotations with well known and successfull psychiatrists. Each scheduled 1 hr per eval and 15 min per followup. That doesn't mean they spend strictly 15 minutes per followup but that's how they are scheduled. I didn't speak to these psychiatrists. I actually rotated with them and sat down with their office managers and saw how the numbers added up.

If you guys want to argue otherwise, I'm certainly open to that but please show how the numbers add up. Anyone can say they know a psychiatrist that spends 2 hours per eval and 1 hour per followup but it doesn't make much sense when you account for the numbers unless of course these psychiatrists are

A. taking a significant numbers of cash based patients
B. they are working far more than 40 hours per week and taking little if any vacation
C. they live in a area in which the cost of living is extremely low thus their overhead is lower

The psychiatrists I'm referring to are those who live in major metropolitan areas whose patients are under most standard insurance plans. They work a standard 40 hrs per week on a 48 week year.

I'm arguing in defense of those psychiatrists who might be portrayed as being unethical for scheduling 15 min followups. I think it's unfair to cast judgement without taking everything into consideration. Maranatha is arguing that psychiatrists who schedule 15 minute followups are unethical and I'm simply showing the reality is that most psychiatrists in major metropolitan areas wouldn't be able to survive if they didn't schedule followups 15 min apart especially if they are to see a viable patient load under most standard insurance plans. If you want to disagree with that logic, please feel free

 

[psm1776]

Again, psychfriend - please re-read my above post - I did not say 2 hour eval. with a one hour follow-up - I said it depends on different factors.

I'm simply showing the reality is that most psychiatrists in major metropolitan areas wouldn't be able to survive if they didn't schedule followups 15 min apart especially if they are to see a viable patient load under most standard insurance plans.

Do all (or even most) psychiatrists in private practice take insurance? No way!

& once again it depends on the practice.

I think you are making generalizations and adding up numbers (ie. insurance versus time spent) with a particular formula in mind. However, you can't put an entire category of people practicing into one single formula. Because not every practice is operating with the same sub-set of data. Sorry.

I think the people most qualified to answer this question are those docs who actually have a private practice or a working in the field, not a medical student with some anecdotal "evidence" gathered rotations (you and me both included).

So please, those in the know - give us some data!

 

[psychfriend]

Do all (or even most) psychiatrists in private practice take insurance? No way!

Would you care to elaborate on this statement? So you are stating that most psychiatrists in private practice do not accept insurance and are cash only? What do you base this upon? Sorry but this is quite an assinine statement.

I think you are making generalizations and adding up numbers (ie. insurance versus time spent) with a particular formula in mind. However, you can't put an entire category of people practicing into one single formula. Because not every practice is operating with the same sub-set of data. Sorry.

I think you didn't like my tone and have chosen to attack me personally rather than read my posts objectively. Even if a doctor who is in private practice responds, he or she will be providing anecdotal evidence. And regardless of practice types, there are some aspects that apply to all physicians namely medicare rates and insurance rates relative to medicare. I spent hours with both practice managers analyzing spread sheets and comparing about 20 of the most common insurance plans. If you want to refute my numbers, please do more that offer the trite: "I think you are making generalizations" So again, calm down and please refute the numbers I put forth. If you are unable to refute my numbers, then please don't respond with insults.

I'm not disputing the variety of payment methods and manners in which psychiatrists practice. However, if someone writes: "What ever you do, please don't be one of those psychiatrist pushing 15 min med checks to increase your salary" then it should be made know that the majority of private practice psychiatrists in large metropolitan cities do in fact schedule 15 minute followups. Again, I'm referring to the majority of psychiatrists in private practice. The majority of psychiatrists in private practice accept insurance as their primary form of payment. Perhaps your psychiatrists who schedules 90 minute evals and 30-60 minute followups accept cash which would enable him or her to practice in that manner. However, a doctor who accepts insurance as his or her primary form of compensation would not be able to survive in a large city seeing 12 patients a day by scheduling 30-60 min followups.

 

[billypilgrim37]

psychfriend:

just wondering (since I have much less than even zero interest in private practice, but would like to know what my colleagues will be doing) what the average sort of overhead a private psychiatric practice might incur. I realize the answer is probably "it depends," but just a ballpark figure, assuming quasi-competent management. Maybe an estimate for a solo practice, and an estimate of a practice with maybe 4-6 docs? Just wondering what kind of take home salary that 300k intake might produce i.e. 50k or 200k.

I know in our resident clinics and such, the 15 minute med check is a bit of an anathema. Part of the indignation toward the 15 minute MC is the idea that insurance companies would someday stop reimbursing (or change reimbursement somehow) for 30 minute MCs. That may be a silly worry, I don't know. A 15 minute check does minimize our ability to demonstrate our "fancy talkin skillz" that justify our four years of residency. It's really a cultural issue, a perception by some (especially those in salaried positions) that the 15 minute MC is a threat to the way many psychiatrists currently practice.

Another perception (I label these as such, since I'm not aware of evidence that proves the point either way) is that the practice of psychiatry varies ridiculously, as many providers not trained recently may not have been trained with the same sort of EBM training we enjoy today. Anecdotally, I've found that many older (certainly not all, but enough) of the non-academic psychiatrists I have come into contact with seem clueless as to any development in the field that's occurred in the past 20 years that hasn't been spoonfed to them at a Pharma Steak Dinner. This seems especially disastrous (from what I've seen) when adult psychiatrists try to treat child and adolescent patients due to a lack of access to c&l board certified folks. Throw two biases together, the notion that private practice docs are giving sloppy care on a q15 minute schedule, and you can see where these sentiments arise, even if unfairly.

Point being, I perceive tension between academic practice and private practice. The latter favors the 15 minute check for its profit potential, and the former stands less to benefit. What's actually best for our patients? I don't know. Since we're all at least originally academically trained, it's not surprising many of us not in private practice (now or yet) are biased against the 15 minute visit. Since this is a student board, and most of us are excited about psychiatry due to its richness of content, trying to capture that richness in a 15 minute zoom-through sounds unappealing.

 

[psychfriend]

psychfriend:

just wondering (since I have much less than even zero interest in private practice, but would like to know what my colleagues will be doing) what the average sort of overhead a private psychiatric practice might incur. I realize the answer is probably "it depends," but just a ballpark figure, assuming quasi-competent management. Maybe an estimate for a solo practice, and an estimate of a practice with maybe 4-6 docs? Just wondering what kind of take home salary that 300k intake might produce i.e. 50k or 200k.

I know in our resident clinics and such, the 15 minute med check is a bit of an anathema. Part of the indignation toward the 15 minute MC is the idea that insurance companies would someday stop reimbursing (or change reimbursement somehow) for 30 minute MCs. That may be a silly worry, I don't know. A 15 minute check does minimize our ability to demonstrate our "fancy talkin skillz" that justify our four years of residency. It's really a cultural issue, a perception by some (especially those in salaried positions) that the 15 minute MC is a threat to the way many psychiatrists currently practice.

Another perception (I label these as such, since I'm not aware of evidence that proves the point either way) is that the practice of psychiatry varies ridiculously, as many providers not trained recently may not have been trained with the same sort of EBM training we enjoy today. Anecdotally, I've found that many older (certainly not all, but enough) of the non-academic psychiatrists I have come into contact with seem clueless as to any development in the field that's occurred in the past 20 years that hasn't been spoonfed to them at a Pharma Steak Dinner. This seems especially disastrous (from what I've seen) when adult psychiatrists try to treat child and adolescent patients due to a lack of access to c&l board certified folks. Throw two biases together, the notion that private practice docs are giving sloppy care on a q15 minute schedule, and you can see where these sentiments arise, even if unfairly.

Point being, I perceive tension between academic practice and private practice. The latter favors the 15 minute check for its profit potential, and the former stands less to benefit. What's actually best for our patients? I don't know. Since we're all at least originally academically trained, it's not surprising many of us not in private practice (now or yet) are biased against the 15 minute visit. Since this is a student board, and most of us are excited about psychiatry due to its richness of content, trying to capture that richness in a 15 minute zoom-through sounds unappealing.

Hi Billy

The overhead for the physicians I rotated with were 37% and 49%. I spoke to one psych practice consultant and he said that the range was 30-50% for psych and that a savy manager should keep expenses below 40%. The discrepancy between the two was based primarily on the lease/mortgage and the number of employees that were hired. The physician whose overhead was 37% had 2 fewer employees and owned his building so his mortgage was negotiated at a great rate. Yes, psych has lower overhead than other fields which range from 50-60% on average, but their total revenue generated is a lot less as well.

In regards to the 15 min followup, I was astonished initially as well. However, both of the physicians performed little psychotherapy. They were managing their medication and doing some initial consultation. They referred their therapy to psychologists. Their evals were usually 1 hour but then their followups would be as little as 10 minutes to as much as 45 minutes. It depended on what the patients presented with and how well they responded to medication. Both psychiatrists would try to schedule frequent followups. The patients seemed to prefer shorter yet frequent followups. They felt there was more of a sense of continuity of care. You also have to account for the different types of patients seen in outpatient setting vs. an inpateint setting. The majority of patients in both practices included ADHD patients. For many of these patients, they didn't need 30 min of psychotherapy each session. They were primarily there to see how they were responding to the medication and how they functioned in home and school. Unlike inpatient settings, we rarely saw schizophrenia, bipolar disorder and personality disorders. This is another reason why many psychiatrists hate outpatient care because they find it boring. 95% of what we saw included ADHD, mild drepression, anxiety disorders, eating disorders and substance abuse of which ADHD comprised of at least 50% of that.

Insurance companies are already fighting back by limiting the number of followups in a given year. I saw several that limited visits to 20-30 per year to prevent abuse. I think there is a bit of a false notion that these physicians are profittingfrom this idea. Many doctors wouldn't be able to afford to practice at all if he or she was limited to 12 patients per day under the current reimbursement scheme. It's not like these physicians are being sneaky. They are not getting rich doing this. The psychiatrists I rotated with saw an average of 19 patients per day with 15-16 of those being followups. That's not a lot of patients. Another reason these psychiatrists were scheduling 15 min followups was to account for no-shows which is extremely common these days in all fields of medicine.

 

[billypilgrim37]

Thanks for the reply PF.

Your figures suggest a slightly sloppy psychiatrist w/o the 15 minute checks could still take home about 150k a year. That ain't too shabby!

Different folks have wildly different conceptions of what their salaries should be. I come from a fairly modest background, and have never lived in NYC or Boston or Cali. 150k in my mid 30s seems like an impossible dream for me, might sound like a total disappointment to others.

You make an excellent point with the "shorter but more frequent" approach to the 15 minute checks. You make some other good points too, but I can't brag on you too much, right?

A nice strategy I've heard from an endocrinologist was scheduling 15 minute MCs, but only 3 of them an hour. Allowed him lots of flexibility, and I think that'd make a lot of sense for some psychiatric practices as well.

A 20-30 visit limit actually sounds pretty generous, compared to a few plans I've seen. It's lovely when an insurance company tells a suicidal woman she's out of psych visits for the rest of the year, and it's only April.

 

[psychfriend]

Thanks for the reply PF.

Your figures suggest a slightly sloppy psychiatrist w/o the 15 minute checks could still take home about 150k a year. That ain't too shabby!

Hey Dr. Pilgrim

You made a lot of great points. Three 15 min MC over an hour time is more responsible than scheduling 4. I do want to add that you may not earn 150K under my calculations. The 300K revenue I quoted was based on a 40 hr work week at 50 weeks a year. That means you are taking strictly 10 days off including holidays. It also assumes that every patients shows up to their appointments. Lastly 300K is what you should receive from the insurance companies but it's not what you actually collect. There is a daily war between your billing manager/office manager and the insurance companies especially when the decide to change their mind and not reimburse for a certain visit etc.

Nonetheless, I agree with your overall point. We aren't going to starve. And we aren't required to live in a large metropolitan city with a higher cost of living. And that's over 3 times what the average American earns in this country. We are not required to send our kids to private school or buy luxury cars. So you are right in that it is completely relative to expectations.

I could see how one would think a psychiatrist is being greedy by scheduling appointments in this manner but they really aren't. A 150K in a large metro isn't living large especially when you account for medical school loans, a loan to start your practice and housing prices. I'm not talking about California either. A 3 bedroom 2000 sq ft home in a safe area of my city (1 million + pop) (not wealthy) will run you at least 400K.