What is the difference between individuals who earn an income in the 300s and those who earn closer to 500K?

[Anotherwin]

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I am still in residency and trying to learn more about the differences in earnings when it comes to the field of psychiatry. My only frame of reference so far is individuals working in academics, which I know is only a small part of the overall picture. Would like to learn more about whether it is a difference an hours worked, job structuring, risk tolerance, or other possible factors.

 

[Atreides]

200k

 

[kelminak]

From what I've read and looked into, it's generally just private practice with good business sense. You can have a cash pay practice charging enough to clear that with high enough rates or hire a ton of midlevels and skim money off of them (or do both). You can also take employed positions and work yourself to death too. Some of the doctors at my hospital would cover 3 service lines which netted them a tremendous amount of RVUs. Whether they could ethically supervise that many patients/residents is a different question.

 

[AD04]

Not too much difference between $300k and $500k. Hustle a bit harder and you can reach the latter.

Frankly, making earned income in medicine is just math, assuming you’re not salaried.

Hours billed * hourly rate = take-home pay.

If you’re not creative, work harder and increase hours billed. If you are creative, increase hourly rate.

If you can work harder, and if you are creative, you can earn more than that.

 

[comp1]

I assume the difference is the impact it has on the rest of their life. I think the bigger question for the OP is why $500k might be a goal?

 

[Merovinge]

You hit 500k in psychiatry by either cobbling together multiple jobs (e.g. rounding on an inpatient unit then going to a nursing home, clinic, PHP/IOP/RTC in the afternoon) OR by having your own practice and charging an appropriate rate (e.g. $500-600/hour) and being mostly full. There are assuredly some niche cases, but the above scenarios probably captures 90% of psychiatrists making 500k/year.

 

[randomdoc1]

Work really hard or work really smart. Or both. In my PP I can clear over 600k a year if desired. I prefer to work smarter. Keep gaps out of your schedule. Make all your time on the clock count with paid encounters. PP has the higher ceiling. Higher earning potential per hour but higher risk. Or take lower risk in other settings and increase work volume.

 

[mistafab]

300k is around median for psychiatry.

Doing more work, job cobbling, and private practice are the easiest ways to go beyond the median. Just realize most people in private practice are doing more work than those clocking in/ clocking out - at least at the start.

I am job cobbling.

 

[randomdoc1]

300k is around median for psychiatry.

Doing more work, job cobbling, and private practice are the easiest ways to go beyond the median. Just realize most people in private practice are doing more work than those clocking in/ clocking out - at least at the start.

I am job cobbling.

wise words.
yes, the non PP settings pay more in the start although I feel like the earning ceiling is lower. Many of my colleagues 5-10 years out are now burned out in non PP settings.

PP is more work and less pay up front. But play it well and the sky is the limit. On the other hand, there are some providers that just aren't cut out for it. Nothing wrong with that. That's where the other gigs are a better fit.

imho, physicians are way too risk averse. If we step up our game and increase a little risk tolerance, there are big rewards literally and figuratively. Not enough folks give it a chance. More are capable of it than they think. PP = higher risk but highest potential gain. other settings, lower risk but lower potential gain.

 

[Merovinge]

wise words.
yes, the non PP settings pay more in the start although I feel like the earning ceiling is lower. Many of my colleagues 5-10 years out are now burned out in non PP settings.

PP is more work and less pay up front. But play it well and the sky is the limit. On the other hand, there are some providers that just aren't cut out for it. Nothing wrong with that. That's where the other gigs are a better fit.

imho, physicians are way too risk averse. If we step up our game and increase a little risk tolerance, there are big rewards literally and figuratively. Not enough folks give it a chance. More are capable of it than they think. PP = higher risk but highest potential gain. other settings, lower risk but lower potential gain.

Docs are risk adverse by selection process because when we make risks at work and they go bad, people die and it is a field notorious for being able to always have a good/high paying job in regardless of economic conditions.

Then you add on the 6 figure debt most docs have which adds to risk aversion with starting a practice. Then you select for psychiatrists who are possibly the most risk adverse subspecialty and it's no wonder the field looks as it does.

 

[FatherPsychiatry]

I assume the difference is the impact it has on the rest of their life. I think the bigger question for the OP is why $500k might be a goal?

MO MONEY MO __________ ?

 

[Anotherwin]

I assume the difference is the impact it has on the rest of their life. I think the bigger question for the OP is why $500k might be a goal?

That is a good question and one I do not have a great answer too. I have a fair bit of debt from medical school and college, and also have family members that are growing older who need financial support. I figured 500K would put me in a place where I can pay off my debts faster, develop a solid foundation for retirement long term, and also take care of the people who took care of me. I will also admit that I do not yet have the greatest financial sense and cannot conceptualize what 300K looks like after tax and how far that much income would go.

 

[Merovinge]

That is a good question and one I do not have a great answer too. I have a fair bit of debt from medical school and college, and also have family members that are growing older who need financial support. I figured 500K would put me in a place where I can pay off my debts faster, develop a solid foundation for retirement long term, and also take care of the people who took care of me. I will also admit that I do not yet have the greatest financial sense and cannot conceptualize what 300K looks like after tax and how far that much income would go.

If you are young/single which it sounds like you are, then you should be looking to cobble together multiple jobs and/or locum/shift work where you can be properly reimbursed for going over 1.0 FTE. There's nothing wrong with hustling for a few years to pay off debt and ideally learn enough psychiatry to figure out a sustainable pathway for the rest of your career. There is plenty of demand for psychiatrists looking to do this type of work.

 

[MedMan80]

It's doable, but you're probably not going to work 30/h a day and see 10 patients a day to hit 500k. You're prob at that 20 encounters a day range, with a good amount of hustle. Probably close to 45+ hours a week, most shrinks want to work less..

 

[FatherPsychiatry]

It's doable, but you're probably not going to work 30/h a day and see 10 patients a day to hit 500k. You're prob at that 20 encounters a day range, with a good amount of hustle. Probably close to 45+ hours a week, most shrinks want to work less..

Agreed... the closest thing I can think of for 30-40h a week with low work load is middle of nowhere prisons in CA where rates were $300+ a year or two ago (I heard one place was offering $400 for short term locums for a bit), but last I heard, those gigs are drying up. Dunno if its due to budget issues or people are actually starting to fill those positions (ie, employees), but probably a mix of those.

 

[MedMan80]

Agreed... the closest thing I can think of for 30-40h a week with low work load is middle of nowhere prisons in CA where rates were $300+ a year or two ago (I heard one place was offering $400 for short term locums for a bit), but last I heard, those gigs are drying up. Dunno if its due to budget issues or people are actually starting to fill those positions (ie, employees), but probably a mix of those.

Locums in boonies in NYS were 300/h 2-3 years ago

 

[FlowRate]

For the people in private practice managing to fill with high rates, there's probably also some sort of specific draw that they've cultivated. They could be extremely good with patients while maintaining high standards of care (which means saying "no" in many cases.) They could have made a name locally/regionally as an expert in a particular diagnosis or diagnostic category (couple of frequent forum contributors fall into this category.) They could be willing to see more severely ill/risky patients than the typical outpatient PP doc. They could diagnose everyone with whatever they want to be diagnosed with and fall just barely on the line of not technically being a pill mill.

I know that it's important to me to maintain very high standards of care and to try and push back some on the diagnostic bloat trend, which means (often figuratively more than literally) saying "no" to patients sometimes. When you combine that with the the idea that I'm probably average with worried well patients, when compared to other psychiatrists, but not extremely good, it means I would not have as good a chance with the easiest side of high-earning PP (in terms of workload.) I'm not naturally effusive/highly emotive, which many of the worried well patients seem to want, but I'm best with patients who have serious problems and who need/want a serious, invested, respectful psychiatrist. So, if I ever wanted to aim for a higher-earning PP, I'd probably need to target specialized or severely ill populations. Meanwhile, I think that makes me a good fit for an employed generalist job, where my primary incentives align toward providing the best quality care possible and only secondarily align with patient satisfaction.

 

[Merovinge]

For the people in private practice managing to fill with high rates, there's probably also some sort of specific draw that they've cultivated. They could be extremely good with patients while maintaining high standards of care (which means saying "no" in many cases.) They could have made a name locally/regionally as an expert in a particular diagnosis or diagnostic category (couple of frequent forum contributors fall into this category.) They could be willing to see more severely ill/risky patients than the typical outpatient PP doc. They could diagnose everyone with whatever they want to be diagnosed with and fall just barely on the line of not technically being a pill mill.

I know that it's important to me to maintain very high standards of care and to try and push back some on the diagnostic bloat trend, which means (often figuratively more than literally) saying "no" to patients sometimes. When you combine that with the the idea that I'm probably average with worried well patients, when compared to other psychiatrists, but not extremely good, it means I would not have as good a chance with the easiest side of high-earning PP (in terms of workload.) I'm not naturally effusive/highly emotive, which many of the worried well patients seem to want, but I'm best with patients who have serious problems and who need/want a serious, invested, respectful psychiatrist. So, if I ever wanted to aim for a higher-earning PP, I'd probably need to target specialized or severely ill populations. Meanwhile, I think that makes me a good fit for an employed generalist job, where my primary incentives align toward providing the best quality care possible and only secondarily align with patient satisfaction.

Good self-reflection, my practice style is very similar to that as well. I do see folks do well in PP that are known for really high quality care without one specific niche, but they have cultivated a reputation over a long time. It's certainly not the easiest path to a lucrative PP (i.e. the serious, well read, invested, and respectful psychiatrist with relatively low expressed emotion), but can be done.

 

[clozareal]

For the people in private practice managing to fill with high rates, there's probably also some sort of specific draw that they've cultivated. They could be extremely good with patients while maintaining high standards of care (which means saying "no" in many cases.) They could have made a name locally/regionally as an expert in a particular diagnosis or diagnostic category (couple of frequent forum contributors fall into this category.) They could be willing to see more severely ill/risky patients than the typical outpatient PP doc. They could diagnose everyone with whatever they want to be diagnosed with and fall just barely on the line of not technically being a pill mill.

My rates are on the higher end but not the highest for my area. I lean more toward seeing more severely ill patients, especially children/teenagers, whose parents are the ones who can afford those rates and are willing to pay for high quality care for their sick kids. I've had parents tell me "I'll pay whatever if you can help because there are no other child psychiatrists in this area who has availability." I often tell patients that they don't have ADHD/autism if that's their clinical question and I don't think they do, and some I don't see again because of it (good riddance). I do about 6-8 hours of psychotherapy per week, mostly psychodynamic and family/parent therapy. The worried well don't stick around for long except for in psychotherapy — as per Jonathan Shedler, I think successful psychotherapy should not only relieve symptoms (i.e. get rid of something) but also foster the positive presence of psychological capacities and resources (i.e., adding something good).