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What are practical examples of doing this?
What mental health shortage?
- Thread starter NeedAdvicelol
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2024 I had my best growth and best gross/net for my practice. Felt really good about the trajectory of things.
~148 patients, down to 131 today but still 10 more likely to be closed down, so 120.
2025: This year has been a shocking downspiral. Such low slow new patients to attrition. In my tiny, middle of nowhere location, an independent referral source, sold their Primary Care practice to the local hospital. The local hospital hired an ARNP, and the PCPs in general there just don't refer with mindset they can do it all. A local corporate entity tries to entice their work force to not use their insurance outside of their mini PCP clinic, and have since hired therapists and even a psychologist to do testing... mostly likely to diagnose the adult ADHD and then their mini PCP clinic will dole out the Adderall. And the PCPs are also trickling out of the local tiny hospitals to open up DPC practices. With the recent legislation changing HSAs to allow coverage of DPC retainer fees I think this might accelerate some. But DPCs never refer to psych either.
So now I am mulling over all my options. Did recently re-open to Medicare patients.
~148 patients, down to 131 today but still 10 more likely to be closed down, so 120.
2025: This year has been a shocking downspiral. Such low slow new patients to attrition. In my tiny, middle of nowhere location, an independent referral source, sold their Primary Care practice to the local hospital. The local hospital hired an ARNP, and the PCPs in general there just don't refer with mindset they can do it all. A local corporate entity tries to entice their work force to not use their insurance outside of their mini PCP clinic, and have since hired therapists and even a psychologist to do testing... mostly likely to diagnose the adult ADHD and then their mini PCP clinic will dole out the Adderall. And the PCPs are also trickling out of the local tiny hospitals to open up DPC practices. With the recent legislation changing HSAs to allow coverage of DPC retainer fees I think this might accelerate some. But DPCs never refer to psych either.
So now I am mulling over all my options. Did recently re-open to Medicare patients.
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to my shock, a saving grace is the marketing. it's hard to survive without an outstanding digital presence. My literature/writing skillset has become surprisingly handy. I write content and post on the website for the past several years. Not a ton of content. But it floats in digital world forever and is an evergreen driver of traffic and awareness of the practice. I wanna see you thrive Sushi!!
I'll get to this : D. Off to do a meeting but love chatting here.
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I don't think that matters to a high degree. Niche psychiatrists are likely to only flourish in big metros.
Most patients don't understand the alphabet soup of PsyD PhD LMHC ARNP DO MD MSW EdD etc.
Most patients don't even know what type of therapy they are doing. It isn't explained - (except for EMDR, lol) and people are like, uh, therapy? When they are only receiving supportive therapy.
Majority people I see don't even know what I am. More of a surprise when patient talks with understanding of the alphabet soup.
As long as this persists, having a special versatility may be for moot.
There are some areas where versatility in the form of specific training can be quite helpful, such as substance use, forensics, or C&A
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I have BC in addiction.
I have a sprinkle of AUD. But 0 opioid. In the past when I worked for a Big Box shop, I was knee deep in OUD, and more AUD, too.
Forensics, likely? I have had lawyer inquiries every few months about some cases, but I decline as no experience in that world.
C&A mostly likely always a niche to grow from.
I have a sprinkle of AUD. But 0 opioid. In the past when I worked for a Big Box shop, I was knee deep in OUD, and more AUD, too.
Forensics, likely? I have had lawyer inquiries every few months about some cases, but I decline as no experience in that world.
C&A mostly likely always a niche to grow from.
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I certainly accept your lived experience, but I was surprised at how savoy some of my rural parents were around this stuff. I will never forget this auto-mechanic (father) who ended my initial eval with his son deriding the care he got from a previous NP and how abundantly clear it was to him after about 5 minutes into the eval how different our domain expertise was. He ended with "it would be like getting into trouble with the law and having a paralegal defend you" when referring to having an NP care for his child's mental health. I was the only CAP in 60+ mile radius so the bar was pretty low, but I cannot express how grateful a good chunk of my patient's and families were (most of which transferred from NPs, some from PCPs).
I am a bit of an oddball in psychiatry in that I wear a suit (but not a tie) to work Mon-Thursday, but I would like to think it was more my interview and conversation style that set me apart from the non-psychiatrists rather than somewhat more formal apparel.
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Is Friday Hawaiian shirt day??
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I truly do think that would actually increase patient satisfaction but no one in the office takes my advice! I did not forget about shoomer's inquiry, still workin' on it!
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Jeans and a more casual shirt normally. I won't forget 10 years ago being on the IP unit and having a bunch of teens that loved my True Religions, that $60 (on sale) pair has held up great for over a decade and bought me a lot of street cred with the adolescents. I absolutely dress up for Halloween and holidays as well, it's an occupational hazard in CAP. My socks are usually star wars, dogs, or other fun things even with a very formal suit Mon-Thur.
I'm unfortunately getting so old I don't know the new trendy jeans, certainly open for suggestions particularly if the craftsmanship is also good to match. I still wish I would have bought a Japanese loamed pair of Trues when they were reasonably attainable, one of my few real regrets 🤣
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I have time on the weekend to reply thoughtfully as many know here, I feel passionate about physician careers.
When we complete our medical training, it's like getting tools for our tool box. Having tools is one thing, being any good at using them is another. We're a really smart bunch. But I face palm when on graduation I see so many physicians act as if the tools will work themselves. Or another way to put it is, we're off to the races in a great car, but are we any good at driving? The car ain't doing the racing for us sister.
1.Psychotherapy
-by far, my biggest money maker is this. I do a fair amount of TMS and mostly practice management. But being a good psychotherapist opens doors for tremendous interpersonal effectiveness, getting buy in for any evidence based treatments and also colleagues to work as a team. And you don't need to be a guru at DBT, exposure hierarchies, etc etc. I attached the 5 levels of listening and if someone can do this, the rapport and patient engagement is there. Good outcomes, reputation and brand building follow. I got that attachment from reading material of career advising just general working professionals are giving each other. Medical education is sorely lacking in effective career advising. The attachment also applies for co workers, family, work place politics. The pharmacology in psychiatry is manageable, but how do we convert that to: patient outcomes, work life balance for us, fulfilling engagement? It's the dynamics. Throw some good listening, interpretations, feedback and you can have a great following and work success in just about any setting. And that includes psychotherapy for ourselves. We don't necessarily have to seek it out but it does help for self discovery. It feels like ability to progress is tightly linked to how much brutal truth, especially about ourselves (and the reality of the world including the not so flattering MH market--which I'd argue has been that way for over a decade actually) we can handle. So, I try to throw my ego at the door, take my lumps and try not to take it too personally but frame things in, how can this be done differently? What happened, what was the cascade of events? Humility and kindness go incredibly far. And those around you can feel if it is sincere. Some will appreciate it and become your allies.
A little side, my first year out of residency, I readily accepted the MH market is not good. It's competitive. I'm not hot stuff and I have a lot more learning to do, it just is what it is. So I threw myself into it and that turbo charged the career. I've seen recently graduated psychiatrists get resentful and go into denial. The faster we drop those heavy hot coals of resent in our palms, the more freed we are to run after and grab what is rightfully ours. But if we hold on to them...well...we know what happens. We walk patients through this all the time, radical acceptance, and just lean in.
2.Financial literacy
-ok, so once someone has reached some mastery of truly being a competitive provider in the market, make sure you are taking home what you deserve and doing smart things with it! It's painful but learning different compensation models and how that exactly translates to
-->how many hours over the YEAR am I actually working (not just scheduled) but doing something work related
-->how much was I paid for said year.
-->calculate your hourly rate
It's really hard to predict with job offers and even after you ask peers who are at the facility. imho, the most accurate way to know is work one or more places simultaneously and really compare them in real time. It also minimizes "the grass is greener over there" complex. The grass is just greener where you water it...and based on what kind of gardener you are? If you thrive in hilly areas go for it, or maybe the flat is more your style lol. To find one's max potential, there needs to be some taking of risks and trying out of different roles. Opening the practice was a huge risk, but was pursued at least if anything for the life experience and not having to wonder what if, down the road. It's probably just a fact of life, low risk but less options, high risk and high potential.
-earning money is great, but it has a ceiling. Once you have reached a nest egg of a certain size, the potential becomes exponential. Don't miss the great opportunity. I plan to make a trust for the local animal shelter too. When I pass, I'm thrilled to see funds be given on an ongoing basis off the index fund directly for things like: housing, food, veterinary care.
3.You are your own brand, whether you like it or not. And it can work for or against you.
Everyone talks. Friends, family, patients, coworkers, employers. So make the brand shine. You are Shoomer LLC! What is Shoomer LLC known for? You may say, you don't care but you'll have an impression in everyone's head in some shape or form. I'm talking about networking and just leaving a positive trail. Life is strange in that our paths take all sorts of turns and you never know how things turn up later. Small historical acts can bring major fruits later. Things like LinkedIn I find to be under utilized. Never hurts to put our face out there and write something here and there. Talk to people, in any capacity. It's opened a lot of unexpected doors for me and also allowed me to have finesse with insurance contracts and not get effed over.
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Number of Psychiatry residency positions over time (courtesy of Chat GPT)
| 2016 | ~1,384 | ) |
| 2017 | ~1,495 | — |
| 2018 | 1,556 | — |
| 2019 | 1,740 | — |
| 2020 | 1,858 | — |
| 2021 | 1,907 | — |
| 2022 | 2,047 | — |
| 2023 | 2,164 | — |
| 2024 | 2,261 | — |
| 2025 | 2,388 |
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what hiring are you doing
