What specifically has driven up psychiatry salaries

[DO_or_Die]

I'm going to preface that I know reported salaries widely vary by subspecialty and region of the country and I'm not asking about cash-pay practices. Back in 2011 reported salaries for employed psychiatrists were around 160k which was in par to pediatrics.

By 2016 salaries were being reported at 220k, and now ~250k which is >$100k in a ten year time span. Pretty dramatic difference and I'm not understanding where this has come from seeing as pediatrics hasn't seen a relative increase like this.

Demand has always been there so it probably isn't that.. Is this because of some specific change that came about with Obama Care or a bill that was passed at the time in how psychiatry services are reimbursed? and in your opinion is this a permanent change? I've tried searching for similar threads and haven't found anything which surprises me or maybe I'm not looking in the right place. Thank you.

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[ObsequiousAplomb]

$160,000 in 2011 is equivalent to $220,000 in 2023. So to start, there's that.

Source: CPI Inflation Calculator

 

[jbomba]

Honestly the average seems low. If that's truly the average, I'm convinced it's because so many people are working part time. I had numerous job offers my pgy4 year, all 1099 but permanent, i.e. not short term locums. Nothing less than 200/hr. If you actually work 40-45 hours a week there's no way you shouldn't be clearing 450k at an absolute minimum

 

[Mad Jack]

$160,000 in 2011 is equivalent to $220,000 in 2023. So to start, there's that.

Source: CPI Inflation Calculator

And the average psychiatrist is earning $309,000, so there's that

 

[Mad Jack]

I'm going to preface that I know reported salaries widely vary by subspecialty and region of the country and I'm not asking about cash-pay practices. Back in 2011 reported salaries for employed psychiatrists were around 160k which was in par to pediatrics.

By 2016 salaries were being reported at 220k, and now ~250k which is >$100k in a ten year time span. Pretty dramatic difference and I'm not understanding where this has come from seeing as pediatrics hasn't seen a relative increase like this.

Demand has always been there so it probably isn't that.. Is this because of some specific change that came about with Obama Care or a bill that was passed at the time in how psychiatry services are reimbursed? and in your opinion is this a permanent change? I've tried searching for similar threads and haven't found anything which surprises me or maybe I'm not looking in the right place. Thank you.

Mental health parity laws and greater recognition of the need for mental health services have driven a lot of it. Insurance used to limit the amount of psych services many patients could receive and would pay much less than for non-psych medical services. Demand is also way up

 

[finalpsychyear]

Honestly the average seems low. If that's truly the average, I'm convinced it's because so many people are working part time. I had numerous job offers my pgy4 year, all 1099 but permanent, i.e. not short term locums. Nothing less than 200/hr. If you actually work 40-45 hours a week there's no way you shouldn't be clearing 450k at an absolute minimum

Aren't you on the west coast maybe cali? 200/hr is not everywhere sadly. In the midwest and other areas it can be less. Also, seems like FT for most is 32-36 hrs. Shockingly, people consider working 40 hrs of clinical over full time. So that may be why salaries are partly as they are. Also, I may add we have a ton of Part time folks either older or younger wanting to be home a lot.

200/hr x 40 hrs lets say 48 wk plus all federal holidays (10 days?) so we come to about 370k but that's before health ins, 401k and any benefits as a 1099 you pay. I agree that if you are working 200/hr for let's say 46 wks at 40 clinical hours your grossing 370k. Most people will consider this over full time though.

Also, I'm willing to bet people in psych are not gunning for money as the rest. We all can do the math if someone works 60 hours a week plus/minus some wknds. I just find our field attracts lifestyle and working that much runs counter to at least that benefit. The trick is getting paid for 50-60 hours but working closer to 40 but that's not possible for everyone.

 

[sloh]

. The trick is getting paid for 50-60 hours but working closer to 40 but that's not possible for everyone.

This is the way

 

[finalpsychyear]

Mental health parity laws and greater recognition of the need for mental health services have driven a lot of it. Insurance used to limit the amount of psych services many patients could receive and would pay much less than for non-psych medical services. Demand is also way up

I would add that people are more comfortable getting services not just because that it is covered but also because the awareness of how important it is and that it is ok to see a psych doc and they are not just for people with SMI.

 

[jbomba]

This is the way

How do you recommend this?

 

[jbomba]

Aren't you on the west coast maybe cali? 200/hr is not everywhere sadly. In the midwest and other areas it can be less. Also, seems like FT for most is 32-36 hrs. Shockingly, people consider working 40 hrs of clinical over full time. So that may be why salaries are partly as they are. Also, I may add we have a ton of Part time folks either older or younger wanting to be home a lot.

200/hr x 40 hrs lets say 48 wk plus all federal holidays (10 days?) so we come to about 370k but that's before health ins, 401k and any benefits as a 1099 you pay. I agree that if you are working 200/hr for let's say 46 wks at 40 clinical hours your grossing 370k. Most people will consider this over full time though.

Also, I'm willing to bet people in psych are not gunning for money as the rest. We all can do the math if someone works 60 hours a week plus/minus some wknds. I just find our field attracts lifestyle and working that much runs counter to at least that benefit. The trick is getting paid for 50-60 hours but working closer to 40 but that's not possible for everyone.

I am in Calif. So yes my perspective is based on those numbers. That said those 200/hr jobs are the floor. I have one that pays 245 and one that past 350/hr for overnight coverage. Also run of the mill insurance around here pays on average 250 per follow up (214+833), so it's not hard to net 400+/hr in a hybrid set up.

 

[randomdoc1]

This is the way

How do you recommend this?

Do your own billing and collections with good automation and software. Hired employees suck. They miss over 30% of it and they don't give a **** because they get paid anyways, so it's not on their salary. That do be the truth tho. I love getting paid for every unit of work I do. That's how most other industries are, so why not us?

 

[jbomba]

Do your own billing and collections with good automation and software. Hired employees suck. They miss over 30% of it and they don't give a **** because they get paid anyways, so it's not on their salary. That do be the truth tho. I love getting paid for every unit of work I do. That's how most other industries are, so why not us?

I've got a medical biller who runs his own company and collects on 95% of submissions. I feel like the 7% I pay him is worth the time/headache of dealing w this myself, no?

 

[nexus73]

To answer OPs question. From my perspective, all cognitive specialty salaries across the FP/IM/Psych/Neuro range have increased over the last 10 years. These have always been fairly close for employed jobs with neuro edging the other out by 5-10% maybe. For psych, there is now better insurance coverage, parity such as it is has improved things. Psych also transitioned to the same e/m codes as other specialties in 2013 I believe. Which also ushered in the psychotherapy add on code which better captures and pays for the work psychiatrists do. Prior to the e/m change, psychiatrists had a single code for med management regardless of patient complexity. Or they could bill a med management with therapy code, which added a very slight amount to the total reimbursment but didn't truly capture the work being done.

I will say not just psychiatry but most other specialties around me consider 32 hours patient facing time to be full time, with 1-1.5 hours per day of admin time to make 40 hours total. 40 hours of face to face time with patients potentially becomes 45-48 hours with administrative time. I personally can't tolerate that much psychiatry each and every week without losing my mind.

 

[finalpsychyear]

To answer OPs question. From my perspective, all cognitive specialty salaries across the FP/IM/Psych/Neuro range have increased over the last 10 years. These have always been fairly close for employed jobs with neuro edging the other out by 5-10% maybe. For psych, there is now better insurance coverage, parity such as it is has improved things. Psych also transitioned to the same e/m codes as other specialties in 2013 I believe. Which also ushered in the psychotherapy add on code which better captures and pays for the work psychiatrists do. Prior to the e/m change, psychiatrists had a single code for med management regardless of patient complexity. Or they could bill a med management with therapy code, which added a very slight amount to the total reimbursment but didn't truly capture the work being done.

I will say not just psychiatry but most other specialties around me consider 32 hours patient facing time to be full time, with 1-1.5 hours per day of admin time to make 40 hours total. 40 hours of face to face time with patients potentially becomes 45-48 hours with administrative time. I personally can't tolerate that much psychiatry each and every week without losing my mind.

Cutting out all the admin/drive time in my schedule I am probably at 45 patient hours. I think if i was in the office everyday or hospital doing that it would be wearing me out much more so i get that 40 hours in person at a clinic may be more demanding in general. Starting and ending the week remote is a luxury that I am not taking for granted. However, the pay is at least double for 1 hr of PP vs 1 hr of remote work.

 

[jbomba]

Even if you want a lighter schedule it would really go a long way to hit it hard the first few years out. Hitting 50-55 hours a week would allow you to save a bunch of money which would then compound over the next twenty years. Dollars saved earlier in your career are much more valuable than later. This is my plan, a la coast FIRE.

 

[randomdoc1]

I've got a medical biller who runs his own company and collects on 95% of submissions. I feel like the 7% I pay him is worth the time/headache of dealing w this myself, no?

I have an over 99% collection rate both from insurance and patients. What is his collection rate on the patient responsibility? The patient responsibility accounts for anywhere from 20-40% of the income potential. They need to pay their copays. And most patients have high deductible plans, which means insurance pays out $0 and patient must pay the full insurance contracted rate. A 0.6-0.7 FTE psychiatrist in my office, with our high collection rates, can bring home 350k.

Insurance submissions don't even require half a brain if you have an EMR integrated with a clearinghouse. Then you just pay the clearinghouse fees which is way less than the 7% cut. That's way too big. imho 95% is on the low rate for an insurance submission. I get at least 99.5%.

 

[jbomba]

I have an over 99% collection rate both from insurance and patients. What is his collection rate on the patient responsibility? The patient responsibility accounts for anywhere from 20-40% of the income potential. They need to pay their copays. And most patients have high deductible plans, which means insurance pays out $0 and patient must pay the full insurance contracted rate. A 0.6-0.7 FTE psychiatrist in my office, with our high collection rates, can bring home 350k.

Insurance submissions don't even require half a brain if you have an EMR integrated with a clearinghouse. Then you just pay the clearinghouse fees which is way less than the 7% cut. That's way too big. imho 95% is on the low rate for an insurance submission. I get at least 99.5%.

Good point. Will ask. However if you have patient cc on file and bill at time of service wouldn't that alleviate this?

 

[randomdoc1]

Good point. Will ask. However if you have patient cc on file and bill at time of service wouldn't that alleviate this?

It does. Patients get VERY emotional about having their cc charged. The method I have at my office is a very detailed consent they sign on file. At the time of each visit, I check their deductible/copay status and insurance contracted rate and give them a pretty accurate estimate of their cost for that visit and get their consent to charge that day verbally. Whereas trying to collect after the visit, most patients intentionally avoid you.

 

[jbomba]

It does. Patients get VERY emotional about having their cc charged. The method I have at my office is a very detailed consent they sign on file. At the time of each visit, I check their deductible/copay status and insurance contracted rate and give them a pretty accurate estimate of their cost for that visit and get their consent to charge that day verbally. Whereas trying to collect after the visit, most patients intentionally avoid you.

Would you mind sharing what you use? I'll be starting my practice in about a month and trying to figure out all these small details

 

[randomdoc1]

Would you mind sharing what you use? I'll be starting my practice in about a month and trying to figure out all these small details

I use icanotes as the EMR and integrate with Waystar. Pricey? yes. But cheaper than a biller and you have way more transparency about where you are getting money and where it is hemorrhaging. Waystar also generates your statements and sends the bills via text, email, and land mail. It has read receipts. I love calling patients out "so, I see you opened the statement on Sunday, since you're here, let me help you resolve the balance"--most of the time they are too embarrassed to decline paying you.

I hear good things about Therapy Notes and the clearinghouses they integrate with as well. Not sure of these options which works out better. Although I think the card transaction fees are a bit higher.

But I love the waystar clearinghouse, it organizes everything so well. It's so easy to track claims, remittances and your patient online payments. More expensive? yes. But also, saving time is also saving money. One tip about waystar though. For each provider that sends a claim. They get autoenrolled at the full time rate. So if they are working part time, you need to open a ticket for the part time rate or you end up paying way too much. Likewise, when someone stops sending claims, you have to send a ticket to take them off the subscription. ALWAYS check your statements from Waystar and make sure you are not overbilled.

 

[jbomba]

I use icanotes as the EMR and integrate with Waystar. Pricey? yes. But cheaper than a biller and you have way more transparency about where you are getting money and where it is hemorrhaging. Waystar also generates your statements and sends the bills via text, email, and land mail. It has read receipts. I love calling patients out "so, I see you opened the statement on Sunday, since you're here, let me help you resolve the balance"--most of the time they are too embarrassed to decline paying you.

I hear good things about Therapy Notes and the clearinghouses they integrate with as well. Not sure of these options which works out better. Although I think the card transaction fees are a bit higher.

But I love the waystar clearinghouse, it organizes everything so well. It's so easy to track claims, remittances and your patient online payments. More expensive? yes. But also, saving time is also saving money. One tip about waystar though. For each provider that sends a claim. They get autoenrolled at the full time rate. So if they are working part time, you need to open a ticket for the part time rate or you end up paying way too much. Likewise, when someone stops sending claims, you have to send a ticket to take them off the subscription. ALWAYS check your statements from Waystar and make sure you are not overbilled.

Appreciate all that info. Will look into. Was also referring to the consent you have them sign.

 

[Stagg737]

To the OP, need and demand are not the same. The need for help has always been there, but the general public and legislature’s demand has not. Increased awareness of MH problems and how significant they are both in terms of QoL for the individual and the societal burden of not addressing them is more well known. The fact that it’s been ignored/minimized as a common problem for so long and that we’re seeing the resulting rebound in addressing it I think plays a large role.

 

[psychemdoc]

I don’t think we’ve answered OPs question. We’ve all stated why we think the salaries have gone up such as supposedly higher reimbursements secondary to increased awareness of greater investment, but I’m not sure that we have answered the “specifically” part of the question. Or at least I don’t see a direct bill or cms update or something to state that “reimbursements for psychiatrists must increase by 10% on x date” for example. Nevertheless, I’ll propose one possible mechanism that may be slightly counterintuitive: the rise of the mid levels. Greater numbers of mid levels are extending the practice of many physicians and increasing much of their pay and efficiency. Several psychs I know in real life would not be able to do what they do without their APRNs. Considering that they are often doing small parts of a psychiatrist’s job then that psychiatrist is technically more efficient. Their pay often increases as a result. Their employer values them more as they manage 1 or more mid levels.

Just an idea I’ve thought about at times. Clearly it has pros and cons for everyone involved but this to me seems like it might have some legs. Feel free to dismiss, but I, like OP, would really like to pinpoint what did it exactly to help predict my possible career prospects and opportunities going forward as much as possible. Cause like stag said need is not always met with higher supply (through higher wages) in a fixed market like US healthcare where 3rd parties (govt, cms, employers, insurers, etc.) are the ones paying and deciding what’s valuable instead of the actual consumers of said services.

If I misrepresented or misunderstood anyone’s point I apologize in advance.

 

[claypigeon]

This doesn’t explain the years prior to this change but the CPT changes in 2021 definitely helped in an RVU setup. Especially those of us who were billing too conservatively before.

I used to bill 50/50 99213 vs 99214. Now it’s 10% and 90%. Those 99213s turned 99214 are now worth ~ double the wRVUs and the 99214s went up 28%.

Telepsych changed our no show and late cancellation rates. Maybe 5% of current visits don’t show and I can usually fill the late cancellations. Before telepsych ~ 20% of booked slots were no shows or late cancellations we couldn’t fill.

I make about 40% more than I did pre telepsych which syncs up with the rvu changes and changes in no shows

 

[Candidate2017]

My guess is a combination of parity laws, increased public funding due to convenient political labelling of social issues as "mental health", decreased stigma (along with monetary incentives to get a psychiatric diagnosis and perceived free pass from a psychiatric diagnosis), and increased Constitutional protections of access for the incarcerated. These factors force commercial payors to increase rates.

Peds doesn't benefit from these social factors. Kids are generally healthy. Meet growth curves, get some shots and they're good on Medicaid funds. If they act out, get abused, can't focus, or do drugs or crimes, they end up in child psych, and then adult psych. So, more money for psychiatry.

Arguably, our specialty increases in value not on its own merits, but upon increased societal issues, which is why the APA likes to insert itself into all kinds of non-psychiatric, societal and political debates.

Aren't you on the west coast maybe cali? 200/hr is not everywhere sadly. In the midwest and other areas it can be less.

Cali should be higher. If you aren't getting 200/hr as a floor in the U.S., you need to negotiate and/or identify opportunities of need and pitch deals for your services. I know it's like herding cats, but if you can bring 1 or 2 more doctors into your pitch, you'll get much better rates. This is old school medical practice 101.

 

[thepoopologist]

Oh no, I've stumbled across some good fortune, how did this happen? I think the only thing I'd ask myself with a salary/rate increase is how to best take advantage of it before the job or my health goes down the drain.

 

[Nudexta]

Supply/demand

 

[Psychresy]

and demand ain't droppin anytime soon.

 

[whopper]

My salary went dramatically up but it's not cause the "rates" went up. It's cause I got out of academia and went into private practice. That switch, however, occurred before these rates we're seeing from websites reported a large increase in salary with the average psychiatrist. My only input I can add is I believe the prior amounts were off and the pay at the time was underreported. I even speculated maybe the average psychiatrist wasn't working full time?

 

[Psychresy]

My salary went dramatically up but it's not cause the "rates" went up. It's cause I got out of academia and went into private practice. That switch, however, occurred before these rates we're seeing from websites reported a large increase in salary with the average psychiatrist. My only input I can add is I believe the prior amounts were off and the pay at the time was underreported. I even speculated maybe the average psychiatrist wasn't working full time?

I absolutely suspect rates are underreported. I'm pgy4 and will earn 700k for 45 hours a week next year.

 

[zenmedic]

I absolutely suspect rates are underreported. I'm pgy4 and will earn 700k for 45 hours a week next year.

Mind elaborating on your practice set up and how you managed to get this?

 

[Psychresy]

Mind elaborating on your practice set up and how you managed to get this?

I have an hourly inpatient gig for 4*8 which is 250/hr. This will generate 368k annually. I then have a small outpatient practice which I began pgy4 and generates about 10k/month after the clinic takes their cut for about 10 hours a week. That's 488k.

I then have a correctional gig which requires me to be available in person half the day and then available by phone half the day. This works out to 160/hr but I'm paid for the entire 24 hours. I do this 5 days a month. So I will work a Friday through Tuesday here once a month and just take a day off from the inpatient gig. This works out to another 230k which brings me up to 718k a year.

I actually imagine this number to grow as I transition to my own practice and I no longer am paying the clinic a cut. Reimbursement is also higher where I will be living after residency. I'm projecting 800k by the end of my first year. Depending on my energy levels I can pick up the occasional ER shift for the same hourly rate which would start after the inpatient day.

So all in my typical week looks like one half day a week of outpatient work, four days a week of 7-3 inpatient with a patient cap of 12 and I'll have resident support. I'll do another 2 hours of clinic after the inpatient gig a couple of days a week and still be done by dinner. One weekend a month I work and will have (what I'm told) light overnight call from home averaging 0-1 calls a night for five days a month.

 

[psychemdoc]

I have an hourly inpatient gig for 4*8 which is 250/hr. This will generate 368k annually. I then have a small outpatient practice which I began pgy4 and generates about 10k/month after the clinic takes their cut for about 10 hours a week. That's 488k.

I then have a correctional gig which requires me to be available in person half the day and then available by phone half the day. This works out to 160/hr but I'm paid for the entire 24 hours. I do this 5 days a month. So I will work a Friday through Tuesday here once a month and just take a day off from the inpatient gig. This works out to another 230k which brings me up to 718k a year.

I actually imagine this number to grow as I transition to my own practice and I no longer am paying the clinic a cut. Reimbursement is also higher where I will be living after residency. I'm projecting 800k by the end of my first year. Depending on my energy levels I can pick up the occasional ER shift for the same hourly rate which would start after the inpatient day.

So all in my typical week looks like one half day a week of outpatient work, four days a week of 7-3 inpatient with a patient cap of 12 and I'll have resident support. I'll do another 2 hours of clinic after the inpatient gig a couple of days a week and still be done by dinner. One weekend a month I work and will have (what I'm told) light overnight call from home averaging 0-1 calls a night for five days a month.

It is hard to fathom for me the huge range here if this is even true. I don’t understand it. Is this an extremely undesirable area that you can just pick and choose your hours anywhere you want and they have you accept it or what exactly? I talk to other psychs who work much more for a lot less.

 

[Psychresy]

It is hard to fathom for me the huge range here if this is even true. I don’t understand it. Is this an extremely undesirable area that you can just pick and choose your hours anywhere you want and they have you accept it or what exactly? I talk to other psychs who work much more for a lot less.

It's a very desirable city. I'm happy to chat on pm.

 

[B52slinger]

It's a very desirable city. I'm happy to chat on pm.

In my area it's easy to make 700k in psych, though $1M/year will require quite long hours (though I know 1 person making this much purely through employed inpatient work). Not much hustle needed to make that much when there are so many gigs in my area paying $250/hour or more.

And this isn't emergency medicine where 60 hours/week will spike your cortisol levels to the moon and cause rapid burnout.

 

[jbomba]

In my area it's easy to make 700k in psych, though $1M/year will require quite long hours (though I know 1 person making this much purely through employed inpatient work). Not much hustle needed to make that much when there are so many gigs in my area paying $250/hour or more.

And this isn't emergency medicine where 60 hours/week will spike your cortisol levels to the moon and cause rapid burnout.

I think the key is to get paid for time that you can spend doing something else, so you're able to double dip in a sense. Not hard to find these gigs either. I am considering a tele ER job with relatively low volume. Yeah the pay isn't what Id get working in person in a busy ER, but its good and I can see clinic patients remotely during the day.

 

[texanpsychdoc]

I have an hourly inpatient gig for 4*8 which is 250/hr. This will generate 368k annually. I then have a small outpatient practice which I began pgy4 and generates about 10k/month after the clinic takes their cut for about 10 hours a week. That's 488k.

I then have a correctional gig which requires me to be available in person half the day and then available by phone half the day. This works out to 160/hr but I'm paid for the entire 24 hours. I do this 5 days a month. So I will work a Friday through Tuesday here once a month and just take a day off from the inpatient gig. This works out to another 230k which brings me up to 718k a year.

I actually imagine this number to grow as I transition to my own practice and I no longer am paying the clinic a cut. Reimbursement is also higher where I will be living after residency. I'm projecting 800k by the end of my first year. Depending on my energy levels I can pick up the occasional ER shift for the same hourly rate which would start after the inpatient day.

So all in my typical week looks like one half day a week of outpatient work, four days a week of 7-3 inpatient with a patient cap of 12 and I'll have resident support. I'll do another 2 hours of clinic after the inpatient gig a couple of days a week and still be done by dinner. One weekend a month I work and will have (what I'm told) light overnight call from home averaging 0-1 calls a night for five days a month.

When you are done making bank, could you throw me some scraps? This lonely psychologist is trying to get more insurance and private pay folks

 

[Psychresy]

In my area it's easy to make 700k in psych, though $1M/year will require quite long hours (though I know 1 person making this much purely through employed inpatient work). Not much hustle needed to make that much when there are so many gigs in my area paying $250/hour or more.

And this isn't emergency medicine where 60 hours/week will spike your cortisol levels to the moon and cause rapid burnout.

Curious what kind of gigs would get you there in your area. Also where are you located generally?

 

[B52slinger]

Curious what kind of gigs would get you there in your area. Also where are you located generally?

I'm looking at jobs in CA. Gigs that pay this much include ER psych, inpatient locums and a couple telepsych gigs. I don't even have professional connections in CA (though grew up there and have family there), just browsing through public job boards including indeed.com lol

 

[Psychresy]

I'm looking at jobs in CA. Gigs that pay this much include ER psych, inpatient locums and a couple telepsych gigs. I don't even have professional connections in CA (though grew up there and have family there), just browsing through public job boards including indeed.com lol

Yup, I am in CA as well. Would concur, it's definitely not hard to gross 700k out here. Heck, just taking insurance in one of the major cities will net 280ish for a 99214 + 833. 20 of those a week and tack another 250k onto whatever else your day to day job is. I find the rates out here more than make up for the cost of living and taxes.

Would you mind PMing me the telepsych gigs you know of?

 

[psychemdoc]

It is by this point now, I think, common knowledge that supply and demand factors have affected physician salaries for a long time. So those who are in more undesirable areas are able to command higher premiums because no one else wants to be there. So then how is Southern California psychiatry the exception to this? What is it about this market that makes these opportunities plentiful even though for other specialties see their wages often go down in desirable cities? As repeatedly said on these forums the offers are abundant in the $250 + range in this very desirable area. I have my theories but nothing but intuition and I’m curious if anyone has anything more substantive.

 

[splik]

Yup, I am in CA as well. Would concur, it's definitely not hard to gross 700k out here. Heck, just taking insurance in one of the major cities will net 280ish for a 99214 + 833. 20 of those a week and tack another 250k onto whatever else your day to day job is.

I dont think these rates are typical for solo practices or else more people would accept insurance. I can tell you I was offered below medicare rates by the major insurances and even when we negotiated them up they weren't at this. group practices can get these rates or higher but then youre only getting 70% of that

 

[Sushirolls]

It is by this point now, I think, common knowledge that supply and demand factors have affected physician salaries for a long time. So those who are in more undesirable areas are able to command higher premiums because no one else wants to be there. So then how is Southern California psychiatry the exception to this? What is it about this market that makes these opportunities plentiful even though for other specialties see their wages often go down in desirable cities? As repeatedly said on these forums the offers are abundant in the $250 + range in this very desirable area. I have my theories but nothing but intuition and I’m curious if anyone has anything more substantive.

I would dry conclusions that rural "undesirable" places command more from insurance. It may be the opposite, they pay less because cost of living is less.

So many variables. Really don't know unless you sleuth out an area.

 

[Psychresy]

I dont think these rates are typical for solo practices or else more people would accept insurance. I can tell you I was offered below medicare rates by the major insurances and even when we negotiated them up they weren't at this. group practices can get these rates or higher but then youre only getting 70% of that

I can only base this on what I've been told by a couple docs practicing in CA, as well as what my very experienced medical biller reports to me. He has about 50 docs he works with (many solo) and will share data on average reimbursements. I don't know where you practice specifically, but in many parts of CA this appears to be the case - reimbursements appear to increase the further north you go in the state fwiw.

I'm certainly happy to share my experiences with the forum 6-9 months down the road once I'm out there on my own.

 

[splik]

I can only base this on what I've been told by a couple docs practicing in CA, as well as what my very experienced medical biller reports to me. He has about 50 docs he works with (many solo) and will share data on average reimbursements. I don't know where you practice specifically, but in many parts of CA this appears to be the case - reimbursements appear to increase the further north you go in the state fwiw.

I'm certainly happy to share my experiences with the forum 6-9 months down the road once I'm out there on my own.

I just went a looked up the rates of a few solo psychiatrists in my area with one of the best paying insurances (I have access to this data) and they are wildly different. n=5 between $214-320 for 99214+90833. This is an insurance that makes up a small % of the market share here so you probably couldn't sustain a practice just of it however. This insurance offered me $214 for the above combo and ignored my emails to negotiate.

 

[Psychresy]

I just went a looked up the rates of a few solo psychiatrists in my area with one of the best paying insurances (I have access to this data) and they are wildly different. n=5 between $214-320 for 99214+90833. This is an insurance that makes up a small % of the market share here so you probably couldn't sustain a practice just of it however. This insurance offered me $214 for the above combo and ignored my emails to negotiate.

Good to know. Although what region are you in?

The rates I quoted were from a major payor, so definitely enough to fill.

 

[sloh]

I dont think these rates are typical for solo practices or else more people would accept insurance. I can tell you I was offered below medicare rates by the major insurances and even when we negotiated them up they weren't at this. group practices can get these rates or higher but then youre only getting 70% of that

Ya I live in SoCal and if it’s so easy to gross 700k as a psychiatrist here then why would any psychiatrist take a job with Kaiser? They pay well below 700k.

 

[Stagg737]

Ya I live in SoCal and if it’s so easy to gross 700k as a psychiatrist here then why would any psychiatrist take a job with Kaiser? They pay well below 700k.

At one point it was because of lifestyle and non-salary benefits. Being employed by someone that actually takes care of administrative BS and offers good benefits including a pension can be a good gig.

Idk about now though, my co-residents that took positions with Kaiser didn’t sound like the land of milk and honey it once was, especially after hearing policy that patients would have the ability to directly message you. No thanks.

 

[sloh]

At one point it was because of lifestyle and non-salary benefits. Being employed by someone that actually takes care of administrative BS and offers good benefits including a pension can be a good gig.

Idk about now though, my co-residents that took positions with Kaiser didn’t sound like the land of milk and honey it once was, especially after hearing policy that patients would have the ability to directly message you. No thanks.

Ya trust me I worked for Kaiser before. I agree it’s soul crushing. Yet I feel like they have no problems finding psychiatrists to sign with them. If it’s so easy to make 700k/yr, that wouldn’t be the case. So I disagree with the statement “it’s definitely not hard to gross 700k in SoCal.”

 

[Psychresy]

Ya trust me I worked for Kaiser before. I agree it’s soul crushing. Yet I feel like they have no problems finding psychiatrists to sign with them. If it’s so easy to make 700k/yr, that wouldn’t be the case. So I disagree with the statement “it’s definitely not hard to gross 700k in SoCal.”

I think you underestimate the number of psychiatrists out there who just want to follow the dotted line, don't want to take risks, or don't know how to think outside of the box.

Also, my understanding in talking to friends who receive care at Kaiser is that it's nearly impossible to get in to see a psychiatrist at kaiser (at least in California). How many psychiatrists are actually employed by Kaiser in California anyways? A few dozen to a hundred? I don't know, but it certainly doesn't seem like they have a bunch. Probably not hard to find a hundred people to sign up to do anything for a few hundred K, regardless of what other options are out there.